Search

Autistic children and adolescents experience a range of co-morbidities, including diagnoses of mental illness. Animal-assisted therapies have advanced rapidly over recent years as an effective and accessible intervention for autistic children and adolescents with various health issues. Horses offer a unique opportunity for interaction as the young person can physically ride the animal, thus creating a therapy with different physical interactions from other animals. This qualitative study had two main aims: first, to understand parents' experiences of their autistic child's involvement with horse-based therapies; and second, to understand the experiences of the staff of organisations offering horse-based therapies to those on the autism spectrum. Twelve interviews were conducted with six parents across four interviews (four mothers and two fathers), and eight staff of equine therapy services in eight individual interviews, to understand their perceptions of the child's experience with horse riding and the perceived mental health impacts. Three emergent themes were prominent among parents and service providers alike: physical and social benefits, including health, self-management skills and social skills; protecting mental health; and recommendations for improvements and accessibility of horse-based therapies. Specifically, service providers with long-standing associations with horse-based therapies saw the actual and potential benefits of horse-based therapies for autistic children, particularly in promoting happiness, calm, resilience, and good mental health.

Animals are increasingly being utilized to assist with therapies for people with various health conditions. Horses are often used as a mechanism of engagement and development for autistic children and adolescents. Horses offer a unique opportunity for interaction as the child or adolescent can physically ride and interact with the animal, thus creating a therapy that involves contact that is different to other animals. Benefits derived from equine-assisted therapies can be physical, social, behavioral, emotional, sensory, and cognitive. However, a current and specific research gap exists in understanding the potential mental health impacts of horse riding on autistic children and adolescents, as perceived and experienced by their parents, carers, and horse-riding service providers. This scoping review examined research on parents' and service providers' perceptions of the benefits of horse-related therapies, with a particular focus on perceptions of positive mental health impacts. A comprehensive electronic search across PubMed, Scopus and Cumulative Index to Nursing and Allied Health Literature identified 16 articles from 15 studies which met the inclusion criteria. Findings included non-mental health-related benefits (as perceived by parents and service providers), mental health-related benefits (as perceived by parents and service providers), benefits for those other than the child/adolescent, and limitations of equine-assisted therapies. With the increased use of equine therapy, and the mounting evidence of its positive impacts on mental health, it is timely to expand research on how to better harness interventions and maximize the mental health benefits for autistic children and adolescents.

Autistic students experience elevated rates of school exclusion, whether this be through expulsion, suspension, informal suspension, refusal of enrolment, or school refusal. This exclusion can come about from a range of factors, including sensory or cognitive overload, a lack of training in neurodiversity for teachers, an absent sense of safety by the student at school, or poor attitudes towards the inclusion of autistic students in schools. The impacts of this exclusion on parents can be logistical, financial, and psychological, with a range of mental health outcomes. This Australian qualitative study presents case studies of seven parents of autistic students, as well as four themes that capture the recommendations of parents to address school exclusion. The findings demonstrate that parents experience stress in finding a suitable school for their child, working with staff to meet the needs of the child, and attempting to maintain employment and other commitments when the child experiences exclusion. Parents recommend greater acceptance of autism by education systems, better communication and use of neuro-affirming language, the option for flexible learning, and individualised support by the school for the student.

Dissociative Identity Disorder (DID) is a highly disabling diagnosis, characterized by the presence of two or more personality states which impacts global functioning, with a substantial risk of suicide. The International Society for the Study of Trauma and Dissociation (ISSTD) published guidelines for treating DID in 2011 that noted individual Psychodynamically Informed Psychotherapy (PDIP) was a cornerstone of treatment. This paper systematically reviews the evidence base for PDIP in the treatment of adults with DID according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-five articles were located and reviewed: seven prospective longitudinal publications, 13 case series and 15 case studies. Results suggested that PDIP has been widely deployed in DID to reported good effect with a range of treatment protocols and using multiple theoretical models. Despite the positive findings observed, the evidence base remains at the level of observational-descriptive design. Creative approaches in recent years have been developed, which add empirical weight to the use of PDIP as an effective treatment. The elevation to observational-analytic designs in the Evidence-Based Medicine hierarchy has yet to take place. Bearing in mind the challenges of research in PDIP, suggestions are offered for how the evidence base might develop.

Despite legislative and policy mechanisms that promote inclusion in education for children with disabilities, many students still experience exclusion from the education setting. For example, autistic children are more likely than their neurotypical counterparts to be expelled or suspended from school or to refuse to attend school on an ongoing basis. This situation gives rise to various challenges for their parents. This discursive paper synthesizes current knowledge on school exclusion involving autistic children, including the causes and consequences of exclusionary practices. The paper also considers the negative impacts of these exclusionary practices on the emotional and psychological well-being of parents and caregivers. Mental health nurses who understand the issues related to school exclusion can better support the educational, social, and developmental needs of autistic children and the mental health needs of parents or caregivers.

Objectives: Older adults utilising healthcare may be vulnerable to systemic bias regarding ageing potentially affecting care. Primary aim is to systematically review the qualitative literature examining attitudes to ageing amongst health care professionals (HCPs). Secondary aim is to describe and compare attitudes to ageing between different professional groups., Methods: Studies examining attitudes to ageing of HCPs were identified using four databases. Original qualitative research with HCPs was included, excluding studies examining students alone, reviews, and grey literature. Three authors undertook standardised data extraction and quality rating for each study and thematic synthesis, with a fourth senior author reviewing. Quality appraisal followed the Attree and Milton guidelines (2006), including studies rated A-C., Results: Of 5869 citations, 13 met initial inclusion criteria. Synthesis of the 12 studies graded A-C followed (excluding one study rated-D). Nurses, doctors, and social workers were most frequently investigated. Identified themes included Attitudes towards older persons, The role of the older persons' family, Behaviour of HCPs towards older persons, Behaviour of older persons towards HCPs, and Definitions of an older person. An overarching theme emerged of the systemic context of attitudes to ageing. Common attitudes were found across disciplines, with doctors emphasising complexity and dependency and nurses the burden of care., Conclusions: HCP's attitudes to ageing vary and are shaped by professional experiences and systemic factors. HCP attitudes may affect responses to and care of the older person. Therefore, interprofessional research, and systemic and service changes across disciplines are required to foster real and sustainable attitudinal change to support older peoples' care., (© 2023. The Author(s).)

Globally, the call for Family-Friendly (FF) workplaces is loud and clear. However, this call is inaudible in medical workplaces, despite both well-established benefits of FF workplaces across businesses and well-known effects of work-family conflict on the well-being and practice of doctors. We aimed to use the Delphi consensus methodology to: (i) operationalise the Family-Friendly medical workplace and (ii) develop a Family-Friendly Self-Audit tool for medical workplaces. The expert medical Delphi panel was deliberatively recruited to capture a breadth of professional, personal, and academic expertise, diversity of age (35-81), life stage, family contexts and lived experience of dual commitments to work and family, and diversity of work settings and positions. Results reflected the inclusive and dynamic nature of the doctor's family and the need to adopt a family life cycle approach to FF medical workplaces. Key processes for implementation include holding firms to zero discrimination; flexibility and openness to dialogue and feedback; and a mutual commitment between the doctor and the department lead to best meet the doctor's individualised needs while still ensuring optimal patient care and team support and cohesion. We hypothesise that the Department Head may be the key to implementation but recognise the workforce constraints to realising these aspirational systemic shifts. It is time we acknowledge that doctors have families, to narrow the gap between identifying as a partner, mother, father, daughter, son, grandparent, and identifying as a doctor. We affirm the right to be both good doctors and good family members.

Autism spectrum conditions are a group of neurodevelopmental conditions that carries an array of co-occurring diagnoses, including a heightened risk of suicide attempts and suicide. This scoping review examined primary research focusing on autism and suicidality, to understand what is currently known on the topic, including how autism changes the presentation of suicidal thoughts and behavior; and to assess the suicide awareness and prevention education programs currently available for autistic people, their families, and health professionals and support workers. A comprehensive search (November 2021) across Scopus, PubMed and CINAHL identified 39 articles from 38 studies. Three themes emerged, with five subthemes. 1. The prevalence of suicidality in autistic people; 2. The presentation of suicidality in autistic people, including (a) risk of suicidality; (b) gender, age, employment and education; (c) co-occurring psychiatric conditions; (d) autism traits and social communication; (e) intellectual disability; and 3. Autism-specific approaches to suicidal thoughts, behavior and prevention. Findings were mixed, including conflicting evidence on the risk of autism and suicidality, and limited evidence of resources related to autism-specific suicide awareness or information, and education or prevention programs.

We hypothesized that fetal exposure to the oxidative stress induced by the combined challenge of preeclampsia (PE) and high altitude would induce a significant impairment in the development of pulmonary circulation. We conducted a prospective study in La Paz (Bolivia, mean altitude 3625 m) in which newborns from singleton pregnancies with and without PE were compared (PE group n = 69, control n = 70). We conducted an echocardiographic study in these infants at the median age of two days. The percentage of cesarean deliveries and small for gestational age (SGA) infants was significantly higher in the PE group. Heart rate, respiratory rate, and oxygen saturation did not vary significantly between groups. Estimated pulmonary arterial pressure and pulmonary vascular resistance were 30% higher in newborns exposed to PE and high altitude compared with those exposed only to high altitude. We also detected signs of right ventricular hypertrophy in infants subjected to both exposures. In conclusion, this study provides evidence that the combination of PE and pregnancy at high altitude induces subclinical alterations in the pulmonary circulation of the newborn. Follow-up of this cohort may provide us with valuable information on the potential increased susceptibility to developing pulmonary hypertension or other pulmonary and cardiovascular disorders.

Given the higher rates of co-occurring mental health issues experienced by autistic people, there is a pressing need to implement an effective framework that integrates autism services with appropriate mental health services. This paper discusses the impact of mental illness on the person with autism and their families, and the current challenges they face when accessing mental health support. A framework for service providers is proposed to support the mental health needs and preferences of autistic people. The paper concludes by highlighting the importance of health professionals utilising mental health interventions appropriate for autistic people, including autism-specific suicide prevention and awareness programs.

A historical perspective offers a chance to reflect on unfolding narratives. The emergence of the diagnosis of autism attracted some positions of blame for "refrigerator mothers". With ensuing neuroscience and developmental research and more nuanced biopsychosocial models, this gave way to notions of strong neurological contributions to the disorder and the positive role of parents supporting the regulation of their child. The notion of co-regulation then emerges with collective agency by parents to offer advocacy and support for those with ASD and their parents and an important role in educating society around the needs and value of those with ASD.

For people with autism spectrum disorder (ASD), the risk of mental illness, including suicidality, has a higher prevalence than the general population. This scoping review explored how people with ASD access suicide hotlines/crisis support services; and current approaches to delivering mental health services (MHS) to people with ASD. A search identified 28 studies meeting the selection criteria with analysis revealing four key findings. The support received by the person with ASD influenced how they accessed MHS; people often encounter barriers to accessing MHS; a separation exists between autism and MHS; and no studies on accessing or delivering MHS through crisis hotlines. The presence of such autism-specific crisis hotlines and the dearth of studies suggest a void in the existing research.

Objectives: Junior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors., Methods: Twenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme., Results: Many participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: ' It was really eye opening how much I felt my body just needed to detox … I wouldn't have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20) .', Conclusion: Junior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection., Competing Interests: Competing interests: BR is the Chief Medical Wellness Officer, WellMD Centre, SLHD and executive owner of MDOK. The MDOK program provided the group exercise control. JT also worked as an instructor on the MDOK program separate from this study., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Functional neurological disorder (FND) is a common and disabling disorder that is often considered difficult to treat, particularly in adults. Psychological therapies are often recommended for FND. Outcome research on psychological therapies for FND has grown in recent years but has not been systematically evaluated since 2005. This study aims to build on that by systematically reviewing the evidence-base for individual outpatient cognitive behavioural and psychodynamic psychotherapies for FND. Medical databases were systematically searched for prospective studies of individual outpatient psychotherapy for FND with at least five adult participants. Studies were assessed for methodological quality using a standardised assessment tool. Results were synthesised, and effect sizes calculated for illustrative purposes. The search strategy identified 131 relevant studies, of which 19 were eligible for inclusion: 12 examining cognitive behavioural therapy (CBT) and 7 investigating psychodynamic therapy (PDT). Eleven were pre-post studies and eight were randomised controlled trials. Most studies recruited a single symptom-based subtype rather than all presentations of FND. Effect sizes, where calculable, showed generally medium-sized benefits for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT. Outcomes were broadly comparable across the two therapy types, although a lack of high-quality controlled trials of PDT is a significant limitation, as is the lack of long-term follow-up data in the majority of identified CBT trials. In conclusion, both CBT and PDT appear to potentially offer some benefit for FND, although better quality studies are needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Mindfulness-based interventions (MBIs), with postures, breath, relaxation, and meditation, such as Mindfulness-based Stress Reduction (MBSR) and yoga, are complex interventions increasingly used for trauma-related psychiatric conditions. Prior reviews have adopted a disorder-specific focus. However, trauma is a risk factor for most psychiatric conditions. We adopted a transdiagnostic approach to evaluate the efficacy of MBIs for the consequences of trauma, agnostic to diagnosis. AMED, CINAHL, Central, Embase, Pubmed/Medline, PsycINFO, and Scopus were searched to 30 September 2018 for controlled and uncontrolled trials of mindfulness, yoga, tai chi, and qi gong in people specifically selected for trauma exposure. Of >12,000 results, 66 studies were included in the systematic review and 24 controlled studies were meta-analyzed. There was a significant, pooled effect of MBIs (g = 0.51, 95%CI 0.31 to 0.71, p < .001). Similar effects were observed for mindfulness (g = 0.45, 0.26 to 0.64, p < .001), yoga (g = 0.46, 0.26 to 0.66, p < .001), and integrative exercise (g = 0.94, 0.37 to 1.51, p = .001), with no difference between interventions. Outcome measure or trauma type did not influence the effectiveness, but interventions of 8 weeks or more were more effective than shorter interventions (Q = 8.39, df = 2, p = .02). Mindfulness-based interventions, adjunctive to treatment-as-usual of medication and/or psychotherapy, are effective in reducing trauma-related symptoms. Yoga and mindfulness have comparable effectiveness. Many psychiatric studies do not report trauma exposure, focusing on disorder-specific outcomes, but this review suggests a transdiagnostic approach could be adopted in the treatment of trauma sequelae with MBIs. More rigorous reporting of trauma exposure and MBI treatment protocols is recommended to enhance future research.

Objective: As the world struggles to come to terms with "corona," we find our collective experience to be entirely alien, struggling to find meaning in the forms of feeling being evoked. When words cannot provide meaning to experience, metaphor is often utilized., Conclusions: Words like "love" are informed autobiographically as "growing words," with no rules defining their use. The significance of "love" to an individual is created through personal history, such that sophisticated understanding is only constructed following a lifetime of experience. "Corona" is perhaps a growing word; we cannot yet grasp its meaning in the face of cólera (passion) and pati (suffering) informing our collective traumatic script. Psychiatrists should aim to focus on the positive forms of feeling emerging during the pandemic, in order to be better equipped to meet the impending "second wave" of mental health complications.

Trauma impacts people's coping mechanisms with their ability to function posing risks to their capacity to manage and respond appropriately to stressors, and to recover. Trauma informed care recognises the needs of survivors by focusing on system-wide design and support during recovery, minimising the risk of re-traumatisation, and maximising choice and empowerment for new adaptations and post-traumatic growth. The principles of TIC are currently not being fully utilised in burns practice, including for severe burns, with the nature, extent and impacts of trauma not being fully understood or acknowledged. Those who sustain a burn injury have an increased risk for developing psychosocial issues that can extend to the family unit, and people with pre-existing mental disorders are more likely to sustain a burns injury, experiencing extended hospitalisation and rehabilitation and being less likely to adhere to burns care. With the application of trauma-informed care within the burns setting, along with an understanding and acknowledging the link between trauma, burns injuries and mental health, health care professionals can minimise potential negative psychological impacts. Investing resources is now essential to effectively address the "trauma deficit" in the area of burns recovery., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To synthesise qualitative research that explored caregivers' experiences of caring for family diagnosed with schizophrenia. Methods: Electronic databases including PsycINFO, PubMed, CINAHL and Scopus were searched to identify relevant journal articles published from 2000 to March 2019. Quality was assessed and thematic synthesis of the qualitative research evidence undertaken. Papers were screened and independently appraised by two reviewers using The Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist. The review was guided by Thomas and Harden's framework for thematic synthesis of qualitative research evidence. Results: The breadth of information across the 43 papers was noteworthy. Review of the findings noted that almost all of what was discussed fell into three broad themes: the 'feelings' of the caregiver towards their role, the patient and others, including the health system; the 'impacts' of the diagnosis and their caregiving role on the caregiver; and the 'needs' of the caregiver to improve the patient's quality of life and thereby the caregiver's quality of life. Within needs also came recommendations for future changes. Conclusion: Studies have shown that the caregiving process is a complex one, with both negative and positive emotional reactions, societal barriers, such as stigma and isolation, and unmet needs, such as timely, relevant and helpful information. Meeting the needs identified by caregivers has the capacity to address the impacts of the illness and caregiving and thereby reduce the negative feelings associated with the caregiver role.

In order to compare the characteristics, including diagnosed mental disorder, of people who commit fraud offences to fund gambling with those who committed fraud for other reasons, we examined a complete series of reports prepared for legal proceedings by two of the authors from between January 2002 and June 2019. A total of 160 fraud offenders were located, of whom 48 (30%) reported offending to fund gambling. Females made up 47.5% of the total sample and 43.8% of the gamblers. Of the problem gambling group, 44% had diagnoses of anxiety or depression, 44% had substance use disorder, 17% had bipolar and other psychosis, and 38% reported childhood trauma. There were no significant differences in the frequencies of diagnosis of mental illness or previous criminal convictions compared to the non-gambling group. Two thirds reported only gambling on poker machines. Only 19% of gamblers reported seeking treatment prior to being charged., (© 2020 The Australian and New Zealand Association of Psychiatry, Psychology and Law.)

Objectives: Junior doctors are frequently exposed to occupational and traumatic stress, sometimes with tragic consequences. Mindfulness-based and fitness interventions are increasingly used to mitigate this, but have not been compared.We conducted a randomised, controlled pilot trial to assess the feasibility, acceptability and effectiveness of these interventions in junior doctors., Methods: We randomised participants (n=21) to weekly 1-hour sessions of personalised, trauma-informed yoga (n=10), with a 4-hour workshop, and eHealth homework; or group-format fitness (n=8) in an existing wellness programme, MDOK. Burnout, traumatic stress and suicidality were measured at baseline and 8 weeks., Results: Both interventions reduced burnout, and yoga increased compassion satisfaction within group on the Professional Quality of Life scale, without difference between groups on this measure.Personalised yoga significantly reduced depersonalisation (z=-1.99, p=0.05) compared with group fitness on the Maslach Burnout Inventory (MBI-HSS (MP)) and showed greater flexibility changes. Both interventions increased MBI Personal Accomplishment, with no changes in other self-report psychological or physiological metrics, including breath-counting.Participants doing one-to-one yoga rated it more highly overall (p=0.02) than group fitness, and reported it comparatively more beneficial for mental (p=0.01) and physical health (p=0.05). Face-to-face weekly sessions were 100% attended in yoga, but only 45% in fitness., Conclusion: In this pilot trial, both yoga and fitness improved burnout, but trauma-informed yoga reduced depersonalisation in junior doctors more than group-format fitness. One-to-one yoga was better adhered than fitness, but was more resource intensive. Junior doctors need larger-scale comparative research of the effectiveness and implementation of individual, organisational and systemic mental health interventions., Trial Registration Number: ANZCTR 12618001467224., Competing Interests: Competing interests: BR is the Chief Medical Wellness Officer, WellMD Centre, Sydney Local Health District. JT worked separately to the trial as a group yoga and meditation instructor on the MDOK programme., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Program overview of a novel cognitive training platform at Walter Reed National Military Medical Center (WRNMMC) for service members with subjective cognitive complaints: analysis of patient participation, satisfaction with the program, and perceived areas of improvement., Materials and Method: Retrospective review of 1,030 participants from November 2008 through May 2017. Data were obtained within an approved protocol (WRNMMC-EDO-2017-0004/# 876230)., Results: The program has shown growth in numbers of referrals, types of patient populations served, and patient visits. Patients report satisfaction with the program and endorse improvements in cognitive functions., Conclusions: This program model may benefit other military facilities looking to provide and assess novel therapeutic approaches., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Murine leukemia virus (MLV) integrase (IN) lacking the C-terminal tail peptide (TP) loses its interaction with the host bromodomain and extraterminal (BET) proteins and displays decreased integration at promoter/enhancers and transcriptional start sites/CpG islands. MLV lacking the IN TP via an altered open reading frame was used to infect tumorigenesis mouse model (MYC/Runx2) animals to observe integration patterns and phenotypic effects, but viral passage resulted in the restoration of the IN TP through small deletions. Mice subsequently infected with an MLV IN lacking the TP coding sequence (TP-) showed an improved median survival by 15 days compared to wild type (WT) MLV infection. Recombination with polytropic endogenous retrovirus (ERV), Pmv20, was identified in seven mice displaying both fast and slow tumorigenesis, highlighting the strong selection within the mouse to maintain the full-length IN protein. Mapping the genomic locations of MLV in tumors from an infected mouse with no observed recombination with ERVs, TP-16, showed fewer integrations at TSS and CpG islands, compared to integrations observed in WT tumors. However, this mouse succumbed to the tumor in relatively rapid fashion (34 days). Analysis of the top copy number integrants in the TP-16 tumor revealed their proximity to known MLV common insertion site genes while maintaining the MLV IN TP- genotype. Furthermore, integration mapping in K562 cells revealed an insertion preference of MLV IN TP- within chromatin profile states associated with weakly transcribed heterochromatin with fewer integrations at histone marks associated with BET proteins (H3K4me1/2/3, and H3K27Ac). While MLV IN TP- showed a decreased overall rate of tumorigenesis compared to WT virus in the MYC/Runx2 model, MLV integration still occurred at regions associated with oncogenic driver genes independently from the influence of BET proteins, either stochastically or through trans-complementation by functional endogenous Gag-Pol protein., Competing Interests: The authors have declared that no competing interests exist.

Research into recovery and adjustment after burn injury has indicated a link between psychopathological symptoms including traumatic stress, distress, depression and anxiety, and worse psychosocial and physical outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, and symptoms can be ongoing in certain patients for extensive periods, leading to a need for early screening in burns patients for psychological vulnerabilities. One potential factor influencing recovery from the psychological impact of burn injury is adult attachment style, specifically secure and insecure attachment, as this describes how an individual organizes their stress regulation. This cross-sectional study measured: (a) attachment style (via the Relationship Questionnaire [RQ]): (b) negative psychological symptoms (via the Depression Anxiety and Stress Scale [DASS]); and, (c) post-traumatic symptoms (via the Davidson Trauma Scale [DTS]) in a cohort of burns patients (n = 104, 51 analysed) in a severe burns unit in Australia during the acute phase of their recovery. Secure attachment style was inversely related to psychopathological symptoms. Secure participants scored significantly lower scores on the DASS (M = 17.63, SD = 17.07) compared to self-rated insecure participants [(M = 42.38, SD = 34.69), p < .01] and on the DTS (M = 14.22, SD = 15.42) compared to insecure participants [(M = 40.54, SD = 35.72), p < .01]. Similar results were found in analyses controlling for covariates of gender, age and burn severity as potential confounders. This research suggests attachment style may play an important role in psychosocial recovery from severe burn injury., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

There is a growing need both locally and internationally to manage the effects of traumatic and loss experiences on the development and recovery of refugee children and young people. Trauma, whether active or through deprivation, is degenerative, with crucial impact on developing bodies, brains and minds. This discursive article considers the nature and scope of the problem and draws on literature and current frameworks to suggest the importance of interventions and proactive protection of mental health for this sub-group of refugees. School is discussed as a place of primary intervention but also a player in creative and sophisticated multimodal integrative services. A range of approaches can be, and, indeed are used in response to mental health issues for children in detention or upon resettlement. Schooling represents one such solution, providing a multi-pronged approach to facilitate mental health improvement for these children. For children needing to recover from loss and trauma secondary to experiences as a refugee, school offers a developmentally appropriate space to mobilise and enhance recovery, both at a simple level and as part of more specialised secondary and tertiary level care. The implications for future practice among health care professionals is to understand the mental health plight of refugee children, through both their pre-arrival exposure to trauma and their post-arrival, detention setting, the key role that schooling can play in facilitating mental health, and the capacity to advocate for programmes and services to work collaboratively with schools to achieve greater access for refugee children.

There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system-the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values ≥ 2 mg/L suggest low-grade inflammation. CRP values > 10 mg/L suggest a disease process. Sixty-six percent of subjects (n = 52) had CRP titres ≥ 2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ 2  = 2.802, df = 1, p = 0.094, φ = 0.190; β = 2.823, p = 0.04) and a diagnosis of anxiety (χ 2  = 2.731, df = 1, p = 0.098, φ = 0.187; β = 4.520, p = 0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells-the brain's innate effector immune cells-is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.

Objective: To understand health professionals' perspectives of burn care and rehabilitation., Design: Qualitative and semi-structured interviews., Setting: Australian burn and rehabilitation units., Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings., Results: The data portrayed the health professionals' perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care., Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes. Implications for rehabilitation Burn care and rehabilitation remains a complex and challenging area of care. Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase. Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.

Objective: Shark bites are rare, with intense media exposure. There are no known studies of the psychological impacts of this specific type of traumatic event. This is the first study that describes those directly and indirectly affected, and evaluates the prevalence of post-traumatic stress disorder (PTSD) and related risk factors., Methods: In total, 124 members of an Australian shark-bite peer-support group were invited to complete an online survey assessing demographic, event, media and psychological factors. Response rate was 48% ( n = 60, 63% male, 44 ± 14 years). Retrospective and current measures of PTSD (PTSD Checklist for DSM-5 [PCL-5]) and suicidality (Suicidal Ideation Attributes Scale [SIDAS-5]) were used., Results: Post-event PTSD was prevalent in this sample ( n = 16/59, 27.1%, 95% confidence interval [CI] = [15.4, 38.8]), but less so currently ( n = 2/55, 3.6%, 95% CI = [0.0, 8.7]). In addition, nine ( n = 9/59, 15.3%, 95% CI = [5.8, 24.7]) had subthreshold, but highly symptomatic, syndromes post event. There was no association of PTSD with direct/indirect bite involvement, gender, or prior trauma. Two respondents were at risk of suicidal behaviour. PTSD was commonly reported by those without a partner (odds ratio [OR] = 5.91, 95% CI = [1.52, 22.99], p = 0.01) or with two friends or fewer to rely on (OR = 5.83, 95% CI = [1.62, 21.01], p = 0.01). PTSD was more likely in those with a negative media experience ( n = 34/52, 65.4%, OR = 11.90, 95% CI = [1.42, 100.04], p = 0.02) and 61.5% ( n = 32/52) of respondents reported media coverage lasting months or years. In multivariate modelling, negative media impact, relationship status and friendships were independently associated with PTSD and explained much of the variance in PTSD ( F 4,41  = 10.94, p < 0.0001, r 2  = 0.52)., Conclusion: Nearly one-third of members of an Australian shark-bite peer-support group report post-event PTSD, and one-quarter of these were not present at the time of the event. Findings support interventions targeting negative media impact, similar to media reporting guidelines for suicide, and enhancing social support.

Advances in surgical techniques and wound management have improved outcomes for burn patients; however, the psychological impacts on burn survivors have had less attention. There is a higher rate of mental health disorders amongst burns victims, with those with pre-existing mental health conditions likely to have worse outcomes. To implement effective burns care and rehabilitation, knowledge and understanding of mental health issues is required. This position paper discusses the extent to which clinicians currently translate knowledge around mental health and burns into practice to identify enables and inhibitors. Successful knowledge translation requires dissemination and accessibility of information with the capacity and readiness for change. Clinicians and researchers need to identify how translating research to practice can meet the needs of burn survivors. There is a gap in the utilization of evidence concerning mental health and the needs of burns survivors, and we need to understand what we know as compared to what we do. Clinicians are well placed to determine how and why knowledge does not necessarily translate to practice and how they can better accommodate the needs of burn survivors., (© 2018 Australian College of Mental Health Nurses Inc.)

This article examines clinician experience in adopting a contemporary psychodynamic model of care by exploring the experiences and perspectives of staff at an Australian hospital-based sexual assault service (SAS), reflecting then on implications for how to best engage clinicians in a model of care change and training. The Conversational Model of Therapy (CMT) is a contemporary psychodynamic approach integrating evidence from developmental psychology, neuroscience and trauma. Training was provided in the CMT approach to Short-Term Intensive Psychodynamic Psychotherapy seeking to enable the service to better provide for the needs of adult clients with less recent sexual assault experiences and/or those able to receive a short-term psychotherapy. Five semi-structured individual interviews and one focus group (with four participants) were undertaken to identify SAS staff perceptions of their experiences after initial training of up to 13 sessions with CMT. Thematic analysis was performed to identify, analyse and report patterns in the responses with the following themes emerging: the challenges staff face in providing a service to clients; coping mechanisms staff utilise in their work; the current service structure and how this compares with their experiences of CMT, and; feelings and thoughts on SAS staff being evaluated. Findings provide evidence that the majority of staff understood the need for change and were able to undertake training towards this due to effective coping mechanisms within their work and good support from within their team. The research also highlights the need to ensure effective training to evaluate participants' understanding of the model being taught. In the context of training experience elsewhere, learning and synthesis of all of the knowledge relevant to a psychodynamic model of care may require experiential learning through supervision of audio-recorded sessions, although this has challenges in the SAS context.

In this paper, we demonstrate the value of implementing a Trauma-Informed Model of Care in a Community Acute Mental Health Team by providing brief intensive treatment (comprising risk interventions, brief counselling, collaborative formulation and pharmacological treatment). The team utilised the Conversational Model (CM), a psychotherapeutic approach for complex trauma. Key features of the CM are described in this paper using a clinical case study. The addition of the Conversational Model approach to practice has enabled better understandings of consumers' capacities and ways to then engage, converse, and intervene. The implementation of this intervention has led to a greater sense of self-efficacy amongst clinicians, who can now articulate a clear counselling model of care.

Background: Survivors of complex childhood trauma (CT) such as sexual abuse show poorer outcomes compared to single event trauma survivors. A growing number of studies investigate Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder (PTSD), but no systematic reviews have focused on EMDR treatment for CT as an intervention for both adults and children. This study therefore systematically reviewed all randomized controlled trials (RCTs) evaluating the effect of EMDR on PTSD symptoms in adults and children exposed to CT. Methods: Databases including PubMed, Web of Science, and PsycINFO were searched in October 2017. Randomized controlled trials which recruited adult and children with experience of CT, which compared EMDR to alternative treatments or control conditions, and which measured PTSD symptoms were included. Study methodology quality was evaluated with Platinum Standard scale. Results: Six eligible RCTs of 251 participants were included in this systematic review. The results indicated that EMDR was associated with reductions in PTSD symptoms, depression and/or anxiety both post-treatment and at follow-up compared with all other alternative therapies (cognitive behavior therapy, individual/group therapy and fluoxetine) and control treatment (pill placebo, active listening, EMDR delayed treatment, and treatment as usual). However, studies suffered from significant heterogeneity in study populations, length of EMDR treatment, length of follow-up, comparison groups, and outcome measures. One study had a high risk of bias. Discussion: This systematic review suggests that there is growing evidence to support the clinical efficacy of EMDR in treating CT in both children and adults. However, conclusions are limited by the small number of heterogenous trials. Further RCTs with standardized methodologies, as well as studies addressing real world challenges in treating CT are required.

Severe burn injuries are highly traumatic requiring lengthy recovery. High levels of distress in the early stages of treatment have been associated with poor physical and psychosocial recovery outcomes. Identifying traits relating to distress and personal coping styles may aid screening. Type-D, or 'distressed', personality may be such a trait. Type-D personality refers to an ongoing personality organization defined by a tendency to experience greater negative emotions and thoughts while simultaneously socially inhibiting their expression (Denollet et al., 1996 . Type-D has been linked to poor health outcomes in those with cardiovascular disease as well as other populations and has been found to be associated with elevated psychological symptoms. Currently, there are no investigations in the literature looking at Type-D in the severe burns injury population. This study aimed to investigate Type-D in severe burn injury patients, specifically regarding the presence of psychological symptoms in early treatment, using data gathered during a pilot study conducted at a severe burn injury unit. The DS-16, Davidson Trauma scale and Depression Anxiety and Stress Scale scores were analysed along with demographic and clinical data in 54 participants (40 males, 14 females). Participants who were found to have Type-D displayed significantly higher levels of psychopathology. Additionally, Type-D was found to be a significant predictor of psychological symptoms.

Aim: To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience., Background: Spinal cord injury is often a sudden and unexpected life-changing event requiring complex and long-term rehabilitation. The development of resilience is essential in determining how spinal cord injury survivors negotiate this injury and rehabilitation., Design: A qualitative systematic review and thematic synthesis of the research evidence., Data Sources: CINAHL, PubMed, Embase, Scopus and PsycINFO were searched, no restriction dates were used., Review Methods: Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis focused on how survivors of adult spinal cord injury experience and make sense of resilience., Results: Six qualitative research articles reported the experiences of 84 spinal cord injury survivors. Themes identified were: uncertainty and regaining independence; prior experiences of resilience; adopting resilient thinking; and strengthening resilience through supports., Conclusion: Recovery and rehabilitation following spinal cord survivors is influenced by the individual's capacity for resilience. Resilience may be influenced by previous life experiences and enhanced by supportive nursing staff encouraging self-efficacy. Survivors identified the need for active involvement in decision-making about their care to enable a sense of regaining control of their lives. This has the potential to have a significant impact on their self-efficacy and in turn health outcomes., (© 2017 John Wiley & Sons Ltd.)

Objectives: Burn injuries are complex traumatic events carrying high risks of acute physical and psychosocial morbidity. With greater survival, clinical and research attention has turned to psychosocial recovery outcomes and risk factors. It is timely to summarise current issues in posttraumatic disorders after burn injury for mental health and integrative care clinicians. Posttraumatic stress disorder (PTSD) is a common outcome of severe burn injury. There are difficulties in delivering current best practice treatments to many survivors especially those in rural and remote areas and those with comorbidities. Vicarious traumatization of clinicians, families and carers requires attention and internationally there are moves to psychosocial screening and outcome tracking., Conclusions: The role of the multidisciplinary treatment, integrated and trauma-informed care is essential. While level 1 evidence for PTSD treatments theoretically applies, adaptations that consider comorbidities and treatment contexts are often essential with further research required.

Objective: We aim to summarise the active learning literature in higher education and consider its relevance for postgraduate psychiatry trainees, to inform the development of a new Formal Education Course (FEC): the Master of Medicine (Psychiatry) at the University of Sydney., Method: We undertook a literature search on 'active learning', 'flipped classroom', 'problem-based learning' and 'psychiatry education'., Results: The effectiveness of active learning pedagogy in higher education is well supported by evidence; however, there have been few psychiatry-specific studies. A new 'flipped classroom' format was developed for the Master of Medicine (Psychiatry)., Conclusions: Postgraduate psychiatry training is an active learning environment; the pedagogical approach to FECs requires further evaluation.