Lis, Eric; Wood, Megan A; Chiniara, Carl; Biskin, Robert; Montoro, Richard
The literature has seen a surge in research on the mental health impacts of technologies such as Facebook, Twitter and other social media, but little is known regarding how mental health workers perceive patients and clients who report use of such technologies. The present study examines how psychiatrists perceive social media and whether they make use of it. Psychiatrists (N = 48) at a tertiary care centre in Canada completed a questionnaire assessing history of using social networking sites (SNSs) such as Facebook and Google Plus and status update sites (SUSs) such as Twitter and Livejournal and whether they associate them with psychopathology. 38.5 % have used SNSs and 9.8 % have used SUSs. Only 37 % believed there was an association between psychopathology and SNSs while 33 % believed there was an association between psychopathology and SUSs. Implications for clinical practice and future research are discussed.
How can we keep our psychiatrists? Merryll Vorster graduated and specialised in psychiatry at the University of the. Witwatersrand. She is currently Chief Specialist and Associate Professor, Community. Psychiatry (joint appointment with the Gauteng Health Department) and Head of the Department of Neurosciences at Wits ...
Shires, B W; Spector, P M
The authors describe a joint practice model between a clinical nurse specialist and psychiatrist. The authors address factors to consider in establishing a joint practice--negotiation of roles and benefits as well as clinical supervision. In addition, specific clinical responsibilities for the nurse specialist, as well as potential expanded duties, are outlined.
While, in general, a certain number of clinical psychiatrists might not be familiar with molecular biology, the mechanisms of mental illnesses have been uncovered by molecular biology for decades. Among mental illnesses, even biological psychiatrists and neuroscientists have paid less attention to the biological treatment of autism spectrum disorder (ASD) than Alzheimer's disease and schizophrenia since ASD has been regarded as a developmental disorder that was seemingly untreatable. However, multifaceted methods of molecular biology have revealed the mechanisms that would lead to the medication of ASD. In this article, how molecular biology dissects the pathobiology of ASD is described in order to announce the possibilities of biological treatment for clinical psychiatrists.
Frankish, Katherine; Ryan, Christopher; Harris, Anthony
This paper proposes ethical guidelines for psychiatrists and psychiatry trainees when interacting with social media. A three-stage process was followed in the development of these guidelines. A literature review provided situations and possible broad rules as to how social media could be ethically engaged. A roundtable discussion by a panel of invited psychiatrists, psychiatry trainees, psychologists, e-health practitioners, lawyers and consumers was held to discuss the situations and to better formulate the ethical principles upon which psychiatrists could act. These vignettes and principles were then broadly discussed at a seminar held at the 2011 RANZCP Congress. Finally, this paper was circulated to the original invitees for final comment. A set of recommendations for working with social media were developed. The new social media provides important avenues for communication, education and treatment. These avenues pose ethical and practical dilemmas that can be resolved by the application of established ethical principles. Practical recommendations for navigating social media are proposed.
Koh, Steve; Cattell, Gwyn M; Cochran, David M; Krasner, Aaron; Langheim, Frederick J P; Sasso, David A
Recent and ongoing advances in information technology present opportunities and challenges in the practice of medicine. Among all medical subspecialties, psychiatry is uniquely suited to help guide the medical profession's response to the ethical, legal, and therapeutic challenges--especially with respect to boundaries--posed by the rapid proliferation of social media in medicine. Ironically, while limited guidelines exist for other branches of medicine, guidelines for the responsible use of social media and information technology in psychiatry are lacking. To collect data about patterns of use of electronic communications and social media among practicing psychiatrists and to establish a conceptual framework for developing professional guidelines. A structured survey was developed to assess the use of email, texting, and social media among the active membership of the Group for the Advancement of Psychiatry (GAP) to gain insight into current practices across a spectrum of the field and to identify areas of concern not addressed in existing guidelines. This survey was distributed by mail and at an annual meeting of the GAP and a descriptive statistical analysis was conducted with SPSS. Of the 212 members, 178 responded (84% response rate). The majority of respondents (58%) reported that they rarely or never evaluated their online presence, while 35% reported that they had at some time searched for information online about patients. Only 20% posted content about themselves online and few of these restricted that information. Approximately 25% used email to communicate with patients, and very few obtained written consent to do so. Discipline-specific guidelines for psychiatrists' interactions with social media and electronic communications are needed. Informed by the survey described here, a review of the literature, and consensus opinion, a framework for developing such a set of guidelines is proposed. The model integrates four key areas: treatment frame, patient
Curlin, Farr A; Lawrence, Ryan E; Odell, Shaun; Chin, Marshall H; Lantos, John D; Koenig, Harold G; Meador, Keith G
This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting.
Dorahy, Martin J; Lewis, Christopher Alan; Mulholland, Ciaran
A sample of Northern Irish clinical psychologists (N=27) and psychiatrists (N=29) completed three clinical vignettes designed to assess the detection of dissociative identity disorder. Data suggested that psychiatrists and clinical psychologists were better able to detect dissociative identity disorder when discriminating and characteristic symptoms were present. However, the majority of clinicians still failed to diagnose dissociative identity disorder as the most likely condition in a clear-cut case.
Alan J. McMichael BSc
Full Text Available Symptom report scales are used in clinical practice to monitor patient outcomes. Using them permits the definition of a minimum clinically important difference (MCID beyond which a patient may be judged as having responded to treatment. Despite recommendations that clinicians routinely use MCIDs in clinical practice, statisticians disagree about how MCIDs should be used to evaluate individual patient outcomes and responses to treatment. To address this issue, we asked how clinicians actually use MCIDs to evaluate patient outcomes in response to treatment. Sixty-eight psychiatrists made judgments about whether hypothetical patients had responded to treatment based on their pre- and posttreatment change scores on the widely used Positive and Negative Syndrome Scale. Psychiatrists were provided with the scale’s MCID on which to base their judgments. Our secondary objective was to assess whether knowledge of the patient’s genotype influenced psychiatrists’ responder judgments. Thus, psychiatrists were also informed of whether patients possessed a genotype indicating hyperresponsiveness to treatment. While many psychiatrists appropriately used the MCID, others accepted a far lower posttreatment change as indicative of a response to treatment. When psychiatrists accepted a lower posttreatment change than the MCID, they were less confident in such judgments compared to when a patient’s posttreatment change exceeded the scale’s MCID. Psychiatrists were also less likely to identify patients as responders to treatment if they possessed a hyperresponsiveness genotype. Clinicians should recognize that when judging patient responses to treatment, they often tolerate lower response thresholds than warranted. At least some conflate their judgments with information, such as the patient’s genotype, that is irrelevant to a post hoc response-to-treatment assessment. Consequently, clinicians may be at risk of persisting with treatments that have failed
Peek, Holly S; Richards, Misty; Muir, Owen; Chan, Steven Richard; Caton, Michael; MacMillan, Carlene
We live in a digital age where information can be found instantaneously via the Internet. Studies have shown that consumers search for much of their medical information on the Internet, particularly utilizing blogs and social media platforms. As the mental health field is riddled with misinformation and stigma, this offers a unique opportunity for psychiatrists and mental health professionals to reach a broad audience for mental health education and advocacy. In this review, we discuss the various methods and techniques for blogging and social media. We then review the current recommendations for ethics and professionalism as well as make recommendations to strengthen our guidance in this new and evolving field.
As soon as Adolf Hitler came to into power in 1933, four laws on racial segregation and race protection were edicted between 1934 and 1935. Schizophrenia, manic-depressive psychoses, epilepsy and alcoholism were regarded as hereditary mental illnesses. These laws were responsible for the sterilisation of 350,000 individuals who were thought to be at the source of the propagation of hereditary illnesses which might endanger the health and the future of the Aryan Germans. On September 1, 1939, Action T4 was launched: it required that all the mentally ill be exterminated. This action, which was run by the highest level of the Reich's chancellery with the help of psychiatrists coming from all backgrounds including university professors, was supposed to grant a serene death to all the mentally ill considered as untreatable. The death sentences were carried out by the medical staff in psychiatric hospitals specially equipped with gas chambers. Following protests, Action T4 was officially stopped on August 24, 1941, but, in reality, continued until the end of the war. The death sentences were carried out using either lethal doses of medication or food deprivation. One hundred and fifty thousand individuals fell victim to that therapeutic extermination which played an economic role as important as the one deemed to social protection. Many German academics, researchers, psychiatrists, geneticians and anthropologists played and active part in these murders which were carried out in the name of Nazi ideology based upon the supremacy of the Northern Germanic race and the necessity to protect it from miscegenation, especially from Jews. In the final part of this paper, the author gives an explanation of the perversion of ethics carried out by German psychiatrists.
Malhi, Gin S; Bassett, Darryl; Boyce, Philip; Bryant, Richard; Fitzgerald, Paul B; Fritz, Kristina; Hopwood, Malcolm; Lyndon, Bill; Mulder, Roger; Murray, Greg; Porter, Richard; Singh, Ajeet B
To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng
Carter, Gregory; Page, Andrew; Large, Matthew; Hetrick, Sarah; Milner, Allison Joy; Bendit, Nick; Walton, Carla; Draper, Brian; Hazell, Philip; Fortune, Sarah; Burns, Jane; Patton, George; Lawrence, Mark; Dadd, Lawrence; Robinson, Jo; Christensen, Helen
To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. © The Royal Australian and New Zealand College of Psychiatrists 2016.
Currie, Alan; Johnston, Allan
Athletes experience a range of mental health problems with at least an equivalent prevalence to the general population. This chapter explores the psychiatrist's role in sport, along a pathway of mental healthcare from 'upstream' prevention, screening, and early detection of mental stress to 'downstream' assessment, treatment, rehabilitation, and recovery from mental illness. At each stage on this pathway the psychiatrist has a broad spectrum of bio-psycho-social strategies to employ in clinical practice. Upstream, the importance of psychological resilience is described along with the concept of mental 'pre-habilitation' (a term usually associated with the prevention of physical injury). Alongside these preventative measures, early detection is improved by education, increased awareness, and by the use of effective mental health screening measures. Further downstream ready access to psychiatric expertise and good collaboration between the psychiatrist and the world of sport improve access to treatment, delivery of that treatment, rehabilitation, and return to sport during recovery.
Full Text Available Objectives: The aim of this study was to assess the pattern and utilisation of psychotropic drug prescriptions by psychiatrists in Kerman Province, Iran. Methods: The prescriptions of 27 psychiatrists were randomly selected from two Iranian public insurance organisations and were analysed for the mean number of drugs/prescriptions, drug category and the most frequently prescribed drug in each category as well as overall. Results: A total of 6,414 prescriptions were analysed. The mean number of drugs per prescription was 2.9. Antidepressants (61.0% were the most frequently prescribed category of psychotropic medications, followed by antipsychotics (29.5%, sedative/hypnotics or anti-anxiety drugs (27.5% and mood stabilisers (18.5%. The combination of antidepressants with antipsychotics was the most commonly prescribed combination (18.8%. Fluoxetine (16.5% and trifluoperazine (13.5% were among the most frequently prescribed antidepressants and antipsychotics, respectively. Clonazepam (10.5% was the most commonly prescribed benzodiazepine agent, followed by alprazolam (8.5%. In terms of total drug utilisation, sertraline (12.4% was the most commonly used psychotropic medication followed by fluoxetine (9.7%, trifluoperazine (6.6%, propranolol (4.5% and clonazepam (3.7%. Conclusion: A high proportion of psychotropic prescriptions in Kerman Province were for antidepressants, followed by antipsychotics and the benzodiazepines. Further research is needed to determine the underlying correlation between prescription practice and the diagnosis and patient characteristics, as well as to investigate the use of different psychotropic medications.
Hay, Phillipa; Chinn, David; Forbes, David; Madden, Sloane; Newton, Richard; Sugenor, Lois; Touyz, Stephen; Ward, Warren
This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014. The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified. In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to
Solli, Hans Magnus; Barbosa da Silva, António; Egeland, Jens
To investigate whether adding descriptions of the health factors "ability," "environment" and "intentions/goals" to the officially sanctioned biomedical disability model (BDM) would improve assessments of work ability for social security purposes. The study was based on a theoretical design consisting of textual analysis and interpretation. Two further work ability models were defined: the mixed health model (MHM), which describes health factors without assessing a person's abilities in context, and the ability-based health model (AHM), which assesses abilities in a concrete context of environment and intention. Eighty-six social security certificates, written by psychiatrists and psychology specialists in a Norwegian hospital-based mental health clinic, were analysed in relation to the three work ability/disability models. In certificates based on the BDM, a general pattern was found of "gradual work training". The MHM added health factors, but without linking them together in a concrete way. With the AHM, work ability was assessed in terms of a concrete unified evaluation of the claimant's abilities, environments and intentions/goals. Applying the AHM in work ability assessments, in comparison with the BDM and the MHM, is useful because this foregrounds claimants' abilities in a context of concrete goals and work-related opportunities, as a unity. Implications for Rehabilitation A concept of health should include ability, environment and intentions/goals as components. When all three of these components are described in concrete terms in a work ability assessment, an integrated picture of the individual's abilities in the context of his/her particular intentions/goals and work opportunities comes to the fore. This kind of assessment makes it possible to meet the individual's needs for individual follow-up in a work environment.
Ruksheda, Syeda N
Incredible India is a multicultural, multilingual, multifaceted, country of contradictions, where the women mental health professionals are participating in substantially increasing numbers. Evolving social, cultural and economical factors have facilitated the empowerment of women which is reflected in the health services. The contemporary Indian Woman Medical Professional is liberated, articulate and free. Remunerative employment has decreased economic vulnerability and dependence on men. Her decisions though, from choosing medicine as a vocation, opting for psychiatry, to specializing in a particular field are all coloured by class, caste, sex, region and religion. Cultural expectations and influences set norms for all in a society, dictating the behaviour and attitude of colleagues, superiors, patients, family and that of the psychiatrist herself. Egalitarianism, while on the rise, the long tradition of social hierarchies replicates themselves in professional arenas. An ever increasing number, women are still less than 10% of all Indian psychiatrists. Women psychiatrists continue to be underrepresented as policy makers in most psychiatric organizations and institutes. This article will discuss some of the experiences of the young Indian woman psychiatrist influencing her life architecture.
Lis, Eric; Chiniara, Carl; Biskin, Robert; Montoro, Richard
The literature has seen a surge in research on the mental health impacts of technologies such as Facebook, video games, and massively-multiplayer online role-playing games such as World of Warcraft, but little is known regarding the mental health impact of non-video role-playing games, such as Dungeons & Dragons. The present study examines how psychiatrists' perceive role-playing games and whether they play them. Psychiatrists at a tertiary care centre in Canada completed a questionnaire assessing history of playing role-playing games and whether they associate them with psychopathology. Forty-eight psychiatrists responded. Twenty-three percent have played a role-playing game over their lifetimes. Twenty-two percent believed there was an association between psychopathology and role-playing games. A majority of psychiatrists who responded do not associate role-playing games with psychopathology. Implications for clinical practice and future research are discussed.
We surveyed 121 Indian psychiatrists to explore their understanding of gambling addiction, their exposure to patients with gambling addiction in their day to day clinical practice, and their perception about the feasibility of getting involved in managing these patients. 80.9% of psychiatrists who responded said they had seen ...
Background. It is not known whether psychiatrists' approach to religious matters in clinical practice reflects their own identification or non-identification with religion or their being active in religious activities. Objective. This question was investigated among South African (SA) psychiatrists and psychiatry registrars, including ...
... qualified psychiatrist or psychologist. 416.1017 Section 416.1017 Employees' Benefits SOCIAL SECURITY... review by a qualified psychiatrist or psychologist. (a) The State agency must determine if additional qualified psychiatrists and psychologists are needed to make the necessary reviews (see § 416.1015(d...
... qualified psychiatrist or psychologist. 404.1617 Section 404.1617 Employees' Benefits SOCIAL SECURITY... review by a qualified psychiatrist or psychologist. (a) The State agency must determine if additional qualified psychiatrists and psychologists are needed to make the necessary reviews (see § 404.1615(d...
Peters, Matthew E; Uible, Elisabeth; Chisolm, Margaret S
Social media tools such as blogs, microblogs, social networking sites, podcasts, and video-sharing sites are now ubiquitous. These tools enable instantaneous interactions with a global community of individuals, including medical professionals, learners, and patients. An understanding of social media tools and how they can be used by psychiatrists is increasingly important. This review defines some relevant social media terms and addresses challenges specific to the use of social media in psychiatry. Focused primarily on Twitter, one of the most commonly used social media tools, the review describes how Twitter is being used in non-psychiatric medical fields and highlights four current and/or potential uses of Twitter in psychiatry: (1) patient care and advocacy, (2) lifelong learning, (3) research data collection and collaboration, and (4) scholarly recognition and impact.
Albert, Umberto; Brugnoli, Roberto; Caraci, Filippo; Dell'Osso, Bernardo; Di Sciascio, Guido; Tortorella, Alfonso; Vampini, Claudio; Cataldo, Nazarena; Pegoraro, Valeria
. There is a gap between what psychiatrists know and what psychiatrists apply to their clinical practice reflecting the feeling of a therapeutical unmet need.
The clinical work of the psychiatrist often faces him to people who openly talk about their wish to die. However, although such thoughts did not culminate in most cases, unfortunately statistics show that suicide is a concrete possibility, more frequent than suspected. Globally, a million people die by suicide each year. The will to kill themselves is a complex phenomenon that is neither new nor modern. Suicide has crossed different times adopting different forms and meanings according to culture and history. As doctors, we tend to describe behaviors, in this case highly such a variable one, which involves various reasons and determinants. Thus, much has been written in the scientific literature about suicide in the causes, risk and protective factors, most vulnerable groups, etc. It has also been remarked the pain that the suicide causes in the family and close friends. Lots of articles propose psychotherapeutic and supporting measures for the suicide survivors to avoid the traumatic consequences of the experience. But, what about the psychiatrist? Isn't him a person who has been in close contact with the subject who has killed himself? The survivor risk of having traumatic symptoms, does it not apply to the doctor who was in charge? In this article, it will be taken into account the point of view of the psychiatrist in the grief after a patient's suicide.
Feb 17, 2004 ... South African Psychiatry Review - February 2004. 10. Euthanasia: a problem for psychiatrists done to those people had no connection whatsoever with what was in their interests. Here the term “euthanasia” was simply a euphemism for the massacre of persons regarded as undesirable by others in power.
Gaebel, Wolfgang; Zäske, Harald; Cleveland, Helen-Rose
to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists...
Hope, L C; Cook, C C; Thomson, A D
Although it is well known that B-vitamin deficiencies directly affecting the brain are common in alcohol misuse, no concise guidelines on the use of vitamin supplements in alcohol misusers currently exist in the UK. The purpose of this study was to assess current practice and opinion among UK physicians. Questionnaires were completed by a total of 427 physicians comprising Accident and Emergency (A&E) specialists and psychiatrists, with a response rate of 25%. The main findings were that vitamin deficiency was perceived as being uncommon amongst alcohol misusers (Wernicke-Korsakoff syndrome in chronic alcohol misusers and parenteral therapy in patients with signs of Wernicke-Korsakoff syndrome. Whilst only just over half the A&E specialists expressed a preference, most favoured parenteral therapy in both cases. Most respondents did not currently have a unit policy/protocol on the management of vitamin supplementation in chronic alcohol misusers. Overall, the findings suggest that there is wide variation in current practice and highlight the need for guidelines in this area.
Maurice O'Connor Drury (1907-76), an Irish psychiatrist, is best known for his accounts of his close friendship with the eminent twentieth-century philosopher, Ludwig Wittgenstein. His only book, The Danger of Words (1973), was well received by those who had an interest in the relationship between psychiatry, psychology and philosophy. This article concentrates on Drury's experiences, studies and writings in these fields.
Bayetti, Clement; Jadhav, Sushrut; Deshpande, Smita N.
Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient–carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care. PMID:28529358
Bayetti, Clement; Jadhav, Sushrut; Deshpande, Smita N
Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient-carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care.
Marcinowski, Filip; Nasierowski, Tadeusz
In the interwar period the eugenic ideas gained the status of a scientific theory and become attractive to a wide range of physicians. Among them were doctors of Jewish origin who perceived eugenics as a tool in the fight for biological rebirth of the Jewish nation. Polish-Jewish psychiatrist Raphael Becker (1891-1939?), the author of dozens of scientific papers, was the most famous eugenist among Jewish psychiatrists, not only in Poland but also in Europe. After graduation in medicine at the University in Zurich and training in the psychiatry clinic Burghölzli under the guidance of Eugen Bleuler, Rafał Becker became interested in the question of epidemiology of mental disorders among the Jews. In the interwar period, dealing with the statistics of mental disorders among Polish Jews, and directing a psychiatric hospital "Zofiówka" in Otwock, he significantly contributed to the development of medical care for the mentally ill Jews in Poland. Becker's scientific ideas were greatly influenced by the work of Alfred Adler and Ernst Kretschmer. The article presents the life and scientific achievements of Becker, with particular emphasis on his views on eugenics.
Peskin, Viviana A; Berrío Cuartas, Diana M; Villafañe, Claudia I; Pereyra, Walter D; Martínez Didolich, Laura C; Cesoni, Oscar M; Uriarte, Martín A
Research is a cornerstone in the training of medical doctors in any specialty, whereas it substantially contributes to good clinical practice. The aim of this study is to determine the importance of research among psychiatrists in training in Ciudad de Buenos Aires. A cross sectional descriptive study using a paper survey, which was voluntary and anonymous, was sent to psychiatrists in training in different training centers between October-November 2013. 76.6% considered research training deficient; 27.8% participated in a research project during their psychiatric training and only 21.5% presented their results at a scientific activity. 95.6% participants considered important to include research in their training. In summary, a small proportion of psychiatrists in training who participated in this study conducted research and we observed limited experience in the area, as opposed to the interest in being trained in this field.
A first reason for the psychiatrist to be interested in music, musicians and their artistic work, comes from the strong biographical and scientific evidence linking mood disorders and in particular, bipolar disorder, to artistic creativity. Moreover, a family association between psychopathology and creativity has been found in several studies. Important changes in mood, but also cognition, personality and behaviour can occur during all phases of manic-depressive illness and these changes have potentially important effects on creativity and productivity. Those changes are usually opposite in mania and depression. Many bipolar artists see emotional turmoil as essential to their creativity, which has therapeutical but also ethical consequences. A second area of interest is the impaired emotional recognition in schizophrenic patients, not only for visual material (faces or contextual scenes) but also for auditive material (voice or music) leading to impaired social interactions in this condition.
Wolfe, Kate; Stueber, Kerstin; McQuillin, Andrew; Jichi, Fatima; Patch, Christine; Flinter, Frances; Strydom, André; Bass, Nick
Background: An increasing number of genetic causes of intellectual disabilities (ID) are identifiable by clinical genetic testing, offering the prospect of bespoke patient management. However, little is known about the practices of psychiatrists and their views on genetic testing. Method: We undertook an online survey of 215 psychiatrists, who…
Psychiatrists have a stressful life. They are reported to encounter work stress and are prone to burnout. Due to the nature of their profession, they experience fluctuating range of powerful emotions in their clinical work. The aim of this study was to assess the levels of burnout and stress reactions among doctors working at a ...
Przydacz, Mikolaj; Golabek, Tomasz; Sobański, Jerzy A; Jaworska, Karolina; Skalski, Michal; Świerkosz, Agata; Dudek, Przemyslaw; Sobieraj, Dariusz; Dudek, Dominika; Chłosta, Piotr
Lower urinary tract symptoms (LUTS) are highly prevalent and costly condition worldwide. Numerous studies have demonstrated their negative impact on health-related quality of life (HRQL), as well as on physical and mental health. The co-existence of LUTS and psychiatric symptoms is common and has been described by psychiatrists, urologists and gynecologists. However, data are lacking regarding the perception of urological symptoms by psychiatrists in their day-to-day clinical practice. 31-question survey was designed to learn what is the perception of LUTS among psychiatrists. Survey link was sent by email to all psychiatrists registered to the Polish Association of Psychiatry via the association's email lists. The SurveyMonkey website was used as a platform where responses were collected and stored. 953 physicians completed the questionnaire. Majority of investigated psychiatrists only 'occasionally'ask their patients about voiding dysfunctions. Respondents estimated the frequency of voiding dysfunctions in their patients as 'moderately frequent'with a '10-30%' prevalence. However, discrepancies between different subgroups of psychiatrists have been noted. Furthermore, psychiatrists may not be fully aware of the effects of psychiatric treatment (psychotherapy/pharmacotherapy) on LUTS improvement, as well as possible deteriorations of voiding dysfunctions with psychiatric disorder progression. This survey showed that the perception of urological symptoms by psychiatrists in their patients may be limited. Therefore, it is necessary to adequately inform and educate psychiatrists in terms of the impact of urological symptoms on patients'management, prognosis and quality of life.
Egan, Tony; Jaye, Chrystal
The social organization of clinical learning is under-theorized in the sociological literature on the social organization of health care. Professional scopes of practice and jurisdictions are formally defined by professional principles and standards and reflected in legislation; however, these are mediated through the day-to-day clinical activities of social groupings of clinical teams. The activities of health service providers typically occur within communities of clinical practice. These are also major sites for clinical curriculum delivery, where clinical students learn not only clinical skills but also how to be health professionals. In this article, we apply Wenger's model of social learning within organizations to curriculum delivery within a health service setting. Here, social participation is the basis of learning. We suggest that it offers a powerful framework for recognizing and explaining paradox and incongruence in clinical teaching and learning, and also for recognizing opportunities, and devising means, to add value to students' learning experiences.
Lippman, D. H.; Lowy, F H; Rickhi, B
In 1979 the opinions of Ontario psychiatrists were sought regarding the influence of the Ontario Health Insurance Plan (OHIP) on the practice of their specialty. Full replies to a 44-item questionnaire were received from more than half the certified psychiatrists in Ontario, half of whom had been in practice before the introduction of OHIP. Both satisfaction and uneasiness were expressed about most aspects of health insurance. Many of the 416 psychiatrists stated that OHIP had improved acces...
Gostomzyk, J G; Simoes, E; Mittelstaedt, G V
The economic transformation of health care systems, which is supported by both the economic and the political sector, is in demand of constant humane correction. Legal regulations of social systems securing health corresponding to the code of social law are guard rails for a responsible use of limited resources and are subject to constant development. All doctors caring for patients should be in a position to reflect the real life context of their patients as both causal and modifying influence for health and disease from a social medical perspective, apart from their specific medical field of expertise.Accordingly 3 parts of sub-specialization training are suggested: clinical tasks of social medicine as detailed in the code of social law, clinical social medicine in health care according to the 5(th) book of the code of social law and social medicine in clinical social medicine/participation. Higher level-of-care hospitals, as well as rehabilitation clinics, should offer sub-specialization in social medicine without interruption of employment contracts. Corresponding criteria for the regulation on further education should be formulated by the German Society of Social Medicine and Prevention (DGSMP) as the competent scientific association and presented to the committee on further education of the Federal Medical Association. This aims at strengthening social medicine in clinical care. © Georg Thieme Verlag KG Stuttgart · New York.
Parish, Michelle Burke; Fazio, Sarina; Chan, Steven; Yellowlees, Peter M
Participatory medicine and the availability of commercial technologies have given patients more options to view and track their health information and to communicate with their providers. This shift in the clinical process may be of particular importance in mental healthcare where rapport plays a significant role in the therapeutic process. In this review, we examined literature related to the impact of technology on the clinical workflow and patient-provider rapport in the mental health field between January 2014 and June 2017. Thirty three relevant articles, of 226 identified articles, were summarized. The use of technology clinically has evolved from making care more accessible and efficient to leveraging technology to improve care, communication, and patient-provider rapport. Evidence exists demonstrating that information and communication technologies may improve care by better connecting patients and providers and by improving patient-provider rapport, although further research is needed.
Firmin, Michael W; Wantz, Richard A; Geib, Ellen F; Ray, Brigitte N
This article reports research findings from a survey of 261 students regarding their perceptions of psychiatrists. Overall, students view psychiatrists as competent and prestigious. At the same time, however, only approximately half of respondents reported having a "positive view" of these professionals and around one-third were neutral. College students view psychiatrists as effective for treating relatively severe mental health problems, although depression was not considered to be a psychiatrist's relative strong suit (only half viewed them as being effective). Some confusion between psychiatrists and psychologists seemed apparent. Although students did not consider the media a highly reliable source of information, media sources nonetheless appeared to play a dominant role in determining how college students framed psychiatry roles. We discuss the results in the context of the need for further education by the specialty of psychiatry and the importance of reversing what appears to be some negative stereotyping.
In this paper I will challenge the individualistic model of clinical reasoning. I will argue that sometimes clinical practice is rather machine-like, and information is called to mind and weighed, but the clinician is not just calculating how to use particular means to reach fixed ends. Often...... of the means and ends in clinical practice where the means and ends are formed in this process....
Social media has been used increasingly as part of nursing education. Nurse educators at a large, multisite teaching hospital used social media to support clinical teaching. A series of educational images was created by nurse educators and shared across Facebook, Twitter, and Instagram. This campaign coincided with in-unit clinical education. Nurse educators can consider using social media as an adjunct to clinical teaching, especially in large hospital settings. J Contin Educ Nurs. 2017;48(12):541-542. Copyright 2017, SLACK Incorporated.
Lavelle, M; Dimic, S; Wildgrube, C; McCabe, R; Priebe, S
Recent evidence found that patients with schizophrenia display non-verbal behaviour designed to avoid social engagement during the opening moments of their meetings with psychiatrists. This study aimed to replicate, and build on, this finding, assessing the non-verbal behaviour of patients and psychiatrists during meetings, exploring changes over time and its association with patients' symptoms and the quality of the therapeutic relationship. 40-videotaped routine out-patient consultations, involving patients with schizophrenia, were analysed. Non-verbal behaviour of patients and psychiatrists was assessed during three fixed, 2-min intervals using a modified Ethological Coding System for Interviews. Symptoms, satisfaction with communication and the quality of the therapeutic relationship were also measured. Over time, patients' non-verbal behaviour remained stable, whilst psychiatrists' flight behaviour decreased. Patients formed two groups based on their non-verbal profiles, one group (n = 25) displaying pro-social behaviour, inviting interaction and a second (n = 15) displaying flight behaviour, avoiding interaction. Psychiatrists interacting with pro-social patients displayed more pro-social behaviours (P communication (P verbal behaviour during routine psychiatric consultations remains unchanged, and is linked to both their psychiatrist's non-verbal behaviour and the quality of the therapeutic relationship. © 2014 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.
The number of patients using social media and the number of applications and solutions used by medical professionals online have been sky-rocketing in the past few years, therefore the rational behind creating a well-designed, clear and tight handbook of practical examples and case studies with simple pieces of suggestions about different social media platforms is evident. While the number of e-patients is rising, the number of web-savvy doctors who can meet the expectations of these new generations of patients is not, this huge gap can only be closed by providing medical professionals with ea
Kontos, Nicholas; Freudenreich, Oliver; Querques, John
To identify scenarios in which consultation psychiatrists encounter difficulty reconciling their clinical role with consultees' expectations and to suggest concepts that help navigate these situations. The authors' clinical experiences are used to generate and discuss three major categories of situations that require psychiatric consultants to thoughtfully adjust the breadth and depth of their obligation to patients and consultees. "Occam's razor 'dulled," "Conflation of the psychosocial with the psychiatric" and "Disposition preoccupation" are proposed as the major categories leading to conflicting patient management views between consultant and consultee. Each has, at its core, a compromise of patient ownership that blurs the boundaries of the consulting psychiatrist's responsibility. Understanding and channeling ownership back to the consultee, while appropriately gauging and embracing one's responsibility, form a two-pronged approach to clarifying one's role in consultations.
Banwari, Girish H
Of late, there has been an increase in the number of psychiatrists shown in Hindi movies. There is dearth of systematic research that focuses specifically upon the depiction of psychiatrists in Hindi cinema. To explore the portrayal of psychiatrists in recent Hindi cinema. Twenty-six Hindi movies released between January 2001 and March 2010 portraying 33 'psychiatrist' characters in a main or a secondary (but significant) role, were reviewed and data related to the personal attributes and professional conduct of the movie psychiatrists was collected. The portrayal of psychiatrists in Hindi movies released in the first decade of the 21st century is unflattering. Hindi movies depicted psychiatrists as most likely to be male, middle-aged, and friendly in their attitude towards the patients. 42.4% of them were clinically incompetent, and only 30.3% could make an accurate diagnosis. 39.4% of them breached professional ethics. Eight (24. 2%) transgressed non-sexual boundaries, whereas five (15.2%) violated both sexual and non-sexual boundaries. The most common clinical/treatment setting was outpatient (53.8%), and pharmacotherapy was the most common treatment modality used. Treatment outcome was depicted positive in only 23.1% of the movies analyzed. Copyright © 2011 Elsevier B.V. All rights reserved.
Chartonas, Dimitrios; Kyratsous, Michalis; Dracass, Sarah; Lee, Tennyson; Bhui, Kamaldeep
Aims and method In 1988, Lewis and Appleby demonstrated that psychiatrists hold negative attitudes towards patients with personality disorder. We assessed the attitudes of psychiatry trainees towards patients with borderline personality disorder and depression, expecting an improvement. 166 trainees were block randomised to receive one of four case vignettes that varied by diagnosis and ethnic group. We used Lewis and Appleby's original questionnaire and the Attitudes to Personality Disorder Questionnaire (APDQ). Results We received 76 responses. Lewis and Appleby's questionnaire showed more negative attitudes towards personality disorder than depression, with no significant patient ethnic group effects, and the APDQ also showed a (weak) trend towards more negative attitudes to personality disorder. In subgroup analysis, only in the White British patient group were there significantly more negative attitudes to personality disorder. Factor analysis showed significantly less sense of purpose when working with personality disorder. Clinical implications The perceived greater lack of purpose in working with personality disorder should be the target of clinical training and intervention. Targeted interventions that include training in managing personality disorder, supervision and practice in non-specialist, general psychiatry settings are important.
Machado, Leonardo; Tavares, Hermano; Petribú, Kátia; Pinto, Tiago; Cantilino, Amaury
The aim of this study was to measure happiness in a sample of Brazilian psychiatrists and correlate it with the defense styles used by them and sociodemographic data. This study was observational, cross-sectional, and analytical. Data were collected through self-administered questionnaires by Brazilian psychiatrists who participated in the XXXII Brazilian Congress of Psychiatry, 2014. In this sample of psychiatrists, happiness levels were high (scoring 5.69 of a total of 7), and mature defense styles prevailed, especially humor and anticipation. In a multivariate analysis, having children, good sleep quality, increased sexual interest, and use of defense styles such as humor, anticipation, and idealization all showed a positive relationship with happiness; on the other hand, using defense style such as acting out or annulment demonstrated a negative relationship with happiness. Despite the well-known professional burden that they bear, Brazilian psychiatrists surveyed presented, in general, high levels of subjective well-being and happiness.
The potential contributions of the community psychiatrist are described, via the interdisciplinary team, to individuals and families dealing with mental illness, and to the communities of the future, along with the opportunities for, and barriers to, effective teamwork and community collaborations. Health and medical training systems still provide perverse incentives deterring psychiatrists from becoming adequately trained in community psychiatry and full members of interdisciplinary teams, and skilled partners in improving the mental health of the whole community. Sources of potential role conflict should be resolved, and advantages of community collaborations, interdisciplinary leadership, support of teamwork, division of labour, cross-fertilization and hybrid vigour should be realized. Truly essential and desirable roles and the skill base of community psychiatrists in interdisciplinary teams and local communities could be developed and strengthened by changes in basic and advanced psychiatric training, and by psychiatric professional bodies and training programmes placing greater emphasis and value upon the roles of a community psychiatrist.
Mela, Mansfield; Luther, Glen; Gutheil, Thomas G
To extract the themes pertaining to prudent psychiatric practice from written court judgments in Canada. We searched the medical and legal literature for cases involving civil litigation against Canadian psychiatrist and reviewed all available written judgments. We completed a thematic analysis of the civil actions against psychiatrists as conveyed by those written court judgments. We classified the cases according to the disposal status and the essential lessons from the decisions on standard of care and practice by Canadian psychiatrists. Forty such cases were identified as involving psychiatrists over a 45-year period. A subgroup included those dealing with limitation periods and disclosure applications. Thirty of the 40 cases (75%) were decided in favour of the defendant psychiatrists, including 2 dismissed for running over the limitation period. The cases that actually went to trial suggest that documentation and obtaining second opinions are protective against claims of negligence. Inpatient cases resulting in successful litigation against psychiatrists involved fatal outcomes, but not all fatal outcomes led to successful litigation. The key lessons from these cases are the importance and relevance of regular best clinical practices, such as documentation, obtaining second opinions, following guidelines, and balancing competencies in the expert and manager or advocate roles. Incorporating these practices should allay concerns about litigation against psychiatrists. © The Author(s) 2015.
Lis, Eric; Chiniara, Carl; Wood, Megan A; Biskin, Robert; Montoro, Richard
Video game use, particularly massively-multiplayer online games (MMOs) and massively-multiplayer online role-playing games (MMORPGs), has been a focus of considerable research in recent years. However, little is known regarding how mental health workers perceive patients and clients who report playing them. The present study examines whether psychiatrists play MMOs/MMORPGs and how they perceive those who play them. Psychiatrists (N = 48) at a tertiary care centre in Canada completed a questionnaire assessing history of playing video games as well as whether they associate such use with psychopathology. Only 36.7 % believed there was an association between psychopathology and MMO/MMORPG use. Implications for clinical practice and future research are discussed.
Adolf Meyer (1866-1950) exercised considerable influence over the development of Anglo-American psychiatry during the first half of the twentieth century. The concepts and techniques he implemented at his prominent Phipps Psychiatric Clinic at Johns Hopkins remain important to psychiatric practice and neuro-scientific research today. In the 1890s, Meyer revised scientific medicine's traditional notion of clinical skill to serve what he called the 'New Psychiatry', a clinical discipline that embodied social and scientific ideals shared with other 'new' progressive reform movements in the United States. This revision conformed to his concept of psychobiology - his biological theory of mind and mental disorders - and accorded with his definition of scientific medicine as a unity of clinical-pathological methods and therapeutics. Combining insights from evolutionary biology, neuron theory and American pragmatist philosophy, Meyer concluded that subjective experience and social behaviour were functions of human biology. In addition to the time-honoured techniques devised to exploit the material data of the diseased body - observing and recording in the clinic, dissecting in the morgue and conducting histological experiments in the laboratory - he insisted that psychiatrists must also be skilled at wielding social interaction and interpersonal relationships as investigative and therapeutic tools in order to conceptualise, collect, analyse and apply the ephemeral data of 'social adaptation'. An examination of his clinical practices and teaching at Johns Hopkins between 1913 and 1917 shows how particular historical and intellectual contexts shaped Meyer's conceptualisation of social behaviour as a biological function and, subsequently, his new vision of clinical skill for twentieth-century psychiatry.
Suetani, Shuichi; Markwick, Elizabeth
Dissociative identity disorder (DID) is a controversial psychiatric diagnosis. This case review presents a retired psychiatrist with a history of DID. This case is used to illustrate current thinking about the characteristics and aetiology of DID. It also argues for the importance of being aware of both our personal and professional biases in our own clinical practice. © The Royal Australian and New Zealand College of Psychiatrists 2014.
Full Text Available Objective: Anxiety disorders are highly prevalent in the United States, and if untreated, result in a number of negative outcomes. This study aimed to investigate psychiatrists' current treatment practices for patients with anxiety disorders in the United States. Methods: Psychiatrist-reported data from the 1997 and 1999 American Psychiatric Institute for Research and Education Practice Research Network (PRN Study of Psychiatric Patients and Treatments (SPPT were examined, focusing on patients diagnosed with anxiety disorders. Information related to diagnostic and clinical features and treatments provided were obtained. Results: Anxiety disorders remain underdiagnosed and undertreated, since only 11.4% of the sample received a principal diagnosis of an anxiety disorder in a real world setting. Posttraumatic stress disorder was associated with particularly high comorbidity and disability, and social anxiety disorder was relatively rarely diagnosed and treated. Although combined pharmacotherapy and psychotherapy was commonly used to treat anxiety disorders, anxiolytics were more commonly prescribed than selective serotonin reuptake inhibitors (SSRIs. Conclusions: These data provide a picture of diagnosis and practice patterns across a range of psychiatric settings and suggest that anxiety disorders, despite being among the most prevalent of psychiatric disorders remain underdiagnosed and undertreated particularly in respect of the use of psychotherapeutic interventions.
Masełbas, Wojciech; Czarkowski, Marek
Each year more than 400 new clinical studies are registered in Poland. They gather above 50.000 of study participants. Social opinion on clinical trials is an important factor. The paper presents the review of actual opinions on clinical research in Poland. It provides the description of standards of protection of study participants, benefits and risks related to the participation in clinical research and the role of media in creating and influencing of the social perception of clinical trials. Results of conducted questionnaire studies imply that Poles correctly identify and assess the risk of participation in clinical experiments. The primary reason for the participation seams to be the possibility to help other patients, contribution to the progress of science and standards of medical care and potential benefits for other sufferers. The need of testing the safety and efficacy of the new medication in man is generally well recognized. At the same time a substantial part of the society is concerned with the possible corruption of investigators and unethical behaviour of sponsors. The social perception of clinical research in Poland is in majority of analyzed parameters not substantially different from opinions in other member states of EU. However, the medical society should be more active in influencing and changing some negative impressions.
Cooke, Brian K; Goddard, Emily R; Werner, Tonia L; Cooke, Erinn O; Griffith, Ezra E H
Journalists often turn to psychiatrists for analysis of medical, social, political, and cultural events that involve human behavior and illness. Once journalists seek their expertise, psychiatrists often rush to be helpful, which can lead to ineffective performance and to statements that may run afoul of principles of professional ethics. In this article, we discuss the bases on which the professionalism of psychiatrists may be impugned when they commit errors in their media presentations. Found within the Principles of Medical Ethics with Special Annotations Especially Applicable to Psychiatry, the Goldwater Rule prohibits certain behaviors when psychiatrists share professional opinions with the public. We first discuss the Goldwater Rule, highlighting the events that led to its development and the professional response to its enactment. We then present a method to guide psychiatrists in their interaction with the media that will help them avoid violating ethics principles or the law. The method encourages knowledge of a framework of ethics principles that in turn guide the psychiatrist's behavior and thinking as he contemplates accepting invitations to interact with the media. The ethics-based roles include the Teacher, the Storyteller, the Celebrity Commentator, the Hollywood Consultant, the Clinician, and the Advertiser. © 2014 American Academy of Psychiatry and the Law.
Munjiza, Ana; Stojiljković, Dragan J; Milekić, Bojana; Latković, Olgica; Jasović-Gasić, Miroslava; Marić, Nada P
The two types of stigmatization are social stigma, which includes discrimination, underestimation and distance in various social circumstances and personal stigma, which includes private relation i.e. a contact in person with stigmatized subject. Majority of recent publications has shown gender asymmetry in stigmatization (mostly indicating male predominance in stigmatizing processes), whereas the opposite data can be also found in some publications. The present study was aimed at exploring the relation of students' gender with their tendency to stigmatize subjects visiting a psychiatrist and at analyzing whether the gender influences the process of stigmatization. The survey included 523 students (227 on the second and 296 on the sixth year of School of Medicine, University of Belgrade). The instrument consisted of a vignette with questionnaire (14 items). Four versions of vignette were distributed: with/without "label" and male/female subject in the vignette. A more personal stigmatization was evident in the female students (p gender-differences existed in social stigmatization (p > 0.05). The stigmatization positively correlated with the intimacy of student's relation with the subject going to a psychiatrist. A higher rate of stigmatization was evident if the vignette was showing a person of the opposite gender. This is a unique study which analyzes separately the gender of a stigmatizing subject versus the subject being stigmatized and types of stigmatization. The data obtained should contribute to recognizing, understanding and controlling the widespread problem of stigma.
... Clinical social worker services. (a) Definition: clinical social worker. For purposes of this part, a... services. (1) Definition. “Clinical social worker services” means, except as specified in paragraph (b)(2... the consultation requirements set forth at § 410.71(f) (reading “clinical psychologist” as “clinical...
Pathé, Michele T; Meloy, J Reid
Stalking is a thriving social and criminal concern and a risk inherent in our personal and professional lives. Health care professionals, particularly psychiatrists and other mental health practitioners, are vulnerable to being stalked by their patients and, far from providing helpful insights that discourage the behavior, their training can be a hindrance. Neither a psychiatrist's gender nor seniority confers protection from the protracted vengeance or infatuation of a patient-turned-stalker, any more than does working through the transference and soldiering on. The ensuing social, psychological, and vocational damage can, however, be minimized through early recognition, informed advice, and the support, not censure, of our colleagues.
The objective of this study was to determine the knowledge, attitudes and current practices of psychiatrists and paediatricians in South Africa regarding the management of children with Attention Deficit/Hyperactivity Disorder (ADHD), to determine if there are significant differences between them. Three hundred and
Clemens, Norman A; Plakun, Eric M; Lazar, Susan G; Mellman, Lisa
Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist. Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care. The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.
Erlich, Matthew D; Rolin, Stephanie A; Dixon, Lisa B; Adler, David A; Oslin, David W; Levine, Bruce; Berlant, Jeffrey L; Goldman, Beth; Koh, Steve; First, Michael B; Pabbati, Chaitanya; Siris, Samuel G
Suicide prevention efforts are increasing to enhance capabilities and better understand risk factors and etiologies. Postvention, or how clinicians manage the postsuicide aftermath, strengthens suicide prevention, destigmatizes the tragedy, operationalizes the confusing aftermath, and promotes caregiver recovery. However, studies regarding its efficacy are minimal. The Psychopathology Committee of the Group for the Advancement for Psychiatry surveyed a convenience sample of psychiatrists to better understand postvention activities. Ninety psychiatrists completed the survey; they were predominantly men (72%) with an average of 24.6 years of experience (SD, 16.7 years). Most had contact with the patient's family within 6 months of the suicide, and most psychiatrists sought some form of support. Few psychiatrists used a suicide postvention procedure or toolkit (9%). No psychiatrists stopped clinical practice after a patient suicide, although 10% stopped accepting patients they deemed at risk of suicide. Postvention efforts, therefore, should be improved to better address survivor care.
Allison, Stephen; Bastiampillai, Tarun; Battersby, Malcolm
Psychiatry faces urgent problems requiring united action. These problems affect academic psychiatrists in the universities, and clinicians in publicly funded mental health services. Academic units are isolated and endangered, finding it difficult to recruit. They could benefit from closer relationships with public mental health services, in terms of recruitment, shared teaching and clinical research. However, mental health services are preoccupied with their own problems, particularly in relation to acute clinical demand. How can we stand together to improve academic units and clinical psychiatry? Clinicians and academic psychiatrists can stand together on important matters, but it takes initiatives from local leaders to overcome the structural barriers between health services and the universities. An example is given of united action by clinicians and academic psychiatrists to address a crisis within a state mental health system. First, psychiatrists undertook independent health services research that compared the state system with those in other Australian and international jurisdictions. The comparative data was used to generate solutions, which were presented at every level from ministerial offices through to service managers. Finally, psychiatrists took up joint academic and clinical leadership roles in the university and the mental health system. This united research-led approach turned around the crisis in the state mental health system.
De Gantes, Elisanne; Bellagamba, Gauthier; Lehucher-Michel, Marie-Pascale
A qualitative study was conducted in 2013 with hospital psychiatrists working in two psychiatric hospitals of different regions in order to document the quality of work life of public hospital psychiatrists. Semi-guided interviews were conducted with psychiatrists using an interview guide. Physicians were randomized according to health institution, age, gender and adult or paediatric psychiatry speciality. Data were analysed with the Alceste software and interpreted. Sixteen psychiatrists were interviewed. Four themes, composed of sub-themes, were highlighted. The first them concerned medical and social patient care, with the child's social and family environment, structural constraints and interactions with the care network. The second them concerned quality of care with the training of healthcare workers and the relational dimension. The third them concerned working in the public hospital system with the role of the "physician-administrator", loss of the meaning of work and job satisfaction. The last theme refers to the specificity of working in psychiatry with forensic aspects and violence issues. This study suggests that psychiatrists are globally satisfied with their jobs. The main factors to be improved are working time organization to allow more time to listen to the patient, interprofessional exchanges and paramedical staff training. These data should be assessed by means of a quantitative study.
Thomyangkoon, Prakarn; Leenaars, Antoon
The objective of this study was to identify the impact of a patient's suicide on psychiatrists in Thailand. A confidential coded postal questionnaire survey was sent to 320 eligible psychiatrists; with a response rate of 52.18%. The results showed that 94 (56.28%) of responding psychiatrists had a patient die by suicide, consistent with high rates…
Gelkopf, M; Kreitler, S; Sigal, M
The study was designed to explore the potential therapeutic effects of humor on hospitalized schizophrenics. For this purpose, in the first stage, we conducted a review of findings in regard to physical health, emotions, psychiatric state, and social behavior. In the second stage, we carried out an experiment with 34 resident patients in two chronic schizophrenic wards who were exposed to 70 movies during 3 months. The experimental group was exposed to humorous movies only, and the control group to different kinds of movies. Before and after the exposure to films for 3 months, both groups were tested on different health, emotional, social, and clinical measures using the Cognitive Orientation of Health Questionnaire, the Shalvata Symptom Rating Scale, blood pressure, heart rate, Perceived Verbal and Motor Aggression (rated by nurses), the Multiple Affect Adjective Check List, the Social Support Questionnaire 6, and the Brief Psychiatric Rating Scale (BPRS; rated by psychiatrists). Covariance analyses yielded significant reductions in Perceived Verbal Hostility, BPRS scales (total score, anxiety/depression), and significant increases in BPRS (activation) and degree of staff support experienced by the patients. The results indicate that the effects of exposure to humor may be mediated by the effects on the staff of the incidental exposure to humorous films.
To outline the problems around overlap between social phobia (SAD) and avoidant personality disorder (AVPD) and provide guidelines that may assist clinicians to differentiate these conditions. A constellation of symptoms can be identified that may distinguish AVPD from SAD, with key features being a strong and pervasively negative self-concept, a view of rejection as equating to a global evaluation of the individual as being of little worth and a sense of not fitting in socially that dates from early childhood. It is important to identify the presence of AVPD in order to anticipate potential problems with engagement and retention in therapy, to target treatment interventions and optimise outcome. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Baylé, F J; Misdrahi, D; Llorca, P M; Lançon, C; Olivier, V; Quintin, P; Azorin, J M
For schizophrenic disorders, the clinical conception of "acute state" is widely used in clinical settings to assess the effectiveness of therapeutic programs as well as epidemiological studies. Schizophrenic-specific symptomatology modification, need for hospitalization, significant change in care, disturbances in social behavior or suicide attempts were all used to define acute schizophrenic state. The decision to hospitalize is frequently used to define acute state but refers to multiple factors such as mood disorder, suicide attempts, drug abuse or social and environmental problems. Indeed, several and distinct definitions in a criteria basis form are available but no one has reached consensus. Because recognition of acute schizophrenic state remains based on the subjective clinician's advice, epidemiological and therapeutic studies fail in validity and reliability. The aim of the study was to evaluate how a population of French psychiatrists define criteria and therapeutic targets of acute schizophrenic state in their clinical practice. Psychiatrists filled out a self administered interview. At the time the interview was given, clinicians were notified that they were participating in a clinical consensus survey about schizophrenia. Six major indicators for acute state definition based on the literature data were proposed: general schizophrenic symptomatology modification (depression, anxiety, agitation, impulsivity/aggressiveness), specific schizophrenic symptomatology modification (positive symptoms, negative symptoms, disorganization), need for hospitalization, significant change in care, disturbance in social behavior and lastly, suicidal behavior. Minimal duration (1.2 or 4 weeks) of general and specific schizophrenic symptomatology modification required to define acute state were evaluated. The booklet included the 30 PANSS symptoms listed with their definitions. Among this symptom list, clinicians were instructed to select the ten criteria which they
Psychiatric barriers to readiness for treatment for hepatitis C Virus (HCV) infection among injection drug users: clinical experience of an addiction psychiatrist in the HIV-HCV coinfection clinic of a public health hospital.
Scheft, Harriet; Fontenette, Dominique C
Among injection drug users, psychological and psychiatric barriers to readiness for treatment for hepatitis C virus (HCV) infection include mood and anxiety disorders, cognitive deficits, temperament disorders, and personality vulnerabilities, as well as ongoing drug use. Many aspects of these barriers can be overcome with direct treatment or social support. To establish effective treatment for HCV infection in this population of patients, it is essential that the patient and providers develop a rapport that allows for active communication. It is also important that the patient make an effort to adhere to the treatment requirements and that the patient receive the appropriate evaluation and management of treatable barriers.
Full Text Available The identification of health care professionals who are incompetent, impaired, exploitative or have criminal intent is important for public safety. It is unclear whether psychiatrists are more likely to commit medical misconduct offences than non-psychiatrists, and if the nature of these offences is different.The aim of this study was to compare the characteristics of psychiatrists disciplined in Canada and the nature of their offences and disciplinary sentences for the ten years from 2000 through 2009 to other physicians disciplined during that timeframe.Utilizing a retrospective cohort design, we constructed a database of all physicians disciplined by provincial licensing authorities in Canada for the ten years from 2000 through 2009. Demographic variables and information on type of misconduct violation and penalty imposed were also collected for each physician disciplined. We compared psychiatrists to non-psychiatrists for the various outcomes.There were 82 (14% psychiatrists of 606 physicians disciplined in Canada in the ten years from 2000 through 2009, double the national proportion of psychiatrists. Of those disciplined psychiatrists, 8 (9.6% were women compared to 29% in the national cohort. A total of 5 (6% psychiatrists committed at least two separate offenses, accounting for approximately 11% of the total violations. A higher proportion of psychiatrists were disciplined for sexual misconduct (OR 3.62 [95% Confidence Interval [CI] 2.45-5.34], fraudulent behavior (OR 2.32 [95% CI 1.20-4.40] and unprofessional conduct (OR 3.1 [95% CI 1.95-4.95]. As a result, psychiatrists had between 1.85-4.35 greater risk of having disciplinary penalties in almost all categories in comparison to other physicians.Psychiatrists differ from non-psychiatrist physicians in the prevalence and nature of medical misconduct. Efforts to decrease medical misconduct by psychiatrists need to be conducted and systematically evaluated.
Koreki, Akihiro; Nakagawa, Atsuo; Abe, Akiko; Ikeuchi, Hidetsugu; Okubo, Jo; Oguri, Atsushi; Orimo, Keisuke; Katayama, Nariko; Sato, Hiroyo; Shikimoto, Ryo; Nishiyama, Go; Nogami, Waka; Haki, Kazuma; Hayashi, Tetsuro; Fukagawa, Yuko; Funaki, Kei; Matsuzawa, Mia; Matsumoto, Ayako; Mimura, Masaru
Psychiatrists in clinical practice face a number of stressors related to patient care, such as overwork. On the other hand, they gain satisfaction from their work. We quantified and assessed the potential relationship between levels of occupational stress, satisfaction, and depressive symptoms among Japanese clinical psychiatrists. We surveyed 206 psychiatrists with up to 15 years of clinical experience who primarily worked in patient care. Levels of occupational stress and occupational satisfaction were measured using the Visual Analogue Scale and the level of depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Workplace stressors and satisfiers were also evaluated. Out of 206 psychiatrists, 154 (74.8%) responded to the survey. The respondents' mean (SD) age was 34.3 (5.2) years. The estimated prevalence of significant depressive symptoms was 34.4% (n = 53), and the experienced frequent violence was 14.9% (n = 23). The level of depressive symptoms was inversely correlated with the level of occupational satisfaction. In respondents who reported a moderate level of occupational stress, having fewer depressive symptoms was associated with higher occupational satisfaction, but this association was not significant in those who reported a high level of stress. In addition, high occupational satisfaction was associated with interest towards work content, ability to work at one's discretion, opportunities for growth and career development, and ease of communication with supervisors and colleagues. Nearly one-third of the psychiatrists screened positive for significant depressive symptoms. Having fewer depressive symptoms was associated with higher occupational satisfaction in those who reported a moderate level of stress. Implications from the present findings may be to enhance occupational satisfaction by discussing work interests with a supervisor, as well as increased opportunities for career development, which may
Praus, P; Riedel-Heller, S; Dressing, H
Currently, there are clear indications that due to their exposed occupational position psychiatrists and psychotherapists are at a higher risk than the general public to become the victim of stalking by patients. This study investigated the frequency of stalking and its psychosocial impact among psychiatrists and psychotherapists in the Federal Republic of Germany. Analysis of an online survey among members of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) from 23 September 2015 until 22 October 2015. Of the respondents 26.5% reported having been the victim of stalking. In more than a third of the reported cases the stalking was described as severely or very severely debilitating. The majority of the perpetrators suffered from psychotic or personality disorders. Male victims were significantly more frequently stalked by a female perpetrator. Approximately 1 in 10 stalking victims continued the treatment of the perpetrator. The majority of the stalking victims did not obtain substantial support from their employer. The phenomenon of stalking within therapeutic relationships needs to be incorporated into the medical and psychotherapeutic professional training, e. g. by implementing specialized training courses and the systematic integration of this topic into clinical supervision. The institutional dealing with stalking by patients needs to optimized, e. g. by promptly transferring treatment of patients who stalk to other professionals and, where required, providing assistance in reporting stalking incidents to the police.
Gül, Ahmet; Gül, Hesna; Özkal, Ummuhan Ceviz; Kıncır, Zeliha; Gültekin, Gozde; Emul, Hacı Murat
Burnout is a serious problem for psychiatrists that has implications for clinical practice and personal health. While burnout is known to affect cognitive functions, no studies have examined the relationship between sluggish cognitive tempo (SCT) and burnout. This study aimed to examine this relationship and related factors as socio-demographic, occupational environment in psychiatrists. Participants(n=201, aged between 25 and 52 years,57.7% female) completed socio-demographic information form, Maslach Burnout Inventory and SCT Scale. According to our results, we have shown that total burnout scores and emotional exhaustion (EE) scores were significantly higher in psychiatrists with SCT. SCT scores were positively correlated with mean total burnout, EE, and depersonalization scores. We did not find any differences between subgroups according to departments, therapeutic approaches and gender. In conclusion, we want to highlight that psychiatrists with SCT were more proneness to general burnout symptoms and were more emotionally exhausted regardless of their therapeutic approach or their profession as adult or child/adolescent psychiatrists. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Martín-Carrasco, Manuel; Arranz, Francisco Javier
Mental health services are not systematically involved in the care of dementias in Spain. Nevertheless, many patients with dementia attend these services. The perspective of psychiatrist as regards this situation has not been evaluated at the national level to date, and it may be of interest to determine their actual involvement and the strategies to foster it. A survey was conducted on 2,000 psychiatrists on a range of mental health care services. Respondents provided socio-demographic data and information about clinical aspects, together with their opinions regarding the management of dementia. Responses were described by their raw frequencies and measures of association for cross-tabulations resulting from selected pairs of questions. Inferences were made by calculating their 95% confidence intervals. Psychiatrist involvement in the management of dementias was limited, aside from those involved in psycho-geriatric units or nursing homes facilities. However, there were wide, regional differences. Nearly all respondents (81%) were ready to augment their knowledge and skills in the area of dementia. In particular, the insufficient medical education, together with other organizational factors, such as the difficulties in ordering diagnostic tests (i.e. neuroimaging), or prescribing anti-dementia drugs in some regions, were common barriers psychiatrists faced when approaching patients with dementia. Increasing psychiatrist involvement and boosting coordinated efforts with other specialists in a form of integrated care may advance the care of dementias in Spain to a more valuable level. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.
... 42 Public Health 2 2010-10-01 2010-10-01 false Clinical psychologist and clinical social worker... Health Clinic and Federally Qualified Health Center Services Federally Qualified Health Center Services § 405.2450 Clinical psychologist and clinical social worker services. (a) For clinical psychologist or...
Waits, Wendi; Brent, Elizabeth
In today's fast-paced, data-saturated, zero-tolerance practice environment, psychiatrists and other health care providers are expected to maintain clinical, fiscal, and administrative competence. The authors present a unique type of psychiatric leader—the leader-teacher—who incorporates teaching of these elements into day-to-day practice, enhancing lifelong learning for credentialed staff and increasing their confidence in managing complex clinical and administrative issues. Particular emphasis is placed on leader-teachers working in military environments. The article discusses the primary characteristics of this type of leader, including their tendency to (1) seek clarification, (2) distill information, (3) communicate guidance, and (4) catalogue products. The authors also address the advantages and disadvantages of being a leader-teacher and present several illustrative cases.
Rocha, Kátia B; Pérez, Katherine; Rodríguez-Sanz, Maica; Alonso, Jordi; Muntaner, Carles; Borrell, Carme
The objective was to identify individual or contextual inequalities in visits to psychiatrists in Spain, a country with a regionalized health care system and variable integration of mental health and primary care. This cross-sectional study used data for the noninstitutionalized population from the 2006 Spanish Health Interview Survey (N=29,478). A score of ≥ 3 on the General Health Questionnaire represented a need for mental health care. The probability of having visited a psychiatrist in the previous four weeks was analyzed in relation to individual-level variables (age, social class, health insurance, and country of origin) and contextual socioeconomic variables (Gross Domestic Product; a measure of income equality; and characteristics of regional mental health systems, such as human resources, services, and organization). Multilevel logistic regression models were used. A total of 161 individuals (.55% of the sample) reported a visit to a psychiatrist during the previous four weeks. Individuals age 65 and older and immigrants from low-income countries were less likely to report a visit. Visits to psychiatrists were more common in regions with higher rates of psychiatrists per hospital (odds ratio [OR]=1.47, 95% confidence interval [CI]=1.18-1.83), more human resources for mental health (OR=1.03, CI=1.01-1.06), and better integration of primary care and specialized mental health care (OR=1.90, CI=1.32-2.76). Individual and contextual inequalities in use of psychiatrists' services exist in Spain. Better coordination between primary and mental health care and greater availability of mental health resources were associated with greater use. Policies seeking better integration of care should be promoted.
Johnston, J A; Rees, M I; Smith, P E M
The approach to epilepsy care has transformed in the last 30 years, with more and better anti-epileptic medications, improved cerebral imaging and increased surgical options. Alongside this, developments in neuroscience and molecular genetics have furthered the understanding of epileptogenesis. Future developments in pharmacogenomics hold the promise of antiepileptic drugs matched to specific genotypes. Despite this rapid progress, one-third of epilepsy patients remain refractory to medication, with their seizures impacting upon day-to-day activity, social well-being, independence, economic output and quality of life. International genome collaborations, such as HapMap and the Welcome Trust Case-Control Consortium single nucleotide polymorphism (SNP) mapping project have identified common genetic variations in diseases of major public health importance. Such genetic signposts should help to identify at-risk populations with a view to producing more effective pharmaceutical treatments. Neurological disorders, despite comprising one-fifth of UK acute medical hospital admissions, are surprisingly under-represented in these projects. Epilepsy is the commonest serious neurological disorder worldwide. Although physically, psychologically, socially and financially disabling, it rarely receives deserved attention from physicians, scientists and governmental bodies. As outlined in this article, research into epilepsy genetics presents unique challenges. These help to explain why the identification of its complex genetic traits has lagged well behind other disciplines, particularly the efforts made in neuropsychiatric disorders. Clinical beginnings must underpin any genetic understanding in epilepsy. Success in identifying genetic traits in other disorders does not make the automatic case for genome-wide screening in epilepsy, but such is a desired goal. The essential clinical approach of accurately phenotyping, diagnosing and interpreting the dynamic nature of epilepsy
Autoethnography is a fairly recent approach to ethnography and one in which the writer becomes the 'subject' of the study. It remains an approach under question until more has been done in the field. In this account, I describe attending an interview with a psychiatrist, as a patient. I map out the process I encountered and offer, alongside the map, various critical and reflective comments. I offer a summary of my 'findings' and close with a critical evaluation both of the method and of the paper. Findings included: a comfortable and comforting 'setting up' of the interview; a sense of moving into the 'patient role'; a clear indication of how the interview would proceed; and empathic manner on the part of the psychiatrist and a sound process of follow-through with my general practitioner. In the critique section, I try to answer the question as to whether or not authoethnography is self-indulgent and the degree to which it can or cannot help others in understanding mental health issues. I remain uncertain about both the method and its value. In the end, it is probably for the reader to answer these questions.
Full Text Available Tariq Mahmood Hassan, Wasif Habib, Mir Nadeem Mazhar, Tariq Munshi Department of Psychiatry, Queen's University, Kingston, ON, CanadaThere have been various opinion pieces on predicting the future of psychiatry and addressing its different domains. This editorial addresses the topic from the vantage point of neuroscientific inquiry. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5 however continues with the tradition of its predecessor (DSM 4 text revision [TR], addressing most diagnoses with descriptive phenomenology as opposed to attempting to change diagnoses based on causative phenomenology or response to treatment. Advances in genomics and imaging, with time, will hopefully help shape psychiatric diagnoses and classifications with a primary basis on morphology. This may in turn help improve the recruitment of academic psychiatrists to the field. In doing so, the profession will gain respect amongst its peers in other disciplines of medicine and cement its future.
Full Text Available This paper was a response to a panel discussion on the author’s book, Jesus the village psychiatrist, published by Westminster John Knox Press, Louisville, KY, 2008 which formed part of the Society of Biblical Literature’s Psychology and Biblical Studies Section, 21–24 November 2009, New Orleans, LA. The response consisted of an explanation of somatoform disorders, a summary of the book and the following case studies: the case of Fraulein Elisabeth, the case of paralytics, the case of blind persons, the demon-possessed boy, the case of the woman with a haemorrhage, the healings of lepers and the woman who cared for Jesus. The paper concluded with a discussion on words and their power to cure. It illustrated how symptomatology had changed from paralysis in the 19th century to chronic fatigue in the first half of the 20th century to stress today.
Strous, Rael D
Despite the advances of civilization, conflict remains in many areas around the world. Often psychiatry finds itself playing an essential role in dealing with the consequences of conflict or influencing the process. Along with this involvement comes great responsibility as well as many associated ethical dilemmas. Although bound by professional medical oaths, many physicians disregard fundamental medical ethical principles during times of conflict and situations of "dual loyalty." The phenomenon should be addressed so that ethical awareness and sensitivity to these issues are nurtured. Important factors for psychiatrists during times of conflict to consider include their "social contract" with the community, dangers of boundary violations, the ethics of media contact, involvement in governmental and political activities and confidentiality. In addition, their role in conflict resolution and unique ethical considerations in the military should be considered. While as regular citizens, psychiatrists in their individual capacity may involve themselves in political activism, at an organizational level it should be discouraged. A physician's skills should only be exploited to save lives and provide comfort as entrusted by society, and any other pursuit, even in the name of the state, should be proscribed. Rather than engage in political activism, psychiatrists can promote the rights of patients, especially if these rights are limited during conflict. Responsibility and ethically-driven commitment needs to be primary for the psychiatrist who involves himself either directly or indirectly with patients during times of conflict. Trauma and its effects during conflict should be addressed without any unbalanced attention to pathological responses.
Weskoppies Hospital Forensic Psychiatry Unit (WHFPU). Results. The psychiatrists' involvement increased over the years. Problematic topics that were identified include nonpathological criminal incapacity, child psychiatry and the different roles of the psychiatrist and the psychologist in court. Exposure to practical aspects, ...
Plan (MHAP), as well as the South African Society of. Psychiatrists (SASOP's) ... met during April 2013, to: operationalise the 12 South African Society of Psychiatrists (SASOP)/SESIG position statements of the previous year; review SASOP's ..... depressive disorder, bipolar mood disorder, schizophrenia, dementia and the ...
Freedman, A M; Halpern, A L
In the United States, a critical controversy is taking place in regard to psychiatrists' and other physicians' participation in legal executions. Under pressure from the criminal justice system and legislatures to expedite executions, some forensic psychiatrists have succeeded in loosening traditional prohibitions against such participation. Further, there has been a weakening of the prohibition against treatment designed to facilitate immediate execution of those condemned to death. The rationale offered for these departures from current psychiatric ethical codes is the novel notion that when a psychiatrist acts in the court or criminal justice situation, that individual is no longer a psychiatrist and is not bound by psychiatric ethics. Rather, the forensic psychiatrist, termed a 'forensicist', serves as an assistant in the 'administration of justice' or 'an agent of the State' and thus works in a different ethical framework from the ordinary psychiatrist. This justification has similarities to the rationale offered by physicians involved in human experiments and other criminal acts in Nazi Germany, as well as psychiatrists in the former Soviet Union who explained their involvement in psychiatric abuse as a result of being agents of the State and thus not responsible for carrying out orders. Clearly, this controversy could be eliminated by a campaign for the abolition of capital punishment, characterised by the American Psychiatric Association as 'anachronistic, brutalizing [and] ineffective'. Such a campaign should serve as a call for psychiatrists and other physicians to join in the struggle to uphold ethical and moral principles.
The forensic psychiatrist's task is often considered to be tightly connected to the concept of free will. Yet, there is also a lack of clarity about the role of the concept of free will in forensic psychiatry. Recently, Morse has argued that forensic psychiatrists should not mention free will in
Warren, Susan; Puryear, Erin; Chapman, Megan; Barnett, Tracey Marie; White, Lanita S
The role of social work in free healthcare clinics and student-run clinics remains an understudied topic. We conducted a literature review of the published studies through four online databases: Google Scholar, Social Work Abstracts, Academic Search Complete, and PsycInfo. The literature review revealed 449 possibly relevant studies, but only nine met the criteria for the final review. Based on these findings, social work is not fully utilized in free healthcare clinics and student-run clinics. Our literature review provides evidence for the need for social work in free healthcare clinics and student-run clinics.
Kokaliari, Efrosini; Berzoff, Joan; Byers, David S.; Fareed, Anan; Berzoff-Cohen, Jake; Hreish, Khalid
The authors were invited to teach clinical social work in the Palestinian West Bank. In order to teach, we designed a study exploring how 65 Palestinian social work students described the psychological and social effects of working under occupation. Students described social stressors of poverty, unemployment, lack of infrastructure, violence,…
Naesström, Matilda; Blomstedt, Patric; Hariz, Marwan; Bodlund, Owe
Background: Deep brain stimulation (DBS) is under investigation for severe obsessive-compulsive disorder (OCD) resistant to other therapies. The number of implants worldwide is slowly increasing. Therefore, it is of importance to explore knowledge and concerns of this novel treatment among patients and their psychiatric healthcare contacts. This information is relevant for scientific professionals working with clinical studies for DBS for this indication. Especially, for future study designs and the creation of information targeting healthcare professionals and patients. The aim of this study was to explore the knowledge and concerns toward DBS among patients with OCD, psychiatrists, and cognitive behavioral therapists. Methods: The study was conducted through web-based surveys for the aimed target groups –psychiatrist, patients, and cognitive behavioral therapists. The surveys contained questions regarding previous knowledge of DBS, source of knowledge, attitudes, and concerns towards the therapy. Results: The main source of information was from scientific sources among psychiatrists and psychotherapists. The patient's main source of information was the media. Common concerns among the groups included complications from surgery, anesthesia, stimulation side effects, and the novelty of the treatment. Specific concerns for the groups included; personality changes mentioned by patients and psychotherapists, and ethical concerns among psychiatrists. Conclusion: There are challenges for DBS in OCD as identified by the participants of this study; source and quality of information, efficacy, potential adverse effects, and eligibility. In all of which the current evidence base still is limited. A broad research agenda is needed for studies going forward. PMID:29285414
Naesström, Matilda; Blomstedt, Patric; Hariz, Marwan; Bodlund, Owe
Deep brain stimulation (DBS) is under investigation for severe obsessive-compulsive disorder (OCD) resistant to other therapies. The number of implants worldwide is slowly increasing. Therefore, it is of importance to explore knowledge and concerns of this novel treatment among patients and their psychiatric healthcare contacts. This information is relevant for scientific professionals working with clinical studies for DBS for this indication. Especially, for future study designs and the creation of information targeting healthcare professionals and patients. The aim of this study was to explore the knowledge and concerns toward DBS among patients with OCD, psychiatrists, and cognitive behavioral therapists. The study was conducted through web-based surveys for the aimed target groups -psychiatrist, patients, and cognitive behavioral therapists. The surveys contained questions regarding previous knowledge of DBS, source of knowledge, attitudes, and concerns towards the therapy. The main source of information was from scientific sources among psychiatrists and psychotherapists. The patient's main source of information was the media. Common concerns among the groups included complications from surgery, anesthesia, stimulation side effects, and the novelty of the treatment. Specific concerns for the groups included; personality changes mentioned by patients and psychotherapists, and ethical concerns among psychiatrists. There are challenges for DBS in OCD as identified by the participants of this study; source and quality of information, efficacy, potential adverse effects, and eligibility. In all of which the current evidence base still is limited. A broad research agenda is needed for studies going forward.
Lucas, R W; Mullin, P J; Luna, C B; McInroy, D C
A computer-administered 'interview' was developed for eliciting evidence relating to alcohol problems. Thirty-six volunteer male patients on their first visits to a specialist alcohol clinic were interviewed three times, by two psychiatrists and by the computer; information was sought about 72 pre-defined indicants concerning alcohol consumption, drinking behaviour, and symptoms. Each patient was asked to complete an attitude questionnaire anonymously. The extent of agreement between the evidence elicited by the computer and by the psychiatrists was quite high, and their estimated error rates were very similar, all between 10 per cent and 12 per cent in total. With respects to amounts of alcohol consumed, patients reported significantly greater amounts to the computer than they reported to the psychiatrists. The median amounts of pure ethanol consumed ranged from 1-19 kg per week calculated from reports made to one of the psychiatrists, up to 1-58 kg per week calculated from reports made to the computer. The results from the attitude questionnaire indicated a high level of acceptability to patients of computer interrogation.
Levinson, Cheri A; Rodebaugh, Thomas L; Shumaker, Erik A; Menatti, Andrew R; Weeks, Justin W; White, Emily K; Heimberg, Richard G; Warren, Cortney S; Blanco, Carlos; Schneier, Franklin; Liebowitz, Michael R
Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N=602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N=180), and by using a variance decomposition model of self- and informant-report of perfectionism (N=134). Using self-report, we found that an interaction of personal standards and evaluative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was associated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants' perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.
Levinson, Cheri A.; Rodebaugh, Thomas L.; Shumaker, Erik A.; Menatti, Andrew R.; Weeks, Justin W.; White, Emily K.; Heimberg, Richard G.; Warren, Cortney S.; Blanco, Carlos; Schneier, Franklin; Liebowitz, Michael R.
Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N = 602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N = 180), and by using a variance decomposition model of self-and informant-report of perfectionism (N = 134). Using self-report, we found that an interaction of personal standards and evaluative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was associated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants’ perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed. PMID:25486087
Full Text Available Abstract Background Little is known about depressed patients' profiles and how they are managed. The aim of the study is to compare GPs and psychiatrists for 1° sociodemographic and clinical profile of their patients considered as depressed 2° patterns of care provision. Methods The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients. Data collected: sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder. Results Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban (10.5% v 5.4% – OR = 2.4, educated (42.4% v 25.4% – OR = 3.9, met DSM-IV criteria for depression (94.6% v 85.6% – OR = 2.9, had been hospitalized for depression (26.1% v 15.6% – OR = 2.0 and were younger at onset of depressive problems (all adjusted p Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants (7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8 with longer duration of antidepressant treatment. GPs' patients received more "non-conventional" treatment (8.8% v 2.4% OR = 0.3 and less psychotherapy (72.2% v 89.1% OR = 3.1 (all adjusted p Conclusion Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.
Umene-Nakano, Wakako; Kato, Takahiro A; Kikuchi, Saya; Tateno, Masaru; Fujisawa, Daisuke; Hoshuyama, Tsutomu; Nakamura, Jun
Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan. The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan. We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used. Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation. A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.
Full Text Available Background/Aim. Child abuse may be related to adverse psychological outcomes in adult life. However, little is known about specific clinical, family and resilience profiles of adolescents that have experienced child abuse. The aim of this study was to investigate clinical symptoms, family functioning and resilience characteristics of adolescents with the experience of abuse, first referred to psychiatrists. Methods. The study included 84 young participants (mean age 14.90 ± 3.10, ranging from 11 to 18 years as consecutive first referrals to the Clinic for Children and Youth of the Institute of Mental Health, Belgrade, Serbia. The sample consisted of two groups, based on the Child Abuse Matrices of Risks. The first group included adolescents with the experience of abuse in childhood (n = 38, 13 males, 25 females, whereas the second, control group, comprised of non-abused adolescents (n = 47, 20 males, 27 females. The presence of abuse was evaluated by the Child Abuse Matrices of Risks. The study used the following questionnaires: Youth Self-Report (YSR, Adolescent Resilience Attitudes Scale (ARAS, and Self-Report Family Inventory (SFI. Results. Significant differences were found only among females. According to YSR, the abused girls had significantly higher scores on the Delinquent Behavior scale and marginally higher scores on Anxious/ Depressed and Social Problems scales. Analyses of the SFI showed significantly lower family functioning among the girls with the child abuse history for all scales except for the Directive Leadership. The abused girls also showed significantly lower scores on the Insight scale, and marginally lower Initiative scores at the ARAS. Conclusions. These findings may have practical application in the creation of specific preventive and treatment strategies, particularly focused on delinquent tendencies, as well as on enhancing resilience through providing positive environments within families, schools and communities.
LoPiccolo, Charles J.; Eldon Taylor, C.; Clemence, Cheryl; Eisdorfer, Carl
The objective of this study was to examine the adherence rates of psychiatrists with APA standards for coordination of care in split treatment. Coordination of care in split treatment is monitored from claims paid data in an academic MBHO as an ongoing quality improvement activity. For an 18-month period, 93 psychiatrists were identified with 559 patients in split treatment and were mailed a survey. Surveys were controlled for change of providers. Self-report survey results were obtained from...
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.
McKenzie, Karen; Fawns, Tim
The paper discusses some of the issues faced by clinical psychology trainees when integrating their 'personal' 'student' and 'professional' images. This is in the context of the increasing use of social networking sites for both personal and educational processes.
Reed, Geoffrey M; Mendonça Correia, João; Esparza, Patricia; Saxena, Shekhar; Maj, Mario
This article describes the results of the WPA-WHO Global Survey of 4,887 psychiatrists in 44 countries regarding their use of diagnostic classification systems in clinical practice, and the desirable characteristics of a classification of mental disorders. The WHO will use these results to improve the clinical utility of the ICD classification of mental disorders through the current ICD-10 revision process. Participants indicated that the most important purposes of a classification are to facilitate communication among clinicians and to inform treatment and management. They overwhelmingly preferred a simpler system with 100 or fewer categories, and over two-thirds preferred flexible guidance to a strict criteria-based approach. Opinions were divided about how to incorporate severity and functional status, while most respondents were receptive to a system that incorporates a dimensional component. Significant minorities of psychiatrists in Latin America and Asia reported problems with the cross-cultural applicability of existing classifications. Overall, ratings of ease of use and goodness of fit for specific ICD-10 categories were fairly high, but several categories were described as having poor utility in clinical practice. This represents an important focus for the ICD revision, as does ensuring that the ICD-11 classification of mental disorders is acceptable to psychiatrists throughout the world.
Gergen, Kenneth J.; Lightfoot, Cynthia; Sydow, Lisa
We explore here the potentials of a social constructionist orientation to knowledge for research and clinical practice. Dialogues on social construction emphasize the communal origins of knowledge. They stress the cultural basis of knowledge claims, the significance of language, the value saturation of all knowledge, and the significance of…
Conlon, Annemarie; Choi, Namkee G.
Objective: This study examined the influence of oncology social workers' expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the patent's age…
Until around 1979, 'confused' or mentally unwell people over 65 years of age tended to be labelled as having 'senile dementia'. Senile dementia was usually regarded as a single, inevitably hopeless condition, despite gradually accumulating clinical and pathological evidence to the contrary. Specific psychiatric services for mental illness in older people began to emerge in the 1950s, but by 1969 there were fewer than 10 dedicated services nationally. During the 1970s, 'old age psychiatrists' established local services and campaigned nationally for them. By 1979, about 100 old age psychiatrists were leading multi-disciplinary teams in half the health districts in England. This paper explores the tortuous development of these new services, focusing on provision for people with dementia. © The Author(s) 2015.
Buck, Benjamin E; Healey, Kristin M; Gagen, Emily C; Roberts, David L; Penn, David L
Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure. This study (1) examines the factor structure of social cognition in both a sample of individuals with schizophrenia-spectrum disorders and non-clinical controls and (2) explores relationships of factors to neurocognition, symptoms and functioning. A factor analysis was conducted on social cognition measures in a sample of 65 individuals with schizophrenia or schizoaffective disorder, and 50 control participants. The resulting factors were examined for their relationships to symptoms and functioning. Results suggested a two-factor structure in the schizophrenia sample (social cognition skill and hostile attributional style) and a three-factor structure in the non-clinical sample (hostile attributional style, higher-level inferential processing and lower-level cue detection). In the schizophrenia sample, the social cognition skill factor was significantly related to negative symptoms and social functioning, whereas hostile attributional style predicted positive and general psychopathology symptoms. The factor structure of social cognition in schizophrenia separates hostile attributional style and social cognition skill, and each show differential relationships to relevant clinical variables in schizophrenia.
Con, D; Goethals, K
In this article we focus on the role, function and composition of the morning report in the training of psychiatrists in residence at psychiatric hospitals. We also pay attention to the way in which the case should be presented in the morning report. To make some proposals regarding ways in which the efficiency of the morning report and the case presented in that report can be improved. We studied currently available literature and publications about the morning report and we also drew on our own experience with the morning report. We found very few publications that dealt specifically with morning report in the psychiatric teaching hospital. However, our studies have shown that the morning report should not be regarded purely as an instrument for passing on care details about the patient; it should also be seen as an essential link in the chain of instruction required by trainee psychiatrist. On the basis of rhetoric, constructivism and social-constructionism, we present a model for case presentation. Making improvements in the quality of the morning report is an important way of contributing to the learning process of trainee psychiatrists and staff members and should therefore enhance the status of the psychiatric hospital as a teaching community.
Full Text Available Pichaya Kusalaruk, Ratana Saipanish, Thanita Hiranyatheb Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Purpose: Negative attitudes from doctors and the resulting stigmatization have a strong impact on psychiatric patients’ poor access to treatment. There are various studies centering on doctors’ attitudes toward psychiatric patients, but rarely focusing on the attitudes to specific disorders, such as obsessive–compulsive disorder (OCD. This research aimed to focus on psychiatrists’ attitudes toward OCD patients.Patients and methods: The participants were actual psychiatrists who signed a form of consent. The main tool used in this study was a questionnaire developed from a focus group interview of ten psychiatrists about their attitudes toward OCD patients.Results: More than 80% of the participating psychiatrists reported a kindhearted attitude toward OCD patients in the form of pity, understanding, and empathy. Approximately one-third of the respondents thought that OCD patients talk too much, waste a lot of time, and need more patience when compared with other psychiatric disorder sufferers. More than half of the respondents thought that OCD patients had poor compliance with behavioral therapy. The number of psychiatrists who had confidence in treating OCD patients with medications (90.1% was much higher than those expressing confidence in behavioral therapy (51.7%, and approximately 80% perceived that OCD patients were difficult to treat. Although 70% of the respondents chose medications combined with behavioral therapy as the most preferred mode of treatment, only 7.7% reported that they were proficient in exposure and response prevention.Conclusion: Even though most psychiatrists had a more positive than negative attitude toward OCD patients, they still thought OCD patients were difficult to treat and had poor compliance with behavioral therapy. Only a small number of the
Olivares, Jose Manuel; Thirunavukarasu, Manickam; Kulkarni, Jayashri; Zhang, Hong Yan; Zhang, Mingyuan; Zhang, Fan
Nonadherence is a well-known problem among schizophrenia patients, among whom relapse is fivefold more likely, adversely affecting health, employment, and social functioning. The Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was developed to determine the scope and causes of medication nonadherence in schizophrenia. The 20-question ADHES survey was distributed to 19,370 psychiatrists in 13 Asia-Pacific countries in January-April 2012, to ascertain psychiatrists' perceptions of antipsychotic medication adherence levels among their schizophrenia patients, reasons for partial/nonadherence, their preferred methods of assessing adherence, and strategies to improve adherence. Responses are reported as mean and range across countries. Four thousand, six hundred sixty one psychiatrists (24% of recipients) completed the survey (highest contributors: People's Republic of China, 1854; India, 1616). Psychiatrists perceived that 56% (range, 30%-71%) of schizophrenia patients were non- or partially adherent to medication. Patients discontinue medication primarily due to lack of insight into their condition (mean, 37%; 1%-65%) and because patients consider medication unnecessary when feeling better (mean, 27%; 15%-68%). Over half of psychiatrists (mean, 55%; 42%-99%) assess medication adherence at every visit, almost exclusively (81%) by asking their patients, versus quantitative measures. One in three psychiatrists expressed their preference to switch to or add a long-acting antipsychotic to improve adherence (15%-82%). The substantial prevalence of partial/nonadherence to medication demonstrates that more proactive management of patients with schizophrenia is needed to improve adherence and thereby treatment outcomes. Registration of this study was not required.
Gillespie, A; Fink, E L; Traino, H M; Uversky, A; Bass, S B; Greener, J; Hunt, J; Browne, T; Hammer, H; Reese, P P; Obradovic, Z
This study describes patient social networks within a new hemodialysis clinic and models the association between social network participation and kidney transplantation. Survey and observational data collected between August 2012 and February 2015 were used to observe the formation of a social network of 46 hemodialysis patients in a newly opened clinic. Thirty-two (70%) patients formed a social network, discussing health (59%) and transplantation (44%) with other patients. While transplant-eligible women participated in the network less often than men (56% vs. 90%, p = 0.02), women who participated discussed their health more often than men (90% vs. 45.5%, p = 0.02). Patients in the social network completed a median of two steps toward transplantation compared with a median of 0 for socially isolated patients (p = 0.003). Patients also completed more steps if network members were closely connected (β = 2.23, 95% confidence interval [CI] 0.16-4.29, p = 0.03) and if network members themselves completed more steps (β = 2.84, 95% CI 0.11-5.57, p = 0.04). The hemodialysis clinic patient social network had a net positive effect on completion of transplant steps, and patients who interacted with each other completed a similar number of steps. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.
The purpose of this study was to explore the tobacco and smoking cessation training and curriculum in graduate clinical psychology and graduate clinical social work programs. The current status of the clinical graduate programs' tobacco education curricula was evaluated by using the Transtheoretical Model's Stages of Change. Perceived barriers to…
Greenspan, E L
In this article, the author explores the relationship between the lawyer as advocate and the psychiatrist as expert. He argues that the role of the psychiatrist in aiding the Court in the determination of relevant issues is one of increasing importance. Often the diagnostic opinions offered by the psychiatrist border on conclusory legal determination. As such, those opinions must necessarily be subjected to the testing of adversarial processes. The role of the psychiatrist is to proffer a relevant opinion while nevertheless realizing that the inexact nature of the science limits the use such an opinion may have. The lawyer as adversary must subject that opinion to as rigorous an examination as possible. This examination is not an affront to the psychiatrist but rather an attempt to explore and expose the definitiveness of that opinion. It is through this combination of realized opinionating and adversarial examination that relevant legal-medical determinations can best be made within the confines of our existing judicial mode of dispute settlement.
James, Bawo O; Omoaregba, Joyce O; Okonoda, Kingsley M; Otefe, Edebi U; Patel, Maxine X
Antipsychotic long-acting injections (LAIs) reduce covert nonadherence with medication in the clinical management of psychotic disorders. However, they are variably utilised by clinicians, especially in the long term. Factors including poor knowledge, stigma and perceived coercion can all adversely influence LAI utilisation. Previous research has emanated almost exclusively from developed countries. This study explores the knowledge and attitudes of psychiatrists and trainees in Nigeria towards LAIs. A cross-sectional study was undertaken among mental health professionals in Nigeria using a pre-existing questionnaire. Participant psychiatrists (n = 128) expressed positive attitudes towards LAIs. Their knowledge concerning LAIs and its side effects was fair. The participants reported that nearly half (41.7%) of their patients with a psychotic illness were on LAIs. Those who reported a high prescribing rate for LAIs (>40%) were more likely to endorse more positive 'patient-centred attitudes' (p injections differs in Africa in comparison to Western cultures, possibly due to the increased potency that injections are perceived to have. This is perhaps evidenced by high rates reported for use of LAIs. Nigerian psychiatrists had positive attitudes to LAIs but their knowledge, particularly regarding side effects, was fair and needs to be improved. Providing information to patients prior to antipsychotic treatment may enhance informed consent in a country where medical paternalism is still relatively strong.
Stanton, Josephine; Randal, Patte
To better understand the complexities of developing an effective psychiatrist-patient relationship when both people involved are doctors. In-depth, semistructured interviews were conducted with 11 doctors with experiences as patients of psychiatrists (DPs) and eight psychiatrists with experience of treating doctors (TPs). A thematic analysis was undertaken. The medical culture of unrealistically high standards with limited room for vulnerability and fallibility, vigilance for judgment and valuing clinical over personal knowledge affected both people in the relationship. DPs struggled with the contradictions involved in entering the patient role but tried hard to be good patients. They wanted guidance but found it hard to accept and seldom communicated dissatisfaction or disagreement to their TPs. They described widely varying responses to diagnosis and treatment within the biomedical model. TPs described enjoyment and satisfaction and extreme challenge in engaging with TPs. Despite focusing on providing ordinary care they described providing extra care in many ways. This study brings forward important issues when a psychiatrist is building a therapeutic relationship with another doctor. These are also likely to arise with other people and contribute to making truly patient-centred 'ordinary care' a hard ideal to fulfil. They include: (1) doctors' sense of ourselves as invincible, (2) TPs' sense of personal connection to, and identity with, DPs, (3) having extensive medical knowledge and (4) striving to be good patients. We need to make these issues explicit and enable the DP (or other patients) to tell their story and speak about their experience of the consultation so that any potential rupture in the therapeutic relationship can be addressed early. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Schwartz, C E; Steinmuller, R I; Dubler, N
A 60-year-old black female with chronic paranoid schizophrenia was admitted to the Medical Service for a workup because of severe iron deficiency anemia; she refused the workup. She was found to be acutely psychotic and incapable of informed medical decision making. The management of her medical workup by her medical/C-L psychiatrist led to a diagnosis of colon cancer, and subsequent surgery. The case is discussed here by a consultation-liaison psychiatrist and a lawyer bioethicist. It illustrates the role of medical/C-L psychiatrists as physicians for chronically mentally ill patients with serious medical illness in the general hospital, who guide the medical/surgical care of these patients without powerful negative countertransference bias, thus balancing respect for patient autonomy with advocacy for medical "best interests."
Quintana-Vidaurri, Adriana Guadalupe; Santana-Chávez, Luis Alejandro; González-Villalobos, Cynthia Guadalupe
to prove the impact of social marketing strategies in breast cancer detection, taking as a parameter the number of mammographies performed. quasi-experimental research, before and after. Sixty-nine physicians in charge of medical consultation and fourteen nurses were studied for a period of seven months, applying social marketing strategies. The total of mammographies were analyzed using Wilcoxon rank-sum test (p social marketing proved to be an adequate strategy, which has an impact on the clinical practice of both physicians and nurses.
Blakely, Thomas Joseph; Dziadosz, Gregory M
This article proposes the use of attachment theory in clinical social work practice. This theory is very appropriate in this context because of its fit with social work concepts of person-in-situation, the significance of developmental history in the emergence of psychosocial problems, and the content of human behavior in the social environment. A literature review supports the significance of the theory. Included are ideas about how attachment styles and working models may be used in assessment and treatment to help clients achieve a secure attachment style.
In 1935 Constance Pascal (1877-1937), France's first woman psychiatrist, published Chagrins d'amour et psychoses (The Sorrows of Love and Psychosis). My analysis of her monograph will consider: her major article leading up to Chagrins; Pascal's debts to her predecessors, particularly Morel and Kretschmer; her relationship to the French psychoanalytic movement; her co-option of psychoanalysis as a tool in her own therapeutic work with patients in the state psychiatric system; and her social/cultural interpretations of her woman patients. The literary and philosophic aspects of her work are emphasized as well as her contribution to French psychiatry. © The Author(s) 2014.
Kebers, F; Janvier, S; Colin, A; Legros, J J; Ansseau, M
Klinefelter's syndrome (KS) concerns men and is usually characterized by tallness, underdeveloped testes and sterility. It is generally due to the 47,XXY genotype, ie one extra X chromosome in each cell. Its estimated frequency among newborn boys is 1/500 to 1/700. It seems that 64% KS would be undiagnosed. Abnormally low levels of testosterone blood values are very common in this syndrome. In this case, replacement androgen therapy should be initiated (ideally at the age of 11-15) which prevents osteoporosis and enhances secondary sexual features. Case report - Since early childhood, Mr X has been shy, passive with few friends. When he was 13 years old, the school physician noted a delay of puberty and referred him to an endocrinologist who diagnosed KS. Androgen therapy was introduced but rapidly stopped, because the boy and his parents thought it was useless. Mr X consulted a psychiatrist at the age of 21. He presented a schizo-affective disorder with influence syndrome, auditory and visual hallucinations, labile mood with disinhibited and depressive periods. He was admitted in a psychiatry ward of a general hospital. An endocrinologist confirmed the diagnosis of KS and found very low blood testosterone levels. Besides lithium and risperidone which had already been introduced before the hospitalization, androgens (testosterone undecanoate) were very progressively given to Mr X with a daily psychiatric evaluation. One month after discharge, a major depressive episode led to the adjunction of citalopram. After one year of follow-up, Mr X shows increased social adjustment and enhanced interest; the influence syndrome has partially regressed and his mood is more stable. Discussion - In the years '60 and '70, systematic screenings in psychiatric hospitals have detected 1.3% KS among hospitalized boys, ie 10 times more than in the general population, and 0.6 to 1% KS among hospitalized men. A large variety of psychiatric disorders have been described. Boys presenting
Full Text Available Over the last twenty years, predicting psychosis has become a priority of both research and policies. Those approaches include the use of the At Risk Mental State category (ARMS and of standardized predictive tools. In comparison to most developed countries, early interventions programs are only little developed in France. However, cases of young patients presenting unclear symptoms that might be a beginning psychosis or might as well reflect some adolescent unease are commonplace in psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding psychosis risk management. Do they anticipate mental disorders?The Grounded Theory is an agreed-upon qualitative method in social science field that links subjective experiences (individual narratives to social processes (professional norms and mental health policies. 12 French youth psychiatrists were interviewed about psychosis early management and their daily prognosis practices with teenagers.If all participants were aware of early intervention programs, most of them did not make use of standardized scales. Psychiatrists' reluctance toward a psychosis risk standardized assessment was shaped by three difficulties: first the gap between theoretical knowledge and practice; second their impossibility to make reliable prognoses; and third, the many uncertainties surrounding medical judgment, adolescence and the nature of psychosis. Nevertheless, they provided their young patients with multiple months follow up without disclosing any risk category.Anticipating a psychosis onset remains a highly uncertain task for psychiatrists. In France, psychiatrists' inconspicuous risk management might be supported by the universal costs coverage that is not conditional on a diagnosis disclosure.
Jefferies-Sewell, Kiri; Sharma, Shivani; Gale, Tim M; Hawley, Chris J; Georgiou, George J; Laws, Keith R
The way that information is presented is well known to induce a range of biases in human decision tasks. Little research exists on framing effects in psychiatric decision making, but it is reasonable to assume that psychiatrists are not immune and, if so, there may be implications for the welfare of patients, staff and the general public. To investigate whether presentation of risk information in different formats (frequency, percentage and semantic) influences inpatient admission decisions by psychiatrists. Six-hundred seventy-eight general adult psychiatrists read a short clinical vignette presenting a case scenario of a patient presenting for inpatient admission. One of four condition questions followed the vignette, incorporating either numerical or percentage probabilities and the semantic labels "high" and "low" risk. In each condition, the actual risk was identical, but the way it was presented varied. The decision to admit the patient or not was recorded and compared across conditions. More individuals chose to admit the patient when risk information was presented in numerical form (X2 = 7.43, p = 0.006) and with the semantic label "high" (X2 = 7.27, p = 0.007). Presentation of risk information may influence decision making in psychiatrists. This has important implications for mental health clinical practice where clinicians are required to interpret probabilistic information within their daily work.
Mooradian, John K.
This article describes a learning method that employed theatre students as family clients in an advanced social work practice course. Students were provided with an opportunity to integrate and apply their learning of theory, clinical skills, and professional conduct in full-length family therapy sessions that occurred in the classroom and were…
Anna Birna Almarsdottir
Full Text Available This commentary seeks to define the areas of social pharmacy and clinical pharmacy to uncover what they have in common and what still sets them apart. Common threats and challenges of the two areas are reviewed in order to understand the forces in play. Forces that still keep clinical and social pharmacy apart are university structures, research traditions, and the management of pharmacy services. There are key (but shrinking differences between clinical and social pharmacy which entail the levels of study within pharmaceutical sciences, the location in which the research is carried out, the choice of research designs and methods, and the theoretical foundations. Common strengths and opportunities are important to know in order to join forces. Finding common ground can be developed in two areas: participating together in multi-disciplinary research, and uniting in a dialogue with internal and external key players in putting forth what is needed for the profession of pharmacy. At the end the question is posed, “What’s in a name?” and we argue that it is important to emphasize what unifies the families of clinical pharmacy and social pharmacy for the benefit of both fields, pharmacy in general, and society at large.
Full Text Available BACKGROUND: Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan. AIMS: The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan. METHOD: We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI, were used. RESULTS: Sixty psychiatric departments (75.0% responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0% experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation. CONCLUSIONS: A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.
Ares, Terri L
Graduate nursing programs facilitate the transition of RNs to advanced roles through a complex process of professional socialization. The purpose of this study was to explore the professional socialization of clinical nurse specialist (CNS) students. Two hundred twenty-five students, representing 73 CNS programs, responded to an online survey. Both preprogram variables and educational experiences contributed to an adequate level of CNS socialization. Students' self-concept was strong, and they felt prepared to practice in the role, which was highly correlated with their perceptions of how well the program prepared them academically and experientially. Having a CNS mentor was positively associated with readiness to practice. Outcomes did not vary with cohort status, and online instruction did not impede socialization. These findings provide implications for CNS program advisement and design. Copyright 2014, SLACK Incorporated.
Objective. The objective was to review psychiatric involvement in seven prosecutorial workshops on criminal capacity between 2004 and 2009. The aim was to evaluate the changing role of the psychiatrists in the workshops in order to identify areas in forensic psychiatry where prosecutors have a specific need for training, ...
Objective: Over half of patients with psychiatric disorders are first seen by primary care physicians before referral to the psychiatrist. An efficient referral system is, therefore, important to offering quality care to such patients. Communication between physicians is often sub-optimal and referral letters to specialists sometimes ...
Yellowlees, P M
The aim of this paper is to examine the delivery of mental health care which will be enabled by the various communications technologies over the next 5 to 10 years. A literature review, reviews of multiple Internet websites and the author's personal experience and opinions are combined to provide a commentary on the group of new technologies for communication available within health, and how they will affect the practice of psychiatry and psychiatrists over the next decade. The driving forces for these changes are the rise of consumerism, technological change and financial necessity, and it is evident that patients will have in future much greater choice of access to their therapists than at present. The health-care environment of the future will be different to today, as will the roles of psychiatrists, who will increasingly have to work as members of teams in an expert capacity rather than in traditional one-to-one practice. It is concluded that it is essential for psychiatrists to become involved in online health care, and in particular to join their patients on the Internet, and that there are major opportunities for Australasian psychiatrists to provide high quality psychiatric care across national boundaries, particularly into the Asia-Pacific region.
Dunn, Marian E.; Abulu, John
Objectives: This article addresses the potential role for psychiatrists in teaching sexuality to other medical disciplines. Methods: The authors searched PsycNet and PubMed/MEDLINE for pertinent articles and studies from the period between 1990 and 2009 using the terms human sexuality; teaching human sexuality; teaching methods; education and…
Osman, Ossama T; Nasir, Laeth; Mollica, Richard F; Zoubeidi, Taoufik; Lavelle, James; Amawi, Noor
To explore in Arab communities the prevalence, dynamics, and resources available to address the physical and psychological consequences that may arise from psychiatric disorders. An online survey of psychiatrists and primary care physicians from 17 Arab countries was conducted between September 2011 and June 2012. The survey serves as a needs assessment in a scientifically valid and culturally sensitive manner. Additionally, it focuses attention on the clinical strengths and weaknesses of Middle Eastern primary health care and mental health centers in identifying and treating trauma-related health and mental health issues. The 90 survey respondents comprised psychiatrists (n = 53) and primary care physicians (n = 37). They practiced in 3 clinical settings: primary mental health (27%), inpatient mental health (43%), and primary health care (29%). Traumas frequently reported by their patients were attributed to recent death of a close relative or friend (62.3%), domestic violence (41.4%), divorce/separation (72.1%), serious traffic accident (45.6%), sexual assault/rape (20.3%), child abuse (20.3%), psychological effects of war (30.9%), victims of crime (15.9%), refugees/internally displaced persons (20.6%), physical effects of war (19.1%), torture (13.2%), elderly abuse (11.6%), psychological effects of a natural disaster (7.4%), physical effect of a natural disaster (7.2%), and child soldiers (4.3%). Psychiatrists had significantly more patients with the following traumatic experiences: divorce/separation (81.4% vs 57.1%, P = .039), recent death of a close relative or friend (72.7% vs 47.6%, P = .048), and domestic violence (51.1% vs 19.0%, P = .014). Clinical teams comprised substantial numbers of students but small numbers of community volunteers and school counselors. This study highlights the need to develop awareness and training programs in Arab communities to identify and properly treat traumatized individuals in psychiatric and primary care settings.
Batt-Rawden, Samantha; Flickinger, Tabor; Weiner, John; Cheston, Christine; Chisolm, Margaret
The provision of excellent patient care is a goal shared by all doctors. The role of social media (SM) in helping medical students and doctors achieve clinical excellence is unknown. Social media may help facilitate the achievement of clinical excellence This report aimed to identify examples of how SM may be used to help promote the achievement of clinical excellence in medical learners. Three of the authors previously conducted a systematic review of the published literature on SM use in undergraduate, graduate and continuing medical education. Two authors re-examined the 14 evaluative studies to identify any examples of SM use that may facilitate the achievement of clinical excellence and to consider whether there were any aspects of clinical excellence for which no studies had been performed, and, if so, whether SM was relevant to these domains. Each study touched on one or more of the following domains of clinical excellence: communication and interpersonal skills; professionalism and humanism; knowledge; diagnostic acumen; exhibiting a passion for patient care; a scholarly approach to clinical practice; and explicitly modelling expertise to medical trainees. No study addressed the role of SM to promote the skillful negotiation of the health care system, and in collaboration with investigators to advance science and discovery; however, additional evidence suggested that SM may play an adjunctive role in promoting the achievement of these aspects of clinical excellence. This report supports the hypothesis that SM may help facilitate the achievement of clinical excellence; however, further research is needed into the role of SM in promoting the achievement of clinical excellence. © 2014 John Wiley & Sons Ltd.
Clemente, Adauto Silva; Santos, Wagner Jorge dos; Nicolato, Rodrigo; Firmo, Josélia Oliveira Araújo
Abstract: This research sought to understand meanings and implications of the stigma related to bipolar disorder in relation to social processes and local cultural value systems. Seven semidirected individual interviews were performed with psychiatrists (from Belo Horizonte city, Minas Gerais State, Brazil) and analyzed with referential from the Medical Anthropology. Some potential stigmatizing views about bipolar disorder patients were endorsed by respondents related to biomedical model of b...
Zhou, Yi Zhou; Wilde, Alex; Meiser, Bettina; Mitchell, Philip B; Barlow-Stewart, Kristine; Schofield, Peter R
The aim of this study was to examine the self-rated competencies and perceived roles of medical geneticists, genetic counselors, and psychiatrists in the communication of genetic risk for psychiatric disorders to patients and families at an increased risk for schizophrenia, bipolar disorder or major depressive disorder, and their perspectives on training needs in this field. Clinically active members of the Human Genetics Society of Australasia (HGSA) and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) were invited to complete the online survey. A total of 157 responses were included in data analysis: 17 medical geneticists, 36 genetics counselors, and 104 psychiatrists. In all, 34.4% of the respondents disagreed that their professional training had prepared them to discuss genetic information about psychiatric illnesses with patients. Medical geneticists perceived significantly higher levels of self-rated competency to discuss with patients and families genetic information on psychiatric disorders compared with genetic counselors and psychiatrists (t=-0.61, P=0.001; β=0.33, 95% confidence interval 0.16-0.49, Pgenetic risk information to patients, suggesting that specialist programs are needed to better support health professionals. As self-rated competencies differed among the professional groups, training programs need to be tailored to participants' professional backgrounds.
Full Text Available Social cognition was assessed in a clinical sample of Personality Disorder (PD stable patients receiving ambulatory treatment (N=17 and healthy matched controls (N=17 using tests of recognition of emotions in faces and eyes, in a test of social faux pas and in theory of mind stories. Results indicated that when compared with healthy controls, individuals with PD showed a clear tendency to obtain lower scoring in tasks assessing recognition of emotion in faces (T=-2,602, p=0,014, eyes (T=-3,593, p=0,001, TOM stories (T=-4,706, p=0,000 and Faux pas (T=-2,227, p=0,035. In the present pilot study, PD individuals with a normal cognitive efficiency showed an impaired performance at social cognition assessment including emotion recognition and theory of mind.
Gergen, Kenneth J; Lightfoot, Cynthia; Sydow, Lisa
We explore here the potentials of a social constructionist orientation to knowledge for research and clinical practice. Dialogues on social construction emphasize the communal origins of knowledge. They stress the cultural basis of knowledge claims, the significance of language, the value saturation of all knowledge, and the significance of relationships as opposed to individuals. An initial illustration of constructionism in action centers on adolescent risk behavior. Such behavior is often constructed negatively within popular writings and the social science and thus ignores the meaning of such actions to the adolescents themselves. Discourse analysis indicates that for adolescents risky behavior serves important functions of enhancing group solidarity and establishing positive identity. A second illustration, exploring the implications of constructionism for therapy, places a strong emphasis on the therapist as a collaborator in the building of meaning. Traditional investments in diagnosis and treatment are replaced with the collaborative creation of new possibilities for action.
Klein, Anke M; Rapee, Ronald M; Hudson, Jennifer L; Schniering, Carolyn A; Wuthrich, Viviana M; Kangas, Maria; Lyneham, Heidi J; Souren, Pierre M; Rinck, Mike
The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral training. Training included 15 sessions in a two-week period. Children with an interpretation bias prior to training in the positive training group showed a significant reduction in interpretation bias on the social threat scenarios after training, but not children in the neutral training group. No effects on interpretation biases were found for the general threat scenarios or the non-threat scenarios. Furthermore, children in the positive training did not self-report lower anxiety than children in the neutral training group. However, mothers and fathers reported a significant reduction in social anxiety in their children after positive training, but not after neutral training. This study demonstrated that clinically anxious children with a prior interpretation bias can be trained away from negative social interpretation biases and there is some evidence that this corresponds to reductions in social anxiety. This study also highlights the importance of using specific training stimuli. Copyright © 2015 Elsevier Ltd. All rights reserved.
The Royal College of Psychiatrists recently issued a revised statement on its position concerning capital punishment. The College proposes to support psychiatrists who refuse to be involved in the capital process, but accepts that some may take up limited involvement in the manner set out in the document. The Royal College is the professional body for psychiatric practitioners in the United Kingdom and Ireland. Almost no public statements are issued from the College without first being deliberated on within at least two of its three major committees. The new document on capital punishment remains in the spirit of the previous ones. The topic of capital punishment is noncontroversial within the British medical profession. In all European countries, capital punishment is against the law, because there is an overarching directive from the Council of Europe (a wide group of nations, wider than the European Union) insisting that it be abolished.
Halpern, Abraham L; Halpern, John H; Doherty, Sean B
Abstract After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very agg...
Halpern, Abraham L; Halpern, John H; Doherty, Sean B
After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very aggressive techniques determined to be torture by many nations and organizations throughout the world. This paper explains why psychiatrists and psychologists involved in coercive interrogations violate the Geneva Conventions and the laws of the United States. Whether done with ignorance of professional ethical obligations or not, these psychiatrists and psychologists have crossed an ethical barrier that may best be averted from re-occurring by teaching medical students and residents in all medical specialties about the ethics principles stemming from the 1946-1947 Nuremberg trials and the Geneva Conventions, together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively. In this way, all physicians and psychologists will clearly understand that they have an absolute moral obligation to "First, do no harm" to the human beings they professionally encounter.
Halpern, Abraham L; Halpern, John H; Doherty, Sean B
After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very aggressive techniques determined to be torture by many nations and organizations throughout the world. This paper explains why psychiatrists and psychologists involved in coercive interrogations violate the Geneva Conventions and the laws of the United States. Whether done with ignorance of professional ethical obligations or not, these psychiatrists and psychologists have crossed an ethical barrier that may best be averted from re-occurring by teaching medical students and residents in all medical specialties about the ethics principles stemming from the 1946–1947 Nuremberg trials and the Geneva Conventions, together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively. In this way, all physicians and psychologists will clearly understand that they have an absolute moral obligation to "First, do no harm" to the human beings they professionally encounter. PMID:18817568
Halpern John H
Full Text Available Abstract After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very aggressive techniques determined to be torture by many nations and organizations throughout the world. This paper explains why psychiatrists and psychologists involved in coercive interrogations violate the Geneva Conventions and the laws of the United States. Whether done with ignorance of professional ethical obligations or not, these psychiatrists and psychologists have crossed an ethical barrier that may best be averted from re-occurring by teaching medical students and residents in all medical specialties about the ethics principles stemming from the 1946–1947 Nuremberg trials and the Geneva Conventions, together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively. In this way, all physicians and psychologists will clearly understand that they have an absolute moral obligation to "First, do no harm" to the human beings they professionally encounter.
Bervoets, Chris; Roelant, Ella; De Fruyt, Jürgen; Demunter, Hella; Dekeyser, Barry; Vandenbussche, Leen; Titeca, Koen; Pieters, Guido; Sabbe, Bernard; Morrens, Manuel
The pharmacotherapeutic management of agitation is a common clinical challenge. Pharmacotherapy is frequently used, the use of published guidelines is not known. The purpose of this study was twofold; to describe the prescribing patterns of psychiatrists and emergency physicians and to evaluate to which extent guidelines are used. A cross-sectional survey in the Dutch-speaking part of Belgium is carried out in 39 psychiatric hospitals, 11 psychiatric wards of a general hospital and 61 emergency departments. All physicians are asked for demographic information, their prescribing preferences, their use of guidelines and the type of monitoring (effectiveness, safety). For the basic demographic data and prescription preferences descriptive statistics are given. For comparing prescribing preferences of the drug between groups Chi square tests (or in case of low numbers Fisher's exact test) were performed. Mc Nemar test for binomial proportions for matched-pair data was performed to see if the prescription preferences of the participants differ between secluded and non-secluded patients. 550 psychiatrist and emergency physicians were invited. The overall response rate was 20% (n = 108). The number 1 preferred medication classes were antipsychotics (59.3%) and benzodiazepines (40.7%). In non-secluded patients, olanzapine (22.2%), lorazepam (21.3%) and clotiapine (19.4%) were most frequently picked as number 1 choice drug. In secluded patients, clotiapine (21.3%), olanzapine (21.3%) and droperidol (14.8%) were the three most frequently chosen number 1 preferred drugs. Between-group comparisons show that emergency physicians prefer benzodiazepines significantly more than psychiatrists do. Zuclopenthixol and olanzapine show a particular profile in both groups of physicians. Polypharmacy is more frequently used in secluded patients. Published guidelines and safety or outcome monitoring are rarely used. Our results show that prescription practice in Flanders (Belgium) in acute
Full Text Available Many of the diseases seen in the clinic are actually symptoms of social problems. It is often easier for the physician to treat the symptoms than to be a coach and help the patient to assume responsibility in order to improve quality of life, social situation, and relations. If the physician ignores the signs of the disease as a symptom of social problems, and treats the patient with pharmaceuticals, he can give the patient the best justification in the world not to do anything about the situation. It is very important that the physician is not tricked by the games the socially troubled patient, more or less unconsciously, is playing. A firm and wise attitude that confronts the patient with his or her lack of responsibility for solving social problems seems to be a constructive way out. The physician can give holding and support, but the responsibility must remain with the patient. Often it is better for the patient that the physician abstains from giving drugs that can remedy the symptoms and takes the role of a coach instead. Suffering is not necessarily bad, suffering is actually highly motivating and often the most efficient source of learning. Coaching can help the patient canalize his motivation into highly constructive considerations and behavior. A holistic approach thus gives the patient learning and helps him rehabilitate his social reality. Concerning children with recurrent or chronic pain, we have observed an overuse of painkillers, where we believe part is of a psychosomatic nature due to poor thriving in the family. Here the physician has an important job helping the parents to develop as persons, teaching them the basic holding of awareness, respect, care, acknowledgment and acceptance of their child. Most of the chronic pain and discomfort with children can be improved if the physician understands how to use the holistic medical toolbox.
This article uses the mass-media career of the British psychiatrist David Stafford-Clark (1916-1999) as a case study in the exercise of cultural authority by celebrity medical professionals in post-war Britain. Stafford-Clark rose to prominence in the mass media, particularly through his presenting work on medical and related topics for BBC TV and Radio, and was in the vanguard of psychiatrists and physicians who eroded professional edicts on anonymity. At the height of his career, he traded upon his celebrity status, and consequent cultural authority, to deliver mass media sermons on a variety of social, cultural, and political topics. Stafford-Clark tried to preserve his sense of personal and intellectual integrity by clinging to a belief that his authority in the public sphere was ultimately to be vindicated by his literary, intellectual, and spiritual significance. But as his credibility dwindled, he came to distrust the cultural intermediaries, such as broadcasters and publishers, who had supported him. PMID:28503668
This article uses the mass-media career of the British psychiatrist David Stafford-Clark (1916-1999) as a case study in the exercise of cultural authority by celebrity medical professionals in post-war Britain. Stafford-Clark rose to prominence in the mass media, particularly through his presenting work on medical and related topics for BBC TV and Radio, and was in the vanguard of psychiatrists and physicians who eroded professional edicts on anonymity. At the height of his career, he traded upon his celebrity status, and consequent cultural authority, to deliver mass media sermons on a variety of social, cultural, and political topics. Stafford-Clark tried to preserve his sense of personal and intellectual integrity by clinging to a belief that his authority in the public sphere was ultimately to be vindicated by his literary, intellectual, and spiritual significance. But as his credibility dwindled, he came to distrust the cultural intermediaries, such as broadcasters and publishers, who had supported him.
Full Text Available Jose Manuel Olivares,1 Manickam Thirunavukarasu,2 Jayashri Kulkarni,3 Hong Yan Zhang,4 Mingyuan Zhang,5 Fan Zhang61Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; 2Department of Psychiatry, SRM Medical College Hospital and Research Center, Tamil Nadu, India; 3Department of Psychiatry, Monash University and the Alfred Hospital, Prahran, Vic, Australia; 4Department of Psychiatry, Peking University Institute of Mental Health, Beijing, People's Republic of China; 5Department of Psychiatry, Shanghai Mental Health Center, Shanghai, People's Republic of China; 6Medical Affairs, Xian Janssen Pharmaceutical, Beijing, People's Republic of ChinaBackground: Nonadherence is a well-known problem among schizophrenia patients, among whom relapse is fivefold more likely, adversely affecting health, employment, and social functioning. The Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES survey was developed to determine the scope and causes of medication nonadherence in schizophrenia.Methods: The 20-question ADHES survey was distributed to 19,370 psychiatrists in 13 Asia–Pacific countries in January–April 2012, to ascertain psychiatrists' perceptions of antipsychotic medication adherence levels among their schizophrenia patients, reasons for partial/nonadherence, their preferred methods of assessing adherence, and strategies to improve adherence. Responses are reported as mean and range across countries.Results: Four thousand, six hundred sixty one psychiatrists (24% of recipients completed the survey (highest contributors: People's Republic of China, 1854; India, 1616. Psychiatrists perceived that 56% (range, 30%-71% of schizophrenia patients were non- or partially adherent to medication. Patients discontinue medication primarily due to lack of insight into their condition (mean, 37%; 1%–65% and because patients consider medication unnecessary when feeling better (mean, 27%; 15%–68%. Over
Anton, Sanda; Gugić, Damir; Katinić, Križo; Topić, Jelena
Being diagnosed with breast cancer is a traumatic event that can lead to development of different mental disorders and influences all aspects of affected woman's life. Anxiety and Depressive Disorders in physically ill people still don't have clear diagnostic criteria which make diagnosis and treatment very difficult since different psychiatric therapeutic approaches have different effects. The aim was to evaluate influence of separate and combined psychotherapeutic approach (psychodynamic and cognitive-behavioral) and psychopharmacotherapy on decrease of anxiety and depression in breast cancer patients. The sample consisted of 120 subjects divided into four groups. The first group of patients was treated with psychopharmacotherapy, the second group received psychotherapy, the third group was treated with the combination of psychopharmacotherapy and psychotherapy, and the fourth group of patients didn't receive any kind of psychiatric treatment. We used psychotherapeutic interview with detailed clinical assessment using DSM-IV criteria for mental disorders, specially structured non-standardized questionnaire for assessment of etiological factors in development of mental disorders, Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D). The subjects filled the questionnaires on entry, one moth and two months after the beginning of research. Psychotherapeutic treatment was conducted once a week. All of the therapeutic approaches of liaison psychiatrist applied in the treatment of women with breast cancer are successful in reduction of anxiety and depression. Liaison psychiatrist's combined approach of psychopharmacological and psychotherapeutic treatment of breast cancer patients with depression obtained better results than separate approach.
Wong, Vanessa Ting Chi
The Hospital Authority employs over 60,000 staff and manages 41 public hospitals and institutions, 47 specialist outpatient clinics and 74 general outpatient clinics throughout Hong Kong. It received HK$41.14 billion (£ 3.475 billion) of funding from the government in the year 2012 to 2013, which represented 92% of its funding income (Census & Statistics Department, 2013). This public healthcare system uses 3% of the Hong Kong gross domestic product (GDP) to provide 88% of inpatient services and 28% outpatient services locally, while the private sector provides only 12% of inpatient services and 72% of outpatient services with 2.3% of GDP. There is a heavy reliance on the public sector to provide healthcare to most of the patients requiring more intensive hospitalization. Hong Kong currently only has about 280 specialists in psychiatry serving a population of over 7 million people, of whom 90 work in the private sector. According to the World Health Organization (WHO) Mental Health Atlas 2011 country profiles (WHO, 2011), the number of psychiatrists per 100,000 population is 4.39, compared to 12.76 in Australia, 10.1 in Japan, 5.12 in Korea, and 2.81 in Singapore. There is a shortage of psychiatrists, especially in the public mental health sector, which urgently needs to be tackled. This article looks at the current trend in psychiatry teaching and recruitment from medical school and the training scheme provided by the Hong Kong College of Psychiatrists.
Full Text Available Albert Schweitzer and the psychiatric studies of Jesus that he critiqued in 1913 shared the belief that Jesus identified himself as the coming Messiah. Unlike the psychiatrists, however, Schweitzer did not therefore judge Jesus to have been delusional. This article concurs with Schweitzer on the grounds that “ideas of reference” were a common feature of the religious milieu in which Jesus lived. It introduces the psychoanalytic concept of the “fictive personality” as relevant to Jesus’ identification of himself as the coming Messiah. In contrast to delusional theories, this concept emphasizes the positive uses of such identifications, especially as a means of self-empowerment.
Souliotis, Kyriakos; Agapidaki, Eirini; Tzavara, Chara; Economou, Marina
Although the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population' needs. The present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies. The vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists' participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners' usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually
Roberts, Chris; Daly, Michele; Held, Fabian; Lyle, David
Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes; connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of integration in the wider community. Preparedness for practice, reflected students' perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students' agentic engagement, collaboration, and learning within an LIC. It
Omurtag, Kenan; Jimenez, Patricia T; Ratts, Valerie; Odem, Randall; Cooper, Amber R
To study and describe the use of social networking websites among Society for Assisted Reproductive Technology (SART) member clinics. Cross-sectional study. University-based practice. Not applicable. Not applicable. Prevalence of social networking websites among SART member clinics and evaluation of content, volume, and location (i.e., mandated state, region) using multivariate regression analysis. A total of 384 SART-registered clinics and 1,382 social networking posts were evaluated. Of the clinics, 96% had a website and 30% linked to a social networking website. The majority of clinics (89%) with social networking websites were affiliated with nonacademic centers. Social networking posts mostly provided information (31%) and/or advertising (28%), and the remaining offered support (19%) or were irrelevant (17%) to the target audience. Only 5% of posts involved patients requesting information. Clinic volume correlated with the presence of a clinic website and a social networking website. Almost all SART member clinics have a website. Nearly one-third of these clinics host a social networking website such as Facebook, Twitter, and/or a blog. Large-volume clinics commonly host social networking websites. These sites provide new ways to communicate with patients, but clinics should maintain policies on the incorporation of social networks into practice. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Bradley, Carolyn; Maschi, Tina; O'Brien, Helen; Morgen, Keith; Ward, Kelly
The purpose of this study was to describe licensed clinical social workers' (LCSWs) professional motivation to pursue a social work career and the decision to enter clinical practice. It used a probability sample of 245 New Jersey LCSWs and the Social Work Values Survey as part of an anonymous self-administered mail survey. Descriptive analyses…
Kato, Takahiro A; Tateno, Masaru; Umene-Nakano, Wakako; Balhara, Yatan P S; Teo, Alan R; Fujisawa, Daisuke; Sasaki, Ryuji; Ishida, Tetsuya; Kanba, Shigenobu
To clarify the impact of biopsychosocial factors on psychiatric training under the new and traditional postgraduate medical education system in Japan and to compare them with young psychiatrists from other countries. Psychiatric residents and early-career psychiatrists were recruited in Japan and other countries. Using mail-based and web-based self-administered questionnaires, we evaluated participants' demographic information, motivation to become psychiatrists, interest and commitment to various aspects of psychiatry, and reactions to a case vignette, focusing on biopsychosocial factors. A total of 137 responses, 81 from Japan and 56 from other countries, were collected. Before starting psychiatric training, Japanese participants showed a strong interest in 'mind' and less interest in 'brain' and 'environmental factors', while the interest in 'brain' and 'environmental factors' is presently as high as that in 'mind.' Japanese participants reported less commitment to their training toward ICD/DSM-based diagnosis, interview, pharmacotherapy, psychosocial treatment and epidemiology, compared with participants from other countries. In particular, Japanese participants showed less commitment to their training in suicide prevention, despite their perception of its high importance due to a high suicide rate in Japan. Suicide risk of a case vignette proved to be differently assessed according to participants' commitment levels to each aspect of psychiatry. Our results suggest that young psychiatrists' attitudes concerning the biopsychosocial model generally become well-balanced with psychiatric training, however sociocultural factors do not seem to be well represented in the Japanese psychiatric training system. Additional training on sociocultural issues, such as suicide in Japan, should be considered. © 2010 The Authors. Psychiatry and Clinical Neurosciences © 2010 Japanese Society of Psychiatry and Neurology.
Since the late 1980s the psychoactive drug 3,4-methylenedioxymethamphetamine (MDMA) has had a well-known history as the recreationally used drug ecstasy. What is less well known by the public is that MDMA started its life as a therapeutic agent and that in recent years an increasing amount of clinical research has been undertaken to revisit the drug?s medical potential. MDMA has unique pharmacological properties that translate well to its proposed agent to assist trauma-focused psychotherapy....
A century has passed since Abraham Flexner posed the question on whether social work is a profession. This article attempts to answer that question, and considers several definitions put forth by global and national social work professional organizations, including a definition of clinical social work. Addressing the current state of social work…
Baumgardt, Johanna; Moock, Jörn; Rössler, Wulf; Kawohl, Wolfram
Greater sustainability in mental health services is frequently demanded but seldom analyzed. Levels of cooperation, job satisfaction, and burnout are indicators of social sustainability in this field and are of particular importance to medical staff. Because registered psychiatrists play a central role, we assessed the status quo and interactions between these three factors among registered psychiatrists in Switzerland. A postal survey with three standardized questionnaires about cooperation, job satisfaction, and burnout was conducted among all registered psychiatrists in the German-speaking part of Switzerland (n = 1485). Addresses were provided by the Swiss Medical Association. Response rate was 23.7% (n = 352), yielding a largely male sample (62.8%; n = 218) aged 55.5 ± 8.7 years old. Quantity (47 ± 56.2 contacts over 3 months) and duration (91.1 ± 101.6 min per week) of cooperation was found to be diverse depending on the stakeholder. Quality of cooperation was greatest in general practitioners (81.5%) while it was worst in community mental health providers (54.9%). Overall job satisfaction was assessed rather high (3.7 ± 0.8), and burnout rates were below crucial values (Emotional Exhaustion, 2.9 ± 0.8; Depersonalization, 1.9 ± 0.5). Both were positively influenced by cooperation. The strongest correlation was found between job satisfaction and burnout, and both had significant inverse relationships in all dimensions. To foster sustainability in outpatient mental health care regarding cooperation, job satisfaction, and burnout, personal aspects such and age or years of registration, organizational aspects, such as networking and practice setting, as wells as supportive aspects such as psychotherapy, and self-help groups, must be considered. Quality of cooperation should be reinforced in particular. Because Integrated and Managed Care models cover several of these factors, the models should be more strongly
Hunt, Caroline; Hyde, Judy
The aim of the article is to describe the current standards for psychology registration and pathways to training that operate in Australia today, to compare these with international requirements, and to discuss how they relate to the work and training of psychiatrists. The standards and training for practice in psychology involve multiple pathways that are not straightforward for the public or other health practitioners to understand. Most developed nations other than Australia require higher entry requirements into the profession. New national standards set by the Psychology Board of Australia, such as endorsed areas of practice, will lead to greater consistency in standards and make the task of referring to psychologists with the appropriate competencies more straightforward, allowing for greater collaboration between clinical psychology and psychiatry practitioners.
Permin, Henrik; Therkelsen, Jørgen
One of the nerve specialists/psychiatrists of the first part of the 20th. century, Professor Daniel Jacobson (1861-1939), chief physician of the Psychiatric Department, Frederiksberg Hospital, was an outstanding person as regards both character and appearance. He was a tall man, and his artistic looks and charismatic authority made him a popular therapist in the Scandinavian Countries. His patients included not only many devoted females, but also several Nordic artists - among these the Norwegian painter, Edvard Munch. Munch was treated in Jacobsons private nerve clinic at Frederiksberg in 1908-09 and during his stay he painted the characteristic portrait of Jacobson. Here we present a new collection of drawing, caricatures, verse and humorous texts from patients, colleagues and friends.
Chur-Hansen, Anna; Parker, Damon
It is generally considered by many practitioners that psychiatry is an art, that is, one of the humanities, as well as being a science. We systematically collected the views of practitioners and trainee psychiatrists regarding the question 'Is psychiatry an art or a science?' Eleven supervisors and nine trainees were interviewed and their responses analysed, using a qualitative method, the modified framework approach. Several themes emerged from the data: that 'art' and 'science' are different; psychiatry as a discipline is difficult to define; psychiatry demands a broader range of skills than other medical specialties; the relationship of psychology to psychiatry; supervisor cynicism to the 'science' of psychiatry; and the 'art' and 'science' of the assessment process. The tension that exists within the profession's identity as a discipline has important implications for teaching, learning, and clinical and research practices.
Mastronardi, Vincenzo M; Pomilla, Antonella; Ricci, Serafino; D'Argenio, Alberto
Research has indicated that medical doctors and paramedics are at higher risk of being stalked than the general population. In particular, mental health care professionals alone represent one third of the victims of harassment. Because of the lack of studies in this specific sector, especially in Italy, in this study, we examined the stalking of psychiatrists by their patients, considering gender differences and the incidence of stalking in private practice and public mental health clinics in Rome. We found that the rate of stalking in private mental health settings is higher than that in public settings and that the perpetrators of stalking are mainly women who mostly target mental health professionals working in private practice. Implications of the findings are noted and discussed.
Many medical organizations have passed resolutions banning participation of psychiatrists in legal executions, such as the Madrid Declaration of World Psychiatric Association. The Criminal Procedure Act of Japan prohibits the execution of the insane. Although the USA and Japan are both among the few so-called developed countries that have a system of capital punishment, many disputes about psychiatrists' participation in death penalty cases have occurred in the US, but few in Japan. This author has reviewed papers addressing this issue. The U.S. Supreme Court decided in Ford v. Wainwright that the execution of an "insane" inmate was not constitutional. The rationale for excluding the mentally incompetent from execution, however, is not completely clear. The most compelling reason is that execution does not satisfy the requirement for "effective retribution," since the insane criminal is not capable of understanding the implications of the death penalty. Nonetheless, there are those who dispute this interpretation and offer other explanations. Psychiatrists may be called upon to assess a criminal's competency for execution. Some find no problem with this practice, while others object to it stating that it conflicts with the ethical tenet to "first do no harm." Those who argue from a middle position insist on assessing competency while recognizing the existence of problems in making such an assessment. Furthermore, there is controversy over which factors exactly constitutes "competency to be executed." Usually, it is thought to be one's capacity to understand the nature of the death penalty and the reasons why the penalty is to be inflicted, but other arguments exist, including the capacity to assist legal counsel in last minute appeals. The question of whether to offer treatment to death row inmates who have been found incompetent to be executed is also under debate. The first position argues that they should "never be treated", because such prisoners would be
Appelbaum, Paul S; Gold, Azgad
Psychiatrists' relationships with the pharmaceutical and device industries have been a growing focus of attention, with questions raised about the impact of those relationships on prescribing practices, diagnostic criteria, practice guidelines, continuing education, conduct and reporting of research, and patients' and public trust. Indeed, these concerns exist for the medical profession as a whole, with various remedial measures proposed. We suggest that such relationships can be understood as giving rise to a "principal-agent problem," which occurs when an agent (here, a physician) is engaged to advance the interests of another party, the principal (typically a patient), but also faces incentives to promote other interests. Studies suggest that at least some relationships--which include attending industry-sponsored presentations, meeting with marketing representatives, and accepting samples--can alter psychiatrists' and other physicians' behavior in ways that can compromise patients' interests, and that industry-funded research may create bias in the medical literature. These effects are difficult to detect in specific cases, however, because of asymmetries of information and may not be apparent even to physicians themselves. Principal-agent analysis suggests that the possible responses to such problems, including appeals to ethical principles, monitoring behavior, and managing risk-inducing situations, should include consideration of aligning agents' incentives with principals' interests. This type of analysis underscores the similarity of the issues raised by physicians' relationships with industry to problems that arise more generally in society, thus reducing physicians' potential affective responses to these issues and efforts to address them. Finally, such analysis directs attention to the benefits and costs of each alternative, thereby encouraging reliance on evidence as a basis for policy.
Hector A. Garcia
Full Text Available Research suggests that mental health workers are at high risk for burnout, and that burnout can increase staff turnover and reduce quality of care. The Veterans Administration (VA employs over 3000 psychiatrists across the United States, but little is known about burnout in this population. This study was conducted to examine predictors of burnout and intent to leave the VA among a national sample of VA psychiatrists. Participants (N = 125 responded to an anonymous online survey. Regression analyses were used to examine relationships between workplace variables, patient characteristics, and burnout as measured by the Maslach Burnout Inventory-General Survey – which includes sub-scales for cynicism, exhaustion, and professional efficacy – as well as intent to leave the VA. Based on established cut-off scores, 90% of the sample reported high cynicism, 86% reported high exhaustion, and 74% reported high professional efficacy. High cynicism predicted the intent to leave the VA (p = .004. Not feeling part of a coherent team predicted greater cynicism (p = .01, and patient characteristics such as suspected malingering showed a positive trend with cynicism (p = .05. Workplace characteristics such as unfair treatment by supervisors (p = .03 and insufficient resources (p = .001 predicted greater exhaustion. The current findings suggest that burnout is prevalent in the VA psychiatry workforce. Specific administrative measures to reduce burnout may have potential to improve the emotional health of that workforce and ensure high quality of care for the veteran population it serves. The size of both the VA psychiatry workforce and patient population underscores the importance of greater understanding of burnout as it occurs in the VA.
... psychologist and clinical social worker services. 405.2452 Section 405.2452 Public Health CENTERS FOR MEDICARE... THE AGED AND DISABLED Rural Health Clinic and Federally Qualified Health Center Services Federally Qualified Health Center Services § 405.2452 Services and supplies incident to clinical psychologist and...
Weiden, Peter J; Roma, Rebecca S; Velligan, Dawn I; Alphs, Larry; DiChiara, Matthew; Davidson, Brad
To characterize patterns of communication in the offer of long-acting injectable (LAI) antipsychotic medication made by psychiatrists to patients with schizophrenia by (1) examining the style and content of their interaction and (2) determining how these may have driven the ultimate response to recommendations for LAI therapy. This was an observational study conducted at 10 community mental health centers in 3 waves from July 2010 to May 2011. The final dataset for discourse analysis was 33 recorded conversations in which a psychiatrist offered an injectable antipsychotic to a patient with schizophrenia. These visits were transcribed and analyzed by a team of linguists and social scientists. Our primary finding is that, based on analyses of their language during the interview, psychiatrists presented LAI therapy in a negative light. Supporting this, 11 of 33 recommendations (33%) were accepted during the discussion, whereas in the postvisit interview, 27 of 28 patients (96%) who seemed to decline the initial recommendation said they actually would be willing to try LAI treatment. These data support a preliminary hypothesis that the relatively low use of injectable antipsychotic therapies in the United States relative to other parts of the world is not fully attributable to patient rejection of the injectable modality. Rather, psychiatrists' ambivalence regarding the value of LAIs may play a significant role in the perceived difficulty with patient acceptance of this recommendation. © Copyright 2015 Physicians Postgraduate Press, Inc.
OMURTAG, Kenan; JIMENEZ, Patricia T.; RATTS, Valerie; ODEM, Randall; COOPER, Amber R.
Objective To study and describe the use of social networking websites among SART member clinics Design Cross-sectional study Setting University Based Practice Patients Not Applicable Interventions Not Applicable Main Outcome Measure Prevalence of social networking websites among SART member clinics and evaluation of content, volume and location (i.e mandated state, region) using multivariate regression analysis Results 384 SART registered clinics and 1,382 social networking posts were evaluated. Of the clinics, 96% have a website and 30% link to a social networking website. The majority of clinics (89%) with social networking websites were affiliated with non-academic centers. Social networking posts mostly provide information (31%) and/or advertise (28%), while the remaining offer support (19%) or are irrelevant (17%) to the target audience. Only 5% of posts involved patients requesting information. Clinic volume correlates with the presence of a clinic website and a social networking website (pnetworking website like Facebook, Twitter and/or a Web-log (“blog”). Larger volume clinics commonly host social networking websites. These sites provide new ways to communicate with patients, but clinics should maintain policies on the incorporation of social networks into practice. PMID:22088209
Faria, Vanda; Gingnell, Malin; Hoppe, Johanna M; Hjorth, Olof; Alaie, Iman; Frick, Andreas; Hultberg, Sara; Wahlstedt, Kurt; Engman, Jonas; Månsson, Kristoffer N T; Carlbring, Per; Andersson, Gerhard; Reis, Margareta; Larsson, Elna-Marie; Fredrikson, Mats; Furmark, Tomas
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD). We did a randomized clinical trial, within an academic medical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram (20mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSAS-SR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face-matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory - State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605. Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n=24) as compared to covert (n=22) SSRI
Sartorius, Norman; Gaebel, Wolfgang; Cleveland, Helen-Rose
In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stig...
Lieff, Susan; Andrew, Melissa; Tiberius, Richard
Objective: This study examines the issues influencing psychiatrists' decisions to provide care to the under-served geriatric population. Methods: Community-based psychiatrists who see geriatric patients participated in focus group discussions exploring factors that influence the characteristics of their current practices. Results: Personal themes,…
Boutain, Doris M
Educating future registered nurses for social justice is an urgent, yet complex undertaking in undergraduate education. Although the need for social justice education is often highlighted, few articles describe practical teaching strategies for ensuring that undertaking. The purpose of this article is to illustrate how a curricular focus on social justice framed and supported the development of a clinical evaluation tool for undergraduate community health clinical experiences. First, social justice is defined and its relationship to baccalaureate nursing education explained. Then a description is provided of how social justice was highlighted in the vision, curriculum, and community health clinical evaluation tool of a College of Nursing. The article subsequently showcases the content and evaluation of students' journal entries about social justice. The development of the social justice component presented in this article may be useful to nurse educators striving to match theory and practice in the evaluation of social justice in students' community health experience.
Ng, Lillian; Steane, Richard; Chacko, Emme; Scollay, Natalie
The objective of this study was to disseminate advice imparted to early career psychiatrists by a panel of senior colleagues at a Royal Australian and New Zealand College of Psychiatrists symposium, reflecting on things they wished they had known at the earlier stage in their careers. Key themes were extracted from notes taken at the symposium, where opinions were expressed by three senior psychiatrists. There are components in building a sustainable career as a psychiatrist, which include considering one's work environment and relationships with colleagues; self-care, mentorship and reflective practice; and seeking opportunities to teach and research for career progression. The mentorship and advice from senior colleagues can be highly influential. In order to sustain a career that has reward, meaning and longevity, psychiatrists would do well to pay attention to aspects of self-care, stay connected to their loved ones, seek an optimal work-life balance and take an interest in their long term career plans.
Werner, S; Stawski, M; Polakiewicz, Y; Levav, I
Psychiatrists are responsible for providing proper care for people with intellectual disability who have psychiatric disorders. This study examined psychiatrists' perceptions of their own training, knowledge and therapeutic skills, as well as their attitudes towards this population. Questionnaires were distributed to 679 psychiatrists working within the public sector in Israel. Completed questionnaires were returned from 256 psychiatrists (38% response rate). Most (90%) participants reported having had limited training in the diagnosis and treatment of people with intellectual disabilities, while between 34% and 72% reported having inadequate knowledge in specific areas. The findings of limited training and self-perceived inadequate knowledge are at least partially explained by the service model, wherein people with intellectual disabilities are cared for by general mental health services. The identified inadequacies could be overcome through the implementation of a model in which specially trained psychiatrists are deployed within generic services. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.
Full Text Available Introduction. Most suicide victims have a diagnosable psychiatric disorder. Treatment of psychiatric disorders should reduce the number of suicides. Higher psychiatrist-per-population ratio increases the opportunity for contact between the patient and psychiatrist. It is reasonable to hypothesize that the higher psychiatrist density is associated with lower suicide rates. The aim of this study is to examine the association between suicide rates and the psychiatrist density in the European Union countries. These countries are economically and culturally connected and located on the same continent. This is an attempt to study a relatively homogenous sample. Methods. Correlations were computed to examine relationships between age-standardized suicide rates in women and men, psychiatrist density, and the gross national income (GNI per capita. Partial correlations were used to examine the relation between the psychiatrist density and age-standardized suicide rates in women and men controlling for the GNI per capita. Results. Higher suicide rates in women correlated with the higher psychiatrist density. Controlling for the GNI per capita, the psychiatrist density positively correlated with suicide rates both in women and in men. There was a trend towards a negative correlation between the GNI per capita and suicide rates in men. The psychiatrist density was positively associated with the GNI per capita. Conclusion. Probably, higher suicide rates directly and/or indirectly affect the decisions made by policy- and lawmakers regarding mental health services and how many psychiatrists need to be trained. The results of this study should be treated with caution because many confounding variables are not taken into account.
Gazelle, Heidi; Workman, Jamie Olson; Allan, Wesley
It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192…
Berzoff, Joan; Drisko, James
Social work doctoral programs are not adequately preparing students to educate future clinical practitioners. Social work is predominantly a practice profession. Social work's PhD programs must continue the education of excellent researchers while also educating for excellence in practice, teaching, field liaison, and the supervision of practice.…
Eldridge, William D.
A proactive human rights posture in clinical practice connotes a unique value commitment and broad social perspective in which professional influence directs, challenges, and stimulates clientele. Clinical practitioners must examine their values and question allegiance and conformity to human rights standards and social action responsibilities of…
Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh
The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.
Gazelle, Heidi; Rubin, Kenneth H.
In this introductory chapter, guided by developmental psychopathology and developmental science as overarching integrative theoretical frameworks, the authors define three constructs related to social anxiety in childhood (behavioral inhibition, anxious solitude/withdrawal, and social anxiety disorder) and analyze commonalities and differences in…
Undergraduate students in clinical workplace frequently compare their own experiences with those of peers. The research reported in this thesis shows that these so called social comparisons are vital to the process of learning in clinical practice. The first study confirms students’ tendency to
Tan, Jacinta O A; Doll, Helen A; Fitzpatrick, Raymond; Stewart, Anne; Hope, Tony
The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that psychiatrists have a range of attitudes towards patients suffering from anorexia nervosa, and towards the use of compulsory treatment for the disorder. A postal self-completed attitudinal questionnaire was sent to senior psychiatrists in the United Kingdom who were mostly general adult psychiatrists, child and adolescent psychiatrists, or psychiatrists with an interest in eating disorders. Respondents generally supported a role for compulsory measures under mental health legislation in the treatment of patients with anorexia nervosa. Compared to 'mild' anorexia nervosa, respondents generally were less likely to feel that patients with 'severe' anorexia nervosa were intentionally engaging in weight loss behaviours, were able to control their behaviours, wanted to get better, or were able to reason properly. However, eating disorder specialists were less likely than other psychiatrists to think that patients with 'mild' anorexia nervosa were choosing to engage in their behaviours or able to control their behaviours. Child and adolescent psychiatrists were more likely to have a positive view of the use of parental consent and compulsory treatment for an adolescent with anorexia nervosa. Three factors emerged from factor analysis of the responses named: 'Support for the powers of the Mental Health Act to protect from harm'; 'Primacy of best interests'; and 'Autonomy viewed as being preserved in anorexia nervosa'. Different scores on these factor scales were given in terms of type of specialist and gender. In general, senior psychiatrists tend to support the use of compulsory treatment to protect the health of patients at risk and also to protect the welfare of patients in their best interests. In particular, eating disorder specialists tend to support the compulsory treatment of patients with anorexia nervosa independently of views about their decision-making capacity, while
Full Text Available Abstract Background The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that psychiatrists have a range of attitudes towards patients suffering from anorexia nervosa, and towards the use of compulsory treatment for the disorder. Methods A postal self-completed attitudinal questionnaire was sent to senior psychiatrists in the United Kingdom who were mostly general adult psychiatrists, child and adolescent psychiatrists, or psychiatrists with an interest in eating disorders. Results Respondents generally supported a role for compulsory measures under mental health legislation in the treatment of patients with anorexia nervosa. Compared to 'mild' anorexia nervosa, respondents generally were less likely to feel that patients with 'severe' anorexia nervosa were intentionally engaging in weight loss behaviours, were able to control their behaviours, wanted to get better, or were able to reason properly. However, eating disorder specialists were less likely than other psychiatrists to think that patients with 'mild' anorexia nervosa were choosing to engage in their behaviours or able to control their behaviours. Child and adolescent psychiatrists were more likely to have a positive view of the use of parental consent and compulsory treatment for an adolescent with anorexia nervosa. Three factors emerged from factor analysis of the responses named: 'Support for the powers of the Mental Health Act to protect from harm'; 'Primacy of best interests'; and 'Autonomy viewed as being preserved in anorexia nervosa'. Different scores on these factor scales were given in terms of type of specialist and gender. Conclusion In general, senior psychiatrists tend to support the use of compulsory treatment to protect the health of patients at risk and also to protect the welfare of patients in their best interests. In particular, eating disorder specialists tend to support the compulsory treatment of patients with anorexia nervosa
Rammage, L A; Nichol, H; Morrison, M D
The University of British Columbia Voice Clinic provides care to patients with various types of voice disorder, and the effectiveness of therapy is enhanced by an interdisciplinary approach. The Voice Clinic team includes an otolaryngologist, speech pathologist, psychiatrist, and singing teacher consultant. This paper particularly highlights the interactions between the speech pathologist and psychiatrist in their therapy programs for voice disordered patients.
Gaines, A D
This paper explores lay and psychiatric actors' definitions of mental illness by focusing on several aspects of emergency psychiatric diagnosis. First, it considers psychiatric diagnosis as a social and cultural process in which mental illnesses are defined with increasing specificity as individuals move from lay to psychiatric contexts. Second, the paper considers variation in psychiatric residents' conceptions of mental illness, their role in emergency contexts, and lastly, their diagnostic styles. Diagnostic styles are shown to exist and to be grounded in residents' definitions of the situation. It is suggested that the variation in psychiatrists' definitions of the psychiatric situation, especially as regards etiology, plays a prominent, but as yet unnoted, role in producing variability in psychiatric diagnosis. It is also argued that actors' definitions are cultural, grounded in non-professional lay ideology, and are not products of secondary professional socialization.
Full Text Available Abstract Background A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. Method We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. Results Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. Conclusions While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.
Silberzahn-Jandt, G; Schmuhl, H-W
Friedrich Mauz is one of the medical perpetrators of the second tier whose biography is difficult to comprehend. Autobiographies from three different political systems exist - Weimar Republic, the Third Reich, and postwar Germany in which he constantly reinvented himself. While after 1933 he suddenly emphasized his participation in the civil war turmoil during the early period of the Weimar Republic and his patriotism, he then depicted himself after 1945 as an apolitical person characterized by Württemberg pietism who inwardly rejected the Nazi State but had found himself prepared to accept "all sorts of humiliating concessions." He claimed that he had always remained true to his scientific code of conduct and had distanced himself from psychiatric genetics. In point of fact, Mauz was among those exonerated in the denazification trial in 1946 and was able to pursue his career in the Federal Republic of Germany. However, if the sources are read against the grain, a different picture emerges. Mauz's career stalled in the 1930s, not because he had been politically offensive, but because his scientific work was flimsy and considered lacking originality, particularly since he had chosen constitution research and psychotherapy as his main fields of interest, which were overshadowed by research in genetic psychiatry in the 1930s. Mauz tendered his services to the Nazi policy of genetic health, served as a medical assessor in proceedings based on the "Law for the Prevention of Genetically Diseased Offspring," permitted himself to be recruited for the T4 program as a medical expert, even participated in the deliberations on a future "Law on Euthanasia," and as a consulting psychiatrist for the German Armed Forces contributed to military medicine.
Álvaro-González, Luis C
Human social capacities are developmentally late and unique. They allow for a specialisation that enhances the availability of resources and facilitates reproduction. Our social complexity rests on specific circuits and mechanisms, which are analysed here. The following are put into operation for those purposes: knowledge of the other by means of empathy, specific mechanisms that endow us with the capacity to detect defrauders, genetic and biochemical factors, and the autonomic nervous system. Empathy is the basic mechanism in sociability. It has different levels of complexity (emotional, cognitive, attribution), with specific anatomical differentiation. Social matters are linked to emotional ones, and this in turn to the homeostatic aspects. Hence, physical and social pain share an anatomical matrix and therapies. We are social beings of a selfish biological nature, which we adjust thanks to a special capacity to detect defrauders, which is dominant over those involving planning or abstraction. Oxytocin is the essential prosocial neurochemical mediator. Serotonin and the enzyme MAO are considered as having an antisocial capacity, which is dependent on the interaction with adverse environments. Finally, the vagal system, which is more recent phylogenetically speaking and myelinated, that of the dorsal nucleus of the vagus nerve, is a requirement for warm and leisurely social interaction. The neurobiology of social matters makes it possible to recognise disorders affecting this behaviour in structural injuries (vascular, of the white matter, dementias, etc.), neurodevelopmental disorders (autism), psychiatric illnesses (schizophrenia) or personality disorders. There are a number of promising therapeutic interventions (transcranial magnetic stimulation, drugs). The addition of cultural and environmental factors to the neurobiological ones introduces a greater amount of ecological complexity, but without lessening the validity of what it outlined.
Simoes, E; Sokolov, A N; Graf, J; Pavlova, M A; Brucker, S Y; Wallwiener, D; Schmahl, F W; Bamberg, M
Advances in biomedicine, especially molecular biology and genetics, gave rise to the concept of personalized medicine targeting the patient's individual characteristics and needs to ensure the best possible therapy and healthcare. This concept, however, can be successfully implemented only if due consideration is given to (psycho-)social factors, as is shown for instance by considerably reduced post-therapy survival rates among cancer patients in regions with lower socioeconomic status, How breast cancer patients, for instance, find their way back to daily life and work after initial treatment at a breast center is substantially determined by multiple factors going beyond pure medical care. These factors critically affect health status and therapy outcomes, but are missing in current research agenda. A profound expertise in social medicine is required to respond in ways tailored to the individual's healthcare needs that go beyond just medical therapy. This expertise comprises, in particular, knowledge of inequality of access to healthcare due to varying health competence that in turn, results in inequality of health outcome and care. Competence in social medicine both in the clinic and outpatient care can help to individually target negative factors that originate from the social environment as well as from deficits in communication and coordination in the healthcare system and have an effect on the health status of patients..This, however, requires institutionalization of (clinical) social medicine and in particular, better opportunities for advanced training in social medicine in clinical departments and outpatient units. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available This article uses the mass-media career of the British psychiatrist David Stafford-Clark (1916-1999 as a case study in the exercise of cultural authority by celebrity medical professionals in post-war Britain. Stafford-Clark rose to prominence in the mass media, particularly through his presenting work on medical and related topics for BBC TV and Radio, and was in the vanguard of psychiatrists and physicians who eroded professional edicts on anonymity. At the height of his career, he traded upon his celebrity status, and consequent cultural authority, to deliver mass media sermons on a variety of social, cultural, and political topics. Stafford-Clark tried to preserve his sense of personal and intellectual integrity by clinging to a belief that his authority in the public sphere was ultimately to be vindicated by his literary, intellectual, and spiritual significance. But as his credibility dwindled, he came to distrust the cultural intermediaries, such as broadcasters and publishers, who had supported him.
McIvor, Ronan J; Potter, Laurence; Davies, Lisa
Mental health professionals are at greater risk than the general population of being stalked, particularly by patients. To assess the prevalence of stalking behaviour by patients towards psychiatrists and ascertain patient characteristics. Semi-structured questionnaire to all psychiatrists (n = 324) working in a large mental health organization. The response rate was 61% (n = 198). Forty-one doctors (21%) reported having been stalked by patients, the majority being consultants (n = 31; 76%). No sub-speciality was over-represented. Most stalkers (n = 24; 59%) were male with a diagnosis of personality disorder (39%) or major mental illness (34%). Duration of stalking ranged from several weeks to 16 years, and most commonly occurred at work. On average, victims experienced two types of inappropriate contact. Physical threats were made against 14 psychiatrists (34%). Stalking by patients towards psychiatrists is common and represents an important occupational risk. Formal training programmes and policy development within healthcare organizations may help manage risk.
Alečković-Nikolić Mila S.
Full Text Available This paper analyzes the problem of the nature of the most difficult nosologic psychopathological diagnosis - psychopathy in all its features, the neurological and psychological, the social and the political. The paper also analyzes the analogy: the character of the society vis-à vis the character of the individual. In the second part, this work develops the concept of psychopathy as a general 'picture of the world,' a period of time and the community, with special reference to the harsh financial Darwinism and the Serbian society today (2014. The conclusion of the paper is that it is impossible to diagnose any disease as psychopathy if the psychiatric and psychological analysis does not include an analysis of sociologists, pedagogues, and especially psychologists of morality and ethicists. Finally, the attitude of the author is that every psychiatrist and psychologist who meet with psychopathy and judge it absolutely needs to know the most important ethical doctrine (deontology and utilitarianism, their opposition, as well as their consequences.
Kohn, Robert; Szabo, Christopher P; Gordon, Alan; Allwood, Clifford W
The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.
Kato, Takahiro A; Tateno, Masaru; Shinfuku, Naotaka; Fujisawa, Daisuke; Teo, Alan R; Sartorius, Norman; Akiyama, Tsuyoshi; Ishida, Tetsuya; Choi, Tae Young; Balhara, Yatan Pal Singh; Matsumoto, Ryohei; Umene-Nakano, Wakako; Fujimura, Yota; Wand, Anne; Chang, Jane Pei-Chen; Chang, Rita Yuan-Feng; Shadloo, Behrang; Ahmed, Helal Uddin; Lerthattasilp, Tiraya; Kanba, Shigenobu
To explore whether the 'hikikomori' syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated. Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment. Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents' felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization. Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.
Kato, Takahiro A.; Tateno, Masaru; Shinfuku, Naotaka; Fujisawa, Daisuke; Teo, Alan R.; Sartorius, Norman; Akiyama, Tsuyoshi; Ishida, Tetsuya; Choi, Tae Young; Balhara, Yatan Pal Singh; Matsumoto, Ryohei; Umene-Nakano, Wakako; Fujimura, Yota; Wand, Anne; Chang, Jane Pei-Chen; Chang, Rita Yuan-Feng; Shadloo, Behrang; Ahmed, Helal Uddin; Lerthattasilp, Tiraya; Kanba, Shigenobu
Purpose To explore whether the ‘hikikomori’ syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated. Methods Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment. Results Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents’ felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization. Conclusions Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings. PMID:21706238
Pfalzgraf, Andrea R; Scott, Virginia; Makela, Eugene; Kavookjian, Jan; Hartsock, Steven L; Miller, Lesley-Ann
Major depressive disorder (MDD) is a serious U.S. public health problem for children and adolescents. This study examined the type and course of treatment and monitoring habits of child psychiatrists treating newly diagnosed children and adolescents with MDD. Length of treatment and monitoring frequency were compared to current recommendations. A national random sample of child psychiatrists (N = 2,250) was surveyed via a modified Dillman approach to mailed surveys. Descriptive statistics and t-tests were used to report and analyze the data. Of 1,982 surveys that were delivered to child psychiatrists, 316 (15.9%) were returned, with 299 surveys (15.1%) providing usable data. The child psychiatrists who responded to the survey reported that they use a combination of antidepressant and psychotherapy treatment, although many (40.1%) treat children with psychotherapy alone as a first-line treatment. With regard to pharmacotherapy for MDD, the child psychiatrists self-reported using fluoxetine or sertraline. Many child psychiatrists also use bupropion or other drug classes as a third-line treatment strategy. The child psychiatrists reported that they treat children and adolescents with antidepressant medication for an average of 10 months. This is significantly (p monitoring reported was significantly (p monitoring did not differ (p = 0.10) from FDA recommendations in the third month. Child psychiatrists reported using combination treatment when treating children and adolescents with MDD. When they reported using antidepressant medications, the most commonly prescribed agents were fluoxetine or sertraline. Reported length of antidepressant treatment was adequate for relapse prevention. The monitoring behavior reported by respondents was not consistent with the FDA's recommendations for the first 2 months of treatment, but it was consistent for month 3.
Bodner, Ehud; Shrira, Amit; Hermesh, Hagai; Ben-Ezra, Menachem; Iancu, Iulian
This study examines the relationship between psychiatrists׳ fear of death and negative emotions toward patients with borderline personality disorder (BPD). A survey (N=120) demonstrated that fear of death is associated with stronger negative attitudes toward BPD patients, after controlling for attitudes toward suicide. Our findings emphasize the importance of psychiatrists׳ awareness to their fear of death as a relevant factor for their emotions toward BPD patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Perinelli, Enrico; Gremigni, Paola
There is still an open debate about the utility of social desirability indicators. This report systematically reviewed the use of social desirability scales in studies addressing social desirability in clinical psychology. A systematic review (January 2010-March 2015) was conducted, including 35 studies meeting the inclusion criteria of being published in peer-reviewed journals and describing quantitative findings about an association of social desirability with clinical psychology variables using a cross-sectional or longitudinal design. Social desirability was associated with self-reports of various clinical-psychological dimensions. Most of the included studies treated social desirability as a 1-dimensional variable and only 10 of 35 disentangled the impression management and self-deception components. Although theoretical literature does not consider social desirability a mere response bias, only 4 of the reviewed articles controlled for the possible suppressor effect of personality variables on social desirability, while the majority focused upon the stylistic (response bias) rather than the substantive (personality) nature of this construct. The present review highlighted some limitations in the use of social desirability scales in recent clinical psychology research and tried to offer a few suggestions for handling this issue. © 2016 Wiley Periodicals, Inc.
Full Text Available Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study’s qualitative phase identified four themes in the decision to participate in telepsychiatry: (1 organizational, (2 shared values, (3 innovation, and (4 the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners.
Del Piccolo, Lidia; Danzi, Olivia; Fattori, Nives; Mazzi, Maria Angela; Goss, Claudia
To describe how emotions are disclosed during psychiatric diagnostic consultations and the contribution of the psychiatrists in facilitating their expression. Descriptive naturalistic study. Sixteen psychiatrists recorded their first consultations with 104 patients. Emotions and the immediate response given by the psychiatrist were coded with the Verona Coding Definitions of Emotional Sequences. For each disclosed emotion, the potential link to preceding expressions with affective content (cue or concern) was checked and the immediate response given by the psychiatrist was coded. Most emotions were expressions of anxiety in terms of psycho-physiological or cognitive correlates. Concerns were present in 94% of the consultations, 47.6% were not linked to previous cues/concerns. Cues which became concerns and concerns which were further elaborated by the patient were those that had been acknowledged and handled by the psychiatrist by actively providing space to their expression. Compared to all other diagnostic groups, patients with mood disorders talked more explicitly and more often about their feelings. The type and frequency of expressed emotions varies with patient diagnosis, suggesting different cognitive processes underlining psychopathology. Psychiatrist's competence in providing space by using active listening skills is essential to uncover patients emotions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Armontrout, James; Gitlin, David; Gutheil, Thomas
Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in "gray area" cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds. Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying "yes/no" question regarding capacity and a certainty scale for each vignette. Participants were identified from mailing lists of professional organizations and local hospitals. We received responses from psychiatry trainees, consultation-liaison psychiatrists, forensic psychiatrists, and lawyers with experience in health care law. Results were analyzed using SPSS. Across the 3 vignettes, the percentage agreeing that the individual described had capacity to refuse medical treatment ranged between 35% and 40% for trainees, 33% and 67% for consult psychiatrists, 41% and 76% for forensic psychiatrists, and 40% and 83% for health care lawyers. Only question 2 reached significance between-group differences (Pearson χ(2) = 11.473, p opinions on capacity. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
М.SH. JAMANTAYEVA; A.S. SUBHANBERDINA; N.E. DUNENBAYEV; D.M.SERGAZIYEV
The article reveals some clinical and social characteristics of women registered on a drug-abuse dispensary with mental and behavioral disorders due to use of drugs. The present study points to their influence on structural dynamic characteristics of social adaptation of patients. There are some comprehensive measures of medical and rehabilitative activities directed at outpatient drug treatment.
Kopp, Svenny; Kelly, Kristina Berg; Gillberg, Christopher
Objective: Examine clinical correlates and distinguishing features of autism spectrum disorders (ASD), ADHD, and tic disorders in girls referred for social impairment, attention/academic deficits, and/or tics. Method: One hundred 3- to 18-year-old girls referred for social impairment and attention symptoms were assessed in detail. Sixty of these…
Faculty members are key stakeholders to support social work students' learning about race and racism in practice and to promote the professional standards established by the field. This qualitative study examines how 15 clinical social work faculty members teaching advanced practice in the Northeast conceptualize and incorporate their…
Pugliese, Cara E.; White, Bradley A.; White, Susan W.; Ollendick, Thomas H.
The present study examined the degree to which social anxiety predicts aggression in children with high functioning autism spectrum disorders (HFASD, n = 20) compared to children with Social Anxiety Disorder (SAD, n = 20) or with Oppositional Defiant Disorder or Conduct Disorder (ODD/CD, n = 20). As predicted, children with HFASD reported levels…
A strong movement has emerged recently which is highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this 'gap' in mental health care. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners 'on the ground'. Employing a narrative-based approach, I accessed the stories about the mental health 'treatment gap' of 28 psychiatrists all working clinically in public mental health care settings in South Africa, Uganda, Nigeria or Ethiopia. Rather than focusing on the content of these stories, I was more interested in their underpinning meaning-codes and epistemological politics. Dominant thinking about the 'treatment gap' was heavily informed by a biomedical paradigm, and associated epistemological order of European Colonial Modernity. There were, however, cracks in this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which appears to be informed by the tradition of phenomenology, and in particular the ideas associated with French philosopher Merleau-Ponty. This more marginalised thinking may offer important insights into reducing the mental health 'treatment gap' in Africa in ways very different from those created by current seats of power.
In this "digital age," the model of healthcare is changing rapidly, primarily in the area of communication that is happening among the major stakeholders each minute. Patients, being the central point of the importance of all the work and development, are more empowered than ever with information from various sources, among which social media is leading from the front. This article reviews how social media engages healthcare service providers, service seekers, and regulatory authorities. If the gaps in the current regulations are filled, better healthcare outputs can be triggered. This article also briefly explores the popular healthcare applications launched by leading pharmaceutical companies, encompassing the big data advantage, in this evolving era of patient centricity.
Cruwys, Tegan; Alexander Haslam, S; Dingle, Genevieve A; Jetten, Jolanda; Hornsey, Matthew J; Desdemona Chong, E M; Oei, Tian P S
Clinical depression is often preceded by social withdrawal, however, limited research has examined whether depressive symptoms are alleviated by interventions that increase social contact. In particular, no research has investigated whether social identification (the sense of being part of a group) moderates the impact of social interventions. We test this in two longitudinal intervention studies. In Study 1 (N=52), participants at risk of depression joined a community recreation group; in Study 2 (N=92) adults with diagnosed depression joined a clinical psychotherapy group. In both the studies, social identification predicted recovery from depression after controlling for initial depression severity, frequency of attendance, and group type. In Study 2, benefits of social identification were larger for depression symptoms than for anxiety symptoms or quality of life. Social identification is subjective and psychological, and therefore participants could not be randomly assigned to high and low social identification conditions. Findings have implications for health practitioners in clinical and community settings, suggesting that facilitating social participation is effective and cost-effective in treating depression. Copyright © 2014 Elsevier B.V. All rights reserved.
In reply to Dr Benians's article which suggests that social workers at times abuse their authority, three areas can be considered: the broader context of the social work task, the legal process itself, and the contribution made by child psychiatrists.
Lau, Chuen-Yen; Swann, Edith M.; Singh, Sagri; Kafaar, Zuhayr; Meissner, Helen I.; Stansbury, James P.
HIV vaccine clinical research occurs within a context where biomedical science and social issues are interlinked. Previous HIV vaccine research has considered behavioral and social issues, but often treated them as independent of clinical research processes. Systematic attention to the intersection of behavioral and social issues within a defined clinical research framework is needed to address gaps, such as those related to participation in trials, completion of trials, and the overall research experience. Rigorous attention to these issues at project inception can inform trial design and conduct by matching research approaches to the context in which trials are to be conducted. Conducting behavioral and social sciences research concurrent with vaccine clinical research is important because it can help identify potential barriers to trial implementation, as well as ultimate acceptance and dissemination of trial results. We therefore propose a conceptual framework for behavioral and social science in HIV vaccine clinical research and use examples from the behavioral and social science literature to demonstrate how the model can facilitate identification of significant areas meriting additional exploration. Standardized use of the conceptual framework could improve HIV vaccine clinical research efficiency and relevance. PMID:21821083
Lau, Chuen-Yen; Swann, Edith M; Singh, Sagri; Kafaar, Zuhayr; Meissner, Helen I; Stansbury, James P
HIV vaccine clinical research occurs within a context where biomedical science and social issues are interlinked. Previous HIV vaccine research has considered behavioral and social issues, but often treated them as independent of clinical research processes. Systematic attention to the intersection of behavioral and social issues within a defined clinical research framework is needed to address gaps, such as those related to participation in trials, completion of trials, and the overall research experience. Rigorous attention to these issues at project inception can inform trial design and conduct by matching research approaches to the context in which trials are to be conducted. Conducting behavioral and social sciences research concurrent with vaccine clinical research is important because it can help identify potential barriers to trial implementation, as well as ultimate acceptance and dissemination of trial results. We therefore propose a conceptual framework for behavioral and social science in HIV vaccine clinical research and use examples from the behavioral and social science literature to demonstrate how the model can facilitate identification of significant areas meriting additional exploration. Standardized use of the conceptual framework could improve HIV vaccine clinical research efficiency and relevance. Published by Elsevier Ltd.
Stickney Ferguson, Stacy; Randall, Jill; Dabney, Jane; Kalbacker, Marion E; Boyle, Nancy; Thao, Viengneesee; Murphy, Elizabeth A; Denzen, Ellen M
Clinical social workers are psychosocial care experts who provide interventions that aim to address the emotional, relational, financial, and logistical challenges that arise throughout the hematopoietic cell transplantation (HCT) treatment and recovery process. Interventions that contribute to better patient outcomes can include cognitive behavioral therapy and counseling for adaptation to illness, family planning for 24/7 caregiver availability and strategies to support patient activities of daily living, instruction on guided imagery and relaxation techniques for symptom management and to decrease anxiety, psychoeducation on the treatment trajectory, and linkage with financial resources. A Social Work Workforce Group (SWG) was established through the System Capacity Initiative, led by the National Marrow Donor Program/Be The Match, to characterize the current social work workforce capacity and challenges. The SWG conducted a web-based survey of HCT clinical social workers in the United States. The response rate was 57% (n = 90), representing 76 transplant centers. Survey results indicated that the clinical social worker role and scope of practice varies significantly between centers; less than half of respondents reported that their clinical social work expertise was used to its fullest potential. With an estimated 3-fold increase in HCT patient volume by 2020, the need for specialized psychosocial health services will increase. The SWG makes recommendations to build capacity for the psychosocial care of HCT patients and to more fully integrate the social worker as a core member of the HCT team. The SWG created a Blood and Marrow Transplant (BMT) Clinical Social Worker role description that can be used by transplant centers to educate healthcare professionals, benchmark utilization of clinical social workers, and improve comprehensive psychosocial health programs. Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by
Bourla, A; Ferreri, F; Ogorzelec, L; Guinchard, C; Mouchabac, S
The search for objective clinical signs is a constant practitioners' and researchers' concern in psychiatry. New technologies (embedded sensors, artificial intelligence) give an easier access to untapped information such as passive data (i.e. that do not require patient intervention). The concept of "digital phenotype" is emerging in psychiatry: a psychomotor alteration translated by accelerometer's modifications contrasting with the usual functioning of the subject, or the graphorrhea of patients presenting a manic episode which is replaced by an increase of SMS sent. Our main objective is to highlight the digital phenotype of mood disorders by means of a selective review of the literature. We conducted a selective review of the literature by querying the PubMed database until February 2017 with the terms [Computer] [Computerized] [Machine] [Automatic] [Automated] [Heart rate variability] [HRV] [actigraphy] [actimetry] [digital] [motion] [temperature] [Mood] [Bipolar] [Depression] [Depressive]. Eight hundred and forty-nine articles were submitted for evaluation, 37 articles were included. For unipolar disorders, smartphones can diagnose depression with excellent accuracy by combining GPS and call log data. Actigraphic measurements showing daytime alteration in basal function while ECG sensors assessing variation in heart rate variability (HRV) and body temperature appear to be useful tools to diagnose a depressive episode. For bipolar disorders, systems which combine several sensors are described: MONARCA, PRIORI, SIMBA and PSYCHE. All these systems combine passive and active data on smartphones. From a synthesis of these data, a digital phenotype of the disorders is proposed based on the accelerometer and the GPS, the ECG, the body temperature, the use of the smartphone and the voice. This digital phenotype thus brings into question certain clinical paradigms in which psychiatrists evolve. All these systems can be used to computerize the clinical characteristics
Feb 17, 2004 ... World Association of Social Psychiatry (WASP) in association with the. South African Society of Psychiatrists (SASOP) with support from the. World Psychiatric Association (WPA) invites you to the. 1st Regional Congress of Social Psychiatry in Africa. Where: Caesars Convention Centre, Johannesburg, ...
Schreiber, Gabriel; Avissar, Sofia; Jotkowitz, Alan; Halperin, Demian
The patient-psychiatrist relationship is a cornerstone of psychiatric professionalism and ethics. We discuss this topic along the axis of the Other and the Same, concepts defined by continental philosophy. The self of Anglo-American philosophy is typically described in individualistic terms. Individualism, autonomy and ideal self are valorized within the current model of care. These characteristics belong to the Lacanian Imaginary Order, which is the core of narcissism. Patients may yearn for another model of interaction. For Levinas, ethics should not involve a search for perfectionism and accomplishment but responsibility toward others. Ethics is, according to him, rooted in the calling into question of one's Sameness by the other's Otherness. The question of hospitality and of the welcoming of Otherness is central to his thought. Derrida further asks whether hospitality is not an interruption of the self. Hospitality may thus become a fundamental way of re-thinking clinical practices. A relationship to the Other as an-other is characterized as of Euclidian-type, establishing borders between the self and the Other, whereas a relationship to the Other as same is characterized as of fractal-type, emphasizing similarities between self and other as same and obliterating boundaries. Winnicott's object-relating versus use of object and Buber's I-you and I-it relations are also examined along the axis of Sameness and Otherness. Since psychiatric clinical practice requires to our view adequate and adaptive to and fro movements along this axis, the two forms of relating to the Other are discussed both theoretically and through a clinical case presentation.
Klein, A.M.; Rapee, R.M.; Hudson, J.L.; Schniering, C.A.; Wuthrich, V.M.; Kangas, M.; Lyneham, H.J.; Souren, P.M.; Rinck, M.
The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral
Korea and Japan are geographically very close, and a variety of cultural exchanges have taken place in recorded history. However, Korea and Japan have been enriched by the influence of Western cultures along with modernization, and mutual exchanges between the two countries have thus decreased in numerous fields including mental health and psychiatry. Prof. Masahisa Nishizono and Prof. Byun-Kun Min, who are leaders in the field of psychiatry in both Japan and Korea, have established "The Joint Workshop for Psychiatric Residents of Korea and Japan", which has been held alternately in Fukuoka or Seoul every summer since 2000. This Joint Workshop provides young psychiatrists with real experiences and many opportunities to learn about transcultural psychiatry regarding both countries. The participants are able to obtain a better mutual understanding of psychiatric epidemiology, recent developments in biological psychiatry while also learning about different concepts regarding the stigma of mental disorders. All participants could also increase their knowledge about the traditional culture and social changes related to the field of psychiatry in both countries. The workshop has helped to build friendship and mutual cooperation between both nations. Contemporary societies are continually becoming more and more diversified and complicated. For young psychiatrists who have to treat patients with modern difficulties and various complicated problems, such cross-cultural experiences may be useful for establishing potentially new and effective treatments for such patients. Psychiatrists and mental health experts have tried to reduce of stigma and discrimination against people with mental disorders, but even today such stigma and discrimination continues to strongly exist. The author thinks that such cross-cultural experiences by the psychiatrists themselves may help to reduce such notions. The author would like to explore the role of cross-cultural experiences in the field of
Nolidin, Karen; Downey, Luke A; Hansen, Karen; Schweitzer, Issac; Stough, Con
Impairments in emotional intelligence (EI) have been found in individuals with high general and social anxiety; however, no studies have examined this relationship in a clinically depressed population. Thirty-one patients (11 male, 20 female) with a DSM-IV-TR diagnosis of a major affective disorder and 28 non-clinical controls (5 male, 23 female) completed self-report instruments assessing EI, depression and social anxiety. Compared to a control group, the clinical group scored lower on the EI dimensions of Emotional Recognition and Expression, Understanding Emotions, Emotional Management, and Emotional Control. Regression analyses revealed Emotional Control was a significant predictor of interaction, performance, and generalised social anxiety. Self-report measures of EI may have predictive value in terms of early identification of those at risk of developing social anxiety and depression. The current study points to the potential value of conducting further studies of a prospective nature.
Blackman, Gabrielle L.; Ostrander, Rick; Herman, Keith C.
Although ADHD and depression are common comorbidities in youth, few studies have examined this particular clinical presentation. To address method bias limitations of previous research, this study uses multiple informants to compare the academic, social, and clinical functioning of children with ADHD, children with ADHD and depression, and…
Vriends, N.; Pfaltz, M. C.; Novianti, P.; Hadiyono, J.
Background: Taijin Kyofusho Scale (TKS) is an interpersonal fear to offend others and is defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a culturally bound syndrome that occurs in Japan and Korea. Recently, cases with TKS have also been recognized in other cultures. The present questionnaire study investigated self-report TKS symptoms and social anxiety symptoms, and their clinical relevance in an Indonesian and Swiss sample. It also investigated whether self-construal is associated with TKS and social anxiety, and if self-construal is a mediator of the expected association between cultural background and social anxiety and TKS symptoms. Method: 311 Indonesian and 349 Swiss university students filled out the Liebowitz Social Anxiety Scale, the Taijin Kyofusho Scale, the Self-Construal Scale, self-report social phobia DSM-IV criteria, and rated their wish for professional help to deal with social fears. Results: TKS and social anxiety symptoms were higher in the Indonesian than the Swiss sample. TKS symptoms were associated with clinical relevance in Indonesia, whereas in Switzerland only social anxiety symptoms were associated with clinical relevance. Independent self-construal was negatively associated and interdependent self-construal was positively associated with TKS and social anxiety symptoms. Interdependent self-construal mediated the association between cultural background and these symptoms. Discussion: TKS might be a clinically relevant syndrome in all individuals or cultures with an interdependent self-construal or less independent self-construal. The proposal to include the fear of offending others in the DSM-V criteria of social phobia is supported by the present findings. PMID:23382720
Rosa, Ana Carolina; Diniz, Juliana Belo; Fossaluza, Victor; Torres, Albina Rodrigues; Fontenelle, Leonardo Franklin; De Mathis, Alice Simões; da Conceição Rosário, Maria; Miguel, Eurípedes Constantino; Shavitt, Roseli Gedanke
Patients with obsessive-compulsive disorder (OCD) frequently show poor social adjustment, which has been associated with OCD severity. Little is known about the effects that age at symptom onset, specific OCD symptoms, and psychiatric comorbidities have on social adjustment. The objective of this study was to investigate the clinical correlates of social functioning in OCD patients. Cross-sectional study involving 815 adults with a primary DSM-IV diagnosis of OCD participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were assessed with the Social Adjustment Scale, the Medical Outcomes Study 36-item Short-Form Health Survey, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Clinical correlates of social adjustment were assessed with generalized linear models with gamma distribution. Poor overall social functioning was associated with greater OCD severity (p = 0.02); hoarding symptoms (p = 0.004); sexual/religious obsessions (p = 0.005); current major depressive disorder (p = 0.004); current post-traumatic stress disorder (p = 0.002); and current eating disorders (p = 0.02). Poor social adjustment was also associated with impaired quality of life. Patients with OCD have poor social functioning in domains related to personal relationships and professional performance. Hoarding symptoms and sexual/religious obsessions seem to have the strongest negative effects on social functioning. Early age at OCD symptom onset seems to be associated with professional and academic underachievement and impairment within the family unit, whereas current psychiatric comorbidity worsen overall social functioning. In comparison with quality of life, social adjustment measures seem to provide a more comprehensive overview of the OCD-related burden. Copyright © 2012 Elsevier Ltd. All rights reserved.
Lawrence, Ryan E; Rasinski, Kenneth A; Yoon, John D; Curlin, Farr A
Historical evidence and prior research suggest that psychiatry is biased against religion, and religious physicians are biased against the mental health professions. Here we examine whether religious and non-religious physicians differ in their treatment recommendations for a patient with medically unexplained symptoms. We conducted a national survey of primary care physicians and psychiatrists. We presented a vignette of a patient with medically unexplained symptoms, and experimentally varied whether the patient was religiously observant. We asked whether physicians would recommend six interventions: antidepressant medication, in-office counseling, referral to a psychiatrist, referral to a psychologist or licensed counselor, participation in meaningful relationships and activities, and involvement in religious community. Predictors included the physician's specialty and the physician's attendance at religious services. The response rate was 63% (896 of 1427) primary care physicians and 64% (312 of 487) psychiatrists. We did not find evidence that religious physicians were less likely to recommend mental health resources, nor did we find evidence that psychiatrists were less likely to recommend religious involvement. Primary care physicians (but not psychiatrists) were more likely to recommend that the patient get more involved in their religious community when the patient was more religiously observant, and when the physician more frequently attended services. We did not find evidence that mental health professionals are biased against religion, nor that religious physicians are biased against mental health professionals. Historical tensions are potentially being replaced by collaboration.
Dębska, Ewa; Szczegielniak, Anna; Skowronek, Anna; Wydra, Katarzyna; Frey, Przemysław; Skowronek, Rafał; Krysta, Krzysztof
The term "aggression" refers to forceful behavior, action, or attitude that is expressed physically, verbally, or symbolically. Aggression in the medical environment can have different forms. The interactions between psychiatrists and patients may be one of the reasons for the appearance of symptoms of aggression in the behaviour of the physicians. The main aim of the study was to evaluate different aspects of aggression among psychiatric professionals. The study was conducted among 132 psychiatrists (97 women and 34 men) from all over Poland. The average age was 43.1±9.48, the average professional experience was 15.76±10.09 years. Authors' original questionnaire and Buss-Perry Aggression Questionnaire were used to evaluate different aspects of aggression. The study showed a correlation between the length of professional experience and the level of verbal aggression (p=0.022) as well as with the level of hostility (paggression among psychiatrists. These negative emotions are also present in relations with patients. The exposure to verbal aggression inflicted by patients causes the increase of verbal aggression, anger and hostility among psychiatrists. Significant occurrence of general aggression among psychiatrists caused by difficult relations with co-workers and patients suggests the importance and necessity of providing appropriate support for this professional group in their work environment.
Sartorius, Norman; Gaebel, Wolfgang; Cleveland, Helen-Rose
In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stig...... of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence....... and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series...... psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention...
In recent decades, historians of English psychiatry have shifted their major concerns away from asylums and psychiatrists in the nineteenth century. This is also seen in the studies of twentieth-century psychiatry where historians have debated the rise of psychology, eugenics and community care. This shift in interest, however, does not indicate that English psychiatrists became passive and unimportant actors in the last century. In fact, they promoted Lunacy Law reform for a less asylum-dependent mode of psychiatry, with a strong emphasis on professional development. This paper illustrates the historical dynamics around the professional development of English psychiatry by employing Andrew Abbott's concept of professional development. Abbott redefines professional development as arising from both abstraction of professional knowledge and competition regarding professional jurisdiction. A profession, he suggests, develops through continuous re-formation of its occupational structure, mode of practice and political language in competing with other professional and non-professional forces. In early twentieth-century England, psychiatrists promoted professional development by framing political discourse, conducting a daily trade and promoting new legislation to defend their professional jurisdiction. This professional development story began with the Lunacy Act of 1890, which caused a professional crisis in psychiatry and led to inter-professional competition with non-psychiatric medical service providers. To this end, psychiatrists devised a new political rhetoric, 'early treatment of mental disorder', in their professional interests and succeeded in enacting the Mental Treatment Act of 1930, which re-instated psychiatrists as masters of English psychiatry.
Shaoling, Zhong; Jun, Wang; Graham, Mellsop; Chen, Chen; Simei, Zhang; Qiguang, Li; Qun, Wang; Jiansong, Zhou; Xiaoping, Wang
The aim of this study was to investigate the attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. A questionnaire designed to record attitudes toward the current forensic psychiatric assessment procedures and the disposal of mentally ill offenders was developed and distributed via a mobile App. A total of 134 community members and 132 psychiatrists voluntarily completed the questionnaire. Most of responders agreed that the department of public-security has the right to apply for a forensic psychiatric assessment but should not be held solely by that department. Community members were less significantly confident in the validation of forensic psychiatric opinions than were the psychiatrists. A significantly higher proportion of community members than psychiatrists considered that offenders judged Not Criminally Responsible on Account of Mental Disorder (NCRMD) should be punished as would be sane people. In addition, only a minority of responders supported that NCRMD should not be held criminally responsible. Our results indicate that both groups have comments on the current distribution of right of startup of forensic psychiatric assessments. Compared to psychiatrists, community members have lower confidence in the validation of forensic psychiatric assessment and have stricter attitudes toward the disposal of offenders with psychiatric disorders. Copyright © 2017 Elsevier B.V. All rights reserved.
Blech, Benzion; West, Joyce C; Yang, Zhuoyin; Barber, Keila D; Wang, Philip; Coyle, Colleen
Lack of access to mental health treatment remains a significant problem in the United States, even after implementation of mental health parity legislation. This study examined availability of psychiatrists listed in insurance carrier network provider databases in the Washington, D.C., area. Contact information was obtained for 1,184 psychiatrists listed in online directories for three of the largest insurance carriers serving the Washington, D.C., area. The "mystery shopper" method was used to assess the accuracy of listed contact information, new outpatient appointment availability, and average wait times for 50 psychiatrists randomly selected from each insurance directory. Most (77%) physicians were successfully contacted, meaning that someone answered the phone or returned a voice mail message, and 51% of the psychiatrists had working telephone numbers verified to be correct. Fifteen percent of the psychiatrists were accepting new outpatients with the target insurance, with average wait times of 19 days; only 7% were able to schedule an appointment within two weeks. Inaccuracy of insurance provider directories significantly affected the ability of patients to obtain timely mental care.
Arcos-Griffiths, Estela; Muñoz-González, Luz Angélica; Vollrath-Ramírez, Antonia; Sánchez-Segura, Ximena
Knowing the effectiveness of clinical management of primary care health in the field of Integral Protection System for Children "Chile Crece Contigo" and "Red Protege". Observational, descriptive, with information available from secondary sources of Chile Crece Contigo system in the district of Pudahuel, Santiago de Chile. The population was 1,656 pregnant women assigned to Chile Crece Contigo system in 2009. Social vulnerability was measured with the Social Protection Record. Sociodemographic and Chile Crece Contigo system performance variables were selected. It featured a raw and refined database. Processing and analysis of data was performed using the statistical program Statistical Package for Social Sciences and Excel. Descriptive statistics for frequency, position and dispersion were calculated. Certification of Scientific Ethics Committee of the School of Nursing was granted. A 91.4% of institutional social vulnerability detected by screening social protection record was observed. Psychosocial risk was higher in women with social vulnerability (42.0 vs. 28.2%) more often recognized as inadequate family support, depressive symptoms, domestic violence, substance abuse and conflicts with motherhood. In the universal, specific and integrated performance it was not met with 100% access to benefits. The invisibility of the social vulnerability and low effectiveness of the transfer of benefits to socially vulnerable women/children deserves skills development of contextualized and integrated clinical management professionals in primary health care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Schill, Janna Marie
Professional socialization is a process that individuals experience as members of a profession and consists of the knowledge, attitudes, and experiences that influence and shape their professional identity. The process of professional socialization has not been studied in the clinical laboratory science profession. Clinical laboratory science is an allied health profession that is faced by a workforce shortage that has been caused by a decrease in new graduates, decreased retention of qualified professionals, and increased retirements. Other allied health professions such as nursing, athletic training, and pharmacy have studied professional socialization as a way to identify factors that may influence the retention of early career professionals. This mixed method study, which quantitatively used Hall's Professionalism Scale (1968) in addition to qualitative focus group interviews, sought to identify the professional attitudes and behaviors, sense of belonging, and professional socialization of early career clinical laboratory scientists. Early career clinical laboratory scientists were divided into two groups based upon the amount of work experience they had; new clinical laboratory science graduates have had less than one year of work experience and novice clinical laboratory scientists had between one and three years of work experience. This study found that early career clinical laboratory scientists have established professional identities and view themselves as members of the clinical laboratory science field within four proposed stages of professional socialization consisting of pre-arrival, encounter, adaptation, and commitment. New CLS graduates and novice clinical laboratory scientists were found to be at different stages of the professional stage process. New CLS graduates, who had less than one year of work experience, were found to be in the encounter stage. Novice clinical laboratory scientists, with one to three years of work experience, were found to
Naik, Rakhi P; Haywood, Carlton
The sickle hemoglobin (HbS) point mutation has independently undergone evolutionary selection at least five times in the world because of its overwhelming malarial protective effects in the heterozygous state. In 1949, homozygous Hb S or sickle cell disease (SCD) became the first inherited condition identified at the molecular level; however, since then, both SCD and heterozygous Hb S, sickle cell trait (SCT), have endured a long and complicated history. Hasty adoption of early mass screening programs for SCD, recent implementation of targeted screening mandates for SCT in athletics, and concerns about stigmatization have evoked considerable controversy regarding research and policy decisions for SCT. Although SCT is a largely protective condition in the context of malaria, clinical sequelae, such as exercise-related injury, renal complications, and venous thromboembolism can occur in affected carriers. The historical background of SCD and SCT has provided lessons about how research should be conducted in the modern era to minimize stigmatization, optimize study conclusions, and inform genetic counseling and policy decisions for SCT. © 2015 by The American Society of Hematology. All rights reserved.
Eaton, Julian; Bouras, Nick; Jones, Lynne; Hanlon, Charlotte; Stewart, Rob; Patel, Vikram
Regular appraisal and revalidation are now a routine part of professional life for doctors in the UK. For British-trained psychiatrists working abroad (in either development/humanitarian or academic fields) this is a cause of insecurity, as most of the processes of revalidation are tailored to those working in the standard structures of the National Health Service. This article explores the degree to which a peer group for psychiatrists working abroad has achieved its aim of helping its members to fulfil their revalidation requirements. It gives recommendations for how those considering work abroad can maximise their chances of remaining recognised under the revalidation system.
Pandya, Anand; Katz, Craig L; Smith, Rebecca; Ng, Anthony T; Tafoya, Michael; Holmes, Anastasia; North, Carol S
To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future
Milton, Alyssa; Parsons, Nicholas; Morant, Nicola; Gilbert, Eleanor; Johnson, Sonia; Fisher, Adrian; Singh, Swaran; Cunliffe, Di; Marwaha, Steven
UK social firms are under-researched but are a potentially important vocational option for people with mental health problems. To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems. Clinical, work and service use characteristics were collected from social firms' employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively. Predominantly, social firms' employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations. The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.
Olbert, Charles M; Penn, David L; Kern, Robert S; Lee, Junghee; Horan, William P; Reise, Steven P; Ochsner, Kevin N; Marder, Stephen R; Green, Michael F
It is unknown whether measures adapted from social neuroscience linked to specific neural systems will demonstrate relationships to external variables. Four paradigms adapted from social neuroscience were administered to 173 clinically stable outpatients with schizophrenia to determine their relationships to functionally meaningful variables and to investigate their incremental validity beyond standard measures of social and nonsocial cognition. The 4 paradigms included 2 that assess perception of nonverbal social and action cues (basic biological motion and emotion in biological motion) and 2 that involve higher level inferences about self and others' mental states (self-referential memory and empathic accuracy). Overall, social neuroscience paradigms showed significant relationships to functional capacity but weak relationships to community functioning; the paradigms also showed weak correlations to clinical symptoms. Evidence for incremental validity beyond standard measures of social and nonsocial cognition was mixed with additional predictive power shown for functional capacity but not community functioning. Of the newly adapted paradigms, the empathic accuracy task had the broadest external validity. These results underscore the difficulty of translating developments from neuroscience into clinically useful tasks with functional significance.
El Alaoui, Samir; Hedman, Erik; Kaldo, Viktor; Hesser, Hugo; Kraepelien, Martin; Andersson, Evelyn; Rück, Christian; Andersson, Gerhard; Ljótsson, Brjánn; Lindefors, Nils
Internet-based cognitive-behavioral therapy (ICBT) has received increased attention as an innovative approach to improve access to evidence-based psychological treatments. Although the efficacy of ICBT for social anxiety disorder has been established in several studies, there is limited knowledge of its effectiveness and application in clinical psychiatric care. The purpose of this study was to evaluate the effectiveness of ICBT in the treatment of social anxiety disorder and to determine the significance of patient adherence and the clinic's years of experience in delivering ICBT. A longitudinal cohort study was conducted using latent growth curve modeling of patients (N = 654) treated with ICBT at an outpatient psychiatric clinic between 2009 and 2013. The primary outcome measure was the Liebowitz Social Anxiety Scale-Self-Rated. Significant reductions in symptoms of social anxiety were observed after treatment (effect size d = 0.86, 99% CI [0.74, 0.98]). Improvements were sustained at 6-month follow-up (d = 1.15, 99% CI [0.99, 1.32]). Patient adherence had a positive effect on the rate of improvement. A positive association between the clinic's years of experience with ICBT and treatment outcome was also observed. This study suggests that ICBT for social anxiety disorder is effective when delivered within the context of a unit specialized in Internet-based psychiatric care and may be considered as a treatment alternative for implementation within the mental health care system. (c) 2015 APA, all rights reserved).
Liu, Chuan; Wang, Lie; Zhao, Qun
Psychiatry has been considered as one of the most stressful medical specialities, and psychiatrists are likely to experience impaired health-related quality of life (HRQOL). However, few studies are available in regard to related factors of HRQOL among psychiatrists in China. This study aims to evaluate the condition of HRQOL of psychiatrists and explore its predictive factors, especially the effects of occupational stress and psychological capital. A cross-sectional, multicenter survey was conducted among psychiatrists from different regions of Liaoning province, China, during August 2013-April 2014. Self-administrated questionnaires including the 36-item Short-Form Health Survey (SF-36), the Chinese version Psychological Capital Questionnaire, effort-reward-imbalance (ERI) scale and participants' basic characteristics were distributed to 500 psychiatrists from 10 psychiatric hospitals of 8 major cities in Liaoning province. Overall, 373 psychiatrists became our final research objects. Hierarchical multiple regression analysis (HMR) was performed to explore the predictors of psychiatrists' HRQOL. The mean (SD) scores of PCS and MCS among psychiatrists were 79.78 (16.55) and 71.50 (19.24) respectively. The mean (SD) of ERR were 0.777 (0.493), and 89 (23.9%) had ERR scores above 1 (ERR > 1). Hierarchical multiple regression analysis showed that, psychiatrists' basic characteristics that significant correlated with PCS and MCS were educational level, turnover intention, and exercise; age, weekly working hours were associated with MCS; psychiatrists' experienced occupational stress (both ERR and overcommitment), and PsyCap were significant predictors for PCS and MCS. Chinese psychiatrists experienced relatively good physical QOL but impaired mental QOL, and they experienced high level of occupational stress. For the sake of psychiatrists' HRQOL, the reduction of occupational stress should be implemented. The enhancement of PsyCap could be a new intervention
Koskinen, Heli I
In this study, the social interactions between students and their teachers in an ambulatory clinic setting were investigated using Bales's interaction process analysis framework. Observational data were collected during five small-group sessions. The observations were quantified, and the behaviors of students and teachers were compared statistically. This study demonstrated that the interaction between students and their teachers was for the most part equal and could be characterized as "positively task oriented." The study has implications for veterinary educators wishing to use social psychology frameworks to assess the quality of learning in small-group clinical setting.
Jenkins, Rachel; Kydd, Robert; Mullen, Paul; Thomson, Kenneth; Sculley, James; Kuper, Susan; Carroll, Joanna; Gureje, Oye; Hatcher, Simon; Brownie, Sharon; Carroll, Christopher; Hollins, Sheila; Wong, Mai Luen
Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149), Nigeria (384), Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100,000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health, and that there are public and fair agreements
Full Text Available BACKGROUND: Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. METHODS: In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. FINDINGS: We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists, Pakistan (1158, Bangladesh (149, Nigeria (384, Egypt (484, Sri Lanka (142, Philippines (1593. For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied, but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania. Without such emigration, many countries would have more than double the number of psychiatrists per 100,000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon; and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia. CONCLUSIONS: Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to
Cowan, Marie J; Freedland, Kenneth E; Burg, Matthew M; Saab, Patrice G; Youngblood, Marston E; Cornell, Carol E; Powell, Lynda H; Czajkowski, Susan M
To determine whether the 'dose' of treatment exposure, delivery of specific components of cognitive behavior therapy (CBT), patient adherence and/or use of antidepressants predict favorable depression and social support outcomes after 6 months of cognitive behavioral treatment. Secondary analyses of the intervention arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial involving persons with acute myocardial infarction (MI): n = 641 for the depression outcomes and n = 523 for the social support outcomes. The outcome measures were, for depression: the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D); for social support: the ENRICHD Social Support Instrument (ESSI) and Perceived Social Support Scale (PSSS). Better depression outcomes (measured by the BDI) were receiving a high number of depression-specific intervention components, p homework assignments, p homework assignments, p homework assignments, p homework assignments is important for both outcomes. Other components of the ENRICHD intervention that were designed to improve social support had no discernible effects on outcomes. Intervention refinements may be needed in order to achieve better results in future post-MI clinical trials. A greater emphasis on CBT homework adherence could improve both depression and social support outcomes. 2008 S. Karger AG, Basel
Hamann, Johannes; Parchmann, Anna; Sassenberg, Nina; Bronner, Katharina; Albus, Margot; Richter, Alwin; Hoppstock, Sandra; Kissling, Werner
Many patients with schizophrenia have a desire for shared decision-making (SDM). However, in clinical practice SDM often does not take place. One cause might be that many patients behave passively in the medical encounter, therefore not facilitating SDM. It was the aim of the study to evaluate the effects of a patient directed SDM-training on patients' communicative behavior in the consultation, their attitudes towards decision-making and their long-term adherence. Randomized-controlled trial comparing a five-session SDM-training for inpatients with schizophrenia with five sessions of non-specific group training. The SDM-training sessions included motivational (e.g. prospects of participation, patient rights) and behavioral aspects (e.g. role plays) and addressed important aspects of the patient-doctor interaction such as question asking or giving feedback. N = 264 patients were recruited in four psychiatric hospitals in Germany. The SDM-training yielded no group differences regarding the main outcome measure (treatment adherence) at 6 and 12 months after discharge. However, there were short-term effects on patients' participation preferences, their wish to take over more responsibility for medical decisions and (according to their psychiatrists' estimate) their behavior in psychiatric consultations. While there was no effect regarding treatment adherence, the shared decision-making training for inpatients with schizophrenia has been shown to increase patients' active behavior in psychiatric consultations during their inpatient treatment. When implemented it should be combined with complementary SDM interventions (decision support tools and communication training for professionals) to yield maximum effects.
Campbell, Kirsti A; Madva, Elizabeth N; Villegas, Ana C; Beale, Eleanor E; Beach, Scott R; Wasfy, Jason H; Albanese, Ariana M; Huffman, Jeff C
Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers. We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
White, Megan M; Lofwall, Michelle R
Assessing medical decision-making capacity is a clinical skill required of all medical professionals, but it is particularly essential for consultation- liaison psychiatrists. Medical decision-making capacity, often confused with competency, is evaluated by assessing 4 standards, which include whether a patient (1) can understand his or her medical situation, (2) can manipulate the information, (3) can evidence a choice about the proposed treatment, and (4) can appreciate the situation and its consequences. Multiple myths and pitfalls may be encountered during capacity evaluations; many of these can be avoided by proper education and training. We discuss the case of a 71-year-old man who presented to the emergency department by ambulance and was refusing non-emergent neurosurgery after a self-inflicted gunshot wound to the head. He was evaluated for medical decision-making capacity, specifically on whether he had the capacity to refuse neurosurgery and accept intravenous antibiotic treatment. In discussing this case, which illustrates the elements, challenges, and ethical dilemmas of the capacity evaluation, we review several mental illnesses that may prevent individuals from having medical decision-making capacity. Myths and pitfalls of capacity evaluations and possible methods for avoiding them are proposed. Specifically, we emphasize the importance of communication between the primary team and the consultationliaison psychiatry service and describe possible solutions to common communication problems that may arise between services. It is hoped that this case presentation and review will help educate psychiatry residents and other physicians so that they are well prepared to perform a medical decision-making capacity evaluation.
Vögele, Claus; Ehlers, Anke; Meyer, Andrea H; Frank, Monika; Hahlweg, Kurt; Margraf, Jürgen
The present study investigated cognitive mediation of clinical improvement in patients with agoraphobia (N=427) or social phobia (N=98) receiving high-density exposure therapy in a naturalistic clinical treatment setting. Patients were assessed before therapy, 6 weeks after the end of therapy, and 1 year thereafter, using a self-report assessment battery. Lower level mediation analyses provided support for the notion that cognitive changes partially mediate clinical improvement after exposure therapy. Changes in cognitions relating to physical catastrophes mediated treatment outcome only for patients with agoraphobia, whereas changes in cognitions about loss of control mediated outcome for both agoraphobia and social phobia patients. Changes in relationship satisfaction did not mediate symptomatic improvement. The results extend previous findings by demonstrating mediation in an unselected clinical sample and by providing evidence for the specificity of mediation effects. They further support the importance of cognitive changes in cognitive-behavior therapy. (c) 2009 Wiley-Liss, Inc.
Nurmi, Sanna-Maria; Halkoaho, Arja; Kangasniemi, Mari; Pietilä, Anna-Maija
Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders' perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for
-traumatic stress disorder clinic A Parkinson 39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research Charles Parry 40. Global mental health - A new global health discipline comes of age Vikram Patel 41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium 42. Personality disorders -The orphan child in axis I - Axis II Dichotomy Willie Pienaar 43. Case Studies in Psychiatric Ethics Willie Pienaar 44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications Janus Pretorius 45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials Suvira Ramlall, Jennifer Chipps 46. Biological basis of addication Solomon Rataemane 47. Genetics of Schizophrenia Louw Roos 48. Management of delirium - Recent advances Shaquir Salduker 49. Social neuroscience: Brain research on social issues Manfred Spitzer 50. Experiments on the unconscious Manfred Spitzer 51. The Psychology and neuroscience of music Manfred Spitzer 52. Mental disorders in DSM-V Dan Stein 53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study Ugashvaree Subramaney 54. Eating disorders: An African perspective Christopher Szabo 55. An evaluation of the WHO African Regional strategy for mental health 2001-2010 Thandi van Heyningen, M Majavu, C Lund 56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia Jacques J M van Hoof 57. The origin of mentalisation and the treatment of personality disorders Jacques J M Hoof 58. How to account practically for 'The Cause' in psychiatric diagnostic classification C W (Werdie van Staden POSTER PRESENTATIONS 59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009 Orlando Alonso
Full Text Available Recruitment of women in the periconceptional period to clinical studies using traditional advertising through medical establishments is difficult and slow. Given the widespread use of the internet as a source for medical information and research, we analyze the impact of social media in the second phase of an ongoing randomized, open-label clinical trial among pregnant women. This study aims to assess the effectiveness of social media as a recruitment tool through the comparison of diverse recruitment techniques in two different phases of the trial.Recruitment in Phase 1 of the study consisted solely of traditional healthcare-based sources. This was compared to Phase 2 of the study where traditional recruitment was continued and expanded, while social media was used as a supplementary source. Yearly recruitment and recruitment rates in the two phases were compared using the Mann Whitney U test. The contributions of each recruitment source to overall recruitment were analyzed, and the impact of potential confounders on recruitment rate was evaluated using a multiple regression and Interrupted Time Series Analysis.In the first phase of the study, with over 56 months of recruitment using traditional sources, 35 women were enrolled in the study, resulting in a mean rate of ±0.62 recruits/month. In the 6 months implementing recruitment through social media, 45 women were recruited, for a 12-fold higher rate of ±7.5 recruits/month. Attrition rates remained constant, suggesting that social media had a positive impact on recruitment. The Interrupted Time Series Analysis detected a significant difference in recruitment after the intervention of social media (p<0.0001 with an evident increase in the number of recruits observed after the use of social media.Clinicians and scientists recruiting for clinical studies should learn how to use online social media platforms to improve recruitment rates, thus increasing recruitment efficiency and cost-effectiveness.
Objective: Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine. Methods: The author develops a broader conception of clinical…
Brakoulias, Vlasios; Macfarlane, Matthew D; Looi, Jeffrey C
To encourage psychiatrists to publish high-quality articles in peer-reviewed journals by demystifying the publishing process. This paper will describe the publishing process and outline key factors that ensure that publishing is an achievable goal for psychiatrists. The publishing process can be long and often this is related to delays associated with obtaining reviewers and their comments. Negative reviewer comments often relate to grammatical and typographical errors, an insufficient literature review, failure to adequately discuss limitations and conclusions that are not adequately supported by the results. Authors who systematically respond to their paper's reviewer comments are usually successful in having their papers accepted. Success in publishing is usually determined by a topic that appeals to the readership of a journal, a credible methodology and a paper that is well-written. Publishing is achievable for all psychiatrists providing they can write a paper that delivers a clear and concise message, are willing to address reviewer comments and that their paper is tailored to the readership of the journal. © The Royal Australian and New Zealand College of Psychiatrists 2014.
Levy, Tal Bergman; Azar, Shlomi; Huberfeld, Ronen; Siegel, Andrew M; Strous, Rael D
Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. © 2012 John Wiley & Sons Ltd.
Konrad, Marcel; Drosselmeyer, Julia; Kostev, Karel
Aims: The aims of this study were to assess how many patients received occupational therapy after diagnosis of developmental disorder (DD) in child psychiatrist practices in Germany and which factors influenced the prescription of occupational therapy. Methods: This study was a retrospective database analysis in Germany utilising the Disease…
McCabe, Rosemarie; Healey, Patrick G T; Priebe, Stefan; Lavelle, Mary; Dodwell, David; Laugharne, Richard; Snell, Amelia; Bremner, Stephen
Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia. Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke. 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02). The quality of doctor-patient communication also appears to influence adherence in schizophrenia. Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
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. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando
Chronic pain places a significant burden on individuals as well as health services. Long wait lists to access public clinical pain management services can result, and health outcomes deteriorate. Innovative technologies, such as social media provide opportunities to support self-management within the participatory health framework. This paper aims to investigate patients' perceptions towards using social media while waiting for clinic access, with a particular focus on therapeutic affordances. Seventeen wait-listed patients underwent intervention using various social media resources as part of self-management. Thematic content analysis of semi-structured interviews examined patients' perceptions about social media use and participation. Three therapeutic affordances were most evident in the qualitative data: exploration, connection and narration. Barriers to participation were also identified, such as 'specificity of the resources'. Findings suggest social media are perceived positively. However, there is also the need to balance a desire to deliver evidence-based practice with patient-preferences in shared-decision making about social media use.
Kunze, Kimberley Annette
To date, no published research has utilized social network analysis (SNA) to analyze graduate cohorts in clinical psychology. The purpose of this research is to determine how issues of likability among students correlate with other measures, such as disclosure, health, spiritual maturity, help in projects, familiarity, and ease of providing…
Atherley, Anique E; Hambleton, Ian R; Unwin, Nigel; George, Colette; Lashley, Paula M; Taylor, Charles G
Transitions in medical education are emotionally and socially dynamic; this may affect learning. Students transitioning from preclinical to clinical training may experience negative consequences. Less is understood about students' experiences during transitions within clinical training and influential factors. The authors used organizational socialization theory to explore a transition within the clinical years. Final-year medical students experienced a nine-week internal medicine clerkship; willing students participated. Students (n = 101; 97 %) completed a questionnaire with open-ended questions at the beginning and end of the clerkship and participated in six consecutive focus groups, until data saturation occurred (n = 37). Data were thematically analyzed. Socialization was challenging. Many students experienced difficulty developing relationships with team members. Students with a positive attitude experienced a smoother transition. Many students were uncertain of their roles, concerned about the workload and desired guidance to meet clerkship demands. This transition resulted in varied outcomes from enjoyment, increased confidence and student development through to disinterest. Transitions within clinical training are complex. Faculty should focus on adequate socialization in a new clerkship as this may facilitate a smoother transition. This may necessitate orientations, staff training, and formal student support. Further research is needed on the impact of these recommendations on learning and well-being.
van Baalen, Sophie; Carusi, Annamaria; Sabroe, Ian; Kiely, David G
In recent years there has been growing attention to the epistemology of clinical decision-making, but most studies have taken the individual physicians as the central object of analysis. In this paper we argue that knowing in current medical practice has an inherently social character and that imaging plays a mediating role in these practices. We have analyzed clinical decision-making within a medical expert team involved in diagnosis and treatment of patients with pulmonary hypertension (PH), a rare disease requiring multidisciplinary team involvement in diagnosis and management. Within our field study, we conducted observations, interviews, video tasks, and a panel discussion. Decision-making in the PH clinic involves combining evidence from heterogeneous sources into a cohesive framing of a patient, in which interpretations of the different sources can be made consistent with each other. Because pieces of evidence are generated by people with different expertise and interpretation and adjustments take place in interaction between different experts, we argue that this process is socially distributed. Multidisciplinary team meetings are an important place where information is shared, discussed, interpreted, and adjusted, allowing for a collective way of seeing and a shared language to be developed. We demonstrate this with an example of image processing in the PH service, an instance in which knowledge is distributed over multiple people who play a crucial role in generating an evaluation of right heart function. Finally, we argue that images fulfill a mediating role in distributed knowing in 3 ways: first, as enablers or tools in acquiring information; second, as communication facilitators; and third, as pervasively framing the epistemic domain. With this study of clinical decision-making in diagnosis and treatment of PH, we have shown that clinical decision-making is highly social and mediated by technologies. The epistemology of clinical decision-making needs
Kotsenas, Amy L; Aase, Lee; Arce, Makala; Timimi, Farris K; Dacy, Matthew; Young, Colleen; Wald, John T
Hippocrates' admonition and the medical community's aversion to risk have caused many physicians and institutions to resist participation in modern social media sites such as Facebook (Facebook, Inc, Menlo Park, California, USA), Twitter (Twitter Inc, San Francisco, California, USA), and YouTube (San Mateo, California, USA). However, because Mayo Clinic's founders were champions of analog social networking, it was among the earliest hospitals worldwide to create official accounts on these digital platforms. A proper understanding of the traditional mechanisms of knowledge diffusion in medicine and of the nature of social media sites should help professionals see and embrace the opportunities for positive engagement in social media. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Mas-Expósito, Laia; Amador-Campos, Juan A; Lalucat-Jo, Lluís; Villegas-Miranda, Francisco
Although most of the research conducted up to now has shown that interventions in social cognition are effective in the rehabilitation of persons with schizophrenia, there are still no clinical practice recommendations on the topic. Their development could facilitate the clinical work, resource management and the care provided to persons with such a disorder. This article addresses this need and performs a systematic review of the identified high-quality scientific evidence and develops clinical practice recommendations. A total of 40 clinical trials and 1 meta-analysis evaluating the effects of social cognition interventions for persons with schizophrenia were selected for the present study. Taking into account the evidence available and its quality, the authors developed three clinical practice recommendations on the positive effects of these interventions. The analysis of the evidence of the quality of the studies shows that more randomized controlled trials with larger sample sizes and longer follow-ups are needed in order to establish more accurately the efficacy and effectiveness of social cognition interventions and therefore to favor the generalization of the results.
Glickman, Seth W; Galhenage, Sam; McNair, Lindsay; Barber, Zachry; Patel, Keyur; Schulman, Kevin A; McHutchison, John G
The rapid growth of internet usage has led to an explosion of social networking sites for discussion of health issues. This provides a forum for subjects to communicate with one another during the course of the studies. Previous studies have raised concerns about the quality of health information on social networking sites, although none have evaluated content related to ongoing clinical trials. We reviewed material posted in virtual communities by self-identified clinical trial participants. We identified material posted in online health forums that could introduce bias into clinical research studies; we believe that this issue warrants further study and discussion. Physicians and others who conduct clinical trials should be aware of this issue. Study investigators and research teams should also talk to their study subjects about where and how they are obtaining information in order to prevent behaviors and correct misinformation that could put a subject's safety or the study objectives at risk. Given the rapid increase in Internet use for health care, a broader evaluation of both the benefits and potential risks of social networking among research participants during the course of a clinical trial appears warranted.
Heidi G Allen
Full Text Available A barrier to dissemination of research is that it depends on the end-user searching for or 'pulling' relevant knowledge from the literature base. Social media instead 'pushes' relevant knowledge straight to the end-user, via blogs and sites such as Facebook and Twitter. That social media is very effective at improving dissemination seems well accepted, but, remarkably, there is no evidence to support this claim. We aimed to quantify the impact of social media release on views and downloads of articles in the clinical pain sciences. Sixteen PLOS ONE articles were blogged and released via Facebook, Twitter, LinkedIn and ResearchBlogging.org on one of two randomly selected dates. The other date served as a control. The primary outcomes were the rate of HTML views and PDF downloads of the article, over a seven-day period. The critical result was an increase in both outcome variables in the week after the blog post and social media release. The mean ± SD rate of HTML views in the week after the social media release was 18±18 per day, whereas the rate during the other three weeks was no more than 6±3 per day. The mean ± SD rate of PDF downloads in the week after the social media release was 4±4 per day, whereas the rate during the other three weeks was less than 1±1 per day (p0.3 for all. We conclude that social media release of a research article in the clinical pain sciences increases the number of people who view or download that article, but conventional social media metrics are unrelated to the effect.
Allen, Heidi G; Stanton, Tasha R; Di Pietro, Flavia; Moseley, G Lorimer
A barrier to dissemination of research is that it depends on the end-user searching for or 'pulling' relevant knowledge from the literature base. Social media instead 'pushes' relevant knowledge straight to the end-user, via blogs and sites such as Facebook and Twitter. That social media is very effective at improving dissemination seems well accepted, but, remarkably, there is no evidence to support this claim. We aimed to quantify the impact of social media release on views and downloads of articles in the clinical pain sciences. Sixteen PLOS ONE articles were blogged and released via Facebook, Twitter, LinkedIn and ResearchBlogging.org on one of two randomly selected dates. The other date served as a control. The primary outcomes were the rate of HTML views and PDF downloads of the article, over a seven-day period. The critical result was an increase in both outcome variables in the week after the blog post and social media release. The mean ± SD rate of HTML views in the week after the social media release was 18±18 per day, whereas the rate during the other three weeks was no more than 6±3 per day. The mean ± SD rate of PDF downloads in the week after the social media release was 4±4 per day, whereas the rate during the other three weeks was less than 1±1 per day (psocial media reach, engagement or virality related to either outcome variable, nor to citation count one year later (p>0.3 for all). We conclude that social media release of a research article in the clinical pain sciences increases the number of people who view or download that article, but conventional social media metrics are unrelated to the effect.
Lincoln, Sarah Hope; Hooker, Christine I'Lee
Individuals at a clinical high risk (CHR) for psychosis have gray matter volume (GMV) abnormalities that are similar to, though less severe than, those in individuals with schizophrenia. Less GMV in schizophrenia is related to worse social cognition and social functioning, but the relationship between GMV and social functioning in CHR individuals has yet to be investigated. The aim of this study was to (1) investigate differences in GMV between healthy controls (HC) and CHR individuals, and (2) evaluate the relationship between GMV and social functioning in these two groups. Participants comprised 22 CHR and 21 HC individuals who completed a structural magnetic resonance imaging (MRI) scan as well as self-reported and interviewer-rated measures of social functioning. Processing and analysis of structural images were completed using voxel based morphometry (VBM). Results showed that the CHR group had less GMV in the left postcentral gyrus, bilateral parahippocampual gyri, and left anterior cingulate cortex. Reduced GMV in the postcentral gyrus and the anterior cingulate was related to self-reported social impairment across the whole group. This study has implications for the neurobiological basis of social dysfunction present before the onset of psychosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Sims, Omar T; Whalen, Christopher C; Nackerud, Larry G; Bride, Brian E
The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing for baby boomers born between 1945-1965 in the United States. This public health initiative is known as birth cohort (baby boomer) testing for HCV. The intent of birth cohort testing is to identify and mobilize undiagnosed HCV-infected persons into care and treatment. Subsequently, clinical social workers in health care settings can anticipate a substantial increase in the number of HCV-infected persons presenting for care and treatment. The purpose of this article is to inform clinical social workers in health care settings of HCV, the standard of care and treatment for HCV, and clinical dilemmas associated with HCV patient care. Epidemiology and natural history of HCV, the standard of care and treatment for HCV, and etiology and management of neuropsychiatric adverse effects associated with patient care are discussed.
Results. Patients' estimates of their own social functioning were not significantly different from examiners' estimates. The impact of clinical variables on social functioning in PD revealed depression to be the strongest association of social functioning in PD on both the patient and the examiner version of the Social Adaptation Self-Evaluation Scale. Conclusions. PD patients appear to be well aware of their social strengths and weaknesses. Depression and motor symptom severity are significant predictors of both self- and examiner reported social functioning in patients with PD. Assessment and treatment of depression in patients with PD may improve social functioning and overall quality of life.
Chow, Philip I; Fua, Karl; Huang, Yu; Bonelli, Wesley; Xiong, Haoyi; Barnes, Laura E; Teachman, Bethany A
likelihood of spending time at home, and more negative or less positive affect was linked to longer homestay. Interactions indicated that, among individuals higher in social anxiety, higher negative affect and lower positive affect within a day was associated with greater likelihood of spending time at home the following day. Results demonstrate the feasibility and utility of modeling the relationship between affect and homestay using fine-grained GPS data. Although these findings must be replicated in a larger study and with clinical samples, they suggest that integrating repeated state affect assessments in situ with continuous GPS data can increase understanding of how actual homestay is related to affect in everyday life and to symptoms of anxiety and depression.
Kamimura, Akiko; Christensen, Nancy; Tabler, Jennifer; Ashby, Jeanie; Olson, Lenora M
This cross sectional study assessed the physical and mental health, health literacy and social support of the uninsured utilizing a free clinic to develop intervention programs and research projects to improve the health of free clinic patients. Free clinics are nonprofit organizations that provide underserved and uninsured individuals access to a broad array of free or low cost healthcare services. English or Spanish speaking patients (N = 187) aged 18 years or older completed a self-administered survey. Physical, mental and oral health, health literacy, and social support were measured using standardized instruments. Eighty-two participants (45 US born and 37 non-US born) chose the English version of the survey (English speakers) while 105 participants (2 US born and 103 non-US born) chose the Spanish version (Spanish speakers). Overall, both the physical and mental health functioning of the participants was lower than that of the US general population. The participants reported being moderately depressed. US-born English speakers reported the poorest physical and mental health while Spanish speakers reported the best physical health and the lowest level of depression. A higher level of health literacy was associated with better physical health functioning, whereas reporting higher social support was associated with better mental health functioning and less severe depression. Because most free clinics have limited resources, developing services and programs that fit free clinics' circumstances are needed. Our study finding indicates that health literacy education, mental health services, and social support are key services needed by free clinic patients to achieve better health.
Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando; Mantopoulos, Steven; Hogg, Malcolm
Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective. The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain. A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire. Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients
Ditton-Phare, Philippa; Loughland, Carmel; Duvivier, Robbert; Kelly, Brian
A range of communication skills training programmes have been developed targeting trainees in various medical specialties, predominantly in oncology but to a lesser extent in psychiatry. Effective communication is fundamental to the assessment and treatment of psychiatric conditions, but there has been less attention to this in clinical practice for psychiatrists in training. This review examines the outcomes of communication skills training interventions in psychiatric specialty training. The published English-language literature was examined using multiple online databases, grey literature and hand searches. The review was conducted and reported using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies examining the efficacy of communication skills training were included. Randomised controlled trials, pseudo-randomised studies and quasi-experimental studies, as well as observational analytical studies and qualitative studies that met criteria, were selected and critically appraised. No limits were applied for date of publication up until 16 July 2016. Total search results yielded 2574 records. Of these, 12 studies were identified and reviewed. Two were randomised controlled trials and the remaining 10 were one-group pretest/posttest designs or posttest-only designs, including self-report evaluations of communication skills training and objective evaluations of trainee skills. There were no studies with outcomes related to behaviour change or patient outcomes. Two randomised controlled trials reported an improvement in clinician empathy and psychotherapeutic interviewing skills due to specific training protocols focused on those areas. Non-randomised studies showed varying levels of skills gains and self-reported trainee satisfaction ratings with programmes, with the intervention being some form of communication skills training. The heterogeneity of communication skills training is a barrier to evaluating the efficacy of
Wasserman, Jason Adam
Calls for incorporating social science into patient care typically have accounted for neither the logistic constraints of medical training nor the methodological fallacies of utilizing aggregate "social facts" in clinical practice. By elucidating the different epistemic approaches of artistic and scientific practices, this paper illustrates an integrative artistic pedagogy that allows clinical practitioners to generate social scientific insights from actual patient encounters. Although there is no shortage of calls to bring social science into medicine, the more fundamental processes of thinking by which art and science proceed have not been addressed to this end. As such, the art of medical practice is conceptualized as an innate gift, and thus little is done to cultivate it. Yet doing so is more important than ever because uncertainty in diagnosing and treating chronic illnesses, the most significant contemporary mortality risks, suggests a re-expanding role for clinical judgment. © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: email@example.com.
Shere, Mahvash; Zhao, Xiu Yan; Koren, Gideon
Recruitment of women in the periconceptional period to clinical studies using traditional advertising through medical establishments is difficult and slow. Given the widespread use of the internet as a source for medical information and research, we analyze the impact of social media in the second phase of an ongoing randomized, open-label clinical trial among pregnant women. This study aims to assess the effectiveness of social media as a recruitment tool through the comparison of diverse recruitment techniques in two different phases of the trial. Recruitment in Phase 1 of the study consisted solely of traditional healthcare-based sources. This was compared to Phase 2 of the study where traditional recruitment was continued and expanded, while social media was used as a supplementary source. Yearly recruitment and recruitment rates in the two phases were compared using the Mann Whitney U test. The contributions of each recruitment source to overall recruitment were analyzed, and the impact of potential confounders on recruitment rate was evaluated using a multiple regression and Interrupted Time Series Analysis. In the first phase of the study, with over 56 months of recruitment using traditional sources, 35 women were enrolled in the study, resulting in a mean rate of ±0.62 recruits/month. In the 6 months implementing recruitment through social media, 45 women were recruited, for a 12-fold higher rate of ±7.5 recruits/month. Attrition rates remained constant, suggesting that social media had a positive impact on recruitment. The Interrupted Time Series Analysis detected a significant difference in recruitment after the intervention of social media (ponline social media platforms to improve recruitment rates, thus increasing recruitment efficiency and cost-effectiveness.
Yong, Emma; Barbato, Mariapaola; Penn, David L; Keefe, Richard S E; Woods, Scott W; Perkins, Diana O; Addington, Jean
Neurocognition and social cognition are separate but related constructs known to be impaired in schizophrenia. The aim of this study was to extend the current knowledge of the relationship between social cognition and neurocognition in individuals at clinical high risk (CHR) of developing psychosis by examining, in a large sample, the associations between a wide range of neurocognitive tasks and social cognition. Participants included 136 young people at CHR. Specific domains within neurocognition and social cognition were compared using Spearman correlations. Results showed that poor theory of mind correlated with low ratings on a wide range of neurocognitive tasks. Facial affect was more often associated with low ratings on spatial working memory and attention. These results support a link between neurocognition and social cognition even at this early stage of potential psychosis, with indication that poorer performance on social cognition may be associated with deficits in attention and working memory. Understanding these early associations may have implications for early intervention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Healey, Kristin M; Penn, David L; Perkins, Diana; Woods, Scott W; Addington, Jean
Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations. Longitudinally examine theory of mind (ToM) and social judgments in a CHR sample to investigate the stability of performance over time and potential ability to predict conversion to psychosis. 147 CHR individuals and 85 help seeking controls (HSC) were assessed for up to 2years; 28 participants developed psychosis across both groups. Generalized linear mixed models for repeated measures were used to examine change over time for ratings on the three social cognitive indices of ToM, trustworthiness, and approachability. Hierarchical regression was used to test whether social cognitive variables explain more variance in conversion than IQ. CHR individuals showed a positive bias in approachability judgments over time compared to HSC. Baseline ToM performance significantly (pIQ scores. These results were attenuated when controlling for baseline symptom level. Although ToM deficits might predate conversion to psychosis, one must consider initial symptoms as well. Social judgments were not associated with conversion to schizophrenia. © 2013 Elsevier B.V. All rights reserved.
Cohen, Jonah N; Potter, Carrie M; Drabick, Deborah A G; Blanco, Carlos; Schneier, Franklin R; Liebowitz, Michael R; Heimberg, Richard G
Therapies for social anxiety disorder (SAD) leave many patients symptomatic at the end of treatment and little is known about predictors of treatment response. This study investigated the predictive relationship of patients' etiological attributions to initial clinical features and response to pharmacotherapy. One hundred thirty-seven individuals seeking treatment for SAD received 12 weeks of open treatment with paroxetine. Participants completed the Attributions for the Etiology of Social Anxiety Scale at baseline in addition to measures of social anxiety and depression at baseline and over the course of treatment. A latent class analysis suggested four profiles of etiological beliefs about one's SAD that may be characterized as: Familial Factors, Need to be Liked, Bad Social Experiences, and Diffuse Beliefs. Patients in the more psychosocially-driven classes, Need to be Liked and Bad Social Experiences, had the most severe social anxiety and depression at baseline. Patients in the Familial Factors class, who attributed their SAD to genetic, biological, and early life experiences, had the most rapid response to paroxetine.These results highlight the effect of biological and genetically-oriented etiological beliefs on pharmacological intervention, have implications for person-specific treatment selection, and identify potential points of intervention to augment treatment response. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Cohen, Jonah N.; Potter, Carrie M.; Drabick, Deborah A.G.; Blanco, Carlos; Schneier, Franklin R.; Liebowitz, Michael R.; Heimberg, Richard G.
Therapies for social anxiety disorder (SAD) leave many patients symptomatic at the end of treatment and little is known about predictors of treatment response. This study investigated the predictive relationship of patients’ etiological attributions to initial clinical features and response to pharmacotherapy. Methods One hundred thirty-seven individuals seeking treatment for SAD received 12 weeks of open treatment with paroxetine. Participants completed the Attributions for the Etiology of Social Anxiety Scale at baseline in addition to measures of social anxiety and depression at baseline and over the course of treatment. Results A latent class analysis suggested four profiles of etiological beliefs about one’s SAD that may be characterized as: Familial Factors, Need to be Liked, Bad Social Experiences, and Diffuse Beliefs. Patients in the more psychosocially-driven classes, Need to be Liked and Bad Social Experiences, had the most severe social anxiety and depression at baseline. Patients in the Familial Factors class, who attributed their SAD to genetic, biological, and early life experiences, had the most rapid response to paroxetine. Conclusions These results highlight the effect of biological and genetically-oriented etiological beliefs on pharmacological intervention, have implications for person-specific treatment selection, and identify potential points of intervention to augment treatment response. PMID:25920804
Smith, Patrick J; Snyder, Laurie D; Palmer, Scott M; Hoffman, Benson M; Stonerock, Gregory L; Ingle, Krista K; Saulino, Caroline K; Blumenthal, James A
Depressive symptoms are common among lung transplant candidates and have been associated with poorer clinical outcomes in some studies. Previous studies have been plagued by methodologic problems, including small sample sizes, few clinical events, and uncontrolled confounders, particularly perioperative complications. In addition, few studies have examined social support as a potential protective factor. We therefore examined the association between pretransplant depressive symptoms, social support, and mortality in a large sample of lung transplant recipients. As a secondary aim, we also examined the associations between psychosocial factors, perioperative outcomes [indexed by hospital length of stay (LOS)], and mortality. We hypothesized that depression would be associated with longer LOS and that the association between depression, social support, and mortality would be moderated by LOS. Participants included lung transplant recipients, transplanted at Duke University Medical Center from January 2009 to December 2014. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI-II) and social support using the Perceived Social Support Scale (PSSS). Medical risk factors included forced vital capacity (FVC), partial pressure of carbon dioxide (PCO2 ), donor age, acute rejection, and transplant type. Functional status was assessed using six-minute walk distance (6MWD). We also controlled for demographic factors, including age, gender, and native disease. Transplant hospitalization LOS was examined as a marker of perioperative clinical outcomes. Participants included 273 lung recipients (174 restrictive, 67 obstructive, 26 cystic fibrosis, and six "other"). Pretransplant depressive symptoms were common, with 56 participants (21%) exhibiting clinically elevated levels (BDI-II ≥ 14). Greater depressive symptoms were associated with longer LOS [adjusted b = 0.20 (2 days per 7-point higher BDI-II score), P support (P support were associated with greater
Catty, Jocelyn; White, Sarah; Clement, Sarah; Cowan, Naomi; Geyer, Connie; Harvey, Kate; Jones, Ian Rees; McLaren, Susan; Poole, Zoe; Rose, Diana; Wykes, Til; Burns, Tom
The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Continuity is a dynamic process, influenced significantly by care structures and organizational change.
Social media are increasingly used by individuals for the purpose of collecting data and reporting on the personal health status, on health issues, symptoms and experiences with treatments. Beyond, fitness trackers are more used by individuals to monitor their fitness and health. The health data that is becoming available due to these developments could provide a valuable source for continuous health monitoring, prevention of unexpected health events and clinical decision making since it gives insights into behavior and life habits. However, an integration of the data is challenging. This paper aims triggering the discussion about this current topic. We present a concept for integrating social media data with mobile sensor data and clinical data using digital patient modelling. Further, we collect requirements and challenges for a possible realization of the concept. Challenges include the data volume, reliability and semantic interoperability.
Terranova, Claudio; Rocca, Gabriele
Interest in psychiatrists' professional liability in Italy has increased in recent years because of the number of medical malpractice claims. Professional liability for failure to prevent violent behaviour by psychiatric patients is particularly debated. This study describes three Italian cases in which health professionals - physicians and nurses - were found guilty of manslaughter for murders committed by psychiatric patients. Examination of the cases focuses on claims of malpractice, patients' characteristics, the circumstances of the homicide and the reasons for the court's judgment. In particular, the predictability of violent behaviour and the concept of causal links are examined in detail. The cases provide an opportunity for a study of comparative jurisprudence. The topics discussed are relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of criminal acts committed by psychiatric patients. © The Author(s) 2015.
Kamdoum, C; Petit, M; Steyaert, H; Delvenne, V
The prevalence of obesity has grown steadily in recent years, making it almost an epidemic. Obesity is a chronic condition whose prognosis is burdened by severe comorbidities. Both the quality of life and the life expectancy are affected. The medical management of morbid obesity is still the rule, but surgical practices are developing rapidly. While bariatric surgery in adults is common and gives excellent results, in adolescents, its practice is less prevalent. Beyond issues specific to this developmental period, this question raises ethical issues. In this context, the pluridiscplinary team faces diverse determinants and challenges and the child and adolescent psychiatrist (CAP) is, the psychiatrist is summoned for psychopathological aspects but also for embarrassing questions. In this work, we are going to specify the role of the CAP in the practice of bariatric surgery.
Janet Raat, A N; Schönrock-Adema, Johanna; van Hell, E Ally; Kuks, Jan B M; Cohen-Schotanus, Janke
In medical education, student distress is known to hamper learning and professional development. To address this problem, recent studies aimed at helping students cope with stressful situations. Undergraduate students in clinical practice frequently use experiences of surrounding peers to estimate their abilities to master such challenging situations. This use of the experiences of others, known as social comparison, may affect student distress both positively and negatively. To find characteristics of a beneficial use of social comparison, we examined differences in comparison behaviours between students expressing low and high levels of distress. The participants in our study, response rate 93% (N = 301/321), were all medical students in their first year in clinical practice. They completed the General Health Questionnaire (GHQ-12) to measure distress, and three separate questionnaires to measure: (1) orientation to comparison, (2) motive for comparison, and (3) interpretation of comparison. Differences were analysed using multivariate analysis of variance. Although all students were oriented towards social comparison, the analyses showed that this orientation was less apparent among low-distress students. Besides, the low-distress students were less inclined to use motives indicative for comparisons with peers perceived as performing worse and were less negative in the interpretations of their comparisons. As social comparison is frequently used among all students, we recommend to make them aware of their comparison behaviours and inform them about the pros and cons of the distinguished aspects of the comparison process.
Full Text Available Background/Aim. So far, studies of stress have shown that physicians are at a high risk of sickness from psychic and somatic disorders related to professional stress, that can lead to important disturbance of personal, familiar and professional functionating. The aim of this study was to investigate the doctors exposition level to professional stress, to compare stress level in general practitioners (GP group with that in the group of psychiatrists and risk level for the apperance of burnout syndrome. Methods. This cross-section study included subjects recruited by a random sample method. Thirty General Practice doctors and 30 psychiatrists (totally 60 doctors filled the set of 3 questionnaires: Sociodemographics features, General Health Questionnaire (GHQ; Goldberg D, 1991, and Maslach Burnout Inventory (MBI; Maslach C, 1996. Appropriate statistical procedures (Pearson test, t-test, variance analysis in interpretation of the results were used. Results. A total level of psychic distress measured with the GHQ test in both groups of physicians was very low implying their good mental health. A difference in Burnout risk based on MBI test between the groups was statistically significant (χ2 = 4,286; p < 0.05 only at subscale Personal Accomplishment (MBI-PA; it was a consequence of a higher number of GPs with medium burnout risk (13.3 : 0.0%. However, even 35 physicians from the sample were affected with a high burnout risk measured with subscales Emotional Ehausation (MBI-EE and MBI-DP, showing that both groups of physicians had risk for the appearance of burnout syndrome. Conclusion. The obtained results showed a high burnout risk level in both, GPs and psychiatrists, groups. In both groups there was no presence of psychic disorders (anxiety, depression, insomnia, while there was a high level of emotional ehausation and overtension by job, and also a lower total personal accomplishment. Level of exposition to professional stress is higher in GPs
Vićentić, Sreten; Jovanović, Aleksandar; Dunjić, Bojana; Pavlović, Zorana; Nenadović, Milutin; Nenadović, Nenad
So far, studies of stress have shown that physicians are at a high risk of sickness from psychic and somatic disorders related to professional stress, that can lead to important disturbance of personal, familiar and professional functionating. The aim of this study was to investigate the doctors exposition level to professional stress, to compare stress level in general practitioners (GP) group with that in the group of psychiatrists and risk level for the apperance of burnout syndrome. This cross-section study included subjects recruited by a random sample method. Thirty General Practice doctors and 30 psychiatrists (totally 60 doctors) filled the set of 3 questionnaires: Sociodemographics features, General Health Questionnaire (GHQ; Goldberg D, 1991), and Maslach Burnout Inventory (MBI; Maslach C, 1996). Appropriate statistical procedures (Pearson test, t-test, variance analysis) in interpretation of the results were used. A total level of psychic distress measured with the GHQ test in both groups of physicians was very low implying their good mental health. A difference in Burnout risk based on MBI test between the groups was statistically significant (chi2 = 4,286; p < 0.05) only at subscale Personal Accomplishment (MBI-PA); it was a consequence of a higher number of GPs with medium burnout risk (13.3 : 0.0%). However, even 35 physicians from the sample were affected with a high burnout risk measured with subscales Emotional Ehausation (MBI-EE) and MBI-DP, showing that both groups of physicians had risk for the appearance of burnout syndrome. The obtained results showed a high burnout risk level in both, GPs and psychiatrists, groups. In both groups there was no presence of psychic disorders (anxiety, depression, insomnia), while there was a high level of emotional ehausation and overtension by job, and also a lower total personal accomplishment. Level of exposition to professional stress is higher in GPs than in psychiatrists, but the difference was not
Vićentić Sreten; Jovanović Aleksandar 1; Dunjić Bojana; Pavlović Zorana; Nenadović Milutin; Nenadović Nenad
Background/Aim. So far, studies of stress have shown that physicians are at a high risk of sickness from psychic and somatic disorders related to professional stress, that can lead to important disturbance of personal, familiar and professional functionating. The aim of this study was to investigate the doctors exposition level to professional stress, to compare stress level in general practitioners (GP) group with that in the group of psychiatrists and risk level for the apperance of burnout...
Andrews, Jac J. W.; Syeda, Maisha M.
School psychologists typically conduct psychological and psychoeducational assessments, provide prevention and intervention services, and consult and collaborate with allied professionals (e.g., teachers, physicians, psychiatrists, physiotherapists, occupational therapists, social workers, and nurses) and parents toward better understanding and…
Carleton, R Nicholas; Collimore, Kelsey C; Asmundson, Gordon J G; McCabe, Randi E; Rowa, Karen; Antony, Martin M
The Social Phobia Inventory (SPIN) was designed to assess three dimensions of social anxiety (i.e., fear, avoidance, and physiological arousal) as posited by the scale authors (Connor et al., 2000). Despite expectations of a 3-factor solution, analyses of the SPIN to date have provided support for 3- and 5-factor solutions (Radomsky et al., 2006). Moreover, a 3-item version, the Mini-SPIN (Connor et al., 2001), has good sensitivity and specificity for generalized social anxiety disorder (SAD), implying some item redundancy. Another recent psychometric analysis of the SPIN was performed in a diagnostically diverse clinical sample (Antony et al., 2006); however, the study did not include a comprehensive evaluation of the factor structure. The current study was designed to comprehensively assess the SPIN factor structure using exploratory (EFA) and confirmatory (CFA) factor analyses in undergraduate (N=227) and clinical samples (N=355) using current recommendations for factor analyses (Osborne et al., 2008). Results suggest a 10-item 3-factor solution may be an ideal fit for clinical samples; however, using the undergraduate sample, the same solution was significantly better than precedent solutions but nonetheless not ideal. Implications and recommendations for future research are discussed.
Pacheco, Adriana; Barguil, Marcela; Contreras, Javier; Montero, Patricia; Dassori, Albana; Escamilla, Michael A; Raventós, Henriette
Schizophrenia (SC) and bipolar disorder (BP) are two of the most severe and incapacitating mental disorders. It has been questioned whether these two conditions designate distinct illnesses with different etiologies or whether they represent different ends of a clinical spectrum with a common etiology. This study compares social and clinical characteristics of 84 SC and 84 BP subjects from the Costa Rican Central Valley (CRCV) using information from the DIGS, FIGS and psychiatric records. Each of these subjects had a best estimate lifetime consensus diagnosis of either bipolar type I or SC. Subjects with SC differed from subjects with BP in social adjustment measures like marital and employment status, and number of children. Both groups were very similar in years of education, age of onset of their illness, history of other psychiatric co-morbidities, and treatment received. The high percentage of psychosis in the BP group (97.6%) may largely explain the similarities found between groups in their clinical characteristics. The differences in social and functional decline support the original dichotomy described by Kraepelin based on chronicity and periodicity between these two psychotic disorders.
Full Text Available Aim: The aim of the study was to determine differences in the image of ideal psychiatrist (IIP among patients, doctors involved in psychiatric care and medical students and also between individuals with different work experience (doctors vs. students. The psychiatrist’s personality seems an important factor in supporting therapeutic process; therefore it is worth searching for the patient’s needs. Materials and methods: Three groups participated in the study: patients of the psychiatric units, medical students of 6th year and psychiatrists. The Gough and Heilbrun ACL (Adjective Check List – based on Mur‑ ray’s theory of needs – was used to assess IIP. Results: Data analysis revealed statistically significant differences among patients, doctors and students involving five scales: Nurturance, Aggression, Change, Succorance and Deference. Patients had lower scores on Change scale than doctors and higher scores on the Nurturance, Succurance and Deference than stu‑ dents. Psychiatrists had higher scores on Nurturance and Deference scale and lower score on Aggression scale than students. Conclusions: The findings showed differences in the expectations of patients compared to those of students and doctors. The most significant difference that was observed involved the Change. It may indicate that patients prefer order, conventional approach and stability in psychiatrist’s personality traits more commonly than doctors. Study findings suggest that work experience has impact on IIP: with increasing work experience, opinion about IIP comes closer to patients’ expectations.
Rotstein, Sarah; Jenkins, Kym
To assess the level of career satisfaction and factors associated with work stress in members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). In 2014 an online survey was distributed to members of the RANZCP (including psychiatrists and psychiatry trainees). A total of 1051 members responded to the survey. Almost 85% of respondents indicated that they were satisfied with the work they were doing at the current stage of their career. 'Too much work to do in too little time' emerged as a key stressor and was ranked as the number one stressor in last 12 months by over one third of respondents. Where applicable, examinations, prospect of revalidation and training hurdles were all noted to be moderately/extremely stressful by over 50% of respondents. The majority of psychiatrists and trainees appear to be satisfied with their current work. However, there are many factors creating increased work stress and affecting welfare. The role of the college in protecting the welfare of its members should be further considered.
Pinto, Diana; Ribeiro, Branca Telles; Lopes Dantas, Maria Tereza
In the present article, we investigate the extent to which professional theories that underlie, inform, and guide the interviewing practices of two psychiatrists (a neuropsychiatrist and a psychoanalyst) are discursively displayed in their ways of conducting a psychiatric interview. This study analyses excerpts from two audio-recorded psychiatric interviews held at the Institute of Psychiatry of the Federal University of Rio de Janeiro. It follows theoretical and methodological frameworks derived from interactional sociolinguistics. Ethnographic data and research interviews with both clinicians also ground our discussion. Using frame analysis as a central tool, we found that the psychiatrist who subscribes to a neuropsychiatric orientation displays a concern on assessing the patient's cognitive processes, and shifts topics away from the patient's delusions to (re)introduce the institutional frame of the psychiatric interview. By contrast, the psychiatrist who holds a psychoanalytic orientation towards interviewing not only listens attentively to very personal topics introduced by the patient, but also sustains and develops these topics. Most of all, she proposes and stays within conversational frames. In keeping a dual understanding about their practices in the interview situation, both doctors balance the need to follow the institutional agenda and the need to listen to the patient, despite their different theoretical orientations.
Spaniel, F; Novak, T; Bankovska Motlova, L; Capkova, J; Slovakova, A; Trancik, P; Matejka, M; Höschl, C
Exposure to psychotic states has detrimental effects on the long-term outcome of schizophrenia and brain integrity. Therefore, improving relapse prevention is a key component of long-term management of schizophrenia. Previous studies using continuous monitoring of an individual's early signs of relapse and adopting preventative pharmacological interventions, when early signs are detected, showed promising clinical results in terms of relapse risk reduction. This 18-month multi-centre parallel randomized controlled, open label, trial with telemedicine relapse prevention programme ITAREPS failed to show superiority of maintenance plus prodrome-based targeted medication strategy over treatment as usual. The study, marked by low investigator's adherence, confirmed that absence of pharmacological intervention at early stage of prodrome, critically influenced the risk of relapse. This and previous randomized controlled trials with telemedicine programme ITAREPS suggested that substantial improvement in relapse prevention in schizophrenia is likely to be unattainable under current clinical settings. Future preventive strategies in schizophrenia would require rapid pharmacological intervention upon occurrence of subclinical prodromal symptoms that are undetectable under conventional outpatient practice. Studies with ITAREPS suggested that integration of telemedicine relapse prevention systems and visiting nurse service might together represent practical solution capable to address those requirements. The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group
Skovgaard, A M; Isager, T; Jørgensen, O S
The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two different...
Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey; Essock, Susan; Riano, Nicholas S; Shumway, Martha; Newcomer, John W; Dilley, James W; Schillinger, Dean
We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.
Sousa, Varley Dias; Silveira, Dâmaris
In the field of health regulation, enabling public access to data from clinical trials is a process currently undergoing consolidation by the principal regulators worldwide. This paper discusses recent developments in public policy regarding regulatory transparency, and the risks and benefits of a regulatory impact-analysis on clinical trial reports, from the perspective of the key stakeholders (i.e., patients, prescribers, government, society, industry, and regulators). Additionally, the social, technical, and ethical aspects of the datasharing process are highlighted, including access limits, commercially-confidential data and patent rights, privacy of research subjects, arrangements and publicity tools, and clinical trials registration. Furthermore, perspectives on improvement and expansion of regulatory transparency policies are presented, contextualizing North American, Latin American, and European experiences, and highlighting in-teragency cooperation and collaboration initiatives that aim to harmonize health programs and regulatory convergence.
Riquelme García, E; Dallal y Castillo, E
The historic development of the units that provided psychiatric care to children and adolescents, which finally yielded the first child guidance clinic early this century is briefly reviewed. We describe the organization of a child psychiatry unit within a social security institute (ISSSTE). The importance of a child psychiatrist, a psychologist and a social worker working together in a team approach to the evaluation and treatment of children is emphasized. The ISSSTE has provided psychiatric care to children and adolescents since 1961. For this purpose the Institute has five psychiatric units, four of them within a general hospital, the other in a neuropsychiatry out-patient clinic. This clinic admitted 749 new cases to the Child Psychiatry department during 1976. Up to December 1976, the total population of the clinic was 14 271 patients, of which 5 471 are children and adolescents. Last but not least, we describe an ambitious project for an in-patient unit for children and adolescents as part of a psychiatric hospital.
Márquez-Calderón, Soledad; Ruiz-Ramos, Miguel; Juárez, Sol; Librero López, Julián
Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.
Heponiemi, Tarja; Aalto, Anna-Mari; Puttonen, Sampsa; Vänskä, Jukka; Elovainio, Marko
Previous studies suggest that psychiatrists may be more stressed than other medical specialists and mental health professionals. This study examined differences in stress factors, job resources, psychological distress, and job satisfaction between psychiatrists and other medical specialists. In addition, the study examined whether stress factors or job resources accounted for possible differences between the groups in psychological distress or job satisfaction. In 2010, the authors obtained cross-sectional, Web-based survey data from a random sample of 2,776 Finnish physicians, including 1,647 women (59%), ranging in age from 25 to 69 years old. Comparisons between the two groups used analyses of covariance adjusted for gender, age, and employment sector. Psychiatrists were less satisfied with their jobs, felt more stressed about patients, and experienced more psychological distress compared with other medical specialists. However, psychiatrists had more opportunities to control their jobs and better team climate compared with other medical specialists. High psychological distress among psychiatrists was partly accounted for by high patient-related stress. The differences in psychological distress and job satisfaction between the two groups were not accounted for by work-family conflicts or optimism. It is important to try to alleviate the high levels of patient-related stress among psychiatrists and to further increase their job resources. Doing so may enhance the attractiveness of psychiatry as a specialty choice.
Kalb, Luther G; Stuart, Elizabeth A; Mandell, David S; Olfson, Mark; Vasa, Roma A
This study compared management by child psychiatrists of mental health crises among youths with and without autism spectrum disorder (ASD). A custom online mental health crisis services survey was administered to members of the American Academy of Child and Adolescent Psychiatry. The survey probed three domains of crisis management: willingness to work with youths with a history of mental health crisis, comfort level in managing a mental health crisis, and availability of external resources during a crisis. Child psychiatrists reporting on management of youths with ASD (N=492) and without ASD (N=374) completed the survey. About 75% of psychiatrists in both groups were willing to accept a child with a history of a mental health crisis in their practice. During a crisis, psychiatrists caring for youths with ASD had less access to external consultation resources, such as a crisis evaluation center or other mental health professionals, compared with those caring for youths without ASD. Psychiatrists also expressed concerns about the ability of emergency department professionals and emergency responders to manage mental health crises among youths in a safe and developmentally appropriate manner, particularly among those with ASD. Child psychiatrists are in need of more external resources to manage youths with ASD who are experiencing a mental health crisis. There is also a need to develop best practice procedures for emergency responders who are working with youths experiencing a mental health crisis.
Kerr, Ron; Hemmings, Brian C; Kay, Russell
Students' feedback of their practicum experiences are typically documented only in terms of established nursing competencies and learning objectives. How nursing students cope with social contingencies (e.g., personal health) while away on clinical placement is not commonly reported in the literature. A sample of Australian student nurses was surveyed as a way of contributing new knowledge about what and how social contingencies could impact on a practicum experience. An analysis of the survey data provided by 244 students revealed that of the 14 contingencies used, financial pressure, accommodation, and geographic location, were rated as having the most influence. All of these social contingencies were examined by a principal components analysis. Three factors were identified and interpreted as professional organization, home organization, and personal organization. Three subscales were then derived using these factors and other measures were also calculated. Bivariate and multivariate relationships were subsequently determined. One key finding was that the first year students, compared to their more senior counterparts, expressed less stress during their practicum. The first year students, as opposed to their more experienced peers, also attached less importance to the professional organizational contingencies. The implications of the study for university administrators, nursing education faculty, and managers of clinical facilities conclude the paper.
De Los Reyes, Andres; Augenstein, Tara M; Aldao, Amelia; Thomas, Sarah A; Daruwala, Samantha; Kline, Kathryn; Regan, Timothy
Social stressor tasks induce adolescents' social distress as indexed by low-cost psychophysiological methods. Unknown is how to incorporate these methods within clinical assessments. Having assessors judge graphical depictions of psychophysiological data may facilitate detections of data patterns that may be difficult to identify using judgments about numerical depictions of psychophysiological data. Specifically, the Chernoff Face method involves graphically representing data using features on the human face (eyes, nose, mouth, and face shape). This method capitalizes on humans' abilities to discern subtle variations in facial features. Using adolescent heart rate norms and Chernoff Faces, we illustrated a method for implementing psychophysiology within clinical assessments of adolescent social anxiety. Twenty-two clinic-referred adolescents completed a social anxiety self-report and provided psychophysiological data using wireless heart rate monitors during a social stressor task. We graphically represented participants' psychophysiological data and normative adolescent heart rates. For each participant, two undergraduate coders made comparative judgments between the dimensions (eyes, nose, mouth, and face shape) of two Chernoff Faces. One Chernoff Face represented a participant's heart rate within a context (baseline, speech preparation, or speech-giving). The second Chernoff Face represented normative heart rate data matched to the participant's age. Using Chernoff Faces, coders reliably and accurately identified contextual variation in participants' heart rate responses to social stress. Further, adolescents' self-reported social anxiety symptoms predicted Chernoff Face judgments, and judgments could be differentiated by social stress context. Our findings have important implications for implementing psychophysiology within clinical assessments of adolescent social anxiety.
Martínez-García, Alicia; Moreno-Conde, Alberto; Jódar-Sánchez, Francisco; Leal, Sandra; Parra, Carlos
Social networks applied through Web 2.0 tools have gained importance in health domain, because they produce improvements on the communication and coordination capabilities among health professionals. This is highly relevant for multimorbidity patients care because there is a large number of health professionals in charge of patient care, and this requires to obtain clinical consensus in their decisions. Our objective is to develop a tool for collaborative work among health professionals for multimorbidity patient care. We describe the architecture to incorporate decision support functionalities in a social network tool to enable the adoption of shared decisions among health professionals from different care levels. As part of the first stage of the project, this paper describes the results obtained in a pilot study about acceptance and use of the social network component in our healthcare setting. At Virgen del Rocío University Hospital we have designed and developed the Shared Care Platform (SCP) to provide support in the continuity of care for multimorbidity patients. The SCP has two consecutively developed components: social network component, called Clinical Wall, and Clinical Decision Support (CDS) system. The Clinical Wall contains a record where health professionals are able to debate and define shared decisions. We conducted a pilot study to assess the use and acceptance of the SCP by healthcare professionals through questionnaire based on the theory of the Technology Acceptance Model. In March 2012 we released and deployed the SCP, but only with the social network component. The pilot project lasted 6 months in the hospital and 2 primary care centers. From March to September 2012 we created 16 records in the Clinical Wall, all with a high priority. A total of 10 professionals took part in the exchange of messages: 3 internists and 7 general practitioners generated 33 messages. 12 of the 16 record (75%) were answered by the destination health professionals
Lehoux, Pascale; Denis, Jean-Louis; Rock, Melanie; Hivon, Myriam; Tailliez, Stephanie
Medical specialists play a pivotal role in health innovation evaluation and policy making. Their influence derives not only from their expertise, but also from their social status and the power of their professional organisations. Little is known, however, about how medical specialists determine what makes a health innovation desirable and why. Our qualitative study investigated the views of 28 medical specialists and experts from Quebec and Ontario (Canada) on three controversial innovations: electroconvulsive therapy, prostate-specific antigen screening and prenatal screening for Down's syndrome. Our findings indicate that the scientific, clinical and social arguments of medical specialists combine to create a relatively consistent narrative for each innovation. Our comparative analysis suggests that these narratives bring about a 'soft' resolution to controversies, which relies on a more or less tacit understanding of the social desirability of innovations and which sets the stage for their routinisation. Such an unpacking of medical specialists' arguments both for and against new technologies is needed because such arguments may easily be considered authoritative and because there are few forums for debating the social desirability of innovations not generally deemed to be highly controversial.
Whitton, Alexis E; Henry, Julie D
Comorbid obsessive-compulsive (OC) symptoms in individuals with a primary diagnosis of schizophrenia are related to poorer cognitive performance and functional outcomes, but no study to date has assessed whether this comorbidity might also have implications for social cognition. The aim of the present study was to provide the first test of this possibility. Individuals with schizophrenia (n = 34) and demographically matched non-clinical controls (n = 44) were assessed on two of the most important aspects of social cognitive function (1) facial affect recognition and (2) theory of mind, alongside more standard measures of cognitive function. The presence of OC symptoms was related to poorer performance on some of the cognitive measures, as well as one of the social cognitive measures (facial affect recognition). However, these relationships disappeared after controlling for scores on more general indices of schizophrenia psychopathology. The presence of OC symptoms in schizophrenia is not only associated with increased cognitive impairment but also increased difficulties with at least some aspects of social cognitive function. However, these relationships appear to reflect the elevated levels of psychopathology seen in this cohort more generally, rather than being uniquely attributable to OC symptomatology. © 2012 The British Psychological Society.
Woodruff, P W; Higgins, E M; du Vivier, A W; Wessely, S
There is a recognized psychiatric morbidity among those who attend dermatology clinics. We aimed to determine the pattern of psychological and social problems among patients referred to a liaison psychiatrist within a dermatology clinic. Notes from 149 patients were reviewed and more detailed assessments performed in a subgroup of 32 consecutive referrals. All but 5% merited a psychiatric diagnosis. Of these, depressive illness accounted for 44% and anxiety disorders, 35%. Less common general psychiatric disorders included social phobia, somatization disorder, alcohol dependence syndrome, obsessive-convulsive disorder, posttraumatic stress disorder, anorexia nervosa, and schizophrenia. Classical disorders such as dermatitis artefacta and delusional hypochondriasis were uncommon. Commonly, patients presented with longstanding psychological problems in the context of ongoing social difficulties rather than following discrete precipitants. Psychiatric intervention resulted in clinical improvement in most of those followed up. Of the dermatological categories 1) exacerbation of preexisting chronic skin disease; 2) symptoms out of proportion to the skin lesion; 3) dermatological nondisease; 4) scratching without physical signs, the commonest were dermatological nondisease and exacerbation of chronic skin disease. Anxiety was common in those from all dermatological categories. Patients with dermatological nondisease had the highest prevalence of depression. Skin patients with significant psychopathology may go untreated unless referred to a psychiatrist. The presence of dermatological nondisease or symptoms out of proportion to the skin disease should particularly alert the physician to the possibility of underlying psychological problems.
Rosman, Yossi; Eisenkraft, Arik; Milk, Nadav; Shiyovich, Arthur; Ophir, Nimrod; Shrot, Shai; Kreiss, Yitshak; Kassirer, Michael
On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events.
Kamimura, Akiko; Christensen, Nancy; Al-Obaydi, Sarah; Solis, Silvia Patricia; Ashby, Jeanie; Greenwood, Jessica L J; Reel, Justine J
Obesity is a significant public health problem in women's health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts. We compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support. Although female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p depression lowers levels of body esteem (p body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Moss, Taryn G; Carney, Colleen E; Haynes, Patricia; Harris, Andrea L
Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N = 69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.
Good, B J; Herrera, H; Good, M J; Cooper, J
A Mexican-American woman who complained of persistent head pain and a bothersome "voice" was seen by a team consisting of a psychiatrist, social scientists, and spiritualist healers in a Cultural Consultation Clinic of a Psychiatric Consultation Liaison Service. This single case is analyzed to provide an understanding of the interpretive dimensions of psychiatric practice. It is argued that a hermeneutic analysis of clinical phenomena focuses attention on three distinct aspects of interpretation: on the interpretation by clinicians and clients of the discourse of the other in terms of their own clinical models; on the influence of deeply embedded personal meanings on this interpretive process; and on the role of the observer in clinical ethnography. It is argued that to sustain a hermeneutic analysis of psychiatric practice, an account of transference and countertransference in terms of interpretation theory will have to be developed.
Brown, Elliot Clayton; Tas, Cumhur; Can, Huseyin; Esen-Danaci, Aysen; Brüne, Martin
Impairments in social functioning commonly seen in schizophrenia are thought to be mediated by deficits in the domains of social cognition. Some previous research has explored how social cognitive skills and psychotic symptoms are associated with social functioning, however these associations are still under debate. The main aim of this study was to investigate the relationship between different domains of social cognition and psychotic symptomatology, and also to look at the relationships with individual subdomains of social functioning within a clinically stable schizophrenia population. 45 outpatients were recruited and symptoms were assessed with the PANSS, and measures of emotion processing, affective and cognitive theory of mind (ToM), mental state reasoning attributional biases, and social functioning were taken. A correlational analysis was performed with the data. Following this, a regression analysis was used to reveal which domains of social cognition best predicted psychotic symptoms. In this stable group of patients, our results support the suggestion of a likely distinction between affective and cognitive components of ToM. The study also demonstrated that ToM and mental state reasoning were the best predictors of psychotic symptoms. Here we reveal that cognitive ToM had the most widespread relationship with social functioning, across multiple subdomains, while only some specific subdomains of social functioning correlated with other domains of social cognition and symptomatology. Further to this, positive symptoms were associated with much fewer subdomains of social functioning than negative and general symptoms. These findings imply that different aspects of social functioning may be served by different domains of social cognition and symptomatology. © 2014.
O'Connor, Thomas G; Matias, Carla; Futh, Annabel; Tantam, Grace; Scott, Stephen
Parenting programs for school-aged children are typically based on behavioral principles as applied in social learning theory. It is not yet clear if the benefits of these interventions extend beyond aspects of the parent-child relationship quality conceptualized by social learning theory. The current study examined the extent to which a social learning theory-based treatment promoted change in qualities of parent-child relationship derived from attachment theory. A randomized clinical trial of 174 four- to six-year-olds selected from a high-need urban area and stratified by conduct problems were assigned to a parenting program plus a reading intervention (n = 88) or nonintervention condition (n = 86). In-home observations of parent-child interactions were assessed in three tasks: (a) free play, (b) challenge task, and (c) tidy up. Parenting behavior was coded according to behavior theory using standard count measures of positive and negative parenting, and for attachment theory using measures of sensitive responding and mutuality; children's attachment narratives were also assessed. Compared to the parents in the nonintervention group, parents allocated to the intervention showed increases in the positive behavioral counts and sensitive responding; change in behavioral count measures overlapped modestly with change in attachment-based changes. There was no reliable change in children's attachment narratives associated with the intervention. The findings demonstrate that standard social learning theory-based parenting interventions can change broader aspects of parent-child relationship quality and raise clinical and conceptual questions about the distinctiveness of existing treatment models in parenting research.
Heydari, Abbas; Dashtgard, Ali; Moghadam, Zahra Emami
.... Thus, the present study was conducted with an aim to examine the effect of Bandura's social cognitive theory implementation on addiction quitting of clients referred to Imam Reza Hospital addiction quitting clinic...
Folk, Johanna B; Disabato, David J; Goodman, Fallon R; Carter, Sarah P; DiMauro, Jennifer C; Riskind, John H
Progress in clinical science, theory, and practice requires the integration of advances from multiple fields of psychology, but much integration remains to be done. The current article seeks to address the specific gap that exists between basic social psychological theories and the implementation of related therapeutic techniques. We propose several "wise additions," based upon the principles outlined by Walton (2014), intended to bridge current social psychological research with clinical psychological therapeutic practice using cognitive behavioral therapy as an example. We consider how recent advances in social psychological theories can inform the development and implementation of wise additions in clinical case conceptualization and interventions. We specifically focus on self and identity, self-affirmation, transference, social identity, and embodied cognition, five dominant areas of interest in the field that have clear clinical applications.
Canuto, Alessandra; Gkinis, Georgios; DiGiorgio, Sergio; Arpone, Francesca; Herrmann, François R; Weber, Kerstin
Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement. Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory. Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder. These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.
Weber, Matthias M; Burgmair, Wolfgang
In 1888, Eduard Robert Michelson (1861-1944), a student of the German psychiatrist Emil Kraepelin at the university clinic of Dorpat (Tartu, Estonia), established a sleep laboratory in which he conducted a fundamental and innovative study about the physiology of sleep regulation. Based on the then current theoretical concepts and methodological techniques of Wundtian experimental psychology, and Kraepelin's research strategy, Michelson, for the first time, was able to describe a "very strange phenomenon" of human sleep - a "remarkable periodicity" of the "sleep depth curve." Furthermore, Michelson postulated that this within sleep periodicity should not be explained as an effect of external stimuli but rather of "antagonistic" physiological processes. Unfortunately, Michelson's publication of 1891 fell almost into oblivion as contemporary theories of sleep could not offer an explanation for his findings. Nevertheless, Michelson's "Untersuchungen über die Tiefe des Schlafes" should be considered as one of the key studies in the development of sleep research in the 19th century and a pioneer description of within sleep periodicity.
Corley, Courtney D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Volkova, Svitlana [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rounds, Jeremiah [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Charles-Smith, Lauren E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Harrison, Joshua J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mendoza, Joshua A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Han, Keith S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)
U.S. military influenza surveillance uses electronic reporting of clinical diagnoses to monitor health of military personnel and detect naturally occurring and bioterrorism-related epidemics. While accurate, these systems lack in timeliness. More recently, researchers have used novel data sources to detect influenza in real time and capture nontraditional populations. With data-mining techniques, military social media users are identified and influenza-related discourse is integrated along with medical data into a comprehensive disease model. By leveraging heterogeneous data streams and developing dashboard biosurveillance analytics, the researchers hope to increase the speed at which outbreaks are detected and provide accurate disease forecasting among military personnel.
Danica Rotar Pavlič
Full Text Available BACKGROUND By 2015, mental illness will become the greatest healthcare burden in the world. Within the community, people with depression are most often treated by family doctors. Treatment for depression also includes psychiatric specialists, with varying cooperation between the primary care provider and the psychiatrist. This study’s goal was to define cooperation between family doctors and psychiatric specialists when treating patients with depression.METHODS In 2009 six focus groups were held that included general practitioners. The data were analyzed using qualitative methods. Results: Seventeen topics and related categories were developed for the study. One of these related to the cooperation between primary care providers and psychiatric specialists. Family doctors see psychiatrists as responsible for working with more challenging patients and as intermediaries in evaluating sick leave and assessing ability to work. Psychiatrists offer family doctors support in the education process and in terms of supervision. Numerous factors influence referral from primary to secondary level, including patients’ and doctors’ personal characteristics.CONCLUSIONSAchieving the goals of treating patients with depression requires not only expertise, organization at the primary care level, and a method of communication between patients and doctors, but also cooperation between primary care providers and psychiatric specialists. This ought to take place in compliance with professional criteria and not as a result of the patient’s condition and pressure from the patient. Representatives of both specializations should establish ways to work together and clarify the issue of information exchange and (inappropriate referrals for obtaining opinions regarding sick leave and disability-based retirement.
Salmeron, Patricia A
To review the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), present an overview of the effects that ADHD has on family dynamics, school performance, and substance abuse, and provide an overview of the American Academy of Pediatrics (AAP) clinical practice and treatment guidelines. An extensive health science literature review was carried out using PubMed and Cumulative Index to Nursing and Allied Health Literature. Other information was collected by searching reference lists of published reports. The diagnostic criteria and guidelines are important to make an accurate clinical assessment and manage a child with ADHD. Early diagnosis and treatment of ADHD decreases academic failure, family conflict, social isolation, substance abuse, and occupational adversity in later years for these children. Often primary care nurse practitioners are the first healthcare provider a child with ADHD will see. Awareness of the diagnostic criteria and treatment for children with ADHD can assist with early identification and perhaps eliminate much impairment that accompanies this chronic disorder.
Gallagher, Michelle; Prinstein, Mitchell J.; Simon, Valerie; Spirito, Anthony
Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens, although this research largely has been cross-sectional and has not examined potential mediators of this relationship. A clinical sample of 144 early adolescents (72 % female; 12?15 years old) was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months post-baseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived ...
Hart, Laura C; Maslow, Gary
More adolescents and young adults are surviving previously fatal childhood illness and need support to transition from pediatric care to adult-oriented care. There are many barriers, but guidelines and tools assist providers with emphasis on gradually addressing transition with patients and families. Child and adolescent psychiatrists should be particularly attuned to the needs of adolescents with previously identified mental illness who are at high risk of falling out of regular care during transition. Providers are also uniquely suited to address the needs of adolescents and young adults with intellectual and developmental disabilities. Copyright © 2017 Elsevier Inc. All rights reserved.
Weiss, Meredith; Schwartz, Bruce J
Comorbid psychiatric illness has been identified as a major driver of health care costs. The colocation of psychiatrists in primary care practices has been proposed as a model to improve mental health and medical care as well as a model to reduce health care costs. Financial models were developed to determine the sustainability of colocation. We found that the population studied had substantial psychiatric and medical burdens, and multiple practice logistical issues were identified. The providers found the experience highly rewarding and colocation was financially sustainable under certain conditions. The colocation model was effective in identifying and treating psychiatric comorbidities.
Pedersen, Dorthe Almind; Hageman, Ida; Wehby, George L
investigated redeemed prescriptions of psychotropic medication during 1996 to 2012 and visits to psychiatrists and psychologists during 1996 to 2011 among individuals born with nonsyndromic OC in Denmark between 1936 and 2009 and a comparison cohort of individuals without OC. This includes 8244 individuals...... and no increased risk for visits to psychologists for either group. CONCLUSIONS: This study indicates that a small group of individuals with nonsyndromic OC, in particular those with palatal involvement, have greater risk of using psychotropic medications. However, elevated use was also observed among younger...
Santos Darci N.
Full Text Available INTRODUCTION: Among psychiatric disorders schizophrenia is often said to be the condition with the most disputed definition.The Bleulerian and Schneiderian approaches have given rise to diagnostic formulations that have varied with time and place. Controversies over the concept of schizophrenia were examined within European/North American settings in the early 1970s but little has since been reported on the views of psychiatrists in developing countries. In Brazil both concepts are referred to in the literature. A scale was developed to measure adherence to Bleulerian and Schneiderian concepts among psychiatrists working in S. Paulo. METHODOLOGY: A self-reported questionnaire comprising seventeen visual analogue-scale statements related to Bleulerian and Schneiderian definitions of Shizophrenia, plus sociodemographic and training characteristics, was distributed to a non-randomised sample of 150 psychiatrists. The two sub-scales were assessed by psychometric methods for internal consistency, sub-scale structure and test-retest reliability. Items selected according to internal consistency were examined by a two-factor model exploratory factor analysis. Intraclass correlation coefficients described the stability of the scale. RESULTS: Replies were received from 117 psychiatrists (mean age 36 (SD 7.9, 74% of whom were made and 26% female. The Schneiderian scale showed better overall internal consistency than the Bleulerian scale. Intra-class correlation coefficients for test-retest comparisons were between 0.5 and 0.7 for Schneiderian items and 0.2 and 0.7 for Bleulerian items. There was no negative association between Bleulerian and Schneiderian scale scores, suggesting that respondents may hold both concepts. Place of training was significantly associated with the respondent's opinion; disagreement with a Bleulerian standpoint predominated for those trained at the University of S. Paulo. CONCLUSIONS: The less satisfactory reliability for the
Linet, Martha S; Kitahara, Cari M; Ntowe, Estelle; Kleinerman, Ruth A; Gilbert, Ethel S; Naito, Neal; Lipner, Rebecca S; Miller, Donald L; Berrington de Gonzalez, Amy
Purpose To compare total and cause-specific mortality rates between physicians likely to have performed fluoroscopy-guided interventional (FGI) procedures (referred to as FGI MDs) and psychiatrists to determine if any differences are consistent with known radiation risks. Materials and Methods Mortality risks were compared in nationwide cohorts of 45 634 FGI MDs and 64 401 psychiatrists. Cause of death was ascertained from the National Death Index. Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for FGI MDs versus psychiatrists, with adjustment (via stratification) for year of birth and attained age. Results During follow-up (1979-2008), 3506 FGI MDs (86 women) and 7814 psychiatrists (507 women) died. Compared with psychiatrists, FGI MDs had lower total (men: RR, 0.80 [95% CI: 0.77, 0.83]; women: RR, 0.80 [95% CI: 0.63, 1.00]) and cancer (men: RR, 0.92 [95% CI: 0.85, 0.99]; women: RR, 0.83 [95% CI: 0.58, 1.18]) mortality. Mortality because of specific types of cancer, total and specific types of circulatory diseases, and other causes were not elevated in FGI MDs compared with psychiatrists. On the basis of small numbers, leukemia mortality was elevated among male FGI MDs who graduated from medical school before 1940 (RR, 3.86; 95% CI: 1.21, 12.3). Conclusion Overall, total deaths and deaths from specific causes were not elevated in FGI MDs compared with psychiatrists. These findings require confirmation in large cohort studies with individual doses, detailed work histories, and extended follow-up of the subjects to substantially older median age at exit. © RSNA, 2017 Online supplemental material is available for this article.
Gallagher, Michelle; Prinstein, Mitchell J; Simon, Valerie; Spirito, Anthony
Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens, although this research largely has been cross-sectional and has not examined potential mediators of this relationship. A clinical sample of 144 early adolescents (72 % female; 12-15 years old) was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months post-baseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived social support were assessed via structured interviews and self-report instruments. Structural equation modeling revealed a significant direct relationship between social anxiety symptoms at baseline and suicidal ideation at 18 months post-baseline, even after controlling for baseline depressive symptoms and ideation. A second multiple mediation model revealed that baseline social anxiety had a significant indirect effect on suicidal ideation at 18 months post-baseline through loneliness at 9 months post-baseline. Social anxiety did not have a significant indirect effect on suicidal ideation through perceived social support from either parents or close friends. Findings suggest that loneliness may be particularly implicated in the relationship between social anxiety and suicidality in teens. Clinicians should assess and address feelings of loneliness when treating socially anxious adolescents.
Prinstein, Mitchell J.; Simon, Valerie; Spirito, Anthony
Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens, although this research largely has been cross-sectional and has not examined potential mediators of this relationship. A clinical sample of 144 early adolescents (72 % female; 12–15 years old) was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months post-baseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived social support were assessed via structured interviews and self-report instruments. Structural equation modeling revealed a significant direct relationship between social anxiety symptoms at baseline and suicidal ideation at 18 months post-baseline, even after controlling for baseline depressive symptoms and ideation. A second multiple mediation model revealed that baseline social anxiety had a significant indirect effect on suicidal ideation at 18 months post-baseline through loneliness at 9 months post-baseline. Social anxiety did not have a significant indirect effect on suicidal ideation through perceived social support from either parents or close friends. Findings suggest that loneliness may be particularly implicated in the relationship between social anxiety and suicidality in teens. Clinicians should assess and address feelings of loneliness when treating socially anxious adolescents. PMID:24390470
Buchbinder, Eli; Barakat, Rouzin
Abused women seek help from medicine services extensively. Qualitative interviews were conducted with 12 married Arab-Israeli abused women about their relationships with social workers in community health clinics. Analysis reveals that women's evaluation of the impact of encounters with social workers is bipolar. On one pole are the difficulties and stressors derived from the cultural limitations that are placed on their ability to bring changes. On the other pole are the benefits--awareness in coping with repressive social powers and empowerment as competent choosers. The discussion elaborates the conflicts and paradoxes inherent in the nature of the interventions with abused women in a collectivistic culture.
Lau, Chuen-Yen; Swann, Edith M; Singh, Sagri
In May 2009, a workshop was held in Washington DC to identify ways in which HIV vaccine clinical research could benefit from and better incorporate behavioral and social science (BSS) considerations. Seventy-one people from government, non-government, and private organizations participated, including HIV vaccine researchers, clinical trial scientists, BSS researchers, community representatives, and sponsors. This workshop elucidated the opportunities and challenges for integrating BSS in HIV vaccine research by highlighting insights gained from previous BSS research on HIV prevention and highlighting new BSS approaches and methodologies. Meeting participants identified priority areas where BSS methodologies could significantly impact HIV research and developed concrete recommendations for addressing current challenges encountered in HIV vaccine research relating to social impact, risk assessment, community engagement, informed consent, risk reduction, and special populations. These recommendations address the need for improving the accuracy of participant data; standardizing data collection to enable comparisons across studies; engaging the community at all levels; using evidenced-based counseling techniques; understanding the needs and concerns of target populations; and considering the impacts of macro-level forces and influences. The importance of establishing collaborations that can carry out these recommendations and facilitate necessary changes in thinking and practice was emphasized throughout the meeting. Copyright © 2011. Published by Elsevier Ltd.
Kiyatkin, Eugene A; Ren, Suelynn; Wakabayashi, Ken T; Baumann, Michael H; Shaham, Yavin
MDMA-induced hyperthermia is highly variable, unpredictable, and greatly potentiated by the social and environmental conditions of recreational drug use. Current strategies to treat pathological MDMA-induced hyperthermia in humans are palliative and marginally effective, and there are no specific pharmacological treatments to counteract this potentially life-threatening condition. Here, we tested the efficacy of mixed adrenoceptor blockers carvedilol and labetalol, and the atypical antipsychotic clozapine, in reversing MDMA-induced brain and body hyperthermia. We injected rats with a moderate non-toxic dose of MDMA (9 mg/kg) during social interaction, and we administered potential treatment drugs after the development of robust hyperthermia (>2.5 °C), thus mimicking the clinical situation of acute MDMA intoxication. Brain temperature was our primary focus, but we also simultaneously recorded temperatures from the deep temporal muscle and skin, allowing us to determine the basic physiological mechanisms of the treatment drug action. Carvedilol was modestly effective in attenuating MDMA-induced hyperthermia by moderately inhibiting skin vasoconstriction, and labetalol was ineffective. In contrast, clozapine induced a marked and immediate reversal of MDMA-induced hyperthermia via inhibition of brain metabolic activation and blockade of skin vasoconstriction. Our findings suggest that clozapine, and related centrally acting drugs, might be highly effective for reversing MDMA-induced brain and body hyperthermia in emergency clinical situations, with possible life-saving results.
Emons, Barbara; Haussleiter, Ida Sybille; Kalthoff, Jörg; Schramm, Anja; Hoffmann, Knut; Jendreyschak, Jasmin; Schaub, Markus; Armgart, Carina; Juckel, Georg; Illes, Franciska
Germany provides a wide range of highly developed mental health care to its citizens. The aim of this study was to identify factors influencing the voluntariness of admissions to psychiatric hospitals. Especially the impact of demographic factors of the region, characteristics of the psychiatric hospitals and characteristics of the psychosocial services was analyzed. A retrospective analysis of hospital admission registers from 13 German adult psychiatric hospitals in 2009 was conducted. Public data on the regional psychiatric accommodation and demographic situation were added. Hospitals were dichotomously divided according to their index of involuntary admissions. Group comparisons were performed between the clinics with low and high involuntary admission indices. Analysis was conducted with clinical, psychiatric provision and demographic data related to inpatients in the Landschaftsverbands Westfalen-Lippe (LWL)-PsychiatryNetwork. Especially the range of services provided by the social-psychiatric services in the region such as number of supervised patients and home visits had an influence on the proportion of involuntary admissions to a psychiatric hospital. Some demographic characteristics of the region such as discretionary income showed further influence. Contrary to our expectations, the characteristics of the individual hospital seem to have no influence on the admission rate. Social-psychiatric services show a preventive impact on involuntary acute psychiatry interventions. Sociodemographic factors and patient variables play a role with regard to the number of involuntary hospitalizations, whereas characteristics of hospitals seemed to play no role. © The Author(s) 2013.
Kiyatkin, Eugene A; Ren, Suelynn; Wakabayashi, Ken T; Baumann, Michael H; Shaham, Yavin
MDMA-induced hyperthermia is highly variable, unpredictable, and greatly potentiated by the social and environmental conditions of recreational drug use. Current strategies to treat pathological MDMA-induced hyperthermia in humans are palliative and marginally effective, and there are no specific pharmacological treatments to counteract this potentially life-threatening condition. Here, we tested the efficacy of mixed adrenoceptor blockers carvedilol and labetalol, and the atypical antipsychotic clozapine, in reversing MDMA-induced brain and body hyperthermia. We injected rats with a moderate non-toxic dose of MDMA (9 mg/kg) during social interaction, and we administered potential treatment drugs after the development of robust hyperthermia (>2.5 °C), thus mimicking the clinical situation of acute MDMA intoxication. Brain temperature was our primary focus, but we also simultaneously recorded temperatures from the deep temporal muscle and skin, allowing us to determine the basic physiological mechanisms of the treatment drug action. Carvedilol was modestly effective in attenuating MDMA-induced hyperthermia by moderately inhibiting skin vasoconstriction, and labetalol was ineffective. In contrast, clozapine induced a marked and immediate reversal of MDMA-induced hyperthermia via inhibition of brain metabolic activation and blockade of skin vasoconstriction. Our findings suggest that clozapine, and related centrally acting drugs, might be highly effective for reversing MDMA-induced brain and body hyperthermia in emergency clinical situations, with possible life-saving results. PMID:26105141
Orndorff-Plunkett, Franklin; Singh, Fiza
Social neuroscience benefits from the experimental manipulation of neuronal activity. One possible manipulation, neurofeedback, is an operant conditioning-based technique in which individuals sense, interact with, and manage their own physiological and mental states. Neurofeedback has been applied to a wide variety of psychiatric illnesses, as well as to treat sub-clinical symptoms, and even to enhance performance in healthy populations. Despite growing interest, there persists a level of distrust and/or bias in the medical and research communities in the USA toward neurofeedback and other functional interventions. As a result, neurofeedback has been largely ignored, or disregarded within social neuroscience. We propose a systematic, empirically-based approach for assessing the effectiveness, and utility of neurofeedback. To that end, we use the term perturbative physiologic plasticity to suggest that biological systems function as an integrated whole that can be perturbed and guided, either directly or indirectly, into different physiological states. When the intention is to normalize the system, e.g., via neurofeedback, we describe it as self-directed neuroplasticity, whose outcome is persistent functional, structural, and behavioral changes. We argue that changes in physiological, neuropsychological, behavioral, interpersonal, and societal functioning following neurofeedback can serve as objective indices and as the metrics necessary for assessing levels of efficacy. In this chapter, we examine the effects of neurofeedback on functional connectivity in a few clinical disorders as case studies for this approach. We believe this broader perspective will open new avenues of investigation, especially within social neuroscience, to further elucidate the mechanisms and effectiveness of these types of interventions, and their relevance to basic research. PMID:28783134
Full Text Available This study aimed to explore linkages of patients' social network composition with health behaviors and clinical risk factors.This observational study was embedded in a project aimed at improving cardiovascular risk management (CRVM in primary care. 657 vascular patients (227 with cardiovascular disease, 380 at high vascular risk, mean age 72.4 (SD 9.4 years, were recruited as were individuals patients considered important for dealing with their disease, so called alters (n = 487. Network composition was measured with structured patient questionnaires. Both patients and alters completed questionnaires to measure health behavior (habits for physical activity, diet, and smoking. Clinical risk factors (systolic blood pressure, LDL cholesterol level, and body mass index were extracted from patients' medical records. Six logistic regression analyses, using generalized estimating equations, were used to test three hypothesized effects of network composition (having alters with healthful behaviors, without depression, and with specialized knowledge on six outcomes, adjusted for demographic, personal and psychological characteristics.Having alters with overall healthful behavior was related to healthful patient diet (OR 2.14, 95%CI: 1.52-3.02. Having non-smoking alters in networks was related to reduced odds for patient smoking (OR 0.17, 95%CI: 0.05-0.60. No effects of presence of non-depressed alters were found. Presence of alters with specialized knowledge on CVRM was inversely related to healthful diet habits of patients (OR 0.47, 95%CI 0.24-0.89. No significant associations between social network composition and clinical risk factors were found.Diet and smoking, but not physical exercise and clinical risk factors, were associated with social network composition of patients with vascular conditions. In this study of vascular patients, controlling for both personal and psychological factors, fewer network influences were found compared to previous
Heijmans, Naomi; van Lieshout, Jan; Wensing, Michel
Background This study aimed to explore linkages of patients’ social network composition with health behaviors and clinical risk factors. Methods/Design This observational study was embedded in a project aimed at improving cardiovascular risk management (CRVM) in primary care. 657 vascular patients (227 with cardiovascular disease, 380 at high vascular risk), mean age 72.4 (SD 9.4) years, were recruited as were individuals patients considered important for dealing with their disease, so called alters (n = 487). Network composition was measured with structured patient questionnaires. Both patients and alters completed questionnaires to measure health behavior (habits for physical activity, diet, and smoking). Clinical risk factors (systolic blood pressure, LDL cholesterol level, and body mass index) were extracted from patients’ medical records. Six logistic regression analyses, using generalized estimating equations, were used to test three hypothesized effects of network composition (having alters with healthful behaviors, without depression, and with specialized knowledge) on six outcomes, adjusted for demographic, personal and psychological characteristics. Results Having alters with overall healthful behavior was related to healthful patient diet (OR 2.14, 95%CI: 1.52–3.02). Having non-smoking alters in networks was related to reduced odds for patient smoking (OR 0.17, 95%CI: 0.05–0.60). No effects of presence of non-depressed alters were found. Presence of alters with specialized knowledge on CVRM was inversely related to healthful diet habits of patients (OR 0.47, 95%CI 0.24–0.89). No significant associations between social network composition and clinical risk factors were found. Discussion Diet and smoking, but not physical exercise and clinical risk factors, were associated with social network composition of patients with vascular conditions. In this study of vascular patients, controlling for both personal and psychological factors, fewer network
Pontillo, Maria; Guerrera, Silvia; Santonastaso, Ornella; Tata, Maria Cristina; Averna, Roberto; Vicari, Stefano; Armando, Marco
Some studies have shown that anxiety is particularly frequent in the Clinical High Risk (CHR) for psychosis population. Notably, social anxiety disorder is identified as one of the most common anxiety disorders in CHR adolescents and young adults. Despite this, the frequency and the clinical significance of social anxiety in this population have been underestimated. A selective review of literature published between 2011 and 2017 on social anxiety disorder in CHR adolescents and young adults. Five studies are included. In particular, three studies demonstrated that CHR adolescents and young adults have higher levels of anxiety compared to controls. Furthermore, anxiety, including social anxiety, is related to the severity of psychotic symptoms. The other studies included show inconsistent results regarding the possible relationship between social anxiety and social functioning. To date, the eidence concerning the comorbidity of social anxiety disorder and CHR in adolescents and young adults is not sufficient to provide clear guidelines for clinical practice. Future longitudinal studies on larger samples of the CHR adolescents and young adults are required to examine the relationship between social anxiety disorder and the presence of attenuated psychotic symptomatology.
Jippes, Erik; Steinert, Yvonne; Pols, Jan; Achterkamp, Marjolein C.; van Engelen, Jo M. L.; Brand, Paul L. P.
Purpose To examine the impact of social networks and a two-day faculty development course on clinical supervisors' adoption of an educational innovation. Method During 2007-2010, 571 residents and 613 clinical supervisors in four specialties in the Netherlands were invited to complete a Web-based
Allen, Sarah; Lowe, Derek; Harris, Rebecca V; Brown, Steve; Rogers, Simon N
Oral cancer has a higher incidence in the lower social strata, and these patients are less likely to engage in supportive interventions and report a poorer quality of life (QoL). The aim of this paper is to compare the Patient Concerns Inventory (PCI) responses across social groups attending routine oral cancer follow-up clinics with particular focus on the deprivation lower quartile. The PCI package is completed by patients as part of their routine review consultation with SNR. Patients were those diagnosed between 2008 and 2012. Deprivation was stratified using the IMD 2010 from postcode. Of the 106 eligible patients, 85 % used the PCI. Just over half (54 %) were living in the most deprived quartile, with two-thirds (68 %) of males in the most deprived quartile, compared with 35 % of females (p = 0.004). In regard to number and type of PCI items selected by patients at their first PCI clinic, there were no notable differences in respect of IMD classification. The two commonest concerns were fear of recurrence (43 %) and sore mouth (43 %). The most deprived quartile reported significant problems in regard to mood (p = 0.004) and recreation (p = 0.02), and a non-significant trend (36 vs 18 %, p = 0.09) in stating their overall QoL as being less than good. It is possible to identify the concerns of patients from lower socioeconomic strata as part of routine follow-up clinics. This allows for targeted multi-professional intervention and supports to improve the outcome in this hard to reach group.
Stark, Thomas Johann; Brownell, Alvin Keith; Brager, Nancy Patricia; Berg, Amanda; Balderston, Rhea; Lockyer, Jocelyn Margot
The pharmaceutical industry has engaged physicians through medical education, patient care, and medical research. New conflict of interest policy has highlighted the challenges to these relationships. The objective of this study was to explore the perceptions that early career psychiatrists (e.g. those within 5 years of entering practice) have regarding their relationship with the pharmaceutical industry. Data were collected through semi-structured interviews and were analysed using a grounded theory methodology. Interviews were conducted and analyzed in an iterative way using a constant comparison approach in which data were collected and open coded for themes and subthemes. As new interviews were conducted, the themes were applied to data along with emergent themes and previous interviews recoded until additional interviews failed to provide new themes and thematic saturation was achieved. Through axial coding, a process of relating codes (categories and concepts) to each other, the theory was generated to explain the core variable mediating perceptions participants had about the relationship with industry. The participants described increasing frequency of experiences with industry throughout training into practice. Their perceptions developed through training, physician culture, industry promotion, and their own practices. In managing the relationship with industry, participants would either avoid interactions or engage in behaviors aimed to reduce the risk of influence. Maintaining one's professional integrity was the underlying driver used to manage the relationship with industry. Psychiatrists develop perceptions about industry through experience and observation leading them to develop their own strategies to manage these relationships while maintaining their professional integrity.
Murphy, Susan L; Byks-Jazayeri, Christine; Calvin-Naylor, Nancy; Divecha, Vic; Anderson, Elizabeth; Eakin, Brenda; Fair, Alecia; Denton, Laura
This article discusses the process of defining competencies and development of a best practices training course for investigators and clinical research coordinators who conduct social and behavioral research. The first project phase established recommendations for training in Good Clinical Practice (GCP) and was done in conjunction with representatives from 62 Clinical and Translational Science Award (CTSA) hubs. Diversity in behavioral clinical trials and differences in regulation of behavioral trials compared with clinical trials involving drugs, devices, or biologics necessitated a separate Social and Behavioral Work Group. This group worked with CTSA representatives to tailor competencies and fundamental GCP principles into best practices for social and behavioral research. Although concepts underlying GCP were deemed similar across all clinical trials, not all areas were equally applicable and the ways in which GCP would be enacted differ for behavioral trials. It was determined that suitable training in best practices for social and behavioral research was lacking. Based on the training need, an e-learning course for best practices is available to all CTSA sites. Each institution is able to track outcomes for its employees to help achieve standardized competency-based best practices for social and behavioral investigators and staff.
Moxham, Lorna; Taylor, Ellie; Patterson, Christopher; Perlman, Dana; Brighton, Renee; Sumskis, Susan; Keough, Emily; Heffernan, Tim
The way people who experience mental illness are perceived by health care professionals, which often includes stigmatising attitudes, can have a significant impact on treatment outcomes and on their quality of life. To determine whether stigma towards people with mental illness varied for undergraduate nursing students who attended a non-traditional clinical placement called Recovery Camp compared to students who attended a 'typical' mental health clinical placement. Quasi-experimental. Seventy-nine third-year nursing students were surveyed; n=40 attended Recovery Camp (intervention), n=39 (comparison group) attended a 'typical' mental health clinical placement. All students completed the Social Distance Scale (SDS) pre- and post-placement and at three-month follow-up. Data analysis consisted of a one-way repeated measures analysis of variance (ANOVA) exploring parameter estimates between group scores across three time points. Two secondary repeated measures ANOVAs were performed to demonstrate the differences in SDS scores for each group across time. Pairwise comparisons demonstrated the differences between time intervals. A statistically significant difference in ratings of stigma between the intervention group and the comparison group existed. Parameter estimates revealed that stigma ratings for the intervention group were significantly reduced post-placement and remained consistently low at three-month follow-up. There was no significant difference in ratings of stigma for the comparison group over time. Students who attended Recovery Camp reported significant decreases in stigma towards people with a mental illness over time, compared to the typical placement group. Findings suggest that a therapeutic recreation based clinical placement was more successful in reducing stigma regarding mental illness in undergraduate nursing students compared to those who attended typical mental health clinical placements. Copyright © 2016 Elsevier Ltd. All rights reserved.
Reuter, Katja; Ukpolo, Francis; Ward, Edward; Wilson, Melissa L; Angyan, Praveen
Kofler, Michael J.; Larsen, Ross; Sarver, Dustin E.; Tolan, Patrick H.
Middle school is a critical yet understudied period of social behavioral risks and opportunities that may be particularly difficult for emerging adolescents with ADHD given their childhood social difficulties. Although childhood ADHD has been associated with increased aggression and peer relational difficulties, relatively few ADHD studies have examined social behavior beyond the elementary years, or examined aspects of positive (prosocial) behavior. In addition, social-cognitive problem solving has been implicated in ADHD; however, its longitudinal impact on prosocial and aggressive behavior is unclear. The current study examined how middle school students with clinically elevated ADHD symptoms differ from their non-ADHD peers on baseline (sixth grade) and age-related changes in prosocial and aggressive behavior, and the extent to which social-cognitive problem solving strategies mediate these relations. Emerging adolescents with (n = 178) and without (n = 3,806) clinically elevated, teacher-reported ADHD inattentive and hyperactive/impulsive symptoms were compared longitudinally across sixth through eighth grades using parallel process latent growth curve modeling, accounting for student demographic characteristics, ODD symptoms, deviant peer association, school climate, and parental monitoring. Sixth graders with elevated ADHD symptoms engaged in somewhat fewer prosocial behaviors (d= −0.44) and more aggressive behavior (d= 0.20) relative to their peers. These small social behavioral deficits decreased but were not normalized across the middle school years. Contrary to hypotheses, social-cognitive problem solving was not impaired in the ADHD group, and did not mediate the association between ADHD and social behavior during the middle school years. ADHD and social-cognitive problem solving contributed independently to social behavior, both in sixth grade and across the middle school years; the influence of social-cognitive problem solving on social behavior was
Baas, D.; van't Wout, M.; Aleman, A.; Kahn, R. S.
Background. Patients with schizophrenia have been found to display abnormalities in social cognition. The aim of the study was to test whether patients with schizophrenia and unaffected first-degree relatives of schizophrenic patients display behavioural signs of social brain dysfunction when making
Oliveira, Sandra E H; Esteves, Francisco; Carvalho, Helena
Some mental illnesses and certain mental health care environments can be severely stigmatizing, which seems to be related to decreased self-esteem and a deterioration of the quality of social relationships for people with mental illness. This study aims to identify clinical profiles characterized by clinical diagnoses more strongly associated with the treatment settings and related to internalized stigma, self-esteem and satisfaction with social relationships. It also aimed to analyze associations between clinical profiles and socio-demographic indicators. Multiple correspondence analysis and cluster analysis were performed on a sample of 261 individuals with schizophrenia and mood disorders, from hospital-based and community-based facilities. MCA showed four distinct clinical profiles allowing a differentiation among levels of: internalized stigma, social relationship satisfaction and self-esteem. Overall, results revealed that internalized stigma remains a pervasive problem for some people with schizophrenia and mood disorders. Particularly, internalized stigma and social relationships dissatisfaction and associated socio-demographic indicators appear to be a risk factor for social isolation for individuals with schizophrenia, which may worsen the course of the disorder. Our findings highlight the importance to develop structured interventions aimed to reduce internalized stigma, and exclusion of those who suffer the loss of their social roles and networks. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Baumeister, David; Russell, Alice; Pariante, Carmine M; Mondelli, Valeria
In the last few decades, mental health research has increasingly provided evidence supporting the role of inflammation in pathogenesis, course and treatment of mental disorders. With such a steep incline of research, resulting in a wealth of emerged findings, it has become difficult to follow developments within the field. The present review sets out to present the recent developments and to give an overview of the inflammatory profiles of depression, psychosis and bipolar disorder, as well as variations within these disorders. Moreover, mediating factors such as social environment and childhood experience are discussed, both in terms of their potential in elucidating the complex interface between the inflammation and other closely related biological systems, as well as the possibly confounding impact of various lifestyle factors. Whilst many issues in this fascinating area of research remain to be fully understood and elaborated, all current evidence suggests that inflammation plays a key role in mental disorders and may open up novel avenues for clinical treatment.
Aaronson, Alexandra; Withy, Kelley
National data reports the number of adults with any diagnosable mental disorder within a given year is nearly 1 in 5. Hawai'i, along with the rest of the nation, faces a serious shortage of mental health providers. This article describes the research undertaken to create a more accurate assessment of the current mental health provider workforce in Hawai'i through developing an estimation strategy to appraise local mental health workforce needs. The results indicate the supply of psychiatrists for Hawai'i's 2010 census population was found to be 161.4 Full Time Equivalents (FTEs) psychiatrists, or 11.86 psychiatrists/100,000 population, with the greatest number of psychiatrists per capita on the island of O'ahu. Of the 161.4 FTEs, 50.4 FTEs or 31.2% were accepting new Medicaid patients. The state's results show that Hawai'i is short of meeting current patient need by more than 100 psychiatrists though the state was only short by 6 FTE psychiatrists with regard to estimates of Medicaid patients' need. While the first number is likely accurate, the second number is likely to be significantly underestimated for a number of reasons. One reason is that practitioners who reported accepting new Medicaid patients likely see comparatively few. Another reason is that it is likely that Medicaid patients make up more than the approximate 20% of the psychiatric patient population. It is reported nationally that a greater percentage of the mentally ill receive Medicaid than the population at large. Thus, there are probably many more patients on Medicaid than our estimations accounted for. It is clear more research and more changes need to be made in Hawai'i's publicly funded healthcare system to incentivize physician acceptance and make mental healthcare more accessible to this growing population.
Carré, Arnaud; Gierski, Fabien; Lemogne, Cédric; Tran, Eric; Raucher-Chéné, Delphine; Béra-Potelle, Céline; Portefaix, Christophe; Kaladjian, Arthur; Pierot, Laurent; Besche-Richard, Chrystel; Limosin, Frédéric
Social anxiety disorder (SAD), which is characterized by the fear of being rejected and negatively evaluated, involves altered brain activation during the processing of negative emotions in a social context. Although associated temperament traits, such as shyness or behavioral inhibition, have been studied, there is still insufficient knowledge to support the dimensional approach, which assumes a continuum from subclinical to clinical levels of social anxiety symptoms. This study used functional magnetic resonance imaging (fMRI) to examine the neural bases of individual differences in social anxiety. Our sample included participants with both healthy/subclinical as well as clinical levels of social anxiety. Forty-six participants with a wide range of social anxiety levels performed a gender decision task with emotional facial expressions during fMRI scanning. Activation in the left anterior insula and right lateral prefrontal cortex in response to angry faces was positively correlated with the level of social anxiety in a regression analysis. The results substantiate, with a dimensional approach, those obtained in previous studies that involved SAD patients or healthy and subclinical participants. It may help to refine further therapeutic strategies based on markers of social anxiety. © The Author (2013). Published by Oxford University Press. For Permissions, please email: firstname.lastname@example.org.
Oxhandler, Holly K; Polson, Edward C; Achenbaum, W Andrew
This article describes the religious and spiritual beliefs and practices among a national sample of 426 licensed clinical social workers (LCSWs). Given the significant role LCSWs' intrinsic religiosity plays in whether or not they consider clients' religion and spirituality (RS) as it relates to practice, it is critical that the profession best understands current LCSWs' religious and spiritual beliefs, and in what ways these mirror or contrast those of the clients whom they serve. Findings from this secondary analysis of a recent national survey suggest that compared with the general U.S. population, fewer LCSWs self-identify as Protestant or Catholic, fewer engage in frequent prayer, and fewer self-identify as religious. However, more LCSWs engage in meditation and consider themselves to be spiritual. Although it appears that RS is an important area in both LCSWs' and clients' lives, the beliefs, practices, and degree of importance with either differ. This article addresses implications for practice and education, as identifying such differing views calls on the profession to strengthen its training surrounding LCSWs' self-awareness of their RS beliefs and recognizing that their clients may not hold similar beliefs or engage in similar practices. © 2017 National Association of Social Workers.
Parsons, Thomas D.
An essential tension can be found between researchers interested in ecological validity and those concerned with maintaining experimental control. Research in the human neurosciences often involves the use of simple and static stimuli lacking many of the potentially important aspects of real world activities and interactions. While this research is valuable, there is a growing interest in the human neurosciences to use cues about target states in the real world via multimodal scenarios that involve visual, semantic, and prosodic information. These scenarios should include dynamic stimuli presented concurrently or serially in a manner that allows researchers to assess the integrative processes carried out by perceivers over time. Furthermore, there is growing interest in contextually embedded stimuli that can constrain participant interpretations of cues about a target’s internal states. Virtual reality environments proffer assessment paradigms that combine the experimental control of laboratory measures with emotionally engaging background narratives to enhance affective experience and social interactions. The present review highlights the potential of virtual reality environments for enhanced ecological validity in the clinical, affective, and social neurosciences. PMID:26696869
Full Text Available O encontro intelectual entre três escritores simpáticos, em algum nível, ao trabalho de Lacan foi reunido no livro Contingência, Hegemonia, Universalidade (Butler, Laclau e Zizek, 2000a. Esses três autores são bem conhecidos em um conjunto difuso de campos que vão dos "estudos culturais" (cultural studies à teoria literária e à teoria política. Como o subtítulo do livro indica - "Diálogos Contemporâneos da Esquerda" - eles também possuem alguma afinidade com o marxismo, "pós-marxismo" e política feminista. Uma questão que este debate entre três pensadores da teoria social lacaniana freqüentemente recoloca diz respeito à possibilidade de articular a teoria lacaniana com a política radical. No presente artigo discute-se se há implicações clínicas para esta leitura proposta pela esquerda Lacaniana, na qual os três autores estão engajados. Tomando como ponto de confluência o livro acima, o objetivo trabalho é mostrar como a prática política e a prática clínica encontram certos pontos de congruência em torno de temas como a negatividade, a sexualidade e a subversão do sujeito.An intellectual encounter between three writers sympathetic to some degree with Lacan's work has been recorded in the book Contingency, Hegemony, Universality (Butler, Laclau and ·i·ek, 2000a. These three writers are well known in the overlapping collection of fuzzy sets "cultural studies", "literary theory" and "political theory", and, as the subtitle of the book "Contemporary Dialogues on the Left" indicates, they also have some sympathy with Marxist, "post-marxist" or feminist politics. One question that the debate between the three often returns to is whether it is possible to articulate Lacanian theory with radical politics. However, another question that is embedded in the encounter but which is only obliquely addressed is whether there are clinical implications for the kind of leftist readings of Lacan that these three writers engage
The discipline of psychiatry promotes well-being and recovery based on a comprehensive understanding of the patient from the perspectives of the brain, real-world, and life-course. Pursuant to efforts toward addressing social issues at a regional and national level, it is assumed that the psychiatrist can assist individuals based on an understanding of these three perspectives. This tripartite relationship goes beyond the history of extreme reductionism in neuroscience and the aftermath resulting from the anti-psychiatry movement to provide a foundation for the development of psychiatry and a theoretical groundwork for such basic psychiatric issues as what role pharmacotherapy plays in psychiatric treatment, just why the lives of people living in the community are thought to be important to an individual's well-being, and just what constitutes recovery. Humans have come to possess highly developed brain and mental functions as a result of the adaptation to the social environment that takes place as part of the evolutionary process. While mental functions are thus dictated in large part by evolution of the brain, they also consist of important features that are not attributable to reductionist models of the brain. That is, human mental functioning forms a foundation for metacognition and sophisticated language functions, and through interactions with others and society, one's mental functioning allows for further brain transformation and development (self-regulation of mental functions). Humans develop their own brain and mental functions through mutual exchanges with others, and their dealings with other people and society form their individual modes of living in the real-world. The human brain and mental functions have evolved in such a way as to provide for a better mode of living. Accordingly, for the individual, the makeup of his or her mode of living in the real-world is the source of the well-being that serves to support that individual's values. The
Scoular, Anne; Abu-Rajab, Kirsty; Winter, Andy; Connell, Judith; Hart, Graham
We conducted a matched case-control study to investigate social factors associated with gonorrhoea acquisition among genitourinary (GU) medicine clinic attendees, designed to inform appropriate prevention strategies. Detailed social and behavioural data were elicited using a self-completed questionnaire. The effect sizes of these characteristics were quantified using univariate and multivariable conditional logistic regression in 53 cases and 106 matched controls. Homo-bisexual orientation was the strongest independent predictor of gonorrhoea acquisition (Adjusted odds ratio 31.1 (95% confidence intervals, 3.09-312.92). Other independent predictors were not currently being in a relationship and concordant residential characteristics. Three principal implications for sexual health policy were identified; social marketing approaches to gonorrhoea prevention should focus on gay men and individuals not in established relationships; gonorrhoea prevention should be more closely integrated with wider social inclusion policies; finally, more proactive, systematic and theory-based approaches should capitalize on opportunities for sexual health promotion in GU medicine clinic settings.
El Hussein, Mohamed; Hirst, Sandra; Osuji, Joseph
Delirium is an acute disorder of attention and cognition. It affects half of older adults in acute care settings and is a cause of increasing mortality and costs. Registered nurses (RNs) and licensed practical nurses (LPNs) frequently fail to recognize delirium. The goals of this research were to identify the reasoning processes that RNs and LPNs use to recognize delirium, to compare their reasoning processes, and to generate a theory that explains their clinical reasoning processes. Theoretical sampling was employed to elicit data from 28 participants using grounded theory methodology. Theoretical coding culminated in the emergence of Professional Socialization as the substantive theory. Professional Socialization emerged from participants' responses and was based on two social processes, specifically reasoning to uncover and reasoning to report. Professional Socialization makes explicit the similarities and variations in the clinical reasoning processes between RNs and LPNs and highlights their main concerns when interacting with delirious patients.
McAleavey, Andrew A; Castonguay, Louis G; Goldfried, Marvin R
Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here. © 2013.
Millman, Zachary B; Pitts, Steven C; Thompson, Elizabeth; Kline, Emily R; Demro, Caroline; Weintraub, Marc J; DeVylder, Jordan E; Mittal, Vijay A; Reeves, Gloria M; Schiffman, Jason
Research suggests that social stress exposure influences illness presentation and course among youth at clinical high-risk (CHR) for psychosis, though less is known about the extent to which self-reported perceptions of social stress relate to the severity of positive symptoms. Importantly, despite the notion that youth at CHR are especially susceptible to elevations in positive symptoms under conditions of stress, no study has examined this presumption relative to other psychiatric groups. Extending previous work demonstrating that perceived social stress was higher in a CHR group than in a clinical group of non-CHR, help-seeking controls, the current study aimed to: (1) examine whether perceived social stress is related to the severity of attenuated positive symptoms in the full sample (N=110); and (2) determine whether CHR status moderates the stress-symptom relation. Exploratory analyses examined relations of perceived social stress to negative, disorganized, and general symptoms. Greater perceptions of social stress were associated with more severe positive symptoms in the entire sample; however, although positive symptoms and perceived social stress were higher in the CHR group, the strength of this relation was statistically indistinguishable across groups. No differential effect of perceived social stress was observed for any symptom domain. Results provide some support for the diathesis-stress model of psychosis, while also suggesting that social stress and symptomatology are related independent of clinical vulnerability to psychosis. Future research would benefit from longitudinal studies of stress-symptom relations across CHR and help-seeking control groups. Copyright © 2017 Elsevier B.V. All rights reserved.
Rashid, Abdul; Mohd, Rokiah
Depression, a type of mental disorder which is portrayed by marked alterations in mood, is associated with distress and/or impaired functioning. Poor social support is an important risk factor for depression in pregnancy. An extensive literature search failed to show any published study conducted in Malaysia on antenatal depressive symptoms and the risk of poor social support on it. The aim of the study was to determine the risk of antenatal depressive symptoms due to poor social support. This cross sectional study was conducted among 3000 pregnant women attending antenatal clinics in Penang, Malaysia. Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depressive symptoms and the Oslo-3 Social Support Scale (OSS-3) was used to measure social support. Odds ratio and adjusted odds ratio were used to quantify the risk of antenatal depressive symptoms due to poor social support. The prevalence of depressive symptoms was 20%. Using OSS-3 scale to gauge social support, most of the participants had moderate support (61.3%) followed by poor support (22%) and strong support (16.7%). Social support was found to be significantly associated with depressive symptoms in this study (OR 2.2, aOR 2.1, AR 45%). Considering that an expecting mother's psychological factors are important in the wellbeing of the mother and child, antenatal depression must be quickly identified. Screening pregnant women for social support can help identify women with higher risk of depression.
Eklund, Mona; Hansson, Lars
Social interaction is crucial for whether a person will successfully accomplish important life tasks. This study investigated the importance of sociodemographic, clinical and self-perceived health-related factors for social interaction among 103 individuals with persistent mental illness, mainly psychoses, visiting an outpatient unit. Bivariate analyses pointed to several relationships, especially between the health-related variables and both quantitative and qualitative aspects of the social network. In multivariate analyses, higher levels of quality of life, self-esteem, being a cohabitant, and living in a house were related to higher ratings on different aspects of the social network. Older age was associated with fewer close relationships but more adequate social integration. The social network appeared to be a function of both self-perceptions and sociodemographic influences. The influence is probably dynamic and, for example, just as a better quality of life may lead to more social interaction, a more developed social network probably promotes better quality of life. Therefore, interventions in mental health care that target social interaction constitute a powerful resource and should be part of the support for people with severe and persistent mental illness.
Peloso, Paolo Francesco; Dening, Tom
Capital punishment was the source of lively debate in Italy, from unification in 1861 until 1888. The precedent for abolishing the death penalty had been set in Tuscany in 1786. This paper presents the arguments put forward by two eminent psychiatrists who opposed the death penalty, Carlo Livi and Andrea Verga. Livi set out his scientific case for abolition in two addresses given to the Accademia dei Fisiocritici in Siena in 1862. In 1889 Verga wrote a commentary on the Senate sitting and argued in favour of approving the Italian Penal Code. Verga agreed with Livi's arguments and disagreed with the School of Criminal Anthropology, led by Cesare Lombroso and Raffaele Garofalo, who were both in favour of capital punishment.
Dombo, Eileen A; Kays, Lisa; Weller, Katelyn
The world that social work exists in is no longer defined by traditional physical settings and boundaries, such as schools, agencies, or even offices. With the advent of the Internet and digital communications, social work now exists in a far more complex reality, with clients and social workers engaging across multiple platforms, and sometimes even unintentionally and without one another's awareness. The implications of this can be ethical, practical, regulatory, and personal. This article explores these areas of concern and suggests strategies professionals can use to navigate these complex issues related to technology and clinical practice.
Raat, A N Janet; Kuks, Jan B M; van Hell, E Ally; Cohen-Schotanus, Janke
During clinical rotations, students move from one clinical situation to another. Questions exist about students' strategies for coping with these transitions. These strategies may include a process of social comparison because in this context it offers the student an opportunity to estimate his or her abilities to master a novel rotation. These estimates are relevant for learning and performance because they are related to self-efficacy. We investigated whether student estimates of their own future performance are influenced by the performance level and gender of the peer with whom the student compares him- or herself. We designed an experimental study in which participating students (n = 321) were divided into groups assigned to 12 different conditions. Each condition entailed a written comparison situation in which a peer student had completed the rotation the participant was required to undertake next. Differences between conditions were determined by the performance level (worse, similar or better) and gender of the comparison peer. The overall grade achieved by the comparison peer remained the same in all conditions. We asked participants to estimate their own future performance in that novel rotation. Differences between their estimates were analysed using analysis of variance (ANOVA). Students' estimates of their future performance were highest when the comparison peer was presented as performing less well and lowest when the comparison peer was presented as performing better (p influences students' estimates of their future performance in a novel rotation. The effect depends on the performance level and gender of the comparison peer. This indicates that comparisons against particular peers may strengthen or diminish a student's self-efficacy, which, in turn, may ease or hamper the student's learning during clinical rotations. The study is limited by its experimental design. Future research should focus on students' comparison behaviour in real transitions
Lin, Chieh-Hsin; Huang, Chieh-Liang; Chang, Yue-Cune; Chen, Po-Wei; Lin, Chun-Yuan; Tsai, Guochuan E; Lane, Hsien-Yuan
The functional outcome of schizophrenia is affected by multiple factors such as cognitive function and clinical symptoms. The complex relationship among cognitive function (both neuro- and social-cognitions), clinical symptoms, and functional outcome remains unclear. The current study employed structural equation modeling (SEM) to examine whether clinical symptoms mediate the relationship between cognitive function and functional outcome in a large cohort of patients with schizophrenia. Three hundred and two Han-Chinese patients with chronically stable schizophrenia received evaluation of cognitive function (using the Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery, including 7 domains covering neurocognition and social cognition), clinical symptoms (including positive, negative and depressive symptoms), and functional outcome as assessed by Global Assessment of Functioning Scale and Quality of Life Scale. SEM identified clinical symptoms as a mediator between cognitive function (including all 7 domains of MATRICS) and functional outcome in schizophrenia. The relationship between cognitive function and functional outcome was significant in the basic model. In the mediation model, the link between cognitive function and functional outcome was mediated by clinical symptoms, mainly negative symptoms. This study suggests that clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia. Future studies should explore the impact on other functional outcomes in different ethnicities and various illness phases. Copyright © 2013 Elsevier B.V. All rights reserved.
Adrian, Molly; Lyon, Aaron R; Oti, Rosalind; Tininenko, Jennifer
Social information processing has emerged as an important construct in understanding children's interpersonal functioning. This article reviews (a) the theoretical models guiding research, (b) the development of normative and atypical social problem solving, and (c) the connection between social information processing and individual differences in functioning. Finally, this review ends with a summary of efficacy of programs aimed at preventing social information processing biases or intervening with youth who display dysfunctional social information processing skills.
BOUHUYS, AL; VANDENHOOFDAKKER, RH
Observed behaviour of a psychiatrist interacting with severely depressed patients during an interview was related to the course of depression during hospitalization. The behavioural structure of such interaction could be described by 6 factors for the patients and 7 factors for the psychiatrist. The
Dullur, Pravin; Hay, Phillipa
Research is limited on psychiatrists' opinions on the concepts of Internet Gaming Disorder (IGD) and Problematic Internet Use (PIU). We aimed to assess health literacy among psychiatrists on IGD/PIU. A self-report survey was administered online to members of the Royal Australia and New Zealand College of Psychiatrists (RANZCP) ( n=289). The majority (93.7%) were familiar with the concepts of IGD/PIU. The majority (78.86%) thought it is possible to be 'addicted' to non-gaming internet content, and 76.12% thought non-gaming addictions could possibly be included in classificatory systems. Forty-eight (35.6%) felt that IGD maybe common in their practice. Only 22 (16.3%) felt they were confident in managing IGD. Child psychiatrists were more likely to screen routinely for IGD (11/45 vs. 7/95; Fishers Exact test χ2=7.95, df=1, p<0.01) and were more likely to elicit specific symptoms of addiction (16/45 vs. 9/95; Fishers Exact test χ2=14.16, df=1, p<0.001). We recommend adoption of terms alternate to PIU/IGD which are more in line with the content of material irrespective of medium of access. Screening instruments/ protocols are needed to assist in early diagnosis and service planning. Barriers to screening would need to be addressed both in research and service settings.
The labelling theory of mental illness and particularly that version formulated by Thomas Scheff has been applied to psychiatry. Studies completed by Scheff have produced considerable evidence to support labelling theory. An attempt is made here to determine to what extent labelling theory applies to a group of British psychiatrists. The results give little support to Scheff's position.
Doubova, Svetlana V; Claudine Ramírez-Sánchez; Alejandro Figueroa-Lara; Ricardo Pérez-Cuevas
Objective. To estimate the requirements of human resources (HR) of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS). Materials and methods. An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using th...
Ma, Yina; Shamay-Tsoory, Simone; Han, Shihui; Zink, Caroline F
Adaptation to the social environment is critical for human survival. The neuropeptide oxytocin (OT), implicated in social cognition and emotions pivotal to sociality and well-being, is a promising pharmacological target for social and emotional dysfunction. We suggest here that the multifaceted role of OT in socio-affective processes improves the capability for social adaptation. We review OT effects on socio-affective processes, with a focus on OT-neuroimaging studies, to elucidate neuropsychological mechanisms through which OT promotes social adaptation. We also review OT-neuroimaging studies of individuals with social deficits and suggest that OT ameliorates impaired social adaptation by normalizing hyper- or hypo-brain activity. The social adaption model (SAM) provides an integrative understanding of discrepant OT effects and the modulations of OT action by personal milieu and context. Copyright © 2015 Elsevier Ltd. All rights reserved.
Sigalit, Warshawski; Sivia, Barnoy; Michal, Itzhaki
The purpose of this study was to explore the (a) associations between students' personal and group resilience to their utilization of social networking platforms and formally taught communication skills, (b) students' personal and clinical characteristics that are related to personal and group resilience and the perceived helpfulness of communication course, and (c) factors that contribute to students' satisfaction with their clinical placement. Data were collected from 149 second year nursing students learning in a major university in the country of Israel with the use of a self-administered structured questionnaire. Students' satisfaction from their clinical placement was measured using 1 open-ended question, analyzed through qualitative methods. Results demonstrated positive correlations between students' use of social networking to their personal and group resilience (Pcommunication course (PStudents' satisfaction with their clinical placement was based primarily on the clinical instructors' personal and professional skills. In conclusion, social networking can and should be used as a learning tool to promote resilience among nursing students. Faculty and nurse managers should be aware of the central role of the clinical instructor and initiate collaborative and supporting initiatives. Copyright © 2016 Elsevier Inc. All rights reserved.
Wiener, Lori; Crum, Caroline; Grady, Christine; Merchant, Melinda
Online social networking has replaced more traditional methods of personal and professional communication in many segments of society today. The wide reach and immediacy of social media facilitate dissemination of knowledge in advocacy and cancer education, but the usefulness of social media in personal relationships between patients and providers is still unclear. Although professional guidelines regarding e-mail communication may be relevant to social media, the inherent openness in social networks creates potential boundary and privacy issues in the provider-patient context. This commentary seeks to increase provider awareness of unique issues and challenges raised by the integration of social networking into oncology communications.
Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur
Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients. © Copyright 2016 by the American Board of Family Medicine.
Min, Gee Ho; Kim, Young; Lee, Jong Seok; Oh, Jee Youn; Hur, Gyu Young; Lee, Young Seok; Min, Kyung Hoon; Lee, Sung Yong; Kim, Je Hyeong; Shin, Chol; Lee, Seung Heon
To determine the social and clinical characteristics of immigrants with tuberculosis (TB) in South Korea. The registered adult TB patients who were diagnosed and treated in Korea Medical Centers from January 2013 to December 2015 were analyzed retrospectively. A total of 105 immigrants with TB were compared to 932 native Korean TB patients. Among these 105 immigrants with TB, 86 (82%) were Korean-Chinese. The rate of drug-susceptible TB were lower in the immigrants group than in the native Korean group [odds ratio (OR): 0.46; 95% confidence interval (CI): 0.22-0.96, p=0.035]. Cure rate was higher in the immigrant group than in the native Korean group (OR: 2.03; 95% CI: 1.26-3.28, p=0.003). Treatment completion rate was lower in the immigrant group than in the native Korean group (OR: 0.50; 95% CI: 0.33-0.74, p=0.001). However, treatment success rate showed no significant difference between two groups (p=0.141). Lost to follow up (default) rate was higher in the immigrant group than in the native Korean group after adjusting for age and drug resistance (OR: 3.61; 95% CI: 1.36-9.61, p=0.010). There was no difference between defaulter and non-defaulter in clinical characteristics or types of visa among these immigrants (null p value). However, 43 TB patients with recent immigration were diagnosed as TB even though they had been screened as normal at the time of immigration. Endeavor to reduce the default rate of immigrants with TB and reinforce TB screening during the immigration process must be performed for TB infection control in South Korea.
Buhl, Christian; Stokholm, Jette; Gade, Anders
Traditional cognitive tests used in clinical practice may not be sensitive enough for the early differentiation of behavioral variant frontotemporal dementia (bvFTD) from Alzheimer's disease (AD). A growing body of literature has shown that deficits in various aspects of social cognition can...
Hyams, Ross; Brown, Grace; Foster, Richard
In July 2010, the faculties of Law, Business and Economics, and Medicine at Monash University, Australia commenced placing law, finance, and social work students in a multidisciplinary clinic at a community legal service operated by the University. Students from the three disciplines began seeing legal service clients at the same time as a team.…
Duvekot, Jorieke; Hoopen, Leontine W.; Slappendel, Geerte; van der Ende, Jan; Verhulst, Frank C.; van der Sijde, Ad; Greaves-Lord, Kirstin
This paper provides an overview of the design and cohort characteristics of the Social Spectrum Study: a clinical cohort study that used a two-phase sampling design to identify children at risk for ASD. After screening 1281 children aged 2.5-10 years who had been consecutively referred to one of six mental health services in the Netherlands,…
Arthur, Darren P
This article focuses on culturally sensitive clinical issues related to best practices with lesbian, gay, bisexual, transgender (LGBT) elder patients at end-of-life (EOL) at key points in the therapeutic relationship. Vital concepts, including practice evaluation and clinical skills, are presented through a cultural and oncology lens. There is a paucity of LGBT research and literature as well as a shortfall of MSW graduate school education specific to social work palliative and end-of-life care (PELC) practice with LGBT elders. The content of this article is designed to be adapted and used as an educational tool for institutions, agencies, graduate programs, medical professions, social work, and students. Learning the unique elements of LGBT cultural history and their implications on EOL care can improve social work practice. This article provides an examination from assessment and engagement basics to advance care planning incorporating specific LGBT EOL issues.
Griffin, Blanche; Edwards, Samantha; Chitty, Lyn S; Lewis, Celine
Non-invasive prenatal testing (NIPT), based on analysis of cell-free foetal DNA, is rapidly becoming a preferred method to screen for chromosomal aneuploidy with the technology now available in over 90 countries. This review provides an up-to-date discussion of the key clinical, social and ethical implications associated with this revolutionary technology. Stakeholders are positive about a test that is highly accurate, safe, can be perfomed early in pregnancy, identifies affected pregnancies that might otherwise have been missed and reduces the need for invasive testing. Nevertheless, professional societies currently recommend it as an advanced screening test due to the low false positive rate (FPR). Despite the practical and psychological benefits, a number of concerns have been raised which warrant attention. These include the potential for routinisation of testing and subsequent impact on informed decision-making, an "easy" blood test inadvertently contributing to women feeling pressured to take the test, fears NIPT will lead to less tolerance and support for those living with Down syndrome and the heightened expectation of having "perfect babies". These issues can be addressed to some extent through clinician education, patient information and establishing national and international consensus in the development of comprehensive and regularly updated guidelines. As the number of conditions we are able to test for non-invasively expands it will be increasingly important to ensure pre-test counselling can be delivered effectively supported by knowledgeable healthcare professionals.
Smailhodzic, E.; Boonsta, A.; Langley, D.J.
Social media enable patients to communicate with a large number of their peers, share experiences, and provide each other with emotional and informational support. In this way, social media using patients develop a new logic in healthcare, which we propose as social media logic. This raises the
Oxhandler, Holly K.
This article describes a national sample of social work field instructors' responses to a cross-sectional survey of social workers' orientation toward integrating clients' religion and spirituality into practice and compares their responses with those of nonfield instructors. Four hundred sixty-nine social workers, including 69 MSW field…
Tian, Xue; Hou, Xin; Wang, Kangcheng; Wei, Dongtao; Qiu, Jiang
Socially anxious individuals are characterized as those with distorted negative self-beliefs (NSBs), which are thought to enhance reactions of social distress (emotional reactivity) and social avoidance (social functioning). However, it remains unclear whether individual differences in social distress and social avoidance are represented by differences in brain morphometry. To probe into these neural correlates, we analyzed magnetic resonance images of a sample of 130 healthy subjects and used the Connectome Computation System (CCS) to evaluate these factors. The results showed that social distress was correlated with the cortical volume of the right orbitofrontal cortex (OFC) and the subcortical volume of the left amygdala, while social avoidance was correlated with the cortical volume of the right dorsolateral prefrontal cortex (DLPFC). Additionally, loneliness might mediate the relationship between the amygdala volume and the social distress score. Our results demonstrated that social distress and social avoidance were represented by segregated cortical regions in the healthy individuals. These findings might provide a valuable basis for understanding the stable brain structures underlying individual differences in social anxiety.
Smailhodzic, Edin; Boonstra, Albert; Langley, David
Social media enable patients to communicate with a large number of their peers, share experiences, and provide each other with emotional and informational support. In this way, social media using patients develop a new logic in healthcare, which we propose as social media logic. This raises the
Frandsen, Mai; Walters, Julia; Ferguson, Stuart G
The aim of the present study was to explore the viability of using social media as a recruitment tool in a clinical research trial. Sociodemographic data and smoking characteristics were assessed in 266 participants recruited to investigate the effectiveness of a behavioral support program for smoking cessation. For analysis, participants were separated into 2 groups based on whether they were recruited either using traditional means (flyers, word of mouth, or newspaper advertisement; n = 125, 47.0%) or by advertisements in online social media (n = 138, 51.9%). Participants recruited via social media were significantly younger, but there were no differences in other socioeconomic variables or smoking characteristics compared with participants recruited via other traditional means. The findings of the present study suggest that using online social media is a viable recruitment method for smoking studies and compliments other more traditional recruitment methods.
Full Text Available This study examines performance of schizophrenia patients, unaffected relatives and controls in social cognition, cognitive and psychiatric scales looking for possible markers of vulnerability in schizophrenia. Performance of schizophrenia patients from multiplex families, first-degree relatives, and matched controls was compared and, subsequently, discriminant analysis method was used for identifying the best predictors for group membership. By using Multigroup Discriminant Analyses on the three groups, the best predictors were PANSS, Premorbid Adjustment Scale, Faux Pas test, and a face/emotion categorizing task. This model obtained 82% correct global classification, suggesting that the combination of psychiatric scales and neuropsychological/social cognition tesks are the best approach for characterizing this disease. Although preliminary, our results suggest that social cognition tasks are robust markers of schizophrenia family impairments, and that combining clinical, social and neuropsychological measures is the best approach to asses patients and relatives vulnerability.
Fradelos, Evangelos C; Tsaras, Konstantinos; Tzavella, Foteini; Koukia, Evmorfia; Papathanasiou, Ioanna V; Alikari, Victoria; Stathoulis, John; Tsaloglidou, Areti; Kourakos, Michael; Zyga, Sofia
Spiritual health is one of the important aspects of health status that is often neglected. the present study aims to evaluate spiritual wellbeing in end stage renal disease patients undergoing hemodialysis and its relation to sociodemographic and clinical variables. A convenience sample of 183 individuals undergoing hemodialysis was recruited. Measurements were conducted with the following instruments: (a) a sheet containing demographic data and clinical information such as duration of dialysis e.t.c (b) Facit Spiritual Wellbeing Scale (Facit-Sp12). Statistical analysis was contacted with SPSS v.22. Descriptive statistics were initially generated for sample characteristics. Parametric and no-parametric statistics were used for searching the relations between the variables. P values mean 61.39 ± 14.11. The subscale "peace" is associated to gender (t = 2.150, p = 0.033), educational level (F = 2.698, p = 0.047) and duration of dialysis (F = 2.969, p = 0.033) and religious beliefs (t = -2.059, p = 0.041). The subscale "faith" is associated to gender (t = -3.428, p = 0.001), age (p = 0.006), number of children (F = 4.347, p = 0.014). Moreover, the subscale "meaning" is associated to age (p = 0.001). Finally its worth to be mentioned that comorbidity is associated to subscales "meaning" (t = -2.071, p = 0.040), "peace" (t = -2.377, p = 0.018) and the overall spiritual wellbeing (t = -1.988, p = 0.048). Social, demographic factors as well as clinical variables such duration of dialysis and comorbidities are affecting spiritual wellbeing in end stage renal disease.
Nagata, Toshihiko; Yamada, Hisashi; Teo, Alan R; Yoshimura, Chiho; Nakajima, Takenori; van Vliet, Irene
Severe social withdrawal (called hikikomori, and defined as isolation lasting more than six months and not due to an apparent mental disorder) has drawn increasing public attention in Japan. It is unclear whether hikikomori is merely a symptom or syndrome of social withdrawal. To evaluate this phenomenon in relationship to social anxiety disorder (SAD), as few previous studies have. One hundred and forty-one consecutive patients with SAD diagnosed according to DSM-IV criteria by a semi-structured interview were treated with a combination of psychotherapy, pharmacotherapy and group activity. Twenty-seven (19%) SAD patients fulfilled the criteria for hikikomori, and these patients had earlier onset, more symptoms and less education than non-hikikomori SAD patients. Only 33% of hikikomori SAD patients spontaneously complained of SAD symptoms at first visit. There were no diagnostic differences between hikikomori and non-hikikomori SAD patients, except that comorbid obsessive-compulsive disorder was more frequent in hikikomori SAD patients. Functional impairment in 10 (37%) hikikomori SAD patients improved after several years of combination therapy. Hikikomori may serve as a proxy for a severe form of SAD. Patients with comorbid SAD and hikikomori have lower treatment response rates than those with SAD alone.
Suveg, Cynthia; Jacob, Marni L; Whitehead, Monica; Jones, Anna; Kingery, Julie Newman
Social difficulties are commonly associated with anxiety disorders in youth, yet are not well specified in the literature. The aim of this study was to identify patterns of social experiences in clinically anxious children and examine the associations with indices of emotional functioning. A model-based cluster analysis was conducted on parent-, teacher-, and child-reports of social experiences with 64 children, ages 7-12 years (M = 8.86 years, SD = 1.59 years; 60.3% boys; 85.7% Caucasian) with a primary diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Follow-up analyses examined cluster differences on indices of emotional functioning. Findings yielded three clusters of social experiences that were unrelated to diagnosis: (1) Unaware Children (elevated scores on parent- and teacher-reports of social difficulties but relatively low scores on child-reports, n = 12), (2) Average Functioning (relatively average scores across all informants, n = 44), and (3) Victimized and Lonely (elevated child-reports of overt and relational victimization and loneliness and relatively low scores on parent- and teacher-reports of social difficulties, n = 8). Youth in the Unaware Children cluster were rated as more emotionally dysregulated by teachers and had a greater number of diagnoses than youth in the Average Functioning group. In contrast, the Victimized and Lonely group self-reported greater frequency of negative affect and reluctance to share emotional experiences than the Average Functioning cluster. Overall, this study demonstrates that social maladjustment in clinically anxious children can manifest in a variety of ways and assessment should include multiple informants and methods.
Haslam, S Alexander
Social identity research was pioneered as a distinctive theoretical approach to the analysis of intergroup relations but over the last two decades it has increasingly been used to shed light on applied issues. One early application of insights from social identity and self-categorization theories was to the organizational domain (with a particular focus on leadership), but more recently there has been a surge of interest in applications to the realm of health and clinical topics. This article charts the development of this Applied Social Identity Approach, and abstracts five core lessons from the research that has taken this forward. (1) Groups and social identities matter because they have a critical role to play in organizational and health outcomes. (2) Self-categorizations matter because it is people's self-understandings in a given context that shape their psychology and behaviour. (3) The power of groups is unlocked by working with social identities not across or against them. (4) Social identities need to be made to matter in deed not just in word. (5) Psychological intervention is always political because it always involves some form of social identity management. Programmes that seek to incorporate these principles are reviewed and important challenges and opportunities for the future are identified. © 2014 The British Psychological Society.
Santos, Larissa F; Loureiro, Sonia R; Crippa, José A S; Osório, Flávia L
The Liebowitz Social Anxiety Scale (LSAS) was the first evaluation instrument developed for screening for the signs and symptoms of Social Anxiety Disorder (SAD) and is currently still the most used worldwide. The aim of this study is to evaluate the ability of the LSAS - self-report version (LSAS-SR) to discriminate different Social Anxiety Disorder (SAD) clinical groups. The sample was composed of Brazilians university students, allocated into three different groups, i.e., cases (C=118), non-cases (NC=95) and subclinical cases (SC=39). To achieve the aim, calculations of the ROC Curve and ANOVA were performed. The results found were excellent regardless of the technique used, highlighting the discriminatory capacity of the LSAS-SR. The score equal to or greater than 32 is suggested as a cutoff score for the Brazilian population, since this presented balance between the standards evaluated and the ability to differentiate both clinical and subclinical SAD cases from non-cases. Despite the specific sample used in this study being composed only of university students, the use of the LSAS-SR can be indicated, in the Brazilian setting, for SAD screening in both clinical and research contexts.
Full Text Available Background: Body dysmorphic disorder (BDD is characterized by a preoccupation with an imagined defect in ones appearance or an exaggeration of a slight physical anomaly. Any part of the appearance may be the focuse of BDD patients. Thus preoccupation with appearance leads to significant damages of social and job functioning. The aim of this study is to determine the prevalence of BDD in patients referred to cosmetic clinic of Razi hospital.Methods: Patients visiting cosmetic clinic of Razi hospital were selected if they agreed to participate in the study. They were evaluated by Yale brown obsessive compulsive scale modified for body dysmorphic disorder (YBOCS-BDD as well as questionnaires containing demographic characteristics of patients including gender, educational status, marital status, history of reference to psychiatrist or psychologist, other medication, history of cosmetic surgery and rate of satisfaction of cosmetic surgery. YBOCS-BDD questionnaires then processed by educated specialist to determine BDD score of patie-nts. Demographic questionnaires, also analysed to evaluate epidemiologic properties of patients visiting cosmetic clinic of Razi hospital.Results: The prevalence of BDD in current sample was 33.3%. 70.7% of BDD patients were female while 29.3% were male. The commonest age range was 21-50 years (82.8%. 65.5% were educated to level of diploma or lower, while 34.5% had academic degrees. 51.7% were married. 20.7% had history of reference to psychiatrist or psycholo-gist. 17/2% had history of cosmetic surgery with satisfaction ranging from unsatisfied (20% to relative satisfaction (80%. None were fully satisfied.Conclusion: BDD had high prevalence in patients visiting cosmetic clinic of Razi skin hospital. This high rate of prevalence show the necessity of diagnosis of BDD in skin patients and it is critical for them to refer to psychiatrists or psychologists.
Haider, Adil H.; Sexton, Janel; Sriram, N.; Cooper, Lisa A.; Efron, David T.; Swoboda, Sandra; Villegas, Cassandra V.; Haut, Elliott R.; Bonds, Morgan; Pronovost, Peter J.; Lipsett, Pamela A.; Freischlag, Julie A.; Cornwell, Edward E.
Context Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. Objective To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes. Design, Setting, and Participants A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students’ explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences. Main Outcome Measures Association of scores on an established IAT for race and a novel IAT for social class with vignette responses. Results Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%–75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%–90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was −0.49 (95% CI, −1.00 to 0.03) and for social class, the coefficient was −0.04 (95% CI
Deiner, Michael S; McLeod, Stephen D; Chodosh, James; Oldenburg, Catherine E; Fathy, Cherie A; Lietman, Thomas M; Porco, Travis C
We sought to determine whether big data from social media might reveal seasonal trends of conjunctivitis, most forms of which are nonreportable. Social media posts (from Twitter, and from online forums and blogs) were classified by age and by conjunctivitis type (allergic or infectious) using Boolean and machine learning methods. Based on spline smoothing, we estimated the circular mean occurrence time (a measure of central tendency for occurrence) and the circular variance (a measure of uniformity of occurrence throughout the year, providing an index of seasonality). Clinical records from a large tertiary care provider were analyzed in a similar way for comparison. Social media posts machine-coded as being related to infectious conjunctivitis showed similar times of occurrence and degree of seasonality to clinical infectious cases, and likewise for machine-coded allergic conjunctivitis posts compared to clinical allergic cases. Allergic conjunctivitis showed a distinctively different seasonal pattern than infectious conjunctivitis, with a mean occurrence time later in the spring. Infectious conjunctivitis for children showed markedly greater seasonality than for adults, though the occurrence times were similar; no such difference for allergic conjunctivitis was seen. Social media posts broadly track the seasonal occurrence of allergic and infectious conjunctivitis, and may be a useful supplement for epidemiologic monitoring.
Buhl, Christian; Stokholm, Jette; Gade, Anders
Traditional cognitive tests used in clinical practice may not be sensitive enough for the early differentiation of behavioral variant frontotemporal dementia (bvFTD) from Alzheimer's disease (AD). A growing body of literature has shown that deficits in various aspects of social cognition can be found in bvFTD. The objective of this study is to investigate whether short and easily administered tests of social cognition are useful in providing clinical information which might aid in the differentiation of bvFTD from AD in the early stages of bvFTD. 11 patients diagnosed with bvFTD and 10 patients diagnosed with AD completed a neuropsychological assessment comprising global, executive and social cognitive tasks. Measures of global cognitive function showed no significant difference between the two groups, whereas even the short social cognitive measures (the Reading the Mind in the Eyes Test and the Emotion Hexagon) showed significant group differences, reflecting a poorer performance by the bvFTD group. Our results suggest that it may indeed be relevant to include short and easily administered measures of social cognition in the differential diagnosis of early bvFTD and AD.
Gottlieb, Laura M; Hessler, Danielle; Long, Dayna; Laves, Ellen; Burns, Abigail R; Amaya, Anais; Sweeney, Patricia; Schudel, Christine; Adler, Nancy E
Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits. After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention). Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later. Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0
Fochtmann, Laura J.; Clarke, Diana E.; Barber, Keila; Hong, Seung-Hee; Yager, Joel; Mościcki, Eve K.; Plovnick, Robert M.
This report highlights findings from the Study of Psychiatrists’ Use of Informational Resources in Clinical Practice, a cross-sectional Web- and paper-based survey that examined psychiatrists’ comfort using computers and other electronic devices in clinical practice. One-thousand psychiatrists were randomly selected from the American Medical Association Physician Masterfile and asked to complete the survey between May and August, 2012. A total of 152 eligible psychiatrists completed the questionnaire (response rate 22.2 %). The majority of psychiatrists reported comfort using computers for educational and personal purposes. However, 26 % of psychiatrists reported not using or not being comfortable using computers for clinical functions. Psychiatrists under age 50 were more likely to report comfort using computers for all purposes than their older counterparts. Clinical tasks for which computers were reportedly used comfortably, specifically by psychiatrists younger than 50, included documenting clinical encounters, prescribing, ordering laboratory tests, accessing read-only patient information (e.g., test results), conducting internet searches for general clinical information, accessing online patient educational materials, and communicating with patients or other clinicians. Psychiatrists generally reported comfort using computers for personal and educational purposes. However, use of computers in clinical care was less common, particularly among psychiatrists 50 and older. Information and educational resources need to be available in a variety of accessible, user-friendly, computer and non-computer-based formats, to support use across all ages. Moreover, ongoing training and technical assistance with use of electronic and mobile device technologies in clinical practice is needed. Research on barriers to clinical use of computers is warranted. PMID:26667248
Etchepare, Aurore; Prouteau, Antoinette
Social cognition has received growing interest in many conditions in recent years. However, this construct still suffers from a considerable lack of consensus, especially regarding the dimensions to be studied and the resulting methodology of clinical assessment. Our review aims to clarify the distinctiveness of the dimensions of social cognition. Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, a systematic review was conducted to explore the factor structure of social cognition in the adult general and clinical populations. The initial search provided 441 articles published between January 1982 and March 2017. Eleven studies were included, all conducted in psychiatric populations and/or healthy participants. Most studies were in favor of a two-factor solution. Four studies drew a distinction between low-level (e.g., facial emotion/prosody recognition) and high-level (e.g., theory of mind) information processing. Four others reported a distinction between affective (e.g., facial emotion/prosody recognition) and cognitive (e.g., false beliefs) information processing. Interestingly, attributional style was frequently reported as an additional separate factor of social cognition. Results of factor analyses add further support for the relevance of models differentiating level of information processing (low- vs. high-level) from nature of processed information (affective vs. cognitive). These results add to a significant body of empirical evidence from developmental, clinical research and neuroimaging studies. We argue the relevance of integrating low- versus high-level processing with affective and cognitive processing in a two-dimensional model of social cognition that would be useful for future research and clinical practice. (JINS, 2017, 23, 1-14).
Gold, Jessica A; Sher, Yelizaveta; Maldonado, José R
Frontal lobe epilepsy (FLE) can masquerade as a primary psychiatric condition, be misdiagnosed in-lieu of a true psychiatric disorder, or may be comorbid with psychiatric illness. To (1) qualitatively review psychiatric manifestations of FLE and (2) to systematically review the cases/case series of psychiatric manifestations of FLE presented in the literature to date. A systematic review of the literature was performed following the PRISMA guidelines and using PubMed/Medline, PsychInfo, and Cochrane database of systematic reviews to identify cases and case series of psychiatric manifestations of FLE. A total of 35 separate articles were identified. Further, 17 patients primarily presented with psychosis, 33 with affective symptoms, and 16 with personality changes. Also, 62% of cases were males and 38% were females. Ages ranged from 2-83 years with the average age of 32.7. Prior psychiatric history was reported in 27.3% of cases. Causes of seizure were known in 53%, with the most common causes being dysplasia and tumor. Only 6 cases (frontal lobes, FLE can present with complex, psychiatric manifestations, with associated motor, cognitive, and medical changes; thus, psychiatrists should keep FLE on the differential diagnosis of complex neuropsychiatric cases. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Albert Bernard Janse van Rensburg
Full Text Available The national Mental Health Action Plan (MHAP flowed from the Ekurhuleni Declaration, adopted at the National Mental Health Summit (NMHS in April 2012. The final draft of the MHAP included eight national objectives, with key activities which were believed to be ‘catalytic.’ These objectives include: district-based mental health service; institutional capacity; surveillance, research and innovation; infrastructure and capacity; mental health technology, equipment and medicines; inter-sectoral collaboration; human resources; and advocacy, mental health promotion and prevention of illness. A representative group of regional State Employed Special Interest Group (SESIG delegates met during April 2013, to: operationalise the 12 South African Society of Psychiatrists (SASOP/SESIG position statements of the previous year; review SASOP’s position statements in the context of the proposed national MHAP; and to identify SASOP’s role and responsibilities accordingly. This paper describes the contextual events in the drafting of the MHAP, as well as the appraisal of the MHAP during the 2013 SASOP/SESIG meeting, and SASOP’S envisaged role and responsibilities according to the national MHAP.
Littlewood, Sonia; Ypinazar, Valmae; Margolis, Stephen A; Scherpbier, Albert; Spencer, John; Dornan, Tim
To find how early experience in clinical and community settings ("early experience") affects medical education, and identify strengths and limitations of the available evidence. A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations. Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs
Cain, Nicole M; Pincus, Aaron L; Ansell, Emily B
This review documents two themes of emphasis found in phenotypic descriptions of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical theories of narcissism spanning 35 years consistently describe variations in the expression of pathological narcissism that emphasize either grandiosity or vulnerable affects and self-states. Recent research in social/personality psychology examining the structure of narcissistic personality traits consistently finds two broad factors representing Grandiosity-Exhibitionism and Vulnerability-Sensitivity-Depletion respectively. However, the majority of psychiatric criteria for narcissistic personality disorder (NPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) emphasize expressions of grandiosity. By placing most of the diagnostic emphasis on overt grandiosity, DSM NPD has been limited by poor discriminant validity, modest levels of temporal stability, and the lowest prevalence rate on Axis II. Despite converging support for two phenotypic themes associated with pathological narcissism, psychiatric diagnosis and social/personality psychology research often focus only on grandiosity in the assessment of narcissism. In contrast, clinical theory struggles with a proliferation of labels describing these broad phenotypic variations. We conclude that the construct of pathological narcissism is at a crossroads and provide recommendations for diagnostic assessment, clinical conceptualization, and future research that could lead to a more integrated understanding of narcissistic personality and narcissistic personality pathology.
Lundervold, Duane A.; Ament, Patrick A.; Peter Holt
Background. While social anxiety has been reported among essential tremor (ET) patients, very little is known about the relation between self-report measures of social anxiety, tremor severity and disability, and cognition. Methods. Sixty-three individuals diagnosed with ET took part in a comprehensive study examining neurocognition and behavioral functioning. A psychiatric diagnostic interview, three social anxiety questionnaires, and an idiographic-based behavioral assessment to pinpoint a...
Sluzki, Carlos E
Social networks affect positively or negatively a person's health, and a person's health affects, in turn, the network's availability. This article discusses this double dynamic, recommends the routine exploration of patients' social networks, and offers a mapping tool that allows detection of strengths and weaknesses of those processes so as to facilitate interventions that improve the social support's health-enhancing effect. Copyright 2010 APA, all rights reserved
Hales, Sarah; Turner-McGrievy, Gabrielle M; Wilcox, Sara; Fahim, Arjang; Davis, Rachel E; Huhns, Michael; Valafar, Homayoun
To test the efficacy of a weight loss mobile app based on recommender systems and developed by experts in health promotion and computer science to target social support and self-monitoring of diet, physical activity (PA), and weight (Social POD app), compared to a commercially available diet and PA tracking app (standard). Overweight adults [N=51] were recruited and randomly assigned to either the experimental group [n=26; theory-based podcasts (TBP)+Social POD app] or the comparison group (n=25; TBP+standard app). The Social POD app issued notifications to encourage users to self-monitor and send theory-based messages to support users who had not self-monitored in the previous 48h. Independent samples t-test were used to examine group differences in kilograms lost and change in BMI. Analysis of covariance was used to analyze secondary outcomes while controlling for baseline values. Participant attrition was 12% (n=3 experimental and n=3 comparison). Experimental group participants lost significantly more weight (-5.3kg, CI: -7.5, -3.0) than comparison group (-2.23kg, CI: -3.6, -1.0; d=0.8, r=0.4, p=0.02) and had a greater reduction in BMI (p=0.02). While there were significant differences in positive outcome expectations between groups (p=0.04) other secondary outcomes (e.g., caloric intake and social support) were not significant. Use of the Social POD app resulted in significantly greater weight loss than use of a commercially available tracking app. This mobile health intervention has the potential to be widely disseminated to reduce the risk of chronic disease associated with overweight and obesity. Published by Elsevier Ireland Ltd.
Wright, Karen Shields
Catholic social teaching (CST), a branch of moral theology, addresses contemporary issues within the political, economic, and cultural structures of society. The threefold cornerstone of CST contains the principles of human dignity, solidarity, and subsidiarity. It is the foundation on which to form our conscience in order to evaluate the framework of society and is the Catholic criteria for prudential judgment and direction in developing current policy-making. With knowledge of these social principles, in combination with our faith, we will be more armed and informed as to articulate the Catholic vision of reality, the truthful nature of the human person and society, to apply and integrate the social teachings in our everyday administrative and clinical encounters, and through the virtue of charity take action within the social, political, and economic spheres in which we have influence. Summary: The Church's social encyclicals are a reflection upon the issues of the day using the light of faith and reason. They offer commentary on the ways to evaluate and address particular social problems-also using natural law principles-in the areas of politics, economics, and culture. Quotes were selected from the encyclicals that define and expand upon the primary principles for the purpose of representing them for study, reflection, and use in everyday personal and business encounters and decision making for healthcare professionals.
The current intensive discussion on the legal and moral aspects of involuntary treatment of psychiatric patients raises a number of ethical issues. Physicians are unambiguously obligated to protect patient welfare and autonomy; however, in psychiatric patients disease-related restrictions in the capacity of self-determination and behaviors endangering the rights of third parties can seriously challenge this unambiguity. Therefore, psychiatry is assumed to have a double function and is also obligated to third parties and to society in general. Acceptance of such a kind of double obligation carries the risk of double moral standards, placing the psychiatrist ethically outside the community of physicians and questioning the unrestricted obligation towards the patient. The present article formulates a moral position, which places the psychiatrist, like all other physicians, exclusively on the side of the patient in terms of professional ethics and discusses the practical problems arising from this moral position.
Henry, Julie D; Cowan, David G; Lee, Teresa; Sachdev, Perminder
Social cognition refers broadly to the way in which we process social information, and is a critical predictor of social competency. This article provides an overview of some of the assessment approaches that have been developed to assess this construct. A variety of well validated assessment approaches are now available. The most frequently used methods index explicit emotion recognition and/or mental state attribution. There has also been an increasing emphasis on the need to better understand the role of specific perceptual features and cognitive task demands in social cognitive difficulties. In the past 20 years, research on social cognitive function has grown exponentially, reflecting an increased recognition that social cognitive skills are critical for communicative discourse, and in turn mental health and well-being. Accordingly, a large number of measures are now available to quantify social cognitive function. This review shows that many of these measures have good psychometric properties, and appear to have at least moderate sensitivity. However, the review also highlights the importance of using appropriate control tasks to assess the specificity of any observed social cognitive failures, as well as the need for the continued development of measures with greater ecological validity.
denBoer, JA; Westenberg, HGM; Pian, KLH
Background: The results of open pilot studies suggest that the serotonin-1A (5-HT1A) receptor agonist buspirone might be effective in social phobia. Method: In the present study, the efficacy of buspirone was investigated in patients with social phobia using a 12-week double-blind placebo-controlled
O'Connor, Thomas G.; Matias, Carla; Futh, Annabel; Tantam, Grace; Scott, Stephen
Parenting programs for school-aged children are typically based on behavioral principles as applied in social learning theory. It is not yet clear if the benefits of these interventions extend beyond aspects of the parent-child relationship quality conceptualized by social learning theory. The current study examined the extent to which a social…
Jippes, Erik; Steinert, Yvonne; Pols, Jan; Achterkamp, Marjolein C; van Engelen, Jo M L; Brand, Paul L P
To examine the impact of social networks and a two-day faculty development course on clinical supervisors' adoption of an educational innovation. During 2007-2010, 571 residents and 613 clinical supervisors in four specialties in the Netherlands were invited to complete a Web-based questionnaire. Residents rated their clinical supervisors' adoption of an educational innovation, the use of structured and constructive (S&C) feedback. Clinical supervisors self-assessed their adoption of this innovation and rated their communication intensity with other clinical supervisors in their department. For each supervisor, a centrality score was calculated, representing the extent to which the supervisor was connected to departmental colleagues. The authors analyzed the effects of supervisor centrality and participation in a two-day Teach-the-Teacher course on the degree of innovation adoption using hierarchical linear modeling, adjusting for age, gender, and attitude toward the S&C feedback innovation. Respondents included 370 (60%) supervisors and 357 (63%) residents. Although Teach-the-Teacher course participation (n=172; 46.5%) was significantly related to supervisors' self-assessments of adoption (P=.001), it had no effect on residents' assessments of supervisors' adoption (P=.371). Supervisor centrality was significantly related to innovation adoption in both residents' assessments (P=.023) and supervisors' self-assessments (P=.024). A clinical supervisor's social network may be as important as faculty development course participation in determining whether the supervisor adopts an educational innovation. Faculty development initiatives should use faculty members' social networks to improve the adoption of educational innovations and help build and maintain communities of practice.
Kato, Takahiro A.; Tateno, Masaru; Umene-Nakano, Wakako; Balhara, Yatan P. S.; Teo, Alan R.; Fujisawa, Daisuke; Sasaki, Ryuji; Ishida, Tetsuya; Kanba, Shigenobu
Aim To clarify the impact of biopsychosocial factors on psychiatric training under the new and traditional postgraduate medical education system in Japan and to compare them with young psychiatrists from other countries. Methods Psychiatric residents and early-career psychiatrists were recruited in Japan and other countries. Using mail-based and web-based self-administered questionnaires, we evaluated participants' demographic information, motivation to become psychiatrists, interest and commitment to various aspects of psychiatry, and reactions to a case vignette, focusing on biopsychosocial factors. Results A total of 137 responses, 81 from Japan and 56 from other countries, were collected. Before starting psychiatric training, Japanese participants showed a strong interest in ‘mind’ and less interest in ‘brain’ and ‘environmental factors’, while the interest in ‘brain’ and ‘environmental factors’ is presently as high as that in ‘mind.’ Japanese participants reported less commitment to their training toward ICD/DSM-based diagnosis, interview, pharmacotherapy, psychosocial treatment and epidemiology, compared with participants from other countries. In particular, Japanese participants showed less commitment to their training in suicide prevention, despite their perception of its high importance due to a high suicide rate in Japan. Suicide risk of a case vignette proved to be differently assessed according to participants' commitment levels to each aspect of psychiatry. Conclusion Our results suggest that young psychiatrists' attitudes concerning the biopsychosocial model generally become well-balanced with psychiatric training, however sociocultural factors do not seem to be well represented in the Japanese psychiatric training system. Additional training on sociocultural issues, such as suicide in Japan, should be considered. PMID:20923431
Svetlana V Doubova
Full Text Available Objective. To estimate the requirements of human resources (HR of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS. Materials and methods. An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using the evidence-based adjusted service target approach for health workforce planning; then, comparisons between existing and estimated HRs were made. Results. To provide healthcare in accordance with the patients’ metabolic control, the conventional model required increasing the number of family doctors (1.2 times nutritionists (4.2 times and social workers (4.1 times. The DiabetIMSS model requires greater increase than the conventional model. Conclusions. Increasing HR is required to provide evidence-based healthcare to diabetes patients.
Doubova, Svetlana V; Ramírez-Sánchez, Claudine; Figueroa-Lara, Alejandro; Pérez-Cuevas, Ricardo
To estimate the requirements of human resources (HR) of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS). An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using the evidence-based adjusted service target approach for health workforce planning; then, comparisons between existing and estimated HRs were made. To provide healthcare in accordance with the patients' metabolic control, the conventional model required increasing the number of family doctors (1.2 times) nutritionists (4.2 times) and social workers (4.1 times). The DiabetIMSS model requires greater increase than the conventional model. Increasing HR is required to provide evidence-based healthcare to diabetes patients.
Autism Spectrum Social Stories In Schools Trial (ASSSIST): study protocol for a feasibility randomised controlled trial analysing clinical and cost-effectiveness of Social Stories in mainstream schools.
Wright, Barry; Marshall, David; Collingridge Moore, Danielle; Ainsworth, Hannah; Hackney, Lisa; Adamson, Joy; Ali, Shehzad; Allgar, Victoria; Cook, Liz; Dyson, Lisa; Littlewood, Elizabeth; Hargate, Rebecca; McLaren, Anne; McMillan, Dean; Trépel, Dominic; Whitehead, Jo; Williams, Chris
Current evidence suggests that Social Stories can be effective in tackling problem behaviours exhibited by children with autism spectrum disorder. Exploring the meaning of behaviour from a child's perspective allows stories to provide social information that is tailored to their needs. Case reports in children with autism have suggested that these stories can lead to a number of benefits including improvements in social interactions and choice making in educational settings. The feasibility of clinical and cost-effectiveness of a Social Stories toolkit will be assessed using a randomised control framework. Participants (n=50) will be randomised to either the Social Stories intervention or a comparator group where they will be read standard stories for an equivalent amount of time. Statistics will be calculated for recruitment rates, follow-up rates and attrition. Economic analysis will determine appropriate measures of generic health and resource use categories for cost-effectiveness analysis. Qualitative analysis will ascertain information on perceptions about the feasibility and acceptability of the intervention. National Health Service Ethics Approval (NHS; ref 11/YH/0340) for the trial protocol has been obtained along with NHS Research and Development permission from Leeds and York Partnership NHS Foundation Trust. All adverse events will be closely monitored, documented and reported to the study Data Monitoring Ethics Committee. At least one article in a peer reviewed journal will be published and research findings presented at relevant conferences. ISRCTN96286707. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Piovan, Cristiano; Gava, Laura; Campeol, Mara
Over past few decades, studies displayed Theory of Mind (ToM) as a system, including cognitive and affective features, rather than an unitary process. Within domains defining social cognition, ToM stands for the best predictor of poor social functioning in schizophrenia. The current study aimed to explore competence in ToM tasks, in metaphorical and idiomatic language identification tasks and in a conversational rules observance test, as well as relationship with social functioning, in a group of outpatients suffering from schizophrenia. METHODS.: 30 outpatients diagnosed with schizophrenia and 24 healthy subjects have been recruited. Both groups underwent TIB as premorbid IQ evaluation, PANSS, Theory of Mind Picture Sequencing Task, a metaphors and idiomatic expressions comprehension test and a conversational test. Social functioning was assessed with PSP. Results.Mean values of premorbid IQ showed no significant difference between patients and control group. In ToM and pragmatic competence tasks, differences between groups resulted in high significance, due to patients' lower performance. A correlation between metaphors and idiomatic expressions comprehension and second order false beliefs was detected. PSP showed a correlation with PANSS and cognitive-ToM, whereas leaving aside affective-ToM. Results showed how people affected with schizophrenia, in stable clinical condition, do have clear impairments in ToM and figurative language comprehension assignments. In our theoretical framework, correlation arisen between cognitive-ToM, pragmatic deficits, clinical status and social functioning level suggests usefulness of rehabilitative interventions to recover metacognitive functions and pragmatic abilities, in order to reduce social disability in schizophrenia.
Mohandoss, Anusa Arunachalam; Thavarajah, Rooban
Contribution of Indian Psychiatrists as publications in peer-reviewed journals listed with PubMed and their impact has not been studied. The aim of this manuscript is to assess such contribution using a new article level metric measure. The relative citation ratio (RCR) has been used to assess the quality, quantity, and impact of research output of Indian Psychiatrists. Publications by Indian psychiatrists in PubMed during 1995-2013 were collected, their RCR and associated factors estimated. The nationality of the journals, type of manuscripts, PubMed Central (PMC) visibility and the type of the journals were factored in. The data collected was analyzed. Descriptive statistics, Chi-square tests, correlations, and linear regression were performed. P ≤ 0.05 was taken as significant. Using the criteria set, 1914 manuscripts were identified. Of the 1914 manuscripts, 1007 were cited at least once and among this, 40.7% were listed with PubMed while of the 907 non-PMC listed manuscripts, only 180 were never cited (P = 0.000). Of the 1032 manuscripts published in Indian journals, 474 were never cited while 214 of the manuscripts published with non-India based journals were never cited even once (P = 0.000). The difference in terms of manuscripts visibility in PMC, nationality of journals and article type in analysis indicate that there exists an innate difference between the cited and noncited manuscripts. The probable explanation behind this and its associated phenomenon are discussed.
Teitelbaum, A; Durst, R; Abramowitz, M; Knobler, H Y; Zislin, J; Fluk, A; Mark, M
Psychiatrists from the former Soviet Union serve in the Department of Mental Health of the Israel Defense Forces. The new immigrant psychiatrists confront a wide range of difficulties during the process of integration to the military system and adaptation to the specifically military aspects of psychiatry. These include unfamiliarity with the military system, cultural clashes with the different groups of soldiers representing the various subgroups of the absorbing society, the psychopathology of soldiers, which is different from that seen in civil psychiatry, and the change in focus in the military mental health service, which emphasizes the importance of evaluating ego strength. Arbitrarily, one can describe four stages of adaptation that the immigrant psychiatrist has to pass through before recruitment and during service until adaptation and integration in the new role take place. Individual and group supervision are the main means by which the assimilation process is eased. The military service smooth the acculturation process and has an important role in helping the immigrant's adaptation to Israeli society and in building his or her professional identity.
Buhler, Amber V; Karimi, Reza M
To create a doctor of pharmacy curricular experience that will decrease students' social barriers to interaction with and treatment of mentally-ill patients. We created a survey instrument to measure 4 aspects of students' conceptions of schizophrenia and clinical depression: (1) understanding of the medical nature of each disease, (2) understanding of patient behavior, (3) belief in the efficacy of treatment, and (4) social distance. We delivered this instrument before and after a neuropsychiatry curriculum including "peer-level patient presenters" in addition to the traditional first-year pharmacy curriculum. Social-distance scores significantly decreased in first-year pharmacy students who attended peer-level patient presentations, indicating increased willingness to interact with persons with schizophrenia and clinical depression. In addition, students' understanding of the causes of illness, behavior of patients, and most importantly, efficacy of drug counseling for these diseases increased. Changes to the curriculum including the addition of peer-level patient presentations can quantitatively decrease pharmacy students' social barriers to the treatment of mentally-ill patients.
Bramstedt, Katrina A; Ierna, Ben N; Woodcroft-Brown, Victoria K
Social media is a valuable tool in the practice of medicine, but it can also be an area of 'treacherous waters' for medical students. Those in their upper years of study are off-site and scattered broadly, undertaking clinical rotations; thus, in-house (university lecture) sessions are impractical. Nonetheless, during these clinical years students are generally high users of social media technology, putting them at risk of harm if they lack appropriate ethical awareness. We created a compulsory session in social media ethics (Doctoring and Social Media) offered in two online modes (narrated PowerPoint file or YouTube video) to fourth- and fifth-year undergraduate medical students. The novelty of our work was the use of SurveyMonkey® to deliver the file links, as well as to take attendance and deliver a post-session performance assessment. All 167 students completed the course and provided feedback. Overall, 73% Agreed or Strongly Agreed the course session would aid their professionalism skills and behaviours, and 95% supported delivery of the curriculum online. The most frequent areas of learning occurred in the following topics: email correspondence with patients, medical photography, and awareness of medical apps. SurveyMonkey® is a valuable and efficient tool for curriculum delivery, attendance taking, and assessment activities.
Full Text Available Understanding factors that influence pregnancy decision-making and experiences among HIV-positive women is important for developing integrated reproductive health and HIV services. Few studies have examined HIV-positive women’s navigation through the social and clinical factors that shape experiences of pregnancy in the context of access to antiretroviral therapy (ART. We conducted 25 semistructured interviews with HIV-positive, pregnant women receiving ART in Mbarara, Uganda in 2011 to explore how access to ART shapes pregnancy experiences. Main themes included: (1 clinical counselling about pregnancy is often dissuasive but focuses on the importance of ART adherence once pregnant; (2 accordingly, women demonstrate knowledge about the role of ART adherence in maintaining maternal health and reducing risks of perinatal HIV transmission; (3 this knowledge contributes to personal optimism about pregnancy and childbearing in the context of HIV; and (4 knowledge about and adherence to ART creates opportunities for HIV-positive women to manage normative community and social expectations of childbearing. Access to ART and knowledge of the accompanying lowered risks of mortality, morbidity, and HIV transmission improved experiences of pregnancy and empowered HIV-positive women to discretely manage conflicting social expectations and clinical recommendations regarding childbearing.
Howell, Dana M; Wittman, Peggy; Bundy, Myra Beth
An interprofessional clinical learning experience was developed for pre-licensure occupational therapy (OT) and psychology graduate students. Students worked in interprofessional teams to plan and implement a social skills training program for children with autism spectrum disorders (ASD). The objectives were to provide a hands-on, student-led clinical experience; facilitate interprofessional collaborative learning through leadership partnerships and teach children with ASD to engage in appropriate social skill behaviors. Concurrently, faculty performed qualitative research to explore how the students worked together to provide intervention to the children. Data were collected via interview, direct observation of student planning sessions and student interprofessional interactions, and collection of posts from an online social network site used for session planning. There were six student participants and two faculty participants. Four themes emerged: learning who I am as a professional, learning to appreciate our professional differences, learning to communicate with each other and figuring it out, for the benefit of the kids. This interprofessional clinical learning experience and research helps ensure that students are adequately prepared to represent their profession as part of a diverse interprofessional health care team.
Koon, Chong Siew; Sidi, Hatta; Kumar, Jaya; Das, Srijit; Xi, Ong Wan; Hatta, Muhammad Hizri; Alfonso, Cesar
Erectile function (EF) is a prerequisite for satisfactory sexual intercourse (SI) and central to male sexual functioning. Satisfactory SI eventually leads to orgasm - a biopsychophysiological state of euphoria - leading to a sense of bliss, enjoyment and positive mental well being. For a psychiatrist, treating ED is self-propelled to harmonize these pleasurable experiences alongside with encouragement of physical wellness and sensuality. Hence, the role of PDE-5i is pivotal in the context of treating ED constitutes a therapeutic challenge. PDE-5i work via the dopaminergic-oxytocin-nitric oxide pathway by increasing the availability of endothelial's guanosine monophosphate (GMP), immediately causing relaxation of the penile smooth muscle and an erection. The PDE-5i, like sildenafil, vardenafil and tadalafil, are effective in the treatment of ED with some benefits and disadvantages compared to other treatment modalities. Prescribed PDE-5i exclusively improve EF, fostering male's self-confidence and self-esteem. Treatment failures are associated with factors such as absent (or insufficient) sexual stimulation, psychosexual conflicts and the co-existence of medical disorders. Managing ED requires dealing with underlying medical diseases, addressing other co-morbid sexual dysfunctions like premature ejaculation (PE), and educating the patient on healthy life-styles beside being cautious with the potential side-effects and drug-drug interactions. Furthermore, by dealing with interpersonal dynamics within the couple and embracing adequate lifestyles (managing stress and revising one's sexual scripts), PDE-5i treatment benefits may be enhanced. In this review, we propose a holistic conceptual framework approach for psychiatric management of patients with ED. Copyright© Bentham Science Publishers; For any queries, please email at email@example.com.
Demoralization is a commonly observed feeling state that is characterized by a sense of loss of or threat to one's personal values or goals and a perceived inability to overcome obstacles toward achieving these goals. Demoralization has features in common with burnout and may precede or accompany it. Psychiatrists working in many mental health care organizational settings, be they in the public or private sectors, may be at particular risk for demoralization. This is due partly to stressors that threaten their own professional values because of factors such as programmatic cut backs, budgetary reductions and changing social emphases on the value of mental health treatments. They also may be at risk for demoralization because of the effects on them of the governance styles of the agencies in which they are employed. The leadership or governance style in large organizational settings often is authoritarian, hierarchical and bureaucratic, approaches that are antithetical to the more participative leadership styles favored by many mental health professionals in their clinical activities. Clinical leaders in mental health organizations must exhibit various competencies to successfully address demoralization in clinical staff and to provide a counterbalance to the effects of the governance style of many agencies in which they are employed. Appropriate leadership skills, sometimes too simplistically termed "social support", have been found to reduce burnout in various populations and are likely to lessen demoralization as well. This paper reviews these important leadership issues and the relationship of social support to recognized leadership competencies.
Full Text Available Pre-exposure prophylaxis (PrEP is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23 participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1 structural factors such as cost and access to financial assistance for medications and clinical services; 2 social factors such as stigma and relationship status; 3 behavioral factors including sexual risk behaviors; and 4 clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.
Arnold, Trisha; Brinkley-Rubinstein, Lauren; Chan, Philip A; Perez-Brumer, Amaya; Bologna, Estefany S; Beauchamps, Laura; Johnson, Kendra; Mena, Leandro; Nunn, Amy
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.
Raykos, Bronwyn C; McEvoy, Peter M; Fursland, Anthea
The present study evaluated the relative clinical validity of two interpersonal models of the maintenance of eating disorders, IPT-ED (Rieger et al., ) and the interpersonal model of binge eating (Wilfley, MacKenzie, Welch, Ayres, & Weissman, ; Wilfley, Pike, & Striegel-Moore, ). While both models propose an indirect relationship between interpersonal problems and eating disorder symptoms via negative affect, IPT-ED specifies negative social evaluation as the key interpersonal problem, and places greater emphasis on the role of low self-esteem as an intermediate variable between negative social evaluation and eating pathology. Treatment-seeking individuals (N = 306) with a diagnosed eating disorder completed measures of socializing problems, generic interpersonal problems, self-esteem, eating disorder symptoms, and negative affect (depression and anxiety). Structural equation models were run for both models. Consistent with IPT-ED, a significant indirect pathway was found from socializing problems to eating disorder symptoms via low self-esteem and anxiety symptoms. There was also a direct pathway from low self-esteem to eating disorder symptoms. Using a socializing problems factor in the model resulted in a significantly better fit than a generic interpersonal problems factor. Inconsistent with both interpersonal models, the direct pathway from socializing problems to eating disorder symptoms was not supported. Interpersonal models that included self-esteem and focused on socializing problems (rather than generic interpersonal problems) explained more variance in eating disorder symptoms. Future experimental, prospective, and treatment studies are required to strengthen the case that these pathways are causal. © 2017 Wiley Periodicals, Inc.
Burke, Nancy J
Approximately 20% of adult cancer patients are eligible to participate in a clinical trial, but only 2.5-9% do so. Accrual is even less for minority and medically underserved populations. As a result, critical life-saving treatments and quality of life services developed from research studies may not address their needs. This study questions the utility of the bioethical concern with therapeutic misconception (TM), a misconception that occurs when research subjects fail to distinguish between clinical research and ordinary treatment, and therefore attribute therapeutic intent to research procedures in the safety net setting. This paper provides ethnographic insight into the ways in which research is discussed and related to standard treatment. In the course of two years of ethnographic fieldwork in a safety net hospital, I conducted clinic observations (n=150 clinic days) and in-depth in-person qualitative interviews with patients (n=37) and providers (n=15). I used standard qualitative methods to organize and code resulting fieldnote and interview data. Findings suggest that TM is limited in relevance for the interdisciplinary context of cancer clinical trial recruitment in the safety net setting. Ethnographic data show the value of the discussions that happen prior to the informed consent, those that introduce the idea of participation in research. These preliminary discussions are elemental especially when recruiting underserved and vulnerable patients for clinical trial participation who are often unfamiliar with medical research and how it relates to medical care. Data also highlight the multiple actors involved in research discussions and the ethics of social justice and patient advocacy they mobilize, suggesting that class, inequality, and dependency influence the forms of ethical engagements in public hospital settings. On the ground ethics of social justice and patient advocacy are more relevant than TM as guiding ethical principles in the context of
Menzies, Ross; O'Brian, Sue; Lowe, Robyn; Packman, Ann; Onslow, Mark
CBTPsych is an individualized, fully automated, standalone Internet treatment program that requires no clinical contact or support. It is designed specifically for those who stutter. Two preliminary trials demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. However, both trials involved pre- and post-treatment assessment at a speech clinic. This contact may have increased compliance, commitment and adherence with the program. The present study sought to establish the effectiveness of CBTPsych in a large international trial with no contact of any kind from researchers or clinicians. Participants were 267 adults with a reported history of stuttering who were given a maximum of 5 months access to CBTPsych. Pre- and post-treatment functioning was assessed within the online program with a range of psychometric measures. Forty-nine participants (18.4%) completed all seven modules of CBTPsych and completed the post-treatment online assessments. That compliance rate was far superior to similar community trials of self-directed Internet mental health programs. Completion of the program was associated with large, statistically and clinically significant reductions for all measures. The reductions were similar to those obtained in earlier trials of CBTPsych, and those obtained in trials of in-clinic CBT with an expert clinician. CBTPsych is a promising individualized treatment for social anxiety for a proportion of adults who stutter, which requires no health care costs in terms of clinician contact or support. The reader will be able to: (a) discuss the reasons for investigating CBTPsych without any clinical contact; (b) describe the main components of the CBTPsych treatment; (c) summarize the results of this clinical trial; (d) describe how the results might affect clinical practice, if at all. Copyright © 2016 Elsevier Inc. All rights reserved.
Milce Burgos Ferreira
Full Text Available The objective of this study was to compare the perceptions of two families living in two different neighborhoods (rated according to risk levels regarding social support. A questionnaire was designed to assess social support according to the following dimensions: instrumental, emotional, religious, and support from friends, neighbors and family. The sample was comprised as follows: considering the 114 families living in neighborhood 1, 52 families were interviewed; and among the 162 families living in neighborhood 2, 60 families were interviewed. No significant difference was found related to instrumental, religious and emotional support, including the support from relatives among the families from both neighborhoods. The results disagree with the reviewed literature, which indicated a strong association between social support and families living at socioeconomic risk. In conclusion, social support is important for families, regardless of their risk stratification.
Hessels, C.; van Aken, M.A.G.; Orobio de Castro, B.; Laceulle, O.M.; van Voorst, G.
Background: This study investigated relations between personality pathology and mentalizing capacities reflected in social information processing (SIP) of adolescents. Sampling and Methods: 96 adolescent outpatients completed a structured interview regarding SIP. Their clinicians completed a
Hessels, Christel; van Aken, Marcel A G; Orobio de Castro, Bram; Laceulle, Odilia M; van Voorst, Guus
BACKGROUND: This study investigated relations between personality pathology and mentalizing capacities reflected in social information processing (SIP) of adolescents. SAMPLING AND METHODS: 96 adolescent outpatients completed a structured interview regarding SIP. Their clinicians completed a
Medvedev, V E; Retiunsky, K Yu; Ovchinnikov, A A; Barylnik, Yu B; Shmilovich, A A; Antokhin, E Yu; Usov, G M; Cheremin, R A; Poletsky, V M; Onegin, A V; Kireeva, I P; Frolova, V I; Filippova, N V; Antonova, A A; Deeva, M A; Onegina, D A
To compare the prognosis of depression severity estimated by the physician and by the patient based on the treatment outcome. One hundred and seven patients with depression were examined. Mental status was assessed with HАМ-D, SHAPS, CGI-S, CGI-I, PGI-S, PGI-I and VAS. A data analysis was performed. There were differences in the estimation of depression severity by psychiatrists and patients. Moreover, the scores on HАМ-D and CGI-S were not consistent when assessed by psychiatrists. As the severity of depression decreased and patient's state improved during the treatment with agomelatine (valdoxan), the assessments of the changes by the psychiatrist and the patient became similar. Agomelatine (valdoxan) is effective and tolerable in the treatment of depression of any severity. The differences between the psychiatrist's and patient's estimation of the depression severity at baseline using different psychometric scales can level the prognostic value of treatment outcome.
Chen, Chen; Ou, Jian-Jun; Zhou, Jian-Song; Zhang, Ying-Dong; Cai, Wei-Xiong; Wang, Xiao-Ping
To understand disposal attitudes towards forensic psychiatric patients among police officers, psychiatrists and community members in China. 118 community members, 121 psychiatrists and 105 police officers completed a questionnaire regarding disposal attitudes towards forensic psychiatric patients. Surveyed respondents (87.4%) believed patients with mental disorders experienced discrimination, and 97.4% were in favor of providing livelihood security for them. Police officers (89.5%) agreed that patients with mental illness were more violent than the general population, which was significantly higher than 74.4% of psychiatrists (X(2) = 14.29, P = 0.000). Among three groups, the most preferred disposal option for those found not guilty by reason of insanity (NGRI) was to treat them in the custody of a forensic psychiatric hospital, such as an Ankang Hospital (86.9%). The respondents agreed (96.8%) that an independent review board should be established for disposing decisions for forensic psychiatric patients. The percentage who agreed that police officers, prosecutors, and judges should be included in the review board was significantly higher among police officers than among community members (x(2) = 6.60, P = 0.01; x(2) = 9.74, P = 0.002; x(2) = 7.38, P = 0.007). When asked, "who has the legal right to determine whether offenders with mental disorders should bear criminal responsibility", forensic psychiatrists and judges were the top two responders (79.5% and 63.4%, respectively). This study suggested that the majority of those surveyed, especially police officers, held that patients with mental illness were violent and should receive violence risk assessments. Although psychiatrists paid more attention to the rights of patients, they also lacked legal knowledge, similar to community members and police officers. Therefore, it is necessary to inform the public regarding mental health, and to provide legal knowledge. Copyright © 2013 Elsevier Ltd and
Martynenko, A V
Population health protection is a vast sphere of professional social activity. At the present stage of reformation medicosocial activity acquires the features of professional activity of an intersectoral type aimed at medical rehabilitation, legislative, psychological, pedagogical, and sociocommunal care of clients in order to repair and maintain his or her physical, mental, and social well-being. Such an approach to the solution of interdiscipline problems of subjects finding themselves in difficult situations implies comprehensive research.
Aluko, Oludele Olumide
The purpose of this study is to emphasize and to identify the immense impact and the use of social skills in the care of elderly people. The aim of the various tools of social skills is to identify problems at the same time enhancing patient's health. Some specialist does not understand what social skill might do in care management. It has been observed that medical doctors such as psychiatrists and other drug prescribers constantly prescribe drugs as opposed to adopting suitable social skill...
Monica M. Matthieu
Full Text Available Veterans and military personnel may be at higher risk for developing addictions due to increased prevalence rates of co-occurring mental health disorders including posttraumatic stress and substance abuse disorders. However, clinicians may feel unprepared to assess and to treat these co-occurring disorders, especially when it includes a behavioral addiction such as gambling. Clinical social work and clinical behavior analysis are two fields with complementary interdisciplinary approaches that can lead to improved client-centered outcomes. Yet, limited evidence exists to guide interdisciplinary treatment teams in effective treatment of gambling addictions and Post Traumatic Stress Disorder (PTSD. The current article provides an interdisciplinary treatment model to assist clinicians in selecting appropriate evidence-based assessments and treatments. A case example focuses on the use of assessment tools and treatment approaches drawn from recommendations from best practice guidelines for veterans. Finally, resources related trauma and addictions are presented.
One of the recent trends in the general hospital is the increase of psychiatric units and the number of psychiatrists working therein. Thus the psychiatrist has had greater opportunities to participate as a member of a clinical team in the care of patients of other units. Accordingly, daily cooperation with other specialties casts him into new roles which transcend those of the traditional psychiatric consultant. The role of liasion psychiatrist involves the complex relations of doctor--nurse--patient--family, interdepartmental relations, communications and so on. By improving these relationships he tries to bring about a more holistic approach in the general hospital.
Raman, N; Janse van Rensburg, A B
academic problems. This study demonstrated the impact that socio-economic circumstances have on the prevalence of childhood disorders; hence the urgent need for government and social welfare departments to improve the socio-economic status of communities. There is a need to improve psychiatric services for the population served by this hospital, including more clinics in its catchment area, as well as child psychiatry training posts and extended social work services.
Okubo, Yumiko; Matsushita, Susumu; Takakuwa, Yuichi; Yoshioka, Toshimasa; Nitta, Kosaku
Problem-based learning (PBL) is popular in medical education in Japan. We wished to understand the influence of PBL on the clinical competence of medical residents, using self-assessment and observer assessment. Tokyo Women's Medical University (TWMU) implemented PBL longitudinally (long-time) for four years, and on this basis we analyzed whether long-time PBL education is useful for clinical work. A self-assessment questionnaire was sent to junior and senior residents who were alumni of several schools, and an observation-based assessment questionnaire to senior doctors instructing them. Respondents were asked if they had used the PBL process in daily clinical tasks, and if so in what processes. Senior doctors were asked whether TWMU graduates perform differently from graduates of other schools. TWMU graduates answered "used a lot" and "used a little" with regard to PBL at significantly higher rates than other graduates. As useful points of PBL, they mentioned extracting clinical problems, solving clinical problems, self-directed leaning, positive attitude, collaboration with others, presentation, doctor-patient relations, self-assessment, and share the knowledge with doctors at lower levels and students. Observer assessments of TWMU graduates by senior doctors represented them as adaptive, good at presenting, good at listening to others' opinions, practical, selfish, and eager in their instructional practice. Longitudinal PBL can be a good educational method to develop lifelong-learning habits and clinical competencies especially in terms of the social aspect.
Nurdan Eren BODUR
Full Text Available In this study it was aimed to assess and evaluate the impact of the levels of perceived social support in infertile couples on stress related with infertility and marital adjustment. The study included 104 couples with primary or secondary infertility and 44 healthy couples with children for the control group. Control group was given the Hospital Anxiety Depression Scale (HADS, Dyadic Adjustment Scale (DAS and Multidimensional Scale of Perceived Social Support (MSPSS. Infertile group was given HADS, DAS, MSPSS and also Fertility Problem Inventory. Women in infertile couples reported greater psychological symptoms and more decreased marital adjustment than men in infertile couples; but the couples did not show any significant difference with those in control groups regarding these parameters. It was determined that, in general, while marital adjustment in infertile couples increases, depression and anxiety levels decrease. It was also observed that perceieved social support from the family has a positive effect on the marital adjustment. The perceived social support level in men in infertil couples is lower than women in the same group, and this outcome is also related with the increasing anxiety in men. These results showed that psychosocial problems in infertile couples should be evaluated with specific scales. Psychosocial support which will be given to infertile couples and motivating social support systems while providing this service would have positive effects especially on men. [Cukurova Med J 2013; 38(2.000: 214-223
Fu, Chia-Yun; Yang, Mei-Sang; Leung, Wan; Liu, Yea-Ying; Huang, Hui-Wen; Wang, Ruey-Hsia
To explore the associations of the professional quality of life and social support with health in nurses. Physical and mental health may be associated with absence from work among nurses. Few studies have explored the associations of professional quality of life and social support on the physical and mental health of nurses. This was a cross-sectional study. In total, 294 nurses were recruited from a hospital in Southern Taiwan. A self-report questionnaire was used to collect data. Burnout, secondary traumatic stress and social support from relatives or friends were important factors of physical and mental health. Interactions between support from relatives or friends and secondary traumatic stress are important factors in physical health. Reducing burnout and secondary traumatic stress is important for physical and mental health of nurses. Increasing social support from relatives or friends may be useful to reduce the negative effects of secondary traumatic stress on the physical health of nurses. Nurse managers could design interventions to reduce and prevent nurses from being influenced by burnout and secondary traumatic stress. Educating nurses to build effective social networks with relatives or friends and to seek support when experiencing secondary traumatic stress may also be needed. © 2017 John Wiley & Sons Ltd.
Full Text Available Results of the comparative analysis of clinical, social and psycho-pathological predictors of violations of the regime requirements, physical and verbal aggression among mentally ill women and men during the compulsory treatment are presented. It is revealed that the type of aggression in women sample significantly more frequently associated with clinical and social and pathopsychological characteristics: emotional unstable stew, learned in childhood and adolescence behavioral model of aggression and the severity of hostility and suspicion; the inertia of mental processes combined with low level of the cognitive functioning and a violation of insight in a broad sense. Among men – with the emotional and personal deformation, which were revealed before the beginning of illness, the decline in cognitive functioning and undeveloped links in the regulation of behavior, high level of aggressiveness in communication, internal conflict combined with the rigidity of self-concept. The authors concluded that assessment of risk factors from hospital-acquired aggression is an independent psycho-diagnostic work that needs to be provided with special tools, aimed whilst on the study of individual psychological characteristics of the regulation of behavior, strategies coping, communication installations and the treats of the aggression, as well as subjective ratings of social functioning in the hospital.
Bernard Janse van Rensburg
Full Text Available Introduction. The State Employed Special Interest Group (SESIG of SASOP was established in Durban during the national congress in September 2000. Issues of concern at the time included: suboptimal physical conditions in state hospitals and clinics; stalling of the essential drug list (EDL review process; and understaffing and difficulties to recruit and retain mental health medical personnel in the state sector. During the past 2 years, attention was given to liaising with the South African Medical Association (SAMA as a medical labour organisation; standards for psychiatric inpatient structures, services and care; and scheduling a national SESIG strategic workshop. Methods. Ethics clearance was obtained for a retrospective quantitative review of the demographic and occupational profile of SESIG’s members, as captured by the SASOP database of current and potential members. The investigation included a review of the policies and process by which strategic activities, priorities and measures for progress were identified within the different areas of SESIG’s mandate. Results. In 2007, 38% (n=144 of the potential total number of stateemployed psychiatrists (380 were paid-up SESIG members; and 53% (n=202 of the potential total number (378 in 2011. The Eastern Cape, Free State and Northern Gauteng subgroups had the biggest percentage of members per region in 2007, which changed in 2011 to Northern Gauteng, Western Cape and Eastern Cape. In 2011, 40% of the total membership were psychiatric registrars. Presentations and discussion during the first national strategic meeting of state employed psychiatrists in 2012 covered: the scope of state sector practice; pertinent policies for state practice; planning per region; teaching and research; accepted principles for care; and strategic mobilisation (details in the supplement of this issue of the SAJP. Conclusion. Eleven position statements were formulated to guide SASOP/SESIG activities during 2012
Bernard Janse van Rensburg
others, become the universal goals by which we measure service provision, should be adopted as soon as possible. Culture, mental health and psychiatry: culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline. Forensic psychiatry: an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners, each with specific needs, problems and possible solutions. Security in psychiatric hospitals and units: it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.
Giovanni Jervis is mainly known as a psychiatrist, but he also worked on psychological methodology and tackled important issues in clinical psychology. This essay describes the concept of personal identity elaborated by Jervis and its importance in Child Clinical Psychology. The problems related to personal identity appear very early in Jervis' work, influenced by the ethnologist Ernesto De Martino. His first considerations are found in his Preface to The Adventures of Pinocchio by Carlo Collodi (1968), in which Jervis describes the unhappy upbringing, the anti-social behaviour, and the unattained identity of the wooden puppet. Subsequently, in Presenza e identith (1984), Fondamenti di Psicologia Dinamica (1993) and La conquista dell'identith (1997), Jervis dealt with the theme of identity from a Dynamic Psychology perspective, showing that the formation of personal identity is a basic aspect of the development of the individual that starts in early childhood.
Full Text Available Background: One of the main usages of social networks in clinical studies is facilitating the process of sampling and case finding for scientists. The main focus of this study is on comparing two different methods of sampling through phone calls and using social network, for study purposes. Methods: One of the researchers started calling 214 families of children with diabetes during 90 days. After this period, phone calls stopped, and the team started communicating with families through telegram, a virtual social network for 30 days. The number of children who participated in the study was evaluated. Results: Although the telegram method was 60 days shorter than the phone call method, researchers found that the number of participants from telegram (17.6% did not have any significant differences compared with the ones being phone called (12.9%. Conclusions: Using social networks can be suggested as a beneficial method for local researchers who look for easier sampling methods, winning their samples' trust, following up with the procedure, and an easy-access database.
Pourabbasi, Ata; Farzami, Jalal; Shirvani, Mahbubeh-Sadat Ebrahimnegad; Shams, Amir Hossein; Larijani, Bagher
One of the main usages of social networks in clinical studies is facilitating the process of sampling and case finding for scientists. The main focus of this study is on comparing two different methods of sampling through phone calls and using social network, for study purposes. One of the researchers started calling 214 families of children with diabetes during 90 days. After this period, phone calls stopped, and the team started communicating with families through telegram, a virtual social network for 30 days. The number of children who participated in the study was evaluated. Although the telegram method was 60 days shorter than the phone call method, researchers found that the number of participants from telegram (17.6%) did not have any significant differences compared with the ones being phone called (12.9%). Using social networks can be suggested as a beneficial method for local researchers who look for easier sampling methods, winning their samples' trust, following up with the procedure, and an easy-access database.
Granholm, Eric; Holden, Jason; Link, Peter C; McQuaid, John R
Identifying treatments to improve functioning and reduce negative symptoms in consumers with schizophrenia is of high public health significance. In this randomized clinical trial, participants with schizophrenia or schizoaffective disorder (N = 149) were randomly assigned to cognitive behavioral social skills training (CBSST) or an active goal-focused supportive contact (GFSC) control condition. CBSST combined cognitive behavior therapy with social skills training and problem-solving training to improve functioning and negative symptoms. GFSC was weekly supportive group therapy focused on setting and achieving functioning goals. Blind raters assessed functioning (primary outcome: Independent Living Skills Survey [ILSS]), CBSST skill knowledge, positive and negative symptoms, depression, and defeatist performance attitudes. In mixed-effects regression models in intent-to-treat analyses, CBSST skill knowledge, functioning, amotivation/asociality negative symptoms, and defeatist performance attitudes improved significantly more in CBSST relative to GFSC. In both treatment groups, comparable improvements were also found for positive symptoms and a performance-based measure of social competence. The results suggest CBSST is an effective treatment to improve functioning and experiential negative symptoms in consumers with schizophrenia, and both CBSST and supportive group therapy actively focused on setting and achieving functioning goals can improve social competence and reduce positive symptoms.
Granholm, Eric; Holden, Jason; Link, Peter C.; McQuaid, John R.
Objective Identifying treatments to improve functioning and reduce negative symptoms in consumers with schizophrenia is of high public health significance. Method In this randomized clinical trial, participants with schizophrenia or schizoaffective disorder (N=149) were randomly assigned to cognitive behavioral social skills training (CBSST) or an active goal-focused supportive contact (GFSC) control condition. CBSST combined cognitive behavior therapy with social skills training and problem solving training to improve functioning and negative symptoms. GFSC was weekly supportive group therapy focused on setting and achieving functioning goals. Blind raters assessed functioning (primary outcome: Independent Living Skills Survey (ILSS)), CBSST skill knowledge, positive and negative symptoms, depression, and defeatist performance attitudes. Results In mixed-effects regression models in intent-to-treat analyses, CBSST skill knowledge, functioning, amotivation/asociality negative symptoms and defeatist performance attitudes improved significantly more in CBSST relative to GFSC. In both treatment groups, comparable improvements were also found for positive symptoms and a performance-based measure of social competence. Conclusions The results suggest CBSST is an effective treatment to improve functioning and experiential negative symptoms in consumers with schizophrenia, and both CBSST and supportive group therapy that is actively focused on setting and achieving functioning goals can improve social competence and reduce positive symptoms. PMID:24911420
Full Text Available Eve T Shapiro,1,2 Jay T Schamel,2 Kimberly A Parker,3 Laura A Randall,1,2 Paula M Frew1,2,4 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 2Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, 3Department of Health Studies, Texas Women’s University, Denton, TX, 4Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA Purpose: Older African Americans experience disproportionately higher incidence of morbidity and mortality related to chronic and infectious diseases, yet are significantly underrepresented in clinical research compared to other racial and ethnic groups. This study aimed to understand the extent to which social support, transportation access, and physical impediments function as barriers or facilitators to clinical trial recruitment of older African Americans.Methods: Participants (N=221 were recruited from six African American churches in Atlanta and surveyed on various influences on clinical trial participation.Results: Logistic regression models demonstrated that greater transportation mobility (odds ratio [OR]=2.10; p=0.007 and social ability (OR=1.77; p=0.02 were associated with increased intentions of joining a clinical trial, as was greater basic daily living ability (OR=3.25; p=0.03, though only among single participants. Among adults age ≥65 years, those with lower levels of support during personal crises were more likely to join clinical trials (OR=0.57; p=0.04.Conclusion: To facilitate clinical trial entry, recruitment efforts need to consider the physical limitations of their potential participants, particularly basic physical abilities and disabilities. Crisis support measures may be acting as a proxy for personal health issues among those aged >65 years, who would then be more likely to seek clinical trials for the personal health benefits. Outreach to
In general education, European American values stand as the unacknowledged norm and are perceived as being culturally neutral or culture free. By recognizing European American culture and spirituality as one of many diversities, social work students may better identify biased values and expectations inherent in the traditional monocultural and…
Tulbure, Bogdan T.; Szentagotai, Aurora; Dobrean, Anca; David, Daniel
Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social…
Rishel, Carrie W.
Rapid changes in health care services and delivery suggest an upcoming paradigm shift in the field of mental health. Recent national reports, health care policy changes, and growing evidence support a shift toward prevention-focused mental health care. The social work profession is uniquely positioned to act as leaders in this shift as the…
Jordan, Alexander H.; Lovett, Benjamin J.; Sweeton, Jennifer L.
Social psychological research suggests that because of concerns about being perceived in stereotypical ways, people may experience negative affect and diminished attention and cognitive capacity during interracial interactions. The authors discuss this research in relation to therapy and assessment and also offer practical suggestions for ensuring…
Ferrera, Maria; Ostrander, Noam; Crabtree-Nelson, Sonya
Utilizing the conceptual framework of Garrison, Anderson, and Archer for critical inquiry, this paper outlines the importance of the community of inquiry (COI) model and how it may inform online social work education. Integrating the COI model, we discuss how online learning in the classroom with a hybrid approach has been used to facilitate…
Baptista, Carlos Alberto; Loureiro, Sonia Regina; de Lima Osório, Flávia; Zuardi, Antonio Waldo; Magalhães, Pedro V; Kapczinski, Flávio; Filho, Alaor Santos; Freitas-Ferrari, Maria Cecília; Crippa, José Alexandre S
Despite the fact that public speaking is a common academic activity and that social phobia has been associated with lower educational achievement and impaired academic performance, little research has examined the prevalence of social phobia in college students. The aim of this study was to evaluate the prevalence of social phobia in a large sample of Brazilian college students and to examine the academic impact of this disorder. The Social Phobia Inventory (SPIN) and the MINI-SPIN, used as the indicator of social phobia in the screening phase, were applied to 2319 randomly selected students from two Brazilian universities. For the second phase (diagnostic confirmation), four psychiatrists and one clinical psychologist administered the SCID-IV to subjects with MINI-SPIN scores of 6 or higher. The prevalence of social phobia among the university students was 11.6%. Women with social phobia had significantly lower grades than those without the disorder. Fear of public speaking was the most common social fear. Only two of the 237 students with social phobia (0.8%) had previously received a diagnosis of social phobia and were under treatment. Social phobia comorbidities were not evaluated in this study. The methods of assessment employed by the universities (written exams) may mask the presence of social phobia. This was not a population-based study, and thus the results are not generalizable to the entire population with social phobia. Preventive strategies are recommended to reduce the under-recognition and the adverse impact of social phobia on academic performance and overall quality of life of university students. Copyright © 2011 Elsevier B.V. All rights reserved.
Curlin, Farr A.; Lawrence, Ryan E.; Odell, Shaun; Chin, Marshall H.; Lantos, John D.; Koenig, Harold G.; Meador, Keith G.
Objective This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. Method The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. Results A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). Conclusions This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting. PMID:18056237
Raat, A. N. Janet; Schonrock-Adema, Johanna; van Hell, E. Ally; Kuks, Jan B. M.; Cohen-Schotanus, Janke
In medical education, student distress is known to hamper learning and professional development. To address this problem, recent studies aimed at helping students cope with stressful situations. Undergraduate students in clinical practice frequently use experiences of surrounding peers to estimate
Jatoi, Aminah; Hillman, Shauna L; Ziegler, Katie L Allen; Stella, Philip J.; Soori, Gamini S.; Rowland, Kendrith M.
Background: Social support is defined as a network of family/friends who provide practical and emotional help. A sizable literature describes a direct relationship between social support and improved cancer clinical outcomes. This study explored the extent of social support and its potential association with survival and adverse events in geriatric lung cancer patients. Methods: One hundred thirteen patients, who were aged 65 years or older, had incurable cancer, and were enrolled in one of t...
Agyapong, Vincent I O; Conway, Catherine; Guerandel, Allys
Internationally, there has been a growing interest in the pursuit of collaborative forms of care for patients with enduring mental health difficulties. The study aims to explore the views of consultant psychiatrists in Ireland on shared care between specialized psychiatric services and primary care for patients with mental health difficulties. A self-administered questionnaire was designed and posted to 470 consultant psychiatrists who are members of the College of Psychiatry of Ireland. Stamped self-addressed envelopes were included for the return of completed questionnaires. Overall, 213 questionnaires were returned, giving a response rate of 45%. Of the respondents, 194 (91%) reported that they would support a general policy on shared care between primary care and specialized psychiatric services for patients who are stable on their treatment. However, 181 (85%) reported that they foresaw difficulties for patients in implementing such a policy including: increased financial burden on some patients (141, 66%); some patients may lack confidence in GP care (100, 47%); primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (128, 60%); primary care providers are not adequately trained to provide psychiatric care (111, 52%); and lack of adequate cooperation between primary care and specialized mental health services (96, 45%). The Irish government and the Colleges of General Practitioners and Psychiatrists in Ireland need to work together to remove the bottlenecks that hinder the active involvement of primary care in the management of patients with enduring mental health difficulties. Also, the health care systems need to be organized along a shared care model to facilitate effective collaboration between primary and specialized psychiatric services.
To begin with, this author has reviewed papers addressing the issue around the participation of psychiatrists in legal executions. The questions of reasoning for the exclusion of the mentally incompetent from execution, what exactly constitutes "competency to be executed," and whether to assess a criminal's competency for execution or to offer treatment to death row inmates who have been found incompetent are under debate. Then, making known the temporary declaration of the Japanese Society of Psychiatry and Neurology, the author has told that it should insist in the final declaration as follows: First, the secretiveness with which the Ministry of Justice and the correctional facilities in Japan handle the death penalty cases should be abolished. Second, in the present situation of the medical care in Japanese penal facilities, the employed psychiatrists should not be involved in the examination or the treatment of the death row inmates. Third, nevertheless the psychiatrist should not examine whether the inmate is competent to be executed in principle, this indifference may bring on the execution of the incompetent in present situation of Japan. Forth, it is not permitted ethically to offer the medical treatment to restore the inmate's competency. Fifth, because the Japanese death penalty confronts the false charges, if the capital punishment case requesting for retrial or preparing it reveal mentally abnormal and the condition is so severe that the inmate cannot assist legal counsel appropriately, the inmate should be transferred to hospital to be provided treatment. And finally the inmate whose competency is doubted should automatically be commuted to life imprisonment.
Maciukiewicz, Malgorzata; Pawlak, Joanna; Kapelski, Pawel; Łabędzka, Magdalena; Skibinska, Maria; Zaremba, Dorota; Leszczynska-Rodziewicz, Anna; Dmitrzak-Weglarz, Monika; Hauser, Joanna
Schizophrenia (SCH) is a complex, psychiatric disorder affecting 1 % of population. Its clinical phenotype is heterogeneous with delusions, hallucinations, depression, disorganized behaviour and negative symptoms. Bipolar affective disorder (BD) refers to periodic changes in mood and activity from depression to mania. It affects 0.5-1.5 % of population. Two types of disorder (type I and type II) are distinguished by severity of mania episodes. In our analysis, we aimed to check if clinical and demographical characteristics of the sample are predictors of symptom dimensions occurrence in BD and SCH cases. We included total sample of 443 bipolar and 439 schizophrenia patients. Diagnosis was based on DSM-IV criteria using Structured Clinical Interview for DSM-IV. We applied regression models to analyse associations between clinical and demographical traits from OPCRIT and symptom dimensions. We used previously computed dimensions of schizophrenia and bipolar affective disorder as quantitative traits for regression models. Male gender seemed protective factor for depression dimension in schizophrenia and bipolar disorder sample. Presence of definite psychosocial stressor prior disease seemed risk factor for depressive and suicidal domain in BD and SCH. OPCRIT items describing premorbid functioning seemed related with depression, positive and disorganised dimensions in schizophrenia and psychotic in BD. We proved clinical and demographical characteristics of the sample are predictors of symptom dimensions of schizophrenia and bipolar disorder. We also saw relation between clinical dimensions and course of disorder and impairment during disorder.
Full Text Available Despite its general acceptance, there has been no research exploring the actual use of bibliotherapy by Licensed Clinical Social Workers (LCSWs. This study sought to determine the extent to which LCSWs, represented by a random sample from one state, used bibliotherapy for specific problems, identified relevant variables that influence bibliotherapy use,and compiled a list of books currently used by respondents. Results suggest that bibliotherapy is used for numerous specific problems and LCSW endorsement of bibliotherapy by LCSWs is similar to that of respondents in other disciplines. Unlike studies involving other disciplines, LCSW usage patterns were not related to gender and less related to employment settings.
Admon, Lindsay; Haefner, Jessica K; Kolenic, Giselle E; Chang, Tammy; Davis, Matthew M.; Moniz, Michelle H
Background Recruiting a diverse sample of pregnant women for clinical research is a challenging but crucial task for improving obstetric services and maternal and child health outcomes. Objective To compare the feasibility and cost of recruiting pregnant women for survey research using social media-based and clinic-based approaches. Methods Advertisements were used to recruit pregnant women from the social media website Facebook. In-person methods were used to recruit pregnant women from the ...
Klein, Daniel N.; Leon, Andrew C.; Li, Chunshan; D'Zurilla, Thomas J.; Black, Sarah R.; Vivian, Dina; Dowling, Frank; Arnow, Bruce A.; Manber, Rachel; Markowitz, John C.; Kocsis, James H.
Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for…
The process of involuntary psychiatric examination and/or hospitalization is a rare experience for the average modern man. As part of it, the citizen shall be subjected to a restriction of his freedom and forced hospitalization without himself having sought neither of the above situations.The rarity of this experience, assisted by the severity of the threat to individual freedom and dignity that leads to, impose the existence of a clear legal framework which will describe the permissive or non-implementation of procedures, the pious keeping on behalf of the stakeholders of these legal provisions and the operation of a reliable system of registration and control of these processes. In our country legal act nr.2071 for involuntary hospitalization in a psychiatric unit became the legal framework, which in 1992 was decided to be adopted, to describe the necessary conditions and requirements needed be fulfilled for the realization of involuntary examination and/or hospitalization in patients with mental illness, while respecting individual rights and freedoms. Although the replacement of previous relevant law with the adoption of this law was hailed by many sides, full implementation thereafter and, where applicable, "stumbled" because it never met with the full agreement of all parties involved. It is estimated that, in Greece, 40 to 50% of all hospitalizations taking place in public psychiatric units are involuntary hospitalizations. This percentage is extremely high, being nearly four times the European average. Therefore, it is now more than ever important to undertake initiatives towards re-testing the conditions under which the involuntary examination and/or treatment is realized in our country. The purpose of this short article is to present a case where the prosecutor and the psychiatrist disagreed on the interpretation of a paragraph of law nr. 2071/92 so the first to prosecute the second. Fortunately, the psychiatrist, who defended the view that only the
Engmann, B; Steinberg, H
The article highlights the important work of the Russian psychiatrist Victor Khrisanfovich Kandinsky. His merits, in particular those in the fields of hallucinations and schizophrenias, have hitherto been neglected despite the fact that several of his articles have been published in German medical journals. He defined the term pseudohallucination in a way which is still common today. For him the criterion which separates it from real hallucinations was that the patient is aware of the fallacy of the phenomena perceived. Furthermore, his concept of ideophrenia can be regarded as a one of the precursors to today's concept of schizophrenias.
Skovgaard, A M; Isager, T; Jørgensen, O S
The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two differe...... and developmental disorders. Adjustment reaction (reactio maladaptiva) was the diagnosis most commonly used, but with varying reliability in both systems. The reliability of the socio-economic and psychosocial axes were generally high....... diagnostic systems. Diagnostic reliability was measured as percentage of interrater agreement. The highest diagnostic reliability was obtained in psychotic disorders, the lowest in personality disorders. The MAS implied improved diagnostic reliability of mental retardation, somatic disorders...
PTSD”, Burnout in Families: The Systemic Costs of Caring. Boca Raton: CRC Press, pp. 139-170.  Riggs, D.S. (2000). “Marital and family therapy ”, in...symptoms consistent with a PTSD diagnosis and an additional 10% presented symptoms that fall just short of the diagnosis . Similarly, major...with 33 professionals , including psychologists, nurses and social workers supporting OSI military members and their families at various locations
Full Text Available The traumatic experience of violence is, in its nature, unspeakable. It causes in the victim a deep wound in identity, changes in the dynamics of psychic investments producing a failure of the ability to symbolize, thus breaking the rules that characterize the usual development of thought. Some affections related to the body prevail, above all the shame which expresses itself in characteristics which reinforce the element of trauma. The loss of a capacity to represent and symbolize is not only a psychic dynamic, but it also reproduces itself in the social systems, shaping that zone of “silent concealment”, that drives the phenomenon of gender violence. The psychoanalytical reflection on the relationship between guilt and shame seems to be a priority in dealing with and at the same time highlighting the risk of victim blaming intended in terms of the unconscious defensive dynamics expressed by the social systems. We will consider the importance in the therapeutic intervention of the work of reconstruction and historicization, to be able to reactivate representation which allows the integration and the chance to distinguish the imaginary plane of the traumatic event from the real one. The psychoanalytical approach to the groups provides an interpretative model to articulate the psychic and the social space.
May 28, 2013 ... East African Medical Journal Vol. 89 No. 2 February 2012. PSYCHIATRIC MORBIDITY IN A NIGERIAN NEUROLOGY CLINIC. P. O. Ajiboye, FWACP, Senior Lecturer/ Consultant Psychiatrist, Department of Behavioural Sciences, University of Ilorin/. University of Ilorin Teaching Hospital, Ilorin, Kwara State, ...
Pomilla, Antonella; D'Argenio, Alberto; Mastronardi, Vincenzo
Among the extensive results supplied by the psychiatric literature on the subject of stalking, few studies focus on the analysis of persecutory behaviors carried out against mental health professionals, who also identified as one of the most affected sample of victims. Particularly, for studies conducted in this way, further examination requires differentiation according to gender type into the social and personal characteristics of the authors' behavior patterns displayed towards the victims. Aim. To obtaine results by an epidemiological survey conducted in public and private psychiatric care structures in the city of Rome, to assess the incidence of the phenomenon as well as gender differences in behavior patterns practised out by the author for the two sample considered. Methods. Administration of a questionnaire to a sample make up by psychiatrists working in out-patient services for the Departments of Mental Health (ASL) of Rome and to a sample of psychiatrists who practise their professional activity in the private sector. Results. Regarding the incidence of the phenomenon, an increased presence has been found in private mental health care settings in comparison to the public service; regarding to the distribution of the phenomenon according to the sexual identity of the authors among the two samples analyzed, a statistical prevalence of female authors has been found in the sample of private sector. Discussion. The health's professionals, so much liable of victimization, are poorly formed on the phenomenon. So it's urgent to operate with integrated approaches (informative trainings; strengthening of administrative and clinical policies of the profession; multidimensional assessment).
Betton, Victoria; Borschmann, Rohan; Docherty, Mary; Coleman, Stephen; Brown, Mark; Henderson, Claire
This editorial explores the implications of social media practices whereby people with mental health problems share their experiences in online public spaces and challenge mental health stigma. Social media enable individuals to bring personal experience into the public domain with the potential to affect public attitudes and mainstream media. We draw tentative conclusions regarding the use of social media by campaigning organisations. © The Royal College of Psychiatrists 2015.
Becker, Kira; Shook, John R; Darragh, Martina; Giordano, James
As a discipline, neuroethics addresses a range of questions and issues generated by basic neuroscientific research (inclusive of studies of putative neurobiological processes involved in moral and ethical cognition and behavior), and its use and meanings in the clinical and social spheres. Here, we present Part 4 of a four-part bibliography of the neuroethics literature focusing on clinical and social applications of neuroscience, to include: the treatment-enhancement discourse; issues arising in neurology, psychiatry, and pain care; neuroethics education and training; neuroethics and the law; neuroethics and policy and political issues; international neuroethics; and discourses addressing "trans-" and "post-" humanity. To complete a systematic survey of the literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine (NLM). A Python code was used to eliminate duplications in the final bibliography. When taken with Parts 1-3, this bibliography aims to provide a listing of international peerreviewed papers, books, and book chapters published from 2002 through 2016. While seeking to be as comprehensive as possible, it may be that some works were inadvertently and unintentionally not included. We therefore invite commentary from the field to afford completeness and contribute to this bibliography as a participatory work-in-progress.
Kimhy, D; Gill, K E; Brucato, G; Vakhrusheva, J; Arndt, L; Gross, J J; Girgis, R R
Social functioning (SF) difficulties are ubiquitous among individuals at clinical high risk for psychosis (CHR), but it is not yet clear why. One possibility is suggested by the observation that effective SF requires adaptive emotion awareness and regulation. Previous reports have documented deficits in emotion awareness and regulation in individuals with schizophrenia, and have shown that such deficits predicted SF. However, it is unknown whether these deficits are present prior to the onset of psychosis or whether they are linked to SF in CHR individuals. We conducted a cross-sectional comparison of emotion awareness and regulation in 54 individuals at CHR, 87 with schizophrenia and 50 healthy controls (HC). Then, within the CHR group, we examined links between emotion awareness, emotion regulation and SF as indexed by the Global Functioning Scale: Social (Cornblatt et al. 2007). Group comparisons indicated significant differences between HC and the two clinical groups in their ability to identify and describe feelings, as well as the use of suppression and reappraisal emotion-regulation strategies. Specifically, the CHR and schizophrenia groups displayed comparable deficits in all domains of emotion awareness and emotion regulation. A hierarchical multiple regression analysis indicated that difficulties describing feelings accounted for 23.2% of the SF variance. The results indicate that CHR individuals display substantial emotion awareness and emotion-regulation deficits, at severity comparable with those observed in individuals with schizophrenia. Such deficits, in particular difficulties describing feelings, predate the onset of psychosis and contribute significantly to poor SF in this population.
Narayanaswami, Pushpa; Gronseth, Gary; Dubinsky, Richard; Penfold-Murray, Rebecca; Cox, Julie; Bever, Christopher; Martins, Yolanda; Rheaume, Carol; Shouse, Denise; Getchius, Thomas S D
Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences. Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines "Complementary and alternative medicine in multiple sclerosis" ("CAM in MS") and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations. Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians ("physicians"). The primary outcome was the difference in participants' intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS). Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence
placement of the child, if parents were alive, level of education of caregiver and parents' marital status. Household variables included income, type of housing and number of co- inhabitants. Clinical variables included the diagnostic formulation on Axes I, II and III, according to the Diagnostic and Statistical Manual of Mental ...
Ozbaran, Burcu; Erermis, Serpil; Bukusoglu, Nagehan; Bildik, Tezan; Tamar, Muge; Ercan, Eyyup Sabri; Aydin, Cahide; Cetin, Saniye Korkmaz
Childhood sexual abuse is a traumatic life event that may cause psychiatric disorders such as posttraumatic stress disorder and depression. During 2003-2004, 20 sexually abused children were referred to the Child and Adolescent Psychiatry Clinic of Ege University in Izmir, Turkey. Two years later, the psychological adjustment of these children (M…
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…
Tunnecliff, Jacqueline; Ilic, Dragan; Morgan, Prue; Keating, Jennifer; Gaida, James E; Clearihan, Lynette; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Maloney, Stephen
Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. The aim of this study was to explore health researchers' and clinicians' current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a
Epkins, Catherine C; Seegan, Paige L
Depression and social anxiety symptoms and disorders are highly comorbid, and are associated with low social acceptance and academic competence. Theoretical models of both depression and social anxiety highlight the saliency of negative self-perceptions. We examined whether children's self-perceptions of social acceptance and mother-reported youth social acceptance are independently and uniquely related to children's depression and social anxiety, both before and after controlling for comorbid symptoms. Similar questions were examined regarding academic competence. The sample was 110 clinic-referred youth aged 8-16 years (65 boys, 45 girls; M age = 11.15, SD = 2.57). In the social acceptance area, both youth self-perceptions and mother-perceptions had independent and unique relations to depression and social anxiety, before and after controlling for comorbid symptoms. In the academic domain, both youth self-perceptions and mother-perceptions had independent and unique relations to depression, before and after controlling for social anxiety; yet only youth self-perceptions were related to social anxiety, before, but not after controlling for depression. For depression, larger effect sizes were observed for children's perceived, versus mother-reported, social acceptance and academic competence. Bootstrapping and Sobel tests found youth self-perceptions of social acceptance mediated the relation between mothers' perceptions and each of youth depression and social anxiety; and perceived academic competence mediated the relation between mothers' perceptions and youth depression, both before and after controlling for social anxiety. We found similarities and differences in findings for depression and social anxiety. Theoretical and treatment implications are highlighted, and future research directions are discussed.
Höger, C; Witte-Lakemann, G
The important role of pediatricians in private practice for the care of psychologically noticeable children makes it seem necessary to implement quality assurance measures. As part of an integrated project for quality assurance in psychosomatic basic care the pediatricians in the medical care district Göttingen were offered two quality circles for two years which in contrast to the original concept were conducted by child psychiatrists. The evaluation of this offer by the participating pediatricians after one year (n = 16) and after the end (n = 15) yielded very positive results regarding the structural characteristics of the quality circles (such as length of sessions, subject selection, moderation, working atmosphere) and also the general usefulness of such a quality assurance measure. The increase in competence regarding practical skills (diagnostics, treatment in the own practice, referee indication, forming the physician-patient relationship) however, was evaluated as being less pronounced. The attractiveness of a quality circle modified by continuously integrating a child psychiatrist/psychotherapist was confirmed by the results of a national survey. In another survey the participating pediatricians documented cases where they suspected psychological problems before the quality circles began and after the first year. Sensitivity and specificity of the pediatricians' assessments increased at the second evaluation point which is a sign for an increased diagnostic competency of pediatricians.
The World Health Organization (WHO) defines health human resource planning as "the process of estimating the number of persons and the kinds of knowledge, skills, and attitudes they need to achieve predetermined health targets and ultimately health status objectives" (OHA 2015). Health human resource planning is a critical component of successful organizational and system transformation, and yet little has been written on how to do this for physicians at the local level. This paper will outline a framework for developing and managing key aspects of physician human resource planning related to both the quantity and quality of work within a hospital setting. Using the example of a complex multiphase hospital-based mental health transformation that involved both the reduction and divestment of beds and services, we will outline how we managed the physician human resource aspects to establish the number of psychiatrists needed and the desired attributes of those psychiatrists, and how we helped an existing workforce transition to meet the new expectations. The paper will describe a process for strategically aligning the selection and management of physicians to meet organizational vision and mandate.
MacDonald, Joanna; Garvie, Christopher; Gordon, Sarah; Huthwaite, Mark; Mathieson, Fiona; Wood, Amber-Jane; Romans, Sarah
Given the longstanding controversy about hypnosedative use, we aimed to investigate the attitudes of prescribing psychiatrists and service users towards long-term use of hypnosedative medication, and their perceptions of barriers to evidence-based nonmedication alternatives. Qualitative data from focus groups in Aotearoa/NZ were analysed thematically. A novel research design involved a service user researcher contributing throughout the research design and process. Service users and psychiatrists met to discuss each other's views, initially separately, and subsequently together. Analysis of the data identified four key themes: the challenge, for both parties, of sleep disturbance among service users with mental health problems; the conceptual and ethical conflicts for service users and psychiatrists in managing this challenge; the significant barriers to service users accessing evidence-based nonmedication alternatives; and the initial sense of disempowerment, shared by both service users and psychiatrists, which was transformed during the research process. Our results raise questions about the relevance of the existing guidelines for this group of service users, highlight the resource and time pressures that discourage participants from embarking on withdrawal regimes and education programmes on alternatives, highlight the lack of knowledge about alternatives and reflect the complex interaction between sleep and mental health problems, which poses a significant dilemma for service users and psychiatrists.
Ahmed, K; Bennett, D M; Halder, N; Byrne, P
The authors proposed that a national film festival organized by psychiatrists could change attendees' views toward psychiatry and psychiatrists positively and increase the numbers of medical students considering psychiatry as a career. Medfest held events at nine UK universities in 2011. The program consisted of short films (The Family Doctor, Shadowscan, Beards & Bow Ties) and panelist discussions. Data were gathered using an anonymous "before and after" questionnaire. A total of 450 attendees across all sites returned 377 feedback forms (84 % response rate). Views of psychiatry and psychiatrists changed for the better for 42 % (98 % of those who answered the question) and 40 % (96 % of those who answered the question) of all respondents, respectively. Respondents' views were significantly more likely to change for the better than for the worse toward both psychiatry (p psychiatry (48 % of those who answered the question). A multicenter film festival organized by psychiatrists was associated with more positive attitudes to psychiatry and psychiatrists and an increase in students considering psychiatry as a career. The festival is now an annual event, continuing to expand.
Koyuncu, Ahmet; Ertekin, Erhan; Binbay, Zerrin; Ozyıldırım, Ilker; Yüksel, Cağrı; Tükel, Raşit
High comorbidity rates of mood disorders have been reported in patients with social anxiety disorder (SAD). Our study aims to identify the frequency of comorbid Axis I disorders in patients with SAD and to investigate the impact of psychiatric comorbidity on SAD. The study included 247 patients with SAD. Thirty eight patients with bipolar depression (SAD-BD), 150 patients with major depressive disorder (SAD-MDD) and 25 patients who do not have any mood disorder comorbidity (SAD-NOMD) were compared. Around 90% of SAD patients had at least one comorbid disorder. Comorbidity rates of lifetime MDD and BD were 74.5% and 15.4%, respectively. There was no comorbidity in the SAD-NOMD group. Atypical depression, total number of depressive episodes and rate of PTSD comorbidity were higher in SAD-BD than in SAD-MDD. Additionally, OCD comorbidity was higher in SAD-BD than in SAD-NOMD. SAD-MDD group had higher social anxiety severity than SAD-NOMD. Mood disorder comorbidity might be associated with increased severity and decreased functionality in patients with SAD. © 2014.
Melfsen, Siebke; Walitza, Susanne; Warnke, Andreas
The Social Phobia and Anxiety Inventory for Children (SPAIK) is a frequently used German questionnaire. The study investigates its psychometric properties and norms in a clinical study. The questionnaire was presented to a clinical sample of n = 320 school-age children (7 to 18 years) prior to beginning therapy. The items indicated a high internal consistency and homogeneity. With regard to dimensions, a one-factor solution was preferred. As to validity, there was a significant difference in total score between the normal and the clinical sample. The sample was also used to provide some normative data. The SPAIK appears to be a reliable and valid measure of childhood social anxiety.
Avny, Ohad; Teitelbaum, Tatiana; Simon, Moshe; Michnick, Tatiana; Siman-Tov, Maya
A consultation model between primary care physicians and psychiatrists that has been in operation for 12 years in the Jerusalem district of the Clalit Health Services in Israel is evaluated. In this model psychiatrists provide consultations twice a month at the primary care clinic. All patients are referred by their family physicians. Communication between the psychiatric consultant and the referring physician is carried out by telephone, correspondence and staff meetings. Evaluation of the psychiatric care consultation model in which a psychiatrist consults at the primary care clinic. A questionnaire-based survey distributed to 17 primary care physicians in primary care clinics in Jerusalem in which a psychiatric consultant is present. Almost all of the doctors (93%) responded that the consultation model was superior to the existing model of referral to a secondary psychiatric clinic alone and reduced the workload in caring for the referred patients. The quality of psychiatric care was correlated with the depression prevalence among patients referred for consultation at their clinic (r=0.530, p=0.035). In addition, correlation was demonstrated between primary care physicians impression of alleviation of care of patients and their impression of extent of the patients' cooperation with the consulting psychiatrist (r=0.679, p = 0.015) Conclusions: Very limited conclusions may be drawn from this questionnaire distributed to primary care physicians who were asked to assess psychiatric consultation in their clinic. Our conclusion could be influenced by the design and the actual distribution of the questionnaires by the consulting psychiatrist. Nevertheless answers to the questionnaire might imply that the consultation model of care between a psychiatric consultant and the primary care physician, where the patient's primary care physician takes a leading role in his psychiatric care, is perceived by family physicians as a good alternative to referral to a psychiatric
Rozel, John S.; Mulvey, Edward P.
The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk. PMID:28375722
Tangney, June Price; Mashek, Debra; Stuewig, Jeffrey
This paper describes our attempt to import social-personality theory and research on moral emotions and moral cognitions to applied problems of crime, substance abuse, and HIV risk behavior. Thus far, in an inmate sample, we have evidence that criminogenic beliefs and proneness to guilt are each predictive of re-offense after release from jail. In addition, we have evidence that jail programs and services may reduce criminogenic beliefs and enhance adaptive feelings of guilt. As our sample size increases, our next step is to test the full mediational model, examining the degree to which programs and services impact post-release desistance via their effect on moral emotions and cognitions. In addition to highlighting some of the key findings from our longitudinal study of jail inmates over the period of incarceration and post-release, we describe the origins and development of this interdisciplinary project, highlighting the challenges and rewards of such endeavors.
Full Text Available List of abstacts and authors: 1. Integrating the art and science of psychiatry Eugene Allers 2. Chronic pain as a predictor of outcome in an inpatient Psychiatric population Eugene Allers and Gerhard Grundling 3. Recent advances in social phobia Christer Allgulander 4. Clinical management of patients with anxiety disorders Christer Allgulander 5. Do elephants suffer from Schizophrenia? (Or do the Schizophrenias represent a disorder of self consciousness? A Southern African perspective Sean Exner Baumann 6. Long term maintenance treatment of Bipolar Disorder: Preventing relapse Charles L. Bowden 7. Predictors of response to treatments for Bipolar Disorder Charles L. Bowden 8. Aids/HIV knowledge and high risk behaviour: A Geo-graphical comparison in a schizophrenia population P Buckley, S van Vuuren, L Koen, J E Muller, C Seller, H Lategan, D J H Niehaus 9. Does Marijuana make you go mad? David J Castle 10. Understanding and management of Treatment Resistant Schizophrenia David J Castle 11. Workshop on research and publishing David J Castle 12. From victim to victor: Without a self-help book Beatrix Jacqueline Coetzee 13. The evaluation of the Gender Dysphoric patient Franco Colin 14. Dissociation: A South African model A M Dikobe, C K Mataboge, L M Motlana, B F Sokudela, C Kruger 15. Designated smoking rooms...and other "Secret sins" of psychiatry: Tobacco cessation approaches in the severely mentally ill Charl Els 16. Dual diagnosis: Implications for treatment and prognosis Charl Els 17. Body weight, glucose metabolism and the new generation antipsychotics Robin Emsley 18. Neurological abnormalities in first episode Schizophrenia: Temporal stability and clinical and outcome correlates Robin Emsley, H Jadri Turner, Piet P Oosthuizen, Jonathan Carr 19. Mythology of depressive illnesses among Africans Senathi Fisha 20. Substance use and High school dropout Alan J. Flisher, Lorraine Townsend, Perpetual Chikobvu, Carl Lombard, Gary King 21. Psychosis
Triarhou, Lazaros C; del Cerro, Manuel
One of the earliest recorded works in Biological Psychology was published in 1910 by Argentine psychiatrist José Ingenieros (1877-1925), Professor of Experimental Psychology at the Faculty of Philosophy and Letters of the University of Buenos Aires. Ingenieros, a multifaceted personality and prolific author and educator famous for his lapidary aphorisms, has been considered a 'luminar