Substance use disorders

Basic competencies in assessing and treating substance use disorders should be core to the training of any clinical psychologist, because of the high frequency of risky or problematic substance use in the community, and its high co-occurrence with other problems. Skills in establishing trust and a therapeutic alliance are particularly important in addiction, given the stigma and potential for legal sanctions that surround it. The knowledge and skills of all clinical practitioners should be sufficient to allow valid screening and diagnosis of substance use disorders, accurate estimation of consumption and a basic functional analysis. Practitioners should also be able to undertake brief interventions including motivational interviews, and appropriately apply generic interventions such as problem solving or goal setting to addiction. Furthermore, clinical psychologists should have an understanding of the nature, evidence base and indications for biochemical assays, pharmacotherapies and other medical treatments, and ways these can be integrated with psychological practice. Specialists in addiction should have more sophisticated competencies in each of these areas. They need to have a detailed understating of current addiction theories and basic and applied research, be able to undertake and report on a detailed psychological assessment, and display expert competence in addiction treatment. These skills should include an ability to assess and manage complex or co-occurring problems, to adapt interventions to the needs of different groups, and to assist people who have not responded to basic treatments. They should also be able to provide consultation to others, undertake evaluations of their practice, and monitor and evaluate emerging research data in the field.

Using digital rights management for securing data in a medical research environment

We propose a digital rights management approach for sharing electronic health records in a health research facility and argue advantages of the approach. We also give an outline of the system under development and our implementation of the security features and discuss challenges that we faced and future directions.

Women who miscarry : the effectiveness and clinical utility of the Kessler 10 questionnaire in screening for ongoing psychological distress

Background: Early pregnancy loss has been linked to enduring psychological morbidity. Aims: This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method: Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures: K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results: A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions: The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage.

Children and consent to medical treatment

This chapter deals with the law concerning children and consent to medical treatment. Where a child under the age of 18 requires medical treatment, issues arise as to who may lawfully consent to the treatment and under what circumstances. Depending on the circumstances, consent may be given by the child’s parent or guardian; the child; or a court. The chapter provides a thorough treatment of Australian law about these issues and circumstances.

Finding a way through the ethical and legal maze : withdrawing medical treatment and euthanasia

This article examines Finnis' and Keown's claim that the intention/foresight distinction should be used as the basis for the lawfulness of withholding and withdrawing medical treatment, rather than the act/omission distinction which is currently used. I argue that whilst the intention/foresight distinction is sound and can apply to palliative pain relief hastening death, it cannot be applied to withholding and withdrawing medical treatment. Instead, the act/omission distinction remains the better basis for the lawfulness of withholding and withdrawal, and law reform is consequently unnecessary.

Recent developments : loss of chance in medical litigation : Tabet v Gett [2010] HCA 12.

Following the judgement of the High Court in Tabet v Gett [2010]HCA 12 handed down on 21 April 2010 it appears that in Australia there is now very limited scope for recovery in negligence for the loss of a chance of a better medical outcome.