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Objective: Lacan is often deemed an obscure theorist with little clinical application. However, in film studies his psychoanalytic theory has been highly influential. This paper is part of a series of articles published in this journal accompanying a psychiatry registrar teaching programme on film and psychodynamic concepts. It introduces the Lacanian ideas of the Symbolic, Imaginary and Real as they appear in Jane Campion's The Power of the Dog, and discusses their societal and clinical significance. Conclusions: A Lacanian reading of Power of the Dog offers insights into 'toxic masculinity'. Furthermore, it demonstrates how clinical symptoms can represent an escape from socially mediated toxicities. [ABSTRACT FROM AUTHOR]

Objectives: The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this. Conclusion: AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to describe the development and technical specifications of a framework and national key performance indicators (KPIs) for Australian mental health Court Liaison Services (CLSs) by the National Mental Health Court Liaison Performance Working Group (Working Group).Methods: Representatives from each Australian State and Territory were invited to form a Working Group. Through a series of national workshops and meetings, a framework and set of performance indicators were developed using a review of literature and expert opinion.Results: A total of six KPIs for CLSs have been identified and a set of technical specifications have been formed.Conclusions: This paper describes the process and outcomes of a national collaboration to develop a framework and KPIs. The measures have been developed to support future benchmarking activities and to assist services to identify best practice in this area of mental health service delivery. [ABSTRACT FROM AUTHOR]

Objective: This paper is based on a case report, describing a protocol to help practitioners communicate mental-health diagnosis to patients from culturally and linguistically diverse (CALD) backgrounds. The protocol was presented by integrating the DSM-5 Cultural Formulation Interview (CFI) and the SPIKES protocol for communicating the diagnosis of cancer, yielding a modified CFI-SPIKES protocol (i.e. S, Support; P, Perception using CFI; I, Invitation; K, Knowledge; E, Emotions). The protocol was demonstrated using a case report with a patient of a Middle-Eastern background experiencing generalised anxiety disorder.Conclusions: The CFI-SPIKES protocol for communicating mental-health diagnosis allows for a collaborative process, whereby the CALD patient and practitioner can address the stigma associated with communicating a mental-health diagnosis, ensuring patient engagement and informed shared decision making. [ABSTRACT FROM AUTHOR]

Objective: There has been a recent dissemination of the term 'excellence' in psychiatric services without a full appreciation of the origins of its contemporary usage. In recent years, we have also been witness to an increasing emphasis on the language and notions of goals and outcomes in clinical practice, particularly in the public sector. This paper examines the origin and prevalence of the term excellence in both commercial and clinical services and the corresponding preoccupation with strategies and outcomes. Conclusions: It is argued that the contemporary talk of 'excellence' has been directly imported from the commercial sector. A closer examination of the ascendency of the use of this term has not been borne out by the results of the companies purported to be 'excellent'. In a similar vein, the political and corporate talk of strategies and outcomes has been transferred onto the clinical field. Such a movement has occurred primarily through political and financial motivations. A model of outcome-driven treatment is examined as an end result of such a preoccupation with outcomes. [ABSTRACT FROM AUTHOR]

Objective: Language has always been a means of imposing political and economic dominance. The ascendancy of the discourse of economics is examined in the context of economic rationalism. Some of the effects of this discourse, both upon our services, as well as upon different modes of conceptualizing the therapeutic relationship, will be examined in this paper. Conclusions: The intensification of the use of terms from economics and management can be dated from the introduction of neo-liberal policies in our Western democracies, but the economic discourse circulates with a life of its own. The use of the language of economics and management has spread generally through our society. Thus, if the economic discourse is the language utilized by some clinicians, it is also to some degree the language adopted by our patients. It is proposed that the extension of the economic discourse into the clinical field is re-shaping the therapeutic relationship with our patients. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the development of a collaborative group of mental health clinicians who have come together to improve practice in adult acute mental health settings for the inpatient management of schizophrenia. Method: Sixteen acute adult mental health inpatient services across Queensland worked together to develop clinical indicators related to the inpatient treatment of schizophrenia. Data collection was conducted by using information available on existing databases and through statewide chart audits using scannable form technology. Through a secure intranet site, and statewide forums, clinicians were able to access information on clinical indicators enabling them to compare their site data to peer and state data. Results: Available data from 15 of the 16 sites provided information on clinical indicators including average length of stay, 28-day readmission rates, antipsychotic prescribing, medication dose and the use of multiple antipsychotic medications at discharge. Conclusions: The formation of the Mental Health Clinical Collaborative has brought together clinicians across the State to develop clinical indicators and openly discuss ideas to inform and improve clinical practice. This process has been effective in improving the quality of routinely collected information across the State and in engaging clinicians in using health information to drive clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to describe some of the challenges in psychiatric classification, using generalized anxiety disorder (GAD) as an example. A range of different conceptualizations of GAD are presented. Some are based on theoretical formulations, while others draw on epidemiological data. Each has merit, but also deficiencies. The evolution of diagnostic criteria is not simply a theoretical exercise, but reflects assumptions about the nature of the underlying pathology and the relationships between different disorders. Furthermore, these criteria determine which subjects are included in research and in clinical trials, so they shape the further development of psychiatric classification systems. Conclusion: The controversies about the classification of GAD illustrate the complexities and challenges of developing a valid classification system for psychiatric disorders. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to review the large US National Institute of Mental Health-sponsored depression intervention effectiveness study, STAR*D, in order to evaluate critically its relevance for Australasian clinicians. Conclusions: STAR*D is a landmark study which tried to address issues of effectiveness rather than efficacy, of a number of interventions for depression. However, methodological shortcomings limit the utility of the study in informing Australasian clinical practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to outline and review some of the qualitative approaches - specifically interviewing and case studies - that can contribute to psychiatric research, and to highlight the existing skills that psychiatrists can bring to such approaches. Conclusions: Qualitative research methods are currently under-utilized in psychiatric research. Psychiatrists are well placed to utilize qualitative methodologies by applying the skills that they acquire through training and clinical practice. Psychiatrists wishing to conduct research might wish to consider and adopt qualitative methods where appropriate. [ABSTRACT FROM AUTHOR]

Objective: There is an emerging consensus that the assessment and management of adverse outcomes in mental health, such as violence and self harm, is best achieved by approaches which incorporate validated tools using “structured professional judgement”. Although several useful tools have emerged from the literature, there is no clear consensus on the best way to integrate these with clinical practice. This paper describes a framework, the Forensicare Risk Assessment and Management Exercise (F.R.A.M.E.), employed by a statewide community forensic mental health service, which incorporates two structured professional judgement tools, and explicitly integrates these into case management and psychiatric treatment. The potential benefits of the framework are discussed in the context of contemporary trends in risk assessment and management. Conclusions: The F.R.A.M.E. appears to assist with the task of integrating risk assessment with clinical management. Formal evaluative research is indicated before it can be recommended for use by other services. [ABSTRACT FROM AUTHOR]

Objective: This paper describes and reflects upon the experience of a small, integrated aged care psychiatry service that has utilized the National Outcomes Casemix Collection (NOCC) routine outcome measurements within clinical practice, service management and evaluation. The goals of the NOCC initiative are reviewed in light of this experience. Conclusion: Routine outcome measurement has the potential to significantly improve aged care psychiatric service delivery. The service described has developed a model that the authors believe demonstrates the potential for routine outcome measures to improve the monitoring of patient progress, care planning, team communication, management and the understanding of service effectiveness - goals that are consistent with NOCC philosophy. However, this requires both ongoing development of infrastructure support and the willingness of clinicians to explore their utility. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the use of the Health of the Nation Outcome Scale (HoNOS) in an outreach-based rehabilitation program in regional Victoria, Australia. Method: Routine outcome measures (ROM), including the HoNOS, were introduced in the Stepping Stones Recovery Program (SSRP) in 2002. HoNOS data routinely collected for 122 patients between 2003 and 2006 was examined for sensitivity in capturing clinical changes by using paired t-tests. Results: There was a statistically significant decrease in total HoNOS scores as well as scores on subsets of 'impairment' and 'symptomatic problems'. HoNOS scores reflected positive changes in patients and were useful as a global overview, but did not tap into process issues that are more clinically meaningful. Conclusions: The SSRP provided a wide range of interventions and promoted a structured collaborative approach which could be the main reason for the uptake of ROM in this service. There are significant hurdles in integrating ROM in routine clinical practice, such as feasibility issues and clinician attitudes, along with larger systemic issues that need to be addressed. The introduction of ROM in Australia has resulted in strongly polarized viewpoints. Suggestions for facilitating the administration and use of ROM in routine clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: College guidelines have been published “to assist practitioner and patient decisions” in treatment. There is little evidence that the guidelines have been used despite their apparent importance in the maintenance of treatment that is adequate, competent, safe, honest and up-to-date. This paper discusses the value and non-use of College clinical practice guidelines and examines possible ways that they may be promulgated and used. Conclusions: Guideline research indicates that clinicians will ignore guidelines for reasons that include impracticality, inflexibility, oversimplification and disagreements with evidence interpretation. Their objections cannot be solved by guideline writers. Consumers have a legitimate use for guidelines and this can become the starting point for informed discussion of treatment and necessary deviations from standardized care. Through consumers, the guidelines can make their way into practitioners' awareness and play a role in the maintenance of treatment quality. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to explore the interface between religion and psychosis, and to comment on its relevance in clinical practice. Method: The context of religious psychotic phenomena is briefly discussed, leading to an examination of the biological substrates of religious experiences, the hypothesized process of religious psychotic symptom formation, and the clinical implications when assessing religious delusions. A PubMED search was conducted to identify original research and review articles of relevance to the discussion. Results: Religion is an enduring theme in psychosis, the understanding of which can be assisted by distinguishing between religion as a culture and religiosity as pathology. There are strong arguments for the involvement of temporolimbic instability in the generation of religious psychotic symptoms. Conclusions: Psychosis can be conceptualized as the manifestation of aberrant perceptual and/or integrative processes. The prevalence of religion as a psychotic theme may be explained by its central cultural role, the implication of temporolimbic overactivity in the pathogenesis of some cases of psychosis, and the tendency to interpret intense or discrepant perceptual events as spiritual. In the clinical setting, the determination of religious delusions can be challenging at times. In addition to seeking advice on unfamiliar religions, a thorough assessment of the dimensions of religious beliefs and symptoms of neurocognitive dysfunction can be useful. [ABSTRACT FROM AUTHOR]

Objective: To review various concepts of psychiatric comorbidity, their implications, surrounding controversies and underlying issues. A further aim is to propose an alternative term that might be more clinically useful and meaningful for describing the coexistence of mental disorders. Conclusions: There is wide dissatisfaction with the concepts of psychiatric comorbidity because of different meanings, speculations on which they are often based and consequent confusion. Although the coexistence of mental disorders should be studied further so that any patterns in the corresponding relationships can be elucidated, there is a need for conceptual clarity and making the concept more meaningful for clinical practice and treatment. With that in mind, this present paper proposes avoidance of the term comorbidity and introduction of the term ‘co-occurrence’. The latter is defined in this article, and the distinction made between diagnostic co-occurrence and clinically significant co-occurrence. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to consider the potential clinical utility of a descriptive typology of negative mood states that can present as, and tend to get loosely subsumed under, the broad ranging term, 'depression'. Method: Information and ideas from clinical practice and the existing literature have been brought together with a view to compiling a provisional, brief, descriptive typology of depressed mood. Conclusion: A qualitative typology of various kinds of depressed mood has heuristic value in engaging, formulating and planning treatment for people presenting with 'depression'. [ABSTRACT FROM AUTHOR]

Objective: This paper considers the potential utility in clinical practice of writing a letter to patients. Conclusion: Letters written by psychiatrists to patients may be helpful in some clinical situations. [ABSTRACT FROM AUTHOR]