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Psychotic and bipolar affective disorders are considered severe mental illnesses with a long-term course and fluctuating presentation. Psychotic disorders are particularly characterized by significant changes to beliefs, cognition, and perception, and bipolar affective disorders are characterized by episodes of elevated mood (mania) and depression, as well as interepisode mood fluctuation. The symptoms and impacts of these disorders can be wide-ranging and complex and their presentations highly varied. Assessors need to be clear about the rationale, aims, and scope of their assessment in order to select appropriate assessment instruments. Generally, valid and meaningful assessments take a holistic approach and are built on thoughtful and sensitive engagement with interviewees. This chapter reviews pertinent issues and common assessment instruments for categorizing, quantifying, and formulating psychotic and bipolar affective disorders.
Death of patients by suicide can have powerful effects on psychiatrists. We report the findings of a survey completed by 174 psychiatrists on the effects of patient suicide on their emotional well-being and clinical practice, and the support and resources they felt would be helpful.
Results and clinical implications
The death of a patient by suicide usually had a major effect on respondents. Clinical practice was often negatively affected, and over a quarter of respondents considered a change of career path as a result. There were some gender differences in responses, with women reporting more sense of responsibility for the deaths and a greater effect on their clinical confidence. Desired support included a senior suicide lead clinician, support during formal post-suicide processes, opportunity for reflection on practice, information about resources to support families and help communicating with families and friends of the deceased.
The mental health outcomes of military personnel deployed on peacekeeping
missions have been relatively neglected in the military mental health
To assess the mental health impacts of peacekeeping deployments.
In total, 1025 Australian peacekeepers were assessed for current and
lifetime psychiatric diagnoses, service history and exposure to
potentially traumatic events (PTEs). A matched Australian community
sample was used as a comparator. Univariate and regression analyses were
conducted to explore predictors of psychiatric diagnosis.
Peacekeepers had significantly higher 12-month prevalence of
post-traumatic stress disorder (16.8%), major depressive episode (7%),
generalised anxiety disorder (4.7%), alcohol misuse (12%), alcohol
dependence (11.3%) and suicidal ideation (10.7%) when compared with the
civilian comparator. The presence of these psychiatric disorders was most
strongly and consistently associated with exposure to PTEs.
Veteran peacekeepers had significant levels of psychiatric morbidity.
Their needs, alongside those of combat veterans, should be recognised
within military mental health initiatives.
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