panacea

the official magazine of the australian medical students association

the
mental
health
issue

Pain
Trauma
Paralysis
And thats just trying to buy a car

Traditional banks look at numbers alone theyll only lend you money
if you can prove that you dont need it. At Investec, we know better.
We know that your qualifications are worth gold, we see your potential.
Investec is a leading Australian specialist bank offering a full range of
financial services to the medical sector our team understands the industry
inside out, so you wont have to explain yourself to someone who doesnt get
it. And you wont have to wait until youre wealthy, well support you early on
in your career, when you most need support.

Take a look at investec.com.au/medical or call one of our financial

specialists on 1300 131 141 to find out how we can help.

O u t o f t h e O r d i n a r y

Car finance | Transactional banking and overdrafts | Savings and deposits | Credit cards | Home loans
Issued by Investec Bank (Australia) Limited ABN 55 071 292 594, AFSL 234975, Australian Credit Licence 234975. The information contained in this document is general in nature and does not take into account your personal
financial or investment needs or circumstances. Terms and conditions, fees and charges apply. Insurance products are offered by Experien Insurance Services (Representative No. 320626), the preferred supplier of insurance
products to Investec Bank.

We would like to thank our Major Sponsors for their ongoing support

panacea
volume 47 issue 1

contents
6 editorial
7 words from the president ben veness

articles

8 understanding mental health seshika ratwatte

10 mental state university ben veness
13 down the rabbit hole beatrice dowsett
15 stepping up harry jennens
17 the cannula david mathew
19 a hidden reality alexandra brown
24 a problem to be solved benjamin lewis
27 three shots and out emily webb-smith

reflections

publications officer
arghya gupta
subeditors
john farey
divya raghavan
cover
flickr: FromSandToGlass
advertising + sponsorship
georgia carroll
miranda norquay
all images in this publication have
been used under the offer of a
creative commons licence and/or
fair use policies
panacea is the biannual publication
of the australian medical students
association (amsa)

9 its a personal thing anonymous

11 a learning experience matt mcalpine
16 wish you were here inu shahira
20 depresh confesh nicole kalish
21 a bandaid aint enough diana ethell
25 the drugs dont work anonymous

australian medical
students association
42 macquarie st
barton ACT 2600

academic

phone 02 6140 5446

fax 02 6270 5499

12 stigma in mental health prasadi adikari

18 mental illness in indian women erin burge
26 perceptions of dementia natalie chilko
30 diagnosing catatonia priscilla wee
32 early treatment in anorexia jessica cutting

reviews

34 think differently! ASC 2013 claire mcallister

35 the house of god toby vinicomb

postal address
po box 6099
kingston ACT 2604

website www.amsa.org.au
twitter @youramsa
for any editorial or publications
enquiries please contact the
publications officer
publications@amsa.org.au
published 3 July 2013

medsoc reports
40 adelaide
36 australian national
36 bond
37 deakin
37 griffith
39 james cook
39 monash
40 melbourne
42 newcastle
42 new england
43 notre dame sydney
43 notre dame fremantle
46 sydney
46 western australia
47 western sydney
contributors

prasadi adikari, alexandra brown, erin burge, natalie chilko, jessica cutting, beatrice
dowsett, diana ethell, harry jennens, nicole kalish, benjamin lewis, david mathew,
claire mcallister, matt mcalpine, seshika ratwatte, inu shahira, ben veness, toby
vinicomb, emily webb-smith, priscilla wee, two anonymous contributors

medsoc reports

thomas carin, grace cowderoy, greg evans, john farey, colin giorcelli, lauren godde,
sam harkin, felicity mcivor, alyssa parsons, aditi raut, andrew robinson, justin winters,
ghassan zammar, kylie zhong, dean zinghini
thank you to all the representatives and the members of the executive who helped with
the production of this edition of panacea
particular thanks are due to treasurer alexander murphy for his photographs

medsoc reports

all articles included in this publication are done on good faith, they do not represent the
views of amsa, and all enquiries should be directed at individual authors

HIGHS AND LOWS

We go through our lives experiencing ecsatic periods of
joy and success, intertwined with episodes of debilitating
stress and sadness.
For many of us in medicine, we can probably go through
these feelings within the period of a day. We may have
the elation of doing a few successful cannulations in the
morning, then dealing with the stress and awkwardness
of being present in a family meeting with an ICU patient
in the afternoon. We may go home from our day in the
hospital, only to find our fridge has broken down, the
street has lost its power, or someone in our extended
family has died. All these events happened to me within a
week, and Im just one person.
What we are pursuing is a life full of stress; whether ours,
our patients, our colleagues, or societys in general. Its a
choice we made, perhaps to aspire to the benefits which
will hopefully come with it. Every time we get to the other
side though, there will be autumn leaves littered among
the green. Most of the time, we can deal with these
stresses. We may get angry, sad, and frustrated, but in
the end, we accept our fate, or we fight.
Sometimes, however, we cant.
Everyone experiences that breaking point. Some struggle
with it everyday, without any intention of it being that way.
Given our demographics and our circles, chances are you
or I will experience some sort of mental illness
during our lifetime, or have people in our immediate family
and friends who do. While maybe one of our colleagues

australian medical students association

may find a cure for diseases such as depression

and schizophrenia, what we can all do is increase
understanding. By talking about our experiences, by
reading more about the aetiology of these conditions, by
sharing what we have learned; we can help society find
an answer, or at the very least, a path to one.
Putting together this Mental Health issue of Panacea has
been fun, exciting, inspiring, but to be brutally honest,
it has been shocking and depressing too. There are
articles about different aspects of mental health, there are
personal reflections of medical students in our cohorts
bravely telling us their stories - and I thank them and
am proud of them for doing so, and there are academic
essays and research reports which have opened my eyes.
Together, with others, I hope these open your eyes too.
Ask how your friends are going. Talk to them about their
6.30am plastics ward round and laugh about it, even if
theyre hallucinating from insomnia. Let them know youre
there when they do. Because if this issue has made me
realise something, its that there is definitely someone in
every common room who could contribute a story to this
issue. If its you, then know that you can do something
about it, because you can. Talk to someone, a friend, a
counsellor, contact a help centre. It will let others know
that when they need it, they can too.

Arghya Gupta
AMSA Publications Officer

WORDS FROM THE PRESIDENT

Just before lunch one recent Sunday, I walked with a friend I
hadnt seen in a couple of years. We spent a while talking about
his semester on exchange in Switzerland and subsequent travels
through Europe, and then moved on to discussing why hes
applying to medical school for 2014. I chuckled when his face
lit up while talking of his post-GAMSAT hospital admission, for
appendicitis. He spoke eagerly of how interesting his three days
in the ward had been, and of all the questions he had been able
to ask his doctors.
We moved on to discussing my experience of medical school,
and I remarked how lucky I thought we were to be learning
such interesting material and gaining an expedited, vicarious
life experience through the patients and families we meet. The
exposure we get is startling, which I mean mostly as a good
thing.
It can, however, also be confronting. For most of us, we
eventually find at least one of the patients we meet has a story
that hits close to home. I remember being particularly distracted
in first-year by a patient my examination skills group met while
practicing something or other. Mysteriously, this very acquiescent
young man had trouble speaking, and something called a PEG
tube sticking through his abdomen. It transpired that he had
taken a deliberate drug overdose and then suffered damage to
his vocal cords during a botched intubation attempt. In addition
to not being able to speak properly, he could now neither eat
nor drink, and a return of function was purely hypothetical. He
would soon be discharged and yet despite maybe never again
being able to share a drink or a meal with his friends, we hoped
he would not attempt suicide again. His face has faded in my
memory, but as I write this I still empathise and wonder how he is
doing now.
There are students for whom this experience might have hit even
closer to home. The dearth of epidemiological data specific to
the Australian university context is a deficiency AMSA would
like to see addressed, but a recent survey of 30,000 students in
Canada, reported in The Globe and Mail, revealed that 9.5 per
cent had seriously considered taking their own lives in the past
year, while 1.3 per cent said they had attempted suicide1. An
Australian study of University of Adelaide students conducted
across various faculties in 2010 found that 44 per cent of medical
students were classified as psychologically distressed (Kessler
Measure of Psychological Distress score greater than or equal to
22)2. This was similar to the rate (48 per cent) the authors found
for all students surveyed, which was noted to be 4.4 times that

of age-matched peers. Is there something in the water? If correct

and generalisable, these numbers are startling.
In line with AMSAs stated priority to advocate for an improvement
in mental health services for all university students, we have
themed this first issue of Panacea for 2013 around the topic of
mental health. We are very grateful for all of the contributions we
have received, particularly from those students who were brave
enough to share their personal experiences. Reducing the stigma
around mental illness is a crucial step towards improved access
to care and enhanced quality of life, and our responsibility to
facilitate this started yesterday. Its heartening to read in some of
these stories of the wonderful support provided to colleagues in
need. I hope we all take heed of their example and pay careful
attention to the wellbeing of ourselves and others. It is, of course,
in patients best interests that doctors be healthy, too.
In addition to passing a Student Mental Health and Wellbeing
Policy earlier this year, AMSA has set up two small project teams
to aid the National Executive in addressing this important and
still somewhat neglected issue. One, led by Ben Middleton
from Flinders University, is benchmarking the preventative and
interventional services and initiatives provided by universities
across Australia. Bens team is starting with a pilot in New South
Wales and will report by the end of the year. The other, led
by Tasha Wahid from Deakin University, is helping to plan our
student mental health advocacy strategy more broadly. Student
mental health features prominently in our Federal Election
strategy and we are seeking to address both the vice-chancellors
and chancellors via Universities Australia. Your help would be
welcomed (please email me at president@amsa.org.au).
Thank you very much to Arghya Gupta from the University
of Sydney for editing this issue. Arghya has compiled a very
impressive collection of articles by authors across Australia,
and I commend them to you. If reading this inspires you to seek
support for yourself or a friend, you may benefit from reading
AMSAs Keeping Your Grass Greener Guide, exploring the many
other services available (see page 48), or in an urgent situation,
calling Lifeline on 13 11 14 or an ambulance on 000.
Thank you for reading Panacea. On behalf of AMSA, best wishes,

Benjamin Veness
AMSA President

1. Miller, A. Postsecondary students dealing with multiple mental-health issues [internet]. The Globe and Mail. 2013 Jun 17.
2. Leahy, C., Peterson, R.F., Wilson, I.G., et al. Distress levels and self-reported treatment rates for medicine, law, psychology and
mechanical engineering tertiary students: cross-sectional study. Australian and New Zealand Journal of Psychiatry, 2010;44:608615.

panacea / 1. 2013

8
UNDERSTANDING MENTAL HEALTH
seshikaratwatte
newcastle

Not long ago I got a phone call, from

someone I am very close to, who was in
absolute hysterics. They called because
they were so worked up and so
distressed that they no longer believed
that people loved them. The phrases;
worst day of my life, you dont know
how bad Im feeling, and Im so scared
of the future, were all cried to me. They
say you can tell you love someone when
you can share in the full strength of their
happiness and feel the full strength of
their pain. Let me tell you, a glimpse
of this persons pain was enough to
break something inside of me. I cant
bear to think what it is to constantly
live with such self doubt, to live with
such little self worth. This tiny window
into the thoughts of someone who had
depression and anxiety scared me.
I believe that mental health issues, in
particular depression and anxiety, are
not something you can truly understand
unless you have had some sort of direct
experience with it: either personally
or watching someone close to you
struggle with it. It can be incredibly
frustrating as a bystander to watch
someone struggle to overcome it. There
have been numerous times that I have
wanted shake a different thought pattern
into people, to scream just take control
of your actions; make yourself not feel
bad. But depression does not work like
that. It is not something you can shake

off in two weeks like a virus, or remove in a

few hours like an appendix; treatment is a
long process and its a disease which rears
its head time and time again.
Mental health issues affect our communities
to a devastating effect, and the burden is
particularly high amongst young people. In
the 15-24 year age group, mental health
issues account for 55% of the total burden
of disease. Mental health conditions in
anyone can be debilitating, but in this age
group it is particularly significant because
it marks a point where we are making
significant decisions in our lives. Its when
you finish school, go to university or TAFE,
or get job, start a family; youre trying to
form lasting relationships.
Even the most pragmatic people in society
should be able to appreciate the financial
burden of mental disease. In 2009, mental
illness in the 12-25 age group cost Australia
$10.6b, with 71% of this due to the costs of
lost productivity from people not being able
to work or contribute to their full potential.
Bottom line: these are significant issues
which need to be addressed.
It is important to be aware that mental
health within our own cohort and
colleagues is significant. Were studying a
highly demanding course; stress is high,
pressure is high, the majority of us are
Type-A personalities and high achievers,

australian medical students association

we are confronted with other peoples

personal issues and circumstances in
the hospital or on placement and this
means there are times when we all
struggle to cope. For many of us this
represents a bad day or week, or a
stressful exam period. None the less it is
important to look out for each other, and
especially watch for when these feelings
dont go away.
As medical students and future
health practitioners we have a lot of
responsibilities to society and each
other as peers. I believe that helping
to address mental health issues is
one such responsibility. Whether it be
through providing a support network for
our friends and colleagues, or spending
that extra bit of time with patients who
are struggling to cope and pointing
them in the right direction to get help,
or advocating to the government
with bigger organisations about the
importance of these issues, we all have
a role to play.
I write this article not to get you down,
or say the world is a horrible place, nor
to preach at you, but rather to share my
small story (albeit in a fairly superficial
way) in the hopes that it gets these
issues a bit more out in the open in our
community and to encourage you to
consider how in little ways you can do
your bit.

ITS A PERSONAL THING

anonymous
melbourne

Depression and anxiety sneak up on

you. In the beginning, I thought that I
was just lazy. Maybe I was; but the day I
was halfway to the station and then had
to return to my bed should have served
as a warning. Instead, I felt I was letting
myself down and that I needed to suck
it up.

up. I sometimes believe that everyone

knows more than me. But, as I deal with
intermittent return of horrid feelings, I have
to be forgiving of myself. Im not going to
top the class or know all the answers all
the time. What I do know is that I want to
be here, and I am entitled to, despite the
issues I have with my mental health.

I cant speak for anyone else who has

experienced an episode of depression
and/or anxiety, but the hardest part
for me was feeling like I didnt want to
be that way, but it was all I could do.
Looking back I cant feasibly understand
feeling and acting like I did - it feels
like a different person was occupying
my mind. It was like having two
consciousnesses present - the wild selfhating miserable beast, and the scared
mouse, both sharing the same house.

My experience makes my life harder - but

I would never change it, it enriches my life
and helps me see things through a different
lens. Ive been forced to reflect on myself
time and time again, and this helps me
relate to others better. Having dealt with
mental illness I feel better equipped to talk
to those that Ill come across as a doctor.

Someone once told me, Your health

has to come first. If youre not healthy
yourself, you can never truly love or
support your friends and families as
well as youd want to. I think this is not
only applicable in caring for your friends,
but also in living out your vocation - if
you are not healthy your work will be
diminished.
I entered this medical degree knowing
that I carried a burden - and I wonder
how many people are experiencing
the same feelings as I am. Ive
missed lectures, and feel completely
overwhelmed by the thought of catching

Mental illness is a personal experience,

in the exact same way that how you
experience life is personal. It is never
your place to make a judgment on how
someone should feel, or their underlying
motivations. What is important is to listen to
what is right in front of you at the time. The
skill of just being able to listen and to not try
and fix it is a gift that can only be learned.
Therapy of any kind is not trying to tell
you what to think, but helping you to
develop/improve/build a framework of
how to think. At any point a person who
is didactic in their treatment of how you
feel is never going to make a difference.
But by understanding why someone
might think that way and suggesting other
ways of looking at it, a receptive patient
can learn ways of managing and living

within the world we maintain. I am so

happy to have been given the chance
to better understand my brain and its
inner workings, and to be continually
developing a framework of thinking.
What we need is a change in
perspective - an understanding that
seeking help is not weak and can be
cost effective. The benefits of mental
health therapy are worth every penny
(and every missed overseas trip) and
we need society to acknowledge that
the outcomes of good mental health
are multiple - for the individual, family,
friends and society. People are inherently
fallible to any illness, and being able
to forgive actions that they were not in
control of and allow them to heal needs
to be a priority in the future.
I like to think Im worth more than
any diagnosis, and that amidst all this
knowledge we are consuming we
continue to put people first, including
our peers. Your friendliness in the
passageway goes a long way to making
me feel better about myself.
As students learning to become part
of one of the greatest professions,
we need to not just learn how to treat
mental illness, but to epitomise what it
is to accept mental illness - to see the
person and not the disease.

panacea / 1. 2013

10
MENTAL STATE UNIVERSITY
benveness
sydney / amsapresident

Six years ago, almost to the day, 33

students and staff died at Virginia
Polytechnic Institute and State University
(Virginia Tech). One of these was
Seung-Hui Cho, a Korean-born student
whose family immigrated to the United
States during his childhood.
Mr Cho had a well-established history
of mental illness, and was known
to the Universitys multi-disciplinary
Care Team, campus police, the
state Department of Mental Health, a
psychiatric hospital in nearby Radford,
and the universitys counselling centre.
For several years, his behaviour in class
and in his residence had been observed
by numerous teachers and peers as
markedly unusual and threatening.
On the 16th of April 2007, Mr Cho shot
and killed 32 people, wounded 17 more,
then committed suicide.
In hindsight, the shootings and suicide
could be considered an expectable
consequence of long-term, untreated
mental illness and disaffection. The fact
that appropriate and coordinated care
was never offered nor enforced upon
Mr Cho represents a tragic systemic
failure on the part of both the university
and the government health service. It
would seem that none of the people
who knew the most about Mr Chos
behaviour knew how to help him, and
that communication between them was
limited.
Such disconnection was noted broadly
at Virginia Tech, and is unfortunately
not uncommon at many universities.
One of the recommendations of the
government review into the incident
was that universities should recognise
their responsibility to a young,
vulnerable, population and promote
the sharing of information internally,
and with parents, when significant
circumstances pertaining to health and

safety arise. Furthermore, the review called

for universities to have systems that link
troubled students to appropriate medical
and counselling services, either on or off
campus.
The events at Virginia Tech were an extreme
example of the consequences of ignoring
a students mental health; students with
mental health problems usually pose no
threat to others. More commonly, the worst
that happens is that individuals commit
suicide, as happened with an international
student at my university last year, and with
an intern who died just a few weeks into
their new job early this year.
The Australian Medical Students
Association (AMSA) spent a great deal of
its first Council meeting for 2013 discussing
the topic of student mental health, and
passed aStudent Mental Health and
Wellbeing Policythat is available on the
AMSA website.
It seeks to bring attention to this issue and
forms the bedrock for AMSAs future policy
initiatives in the area.
Mental health is one of Australias nine
National Health Priority Areas (predating
the addition of diabetes, asthma, arthritis,
obesity, and dementia). Australian Institute
of Health and Welfare (AIHW) data show
more than one quarter (26 per cent) of
the 16-24 age group experience a mental
health disorder in a 12-month period the
highest incidence of any age group. Anxiety
disorders are the most common, followed
by substance use disorders and affective
disorders. Furthermore, compared with
other age groups, youth are less likely to
access services for mental health problems.
There is an opportunity being missed. More
than 1.2 million students are enrolled at
Australias 39 universities, and more than 60
per cent of domestic students are aged less
than 25 years (by which age roughly 75 per
cent of mental disorders have their onset).

australian medical students association

Federal Government policy is to broaden

access to tertiary education, with the
goal that 40 per cent of 25-34 year olds
hold a bachelors degree or higher by
the year 2025. This means that nearly
half of all young people will soon be
attending university for three, four, five,
or more years making them accessible
in a way that is otherwise rare once
people leave school.
AMSA would like to see universities and
governments take advantage of this
window of opportunity, implementing
effective prevention and early
intervention programmes for students
mental health.
One of the obvious starting points is
regulation, so were currently speaking
to the Standards Panels that are
reviewing the higher education provider
standards monitored by the new
industry regulator, the Tertiary Education
Quality and Standards Agency.
Suggested interventions are broad,
and will require collaboration between
governments, universities, and students.
This is a tricky issue, but it is also a
battle that AMSA believes is worth
the fight. The university student
group includes some of the best and
brightest of Australias youth, captive
in a potentially supportive environment
for a small but significant number of
years, and with open minds eager for
opportunities for growth and personal
development.
AMSA will do all it can to help them
succeed.
Editors note: An earlier version of this
article was previously published on the
AMA website.

11
A LEARNING EXPERIENCE
mattmcalpine
westernsydney

During a shift in the emergency

department, a mother carried in her
6 year old daughter with a deep gash
in her arm, with blood still seeping
through a makeshift tea-towel bandage.
Although she was in pain, the girl was
pretty comfortable being assessed
and treated. I was asked to hold her
still as the ED physician gave the local
anaesthetic and stitched the wound
shut.
For the next ten minutes I found myself
firmly gripping the screaming girls
wrists while a nurse held her legs; it
was all we could do to keep her still.
Her mother was by her side, reassuring
her that it would end, that she loved
her and that this had to happen for the
pain to go away. All the while the girl
cryingmummy, make them stop!
I still havent forgotten the look in her
eyes as the sutures pierced the skin.
Pain, confusion, and abandonment
written across her face as she looked up
at her mother begging for an end.
Of course, the end came and all was
well. But in that moment, anything
would have been better than the pain of
being fixed. Anything.
As medical students and future doctors
we have the most amazing opportunity
to be welcomed into peoples lives
when they are most vulnerable.
Our hands will one day be suturing
the wounds of children kicking and
screaming and begging us to stop, and
although we may choke back tears
we will continue. Why? Because we
understand that sometimes in medicine,
momentarily enduring pain is necessary
to facilitate true recovery and healing.
As a 17 year old in my first year of
medicine, life could not have been more
perfect. I left home, started the most
brilliant course, met some amazing
people, enjoyed a fulfilling relationship
and loved the adventure of each day.
Seemingly overnight however, everything
changed to the point that I found myself
violently sobbing under my bed for

hours each night, pushing away the people

that cared about me most, and loathing
everything about my brave new world. I
was at a point where I no longer recognised
myself; and I was trapped inside a mind
and body I couldnt control. After months of
denial, I finally sought help, and began the
painful journey to recovery that I still crawl
along.
Mental illness doesnt discriminate and can
arbitrarily devastate everything, leaving you
helpless and void of hope. There are no
words to describe the absolute desolation
that infiltrates each and every day. My story
is just one, and I forewarn that my story
is an incredibly individual experience. But
I hope that in embracing vulnerability and
sharing my story, others may find solace in
their own.
I discovered the bitter irony of depression;
that once you find yourself at the end
of the earth where worthlessness and
despair wreak havoc rock bottom can
actually be the most comfortable place.
Not comforting, not bearable and certainly
not sustainable but comfortable
nonetheless. I slowly began to embrace the
suffering and heartache, and amazingly it
momentarily relieved the anxiety I felt about
the present. The future still scared me,
the past still haunted me but finally the
present was bearable. Although my wounds
were open and bleeding, I opted for the
temporary relief of isolation and alcohol;
and kicked and screamed at the thought of
acknowledging weakness and accepting
help - the sutures I so desperately needed.
Whoever you are, whatever you are going
through - please know that recovery and
redemption are possible but not without
great cost. Trying to get better is not easy. It
is excruciating.
Choosing to exercise, sort out your sleep,
eat healthier, see friends when youd rather
be alone - these things arent easy. They
are excruciating. You will resent every step
you take - every meal you force down,
every event you attend, every alarm you
set. Slowly however, your body will begin to
thank you.

Choosing to see your doctor, talking

with a psychologist, even to start
medication if necessary, isnt easy.
Acknowledging weakness and
putting yourself at the mercy of a pill
is humbling; sharing your most guiltridden thoughts with a stranger can be
humiliating but you are dedicating
your life to this profession; start by
trusting it.
Choosing to reach out to those who
care for you isnt easy. Its excruciating.
Making yourself vulnerable, risking
embarrassment, and rejection, isnt
comfortable. Sharing your story will
tear your heart open in all the places
you swore to keep safe and protected.
But its this catharsis that leads to
understanding, support, and safety.
Once you reach out and take that initial
step you are not alone. Hopefully, you
will find people around you holding your
hand, and cheering you on.
I cannot promise that it will be simple or
quick; in fact I promise that it wont be.
I cannot promise that people will always
understand what youre going through,
or how hard the choices you make are.
They usually wont. I cannot promise
there wont be failures, setbacks, and
relapses. Again, I can guarantee them.
I can however promise you this:
This is not the end of your story.
Your heart and mind are not beyond
redemption.
You are dearly loved, and you do not
have to be alone on this road.
Your future is worth fighting for.
Take a deep breath; hold the hands of
those who care for you while you endure
each excruciating needle and stitch.
Recovery is real, and the sun is already
beginning to rise.
Keep your head up, keep your heart
strong.

panacea / 1. 2013

12
STIGMA IN MENTAL HEALTH
prasadiadikari
jamescook

Our approach to mental health has

decidedly come a long way since
the locking away of the mentally
unfit. Innovative reforms such as the
increased deinstitutionalisation of
psychiatric patients, development of
family therapy, and the introduction of
social support groups have undoubtedly
improved outcomes for consumers of
mental health1-3.
However, while society is more
empathetic towards victims of these
crippling diseases, there still remain
hidden stigmas associated with mental
health3-6. This is evident in the common
misconceptions held by society, the
media, and by individuals3-6.
Them. Strangely that is the most
common word used in reference to
people with mental illness. Not us or
me but them. Ask the common Jo
off the street and he would probably
deny that mental illness could affect him.
In fact this sweeping under the carpet
approach to mental health is one of the
reasons why stigmatisation exists3-6.
Alienating the subject makes it sound
as if mental disorders are negative and
abnormal. The fiction that mental health
is rare is highlighted by recent surveys
that show almost 50 per cent of the
Australian population have experienced
a mental disorder and that 1 in 7
experience depression3-6. Sadly this
ignorance that swamps society results
in isolation and shunning of individuals
with mental disease; labelling them
as freaks or outcasts3-6. In order for
people to accept mental health, more
light has to be shed on the commonality
of these diseases.
Despite its prevalence, society still has
a poor understanding of those with a

mental illness6-9. Indeed it is not unusual

to hear words such as loony and crazy
being carelessly tossed around to describe
those suffering from mental disorders6-9.
But are we fully to blame? With characters
such as the Joker from The Dark Knight,
and portrayal of mental asylums such as
that in Shutter Island, it is no wonder that
people potentially associate mental health
with disrepute and destruction. A recent
study on media depiction of mental illness
showed that criminality, dangerousness
to others and violence were the most
common topics under which mental health
was discussed6-9. More communication
needs to be created between those with
and without mental disorders in order to
bury false representations and unnecessary
fear.
While society and media play large part
in stereotyping mental health, individuals
suffering from mental disorders also play
a key role10-13. Interestingly, self-inflicted
stigma is not an uncommon phenomenon
with some individuals believing that mental
disorders are more a personal weakness
rather than a clinical disease. Shrugging
feelings of loneliness and symptoms
such as crying as character flaws not
in line with images of strength and
success are typical in certain cultures
and personalities14,15. Remarkably an
association was found between a cartain
type S personality (those always seeking a
positive outcome at all costs) and masked
depression14,15. While this is likely due to
the sufferers own self-critical nature, it
may also stem from a lack of knowledge
about the biochemistry and genetic basis
of mental disorders14,15. For assurance that
mental illness is not a personal defect, but
a disease that is out of ones control it is
important that initiatives, such as those led
by BeyondBlue, continue to educate people

australian medical students association

about the causes and diagnostic factors

of mental health.
Overall while there have been definite
advancements in mental health,
stigmatisation is still a barrier which
needs to be charged at with full force.
The process of de-stigmatisation will
not happen overnight and requires the
re-moulding of certain misconceptions
and beliefs prominent in society.
Improving education via introducing
mental health discussion into schools
and workplaces as well as opening up
communication between people with
and without mental illness may be steps
taken towards acceptance.

REFERENCES
1. Council of Australian Governments (2010), National Action Plan on
Mental Health 2006-2011.
2. Australian Bureau of Statistics, 2007-2008 National Survey of Mental
Health and Wellbeing: Summary of Results, (4326.0).
3. Senate Community Affairs Committee (2008), Towards recovery:
mental health services in Australia.
4. Corrigan P. Mental Health Stigma as Social Attribution: implications for
research methods and attitude change. WILEY 2006; 7: 49-67.
5. Hickie I, Davenport T, Luscombe G et al. Australian mental health
reform: time for real outcomes. Med J 2005; 182: 401-406.
6. Pinfold V, Thornicroft G, Huxley P et al. Active ingrdients in anti-stigma
programmes in mental health. BJ Psych 2005; 17 (2): 123-131.
7. Form A. Mental health literacy: Public knowledge and beliefs about
mental health. BJ Psych 2010; 196-401.
8. Lemoine P, Zawieja P, Ohayon M. Associations between morningness/
eveningness and psychotherapy: An epidemiological survey in three
in-patient psychiatric clinics. ELSIEVIER 2013; 47: 1-4.
9. Thornicroft G. Shunned: Discrimination against people with mental
illness. Oxford J 2006.
10. Papastylianou A. Personality Traits and depression: Research and
implications. EJCOP 2013; 2: 1.
11. Paul A. Frewen, M.A., David J.A. Dozois, PhD. Self-Worth Appraisal
of Life Events ad Becks Congruency Model of Depression Vulnerability.
Journal of Cognitive Psychotherapy: An International Quarterly. 20(2);
2006: 231-240.
12. Suls, J., Fletcher, B. The relative efficacy of avoidant and non-avoidant
coping strategies: A meta-analysis Health Psychology 4 247288 1985.
13. Peter Tyrer, Sarah Mitchard, Caroline Methuen, Maja Ranger, (2003).
Treatment Rejecting and Treatment Seeking Personality Disorders: Type R
and Type S. Journal of Personality Disorders: Vol. 17, No. 3, pp. 263-268.
14. Polman R, Borkoles E, Nicholls A. Type D personality, stress and
burnout: the influence of avoiding coping and social support. BJ Psych
2010; 15: 581-696.
15. Thompson A, Hunt C, Issakidis C. Why wait? Reasons for delay and
promopts to seek help for mental health problems in Australian Clinical
Sample. Soc Psychiatric Epidemiol 2004; 38: 810-817.

DOWN THE RABBIT HOLE

13

beatricedowsett
wollongong

I have often likened medical school to

Alice in Wonderland. It is a wondrous
little microcosm with something new
around every corner. This vibrant
newness can be very stimulating,
but, sometimes it can also be very
overwhelming. There will always
be a fast-paced White Rabbit (the
personification of medical knowledge,
perhaps?) who we try and follow as
best we can. We may encounter a
condescending Queen of Hearts, who
teaches us the power of resilience. And,
if were lucky, we may also encounter a
Cheshire Cat who seeks to guide us at
times when we need help. Nevertheless,
we all know that medical school has the
potential to be a stressful place and,
alas, sometimes we can become more
Mad Hatter than chilled-out Caterpillar.
Medicine is a profession that conjures
images of melodramatic TV dramas,
heroic saving of lives, crisp white coats
and stethoscopes dignifiedly draped
across proud shoulders. However, the
vision of medical students just before
major exams presents quite a different
image. We all know what its like: puffy
eyes, slightly scruffier-than-usual hair,
stiff trapezius muscles from hours
spent at a desk, the inability to open
doors (or maybe that last one is just
me?). Usually, this heightened sense
of stress dissipates once exams are
over and we are no longer inclined to

watching Greys Anatomy late at night

whilst clutching a pillow and whimpering
One day...one day... (or is this once again
just me?). Jokes aside, the art of trying to
balance study, a mildly-functioning personal
life, and finances can sometimes become
overwhelming. It is important to note that
medical students, just like everyone else,
are not impervious to burnout.
Impairment in medical practice refers
to any physical or mental illness, which
is likely to be detrimental to a persons
ability to perform their work effectively and
safely. Under the Medical Practice Act, this
doctrine also applies to medical students.
If you ever feel that you are not coping,
always have someone to talk to; whether
this is a mentor, a counsellor, or your own
personal GP. My university also recently
alerted our attention to the Doctors Health
Advisory Service, a confidential service that
is available twenty-four hours a day. Asking
for help will never reflect badly upon your
character. In contrast, hiding a problem and
letting it impinge upon your professionalism
is not ethically sound. Getting help early
is not a sign of weakness; it is a sign of
courage and strength. As Im sure youre
all aware, the best doctors know the
importance of seeking advice in the face of
uncertainty.
So, what about those of us for whom stress
doesnt affect the practice of medicine,
but does affect the enjoyment of daily life?

Personally, I have found that yoga is an

effective way of calming my mind and
sustaining a satisfactory level of fitness.
Whilst I could extol the benefits of yoga
until the cows come home, I realise that
it is not for everybody. The important
thing is to find a hobby that gives you
a replenishing break from medicine.
However, always make sure that your
hobby is beneficial to your health and
not detrimental to it (drugs and alcohol
are not a viable solution to stress, and
dependence on said substances will
lead to further impairment). One thing
that works for all students, I believe, is
time management. By scheduling in set
study and relaxation periods during the
week, we are not only giving ourselves
concrete study goals to achieve, but, we
are also giving ourselves permission to
relax which is important.
Finally, sometimes having a glimpse
of the bigger picture can help soothe
those prickly medical school nerves.
Amidst all the stress and sacrifices of
medical school, its nice to be reminded
how privileged we are to be a part of
this miraculous little microcosm, or
Wonderland. As future doctors, we can
look forward to constant intellectual
growth and stimulation. As future
doctors, we have the ability to alter
peoples lives in a positive way. And in
these truths, dear colleagues, there lies
great comfort.

panacea / 1. 2013

avant

15

STEPPING UP
harryjennens
melbourne

So why did you choose medicine?

Oh, I want to help people.
Great! There is no better reason.
Maybe not everyone entered their
course with this idea clear in their head.
But I sure hope its at the top of your list
now, or at least high up.
But how exactly are you going to help
people? And when?
Will you adjust tablets to control blood
pressure? Will you give resuscitation
in ED? Will you coax appendices out
of minute incisions? Will you counsel
patients with major depression?
Perhaps youll venture out to
disadvantaged communities to ply and
share your skills with people who need
them most. (If so, more power to you!)
All these things will come at the end of
your degree. But how would you like to
do something that will help to protect
the health and welfare of billions of
people around the world for generations
to come right now?
We are in the Critical Decade for our
climate. Last year the World Bank
reported that current energy practices
are likely to lead to a mean global
temperature rise of 4C by the end of
this century, and even more beyond.
Unless we act, the consequences will
be nothing short of devastating for our
planet and the human race: metres
of sea level rise, inundation of coastal
cities, displacement and conflict,
crop failures, famine, major cyclones,
droughts, floods, fires, and increases
in heat-related illnesses and the spread

of infectious diseases. Indeed, the World

Bank warns that there is no certainty that
adaptation to a 4C world is possible. The
Lancet and University College London
certainly werent kidding in 2009 when
they identified climate change as the
biggest global health threat of the 21st
century. And already today in Australia
we are seeing warmer days, more severe
heatwaves, bushfires and floods.
In short, its a big problem. Fortunately,
there is a solution. You.
Im not just talking about riding bikes,
switching off lights, and eating vegetarian.
All those things help, but focusing on
them exclusively keeps the spotlight
on us as individuals and away from the
institutions that prosper under the status
quo. We need to understand the problem
individually, but we need to address it
collectively. Why do our politicians drag
their feet in drafting significant policies to
address this emergency? Why does our
media give equal or greater coverage to
climate change deniers when the proportion
of scientists agreeing on it is over 97%?
Simply put, it is because large industries
have enormous interests in keeping it that
way, and theyre not afraid to exercise their
power.
But things are changing. A movement of
fossil fuel divestment has sprung up across
the United States. Following student and
community campaigns, six universities and
colleges, 16 city councils and ten religious
institutions have pledged to freeze and wind
down all their investments in the coal, oil,
and gas companies that commercialise our
planets destruction. The movement is still
building and has spread to Australia, where
university groups are campaigning and

the Uniting Church Synod of NSW and

the ACT has also committed to divest.
Now is our chance to turn around our
societys dangerous environmental
trajectory, starting with our own social
institutions.
To help make this kind of change, Ive
joined Doctors for the Environment
Australia, a national association of
medical students and doctors dedicated
to addressing the health risks imposed
by damage to our environment. At a
student level, we have a network of
members around most medical schools
in Australia running seminars, meetings,
film screenings, actions and our annual
conference. Visit www.dea.org.au if
youd like to join and get in touch with
your state representative. If there isnt
yet a group at your university, there
should be, and you can make it happen.
We would love your help we are all
responsible for what happens to our
world, and everyone can make a big
difference.
We are medical students, and we will be
doctors. We are among the academic
elite. We are trained to critically evaluate
information and make difficult decisions
in the face of uncertainty. Most
importantly, we have the trust of the
public that we will do our best to serve
the interests of everyone.
We are ideally placed to lead our world
to a healthy future.
Lets make the most of it.
Harry is the Victorian Student
Representative for Doctors for the
Environment Australia.

panacea / 1. 2013

16
WISH YOU WERE HERE
inushahira
newcastle

My name is Inu and I was diagnosed

with Type I Bipolar Disorder at the end
of last year. I was hospitalised for 3
weeks in a psychiatric ward due to my
sickness. It was there I had my first
manic episode. I had a few depression
episodes before that. I just want to share
a little bit of what I had experienced that
touched me during that troubling time.
While I was in an Australian hospital, my
parents were in Malaysia. They were
very determined to come to Australia,
especially my mother. My mum asked
my dad to find money so that she could
come to Australia to be with her child.
My fathers friends donated enough
money for my mum to come, with just a
backpack a small suitcase.
She took care of me. She was really
patient when I had my mood swings.
My tantrums, my childishness she
put up with it. My father would call me
after I had my breakfast everyday. He
would listen to me and would try to
comfort me when I started demanding
ridiculous things such as wanting to talk
to [Malaysian Prime Minister] Dato Sri
Najib or to President Obama. He said
he would try his best to adhere to my
demands, but later he would call my

mum and say; Your daughter is asking for

ridiculous things. What am I supposed to
do?
And then they would laugh together.
When I went back on a trip to Malaysia, I
had to struggle with myself. I felt so bad. I
felt that I was a monster for becoming what
I had. I hurt people when I mentioned my
illness. People were angry with me. People
were hurt with my words, with my actions.
People kept on saying that I was sick
during that time, as if trying to suggest if I
was a normal person, I would not have
done the things I did. When I tried to let
out my feelings, people rejected me. They
could not take me seriously because I
was seeing a psychiatrist. People feared
me. They stayed away from me. I was
embarrassed because of the messages that
I wrote where I tried to express my feelings.
I tried fruitlessly to reverse my actions by
deleting all the messages that I wrote to
people, my Facebook posts, just because
people said my writing was radical. I
apologised again and again. I wrote an
apology message on my Facebook wall,
I wrote apology messages personally to
people who I thought were affected by
my situation, whether directly or indirectly.
Some replied, some did not. To the ones

australian medical students association

who replied, I thank them so much. To

the ones who did not, I understand they
must have been busy. I regretted my
actions, because I thought it was wrong
- because people told me that. Because
its a disease where you became stark
raving lunatic.
Or so I thought. I was afraid of what
people were talking or thinking about
me.
I just want to give a shout out to people
like me, especially to those with bipolar
disorder, people with mental illnesses,
people who are different or weird,
people who are going through a tough
time; you are not alone. To people who
have family members with an illness or
know someone like this; love them. If
you love someone sincerely, dont be
afraid to tell it to them. Show to them
what love is because actions speak
louder than words. Take the time to
listen to their stories. Cherish them.
Try to understand. Be patient. Respect
them. Respect their opinions, respect
their decisions, even if you dont agree.
We are born to be different. Try and
embrace each other differences.

17
THE CANNULA
davidmathew
monash

The next procedure: laparoscopic

cholecystectomy. Being with the
anaesthetists, that was all I needed to
know for now.
The patient was ready. A 26 year old
lady, clad in a hospital gown. Her trolley
was wheeled into the OT. She was
otherwise healthy, and could readily
move herself to the OT bed.
The nurses got her comfortable and
straightened her arm out so we could
put in a drip.
I headed for the facemask and chose
my gloves - medium. Gloves were
important. Too tight and they would
make the whole process uncomfortable.
Too loose and they would get in your
way.
Then I prepared my equipment.
One pink cannula.
Tourniquet.
Some alcohol swabs.
And some local anaesthetic.
I put all the equipment into a dish next
to me. The patient was very confused.
She obviously knew she was here for
the operation, but now everything was
in a whirl. Nurses were hurrying around.
Surgeons were getting scrubbed. And
here, the anaesthetist was holding her
hand.
Just gonna put a little drip in your hand,
alright?
She nodded back. A timid nod; maybe
slightly fearful. She didnt like the
pain, didnt like the needle. I put the
tourniquet on, just above her wrist. She
had good veins.
Is it gonna hurt?
A simple question, but one that

mattered to her.
Its just gonna be a tiny prick, like an ant
bite. And then the area will go numb and
well put in the drip. Youll just feel a bit of
pressure.
She nodded, contented.
Her veins were all there, like little snakes,
bulging and joining up. Like little streams,
flowing to a river. I picked one coming out
of a Y junction, took the alcohol swab and
tore it open.
Just gonna clean the area, alright? Youll
feel a little cold.
I took the flimsy piece of swab and cleaned.
Putting in a drip was like inserting a foreign
body. The area had to be clean. Another
good thing about the alcohol, cleaning
made the veins show up better. Some law
of physics I never understood.
She looked away, knowing the worst was
about to come.
Youre gonna feel a little sting, alright? And
then the worst part of is all gonna be over.
She whimpered unintelligibly, and looked
away, overcome by fear.
I stuck the local exactly where I wanted. A
little bulge formed and a tiny drop of blood
emerged.
While waiting for the local to work, I
jammed a piece of gauze onto it; partly to
clear the blood, partly to reduce the lump.

Youre gonna feel a little pressure now

okay.
This time she didnt even answer. Her
head managed a weak nod, her eyes
fixated someplace else. I grasped her
palm to prevent her from making
sudden large movements, and also to
anchor the vein.
I concentrated on the spot and inserted
the cannula. Felt the needle pierce the
skin; the resistance. The resistance
eased, and I knew I entered the vein.
Saw the flashback. I advanced the
cannula further. And as I did I searched
for the flow of blood.
It came, and I breathed a sigh of relief. I
pushed the cannula as far as it could go.
I undid the tourniquet. I carefully
occluded the vein and took out the
needle.
The nurse handed me the drip and I
connected it. I looked up at the drip as
the nurse opened the valve. The drops
came, slowly at first, and then steadily.
I breathed a sigh of relief.
All over now, the hardest part is over, I
said as I motioned for a Tegaderm. The
patient looked at her hand, still fearful.
Its just a little plastic in there, wont hurt
you.
She nodded, and a little smile crept
across her face. She survived this. It
was not even the operation, but you
could see her relief.

And then I took the cannula. Flicked open

the plastic covering from above, exposing
the needle. Looked at the spot where I put
the local. The cannula was going to go
through the same spot, but this time further,
piercing the vein and settling inside. It was
all technique.

panacea / 1. 2013

18
MENTAL ILLNESS AS A SUBSEQUENCE
OF DOMESTIC VIOLENCE IN INDIA
development of an organisation as a
solution
erinburge
monash
The prevalence of mental disorders
effecting married women in India
is being embraced by the global
community as studies are released
that relate physical and mental marital
abuse to mental illness. The causative
agents of mental illness suffered include
domestic violence, disempowerment
and separation from family, as well
as age of first child. An organisation
focused solely on targeting the needs
of Indian women in abusive marriages
through educational programs would be
an ideal way in which to advance female
mental health.
Education and psychiatric support
programs catering for the needs of
Indian women in abusive marriages,
both mental and physical, are necessary
to target the high levels of abuse and
subsequent mental illnesses suffered
by these women. An article released
by the Indian Clinical Epidemiological
network stated that a history of being
the target of violence puts women at
increased risk of depression, suicide
attempts, psychosomatic disorders
and physical injury with 4005 [of
the 9938 women surveyed] (40%)
reported experiencing `any violence
during their marriage, of whom 2243
(56%) had SRQ scores indicating poor
mental health1 correlating marital
abuse with subsequent mental illness.
An aspirational idea to help these
women would be the formation of an
organisation which aims to deliver
support in terms of psychological
services for the diagnosis and treatment
of mental illness brought about by
domestic violence. The aim of this
organisation would be to support
and treat women during and after
periods of domestic abuse through
free psychological counselling and
community support networks created
by the organisation. It should be
noted that abuse can come in many
forms, including disempowerment,

forced seclusion and insults and therefore

supportive services to help with self-esteem
and empowerment should also be offered
to these women. Many organisations today
work to help alleviate the domestic violence
inflicted on these women as a solution to
solving the issues of mental illness, however
until that aim of reducing domestic violence
is reached, mental illness in these women
experiencing abuse will continue.
The planning involved in this form of
organisation takes substantial time and
financial aid, compliance from affected
women and their families as well as
dedication from staff. To create the sense of
support which the program aims to extend
to these women, psychological programs
would need to be scheduled at regular
intervals to give women a consistency that
they cannot find elsewhere in their lives as
well as provide goals and tasks to work
towards in terms of ridding themselves
of their mental illness. Furthermore, even
though domestic violence is relatively
widespread throughout India, certain areas
of the country have been targeted with
having higher levels of marital abuse. An
article relating to abuse of Indian women
from John Hopkins University stated
that lifetime rates of physical beating or
mistreatment for our study sample range
from a low of 16% in Maharashtra to a high
of 31% in Tamil Nadu2 emphasising that
the initial placement of these educational
and support programs should be in areas
with the greatest initial need, with future
expansive aims. Moreover, planning would
initially need to be conducted into how the
recruitment of abused women into these
programs would be achieved as it has
been stated that 49% of [Indian] women
felt nothing would improve the situation3
and therefore refused to seek help for their
subsequent mental issues relating to their
abuse.
Alleviating mental health issues in India
takes not only planning, but action. The
global community is becoming more aware

australian medical students association

of issues affecting Indian women,

however reforms are still in their infancy.
The worldwide community hears of
these injustices against women from
reports, such as the 2012 Dehli Gang
Rape Case, which reached Western
media. However, mental illnesses
relating to these forms of attacks are
more common and damaging than is
reported in Western newspapers and TV
programs. Its the global communities
obligation to work towards alleviating
mental illness in Indian women by
supporting the work of organisations
who deal with this form of mental
illness. As more organisations become
dedicated to helping the plight of Indian
women, more light will be shed on the
daily suffering of these women, mentally
and physically, which hopefully one day
will see a substantial change occur.
The number of organisations
and support services for women
experiencing mental issues relating to
domestic violence is lacking in India
and therefore mental illness continues.
Throughout this essay, an organisation
has been described whose main aim
is in psychologically supporting Indian
women with mental illness brought on
by domestic violence. Ideally, one day
this organisation will become integral to
improving outcomes for women who are
trapped in cycle of domestic violence
and subsequent mental illness.
REFERENCES
1. Frances, R. Domestic Violence and Its Mental Health
Correlates in Indian WomenKumar S, for the IndiaSAFE
Steering Committee (India Clin Epidemiology Network,
Chennai; Et Al) Br J Psychiatry 187:6267, 2005. Yearbook of Psychiatry and Applied Mental Health 2007 (2007):
111. Print.
2. Koenig, M. A., R. Stephenson, R. Acharya, L. Barrick, S.
Ahmed, and M. Hindin. Domestic Violence and Early Childhood Mortality in Rural India: Evidence from Prospective
Data. International Journal of Epidemiology 39.3 (2010):
825-33. Print.
3. Shrivastava, Prateek S., and Saurabh R. Shrivastava. A
Study of Spousal Domestic Violence in an Urban Slum of
Mumbai. International Journal of Preventative Medicine
(2013): 111. Print.

19

A HIDDEN REALITY
alexandrabrown
australiannationaluniversity

Imagine this; a student in your class,

the picture of perfection. Flawless skin,
fancy clothes, oozing confidence, an
astounding intelligence. The friendliest
of students, the social guru, the sports
star, the student advocate.
Then imagine getting a phone call from
a friend terrified and hysterical. You can
barely hear what they are saying. You
need to get to their place. You are out
for dinner and you are a little confused.
But their final words make you sit up.
Overdose.
You arrive at your friends house to
empty pill packets beside a limber body
on the bed. The body is your friend;
unresponsive, but a strong pulse and
slow breaths. You try to rouse your
friend to no avail, the ambulance arrives
and you watch them get taken to
hospital.
Scenarios such as these do happen.
And with the rising rates of mental
illness amongst students, and medical
students in particular, it is not as
uncommon an event as one may think.
Mental illness isnt rare. Depression is
real. It affects 6-7% of young people

aged 16-24 each year in Australia. Of the

mental disorders affecting 16-85 year
olds, 14% were anxiety disorders. And to
all of you reading this out there, this exact
thing, this health problem is affecting our
colleagues and is likely to one day affect us
along the path of our career unless we take
action now.

kind of mental illness, is necessary.

For me its exercise, its motivating
people to get out there and run through
their pain and stress. It is not simply
about awareness, although that too is
important. We have to equip ourselves
with ways to recognise and help others
who are falling from the grips of sanity.

However it is not only anxiety and

depression which wreak havoc through
the students across Australia. Substance
abuse is becoming an ever-increasing
concern. Whether it is alcohol, prescription
or recreational drugs, we are vulnerable
to this abuse; to the overconsumption and
the attempt to use these substances to
alleviate our worries, our guilt, our stress
and our pain.

Medicine is not meant to be a walk

in the park. I think there would barely
be any medical student who thought
it would be. But with this illustrious
endeavour we have all made comes
what seems to be a debilitating
responsibility and workload. For this
reason, we, as peers to one another,
must guide and assist all who walk
the path we do, share in each others
experiences, and most importantly,
share the times when not everything is
all fine and dandy.

The most important fact I have learnt while

being at med school, is that youre never on
your own. If youre beginning to succumb
to the pressure and workload that is
innate to medicine, then most likely a large
proportion of your class are too. If you are
feeling overwhelmed like you could never
know everything you need to, then others
will be feeling it too.
Having strategies in place to cope with
situations like the one mentioned, and for
any suspected friends experiencing any

And remember, if you notice the signs

or if you get that call, dont judge. Be
aware. Be vigilant. Look after your wellbeing. And look after your friends, your
family and all your colleagues, because
you never know who is slowly killing
themselves inside.

panacea / 1. 2013

20
DEPRESH CONFESH
nicolekalish
sydney

This is the story about what I have come

to call My Second Year Depresh, how
I overcame it and what you can do to
help your friends who are feeling it too.
I never ever thought I would get into
Sydney Medical School, and so, the
euphoria of gaining entry seemed to
continue endlessly. Stage 1 was filled
with amazing people and an even more
incredible atmosphere with MedCamp,
MedBall, Convention, Revue, RAW, end
of block parties; each event better than
the last. It was the best year of my life
and I had never been happier. After a
wonderful holiday I was excited to return
to Sydney and see what Stage 2 had to
offer.
Uni was still full of the same gorgeous
people and the same wonderful, neverending social calendar; but something
was definitely different. This time I wasnt
excited; not at all. The elation of getting
into the SMP had worn off and suddenly
I wasnt enthusiastic about anything
and just seemed to be going through
the motions. As someone who regularly
gets told to calm down and be quiet,
this new bland demeanour did not feel
comfortable, but unfortunately, it was
one I just couldnt shake off. I constantly
felt sad for no reason at all. As all you
keen beans might have figured out (and
also, I gave it away already), these are
all signs of depression. I recognised
them too, and so in desperation, I called
a friend and admitted to her that Im

feeling depresh. I felt so silly explaining

to her that after the awe of Stage 1 I had
realised that Med school was just my life
now, and it wasnt as exciting as I thought
it would be. Thankfully, she listened and did
not judge and it was such a relief to share
my feelings with someone.
We set a date and agreed that if I had not
started to feel better by then, that I would
go speak to a doctor. Over the subsequent
weeks we spoke regularly and I called her
whenever I felt particularly low and slowly
the clouds began to fade and I found
myself enjoying uni life again. Ultimately
the catalyst which pulled me out of my
depresh occurred one clinical day, when
an interaction with a patient reminded me
how much I loved the opportunity to be
involved in a patients wellbeing. It reminded
me that my ultimate goal was not just to get
into a good med school, but rather to be
a good doctor; a goal I had yet to achieve
and thus one I could work towards. Since
having this epiphany I have often thought
back on my second year depresh and
I would like to share some of the things I
have learnt from the experience.
Firstly, just because someone acts fine
doesnt mean they are. Taking a hint
from The Bro Code, whenever I felt sad,
I stopped being sad and was awesome
instead; or at least I pretended to be
awesome. I put on a great show of being
my usually bubbly, extroverted self and I
doubt if anyone cottoned on to how down I
really felt. Please ask your friends how they

australian medical students association

are, or if they need help, and dont let

their actions dismiss your suspicions.
Secondly, just because you arent yet
a doctor, doesnt mean you cant be
doctorly. I will forever be grateful to
my friends for their help, support and
their professionalism. I doubt the help
I received under their care could be
bettered by any qualified doctor. I hope
that when I actually am a doctor, I will
be able to provide my patients with as
much comfort and support.
I know that this vignette is silly when
compared to the tragedies which have
befallen many people reading this; as
a cohort we have lost brothers, sisters,
parents, grandparents and friends. For
many it has been a hard, heart-breaking
year, and I beg you; please dont forget
that we need to support each other.
Be the person that someone seeks to
lean on and gain strength from. Be the
friend who shows support throughout
any tragedy, no matter how big or small.
Most importantly, if you think you might
be in trouble and you need help yourself,
please confide in somebody and let
them help you; everything is easier with
a friend at your side.
Editors note: This article was previously
published in Sydney University Medical
Societys publication, Innominate. It
was selected for inclusion in Panacea
given its relevance and nomination by an
AMSA Representative.

21
A BANDAID ISNT ENOUGH TO FIX IT
dianaethell
notredamefremantle

The power of words and the English

language is a force to be reckoned
with. Depression, anxiety, bipolar,
schizophrenia names given to mental
illnesses, words associated with stigma
and in many cases isolation, words
associated with crazy people, and,
words commonly met with the phrase it
will never happen to me. It is the power
of the language society uses that has
contributed to our beliefs about people
with a mental illness that has fuelled
the fire of stigmatism and segregation,
and yet 1 in 5 Australians are expected
to experience a mental illness in their
lifetime.
Growing up, I did not (and still dont
think I do) fully understand what it
meant to have a mental illness. Yes,
I understood it was an illness. No,
it wasnt something people did for
attention. But I did not truly understand
the impact it can have on an individual,
a family, or a community. I feel confident
to say, even as a teenager I would not
intentionally segregate someone with
a mental illness, but what I do know is
that I did not understand how or why
it could affect someone so much. It
was not until it has affected me directly
that I have begun to understand the
ripple effect of mental illness and its
complexities.
Mental illness is not like a graze that
can have a bandage put on, where a
scab will form underneath, heal, maybe

leave a scar but within a week you have

forgotten its existence. No, mental illness
is something much more complex than a
graze; it involves everyone, and no matter
what, it is always there, always being
managed, and you never forget when it
affects you.

happen to people like me, and the

uttermost wish and want that she would
just snap out of it. As a consequence,
I recognised that I wanted a quick fix,
something that would help her instantly
so she was not struggling with pain and
sadness.

I clearly remember the day my Mum told

me that my younger sister (who was in
London at the time) was suffering from
depression. Even more clearly, I remember
the day my sister told me herself that she
was suffering from depression and had
thought about suicide on several occasions.
I remember choking back tears on the
phone. I remember feeling the thousands of
kilometres between us and having to hang
up very quickly. I felt like the world around
me was falling apart. There was nothing
I could do, and the scariest thought of all
was that I could not fix it.

Obviously, there is no quick fix, she

didnt just snap out of it, and while I
now know this, it took me a long time
to truly understand it. It was through
a team of clinical psychologists, my
sisters general practitioner, counsellors,
and us as a supportive and loving family,
alongside medication over several years,
that my sister has learned to live with her
depression. She is not cured, but she is
a happy person. She has strategies to
deal with it when she isnt, and she lives
her life to the fullest.

Forever being the older sister that looked

after her younger sister, helped her out, and
gave advice, it was the helplessness that
truly overwhelmed me. Never did I think
that I would be in a position where one of
my best friends and family members would
experience such depression that they were
struggling to get out of bed each day and
had no will to live. I remember thinking; how
could my sister, the sister that had it all
great friends, good education, a supporting
and loving family and the ability to pursue
any of her dreams have depression? It
was then I realised I applied a stigma to
mental illness, the belief that it doesnt

For me, experiencing mental illness

through someone I truly love, adore,
and respect, has also allowed me
to reflect on the stigmas I had about
mental illness without even knowing. I
believe mental illness is multifaceted,
and often it is something that can be
overcome and managed with the right
help. Ultimately, how people view mental
illness can be altered depending on
their experiences with it and, for me;
mental illness does not consume ones
life, it becomes another facet of life we
experience each day.

panacea / 1. 2013

SHIP
R
E
B
M
E
M
T
STUDEN
IS FREE

for you, to
g
in
k
r
o
w
is
A
The AM
your medical
ut
o
h
ug
o
r
h
t
u
o
y
support
presentation,
e
r
l
e
v
le
h
ig
H
career.
publications,
s,
e
c
ur
so
e
r
f
o
h
a wealt
professional
d
an
e
ic
v
ad
s
r
caree
to you join
le
b
la
ai
av
l
al
e
ar
benefits
!
the AMA today

the
e
ls
e
w
o
h
t
u
o
Find
or you:
AMA works f

u
a
.
m
o
c
.
a
m
a
.
w
ww

24

A PROBLEM TO BE SOLVED
benjaminlewis
monash
The consult has reached its 40th minute
- almost an eternity in GP land - and I
sit quietly nodding in vague sympathy
at the generic story of the depressed
patient. My mind has long since drifted
to thoughts of coffee, muffins, and the
episode of Game of Thrones that will be
on that night. The GP I am consulting
with eventually enters, calmly reassures
the patient before ushering her from
the room glancing at me somewhat
telepathically. Its a common scene for
many GPs dealing in chronic mental
health and the patient has already
been flagged with the enduring term
heartsink.
Much about the way we view mental
health has improved over recent years.
Organisations such as Beyond Blue
have improved social awareness of
depression and the push for early
intervention by visible figures such
as Patrick McGorry further brings
discussion about mental health into the
public arena. What tends to persist in
the medical profession however is a
sense of fatigue and frustration about
the way to manage patients with chronic
mental illness.
As students, medical school teaches us
to approach patients with a particular
paradigm in mind: The ailments of our
patients are seen as problems to be
solved, and most of us feel a sense
of comfort through the understanding
of why an illness occurs. Many have
criticised the simplicity of such an
approach but we would nonetheless
be lost without it. Relating a group of

clinical symptoms to a biological aetiology

not only provides an obvious practical
benefit it allows us to cast a patient in the
sick role. Youre being too scientific! I
hear you say, patients are people not just
problems to be solved!
As much as we like to see ourselves as
endlessly empathetic we have to admit that
we each have our own limit. Even the most
kind-hearted medical student will eventually
grow tired of the same patient presenting
for the 20th time because they just arent
enjoying life. If, on the other hand, a
patient presents for the 20th time with high
cholesterol we might be annoyed by their
choice of lifestyle but we can nevertheless
be content that the way forward is clear.
There is a feeling of satisfaction that comes
with the objectivity of medicine and the
sense that suffering can be grounded in
something physical. After all, if an objective
medical approach means that fewer people
are suffering then doesnt it make the rest
of the argument seem a little pointless?
Its been said that in order to cure you
must first understand, and in no area of
medicine does this statement have greater
resonance than the area of mental health. I
can hear the collective sigh of exasperation
when the prospect of understanding
neuropsychopathology is mentioned but
Id like to propose that here and now, in
2013, there may be a light at the end of
the tunnel. I am spending this year at the
Monash Alfred Psychiatry research centre
(or MAPrc). Here, a team of dedicated
researchers have been proposing a
technique called transcranial magnetic
stimulation (TMS) to both investigate and

australian medical students association

treat a range of psychiatric illnesses.

The prospect of brain stimulation
usually conjures up thoughts of One
Flew Over the Cuckoos Nest but TMS
by contrast is completely non-invasive
with only a slight risk of seizure in
those with a history of epilepsy, and
a small risk of a mild headache poststimulation. The procedure is currently
in use at a number of health centres
for the treatment of depression and
has been shown to be equivalent to
pharmacotherapy in terms of its efficacy.
What is perhaps most exciting about
technology like TMS is that it seems to
herald a very real coalescence between
the biological and the psychological.
One can perhaps imagine a time in the
not too distant future when techniques
such as this allow us to accurately
explain the symptoms we see in our
patients. A time when we can for
example, say to a depressed patient:
Ah, your results suggest you have
some dysfunction of your dorsolateral
prefrontal cortex, Im going to refer you
for a course of TMS and Id like to see
you again in 3 weeks.
Perhaps Im being too fanciful, but I
think if history has taught us anything its
that those who cry impossible are often
taught a very valuable lesson. I choose
to remain a cautious optimist, whilst
always hoping for the day when mental
illness can become grounded in the
same orthodoxy that has allowed us to
alleviate the suffering of so many others
for so long.

25

THE DRUGS DONT WORK

anonymous
universitywithheld
Studying medicine is a roller coaster
ride. We have all experienced the
amazing highs and depressing lows of
studying something that you love, and
we have all had to come to terms with
the sheer enormity of it all. My story in
medicine is similar to most; trying to
balance my workload while maintaining
some semblance of a life outside of
medicine. Where it differs, in one small
way, is that I have a serious mental
health condition that sees me taking
medications every night and visiting my
psychiatrist every month.

However Im not writing this to talk about

my journey to wellness but rather about
what it is like to have a mental health
condition and to be studying medicine. I
hope that perhaps someone who may be
at the beginning of their own mental health
journey might see that there is some light at
the end of the tunnel. I also hope that my
well peers will take something out of this,
maybe as future treating doctors, or maybe
thinking again about that discussion on
advising people with serious mental health
conditions against breeding together (yep
this really happened to me).

For me, my mental health condition

and medicine are intricately entwined.
In fact it was the excitement of starting
medicine that precipitated my first manic
episode, and then the subsequent
decreased-fun major depressive
episode. Unfortunately this saw me
having to defer from first year as trying
to find the right drug in this disease (as
Im sure you have or will learn) is not the
easiest task. Having been tried on six
different drugs, and with some lovely
extra-pyramidal side effects (akithesia
is not fun) along the way, it was a long
road before finding the one. But hey, we
all have to kiss some frogs dont we?

So what does my mental illness mean for

me and studying medicine? Well, not a
huge amount really. I just happen to have a
mental health condition and be a medical
student. It took me a long time to see this
but now it is clearer to me. I dont define
myself by my other chronic health condition
(asthma), so why should I treat my bipolar
any differently? I am on a mood stabiliser
that works for me so I am really not that
much different from any other student. I
may have to be a little bit more careful with
my sleep patterns and watching out for
triggers but thats pretty much it. I still go to
all the parties! I just make sure that I have
my meds stashed in all my bags so that I
can take them before bed (short half life =
horrible withdrawals). Probably the trickiest
thing is dealing with the metabolic side
effects. Those delicious treats in PBL are
just that little bit harder to resist. I do really
crave carbs more than the average person

My journey to health took a good two

years; with some hospitalisations, lots
and lots of psychiatrist visits, tears (not
just mine) and some amazing friends,
family and medical school as well.

now due to the drugs, but falling prey

would introduce insulin to my regimen.
I have been really lucky in medicine to
have some great friends. Some know
about my condition and some do not,
but they all relate with me for who I
am. I really wish I were brave enough
to be more open about my bipolar.
Unfortunately, the stigma associated
with mental health is still very strong
and kicking, even within medicine. I
was studying in a PBL room once and
hadnt realised that my medication had
fallen out of my bag and onto the floor. A
fellow student soon found it. Fortunately
for me, they didnt assume that the
medication was mine. Less fortunate
was the subsequent discussion on
who might be the crazy person in our
cohort. This was not my finest moment;
I went along with the conversation rather
than admitting that the medication was
indeed mine. I hope that in the future I
will feel comfortable enough to speak
honestly in such a circumstance.
I have shared my experiences in the
hope that we can promote positive
changes in this area. Lets create a
world where people can be open and
honest rather than ashamed of what
is essentially just a medical condition. I
look around me and see some brilliant
and passionate people in my course. I
strongly feel that together we can play a
part in making this a reality.

panacea / 1. 2013

26

FORGETFUL BUT NOT FORGOTTEN

nataliechilko
deakin

Imagine waking every morning and

being slightly confused about your
surroundings. It doesnt seem like your
home, but there is something familiar in
the setting. Then someone enters your
room and tells you it is shower time.
You are confused because you usually
dont have a shower in the morning;
you prefer night time. Then this person
approaches and starts undressing
you. You are startled and become
aggressive. Next, you are restrained at
the bedside for fear of others safety.
You are left feeling isolated, confused
and frightened.
We, in the health profession, witness
fundamental human struggles in patients
on a daily basis. Sickness can leave
people feeling scared and vulnerable
as they become confronted with their
mortality, and physicians are in a unique
position to observe this. It is thus
essential that we remember the human
being in patient care. This is particularly
important for those who need us to be
their advocates. People with dementia
generally lack the cognitive capacity to
form new memories, to make decisions
and judgements, and to communicate
verbally, but their fundamental human
needs of engagement, inclusion, and
acceptance, remain.
Dementia is a neurological syndrome
marked by a gradual decline in
memory and other cognitive domains,
such as language, reasoning and
comprehension. Although this syndrome
is increasingly recognised, it is not
typically involved in the mental health
conversation. The public discussion of
dementia usually focuses on memory
loss. However a range of behavioural
and psychological symptoms
accompanies the cognitive deficits. It
is these symptoms which combine to
create a truly debilitating disease for
patients both physically and socially.
The dramatic statistics regarding
dementia prevalence highlight the
importance for health professionals
and the community to be aware of this
syndrome and its associated mental
health. On average, there is a new
case of dementia in Australia every
six minutes1. Worldwide, dementia
prevalence is expected to triple to
115.4 million cases by 20502. Such
increases in prevalence will lead to

significant increases in the cost and burden

of disability attributed to this disease, with
dementia predicted to require the greatest
funding of all health conditions in Australia
by 20701. Whilst modern medicine has
significantly advanced life expectancy for
the developed world, an ageing population
brings its own challenges to the health
system.
Persons with dementia attempt to navigate
a world in which they are confused,
frightened, and operating on islands of brain
that decline at different rates. The decline in
social functioning compounds the physical
disability. Anxiety, apathy, depression, and
psychosis are psychological symptoms
that have been identified in the literature.
Approximately 90% of people with
dementia will experience one of these
symptoms at least once in their condition3.
Prevalence of each of the symptoms
ranges between 56% and 90%3, although
the actual presentation varies. Because
dementia involves a gradual neurological
decline, the behaviour associated with the
mental health disorder is influenced by the
cognitive state of the person. For example,
anxiety, which typically involves rumination
on thoughts, may manifest as agitation or
aggression in more advanced dementia.
Similarly, depression may manifest
as a state of apathy, with increasingly
unresponsiveness. Additional depressive
behaviours include loss of appetite,
anhedonia, insomnia, increased confusion,
and lack of energy4.
Persons with dementia have a sad history
of being treated as incapable, and as
vegetables without a social standing4.
This perception has changed in recent
decades, and the assumption that
people with dementia are unemotional
has been challenged. Recent research
supports person-centred care approaches
in reducing problem behaviours. The
hypothesis behind this is that human
connection and involvement caters for
fundamental human values that reduce
the agitation, depression and anxiety
that comes with being marginalised4.
Person-centred approaches recognise
that behaviours in dementia can be a form
of communication, and that the feelings
of these people can be intact despite
cognitive decline. The Australian CADRES
study used a cluster randomized trial
design to assess person-centred care, and
found a significant reduction in agitation
in residential facility clients in this group
compared to those receiving usual care5.

australian medical students association

Humour therapy has also been found to

reduce agitation in dementia, potentially
comparable to the effectiveness of
antipsychotic medication6. Humour
therapy involves clowns visiting
residential aged care facilities and using
gestures, noise and props to engage
persons with dementia, rather than
solely verbal communication6. Many
other studies support these positive
findings7 8 9.
The results of research into personcentred care remind us that a person
exists behind the physical, cognitive,
psychological and behavioural
symptoms with which they present10.
Kitwood theorized that people have
a sense of personhood that is based
on the respect, recognition and trust
that exists in social relationships10. A
sense of personhood is significantly
compromised in persons with dementia
who are generally ignored because they
are assumed to be unable to engage
with society4. As a society and as a
profession, we need to recognise that a
person exists behind the disease. How
can we do this? We must incorporate
the life story of our patient into the care
plan. We need to consider our patients
socio-economic, historic and cultural
context, their individual preferences,
likes and dislikes, and then use these
to engage with our patients both in
therapeutic and care situations. We
need to listen to the vulnerable through
their unique communication style, and
realize that they too can feel withdrawn,
depressed and anxious.
We need to remember that a person
exists behind the disease that makes
them forget.
References
1.Access Economics. 2009, Report for Alzheimers Australia.
2. Alzheimers Disease International, World Alzheimer Report.
3. Dementia Behaviour Management Advisory Service and
Dementia Collaborative Research Centre, Behaviour Management - A Guide to Good Practice. Managing Behavioural and
Psychological Symptoms of Dementia (BPSD), 2012.
4. National Institute for Health and Clinical Excellence Social
Care Institute for Excellence, Dementia. 2007, NICE-SCIE:
London.
5. Chenoweth, L., King, M.T., Jeon, Y.H. et al. Lancet Neurology, 2009. 8(4): p. 317-25.
6. Low, L., Brodaty, H., Goodenough, B. et al. BMJ Open,
2013. 3: p. 1-8.
7. Spector, A., M. Orrell, and J. Goyder, A. Ageing Research
Reviews, 2013. 12: p. 354-64.
8. Cohen-Mansfield, J. and J. Mintzer. Alzheimer Disease and
Associated Disorders, 2005. 19: p. 37-40.
9. Orsulic-Jeras, S., K.S. Judge, and C.J. Camp. The Gerontologist, 2000. 40: p. 107-111.
10. Kitwood, T. Aging and Mental Health, 1997. 1: p. 13-22.

27
THREE SHOTS AND OUT
emilywebb-smith
westernaustralia

I like coffee. I like the taste of it, I like the routine of it, I like being
able to say lets go grab a coffee. Coffee takes me into its
warm embrace at midnight when my ethics essay is only half
complete. You could almost say that it is my go-to drug. Coffee
loves me. I may even love it. And I suspect you might too.
Caffeine is the most widely used psychoactive drug in the world.
Drinking 2-3 cups of coffee will land you in caffeine intoxication.
And then comes the caffeine withdrawal. Caffeine intoxication,
caffeine-induced anxiety disorder, caffeine-induced sleep
disorder, and caffeine-related disorder not otherwise specified
are listed as a substance-use disorders in the DSM-IV and now
caffeine withdrawal join them in the DSM-V.
However, its not common to ask patients about their caffeine
intake. We focus on alcohol and other substances. Its also not
common to reflect on your own caffeine intake. We know we
might abuse caffeine at exam time (No Doz, anyone?). Or when
we stay out late (Red Bull, you know it). Or on a daily basis
(many cups of warm delicious coffee?). Throw in any of the other
myriad of caffeinated beverages we guzzle down (ie. tea and
cola). It might even get to the point where you cant sleep and

your doctor doles out the temazepam. Whoops, its just my 6 a

day habit.
Are we putting enough thought into how this caffeine culture,
widely accepted amongst medical students, is affecting our own
mental well-being? Excessive caffeine intake has been pretty
well linked to anxiety and sleep disturbances. It may increase our
performance in some areas, however it ultimately can negatively
affect our mental wellbeing. Mental wellbeing is about realising
your own potential, being able to cope with normal stressors
in our lives, working productively and fruitfully and being able
to make a contribution to our community (WHO). That sounds
pretty desirable to me. In our profession, its very important to
have an understanding of our own mental wellbeing. Well be
better doctors for it. We risk heading down the path of early burn
out if we dont watch it. We know we should watch what we eat
and get daily exercise to be physically healthy. Is it about time we
watched our intake of other substances as well?
I still love coffee. But I love me too. Maybe Ill give herbal tea a
go.

panacea / 1. 2013

www.LWWBooks.com.au
The one stop shop for medical education

Free, fast delivery entire LWW range fantastic prices

AMSA Members
get

25%discount!

Launching May 1st 2013!

*To claim find your new discount code in Embolus each month beginning in May 2013. This code will change continually. Valid from May 1st 2013 to May 1st 2014.
Subject to availability.

30

DIAGNOSING CATATONIA
priscillawee
jamescook

Introduction
Catatonia was first described by
Karl Kahlbaum (1874) as a motor
disturbance that represents a phase in a
progressive illness involving depression,
mania, confusion, stupor and dementia
praecox1-6. Catatonic symptoms
include negativism, mutism, posturing,
grimacing, mannerisms, staring,
waxy flexibility and echophenomena1.
Despite the term catatonia being
over a century-old, and many
attempts to define and classify it, the
literature remains unclear regarding
pathophysiology and classification of
catatonia1-5,7-10. However, studies are
unanimous in asserting its possible
lethality1-3,8. Considering the poor
prognosis of catatonia, it is vital
to diagnose it early to commence
aggressive treatment rapidly, improving
patient outcomes. The difficulty is that
catatonia and many other syndromes
have similar clinical presentations. Such
problems prompt the question, How
does one diagnose catatonia?
This essay will answer this question via
exploration of different catatonia types,
differential diagnoses of the clinical
presentations and investigations that
aid diagnosis, as well as reviewing the
current literature. The implications of
these findings will be applied to the
overall management of catatonia.
Methods
A literature search was conducted
using the databases Medline, NCBI,
SpringerLink and ScienceDirect for
fulltext articles including the following
terms: catatonia OR catatonic AND
diagnosis and catatonia OR catatonic
AND differential diagnosis. These
searches were restricted to Human/s,
in English, and to be between the dates
1999-Current.
Ten articles were selected for this
essay because of their relevance
and information. These included 8
systematic reviews (Level 3a), 1 case
control study (Level 3b) and 1 Case-

australian medical students association

31
series (Level 4).
The literature search highlighted the
scarcity of evidence-based studies on
catatonia and its differential diagnoses.
This can be attributed to the rarity of
its presentation4,7, difficulty in obtaining
ethical approval, and its elusive nature
blurring classification and diagnoses.
Therefore, it must be noted that this
essay, although supported by thorough
systematic reviews by experienced
psychiatrists, lacks conclusive evidence
due to the nature of the topic.
Classifications of Catatonia
Catatonia is classified by DSM-IV-TR
as a schizophrenia type, a specifier
for mood episodes or due to general
medical conditions (GMC). Finks
literature review demonstrated that
catatonia has grown to include
syndromes such as delirious mania,
neuroleptic malignant syndrome (NMS)
and toxic serotonin syndrome (TSS)7.
There are two main presentations
of catatonia: (1) Retarded (including
immobility, negativism/mutism and
posturing); (2) Excited (excessive motor
activity, echophenomena, verbigation
and delirium)4-7, 9. Patients can cycle
between both presentations4.
Another type of catatonia (which is
regarded as an insidious progression
from other catatonic states) is lethal
catatonia1,4-6. This type involves
autonomic instability including
tachycardia, tachypnoea, hypertension,
fever and disorganised speech,
delusional thoughts and refusal of foods
and liquids2,7. Malignant catatonia, NMS
and TSS are subsets of this type4,7,9.
As any catatonia can lead to lethal
catatonia, early diagnosis is important3.
The Differential Diagnoses of Catatonia
Taylor et al. and Bhatis literature reviews
revealed six syndromes similar, but
distinguishable to catatonia5,6. They are
elective mutism, metabolic-induced
stupor, Parkinsonism, malignant
hyperthermia, locked-in syndrome and
stiff-persons syndrome. Additionally,
Penland et als extensive literature review
included delirium in their differential
diagnoses2,9. The Hem and collegues
report on two cases with literature
review support proposed that coma
should be included as a differential.
Investigations and Management of
Catatonia
To investigate catatonia, a thorough
history of the patient should occur,

looking for a history of Parkinsons,

antipsychotics and serotinergic use which
may lead to NMS or TSS, and a surgical
history for malignant hyperthermia. A
psychiatric history, especially affective mood
disorders1,10, may highlight catatonia or
elective mutism.
One should examine for autonomic
instability (NMS and TSS), generalised
rigidity (stiff-persons syndrome, locked-in
syndrome and malignant hyperthermia) and
cogwheel rigidity (parkinsonism).
The literature also suggests that the
following investigations should take place
for catatonic presentations:
Serology: FBC (infections such
as meningitis, encephalitis), CMP
(hypocalcaemia)6, BSL (hyper/
hypoglycaemia)5 and eLFTs (metabolic
stupor)
Imaging: CT head may reveal lesions
that cause stuporous states and rule out
catatonia. An MRI should be considered
to investigate stiff-persons syndrome or
stroke5,9.
Others: if meningitis is queried, a lumbar
puncture is considered8. Muscle biopsy if
malignant hyperthermia considered5.
Management of queried catatonia
presentations is unanimous in the literature,
especially regarding the diagnosis of
catatonia with a primary differential of
NMS. Withdrawal of antipsychotics and
initiation of benzodiazepines and ECT have
been found to be very effective in patient
treatment1,2,5,6,8,9. In a cohort study by
Fink, two-thirds of patients were relieved
of catatonia and NMS by high doses
of lorazepam (6-16mg)2. Penland and
colleagues, in their literature review, refer
to at least one clinical trial revealing the
efficacy of benzodiazapines on treatment of
catatonia and NMS, but also asserted the
use of ECT if a patient is unresponsive to
benzodiazapines9. In his literature review,
Francis revealed that treatment of parenteral
or oral benzodiazapines such as lorazepam
had a success rate of 60-80% within hours
to days. He also revealed that clinical
experience and case studies highlighted
the efficacy of ECT when benzodiazapines
fail to treat.8 Huang et al in their 2-year
cohort study (n=34) concluded that
ineffective treatment of catatonia or NMS
via benzodiazepines and ECT may be due
to the need to treat specific aetiologies
of catatonia1. This highlights that part
of management should involve specific
classification of catatonic presentations
in regards to its aetiology (DSM-IV-TR),
to aid in treatment. A treatment load of

benzodiazapines has proved harmless,

but will also aid in ruling out catatonia
or NMS, if these arent the cause of the
presentation5.
Recommendations for the Future
In conclusion, precise diagnosis of
catatonia is vital due to its potential
lethality and the similarity of its
presentation to other fatal diseases.
Catatonia is a syndrome that still lacks
evidence-based research and requires
further study regarding its aetiology
and classification, in order to achieve
successful management. Despite
this, current literature reveals a way
to diagnose and classify catatonia in
order to deduce differentials, allowing
appropriate investigations and
management to be carried out. Efficient,
rapid diagnosis of catatonia is crucial as
lethal catatonia kills if not appropriately
managed.

References

1. Huang TL, Ree SC, Huang YC, Liu HY, Yang YY.
Catatonic features: differential diagnosis and treatments
at an emergency unit. Psychiatry Clin Neurosci. 1999
Feb;53(1):63-6.
2. Fink M. Catatonia: syndrome or schizophrenia
subtype? Recognition and treatment. J Neural Transm.
2001;108(6):637-44.
3. Hem E, Andreassen OA, Robasse JM, Vatnaland
T, Opjordsmoen S. Should catatonia be part of the
differential diagnosis of coma? Nord J Psychiatry.
2005;59(6):528-30.
4. Fink M. Catatonia: a syndrome appears, disappears, and is rediscovered. Can J Psychiatry. 2009
Jul;54(7):437-45.
5. Taylor MA, Fink M. Catatonia in psychiatric classification: a home of its own. Am J Psychiatry. 2003
Jul;160(7):1233-41.
6. Bhati MT, Datto CJ, OReardon JP. Clinical manifestations, diagnosis, and empirical treatments for
catatonia. Psychiatry (Edgmont). 2007 Mar;4(3):46-52.
7. Fink M, Taylor MA. The many varieties of catatonia.
Eur Arch Psychiatry Clin Neurosci. 2001;251 Suppl
1:I8-13.
8. Francis A. Catatonia: diagnosis, classification, and
treatment. Curr Psychiatry Rep. 2010 Jun;12(3):180-5.
9. Penland HR, Weder N, Tampi RR. The catatonic
dilemma expanded. Ann Gen Psychiatry. 2006;5:14.
10. Smith JH, Smith VD, Philbrick KL, Kumar N. Catatonic disorder due to a general medical or psychiatric
condition. J Neuropsychiatry Clin Neurosci. 2012
Spring;24(2):198-207.

panacea / 1. 2013

32
INVOLUNTARY TREATMENT ORDERS
FOR THE EARLY INTERVENTION OF
ANOREXIA NERVOSA
jessicacutting
jamescook
Introduction
Anorexia nervosa is a destructive
mental illness characterized by extreme
measures to lose weight, a strong fear
of becoming fat and amenorrhoea1,2,3.
It has the highest rate of mortality
amongst all mental disorders; with a
suicide rate 1.5 times that of major
depression4,5. The prevalence of
anorexia ranges up to 1.0% and is
commonest in early adult or adolescent
females. Anorexia has a prevalence of
up to 1%, is commonest in females
and generally presents in adolescence
or early adulthood. The treatment of
anorexia is complex and multifactorial,
requires multidisciplinary input, empathy
and perseverance, with a highly variable
outcome2,4. Studies are suggesting
that early intervention may improve
the outcome for recovery of anorexic
individuals2,3. However, getting those
with anorexia nervosa to engage in
treatment is difficult due to the poor
insight and altered values that are part of
the illness1,6,7. This is where the Mental
Health Act may intervene.
Under the Australian Mental Health
Act 2000 a person with a mental
illness can be treated without consent
using an involuntary treatment order
(ITO). The criteria for an ITO includes:
the person has a mental illness; they
require immediate treatment; the
treatment is available at an authorized
mental health service; because of the
illness there is imminent risk of harm
to self or someone else, or the person
is likely to suffer serious mental or
physical deterioration; there is no less
restrictive way of ensuring appropriate
treatment; and the person lacks
capacity to consent to treatment or
has unreasonably refused treatment for
the illness8. This article aims to discuss
whether there are grounds to place an
individual with anorexia on an ITO early
in the course of their illness to prevent
serious physical harm and improve longterm psychological outcome.

australian medical students association

33
Rationale for involuntary treatment in
eating disorders
A topic that has been much studied and
debated is the issue of competence
and capacity in those with anorexia
nervosa. In a study that was published
in the journal Philosophy, Psychiatry
and Psychology, participants, aged
13 to 21 years, were assessed using
the MacCAT-T test of competence, a
highly regarded clinical tool in identifying
patient competence.
The participants scores were
analogous with control group scores
from a previous study and showed
high reasoning and understanding.
Unfortunately due to the sample size
this study is not statistically significant,
but it is important to note that the
issue of competence in anorexia
nervosa is highly complex, and even
with high insight, judgment may still
be impaired. However, even when
a patient is deemed competent, the
mental health act allows for mental
health professionals to treat patients if
there is a risk to themselves, as there
is in anorexia6. It is widely agreed by
both mental health professionals and
individuals with anorexia nervosa alike
that compulsory treatment is justified
to save a patients life when their
illness has become life threatening1,7.
However, as research has shown that
early intervention is superior in delivering
a better outcome in remission of
anorexic patients, the question remains:
should patients with early anorexia be
placed under a compulsory treatment
order, if they are unwilling to undergo
treatment2,4,9?
At all stages of anorexia patients are
at risk to themselves, and an ITO may
provide an environment in which their
physical health can be prevented
from deteriorating, while their mental
health can be treated and the patient
encouraged to move through the stages
of change7,9. Early intervention may
prevent an individual from developing
chronic anorexia nervosa by targeting
treatment at a stage of illness that may
be easier to treat9.
Studies have shown that short-term
outcome is similar between patients
treated voluntarily and involuntarily
for anorexia nervosa, and in general,
compulsory patients respond well to

treatment. Unfortunately, there is little data

on long-term outcomes in patients treated
by an ITO5,7,10. One study has described
an increased long-term morbidity in those
treated by coercion, however this may
be influenced by the higher degree of
severity and chronicity of anorexia nervosa
seen in those who are currently placed on
involuntary treatment orders10.
Encouraging engagement in treatment
Interestingly, an article studying patient
attitudes to involuntary treatment found
that patient relationships with the treating
team, as well as trust and a caring and
supportive environment were more
important than freedom of choice in their
treatment. The patients who did begrudge
their perceived loss of rights were those
who had a poor relationship with those
engaged in their treatment and who felt
disempowered and demeaned in their
treatment course1. Research has found
that if compulsory treatment is used
within a trusting relationship, it may be
experienced as good care1,9. The goal of
early involuntary treatment should be the
voluntary continuation of treatment and
motivation of the individual to change. This
may involve empowering the individual and
allowing some freedom of choice regarding
treatment methods1,5,9.
A long held view is that an ITO may be
detrimental to an individuals recovery
if used inappropriately, such as when a
person is not in immediate, life-threatening
risk. However, as other studies have shown
that the involuntary nature of treatment may
not affect outcome, perhaps the altered
view that it is the type of treatment and the
relationship between the treating team and
the patient, that may have the detrimental
effect, should be considered. If a patient
feels that their feelings and opinions are
ignored, they are more likely to resist help,
as exhibited by patients in the research6.

of patients currently placed on ITOs.

Limitations in the literature included a
lack of controlled trials and very little
research on long-term outcomes in
individuals with anorexia nervosa; which
was also commented on in several
articles. Early intervention to prevent the
progression of the illness may lead to
better outcomes for the individual and
an ITO may be the means of providing
this secondary prevention. All health
professionals need to consider the
role of an ITO in the early treatment of
anorexia nervosa.

References
1. Tan JO, Stewart A, Fitzpatrick R, Hope T. Attitudes of patients
with anorexia nervosa to compulsory treatment and coercion. Int
J Law Psychiatry. 2010 Jan-Feb;33(1):13-9.
2. Attia E, Walsh T. Anorexia Nervosa. Am J Psychiatry. 2007 01
December 2007;164:1805-10.
3. Fitzpatrick KK, Lock J. Anorexia nervosa. Clin Evid (Online).
2011;2011.
4. Beumont P, Beumont R, Hay P, Beumont D, Birmingham L,
Derham H, et al. Australian and New Zealand Clinical Practice
Guidelines for the Treatment of Anorexia Nervosa. Focus. 2005
01 October 2005;3:618-28.
5. Espindola CR, Blay SL. Long term remission of anorexia nervosa: factors involved in the outcome of female patients. PLoS
ONE. 2013 February 2013;8(2):e56275.
6. Tan DJ, Hope PT, Stewart DA, Fitzpatrick PR. Competence to
make treatment decisions in anorexia nervosa: thinking processes and values. Philos Psychiatr Psychol. 2006 Dec;13(4):267-82.
7. Tan JO, Doll HA, Fitzpatrick R, Stewart A, Hope T. Psychiatrists attitudes towards autonomy, best interests and compulsory
treatment in anorexia nervosa: a questionnaire survey. Child
Adolesc Psychiatry Ment Health. 2008;2(1):40.
8. Mental Health Act 2000. Sect. Involuntary Treatment (2002).
9. Schmidt Holm J, Brixen K, Andries A, Horder K, Klinkby
Stoving R. Reflections on involuntary treatment in the prevention
of fatal anorexia nervosa: a review of five cases. Int J Eat Disord.
2012 2012;45:93-100.
10. Watson TL, Bowers WA, Andersen AE. Involuntary treatment of eating disorders. Am J Psychiatry. 2000 01 November
2000;157:1806-10.

Conclusion
In conclusion, anorexia nervosa is a serious
condition with a significant morbidity and
mortality. More needs to be done to treat
this illness, which has a major impact on
the lives of the individual, as well as their
families1. More research is needed to better
assess the effect compulsory treatment
has on long-term outcome in anorexic
patients. However, particular attention
needs to be taken to ensure results are
not biased by the already poor prognosis

panacea / 1. 2013

34
AUSTRALASIAN SCHIZOPHRENIA CONFERENCE 2013
a review
clairemcallister
griffith

Recently I had the pleasure of attending

the Australasian Schizophrenia
Conference (ASC). I chose this
conference as I believed it would give
me an insight into the current research in
schizophrenia, particularly in my area of
interest; molecular biology.

and supportive mental health system in

Australia. The most striking pictures were
shown at the end of the speech, and they
were of a man that had been kept in a cage
for eight years, but after only one year of
proper treatment, he was able to live in the
community, get married, and have a son.

I first attended a satellite session on

Mothers Day, quite fittingly on Womens
Mental Health. It was a great insight into
the hormonal aspects of mental health,
including studies on contraceptive
pills, menopause, and Premenstrual
Dysphoric Disorder (PMDD).

James Le Bas Prestige and Bipolarity:

An evolutionary perspective This talk
focused on the evolution of humans and
their new reliance on communal problem
solving. The result of this reliance was that
leadership was now being gained through
prestige competition such as narrative
skills, affective engagement and social
goal pursuit. Social withdrawal may have
also provided protection through stealth
processes. He proposed that these two
evolutionary models could be translated
into the manic and depressive phases of
biopolar disorder.

The conference officially began bright

and early on the Monday morning with
a welcome speech from a hilarious
comedian. But after all the laughter, it
was time to get into business. I went to
a number of different sessions over the
two days but Ill give you a run down of
some of my favourites.
Pat McGorry Clinical staging and
Personalised Medicine in Potentially
Serious Mental Disorders. Pat McGorry
works at ORYGEN Youth Health
Research Centre and was the Australian
of the Year in 2010. He has recently
developed a clinical staging model for
the early detection of mental illness
and believes this early recognition will
drastically improve outcomes. He also
spoke of the future possibility of using
biomarkers to aid in this stratified or
personalised medicine.
Cokorda Lesmana Healing the
living zombies of paradise: A model of
a community-based treatment of the
physically restrained schizophrenics in
Bali. This was the most inspiring talk
of the entire conference, having moved
some delegates to tears. The images
of mental health patients in Bali being
kept in woodstocks will stay with me
for a very long time, and it reiterated
how lucky we are to have a functional

Rachel Hill A two-hit rat model of

developmental stress shows sex-specific
disruptions in spatial memory and
anhedonia and alterations in exon-specific
BDNF expression in the hippocampus
The two-hit model is popular in molecular
research and proposes that two or more
major disruptions during development
can precipitate schizophrenia. This
study used rats given two hits; neonatal
maternal separation and the administration
of corticosterone in adolescence. They
found two sex-dependent behavioural
phenotypes that correlated with sexspecific and region-specific alterations
in neuronal BDNF expression. The male
two hit rats had decreased spatial short
term memory in a Y-maze, with dorsal
hippocampus alterations in BDNF, whilst
female two hit rats had anhedonia in
a sucrose preference test, with ventral
hippocampus BDNF expression changes.
The sucrose preference test was perhaps
the most interesting aspect of the speech.
In it, rats can choose between normal
water and sugar water. The female rats that
had the two hits were the only ones that

australian medical students association

didnt have a preference for the sugar

water over normal water, demonstrating
characteristics associated with
anhedonia.
Jeff Conn Allosteric modulators
of GPCRs as a novel approach for
treatment of Schizophrenia Selective
M1 and M4 mAChR activators have
been seen to improve schizophrenia
symptoms with less antimuscarinic
side effects (thought to be mediated by
M2 and M3 receptors). Dr Conns lab
has been developing PAMs (positive
allosteric modulators) of these receptors.
In their animal models, highly selective
M1 PAMs appear to improve cognition,
whilst highly selective M4 PAMs improve
antipsychotic symptoms. They are
partnering with drug companies at
present to develop drugs that may one
day be used in clinical treatment.
James Gold Reward processing and
negative symptoms in schizophrenia.
There have been many theories into
how the brain produces negative
symptoms in schizophrenia. Dr Golds
tests in humans (healthy, schizophrenics
with low negative symptoms and
schizophrenics with high negative
symptoms) show that they have difficulty
representing the prospective value of
potentially rewarding actions, rather
than finding them not rewarding to begin
with. This means that they are unable
to calculate cost/benefit i.e. their brain
sees the effort required to obtain the
reward as too high.
I had a fantastic time at the conference,
not to mention all the other things I did
in Melbourne. I recommend anyone
interested in psychiatry, psychology or
neurology attend it in future years. Big
thanks also to GUMS (my medsoc)
for helping me attend this conference
through their subsidy scheme.

35

THE HOUSE OF GOD

book review
tobyvinicomb
monash

You may laugh; you may cry; you may

get a little bit turned on, but Samuel
Shems didactic novel The House of
God is really just the what to expect
in medicine guidebook that should be
posted with every medical school offer.
Shems novel is set in the mid-1970s
when 80-hour work weeks, flings with
nurses, and paternalistic doctors were
the norm. Dr Roy G. Bach the novels
narrator and protagonist is a bright
young internist that has just graduated
from the BMS (Best Medical School)
and is beginning his treacherous intern
year at the House of God Hospital.
Shems warning came late for me. I was
given the book by my third year ethics
tutor who had a fascination with quoting
the books Laws of the House of God.
Law #3: At a cardiac arrest, the first
procedure is to take your own pulse.
These thirteen laws all humorous and
absurd, yet insightful in their own way
should be added to the Hippocratic
Oath. If you feel this is mutiny against
the Hippocratic Oath, dont worry;
Hippocrates likely taught some of them
to his students in 400BC.
Law #12: If the radiology resident and
the medical student both see a lesion on
the chest X-ray, there can be no lesion
there.
Following Bach is as bleak as it is
inspiring. As internists, Bach and his
colleagues are haunted by their medical
mistakes, lead into despair by the senior
physicians, and pushed to the edge
until one of them commits suicide. This

leaves them to deal with the pain of their

patients and colleagues dying.
Bachs mentor is his second year resident
that he affectionately calls The Fat Man. The
Fat Man, an aspiring gastroenterologist,
humours Bach with his special viewing
device that he is adamant will make him
rich. However, The Fat Mans secret
success has been coining the term GOMER
(Get Out of My Emergency Room)
immortalising the term into medical literacy.
Law #1: GOMERs dont die.
The actions of Bach, his colleagues and
some of the senior doctors will likely seem
farcical to those outside the medical
field. Even from within the field, it can feel
that Shem is just a cynic: doctors using
patients as cash cows, treating them with a
cavalier attitude, laughing at the GOMERs
idiosyncrasies.
Law #9: The only good admission is a
dead admission.
For those who read the book and thought,
Ill never be like that, are you sure?
Had I been handed this book before I
started medical school, I would have
agreed. How is it possible that medical staff
be so callous and insensitive to treat their
patients in this way? However, fast-forward
and I have found that clinical years have
sublimely taught me that it is easy to be
inconsiderate and indifferent when tittering
about the quirks of a patient. Everyone
does it: senior doctors, nursing staff, and
allied health - its part of the medical culture
to cope with disease, death, and dying.

Readers who enjoy Fifty Shades of

Grey will not be let down by The House
of God. Shem details the minutiae of
Bachs adulterous encounters with
the nurses: she was dressed in a
slinky gold wrap around which left one
shoulder bare, two nipples poking. And
a partridge in a pear tree.
Law #13: The delivery of medical care
is to do as much nothing as possible.
The House of God is not without
its controversies. Over-treatment of
patients is a major theme in the novel.
I doubt Shem is a clairvoyant, but an
increasing number of treatment options
gives rise to the question are we doing
too much?
The House of God is as relevant today
as it was in the 1970s. Shem not
his real name by the way provides
a unique perspective into hospital
hierarchy, doctors personalities, the
funding of medical practice, and the
personal cost of choosing medicine
as a profession. Readers are given
insight into dealing with the internal and
external conflict of working within the
medical workforce before they inevitably
face it themselves.
Readers have been polarised by the The
House of God but I would recommend
it to all aspiring medical professionals.
Available for under $20, the novel is a
bargain that not only highlights some
of the difficulties of working as a junior
doctor, but is also a good summer
holiday read.

Law #5: Placement comes first.

panacea / 1. 2013

36

ANU MEDICAL STUDENTS SOCIETY (ANUMSS)

the australian national university
samharkin
amsarep

2013 is going beautifully for ANUMSS. This years

Med Revue, Para-Medical Activity, was a rollicking
success, raising an exceptional $6500 for the
Neonatal Intensive Care Unit at the Canberra
Hospital. Weve also hosted numerous events The
Annual Medical Symposium, featuring a panel of
prominent consultants addressing end of life issues;
When I Grow Up evenings; Global Health guest
speaker nights; a Med vs. Law debate; and a No
Lights, No Lycra wellbeing event just to keep things
holistic.
Our four year levels are currently locked in an
(unsurprisingly) intense, hard-fought battle for
the inaugural Inter-Year Sporting Cup led at the
moment by the enthusiastic and deceptively athletic
first years.

The Fiji Village Project team hosted the inaugural Fiji

Village Five walk, raising money for their cause and
representing the ANUMSS proudly in the Canberra
community. Our Live Below The Line-rs also did
a sterling job in their fundraising efforts. We soon
have the muchanticipated What Happens in Vegas
themed Winter Formal, a shining light in the notsoanticipated Canberra winter!
Our graduating class of 2013, and MedSoc, at
large have been grateful for the advocacy and
support provided by AMSA in what is an increasingly
interesting internship situation!
Finally, it would be remiss not to mention the hype
that is building to uncontrollable levels for the record
number of Convention attendees; ANUMSS will see
you at GC2013!

MEDICAL STUDENTS SOCIETY OF BOND UNIVERSITY (MSSBU)

bond university
andrewrobinson
amsarep
Coming in from a highly successful semester (with
MedBall 2013 and the launch of our new publication
Synapse) we kicked our 132 season off with one of
our best MedEagles yet. Filled with the fresh faces
of our newly initiated first years, MedEagle once
again proved to be the gold standard for getting to
know your peers in other years, and to catch up with
friends after the much-needed holidays.
Its just days until the AMSA National Convention right
here on the Gold Coast, and our Bond team have
been hard at work preparing weve had the highest
number of registered delegates from Bond ever this
year, and thusly it promises to be one for everyone
else to remember.
This year has seen us run two separate trivia nights,
one for all our Bond meddies, and one for our postgrads specifically, which was a perfect opportunity
australian medical students association

for our teams to prove that their brains swallow filthy

pop-culture just as well as a list of differentials for
microangiopathic hemolysis.
Weve also launched our universitys first ever Surgical
Interest Group, working dilligently to plant our roots
into Queenslands florid surgical society. Our launch
event garnered unprecedented interest, and we cant
wait to see how far we can take this.
Coming up is our inaugural All Abilities Olympics on
June 19 - a fun sports day for children of all abilities
to come together and enjoy themselves in our safe
and very awesome new initiative. Weve got a great
number of events planned for our fine competitors, a
day of good fun and competition awaits.
Stay updated on the latest by checking out our
publication Synapse, which always brings a
great mix of MedSoc updates and your very own
submissions.

DEAKIN MEDICAL STUDENTS ASSOCIATION (MeDUSA)

deakin university
gregevans
amsarep
Our Medcamp and Cocktail Nights had record
attendance back in February. Our Victorian MDNM ball
went off well in May, with creative costumes all round, as
well as some good socialising between Victorian med
schools. MeDUSA is also getting into the merchandise
game, with our first round sales of keyrings, ID tags, and
eye-catching Keepcups being a resounding success.
Rivalry is strong between our 1st and 2nd years. Weve
had a primary school themed sports day, and an AFL
clash is planned for later in the year. They are also super
keen to commence the battle for blood-drop costume
rights come July, whilst 3rd and 4th years have had
their share of social nights, resume writing/interview
workshops, and careers seminars.
Our MedSchool continues to be receptive to our
feedback regarding marking, assessments, and
content delivery; and our rural western Victorian GP/

37

hospital students have started an academic

mentoring and support program to help bridge the
sometimes large distances between their
various clinic sites.
On the community front, our community minded
students participated in a number of charity events,
a refugee biographical movie night, and our Deakin
Surgical Interest Group (D-SIG) has recently run an
organ donation advocacy campaign in conjunction with
Diversitat.
Our students have chosen very capable and motivated
junior AMSA Reps, and this is my first of many public
thanks for their contributions and initiatives theyve led
so far. Lets hope they continue their good work!
Deakins Convention delegation is 60 strong, more than
double the numbers of any other of our six illustrious
years as a medical school. Our preclinical students have
really got on board with the spirit of convention and
are keen to GAI and represent with vigour. Training for
this years boat races with full strength beer is similar to
altitude training...right?

GRIFFITH UNIVERSITY MEDICAL SOCIETY (GUMS)

griffith university
felicitymcivor
amsarep

So, Whats Been Happening at Griffith?

Twenty thirteen has become a year of big changes
at the Griffith University Medical School, with some
of them expected, and others not so much. Firstly,
the long-awaited Gold Coast University Hospital is
opening this year, as is the shiny new Griffith Health
Building just across the road. The Medical School will
be moving to the new building during Convention,
with pre-clinical students based in this new facility
from 15 July and clinical students visiting for their
Clinical Learning through Extended Immersion in
Medical Simulation weeks from then onwards.
A couple of more unexpected changes, however,
have also occurred recently, with modification of
admissions criteria, now 25:25:50 weighting of GPA,
GAMSAT, and Interview respectively; as well as

changes to OSCE-based assessment for clinical

students, with stations now eight minutes rather than
five.
Finally, Griffith University has announced the
implementation of an MD program from 2014,
replacing the current MBBS programme. According
to the School, this will not lead to any significant
change at the curriculum level, which may allow
current students to graduate with the MD title. Details
are currently scant, with more information expected
soon. GUMS has been involved in discussions
regarding these changes through representation on
various school committees and will continue to take
an active interest in these and future issues.

panacea / 1. 2013

38

ANUMSS MedRevue

JCUMSA

JCUMSA; Amuthan Annamalai (L)

MUMUS; Monash Medical Orchestra

australian medical students association

39

JCU MEDICAL STUDENTS ASSOCIATION (JCUMSA)

james cook university
colingiorcelli
amsaliaison
This year has been a busy year so far for JCUMSA.
We kicked off the year with a carnival experience
for the sign-on barbeque, which welcomed the 240
first year medical students to Far North Queensland.
A few weeks later this was soon followed by 120
medical students making their way to Prosepine
for the annual Medcamp, full of fun and acitivities
for the new students to meet older students. The
guest speaker night saw Dr Will Millford present to
students of all years, followed by a pre-clinical skills
night involving cannulation, suturing, and phlebotomy.
These was just a few of the events JCUMSA has
organised so far and there are many more to come,
including Medball and Clinical Cocktail Parties.

On a sadder not however, earlier this year the medical

student community at JCU experienced the loss of
our fellow student and friend, Amuthan Annamalai.
He was a young man passionate about medicine,
global health and most of all his family and friends.
Andy; we all miss you and may you rest
in peace.

MONASH UNIVERSITY MEDICAL UG SOCIETY (MUMUS)

monash university
gracecowderoy
amsarep

MUMUS has been working hard in 2013 to introduce

exciting new events and revitalise old favourites. Our
most exciting achievement this year is the release
of the MUMUS Revision & Study App (MRSA), an
incredible question bank for medical students all over
the country (available for download free for Apple
and Android) created by incredibly talented Monash
students.
Monash was proud to produce the two fantastic
coordinators of the first Victorian National remier
Night. Delegates from Melbourne (FM), Monash,
Deakin, rAdelaide, JMP, and Tasmania, layed the
great game in style, encouraging the burgeoning
Victorian remier scene and encouraging interstate
networking, vital to our future careers.

Our magazine and logo have both been revamped.

Our beloved MUMUS man has moved forward into
the suave world of incorporated business, while our
Medsoc magazine, The Auricle has been beautified
and relaunched on the web, massively increasing our
readership over 75% of our cohort has read it in
either its online or paper forms.
Our intra-soc sporting event, the Caduceus Cup, has
taken another step this year with the introduction of
faculty mascots and an explosion of events including
the Mothers Day Classic, Bowling, Laser Force,
Soccer, Netball, Tennis, Track, Dodgeball and golf.
With year levels pitted against each other, this years
cup is sure to be fiercely contested and incredible
fun.

panacea / 1. 2013

40
ADELAIDE MEDICAL STUDENTS SOCIETY (AMSS)
adelaide university
alyssaparsons
amsarep

As things in rAdelaide begin to settle down in the

lead-up to pre-clinical exams, we have a chance to
reflect on the year that has been thus far, and look
ahead to what will no doubt be an epic second
half of the year.
Some big things to come out of the AMSS include;
the introduction of a Health and Wellbeing Officer to
our Committee to adequately reflect the importance
of this issue among our cohort; the welcoming of a
new Dean of Medicine to the mix, Professor Alistair
Burt; planning towards the introduction of a parallel
MD program to begin in 2014; advocacy relating to
recent changes to internships; drafting of new AMSA
policy; logistically trying to figure out how to maximise

enjoyment and minimise collateral damage as 270+

Adelaideans prepare to descend on the Gold Coast
for what will be an unforgettable and unparalleled
Convention experience; and of course observing
Convention 2014 take shape under the leadership of
the brilliant James Johnston.
Keep an eye on Adelaide. Big things are on the
horizon.

UoM MEDICAL STUDENTS SOCIETY (UMMSS)

the university of melbourne
thomascarins
amsarep
MD Student Conference
The MD Student Conference is part of the new
curriculum at the University of Melbourne. This
weeklong conference allows for multiple year levels of
the course to come together and interact in a
way that allows for strong student input. The
Conference is organised by a group of medical
students who are appointed by the Medical Faculty to
oversee its running each year. Typically the format of
the week allows for different topics to be discussed,
such as Mindfulness sessions, debates, andbreakout
sessions. Although timetabling issues forced the
conference to be split between the yearlevels this
year, next year everyone will once again be united into
an enormous single conference.
Its not all about lectures though, with a social
program supporting the academic program. The
australian medical students association

social events this year included an Opening Cocktail

Event, a Red Cocktail evening to raise awareness for
HIV/AIDS, and an End of Conference Party. The
final year MD students will be conducting their
ownresearch next year, with many students able to
present their research at the Conference.
Furthermore, with all year levels present, the 2014
Conference will see over 1300 students attend,
making it even larger than AMSA Convention.

41

AMSS at NLDS

UMMSS Red Cocktail

AMSS MedCamp

UMMSS Red Cocktail

panacea / 1. 2013

42
UNIVERSITY OF NEWCASTLE MEDICAL SOCIETY (UNMS)
the university of newcastle
laurengodde
amsarep

In 2013, UNMS introduced its first major academic

support initiative in the form of MedPALS. These
are sessions that utilise the experience of older
successful students to guide earlier years and in
doing so, support the spiral learning style of Medicine
at Newcastle.
Sessions are run in small groups of no more than 20
in a semi-structured & interactive atmosphere at the
end of each semester. Dinner is provided, funded
by our MedSocs Education budget, and they are
held on campus in tutorial rooms. Our sessions this
semester have had an 85% attendance level from
students.

Feedback surveys have delivered overwhelming

positive responses as well as improvements to the
structure and process of the sessions.
Being a course based entirely on end of semester
100% assessments, with next to no remediation
offered if students fail, the lead up to exam time
is very stressful. The MedPALS initiative provides
academic support for students when they need it
most. On a broader scale, this initiative has engaged
a wider range of students than any other initiative has!
UNMS is committed to providing educational support
to its members and we feel that this has made our
society more accessible to students who would not
normally engage in our events.

UNE MEDICAL STUDENTS ASSOCIATION (UNEMSA)

the university of new england
wellbeing gym classes, BodyStep, Combat, and
kyliezhong
amsarep
This year, the University of New England Medical
Students Association has seen its first graduates and
alumni cohort. The organisation is now in its fifth year
of development, representing more than 300 medical
students.
UNEMSA has settled well into the new year, equipping
first years and new clinical students with the survival
skills necessary to life in Armidale and in Medicine. First
semester has been hectic+ ; with great academic and
social events for Armedillos to GAI and FSU. Some
highlights include First Incision, Surviving Medicine,
O Camp with our Novocastrian siblings, Futures in
Medicine, MedWeek, the Annual Charity MedBall, and
Students vs Hospital Cricket.
UNE students arent all play - UNEMSA promotes a
balanced lifestyle and continues to support its students
with Peer Assisted Study Sessions, OSCE preparations,
and advocacy. Committee members represent on
various School councils and boards. Fortnightly
australian medical students association

Balance, are well attended and supplement the many

extracurricular activities of UNEMSA members. There
is an inter-year blood drive competition (were coming
Deakin!), our quarterly publications are amazing, and
UNE pride is at an all-time high!
UNEMSA continues its amazing tradition of
achievements. We are currently placing 1st in the AGH
LBL Cup, and have commenced the new soccer
and mixed netball seasons - 2013 will be the fourth
consecutive year that UNEMSA FC brings home the
Premiership!
Special interest groups have continued to pump out
exciting top-quality events, including GPSN Trivia
Night, UNESS Surgical Skills Day, NERCHA Indigenous
Health Night, and ASPIRE Maternal Health Weekend
- rounding out an already-packed 2013 calendar!
There is a lot more on the way for Armedillos, with the
Committee working hard to prepare for many upcoming
events - and the third annual Med Revue Around
the Wards in 80 Hours is in full development with
production and rehearsals well under way, and boy, it is
looking good!

MEDICAL ASSOCIATION OF NOTRE DAME SYD (MANDUS)

the university of notre dame, sydney
johnfarey
amsarep
Yo ho diablo! Im writing this MANDUS update in the
aftermath of our annual Red Party soiree yesterday
evening. The Little Red Riding Hood theme turned
out spectacularly, with every student adorned as little
Miss Red herself or the Big Bad Wolf. This year, were
doubling-down on HIV awareness by transforming our
annual MedBall event into RedBall with all the funds
raised going to Ametur House in Port Moresby, a
short-stay hospice for HIV positive people to receive
basic care. Were very proud of this initiative, especially
since blood-borne viruses are still shockingly taboo in
Papua New Guinea.
Did you know that the average medical curriculum has
less than 1.5 hours of formal teaching on prescribing
exercise for your patients? If youre looking for a great
wellbeing idea for your Medsoc, weve just held a very
successful lecture series on the topic of Exercise is
the Best Medicine. Newcastle legends The Naked

43

Runners held an interactive session on the best way to

motivate patients, make appropriate referrals to allied
health, and topped it all off with an outstanding talk on
nutrition and exercise for Aboriginal and Torres Strait
Islanders by Nat Heath from the Indigenous Marathon
Project. We highly recommend these guys!
On the not to distant horizon the inaugural Medicine
XV match between Notre Dame, Sydney and
the University of Sydney will be held in early-mid
September. Weve made sure all our former and
current representative players will be available, so
brace yourselves USyd. The game will be a friendly
match followed by a barbeque fundraising for Mens
Sheds, providing peer support for men in need of help
arising from mental illness.
Watch out for us on the Gold Coast were bringing
our biggest ever Convention contingent. Youll be all
like Dayum! when Notre walk past.
Johns big prediction: UNDS NSWMSC Sports Day
Champions. You read it here first.

MEDICAL STUDENTS ASSOCIATION OF NOTRE DAME (MSAND)

the university of notre dame, fremantle
ghassanzammar
amsarep

By gosh its been a hectic start of the year for

MSAND. Weve put on a plethora of popular
educational events hosted by our Special Interest
Groups. Our social events have run smoothly, minus
a missing cutout of a Singapore Airlines waitress that
ended up in the bed of a dodgy first year student.
There goes another potential venue off our list.
This years jointly run Leadership Development
Workshop with WAMSS was a huge hit, reaching
a record number of ticket sales. Guest speakers
included public health advocate Professor Daube,
AMA (WA) President Dr Richard Choong, and W.A
Chief Health Officer Professor Turan Weeramanthri.

years ready to destroy the UWA med team in 2013.

All we need to do now is teach the first years (60%
from QLD and NSW) a little bit about AFL!
More importantly, our convention costume committee
(a.k.a the CCC) is busy creating some wild and
wonderful outfits, with the sole purpose of showing
as much painted flesh as legally permitted in the state
of Queensland.
See you on the Gold Coast.

Guys football and girls touch rugby training has

commenced and with a huge turn out from our first
panacea / 1. 2013

44

UNMS

UNEMSA MedCamp

UNEMSA

MSAND

UNMS

australian medical students association

45

WAMSS Dragon Boat Racing Day

UWSMS

SUMS Medical Leadership Seminar

WAMSS

UWSMS Blue Week

panacea / 1. 2013

46
SYDNEY UNIVERSITY MEDICAL SOCIETY (SUMS)
the university of sydney
student and how these opportunities can extend to a
aditiraut
amsajuniorrep
SUMS Medical Leadership Seminar 2013
The SUMS Medical Leadership Seminar is one of our
most popular academic events of the year and the
2013 edition did not disappoint! With the theme of
Crossing Boundaries: Dynamic Leadership Across
Fields in mind, five incredible doctors challenged,
inspired, and revitalised the minds of the medical
students attendees.
Dr Joe Duncan, founder of the Bowral Brewing
Company, was a crowd favourite and shared the
nuances of continuing to follow his passion alongside
a medical career. Next, SUMS hero Dr. Monique
Atkinson highlighted the many benefits of immersing
oneself in the leadership opportunities as a medical

fulfilling career as physician.

This holistic self-development was further underlined
by NSW Shadow Minister for Health Dr Andrew
McDonald who shared with us the challenges of
acting as both an MP and as a paediatrician. His
leadership mantra of persistence and being
realistic resonated with the audience. Dr. Helen
Redmond defined herself as the accidental leader
and has used her role to champion environmental
issues.
The final talk by Dr Mohammed Khadra filled the
audience with awe. His character and life experience
showed us the very essence of what it means to be a
person of integrity, whilst maintaining a wicked sense
of humour. The seminar left us feeling empowered,
with a renewed sense of purpose, equipped to artfully
tackle the balancing act that is the life of the modern
medical student.

WESTERN AUSTRALIAN MEDICAL STUDENTS SOCIETY (WAMSS)

the university of western australia
justinwinters
amsarep
What a beginning to the year it has been. The social
and sports teams have put together an incredible
list of events to welcome us all back from our much
loved holidays and electives. The inaugural gladiatorstyle WAMSS Warfare and huge team entry into the
mud-crawling Warrior-Dash proved to be instant hits.
These were backed up by an incredible social agenda
including OCamp, a sold-out Allied Health, and the
River Cruise.
With student wellbeing high our list of priorities, our
dedicated wellbeing team and Students Passionate
About Mental Health (SPAMH) have been taking a lead
in ensuring everyone has a place to go and a friend to
turn to during difficult times. Sometimes it is as simple
as remembering to ask R U OK? The Coffee Crawl has
been a huge success; weve enjoyed Pancake day and
the fundraiser Scrubber day, with the weekly Temple of
Wellbeing being a friendly reminder of the lighter side of
medicine and life in general.
australian medical students association

WAMSS has proudly encouraged the development

of global health initiatives in the university. Our Global
Health Group - Interhealth - has taken on board national
projects like Crossing Borders for Health (CB4H),
forming a partnership with the Fremantle Multicultural
Centre to assist newly arrived refugees settling into an
unfamiliar environment, as well as continuing with old
favourites like Red Party, Greening WAMSS through
Code Green, supporting little kiddies through Teddy
Bear Hospital and the ZONTA birthing kits workshop.
Finally, our academic and advocacy teams are also
charging full steam ahead. Keeping abreast of all things
Moving to MD, and ensuring our current students
arent left behind is a full time job. The dedicated work of
our team is bringing fruitful results, overseeing changes
big and small to the new curriculum, and providing
hugely valuable feedback to the Faculty. Yet on top of
all this, there is still time to run great events such as the
WAMSS-MSAND Leadership Development Workshop,
suturing workshops, and peer-to-peer Student Grand
Round teaching sessions.

UWS MEDICAL SOCIETY (UWSMS)

the university of western sydney

47

deanzinghini
amsarep
Its great to see this relatively young med school grow
year after year. So quickly we have adapted the ways
of the medical students culture that many of us may
occasionally attend non-compulsory seminars just for
the free food. More interestingly however, is how often
I see even the younger firsties omit crucial letters
of the alphabet when talking to tutors, lecturers, and
most humorously, their unsuspecting doctors. Whilst
reparing for a rocedure is a common task to most of
our colleagues, some of the consultants still struggle to
grasp the aetiology of our unusual speech impediment.

This year has seen launch of our remarkable new

website which has greatly assisted in our interaction
and communication with our members whilst also
promoting our work, events and values nationwide.

Nonetheless, the UWS Meddies power through

these communication barriers. We direct our efforts
to not only being academically, professionally and
clinically proficient, but also to being admirable and
worthy medical students from the youthful grounds of
Sydneys west.

UWS Meddies constantly look forward to every

AMSA event as a chance to interact with and make
great networks with as many students from around
Australia... a thought that can keep a smile on any
AMSA Reps face.

Such events included the wellbeing project, Blue

Week, which was highly successful. It promoted
mental health and well-being to the medical
society and the local community with a balance
of entertainment, information and (perhaps most
importantly) free blue lollies!

panacea / 1. 2013

48

If you need support to get you through when you are feeling down,
experiencing some stress, there is always something to help you
understand, and someone to help you cope.
Talk to a friend
Talk to your educational counsellor
Talk to your GP
Get a referral for a psychologist or psychiatrist
Read the AMSA Keeping Your Grass Greener Guide
Get in touch with one of these centres
Headspace
1800 650 890
www.headspace.org.au
www.eheadspace.org.au (online counselling)
Beyond Blue
1300 22 4636
www.beyondblue.org.au
Reach Out
au.reachout.com
SANE Australia
1800 18 7263
www.sane.org
National Sexual Assault and Domestic Violence Counselling
1800 737 732
For immediate and urgent help, contact the following
Suicide Call Back Service
1300 659 467
Lifeline
13 11 14
Emergency Services
000

Psychiatry terms seem particularly prone to causing distress. One of my experiences involved
accompanying a psychiatrist while she interviewed a young woman newly on remand for fatally
stabbing her own mother during an altercation. The social history elicited was sorrowful, and
her distress and anxiety understandably intense. Another patient who comes to mind was a
wheelchair-bound elderly immigrant from Asia with severe Parkinsons Disease who had recently
attempted suicide. A third was a fascinating, but again very sad, case of Cotards Syndrome, in
which the patient believed that she was dead, as evinced by the maggots she could see near her.
Especially for those students who themselves have a mental health difficulty, some of the stories
found during psychiatry placements are upsetting.
- (Anon) Stage 3 Student at Sydney
australian medical students association

Copyright 2013, All Rights Reserved

Australian Medical Students Association

panacea
the official magazine of the
australian medical students association
the mental health issue
volume 47 issue 1
july 2013