Current research highlights

The RANZCP Foundation encourages psychiatric research as an important activity to drive new discoveries in mental health, research theory and methods essential for clinical psychiatry practice. 

Our grants, scholarships and awards programs support this aim.

2020 Beverley Raphael New Investigator Grant recipients

The Beverley Raphael New Investigator Grants provide a number of small grants up to a combined total of $20,000 annually to RANZCP trainees or recent Fellows to facilitate research projects.

Detecting and managing PTSD amongst new mothers

Dr Hannah Dobson, RANZCP Trainee

Pregnancy and childbirth are complex life events. For some, childbirth is perceived as a traumatic experience. Post-traumatic stress disorder (PTSD) is generally reported to affect 3-4% of women following birth, and 15-19% of women who have had complications associated with their birth, such as requiring an emergency caesarean section. Postnatal PTSD can have a negative impact on a woman’s quality of life, the relationship with their infant, and their future reproductive choices.

This project aims to improve the way we detect and manage post-natal PTSD in women. It involves two distinct but related components.

Early detection of postnatal PTSD through implementation of a self-report screening tool:

We evaluated an adapted version of the City Birth Trauma Scale in order to identify women at risk of developing postnatal PTSD. Data analysis is underway, and we anticipate this will contribute to the expanding body of literature which suggests that the City Birth Trauma Scale is a reliable and valid measure of postpartum PTSD.

Development of an innovative, operationalised psychotherapeutic treatment method:

There is no consensus regarding the most appropriate treatment modality for PTSD which develops following childbirth. We have additionally developed a brief, structured therapy titled Narrative Behaviour Therapy (NBT) to manage postnatal PTSD. NBT draws upon principles of cognitive behavioural therapy, prolonged exposure, and narrative exposure therapy; methods which have evidence supporting their use in the treatment of PTSD.

Establishing a link between schizophrenia and dementia for improved longevity

Dr Anthony Hew, RANZCP Trainee

Schizophrenia and dementia are both characterised by significant cognitive decline, functional impairment, and early mortality. Many individuals who experience these conditions require supported care and are at risk of a range of physical co-morbidities.

While advancement in psychiatric treatment and management has resulted in an increasing lifespan in schizophrenia, it is expected that there may be more individuals with schizophrenia

being diagnosed with dementia. However, the association between schizophrenia and the risk of subsequent dementia remain unclear and is an area of limited study. Given the significant impact of a dementia process in individuals with established schizophrenia, research into this area is important.

The aim of this study is to explore characteristics and risk factors for a dementia diagnosis in schizophrenia, along with the impact that a dementia diagnosis has on mortality. It will incorporate information obtained from AIHW mortality records and the clinical database of the Neuropsychiatry Unit at Royal Melbourne Hospital.

Investigating managing anxiety in older people with psychotic disorders

Dr Magdalena Hagn, RANZCP Trainee

Although anxiety symptoms in people with schizophrenia have long been described, the concept of anxiety in this population is not well understood. Despite comorbid anxiety symptoms being a source of considerable suffering, they are often not identified and clinical emphasis is directed towards management of delusions and hallucinations using antipsychotic medication.

Our study will measure the prevalence and correlates of clinically significant anxiety in older people with a psychotic disorder, with focus on the associations between psychotic symptoms, anxiety, and cognitive function. We will then determine whether this anxiety is part of an anxiety disorder, which then can be treated according to consensus guidelines that are currently based on recommendations for people without a psychotic disorder. If the anxiety is not part of an anxiety disorder, and as such occurring as an epiphenomenon, we will aim to develop a draft management protocol ready for field-testing with consumers, carers, and clinicians.

Using patient perspectives to improve addiction treatment program outcomes

Dr Daniel Pham, RANZCP Trainee

Addiction treatment programs are effective in reducing substance use and improving the health and social function of patients with substance use disorder, as well as reducing public health and safety risks. Acute withdrawal management in detox facilities usually cannot suffice as stand-alone treatment but can be crucial points of entry for further treatment.

Previous studies show that addiction treatment programs including detoxification admissions often face high treatment dropout rates with subsequent high risk of substance use relapse. Studies into the factors that influence treatment outcomes have usually focused on patient psychosocial factors, patterns of drug use and health service characteristics. These studies have been limited, particularly in the Australian context. Results are inconsistent, particularly due to the heterogenicity of sample populations, treatment settings and the varying definitions of treatment ‘drop-out’ or ‘discharge against medical advice’.

This study will aim to obtain a patient-centred perspective of the themes behind reasons for early discharges against medical advice, and to provide some insight into barriers for treatment completion. Ideally the themes explored may contribute to a better understanding of these barriers and hopefully contribute to optimising addiction treatment programs outcomes for our patients.

2020 RANZCP Foundation Early Research Career Grant recipient

The Early Career Research Grants are designed to encourage innovative research in psychiatry and to encourage those who might be new to research or intend to have a career in research, by providing up to $10,000 in funding.

Seeking clarity: how to treat hallucinations within different patient groups

Dr Deborah Wearne, RANZCP Fellow

Mental health professionals and the general community commonly believe that ‘hearing voices’ or ‘seeing visions’ is a sign of a psychotic disorder. However, diagnosing a psychotic disorder in these individuals is not always justified. In fact, many people who seek treatment for chronic and distressing auditory hallucinations have no other psychotic symptoms, preserved reality-testing capacity, and will never develop a schizophrenia spectrum disorder. Antipsychotic medications should be discouraged in individuals without psychosis, as their action on striatal dopaminergic mechanisms will not have the desired clinical outcomes and the side-effects can be disabling.

In this research we intend to examine the experience of hearing voices and dissociation, in three groups: those with PTSD, those with schizophrenia and those who fulfill both diagnostic criteria. We have found in previous research, a significant link between dissociative amnesia and hallucinations in trauma-exposed individuals but not those with schizophrenia, supporting a potential clinical strategy to differentiate the groups. We intend to continue this research in an effort to recruit more participants to improve our statistical power and further explore the phenomenology.

We will also develop our research in two areas. Firstly, we will examine cognitive beliefs about voices, in order to further clarify the experience of hearing voices in the three diagnostic groups. Secondly, given the lack of available literature on visual hallucinations, we would like to extend this study to examine this area in schizophrenia and PTSD. Despite visual hallucinations being recognised in people with schizophrenia and with PTSD, auditory hallucinations are often the only symptoms that clinicians commonly inquire about. This extension will provide more information about the phenomenology of this experience in individuals with varying diagnoses.

In summary, we look to explore important and clinically significant differences in the experience of hallucinations in three patient groups. The hypothesis is that there are significant differences in the phenomenology between the groups, particularly in the area of dissociation. Clarifying these differences will be helpful clinically in the management of hallucinations.

Pat, Toni and Peter Kinsman Research Scholarship recipient

The Pat, Toni and Peter Kinsman Research Scholarship, supported by a bequest from the Kinsman family, was established in 1996 to encourage research into post-natal depression in women in Australia and New Zealand. The Scholarship comprises a sum of up to $50,000 over a two-year period.

Progesterone loading as a strategy for treating postpartum depression: A proof of concept study

Associate Professor Yoram Barak, RANZCP Fellow

The 2020-21 Pat, Toni and Peter Kinsman Research Scholarship recipient was Associate Professor Yoram Barak, who is currently undertaking the following research.

Progesterone loading as a strategy for treating postpartum depression: A proof of concept study’ aims to assess the feasibility of oral progesterone loading as a treatment for postpartum depression (PPD).

Recently, brexanolone (synthetic allopregnanolone) received USA approval for treatment of PPD. However, brexanolone, which is only available through a restricted program, has to be given intravenously and costs US$35,000. A safe, equitable and globally accessible inexpensive treatment for PPD is needed.

Perinatal hormones such as allopregnanolone (an endogenous progesterone metabolite) are currently the most promising avenues of search for treatment. Studies of progesterone’s effects in PPD are few and inconclusive. This study will help confirm predictions that orally dosed progesterone will increase concentrations of allopregnanolone in the central nervous system, which should relieve symptoms of PPD.

Associate Professor Yoram Barak is a psychogeriatrician and academic in Dunedin, New Zealand who is dedicated to translating scientific endeavours into public health benefits. He will undertake this project alongside his colleagues Professor Paul Glue, Dr Chris Gale and Associate Professor Natalie Medlicott at the University of Otago, School of Medicine.

Improving depression in Indigenous mothers using art and health education

Dr Beth Mah, RANZCP Fellow

The 2018-19 Pat, Toni and Peter Kinsman Research Scholarship recipient was Dr Beth Mah, who has provided the below update on her research.

During 2020, research funds were used to employ an Aboriginal research assistant who successfully completed a five-week pilot program in three Aboriginal organisations in the Taree-Forster area (despite the bushfires, and then the pandemic). Women were engaged into the program by use of art. Traditionally, Aboriginal toys were

items made from carved wood, shells, grasses, wood, leaves, bark and other organic materials such as clay, animal bones and manure. This traditional art form was chosen for cultural relevance and for simplicity to allow women to focus upon the health component of the intervention.

This consisted of yarning (psychoeducation) about the following topics: social and emotional wellbeing, self-care, post-natal depression, attachment, infant feeding, infant behaviour and domestic violence.

Twenty-three women participated in the pilot. Initial analyses indicate significant improvement immediately after each session in the domains of mood, confidence and calmness.

There was also a significant improvement in the connectedness subscale of the Growth and Empowerment Scale from baseline to after completion of the five-week intervention. A non-significant but improving trend existed for the total scores of both the Aboriginal Resilience and Recovery Questionnaire and the Social Support Survey.

ArtsHealth participants commented that:

‘I really enjoy spending time with everyone – sharing my story with others allows me to feel strong within myself, and being around an understanding group really helps me feel normal. Thank you so much’

‘Was great and was very soothing therapy – would love to be here every week’

‘Today was awesome, it was relaxed, I came out of my shell and spoke a lot more and it was good to talk and laugh with people out of my friend circle’

The research team are now planning a longer intervention which will be provided to a larger group of Aboriginal mothers struggling with depression.

2020 Trisno Family Research Grant in Old Age Psychiatry recipient

Supported by an ongoing donation from Dr Roth Trisno and family, the Trisno Family Research Grant in Old Age Psychiatry works to address the need for more research in the prevention, diagnosis, management and continuing care strategies for mental health conditions in older people.

Two grants of up to $5,000 can be awarded each year.

A patient and carer-friendly tool to assess frailty

Dr Vivek Phutane, RANZCP Fellow

Frailty is the state of increased vulnerability to adverse outcomes among people of the same chronological age. It is a dynamic process, where improvement is possible. It is essential that frailty is identified and treated early to suggest appropriate preventative and rehabilitative actions to be taken to slow, prevent, or even reverse decline associated with frailty.

The Pictorial Fit-Frail Scale (PFFS) was designed to allow rapid assessment of frailty. It was developed in 2012 and it takes about 3-4 minutes to administer. Previous frailty scales mainly take into account the clinician’s viewpoint. However, this scale allows us to involve patients and their carers’ perspectives along with that of the clinician.

Dr Vivek Phutane is an advanced trainee in old age psychiatry in Shepparton, Victoria. He was awarded the Trisno Family Research Grant in Old Age Psychiatry to carry out his research project ‘Testing the Pictorial Fit-Frail Scale (PFFS) at the Aged Persons Mental Health Service (APMHS) in Rural Australia’, which will test the feasibility, reliability, and validity of the PFFS. In doing so, Dr Phutane aims to improve the frailty assessment by using a test which is simpler, easier to administer, more sensitive to cultural differences, and more practical in approach for identifying frailty compared with previous frailty scales. By validating a patient and caregiver-friendly scale, this project might contribute to early detection and management of frailty, which will ultimately help reduce mortality and morbidity associated with frailty and improve quality of life of older people.

2020 RANZCP Psychotherapy Research Award winner

The RANZCP Psychotherapy Research Award encourages research in psychotherapy among RANZCP trainees and recent Fellows in Australia and New Zealand.

Working with patients to more effectively treat major depressive disorder

Dr Dwain Burridge, RANZCP Trainee (pictured), and Dr Eliot Frickey, RANZCP Trainee

Major depressive disorder (MDD) is one of the most prevalent of all psychiatric disorders and as a medical condition, is one of the most disabling. The lifetime prevalence of MDD is approximately 17% of the population and it results in immense personal and secondary costs to society.

Given the individual and societal consequences of undiagnosed or sub-optimally treated MDD, it makes intuitive sense to develop ways of relating with depressed individuals that heighten their chances of recovery and promote treatment adherence, while improving their quality of life. Most evidence-based treatment approaches to MDD endorse combining psychopharmacologic and psychological therapies; however, a critical and often neglected component of any treatment effort is the person with the illness. Within this patient- centric paradigm, psychoeducation is endorsed as a means of empowering patients to increase self-understanding of their illness so as to effect their own change.

This study aims to obtain preliminary evidence of the feasibility and effectiveness of a brief training module designed to enhance the quality of the working alliance between patients with MDD and psychiatric registrars. It also aims to better understand the perceptions of the barriers and facilitators to delivering psychoeducation, and establishing a therapeutic alliance with depressed patients, from the perspective of psychiatric registrars.

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