A community of practice to address system-based issues and promote clinical leadership among trainee medical officers in a large public health service: an evaluation of a trainee-led forum.

Clinical leadership is necessary to improve the performance of large public hospitals. Trainee medical officers (TMOs) are important stakeholders in organisation-wide initiatives that affect the medical workforce and support clinician engagement. This case study describes the development of a representative body known as the 'TMO Forum' within the Central Adelaide Local Health Network as a mechanism to promote engagement between medical trainees and the hospital executive to facilitate escalation and discussion of system-based issues.

Parkinsonism in the psychiatric setting: an update on clinical differentiation and management.

Parkinsonism is seen frequently in patients with psychiatric conditions. Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonism in the general population after Parkinson's disease (PD) but a range of rarer aetiologies, some of them reversible, should also be considered in patients of all ages. DIP is more common in older patients, as are neurodegenerative diseases that may produce parkinsonism and it is relatively more likely that drug exposure could be unmasking an underlying process in this population.

Mirtazapine add-on therapy in the treatment of schizophrenia with atypical antipsychotics: a double-blind, randomised, placebo-controlled clinical trial.

Objective: Schizophrenia is a multifaceted illness with positive, negative and cognitive symptom domains. Standard treatments often focus on positive symptoms and may not adequately relieve other symptoms. Previous studies have suggested a role for mirtazapine in schizophrenia, particularly in negative symptoms.

An interdisciplinary course for trainee psychiatrists: feedback and implications.

Objective: To describe a course for trainee psychiatrists, designed to encourage critical thinking within an interdisciplinary framework. Trainees' responses to the course, and the implications of these for teaching, learning and clinical practice, are considered.

Method: Trainees were interviewed, and their responses subjected to content analysis.

Formative feedback in teaching undergraduate psychiatry.

Objective: This paper describes the introduction of formative feedback into a psychiatry attachment at an Australian university and evaluates students' responses to that initiative.

Method: Students were provided with formative feedback sessions employing a standardized instrument, also used at the end of the attachment for summative assessment. They were asked to both define formative feedback and rate its usefulness on a questionnaire, providing open-ended written comments where appropriate.

Description and evaluation of an up-skilling workshop for rural and remote mental health practitioners in South Australia.

Objective: In response to the identified need for up-skilling in psychiatry for rural and remote general practitioners, a series of workshops has been designed and delivered to medical and nursing staff in South Australia. In this paper one such workshop is described, dealing with acute psychiatric care. Quantitative and qualitative evaluations of the workshop are reported on, and recommendations are made for future training programmes.

The patient's voice in a problem-based learning case.

Objective: Problem-based learning (PBL) relies upon trigger material, often a paper case, to stimulate self-directed enquiry and group discussion. We describe the process of writing a PBL case based upon a patient's narrative account of her experiences of psychiatric illness, and the possible benefits of that collaboration for the patient, as well as for student learning.

Conclusion: Real patients are under-utilized in teaching, as are their narratives, and both are believed to be resources worthy of further attention.

Psychiatric aspects of detention: illustrative case studies.

Objective: Although the two political systems cannot be equated, the psychiatric and psychosocial issues raised by people detained under the migration regulations of the present Australian government, and those detained under the security legislation of the last apartheid government in South Africa, are similar in many aspects.

Method: We present two case scenarios representative of the cumulative clinical experience of the authors in their work (as part of their routine clinical practice and medical school experience) with asylum seekers and political detainees in acute psychiatric units in both South Africa and Australia.

Results: Similar issues raised included the validity of a psychiatric diagnosis in these patients and the debate this conundrum provoked among the multidisciplinary teams.

Introducing psychosocial and psychiatric concepts to first year medical students using an integrated, biopsychosocial framework.

Objective: The main objective of the problem-based teaching unit reported in this paper was to introduce psychosocial and psychiatric concepts to first year medical students using an integrated approach.

Method: A total of 131 undergraduate students studied a case of delirium. Students were encouraged to understand the problem from a number of perspectives and approaches.

A naturalistic study of the measurement of seizure adequacy in electroconvulsive therapy.

Objective: The aim of this study was to assess an electroconvulsive therapy (ECT) rating scale by studying the intraictal electroencephalograph parameters induced by the seizure, and determine the clinical utility of such a scale in terms of time, application and ease of use.

Method: This naturalistic study of 55 depressed patients over a 2-year period examined specific parameters of the intraictal electroencephalograph seizure morphology and computer printout, and their association with overall clinical outcome. The rating scale was developed and evaluated in terms of clinical reliability and ease of use.

The subjective experience of patients who received electroconvulsive therapy.

Objective: Despite the vast amount of scientific literature available on electroconvulsive therapy (ECT), there is little qualitative focus upon the patients' subjective experience of this procedure. Using an exploratory descriptive methodology, this study aims to provide a more unique insight into what certain patients actually think of ECT.

Method: Semistructured interviews were conducted to explore eight patients' opinions and experiences of ECT.

Response of obsessive compulsive disorder to carbamazepine in two patients with comorbid epilepsy.

An association between epilepsy and obsessive compulsive disorder (OCD) has been noted. The response of two patients with OCD and comorbid epilepsy to carbamazepine is reported. It is hypothesized that obsessive compulsive symptoms may be a variant of epileptiform forced thinking in a subgroup of patients, and may be preferentially responsive to anticonvulsant therapy.

Antidepressant induced mania in obsessive compulsive disorder.

Five cases of obsessive compulsive disorder (OCD) and antidepressant (clomipramine, fluoxetine and citalopram) treatment emergent manic symptoms are presented. This is of relevance in terms of management, and may suggest an association between OCD and bipolar disorder.

Survey of certification practices for patients admitted to Sterkfontein Hospital.

The involuntary hospitalisation of psychiatric patients continues to be a controversial issue. All patients certified and admitted to Sterkfontein Hospital under Sections 9 and 12 of the Mental Health Act, No. 18 of 1973, over a 4-week period were surveyed.