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World study proves exercise good for mental health

Everyone knows exercise is good for your health, physical and mental.

New findings from an international collaboration of researchers, however, has revealed that physical activity can protect against the emergence of depression, regardless of age and geographical region.

Researchers from Brazil, Belgium, Australia, USA, UK and Sweden pooled data from 49 unique cohort studies of people free from mental illness that examined if physical activity is associated with a decreased risk of developing depression.

In total, 266,939 individuals were included, with a gender distribution of 47 per cent males, and on average the individuals were followed up after 7.4 years.

Once the data was extracted they found that compared with people with low levels of physical activity, those with high levels had lower odds of developing depression in the future.

Physical activity had a protective effect, they found, against the emergence of depression in youths, in adults, and in the elderly and across geographical regions.

The geographic regions studied were in Europe, North America, and Oceania.

Australians researchers involved in the study were from Western Sydney University’s NICM Health Research Institute, the Black Dog Institute and UNSW Sydney.

Dr Felipe Barreto Schuch, from Universidade La Salle in Brazil, was the lead author and said the study was the first global meta-analysis to establish that engaging in physical activity is beneficial for protecting the general population from developing depression.

“The evidence is clear that people that are more active have a lesser risk of developing depression,” Dr Barreto Schuch said.

“We have looked at whether these effects happen at different age groups and across different continents and the results are clear. Regardless your age or where you live, physical activity can reduce the risk of having depression later in life.”

Co-author Dr Simon Rosenbaum, Senior Research Fellow at UNSW Sydney and the Black Dog Institute, said: “The challenge ahead is ensuring that this overwhelming evidence is translated into meaningful policy change that creates environments and opportunities to help everyone, including vulnerable members of our society, engage in physical activity.”

The findings in Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies were first published in the American Journal of Psychiatry.

The researchers say further studies are warranted to evaluate the minimum physical activity levels required and the effects of different types and lengths of activity on subsequent risk for depression. 

CHRIS JOHNSON

Impostor syndrome: the doctors who feel like frauds

 

Have you ever had the sensation in your professional life that you don’t know what you’re doing, that you’re a fraud, and that one day someone is going to catch you out? If so, you’re far from alone: what’s known as ‘impostor syndrome’ seems to be surprisingly common in medicine.

A recent study of nearly 150 American medical students found that around half the women and just under a quarter of the men suffered from impostor syndrome, which is characterised by chronic feelings of self-doubt and fear of being discovered as an intellectual fraud. And that far from improving as the students progressed from year to year, their symptoms actually got worse. What’s more, the study found a strong correlation between impostor syndrome and some of the components of burnout, such as emotional and physical exhaustion, cynicism and depersonalisation – a disturbing association that the study authors say “cannot be ignored”.

But it’s not just med students who are affected by impostor syndrome. And among doctors, it’s not just the younger, less experienced ones, either: impostor syndrome cuts across all ages and career levels, another recent study has found. Based on interviews with 28 specialists, the Canadian study found that even doctors at advanced stages of their careers often questioned their abilities and the validity of their achievements. One of the interviewees reported that after many years of practising, “I still think someone is going to send me a letter saying ‘actually it was all a mistake. You weren’t supposed to get into medical school, therefore we’re taking it all away.’”

The authors from the University of Ottawa note that the medical profession “neither sufficiently prepares physicians to grapple with mistakes nor adequately supports them to share their insecurities”.

Once they enter clinical and academic medicine, doctors can get shaken by a seemingly endless series of setbacks such as bad clinical outcomes, patient complaints, poor evaluations and rejected grants or manuscripts, all of which can be fodder for insecurity.

With limited support, the authors say, doctors wrestling with errors and self-doubt can become immobilised by fear. This can come at a considerable cost not only to their mental health and well-being, but also to their career.

Female doctors seem to be at particular risk of impostor syndrome, which may be to do with a traditional lack of female role models in the higher echelons of medicine, despite the rising numbers of women graduating from medical school. A position paper published this month on achieving gender equality in medicine singles out impostor syndrome among women as one of the barriers. Impostor syndrome “may bar women’s success if it causes them to pass up career development opportunities”, the paper says.

In a culture where revealing self-doubt is seen as a weakness, doctors suffering from impostor syndrome may be difficult to identify and help. The challenge, the authors of the Canadian study say, is to develop an awareness and understanding that feelings of insecurity in medicine are both common and recurrent, and that features of the medical culture may actually foster those feelings of self-doubt.

“It is critical to develop opportunities for practitioners to safely acknowledge and share their feelings. Rather than ignoring or ‘punishing’ mistakes, medicine needs to cultivate safe spaces to share struggle, and to develop opportunities that transform failure into a teaching tool,” the authors conclude.

Access the full papers referred to in this article here, here and here.

[Perspectives] A neurologist’s detective stories

Western medicine is organised into silos. Faced with a patient requiring specialist advice, a general practitioner or emergency doctor has to make a call about where to direct them. Sometimes, the right clinical destination is obvious: a compound thigh fracture will always need an orthopaedic surgeon. But many patients fall foul of this rigid system. An individual complaining of dizziness might get bounced from ENT, to cardiology, to neurology, to psychiatry before achieving a diagnosis.

Psychiatrist’s $64,000 discharge error

A court has found a psychiatrist breached their duty of care to a patient for the injuries she sustained in a car accident while driving home following discharge from the hospital.

The patient alleged that at the time of her discharge, she was excessively tired and/or sedated and should not have been permitted to drive home. She claimed the psychiatrist and admitting hospital’s negligent conduct had caused her to lose control of the car and sustain personal injuries.

In reaching its decision, the court considered a range of evidence from the psychiatrist, hospital, witnesses, experts, as well as medical notes and letters.

Ultimately, the court found the psychiatrist and the hospital each liable for negligence, and apportioned responsibility between them. The hospital and the psychiatrist were ordered to pay the patient $32,167 and $64,333, respectively, plus costs.

The case highlights the risks when discharging patients potentially under the influence of sedating and psychoactive agents, and the importance of conducting and documenting a careful assessment before allowing any unattended patient to drive home.

Car accident following discharge

The patient was a woman with a background as a registered nurse, who had been terminated from her job due to absences because of back pain following a work accident. She visited her GP complaining of depression and feeling suicidal, and was admitted to an acute hospital’s mental health unit for about a month. She was then admitted as a voluntary inpatient, to a private hospital under the psychiatrist.

During her admission, which lasted another month, she suffered both insomnia and daytime tiredness. She was taking multiple psychoactive drugs including antidepressants, opiates and other strong analgesics as well as Stilnox at night.

During a consultation the day prior to the patient’s discharge, the psychiatrist assessed her readiness for discharge in relation to her mental state. The patient was able to assure the psychiatrist she was no longer suicidal and the psychiatrist authorised discharge for the next day.

On the morning of discharge, the patient took her regularly prescribed OxyContin. Prior to discharging her in the afternoon, a nurse completed a driving risk assessment and then returned the patient’s car keys so she could drive the 50 kilometre journey home. Unfortunately, the patient drove off the road and into a wall, quite close to home.

She was taken by ambulance and treated at an acute hospital for her injuries, including pain in her neck, head, shoulder, lower back and leg. She was then re-admitted to the private hospital under the original psychiatrist, where she remained for another month.

Court’s findings

The court heard in the days prior to discharge, the patient was often excessively drowsy and would fall asleep even while sitting eating meals. On the day of discharge, the patient had again fallen asleep over breakfast. Nursing staff had tried to wake her on several occasions, but she kept falling back asleep.

The court noted medical records from the hospital in which staff had reported the patient appeared over-sedated and drowsy. The nurse’s risk assessment completed at the time of discharge, also stated, “reports tiredness lately – Psych aware”.

Given the “overwhelming evidence”, the court found the patient was tired, drowsy and sedated upon discharge.

“I find she was not in a fit state to make a decision about her capacity to drive and find that she relied upon her carers to advise as to whether or not it was safe for her to drive herself home and warn her of the risks of drowsiness,” the court said.

The court concluded the car accident occurred as a result of the patient falling asleep due to tiredness, fatigue or excessive sedation.

Psychiatrist’s grounds for negligence

While the psychiatrist conceded the scope of their duty of care extended to reasonable care of treatment, they sought to deflect liability on the basis of s50 of the Civil Liability Act (CLA), claiming they had acted in a manner which at the time was widely accepted in Australia by peer professional opinion as competent professional practise.

In determining the psychiatrist had breached their duty of care to the patient, the court noted they had granted the patient permission to drive her car and was the sole person with control over whether the patient drove. Based on hospital protocol, staff could only give the keys to the patient with the psychiatrist’s permission.

The court accepted the patient’s evidence she had expressed concern to the psychiatrist about driving due to drowsiness, to which the psychiatrist had responded, “you should be fine to drive.”

The court found that at no stage during the consultation before her discharge, did the psychiatrist discuss how she would travel home. Furthermore, the psychiatrist admitted they left the decision up to the patient as to whether she was fit to drive.

“To leave it up to a psychiatric patient who suffered from pain, fatigue and sedation, which would vary from day to day, to decide whether to she was fit to drive at the time of discharge, is a complete abrogation of the psychiatrist’s duty of care and responsibility,” the court said.

The psychiatrist was also found negligent by failing to review the patient or enquire about her condition on the actual day of discharge, despite her observations of the patient the day before discharge and personal knowledge of the patient’s sedation, as evident in the records and other correspondence.

In a letter to the patient’s insurer, the psychiatrist had reported increased sedation over the last week which the introduction of OxyContin may have caused. Another letter to a neurologist said in the three days prior to discharge, the patient was “excessively sedated” and had some semi-falls.

The court accepted expert opinion that in allowing the patient in such a state to drive unattended, the psychiatrist and hospital breached accepted professional standards, and had not acted in a manner which would be widely accepted by peer professional opinion.

Hospital breaches duty of care

The hospital argued they had relied upon the fact the psychiatrist had authorised the patient to drive, as well as the patient’s own assessment of her capacity to drive and knowledge of the effects of the medication, given she was a registered nurse. The court rejected these defences.

The hospital was found to have breached its duty of care to the patient for permitting her to drive following discharge in circumstances where she was unfit to drive.

No basis for patient’s contributory negligence

The court rejected claims made by the hospital and psychiatrist against the patient that her actions constituted “contributory negligence”, by failing to take reasonable precautions against her risk of harm. The court found the sedating effects of the medications impeded her ability to make a responsible decision in the circumstances.

Key lessons

  • Doctors and hospitals have a responsibility to carefully assess the safety of their patients being discharged from their care. This includes identifying suitable arrangements for transport home and may require prolonging admission if no arrangements can be organised.
  • Doctors should remain aware of the risk of excessive sedation of patients taking psychoactive agents, especially in combination, and carefully assess their risk for harms. In preparing patients for discharge it is good practice to carefully review their use of sedating medications and other risky agents warranting special advice. This of course extends to showing caution when prescribing sedating medication in the community including sleeping tablets, strong analgesics and psychoactive agents, and adequately warning of the risks.
  • Doctors should always carefully document their assessments of patients, especially in higher-risk contexts such as transitioning from care. It is important to record the relevant positive and negative findings which would justify discharge and to outline the discussed options and agreed plan.

This article was originally published by Avant Mutual. You can access the original here.

Is psychiatry ready for medical MDMA?

 

Within five years, science will likely have answered a controversial question: can methylenedioxymethamphetamine (MDMA) treat psychiatric disorders?

After some studies showing a positive effect, MDMA-assisted psychotherapy is entering final clinical trials as a treatment for post-traumatic stress disorder (PTSD). If these trials show positive results, MDMA will go from an illegal drug to a prescription medicine in the United States by 2021, potentially prompting movement in this space in Australia and Europe.

MDMA would move from the fringes to mainstream psychiatry, becoming recognised as a mainstream treatment option. What remains less clear is how psychiatry will deal with questions arising from this new treatment approach.

MDMA in medicine: a brief history

German pharmaceutical company Merck patented MDMA in 1912. However, it appears not to have been used in humans until later that century.

Better known as a street drug in the rave scene of the 1980s and ’90s, MDMA was used in the 1970s by a small band of US psychiatrists and therapists. This group believed it enhanced the therapeutic bond and improved treatment for ailments ranging from marital distress to, potentially, schizophrenia.

Following rebranding as “ecstasy”, large-scale recreational use of MDMA led to its 1985 listing as an illegal drug in the USA (Australia followed in 1986). The MDMA-therapy community unsuccessfully protested against this designation.

Advocates for MDMA-assisted psychotherapy have been playing the long game ever since, undertaking a painstaking process of research and advocacy, which has culminated in the upcoming trials.

MDMA versus ecstasy

Advocates for MDMA-assisted psychotherapy have been at pains to distinguish the street drug ecstasy from MDMA the medicine. Ecstasy can contain a range of substances as well as varying doses of MDMA.

This is unsurprising given early evidence that high repeated MDMA doses – more relevant for recreational than therapeutic use – damage serotonergic neurons in animals.

Catastrophic predictions of a lost generation of ecstasy users, however, failed to materialise. Indeed, numerous people have received MDMA doses similar to those proposed for therapy in laboratory studies. This shows that MDMA can be safely administered under controlled conditions to well-screened healthy adults.

It remains unknown whether the same is true of groups excluded from most studies. This includes children and older people, and those with psychiatric or physical illnesses. Studies to date do, however, suggest acceptable safety in adults with PTSD.

Pharmacologically enhanced treatment

One aspect of MDMA therapy attracting less attention is that it involves a fundamental shift in psychiatric medication. All currently approved psychiatric medications treat symptoms rather than the disease itself. Relapse is common after stopping treatment.

MDMA-assisted psychotherapy, by comparison, involves limited MDMA doses over two or three sessions of eight to ten hours. The aim is to “fast-track” psychotherapy to produce long-lasting changes.

Possible mechanisms of such an effect are unclear. One suggestion is that the effects of MDMA, such as feelings of empathy, openness and reduced fear, might allow people to reprocess traumatic memories during psychotherapy.

Other medications are also being considered as adjuncts for psychotherapy. These include potent psychoactives like LSD and psilocybin, or drugs thought to enhance psychotherapy via mechanisms other than psychoactive effects (e.g. d-cycloserine).

It is possible, however, that a broader range of pharmaceuticals could be used in this way. Thus, a potential benefit of MDMA’s approval could be to spur further research in this area.

The challenges of regulation

The potential approval of MDMA for prescription gives rise to pressing questions about regulation. For instance, should prescribing be limited to physicians with specific qualifications? What training should be required for those conducting the psychotherapy? How should the drug be handled and stored by pharmacists?

The combination of a drug-affected patient with non-drug-affected therapists could make patients vulnerable during psychotherapy. This suggests a need for stringent training and oversight of MDMA-assisted therapy.

Approval of MDMA will also lead to off-label prescribing, with doctors prescribing the drug for conditions other than PTSD. This could include a range of conditions, such as depression and substance use disorders, and various patient groups.

A particular issue is prescribing to children/adolescents. To date no controlled studies have assessed the safety of MDMA in young people. Planned studies in adolescents with PTSD will thus be important.

Is anything ‘penicillin for the soul’?

The slow progression of MDMA-assisted psychotherapy from the subcultural margins towards approval has been driven by the belief of those advocating for it.

Without this motivated community, MDMA would likely not have been developed as a medication, as it is off patent. The downside of this robust advocacy base is that it can lead to rather extreme claims (e.g. “penicillin for the soul”) and experimenter bias.

In addition to well-designed studies that control for experimenter bias, there is a need for researchers and clinicians outside the MDMA-advocacy community to be involved in the ongoing development of this research direction.

The ConversationIf MDMA is to become a part of mainstream psychiatry’s armamentarium, many questions will need to be answered. The next few years will be critical to see if MDMA joins the ranks of failed psychiatric treatments, or offers new hope to people suffering from PTSD.

Gillinder Bedi, Assistant Professor of Clinical Psychology (in Psychiatry) University of Melbourne and Orygen National Centre of Excellent in Youth Mental Health, University of Melbourne

This article was originally published on The Conversation. Read the original article.

New studies give greater understanding on menopause

One year of hormone replacement therapy may be able to prevent development of depressive symptoms in women who are in the menopause transition, a study published online in JAMA Psychiatry has shown.

The double-blind, randomised controlled trial, conducted by University of North Carolina (UNC) School of Medicine found certain women would be more likely to experience the greatest mood benefit of hormone replacement therapy during the menopause transition, which are women early in the transition and women with a greater number of recent stressful life events.

Women are two to four times more likely to develop clinically significant depressive symptoms during the menopause transition, according to the study.

“We know that midlife for women, particularly in the transition to menopause, is a time of substantial elevations in risk for depression,” said Professor Susan Girdler, who helped lead the research.

“During the menopause transition, our risk for depression actually increases two to four times. And that’s true even for women who haven’t had a history of depression early in life.”

The participants were randomly selected and put into two separate groups. Over the course of a year, one group received transdermal estradiol on a daily basis, the other a placebo.

The study found more than 30 percent of the placebo group developed clinically significant depression. However, only 17 percent of women who received estradiol developed the same depression symptoms.

Other research published by The University of Illinois (UI) in the journal Sleep Medicine suggests addressing menopausal symptoms of hot flushes and depression may also address sleep disruptions.

The UI study also gives women hope that their sleep symptoms may not last past the menopausal transition, said Professor Rebecca Smith, from the Pathobiology Department at the University of Illinois. Professor Smith conducted the study with Professors Jodi Flaws and Megan Mahoney.

“Poor sleep is one of the major issues that menopausal women seek treatment for from their doctors,” Professor Mahoney said.

“It’s a huge health care burden, and it’s a huge burden on the women’s quality of life. Investigating what’s underlying this is very important.”

The study used data from the Midlife Women’s Health Study, which followed 776 women aged 45-54 in the greater Baltimore area for up to seven years.

The study found no correlation between the likelihood of reporting poor sleep before menopause, during menopause and after menopause. Meaning, for many women in the study, their reported sleep problems changed as they transitioned to different stages of menopause. For example, women who had insomnia during menopause were not more likely to have insomnia after menopause.

“That’s a hopeful thing for women who feel like their sleep has gone downhill since they hit the menopause transition: It might not be bad forever,” Professor Smith said.

“Your sleep does change, but the change may not be permanent.”

The researchers found that hot flushes and depression were strongly correlated with poor sleep across all stages of menopause.

Those two risk factors vary in reported frequency across menopausal stages, which might help explain why poor sleep also varies across the stages, the researchers said.

Professor Smith believes that the study has shown sleep disturbances in menopause are part of a bigger picture that doctors should be looking at.

“It indicates that when dealing with sleep problems, physicians should be asking about other symptoms related to menopause, especially looking for signs of depression and asking about hot flushes,” Professor Smith said.

MEREDITH HORNE

What the research says about combating anxiety

 

Do you have anxiety? Have you tried just about everything to get over it, but it just keeps coming back? Perhaps you thought you had got over it, only for the symptoms to return with a vengeance? Whatever your circumstances, science can help you to beat anxiety for good.

Anxiety can present as fear, restlessness, an inability to focus at work or school, finding it hard to fall or stay asleep at night, or getting easily irritated. In social situations, it can make it hard to talk to others; you might feel like you’re constantly being judged, or have symptoms such as stuttering, sweating, blushing or an upset stomach.

It can appear out of the blue as a panic attack, when sudden spikes of anxiety make you feel like you’re about to have a heart attack, go mad or lose control. Or it can be present all the time, as in generalised anxiety disorder, when diffuse and pervasive worry consumes you and you look to the future with dread.

Most people experience it at some point, but if anxiety starts interfering with your life, sleep, ability to form relationships, or productivity at work or school, you might have an anxiety disorder. Research shows that if it’s left untreated, anxiety can lead to depression, early death and suicide. And while it can indeed lead to such serious health consequences, the medication that is prescribed to treat anxiety doesn’t often work in the long-term. Symptoms often return and you’re back where you started.

How science can help

The way you cope or handle things in life has a direct impact on how much anxiety you experience – tweak the way you’re coping, therefore, and you can lower your anxiety levels. Here are some of the top coping skills that have emerged from our study at the University of Cambridge, which will be presented at the 30th European Congress of Neuropsychopharmacology in Paris, and other scientific research.

Do you feel like your life is out of control? Do you find it hard to make decisions – or get things started? Well, one way to overcome indecision or get going on that new project is to “do it badly”.

This may sound strange, but the writer and poet GK Chesterton said that: “Anything worth doing is worth doing badly.” And he had a point. The reason this works so well is that it speeds up your decision-making process and catapults you straight into action. Otherwise, you could spend hours deciding how you should do something or what you should do, which can be very time-consuming and stressful.

People often want to do something “perfectly” or to wait for the “perfect time” before starting. But this can lead to procrastination, long delays or even prevent us from doing it at all. And that causes stress – and anxiety.

Instead, why not just start by “doing it badly” and without worrying about how it’s going to turn out. This will not only make it much easier to begin, but you’ll also find that you’re completing tasks much more quickly than before. More often than not, you’ll also discover that you’re not doing it that badly after all – even if you are, you can always fine tune it later.

Using “do it badly” as a motto gives you the courage to try new things, adds a little fun to everything, and stops you worrying too much about the outcome. It’s about doing it badly today and improving as you go. Ultimately, it’s about liberation.

Just jump right in …
The National Guard via flickr, CC BY

Forgive yourself and ‘wait to worry’

Are you particularly critical of yourself and the blunders you make? Well, imagine if you had a friend who constantly pointed out everything that was wrong with you and your life. You’d probably want to get rid of them right away.

But people with anxiety often do this to themselves so frequently that they don’t even realise it anymore. They’re just not kind to themselves.

So perhaps it’s time to change and start forgiving ourselves for the mistakes we make. If you feel like you’ve embarrassed yourself in a situation, don’t criticise yourself – simply realise that you have this impulse to blame yourself, then drop the negative thought and redirect your attention back to the task at hand or whatever you were doing.

Another effective strategy is to “wait to worry”. If something went wrong and you feel compelled to worry (because you think you screwed up), don’t do this immediately. Instead, postpone your worry – set aside 10 minutes each day during which you can worry about anything.

If you do this, you’ll find that you won’t perceive the situation which triggered the initial anxiety to be as bothersome or worrisome when you come back to it later. And our thoughts actually decay very quickly if we don’t feed them with energy.

Find purpose in life by helping others

It’s also worth considering how much of your day is spent with someone else in mind? If it’s very little or none at all, then you’re at a high risk of poor mental health. Regardless of how much we work or the amount of money we make, we can’t be truly happy until we know that someone else needs us and depends on our productivity or love.

This doesn’t mean that we need people’s praise, but doing something with someone else in mind takes the spotlight off of us (and our anxieties and worries) and places it onto others – and how we can make a difference to them.

Being connected to people has regularly been shown to be one of the most potent buffers against poor mental health. The neurologist Viktor Frankl wrote:

For people who think there’s nothing to live for, nothing more to expect from life … the question is getting these people to realise that life is still expecting something from them.

Knowing that someone else needs you makes it easier to endure the toughest times. You’ll know the “why” for your existence and will be able to bear almost any “how”.

The ConversationSo how can you make yourself important in someone else’s life? It could be as simple as taking care of a child or elderly parent, volunteering, or finishing work that might benefit future generations. Even if these people never realise what you’ve done for them, it doesn’t matter because you will know. And this will make you realise the uniqueness and importance of your life.

Olivia Remes, PhD Candidate, University of Cambridge

This article was originally published on The Conversation. Read the original article.

[Perspectives] Schizophrenia

Dementia praecox, dementia paranoides, catatonia, hebephrenia, stupefaction—just the terms historically associated with schizophrenia could fill up a short essay on the subject. The contentious and surprisingly short history of this diagnosis draws out some of the most difficult questions in psychiatry. Is schizophrenia a natural entity, awaiting objective description, or does it emerge from a shifting intersection of contexts? Is good practice a matter of grouping disorders into broad categories based on underlying resemblances, or does accurate diagnosis depend on breaking these generalisations down into lists of specific symptoms?

Tokophobia: what it’s like to have a phobia of childbirth

 

Catriona Jones, University of Hull; Franziska Wadephul, University of Hull, and Julie Jomeen, University of Hull

It’s very common for women to feel anxious about labour and birth. Worries about the pain of contractions, interventions and the uncertainty of the process are not unusual. But for some women, the fear of labour and birth can be so overwhelming that it overshadows their pregnancy and affects daily functioning.

This severe fear of birth is called tokophobia – which literally means a phobia of childbirth. And for some women, this also includes a dislike or disgust with pregnancy.

Tokophobia can be split into two types – primary and secondary. Primary tokophobia occurs in women who have not given birth before. For these women, a fear of birth tends to come from traumatic experiences in their past – including sexual abuse. It can also be linked to witnessing a difficult birth or listening to stories or watching programmes which portray birth as embarrassing or dangerous. Whereas women who suffer from secondary tokophobia, tend to have had a previous traumatic birth experience which has left them with a fear of giving birth again.

It is difficult to say how common tokophobia is. Research suggests that between 2.5% and 14% of women are affected by tokophobia. But some researchers believe this figure could be as high as 22%.

These figures vary so much because women with different levels of tokophobia were included in the research. So while some women may have relatively mild tokophobia, for others, the condition is much more severe. The figures may also include women who have anxiety and depression rather than tokophobia.

Not a happy occasion

Women with tokophobia come from a wide variety of backgrounds. It is difficult to predict who might be affected, although it is clear that women with tokophobia are also more likely to experience difficulties with anxiety and depression and other mental health problems.

Research suggests some women with the condition choose to avoid pregnancy altogether – or may consider a termination if they find themselves in that position. When pregnant, women with tokophobia may request a caesarean section to avoid the process of actually having to give birth.

Some women find pregnancy itself very difficult, particularly dealing with the growing bump and feeling the baby’s movements. Anxiety, insomnia, sleeplessness, eating disorders and antenatal depression or increased risk of postnatal depression, have all been identified as consequences of tokophobia.

Mothers with tokophobia can struggle to bond with their babies.
Shutterstock

Some of the consequences for women with tokophobia – which emerge during labour – are longer labours. These are usually with an epidural and increased need for forceps or ventouse – this a cup-shaped suction device which is applied to the baby’s head to assist the birth. All of which can have implications for both the woman and her baby.

Afterwards some women with tokophobia may have a less satisfying bond with their babies. And a difficult experience of birth can make women more afraid of birth if they become pregnant again.

Tokophobia treatment

Anecdotal evidence indicates that clinical care for women with tokophobia is patchy. But the good news is that there is help out there for women with this condition. Some women find it helpful to talk through a previous experience of a traumatic birth, others might be reassured by information about labour and birth. Other women, however, may need more targeted treatment – a number of counselling approaches can be helpful.

Giving birth to a child is one of the most intense experiences the body can go through.
Shutterstock

Many women also find it helpful to visit the maternity ward and talk to midwives and obstetricians during pregnancy. Some women find the condition can be very isolating, feeling that nobody else shares this intense fear. For these women, simply knowing that they are not alone, can be very comforting and helpful.

Overcoming a phobia

In Hull and East Riding of Yorkshire, where there is an established perinatal mental health service for women and their families, there has been a recognised need for a consistent approach to caring for and supporting women with tokophobia.

This has led to a group of practitioners, academics and patients to work together to explore the care and support available to these women – and to help address the gaps in service provision.

This pioneering work, which is at the forefront of tokophobia service provision and research in the UK, aims to ensure that women get the right support, and that their psychological and pregnancy needs are met.

The ConversationTokophobia can have debilitating effects on women and their families. Some women will avoid pregnancy, even though they might want to have children. For those who do become pregnant, the condition can overshadow pregnancy and affect the choices they make for labour and birth. This is why we need to work towards preventing tokophobia if possible – as well as providing effective treatment for women who suffer from this difficult condition.

Catriona Jones, Senior Research Fellow in Maternal and Reproductive Health, University of Hull; Franziska Wadephul, Research assistant, University of Hull, and Julie Jomeen, Professor of Midwifery and Dean in the Faculty of Health Sciences, University of Hull

This article was originally published on The Conversation. Read the original article.

AMA shines in Australia Day Honours

Former Australian Medical Association President Dr Mukesh Haikerwal has been awarded the highest honour in this year’s Australia Day awards by being named a Companion of the Order of Australia (AC).

He is accompanied by the current Editor-in-Chief of the Medical Journal of Australia, Laureate Professor Nick Talley, as well as longstanding member Professor Jeffrey Rosenfeld – who both also received the AC.

The trio top a long and impressive list of AMA members to receive Australia Day Honours this year.

AMA Federal Councillor, Associate Professor Julian Rait, received the Medal of the Order (OAM).

A host of other members honoured in the awards are listed below.

AMA President Dr Michael Gannon said the accolades were all well-deserved and made he made special mention of those receiving the highest Australia Day Honours.

“They have dedicated their lives and careers to helping others through their various roles as clinicians, researchers, teachers, authors, administrators, or government advisers – and importantly as leaders in their local communities,” Dr Gannon said.

“On behalf of the AMA, I pay tribute to all the doctors and other health professionals who were honoured today for their passion for their profession and their dedication to their patients and their communities.

“The great thing about the Honours is that they acknowledge achievement at the international, national, and local level, and they recognise excellence across all avenues of human endeavour.

“Doctors from many diverse backgrounds have been recognised and honoured again this year.

“There are pioneering surgeons and researchers, legends across many specialties, public health advocates, researchers, administrators, teachers, and GPs and family doctors who have devoted their lives to serving their local communities.

“The AMA congratulates all the doctors and other health advocates whose work has been acknowledged.

“We are, of course, especially proud of AMA members who are among the 75 people honoured in the medicine category.”

Dr Haikerwal, who was awarded the Officer in the Order of Australia (AO) in 2011, said this further honour was “truly mind-blowing” and another life-changing moment. 

“To be honoured on Australia Day at the highest level in the Order of Australia is beyond imagination, beyond my wildest dreams and extremely humbling,” Dr Haikerwal said.

“For me to be in a position in my life and career to receive such an honour has only been made possible due to the unflinching support and unremitting encouragement of my closest circle, the people who have been with me through every step of endeavour, adversity, achievement, and success.”

CHRIS JOHNSON

 

 

AMA MEMBERS IN RECEIPT OF HONOURS

COMPANION (AC) IN THE GENERAL DIVISION 

Dr Mukesh Chandra HAIKERWAL AO
Altona North Vic 3025
For eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of western Melbourne.

Professor Jeffrey Victor ROSENFELD AM
Caulfield North, Vic
For eminent service to medicine, particularly to the discipline of neurosurgery, as an academic and clinician, to medical research and professional organisations, and to the health and welfare of current and former defence force members. 

Professor Nicholas Joseph TALLEY
Black Hill, NSW
For eminent service to medical research, and to education in the field of gastroenterology and epidemiology, as an academic, author and administrator at the national and international level, and to health and scientific associations. 

OFFICER (AO) IN THE GENERAL DIVISION 

Emeritus Professor David John AMES
East Kew, Vic
For distinguished service to psychiatry, particularly in the area of dementia and the mental health of older persons, as an academic, author and practitioner, and as an adviser to professional bodies. 

Dr Peggy BROWN
Sanctuary Cove, Qld
For distinguished service to medical administration in the area of mental health through leadership roles at the state and national level, to the discipline of psychiatry, to education, and to health care standards. 

Professor Creswell John EASTMAN AM
St Leonards, NSW
For distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects.

Professor Suzanne Marie GARLAND
Docklands, Vic
For distinguished service to medicine in the field of clinical microbiology, particularly to infectious diseases in reproductive and neonatal health as a physician, administrator, researcher and author, and to professional medical organisations. 

Dr Paul John HEMMING
Queenscliff, Vic
For distinguished service to higher education administration, to medicine through contributions to a range of professional medical associations, and to the community of central Victoria, particularly as a general practitioner. 

Professor Anthony David HOLMES
Melbourne, Vic
For distinguished service to medicine, particularly to reconstructive and craniofacial surgery, as a leader, clinician and educator, and to professional medical associations. 

Dr Diana Elaine O’HALLORAN
Glenorie, NSW
For distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care.

MEMBER (AM) IN THE GENERAL DIVISION

Dr Michael Charles BELLEMORE
Croydon, NSW
For significant service to medicine in the field of paediatric orthopaedics as a surgeon, to medical education, and to professional medical societies. 

Dr Colin Ross CHILVERS
Launceston, Tas
For significant service to medicine in the field of anaesthesia as a clinician, to medical education in Tasmania, and to professional societies. 

Associate Professor Peter HAERTSCH OAM
Breakfast Point, NSW
For significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education. 

Professor Ian Godfrey HAMMOND
Subiaco, WA
For significant service to medicine in the field of gynaecological oncology as a clinician, to cancer support and palliative care, and to professional groups. 

Dr Philip Haywood HOUSE
WA
For significant service to medicine as an ophthalmologist, to eye surgery foundations, and to the international community of Timor Leste. 

Adjunct Professor John William KELLY
Vic
For significant service to medicine through the management and treatment of melanoma, as a clinician and administrator, and to education.

Dr Marcus Welby SKINNER
West Hobart, Tas
For significant service to medicine in the field of anaesthesiology and perioperative medicine as a clinician, and to professional societies. 

Professor Mark Peter UMSTAD
South Yarra, Vic
For significant service to medicine in the field of obstetrics, particularly complex pregnancies, as a clinician, consultant and academic. 

Professor Barbara S WORKMAN
East Hawthorn, Vic
For significant service to geriatric and rehabilitation medicine, as a clinician and academic, and to the provision of aged care services.

MEDAL (OAM) IN THE GENERAL DIVISION

Professor William Robert ADAM PSM
Vic
For service to medical education, particularly to rural health. 

Dr Marjorie Winifred CROSS
Bungendore, NSW
For service to medicine, particularly to doctors in rural areas. 

Associate Professor Mark Andrew DAVIES
Maroubra, NSW
For service to medicine, particularly to neurosurgery. 

Dr David William GREEN
Coombabah, Qld
For service to emergency medicine, and to professional organisations. 

Dr Barry Peter HICKEY
Ascot, Qld
For service to thoracic medicine.

Dr Fred Nickolas NASSER
Strathfield, NSW
For service to medicine in the field of cardiology, and to the community.

Dr Ralph Leslie PETERS
New Norfolk, Tas
For service to medicine, and to the community of the Derwent Valley.

Associate Professor Julian Lockhart RAIT
Camberwell, Vic
For service to ophthalmology, and to the development of overseas aid.

Mr James Mohan SAVUNDRA
South Perth, WA
For service to medicine in the fields of plastic and reconstructive surgery.

Dr Chin Huat TAN
Glendalough, WA
For service to the Chinese community of Western Australia.

Dr Karen Susan WAYNE
Toorak, Vic
For service to the community of Victoria through a range of organisations. 

Dr Anthony Paul WELDON
Melbourne, Vic
For service to the community, and to paediatric medicine.

PUBLIC SERVICE MEDAL (PSM) 

Dr Sharon KELLY
Yeronga, Qld
For outstanding public service to the health sector in Queensland.

Professor Maria CROTTY
Kent Town, SA
For outstanding public service in the rehabilitation sector in South Australia.