Dr Skye Kinder
@drskyekinder.bsky.social
Doctor, medical educator, company director. Interested in psychiatry, rural health, gender equity. Forbes 30 Under 30. 2019 VIC Young Australian of the Year. 2017 VIC Junior Doctor of the Year. Views my own.
Common biases cont:
👉 Outcome bias (judging decisions based on an outcome rather than on the quality of the decision at the time that it was made)
👉 Attribution error (tendency to attribute someone else’s behaviour to a situation to their personality or other intrinsic qualities)
👉 Outcome bias (judging decisions based on an outcome rather than on the quality of the decision at the time that it was made)
👉 Attribution error (tendency to attribute someone else’s behaviour to a situation to their personality or other intrinsic qualities)
February 3, 2025 at 3:58 AM
Common biases cont:
👉 Outcome bias (judging decisions based on an outcome rather than on the quality of the decision at the time that it was made)
👉 Attribution error (tendency to attribute someone else’s behaviour to a situation to their personality or other intrinsic qualities)
👉 Outcome bias (judging decisions based on an outcome rather than on the quality of the decision at the time that it was made)
👉 Attribution error (tendency to attribute someone else’s behaviour to a situation to their personality or other intrinsic qualities)
A just culture in healthcare requires management of common biases:
👉 Confirmation bias (seeking out info that confirms our existing beliefs)
👉 Availability bias (focus on what easily comes to mind)
👉 Representative bias (stereotyping)
👉 Hindsight bias (tendency to see past events as predictable)
👉 Confirmation bias (seeking out info that confirms our existing beliefs)
👉 Availability bias (focus on what easily comes to mind)
👉 Representative bias (stereotyping)
👉 Hindsight bias (tendency to see past events as predictable)
February 3, 2025 at 3:56 AM
A just culture in healthcare requires management of common biases:
👉 Confirmation bias (seeking out info that confirms our existing beliefs)
👉 Availability bias (focus on what easily comes to mind)
👉 Representative bias (stereotyping)
👉 Hindsight bias (tendency to see past events as predictable)
👉 Confirmation bias (seeking out info that confirms our existing beliefs)
👉 Availability bias (focus on what easily comes to mind)
👉 Representative bias (stereotyping)
👉 Hindsight bias (tendency to see past events as predictable)
Justice can take make forms:
👉 Distributive justice (determines how resources are allocated)
👉 Procedural justice (determines how people are treated)
👉 Retributive justice (punishment for wrong-doings)
👉 Restorative justice (restoring relationships)
👉 Distributive justice (determines how resources are allocated)
👉 Procedural justice (determines how people are treated)
👉 Retributive justice (punishment for wrong-doings)
👉 Restorative justice (restoring relationships)
February 3, 2025 at 12:04 AM
Justice can take make forms:
👉 Distributive justice (determines how resources are allocated)
👉 Procedural justice (determines how people are treated)
👉 Retributive justice (punishment for wrong-doings)
👉 Restorative justice (restoring relationships)
👉 Distributive justice (determines how resources are allocated)
👉 Procedural justice (determines how people are treated)
👉 Retributive justice (punishment for wrong-doings)
👉 Restorative justice (restoring relationships)
Non-maleficence is aligned with the notion of doing no harm. Beneficence is a positive duty to promote wellbeing, but at times raises issues of paternalism and conflict with the respect for autonomy principle
February 3, 2025 at 12:00 AM
Non-maleficence is aligned with the notion of doing no harm. Beneficence is a positive duty to promote wellbeing, but at times raises issues of paternalism and conflict with the respect for autonomy principle
Respect for autonomy imposes both negative and positive obligations on clinicians:
👉 Negative obligation not to interfere in choice
👉 Positive obligation to provide appropriate information so that an informed decision can be made
👉 Negative obligation not to interfere in choice
👉 Positive obligation to provide appropriate information so that an informed decision can be made
February 2, 2025 at 11:58 PM
Respect for autonomy imposes both negative and positive obligations on clinicians:
👉 Negative obligation not to interfere in choice
👉 Positive obligation to provide appropriate information so that an informed decision can be made
👉 Negative obligation not to interfere in choice
👉 Positive obligation to provide appropriate information so that an informed decision can be made
In 2009, Beauchamp and Childress proposed four principles to help guide ethical decisions:
👉 Respect for autonomy
👉 Non-maleficence
👉 Beneficence
👉 Justice
👉 Respect for autonomy
👉 Non-maleficence
👉 Beneficence
👉 Justice
February 2, 2025 at 11:57 PM
In 2009, Beauchamp and Childress proposed four principles to help guide ethical decisions:
👉 Respect for autonomy
👉 Non-maleficence
👉 Beneficence
👉 Justice
👉 Respect for autonomy
👉 Non-maleficence
👉 Beneficence
👉 Justice
The CUtLASS 2 trial was of a similar design and compared use of clozapine with other second generation antipsychotics, in patients who had not responded well to two or more previous drugs. Results showed significant advantage for clozapine in symptom improvements over 1 year
February 2, 2025 at 11:50 PM
The CUtLASS 2 trial was of a similar design and compared use of clozapine with other second generation antipsychotics, in patients who had not responded well to two or more previous drugs. Results showed significant advantage for clozapine in symptom improvements over 1 year
Other interesting findings from CUtLASS include:
👉 Some patients with FGAs did better in terms of quality of life and symptom reduction
👉 No significant differences in rates of objectively assessed EPSEs
👉 No clear preference for either class of drug by participants
👉 Some patients with FGAs did better in terms of quality of life and symptom reduction
👉 No significant differences in rates of objectively assessed EPSEs
👉 No clear preference for either class of drug by participants
February 2, 2025 at 11:49 PM
Other interesting findings from CUtLASS include:
👉 Some patients with FGAs did better in terms of quality of life and symptom reduction
👉 No significant differences in rates of objectively assessed EPSEs
👉 No clear preference for either class of drug by participants
👉 Some patients with FGAs did better in terms of quality of life and symptom reduction
👉 No significant differences in rates of objectively assessed EPSEs
👉 No clear preference for either class of drug by participants
The CUtLASS (UK Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) comprised open randomised trials, comparing outcomes of first generation antipsychotics vs second generation antipsychotics across 1 year. Benefits of SGA were much smaller than hypothesised
February 2, 2025 at 11:44 PM
The CUtLASS (UK Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) comprised open randomised trials, comparing outcomes of first generation antipsychotics vs second generation antipsychotics across 1 year. Benefits of SGA were much smaller than hypothesised
One way that this debate is articulated, is through the conceptual “recovery from” versus “recovery in” dichotomy. Clinicians usually consider recovery from mental illness. Consumers may instead focus on recovery in mental health.
February 2, 2025 at 11:32 PM
One way that this debate is articulated, is through the conceptual “recovery from” versus “recovery in” dichotomy. Clinicians usually consider recovery from mental illness. Consumers may instead focus on recovery in mental health.
The CHIME framework is a model for personal recovery, supported by the @ranzcp.bsky.social. It includes:
👉 Connectedness (with others)
👉 Hope
👉 Identity (understanding who you are)
👉 Meaning (finding meaning in life)
👉 Empowerment (sense of control, self-efficacy)
👉 Connectedness (with others)
👉 Hope
👉 Identity (understanding who you are)
👉 Meaning (finding meaning in life)
👉 Empowerment (sense of control, self-efficacy)
February 2, 2025 at 11:23 PM
The CHIME framework is a model for personal recovery, supported by the @ranzcp.bsky.social. It includes:
👉 Connectedness (with others)
👉 Hope
👉 Identity (understanding who you are)
👉 Meaning (finding meaning in life)
👉 Empowerment (sense of control, self-efficacy)
👉 Connectedness (with others)
👉 Hope
👉 Identity (understanding who you are)
👉 Meaning (finding meaning in life)
👉 Empowerment (sense of control, self-efficacy)
Recovery-oriented practice often has similarities with patient-centred care, but recovery goals may be very attainable without clinical improvement
February 2, 2025 at 11:20 PM
Recovery-oriented practice often has similarities with patient-centred care, but recovery goals may be very attainable without clinical improvement
Markers of recovery-orientated practice include:
👉 Focus on needs of service-users not organisational priorities
👉 Use of language that reflects hope, optimism
👉 Engaging people with lived experience in decisions
👉 Engaging carers/significant others
👉 Working across all social determinants of health
👉 Focus on needs of service-users not organisational priorities
👉 Use of language that reflects hope, optimism
👉 Engaging people with lived experience in decisions
👉 Engaging carers/significant others
👉 Working across all social determinants of health
February 2, 2025 at 11:14 PM
Markers of recovery-orientated practice include:
👉 Focus on needs of service-users not organisational priorities
👉 Use of language that reflects hope, optimism
👉 Engaging people with lived experience in decisions
👉 Engaging carers/significant others
👉 Working across all social determinants of health
👉 Focus on needs of service-users not organisational priorities
👉 Use of language that reflects hope, optimism
👉 Engaging people with lived experience in decisions
👉 Engaging carers/significant others
👉 Working across all social determinants of health
Descriptions of recovery vary. Clinical recovery focuses on objective improvements in symptoms and function. Personal recovery focuses on living a meaningful life. There exists continuing debate about the intersection of these two recovery definitions
February 2, 2025 at 9:59 PM
Descriptions of recovery vary. Clinical recovery focuses on objective improvements in symptoms and function. Personal recovery focuses on living a meaningful life. There exists continuing debate about the intersection of these two recovery definitions
The concept of recovery is an important principle in #psychiatry. It originated in the 1970s as a social movement aimed at improving the human rights and social inclusion of people with #mentalillness. In 1998 NZ became first country to require mental health services use a recovery approach
January 27, 2025 at 4:44 AM
The concept of recovery is an important principle in #psychiatry. It originated in the 1970s as a social movement aimed at improving the human rights and social inclusion of people with #mentalillness. In 1998 NZ became first country to require mental health services use a recovery approach
Main outcomes cont:
👉 Clozapine significantly more effective than quetiapine or risperidone
👉 No superiority in any agent WRT psychosocial functioning
👉 No advantages in efficacy for second generation agents WRT negative symptoms
👉 Each agent might be most useful in particular situations
👉 Clozapine significantly more effective than quetiapine or risperidone
👉 No superiority in any agent WRT psychosocial functioning
👉 No advantages in efficacy for second generation agents WRT negative symptoms
👉 Each agent might be most useful in particular situations
January 26, 2025 at 6:03 AM
Main outcomes cont:
👉 Clozapine significantly more effective than quetiapine or risperidone
👉 No superiority in any agent WRT psychosocial functioning
👉 No advantages in efficacy for second generation agents WRT negative symptoms
👉 Each agent might be most useful in particular situations
👉 Clozapine significantly more effective than quetiapine or risperidone
👉 No superiority in any agent WRT psychosocial functioning
👉 No advantages in efficacy for second generation agents WRT negative symptoms
👉 Each agent might be most useful in particular situations
Main outcomes included:
👉 Olanzapine significantly more effective than risperidone or quetiapine, and favoured over ziprasidone or perphenazine. But associated with most weight gain
👉 In those who did not tolerate use of perphenazine, quetiapine was most well tolerated option
👉 Olanzapine significantly more effective than risperidone or quetiapine, and favoured over ziprasidone or perphenazine. But associated with most weight gain
👉 In those who did not tolerate use of perphenazine, quetiapine was most well tolerated option
January 26, 2025 at 5:55 AM
Main outcomes included:
👉 Olanzapine significantly more effective than risperidone or quetiapine, and favoured over ziprasidone or perphenazine. But associated with most weight gain
👉 In those who did not tolerate use of perphenazine, quetiapine was most well tolerated option
👉 Olanzapine significantly more effective than risperidone or quetiapine, and favoured over ziprasidone or perphenazine. But associated with most weight gain
👉 In those who did not tolerate use of perphenazine, quetiapine was most well tolerated option
Perphenazine was used as first generation agent of choice, and options for second generation antipsychotics included olanzapine, quetiapine, risperidone and ziprasidone. Clozapine was included in phase 2 of the study
January 26, 2025 at 5:50 AM
Perphenazine was used as first generation agent of choice, and options for second generation antipsychotics included olanzapine, quetiapine, risperidone and ziprasidone. Clozapine was included in phase 2 of the study
CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) was an NIMH-funded study in the US that compared the effectiveness of first generation antipsychotics (available in 1950s) to second generation (available since 1990s) for use in schizophrenia
January 26, 2025 at 5:47 AM
CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) was an NIMH-funded study in the US that compared the effectiveness of first generation antipsychotics (available in 1950s) to second generation (available since 1990s) for use in schizophrenia
General conclusions cont:
👉 If initial treatment doesn’t work, both augmentation and switching strategies are appropriate next steps
👉 Likelihood of improvement after two aggressive medication trials is much lower
👉 If initial treatment doesn’t work, both augmentation and switching strategies are appropriate next steps
👉 Likelihood of improvement after two aggressive medication trials is much lower
January 26, 2025 at 5:37 AM
General conclusions cont:
👉 If initial treatment doesn’t work, both augmentation and switching strategies are appropriate next steps
👉 Likelihood of improvement after two aggressive medication trials is much lower
👉 If initial treatment doesn’t work, both augmentation and switching strategies are appropriate next steps
👉 Likelihood of improvement after two aggressive medication trials is much lower
General conclusions:
👉 Pharmacological differences in medications didn’t translate into substantial clinical differences, with the exception of tolerability for the patient
👉 Should ensure trial of maximal tolerable dose of antidepressant for at least 8 weeks before determining intervention failed
👉 Pharmacological differences in medications didn’t translate into substantial clinical differences, with the exception of tolerability for the patient
👉 Should ensure trial of maximal tolerable dose of antidepressant for at least 8 weeks before determining intervention failed
January 26, 2025 at 5:34 AM
General conclusions:
👉 Pharmacological differences in medications didn’t translate into substantial clinical differences, with the exception of tolerability for the patient
👉 Should ensure trial of maximal tolerable dose of antidepressant for at least 8 weeks before determining intervention failed
👉 Pharmacological differences in medications didn’t translate into substantial clinical differences, with the exception of tolerability for the patient
👉 Should ensure trial of maximal tolerable dose of antidepressant for at least 8 weeks before determining intervention failed
Level three outcomes showed:
👉 Switching medications during this level was not as effective as it had been during second step
👉 Medication augmentation was also less effective than during second step
👉 Switching medications during this level was not as effective as it had been during second step
👉 Medication augmentation was also less effective than during second step
January 26, 2025 at 5:32 AM
Level three outcomes showed:
👉 Switching medications during this level was not as effective as it had been during second step
👉 Medication augmentation was also less effective than during second step
👉 Switching medications during this level was not as effective as it had been during second step
👉 Medication augmentation was also less effective than during second step
Level two outcomes included:
👉 Additional 30% participants achieved remission
👉 No difference between cognitive therapy and medication. However augmentation with antidepressant was more rapidly effective, while CBT was better tolerated
👉 Additional 30% participants achieved remission
👉 No difference between cognitive therapy and medication. However augmentation with antidepressant was more rapidly effective, while CBT was better tolerated
January 26, 2025 at 5:28 AM
Level two outcomes included:
👉 Additional 30% participants achieved remission
👉 No difference between cognitive therapy and medication. However augmentation with antidepressant was more rapidly effective, while CBT was better tolerated
👉 Additional 30% participants achieved remission
👉 No difference between cognitive therapy and medication. However augmentation with antidepressant was more rapidly effective, while CBT was better tolerated
Outcomes from level one:
👉 Remission rate 27-33%
👉 Response rate 47%
👉 Higher remission associated w women, employment, education, higher income
👉 Lower remission associated w chronic illness, concurrent psychiatric illness, lower QOL at baseline
👉 Required 7 weeks on average for remission
👉 Remission rate 27-33%
👉 Response rate 47%
👉 Higher remission associated w women, employment, education, higher income
👉 Lower remission associated w chronic illness, concurrent psychiatric illness, lower QOL at baseline
👉 Required 7 weeks on average for remission
January 26, 2025 at 5:16 AM
Outcomes from level one:
👉 Remission rate 27-33%
👉 Response rate 47%
👉 Higher remission associated w women, employment, education, higher income
👉 Lower remission associated w chronic illness, concurrent psychiatric illness, lower QOL at baseline
👉 Required 7 weeks on average for remission
👉 Remission rate 27-33%
👉 Response rate 47%
👉 Higher remission associated w women, employment, education, higher income
👉 Lower remission associated w chronic illness, concurrent psychiatric illness, lower QOL at baseline
👉 Required 7 weeks on average for remission
Level three included options for addition of lithium, or switch to mirtazapine (tetracycline) or nortriptyline (tricyclic). Level four consisted of use of a monoamine oxidase inhibitor or a combination of mirtazapine with venlafaxine
January 26, 2025 at 5:08 AM
Level three included options for addition of lithium, or switch to mirtazapine (tetracycline) or nortriptyline (tricyclic). Level four consisted of use of a monoamine oxidase inhibitor or a combination of mirtazapine with venlafaxine