Guilera, Georgina; Pino, Oscar; Gómez-Benito, Juana; Rojo, J Emilio; Vieta, Eduard; Tabarés-Seisdedos, Rafael; Segarra, Nuria; Martínez-Arán, Anabel; Franco, Manuel; Cuesta, Manuel J; Crespo-Facorro, Benedicto; Bernardo, Miguel; Purdon, Scot E; Díez, Teresa; Rejas, Javier
Background The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients. PMID:19338661
Background The Screen for Cognitive Impairment in Psychiatry (SCIP) is a simple and easy to administer scale developed for screening cognitive deficits. This study presents the diagnostic-specific standardization data for this scale in a sample of schizophrenia and bipolar I disorder patients. Methods Patients between 18 and 55 years who are in a stable phase of the disease, diagnosed with schizophrenia, schizoaffective disorder, schizophreniform disorder, or bipolar I disorder were enrolled in this study. Results The SCIP-S was administered to 514 patients (57.9% male), divided into two age groups (18–39 and 40–55 years) and two educational level groups (less than and secondary or higher education). The performance of the patients on the SCIP-S is described and the transformed scores for each SCIP-S subtest, as well as the total score on the instrument, are presented as a percentile, z-score, T-scores, and IQ quotient. Conclusions We present the first jointly developed benchmarks for a cognitive screening test exploring functional psychosis (schizophrenia and bipolar disorder), which provide increased information about patient’s cognitive abilities. Having guidelines for interpreting SCIP-S scores represents a step forward in the clinical utility of this instrument and adds valuable information for its use. PMID:23648193
Shankar, Rohit; Laugharne, Richard; Pritchard, Colin; Joshi, Pallavi; Dhar, Romika
Objective: The Attitudes to Psychiatry Scale (APS) is a tool used to assess medical students' attitudes toward psychiatry. This study sought to examine the internal validity of the APS in order to identify dimensions within the questionnaire. Method: Using data collected from 549 medical students from India and Ghana, the authors analyzed 28…
Wang, Xiao-Jing; Krystal, John H.
Psychiatric disorders such as autism and schizophrenia arise from abnormalities in brain systems that underlie cognitive, emotional and social functions. The brain is enormously complex and its abundant feedback loops on multiple scales preclude intuitive explication of circuit functions. In close interplay with experiments, theory and computational modeling are essential for understanding how, precisely, neural circuits generate flexible behaviors and their impairments give rise to psychiatric symptoms. This Perspective highlights recent progress in applying computational neuroscience to the study of mental disorders. We outline basic approaches, including identification of core deficits that cut across disease categories, biologically-realistic modeling bridging cellular and synaptic mechanisms with behavior, model-aided diagnosis. The need for new research strategies in psychiatry is urgent. Computational psychiatry potentially provides powerful tools for elucidating pathophysiology that may inform both diagnosis and treatment. To achieve this promise will require investment in cross-disciplinary training and research in this nascent field. PMID:25442941
Park, Young Su; Park, Sang Min; Jun, Jin Yong
Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea. PMID:25395966
Park, Young Su; Park, Sang Min; Jun, Jin Yong; Kim, Seog Ju
Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.
Tang, S; Helmeste, D
The American managed care movement has been viewed as a big experiment and is being watched closely by the rest of the world. In the meanwhile, computer-based information technology (IT) is changing the practice of medicine, much more rapidly than managed care. A New World of digitized knowledge and information has been created. Although literature on IT in psychiatry is largely absent in peer-reviewed psychiatric journals, IT is finding its way into all aspects of medicine, particularly psychiatry. Telepsychiatry programs are becoming very popular. At the same time, medical information sites are flourishing and evolving into a new health-care industry. Patient-physician information asymmetry is decreasing as patients are gaining easy access to medical information hitherto only available to professionals. Thus, psychiatry is facing another paradigm shift, at a time when most attention has been focused on managed care. In this new digital world, knowledge and information are no longer the sole property of professionals. Value will migrate from traditional in-person office-based therapy to digital clinical products, from in-person library search and classroom didactic instruction to interactive on-line searches and distance learning. In this time of value migration, psychiatrists have to determine what their 'distinctive competence' is and where best to add value in the health-care delivery value chain. The authors assess the impact of IT on clinical psychiatry and review how clinical practice, education and research in psychiatry are expected to change in this emerging digital world.
Lewis, Catherine F.
Objective: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been…
This book contains the following five chapters: Positron Emission Tomography (PET) in Psychiatry; Regional Cerebral Blood Flow (CBF) in Psychiatry: Methodological Issues; Regional Cerebral Blood Flow in Psychiatry: Application to Clinical Research; Regional Cerebral Blood Flow in Psychiatry: The Resting and Activated Brains of Schizophrenic Patients; and Brain Electrical Activity Mapping (BEAM) in Psychiatry.
... What Is Psychiatry? Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of ... written examination for a state license to practice medicine, and then complete four years of psychiatry residency. ...
Gulati, Prannay; Das, Subhash; Chavan, B. S.
Context: Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. Aims: (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Settings and Design: Cross-sectional, single assessment study conducted at a tertiary hospital. Subjects and Methods: Participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire-12 (GHQ-12), opinion about mental illness (OMI) scale, and attitude to psychiatry-29 (ATP-29) scale. Statistical Analysis: Standard descriptive statistics (mean, percentage), Chi-square test. Results: A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Conclusions: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry. PMID:25316938
Beyond an a priori antagonism between these two notions, alienism and mental health cultivate analogies as to the place to which they assign mental health. Is community psychiatry not therefore simply a parenthesis in the history of psychiatry? The question is raised therefore regarding the place given to subjectivity and complexity. What must be done to ensure that this parenthesis of community psychiatry does not close? It is perhaps a case of making use of the tools which institutional psychotherapy has developed to keep the community psychiatry spirit alive.
Tranøy, Joar; Blomberg, Wenche
Lobotomy is still a hidden chapter in the history of Norwegian psychiatry. The main reasons, which are discussed here, may have been the role of Ørnulv Ødegård at Gaustad Hospital in Oslo and the links between health authorities and the power élite in Norwegian psychiatry.
Matcheswalla, Yusuf; De Sousa, Avinash
Psychiatry and crime are linked in certain ways. On one hand, we have criminal offenders with serious psychopathology; and on the other hand, we have psychiatric patients who may commit criminal offences during the influence of a psychiatric disorder. The psychiatrist in practice has to come in contact with the criminal justice system at some point of time in his career. Forensic psychiatry under whose realm these issues reside is a branch yet underdeveloped in India. The present paper reviews the inter-relationship between crime and psychiatry and the factors involved therein. PMID:25838733
Basu, Amit Ranjan
Our historical endeavour to map Indian psychiatry has largely remained linear, positivistic and evolutionary. Whether it starts from the ancient times or modern, it shows our past as a tale of victory for the western science, without questioning the borrowed paradigm. The use of historical methods for serious enquiry of psychiatry has been ignored. Emergence of a new genre of historicism that is critical of both colonialism and psychiatry as a universal science, has raised hopes to critically review the emergence of psychiatric knowledge.
Basu, Amit Ranjan
Our historical endeavour to map Indian psychiatry has largely remained linear, positivistic and evolutionary. Whether it starts from the ancient times or modern, it shows our past as a tale of victory for the western science, without questioning the borrowed paradigm. The use of historical methods for serious enquiry of psychiatry has been ignored. Emergence of a new genre of historicism that is critical of both colonialism and psychiatry as a universal science, has raised hopes to critically review the emergence of psychiatric knowledge. PMID:20711299
Arthur, R J
The need for psychiatrists in the military was recognized for the first time during World War I, which involved millions of men in unusually protracted warfare. The policy of treating psychiatric casualties close to the from and returning soldiers to their military units as quickly as possible proved of great significance in the U.S. war effort. During World War II, the Korean conflict, and the war in Viet Nam, military psychiatry made great contributions and learned many lessions, both at home and abroad. The lessions learned by military psychiatry have important applications for the rest of medicine, especially in the fields of stress, crisis therapy, and community psychiatry.
Our regular readers will notice that the title of our journal has changed from Annals of General Hospital Psychiatry (AGHP) to Annals of General Psychiatry (AGP) since January 1st, 2005. This was judged as necessary, in order to be able to serve better the aims of the journal. Our initial thoughts were that including the term 'General Hospital' in the journal's title would help us to launch a journal dedicated to the idea of Psychiatry as a medical specialty. But they were not justified; so, now the Annals of General Psychiatry (AGP) is born! It is still an Open Access, peer-reviewed, online journal covering the wider field of Psychiatry, Neurosciences and Psychological Medicine, and aims at publishing articles on all aspects of psychiatry. Primary research articles are the journal's priority, and both basic and clinical neuroscience contributions are encouraged. The AGP strongly supports and follows the principles of evidence-based medicine. AGP's articles are archived in PubMed Central, the US National Library of Medicine's full-text repository of life science literature, and also in repositories at the University of Potsdam in Germany, at INIST in France and in e-Depot, the National Library of the Netherlands' digital archive of all electronic publications. We hope that the change in the journal's name will cure the confusion caused by its previous title and help to achieve the journal's aims and scope, that is to help the world-wide promotion of research and publishing in the mental health area.
De Sousa, Avinash
In this commentary on the article, “The Task Before Psychiatry Today Redux: STSPIR,” (Singh, 2014), the author, while agreeing with most of the paper's findings, proposes a rather parallel judgment that intersects at the same paths ahead. There is a need for widespread and easily available essential mental health services in India. Health agenda must focus on spreading and scaling up psychiatric services. There is also a need to spread awareness of psychiatry and mental health and, as a psychiatrist, one must focus on making psychiatry available to a wider audience. Psychiatrists need to maintain a holistic view of psychiatric disorders while viewing them from both a neurobiological and psychosocial perspective. There is a need to revamp psychiatric training in departments with an increase in the thrust toward fostering translational research excellence in various spheres. Psychiatrists must continue to be trained in psychotherapy and practice it regularly. Psychiatric departments need to promote research excellence and focus on reducing brain drain. The practical applications of the tasks set out for psychiatry are more difficult than one can imagine, and a conscientious effort in that direction shall serve for its betterment. The future is bright and psychiatry must work toward making it brighter. PMID:28031626
Prabhu, H. R. A.
Military personnel, because of the unique nature of their duties and services, are likely to be under stress which at times has no parallel in civilian life. The stress of combat and service in extreme weather conditions often act as major stressors. The modern practices in military psychiatry had their beginning during the two World Wars, more particularly, the IInd World War. The GHPU concept had the beginning in India with military hospitals having such establishments in the care of their clientele. As the nation gained independence, many of the military psychiatrists shifted to the civil stream and contributed immensely in the development of modern psychiatry in India. In the recent years military psychiatry has been given the status of a subspecialty chapter and the military psychiatrists have been regularly organizing CMEs and training programs for their members to prepare them to function in the special role of military psychiatrists. PMID:21836702
Stewart, Adam Michael; Ullmann, Jeremy F.P.; Norton, William H.J.; Brennan, Caroline H.; Parker, Matthew O.; Gerlai, Robert; Kalueff, Allan V.
Due to their well-characterized neural development and high genetic homology to mammals, zebrafish (Danio rerio) have emerged as a powerful model organism in the field of biological psychiatry. Here, we discuss the molecular psychiatry of zebrafish, and its implications for translational neuroscience research and modeling CNS disorders. In particular, we outline recent genetic and technological developments allowing for in-vivo examinations, high-throughput screening and whole-brain analyses in larval and adult zebrafish. We also summarize the application of these molecular techniques to the understanding of neuropsychiatric disease, outlining the potential of zebrafish for modeling complex brain disorders, including attention-deficit/hyperactivity disorder (ADHD), aggression, post-traumatic stress and substance abuse. Critically evaluating the advantages and limitations of larval and adult fish tests, we suggest that zebrafish models become a rapidly emerging new field in modern biological psychiatry research. PMID:25349164
Opposing positions on mental disorder in current psychiatry, their origins and therapy are presented through a few extreme viewpoints. Considering the foundations of the 'medical model' of psychiatric disorder (Griesinger), it is evident that this model is not a closed system, but rather an open approach which still has validity today. The humanitarian roots of psychiatry prevented Griesinger from treating various positions in an absolute or ideological manner. Finally, the concept of 'illness' is discussed in relation to psychophysiological activation research. Pathology changes in each different situation and is therefore not a static phenomenon. Mental disturbance is not determined by absolute measures, but rather by a reduction in variability of reactions to the particular situation. This concept of illness can determine somato-, psycho-, and sociotherapeutic measures. Psychiatry can only remain based on humanitarian concepts as long as the sciences upon which it is founded are kept in appropriate relation to one another.
In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness. Key Words: Agency • alchemy • behaviour • cause • chemistry • dignity PMID:11579183
das Chagas Medeiros, Francisco; Meireles Sales de Bruin, Veralice; Pinheiro Santana, José Abraão; Bastos Lima, Alexandre; De Francesco Daher, Elizabeth
Objective: Medical residency programs are traditionally known for long working hours, which can be associated with a poor quality of sleep and daytime sleepiness. However, few studies have focused on this theme. Our objective was to investigate sleep quality, daytime sleepiness, and their relation with anxiety, social phobia, and depressive symptoms. Methods: This cross-sectional observational study involved 59 psychiatry residents. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were used to measure the quality of sleep and excessive daytime sleepiness ([EDS] and ESS > 10), respectively. Results: Among the 59 psychiatry residents, 59.3% had poor sleep quality (PSQI > 5) and 28.8% had EDS. Poor sleep quality was associated with higher EDS (P = 0.03) and the year of residency program (P = 0.03). Only 20% of residents with poor sleep had consulted at least once for sleep problems; 54.2% had used medications for sleep; and 16.9% were using medications at the time of interview. Only 30% obtained medication during medical consultations. Poor sleep was associated with irregular sleep hours (P = 0.001) and long periods lying down without sleep (P = 0.03). Poor sleep quality was also associated with high scores of anxiety symptoms (P < 0.001) and social phobia symptoms (P = 0.02). Conclusion: Psychiatry residents frequently have poor sleep quality and EDS. Considering that sleep disorders can affect quality of life, predispose to metabolic syndrome, and be associated with worse performance at work, attention to this clinical problem is needed. PMID:27582452
Wells, Lloyd A
I discuss the lack of precision in the term 'clinical reasoning' and its relationship to evidence-based medicine and critical thinking. I examine critical thinking skills, their underemphasis in medical education and successful attempts to remediate them. Evidence-based medicine (and evidence-based psychiatry) offer much but are hampered by the ubiquity and flaws of meta-analysis. I explore views of evidence-based medicine among psychiatry residents, as well as capacity for critical thinking in residents before and after a course in philosophy. I discuss decision making by experienced doctors and suggest possible futures of this issue.
A relatively new discipline in the field of human sciences, sophrology seeks, through a physical as well as mental approach, to awaken awareness while energising the patient's resources and capacities. In psychiatry, it favours the development of body awareness and the positive activation of the mental structures, for the greater wellbeing of the patient.
Thomas, Alexander; Sillen, Samuel
White racism has influenced theory and practice in psychiatry and allied fields. Psychiatrists have largely ignored the interactionist approach, as expounded by Sullivan and Rush, in analyzing Negroes within their respective societies. Rather, in the vein of Freudian preoccupation with unconscious motivation, abnormal behavior and what is…
This paper provides a brief historical introduction to the new field of artificial intelligence and describes some applications to psychiatry. It focuses on two successful programs: a model of paranoid processes and an expert system for the pharmacological management of depressive disorders. Finally, it reviews evidence in favor of computerized psychotherapy and offers speculations on the future development of research in this area.
Marková, Ivana S; Berrios, German E
In historical and epistemological terms, psychiatry is a new discipline born during the 19th century. Rooted in both the natural and social sciences, psychiatric objects of inquiry, namely mental symptoms and mental disorders, are hybrid, constituted by the blending of components arising from disparate sources of knowledge ranging from the biological to the semantic in its widest sense. This poses problems for psychiatric research and therapy. Whilst conventional pluralism may be a convenient approach to manage aspects of psychiatric practice, it lacks the capacity to analyse psychiatric objects in their entirety. For the latter, psychiatry demands a new, tailored regional epistemology. This paper outlines the main features of an epistemology specific to the needs of psychiatry. It highlights the relational approach that needs to be taken and illustrates the usefulness of this approach by analysing the structure of psychiatric objects, exploring the manner in which they may be inscribed in the brain, and identifying the need to periodically recalibrate the language of psychiatry.
Anderson-Schmidt, Heike; Adler, Lothar; Aly, Chadiga; Anghelescu, Ion-George; Bauer, Michael; Baumgärtner, Jessica; Becker, Joachim; Bianco, Roswitha; Becker, Thomas; Bitter, Cosima; Bönsch, Dominikus; Buckow, Karoline; Budde, Monika; Bührig, Martin; Deckert, Jürgen; Demiroglu, Sara Y; Dietrich, Detlef; Dümpelmann, Michael; Engelhardt, Uta; Fallgatter, Andreas J; Feldhaus, Daniel; Figge, Christian; Folkerts, Here; Franz, Michael; Gade, Katrin; Gaebel, Wolfgang; Grabe, Hans-Jörgen; Gruber, Oliver; Gullatz, Verena; Gusky, Linda; Heilbronner, Urs; Helbing, Krister; Hegerl, Ulrich; Heinz, Andreas; Hensch, Tilman; Hiemke, Christoph; Jäger, Markus; Jahn-Brodmann, Anke; Juckel, Georg; Kandulski, Franz; Kaschka, Wolfgang P; Kircher, Tilo; Koller, Manfred; Konrad, Carsten; Kornhuber, Johannes; Krause, Marina; Krug, Axel; Lee, Mahsa; Leweke, Markus; Lieb, Klaus; Mammes, Mechthild; Meyer-Lindenberg, Andreas; Mühlbacher, Moritz; Müller, Matthias J; Nieratschker, Vanessa; Nierste, Barbara; Ohle, Jacqueline; Pfennig, Andrea; Pieper, Marlenna; Quade, Matthias; Reich-Erkelenz, Daniela; Reif, Andreas; Reitt, Markus; Reininghaus, Bernd; Reininghaus, Eva Z; Riemenschneider, Matthias; Rienhoff, Otto; Roser, Patrik; Rujescu, Dan; Schennach, Rebecca; Scherk, Harald; Schmauss, Max; Schneider, Frank; Schosser, Alexandra; Schott, Björn H; Schwab, Sybille G; Schwanke, Jens; Skrowny, Daniela; Spitzer, Carsten; Stierl, Sebastian; Stöckel, Judith; Stübner, Susanne; Thiel, Andreas; Volz, Hans-Peter; von Hagen, Martin; Walter, Henrik; Witt, Stephanie H; Wobrock, Thomas; Zielasek, Jürgen; Zimmermann, Jörg; Zitzelsberger, Antje; Maier, Wolfgang; Falkai, Peter G; Rietschel, Marcella; Schulze, Thomas G
The German Association for Psychiatry and Psychotherapy (DGPPN) has committed itself to establish a prospective national cohort of patients with major psychiatric disorders, the so-called DGPPN-Cohort. This project will enable the scientific exploitation of high-quality data and biomaterial from psychiatric patients for research. It will be set up using harmonised data sets and procedures for sample generation and guided by transparent rules for data access and data sharing regarding the central research database. While the main focus lies on biological research, it will be open to all kinds of scientific investigations, including epidemiological, clinical or health-service research.
Weinberg, Michael; LeMelle, Stephanie; Ranz, Jules
In order to improve recruitment into public/community psychiatry fellowships, a survey was administered to understand psychiatry residents' perception of benefits and obstacles to fellowship training. Using standard statistical methods, the responses of those residents who indicated interest in public/community psychiatry training were compared to those who were not. Residents who were interested in public/community psychiatry fellowships were earlier in their training. These same residents gave higher endorsements to items related to quality, location and flexibility of training program, recommendation of colleagues, opportunities for health policy training and networking as compared to residents who were not interested in pursuing a public/community. Those results attained statistical significance while philosophical approaches including emphasis on recovery and tailoring specific training experiences approached significance. Psychiatric residents appear to start residency training with some interest in public/community psychiatry and this interest can be nurtured if public/community psychiatry is emphasized during training.
Nizamie, Shamsul Haque; Tikka, Sai Krishna
Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry and music, neural processing underlying music, music's relation to classical psychology and psychopathology and scientific evidence base for music therapy in major psychiatric disorders. We highlight the role of Indian forms of music and Indian contribution to music therapy. PMID:24891698
Nizamie, Shamsul Haque; Tikka, Sai Krishna
Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry and music, neural processing underlying music, music's relation to classical psychology and psychopathology and scientific evidence base for music therapy in major psychiatric disorders. We highlight the role of Indian forms of music and Indian contribution to music therapy.
Trivedi, J. K.; Goel, Dishanter
Psychiatry has come up as one of the most dynamic branches of medicine in recent years. There are a lot of controversies regarding concepts, nosology, definitions and treatments in psychiatry, all of which are presently under a strict scanner. Differences are so many that even the meaning of psychiatry varies amongst individual psychiatrists. For us, it is an art to practice psychiatry and give the patient what he needs. Still, it should be practiced with great caution and utmost sincerity towards the patient, based on scientific knowledge and not to be guided by individual conceptions alone. Ethics in psychiatry forms an integral part of its basic concept and meaning, and a tight balance should be maintained between professional advancement and patient benefit. In recent years, the scope of psychiatry has enlarged considerably, with wide ranging influences from Sociology, Anthropology and Philosophy on the one hand, and Neurology and Medicine on the other. PMID:22013340
Bagadia, Sanjay V.
Mumbai, like any other Metro city, has its own share of contentious issues influencing psychiatric management. These could be old ongoing issues like myths about medications, electroconvulsive therapy and counselling, or newer ones like our stand on homosexuality and crime related to psychosocial factors. A range of these issues is considered in this paper along with some possible solutions. Getting due credit and status for psychiatry as a medical branch is also a challenge we need to address. PMID:25838737
Psychiatry is a borderline science that has relations on one hand with the methods of knowledge of natural sciences, on the other with those of the humanities. To investigate the bases of its studies, the psychiatric science often refers to literary and philosophical masterpieces. Therefore, the author analyses some examples of the classic fiction which presents psychopathologic issues. Particularly, the author examines some principal topics: anxiety, psychosomatic illness, depression, schizophrenia and delirium.
Dalal, P. K.; Sivakumar, T.
Cognitive deficits have been shown to exist in various psychiatric disorders. Though most Indian studies pertaining to cognition have been replication studies, well designed original studies have also been conducted. This article traces the evolution of cognitive psychiatry in India. Cognitive research has huge potential in India and can help us unravel mysteries of the human mind, identify etiopathogenesis and facilitate treatment of psychiatric disorders. PMID:21836668
Suárez Richards, Manuel
Neuroscientific knowledge have enter to psychiatry in a new era, however, new technology for viewing images, brain function, psychopharmacology, non-invasive methodology requires an ethical approach, framed in the bioethical environment. The field of neuroethics has evolved to address many of the specific concerns and what neuroenhancement and neuroimaging provide us, is necessary to extend the scope of ethical things to consider the clinical implications for the psychiatric work.
Reynolds, Edward H; Trimble, Michael R
This article reviews the relationship between the psychiatry and neurology of epilepsy, especially in the last 100 years. Throughout most of its recorded history of 3 to 4 millennia epilepsy has been viewed as a supernatural or mental disorder. Although first suggested by Hippocrates in the 5th century B.C., the concept of epilepsy as a brain disorder only began to take root in the 17th and 18th centuries. The discipline of neurology emerged from "nervous disorders" or neuropsychiatry in the late 19th century, when vascular theories of epilepsy predominated. By the turn of the 19th century psychiatry and neurology were diverging and epilepsy remained to some extent in both disciplines. It was only in the middle of the 20th century with the development of electromagnetic theories of epilepsy that the concept of epilepsy per se as a neurological disorder was finally adopted in international classifications of disease. This was associated with a refined definition of the ictal, pre-, post-, and interictal psychological disorders of epilepsy, which have contributed to a renaissance of neuropsychiatry. At the beginning of the 21st century and the centenary of the ILAE psychiatry and neurology have been converging again, led in some respects by epilepsy, which has provided several useful models of mental illness and a bridge between the two disciplines.
Hulshoff Pol, Hilleke; Bullmore, Edward
Over the past three decades numerous imaging studies have revealed structural and functional brain abnormalities in patients with neuropsychiatric diseases. These structural and functional brain changes are frequently found in multiple, discrete brain areas and may include frontal, temporal, parietal and occipital cortices as well as subcortical brain areas. However, while the structural and functional brain changes in patients are found in anatomically separated areas, these are connected through (long distance) fibers, together forming networks. Thus, instead of representing separate (patho)-physiological entities, these local changes in the brains of patients with psychiatric disorders may in fact represent different parts of the same 'elephant', i.e., the (altered) brain network. Recent developments in quantitative analysis of complex networks, based largely on graph theory, have revealed that the brain's structure and functions have features of complex networks. Here we briefly introduce several recent developments in neural network studies relevant for psychiatry, including from the 2013 special issue on Neural Networks in Psychiatry in European Neuropsychopharmacology. We conclude that new insights will be revealed from the neural network approaches to brain imaging in psychiatry that hold the potential to find causes for psychiatric disorders and (preventive) treatments in the future.
Over the last 30 years psychiatry and psychoanalysis have moved in substantially divergent directions. Psychiatry has become rich in methodology but conceptually limited, with a drift toward biological reductionism. Psychoanalysis has remained relatively limited in methodology, but conceptually rich. The rich methodology of psychiatry has led to major contributions in discovering gene by environment interactions, the importance of early adversity, and to recognition of the serious problem posed by treatment resistance. However, psychiatry's biologically reductionistic conceptual focus interferes with the development of a nuanced clinical perspective based on emerging knowledge that might help more treatment resistant patients become treatment responders. This article argues that recognition of the problem of treatment resistance in psychiatry creates a need for it to reconnect with the conceptual richness of psychoanalysis in order to improve patient care. Psychodynamic psychiatry is defined as the relevant intersection of psychiatry and psychoanalysis where this reconnection can occur. I will suggest selected aspects of psychoanalysis that are especially relevant to psychiatry in improving outcomes in work with treatment resistant patients.
A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.
Liptzin, Benjamin; Meyer, Roger E.
Objective: The authors describe the many financial challenges facing academic departments of psychiatry and the resulting opportunities that may arise. Method: The authors review the history of financial challenges, the current economic situation, and what may lie ahead for academic departments of psychiatry. Results: The current environment has…
Some of the important points in geriatric psychology and geriatric psychiatry (such as vocabulary and base line concepts, old myths in geriatrics, reference models, principle of action, therapeutic procedures, nasalgraphy, pluri, inter and transdisciplinarity) will be developed for the dentist practicing geriatric dentistry. Knowledge of these concepts should provide the basis for an effective association with the psychiatrist, in order to enhance better care for the elderly. Two types of approaches of the elderly, well known of the geriatric psychiatrist will be developed. The cognitive and motory approaches will be set as examples capable of helping the exchange between the two specialties.
How might meditation promote wellness and healing from psychiatric illness? How might it contribute to the practice of psychiatry? This review of the literature attempts to answer these questions. Meditation is the consciously willed practice of two actions, attending and abstaining, that all people spontaneously perform to a greater or lesser degree. Psychological health may correlate in part with the degree to which we naturally perform these actions. This review analyzes the nature of meditation and its therapeutic benefits. It then concludes with a summary of the issues pertinent to the adjunctive use of meditation in psychiatric care. PMID:19727302
Doongaji, Dinshaw R.
An overview of psychiatry during the last three decades as practised in a general teaching hospital is presented. Psychiatry as an academic subject has matured tremendously during this period. The empirical treatments of the 1950s and the 1960s which evoke nostalgic memories, have been replaced by modern methods of treatment. However, there is a need to exercise caution against the blind acceptance of new and sophisticated research findings in biological psychiatry. Inspite of the bright future facing psychiatry, the identity of psychiatry as a medical discipline must be preserved at all cost. Psychiatrists should also realise the dangers of gradual fractionation and impersonalisation which threatens the speciality, and makes all possible efforts to prevent this. PMID:21584054
Chan, Lai Gwen; Tomita, Todd
Singapore is a geographically small nation-state that has transformed itself from a third-world country to a developed nation after attaining political independence 46 years ago. The pace of change has been tremendous and mental health care is no exception. This paper provides an overview of mental health care and a review of key mental health legislation, including a National Mental Health Blueprint that was rolled out in 2007. On this background, the paper focuses on a description of forensic psychiatric services in Singapore. The role of the Department of Forensic Psychiatry at the Institute of Mental Health, which is the only forensic psychiatry department in the country, will be highlighted. Civil commitment and the treatment of unfit accused persons and insanity acquittees is reviewed. The role of forensic psychiatric assessments in the Singapore courts is examined. The application of the insanity and diminished responsibility defenses are reviewed. A trend is identified in the Singapore courts towards a more rehabilitation-focused sentencing approach and the role that forensic psychiatric assessments play in cases involving mentally disordered offenders is highlighted.
Psychiatrists would undoubtedly support the notion of promoting such qualities as empathy, sensitivity and caring in the pursuit of good clinical practice. However, cultivating what we may call the "art of psychiatry" is not straightforward, since the qualities that constitute it are elusive. I propose that the means by which we can accomplish the goal of relating empathically and compassionately to our patients and their families is by regarding the humanities and the sciences as of equal relevance and as complementary. The humanities, particularly literature, the visual arts, film and music, are most suited to promoting empathic skills when they are woven into the clinical scenario. Examples are provided to demonstrate how this may be achieved. Were we to succeed in highlighting the art of psychiatry in our educational programs, and as part of continuing professional development, I surmise that our patients and their families would be the beneficiaries. We cannot merely vow to act empathically and sensitively. Instead, we should embark on a lifelong journey through the wonderful world of literature, the visual arts, film and music. The experience will not only prove appealing and engaging, but it will also go far to enrich our personal and professional lives. PMID:16633530
Smalc, Vera Folnegović; Varda, Robert; Grosić, Petra Folnegović
The integrative approach to psychiatry has gained more importance in recent years. Is it justified or not, does it improve theory or practice, those are only some of the questions to which we are looking for answers, but in this paper we shall underline the necessity of enrolling forensic psychiatry into integrative, modern psychiatry. The reason and the motive for that integration is the fact that nowadays the content and the activities of contemporary forensic psychiatrists are totally reduced to executing the tasks given by courts. It is therefore entirely right to say that current forensic psychiatry finds itself in the passive role of executing orders of the court. Our aim is to point out how important it is that forensic psychiatry becomes an interdisciplinary profession in interaction with psychiatry but also with other medical branches just as with judiciary, educational institutions, moral-ethical institutions and religious institutions in producing preventive programmes and by participating in individual decision making process likewise. Our primary goal is to present the status and the position of contemporary forensic psychiatry and to specify the necessary improvements and its place in integrative psychiatry. It should be better, more meaningful and more ethical, both for the individual and the society in total. We want forensic psychiatry to include a protective and therapeutic role for each individual forensic examinee, i.e. a person who has already been in forensic examination and for whom one evaluates mental competence because of a mental disorder. We also want it to get a far larger and more active general role in society in terms of preventing criminal acts among the mentally ill and in society in total.
Gordon, Robert; Miller, John; Collins, Noel
YouTube is a video-sharing website that is increasingly used to share and disseminate health-related information, particularly among younger people. There are reports that social media sites, such as YouTube, are being used to communicate an anti-psychiatry message but this has never been confirmed in any published analysis of YouTube clip content. This descriptive study revealed that the representation of 'psychiatry' during summer 2012 was predominantly negative. A subsequent smaller re-analysis suggests that the negative portrayal of 'psychiatry' on YouTube is a stable phenomenon. The significance of this and how it could be addressed are discussed.
Stoddard, Frederick J; Gold, Joel; Henderson, Schuyler W; Merlino, Joseph P; Norwood, Ann; Post, Jerrold M; Shanfield, Stephen; Weine, Stevan; Katz, Craig L
Terrorism has dominated the domestic and international landscape since 9/11. Like other fields, psychiatry was not well prepared. With the 10th anniversary of the 9/11 attack approaching, it is timely to consider what can be done to prepare before the next event. Much has been learned to provide knowledge and resources. The roles of psychiatrists are challenged by what is known of the causes of, consequences of, and responses to terrorism. Reflecting on knowledge from before and since 9/11 introduces concepts, how individuals become terrorists, how to evaluate the psychiatric and behavioral effects of terrorism, and how to expand treatments, behavioral health interventions, public policy initiatives, and other responses for its victims. New research, clinical approaches, and policy perspectives inform strategies to reduce fear and cope with the aftermath. This article identifies the psychiatric training, skills and services, and ethical considerations necessary to prevent or reduce terrorism and its tragic consequences and to enhance resilience.
Among the specialties involved in the order of 31 August 2010, psychiatry is in Chapter IV alongside addictive behavior and drug use may impair the ability of the driver. As well as for personal vehicles for professional vehicles the incompatibility of health with driving exists when clinical factors can interfere with the skills required of the driver. There would simply absolute incompatibility for psychoses in active phase. In the other phases of psychosis is at the discretion of specialist as for illiteracy or social maladjustment. The role of the authorized psychiatrist is therefore always subjective. This article also makes room for attention-deficit disorder with hyperactivity (ADHD), not listed, but the subject of numerous articles in the English literature.
Gautam, Shiv; Jain, Nikhil
‘Culture’ is an abstraction, reflecting the total way of life of a society. Culture uniquely influences mental health of people living in a given society. Similarity in thinking and understanding of mental health across the ancient cultures has been observed. Studies which relate to the demographic factors, cultural factors influencing presentation of illness, diagnosis of the illness-culture bound syndromes and influence of the cultural factors and the belief system on psychopathology, stigma and discrimination towards the patient have been reviewed. An attempt has been made to critically look at the research on culture and psychiatry in different areas. There is a need for culturally oriented modules of non-pharmacological management. PMID:21836701
Hassan, Tariq; Nizami, Asad Tamizuddin; Hirji, Sarah
This article reviews existing forensic psychiatric services in Pakistan highlighting the role played by the judicial and the medical fraternity in managing the legal and forensic issues of the population of patients with mental illnesses. Until 2001, all legal and forensic issues were dealt with the mental health legislation of 1912, the Lunacy Act of 1912. This was inherited from the British rulers in the Sub-Continent at the time. The Mental Health Ordinance of 2001 could not sustain following the 18th constitutional amendment in 2010, whereby psychiatric healthcare was devolved to the provinces from the previous federal authority. The article also highlights the difficulties and the barriers in implementation of the forensic psychiatric services in Pakistan at various levels within the healthcare system. This article also delves into the current framework of training in forensic psychiatry for postgraduates as well as the assessments and management schedules for the mentally ill offenders at tertiary care institutions in Pakistan.
Alarcón, Renato D
The current scene in the field of cultural psychiatry shows a vigorous growth, multifaceted conceptual and research developments and more relevant clinical presence. After a pertinent definition of the discipline, this chapter examines the contribution of cultural psychiatry to the etiopathogenesis of mental disorders, to the variations of clinical presentations in numerous entities, to psychiatric diagnosis and treatment and to the relatively unexplored rubric of preventive psychiatry. Advanced concepts of neurosciences and technology-based research can find a place in the realm of biocultural correlates. The role of culture in the definition of mental illness, the renewed notions of the old 'culture-bound syndromes', hope, cognition and culture in psychiatric treatments (including the so-called 'cultural therapies'), and resiliency are areas duly examined and discussed. Cultural psychiatry has re-emerged as a reliable body of knowledge aimed at a comprehensive assessment of human beings as patients.
This article is based on German and Japanese sources and shows how around 1900 European psychiatric concepts and practices embedded themselves into emerging scientific Japanese discourses. The article argues that now forgotten German-Japanese exchanges in the field of psychiatric pathology, together with the historical development of psychiatric care, were central mechanisms for the establishment of a distinctly psychiatric discourse in Japan priot to its broad institutionalization. Three discursive strategies were key: Japanese and German experts from a range of medical fields reinvented a body of traditions loosely related to actual pre-modern cultural practices; they engaged in comparative evaluations of psychiatric conditions; and, through the simple but effective transformation of specific concepts and termini at the margins of European psychiatry, these experts contributed to the transfer not only of a psychiatric discourse but also affected the power relations on a national and international scale as European psychiatry permeated into new territory, namely the Japanese landscape of emerging modern scientific disciplines.
Damjanović, Aleksandar; Vuković, Olivera; Jovanović, Aleksandar A; Jasović-Gasić, Miroslava
As one of the most potent and substantial form of mass communication, film exercises a very significant influence upon the perceptions of the audience, especially in relation to mental illness issues, and that perception is very much blurred with populists' misinterpretation and lack of awareness regarding problems faced by persons suffering from mental disorders. Movies such as "Psycho", "One Flew Over Cuckoo's Nest", "Exorcist", despite being valuable in an artistic sense, corroborated and encouraged confusion and undermined the clarity and certainty concerning the fine line separating mental health from mental illness. Modern film makers and movie theoreticians try to overcome these limitations which are often generated by exploitation of stereotypes and myths referring to mentally ill people. This paper defines and discusses the most frequent thematic stereotypes seen in movies which are perpetuating stigmatization of mentally ill people. They are: free-spirited rebel, maniac on a killing spree, seducer, enlightened member of society, narcissistic parasite, beastly person (stereotype of animal sort). Psychiatry and cinematography are linked inseparably not only because they creatively complement each other, but also as an opportunity of mutual influences blending into didactical categories and professional driving forces, benefiting both the filmmakers' and the psychiatrists' professions.
Kanas, N.; Manzey, D.
This book deals with psychological, psychiatric, and psychosocial issues that affect people who live and work in space. Unlike other books that focus on anecdotal reports and ground-based simulation studies, this book emphasizes the findings from psychological research conducted during actual space missions. Both authors have been active in such research. What is presented in this readable text has previously been found only in scientific journal articles. Topics that are discussed include: behavioral adaptation to space; human performance and cognitive effects; crewmember interactions; psychiatric responses; psychological counter-measures related to habitability factors, work-design, selection, training, and in-flight monitoring and support; and the impact of expeditionary missions to Mars and beyond. People finding this book of interest will include: psychology and social science students and professors in universities; medical students and residents in psychiatry and aerospace medicine; human factors workers in space and aviation professions; individuals involved with isolated environments on Earth (e.g., the Antarctic, submarines); aerospace workers in businesses and space agencies such as NASA and ESA; and anyone who is interested in learning the facts about the human side of long-duration space missions. Link: http://www.wkap.nl/prod/b/1-4020-1341-8
Singh, Ajai R.
This paper outlines six important tasks for psychiatry today, which can be put in short as: Spread and scale up services;Talk;Science,Psychotherapy;Integrate; andResearch excellence. As an acronym, STSPIR. Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:Mental disorders are leading cause of ill health but bottom of health agenda;Patients face widespread discrimination, human rights violations and lack of facilities;Need to stem the brain drain from developing countries;At any given point, 10% of the adult population report having some mental or behavioural disorder;In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.Talk: Speaking to a wider audience about positive contributions of psychiatry: Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;Defining normality and abnormality;Bringing about greater precision in diagnosis and care;Motivating those helped by psychiatry to speak up;Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;Setting up regular columns in psychiatry journals around the globe, called ‘Patients Speak’, or something similar, wherein those who have been helped get a chance to voice
March, John S.; Silva, Susan G.; Compton, Scott; Anthony, Ginger; DeVeaugh-Geiss, Joseph; Califf, Robert; Krishnan, Ranga
Objective: The current generation of clinical trials in pediatric psychiatry often fails to maximize clinical utility for practicing clinicians, thereby diluting its impact. Method: To attain maximum clinical relevance and acceptability, the Child and Adolescent Psychiatry Trials Network (CAPTN) will transport to pediatric psychiatry the practical…
Ban, Thomas A
In the second half of the 19th century new drugs introduced by the pharmaceutical industry helped lead to the establishment of academic departments in psychiatry. Causal treatment of cerebral pellagra by nicotinic acid and cerebral syphilis by penicillin in the first half of the 20th century led to major changes in the diagnostic distribution of psychiatric patients. In the second half of the 20th century with the introduction of a rapidly growing number of psychotropic drugs, pharmacotherapy became the primary form of treatment in mental illness. Psychiatrists today perceive neuropharmacology as one of the basic sciences of psychiatry and psychopharmacology as the bridge between the mode of action and the clinical indications of psychotropic drugs. Pharmacotherapy with psychotropic drugs focused attention on the differential responsiveness to the same drug within the same diagnostic category. Yet, instead of re-evaluating psychiatric nosology and conducting research in psychopathology, a statistical methodology was adopted for the demonstration of therapeutic effectiveness in pharmacologically heterogeneous populations. Employment of consensus-based classifications and psychiatric rating scales in the clinical development of psychotropic drugs led to semi-finished products, which are prescribed indiscriminately. Replacement of single-center clinical trials by multi-center centrally coordinated clinical investigations led to the control of education in pharmacotherapy by the pharmaceutical industry. To separate education from marketing, the identification of the treatment-responsive forms of illness and the delineation of the therapeutic profile of psychotropic drugs are proposed with the employment of a new methodology, the "Composite Diagnostic Evaluation System." It is postulated that development of a pharmacologically valid psychiatric nosology with the employment of a "nosologic matrix" would provide the pharmaceutical industry with the necessary feedback to
Ueda, Mikito; Ishiguro, Shin; Watanabe, Takashi; Saeki, Yoshinori; Shimoda, Kazutaka
Pharmacogenetics/pharmacogenomics has been developed so rapidly in these twenty years and the pharmacogenetic/pharmacogenomic research in psychiatry is also the case. Especially, the impact of genetic polymorphism (e.g., cytochrome P450 (CYP)) on pharmacokinetics of psychotropics have been extensively studied, however, recently, most of the studies in this field have been moved to pharmacodynamic study, i.e., the studies on impact of genetics polymorphism on clinical response and adverse effects to pharmacotherapy with psychotropics. Development of pharmacogenetics/ pharmacogenomics in psychiatry may well lead to a future of individualized pharmacotherapy for psychiatric disorders.
Bayardo, Sergio Javier Villaseñor
Mexican psychiatry initiated since pre-Hispanic times. Historically, treatments were a mixture of magic, science and religion. Ancient Nahuas had their own medical concepts with a holistic view of medicine, considering men and cosmos as a whole. The first psychiatric hospital appeared in 1566 and a more modern psychiatric asylum emerged until 1910. International exchanges of theoretical approaches started in the National University with the visit of Pierre Janet. There were other important figures that influenced Mexican psychiatry, such as Erich Fromm, Henri Ey, Jean Garrabé and Yves Thoret. Regarding Mexican psychiatrists, some of the most important contributors to Mexican psychiatry were José Luis Patiño Rojas, Manuel Guevara Oropeza and Ramón de la Fuente Muñiz. This article includes excerpts from "Clinical Psychiatry", a book by Patiño Rojas where he tries to understand and describe the inner world experienced by patients with schizophrenia; also, the thesis conducted by Guevara Oropeza ("Psychoanalisis"), which is a critical comparison between the theories of Janet and Freud. Finally, we include "The study of consciousness: current status" by Ramón de la Fuente, which leads us through the initial investigations concerning consciousness, its evolution, and the contributions made by psychology, philosophy and neurobiology.
Stein, Dan J
Darwin's seminal publications in the nineteenth century laid the foundation for an evolutionary approach to psychology and psychiatry. Advances in 20th century evolutionary theory facilitated the development of evolutionary psychology and psychiatry as recognized areas of scientific investigation. In this century, advances in understanding the molecular basis of evolution, of the mind, and of psychopathology, offer the possibility of an integrated approach to understanding the proximal (psychobiological) and distal (evolutionary) mechanisms of interest to psychiatry and psychopharmacology. There is, for example, growing interest in the question of whether specific genetic variants mediate psychobiological processes that have evolutionary value in specific contexts, and of the implications of this for understanding the vulnerability to psychopathology and for considering the advantages and limitations of pharmacotherapy. The evolutionary value, and gene-environmental mediation, of early life programming is potentially a particularly rich area of investigation. Although evolutionary approaches to psychology and to medicine face important conceptual and methodological challenges, current work is increasingly sophisticated, and may prove to be an important foundational discipline for clinicians and researchers in psychiatry and psychopharmacology.
... participate in AAGP's annual meeting. I really enjoyed learning about geriatric psychiatry as well as meeting such a warm and caring group of doctors and students. I could see that a lot of work went into the scholars program and I am ...
Brittlebank, Andrew; Hermans, Marc; Bhugra, Dinesh; Pinto da Costa, Mariana; Rojnic-Kuzman, Martina; Fiorillo, Andrea; Kurimay, Tamas; Hanon, Cecile; Wasserman, Danuta; van der Gaag, Rutger Jan
Psychiatry is the largest medical specialty in Europe. Despite efforts to bring harmonisation, training in psychiatry in Europe continues to be very diverse. The Union Européenne des Médecins Spécialistes (UEMS) has issued as from 2000 a charter of requirements for the training in psychiatry with an additional European Framework for Competencies in Psychiatry in 2009. Yet these have not been implemented throughout Europe. In this paper, the diversity in training throughout Europe is approached from different angles: the cultural differences between countries with regards to how mental health care is considered and founded on, the cultural differences between people throughout Europe in all states. The position of psychotherapy is emphasised. What once was the cornerstone of psychiatry as medical specialty seems to have become a neglected area. Seeing the patient with mental health problems within his cultural context is important, but considering him within his family context. The purpose of any training is enabling the trainee to gain the knowledge and acquire the competencies necessary to become a well-equipped professional is the subject of the last paragraph in which trainees consider their position and early career psychiatrists look back to see whether what they were trained in matches with what they need in the working situation. Common standard for training and certification are a necessity within Europe, for the benefit of the profession of psychiatrist but also for patient safety. UEMS is advised to join forces with the Council of National Psychiatric Associations (NPAs) within the EPA and trainings and early career psychiatrist, to discuss with the users what standards should be implemented in all European countries and how a European board examination could ensure professional quality of psychiatrists throughout the continent.
The history of British psychiatry is considered from five main viewpoints: clinical practice, the institutional basis, the legislative basis, lay perspectives of-mental disorder, and European influences. Its philosophical basis can be traced back to the work of the seventeenth-century philosophers. Thomas Hobbes and John Locke. In Scotland, both 'philosophy of mind' and new clinical methods flourished during its Enlightenment; the concept of 'neurosis' was developed by William Cullen. Around 1800, James Prichard's concept of 'moral insanity' became the foundation of modern work on personality disorder and psychopathy. The psychotic illness of King George III, beginning in 1788, led to greater public sympathy for the mentally ill. Attitudes since then have varied, with 'antipsychiatry' becoming very influential in the 1960s. By the mid-eighteenth century, specialised institutions for the mentally ill existed in a number of cities, there were also units attached to charitable general hospitals, but none of these continued after about 1830. The neglect of patients in private madhouses, prisons, and poorhouses led to increasing concern by Parliament, which resulted in the development of public asylums throughout the country. Severe legal restrictions on their activities were modified in 1930 and completely reformed in 1959. From the mid-nineteenth century, French and German influences became increasingly strong, but British universities played no active part in psychiatry until the 1950s. Psycho-analysis did not develop strongly in Britain, where the main contribution was through translation and biography, but some leading analysts came as refugees in the 1930s-as did other psychiatrists from central Europe. Another important influence was that of Adolf Meyer at the Institute of Psychiatry, London, particularly through Sir Aubrey Lewis; physical treatment methods also came to Britain from Europe. In the second half of this century, the most important British
For decades, films across the world have entertained people and affected their attitudes regarding certain issues and conditions. Documentary films have been used by governments in different parts of the world to educate the general public and promote health and prevent the spread of disease as part of public health programs. Psychiatry as a branch of medicine like the rest of medicine continues to develop. With an increasing awareness among the general population and popularity of films showing various aspects of mental illnesses on the rise, educators and teachers are turning their attention to using films for education of medical students and psychiatric trainees. Although films may be stereotypical and prejudiced, they can be used successfully in teaching psychiatry trainees. In this paper, development of a movie club and its use are described and suggestions made to improve the use of films in this process.
The need to merge child and adult psychiatry into a continuum was discussed based on forensic issues in criminal cases involving developmental disorder. Recently, a number of offenders (both juvenile and adult) are being diagnosed with developmental disorder every year, when the system of sending severe juvenile cases from juvenile court to the prosecution as well as the new juror system makes the role of psychiatric examination more important than ever. Because of the unique symptomatology of autism spectrum disorder (ASD), conventional forensic psychiatry does not seem applicable to cases of ASD when making a fair judgement on criminal liability. This indicates that there is a need for not only basic knowledge on child psychiatry for all psychiatrists, but also knowledge on the developmental link between child and adult psychiatry. Therefore, there is a need to merge child and adult psychiatry into a comprehensive field of developmental psychiatry.
Cleghorn, R A
The division between the two cultures of the literary and scientific worlds is considered, as is the division between the two cultures of humanism and somaticism. The development of psychiatric thought important to this latter dichotomy is described through the Age of Enlightenment, the Romantic Movement and the New Enlightenment. The two cultures of our present literary and scientific milieux are equated with the romanticism and somaticism of the past. The development of two cultures in psychiatry is traced, beginning with Freud's attempt to combine science and romanticism, to the present day where one finds some degree of convergence between the somatic and psychoanalytic approaches. Criteria are presented for a greater union of the two cultures in psychiatry.
Cleghorn, R. A.
The division between the two cultures of the literary and scientific worlds is considered, as is the division between the two cultures of humanism and somaticism. The development of psychiatric thought important to this latter dichotomy is described through the Age of Enlightenment, the Romantic Movement and the New Enlightenment. The two cultures of our present literary and scientific milieux are equated with the romanticism and somaticism of the past. The development of two cultures in psychiatry is traced, beginning with Freud's attempt to combine science and romanticism, to the present day where one finds some degree of convergence between the somatic and psychoanalytic approaches. Criteria are presented for a greater union of the two cultures in psychiatry. PMID:20328284
The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry. PMID:16759353
The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry.
Defining bioethics as the rational use of dialogue in the formulation, justification, and application of ethical principles, with the aim ofgenerating good practices in research, clinical practice, and advocacy, this paper focuses on methods for bioethical deliberation relevantto psychiatry. Stressing that bioethics fuses the two main ethical traditions in Western thought, the deontological and the teleological, thepaper emphasizes the three conditions that any intervention, if considered in the context of bioethics, should fulfil: it should be appropriateto the problem at hand, it should be good (in the sense that it does good to those who receive it but also to those who perform it),and it should be just (in the sense that its outcomes can be generalized to the whole of society). Some implications of these notions for thepractice and teaching of psychiatry are presented. PMID:17139356
Palijan, Tija Zarković; Muzinić, Lana; Radeljak, Sanja
For the past several years a numerous studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse. The comorbid substance abuse in violent offenders was usually unrecognized and misdiagnosed. Furthermore, comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorder known in the literature as dual diagnosis and defined by World Health Organization (WHO). In fact, many violent offenders have multiple psychiatric diagnoses. Recent studies have confirmed causal relationship between major psychiatric disorders and concomitant substance abuse (comorbidity) in 50-80% of forensic cases. In general, there is a high level of psychiatric comorbidity in forensic patients with prevalence of personality disorders (50-90%), mood disorders (20-60%) and psychotic disorders (15-20%) coupled with substance abuse disorders. Moreover, the high prevalence of psychiatric comorbidities could be found in mentally retarded individuals, as well as, in epileptic patients. Drugs and alcohol abuse can produce serious psychotoxic effects that may lead to extreme violent behavior and consequently to serious criminal offence such as physical assault, rape, armed robbery, attempted murder and homicide, all due to an altered brain function and generating psychotic-like symptoms. Studies have confirmed a significant statistical relevance in causal relationship between substance abuse and violent offences. In terms of forensic psychiatry, the comorbidity strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offence in the course of clinical assessment and evaluation of violent offenders. Today, the primary focus of forensic psychiatry treatment services (in-patient or community) is management of the violent offenders with psychiatric comorbidity which requires a multilevel, evidence based approach to
This article examines contemporary Ukrainian psychiatry through the voices of patients, practitioners, and advocates, focusing on shifting objects of knowledge, interventions, and institutional transitions. Currently, we are witnessing the reconfiguration of psychiatry on a global scale through neoliberal rhetoric combined with the call for global mental health. The goal of the movement for global mental health is to scale up psychiatric treatments through greater access to psychiatric drugs, justified through the framing of distress as an illness. Neoliberal rhetoric suggests that cutting social service expenditure through the privatization and decentralization of the health care system will stimulate economic growth and, in the long term, combat poverty. This paper traces how these dynamics are playing out in Ukraine, drawing on ethnographic fieldwork conducted at a psychiatric hospital in south-central Ukraine from 2008-2010, while working with a non-governmental organization.
Objective: The discipline of psychiatry, and psychiatry as a career option, have been negatively regarded by medical students for decades. There is a large amount of literature on attitudes of students and the factors that attract them to and detract from psychiatry. The aim of this article is to systematically review this literature from 1990 to…
Sexson, Sandra B.; Thomas, Christopher R.; Pope, Kayla
Objective: Previous studies indicate declining interest in child and adolescent psychiatry (CAP) as a career choice during psychiatry residency training. Programs have developed integrated training in psychiatry and CAP as a means to address the workforce shortage in CAP, but little is known about the number or nature of these training tracks.…
Jeste, Dilip V; Palmer, Barton W; Rettew, David C; Boardman, Samantha
Traditionally, psychiatry has been defined and practiced as a branch of medicine focused on the diagnosis and treatment of mental illnesses. Based on growing empirical evidence, we believe that this definition warrants expansion to include the concept of positive psychiatry. In the present article, we provide a critical overview of this emerging field and a select review of relevant scientific literature. Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions involving positive psychosocial characteristics (PPCs) in people who suffer from or are at high risk of developing mental or physical illnesses. It can also benefit nonclinical populations. Positive psychiatry has 4 main components: (1) positive mental health outcomes (eg, well-being), (2) PPCs that comprise psychological traits (resilience, optimism, personal mastery and coping self-efficacy, social engagement, spirituality and religiosity, and wisdom-including compassion) and environmental factors (family dynamics, social support, and other environmental determinants of overall health), (3) biology of positive psychiatry constructs, and (4) positive psychiatry interventions including preventive ones. There are promising empirical data to suggest that positive traits may be improved through psychosocial and biological interventions. As a branch of medicine rooted in biology, psychiatry, especially with the proposed conceptualization of positive psychiatry, is well poised to provide major contributions to the positive mental health movement, thereby impacting the overall health care of the population.
El-Mallakh, Rif; Zinner, Jill; Mackey, Amanda; Tamas, Rebecca L.; Martin, Chanley M.; Dalton, Jerad; Dhaliwal, Nitu; Luddington, Nicole; Numan, Farhad U.; Nunes, Ross; Taylor, Stephen; Ye, Lu
Objective: Several conspiring factors have resulted in an increase in the level of medical burden in psychiatric patients. Psychiatry residents require increasing levels of medical sophistication. To assess the medical decision-making of psychiatry residents, the authors examined the outcome in subjects initially seen in the emergency psychiatric…
Hirshbein, Laura D.; Fitzgerald, Kate; Riba, Michelle
Objective: This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. Background: Although women have…
Sawyer, Michael Gifford; Giesen, Femke; Walter, Garry
A study to review the amount of time devoted to child psychiatry in undergraduate medical education is conducted. Results conclude that relatively low priority is given to child psychiatry in medical education with suggestions for international teaching standards on the subject.
Nelson, William A.; Pomerantz, Andrew; Schwartz, Jonathan
Objective: Evidence indicates disparities in the number of psychiatrists practicing in rural America compared to urban areas suggesting the need for a greater emphasis on rural psychiatry in residency training programs. The authors offer suggestions for integrating a rural focus in psychiatry residency training to foster greater competency and…
Maryland State Dept. of Health and Mental Hygiene, Baltimore.
The major goal of the 2-year child and adolescent psychiatry fellowship program at the University of Maryland is to provide an integrated but flexible set of learning experiences, with areas of emphasis including child and adolescent development, early intervention and prevention of mental health problems, community child psychiatry, and research.…
Clegg, Kathleen A
Gestalt theory and methods support significant behavioral change and personal growth, yet they have not been widely incorporated into modern psychiatric practice. Challenges to employing Gestalt principles in psychiatric practice exist, such as focus on diagnosis to guide treatment planning, key elements of psychiatric training, primacy of medication management in psychiatric practice, and financial pressures. However, the concepts of the co-created relational field in the here and now, the paradoxical theory of change, the cycle of experience, and the use of experiment are Gestalt concepts and methods that can be effectively applied in the modern practice of clinical psychiatry and psychiatric education.
The history of psychiatry is characterised by the confrontation of theoretical models, or dualism.The contrast between these trends has always added to the richness of this discipline, from Philippe Pinel to Henri Ey, and from Bénédict-Augustin Morel to Valentin Magnan.Today, we are faced with an epistemological malaise which is the result of the domination of neurosciences. In order to protect against the temptation to allow the domination of one of the theoretical models, a return to dualism is recommended.
Jukić, Vlado; Brecić, Petrana; Savić, Aleksandar
Movies are a complex entity representing simultaneously an art form, a powerful industry, and a social phenomenon. The movie industry has always shown keen interest in physicians and medicine in general, and psychiatry in particular has often been in the spotlight. While there can be positive aspects of interaction of the movies and the psychiatry, stigmatization and negative public perception are also the results we often have to consider. Movies exploit psychiatric topics, at the same time portrayal of mental conditions, psychiatrists, and psychiatry on big screen could be used in different kinds of education in psychiatry. We present our initial experience with introducing movies in education of psychiatry residents in Psychiatric Hospital Vrapce.
Ng, B-Y; Chee, K-T
The development of psychiatric services in Singapore during the last 150 years can be divided into four distinct, albeit overlapping, phases: (1) the origins of the Lunatic Asylum; (2) the interruption caused by the Japanese Occupation, and the post-war years; (3) the training of local psychiatrists and mental health professionals; and (4) the development of general hospital psychiatry and community mental health services. Early psychiatry in Singapore was essentially British psychiatry as an outpost but modified by local conditions. Modern psychiatry in Singapore has its roots in Singapore's colonial past and is strongly influenced by Western psychiatry. It has come a long way since its humble beginnings when the first mental hospital was established in 1841.
Forensic psychiatry is the branch of psychiatry that deals with issues arising in the interface between psychiatry and the law, and with the flow of mentally disordered offenders along a continuum of social systems. Modern forensic psychiatry has benefited from four key developments: the evolution in the understanding and appreciation of the relationship between mental illness and criminality; the evolution of the legal tests to define legal insanity; the new methodologies for the treatment of mental conditions providing alternatives to custodial care; and the changes in attitudes and perceptions of mental illness among the public. This paper reviews the current scope of forensic psychiatry and the ethical dilemmas that this subspecialty is facing worldwide. PMID:16946941
Piazzi, Andrea; Testa, Luana; Del Missier, Giovanni; Dario, Mariopaolo; Stocco, Ester
Specific features characterized Italian psychiatry during Fascism (1922-45), distinguishing it from Nazi psychiatry and giving rise to different operational outcomes, so we have investigated the state of Italian psychiatry during this period. We review the historical situation that preceded it and describe the social and health policies that Fascism introduced following new legislative and regulatory acts. We examine the preventive and therapeutic role played by psychiatry (the electric shock was an Italian invention) and, thanks to the Enciclopedia Italiano published during those years, we are able to highlight psychiatry's relationship to psychology, psychoanalysis, philosophy and religion. The shortcomings of Italian psychiatric research and practice are also seen in terms of what the State failed to do rather than what it did.
The idea that psychiatry contains, in principle, a series of levels of explanation has been criticized not only as empirically false but also, by Campbell, as unintelligible because it presupposes a discredited pre-Humean view of causation. Campbell’s criticism is based on an interventionist-inspired denial that mechanisms and rational connections underpin physical and mental causation, respectively, and hence underpin levels of explanation. These claims echo some superficially similar remarks in Wittgenstein’s Zettel. But attention to the context of Wittgenstein’s remarks suggests a reason to reject explanatory minimalism in psychiatry and reinstate a Wittgensteinian notion of levels of explanation. Only in a context broader than the one provided by interventionism is that the ascription of propositional attitudes, even in the puzzling case of delusions, justified. Such a view, informed by Wittgenstein, can reconcile the idea that the ascription mental phenomena presupposes a particular level of explanation with the rejection of an a priori claim about its connection to a neurological level of explanation. PMID:26696908
Meise, Ullrich; Frajo-Apor, Beatrice; Stippler, Stippler; Wancata, Johannes
History shows that the discussion concerning coercive measures against mentally ill is as old as psychiatry itself. The dilemma of psychiatry lies in its double role - having both a therapeutic and a regulatory function. Violence against sick and disabled people conflicts with the ethical principles of helping professions. This, however, is where the danger lies: that the violent parts of psychiatric work - which in the opinion of experts cannot be entirely avoided - are repressed or seen as taboo and are therefore more difficult to control. Comparisons between EU countries of the nature, frequency and duration of coercive measures are difficult because of the heterogeneity of regulation and differences in established practice. Scientific examination of this issue seems to be insufficient. There are only a few studies on important issues such as how patients rate these measures. An open and thorough debate about the meaning and meaninglessness of coercion and violence in psychiatric treatment would be necessary to prevent "routine violence" or the excessive use of force against the mentally ill.
The idea that psychiatry contains, in principle, a series of levels of explanation has been criticized not only as empirically false but also, by Campbell, as unintelligible because it presupposes a discredited pre-Humean view of causation. Campbell's criticism is based on an interventionist-inspired denial that mechanisms and rational connections underpin physical and mental causation, respectively, and hence underpin levels of explanation. These claims echo some superficially similar remarks in Wittgenstein's Zettel. But attention to the context of Wittgenstein's remarks suggests a reason to reject explanatory minimalism in psychiatry and reinstate a Wittgensteinian notion of levels of explanation. Only in a context broader than the one provided by interventionism is that the ascription of propositional attitudes, even in the puzzling case of delusions, justified. Such a view, informed by Wittgenstein, can reconcile the idea that the ascription mental phenomena presupposes a particular level of explanation with the rejection of an a priori claim about its connection to a neurological level of explanation.
The Future Psychiatry Project was founded with the goal to address the critical ratio of research/training / clinic. In
a series of regular meetings, each devoted to a specific clinical topic, data and more advanced models for the clinical area in question
will be analyzed in an integrated and multidisciplinary approach and the real possibility of extension of development and
prospects of scientific advances to the clinic and therapy will be evaluated.The primary methodological objective of the Future
Psychiatry meetings is the training method to overcome the common type of teacher/learner classroom teaching, albeit divided
into the various possibilities offered by different types of educational meetings.The structure is informal, with features of intensive
seminars and suggested modes for better interaction.The objective is the "Think Tank", a common space for study and exchange
of knowledge, experiences, opinions and expectations, aimed at producing an integrated and shared dynamic result, that
can provide a real reference point for participants and for all researchers and clinicians engaged in improving their level of updating
and best clinical activity.The first Future Psychiatry meeting was held in Sermoneta (Latina) in the halls of the Castello Caetani
on September 16th to 18th 2010.The chosen topic was "The Future of Depression: the development of knowledge, the evolution
of therapies". The currently most advanced data of research were discussed and developed in their potential to reach a
shared model taking into account the etiological complexity of Depression and to be a real reference to the possibility of application
to real clinical experience.The main guidelines of the current research and major prospects for development of this in the
field Depression have been outlined, also in relation to the ongoing evolution and the future outlook of the models and tools of
therapy. Psychiatrists' clinical needs and
The Future Psychiatry Project was founded with the goal to address the critical ratio of research/training/clinic. In a series of regular meetings, each devoted to a specific clinical topic, data and more advanced models for the clinical area in question will be analyzed in an integrated and multidisciplinary approach and the real possibility of extension of development and prospects of scientific advances to the clinic and therapy will be evaluated. The primary methodological objective of the Future Psychiatry meetings is the training method to overcome the common type of teacher/learner classroom teaching, albeit divided into the various possibilities offered by different types of educational meetings. The structure is informal, with features of intensive seminars and suggested modes for better interaction. The objective is the "think tank", a common space for study and exchange of knowledge, experiences, opinions and expectations, aimed at producing an integrated and shared dynamic result, that can provide a real reference point for participants and for all researchers and clinicians engaged in improving their level of updating and best clinical activity. The first Future Psychiatry meeting was held in Sermoneta (Latina) in the halls of the Castello Caetani on September 16th to 18th 2010. The chosen topic was "The Future of Depression: the development of knowledge, the evolution of therapies". The currently most advanced data of research were discussed and developed in their potential to reach a shared model taking into account the etiological complexity of Depression and to be a real reference to the possibility of application to real clinical experience. The main guidelines of the current research and major prospects for development of this in the field Depression have been outlined, also in relation to the ongoing evolution and the future outlook of the models and tools of therapy. Psychiatrists' clinical needs and expectations in front of the development of
Without researching psychedelic drugs for medical therapy, psychiatry is turning its back on a group of compounds that could have great potential. Without the validation of the medical profession, the psychedelic drugs, and those who take them off-license, remain archaic sentiments of the past, with the users maligned as recreational drug abusers and subject to continued negative opinion. These two disparate groups--psychiatrists and recreational psychedelic drug users--are united by their shared recognition of the healing potential of these compounds. A resolution of this conflict is essential for the future of psychiatric medicine and psychedelic culture alike. Progression will come from professionals working in the field adapting to fit a conservative paradigm. In this way, they can provide the public with important treatments and also raise the profile of expanded consciousness in mainstream society.
Cultural psychiatry, as a subspecialty of psychiatry and thus medicine, has grown steadily and extensively in the 20th century, especially during the second part of this century. In this article, we look at the origins of cultural psychiatry; at its history through the centuries; at its role in the clinical, educational, and research domains; at its significance in today's conceptualization of the fields of psychiatry and mental health; and at its future perspectives within the realms of both medicine and psychiatry.
Lipowski, Z J
American psychiatry has reached its bicentennial. Holistic-medical foundations have been its hallmark, inspiration, and source of preeminence. Incorporated by psychobiology, the American school, they enabled the growth of psychiatry as a medical specialty and scientific discipline and stimulated unparalleled growth of general hospital psychiatry, psychiatric research and teaching, and psychosomatic medicine and liaison psychiatry. Holistic conceptions, a product of a democratic system and the liberal mind, continue to provide the best framework for psychiatry and an antidote to dogma and fanaticism.
While contemporary mental health services have been marked by the burgeoning of outpatient and preventive care, the historiography of psychiatry remains largely tied to the study of custodial and palliative treatment.The work in which contemporary psychiatry has been involved cannot be adequately understood as a singular, autonomous enterprise based in a residential facility. It has become a technoscience that operates in numerous settings and alongside multiple sciences, technologies and decision-makers. This paper explores what it might mean to 'deinstitutionalize' the history of contemporary psychiatry by examining the case of social therapy for sex offenders in West Germany.
Ranz, Jules M; Deakins, Susan M; LeMelle, Stephanie M; Rosenheck, Stephen D; Kellermann, Sara L
As the oldest, largest, and best known program for training psychiatrists to become public-sector leaders, the Columbia University Public Psychiatry Fellowship (PPF) at New York State Psychiatric Institute has frequently been consulted by other departments of psychiatry planning public and community fellowship programs. PPF's faculty has developed seven core elements for such training programs. The fellowship's longevity and the career paths of its graduates suggest that these core elements represent a best-practices model for fellowship training in public-community psychiatry.
Dike, Charles C
The role of psychiatry in the legal arena is grossly misunderstood and even controversial. Some respected psychiatrists and members of the public have argued that the current state of the science of psychiatry is such that it has little to offer the legal system, and consequently, psychiatrists should be banned from the courts. Alan Stone's critique of forensic psychiatry 25 years ago is probably the most pointed. In this article, a summary of four different responses to Alan Stone's critique will be presented and analyzed.
Serafini, Kelly; Bryant, Katurah; Ikomi, Jolomi; LaPaglia, Donna
Objective Acupuncture has been studied as an adjunct for addictions treatment. Because many hospitals, outpatient clinics, and facilities are integrating acupuncture treatment, it is important that psychiatrists remain informed about this treatment. This manuscript describes the National Acupuncture Detoxification Association (NADA) protocol and its inclusion as part of the curriculum for psychiatry addictions fellows. Methods Psychiatry and psychology fellows completed the NADA training (N = 20) and reported on their satisfaction with the training. Results Overall, participants stated that they found the training beneficial and many were integrating acupuncture within their current practice. Conclusions Results support the acceptability of acupuncture training among psychiatry fellows in this program. PMID:26048457
The two primary audiences for this article are psychiatrists interested in a cultural psychiatry career and academic as well as healthcare leaders who are in a position to support cultural psychiatry training. In addition to describing my own personal journey through cultural psychiatry, this report includes strategic recommendations for becoming a cultural psychiatrist as well as rationales for supporting a cadre of cultural psychiatrists in the coming decades. A World Health Organization (WHO) sponsored program for training clinicians in addictions is described. Finally, the account summarizes those clinical, research, educational, consultative, and leadership roles that cultural training influenced during my career.
Marxism considers psychology and psychiatry to be young and complex sciences which are powerfully affected by the nature of society. Marxism contributes to these sciences by applying dialectical and historical materialism to their study and development. The Marxist critique of psychology and psychiatry under capitalism identifies the immense harmful effect on them of capitalist class ideology in a number of areas: anti-working class theories, racism, national chauvinism, sexism, theories of fixed evil human nature, and false or one-sided theories. Socialism is held to provide a healthy environment for individual psychological development and to utilize psychology and psychiatry for scientific and humane ends.
Levine, Robert; Fink, Max
There is an organized movement by governmental, academic and commercial interests to make evidence-based practice the standard of care in the United States. There is little proof that this model can be adapted to psychiatry. We examine the diagnostic system, the validity of the data from clinical trials and how these are applied to clinical practice. The discipline of psychiatry relies on imprecise and unstable diagnostic criteria. It divides psychiatric disorders into discrete categories based on discussion and consultations among designated experts in the field. The diagnostic system is based on consensus and not experimental evidence. In fact, psychiatric disorders are not discrete. High co-morbidities between disorders and the propensity of one condition to change into another makes the present diagnostic system extremely questionable. Outcomes of clinical trials are defined by fractional reductions in the number and severity of symptoms measured by rating scales and not remission of illness. The data obtained from clinical trials are flawed in design, execution and the selective reporting of outcomes. There is substantial evidence to indicate that both investigators and patients can distinguish between active treatment and placebo in double blind studies. In addition, negative outcomes are frequently not reported. Such evidence impacts not only on the specific study, used as evidence, but invalidates the value of meta analyses. Financial considerations lead to the inclusion of inappropriate subjects into studies and favor newer, patented treatments. When the conclusions derived from evidence-based psychiatry are applied to clinical practice they have little to offer and often produce poor treatment outcomes. In fact, when the data used to support the principles of evidence-based psychiatry are examined, they are unsound. The system itself is best considered an untested hypothesis. The diagnostic system, the manner in which data are gathered, and financial
Rubin, Romina; Jauregui, Ricardo
The changes associated with aging influence the clinical presentation and treatment approach of psychiatric illness. Several psychiatric disorders are common in old age as depression or set of diseases with cognitive impairment requiring geriatric knowledge. In many countries psychiatry of the elderly are called psychogeriatric. Regardless of the name objective of this article is to convey that the psychiatrist who treats patients over 65 years with multiple disorders, with frailty social problems and polypharmacy should have some tools in addition to the thorough understanding of psychiatric illness itself. Teamwork, meet physiological changes of aging and how these affect the response to drugs, atypical presentation of illness and keep in mind the importance of psychosocial and environmental issues both in presentation and in addressing and monitoring of disease.
From the ancient times, there are three basic approaches for the interpretation of the different psychic phenomena: the organic, the psychological, and the sacred approach. The sacred approach forms the primordial foundation for any psychopathological development, innate to the prelogical human mind. Until the second millennium B.C., the Great Mother ruled the Universe and shamans cured the different mental disorders. But, around 1500 B.C., the predominance of the Hellenic civilization over the Pelasgic brought great changes in the theological and psychopathological fields. The Hellenes eliminated the cult of the Great Mother and worshiped Dias, a male deity, the father of gods and humans. With the Father's help and divinatory powers, the warrior-hero made diagnoses and found the right therapies for mental illness; in this way, sacerdotal psychiatry was born. PMID:24725988
Tzeferakos, Georgios; Douzenis, Athanasios
From the ancient times, there are three basic approaches for the interpretation of the different psychic phenomena: the organic, the psychological, and the sacred approach. The sacred approach forms the primordial foundation for any psychopathological development, innate to the prelogical human mind. Until the second millennium B.C., the Great Mother ruled the Universe and shamans cured the different mental disorders. But, around 1500 B.C., the predominance of the Hellenic civilization over the Pelasgic brought great changes in the theological and psychopathological fields. The Hellenes eliminated the cult of the Great Mother and worshiped Dias, a male deity, the father of gods and humans. With the Father's help and divinatory powers, the warrior-hero made diagnoses and found the right therapies for mental illness; in this way, sacerdotal psychiatry was born.
Dax, E C
Community Psychiatry is sometimes regarded as a separate and even as a recent study. The history of its evolution in Australia shows it to have resulted from a logical progression since the earliest days of the psychiatric services. The demand for care completely outstripped the accommodation available so two separate but parallel methods of dealing with this problem were evolved. The first explored how the numbers in the overcrowded hospitals could be reduced, and the second, the ways in which admission could be avoided. Both methods resulted in the expansion of community services. Present day activities must be viewed in this light and community services recognised to be an indivisible portion of a professionally organised total mental health organisation.
Chowdhury, A.N.; Dobson, Teara Wharemate
This paper provides a critical appraisal of the importance of cultural perspective in the psychiatric diagnosis and management plan. The working philosophy of mental health services in New Zealand is primarily monocultural and based on Western medical conceptualisation of diagnosis and treatment protocol. In view of the emphasis on bicultural health perspectives in recent years and in tune with the objectives of the Treaty of Waitangi's ethnocultural partnership, the provision of a culturally safe and sensitive mental health coverage of Maori and Pacific Islander clients has become an important health issue in the country. The present discussion of the ethnocultural influence on clinical psychiatry highlights some of the relevant issues from the transcultural perspective. PMID:21206600
O'Flynn, R R; Waldron, H A
Auguste-Louis Delpech (1818-80) has been remembered principally as the author of the first detailed description of the serious consequences of exposure to carbon disulphide. A close reading of his work suggests that his reputation has been seriously undervalued. The subsequent development of occupational psychiatry, with its emphasis on the distinction between the organic and the functional, may be traced through publications on carbon disulphide. It is argued that a contemporary approach to occupational psychiatry is long overdue. PMID:2183876
Fulford, Kenneth WM; Stanghellini, Giovanni; Broome, Matthew
This article illustrates the practical impact of recent developments in the philosophy of psychiatry in five key areas: patient-centred practice, new models of service delivery, neuroscience research, psychiatric education, and the organisation of psychiatry as an international science-led discipline focused on patient care. We conclude with a note on the role of philosophy in countering the stigmatisation of mental disorder. PMID:16633476
This review traces the evolution of modern medical education in India on the one hand and the formation of the Indian Psychiatric Society and the progress of postgraduate psychiatric education on the other hand, all in the context of Indian psychiatry. The topic is covered under the headings standard of psychiatric education, the goals, competencies required, impact of psychiatric disorders, relation of medicine to psychiatry, and the directions for the future of postgraduate psychiatric training. PMID:21836724
Rutherford, Bret R.; Hellerstein, David J.
Objective: To determine the degree to which the medical humanities have been integrated into the fields of internal medicine and psychiatry, the authors assessed the presence of medical humanities articles in selected psychiatry and internal medicine journals from 1950 to 2000. Methods: The journals searched were the three highest-ranking…
Kuhnigk, Olaf; Strebel, Bernd; Schilauske, Joerg; Jueptner, Markus
Objective: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. Methods: Five hundred and eight medical students in their second, fifth, ninth and tenth…
Sockalingam, Sanjeev; Stergiopoulos, Vicky; Maggi, Julie
Objective: The authors determine psychiatry residents' perceived needs and educational preferences for a physician-manager curriculum. Method: The authors surveyed 102 psychiatry residents at the University of Toronto for their perceived current and desired knowledge and skills in specific administrative areas, and their educational preferences…
Briscoe, Gregory W.; Fore-Arcand, Lisa; Levine, Ruth E.; Carlson, David L.; Spollen, John J.; Pelic, Christopher; Al-Mateen, Cheryl S.
Objective: Psychiatry clerkship training involves many learning components, one of which is acquisition of scholarly knowledge. The authors investigate the reading materials and learning methods used by clinical clerks in their preparation for the National Board of Medical Examiners (NBME) Psychiatry Subject Exam (PSE). Methods: Clerkship students…
Gleason, Mary Margaret; Fritz, Gregory K.
Objectives: The authors describe the history, rationale, and outcomes of combined training programs in pediatrics, psychiatry, and child psychiatry ("triple board"), including narrative feedback from graduates and reflections upon the important components of the program. Methods: This article reviews the background and experiences of triple board…
Jakovljević, Miro; Tomić, Zoran; Maslov, Boris; Skoko, Iko
The mass media has a powerful impact on public attitudes about mental health and psychiatry. The question of identity of psychiatry as a medical profession as well as of the future of psychiatry has been the subject of much controversial discussion. Psychiatry today has the historical opportunity to shape the future of mental health care, medicine and society. It has gained in scientific and professional status by the tremendous increase of knowledge and treatment skills. Psychiatry should build up new transdisciplinary and integrative image of a specialized profession, promote it and make it public. Good public relations are very important for the future of psychiatry.
Aslam, Mubashir; Taj, Tahir; Ali, Arif; Badar, Nasira; Saeed, Farzan; Abbas, Muhammed; Muzaffar, Saad; Abid, Bilal
The objectives of this study were to determine the characteristics of medical students and graduates interested in choosing psychiatry as a career and the obstacles in choosing this field of medicine. Two private and two public medical institutes were surveyed from June 2007 to August 2007. A self-administered questionnaire was distributed to third, fourth and final year students and to medical graduates doing their internship in these four medical institutes. A total of 909 medical students and graduates participated in the study. Seventeen percent of participants responded positively regarding their interest in psychiatry as a career. Significantly higher proportion belonged to private medical institutes (14% vs. 24%, P-value =0.001). There was no significant difference in reporting interest for psychiatry in regard to age, sex, year in medical school and whether or not the participant had done a psychiatry ward rotation. However significantly higher proportion of participants (22%, n=43) were reporting their interest in the field of psychiatry who had done more than a month long psychiatry ward rotation as compared to those participants (14%, n=54) with less than a month or no psychiatry rotation (P-value=0.01). More students were reporting their interest in psychiatry with a family history of psychiatric illness as compared to without family history (24% vs 16%, P-value=0.03). In conclusion, students and graduates with more than a month long rotation in psychiatry, studying in private medical colleges and with a family history of psychiatric illness were more interested in choosing psychiatry as a career. PMID:19753292
Reynolds, Edward H; Wilson, James V Kinnier
We here review Babylonian descriptions of neurological and psychiatric disorders, including epilepsy, stroke, psychoses, obsessive compulsive disorder, phobias, psychopathic behaviour, depression and anxiety. Most of these accounts date from the first Babylonian dynasty of the first half of the second millennium BC, within a millennium and a half of the origin of writing. The Babylonians were remarkably acute and objective observers of medical disorders and human behaviour. Their detailed descriptions are surprisingly similar to modern 19th and 20th century AD textbook accounts, with the exception of subjective thoughts and feelings which are more modern fields of enquiry. They had no knowledge of brain or psychological function. Some neuropsychiatric disorders, e.g. stroke or facial palsy, had a physical basis requiring the attention of a physician or asû, using a plant and mineral based pharmacology; some disorders such as epilepsy, psychoses, depression and anxiety were regarded as supernatural due to evil demons or spirits, or the anger of personal gods, and thus required the intervention of the priest or ašipu; other disorders such as obsessive compulsive disorder and psychopathic behaviour were regarded as a mystery. The Babylonians were the first to describe the clinical foundations of neurology and psychiatry. We discuss these accounts in relation to subsequent and more modern clinical descriptions.
Hünnerkopf, R; Grassl, J; Thome, J
Over the last decade, genomics research in psychiatry and neuroscience has provided important insights into genes expressed under different physiological and pathophysiological conditions. Contrary to the great expectations regarding a clinical use of these datasets, genomics failed to improve markedly the diagnostic and therapeutic options in brain disorders. Due to alternative splicing and posttranslational modifications, one single gene determines a multitude of gene products. Therefore, in order to understand molecular processes in neuropsychiatric disorders, it is necessary to unravel signal transduction pathways and complex interaction networks on the level of proteins, not only DNA and mRNA. Proteomics utilises high-throughput mass spectrometric protein identification that can reveal protein expression levels, posttranslational modifications and protein-protein interactions. Proteomic tools have the power to identify quantitative and qualitative protein patterns in postmortem brain tissue, cerebrospinal fluid (CSF) or serum, thus increasing the knowledge about etiology and pathomechanisms of brain diseases. Comparing protein profiles in healthy and disease states provides an opportunity to establish specific diagnostic and prognostic biomarkers. In addition, proteomic studies of the effects of medication - in vitro and in vivo - might help to design specific pharmaceutical agents with fewer side effects. In this overview, we present the most widely used proteomic techniques and illustrate the potential and limitations of this field of research. Furthermore, we provide insight into the contributions of proteomics to the study of psychiatric diseases such as Alzheimer's disease, drug addiction, schizophrenia and depression.
Qureshi, A; Collazos, F; Ramos, M; Casas, M
Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.
Krasnov, Valery N; Gurovich, Isaak
Russian psychiatry has a dramatic history, and until now has been at a transitional stage of development. It is facing problems not only common in world psychiatry, but also specific to eastern Europe, in particular Russia. Starting from the beginning of the 1990s, considerable changes have occurred in psychiatry, especially after 1992 when the law on psychiatric care and guarantees of citizens' rights in its provision was adopted. It became the ideological and legislative basis for reforms. However, there are definite obstacles to structural reforms in psychiatry. They are unfavourable technical conditions in many psychiatric clinics, hypercentralization of psychiatric services, shortage of clinical psychologists and social workers in psychiatry, some difficulties in cooperation between psychiatric and general medical institutions. Economic difficulties in the transition period of Russia's social development prevent the overcoming of these problems. They are being actively discussed and some of them are being gradually solved, e.g. the organization of team work in mental health services, the increasing number of specialists on social work, and the involvement of non-government organizations in psychosocial rehabilitation.
This contribution provides a critical outline of the current trends in the field of "philosophy of psychiatry" by following their developments in the last decade. The first part of the paper focuses on the evolution of this field from a strictly conceptual approach to a perspective more attentive to the social, practical, and clinical dimension of psychiatry. The second part of the paper points out that the need of a mutual commitment of philosophy and psychiatry is perceived according to different ways by the countries involved in this research area. The paper deals especially with the case of France, where the enthusiasm for the "new philosophy of psychiatry" has not had the same impact on the philosophical scene as in the English speaking countries. In conclusion, the paper shows that the field of philosophy of psychiatry stands as a fertile ground for new forms of interaction between the analytic, and the continental philosophical traditions. This interaction takes place, more particularly, as regards such topics as normativity, language, and interpretation.
Sarris, Jerome; Logan, Alan C; Akbaraly, Tasnime N; Amminger, G Paul; Balanzá-Martínez, Vicent; Freeman, Marlene P; Hibbeln, Joseph; Matsuoka, Yutaka; Mischoulon, David; Mizoue, Tetsuya; Nanri, Akiko; Nishi, Daisuke; Ramsey, Drew; Rucklidge, Julia J; Sanchez-Villegas, Almudena; Scholey, Andrew; Su, Kuan-Pin; Jacka, Felice N
Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest benefits in addressing the burden of poor mental health worldwide. Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology. Evidence is steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental health, and for the select use of nutrient-based supplements to address deficiencies, or as monotherapies or augmentation therapies. We present a viewpoint from an international collaboration of academics (members of the International Society for Nutritional Psychiatry Research), in which we provide a context and overview of the current evidence in this emerging field of research, and discuss the future direction. We advocate recognition of diet and nutrition as central determinants of both physical and mental health.
Neuropsychiatry and psychiatric neuroscience should be part of the general psychiatry curriculum so that graduate psychiatrists will be able to allow their patients the benefit of neuroscientifically informed diagnosis and treatment. Current neurology and neuroscience educational requirements for US psychiatry training are reviewed. The draft milestone requirements for clinical neuroscience training as part of the US Accreditation Council for Graduate Medical Education's Next Accreditation System are also provided. Suggestions for the neuropsychiatric and neuroscience content of psychiatry residency training are made, along with a description of pedagogic methods and resources. Survey data are reviewed indicating agreement by programme directors with the importance of neuroscience training and an increase in the amount of time devoted to this area. Faculty staff development in neuropsychiatry and neuroscience literacy will be needed to provide high quality training in these areas.
Prakash, Jyoti; Ramakrishnan, TS; Das, R. C.; Srivastava, K.; Mehta, Suresh; Shashikumar, R.
Background: Central registry in psychiatry is being practiced in few countries and has been found useful in research and clinical management. Role of central registry has also expanded over the years. Materials and Methods: All accessible internet database Medline, Scopus, Embase were accessed from 1990 till date. Available data were systematically reviewed in structured manner and analyzed. Results: Central registry was found useful in epidemiological analysis, association studies, outcome studies, comorbidity studies, forensic issue, effective of medication, qualitative analysis etc., Conclusion: Central registry proves to be effective tool in quantitative and qualitative understanding of psychiatry practice. Findings of studies from central registry can be useful in modifying best practice and evidence based treatment in psychiatry. PMID:25535438
Crisp-Han, Holly; Chambliss, R. Bryan; Coverdale, John
Objective: Because there have been no previously published national surveys on teaching psychiatry residents about how to teach, the authors surveyed United States psychiatry program directors on what and how residents are taught about teaching. Methods: All psychiatry training programs across the United States were mailed a semistructured…
Shaw, Jon A.; Lewis, John E.; Katyal, Shalini
Objective: The authors studied the factors affecting the recruitment into child and adolescent psychiatry training in the United States. Methods: Medical students (n = 154) and general and child and adolescent psychiatry residents (n = 111) completed a questionnaire to evaluate career choice in child psychiatry (n = 265). Results: Compared with…
Kirmayer, Laurence J.; Rousseau, Cecile; Guzder, Jaswant; Jarvis, G. Eric
Objectives: The authors summarize the pedagogical approaches and curriculum used in the training of clinicians in cultural psychiatry at the Division of Social and Transcultural Psychiatry, McGill University. Method: We reviewed available published and unpublished reports on the history and development of training in cultural psychiatry at McGill…
Dvir, Yael; Moniwa, Emiko; Crisp-Han, Holly; Levy, Dana; Coverdale, John H.
Objective: The authors sought to determine the prevalence of threats and assaults by patients on psychiatry residents, their consequences, and the perceived adequacy of supports and institutional responses. Method: Authors conducted an anonymous survey of 519 psychiatry residents in 13 psychiatry programs across the United States. The survey…
The political abuse of psychiatry in the former USSR was enabled by: 1. a disproportionate pointing up of the medical criteria of mental disorder to the detriment of the social ones, above all by circumventing the sociological labelling process; 2. lack of control of involuntary psychiatric hospitalisation by the law; 3. an obsolete definition of psychiatry. The author suggests a definition of psychiatry taking into consideration both the above mentioned criteria and making the importance of the legal control of involuntary psychiatric hospitalisation more evident.
Darwin's evolutionary theory was the starting point for ethology, associated with an impact on scientific psychiatry. Psychiatry and ethology have common scientific and methodological prerequisites: inductive and deductive methods and "gestalt theory" as a basis for observing and describing behaviour patterns with subsequent causal analysis. There have been early endeavours to anchor ethological thinking in psychiatry but this tendency did not prevail for the following reasons: on the one hand, the methodology of ethology was immature or not applicable to man, whereas on the other hand the dominating experiential phenomenological school of Karl Jaspers and Kurt Schneider stressed the privileged position of human thinking, perception, and feeling. These fundamental categories of human existence did not appear amenable to any causal ethological analysis. Psychiatry and evolutionary biology were linked in an atrocious manner during the Nazi regime, both being abused for propaganda purposes and genocide. More recently, there is a "reconciliation" of both disciplines. In psychiatric nosology, operational, behaviour-oriented diagnostic systems have been introduced; ethology has opened up for theories of learning; new subsections like human ethology and sociobiology have evolved. The seeming incompatibility of (behavioural) biological psychiatry and experiential phenomenological psychopathology may be overcome on the basis of Konrad Lorenz' evolutionary epistemology. The functional analysis of human feeling and behaviour in psychotic disorders on the basis of Jackson's theory of the evolution and dissolution of the nervous system may serve as an example. The significance of an "ethological psychiatry" for diagnostic and therapeutical processes of psychiatric disorders derive from prognostic possibilities and the analysis of non-verbal communication in therapist-patient-interactions, but have not yet been systematically investigated.
Krystal, John H; Murray, John D; Chekroud, Adam M; Corlett, Philip R; Yang, Genevieve; Wang, Xiao-Jing; Anticevic, Alan
Schizophrenia research is plagued by enormous challenges in integrating and analyzing large datasets and difficulties developing formal theories related to the etiology, pathophysiology, and treatment of this disorder. Computational psychiatry provides a path to enhance analyses of these large and complex datasets and to promote the development and refinement of formal models for features of this disorder. This presentation introduces the reader to the notion of computational psychiatry and describes discovery-oriented and theory-driven applications to schizophrenia involving machine learning, reinforcement learning theory, and biophysically-informed neural circuit models.
Shaner, Roderick; Thompson, Kenneth S; Braslow, Joel; Ragins, Mark; Parks, Joseph John; Vaccaro, Jerome V
This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.
Müller, Ulf J; Bogerts, Bernhard; Voges, Jürgen; Galazky, Imke; Kohl, Sina; Heinze, Hans-Jochen; Kuhn, Jens; Steiner, Johann
Deep brain stimulation (DBS) has been shown to be an efficacious treatment for many neurological conditions and has thus been expanded to psychiatric diseases as well. Following an introduction on the history of DBS in psychiatry, this review summarizes commonly raised ethical concerns and questions on clinical trial design, selection of patients, informed consent and concerns about the possible impact of DBS on an individual's personality. Finally, it highlights the fact that critique on DBS in psychiatry is probably not selectively based on scientific concerns about potential risks; instead, the neurobiological origin of specific psychiatric disorders has been questioned.
Amini, Homayoun; Moghaddam, Yasaman; Nejatisafa, Ali-Akbar; Esmaeili, Sara; Kaviani, Hosein; Shoar, Saeed; Shabani, Amir; Samimi-Ardestani, Mehdi; Akhlaghi, Amir Abbas Keshavarz; Noroozi, Alireza; Mafi, Mostafa
Objectives: The study aimed to assess 1) the attitudes of medical students in the sixth and seventh years (known as interns in Iran) toward psychiatry as a career choice, and 2) the degree of attractiveness of psychiatry as a career choice, with regard to various defined aspects, before and after an undergraduate psychiatry internship (similar to…
In this century, marked advances in human genetics and brain imaging technology have finally allowed us to approach fundamental questions in psychiatry, even those in clinical psychiatry, by utilizing biological science. As of 2014, discussion on the advantages and limitations in operational diagnostic criteria, such as DSM (Diagnostic and Statistical Manual of Mental Disorders), in clinical psychiatry is becoming even more important. In contrast to most of the medical areas in which multi-disciplinal approaches are successful, factionalism augmented by mind-brain problem or mind-body problem has hampered the progress of psychiatry. Here I discuss the importance of building integrative perspectives of psychiatry.
A quarter of a century ago the change of the political system in Hungary precipitated a serious value-crisis and caused a lot of harmful effects in nurturing and the development of psychiatry. The author establishes that the attack against psychiatry is more intensive than previously but neither the education and health management nor the psychiatric leadership could cope with these difficulties. It can't be denied that the foundation of lifelong mental health begins in the early life years and about 75% of the first Mental Disorder manifests in adolescence and youth. We are not able to ensure the special rights of every child according to the Hungarian Constitution and the Declaration of the Rights of the Child by the United Nations. The large inequalities within the country, the lack of paramount mental education and nurturing, the lack of essential, consistent eternal values, the lack of required psychiatric care system are huge obstacles of the development of healthy individual and leads to self-destructive behaviour and several, serious physical and mental disorders. The purpose of the author is to call psychiatrists' attention to the main obstacles of the development of Hungarian Psychiatric Care System. The main obstacles of the present psychiatric care system: 1. Unclarified notions, confusion of ideas. 2. Somatic, neurologic, mental, cultural-social and spiritual ignorance. 3. Lack of organization in Mental Education and Psychiatric Care System. 4. Value-crisis in our society despite the fact that the "Council of Wise Men" created a "Scale of the Essential Consistent Eternal Values" for the Hungarian Education System in 2008. 5. Lack of mental health prevention both in education system and health care system. There is no teaching of hygiene lessons in the Hungarian schools. 6. Negligence and selfishness among the population. 7. Disinterest among competent authorities. 8. Leaving the most important possibilities out of consideration. The author establishes
Ansorge, Jessie; Sudres, Jean-Luc
The use of a horse or pony as a therapeutic tool is often presented in the media as a recent phenomenon. A survey of 103 institutions shows that it is in fact an approach well rooted in child and adolescent psychiatry. However, professionals who use equine-assisted therapy are calling for an assessment to be carried out enabling them to hone their practices.
Bouché, Christophe; Marigaux, Sandrine; Pattedoie, Nicolas
Repetitive transcranial magnetic stimulation is a non-invasive treatment technique, using electromagnetism properties. It has been used for around twenty years in neurology (treatment of neuropathic pain, certain abnormal movements, Parkinson's disease), and in psychiatry (obsessive compulsive disorder, hallucinations, mood disorders, etc.). The presence and support of a nurse during the sessions is essential.
Rele, Kiran; Tarrant, C. Jane
Objective: The authors studied the regularity and content of supervision sessions in one of the U.K. postgraduate psychiatric training schemes (Mid-Trent). Methods: A questionnaire sent to psychiatry trainees assessed the timing and duration of supervision, content and protection of supervision time, and overall quality of supervision. The authors…
Gough, Jenny K.; McCallum, Zoe; Bevan, Catherine; Vance, Alasdair
Objective: The teaching of child psychiatry in Australian medical schools is under review: the content, the placement of the field within medical curricula, and the appropriate teaching and learning methods are all contested. The authors developed a 1-day program in the 9-week child and adolescent health course conducted in the final two semesters…
The developments in child psychiatry in the past 25 years have been encouraging but represent only a prelude to the significant work that must be done relatively soon to meet the needs of the contemporary child. Before 1940, the desirability of multidisciplinary study of the child had been well established, and child guidance clinics had appeared.…
Pine, Daniel S.; Ernst, Monique; Leibenluft, Ellen
Objective: To place imaging-genetics research in the context of child psychiatry. Method: A conceptual overview is provided, followed by discussion of specific research examples. Results: Imaging-genetics research is described linking brain function to two specific genes, for the serotonin-reuptake-transporter protein and a monoamine oxidase…
The author provides an annotated bibliography to introduce psychodynamic psychotherapy and psychoanalysis to residents in psychiatry. The emphasis of the selection is on relevance to practice. The entries are grouped by topic, levels of difficulty are noted, and readings are identified as being of either current or historic relevance. PMID:22700303
Pinna, Federica; Del Vecchio, Valeria; Luciano, Mario; Sampogna, Gaia; De Rosa, Corrado; Ferrari, Silvia; Pingani, Luca; Tarricone, Ilaria; Volpe, Umberto; Carrà, Giuseppe; Roncone, Rita; Catapano, Francesco; Fiorillo, Andrea
In this paper we will describe cultural, social and scientific changes occurred in psychiatry in the last years, identifying the new target for mental health professionals. Groups of young psychiatrists from the Italian Psychiatric Association, the European Psychiatric Association and the World Psychiatric Association have established an international network that launched a debate on the future role of psychiatry. In a rapidly changing world, there is the need to: 1) adapt training in psychiatry to the modern world; 2) identify the new target of mental health professionals; 3) enhance the image of psychiatry in the society; 4) overcome stigma towards people with mental disorders. In recent years, socio-cultural and scientific changes have had a significant impact on the psychiatrists' clinical practice. Mental health professionals should deal with these changes appropriately in order to overcome the current "crisis" of psychiatry, which should be considered as a developmental phase rather than a conceptual one. From time to time psychiatry is criticized both from inside and outside the profession. The current crisis was unavoidable due to the recent socio-cultural changes, but it should be considered an opportunity to adapt the profession to modern times.
Rakofsky, Jeffrey J; Ferguson, Britnay A
Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient's psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well.
Weber, Rebecca J; Gadow, Kenneth D
The present study aimed to characterize the association of psychopathology with the clinical correlates of epilepsy, asthma, and allergy within and between neurobehavioral syndromes. Participants were consecutively evaluated youth (6-18 years, 75 % male) with autism spectrum disorder (ASD; n = 589) and non-ASD outpatient psychiatry referrals (n = 653). Informants completed a background questionnaire (parents) and a psychiatric symptom severity rating scale (parents, teachers). Youth with ASD had higher rates of epilepsy and allergy but not asthma than psychiatry referrals, even when analyses were limited to youth with IQ ≥ 70. Somatic conditions evidenced variable associations with medical services utilization, educational interventions, family income, and maternal education. Youth with ASD with versus without epilepsy had more severe ASD social deficits (parents' ratings) and less severe ASD repetitive behaviors (teachers' ratings). Epilepsy was associated with more severe depression, mania, and schizophrenia symptoms in youth with ASD. Youth with allergy (psychiatry referrals only) had more severe anxiety and depression symptoms (parents' ratings) but less severe aggression (teachers' ratings) thus providing evidence of both context- and diagnostic-specificity. Youth with ASD versus non-ASD psychiatry referrals evidence a variable pattern of relations between somatic conditions and a range of clinical correlates, which suggests that the biologic substrates and psychosocial concomitants of neurodevelopmental disorders and their co-occurring somatic conditions may interact to produce unique clinical phenotypes.
Soma, Ashok; Myatt, Mathew; McKenna, Mario; Ganesa, Soma; Leung, Ka Wai
Background Although international medical graduates (IMGs) are essential in health care service delivery, a gap exists in the literature about how IMGs are selected into psychiatry residency programs in Canada. The purpose of this study was to identify the relative weight or importance that Canadian program directors (PDs) of psychiatry place on certain selection criteria when matching IMGs into residency programs. Methods We electronically distributed a web-based questionnaire to 16 university residency program directors of psychiatry in Canada. Program Directors were asked to rate the importance of 43 selection criteria using 5-point Likert Scales. Criteria were grouped into six domains: academic criteria, extracurricular activities, supporting information, behavioural issues of concern, medical school country, and other education. Mean total values for each set of criteria were calculated and used to create rank orders within each domain. Results Eight out of 16 program directors responded. Our analysis indicated that academics and behavioral issues of concern were the most important selection criteria. Conclusion Our findings provide valuable insight about the perspectives of Program Directors toward IMGs who apply for psychiatry residency programs in Canada. Further studies are needed to better understand which criteria contribute to IMGs’ performances as psychiatric residents. PMID:28344716
Lewis-Fernández, R; Kleinman, A
As a discipline, cultural psychiatry has matured considerably in recent years and the ongoing quality of its theoretical, clinical, and research development holds great promise. The contemporary emphasis on culture as process permits a deeper analysis of the complexities of sociosomatics--the translation of meanings and social relations into bodily experience--and, thus, of the social course of illness. We also are learning a great deal more about cultural processes that affect therapy, including ethnopharmacologic and culturally valid family interventions that are directly relevant to patient care and mental health policy. And an important set of studies is examining the trauma experienced by refugees and immigrants. But at the same time many disquieting findings still point to the limited impact of cultural psychiatry on knowledge creation and clinical application in psychiatry. The failure of the cultural validation of DSM-IV is only the most dismaying. The persistent misdiagnosis of minority patients and the continued presence of racial bias in some treatment recommendations are also disheartening, as is the seeming contempt of many mainstream psychiatrists for culturally defined syndromes and folk healing systems. Widespread inattention to ethnic issues in medical ethics is another source of dismay. It is for these reasons that the culture of psychiatry itself becomes as important as the culture of patients as a topic for research and intervention. Most of the world still suffers from a terrible lack of basic mental health services, including life-saving medications and hospital beds. In the face of these limitations, and because of the increasing multicultural and pluralistic reality of contemporary life, the growing interpretive bridges linking indigenous systems of illness classification and healing to Western nosologies and therapeutic modalities become even more essential and the reluctance of mainstream clinicians to explore folk healing methods more
The history of the concept of delusion can be used to explore the general history of psychiatry in Spain and assess the contribution of her most distinguished practitioners. As this paper shows, the latter have not been as creative as their fellow artists or writers. Nonetheless, the ideas on delusions that some of them formulated deserve attention. The history of Spanish psychiatry (qua science) can be divided into four historical periods. (1) The native origins (up to the end of the eighteenth century). (2) The introduction of European psypchiatry (nineteenth century). (3) The period of consolidation (first third of the twentieth century). (4) From the Civil War (1936-39) to the present. These four periods provide a framework within which theories about delusion can be explored. Aspects of these four stages have been dealt with in earlier papers.
Psychiatry in Communist China is at a delicate phase where it is drawn both to modern Western medicine and to the wealth of traditional medicine. This is conveyed through accounts of some present-day situations as seen by the author during stays in Peking and Shanghai. After the treatment provided in various hospitals for acute-care and chronic-care patients is described, we are introduced to the organization of mental health at the various levels of hospital and external structures. A general survey of the research being done in epidemiology, neurology and traditional medicine at the Peking Research Centre is also presented. The novel nosography reveals one particular entity: phasophrenia, described as a stereotyped and recurring acute psychotic episode that responds poorly to neuroleptic chemotherapy. Finally, the medico-legal aspects of psychiatry and the effects of the new birth-rate policy are briefly discussed.
Avasthi, Ajit; Kate, Natasha; Grover, Sandeep
Most of the psychiatry practice in India is guided by the western concepts of mental health and illness, which have largely ignored the role of religion, family, eastern philosophy, and medicine in understanding and managing the psychiatric disorders. India comprises of diverse cultures, languages, ethnicities, and religious affiliations. However, besides these diversities, there are certain commonalities, which include Hinduism as a religion which is spread across the country, the traditional family system, ancient Indian system of medicine and emphasis on use of traditional methods like Yoga and Meditation for controlling mind. This article discusses as to how mind and mental health are understood from the point of view of Hinduism, Indian traditions and Indian systems of medicine. Further, the article focuses on as to how these Indian concepts can be incorporated in the practice of contemporary psychiatry.
Avasthi, Ajit; Kate, Natasha; Grover, Sandeep
Most of the psychiatry practice in India is guided by the western concepts of mental health and illness, which have largely ignored the role of religion, family, eastern philosophy, and medicine in understanding and managing the psychiatric disorders. India comprises of diverse cultures, languages, ethnicities, and religious affiliations. However, besides these diversities, there are certain commonalities, which include Hinduism as a religion which is spread across the country, the traditional family system, ancient Indian system of medicine and emphasis on use of traditional methods like Yoga and Meditation for controlling mind. This article discusses as to how mind and mental health are understood from the point of view of Hinduism, Indian traditions and Indian systems of medicine. Further, the article focuses on as to how these Indian concepts can be incorporated in the practice of contemporary psychiatry. PMID:23858244
Psychiatric patients of non-western origin leave treatment against the advice of their clinicians far more often than do their western counterparts. This article presents a theoretical framework for better understanding such clinical cases, developed from examples of psychiatric practice in different cultures. The theory is based on two meanings of the concept of culture, an elaboration of the universality-relativity dichotomy, and a view of the work of mental health care providers as involving three components: (1) building a trusting relationship with the patient; (2) making a diagnosis and treatment plan; and (3) carrying out treatment that is acceptable and meaningful to the patient. The article argues that all psychiatry is transcultural psychiatry, because a cultural gap always exists between the psychiatrist and the patient.
Sobański, Jerzy A; Dudek, Dominika
The two objectives of the following paper are: to make few remarks on the topic absorbing neurologists, psychiatrists, and neuropsychiatrists - integration and division of their specialties; and to describe the situation in Poland, reflected in the latest literature. The authors describe the former and present processes of approaches and divisions in psychiatry and neurology. They indicate dissemination of mutual methods of structural and action brain neuroimaging, neurophysiology, neurogenetics, and advanced neurophysiology diagnostics. As it seems, even the effectiveness of psychotherapy, has recently been associated with changes in brain in functional and even structural markers. The authors indicate the value of the strive to join the still divided specialties, reflected worldwide in attempts of common education and clinical cooperation of physicians. It can be expected that subsequent years will bring further triumphs of neuropsychiatry - a field that combines psychiatry and neurology.
The main hypothesis of this paper is the presence of malaise in psychiatry. The malaise has two sides: on one hand, the end of psychiatry hegemony that dominated the theoretical field of psychiatry until the 1990s. The loss of influence of psychoanalysis is due to its inability to be submitted to any kind of assessment. On the other hand, the supremacy of neurosciences. The idea is not to underestimate the importance of neurosciences but rather to affirm that they occupy the whole theoretical field of psychiatry. This is an unusual situation that is specific to our time. Indeed, this monism has succeeded to an epistemological dualism that has existed throughout the history of psychiatry. In this article, we'll try to draw a history of dualism in psychiatry. Firstly, with Pinel, we find a tension between a metaphysical philosophical pole and a physiological one. Pinel's philosophy has something to do with Condillac's ideology as Pinel applies the analytical method to mental diseases. Under Cabanis's influence, the author of the famous Rapports du physique et du moral de l'homme, this ideology is under pressure with physiologism. As a materialist, he gives an essential part to the brain that distributes pieces of information throughout the body because he thinks that mind influences body. Secondly, dualism lies between the doctrine of localizations defended by Gall and the theory of degeneration elaborated by Magnan. Gall, in Anatomie et physiologie du système nerveux en général, seeks to know how bumps or hollows that are found on the skull are shaped. Gall is for the theory of delocalizations. He is the counterpart of Magnan who wrote a work about Les Dégénérés, that takes its part in the physiological trend with the famous theory of degeneration. For him, degeneration means the imperfect state of a subject whose cerebral functions are in a noticeably imperfect state. Thirdly, with Henry Ey, dualism starts to be less important. Indeed, he tends a monist
De Sousa, Alan; De Sousa, Avinash
Setting up a private practice in Mumbai is an onerous task. The present paper looks at the difficulties face by young psychiatrists when starting a private practice in psychiatry. It suggests certain guidelines to be followed to ensure the development of a successful practice. It also suggests methods to gain popularity among patients and society along with the ethics to be followed, knowledge base to be garnered, and the role of using multiple therapies and versatility in private practice. PMID:25838718
Lobbying for child and adolescent psychiatry works best when association members team with staff to communicate with members of Congress. Communication comes in many forms, some more effective than others, but without it, no opportunities for policy changes are generated. Legislators want to know what their constituents are interested in, and child and adolescent psychiatrists serve themselves and their profession by knowing the legislative agenda, using the tools available for reaching out to legislators, and using every opportunity available to move the agenda.
Kamath, Ravindra M
It is important that every citizen knows the law of the state. Psychiatry and law both deal with human behaviour. This paper attempts to highlight the interplay between these two by discussing about various legislations like The Family Courts Act 1984, Narcotic Drugs and Psychotropic Substances Act 1985, Juvenile Justice Act 1986, Consumer Protection Act 1986, Persons with Disability Act 1995, The Maintenance and Welfare of Senior Citizens Act 2007.
The decision to treat a patient in solitary confinement in psychiatry does not follow any protocol and is not made on a case-by-case basis. Team deliberation opens discussion and enables the group as a whole to take responsibility for clarifying what is to be supported by the team and implemented by the carer during treatment. When presented with complex situations, uncertainty can be a force when it calls upon an ethical dilemma.
ap- proach systematically considers biological, psychological, and social factors in the complex interactions in understanding health, illness, and...view themselves and how they interact with others? Dr. Lande, our service chief for Psychiatry Continuity Service (PCS), and I were discussing this...The dis- charge planning is usually coordinated by social workers and case manage- ment staff. They typically know all the resources in the community
This attempt to correlate Jung's work with practical psychiatry is concerned mainly with his conception of clinical types. Jung went far away from the provinces of clinical medicine and psychiatry for his evidence, and the possible cause for this is discussed. He expands his view of introversion and extraversion, and so the suggestion is made that for practical purposes his early limitation of these terms should be maintained. The difficulties encountered in type description by comparison and contrast are emphasized. The value of his conception of basic functions is discussed and criticized. A review is made of the personalities he describes, and a simplification of his resulting classification suggested for practical purposes. The notion is put forward that Jung describes one type in psychological adaptation much better than any others, and it is hinted that his psycho-pathological description of this type in nerve disorder constitutes his main contribution to clinical psychiatry. A review of the treatable nerve disorders suggests that this disorder has received more adequate description from Jung than any other, and reveals a unique method of investigation and therapy. This does not apply to his other descriptions. Possibly some of the vagueness attributed to Jung is because he did not give this disorder an adequate diagnosis, and an explanation for this is offered. The correlation between the simplified classification and the classification of treatable nerve disorders is close, and it is suggested that this constitutes Jung's contribution to clinical psychiatry in general. The application of Jung's principles is of daily help to the practising psychiatrist. PMID:19990325
Sarma, Gopala P.
An analysis of patients attending general hospital psychiatry out-patient (OP) showed that cost of one visit was Rs. 201/- Management's contribution of the total expenditure was 68% and patients' 32%. Salaries accounted for the maximum-48%. This was followea by loss of earnings- 17%. Drugs accounted for less than 10%. If MCI norms are followed, cost of a visit would increase by 61%, drug supply and number of patient's visits remaining the same. PMID:21407953
Kamath, Ravindra M.
It is important that every citizen knows the law of the state. Psychiatry and law both deal with human behaviour. This paper attempts to highlight the interplay between these two by discussing about various legislations like The Family Courts Act 1984, Narcotic Drugs and Psychotropic Substances Act 1985, Juvenile Justice Act 1986, Consumer Protection Act 1986, Persons with Disability Act 1995, The Maintenance and Welfare of Senior Citizens Act 2007. PMID:25838729
Rabe, Silke C; Fegert, Jörg M; Krüger, Ulrich; Kölch, Michael
Coercive Measures in Child and Adolescent Psychiatry To keep the use of coercive measures in child and adolescent psychiatry low or reduce them completely, there needs to be a specific knowledge of the starting point. The study provides an overview of the current situation using a systematic literature review of published studies from the European and the outer European regions between 2005 and 2015. In summary only twelve publications addressed the topic, differentiated in four studies from inner and eight studies from outer European countries. In the studies from Europe, girls in their late adolescence experienced coercive measures more often, whereas the outer European studies identified more boys in early school age. Regarding the diagnoses of the respective patients, no distinct trend could be identified, as coercive measures were applied with a range of different diagnoses. In the European studies, coercive measures were more often used with children and adolescents fitting in the ICD-10-category F9. Results point to a lack of empirical studies concerning coercive measures in the context of child and adolescent psychiatry. Besides, clinical practice between the countries varies tremendously, resulting in difficulties comparing the findings. One possibility to address these issues might be a central register for every kind of coercive measure, as it was introduced in Baden-Württemberg lately and is currently in development for North Rhine-Westphalia.
A distinctive characteristic of psychiatry is that it is a discipline that deals with both the physical and the mental lives of individuals. Largely because of this characteristic, different models are used for different disorders, however, there is still a remnant tendency towards reductionist views in the field. In this paper I argue that the available empirical evidence from psychiatry gives us reasons to question biological reductionism and that, in its place, we should adopt a pluralistic explanatory model that is more suited to the needs of the discipline and to the needs of the patients it is meant to help. This will allow us to retain psychiatry as an autonomous science that can productively co-exist with neuroscience while also giving patients the kind of attention they need. I further argue that this same evidence supports a view of the mind that is anti-reductive and that allows that causation can be both bottom-up and top-down and that such a view is available in emergentism coupled with an interventionist model of causation.
Abstract Computational psychiatry is a rapidly emerging field that uses model-based quantities to infer the behavioral and neuronal abnormalities that underlie psychopathology. If successful, this approach promises key insights into (pathological) brain function as well as a more mechanistic and quantitative approach to psychiatric nosology—structuring therapeutic interventions and predicting response and relapse. The basic procedure in computational psychiatry is to build a computational model that formalizes a behavioral or neuronal process. Measured behavioral (or neuronal) responses are then used to infer the model parameters of a single subject or a group of subjects. Here, we provide an illustrative overview over this process, starting from the modeling of choice behavior in a specific task, simulating data, and then inverting that model to estimate group effects. Finally, we illustrate cross-validation to assess whether between-subject variables (e.g., diagnosis) can be recovered successfully. Our worked example uses a simple two-step maze task and a model of choice behavior based on (active) inference and Markov decision processes. The procedural steps and routines we illustrate are not restricted to a specific field of research or particular computational model but can, in principle, be applied in many domains of computational psychiatry. PMID:27517087
Penfold, P S
A comparison of numbers of women psychiatrists with faculty appointments and women residents in Departments of Psychiatry in Canada in 1975 and 1985 showed that the average percentage of women faculty has increased from 11.4% to 14.3% and of women residents from 23.5% to 43.4%. Some departments appeared to be oblivious to the special educational role of women faculty and had not discussed the discrepancy between the numbers of faculty and residents. Only two departments were actively recruiting women faculty. The study also demonstrated a continued concentration of women in the lower ranks. Barriers to recruiting women faculty include lack of academic role models, job advertising not specifically designed to attract women candidates, rigid requirements for appointments, women's lack of access to male corridors of power, pervasive underlying doubts about women's abilities and competence based on cultural stereotypes, female socialization which does not lend itself readily to roles of authority, assertiveness and leadership, and the role strain that ensues when women psychiatrists try to combine career, marriage and motherhood. If women psychiatrists are to fill some of the positions in Departments of Psychiatry, which will fall vacant over the next decade, much more attention must be paid to eliminating or diminishing the multiple obstacles for women who chose a career in academic psychiatry.
Abed, Riadh; St John-Smith, Paul
Evolutionary science remains an overlooked area in psychiatry and medicine. The newly established Royal College of Psychiatrists' Evolutionary Psychiatry Special Interest Group aims to reverse this trend by raising the profile of evolutionary thinking among College members and others further afield. Here we provide a brief outline of the importance of the evolutionary approach to both the theory and practice of psychiatry and for future research. PMID:27752339
de Leon, Jose
During the development of the DSM-5, even the lay press questioned psychiatr's scientific validity. This review provides 21st century psychiatry residents with ways of answering these attacks by defining the concepts and history of psychiatry (a branch of medicine), medicine and science. Psychiatric language has two levels: first, describing symptoms and signs (19th century descriptive psychopathology developed in France and Germany), and second, describing disorders (psychiatric nosology was developed in the early 20th century by Kraepelin and resuscitated by the US neo-Kraepelinian revolution leading to the DSM-III). Science is a complex trial-and-error historical process that can be threatened by those who believe too much in it and disregard its limitations. The most important psychiatric advances, electroconvulsive therapy and major psychopharmacological agents, were discovered by "chance", not by scientific planning. Jaspers's General Psychopathology is a complex 100-year-old book that describes: 1) psychiatric disorders as heterogeneous and 2) psychiatry as a hybrid scientific discipline requiring a combination of understanding (a social science method) and explanation (a natural science method). In the 21st century Berrios reminds us of psychiatry's unfortunate methodological issues due to hybrid symptoms and disorders, some of which are better understood as problems in communication between interacting human beings; in those situations neuroscience methods such as brain imaging make no sense. A new language is needed in psychiatry. East Asian psychiatry residents, who are not particularly attached to the antiquated language currently used, may be particularly equipped for the task of recreating psychiatric language using 21st century knowledge.
During the development of the DSM-5, even the lay press questioned psychiatr's scientific validity. This review provides 21st century psychiatry residents with ways of answering these attacks by defining the concepts and history of psychiatry (a branch of medicine), medicine and science. Psychiatric language has two levels: first, describing symptoms and signs (19th century descriptive psychopathology developed in France and Germany), and second, describing disorders (psychiatric nosology was developed in the early 20th century by Kraepelin and resuscitated by the US neo-Kraepelinian revolution leading to the DSM-III). Science is a complex trial-and-error historical process that can be threatened by those who believe too much in it and disregard its limitations. The most important psychiatric advances, electroconvulsive therapy and major psychopharmacological agents, were discovered by "chance", not by scientific planning. Jaspers's General Psychopathology is a complex 100-year-old book that describes: 1) psychiatric disorders as heterogeneous and 2) psychiatry as a hybrid scientific discipline requiring a combination of understanding (a social science method) and explanation (a natural science method). In the 21st century Berrios reminds us of psychiatry's unfortunate methodological issues due to hybrid symptoms and disorders, some of which are better understood as problems in communication between interacting human beings; in those situations neuroscience methods such as brain imaging make no sense. A new language is needed in psychiatry. East Asian psychiatry residents, who are not particularly attached to the antiquated language currently used, may be particularly equipped for the task of recreating psychiatric language using 21st century knowledge. PMID:24302942
Thomas, Christopher R
Epigenetics has the potential to revolutionize diagnosis and treatment in psychiatry, especially child psychiatry, as it may offer the opportunity for early detection and prevention, as well as development of new treatments. As with the previous introduction of genetic research in psychiatry, there is also the problem of unrealistic expectations and new legal and ethical problems. This article reviews the potential contributions and problems of epigenetic research in child psychiatry. Previous legal and ethical issues in genetic research serve as a guide to those in epigenetic research. Recommendations for safeguards and guidelines on the use of epigenetics with children and adolescents are outlined based on the identified issues.
Biological psychiatry is an exploratory science for mental health. These biological changes provide some explicit insight into the complex area of ‘brain-mind and behavior’. One major achievement of research in biological field is the finding to explain how biological factors cause changes in behavior. In India, we have a clear history of initiatives in research from a biological perspective, which goes back to 1958. In the last 61 years, this field has seen significant evolution, precision and effective utilization of contemporary technological advances. It is a matter of great pride to see that in spite of difficult times in terms of challenges of practice and services, administration, resource, funding and manpower the zest for research was very forthcoming. There was neither dedicated time nor any funding for conducting research. It came from the intellectual insight of our fore fathers in the field of mental health to gradually grow to the state of strategic education in research, training in research, international research collaborations and setting up of internationally accredited centers. During difficult economic conditions in the past, the hypothesis tested and conclusions derived have not been so important. It is more important how it was done, how it was made possible and how robust traditions were established. Almost an entire spectrum of biological research has been touched upon by Indian researchers. Some of these are electroconvulsive therapy, biological markers, neurocognition, neuroimaging, neuroendocrine, neurochemistry, electrophysiology and genetics. A lot has been published given the limited space in the Indian Journal of Psychiatry and other medical journals published in India. A large body of biological research conducted on Indian patients has also been published in International literature (which I prefer to call non-Indian journals). Newer research questions in biological psychiatry, keeping with trend of international standards are
After experiencing the catastrophic Great East Japan Earthquake and Tsunami disaster in 2011, Tohoku University founded the International Research Institute of Disaster Science (IRIDeS) in April, 2012. IRIDeS, comprising 7 divisions and 36 laboratories with broad areas of specialization, from the humanities to natural sciences, aims to become a global center for the study of disasters and disaster mitigation, learning from and building upon past lessons in disaster management from Japan and around the world. In IRIDeS, the Department of Disaster Psychiatry is in charge of dealing with issues related to disaster psychiatry, including the psychosocial impact of disasters. Now, at more than 2 and a half years after the catastrophic disaster, the psychological impact actually seems to be getting stronger and wider, whereas the memory of the disaster seems to be waning in other areas of the country. In such a situation, where a number of problems need to be resolved, what can/should we do as psychiatrists? On the other hand, other natural disasters, such as storms and floods, have kept hitting Japan, and catastrophes seem to strike somewhere in the world every year. In addition, we need to prepare for the possibility of a Nankai Trough Quake and an earthquake directly hitting the Tokyo area, which may occur sometime in the future. Considering the situation, we need to establish an education system for disaster psychiatry, and proceed with research to collect useful information to prepare for coming disasters. The aim of our department is to integrate multi-faceted basic and clinical research approaches to investigate the following topics: 1) to identify social, psychological, and biological factors involved in the pathophysiology of and recovery from disaster-related mental health problems; 2) to develop systems for disaster prevention, disaster response, and recovery, considering disaster-related psychiatric and psychological issues; 3) to develop useful tools for the
Biological psychiatry is an exploratory science for mental health. These biological changes provide some explicit insight into the complex area of 'brain-mind and behavior'. One major achievement of research in biological field is the finding to explain how biological factors cause changes in behavior. In India, we have a clear history of initiatives in research from a biological perspective, which goes back to 1958. In the last 61 years, this field has seen significant evolution, precision and effective utilization of contemporary technological advances. It is a matter of great pride to see that in spite of difficult times in terms of challenges of practice and services, administration, resource, funding and manpower the zest for research was very forthcoming. There was neither dedicated time nor any funding for conducting research. It came from the intellectual insight of our fore fathers in the field of mental health to gradually grow to the state of strategic education in research, training in research, international research collaborations and setting up of internationally accredited centers. During difficult economic conditions in the past, the hypothesis tested and conclusions derived have not been so important. It is more important how it was done, how it was made possible and how robust traditions were established. Almost an entire spectrum of biological research has been touched upon by Indian researchers. Some of these are electroconvulsive therapy, biological markers, neurocognition, neuroimaging, neuroendocrine, neurochemistry, electrophysiology and genetics. A lot has been published given the limited space in the Indian Journal of Psychiatry and other medical journals published in India. A large body of biological research conducted on Indian patients has also been published in International literature (which I prefer to call non-Indian journals). Newer research questions in biological psychiatry, keeping with trend of international standards are
For over a quarter century, until it disbursed its remaining funds in 1981, the Foundations' Fund for Research in Psychiatry (FFRP) aided hundreds of researchers in fields related to mental health. The fund was established by a private donor, the late Charles B. G. Murphy. Much of the research it sponsored during its early years was psychoanalytically oriented. In the 1960s it shifted to a more biological and social orientation. Its influence was greatest during its first decade, when its research grants, fellowships, and support to departments of psychiatry helped to launch the modern era of psychiatric research. This review analyzes FFRP's activities and examines its achievements.
Bostwick, J. Michael; Alexander, Cara
Objective: The goal of this study was to evaluate a recent medical school curriculum change at our institution 3 years ago; specifically: shortening the Psychiatry core clerkship from 4 to 3 weeks and adding an optional 6-week core/elective combination rotation in lieu of the 3-week core. The authors aimed to determine whether clerkship length was…
The editorial presents the arguments that an alliance between academic psychiatry and the pharmaceutical industry is harmful through a critical review of the academic literature and media coverage of activities of the pharmaceutical industry. The industry and the psychiatric profession both gain advantages from promoting biomedical models of psychiatric disturbance and pharmacological treatment. This confluence of interests has lead to the exaggeration of the efficacy of psychiatric drugs and neglect of their adverse effects and has distorted psychiatric knowledge and practice. Academic psychiatry has helped the industry to colonise more and more areas of modern life in order to expand the market for psychotropic drugs. Persuading people to understand their problems as biological deficiencies obscures the social origin and context of distress and prevents people from seeking social or political solutions. Psychiatry has the power to challenge the dominance of the pharmaceutical industry and should put its efforts into developing alternatives to routine drug treatment. Psychiatry needs to disengage from the industry if it wants to make genuine advances in understanding psychiatric disorder and help reverse the harmful social consequences of the widening med-icalisation of human experience.
Dunstone, David C.
Objective: The author describes a 20-session, student-centered course relating contemporary neuroscience to psychiatry for second-year psychiatric residents. Methods: Twenty residents who took the course (2003-2007) completed pre- and postcourse surveys and were contacted for more remote follow-up regarding the course. Results: Survey results are…
Prochaska, Judith J.; Fromont, Sebastien C.; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.
Objective: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. Method: The authors recruited training directors to complete a survey of their…
Möller-Leimkühler, A M; Möller, H-J; Maier, W; Gaebel, W; Falkai, P
This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.
Layde, Joseph B.
Objective: Forensic psychiatry was officially recognized as a subspecialty by the American Board of Medical Specialties in the 1990's. In 1994, the American Board of Psychiatry and Neurology (ABPN) gave its first written examination to certify forensic psychiatrists. In 1996, the Accreditation Council for Graduate Medical Education (ACGME) began…
Rios, Francisco Javier Mesa; Munoz, Maria Del Carmen Lara
Background: Various rates of alcoholism, drug abuse, mental illness, and suicide among physician have been reported, generally higher than those in the general population. Psychiatry residents, as other specializing physicians, seem to be prone to suffering them. The prevalence of psychological symptoms among psychiatry residents has not been…
Chlebowski, Susan; Fremont, Wanda
Objective: The authors provide examples for the use of the WebCam as a therapeutic tool in child psychiatry, discussing cases to demonstrate the application of the WebCam, which is most often used in psychiatry training programs during resident supervision and for case presentations. Method: Six cases illustrate the use of the WebCam in individual…
The continuing shortfall in recruitment to Psychiatry is examined with suggestions for affirmative action. Recruitment may improve in the near future because of the high demand for psychiatrists, the incentives offered, greater competition for other specialties and a pool of international graduates willing to work in Psychiatry. There remains the…
Dingle, Arden D.
Objective: The author describes child and adolescent psychiatry (CAP) undergraduate teaching in American and Canadian medical schools. Methods: A survey asking for information on CAP teaching, student interest in CAP, and opinions about the CAP importance was sent to the medical student psychiatry director at 142 accredited medical schools in the…
This research study was conducted to explore the phenomenon of the third-year experiences of the psychiatry residents. A review of the literature identified themes and subthemes related to the third-year of psychiatry education. The study was conducted at a university health science center. Data were collected from five residents using participant…
Prochaska, Judith J.; Fromont, Sebastien C.; Hall, Sharon M.
Objective: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and a leading cause of death and disability. The authors examined the extent to which psychiatry residents are prepared to treat nicotine dependence in clinical practice. Methods: Residents from five psychiatry residency programs in…
Segraves, Robert Taylor
Objective: This article examines the positive and negative aspects of psychiatry encompassing sexual medicine within its purview. Methods: MEDLINE searches for the period between 1980 to the present were performed with the terms "psychiatry," "sexual medicine," and "sexual dysfunction." In addition, sexual medicine texts were reviewed for chapters…
Seritan, Andreea L.; Bhangoo, Robinder; Garma, Sylvia; DuBe, Jane; Hales, Robert
Objective: Despite an increasing presence of women in medicine, the percentage of women in academic psychiatry remains low. At the University of California, Davis, women represent two-thirds of psychiatry residents; however, the percentage of female faculty is one-third. This article presents a novel approach to the academic gender gap problem.…
Buckley, Peter F.; Rayburn, William F.
Objective: The authors examine the tenure of first-time Chairs in academic departments of psychiatry in order to stimulate discussion on extant workforce and leadership issues. Method: Data on tenure of Chairs in psychiatry and other nonsurgical specialties were derived from the longitudinal database of the Association of American Medical Colleges…
Bennett, Aurora J.; Clardy, James A.; Cargile, Christopher S.; Thrush, Carol R.
Objective: This article describes initial efforts by the newly developed Clinician-Educator Section (CES) of the Association for Academic Psychiatry (AAP) to support the career advancement of academic faculty within psychiatry. The CES provided its first workshop at the 2005 AAP annual meeting, focusing on early career development and academic…
Objective: This article provides a brief overview of the history of psychiatry residency training in Canada,and outlines the rationale for the current training requirements, changes to the final certification examination,and factors influencing future trends in psychiatry education and training. Method: The author compiled findings and reports on…
Bhuvaneswar, Chaya; Stern, Theodore; Beresin, Eugene
Objective: The authors discuss journal writing in learning emergency psychiatry. Methods: The journal of a psychiatry intern rotating through an emergency department is used as sample material for analysis that could take place in supervision or a resident support group. A range of articles are reviewed that illuminate the relevance of journal…
Rait, Douglas Samuel
Objective: This study describes the current state of family therapy training in a sample of child and adolescent psychiatry fellowship programs. Method: Child and adolescent psychiatry fellows (N = 66) from seven training programs completed a questionnaire assessing demographics, family therapy training experiences, common models of treatment and…
Gilbert, Andrew R.; Tew, James D., Jr.; Reynolds, Charles F., III; Pincus, Harold A.; Ryan, Neal; Nash, Kenneth; Kupfer, David J.
Objective: The authors describe a developmental model for enhancing residency research training for careers in academic psychiatry. Over the past 10 years, the University of Pittsburgh Department of Psychiatry has developed a research track (RT) for its residents. While the Department's plan has been to address the critical need of training…
Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina
Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…
Grujich, Nikola N.; Razmy, Ajmal; Zaretsky, Ari; Styra, Rima G.; Sockalingam, Sanjeev
Objective: The authors sought to determine psychiatry residents' perceptions on the current method of evaluating professional role competency and the use of multi-source feedback (MSF) as an assessment tool. Method: Authors disseminated a structured, anonymous survey to 128 University of Toronto psychiatry residents, evaluating the current mode of…
Goldman, Stuart; Demaso, David R.; Kemler, Beth
Objective: This study assessed the implementation of psychiatry morbidity and mortality rounds (M&Ms) on the clinical and educational practice in a children's hospital. Methods: Attendees to monthly M&Ms between July 2005 and May 2007 included staff and trainees from psychiatry, psychology, nursing, and social work. Cases were selected based on a…
Balon, Richard; Heninger, George; Belitsky, Richard
Objective: The authors discuss the importance of introducing research training in psychiatry and neurosciences to medical students. Methods: A review of existing models of research training in psychiatry with focus on those providing research training to medical students is presented. Results: Two research-training models for medical students that…
Glick, Ira D; Kamm, Ronald; Morse, Eric
Over the past three decades, the world of both amateur and professional sports has expanded greatly and become more complex. In part related to these changes - and relatively unknown to sports medicine practitioners - the field of sport psychiatry has steadily evolved and grown. This paper focuses on what these changes have been. A sport psychiatrist is a physician-psychiatrist who diagnoses and treats problems, symptoms and/or disorders associated with an athlete, with their family/significant others, with their team, or with their sport, including spectators/fans. The primary aims of the specialty are to (i) optimize health, (ii) improve athletic performance, and (iii) manage psychiatric symptoms or disorders. The training includes medical training to provide knowledge and skills unique to physicians; psychiatric training to provide knowledge and skills inherent in that field, and training and/or experience in sport psychiatry to provide knowledge and skills about psychiatric aspects of sports. The sport psychiatrist first makes an individual, family-systems and phenomenological diagnosis of the clinical situation. Based on this evaluation, he sets goals for not only the athlete, but also for significant others involved. He delivers treatment based on the psychiatric disorder or problem using a combination of medication, psychotherapy or self-help group interventions plus strategies targeted to specific sport performance issues. Evolution of the International Society of Sport Psychiatry as well as the field, including incorporation into school and professional team sports, is described along with a 'typical day' for a sport psychiatrist. Case examples, a training curriculum and core literature are included.
Möller, H J; Rujescu, D
Pharmacogenetic influences on therapeutic response to e.g. antidepressant or neuroleptic treatment are poorly understood and the lack of efficacy in many of the patients together with side effects can both limit therapy and compliance. Thus the aim of pharmacogenetics and pharmacogenomics is to provide predictive tools for the response to psychopharmacologic agents in the therapy of psychiatric disorders and in that ways to provide a real personalized psychiatry. The following review will summarize the current stage of pharmacogenetics and pharmacogenomics and will critically discuss the possibilities of a personalized medicine.
Gravier, Bruno; Eytan, Ariel
Psychiatry is now subject to two apparently contradictory movements. On the one hand, the need to respect the autonomy and rights of patients is reinforced and coercive measures are strictly defined and limited. On the other hand, security concerns in our society leads to prosecution of psychiatric disorders, especially when accompanied by behavioral problems or criminal acts. In these situations of compulsory treatment or care provided in prisons, a number of dilemmas emerge. The place of the healthcare professional in treatments ordered by the Judge and problems related to administrative detention are discussed in more detail.
Green, J; Stewart, A
This paper concerns the special ethical problems in child and adolescent psychiatry which relate to the child as a developing being. Two themes are discussed--the sense of responsibility in the child, and the therapist's responsibility towards the child. As a background to understanding the former, ideas on moral and cognitive development are reviewed. The therapist's responsibility is discussed in relation to different styles of therapy and the ethical issues they raise. The article concludes with a number of suggested ethical principles. PMID:3572994
Dave, Kishore P
Attempting to predict future is dangerous. This is particularly true in medical science where change is a result of chance discoveries. Currently, practicing psychiatrists are aware of deficiencies in psychiatric practice. However, we have a number of genuine reasons for optimism and excitement. Genetics, novel treatment approaches, new investigative techniques, large-scale treatment trials, and research in general medicine and neurology will give better insights in psychiatric disorders and its management. Psychiatric services in rural India can be reached by telemedicine. There are some threat perceptions which require solving and remedying. Subspecialties in psychiatry are the need of the hour. There is also a requirement for common practice guidelines. Mental Health Care Bill, 2013, requires suitable amendments before it is passed in the Indian Parliament. Research in psychiatry is yet to be developed as adequate resources are not available.
Dave, Kishore P.
Attempting to predict future is dangerous. This is particularly true in medical science where change is a result of chance discoveries. Currently, practicing psychiatrists are aware of deficiencies in psychiatric practice. However, we have a number of genuine reasons for optimism and excitement. Genetics, novel treatment approaches, new investigative techniques, large-scale treatment trials, and research in general medicine and neurology will give better insights in psychiatric disorders and its management. Psychiatric services in rural India can be reached by telemedicine. There are some threat perceptions which require solving and remedying. Subspecialties in psychiatry are the need of the hour. There is also a requirement for common practice guidelines. Mental Health Care Bill, 2013, requires suitable amendments before it is passed in the Indian Parliament. Research in psychiatry is yet to be developed as adequate resources are not available. PMID:28031625
Singh, Ajai R.; Singh, Shakuntala A.
The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, non-malfeasance, autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy
Corral, Irma; Johnson, Toni L; Shelton, Pheston G; Glass, Oliver
Resident physicians training in psychiatry in the U.S. are required to master a body of knowledge related to cultural psychiatry; are expected to adopt attitudes that endorse the principles of cultural competence; and finally are expected to acquire specific cultural competence skills that facilitate working effectively with diverse patients. This article first provides an overview of the Accreditation Council for Graduate Medical Education (ACGME) competencies related to cultural competence, as well as the American Academy of Child and Adolescent Psychiatry's (AACAP) recommendations for the cultural competence training of child/adolescent fellows. Next, numerous print and electronic resources that can be used in cultural competence education in psychiatry are reviewed and discussed. Finally, we conclude by providing recommendations for psychiatry residency programs that we culled from model cultural competence curricula.
Dobscha, Steven K.; Snyder, Kristen M.; Corson, Kathryn; Ganzini, Linda
Objective: To determine if a psychiatry-primary medical care (PPMC) training track impacts comfort and behaviors related to addressing general medical issues after residency. Method: Thirty five psychiatry resident graduates completed mailed surveys; nine of them had completed the PPMC track. Results: Compared to non-PPMC participants, PPMC…
Maung, Hane Htut
In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves.
Weimer, Katja; Colloca, Luana; Enck, Paul
A strong placebo response in psychiatric disorders has been noted for the past 50 years and various attempts have been made to identify predictors of it, by use of meta-analyses of randomised controlled trials and laboratory studies. We reviewed 31 meta-analyses and systematic reviews of more than 500 randomised placebo-controlled trials across psychiatry (depression, schizophrenia, mania, attention-deficit hyperactivity disorder, autism, psychosis, binge-eating disorder, and addiction) for factors identified to be associated with increased placebo response. Of 20 factors discussed, only three were often linked to high placebo responses: low baseline severity of symptoms, more recent trials, and unbalanced randomisation (more patients randomly assigned to drug than placebo). Randomised controlled trials in non-drug therapy have not added further predictors, and laboratory studies with psychological, brain, and genetic approaches have not been successful in identifying predictors of placebo responses. This comprehensive Review suggests that predictors of the placebo response are still to be discovered, the response probably has more than one mediator, and that different and distinct moderators are probably what cause the placebo response within psychiatry and beyond. PMID:25815249
Ranz, J; Rosenheck, S; Deakins, S
In 1981 the fellowship in public psychiatry was established at New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons to provide subspecialty training for psychiatrists who plan careers in the public sector. Ten one-year postresidency fellowships are awarded annually. The fellowship consists of supervised work and didactic experiences focused on the clinical modalities most effective in public mental health services and the managerial skills that the psychiatrist must possess to make those services work well. Fellows work three days a week at collaborating public-sector agencies throughout the New York metropolitan area. The curriculum includes an academic seminar, which gives fellows an introductory overview of major topics in public psychiatry; an organizational practicum, which is an exercise in management principles and practices; an evaluation practicum, which addresses the theory and practice of program evaluation; and an applied seminar, organized as a cycle of clinical, administrative, fiscal, and evaluation presentations in which each fellow applies the concepts learned in the other seminars to his or her field placement work. Of the 75 fellows who have graduated from the program, only six have chosen to leave the public arena. Nearly all work full time in the public sector, where more than half hold management positions. More than three-fourths hold academic appointments at medical schools in the area in which they are working as public psychiatrists.
This paper was given as a talk at the Venice Biennale on 9 December 1977. It was part of a symposium on "The Freedom of Science--Problems of Science of Scientists in Eastern Europe". Dr Bloch details some of the problems of psychiatry and its vulnerability to improper use and thus the dilemmas which must ensue in day to day practice. He looks at psychiatry in the USSR and the system within which Soviet psychiatrists must work. The Communist Party and career advancement for psychiatrists would appear to be closely related and it is suggested that, in all probability, the majority of psychiatrists are as perturbed at the misuse of their profession as their Western colleagues, but act compliantly out of fear. Severe punishments have been imposed on those psychiatrists who have dared to speak out against the régime and the system as operated. Dr Bloch concludes by urging Western psychiatrists to do all they can to help their Soviet colleagues to initiate a return to an independent and automous psychiatric profession. PMID:691016
Kirmayer, Laurence J.; Crafa, Daina
Psychiatry has invested its hopes in neuroscience as a path to understanding mental disorders and developing more effective treatments and ultimately cures. Recently, the U.S. NIMH has elaborated this vision through a new framework for mental health research, the Research Domain Criteria (RDoC). This framework aims to orient mental health research toward the discovery of underlying neurobiological and biobehavioral mechanisms of mental disorders that will eventually lead to definitive treatments. In this article we consider the rationale of the RDoC and what it reveals about implicit models of mental disorders. As an overall framework for understanding mental disorders, RDoC is impoverished and conceptually flawed. These limitations are not accidental but stem from disciplinary commitments and interests that are at odds with the larger concerns of psychiatry. A multilevel, ecosocial approach to biobehavioral systems is needed both to guide relevant neuroscience research and insure the inclusion of social processes that may be fundamental contributors to psychopathology and recovery. PMID:25071499
Fox, Geraldine S.; Stock, Saundra; Briscoe, Gregory W.; Beck, Gary L.; Horton, Rita; Hunt, Jeffrey I.; Liu, Howard Y.; Rutter, Ashley Partner; Sexson, Sandra; Schlozman, Steven C.; Stubbe, Dorothy E.; Stuber, Margaret L.
Objective: A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper…
Pinals, Debra A
As an official subspecialty of psychiatry, forensic psychiatry residency training must meet the requirements established by the Accreditation Council of Graduate Medical Education. Attendant to these requirements is the expectation that graduates demonstrate core competencies in general areas common to all medical training programs but delineated for each specialty. In forensic psychiatry, trainees must learn to move from the role of healer to objective evaluator on behalf of third parties, a task that differs from general medical care and treatment. Thus, it is important for educators to maintain awareness of the experience of trainees as they adapt to forensic psychiatry, while understanding core competency requirements. This article outlines stages of development of forensic psychiatry fellows as a model for characterizing learning objectives and for supervising trainees in forensic psychiatry fellowship programs. These stages of development include (1) transformation, (2) growth of confidence and adaptation, and (3) identification and realization. Training directors and trainees can utilize this theoretical framework as a basis on which to establish parameters for core competency attainment and supervisory and assessment methods for forensic psychiatry training.
Afonso, Pedro; Ramos, Maria Rosário; Saraiva, Sérgio; Moreira, Cátia Alves; Figueira, Maria Luísa
Lifelong learning (LLL) is an essential feature for the doctor to keep clinically updated and has been described as an indicator of competence and professionalism. The aim of this study was to evaluate the association between career satisfaction in psychiatry, lifelong learning, and commitment in scientific activities, taking into account other personal and professional effects. The survey was sent to 453 national psychiatrists and 190 surveys (41.9%) were completed online and validated. The Jefferson Scale of Physician Lifelong Learning (JSPLL) was used to assess the level of LLL for each doctor. The results of the analysis of JSPLL showed that participants more satisfied with their career have greater motivation and invest more in the LLL. Furthermore, participants who were more satisfied with their career had a higher percentage of scientific activity in the last year. Multiple linear regression with these two effects in the model revealed a positive association between career satisfaction in psychiatry, LLL and the publication of scientific papers, leading to the main conclusion that satisfaction with a career in psychiatry has a significant correlation with LLL and with involvement in scientific activities.
Conti, Norberto A
In this work, the proposal of evidence based psychiatry (EBP) is presented together with a critical reflection about its paradigmatic perspective, taking into account Thomas S. Khun's epistemological lineaments. It is also shown how blurring of language in its approximation to the human behavioral disorders is EBP point of major inconsistency, as demonstrates a marked epistemological reductionism. Finally, consequences of its restrictive employment both to psychiatrists teaching and to the treatments they provide to their patients are also discussed.
narcosynthesis and hypnosis may still be useful techniques in treating acute reactions in which amnesia is present and in treating some refractory PTSD...residency under Army auspices) also required instruction in combat psychiatry and was introduced to the techniques of hypnosis and barbiturate interviews. As...manifestations and prevalence of gain in illness, brief directive methods of psychotherapy, and the use of hypnosis and barbiturate interviews as
Murthy, R. Srinivasa
Indian psychiatrists have actively engaged with world psychiatry by contributing to understanding and care of persons with mental disorders based on the religious, cultural and social aspects of Indian life. The contributions are significant in the areas of outlining the scope of mental health, classification of mental disorders, understanding the course of mental disorders, psychotherapy, traditional methods of care, role of family in mental health care and care of the mentally ill in the community settings. PMID:21836699
Kent, Stephen A.; Manca, Terra A.
Over 60 years ago, founder L. Ron Hubbard began what has become Scientology's greatest battle. Scientology emerged from Dianetics, which Hubbard hoped would replace the psychiatric profession. In this article, we discuss how Scientology attempted to position itself as a rival profession to psychiatry and the consequences of those attempts. Scientology's battle with psychiatry gained some success from the social conditions during which it emerged, but it continues in a time that has seen increasing success with various psychiatric treatments. As such, Scientology's direct influence on the psychiatric profession may be difficult to measure, but its actions have coincided with substantial challenges to psychiatry. PMID:24348087
de Menezes, Mardônio Parente; Yasui, Silvio
This article deals with interdisciplinarity as well as psychiatric and psychosocial care. Throughout the text, a historical account of the constitution and the crisis of scientific knowledge is presented and organized into disciplines. The theoretical difficulty of conceptualizing interdisciplinarity is analyzed and, in the concluding remarks, psychiatry and its relationship to psychosocial care is discussed. The argument is that, because of its history, psychiatry has singularities that differentiate it from other medical specialties and these singularities could initially cause psychiatry to go in the opposite direction in relation to interdisciplinarity. The conclusion is that because of their inherent characteristics psychosocial care services are privileged places for psychiatric training with interdisciplinary characteristics.
Kent, Stephen A; Manca, Terra A
Over 60 years ago, founder L. Ron Hubbard began what has become Scientology's greatest battle. Scientology emerged from Dianetics, which Hubbard hoped would replace the psychiatric profession. In this article, we discuss how Scientology attempted to position itself as a rival profession to psychiatry and the consequences of those attempts. Scientology's battle with psychiatry gained some success from the social conditions during which it emerged, but it continues in a time that has seen increasing success with various psychiatric treatments. As such, Scientology's direct influence on the psychiatric profession may be difficult to measure, but its actions have coincided with substantial challenges to psychiatry.
Fox, E C; Waldron, J A; Bohnert, P; Hishinuma, E S; Nordquist, C R
A formalized mentoring program was developed in response to several problems experienced by new faculty in a department of psychiatry. Goals of the program were to facilitate socialization/orientation to academic psychiatry, facilitate and improve functioning of faculty, and increase retention of new faculty members. A 36-item questionnaire and a program evaluation form were developed to evaluate the effectiveness of the program. Significant differences were found for the overall mean of all pre- vs. postmeasures and the sum of the items related to facilitation of socialization/orientation to academic psychiatry. Mentors and mentees evaluated the program as worthwhile and would recommend it to other faculty members.
This article describes a course, Psychodynamic Cultural Psychiatry, taught to PGY-3 residents at the New York Presbyterian Hospital-Weill Cornell Medical Center that uses psychodynamic theory to help deepen cultural understanding. We (Sandra Park, the instructor for the course, and Elizabeth Auchincloss, the residency training director) developed the class in 2006 in an effort to raise cultural awareness in the residency curriculum. We believe that despite an inherent Western bias, psychodynamic theory can be an effective way to teach cultural psychiatry. Additionally, cultural understanding can enhance understanding of psychodynamic principles. In this article, we argue that our course in psychodynamic cultural psychiatry helps residents to integrate these two points of view.
Denman, Melissa; Oyebode, Femi; Greening, Jayne
Aims and method This questionnaire study aimed to investigate the reasons for choosing to specialise in psychiatry in a sample of consultant psychiatrists and core trainee psychiatrists from within the West Midlands. Results Five reasons were significantly different between the core trainees and consultant psychiatrists. ‘Emphasis on the patient as a whole’ was identified as the most important reason for choosing to specialise for both core trainees and consultants. Six additional reasons were shared within the top ten ‘very important’ reasons, although their actual ranking varies. Clinical implications Some of the reasons for choosing to specialise in psychiatry were shown to significantly differ between core trainees and consultants. Numerous key driving factors have remained important over time for both groups, whereas other reasons have been replaced with a shift of importance towards lifestyle and humanitarian factors for core trainees. Consequently, it may be advisable not to use the reasons that consultants gave for choosing psychiatry when thinking about how to attract today's prospective psychiatrists. PMID:26958354
Hanson, Annette; Martinez, Richard; Candilis, Philip J
Psychiatrists who publish case reports are required to seek informed consent from their subjects on the basis of the ethics-related obligation to maintain patient confidentiality. Academic journals have developed editorial standards to fulfill this obligation. Forensic evaluations do not create a doctor-patient relationship in the traditional sense, and information obtained through a forensic evaluation may also be found in the public domain. This public exposure is particularly likely, given the development of open access publishing standards, online journals, and increasing professional involvement in social media. This article outlines the ethics of informed consent in published case reports for general and forensic psychiatry and offers recommendations for forensic case study publishing. The authors suggest changes in the current requirements stated in The Journal for publication of case reports.
The author deals with 3 possible types of epidemiological studies in community mental health services: studies on the efficiency measuring the difference between the objectives of each team and the results; studies on the distribution between the teams and within each team, institutionalised models and implicit defensive modalities elaborated by the staff against the fear of the insane; studies on the populations considered at risk by psychoanalytical theories en vogue (depressive mothers, relationship anomalies). These studies would have the advantage to limit the "etiopathogenic pretentions" in psychiatry and avoid the "realistic slide" of imaginary constructions (myths or fiction of origin) which the community health service psychiatrist needs to work with but which has only an uncertain relationship with historical truth.
Villaseñor-Bayardo, Sergio J; Rojas-Malpica, Carlos; Aceves-Pulido, Martha P
This paper presents only some of the most important contributions in the development of cultural psychiatry in Latin America. The continental efforts to understand the role that culture plays in the manifestation and treatment of mental disorders have been fruitful. The authors included are: Fernando Pagés of Argentina; Mario G. Hollweg of Bolivia; Rubim Alvaro de Pinho and Adalberto Barreto of Brazil; Carlos A. Leon and Carlos A. Uribe of Colombia; Antonio José A. Bustamante and Santa Cruz de Cuba, Carlos Leon Andrade of Ecuador, Guatemala Cristina Chavez; Sergio Villasenor J. Bayardo of Mexico; Carlos A. Seguin, Hermilio Valdizán and Javier Mariátegui in Peru; Y. Bespaldi of Consens of Uruguay; Rojas and Carlos Malpica and Jacqueline Briceño Clarac of Venezuela.
The author sees the task of industrial psychiatry as one of preventing emotional maladjustment and the more serious mental disorders in the industrial population, and of treating early cases of emotional disorders. He classifies the preventive functions as: giving “emotional” first-aid, holding psychiatric consultations, and training in mental health. The function of the psychiatrist is to concentrate on patients who are too difficult to be handled by the industrial medical officer, his nurse, or the psychologist, and to train management and medical staff to collaborate in preventive mental health activity. Some of the techniques used by the psychiatrist are described, and the important problem of how to handle confidential material is discussed. The author points out that the selection of medical staff for such work is extremely important, and that choosing the right type of psychiatrist is of primary importance for the whole organization. PMID:13276810
Carlos, A Palacio A
The research component and the acquisition of skills related to the generation of knowledge in the training of medical and surgical specialists in the country is an issue that has recently begun to be discussed. For over 50 years this training has included only the area of professionalism as a copy of an educational model from the mid-twentieth century. Currently the country requires specialists with critical and analytical skills to question their actions and knowledge and generate alternative clinical care to apply to the general population in the search of bettering their own welfare. This article is a review in which the current situation of the teaching of psychiatry and the inclusion of research in the academic processes of our medical specialties in the country are analyzed.
Ventriglio, A; Bhugra, D
René Descartes described the concept of mind-body dualism in the 16th century. This concept has been called his error but we prefer to call it his dogma because the error was recognised much later. We studied the original writings translated by various scholars. We believe that his dogma has caused tremendous amount of damage to Western psychiatry. This dualism has created boundaries between mind and body but as we know they are inextricably interlinked and influence each other. This has affected clinical practice and has increased the dichotomy between psychiatric services and the physical health care services in the West at least. This dualism has also contributed to stigma against mental illness, the mentally ill and the psychiatric services. We propose that it is time to abandon this mind-body dualism and to look at the whole patient and their illness experiences as is done in some other health care systems such as Ayurveda.
Costa E Silva, Jorge Alberto; Steffen, Ricardo Ewbank
Recent advances in deep brain stimulators and brain-machine interfaces have greatly expanded the possibilities of neuroprosthetics and neuromodulation. Together with advances in neuroengineering, nanotechnology, molecular biology and material sciences, it is now possible to address fundamental questions in neuroscience in new, more powerful ways. It is now possible to apply these new technologies in ways that range from augmenting and restoring function to neuromodulation modalities that treat neuropsychiatric disorders. Recent developments in neuromodulation methods offer significant advantages and potential clinical benefits for a variety of disorders. Here we describe the current state of the art in neuromodulation methods, and some advances in brain-machine interfaces, describing the advantages and limitations of the clinical applications of each method. The future applications of these new methods and how they will shape the future of psychiatry and medicine, along with safety and ethical implications, are also discussed.
Rohlof, Hans; Ulman, Anne-Marie
The First Mediterranean Conference on Cultural Psychiatry took place in Tel Aviv, Israel. This conference was a great success. With about 200 participants, mostly from Israel but with also 46 participants coming from 13 other countries: Mediterranean countries, Europe, North America and Australia. It contained three intensive days of plenary lectures and symposia, and a very impressive film, "Waltz with Bashir". The proceedings included 88 lectures, and there were 8 posters, which meant that nearly half of the attending persons were giving a lecture, as is always the case in real scientific conferences. Four parallel programs were running at the same time, which made it very difficult to choose which to attend. Inevitably, this report reflects only a part of the conference.
Vaillant, George E
This paper proposes that eight positive emotions: awe, love/attachment, trust/faith, compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology. Rather, spirituality is all about emotion and social connection that are more dependent on the limbic system than the cortex. Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change, if clinicians set about enhancing positive emotions, rather than focusing only on the negative ones.
Endogenous biological clocks enable living species to acquire some independence in relation to time. They improve the efficiency of biological systems, by allowing them to anticipate future constraints on major physyological systems and cell energy metabolism. The temporal organization of a giwen biological function can be impaired in its coordination with astronomical time or with other biological function. There are also external conditions that influence biological clocks. This temporal organization is complex, and it is possible that a series of psychiatric disorders and syndromes involve primary or secondary changes in biological clocks: seasonal and other mood disorders, premenstrual syndromes, social jet lag, free-running rhythms, and several sleep disorders are among them. In this review, we describe the main concepts relevant to chronobiology and explore the relevance of knowledge about biological clocks to the clinical practice of psychiatry PMID:17969862
Milovanović, Srdjan; Jovanović, Aleksandar; Jasović-Gasić, Miroslava; Ilanković, Nikola; Dunjić, Dusan; Lakić, Aneta; Djukić-Dejanović, Slavica; Nenadović, Milutin; Randjelović, Dragisa; Milovanović, Dimitrije
The development of legislation in the field of mental health in our region is linked with the emergence and development of the oldest psychiatric hospitals in Serbia.The principle that the mentally ill who committed a criminal offense need to be placed in a psychiatric hospital instead of a prison was introduced at the same time as in the most developed European countries. The founders of the Serbian forensic psychiatry, Dr. Jovan Danić, Dr.Vojislav Subotić Jr. and Dr. Dusan Subotić, were all trained at the first Serbian Psychiatric Hospital ("Home for the Unsound of Mind") that was founded in 1861 in the part of Belgrade called Guberevac. Their successors were psychiatric enthusiasts Prof. Dr.Vladimir F.Vujić and Prof. Dr. Laza Stanojević. A formal establishment of the School of Medicine of Belgrade, with acquirement of new experience and positive shifts within this field, based on the general act of the University in 1932, led to the formation of the Council of the School of Medicine, which, as a collective body passed expert opinions. Thus, the first Forensic Medicine Committee of the School of Medicine was formed and started its activities in 1931 when Forensic Medicine Committee Regulations were accepted. After the World War II prominent educators in the field of mental health, and who particularly contributed to further development of forensic psychiatry in Serbia were Prof. Dr. Uros Jekić, Prof Dr. Dusan Jevtić, Dr. Stevan Jovanović, Prof. Dr. Borislav Kapamadzija, Prof. Dr. Maksim Sternić, Prof. Dr. Josif Vesel and Prof. Dr. Dimitrije Milovanović.
Scales are a visible peeling or flaking of outer skin layers. These layers are called the stratum ... Scales may be caused by dry skin, certain inflammatory skin conditions, or infections. Eczema , ringworm , and psoriasis ...
Baddeley, A D
Cognitive neuropsychiatry occupies the comparatively neglected research region that lies between neurology, psychiatry, and cognitive psychology. Reasons for this neglect are discussed, together with arguments as to why it may be timely to focus on this intellectual no man's land.
LIPSITT, DON R
General hospitals have had an illustrious role in the evolution of psychiatry. They have provided a rich soil for the growth of inpatient psychiatric units, consultation-liaison psychiatry, psychosomatic medicine, med-psych units, outpatient psychiatric clinics, emergency services and a whole spectrum of resources for the communities in which they dwell. In some respects, whether attached to universities or not, they have functioned as small colleges for the education and training of scores of health professionals. In the setting of the general hospital, psychiatry has had opportunities to become remedicalized and integrated into the mainstream of medicine. However, recent trends in health care run the risk of jeopardizing these accomplishments. Managed care has had a profound impact on the way psychiatry is practiced, taught, and reimbursed. Concerns about cost-containment have raised questions about whether the general hospital will remain the best and most economical setting for psychiatric services. If the primacy of the patient is lost, psychiatry's role in the general hospital will be uncertain. The need to safeguard psychiatry's achievements must be a worldwide endeavor. PMID:16946901
von Zerssen, Detlev
This report consists of the author's personal experience in German psychiatry during the second half of the last century. The focus is on scientific development in the area of biological psychiatry, a branch of psychiatry dominated, during the second quarter of the 20th century, by Kretschmer's constitutional conceptions. These, however, could not be substantiated by the author's and his co-worker's extensive research using biometrical and statistical methods still rather unusual for German psychiatry at that time. In particular, the extent as well as kind of correlation between physique and personality and the differences in physical shape between patients with either schizophrenic or affective psychoses were invalidated. The latter could largely be explained by the age dependence of physique and type of psychosis. In the psychopharmacological phase of psychiatric development following that of constitutional biology, the focus of research moved to pharmacology and, in connection with it, to neurochemistry and neuroendocrinology. In this context, objectifying and quantifying techniques, also in the area of psychopathology, became more and more important for biological research in psychiatry. This is exemplified by selected investigations of ours at the Max Planck Institute of Psychiatry in Munich. Methodologically, this prepared the ground for the neurobiological phase of development induced by progress in neuroimaging and molecular genetics which marked the transition into the 21st century.
Kotwicki, Raymond J; Compton, Michael T
The Emory University Fellowship in Community Psychiatry/Public Health is a unique training opportunity whose mission is to train future leaders in the arena of community psychiatry. To complement the recent description of the Public Psychiatry Fellowship of New York State Psychiatric Institute at Columbia University Medical Center, this report describes the key features of Emory's fellowship-its academic curriculum, practicum experiences, site visits and other opportunities for collaboration, and ongoing mentoring and career development. Congruencies between these four key features and the seven core elements of Columbia's fellowship are highlighted, as are several important differences. Such descriptions of innovative training programs in community and public psychiatry are essential in promoting excellence in education, which will translate into vital enhancements in programs, policy, and community-based approaches to mental health services.
Margariti, M; Papadimitriou, G N
Computer technology dominates our daily lives and has become an integral professional tool in medical practice and by extension, in psychiatry as well. The widespread use of internet technology has taken place with unprecedented speed in the history of human civilization, spreading in a few decades to all countries of the world, offering novel possibilities for transmitting information, and leading to the globalization of knowledge. However, the speed with which computer technology is becoming a part of our lives is accompanied by difficulties in integration. The continued evolution of applications often leads to the impression that to be modern and efficient we have to run continuously after developments, dedicating time and effort that we cannot often afford. At the same time, its widespread use alters the needs of our patients, and our efficiency is constantly judged in a globalized environment which, while offering new possibilities, also has new demands. The initial impression that computer technology is simply a tool that can facilitate the work of those who are willing and able to use it has been replaced by the perception that the practice of medicine, in both clinical and academic level, requires sufficient knowledge of modern technology and the development of relevant skills for ongoing training and following innovative applications. The result of this assumption is the introduction of technology courses in the curricula of medical schools in the country. This article offers a brief description of the uses of information technology in psychiatry. In particular, e-mail is one of the most popular Internet services and there is internationally an increasing pressure from the public to be able to contact their doctor by e-mail. Furthermore, almost all psychiatric journals now have a digital electronic edition, thus increasing the volume of articles published, the ease of accessing the required information, and ultimately the reduction of the time it takes a
Summary Hyperactivity is the most commonly diagnosed childhood psychiatric disorder in north America. Most physicians believe that the disorder is a neurological dysfunction which is best treated with stimulants, such as ritalin. Accounts of the history of hyperactivity written by physicians, psychologists and even historians suggest that the disorder was always conceived as such. This paper argues that, on the contrary, the notion that hyperactivity was a neurological condition only emerged after vigorous debate during the 1960s between three competing fields within American psychiatry: specifically psychoanalysis, social psychiatry and biological psychiatry. Biological psychiatry won the debate, not because its approach to hyperactivity was more scientifically valid, but rather because its explanations and methods fit the prevailing social context more readily than that of its rivals. American psychiatry's refusal to draw pluralistic conclusions about hyperactivity undermined the development of a deeper understanding of the disorder. The history of hyperactivity provides an ideal lens through which to view the evolution of psychiatry from a field dominated by Freudian psychoanalysis to one rooted in the neurosciences.
Ritchie, Elspeth Cameron; Benedek, David; Malone, Ricky; Carr-Malone, Rosemary
The United States has historically been concerned about the successful adjustment of its military members returning from war. These concerns are based on the recognition that war-zone exposures may have considerable negative emotional or behavior consequences. As the global war on terror continues, the United States military medical system will be required to address issues at the interface of psychiatry and the law. Despite clinical advances within the theater of war and at tertiary facilities in the United States, some military members will develop chronic and disabling mental illness as a result of traumatic exposure and exacerbated by the demands of the austere and dangerous operational environment. The extent to which violent and aggressive behavior in the aftermath of deployment can be attributed to combat experience remains an area of debate and ongoing investigation. However, experience suggests that a very small subgroup of the hundreds of thousands of war veterans deployed in conjunction with the current conflict in Iraq has already been involved in violent crimes. For this group, military forensic psychiatrists will be called on to make determinations of competency and criminal responsibility and to inform the courts about the potential contributions of war-related distress or disorder to criminal behavior. Though the overwhelming majority of war veterans will not be involved in criminal proceedings, a minority will develop career-ending (and in rare instances, life-ending) disabilities as a result of mental illness. For those who are no longer fit for duty, the military Physical Disability Evaluation System must make determinations of the extent to which future military performance and future civilian social and occupational function have been compromised. For a small yet highly visible minority of returning veterans, questions about the cause, precipitants, and manner of death will necessitate psychological autopsies. This article highlighted recent
Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent "totalitarian" regime, reformed and stagnated under "mature socialism" and then embraced capitalism and "managed democracy" at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the second half of the nineteenth century debates about the role of psychiatry in criminal justice took place against a backdrop of increasingly alarming terrorist activity, and call for revolution. While German influence, with its preference for hereditarianism, was strong, Russian psychiatry was inclined toward social and environmental explanations of crime. When revolution came in 1917, the new communist regime quickly institutionalized forensic psychiatry. In the aftermath of revolution, the institutionalization of forensic psychiatry "advanced" with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. The abuses of Soviet psychiatry under Stalin and more intensively after his death in the 1960s-80s remain under-researched and key archives are still classified. The return to democracy since the late 1980s has seen mixed results for fresh attempts to reform both the justice system and forensic psychiatric practice.
Frecska, Ede; Bokor, Petra; Andrassy, Gabor; Kovacs, Attila
Ayahuasca is a decoctum made of admixture plants containing dimethyltryptamine and harmine. For millennia it has been used as a central element of spiritual, religious, initiation, and other - foremost healing - rituals, originally by the indigenous groups of the Amazon basin and later by the mestizo populations of the region. During the last two decades the brew has raised increased scientific and lay interest about its healing potentials within the framework of Western therapeutic settings. The typical ayahuasca effects consist of strong somatic reactions, vivid visions, relived personal memories, cathartic emotions, and insightful, introspective experiences when the emerging mental contents take different context and get deeper perspectives. The ayahuasca-experience can be exhausting necessitating the presence of an experienced leader for helping participants to pass difficult phases and for maximizing therapeutic benefits. No health damaging adverse effect has been confirmed thus far as result of its well-structured, institutionalized use. The scientific investigation of ayahuasca is hindered by legal issues, methodical problems, and sociocultural preconceptions. The present review outlines the therapeutic potentials of ayahuasca use in psychiatry with its psychobiological and spiritual background.
Wortzel, Hal S
In his first Law and Psychiatry column for the Journal of Psychiatric Practice, the author discusses potential forensic consequences of the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While the transition to DSM-5 may prove challenging for both patients and clinicians, the scrutiny and adversarial process associated with forensic psychiatric practice will entail a unique set of challenges. The philosophy of innovation behind the DSM-5, and the attendant changes, could lead to some unintended consequences, particularly in medicolegal settings. This column highlights some of the major changes in DSM-5 and explores points of particular concern for forensic psychiatric practice, such as the move toward a non-multiaxial diagnostic system and dimensional severity ratings being superimposed on certain categorical diagnoses. The innovative changes featured in DSM-5, and the controversies surrounding some of them, could yield an environment of increased cynicism in courts of law, with renewed skepticism regarding mental health diagnoses and the forensic psychiatrists who testify about them. Fortunately, the best method for forensic psychiatric practice in this environment of change is to continue to adhere to a meticulous and transparent medicolegal process, with recognition that changes in the diagnostic manual will seldom alter essential medicolegal conclusions. Forensic psychiatrists may enhance their credibility and the strength of the opinions they offer by proactively illustrating how nuances in diagnosis do not change legally defined constructs such as insanity or incompetence.
Kirmayer, Laurence J; Ban, Lauren
This chapter reviews some key aspects of current research in cultural psychiatry and explores future prospects. The first section discusses the multiple meanings of culture in the contemporary world and their relevance for understanding mental health and illness. The next section considers methodological strategies for unpacking the concept of culture and studying the impact of cultural variables, processes and contexts. Multiple methods are needed to address the many different components or dimensions of cultural identity and experience that constitute local worlds, ways of life or systems of knowledge. Quantitative and observational methods of clinical epidemiology and experimental science as well as qualitative ethnographic methods are needed to capture crucial aspects of culture as systems of meaning and practice. Emerging issues in cultural psychiatric research include: cultural variations in illness experience and expression; the situated nature of cognition and emotion; cultural configurations of self and personhood; concepts of mental disorder and mental health literacy; and the prospect of ecosocial models of health and culturally based interventions. The conclusion considers the implications of the emerging perspectives from cultural neuroscience for psychiatric theory and practice.
The Convention on the Rights of Persons with Disabilities became legally binding in Germany in March 2009. “Inclusion” is the major concept–all people with any kind of handicap must have the same rights to full and effective participation and inclusion in society. Preceding inclusion come adjustments in society with regard to ethical, legislative, administrative, conceptual, structural, economical, and thus also to healthcare-political frameworks, in order to make disabilities are as far as possible no longer a handicap in an individual’s everyday life. This review first outlines the present social status influencing the development of children, a child’s welfare, and especially the healthcare of children and adolescents with psychiatric disorders and conditions indicating barriers to inclusion. It focuses on those articles of the UN convention which are relevant with regard to ethical attitude, epidemiology, healthcare framework, diagnostics, therapy, teaching, and research with respect to child and adolescent psychiatry. The analysis points to a significant backlog demand in child psychiatric healthcare, teaching, and research.
Gurvich, Caroline; Maller, Jerome J; Lithgow, Brian; Haghgooie, Saman; Kulkarni, Jayashri
The vestibular system has traditionally been thought of as a balance apparatus; however, accumulating research suggests an association between vestibular function and psychiatric and cognitive symptoms, even when balance is measurably unaffected. There are several brain regions that are implicated in both vestibular pathways and psychiatric disorders. The present review examines the anatomical associations between the vestibular system and various psychiatric disorders. Despite the lack of direct evidence for vestibular pathology in the key psychiatric disorders selected for this review, there is a substantial body of literature implicating the vestibular system in each of the selected psychiatric disorders. The second part of this review provides complimentary evidence showing the link between vestibular dysfunction and vestibular stimulation upon cognitive and psychiatric symptoms. In summary, emerging research suggests the vestibular system can be considered a potential window for exploring brain function beyond that of maintenance of balance, and into areas of cognitive, affective and psychiatric symptomology. Given the paucity of biological and diagnostic markers in psychiatry, novel avenues to explore brain function in psychiatric disorders are of particular interest and warrant further exploration.
Psychiatric medication, or psychotropics, are increasingly prescribed for people of all ages by both psychiatry and primary care doctors for a multitude of mental health and/or behavioral disorders, creating a sharp rise in polypharmacy (i.e., multiple medications). This paper explores the clinical reality of modern psychotropy at the level of the prescribing doctor and clinical exchanges with patients. Part I, Geographies of High Prescribing, documents the types of factors (pharmaceutical-promotional, historical, cultural, etc.) that can shape specific psychotropic landscapes. Ethnographic attention is focused on high prescribing in Japan in the 1990s and more recently in the Upper Peninsula of Michigan, in the US. These examples help to identify factors that have converged over time to produce specific kinds of branded psychotropic profiles in specific locales. Part II, Pharmaceutical Detox, explores a new kind of clinical work being carried out by pharmaceutically conscious doctors, which reduces the number of medications being prescribed to patients while re-diagnosing their mental illnesses. A high-prescribing psychiatrist in southeast Wisconsin is highlighted to illustrate a kind of med-checking taking place at the level of individual patients. These various examples and cases call for a renewed emphasis by anthropology to critically examine the "total efficacies" of modern pharmaceuticals and to continue to disaggregate mental illness categories in the Boasian tradition. This type of detox will require a holistic approach, incorporating emergent fields such as neuroanthropology and other kinds of creative collaborations.
Historians recognize Adolf Meyer (1866-1950), first psychiatrist-in-chief at Johns Hopkins Hospital, as one of the principal architects of clinical psychiatry in the United States. This wholesale influence on the fledgling discipline had much to do with the authority he wielded as a Hopkins chief, but an important question remains: why was Meyer the obvious candidate to establish a department of psychiatry at the nation's foremost institution for medical research and teaching? Taking examples from Meyer's employment in three large American asylums before his appointment to Johns Hopkins in 1908, this article explores how he transformed an improvised set of practices into a clinical system for psychiatry that he implemented on a widespread scale, something that garnered him a reputation as a modernizer of outdated asylums and pegged him, in the minds of Hopkins authorities, as a psychiatric exemplar of commitment to pathological research and clinical teaching.
Nambi, S.; Ilango, Siva; Prabha, Lakshmi
Forensic psychiatry is a subspecialty of psychiatry, in which scientific and clinical expertise is applied to legal issues in legal contexts embracing civil, criminal, correctional, or legislative matters. Forensic psychiatry is still in an infant stage in India and other developing countries. Law is the sanctioning discipline, and Psychiatry is the therapeutic discipline. Due to various reasons, Forensic Psychiatry is reared as Cinderella in our country; “which is much neglected, ignored, misinterpreted, and misunderstood. Legislation forms an integral component in the implementation of Mental Health Care; there is a dynamic relationship between the concept of mental illness, treatment of the mentally ill, and the law. Mental Health legislation is essential in protecting the rights and dignity of persons with Mental Disorders and for implementing effectively the mental health services. “Effective mental health legislation can provide a legal frame work to integrate mental health services in the community as to overcome stigma, discrimination, and exclusion of mentally ill persons. Legislations can also create enforceable standards for high quality medical care and improve access to care and protect civil, political, social, and economic rights of the mentally ill individual, including right to access to education, employment, housing, and social security.” PMID:28216766
What is psychiatry? Such a question is increasingly important to engage with in light of the development of new diagnostic frameworks that have wide-ranging and international clinical and societal implications. I suggest in this reflective essay that ‘psychiatry' is not a singular entity that enjoins consistent forms of critique along familiar axes; rather, it is a heterogeneous assemblage of interacting material and symbolic elements (some of which endure, and some of which are subject to innovation). In underscoring the diversity of psychiatry, I seek to move towards further sociological purchase on what remains a contested and influential set of discourses and practices. This approach foregrounds the relationships between scientific knowledge, biomedical institutions, social action and subjective experience; these articulations co-produce both psychiatry and each other. One corollary of this emphasis on multiplicity and incoherence within psychiatric theory, research and practice, is that critiques which elide this complexity are rendered problematic. Engagements with psychiatry are, I argue, best furthered by recognising its multifaceted nature. PMID:23226975
Decker, Hannah S
Progress in psychiatry in the West has been retarded by the proclivity of the discipline to swing violently between 2 approaches to viewing mental illness; that is, emphasizing-to the exclusion of the other-the material-somatic vs the psychical-experiential avenues to knowledge. Each time a shift occurs, the leaders of the new dominant approach emotionally denounce the principles and ideas that came before. We can examine this phenomenon historically by looking at Romantic psychiatry, mid-/late-19th century empirical psychiatry, psychoanalysis, and modern biological psychiatry. Looking at the 2 approaches in treatment today, the gold standard of patient care involves combining empirical/psychological care in 1 person (the psychiatrist) or shared between 2 clinicians working intimately with each other (psychiatrist with psychologist or social worker.) Yet as regards psychiatrists, they are discouraged from paying full attention to the psychological side by the way managed care and third-party payment have combined to remunerate them. Finally, how do we account for the intense swings and denunciations in psychiatry? The author speculates on possible explanations but leaves the question open for her readers.
In the author's opinion the contemporary western world is experiencing an offensive of irrationality which affects also psychiatry. When psychiatry got rid of irrational illusions of preceding centuries, analytical psychology contributed to the introduction of irrationality into psychiatry. In the first part of his paper he maintains that Freud's share was not substantial in this respect and that in particular Jung contributed towards the development of irrational trends in psychiatry by this concept of collective unconscious. In the second part of his paper the author deals with so-called transpersonal, psychology, in particular the contribution made by the Czech psychiatrist Grof who, based on his experiments with LSD, created the theory of three levels of experience from unconscious (psychodynamic, perinatal, and transpersonal). His interpretation is a relapse of neoplatonism and represents antirational agnostic spiritualism with utopic antipsychiatric elements. In the third part of his paper the author deals with Capro's ideology of the New Age Movement to the establishment of which Ghof contributed in an important way. The New Age ideology is an irrational conglomeration of anti-civilization trends which negate modern thinking. The chances of manking are fallaciously seen in alienation from science and an approach to mysticism and irrational Asian traditions. Contemporary popularity of irrational trends, incl. transpersonal psychology, is a reaction of the overationalized society. Consequential enforcement of transpersonal psychology would imply a negation of the entire arsenal of thinking in psychiatry as a medial discipline.
Lui, Su; Zhou, Xiaohong Joe; Sweeney, John A; Gong, Qiyong
Unlike neurologic conditions, such as brain tumors, dementia, and stroke, the neural mechanisms for all psychiatric disorders remain unclear. A large body of research obtained with structural and functional magnetic resonance imaging, positron emission tomography/single photon emission computed tomography, and optical imaging has demonstrated regional and illness-specific brain changes at the onset of psychiatric disorders and in individuals at risk for such disorders. Many studies have shown that psychiatric medications induce specific measurable changes in brain anatomy and function that are related to clinical outcomes. As a result, a new field of radiology, termed psychoradiology, seems primed to play a major clinical role in guiding diagnostic and treatment planning decisions in patients with psychiatric disorders. This article will present the state of the art in this area, as well as perspectives regarding preparations in the field of radiology for its evolution. Furthermore, this article will (a) give an overview of the imaging and analysis methods for psychoradiology; (b) review the most robust and important radiologic findings and their potential clinical value from studies of major psychiatric disorders, such as depression and schizophrenia; and (c) describe the main challenges and future directions in this field. An ongoing and iterative process of developing biologically based nomenclatures with which to delineate psychiatric disorders and translational research to predict and track response to different therapeutic drugs is laying the foundation for a shift in diagnostic practice in psychiatry from a psychologic symptom-based approach to an imaging-based approach over the next generation. This shift will require considerable innovations for the acquisition, analysis, and interpretation of brain images, all of which will undoubtedly require the active involvement of radiologists. (©) RSNA, 2016 Online supplemental material is available for this
Penrose, L. S.
The paper gives an outline, with examples, of various statistical methods which may be of special use in psychiatry. (1) Actuarial data.—The simple accumulation of accurate figures on the ages of patients, their diagnoses and length of stay in hospital or under treatment for mental illness is of great value in understanding the scope of psychiatric problems. The age and sex incidences which correspond to different disease groups are very characteristic. Such material has value in the estimation of the results of therapeutic experiments but special methods have to be devised, as there is no exact prototype in standard vital statistics or in work on therapeutic trials. (2) Biometric techniques.—Knowledge of ordinary statistical practice guards against elementary errors and aids in establishing significance or otherwise of metrical deviations from the normal found in mentally ill subjects. Also the range of variations may be much more marked in abnormal than in normal groups. Furthermore, abnormal reactions in themselves may be characterized by either too much or too little variety, i.e. by scatter or by stereotypy. Discrimination between normal and abnormal reaction can be based on a single quantitative measurement, on difference in variance or on a compound measurement, i.e. pattern or profile. The discriminative approach has advantages over other methods because in this approach the initial factors are concrete and based on known classes such as males and females, children and adults, special clinical types, &c. (3) Genetical analysis.—Actuarial data can be useful in genetic studies by leading to estimation of population frequency of genes and consanguinity rates. Moreover, combined clinical and genetical observations can reveal the existence of new clinical entities. PMID:18919283
For the last five centuries, France's international influence has been constant. This has been particularly evident in the areas of general culture, history and science. In psychiatry, the role of Pinel during the French Revolution, and the discovery of the first psychotropic agent, chlorpromazine, by Delay and Deniker are two outstanding historical facts. This chapter examines the contributions of French social scientists in the understanding of the sequelae of colonial exploitation, racism and political oppression. The establishment of a multi-ethnic society in France and Francophile regions of the world has led to the gradual creation of a cultural psychiatry rich in terminological influences, clinical understanding, training programs and research. Closer connections between French psychiatric thought and Anglophile psychiatry is likely to produce beneficial effects.
OBJECTIVE This article provides a brief overview of the history of psychiatry residency training in Canada, and outlines the rationale for the current training requirements, changes to the final certification examination, and factors influencing future trends in psychiatry education and training. METHOD The author compiled findings and reports on residency education in Canada from current and historical sources. RESULTS Residency training in psychiatry in Canada has undergone significant change in the past 5 years, moving from an "apprenticeship" model to a competency-based curriculum with explicit expectations for the acquisition of key, defined competencies. CONCLUSION Continuous evaluation of teaching methodologies, increasing use of innovative and creative medical education techniques, flexible curricula, and increasingly rigorous standards of accreditation are some of the factors likely to continue to shape the future.
Li, Weiwei; Mei, Xue; Wang, Hao; Zhou, Yu; Huang, Jiashuang
Functional connectivity network (FCN) is an effective tool in psychiatry disorders classification, and represents cross-correlation of the regional blood oxygenation level dependent signal. However, FCN is often incomplete for suffering from missing and spurious edges. To accurate classify psychiatry disorders and health control with the incomplete FCN, we first `repair' the FCN with link prediction, and then exact the clustering coefficients as features to build a weak classifier for every FCN. Finally, we apply a boosting algorithm to combine these weak classifiers for improving classification accuracy. Our method tested by three datasets of psychiatry disorder, including Alzheimer's Disease, Schizophrenia and Attention Deficit Hyperactivity Disorder. The experimental results show our method not only significantly improves the classification accuracy, but also efficiently reconstructs the incomplete FCN.
Cheung, Erick H
Neuroethics is a new subset of bioethics that addresses ethical issues pertaining to the brain, primarily in the fields of neuroscience, cognitive science, and neuroradiology. Research in brain science is progressing at a phenomenal rate and, as a result, the acquisition and application of knowledge and technology raises ethical questions of a practical and philosophical nature. While neuroethics is developing as a distinct field of study, one area that should be addressed in greater depth is the relevance and potential impact of neurotechnology in psychiatry. New knowledge in the mind-brain conundrum and increasingly sophisticated techniques for imaging and intervening in human cognition, emotion, and behavior pose ethical issues at the intersection of technology and psychiatry. This article presents a broad survey of the new directions in neuroethics, neuroscience, and technology and considers the implications of technological advances for the practice of psychiatry in the new millennium. (Journal of Psychiatric Practice 2009;15:391-401).
1. What is usually taught as biological psychiatry in psychiatric residency training is mainly psychopharmacology, but biology has a lot more to offer to psychiatry educators. 2. The main thesis of this article is that an introductory course on the applications to psychiatry based on the theory of the evolution of the species by natural selection and mutation, along with a comprehensive theory of mind, may contribute to: (i) helping young physicians to integrate the diverse and extensive knowledge acquired during the residency training; (ii) aid in keeping the psychiatrist within the medical approach to mental illnesses while promoting the specific features of the specialty, and (iii) perhaps developing a general theoretical framework that allows psychiatrists to maintain a prominent role in the mental health staff. 3. The author describes how he has conducted such training in Venezuela. It is expected that the author's ideas will serve as a forum for discussion of this pivotal subject.
Forensic mental health services exist in a nebulous space at the intersection of two different systems-criminal justice and mental health-and the entanglement of these systems poses intricate problems for psychiatrists. This article discusses the present circumstances of forensic mental health services in Japan, focusing on trends in prison psychiatry. In the traditional Japanese system, offenders with mental disorders were treated within general psychiatry as involuntarily admitted patients, or within the prison system as mentally ill inmates. As a consequence of recent legal reform, however, this situation has radically changed. The Medical Treatment and Supervision Act of 2005 aimed to provide intensive psychiatric treatment to offenders with mental disorders, attaching great importance to their reintegration into society. Under the new system, a person who commits a serious criminal offense in a state of insanity or diminished capacity shall be referred by the public prosecutor to the district court; following a treatment order of the court, the person shall be treated in psychiatric facilities established by the law. While the new system is expected to play a role in the context of specialist forensic psychiatry, its distinction from general psychiatry remains unclear. For example, persons who commit serious crimes, such as assault, in an acute psychotic state are occasionally admitted to general psychiatric hospitals, even if they meet the criteria for a treatment order under the Medical Treatment and Supervision Act. The relationship between prison psychiatry and specialist forensic psychiatry is still more problematic. Compared to the intensive, rehabilitation-oriented care provided under the Medical Treatment and Supervision Act, mental health services in penal institutions have a number of disadvantages, and it is unlikely that mentally ill prisoners have benefited from the recent progress in forensic psychiatry. Statistics show that the number of
Jäger, Markus; Lang, Fabian U; Becker, Thomas
Karl Jaspers, in his book "General Psychopathology", argued for methodological pluralism rather than theoretical dogmatism. He formulated a methodological order of psychopathology with a distinction between "explanation" (objective psychopathology) and "understanding" (subjective psychopathology, psychopathology of meaning). The latter approach focused on patients' subjective experience and biographical issues. Karl Jaspers emphasised social factors in the genesis and course of mental disorders. Following a multiperspective concept, from Jaspers' viewpoint social psychiatry should consider itself of equal importance with biological and psychotherapeutic psychiatry. Therefore, uncritical generalization of one of these perspectives should be avoided. Personalized psychiatry, apart from searching biological markers to tailor treatment should identify psychosocial factors and subjective meaning. Concepts of recovery should not ignore biological foundations in mental disorders.
The significance of mental health in the entire health scenario has increased. However, the representation of psychiatry in the current MBBS curriculum for undergraduate students in India still remains much less than desirable. Further, stigmatising attitudes lessen these future doctors’ ability to detect and manage patients with psychological problems despite adequate knowledge about psychiatry. Students believe that psychiatrically ill patients are unpredictable and can be dangerous to others. Some feel that psychiatry is unscientific, imprecise and treatment is not effective. Traditional teaching methods are directed more towards imparting knowledge than changing the attitudes of students. Newer teaching and assessment techniques should be used to bring about attitudinal changes and develop interest among medical students. Case based and problem based learning, small group teaching, simulated patients, using movies, multidisciplinary seminars, integrated teaching, attitude questionnaires, objective structured clinical examinations etc., could be introduced in the curriculum to achieve this objective. PMID:25838738
Renner, John A., Jr.; Karam-Hage, Maher; Levinson, Marjorie; Craig, Thomas; Eld, Beatrice
Objective: The authors attempt to better understand the recent decline in the number of applicants to addiction psychiatry training. Methods: The Corresponding Committee on Training and Education in Addiction Psychiatry of APA's Council on Addiction Psychiatry sent out a 14-question anonymous e-mail survey to all postgraduate-year 2 (PGY-2)…
Morreale, Mary; Arfken, Cynthia; Bridge, Patrick; Balon, Richard
Objective: Medical students' satisfaction with the psychiatry clerkship, sense of preparedness for an institutional Objective Structured Clinical Exam (OSCE), expressed likelihood of choosing psychiatry as a specialty, and National Board of Medical Examiners (NBME) psychiatry shelf-examination scores were compared after a curriculum based on…
Cooke, Brian K.; Cooke, Erinn O.; Sharfstein, Steven S.
Objective: The purpose of this study was to review the workload inventory of on-call psychiatry residents and to evaluate which activities were associated with reductions in on-call sleep. Method: A prospective cohort study was conducted, following 20 psychiatry residents at a 231-bed psychiatry hospital, from July 1, 2008 through June 30, 2009.…
Sockalingam, Sanjeev; Stergiopoulos, Vicky; Maggi, Julie D.; Zaretsky, Ari; Stovel, Laura; Hodges, Brian
Objectives: With the emergence of physician-manager (PM) curricula in medical education, more effective assessment tools are needed to evaluate psychiatry trainees in this role. The aim of this study was to determine psychiatry residents', program directors', and PM educators' perceptions about PM role-assessment. Methods: Psychiatry residents at…
Dogra, Nisha; Edwards, Ruth; Karim, Khalid; Cavendish, Susan
Background: Recruitment into psychiatry is correlated with the quality of undergraduate medical school teaching programmes and with a commitment of major resources to teaching students. There is an extensive literature related to attitudes towards psychiatry but less on the learning and teaching of psychiatry. Aims: To identify the current issues…
Varley, Christopher K.; Jibson, Michael D.; McCarthy, Mary; Benjamin, Sheldon
OBJECTIVE: The authors report a survey of the American Association of Directors of Psychiatry Residency Training (AADPRT) on interactions between the pharmaceutical industry and psychiatry residency programs. METHODS: American Association of Directors of Psychiatry Residency Training membership was anonymously surveyed by e-mail and by paper…
Burgut, F. Tuna; Polan, H. Jonathan
Objective: To assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries. Methods: A…
The author establishes that Psychiatry has been in a difficult situation especially in Hungary since closing down the National Institute of Psychiatry and Neurology. He reviews the most important factors which hold up the development of Psychiatry. He settles that the development of Psychiatry is inconceivable without a person's holistic approach which assumes the biological, mental, cultural-social and spiritual approach. Disturbances of perception have particular roles in the formation of psychopathological symptoms which are based on the operation of the nervous system. This fact emphasises the importance of the nervous system and the neuropsychopharmacology which we have known since the beginning of history although it is hardly half a century old. He pays the attention to the psychoactive medicine that was well-known in the ancient civilization. He reviews some of them which were actually the first neuropsychopharmacological pharmaceuticals. He emphasises the dichotomy of the psychopathological symptoms which are partly objective, partly subjective but based on the operation of the nervous system by all means. His statements not only establish a new kind of approach of both the person and the Psychiatry but enables the development of Psychiatry, the creation of a new sort of diagnostic system, eliminating the variance among the experts dealing with people, the neurologists, the psychiatrists, the psychologists, the sociologists, the philosophers and the theologians, ensuring the biological (neurological), psychological, cultural and spiritual perpetuity. The biological, genetic, psychic, cultural-social and spiritual approach, the application of nanomedicine that enable not only recognising the organic neurological bases of the psychiatric disorders that are all crucial for the future researchers but also essential in the development of the neuropsychopharmacology based on the function of the nervous system.
Philo, Chris; Andrews, Jonathan
This paper introduces a special issue on 'Histories of asylums, insanity and psychiatry in Scotland', situating the papers that follow in an outline historiography of work in this field. Using Allan Beveridge's claims in 1993 about the relative lack of research on the history of psychiatry in Scotland, the paper reviews a range of contributions that have emerged since then, loosely distinguishing between 'overviews' - work addressing longer-term trends and broader periods and systems - and more detailed studies of particular 'individuals and institutions'. There remains much still to do, but the present special issue signals what is currently being achieved, not least by a new generation of scholars in and on Scotland.
This article describes my developing interest in cultural psychiatry. This is both a challenging and yet a privileged opportunity to reflect on my research and clinical work over the last 25 years. I describe cultural and interpersonal influences on my thinking and interests, and the development of my research career moving from health services research of specialist services, to primary care research to public mental health research. Specifically, social and cultural influences on risks and responses to mental illness are discussed, as are pathways to care, the recognition of mental illness, and public health and cultural psychiatry research.
Monteith, Scott; Glenn, Tasha; Geddes, John; Bauer, Michael
Big data are coming to the study of bipolar disorder and all of psychiatry. Data are coming from providers and payers (including EMR, imaging, insurance claims and pharmacy data), from omics (genomic, proteomic, and metabolomic data), and from patients and non-providers (data from smart phone and Internet activities, sensors and monitoring tools). Analysis of the big data will provide unprecedented opportunities for exploration, descriptive observation, hypothesis generation, and prediction, and the results of big data studies will be incorporated into clinical practice. Technical challenges remain in the quality, analysis and management of big data. This paper discusses some of the fundamental opportunities and challenges of big data for psychiatry.
Layfayette Ronald Hubbard (1911-1986) was a colourful and prolific American writer of science fiction in the 1930s and 1940s. During the time between his two decades of productivity and his return to science fiction in 1980, Hubbard founded the Church of Scientology. In addition to its controversial status as a religion and its troubling pattern of intimidation and litigation directed towards its foes, Scientology is well known as an organised opponent to psychiatry. This paper looks at Hubbard's science fiction work to help understand the evolution of Scientology's antipsychiatry stance, as well as the alternative to psychiatry offered by Hubbard.
Lerner, Vladimir; Kaptsan, Alexander; Witztum, Eliezer
The aim of our paper is to describe Kandinsky-Clerambault's Syndrome, which has important cultural-historical value in the history of psychiatry, and to illustrate the syndrome by means of a case report. Although its component symptoms are known among Western psychiatrists, the syndrome's specific name is generally unknown. The authors suggest that detailed clinical descriptions of some specific conditions may contribute to a more detailed knowledge of psychopathology, a more colorful and memorable view of conditions, with an increased awareness of the historical and cultural origins of psychiatry.
Musical scales involve notes that, sounded simultaneously (chords), sound good together. The result is the left brain meeting the right brain â a Pythagorean interval of overlapping notes. This synergy would suggest less difference between the working of the right brain and the left brain than common wisdom would dictate. The pleasing sound of harmony comes when two notes share a common harmonic, meaning that their frequencies are in simple integer ratios, such as 3/2 (G/C) or 5/4 (E/C).
Musical scales involve notes that, sounded simultaneously (chords), sound good together. The result is the left brain meeting the right brain — a Pythagorean interval of overlapping notes. This synergy would suggest less difference between the working of the right brain and the left brain than common wisdom would dictate. The pleasing sound of harmony comes when two notes share a common harmonic, meaning that their frequencies are in simple integer ratios, such as 3/2 (G/C) or 5/4 (E/C).
Engel, J. W.
Yale's current department of psychiatry was created by Dean Milton C. Winternitz in the 1920s as part of a broader effort to combine mental and physical components of medical care. This effort, which spurred the founding of Yale's institute of Human Relations, was the basis of Winternitz' interest in mental health. Although the institute soon closed because of interdisciplinary squabbling, this brief chapter in Yale's history illustrates the progressive thinking of the Dean and the pre-War place of psychiatry in medicine. PMID:7645310
Over the years Consultation-Liaison (C-L) psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill. In India, although the General Hospital Psychiatric units were established in 1930s, C-L Psychiatry has never been the main focus of training and research. Hence there is an urgent need to improve C-L Psychiatry services and training to provide best and optimal care to the patients and provide best education to the trainees. PMID:22135437
Banner, Natalie F; Thornton, Tim
There has been a recent growth in philosophy of psychiatry that draws heavily (although not exclusively) on analytic philosophy with the aim of a better understanding of psychiatry through an analysis of some of its fundamental concepts. This 'new philosophy of psychiatry' is an addition to both analytic philosophy and to the broader interpretation of mental health care. Nevertheless, it is already a flourishing philosophical field. One indication of this is the new Oxford University Press series International Perspectives in Philosophy and Psychiatry seven volumes of which (by Bolton and Hill; Bracken and Thomas; Fulford, Morris, Sadler, and Stanghellini; Hughes, Louw, and Sabat; Pickering; Sadler; and Stanghellini) are examined in this critical review.
Hodapp, Robert M.; Dykens, Elisabeth M.
We begin this article by examining the role of intellectual disabilities within child psychiatry, highlighting the relatively steady role of disabilities and the recent movement to examine behavior in specific genetic syndromes. We next propose five questions for future work. Questions relate to (1) specifying the nature of gene-brain-behavior…
Osteopathic medicine represents a valid tradition in Western medicine, but there are concerns about whether it is a viable tradition: will it end up a "poorer cousin" of the allopathic tradition or will it eventually simply be absorbed by the dominant model? This is particularly the case in psychiatry, where osteopathic medicine has never established a firm presence. Currently, the dominant ethos in psychiatry is reductive biologism, which tries to eliminate the notion of mind as a causative factor in behavior. The author's case is that this has failed to give rise to a human-centered psychiatry. His own model of mental disorder, the biocognitive model, is based on a molecular resolution of the mind-body problem (ie, the ancient question of how the immaterial mind and the material body interact). It is manifestly dualist (ie, it accords causative primacy to mind). This is firmly in the osteopathic medical tradition and is offered as a means of developing a distinctive model of psychiatry and hence a holistic general medicine.
Chess, Stella, Ed.; Thomas, Alexander, Ed.
Selected studies of infant development concern biological rhythms, pattern preferences, sucking, and Negro-white comparisons. Sex, age, state, eye to eye contact, and human symbiosis are considered in mother-infant interaction. Included in pediatrics are child development and the relationship between pediatrics and psychiatry. Environmental…
Perlmutter, Richard A.
Awareness of interpersonal forces upon mental health clinicians is crucial to allow mature balancing of the many factors involved in the decision-making process. An integration of family and systems thinking into the practice of emergency psychiatry can enhance comfort and effectiveness in many difficult crisis situations. (Author/BL)
Aitchison, Katherine J; Malhotra, Anil K
The Ninth Annual Pharmacogenetics in Psychiatry meeting was held in New York City on 23-24 April 2010 with a series of panel presentations, as well as a debate on the commercialization of genetic testing and a poster reception. The following is a brief report of the meeting presentations.
Malhotra, A K; Zhang, J-P; Lencz, T
Pharmacogenetic/pharmacogenomic (PGx) approaches to psychopharmacology aim to identify clinically meaningful predictors of drug efficacy and/or side-effect burden. To date, however, PGx studies in psychiatry have not yielded compelling results, and clinical utilization of PGx testing in psychiatry is extremely limited. In this review, the authors provide a brief overview on the status of PGx studies in psychiatry, review the commercialization process for PGx tests and then discuss methodological considerations that may enhance the potential for clinically applicable PGx tests in psychiatry. The authors focus on design considerations that include increased ascertainment of subjects in the earliest phases of illness, discuss the advantages of drug-induced adverse events as phenotypes for examination and emphasize the importance of maximizing adherence to treatment in pharmacogenetic studies. Finally, the authors discuss unique aspects of pharmacogenetic studies that may distinguish them from studies of other complex traits. Taken together, these data provide insights into the design and methodological considerations that may enhance the potential for clinical utility of PGx studies.
Zhang, Jian-Ping; Aitchison, Katherine J; Malhotra, Anil K
The 12th Annual Pharmacogenetics in Psychiatry meeting was held in Hollywood, Florida, from 31 May to 1 June 2013, in conjunction with the NCDEU meeting. It included a series of oral presentations as well as a poster session. This report summarizes the presentations at the conference.
Mezzacappa, Enrico; Hamoda, Hesham M.; DeMaso, David R.
Background: In 2003, the Institute of Medicine (IOM) drew attention to the critical national shortage of psychiatrist-researchers and the need for competency-based curricula to promote research training during psychiatry residency as one way to address this shortage at the institutional level. Here, the authors report on the adaptation,…
Cutler, Janis L.; Alspector, Sharon L.; Harding, Kelli J.; Wright, Leslie L.; Graham, Mark J.
Objective: This study describes medical students' perceptions of the field of psychiatry and identifies the impact of those perceptions on their career choices in order to explore the questions: Are we as a field doing all that we can to enhance the educational experience of all medical students, regardless of their career preferences? What are…
A brief account is given of attitudes towards mental health and the development of psychiatry in the Middle East from an historical perspective. The Middle East is considered as a cultural entity and the influence of the beliefs and practices of ancient times on the collective mind of the people of the Region is discussed.
Eyal, Roy; O'Connor, Mary J.
Background/Objective: Alcohol is a teratogen. Fetal alcohol spectrum disorders (FASDs) affect about 1% of live births, causing severe impairment. Individuals affected by FASDs are overrepresented in psychiatric settings. This study reports on the education and experience of psychiatry trainees in approaching FASDs. Method: Data were collected from…
Lang, Timothy P.; Rohrer, James E.; Rioux, Pierre A.
Context: Access to psychiatric services, particularly inpatient psychiatric care, is limited and lacks comprehensiveness in rural areas. Purpose: The purpose of this study was to evaluate the impact on readmission rates of a multifaceted inpatient psychiatry approach (MIPA) offered in a rural hospital. Methods: Readmissions within 30 days of…
Slaby, Andrew E.; And Others
The pattern of use of psychiatry over a 12-month period in a university-based primary care center is reported. Interest in pursuing careers in family practice and amount of time spent in the center were related to seeking consultation. Differences in use by nurse practitioners, social workers, and patients are cited. ( Author/LBH)
West, Donald A.; Nierenberg, David W.
Objectives: The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and…
Shemo, John P. D.; And Others
To lessen the traditional mind-body dichotomy in medicine, the West Virginia University School of Medicine has integrated psychiatry into the Department of Internal Medicine and the university hospital's psychiatric ward has been transformed into the Conjoint Medicine Service. Patients with a variety of emotional and medical problems are admitted.…
Fabrega, Horacio, Jr.
Critically examines contemporary Hispanic mental health research. Develops idea that "establishment psychiatry" dominates methods, research, reimbursement, and treatment. Suggests need to broaden paradigms with culturally sensitive insight and contemporary psychiatric theory. Analyzes issues using frameworks of mental health research,…
Frederick, John T.; Comtois, Katherine Anne
Objective: The University of Washington (UW) psychiatry residency program attempted to determine how participation in a dialectical behavior therapy (DBT) training program influenced the practice of its graduates. Methods: A survey was completed by 30 graduates who participated in elective DBT training. This survey obtained information about their…
Sigmon, Scott B.
"Communication: The Social Matrix of Psychiatry" (J. Ruesch and G. Bateson) is a work that outlines in a more conversational than pedantic way a theory of human communication. The main thrust is to unite two types of organized information: (1) an understanding of the cultural matrix within which the psychiatrist operates; and (2) the nature of…
The history of placebos in psychiatry can be understood only in the context of randomized controlled trials (RCTs). Placebo treatments are as old as medicine itself, and are particularly effective in dealing with psychosomatic symptoms. In psychiatry, placebos have mainly been featured in clinical drug trials. The earliest controlled trial in psychiatry (not involving drugs) occurred in 1922, followed by the first crossover studies during the 1930s. Meanwhile the concept of randomization was developed during the interwar years by British statistician Ronald A Fisher, and introduced in 3 trials of tuberculosis drugs between 1947 and 1951. These classic studies established the RCT as the gold standard in pharmaceutical trials, and its status was cemented during the mid-1950s. Nevertheless, while the placebo became established as a standard measure of drug action, placebo treatments became stigmatized as unethical. This is unfortunate, as they constitute one of the most powerful therapies in psychiatry. In recent years, moreover, the dogma of the placebo-controlled trial as the only acceptable data for drug licensing is also being increasingly discredited. This backlash has had 2 sources: one is the recognition that the US Food and Drug Administration has been too lax in permitting trials controlled with placebos alone, rather than also using an active agent as a test of comparative efficacy. In addition, there is evidence that in the hands of the pharmaceutical industry, the scientific integrity of RCTs themselves has been degraded into a marketing device. The once-powerful placebo is thus threatened with extinction.
Onate, John; Hales, Robert; McCarron, Robert; Han, Jaesu; Pitman, Dorothy
Objective: A unique rotation was developed to address limited outpatient internal medicine training in psychiatric residency by the University of California, Davis, Department of Psychiatry and Behavioral Sciences, which provides medical care to patients with mental illness. Methods: The number of patients seen by the service and the number of…
Lichtmacher, Jonathan; Eisendrath, Stuart J.; Haller, Ellen
Objective: Interpersonal psychotherapy (IPT) for depression is a brief, well researched treatment for acute major depression. This article describes the implementation of IPT as an evidence-based treatment for depression in a psychiatry residency program. Method: The authors tracked the implementation process over 5 years as interpersonal…
Myers, Michael F.
Objective: This article examines the relevance of physician impairment to the discipline of academic psychiatry. Method: The author reviews the scientific literature, the proceedings of previous International Conferences on Physician Health, and held discussions with experts in the physician health movement, department chairs, program directors,…
Cultural psychiatry in the United Kingdom exhibits unique characteristics closely related to its history as a colonial power, its relationship with Commonwealth countries and the changing socio-demographic characteristics of its diverse population throughout the centuries. It is not surprising, therefore, that the emergence of this discipline was centred around issues of race and religion. After a brief historical review of the development of cultural psychiatry and the mention of pioneering intellectual and academic figures, as well as the evolvement of the field in organizations such as the Royal College of Psychiatrists, this chapter examines the need of a critical cultural psychiatry, more than a narrative social science distanced from the realities of clinical practice. In such context, issues such as policies and experience with efforts to delivering race equality, and address inequities in a renewed public health approach seem to confer British cultural psychiatry with a defined socially active role aimed at the pragmatic management, understanding and improvement of diverse and alternative systems of care and care practices.
The history committee within the American Psychiatric Association was actively involved in the history of psychiatry in the early decades of the twentieth century, as well as from 1942 to 2009.This paper explores the role of this committee in the context of changes in the psychiatric profession over the twentieth century.
Carney, Stuart; Bhugra, Dinesh K.
Background/Objective: Recent training and education changes have raised important issues in delivery of psychiatric education at all levels. In this article, the authors describe the current status of mental health education in the training of all doctors and postgraduate training and education in psychiatry in the U.K. Method: The authors explore…
Bennett, Aurora J.; Arnold, Lesley M.; Welge, Jeffrey A.
Objective: Standardized patients are used in teaching medical students and evaluating their clinical skills during the psychiatric clerkship. The purpose of this study was to evaluate whether the addition of a Psychiatry Clinical Standardized Patient Examination (PCX) during the third-year clerkship improved students' performances on the…
Moutoussis, M.; Story, G. W.; Dolan, R. J.
Research into the biological basis of emotional and motivational disorders is in danger of riding roughshod over a patient-centered psychiatry and falling into the dualist errors of the past, i.e., by treating mind and brain as conceptually distinct. We argue that a psychiatry informed by computational neuroscience, computational psychiatry, can obviate this danger. Through a focus on the reasoning processes by which humans attempt to maximize reward (and minimize punishment), and how such reasoning is expressed neurally, computational psychiatry can render obsolete the polarity between biological and psychosocial conceptions of illness. Here, the term ‘psychological’ comes to refer to information processing performed by biological agents, seen in light of underlying goals. We reflect on the implications of this perspective for a definition of mental disorder, including what is entailed in asserting that a particular disorder is ‘biological’ or ‘psychological’ in origin. We propose that a computational approach assists in understanding the topography of mental disorder, while cautioning that the point at which eccentric reasoning constitutes disorder often remains a matter of cultural judgment. PMID:26483713
Neumaier, Felix; Paterno, Mario; Alpdogan, Serdar; Tevoufouet, Etienne E; Schneider, Toni; Hescheler, Jürgen; Albanna, Walid
Brain surgery to promote behavioral or affective changes in humans remains one of the most controversial topics at the interface of medicine, psychiatry, neuroscience, and bioethics. Rapid expansion of neuropsychiatric deep brain stimulation has recently revived the field and careful appraisal of its 2 sides is warranted: namely, the promise to help severely devastated patients on the one hand and the dangers of premature application without appropriate justification on the other. Here, we reconstruct the vivid history of the field and examine its present status to delineate the progression from crude freehand operations into a multidisciplinary treatment of last resort. This goal is accomplished by a detailed reassessment of numerous case reports and small-scale open or controlled trials in their historical and social context. The different surgical approaches, their rationale, and their scientific merit are discussed in a manner comprehensible to readers lacking extensive knowledge of neurosurgery or psychiatry, yet with sufficient documentation to provide a useful resource for practitioners in the field and those wishing to pursue the topic further.
ERDEN AKİ, Özlem; ÖZÇELİK EROĞLU, Elçin; USLU, Ece
Introduction The number of women with careers in medicine and with academic positions at medical schools has increased substantially since the 1980s; however, women remain underrepresented in medical academia, which may be because of the fewer research publications authored by women. This study aimed to determine the gender distribution among Turkish authors of psychiatry articles published in international scientific journals during a 30-year period. Methods The ISI Web of Science database was searched for all psychiatry publications between 1980 and 2009 using the search term Turkey. All articles were classified according to publication period (1980–1989, 1990–1999, 2000–2004, and 2005–2009), gender of the first and last authors, first author title, total number of authors, and type of article. Results In all, 1961 articles meet the study criteria. The first author of 36.5% of the articles and 34.9% of last authors were women. The percentage of female first and last authors did not differ according to publication period (p=0.57). Conclusion To the best of our knowledge this is the first study to examine gender and authorship of psychiatric research in Turkey. In total, 33% of academic positions in Turkish university psychiatry departments were occupied by women, which is comparable to the percentage of female first authors of psychiatric research papers from Turkey. It could be concluded that women academics in psychiatry departments from state universities are as reproductive as their male counterparts, but there is still a “gender gap” in psychiatry field in our country.
Brasch, Jennifer; Glick, Rachel Lipson; Cobb, Thomas G.; Richmond, Janet
Objective: Describe training goals, objectives and requirements in emergency psychiatry to assist residency programs in developing comprehensive training programs to ensure psychiatric residents acquire the necessary skills and knowledge to competently assess and manage patients with psychiatric emergencies. Methods: The American Association for…
Stuck, Craig; Campbell, Nioaka; Bragg, John; Moran, Robert
Objective: The authors describe an interdisciplinary training experience developed for psychiatry residents and seminary students that assessed each group's beliefs and attitudes toward the other's profession. The training was designed to enhance awareness, positive attitudes, and interaction between the disciplines. Methods: From 2005 to 2008,…
Hanson, Mark D.; Szatmari, Peter; Eva, Kevin W.
Objective: The authors evaluated the differential impact of clerk interest and participation in a Child and Adolescent Psychiatry (CAP) clerkship rotation upon psychiatry and pediatrics residency matches. Method: Authors studied clerks from the McMaster University M.D. program graduating years of 2005-2007. Participants were categorized as 1)…
Silva Ayçaguer, L C
This present paper is mainly methodological and has been written with the aim of helping researchers in psychiatry to produce results with higher quality and help readers to have adequate assessment values of others. Brief reflection is made on the most important conditions that must be fulfilled to prove a causality hypothesis, regardless of the investigation design used. However, the main purpose of the text is to examine and illustrate how these conditions work under a case-control study environment. Besides outlining the basic aspects concerning design and analysis, areas extremely illustrated with examples of case and controls in psychiatry found in the literature, a number of suggestions to avoid pitfalls that can invalidate research efforts developed using case-control methodology is offered.
Philo, Chris; Andrews, Jonathan
This paper introduces a special issue on ‘Histories of asylums, insanity and psychiatry in Scotland’, situating the papers that follow in an outline historiography of work in this field. Using Allan Beveridge’s claims in 1993 about the relative lack of research on the history of psychiatry in Scotland, the paper reviews a range of contributions that have emerged since then, loosely distinguishing between ‘overviews’ – work addressing longer-term trends and broader periods and systems – and more detailed studies of particular ‘individuals and institutions’. There remains much still to do, but the present special issue signals what is currently being achieved, not least by a new generation of scholars in and on Scotland. PMID:27956649
Marsot, A; Boucherie, Q; Kheloufi, F; Riff, C; Braunstein, D; Dupouey, J; Guilhaumou, R; Zendjidjian, X; Bonin-Guillaume, S; Fakra, E; Guye, M; Jirsa, V; Azorin, J-M; Belzeaux, R; Adida, M; Micallef, J; Blin, O
Clinical trials in psychiatry allow to build the regulatory dossiers for market authorization but also to document the mechanism of action of new drugs, to build pharmacodynamics models, evaluate the treatment effects, propose prognosis, efficacy or tolerability biomarkers and altogether to assess the impact of drugs for patient, caregiver and society. However, clinical trials have shown some limitations. Number of recent dossiers failed to convince the regulators. The clinical and biological heterogeneity of psychiatric disorders, the pharmacokinetic and pharmacodynamics properties of the compounds, the lack of translatable biomarkers possibly explain these difficulties. Several breakthrough options are now available: quantitative system pharmacology analysis of drug effects variability, pharmacometry and pharmacoepidemiology, Big Data analysis, brain modelling. In addition to more classical approaches, these opportunities lead to a paradigm change for clinical trials in psychiatry.
Daray, Federico Manuel; Maffia, Paulo César; Rothlin, Rodolfo Pedro; Errasti, Andrea Emilse
Pharmacogenetics studies how genetic variation influences the response of patients to drugs. This discipline has a greater impact in those medical specialties that treat complex diseases in which the therapeutic response is insufficient and/or have high costs such as psychiatry. This is a narrative review in which we analyze the main results of pharmacogenetic studies performed with the most relevant groups of psychoactive drugs and discusses missing for incorporating these advances into our daily practice. We conclude that despite the remarkable progress in the field of Pharmacogenetics in the last 10 years, studies in psychiatry have been inconclusive and the clinical use of pharmacogenetic testing is still limited. However, there are some encouraging elements about the applicability of these tools for the improvement of psychiatric treatments.
Huys, Quentin J M; Maia, Tiago V; Frank, Michael J
Translating advances in neuroscience into benefits for patients with mental illness presents enormous challenges because it involves both the most complex organ, the brain, and its interaction with a similarly complex environment. Dealing with such complexities demands powerful techniques. Computational psychiatry combines multiple levels and types of computation with multiple types of data in an effort to improve understanding, prediction and treatment of mental illness. Computational psychiatry, broadly defined, encompasses two complementary approaches: data driven and theory driven. Data-driven approaches apply machine-learning methods to high-dimensional data to improve classification of disease, predict treatment outcomes or improve treatment selection. These approaches are generally agnostic as to the underlying mechanisms. Theory-driven approaches, in contrast, use models that instantiate prior knowledge of, or explicit hypotheses about, such mechanisms, possibly at multiple levels of analysis and abstraction. We review recent advances in both approaches, with an emphasis on clinical applications, and highlight the utility of combining them.
Artificial neural networks make a highly specialised tools in data transformation. The human brain has become an inspiration for the makers of artificial neural networks. Although even though artificial neural networks are more frequently used in areas like financial analysis, marketing studies or economical modelling, their application in psychology and medicine has given a lot of promising and fascinating discoveries. It is worth that artificial neurol networks are successfully used in the diagnosis and etiopathogenesis description of various psychiatric disorders such as eating disorders, compulsions, depression or schizophrenia. To sum up, artificial neural networks offer a very promising option of research methodology for modern clinical psychology and psychiatry. The aim of this article is only an illustration of the applications of artificial neural networks in clinical psychology and psychiatry.
A revival of the dialogue between phenomenology and psychiatry currently takes place in the best international journals of psychiatry. In this article, we analyse this revival and the role given to phenomenology in this context. Although this dialogue seems at first sight interesting, we show that it is problematic. It leads indeed to use phenomenology in a special way, transforming it into a discipline dealing with empirical facts, so that what is called "phenomenology" has finally nothing to do with phenomenology. This so-called phenomenology tallies however with what we have always called semiology. We try to explain the reasons why phenomenology is misused in that way. In our view, this transformation of phenomenology into an empirical and objectifying discipline is explained by the role attributed to phenomenology by contemporary authors, which is to solve the problems raised by the Diagnostic and Statistical Manual of Mental Disorders.
Delgado Baquero, Y; Crespo Hervás, D; Cisneros, S; López-Ibor Aliño, J J
Transcranial magnetic stimulation is the noninvasive application of localized pulsed magnetic field to the surface of the skull, to cause a depolarization of neurons in the underlying cerebral cortex (Daryl E., Bohning PH.D.). Based on Reciprocal Induction (Faraday, 1831), and the Ampere Maxwell Law, according to which electric energy is associated with magnetic energy and vice versa, transcranial magnetic stimulation has been used during the last fifteen years in the diagnosis of Central Nervous System dysfunctions, its safeness and good tolerance having been proven. Since 1876, when Dàrsonval discovered that the use of a similar apparatus caused vertigo, phosphenes and fainting, thousands of transcranial magnetic stimulation studies have been carried out in the fields of Neurology and Psychiatry. The present is a review of clinical studies carried out in Psychiatry, specifically related to Mood Disorders, Obsessive-Compulsive Disorder and Post traumatic-Stress Syndrome.
O'Hara, Ruth; Beaudreau, Sherry A; Gould, Christine E; Froehlich, Wendy; Kraemer, Helena C
The purpose of this paper is to a) outline the importance of including patients with clinical comorbidities in Randomized Clinical Trials (RCTs) of psychiatric treatments; and b) to propose a specific approach for best handling, analyzing and interpreting the data on clinical comorbidities in terms of their impact on treatment outcomes. To do this we first define and describe clinical comorbidity and differentiate it from other forms of comorbidity. We then describe the methodological and analytical problems associated with excluding patients with clinically comorbid conditions from RCTs, including the impact on the outcomes of RCTs in psychiatry and the impact on evidence-based clinical decision-making. We then address the challenges inherent to including patients with clinical comorbidities in RCTs. Finally, we propose a methodological and analytic approach to deal with these issues in RCTs which aims to significantly improve the information yielded from RCTs in psychiatry, and thus improve clinical decision-making.
Freedman, A M
Although hazardous, prediction is necessary for sensible programming for the future of psychiatry. Because of the multitude of variables essential for comprehending normal and abnormal behavior, a complex, all-encompassing model takes on increasing importance. Dualism and reductionism have had a chilling effect on progress in developing psychiatric models. The biopsychosocial model as elaborated by Dr. George Engel would appear to be a major step in moving toward an adequate workable model. Dr. Engel rejects the biomedical or Newtonian model in favor of the biopsychosocial model, basing his conception in part on developments in the past century, particularly the contributions of Einstein, Heisenberg, and Planck. The implications and relevance of these advances, including the work of Niels Bohr, are presented. Other ideas such as Chaos Theory and the work of Roger Penrose are also discussed, together with the new thinking that arises from them. This work reinforces notions of holism, leading to a more humanitarian psychiatry and medicine.
Kirwin, Paul; Conroy, Michelle; Lyketsos, Constantine; Greenwald, Blaine; Forester, Brent; deVries, Christine; Ahmed, Iqbal Ike; Wiechers, Ilse; Zdanys, Kristina; Steffens, David; Reynolds, Charles F
Dire shortages of psychiatrists with special expertise in geriatrics, substance abuse, forensics, and psychosomatics create barriers to care for populations with complex mental disorders and pose a significant public health concern. To address these disparities in access to care, we propose streamlining graduate medical education to increase efficiency and enhance cost-effectiveness while simultaneously increasing the number of psychiatric subspecialists in these key areas. We propose that trainees interested in subspecialties complete their general training in 3 years, while meeting ACGME required milestones, and then utilize their 4th year to complete subspecialty fellowship training. Eligible trainees would then qualify for psychiatry subspecialty certification and general psychiatry ABPN certification at the end of 4 years.
Lambe, Jennifer Lynn
This article traces the battle over Freud within Cuban psychiatry from its pre-1959 origins through the "disappearance" of Freud by the early 1970s. It devotes particular attention to the visit of two Soviet psychiatrists to Cuba in the early 1960s as part of a broader campaign to promote Pavlov. The decade-long controversy over Freud responded to both theoretical and political concerns. If for some Freud represented political conservatism and theoretical mystification, Pavlov held out the promise of a dialectical materialist future. Meanwhile, other psychiatrists clung to psychodynamic perspectives, or at least the possibility of heterogeneity. The Freudians would end up on the losing side of this battle, with many departing Cuba over the course of the 1960s. But banishing Freud did not necessarily make for stalwart Pavlovians-or vanguard revolutionaries. Psychiatry would find itself relegated to a handmaiden position in the work of revolutionary mental engineering, with the government itself occupying the vanguard.
Philo, Chris; Pickstone, John
This paper introduces a theme section comprising of three other papers, written from cross-disciplinary perspectives, exploring what might be termed 'local historical geographies of psychiatry', and in particular demonstrating how pioneering innovations in the treatment of mental health problems sometimes emerge from the most 'unpromising' of spaces and places. The introductory paper contextualises the studies that follow, laying out claims regarding the need to take seriously the thoroughly situated character of the knowledge and practices that are taken to comprise the 'stuff' of science, technology and medicine, and more specifically drawing out what such claims mean for an emerging 'spatial turn' in historical research on psychiatry and other mental health subjects. We focus on innovations which emerged where least expected, in 'backwaters' or even 'deprived' locations and institutions, thereby qualifying more conventional accounts of change in the field that prioritise centres of learning as the key sites from which developments arise and diffuse.
Dawson, P J
Mental health nursing operates without a clear idea of the nature of both mind and mental. Increasingly, this lack of a defensible theoretical position has led to an increasing dependence on the concept of mind now current in biological psychiatry. But the materialist monism of biological psychiatry is itself open to doubt, particularly concerning its dependence on a priori assumptions about the nature of the relationship between mind and brain. The reductionism and objectivism inherent in this approach necessarily ignores that aspect of mind most germane to nursing, the first-person nature of the mental. An alternative is briefly sketched which stresses the mediation of behaviour by the brain, rather than viewing behaviour as causally related to brain processes. Adoption of this approach conserves nursing's focus on the subjective experience as being paramount. Nursing education should, therefore, be wary of incorporating the biological approach without a critical analysis of its suppositions and of the conception of human nature which it supports.
Psychiatry can be seen as a natural and cultural science. According to this the postulate of freedom is its strong value judgment. Since the times of enlightenment it has been described metaphorically by the myth of the expulsion from Paradise. Following Max Weber and Wilhelm Dilthey, Karl Jaspers has introduced this perspective into psychiatry. His strict dichotomy between explaining and understanding has later been critically revised by Werner Janzarik and Hans Heimann. Their concepts of structure dynamic, of pathography and of anthropology are closer to Max Weber who connected natural and cultural sciences in a much stronger way. Especially the pathographic example of Nietzsche allows to demonstrate the differences between Jaspers and the later psychopathologists of the Heidelberg and Tübingen schools.
Appelbaum, Paul S
Twenty-five years ago, Alan Stone expressed his skepticism that forensic psychiatry could be practiced ethically. His remarks have proven a useful goad to the field, focusing attention on the importance of an ethics framework for forensic practice. But Stone remains dubious that any system of ethics--including the "Standard Position" on which he focuses his critique--could be of much value in practice. In contrast, I suggest that Stone's pessimism is not well founded. Immanent in forensic practice itself is a reasonable set of ethics principles, based on truth-telling and respect for persons. Psychiatrists can offer reliable and valid testimony, while resisting seduction into an advocacy role. Indeed, with new structured approaches to assessment, the potential utility of forensic testimony is probably greater than ever. Though problematic behavior still exists, forensic psychiatry offers the factual background and interpretive context to allow legal decision-makers to make better choices than they otherwise would.
Phenomenological and existential philosophical approaches to mental illness have had great influence on psychiatric research and theory in European psychiatry (Berrios, 1992: 309). Among them, the work of Jürg Zutt (1893-1980), Professor of Psychiatry at University Hospital Frankfurt 1950-63, closely relates to the anthropological psychiatry of Ludwig Binswanger, Victor von Gebsattel and Erwin Straus. Since both anthropological psychiatry and social psychiatry are based on a person-centred approach, it was hypothesized that common roots are to be detected in what is called humanistic psychology. The main finding of the present paper is that there is a strong relationship between Zutt's concept of Comprehending Anthropology and the biopsychosocial model on which social psychiatry is based. However, it cannot be concluded from the existing evidence that the reform of psychiatric services necessarily resulted from the anthropological approach.
This paper takes a critical look at pay for performance (P4P) as a model for introducing new incentives in psychiatry. This model is to be seen as a tool of commercialism, and such a restructuring of psychiatry represents a wide-reaching political maneuver which actively introduces economical parameters into the field and will have a great impact on psychiatry. P4P starts with the false premise that medicine has to be structured like industry. This premise is false because psychiatry has to do with relationships to patients, and not with the production of a product. Therefore, it is essential to reflect critically upon the premises and consequences of P4P for psychiatry. Only this critical reflection can help psychiatry to keep its identity as a humane service for suffering people.
Psychiatric epidemiology is one of the many paths to a career in cultural psychiatry. Psychiatric epidemiology has made numerous substantive contributions to cultural psychiatry. Areas in which psychiatric epidemiologists have contributed to cultural psychiatry include the undertaking of cross-national comparisons, studying the mental health of populations of importance to cultural psychiatry, studying risk factors that are of cultural importance such as immigration and social class, studying trauma, examining the role of stigma in cultural settings, and investigating cultural influences on mental health service delivery. This article highlights examples from the author's own research examining cross-national comparisons, trauma, and mental health service delivery. Research is vital to enable the field of cultural psychiatry to be a vibrant, evidence-based discipline within psychiatry.
Wise, T N
Although the importance of consultation-liaison (C-L) psychiatry is increasingly recognized, obstacles to acceptance of the specialty persist in many service delivery settings. These can be countered by identifying specific consumers of C-L services and demonstrating that products of the specialty will meet consumers' needs. Once access to the market is gained, it is important to monitor potential sources of competition in the interest of ensuring continued high quality patient care.
MacVicar, A. S.
A community psychiatry program was developed for R.C.A.F. personnel and members of their families in the Air Division in Europe. The community consisted of about 20,000 people, divided into four separate units in France and Germany. Officers of the personnel branch, the chaplain branch and the medical branch were organized into “caretaker” groups. The methods of integrating the groups and enhancing their effectiveness are described. PMID:5969347
Freitas, Fernando Ferreira Pinto de
The article proposes a revision of the approach to madness and the birth of the psychiatric institution taken by Foucault in History of Madness. The hypothesis is that the origins of modern Psychiatry revolutionize the approach to madness by proposing it is possible to dialogue with the insane, because the madman is not someone who has lost his reason . It is hoped that this critique of Foucault's book will be a contribution to the process of psychiatric reform currently underway in Brazil.
In the first part of this paper there is a short abstract of the biography of the famous professor of psychiatry from Torino. The second part consists of a summary of the most fundamental ideas and the most important results of his extensive research, setting the base of his widest-known work, 'l'uomo delinquente'. At last, a number of contemporary and recent comments concerning his theories are quoted, and some criminologically relevant findings of modern genetics are mentioned.
This article draws attention to a generalizable phenomenon called "transforming poison into medicine," illustrating both literal and figurative applications. The purpose of such illustrations is to support a strong philosophical claim, namely the currently incomplete reduction (if not the ultimate irreducibility) of intentional mind-states - e.g., beliefs, desires, volitions - to electro-chemical brain-states. Such incomplete reduction (or irreducibility) holds profound implications for the ineluctable role of dualism in neuroscience and psychiatry alike.
Tarsitani, Lorenzo; Tarolla, Emanuele; Pancheri, Paolo
United States cinema motion pictures from the beginning of 20th century to the present are characterized by massive use of sterotypes to represent psychiatrist's image, as well as psychiatric treatment and inpatients psychiatric facilities. Representation tends to undergo considerable changes between psychiatric different historical periods. Psychiatric disorders also are commonly depicted in movies, often in a not realistic way. The images of psychiatrist and mental disorders shown in movies are likely to impact on the beliefs and attitudes of people towards psychiatry.
Hamoda, Hesham M; Belfer, Myron L
International collaboration in child and adolescent psychiatry has historically been weak and fragmented. The field has also lagged in developing remedies for improving collaboration. This article identifies barriers to successful collaboration and examines problems in the areas of finance, professional development, knowledge dissemination, professional organisations, public policy and the political environment, priority setting, nomenclature, as well as ethical challenges. The article then identifies some promising initiatives and proposes solutions to improve international collaboration in child and adolescent mental health.
Lepetit, Alexis; Lavigne, Benjamin; Legros, Emilie; Herrmann, Mathieu; Sebbane, Déborah
Aging of the population is a growing concern in developed countries. Therefore, geriatric psychiatry has gradually emerged from general psychiatry. Many names have been proposed to term this sub-specialty: old age psychiatry (OAP), psychogeriatrics, geropsychiatry. A working group of the French federation of psychiatric trainees (AFFEP) set up an inventory of the theoretical instruction and clinical practice of OAP during the training of psychiatrists in France. Methods. A survey of both academic teaching and practical training for OAP was carried out in the 28 local AFFEP representatives of every French medical residency district, including overseas. We assessed the supply of general courses and seminars devoted to OAP during the training of French residents in psychiatry, and the offer of university or inter-university degrees as well as the possibility of specialized internship in every residency district. Results. 96% of French medical residency districts offered general courses of OAP with a mean volume of 11.5 hours along the four years of psychiatric training in France. Fifty percent of medical residency districts proposed at least one seminar devoted to OAP. Half of medical residency districts also offer a specialized university or inter-university degree. Concerning clinical practice, 86% of medical residency districts had one internship dedicated to OAP, in 39% of cases in teaching hospitals. Conclusion. Nationwide, there is an overall effort to make OAP available to French psychiatric residents by general courses and internship, but some disparity appeared in academic teaching (i.e. offering seminars and university/inter-university degrees) according to various residency districts.
Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs
Benedict, R H; Goldstein, M Z; Dobraski, M; Tannenhaus, J
This study examined the degree to which demographic variables, psychiatric diagnosis, depression rating, and neuropsychological test performance predict adaptive kitchen behavior in geriatric psychiatry patients and normal elderly volunteers. Amixed group of 27 participants including 8 normal volunteers and 19 geriatric psychiatry inpatients underwent psychiatric evaluation, neuropsychological testing, and a kitchen skills assessment conducted in a natural setting. Both depression and dementia were prevalent among patients. The kitchen skills assessment was abnormal in 69% of patients, compared to none of the normal volunteers. Estimated premorbid IQs, psychiatric diagnosis, and neuropsychological test scores significantly predicted the pass/fail status on the kitchen skills assessment, but there was no effect for age, education, gender, or depression. The discriminant function analysis classified 92% of cases, and the canonical correlation coefficient was .84. Of the neuropsychological tests employed in the study, two tests involving visuospatial processing and attention were retained in the discriminant function analysis. The results are consistent with previous studies that suggest that visuospatial tasks are more predictive of instrumental activities of daily living than are cognitive tasks emphasizing verbal and memory abilities. In addition, we conclude that neuropsychological test data are useful and valid for the purpose of guiding clinical judgments regarding activities of daily living in geriatric psychiatry patients.
Rutherford, Bret R; Taylor, Warren D; Brown, Patrick J; Sneed, Joel R; Roose, Steven P
Advances in understanding the biological bases of aging have intellectually revitalized the field of geriatric psychiatry and broadened its scope to include promoting successful aging and studying resilience factors in older adults. To describe the process by which this paradigm shift has occurred and illustrate its implications for treatment and research of late-life brain disorders, late-life depression is discussed as a prototype case. Prior phases of geriatric psychiatry research were focused on achieving depressive symptom relief, outlining pharmacokinetic and pharmacodynamic differences between older and younger adults, and identifying moderators of treatment response. Building on this work, current geriatric psychiatry researchers have begun to disentangle the etiologic complexity in late-life depression by focusing on the causative aging-related processes involved, identifying both neurobiological and behavioral intermediates, and finally delineating depression subtypes that are distinguishable by their underlying biology and the treatment approach required. In this review, we discuss several age-related processes that are critical to the development of late-life mood disorders, outline implications of these processes for the clinical evaluation and management of later-life psychiatric disorders, and finally put forth suggestions for better integrating aging and developmental processes into the National Institute of Mental Health's Research Domain Criteria.
Peters, U H
German psychiatrists do not have an easy access to Adolf Meyer. The reasons include: his influence on American psychiatry was mainly exercised by his personal influence; he did not have the gift of writing his important and influential ideas in a clear language; these ideas, furthermore, were scattered over great number of papers in a variety of periodicals; there is only one unsatisfactory (from the point of view of edition) collection of Meyers papers; no textbook of Meyerian psychiatry exists. There seems to be no German translation of any of Meyers papers. Meyer, who was always in close contact with German psychiatry and psychiatrists, transmitted their ideas to the American scientific public, although in a critical vein. His own psycho-biological or genetico-psychodynamic theory pointed to the importance of the biological and personality structure and its reactions, of how the patient reacts to which live events and which illness in his or her body contrasts to Kraepelins concept of self-sufficiency of the endogenous psychoses. Whereas DSM I und II had been moulded in Meyers spirit, DSM III led far away from it.
Li, Wenjing; Schmiedebach, Heinz-Peter
Modern psychiatry was first introduced to mainland China around 1900 by Western missionaries. By 1949 the field had developed gradually as a result of contact with Western psychiatry and especially its American practitioners. This paper analyses the role played by key individuals and events in this process in the years prior to 1949. It argues that modern psychiatry was introduced to China through a process of cultural adaptation in which the USA served as a bridge for German thought.
Renou, S; Hergueta, T; Flament, M; Mouren-Simeoni, M-C; Lecrubier, Y
Structured diagnostic interviews, which evolved along the development of classification's systems, are now widely used in adult psychiatry, in the fields of clinical trials, epidemiological studies, academic research as well as, more recently, clinical practice. These instruments improved the reliability of the data collection and interrater reliability allowing greater homogenisation of the subjects taking part in clinical research, essential factor to ensure the reproducibility of the results. The diagnostic instruments, conversely to the clinical traditional diagnostic processes allow a systematic and exhaustive exploration of disorders, diagnostic criteria but also severity levels, and duration. The format of the data collection, including the order of exploration of the symptoms, is fixed. The formulation of the questions is tested to be univocal, in order to avoid confusions. In child and adolescent, researches in pharmacology and epidemiology increased a lot in the last decade and the standardisation of diagnostic procedures is becoming a key feature. This Article aims to make an assessment, a selection, and a description of the standardized instruments helping psychiatric diagnosis currently available in the field of child and adolescent's psychiatry. Medline and PsycINFO databases were exhaustively checked and the selection of the instruments was based on the review of four main criteria: i) compatibility with international diagnostic systems (DSM IV and/or ICD-10); ii) number of disorders explored; iii) peer reviewed Journals and iv) richness of psychometric data. After the analysis of the instruments described or mentioned in the literature, 2 structured interviews [the Diagnostic Interview Schedule for Children (DISC) and the Children's Interview for Psychiatric Syndromes (ChIPS)] and 4 diagnostic semi-structured interviews [the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS), the Diagnostic Interview for
Carpenter-Song, Elizabeth; Torrey, William C
The US needs engaged and skilled psychiatrists to support the recovery of people with severe mental illnesses and we are currently facing a shortage. This paper examines what attracts providers to community psychiatry and what sustains them in their work. Focus groups and interviews were used to elicit the perspectives of prescribing clinicians in three community mental health clinics in the US. Community psychiatry has inherent challenges, including facing high-risk decisions, encountering intense affects, and occasionally witnessing bad outcomes. Psychiatrists are motivated and sustained in this work by (1) cultivating relationships with patients and colleagues, (2) focusing on the mission of promoting recovery, and (3) engaging with clinical practice as intellectually stimulating work. Administrators support the engagement and morale of psychiatrists by creating workflows that allow psychiatrists to meaningfully apply their expertise to support patients' recovery. These findings hold implications for recruiting and retaining a new generation of physicians.
This conceptual, perspective and review paper on Indian scales and inventories begins with clarification on the historical and contemporary meanings of psychometry before linking itself to the burgeoning field of clinimetrics in their applications to the practice of clinical psychology and psychiatry. Clinimetrics is explained as a changing paradigm in the design, administration, and interpretation of quantitative tests, techniques or procedures applied to measurement of clinical variables, traits and processes. As an illustrative sample, this article assembles a bibliographic survey of about 105 out of 2582 research papers (4.07%) scanned through 51 back dated volumes covering 185 issues related to clinimetry as reviewed across a span of over fifty years (1958-2009) in the Indian Journal of Psychiatry. A content analysis of the contributions across distinct categories of mental measurements is explained before linkages are proposed for future directions along these lines. PMID:21836709
Psychiatry as a discipline is often perceived as 'different' by other medical professionals as much as by a common man. This perception of 'difference' may give rise to stigma both towards mental illness and to mental health professionals. Mental health professionals are thus both recipients of stigma and agents who can de-stigmatize psychiatry. A psychiatry movie club approach can be a very useful learning experience to understand various aspects of this stigmatization process. This paper presents a brief account of such an endeavour in which the film Gothika (2003) was used to help psychiatry trainees talk about their experiences with stigma towards mental illness as well as their profession.
Lerner, Vladimir; Margolin, Jacob; Witztum, Eliezer
The paper describes Victor Kandinsky's professional achievements within nineteenth-century Russian forensic psychiatry. A thorough review of nineteenth-century Russian psychiatry is presented, followed by a short biographical account of Kandinsky's personal life. Within the backdrop of Russian forensic psychiatry toward the end of nineteenth century, Kandinsky's pioneer innovations in psychopathology and classification as well as his contributions to Russian forensic psychiatry are reviewed. These are exemplified by two of his forensic case studies relating to forensic responsibility and malingering, which are included in his famous book 'On Irresponsibility'.
Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice. PMID:23794027
Gerke, Wolfgang; Rufer, Michael; Schnyder, Ulrich
For several years the demand regarding psychiatrists in Switzerland can only be satisfied by recruiting colleagues from other countries. Given the global increase of mental disorders, initiatives encouraging young academics to choose psychiatry as their speciality, and enhancing the attractiveness of our field, are urgently needed. Two projects for the promotion of young academics are presented in this paper, one working with medical students, the other with residents in psychiatry. The Zurich 'Study Focus on Psychiatry' provides medical students with knowledge and key competencies in psychiatry at an early stage of their undergraduate training. This way, students are offered an opportunity to have a thorough look into psychiatry as a clinical specialism and as a science. The three-year psychotherapy training curriculum in medical psychotherapy provides residents in psychiatry and psychotherapy with specific training in either cognitive behavioural, or psychodynamic, or systemic psychotherapy. Additionally, and independent of the psychotherapeutic orientation they have chosen, all trainees attend joint sessions focusing on generic elements of psychotherapy and facilitating a hands-on transfer of psychotherapeutic principles into their clinical routine. These two projects aim at enhancing the attractiveness of psychiatry and psychotherapy as a speciality, and thus contributing to the promotion of young academics.
Research in Biological and Medical Sciences, Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 1
Contents: In-house laboratory independent research; Communicable diseases and immunology; Surgery, internal medicine , psychiatry, Biochemistry...surgery, military internal medicine , military psychiatry; Malaria prophylaxis; and Biosensor systems.
Beahrs, J O
Psychological trauma heightens and rigidifies the penchant of humans for dichotomizing others into allies and enemies. With today's "adult delayed recall" controversy a case in point, traumatized individuals tend to unite into tightly knit in-groups that resemble cults and to denigrate others as enemies. This process creates new enmities where objective interests otherwise clash only minimally. The trauma response is reinforced by the neurobiology of avoidance and reenactment. Among all protagonists, polarized beliefs are mutually shaped by suggestive interactions that resemble hypnosis. The end result is to reenact and perpetuate the trauma response on a large scale. In the contemporary milieu, this process presents a formidable obstacle to cooperative problem solving. Discussion focuses on strategies by which clinical and forensic psychiatrists can help to master this obstacle. These strategies include balancing interests, extending the role of informed consent, and overall, striving to mitigate the unwitting reinforcement and transmission of the trauma response.
Background Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. Methods Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students’ career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students’ attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. Results 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were “quite likely”, and 25% were “definitely not” considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p < 0.001) and number of placements (correlation coefficient =0.21, p < 0.001) were associated with higher ATP scores. During medical school, experience of psychiatric enrichment activities (special studies modules and university psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry. Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p < 0.001); interest in psychiatry before medical school, OR 10.8 (5.38 to 21.8, p < 0.001); undertaking a
In addition to the prolonged economic recession and global financial crisis, the Great East Japan Earthquake of March 2011 has caused great fear and devastation in Japan. In the midst of these, Japanese people have felt to lose the traditional values and common sense they used to share, and it has become necessary to build a new consciousness. Engaged in psychiatry and psychiatric care under these circumstances, we have to analyze the challenges we face and to brainstorm on appropriate prescriptions that can be applied to solve the problems. Five points in particular were brought up:  The persistently high number of suicides.  The increase in depression and overflowing numbers of patients visiting clinics and outpatient departments at hospitals.  The absolute shortage of child psychiatrists.  Little progress with the transition from hospitalization-centered to community-centered medical care.  The disappearance of beds for psychiatry patients from general hospitals. The situations surrounding these five issues were briefly analyzed and problems were pointed out. The following are five problems that psychiatry is facing: 1) A lack of large clinical trials compared to the rest of the world. 2) The drug lag and handling of global trials. 3) The lack of staff involved in education and research (in the field of psychiatry). 4) Following the DSM diagnostic criteria dogmatically, without differentiating therapeutics. 5) Other medical departments, the industry, patients, and their families are demanding objective diagnostic techniques. After analyzing the problems, and discussing to some extent what kind of prescription may be considered to solve the problems, I gave my opinion. (1) The first problem is the deep-rooted prejudice and discrimination against psychiatric disorders that continue to be present among Japanese people. The second problem is the government's policy of low remuneration (fees) for psychiatric services. The third problem, symbolic of the
Steinberg, Holger; Schmidt-Recla, Adrian; Schmideler, Sebastian
In contrast to other areas of psychiatry, little work has been done on the history of forensic psychiatry, and such work is especially scarce regarding the first half of the 19th century, when forensic psychiatry began to develop together with the neurosciences. One newly discovered archival source bears immediate witness to the genesis of forensic psychiatry and is presented for the first time in this study. That source helps us to better understand, in particular, one of the most important cases in 19th-century German forensic psychiatry - namely, that of Johann Christian Woyzeck, the murderer who became the lead figure and the decisive model for the famous eponymous drama by German poet Georg Büchner. Duke Friedrich August, the heir to the throne of the German kingdom of Saxony, submitted a separately recorded special vote (or, very roughly speaking, a brief) that denied the criminal responsibility of the murderer since he had committed his crime out of jealousy and in an emotionally agitated state of mind that eliminated the offender's free will. Though possessing no relevant professional training, the duke applied, and argued in support of, a syndrome - partial mania - that was then the subject of ongoing controversy in general psychiatry. In that context, his vote and analysis can be seen a part of the conceptual development not only of forensic psychiatry, but also of German psychiatry and criminal law.
March, John S.; Szatmari, Peter; Bukstein, Oscar; Chrisman, Allan; Kondo, Douglas; Hamilton, John D.; Kremer, Charlotte M. E.; Kratochvil, Christopher J.
Objectives: At the 2005 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the Academy's Workgroup on Research conducted a Research Forum entitled "Increasing Research Literacy Through the Adoption of Evidence-Based Practice (EBP) in Pediatric Psychiatry." Method: Forum participants focused on speeding the adoption…
Agrawal, Sacha; Szatmari, Peter; Hanson, Mark
Objective: The authors argue that adopting evidence-based psychiatry will require a paradigm shift in the training of psychiatry residents, and offer some suggestions for how this transformation might be achieved. Methods: The authors review the growing literature that addresses how best to teach evidence-based medicine and highlight several…
Niedermier, Julie; Way, David; Kasick, David; Kuperschmidt, Rada
Objective: The authors investigated whether curriculum change could produce improved performance, despite a reduction in clerkship length from 8 to 4 weeks. Methods: The exam performance of medical students completing a 4-week clerkship in psychiatry was compared to national data from the National Board of Medical Examiners' Psychiatry Subject…
Purpose: The purpose of this thesis was to examine the teaching ways I undertook in teaching medical students and to examine the use of a structured teaching plan for the academic and clinical tutors in psychiatry. The teaching plan was developed for use, initially by Oxford University Academic tutors at the Department of Psychiatry. In addition,…
Ndetei, David M.; Khasakhala, Lincoln; Ongecha-Owuor, Francisca; Kuria, Mary; Mutiso, Victoria; Syanda, Judy; Kokonya, Donald
Objectives: The authors aim to determine the attitudes of University of Nairobi, Kenya, medical students toward psychiatry. Methods: The study design was cross-sectional. Self-administered sociodemographic and the Attitudes Toward Psychiatry-30 items (ATP-30) questionnaires were distributed sequentially to every third medical student in his or her…
Kupfer, David J.; Schatzberg, Alan F.; Grochocinski, Victoria J.; Dunn, Leslie O.; Kelley, Katherine A.; O'Hara, Ruth M.
Objectives: The Research Career Development Institute for Psychiatry is a collaboration between the University of Pittsburgh and Stanford University to recruit and train a broad-based group of promising junior physicians by providing the necessary skills and support for successful research careers in academic psychiatry. Methods: Participants…
Iannucci, Rocco; Sanders, Kathy; Greenfield, Shelly F.
Objective: The authors describe an addiction psychiatry curriculum integrated in a general psychiatry training program to demonstrate comprehensive and practical approaches to educating general psychiatric residents on the recognition and treatment of substance use disorders. Methods: The Massachusetts General Hospital/McLean Hospital adult…
Riedel-Heller, Steffi G
Demographic change, limited financial resources and increasing social exclusion of individuals suffering chronic illness are major challenges for health and social systems in general and for psychiatry in particular. The paper analyses to what extent social psychiatric research currently addresses this challenges. Future perspectives are discussed, exploring the relationship of clinical neuroscience and social psychiatry.
Keynejad, Roxanne; Ali, Faisal R.; Finlayson, Alexander E. T.; Handuleh, Jibriil; Adam, Gudon; Bowen, Jordan S. T.; Leather, Andrew; Little, Simon J.; Whitwell, Susannah
Objective: The proportion of U.K. medical students applying for psychiatry training continues to decline, whereas, in Somaliland, there are no public-sector psychiatrists. This pilot study assessed the usefulness and feasibility of online, instant messenger, peer-to-peer exchange for psychiatry education between cultures. Method: Twenty medical…
Haviland, Mark G.; Dial, Thomas H.; Pincus, Harold Alan
Objective: The authors compare trends in the salaries of physician faculty in academic departments of psychiatry with those of physician faculty in all academic clinical science departments from 1980-2006. Methods: The authors compared trend lines for psychiatry and all faculty by academic rank, including those for department chairs, by graphing…
Laugharne, Jonathan; Appiah-Poku, John; Laugharne, Richard; Stanley, Susanne
Objective: The aim of the current study was to evaluate a short review course in psychiatry conducted at the Kwame Nkrumah University of Science and Technology medical school and any change in student interest in a career in psychiatry. Method: Students were asked to complete a general psychiatric knowledge questionnaire before and immediately…
Retamero, Carolina; Ramchandani, Dilip
Objective: The authors compared the NBME subject examination scores and subspecialty profiles of 3rd-year medical students who were assigned to psychiatry subspecialties during their clerkship with those who were not. Method: The authors collated and analyzed the shelf examination scores, the clinical grades, and the child psychiatry and emergency…
Caplan, Jason P.; Borus, Jonathan F.; Chang, Grace; Greenberg, William E.
Objective: This study examines the veracity of self-reported data by applicants to psychiatry residency. Methods: The authors reviewed the reported publications of all applicants to a psychiatry residency training program over a 2-year span. Results: Nine percent of applicants reporting publications were found to have misrepresented them.…
Brenner, Adam M.
Objective: The author describes the results of a reflection exercise for psychiatry clerkship students. Method: The author performed a qualitative analysis on 100 "reflection" papers written by medical students in their psychiatry clerkship and identified the most prominent thematic content. Results: The most common thematic content involved…
Zigman, Daniel; Young, Meredith; Chalk, Colin
Objective: This article examines the benefit and feasibility of introducing a new, simulation-based learning intervention for junior psychiatry residents. Method: Junior psychiatry residents were invited to participate in a new simulation-based learning intervention focusing on agitated patients. Questionnaires were used to explore the success of…
Touchet, Bryan K.; Coon, Kim A.
Objective: Demonstrating psychotherapy competency in trainees will test the resources of psychiatry training programs. The authors outline the phases of team-based learning (TBL). Methods: The University of Oklahoma College of Medicine, Tulsa (OUCM-T), Department of Psychiatry reorganized its psychodynamic psychotherapy didactic course using TBL.…
Morrison, Ann; Roman, Brenda; Borges, Nicole
Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…
Meyer, Roger E.
Within academic medical centers, psychiatry, pediatrics, and certain other specialties of internal medicine carry a disproportionate responsibility for teaching but are least able to support teaching and research through clinical income. This article reviews the educational, research and clinical missions of an academic psychiatry department and…
Krain, Lewis P.; Bostwick, J. Michael; Sampson, Shirlene
Objective: This article reviews the existing literature on the use of computer assisted instruction (CAI) in the field of psychiatry to answer the questions, 1) Is CAI an effective tool for teaching psychiatry? and 2) What are the best methods for studying CAI in a real-world training environment? Method: A Medline search was conducted for…
Lee, Terry G.; Cox, Julia R.; Walker, Sarah C.
Objective: This study surveys child psychiatry residency program directors in order to 1) characterize child welfare training experiences for child psychiatry residents; 2) evaluate factors associated with the likelihood of program directors' endorsing the adequacy of their child welfare training; and 3) assess program directors'…
Sockalingam, Sanjeev; Hawa, Raed; Al-Battran, Mazin; Abbey, Susan E.; Zaretsky, Ari
Objective: Despite the growing number of international medical graduates (IMGs) training in medicine in Canada and the United States, IMG-specific challenges early in psychiatry residency have not been fully explored. Therefore, the authors conducted a needs-assessment survey to determine the needs of IMGs transitioning into psychiatry residency.…
Agyapong, Vincent Israel Opoku; McLoughlin, Declan
Objectives: Authors assessed the impact of a public-speaking competition on the level of interest in psychiatry of Ghanaian medical students. Method: An inter-medical school public-speaking competition was organized to promote psychiatry as a fulfilling career option for Ghanaian medical students. Feedback questionnaires were completed by the…
Manley, Myrl; Heiss, Glenn
Objective: The authors investigate whether the timing of the psychiatry clerkship influences scores on the National Board of Medical Examiners (NBME) subject exam as has been reported for other clerkships. The authors attempt to identify which clerkships, if any, offer an advantage when taken before psychiatry. Methods: Mean aggregate exam scores…
Juul, Dorthea; Winstead, Daniel K.; Sheiber, Stephen C.
OBJECTIVE: To report the assessment of psychopharmacology on the certification and recertification exams in general psychiatry and in the subspecialties administered by the American Board of Psychiatry and Neurology (ABPN). METHODS: The ABPN's core competencies for psychiatrists were reviewed. The number of items addressing psychopharmacology or…
Jibson, Michael D.; Broquet, Karen E.; Anzia, Joan Meyer; Beresin, Eugene V.; Hunt, Jeffrey I.; Kaye, David; Rao, Nyapati Raghu; Rostain, Anthony Leon; Sexson, Sandra B.; Summers, Richard F.
Objective: The American Board of Psychiatry and Neurology (ABPN) announced in 2007 that general psychiatry training programs must conduct Clinical Skills Verification (CSV), consisting of observed clinical interviews and case presentations during residency, as one requirement to establish graduates' eligibility to sit for the written certification…
Baig, Benjamin J; Beaglehole, Anna; Stewart, Robert C; Boeing, Leonie; Blackwood, Douglas H; Leuvennink, Johan; Kauye, Felix
Background International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper. Methods An undergraduate psychiatry course followed by an MCQ exam was delivered by the SMMHEP to 57 Malawi medical students. This same MCQ exam was given to 71 Edinburgh University medical students who subsequently sat their own Edinburgh University examination. Results There were no significant differences between Edinburgh students' performance on the Malawi exam and their own Edinburgh University exam. (p = 0.65). This would suggest that the Malawi exam is a comparable standard to the Edinburgh exam. Malawi students marks ranged from 52.4%–84.6%. Importantly 84.4% of Malawi students scored above 60% on their exam which would equate to a hypothetical pass by UK university standards. Conclusion The support of an undergraduate course in an African setting by high income country specialists can attain a high percentage pass rate by UK standards. Although didactic teaching has been surpassed by more novel educational methods, in resource poor countries it remains an effective and cost effective method of gaining an important educational standard. PMID:18430237
Background The significant proportion of patients suffering from subthreshold diagnoses such as partial posttraumatic stress disorder (PTSD) shows that today's diagnostic entities do not fully meet the reality and needs of clinical practice. Moreover, as stated also in the recently announced concept of research domain criteria (RDoC), the use of today's traditional diagnostic systems in psychiatric research does not sufficiently promote an integrative understanding of mental disorders across multiple units of analysis from behavior to neurobiology. Besides RDoC, core symptom-based research concepts have been proposed to bridge the translational gap in psychiatry, but, unfortunately, have not yet become the rule. Objective/method First, this article briefly reviews literature on subthreshold PTSD (as an example for subthreshold diagnoses) and, second, pleas for and proposes a modified symptom-based research concept in psychiatry. Results Subthreshold PTSD has, like other subthreshold psychiatric diagnoses, not yet been clearly defined. Diagnostic entities such as subthreshold PTSD are subject to a certain arbitrariness as they are mainly the result of empiricism. This fact stresses the urgent need for neurobiologically-informed psychiatric diagnoses and motivated the here-presented proposal of a symptom-based research concept. As proposed here, and before by other researchers, symptom-based research in psychiatry should refrain from studying patient cohorts compiled according to diagnoses but, instead, should focus on assessing cohorts grouped according to chief complaints or predominant psychopathological symptoms. Conclusions The linkage of the RDoC concept and symptom-based psychiatric research might probably speed up the definition of biologically or symptom-based psychiatric diagnoses, which might replace the auxiliary constructs of “traditional” diagnoses such as full and subthreshold PTSD, and promote the development of novel psychological and
The recognition of mental health disorders and its association with psychiatric scepticism, knowledge of psychiatry, and the Big Five personality factors: an investigation using the overclaiming technique.
Swami, Viren; Persaud, Raj; Furnham, Adrian
The present study examined the general public's ability to recognise mental health disorders and this ability's association with psychiatric scepticism, knowledge of psychiatry, and the Big Five personality factors. A total of 477 members of the British general public completed an overclaiming scale, in which they were asked to rate the degree to which they believed 20 mental health disorders (of which five were foils designed to resemble real disorders) were real or fake. Participants also completed a novel scale measuring psychiatric scepticism, a single-item measure of knowledge of psychiatry, and a measure of the Big Five personality factors. Results showed that participants were significantly more likely to rate foils as fake disorders than real disorders. In addition, the difference between real and foil ratings was significantly predicted by knowledge of psychiatry, psychiatric scepticism, and the Big Five personality factors of agreeableness and openness to experience. These results are discussed in relation to the overclaiming technique as a novel method to study mental health literacy.
This article will closely examine the phenomenological method as applied to qualitative inquiry in psychology and psychiatry. In a critical comparison between Amedeo Giorgi's and Larry Davidson's qualitatively methods, conclusions were drawn with regard to how different kinds of qualitative inquiry are possible while remaining faithful to Husserlian philosophical foundations. Utilizing Lester Embree's recent articulation of how Husserl's method of the epochē can be disclosed as specific to a discipline, varieties of these two qualitative methods were seen in their relation to the original scientific aim instigated by the developer.
Kates, Nick; Toews, John; Leichner, Pierre
Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement—particularly in finding psychiatrists with a better understanding of family practice, in integrating the teaching to a greater degree with clinical work, thereby increasing its relevance, and in utilizing more suitable clinical settings. PMID:21279156
Singh, Ajai; Singh, Shakuntala
The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of
Marchais, P; Grize, J B
Logic and analogy pose a fundamental problem in psychiatry. The latter is at the moment renewed by the existence of fuzzy logics. The authors put forward the hypothesis of a common root using the systemal method, an original strategy and a particular test. Several questions are tackled: definitions, hierarchy, linking, linearity or circularity, closed of open aspect of thought process, integration, separation or continuity, ways of appearance, discrete organization or organization in networks, different or common origin, importance of modal and non monotonous logics. A discussion and the consequences of this hypothesis are specified.
Gama, Jairo Roberto de Almeida
The article analyzes two opposing views of the formation of the psychiatric field: the Foucauldian perspective, which holds sway in Brazil, and the perspective of Gauchet and Swain. Two works by Foucault (History of Madness and Psychiatric Power) are contrasted with Madness and Democracy, by the latter authors. It is argued that a society's political and assistance strategies about madness are shaped by the conceptual bases defining what constitutes the field of psychiatric theory and how it was formed. The article calls attention to the diverse consequences that these two approaches may have on the reform of Brazilian psychiatry.
This article will closely examine the phenomenological method as applied to qualitative inquiry in psychology and psychiatry. In a critical comparison between Amedeo Giorgi's and Larry Davidson's qualitatively methods, conclusions were drawn with regard to how different kinds of qualitative inquiry are possible while remaining faithful to Husserlian philosophical foundations. Utilizing Lester Embree's recent articulation of how Husserl's method of the epochē can be disclosed as specific to a discipline, varieties of these two qualitative methods were seen in their relation to the original scientific aim instigated by the developer. PMID:26968361
Fantin, Juan Carlos
The notion of prejudice in epistemology starts in the early times of modern thought, together with the first reflections on science. Tracks of the notion of prejudice can be followed right up to our own days, all throughout the succession of epistemologies, with such notion always opposed to the notion of evidence. However, what in one epistemology stands for prejudice, is labeled as evidence in subsequent epistemologies, and the other way round. The present work aims at demonstrating the multivocal character of the evidence-prejudice schemas, and at critically reconsidering its use in present psychiatry.
Friedman, Susan Hatters; Howie, Andrew
In 1692 and 1693, in Salem, Massachusetts, more than 150 colonists were accused of witchcraft, resulting in 19 being hanged and one man being crushed to death. Contributions to these events included: historical, religious and cultural belief systems; social and community concerns; economic, gender, and political factors; and local family grievances. Child witnessing, certainty of physician diagnosis, use of special evidence in the absence of scholarly and legal scrutiny, and tautological reasoning were important factors, as well. For forensic psychiatry, the events at Salem in 1692 still hold contemporary implications. These events of three centuries ago call to mind more recent daycare sexual abuse scandals.
The idea that "shock" therapies were introduced by "Nazi-Psychiatry" very early and used radically in a cruel way darkens the image of these therapies until today. A case analysis of patient files of psychiatric hospitals in Berlin is used to recapitulate the introduction of insulin coma, metrazol and electroconvulsive therapy during the National Socialism era. Contrary to the false assumption that these "shock" therapies would have been introduced and preferred by psychiatrists involved with the Nazi regime and "euthanasia", in the case of Berlin these therapies were delayed by them and seldom used.
Miller, D A; Sadler, J Z; Mohl, P C; Melchiode, G A
Psychiatric practice involves complex thinking patterns. In addition to commanding a huge number of facts, the student must learn to manipulate factual knowledge to solve diagnostic problems, develop treatment plans, and critically evaluate those plans. This study demonstrates an empirical method for evaluating the level of cognitive processes tested in multiple choice examinations. Use of Bloom's taxonomy in evaluating test items demonstrated the majority of test items on a psychiatry clerkship examination and a resident in-training examination fell into the most basic cognitive level, that of simple recall. The utility of Bloom's taxonomy is discussed along with implications for medical education.
The growing danger of a nuclear holocaust has intensified two aspects of the human predicament that concern both religion and psychiatry: the inevitability of death and the disastrous consequences of the characteristic termed pride by theologians and narcissism by psychiatrists. For the first time, humans have power to exterminate themselves and death threatens all ages equally. Pride of power causes leaders to exaggerate their ability to control nuclear weapons; moral pride leads to demonizing enemies. The author considers implications for psychiatrists and clergy, with special reference to preventing a nuclear holocaust.
Abdul-Hamid, Walid Khalid; Bhui, Kamaldeep
The birthplace of the specialty of psychiatry was in the asylum, which was created to divert patients from workhouses where the most disadvantaged and destitute people with mental illness were to be found. The current welfare reforms are endangering the welfare and livelihood of the most disadvantaged of our patients. These reforms in the authors' opinion are related more to the historical cycle of societal attitude to homeless people than to seeing them as the undeserving poor. This is particularly true since the current economic crisis was not caused by the poor, so it is very unfair that our poorest patients should suffer most as a result of the welfare reforms.
Malloy, Erin; Hollar, David; Lindsey, Anthony
Objective: The authors aimed to determine whether a structured clinical experience in child and adolescent psychiatry (CAP) during the third-year psychiatry clerkship would impact interest in pursuing careers in psychiatry and CAP. Methods: The authors constructed and administered a post-rotation survey, the Child and Adolescent Psychiatry…
Reardon, Claudia L.; Walaszek, Art
Objective: Minimal literature exists on neurology didactic instruction offered to psychiatry residents, and there is no model neurology didactic curriculum offered for psychiatry residency programs. The authors sought to describe the current state of neurology didactic training in psychiatry residencies. Methods: The authors electronically…
Bhugra, D; Sartorius, N; Fiorillo, A; Evans-Lacko, S; Ventriglio, A; Hermans, M H M; Vallon, P; Dales, J; Racetovic, G; Samochowiec, J; Roca Bennemar, M; Becker, T; Kurimay, T; Gaebel, W
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
Pies, Ronald W
The history of psychiatry is characterized by some deep ideological and conceptual divisions, as adumbrated in Professor Hannah Decker's essay. However, the schism between "biological" and "psychosocial" models of mental illness and its treatment represents extreme positions among some psychiatrists-not the model propounded by academic psychiatry or its affiliated professional organizations. Indeed, the "biopsycho-social model" (BPSM) developed by Dr. George L. Engel has been, and remains, the foundational model for academic psychiatry, notwithstanding malign market forces that have undermined the BPSM's use in clinical practice. The BPSM is integrally related to "centralizing" and integrative trends in American psychiatry that may be traced to Franz Alexander, Karl Jaspers, and Engel himself, among others. This "Alexandrian-Jaspersian-Engelian" tradition is explored in relation to Professor Decker's "cyclical swing" model of psychiatry's history.
McBain, Stacy M; Hinton, Jeremy A; Thrush, Carol R; Williams, D Keith; Guise, J Benjamin
This article describes how the establishment and existence of a forensic psychiatry fellowship program was associated with improvements in general psychiatry residents' scores on the Psychiatry Resident In-training Examination (PRITE). Four consecutive years of general psychiatry residents' PRITE scores spanning 2 years before and 2 years after implementation of the forensic fellowship program at our institution were compared. Mixed-model statistical analyses accounting for repeated measurements of individual residents across the periods indicated statistically significant improvement in forensic content scores and several other subspecialty areas in which our institution offers educational fellowship programs. External indicators of program outcomes such as standardized examination scores may provide a useful indication of the effects that an educational fellowship program can have on general psychiatry education.
Ruiz Torres, A
Augusto Orrego Luco born in 1848 and dead in 1933 in Valparaiso, was one of the greatest clinicians and researchers of chilean medicine during the late nineteenth and early twentieth century. Besides being a psychiatrist he contributed to literature, history, politics and medicine. He received his medical degree in 1874 and, apart from being an anatomist, soon became interested in mental illnesses. The title of his thesis was "Mental Hallucinations". He worked in the insane asylum after José Ramón Elguero. Later, in 1891, he was the successor of professor Carlos Sazie at the Hospital for Nervous and Mental Illnesses. Orrego Luco was influenced by french neurology of Jean Martin Charcot and taught a preferentially neurological psychiatry, based on the anatomo-clinical method. His original works were on traumatic hysteria, the mechanism of hypnosis, hysterical hemiplegia, causes of mental hallucinations, syphilitic etiology of Tabes and anatomy of cerebral sulci. In his work about mimical neuroses, he considered and obligation not to discriminate between organic and non-organic patients, because both suffer, he claimed. Presently, Orrego Luco is considered the creator and instigator of the Psychiatry chair, turning it into one of the main medical specialties in Chile.
This article presents an introduction to the history of Indian psychiatry. It suggests that this history can be divided into four main periods, 1795 to 1857, 1858 to 1914, 1914 to 1947 and 1947 to the present day. The focus of the piece is on the periods 1858-1914 and 1914-1947, as it traces the main trends and developments of the colonial era and argues that the foundations of modern psychiatry in India were laid down in the period of British rule. A brief consideration of the post-Independence period suggests that the patterns established in the years of British rule have continued to influence the psychiatric system of modern India. Research for these conclusions is based on extensive archival work in Indian mental health institutions and in Indian records offices, as well as work conducted at the National Library of Scotland in Edinburgh and at the India Office Library, the Wellcome Institute Library and the London School of Hygiene and Tropical Medicine.
Kornischka, J; Cordes, J; Agelink, M W
Beta-adrenoceptor blockers belong to the most successful drug classes of medicine. Mainly they are used in internal medicine. 40 years ago beta-adrenoceptor blockers have occasionally been used in psychiatry for the treatment of anxiety disorders. Over the past four decades, the effects of beta-adrenoceptor blockers in the treatment of schizophrenic and manic psychoses, withdrawal syndromes and aggressive behaviour with temper outbursts has been investigated. Beta-adrenoceptor blockers are also used in the treatment of side-effects of psychopharmacological agents like neuroleptic or antidepressant-induced tachycardias, lithium-induced tremor, antipsychotic-induced akathisia or tardive dyskinesia as well. Since the mid-nineties it has been attempted to improve the efficacy of antidepressant agents by means of the 5-HT-(1a)-receptorantagonist pindolol. Presumedly memory consolidation of traumatic events can be enhanced by adrenergic activation. Therefore some open clinical trials investigated the effects of propranolol, a lipid soluble drug, which crosses the blood-brain barrier easily, to reduce the manifestation of PTSD. The present review presents the results of the literature with respect to the indications for beta-blockers in psychiatry. Considering evidence-based-medicine criteria beta-blockers are indicated to treat lithium-induced tremor, antipsychotic-induced akathisia and to reduce aggressive behavior of patients with brain-injuries.
Costa e Silva, Jorge A
Psychiatric patients tend to exhibit significant interindividual variability in their responses to psychoactive drugs, as well as an irregular clinical course. For these (and other) reasons, increasing numbers of psychiatrists are turning to genotyping for help in selecting the psychopharmacologic agents best suited to an individual patient's distinctive metabolic characteristics and clinical presentation. Fortunately, routine genotyping is already available for gene variations that code for proteins involved in neurotransmission, and for drug-metabolizing enzymes involved in the elimination of many medications. Thus, genotyping-based personalized psychiatry is now in sight. Increasing numbers of clinically useful DNA microarrays are in the development stage, including a simplified procedure for genotyping patients for CYP2D6, which metabolizes a high proportion of the currently prescribed antidepressants and antipsychotics. It has been pointed out that psychiatric disease is rarely a consequence of an abnormality in a single gene, but reflects the perturbations of complex intracellular networks in the brain. Thus, analysis of functional neuronal networks is becoming an essential component of drug development strategies. The integrated use of technologies such as electroencephalography, magnetoencephalography, functional magnetic resonance imaging (fMRI), and diffusion tensor imaging (DTI), in combination with pharmacogenetics, promises to transform our understanding of the mechanisms of psychiatric disorders and their treatment. The concept of network medicine envisions a time to come when drugs will be used to target a neural network rather than simply components within the network. Personalized medicine in psychiatry is still at an early stage, but it has a very promising future.
Egberts, K M; Mehler-Wex, C; Gerlach, M
Psychopharmacotherapy in children and adolescents is characterized by an increased susceptibility for adverse events and an increased risk of ineffective treatment due to specific age-dependent and developmental characteristics in comparison to adults. Dosing in paediatric psychiatric patients requires careful handling, since the dose recommendations for adults can not simply be extrapolated to minors because of pharmacokinetic and pharmacodynamic differences. In addition, psychopharmacotherapy in children and adolescents is hampered by lack of high quality evidence on efficacy and safety in many indications and subsequently a high degree of off-label use. Therapeutic Drug Monitoring (TDM) is an established and useful tool in psychiatry to individualize and optimize the outcomes (efficacy/safety balance) of psychopharmacological drug treatment in the individual patient by dose adjustments based upon measured serum concentrations. In children and adolescents the administration of psychotropic drugs is a general indication for performing TDM. However, TDM studies specific in these age groups are necessary to identify age and indication specific therapeutic ranges of serum concentrations. Systematic collection of data on drug exposure, serum concentrations and clinical characteristics as well as outcomes can generate such practice-based evidence. A German-Swiss-Austrian competence network for TDM in child and adolescent psychiatry using a multi-centre internet-based data infrastructure was founded to document and collect demographic, safety and efficacy data as well as blood concentrations of psychotropic drugs in children and adolescents (further information: www.tdm-kjp.com).
Thong, Ivan SK; Foo, Meng Yee; Sum, Min Yi; Capps, Benjamin; Lee, Tih-Shih; Ho, Calvin; Sim, Kang
Therapeutic misconception (TM) denotes the phenomenon in which research subjects conflate research purpose, protocols and procedures with clinical treatment. We examined the prevalence, contributory factors, clinical associations, impact, and collated solutions on TM within psychiatric research, and made suggestions going ahead. Literature search for relevant empirical research papers was conducted until February 2015. Eighty-eight reports were extracted, of which 31 were selected, summarised into different headings for discussion of implications and collated solutions of TM. We found variable and high rates of TM (ranging from 12.5% to 86%) in some psychiatry research populations. Contributory factors to TM included perceived medical roles of researchers, media, research setting and subject factors. Greater TM in affective, neurodevelopmental and psychotic spectrum conditions were associated with demographic variables (such as lower education, increased age), clinical factors (such as poor insight, cognitive deficits, increased symptoms, poorer self-rated quality of health), and social functioning (such as decreased independence). Inattention to TM may lead to frustration, negative impression and abandonment of participation in psychiatry research. Strategies such as the employment of a neutral educator during the informed consent process and education modules may be effective in addressing TM. Further research is warranted to examine the different TM facets, specific clinical correlates and more effective management strategies. PMID:26792036
Psychiatry is different from all other branches of medicine as it pertains on “psyche” which is intangible, effervescent and indefinable. It is influenced by interviewer and client's communication skills, personality, socio-cultural beliefs and interpretations. The inference of “normal” and “abnormal” varies across cultures and understanding of the cultural nuances is an integral part of understanding psychopathology. Knowledge gained in one culture cannot be extrapolated completely to another culture. Indian psyche is distinct as it is has been influenced by various invaders into the country, collectivism and interdependence. Because of all these factors, presentation of mental illness is different in the Indian culture and many a times it is difficult to fit patients into the categories developed by the Western world. Similar factors also influence attitude towards treatment seeking and visit to magico-religious healers and those practicing alternative system of medicine. Moreover, the principles of Western psychotherapy cannot be applied to the Indian subjects. Compared to West, family plays a vital role in all major decision in an individual's life including his treatment and care. They bear the major burden and take up the responsibility of care of the persons with mental illness and dampen the effect of limited resources. These families cope by trusting and passing on the responsibility to almighty. Hence, there is a need for Indianization of psychiatry. PMID:21772642
Aitken, Peter; Lloyd, Geoffrey; Mayou, Richard; Bass, Christopher; Sharpe, Michael
Aims and method To record the development of liaison psychiatry in the UK and to summarise the current levels of activity. We also highlight the challenges the specialty may face if it is to develop further. History since the 1970s is reviewed by early pioneers and those involved in the present day, with a focus on the key role played by members of the Royal College of Psychiatrists. Results We describe the development of training guidelines, the publication of joint documents with other Royal Colleges, establishing international collaborations and defining service specifications. We emphasise the importance of collaboration with other medical organisations, and describe successes and pitfalls. Clinical implications Much has been achieved but challenges remain. Liaison psychiatry has a potentially important role in improving patient care. It needs to adapt to the requirements of the current National Health Service, marshal evidence for cost-effectiveness and persuade healthcare commissioners to fund services that are appropriate for the psychological needs of general hospital patients. PMID:27512589
Since its development around 1800 psychiatry has been oscillating between the poles of the sciences and the humanities, being directed towards subjective experience on the one hand and towards the neural substrate on the other hand. Today, this dualism seems to have been overcome by a naturalism, which identifies subjective experience with neural processes, according to Griesinger's frequently quoted statement "mental diseases are brain diseases". The progress achieved by the neurobiological paradigm on the level of a fundamental science is in contrast to the tendency to isolate mental illnesses from the patients' social relationships and to neglect subjectivity and intersubjectivity in their explanation. What should be searched for is therefore an overarching paradigm that is able to establish psychiatry as a relational medicine in an encompassing sense: as a science and practice of biological, psychological and social relationships and their disorders. Within such a paradigm, the brain may be understood and investigated as the central "relational organ" without reductionist constrictions.
Huys, Quentin J M; Roiser, Jonathan P
Computational Psychiatry aims to describe the relationship between the brain's neurobiology, its environment and mental symptoms in computational terms. In so doing, it may improve psychiatric classification and the diagnosis and treatment of mental illness. It can unite many levels of description in a mechanistic and rigorous fashion, while avoiding biological reductionism and artificial categorisation. We describe how computational models of cognition can infer the current state of the environment and weigh up future actions, and how these models provide new perspectives on two example disorders, depression and schizophrenia. Reinforcement learning describes how the brain can choose and value courses of actions according to their long-term future value. Some depressive symptoms may result from aberrant valuations, which could arise from prior beliefs about the loss of agency (‘helplessness’), or from an inability to inhibit the mental exploration of aversive events. Predictive coding explains how the brain might perform Bayesian inference about the state of its environment by combining sensory data with prior beliefs, each weighted according to their certainty (or precision). Several cortical abnormalities in schizophrenia might reduce precision at higher levels of the inferential hierarchy, biasing inference towards sensory data and away from prior beliefs. We discuss whether striatal hyperdopaminergia might have an adaptive function in this context, and also how reinforcement learning and incentive salience models may shed light on the disorder. Finally, we review some of Computational Psychiatry's applications to neurological disorders, such as Parkinson's disease, and some pitfalls to avoid when applying its methods. PMID:26157034
van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K
Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.
Koss-Chioino, Joan D
An understanding of the nature and meaning of 'dissociative,' 'altered' or unusual states ultimately turns on the meaning and definition of consciousness. The view of consciousness from the discipline of psychiatry is largely based on a biomedically endorsed, culturally specific perspective of 'normal' consciousness as an integrated pattern of quotidian relationships with the 'observable' physical world. This perspective underlies the nosology for mental disorders, particularly psychoses, suggesting irreconcilable difference in cognition and affect of persons with these diagnostic labels. This article reviews some theories of Carl Gustav Jung regarding the structure and content of human consciousness and their relationship to aspects of 'dementia praecox' or 'schizophrenia.' It traces the origin and development of these ideas in part to Jung's early contact with, and intense interest in spiritualists and spirits, to later influences comprised of his own altered states (dreams and fantasies) and his involvement with patients diagnosed as schizophrenic. Data on current Spiritist beliefs and healing practices focused on 'madness' (i.e. most often diagnosed as schizophrenia in mental health settings), are described to explore parallels with Jung's ideas on the structure and dynamics of the psyche. These parallels are of special interest because the experience of spirits is ubiquitous, not well explained and often rejected as meaningful by psychiatrists and clinical psychologists. Jung, however, offers a cogent explanation of spirit phenomena as manifestations of the unconscious. A concluding section suggests contributions to cultural psychiatry by Jung.
Choudhury, Suparna; Kirmayer, Laurence J.
There is a long tradition that seeks to understand the impact of culture on the causes, form, treatment, and outcome of psychiatric disorders. An early, colonialist literature attributed cultural characteristics and variations in psychopathology and behavior to deficiencies in the brains of colonized peoples. Contemporary research in social and cultural neuroscience holds the promise of moving beyond these invidious comparisons to a more sophisticated understanding of cultural variations in brain function relevant to psychiatry. To achieve this, however, we need better models of the nature of psychopathology and of culture itself. Culture is not simply a set of traits or characteristics shared by people with a common geographic, historical, or ethnic background. Current anthropology understands culture as fluid, flexible systems of discourse, institutions, and practices, which individuals actively use for self-fashioning and social positioning. Globalization introduces new cultural dynamics and demands that we rethink culture in relation to a wider domain of evolving identities, knowledge, and practice. Psychopathology is not reducible to brain dysfunction in either its causes, mechanisms, or expression. In addition to neuropsychiatric disorders, the problems that people bring to psychiatrists may result from disorders in cognition, the personal and social meanings of experience, and the dynamics of interpersonal interactions or social systems and institutions. The shifting meanings of culture and psychopathology have implications for efforts to apply cultural neuroscience to psychiatry. We consider how cultural neuroscience can refine use of culture and its role in psychopathology using the example of adolescent aggression as a symptom of conduct disorder. PMID:19874976
Himmerich, H; Steinberg, H
This study retells key aspects of the history of the idea of hormone-based classification and therapy concepts in psychiatry. Different contributions to the history are not only represented from a historical, but also from a current medico-scientific perspective. One of the oldest, yet ethically most problematic, indications concerning hormonal methods to modify undesirable behaviour and sexuality was castration, which was widely used in the 20th century to "cure" homosexuality. Felix Platter, whose concept was humoral-pathological in nature, documented the first postpartum psychosis in the German-speaking countries, the pathogenesis of which according to present-day expertise is brought about by changes in female hormones. The concept of an "endocrine psychiatry" was developed at the beginning of the 20th century. Some protagonists for neuroendocrinology are highlighted, such as Paul Julius Möbius around 1900 or, in the 1950s, Manfred Bleuler, the nestor of this new discipline. Only the discovery of the hormones as such and the development of technologies like radioimmunassay to measure and quantify these hormone changes in mental illnesses allowed investigating these conditions properly. Ever since hormone-based therapeutic and classification concepts have played an important role, above all, in sexual, affective and eating disorders as well as alcohol dependence.
Blumenthal-Barby, J S
The introduction of the Diagnostic and statistical manual of mental disorders (DSM-5) in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual:(1) Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview (eg, binge eating disorder, internet gaming disorder, caffeine use disorder, hoarding disorder, premenstrual dysphoric disorder). Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of "construct validity" and "conceptual validity" and a failure to distinguish between "disorder" and "non disordered conditions for which we help people."(2) The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. (3) Categorisation nosology to spectrum nosology: The move to "degrees of severity" of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication.
Serpa Junior, Octavio Domont de
Psychiatry emerged just over two hundred years ago as a special branch of medicine offering institutional care for the insane, since it encompassed the fields of medicine, natural history (biology) and philosophy (humanities). It appeared at a time marked by the transition with the exclusion apparatus of the marginalized people of the Old Regime and by epistemic pluralism. In this article, the contribution that psychiatry can make today - just over two centuries and some important conceptual and institutional rearrangements later - is discussed. It is well established in the academic world and socially legitimized, albeit at another moment of transition, in which new paradigms of care are established placing importance on the contextual and intersubjective situation of psychic distress. Redefining Pinelian intuition using contemporary vocabulary regarding the epistemological and ethical challenge of an area of knowledge and practice of care the scope of which is psychic distress, the thesis will be proposed that it is also necessary to articulate the planes of body, experience and narrative in an ongoing dialogue.
Mulert, Christoph; Pogarell, Oliver; Hegerl, Ulrich
Neurophysiological findings such as reduced amplitudes of the P300 potential in patients with schizophrenia are among the most robust findings in biological psychiatry. An enormous literature with findings of abnormal central processing in psychiatric diseases has been acquired during the last decades. However, the benefit of this research has been limited in part due to the unresolved problem of precise and correct localization of the underlying neural generators. The difficulty of correct localization is due to the fact that different constellations of cortical neuroelectric generators can produce identical EEG activity. Therefore, even concerning several major event related potentials no generally accepted knowledge about their cerebral generation exists. While correct localization can easily be obtained by imaging methods based on hemodynamic changes such as functional magnetic resonance imaging (fMRI), these techniques can not distinguish between different aspects of neural activity such as oscillation modes or stages of information processing that are only some milliseconds apart. Accordingly, the integration of simultaneous measurements of EEG and fMRI has become a methodological key issue today. EEG-fMRI may prove to be crucial in providing much deeper understanding of brain activity over the next decades. This review summarizes the basic physiology, methodological issues and interesting applications in psychiatry.
Khalsa, Sahib S.; Lapidus, Rachel C.
Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes. PMID:27504098
Ehlis, Ann-Christine; Schneider, Sabrina; Dresler, Thomas; Fallgatter, Andreas J
Two decades ago, the introduction of functional near-infrared spectroscopy (fNIRS) into the field of neuroscience created new opportunities for investigating neural processes within the human cerebral cortex. Since then, fNIRS has been increasingly used to conduct functional activation studies in different neuropsychiatric disorders, most prominently schizophrenic illnesses, affective disorders and developmental syndromes, such as attention-deficit/hyperactivity disorder as well as normal and pathological aging. This review article provides a comprehensive overview of state of the art fNIRS research in psychiatry covering a wide range of applications, including studies on the phenomenological characterization of psychiatric disorders, descriptions of life-time developmental aspects, treatment effects, and genetic influences on neuroimaging data. Finally, methodological shortcomings as well as current research perspectives and promising future applications of fNIRS in psychiatry are discussed. We conclude that fNIRS is a valid addition to the range of neuroscientific methods available to assess neural mechanisms underlying neuropsychiatric disorders. Future research should particularly focus on expanding the presently used activation paradigms and cortical regions of interest, while additionally fostering technical and methodological advances particularly concerning the identification and removal of extracranial influences on fNIRS data as well as systematic artifact correction. Eventually, fNIRS might be a useful tool in practical psychiatric settings involving both diagnostics and the complementary treatment of psychological disorders using, for example, neurofeedback applications.
Yung, C Y
A total of 40 metals are reviewed and summarized to give a general perspective on the metal's two major effects, relevant to medicine and psychiatry in man. These two effects are metal excess (poisoning) and deficiency. These metals are grouped arbitrarily into six categories; (a) The heavy metals, (b) the essential and questionable essential trace elements, (c) the macrominerals, (d) the alkali metals, (e) elements used as therapeutic agents, and (f) miscellaneous elements. The heavy metals are invariably toxic and could be lethal, and no deficiency state has yet been described in man, although arsenic has been postulated to be essential. The essential trace elements are vital to a number of vital physiological and biochemical functions, and newer essential trace elements are to be identified in the future. The recent findings suggest vanadium excess may aggravate the affective symptoms in bipolar affective disorder; selenium may inhibit certain carcinogenesis such as oesophageal cancer; and silicon may inhibit atheromatous formation in the aorta. There is also some suggestion that certain allergic syndromes may be correlated with very low levels of iron, copper, manganese. The study of elements will undoubtedly expand the understanding of disease processes in medicine and psychiatry.
Like Hannah Decker, I too deplore the destructive battle of psychosocial and biological reductionisms that has bedeviled psychiatry. When I started my psychiatric training almost 50 years ago, the prevailing model for understanding mental disorders was broadly bio/psycho/social in the grand tradition of Pinel and Freud, brought to and adapted in America by Adolph Meyer. When psychiatry is practiced well, it integrates insights from all the different ways of understanding human nature. Unfortunately, the mental health field has since degenerated into a civil war between the biomedical and psychosocial models with little room for compromise or finding middle ground. The inflexible biological reductionists assume that genes are destiny and that there is a pill for every problem: they take a "mindless" position. The inflexible psychosocial reductionists assume that mental health problems all arise from unpleasant experience: They take a "brainless" position. I have spent a good deal of frustrating time trying to open the minds of extremists at both ends, though rarely making much headway. In my view, however, and where I differ from Decker, the reductionisms do not sort so neatly into alternating historical periods.
Fads in psychiatry are little more than bad ideas with short half-lives. They have arisen because of the great discontinuities that have swept psychiatry unlike other specialties in the 20th century: the transition in the 1920s from asylum-based biological psychiatry to psychoanalysis, and the transition in the 1960s from psychoanalysis to a biological model based on psychopharmacology. In no other medical specialty has the knowledge base been scrapped and rebuilt, and then again scrapped and rebuilt. In these great transitions, when psychiatry each time has had to reconstruct from scratch, bad ideas have crept in with good. Psychiatry, in its heavy use of consensus conferences, is often unable to employ science as a means of discarding fads, which, once installed, are often difficult to remove. Each of the great paradigms of psychiatry in the last hundred years has given rise to fads, and psychopharmacology is no exception, with faddish uses of neurotransmitter doctrine claiming centre stage. Only when psychiatry becomes firmly linked to the neurosciences will its subjugation to the turbulence of faddism be moderated.
Brown-Johnson, Cati; Sanders-Jackson, Ashley
Objective Individuals with mental health concerns are disproportionately affected by, and suffer the negative consequences of, tobacco use disorder, perhaps because smoking has historically been part of psychiatry’s culture. In the early 1990s, psychiatric inpatient facilities were exempted from US hospital smoking bans, in response to public outcries with national media attention. Almost two decades later, the current study characterizes online conversation about psychiatric hospital smoking bans. Previous commenting studies have demonstrated commenting’s negativity, documenting the “nasty effect” wherein negative comments color perceptions of neutral articles. Thus, we focused particular attention on cited barriers to implementing health-positive smokefree policies. Methods We collected online comments (N=261) responding to popular media articles on smoking bans in inpatient psychiatry between 2013 and 2014, and conducted an inductive and exploratory qualitative content analysis. Results Verifying previous studies documenting the prevalence of negative commenting, of the comments explicitly supporting or refuting psychiatry smoking bans, there were over twice as many con comments (44) than pro (18). Many commenters argued for access to outdoor smoking areas and warned of patient agitation and risk posed to care workers. Identified content themes included psychiatric medication and negative side effects, broken mental health systems and institutions, denigration of the health risks of tobacco in the context of mental illness, typical pro-smoking arguments about “smokers’ rights” and alternatives (including e-cigarettes), addiction, and stigma. Conclusions The current findings provide a platform to begin to understand how people talk about mental health issues and smoking. Our analysis also raised complex issues concerning forces that impact US patients with serious mental illness, but over which they have little control, including medication, the US
Boyle, Ann; Davies, Sophie; Dogra, Nisha; Perry, Jennifer; Fosker, Hannah
Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry. Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects. Clinical implications Those developing foundation placements will need to ensure they are of high quality. PMID:27752349
The 10th revision of the classification of mental disorders and behavioural disorders is due to description of clinical symptoms and diagnostic criteria more accurate and enriches the activities of departments of child and adolescent psychiatry. Diagnostics, therapy and prevention profit not only from sections dealing with newly conceived disorders which begin in childhood and adolescence but also other sections where problems relating to children and adolescents are pointed out. The Czech translation inovates clinical pictures given in our textbook of Child psychiatry published in 1963 and thus replaces partly a hitherto not published modern Czech textbook of child and adolescent psychiatry.
Runnels, Patrick; Ronis, Robert
Fellowship training in public and community psychiatry has been shown to both extend career tenure and promote leadership attainment. While starting and sustaining a successful fellowship involves overcoming several hurdles, a successful fellowship can serve as a foundation for developing a viable academic division. Case Western Reserve University has redesigned and expanded its public and community psychiatry fellowship. At the same time, it has retained several fellowship graduates by developing a division of public and community psychiatry with a unique academic identity. This model could serve as a blueprint for other programs looking to establish or expand similar programs.
Avery, Jonathan; Zerbo, Erin
Special attention needs to be paid to the attitudes of psychiatry residents toward individuals diagnosed with substance use disorders. The attitudes of trainees may be worse toward these individuals than toward individuals with other diagnoses, and these attitudes may worsen over time. While psychiatry residencies are increasingly teaching residents about how to diagnosis and treat individuals diagnosed with substance use disorders, more attention needs to be paid to educating residents about common attitudes toward these individuals. We recommend that psychiatry residency programs start with basic educational didactics and reflection exercises on attitudes toward individuals diagnosed with substance use disorders and that programs try to form a positive "hidden curriculum" in their institutions.
Trigwell, Peter; Kustow, James
In the field of liaison psychiatry, as in all areas of healthcare, there is an essential need for well-organised and consistent collection of information on outcomes, from a range of perspectives. This special article introduces, and describes the development of, the multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP). This was challenging owing to the variety of service settings and types of intervention which characterise liaison psychiatry. Similar challenges may be faced by other specialties and this, along with the direct relevance of much of the eventual content of the framework, will broaden the interest of this article. PMID:27512587
Jones, David W
This paper traces the significance of the diagnosis of 'moral insanity' (and the related diagnoses of 'monomania' and ' manie sans délire') to the development of psychiatry as a profession in the nineteenth century. The pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition in the high status surroundings of the criminal court. Some success was achieved in presenting a form of expertise that centred on the ability of the experts to detect quite subtle, 'psychological' forms of dangerous madness within the minds of offenders in France and more extensively in England. Significant backlash in the press against these new ideas pushed the profession away from such psychological exploration and back towards its medical roots that located criminal insanity simply within the organic constitution of its sufferers.
Martins-de-Souza, Daniel; Guest, Paul C; Vanattou-Saifoudine, Natacha; Harris, Laura W; Bahn, Sabine
In the postgenome era, proteomics has arisen as a promising tool for more complete comprehension of diseases and for biomarker discovery. Some of these objectives have already been partly achieved for illnesses such as cancer. In the case of psychiatric conditions, however, proteomic advances have had a less profound impact. Here, we outline the necessity of improving and applying proteomic methods for biomarker discovery and validation in the field of psychiatric disorders. While proteomic-based applications in neurosciences have increased in accuracy and sensitivity over the past 10 years, the development of orthogonal validation technologies has fallen behind. These issues are discussed along with the importance of integrating systems biology approaches and combining proteomics with other research approaches. The future development of such technologies may put proteomics closer to clinical applications in psychiatry.
van Praag, H M
Inherent in human existence is one's need to give sense to one's life. It is this need that drives life forward. In this paper the terms 'giving sense' and 'giving meaning' are used more or less interchangeably. A life acquires meaning when goals are set and attempts are made to achieve them. Giving meaning to one's existence often involves engaging in altruistic activity. The need to give sense to one's life can be felt to be 'self generated' or metaphysically inspired, in other words inspired by a supernatural authority. Sense-deficiency is a mental condition which is barely recognised in psychiatry and hardly ever treated. Thorough research is needed to find the causes and the appropriate treatment and, in particular, to discover to what extent the spiritual domain is able to perform therapeutic functions. A discussion of certain aspects of this domain should be given a definitive place in the curriculum of trainee psychiatrists.
Sowers, Wesley; Marin, Robert
Transforming the mental health system into a recovery oriented, integrated system of care requires a psychiatric work force that understands the relationship between recovery processes and community living. Fellowship programs in public and community psychiatry contribute to this transformation by educating psychiatrists about recovery, system dynamics, leadership, effective administration and community involvement. This paper describes a novel approach to fellowship programming that accomplishes these aims through an organizational strategy that emphasizes community engagement. After describing the administrative background for the program, we describe how the content curriculum and teaching process focus on the engagement of community members-both service users and service providers-as participating faculty. The faculty includes over 100 consumers, family members, advocacy group representatives, clinicians, and administrators. We present evaluation data obtained from 45 of the 100 community and university faculty who participated in the first 2 years' of the fellowship and conclude with a critique and recommendations for further progress in community engaged fellowship training.
Shoyinka, Sosunmolu O; Barber, Mary E; Ranz, Jules
Now in its 29th year, the Public Psychiatry Fellowship of the New York Psychiatric Institute at Columbia Medical Center selects 10 fellows per year for its 1-year program (1). This award-winning fellowship trains future leaders for the public mental health sector. The curriculum (2) employs a combination of a didactic seminar series, management-problem-focused presentations by guest speakers, field trips, and supervision by fellowship faculty to instill the values and skills required for practice and leadership in the public sector. Fellows utilize the framework of the academic curriculum to carry out a series of presentations throughout the year that allow them to organize, implement and evaluate concepts that they learn during the year. The following account, written from bird's eye view, details one fellow's day at his field placement in a State Hospital outpatient clinic setting, with the aim of illustrating how the concepts taught by the fellowship find application in day to day practice.
Kennedy, Robert S.
One of the many problems confronting today's physician is the need to communicate with patients of many different cultural backgrounds and different languages. In psychiatry, as in many other medical specialties, the initial assessment depends on the ability of the clinician to communicate with the patient. Currently, if the doctor and the patient do not speak the same language, a sometimes clumsy translation process impedes the patient-physician relationship and frequently hampers or minimizes this crucial first evaluation. A new system to translate patient information to the clinician is being explored. Using scan forms to ask patients important clinical questions in their own language, offers a unique way to begin to gather necessary medical information.
Lepach, Anja C; Lehmkuhl, Gerd; Petermann, Franz
Neuropsychological aspects are of relevance to a variety of psychological concerns, especially in assessments. But is this trend represented in journals which do not explicitly refer to neuropsychologists? To investigate this question, publications in 2008 and 2009 editions of representative German journals on child psychology and psychiatry were bibliometrically analyzed. Main topics of neuropsychological publications were attention disorders and diagnostic issues. Neuropsychological findings support the development of assessment instruments and interventions and help improve the basic understanding of disorders and treatment limitations. For example, reduced attention or memory resources are possible hindrances for individual progress in cognitive behavioral intervention. An intensified dialogue of the disciplines is essential for developing advanced guidelines for diagnostics and therapy.
The development of liaison psychiatry services over the last 20 years is briefly reviewed--sophisticated liaison services have been confined to teaching hospitals. Limited manpower and other resources have prevented the development of liaison services in most district general hospitals; further developments are unlikely unless these deficiencies are corrected and psychiatrists take a more active role in developing links with physicians and surgeons. The time is right for such development as physicians are keen to extend our understanding of psychological and social factors in causing non-organic disorders, reduce unnecessary investigations and provide more comprehensive care. Increased collaboration between physicians and psychiatrists will provide a better service for many patients and this should be extended to all district general hospitals. PMID:1865449
Cacioppo, John T; Cacioppo, Stephanie; Dulawa, Stephanie; Palmer, Abraham A
Most mental disorders involve disruptions of normal social behavior. Social neuroscience is an interdisciplinary field devoted to understanding the biological systems underlying social processes and behavior, and the influence of the social environment on biological processes, health and well-being. Research in this field has grown dramatically in recent years. Active areas of research include brain imaging studies in normal children and adults, animal models of social behavior, studies of stroke patients, imaging studies of psychiatric patients, and research on social determinants of peripheral neural, neuroendocrine and immunological processes. Although research in these areas is proceeding along largely independent trajectories, there is increasing evidence for connections across these trajectories. We focus here on the progress and potential of social neuroscience in psychiatry, including illustrative evidence for a rapid growth of neuroimaging and genetic studies of mental disorders. We also argue that neuroimaging and genetic research focused on specific component processes underlying social living is needed. PMID:24890058
Santander, Jaime; Santander, Pablo; Berner, Juan Enrique
The contribution of Dr. Bruner to psychology and psychiatry is largely unknown. This is a summary of the ideas proposed in his "Medical-Psychological Monograph" from 1857, that was written after a case of a possibly possessed woman from Santiago. In this work Dr. Bruner discards the spirit-brain duality, proposes a functional morphology of the brain, recognizes the importance of remote history taking when interviewing patients, proposes a theory for self-formation and the risks of self-fragmentation. He proposes that the case of the woman corresponds to a brain disease, opposing the thought of an ovarian and uterine origin. He proposes a hypothesis of the psychogenic origin of the disease, the importance of what happened during dreams and beyond the conscience of the patient. Many of his ideas preceded by decades those of Charcot and Freud, but they have not had a proper recognition.
Exploring stem ceils is a fascinating task, especially in a discipline where the use of stem cells seems far-fetched at first glance, as is the case in psychiatry. In this article we would like to provide a brief overview of the current situation in relation to the treatment of mental diseases. For reasons that we will explain, this review will focus on affective disorders. The following section will give a more detailed account of stem-cell biology, including current basic science approaches presenting in-vivo andin-vitro techniques. The final part will then look into future perspectives of using these stem cells to cure mental illnesses, and discuss the related challenges and opportunities. PMID:20135897
Exploring stem cells is a fascinating task, especially in a discipline where the use of stem cells seems far-fetched at first glance, as is the case in psychiatry. In this article we would like to provide a brief overview of the current situation in relation to the treatment of mental diseases. For reasons that we will explain, this review will focus on affective disorders. The following section will give a more detailed account of stem-cell biology including current basic science approaches presenting in-vivo and in-vitro techniques. The final part will then look into future perspectives of using these stem cells to cure mental illnesses, and discuss the related challenges and opportunities.
Palazzolo, J; Julerot, J M; Lachaux, B
The plug in account of the suffering, notably psychological, in a consultation, puts the problem of the relationship between suffering and ethics. However, the originality of the ethical step is justly not to be confined to the social norm conformism, but being specific to the individual dimension. The psychiatric pathology offers in this area of particularities interesting. The neurotic, as the obsessed, suffering inwardly pathological manifestations that he judges absurd, replies to the medical moral in asking a care. The psychotic, which projects his suffering on the other, does not feel sick, requests no therapeutic assistance. As such he contests the medical order in an immoral position by definition, and the patient represents from then on a social and medical scandal. In front of a such clinical diversity, we can easily underline that approaching the theme of ethics in psychiatry isn't a well-off exercise, and necessitates a precise locating registered in the history of the patient.
Sexson, Sandra B
Directing child and adolescent psychiatry (CAP) training for residents is a complex and challenging administrative task that encompasses the broad creativity of the orchestral conductor, the social and interpersonal effectiveness of the best politician, and the orientation to details of the finest accountant. This article examines these roles in detail, recognizing the leadership, administrative, and managerial achievements of the successful child and adolescent program director. Resources for optimizing the chances for success in each of these areas, and the common pitfalls to avoid, are identified and discussed. The article concludes with suggestions for CAP training directors to influence medical student education. Although challenging and sometimes frustrating, the role of the program director in CAP training is almost always exciting and rewarding.
Itil, T; Martorano, D
Natural substances and/or their synthetically developed active ingredients are frequently used in medicine. In psychiatry, two of the most well known natural compounds are reserpine and Ginkgo biloba extract (EGb). EGb is among the most popular over-the-counter medicines in Europe and is also available in the United States, primarily in health food stores. Already the European medical community has recognized EGb as an effective compound in the treatment of cerebral insufficiency. In a pilot bioequivalency study, the effects of three different commercially available EGb products were examined. Findings indicated significant quantitative central nervous system (CNS) effects in, at least, one of the three. Furthermore, the CNS effects of Ginkgold were similar to other psychoactive compounds classified as cognitive activators. Recent studies in which EGb 761 demonstrated therapeutic effects in the treatment of dementia have earned EGb the approval of the German BGA (Bundesgesundheit Amt) for use in the treatment of dementia.
Vaillant, George E.
This paper proposes that eight positive emotions: awe, love (attachment), trust (faith), compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology; rather, spirituality is all about emotion and social connection. Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change if clinicians set about enhancing positive emotions rather than focusing only on negative emotions. PMID:22013350
Thacker, Simon; Skelton, Mike; Harwood, Rowan
Integrating mental and physical healthcare is difficult to achieve because of professional and organisational barriers. Psychiatrists recognise the problems resulting from fragmentation of services and want continuity of care for patients, but commissioning and service structures perpetuate these problems. One way forward may be to follow the syndromic model employed by geriatricians as a means of avoiding over-emphasis on diagnosis above the pragmatics of implementing multi-component, coordinated care. Commissioners need to be made aware of the overlap and complementarity of skills possessed by old age psychiatry and geriatric medicine to create joint services for people vulnerable to dementia and delirium. A re-forged alliance between the two specialties will be necessary to turn integrated care for frail, elderly people from rhetoric into reality.
Engel, M G
The article examines some of the main aspects governing psychiatry's role in the Brazilian political and social context at the close of the nineteenth century and beginning of the twentieth. It analyzes certain themes - civilization, race, labor, fanaticism, political dissent, sexuality - that were emphasized by specialists in their construction of a very broad notion of 'mental illness'. Through the analysis of texts produced by psychiatrists and legal experts (including dissertations written at the Faculdade de Medicina do Rio de Janeiro, reports from the Serviço de Assistência a Alienados, and works and articles by specialists), the relation between the psychiatric definition of the frontiers of 'abnormality' and efforts to implement new strategies of social control is discussed.
Rojas Malpica, Carlos Alberto
The purpose of this communication is to compare behavioral mineralization occurring in mental illness to the freshness and plasticity behavior in health. The epistemological fundamentals of this paper include the theories of chaos and complexity of Edgar Morin, the concept of autopoiesis developed from the theory of systems, the latest discoveries on the neurobiology of consciousness and their associations with Darwinian psychiatry and also, following Lain Entralgo, recreating the Greek concept of ananke to describe the behavior fixation in an anachronistic place of the physis in mental illness. It provides some empirical evidence to support the proposal, and all this is rigorously examined with hermeneutic phenomenology and its theoretical possibilities. This leads to an epistemological rethinking of clinical and therapeutic proposal aimed at the subject and the recovery of his or her freedom.
Ibáñez, Agustín; García, Adolfo M; Esteves, Sol; Yoris, Adrián; Muñoz, Edinson; Reynaldo, Lucila; Pietto, Marcos Luis; Adolfi, Federico; Manes, Facundo
Multiple disorders once jointly conceived as 'nervous diseases' became segregated by the distinct institutional traditions forged in neurology and psychiatry. As a result, each field specialized in the study and treatment of a subset of such conditions. Here we propose new avenues for interdisciplinary interaction through a triangulation of both fields with social neuroscience. To this end, we review evidence from five relevant domains (facial emotion recognition, empathy, theory of mind, moral cognition, social context assessment), highlighting their common disturbances across neurological and psychiatric conditions and discussing their multiple pathophysiological mechanisms. Our proposal is anchored in multidimensional evidence, including behavioral, neurocognitive, and genetic findings. From a clinical perspective, this work paves the way for dimensional and transdiagnostic approaches, new pharmacological treatments, and educational innovations rooted in a combined neuropsychiatric training. Research-wise, it fosters new models of the social brain and a novel platform to explore the interplay of cognitive and social functions. Finally, we identify new challenges for this synergistic framework.
Flannelly, Kevin J; Galek, Kathleen; Ellison, Christopher G; Koenig, Harold G
The present study analyzed the association between specific beliefs about God and psychiatric symptoms among a representative sample of 1,306 U.S. adults. Three pairs of beliefs about God served as the independent variables: Close and Loving, Approving and Forgiving, and Creating and Judging. The dependent variables were measures of General Anxiety, Depression, Obsessive-Compulsion, Paranoid Ideation, Social Anxiety, and Somatization. As hypothesized, the strength of participants' belief in a Close and Loving God had a significant salutary association with overall psychiatric symptomology, and the strength of this association was significantly stronger than that of the other beliefs, which had little association with the psychiatric symptomology. The authors discuss the findings in the context of evolutionary psychiatry, and the relevance of Evolutionary Threat Assessment Systems Theory in research on religious beliefs.
The concept of globalization has been applied recently to ways in which mental health may be developed in low- and middle-income countries (LMICs), sometimes referred to as the 'Third World' or developing countries. This paper (1) describes the roots of psychiatry in western culture and its current domination by pharmacological therapies; (2) considers the history of mental health in LMICs, focusing on many being essentially non-western in cultural background with a tradition of using a plurality of systems of care and help for mental health problems, including religious and indigenous systems of medicine; and (3) concludes that in a post-colonial world, mental health development in LMICs should not be left to market forces, which are inevitably manipulated by the interests of multinational corporations mostly located in ex-colonizing countries, especially the pharmaceutical companies.
Several fields contributing to psychiatric advances, such as psychology, biology, and the humanities, have not yet met to produce a cohesive and integrated picture of human function and dysfunction, strength and vulnerability, etc., despite advances in their own areas. The failure may have its roots in a disagreement on what we mean by the human person and his or her relationship with the world, for which the incommensurate language of these disciplines may be partly to blame. Turns taken by western philosophy over the past 400 years may help to explain this. Language is such an important tool for psychiatrists, that examination of it may afford an insight into the reasons for divisions in the field. This paper aims to examine and compare psychologies (and hence psychiatries) derived from modern western philosophy, with similar concepts in other cultures, through the study of developments in terminology, in terms of the simplest facts about what it means to be human. Terminology used in mental health in western cultures is examined, with particular consideration of the term "self" as it has come to be used in a technical sense. Analogous terms from non-English speaking European languages, and some non-western cultures are studied. Western philosophy and psychology have evolved a meaning for the term "self" which is quite different from equivalent terms in non-western cultures. It is a moot point whether or not the development in western psychiatry of what are now technical terms to describe normal human experience has become needlessly obscure and ambiguous. It is not evident that this "new" language represents a genuine advance in understanding; it distances mental health professionals from those who are not familiar with it; and it makes transcultural dialogue difficult.
Singh, Ajai R; Singh, Shakuntala A
The paper begins by asserting the need for bioethical and related philosophical considerations in the emerging subspecialty Positive Psychiatry. Further discussion proceeds after offering operational definitions of the concepts fundamental to the field - Bioethics, Positive Psychology, Positive Psychiatry and Positive Mental Health - with their conceptual analysis to show their areas of connect and disconnect. It then studies the implications of positive and negative findings in the field, and presents the Positive Psychosocial Factors (PPSFs) like Resilience, Optimism, Personal Mastery, Wisdom, Religion/Spirituality, Social relationships and support, Engagement in pleasant events etc. It then evaluates them on the basis of the 4-principled bioethical model of Beneficence, Non-malfeasance, Autonomy and Justice (Beauchamp and Childress, 2009, 2013), first offering a brief clarification of these principles and then their bioethical analysis based on the concepts of 'Common Morality', 'Specific Morality', 'Specification', 'Balancing' and 'Double Effects'. The paper then looks into the further development of the branch by studying the connectivity, synergy and possible antagonism of the various Positive Psychosocial Factors, and presents technical terms in place of common terms so that they carry least baggage. It also takes note of the salient points of caution and alarm that many incisive analysts have presented about further development in the related field of Positive Mental Health. Finally, the paper looks at where, and how, the field is headed, and why, if at all, it is proper it is headed there, based on Aristotle's concept of the four causes - Material, Efficient, Formal and Final. Suitable case vignettes are presented all through the write-up to clarify concepts.
The hypothesis that anatomically modern homo sapiens could have undergone changes akin to those observed in domesticated animals has been contemplated in the biological sciences for at least 150 years. The idea had already plagued philosophers such as Rousseau, who considered the civilisation of man as going against human nature, and eventually "sparked over" to the medical sciences in the late 19th and early 20th century. At that time, human "self-domestication" appealed to psychiatry, because it served as a causal explanation for the alleged degeneration of the "erbgut" (genetic material) of entire populations and the presumed increase of mental disorders. Consequently, Social Darwinists emphasised preventing procreation by people of "lower genetic value" and positively selecting favourable traits in others. Both tendencies culminated in euthanasia and breeding programs ("Lebensborn") during the Nazi regime in Germany. Whether or not domestication actually plays a role in some anatomical changes since the late Pleistocene period is, from a biological standpoint, contentious, and the currently resurrected debate depends, in part, on the definitional criteria applied. However, the example of human self-domestication may illustrate that scientific ideas, especially when dealing with human biology, are prone to misuse, particularly if "is" is confused with "ought", i.e., if moral principles are deduced from biological facts. Although such naturalistic fallacies appear to be banned, modern genetics may, at least in theory, pose similar ethical problems to medicine, including psychiatry. In times during which studies into the genetics of psychiatric disorders are scientifically more valued than studies into environmental causation of disorders (which is currently the case), the prospects of genetic therapy may be tempting to alter the human genome in patients, probably at costs that no-one can foresee. In the case of "self-domestication", it is proposed that human
Singh, Ajai R.; Singh, Shakuntala A.
The paper begins by asserting the need for bioethical and related philosophical considerations in the emerging subspecialty Positive Psychiatry. Further discussion proceeds after offering operational definitions of the concepts fundamental to the field – Bioethics, Positive Psychology, Positive Psychiatry and Positive Mental Health - with their conceptual analysis to show their areas of connect and disconnect. It then studies the implications of positive and negative findings in the field, and presents the Positive Psychosocial Factors (PPSFs) like Resilience, Optimism, Personal Mastery, Wisdom, Religion/Spirituality, Social relationships and support, Engagement in pleasant events etc. It then evaluates them on the basis of the 4-principled bioethical model of Beneficence, Non-malfeasance, Autonomy and Justice (Beauchamp and Childress, 2009, 2013), first offering a brief clarification of these principles and then their bioethical analysis based on the concepts of ‘Common Morality’, ‘Specific Morality’, ‘Specification’, ‘Balancing’ and ‘Double Effects’. The paper then looks into the further development of the branch by studying the connectivity, synergy and possible antagonism of the various Positive Psychosocial Factors, and presents technical terms in place of common terms so that they carry least baggage. It also takes note of the salient points of caution and alarm that many incisive analysts have presented about further development in the related field of Positive Mental Health. Finally, the paper looks at where, and how, the field is headed, and why, if at all, it is proper it is headed there, based on Aristotle's concept of the four causes - Material, Efficient, Formal and Final. Suitable case vignettes are presented all through the write-up to clarify concepts. PMID:28031624
Pezard, L; Nandrino, J L
For the last thirty years, progress in the field of physics, known as "Chaos theory"--or more precisely: non-linear dynamical systems theory--has increased our understanding of complex systems dynamics. This framework's formalism is general enough to be applied in other domains, such as biology or psychology, where complex systems are the rule rather than the exception. Our goal is to show here that this framework can become a valuable tool in scientific fields such as neuroscience and psychiatry where objects possess natural time dependency (i.e. dynamical properties) and non-linear characteristics. The application of non-linear dynamics concepts on these topics is more precise than a loose metaphor and can throw a new light on mental functioning and dysfunctioning. A class of neural networks (recurrent neural networks) constitutes an example of the implementation of the dynamical system concept and provides models of cognitive processes (15). The state of activity of the network is represented in its state space and the time evolution of this state is a trajectory in this space. After a period of time those networks settle on an equilibrium (a kind of attractor). The strength of connections between neurons define the number and relations between those attractors. The attractors of the network are usually interpreted as "mental representations". When an initial condition is imposed to the network, the evolution towards an attractor is considered as a model of information processing (27). This information processing is not defined in a symbolic manner but is a result of the interaction between distributed elements. Several properties of dynamical models can be used to define a way where the symbolic properties emerge from physical and dynamical properties (28) and thus they can be candidates for the definition of the emergence of mental properties on the basis of neuronal dynamics (42). Nevertheless, mental properties can also be considered as the result of an
Duffy, Olivia Anne
On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who "clearly consents to the termination of life" and has a "grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering.
Lehmann, Susan W
The author describes the Association of Directors of Medical Student Education in Psychiatry's Education Scholars Program, a 2-year longitudinal, guided mentorship program, anchored by didactic instruction in the fundamental concepts of educational scholarship.
This article tries to link the present lack of theoretical discussion within German Social Psychiatry with a loss of phenomenological and anthropological thought. The so-called Phenomenological Psychiatry used to play a very important role in German psychiatry during the 50 ies until the 70 ies and had strong influences on the first reformers of German psychiatry, such as Walter Ritter von Baeyer, Heinz Häfner, Caspar Kulenkampff, Karl Peter Kisker and Erich Wulff. Their reforms were not only founded by a social criticism put forth by theories such as marxism (Basaglia, Wulff) or structuralism (Foucault) but also by a concrete notion of what it is like to suffer from mental illness and what kind of needs are linked to such suffering. This very notion was given by the phenomenological approach. Finally the article tries to give reasons for today's reciprocal loss of connection of the phenomenological and the socio-psychiatric school.
Schepker, Renate; Fegert, Jörg M; Becker, Katja
The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.
Andrews, Jonathan; Digby, Anne
This volume had its origin in a stimulating seminar series devoted to historical perspectives on gender and class in the history of psychiatry. The papers presented outlined a number of important perspectives on the place of gender and class within the history of psychiatry and, more broadly, medicine and society. There were also considerable inter-relationships between the various thematic strands developed in the papers - so much so, that organisers, speakers and participants alike were keen to see a published outcome.
In this article I discuss my career in cultural psychiatry. I begin by examining the influence of my personal background on my interests in cultural psychiatry and religion and health. I then discuss my research, which has focused upon two areas: the cognitive and phenomenological parallels between religious experiences and psychopathological states, and relationships between biomedicine and religious healing in diverse cultural contexts. Finally, I discuss plans for future research and teaching.
Background Team-based learning (TBL) is an effective teaching method for medical students. It improves knowledge acquisition and has benefits regarding learner engagement and teamwork skills. In medical education it is predominately used with undergraduates but has potential benefits for training clinicians. The aims of this study were to examine the impact of TBL in a sample of psychiatrists in terms of classroom engagement, attitudes towards teamwork, learner views and experiences of TBL. Methods Forty-four psychiatry residents participated in an Addictions Psychiatry TBL module. Mixed-methods were used for evaluation. Self-rated measures of classroom engagement (Classroom Engagement Survey, CES) were compared with conventional lectures, and attitudes regarding the value of teams (Value of Teams Scale, VTS) were compared before and after the module. Independent t-tests were used to compare ‘lecture’ CES scores with TBL CES scores and pre and post scores for the VTS. Feedback questionnaires were completed. Interviews were conducted with a subset of residents and transcripts analysed using thematic analysis. Results Twenty-eight residents completed post-course measures (response rate 63.6%). Seven participants volunteered for qualitative interviews–one from each team. There was a significant difference in the mean CES score lectures compared to TBL (p < 0.001) but no difference was found in mean VTS score pre and post for either subscale (p = 0.519; p = 0.809). All items on the feedback questionnaire were positively rated except two regarding session preparation. The qualitative analysis generated seven themes under four domains: ‘Learning in teams’, ‘Impact on the individual learner’, ‘Relationship with the teacher’ and ‘Efficiency and effectiveness of the learning process’. Conclusions In this group of residents, TBL significantly improved learner-rated classroom engagement and seemed to promote interactivity between learners
Bahrini, Lilia; Damak, Rahma; Cheour, Mejda
Introduction Adherence to psychotropic medications is affected by factors related to the treatment, to the physician, to the environment and to the patient himself. The purpose of the present study was to investigate the influence of affective temperaments on treatment adherence. Methods Thirty six stabilized outpatients were recruited from the aftercare consultation of Psychiatry to perform Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire version (TEMPS-A) for affective temperaments and the Medication Adherence Rating Scale (MARS) for treatment adherence. Results The total MARS score was negatively correlated with the irritable temperament score. The MARS’s score relative to the attitude of patients to psychotropic medications and their negative side effects was negatively correlated with the cyclothymic, the irritable and anxious temperaments. Patients having a diagnosis of psychotic disorder had a significantly greater medication adherence and behaviour toward medication score compared to those having a diagnosis of affective disorder. A greater MARS’s score for the negative side effects and attitudes to psychotropic medication was associated with medication by neuroleptics with prolonged action. Conclusion The results of the present study suggest that patients with irritable temperament may have more difficult to follow psychotropic medications, and that patients with cyclothymic, irritable and anxious temperaments may be more attentive and sensitive toward psychotropic medications and their negative side effects. PMID:28154695
Lamers, Audri; Vermeiren, Robert R J M
Although therapeutic alliance is widely acknowledged as a key component for therapeutic change, its role is almost unknown in youth residential psychiatry. A likely reason for the lack of research is the absence of assessment tools and procedures for youth residential settings. This study assesses the psychometric properties of the Dutch version of the Family Engagement Questionnaire (FEQ), an alliance measure completed by team members. In addition, agreement among team members is explored. Eleven youth psychiatric day and inpatient units participated. Parent counsellors and case managers of 86 patients from 6 to 17 years old reported on the therapeutic alliance. Exploratory factor analysis of team members' reports resulted in meaningful structures, with child and parent alliance scales primarily corresponding to the conceptualization of the developers and earlier factor analysis. Internal reliability and validity were good for most of the subscales. The hypothesis that team members would show low levels of agreement in their reports of the therapeutic alliance was confirmed, demonstrating the need to include multiple team members in assessment procedures. Overall, this study underscores the psychometric properties of the Dutch version of the FEQ. Team members in residential youth psychiatric settings are encouraged to reflect regularly with their colleagues on the youth and parent therapeutic alliance.
Fond, G; Macgregor, A; Miot, S
Nanomedicine is defined as the area using nanotechnology's concepts for the benefit of human beings' health and well being. In this article, we aimed to provide an overview of areas where nanotechnology is applied and how they could be extended to care for psychiatric illnesses. The main applications of nanotechnology in psychiatry are (i) pharmacology. There are two main difficulties in neuropharmacology: drugs have to pass the blood-brain barrier and then to be internalized by targeted cells. Nanoparticles could increase drugs bioavailability and pharmacokinetics, especially improving safety and efficacy of psychotropic drugs. Liposomes, nanosomes, nanoparticle polymers, nanobubbles are some examples of this targeted drug delivery. Nanotechnologies could also add new pharmacological properties, like nanoshells and dendrimers (ii) living analysis. Nanotechnology provides technical assistance to in vivo imaging or metabolome analysis (iii) central nervous system modeling. Research teams have succeeded to modelize inorganic synapses and mimick synaptic behavior, a step essential for further creation of artificial neural systems. Some nanoparticle assemblies present the same small worlds and free-scale networks architecture as cortical neural networks. Nanotechnologies and quantum physics could be used to create models of artificial intelligence and mental illnesses. We are not about to see a concrete application of nanomedicine in daily psychiatric practice. Even if nanotechnologies are promising, their safety is still inconsistent and this must be kept in mind. However, it seems essential that psychiatrists do not forsake this area of research the perspectives of which could be decisive in the field of mental illness.
Singh, Ajai R.
The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts to speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests – psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal – studying and deciphering those brain processes that result in psychiatric malfunction
de Leon, Jose
The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980, has led to a dead end, the DSM-V. Following the allegory of Sleeping Beauty, the DSM-III put European psychiatry to sleep; it now must wake up to create a 21st century psychiatric language for descriptive psychopathology and psychiatric nosology. Four topics are reviewed. First, the review of descriptive psychopathology focuses on: a) Chaslin's and Jaspers's books, and b) Schneider's transmittal of Jaspers's ideas and involvement with Kraepelin in incorporating neuroscience into psychiatric nosology. Second, US psychiatry's historic steps include: a) the pseudoscience of psychoanalysis, b) the low level of pre-DSM-III diagnostic expertise, c) the neo-Kraepelinian revolution which led to DSM-III, d) the failure to improve diagnostic skills, and e) the reprise of Kraepelin's marketing ("neuroscience will save psychiatry"). Third, the DSM-III devastated European psychiatry by destroying: a) the national textbooks which increased consistency but eliminated creative European thinking; and b) the Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie, the most reasonable attempt to reach diagnostic agreement: start with symptoms/signs (first level) rather than disorders (second level). Fourth, Berrios elaborated upon Jaspers, who described psychiatry as a hybrid science and heterogeneous. Berrios affirmed that psychiatric symptoms/signs are hybrid. Some symptoms are in the "semantic space" and cannot be "explained" by neuroscience.
Richard, George; Durkin, Martin
Objectives The purpose of this pilot study is to examine the association between Myers-Briggs Type Indicator (MBTI) and prospective psychiatry residents. Methods Forty-six American medical schools were contacted and asked to participate in this study. Data were collected and an aggregated list was compiled that included the following information: date of MBTI administration, academic year, MBTI form/version, residency match information and student demographic information. The data includes 835 American medical students who completed the MBTI survey and matched into a residency training program in the United States. All analyses were performed using R 3.1.2. Results The probability of an introvert matching to a psychiatry residency is no different than that of an extravert (p= 0.30). The probability of an intuitive individual matching to a psychiatry residency is no different than that of a sensing type (p=0.20). The probability of a feeling type matching to a psychiatry residency is no different than that of a thinking type (p= 0.50). The probability of a perceiving type matching to a psychiatry residency is no different than that of a judging type (p= 0.60). Conclusions Further analyses may elicit more accurate information regarding the personality profile of prospective psychiatry residents. The improvement in communication, team dynamics, mentor-mentee relationships and reduction in workplace conflicts are possible with the awareness of MBTI personality profiles. PMID:26851600
Prasad, K. Niranjan; Sajeev Kumar, P. B.; Narayanankutty, O. K.; Abraham, Amal; Raj, Zoheb; Madanagopal, Vinayak; Balu, Akash
Purpose: This study is to assess the attitude of the medical interns toward psychiatry, psychiatrists and patients with mental health problems. Materials and Methods: A personal data sheet and the Balon et al. questionnaire was used to assess the attitude among medical interns (n = 44) of a medical college in Northern Kerala. Results: There was modestly good attitude toward psychiatry throughout the study. Data were compared between interns who have completed their posting in psychiatry and those who have not. There was no significant difference except for their awareness about consultation liaison services and the authoritative power of psychiatrists in mental health field. The stigma toward psychiatry is on the decline at least among medical professionals, and more interns are interested in taking up psychiatry as a future specialty. Conclusion: Although the study has evidenced a positive attitude to psychiatry, there is still room to improve. A clearer picture could be attained by conducting similar studies in a bigger sample size. A structured curriculum and compulsory internship during the undergraduate course have greatly contributed toward building a more positive opinion of the subject. PMID:27385855
Ferrari, Silvia; Reggianini, Corinna; Mattei, Giorgio; Rigatelli, Marco; Pingani, Luca; Bhugra, Dinesh
Italy was one of the 16 countries to take part in the International Study of Student Career Choice in Psychiatry (ISoSCCiP). This paper reports and comments on the IsoSCCiP data on Italian medical students. Italian final year medical students from the University of Modena and Reggio Emilia were asked to fill in an on-line questionnaire during the first semester of two consecutive academic years (2009-2010, 2010-2011). Step-wise logistic regressions were performed. Of the 231 students invited, 106 returned completed questionnaires (response rate = 46.7%). Women constituted 66%, and mean age was 25.14 (SD = 1.15). Psychiatry was the second most common choice of possible career by students (5.7%, n = 6). Choosing psychiatry was predicted by having volunteered for further clinical/research activities in psychiatry (p = 0.01), believing that 'the problems presented by psychiatric patients are often particularly interesting and challenging' (p < 0.01), and by accounts of personal/family experience with physical illness (p < 0.01). Both personal factors and factors related to training may be involved in the choice of psychiatry among Italian medical students. Cultural and organizational specificities of Italian mental healthcare may be involved, particularly the strong tradition of social psychiatry.
Wahlström, Lars; Blomdahl-Wetterholm, Margareta
The mental health needs of patients receiving physical health care often remain undiagnosed and untreated, resulting in significant costs to the health care system. However, some countries have recently seen fast progress with the development of consultation liaison psychiatry. In Sweden, this service has developed quite slowly, but a breakthrough may be imminent. There is evidence that providing better support for co-morbid health problems may improve the psychological quality of care and reduce physical health care costs in acute hospitals. Consultation liaison psychiatry fits well with the current trends of value-based health care, personalized care, and an emphasis on networking in care.
In the 1960s Franco Basaglia, the Director of a Psychiatric Hospital in a small city on the edge of Italy (Gorizia), began to transform that institution from the inside. He introduced patient meetings and set up a kind of Therapeutic Community. In 1968 he asked two photographers - Carla Cerati and Gianni Berengo Gardin - to take photos inside Gorizia and other asylums. These images were then used in a photobook called Morire di Classe (To Die Because of your Class) (1969). This article re-examines in detail the content of this celebrated book and its history, and its impact on the struggle to reform and abolish large-scale psychiatric institutions. It also places the book in its social and political context and as a key text of the anti-psychiatry movement of the 1960s.
Wu, Harry Yi-Jui
This paper examines the relationship between 'world citizenship' and the new psychiatric research paradigm established by the World Health Organization in the early post-World War II period. Endorsing the humanitarian ideological concept of 'world citizenship', health professionals called for global rehabilitation initiatives to address the devastation after the war. The charm of world citizenship had not only provided theoretical grounds of international collaborative research into the psychopathology of psychiatric diseases, but also gave birth to the international psychiatric epidemiologic studies conducted by the World Health Organization. Themes explored in this paper include the global awareness of mental rehabilitation, the application of public health methods in psychiatry to improve mental health globally, the attempt by the WHO to conduct large-scale, cross-cultural studies relevant to mental health and the initial problems it faced.
In the 1960s Franco Basaglia, the Director of a Psychiatric Hospital in a small city on the edge of Italy (Gorizia), began to transform that institution from the inside. He introduced patient meetings and set up a kind of Therapeutic Community. In 1968 he asked two photographers – Carla Cerati and Gianni Berengo Gardin – to take photos inside Gorizia and other asylums. These images were then used in a photobook called Morire di Classe (To Die Because of your Class) (1969). This article re-examines in detail the content of this celebrated book and its history, and its impact on the struggle to reform and abolish large-scale psychiatric institutions. It also places the book in its social and political context and as a key text of the anti-psychiatry movement of the 1960s. PMID:25698683
TAYMUR, İbrahim; ÖZDEL, Kadir; AYPAK, Cenk; DUYAN, Veli; TÜREDİ, Özlem; GÜNGÖR, Buket Belkız; SELVİ, Yavuz
Introduction We aimed to determine the level of bereavement and depression symptoms among elderly patients who experience the loss of a significant other and the relationship between depressive symptoms and bereavement symptoms. Methods The study sample consisted of elderly adults who lost a significant other at least 6 months prior to the submission time. Participants were recruited from patients who presented to either the psychiatry or family medicine outpatient unit of a Training and Research Hospital. Cognitive functions were assessed using Standardized Mini Mental Examinations for Educated and Uneducated People (SMME/SMME-U). Participants were excluded from the study if their SMME or SMME-U scores were lower than 23 points. To assess the severity of depressive and bereavement symptoms, the Geriatric Depression Scale (GDS) and Core Bereavement Items (CBI) scales were used, respectively. Results Overall, 33 out of 67 individuals (49.2%) who presented to the psychiatry unit and 7 out of the 43 individuals (16.3%) who presented to the family medicine unit were diagnosed with major depressive disorder (MDD). CBI scale score means were higher in the MDD groups than in the non-depressive groups (p=0.012 and p=0.001, respectively). CBI scores were significantly correlated to acute (p=0.047) and chronic stress (p=0.007) in the psychiatry group and to chronic stress in the family medicine group (p=0.001). Conclusion Probing loss experiences and reactions to them can be important to understand depression, to evaluate its symptoms, and to help manage the relevant symptoms. Considering the significant contributions of bereavement to depressive symptom severity in elders, interventions specific to bereavement symptoms should not be ignored. PMID:28360781
History of psychiatry can provide us with a map of the evolution of the practice and identify its major figures. A historiometric approach was taken to available history of psychiatry texts and a historical dictionary. Reliability was tested against data from the journal History of Psychiatry. Those cited in all historical accounts are characterized as major figures, while those cited in at least 60% of the sources are considered significant figures. An index of eminence is calculated for each significant figure. The Cronbach’s alpha was .89. Seventy-four significant figures were identified, of which eighteen are considered major figures. Among these, Freud, Pinel, and Kraepelin have the highest eminence – respectively. Pinel, Freud, and Kraepelin represent key moments in three epochs in the history of psychiatry: the asylum era, the first biological psychiatry, and the psychoanalytical period, respectively. The most recent historical periods are not well represented yet in histories of psychiatry. PMID:25268155
Singh, Ajai R.
There are a number of spoofs and light-hearted writings in blogs, journalistic pieces and book form (even from former Nobel Laureates), which attempt at ‘understanding’ the secret of getting a Nobel. This is not one of them. It is more pedantic without necessarily being dry. It first analyses the meaning of the concept, ‘the greatest benefit of mankind’, which is the crux of the Nobel Will and the overarching requirement for a Nobel in Medicine. Further discussion in the paper is divided into 5 parts: (1)General qualities for a Nobel: The need to be really bright is a given; what is necessary is to be sufficiently crazy about a research topic to make it an obsession; be ready to forgo many creature comforts for long stretches of time; and after all this, be ready to accept that the Nobel may never happen, yet continue to do a type of research solely because it is intrinsically worth doing.(2)Nobel in Physiology or Medicine: Here, the key is to do fundamental/basic research to answer persistent, nagging, unanswered questions of medicine which others neglect because they are discomforting. Or, find treatments that change the whole manner a disease has been hitherto treated.(3)Nobel in Psychiatry: There are many Nobels waiting to be won, provided: (a) The branch becomes more precise; (b) Science, quantitative study and biology remain its bedrock; and (c) There is an almost obsessive preoccupation with unravelling the mysteries of the brain. One has to choose wisely where to put in efforts, e.g., fields like fundamental research into the causes of psychiatric disorders, especially schizophrenia, depression, bipolar disorders. Or their definitive treatments. Or, work at the cellular or molecular level of the neuron and brain; or, the glandular or genetic level of the systems connected with psychiatric disorders; or, in brain radio imaging. If other, or allied, fields are chosen, to work with finding quantitative data and attempt to pinpoint their precise
Lagarde, J; Sarazin, M
Frontotemporal degeneration (FTD) in its behavioral variant (bvFTD) is probably one of the conditions that best illustrates the links between psychiatry and neurology. It is indeed admitted that between a third and half of patients with this condition, especially in early-onset forms, receive an initial diagnosis of psychiatric disorder (depression, schizophrenia, bipolar disorder) and are then referred to a psychiatric ward. BvFTD can thus be considered a neurological disorder with a psychiatric presentation. Among psychiatric symptoms reported in this disease, psychotic symptoms (hallucinations, delusions, especially of persecution), which have long been underestimated in bvFTD and are not part of the current diagnostic criteria, are present in about 20% of cases and may be inaugural. They are particularly common in the genetic forms related to a mutation in the C9orf72 gene (up to 50%), and to a lesser extent in the GRN gene (up to 25%). C9orf72 gene mutation is often associated with a family history of dementia or motor neuron disease but also of psychiatric disorders. It has also been described in sporadic presentation forms. Sometimes, the moderate degree of brain atrophy on MRI described in patients carrying this mutation may complicate the differential diagnosis with late-onset psychiatric diseases. In the present article, we underline the importance of considering that psychiatric - especially psychotic - symptoms are not rare in bvFTD, which should lead to a revision of the diagnostic criteria of this disease by taking greater account of this fact. We also propose a diagnostic chart, based on concerted evaluation by neurologists and psychiatrists for cases of atypical psychiatric symptoms (late-onset or pharmacoresistant troubles) leading to consider the possibility of a neurological disorder, in order to shed a new light on these difficult clinical situations. In the field of research, bvFTD may constitute a model to explore the neural basis of certain
Bezchasniy, K V
The formation of forensic psychiatry knowledge as a special area of concern was due to fundamental changes in the social, economic and political life of Russia society. It reflected public awareness of the urgent need in solving the problem of support, preserve and maintain the mental health of the people. Forensic psychiatry was based on the development of psychiatry, public health and community medicine. Author describes of the role of Russian psychiatrists in the formation of forensic psychiatry, their active particitpation in internation professional meetings and in the development of the problem of responsibility.
Baca, Enrique; Lázaro, José; Hernández-Clemente, Juan C
This paper shows how the community of Latin-American and Spanish psychiatry represents a solid platform for the so-called 'continental thought' to meet the analytical Anglo-Saxon thought. It reviews what both Latin America and the Spanish and Portuguese languages represent in the American continent; the relation between Spanish psychiatry and Spanish-speaking psychiatry in America during the twentieth century; the reality of psychiatric research and profession in Latin America; the evolution of Spanish psychiatry in the twentieth century from the post civil war diaspora to the beginning of the twenty-first century, and research on mental health in Spain and the foreseeable future.
Söderberg, Siv; Skär, Lisa
Young adults with mental illness who need continuing care when they turn 18 are referred from child and adolescent psychiatry to general adult psychiatry. During this process, young adults are undergoing multiple transitions as they come of age while they transfer to another unit in healthcare. The aim of this study was to explore expectations and experiences of transition from child and adolescent psychiatry to general adult psychiatry as narrated by young adults and relatives. Individual interviews were conducted with three young adults and six relatives and analysed according to grounded theory. The analysis resulted in a core category: managing transition with support, and three categories: being of age but not mature, walking out of security and into uncertainty, and feeling omitted and handling concerns. The young adults' and relatives' main concerns were that they might be left out and feel uncertainty about the new situation during the transition process. To facilitate the transition process, individual care planning is needed. It is essential that young adults and relatives are participating in the process to be prepared for the changes and achieve a successful transition. Knowledge about the simultaneous processes seems to be an important issue for facilitating transition. PMID:24829900
Parikh, Nimesh C.; Sharma, Prateek S.; Chaudhary, Pradhyuman J.; Gandhi, Hitendra A.; Banwari, Girish H.
Background: Worldwide, multiple studies demonstrate a negative attitude of interns toward psychiatry. Scenario in Gujarat state has never been looked upon. The objective of this study is to identify the situation in this region by studying the attitude of interns toward various areas of psychiatry and to study the gender differences if any. Materials and Methods: For study, all 122 interns who attended psychiatry posting for the 1st time in their internship, over a period of 8 months were approached amongst which 100 (56 males and 44 females) consented to be a part. Attitude was measured with 30 items attitude toward psychiatry (ATP 30) questionnaire on the 1st day of their posting. The data thus collected were analyzed by SPSS version 20. Result: The results showed a neutral to the negative attitude in major areas of psychiatry. Most neutral responses were seen regarding contribution of psychiatric hospitals in the treatment, regarding psychiatric patients considered to be interesting and psychiatry enabling people to have rewarding relationships. Negative attitude toward areas on scientific information in psychiatry and psychotherapy's validity were obtained. While attitude was positive in areas of psychiatric knowledge and teaching, but female interns were lagging behind their male counterparts. Psychiatric treatment lessens worries and psychiatric illness should be considered at par with other medical illnesses, were most common positively viewed attitude. Conclusion: Interns overall shared a neutral to negative ATP. Adequate rectification is required in existing medical curriculum, and more exposure to the subject is essential to improve the attitude of interns toward mental health PMID:25788804
Objective To conduct a survey about teaching child and adolescent psychiatry to undergraduate medical students in German-speaking countries. Methods A questionnaire was sent to the 33 academic departments of child and adolescent psychiatry in Germany, Austria, and the German-speaking part of Switzerland. Results All departments responded. For teaching knowledge, the methods most commonly reported were lectures and case presentations. The most important skills to be taught were thought to be how to assess psychopathology in children and how to assess families. For elective courses, the departments reported using a wide range of teaching methods, many with active involvement of the students. An average of 34 hours per semester is currently allocated by the departments for teaching child and adolescent psychiatry to medical students. Required courses are often taught in cooperation with adult psychiatry and pediatrics. Achievement of educational objectives is usually assessed with written exams or multiple-choice tests. Only a minority of the departments test the achievement of skills. Conclusions Two ways of improving education in child and adolescent psychiatry are the introduction of elective courses for students interested in the field and participation of child and adolescent psychiatrists in required courses and in longitudinal courses so as to reach all students. Cooperation within and across medical schools can enable departments of child and adolescent psychiatry, despite limited resources, to become more visible and this specialty to become more attractive to medical students. Compared to the findings in earlier surveys, this survey indicates a trend towards increased involvement of academic departments of child and adolescent psychiatry in training medical students. PMID:20653973
Ekblad, Solvig; Kastrup, Marianne Carisius
This article discusses major themes in recent transcultural psychiatric research in the Nordic countries from 2008 to 2011: (a) epidemiological studies of migration, (b) indigenous populations, and (c) quality of psychiatric care for migrants. Over the past several decades, the populations of the Nordic countries, Denmark, Finland, Norway, and Sweden, which were relatively homogeneous, have become increasingly culturally diverse. Many migrants to Nordic countries have been exposed to extreme stress, such as threats of death and/or torture and other severe social adversities before, during, and after migration, with potential effects on their physical, mental, social, and spiritual health. Growing interest in transcultural issues is reflected in the level of scientific research and clinical activity in the field by Nordic physicians, psychologists, social scientists, demographers, medical anthropologists, as well as other clinicians and policy planners. Research includes work with migrants and indigenous minorities in the Nordic countries, as well as comparisons with mental health in postconflict countries. We conclude by suggesting future directions for transcultural psychiatry research and providing guidelines for the education and training of future clinicians in the Nordic countries.
Dijkstra, Nadine; de Bruin, Leon
In this paper, we investigate to what extent it is justified to draw conclusions about causal relations between brain states and mental states from cognitive neuroscience studies. We first explain the views of two prominent proponents of the interventionist account of causation: Woodward and Baumgartner. We then discuss the implications of their views in the context of traditional cognitive neuroscience studies in which the effect of changes in mental state on changes in brain states is investigated. After this, we turn to brain stimulation studies in which brain states are manipulated to investigate the effects on mental states. We argue that, depending on whether one sides with Woodward or Baumgartner, it is possible to draw causal conclusions from both types of studies (Woodward) or from brain stimulation studies only (Baumgartner). We show what happens to these conclusions if we adopt different views of the relation between mental states and brain states. Finally, we discuss the implications of our findings for psychiatry and the treatment of psychiatric disorders. PMID:27486408
Lombard, Jay; Doraiswamy, P Murali
Psychiatric disorders are a leading cause of disability worldwide and despite significant pharmacologic advances, often remain difficult to diagnose correctly and treat fully. Factors which contribute to these difficulties include imprecise understanding of etiology, syndromal nature of many disorders and overlap in diagnostic criteria between conditions, medical and psychiatric comorbidity and high rates of noncompliance to treatment either due to lack of efficacy or adverse effects. In addition to genetics and known biological factors, the severity and presentation of many psychiatric conditions may be influenced by psychosocial factors, which in turn can affect treatment outcomes. Currently, the selection of medications for a given patient in psychiatry is primarily based on a trial and error process; thus, there is an urgent need to identify biomarkers that can improve diagnostic homogeneity and provide useful prognostic information. Pharmacogenetics has the potential, in combination with other approaches, to enhance both care at an individual level as well as in drug development by improving efficacy and minimizing drug-induced side effects.
Zik, Jodi B; Roberts, David L
Oxytocin is known as the 'love hormone' due its role in promoting mother-child and pair bonding. More recent research indicates that oxytocin may have broader pro-social effects on behavior and cognition, which points towards oxytocin's potential as an agent to help improve social cognition and functioning in psychiatric disorders such as schizophrenia and autism. However, new research on oxytocin has also uncovered a 'darker side', including oxytocin's possible role in social out-grouping and envy. Instead of a simple view of oxytocin as 'good' or 'bad', a more accurate depiction of oxytocin's role in social processing likely involves the presence of moderating factors. We review moderation effects in oxytocin and their implications for psychiatry. One implication is that, across diagnostic categories, oxytocin administration may have positive effects for patients with social cognitive deficits but negative effects for patients with social cognitive bias. We conclude that future intervention studies should use methods such as signal detection to measure both deficit and bias parameters of social cognition and to evaluate potential individual and contextual moderators both within and between psychiatric diagnoses in order to determine for whom oxytocin treatment may be beneficial and for whom it may actually be harmful.
Causality or etiology in psychiatry is marked by standard biomedical, reductionistic models (symptoms reflect the construct involved) that inform approaches to nosology, or classification, such as in the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; (1)]. However, network approaches to symptom interaction [i.e., symptoms are formative of the construct; e.g., (2), for posttraumatic stress disorder (PTSD)] are being developed that speak to bottom-up processes in mental disorder, in contrast to the typical top-down psychological construct approach. The present article presents a hybrid top-down, bottom-up model of the relationship between symptoms and mental disorder, viewing symptom expression and their causal complex as a reciprocally dynamic system with multiple levels, from lower-order symptoms in interaction to higher-order constructs affecting them. The hybrid model hinges on good understanding of systems theory in which it is embedded, so that the article reviews in depth non-linear dynamical systems theory (NLDST). The article applies the concept of emergent circular causality (3) to symptom development, as well. Conclusions consider that symptoms vary over several dimensions, including: subjectivity; objectivity; conscious motivation effort; and unconscious influences, and the degree to which individual (e.g., meaning) and universal (e.g., causal) processes are involved. The opposition between science and skepticism is a complex one that the article addresses in final comments.
Corradi, Richard B
Identification-a psychic process in which a person takes on characteristics of another-is a concept important to the understanding of human nature. It plays an important role in how our personalities develop, in our ability to deal with life's stresses, and in how we interact with other people. Knowledge of its manifestations is essential to dynamic psychiatry and to its applications in psychotherapy. This article defines identification and reviews its role in development and as a defense. It discusses its role in the psychopathology of disorders commonly encountered in psychotherapy practice-depression and anxiety states reactive to losses in life, and borderline states. Clinical vignettes illustrate how identification functions in these conditions, and also how identifications reveal themselves in the transference and are utilized in psychotherapy. A teaching vignette illustrates how important it is that residents learning the art of psychotherapy appreciate the therapeutic potential of identification. The article maintains that, although it often goes unrecognized, identification with the therapist is one of the most effective therapeutic devices in the transference.
Ilechukwu, Sunny T
Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and lead to drastic permanent body image changes from scarring and limb-function loss. Close relatives, if not killed in the fire, often also experience clinically significant bystander stress. Closeness of relationships may be lost, and self-image may suffer. Property damage and loss of crucial resources may be associated with fires. Although many burns result from accidents, most result from preventable causes associated with psychiatric disorders, which include mood disorders, psychoses, cognitive disorders, and substance-use disorders. Burns then result from: Deliberate self-harm Impaired judgment and poor coordination associated with substance intoxication Risk-taking behavior Poor supervision of children and impaired elderly persons Careless handling of flammable materials. Many clinical syndromes, such as delirium, ASD, acute psychosis, suicidality, and pain need to be addressed by the consulting psychiatrist to facilitate surgical treatment of the burn injury. Other psychiatric disorders, such as PTSD, major depression, and adjustment disorder, need to be treated to expedite long-term adjustment. Hospital length of stay and RTW/RTS are major outcome variables. The psychiatry consultant can positively affect both variables substantially using both pharmacologic and psychosocial measures. The important role of psychiatric issues both before and after burn injury support the need for more consistent and comprehensive medical insurance coverage for psychiatric consultation to burn units and clinics. Burn Support Groups are an invaluable asset.
This study reports upon the results of a postal questionnaire survey of 107 adult psychiatrists which investigated their current use of psychostimulant pharmacotherapy and their attitudes towards the diagnostic status of attention-deficit hyperactivity disorder (ADHD) in adulthood. Of the 88 respondents, only a minority of 11 (12.5%) used psychostimulants in their usual practice, albeit very infrequently (one or two prescriptions per year on average). Methylphenidate hydrochloride ('Ritalin') was the prescribers' most popular agent and 'narcolepsy' was the most frequently cited clinical indication for psychostimulants. ADHD appeared to represent only a very small area of current clinical activity and a minority of clinicians expressed the view that it did not exist in adults. It is concluded that psychostimulant therapy is relatively undeveloped in British adult psychiatry and that the clinical speciality generally appears to be unprepared for the growing numbers of adolescents with ADHD who are currently managed by child psychiatrists and who may require ongoing psychiatric care, including psychostimulant therapy.