Natalia Cámara Conde
Full Text Available We show a proposal to increase the quality of nursing cares, improving mental health care of hospitalized patients by creating the figure of the liaison nurse within the liaison psychiatry team. This nurse would not only be a reference to support the nursing staff at the level of patient care, but also the psycho-emotional self-care professional.Objectives: Justifying the need to include the figure of the specialist mental health team liaison psychiatry nurse. Method: The rotation as residents, for a month, with the interconsultation team psychiatric hospital Gregorio Marañón and literature review. Results: There have been partially unmet needs, these could be covered with the existence of a nurse specialist in mental health consultation in this hospital. Discussion: Possibly it poses difficulties in defining the roles of various liaison team professionals, which we expect can be defined at the start implementing the new member.The hospital itself has an own field defined, articulated through the NANDA, NIC, NOC methodology, which covers aspects that so far have not being made, there is not a nurse figure into the psychiatric consultation liaison team.
Noblett, J; Caffrey, A; Deb, T; Khan, A; Lagunes-Cordoba, E; Gale-Grant, O; Henderson, C
Explore the experiences of liaison psychiatry professionals, to gain a greater understanding of the quality of care patients with mental illness receive in the general hospital setting; the factors that affect the quality of care; and their insights on interventions that could improve care. A survey questionnaire and qualitative in depth interviews were used to collect data. Data collection took place at the Royal College of Psychiatrists Faculty of Liaison Psychiatry Annual conference. Qualitative analysis was done using thematic analysis. Areas of concern in the quality of care of patients with co-morbid mental illness included 'diagnostic overshadowing', 'poor communication with patient', 'patient dignity not respected' and 'delay in investigation or treatment'. Eleven contributing factors were identified, the two most frequently mentioned were 'stigmatising attitudes of staff towards patients with co-morbid mental illness' and 'complex diagnosis'. The general overview of care was positive with areas for improvement highlighted. Interventions suggested included 'formal education' and 'changing the liaison psychiatry team'. The cases discussed highlighted several areas where the quality of care received by patients with co-morbid mental illness is lacking, the consequences of which could be contributing to physical health disparities. It was acknowledged that it is the dual responsibility of both the general hospital staff and liaison staff in improving care. Copyright © 2017 Elsevier Inc. All rights reserved.
In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness.
Gulati, Prannay; Das, Subhash; Chavan, B S
Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Cross-sectional, single assessment study conducted at a tertiary hospital. Participants consisted of medical students of 1(st) and 2(nd) year who didn't have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire-12 (GHQ-12), opinion about mental illness (OMI) scale, and attitude to psychiatry-29 (ATP-29) scale. Standard descriptive statistics (mean, percentage), Chi-square test. A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1(st) year, 2(nd) year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry.
Gulati, Prannay; Das, Subhash; Chavan, B. S.
Context: Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. Aims: (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Settings and Design: Cross-sectional, single assessment study conducted at a tertiary hospital. Subjects and Methods: Participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire-12 (GHQ-12), opinion about mental illness (OMI) scale, and attitude to psychiatry-29 (ATP-29) scale. Statistical Analysis: Standard descriptive statistics (mean, percentage), Chi-square test. Results: A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Conclusions: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry. PMID:25316938
Jovanović Aleksandar A.
Full Text Available Forensic psychiatry determination is, ordered by a court, the analysis and interpretation of medical facts with important legal implications. In that sense, psychiatrists (or neuropsychiatrists, apart from their professional expertise, must be familiar with legal, economical and social significance of medical data, so that their forensic reports are clear and useful in the context of legal procedure. This review deals with forensic psychiatry aspects of mental capacity. In the introduction of the article, the explanation of relevant concepts such as mental capacity, contractual and testamentary capacity, informed consent, undue influence and forensic determination in light of Serbian statutory law is presented. Further, the authors present basic principles of making forensic reports on mental capacity as well as contractual and testamentary capacity, and informed consent for eventual medical examination and treatment.
Avasthi, Ajit; Kate, Natasha; Grover, Sandeep
Most of the psychiatry practice in India is guided by the western concepts of mental health and illness, which have largely ignored the role of religion, family, eastern philosophy, and medicine in understanding and managing the psychiatric disorders. India comprises of diverse cultures, languages, ethnicities, and religious affiliations. However, besides these diversities, there are certain commonalities, which include Hinduism as a religion which is spread across the country, the traditional family system, ancient Indian system of medicine and emphasis on use of traditional methods like Yoga and Meditation for controlling mind. This article discusses as to how mind and mental health are understood from the point of view of Hinduism, Indian traditions and Indian systems of medicine. Further, the article focuses on as to how these Indian concepts can be incorporated in the practice of contemporary psychiatry.
Avasthi, Ajit; Kate, Natasha; Grover, Sandeep
Most of the psychiatry practice in India is guided by the western concepts of mental health and illness, which have largely ignored the role of religion, family, eastern philosophy, and medicine in understanding and managing the psychiatric disorders. India comprises of diverse cultures, languages, ethnicities, and religious affiliations. However, besides these diversities, there are certain commonalities, which include Hinduism as a religion which is spread across the country, the traditional family system, ancient Indian system of medicine and emphasis on use of traditional methods like Yoga and Meditation for controlling mind. This article discusses as to how mind and mental health are understood from the point of view of Hinduism, Indian traditions and Indian systems of medicine. Further, the article focuses on as to how these Indian concepts can be incorporated in the practice of contemporary psychiatry. PMID:23858244
The specialty of Psychiatry and the interdisciplinary work performed by psychiatrists in conjunction with other scientific and humanistic disciplines is being affected by some facts which lead to its stigmatization. There are both internal and external risks that are affecting the profession. Among the internal ones we may mention the different diagnostic criteria used by psychiatrists and the differences between treatments--as there is a wide variety of treatment options. Besides, the practice of psychiatry may differ enormously, according to the perspective--biological, psychological, social, cultural, and so on--of each psychiatrist. The internal inconsistencies give rise to some of the external risks psychiatry and psychiatrists have to face: patients' discontent or even mistrust, the intrusion of other professions in the field of psychiatry and the negative image psychiatry has among the public. Just as it occurred in many other places before, the passing of a new mental health law in Argentina has proved to be an occasion for deep debate. The passing of this law has caused big controversy, especially among professional associations, private mental health services, NGOs which represent users and their families, trade unions which represent health workers, political and economic decision makers, etc. In Argentina, the debate of ideas has always been rich. Even when political parties were forbidden, there were discussions taking place among groups which supported psychoanalytic and psychodynamic approaches. There are many who demonize the developments made in the field of psychiatry and they also campaign against such developments. They catch the public's attention and they convince legislators, thus spreading the idea that psychiatry may be dangerous. As a consequence, for example, the new law gives similar status to psychiatrists and psychologists when it states that the decision to confine a patient into hospital "should be signed by two professionals, one of
Martínez, Nathalie Tamayo
To provide an explanation about what mental imagery is and some implications in psychiatry. This article is a narrative literature review. There are many terms in which imagery representations are described in different fields of research. They are defined as perceptions in the absence of an external stimulus, and can be created in any sensory modality. Their neurophysiological substrate is almost the same as the one activated during sensory perception. There is no unified theory about its function, but it is possibly the way that our brain uses and manipulates the information to respond to the environment. Mental imagery is an everyday phenomenon, and when it occurs in specific patterns it can be a sign of mental disorders. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Bland, R C
To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system. Using prevalence data for psychiatric disorders and population projections, this paper presents the likely changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery. Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged, including many mentally ill, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being closed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services; users will pay for services more directly. Psychiatry is very vulnerable to minor changes in health care schemes and will
International psychiatry has its roots in Anglo-European societies of the 19th century. Ideas and methods on mental health and illness grew out of the modern concept of disease that had consolidated in the early ... and into the 20th century a medical, organic approach to mental ... It cannot be divorced from the history of the.
Bórquez Rojas, E; Torres, P; Tapia, L; Rodríguez, A; Rocha, P; Larrea, J; Yulis, J; Bórquez, J A
The situation of Mental Health in Latin America is analyzed. Urgently creating a system able at handling the psychiatric disease increase in the years to come is a conclusion this paper strongly aims at. The beginning of Psychiatry is reviewed, and the importance of Psychiatry at the General Hospital is outlined as well as its rapprochement toward the community, which led to a better control and prevention in the field of Mental Health. A definition of Psychiatry is proposed, as a branch of Medicine which stands in between mental hospitals and communities. Active teamwork, coupled with the physician's work and the tasks other members of the health personnel are engaged in, has led to a more integrated approach onto the ill thus benefiting not only patients but also the whole community.
Full Text Available BACKGROUND: At least one half of all patients who admitted to general hospitals, suffer from psychiatric comorbidities. Management of mental disorders in these patients, significantly, improves the course and outcome of medical diseases. The aim of this survey was to answer the following questions: 1 what is the rate of diagnosable psychiatric symptoms among medical and surgical inpatients? and 2 what proportion of them undergo psychiatric consultation? METHODS: Three hundred and ninety two patients admitted to medical and surgical wards of Alzahra hospital (Isfahan from January 2005 until March 2005 were evaluated by the revised form of psychiatric symptoms checklist (SCL-90-R. The total referral records were also maintained and compared with the data of morbidity. RESULTS: One hundred and fifty six (42.7% of the evaluated subjects had psychiatric co-morbidities. The most prevalent psychiatric symptoms determined in this group were depression, somatization and anxiety. Only 84 (3% of these patients had undergone psychiatric consultation. CONCLUSIONS: This study demonstrates that many of the patients, who are admitted to general hospitals, may have psychiatric co-morbidities but only a very small percentage of them receive appropriate mental cares. KEY WORDS: Consultation-liaison psychiatry, general hospital, mental disorder.
Full Text Available Aim: The objective of our study was to evaluate the socio-demegraphic data, psychiatric diagnosis according to Diagnostic and Statistical Manuel of Mental disorder (DSV-IV of patients, referral rates of medical and surgical clinics and reasons for referrals in inpatients who were requested psychiatry consultationb Material and Method: This study was conducted in Afyonkarahisar, in a 530 bed university hospital. For a period of six months, a retrospective data was collected from 124 inpatients who were requested psychiatric consultations. Psychiatric diagnoses were based on DSM-IV. Results: Indicated that mean age of patients are 50.1±19.7%u2019di. Seventy (56.5% patients were female and 54 (43.5% of patients were male. The most frequent referral clinics were internal medicine (24.2%, followed by neurology (14.5% and physical medicine (14.5% and rehabilitation (11.3% The most frequent reasons for referral were depressive symptoms (21.8% somatic complaint (17.7%, agitation and non-compliance to treatment (16.1% and suicidal attempted (10.5%. Psychopathology was determined in majority of patients (86.3%. Regarding the psychiatric diagnosis, adjustment disorders (21 % were the most common. Discussion: The interaction between psychiatry and other medical clinical is important because of psychiatric disorders are more commonly seen among medical and surgical inpatients.
Full Text Available Xavier-Yves Zendjidjian,1,2 Karine Baumstarck,1 Pascal Auquier,1 Anderson Loundou,1 Christophe Lançon,1,2 Laurent Boyer11Public Health, Chronic Diseases and Quality of Life Research Unit, Aix-Marseille Université, 2Department of Psychiatry, La Conception Hospital, Marseille, FranceBackground: The aim of this study was to determine the relationship between inpatient satisfaction and health outcomes, quality of life, and adherence to treatment in a sample of patients with schizophrenia, while considering key sociodemographic and clinical confounding factors.Methods: This cross-sectional study was conducted in the psychiatric departments of two public university hospitals in France. The data collected included sociodemographic information, clinical characteristics, quality of life (using the 36-Item Short Form Health Survey, nonadherence to treatment (Medication Adherence Report Scale, and satisfaction (a specific self-administered questionnaire based exclusively on patient point of view [Satispsy-22] and a generic questionnaire for hospitalized patients [QSH]. Multiple linear regressions were performed to assess the associations between satisfaction and quality of life and between satisfaction and nonadherence. Two sets of models were performed, ie, scores on the Satispsy-22 and scores on the QSH.Results: Ninety-one patients with schizophrenia were enrolled. After adjustment for confounding factors, patients with better personal experience during hospitalization (Satispsy-22 had a better psychological quality of life (SF36-mental composite score, β=0.37; P=0.004, and patients with higher levels of satisfaction with quality of care (Satispsy-22 showed better adherence to treatment (Medication Adherence Report Scale total score, β=−0.32; P=0.021. Higher QSH scores for staff and structure index were linked to better adherence with treatment (respectively, β=−0.33; P=0.019 and β=−0.30; P=0.032, but not with quality of life
Sathyanath, Shashwath; Mendonsa, Rohan Dilip; Thattil, Anitha Maria; Chandran, Varikkara Mohan; Karkal, Ravichandra S
Unfortunately, stigmatizing attitudes towards mentally ill are common among medical students, nurses as well as doctors. This is a major obstacle in the delivery of mental health services. To assess the socially restrictive attitudes towards mentally ill among the medical professionals and to investigate the association between such attitudes and relevant variables. We assessed the attitudes towards people with mental illness among the medical professionals (N = 130) in a medical university using shortened version of the 40-item Community Attitudes toward the Mentally Ill (CAMI) scale. We found that socially restrictive attitudes were endorsed by quite a number of faculty members and trainees. Significantly higher number of faculty members (22.5%) compared to the trainees (9.1%) endorsed unfavourable attitudes towards previously mentally ill man getting married. Similarly, significantly more number of faculty (22.5%) were averse to the idea of living next door to someone who has been mentally ill compared to the trainees (9.1%). However, significantly lesser number of faculty members (16.1%) compared to the trainees (30.3%) believed that previously mentally ill people should be excluded from taking public office. Personal acquaintance with a mentally ill individual was the only variable that was associated with significantly lesser socially restrictive attitudes among the medical professionals, irrespective of their age, gender and clinical exposure to people with mental illness. Socially restrictive attitudes towards people with mental illness are prevalent among substantial number of medical professionals in a low-income country like India. Personal acquaintance with people who have mental illness appears to be the only significant factor that reduces medical professionals' socially restrictive attitudes towards them. © The Author(s) 2016.
Coverdale, John; Roberts, Laura Weiss; Balon, Richard; Beresin, Eugene V
Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.
Honig, A; Sierink, D; Verwey, B
Care provided by consultation-liaison (CL) psychiatry and general hospital (GH) psychiatry varies widely. This means that certain services are almost unrecognisable and therefore less readily available to patients. AIM: To describe the core tasks of current CL- and GH-psychiatry care and to suggest how these tasks can best be performed and developed in the future. METHOD: We conducted a selective review of relevant CL- and GH-related literature and combined the information we obtained with the results of a consultation with CL-psychiatrists about how CL- and GL psychiatry should function in the future. RESULTS: Core tasks of CL- and GH-psychiatry are: 1. inpatient and outpatient care for complex patients with combined somatic and psychiatric problems (including addiction) and 2. acute care, diagnosis and treatment of patients referred to the Emergency Department. We gave an outline of how the quality of training can be maintained and/or improved and we suggest ways in which the funding of CL- and GH-psychiatry can be safeguarded and, if possible, increased in the future. CONCLUSION: We strongly recommend that large teaching hospitals and all university hospitals should have at their disposal a psychiatric consultation service that includes psychiatric Emergency Department facilities and specialised CL and GH inpatient and outpatient facility such as a medical-psychiatric unit. The CL- and GH-service should have a psychiatrist as gatekeeper and should be integrated into the hospital's chain of care. Partners in this chain of care are interns who have other medical specialisms, mental health specialists employed at other (mainly psychiatric) hospitals and general practitioners (GPs).
Trachsel, Manuel; Irwin, Scott A; Biller-Andorno, Nikola; Hoff, Paul; Riese, Florian
As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness. Based on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed. Palliative psychiatry focuses on mental health rather than medical/physical issues. We propose that the beneficiaries of palliative psychiatry are patients with severe persistent mental illness, who are at risk of therapeutic neglect and/or overly aggressive care within current paradigms. These include long-term residential care patients with severe chronic schizophrenia and insufficient quality of life, those with therapy-refractory depressions and repeated suicide attempts, and those with severe long-standing therapy-refractory anorexia nervosa. An explicitly palliative approach within psychiatry has the potential to improve quality of care, person-centredness, outcomes, and autonomy for patients with severe persistent mental illness. The first step towards a palliative psychiatry is to acknowledge those palliative approaches that already exist implicitly in psychiatry. Basic skills for a palliative psychiatry include communication of diagnosis and prognosis, symptom assessment and management, support for advance (mental health) care planning, assessment of caregiver needs, and referral to specialized services. Some of these may already be considered core skills of psychiatrists, but for a truly palliative approach they should be exercised guided by an awareness of the limited functional prognosis and lifespan of patients with severe persistent mental illness.
Aguiar, Inês Guerra; Barroso, Cláudia; Moreira, Filipa; Fonseca, Maria da Luz; Mendes, Patrícia; Pangaio, Nuno; Miranda, Vânia; Fernandes, Graça
Introduction: The Infancy and Early Childhood Psychiatric Outpatient Clinic at the Oporto Hospital Centre’s Department of Child and Adolescent Psychiatry opened in 2007. Our aim is to characterize the first consultations between June 2012 and June 2013.Methods: Review of clinical files and collection of demographic and medical data; diagnostic evaluation according to the Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood: Revised Edition; stati...
The concept of globalization has been applied recently to ways in which mental health may be developed in low- and middle-income countries (LMICs), sometimes referred to as the 'Third World' or developing countries. This paper (1) describes the roots of psychiatry in western culture and its current domination by pharmacological therapies; (2) considers the history of mental health in LMICs, focusing on many being essentially non-western in cultural background with a tradition of using a plurality of systems of care and help for mental health problems, including religious and indigenous systems of medicine; and (3) concludes that in a post-colonial world, mental health development in LMICs should not be left to market forces, which are inevitably manipulated by the interests of multinational corporations mostly located in ex-colonizing countries, especially the pharmaceutical companies.
relevant from the point of view of forensic psychiatry. The author's primary goal in this paper is to present the basic postulates underlying the perception of drug abuse and drug addiction in forensic psychiatry, both from the theoretical and practical point of view. In exploring the practical aspect of this issue, the author focuses on presenting the basic principles of forensic-psychiatric expertise of criminal offenders who have been diagnosed as having mental disorders caused by drug abuse. The expertise includes different aspects of assessing mental disorders: giving professional opinions on the offender's mental capacity (sanity, assessing the potential danger of recidivism or commission of a more serious criminal act, and giving proposals for relevant of security measures concerning the mandatory treatment of drug addicts both in outpatient clinics and in other relevant in-patient medical institutions. Given the fact that mental disorders stemming from drug abuse frequently have numerous financial, family and professional implications, the author presents some forensic psychiatric attitudes pertaining to the assessment of contractual capacity of these persons, the assessment of their working capacity (including the remaining working ability or temporary inability to work, the assessment of mental capacity for exercising the parental right or custodianship rights. In that context, the author provides the forensic psychiatric aspects of these mental disorders from the aspect of civil law. Drug abuse and drug addiction involve serious and complex socio-pathological problems which are difficult to treat/cure. This paper is the author's contribution to casting light on these issues, primarily from the aspect of forensic psychiatry.
Huys, Quentin J M; Roiser, Jonathan P
Computational Psychiatry aims to describe the relationship between the brain's neurobiology, its environment and mental symptoms in computational terms. In so doing, it may improve psychiatric classification and the diagnosis and treatment of mental illness. It can unite many levels of description in a mechanistic and rigorous fashion, while avoiding biological reductionism and artificial categorisation. We describe how computational models of cognition can infer the current state of the environment and weigh up future actions, and how these models provide new perspectives on two example disorders, depression and schizophrenia. Reinforcement learning describes how the brain can choose and value courses of actions according to their long-term future value. Some depressive symptoms may result from aberrant valuations, which could arise from prior beliefs about the loss of agency (‘helplessness’), or from an inability to inhibit the mental exploration of aversive events. Predictive coding explains how the brain might perform Bayesian inference about the state of its environment by combining sensory data with prior beliefs, each weighted according to their certainty (or precision). Several cortical abnormalities in schizophrenia might reduce precision at higher levels of the inferential hierarchy, biasing inference towards sensory data and away from prior beliefs. We discuss whether striatal hyperdopaminergia might have an adaptive function in this context, and also how reinforcement learning and incentive salience models may shed light on the disorder. Finally, we review some of Computational Psychiatry's applications to neurological disorders, such as Parkinson's disease, and some pitfalls to avoid when applying its methods. PMID:26157034
Rojas Malpica, Carlos Alberto
The purpose of this communication is to compare behavioral mineralization occurring in mental illness to the freshness and plasticity behavior in health. The epistemological fundamentals of this paper include the theories of chaos and complexity of Edgar Morin, the concept of autopoiesis developed from the theory of systems, the latest discoveries on the neurobiology of consciousness and their associations with Darwinian psychiatry and also, following Lain Entralgo, recreating the Greek concept of ananke to describe the behavior fixation in an anachronistic place of the physis in mental illness. It provides some empirical evidence to support the proposal, and all this is rigorously examined with hermeneutic phenomenology and its theoretical possibilities. This leads to an epistemological rethinking of clinical and therapeutic proposal aimed at the subject and the recovery of his or her freedom.
de Jong, J.T.V.M.
This article addresses four major challenges for efforts to create synergy between the global mental health movement and cultural psychiatry. First, although they appear to share domains of mutual interest, the worlds of global mental health and cultural psychiatry have distinct lineages. Expanding
Bujoreanu, Simona; White, Matthew T; Gerber, Bradley; Ibeziako, Patricia
The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals. Copyright © 2015 by the American Academy of Pediatrics.
Adams, Rick A; Huys, Quentin J M; Roiser, Jonathan P
Computational Psychiatry aims to describe the relationship between the brain's neurobiology, its environment and mental symptoms in computational terms. In so doing, it may improve psychiatric classification and the diagnosis and treatment of mental illness. It can unite many levels of description in a mechanistic and rigorous fashion, while avoiding biological reductionism and artificial categorisation. We describe how computational models of cognition can infer the current state of the environment and weigh up future actions, and how these models provide new perspectives on two example disorders, depression and schizophrenia. Reinforcement learning describes how the brain can choose and value courses of actions according to their long-term future value. Some depressive symptoms may result from aberrant valuations, which could arise from prior beliefs about the loss of agency ('helplessness'), or from an inability to inhibit the mental exploration of aversive events. Predictive coding explains how the brain might perform Bayesian inference about the state of its environment by combining sensory data with prior beliefs, each weighted according to their certainty (or precision). Several cortical abnormalities in schizophrenia might reduce precision at higher levels of the inferential hierarchy, biasing inference towards sensory data and away from prior beliefs. We discuss whether striatal hyperdopaminergia might have an adaptive function in this context, and also how reinforcement learning and incentive salience models may shed light on the disorder. Finally, we review some of Computational Psychiatry's applications to neurological disorders, such as Parkinson's disease, and some pitfalls to avoid when applying its methods. 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/
Jonker, E J; Goossens, P J J; Steenhuis, I H M; Oud, N E
Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and addition care, has initiated a project to decrease the number of seclusions in clinical psychiatry. A first step in this project is to gain insight into the current situation: the perceived prevalence of patient aggression, the attitudes of mental health nurses towards patient aggression and those socio-demographic and psychosocial factors that contribute to the use of coercive interventions. A survey was undertaken among 113 nurses from six closed and semi-closed wards. In this survey, two questionnaires were used: (1) the Attitude Toward Aggression Scale; and (2) the Perceptions of the Prevalence of Aggression Scale. Variables derived from the Theory of Planned Behaviour were also measured. Nurses reported being regularly confronted with aggression in general and mostly with non-threatening verbal aggression. They perceived patient aggression as being destructive or offensive and not serving a protective or communicative function. The nurses generally perceived themselves as having control over patient behaviour (i.e. considerable self-efficacy) and reported considerable social support from colleagues. Although the nurses in this study were frequently confronted with aggression, they did not experience the aggression as a major problem.
Medlock, Morgan; Weissman, Anna; Wong, Shane Shucheng; Carlo, Andrew; Zeng, Mary; Borba, Christina; Curry, Michael; Shtasel, Derri
Mental health disparities based on minority racial status are well characterized, including inequities in access, symptom severity, diagnosis, and treatment. For African Americans, racism may affect mental health through factors such as poverty and segregation, which have operated since slavery. While the need to address racism in medical training has been recognized, there are few examples of formal didactic curricula in the psychiatric literature. Antiracism didactics during psychiatry residency provide a unique opportunity to equip physicians to address bias and racism in mental health care. With advocacy by residents in the Massachusetts General Hospital/McLean Psychiatry residency program, the Division of Public and Community Psychiatry developed a curriculum addressing racial inequities in mental health, particularly those experienced by African Americans. Four 50-minute interactive didactic lectures were integrated into the required didactic curriculum (one lecture per postgraduate training class) during the 2015-2016 academic year. Of residents who attended lectures and provided anonymous feedback, 97% agreed that discussing racism in formal didactics was at least "somewhat" positive, and 92% agreed that it should "probably" or "definitely" remain in the curriculum. Qualitative feedback centered on a need for more time to discuss racism as well as a desire to learn more about minority mental health advocacy in general. Teaching about racism as part of required training conveys the explicit message that this is core curricular material and critical knowledge for all physicians. These lectures can serve as a springboard for dissemination and provide scaffolding for similar curriculum development in medical residency programs.
Myriam Raquel Mitjavila; Priscilla Gomes Mathes
This paper analyzes some socio-cultural dimensions of the semantic field and ways of structuring forensic psychiatry discourses in relation to the criminal dangerousness and its connections with mental health...
Haslam, N; Lusher, D
Psychiatry and clinical psychology are the two dominant disciplines in mental health research, but the structure of scientific influence and information flow within and between them has never been mapped. Citations among 96 of the highest impact psychiatry and clinical psychology journals were examined, based on 10 052 articles published in 2008. Network analysis explored patterns of influence between journal clusters. Psychiatry journals tended to have greater influence than clinical psychology journals, and their influence was asymmetrical: clinical psychology journals cited psychiatry journals at a much higher rate than the reverse. Eight journal clusters were found, most dominated by a single discipline. Their citation network revealed an influential central cluster of 'core psychiatry' journals that had close affinities with a 'psychopharmacology' cluster. A group of 'core clinical psychology' journals was linked to a 'behavior therapy' cluster but both were subordinate to psychiatry journals. Clinical psychology journals were less integrated than psychiatry journals, and 'health psychology/behavioral medicine' and 'neuropsychology' clusters were relatively peripheral to the network. Scientific publication in the mental health field is largely organized along disciplinary lines, and is to some degree hierarchical, with clinical psychology journals tending to be structurally subordinate to psychiatry journals.
Abdul-Hamid, Walid Khalid; Lewis-Cole, Kelly; Holloway, Frank; Silverman, Ann Marisa
There is little research evidence as to whether general adult psychiatry or old age psychiatry should look after old people with enduring mental illness. To compare the extent to which general adult and old age psychiatric services meet the needs of older people with enduring mental illness. A total of 74 elderly patients with functional psychiatric disorders were identified by reviewing the notes of patients over the age of 60 living in a defined inner urban catchment area. Data were collected on the morbidity and needs of the sample. Needs were assessed using the Elderly Psychiatric Needs Schedule (EPNS). The participants in contact with old age psychiatry had significantly fewer unmet needs compared with those in contact with general adult psychiatry (2.8 v. 5.6, t = 2.2, Pmeet the needs of elderly people with mental illness. This finding supports the need for a separate old age psychiatry service. © The Royal College of Psychiatrists 2015.
Kent, Stephen A; Manca, Terra A
Over 60 years ago, founder L. Ron Hubbard began what has become Scientology's greatest battle. Scientology emerged from Dianetics, which Hubbard hoped would replace the psychiatric profession. In this article, we discuss how Scientology attempted to position itself as a rival profession to psychiatry and the consequences of those attempts. Scientology's battle with psychiatry gained some success from the social conditions during which it emerged, but it continues in a time that has seen increasing success with various psychiatric treatments. As such, Scientology's direct influence on the psychiatric profession may be difficult to measure, but its actions have coincided with substantial challenges to psychiatry.
Full Text Available Objective: To analyze the available scientific literature on the follow-up models in Clinical Teaching in Mental Health, carrying out a systematic review of the literature with re- search in the electronic databases PubMed, B-On, EBSCO platform and Scielo, as well as the Open Access scientific repositories of Portugal. Methodology: The present work consists of a systematic literature review (RSL. Keyword databases were searched first, the results were filtered according to exclusion and inclusion criteria and only selected the most appropriate references to answer the research question that were subsequently submitted to an evaluation by CASPe. The final sample includes 11 articles. Results: In the last decades, the training of nursing students has been the subject of several changes and transformations, once it is agreed that the training takes place in moments of theoretical training and moments of practical training in clinical teaching. Clinical teaching is a privileged space for the learning of nursing students. This is where they have the possibility to develop and mobilize skills and build knowledge The orientation of nursing students in clinical education has been the subject of numerous investigations in recent years; the area of Mental Health and Psychiatry (MHP shows a significant role in the development and construction of the identity of the nursing professional future. in the follow-up of students in clinical teaching, several actors stand out: the student, the teacher and the nurse orientate, who take special importance in the process of personal and professional development of the student, having a pedagogical, social and professional responsibility. The provision of care in MHP Clinical Teaching requires a wide range that allows the student to develop several aspects, namely creativity, therapeutic communication, sensitivity to care, listening, empathy, and interpersonal relationship capacity with the person, multi- disciplinary
A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.
Kent, Stephen A.; Manca, Terra A.
Over 60 years ago, founder L. Ron Hubbard began what has become Scientology's greatest battle. Scientology emerged from Dianetics, which Hubbard hoped would replace the psychiatric profession. In this article, we discuss how Scientology attempted to position itself as a rival profession to psychiatry and the consequences of those attempts. Scientology's battle with psychiatry gained some success from the social conditions during which it emerged, but it continues in a time that has seen incre...
Gomez, D M; Gunarathna, C; Gunarathna, S; Gnanapragasam, K; Hanwella, Raveen
Mental illness contributes significantly to the global disease burden. There is great diversity in the manner in which mentally ill patients seek help as this is influenced by their beliefs and the opinion of the family-social support unit. The stigma associated with mental illness is a barrier to effective therapy in Sri Lanka where systematic public awareness programmes are minimal. To study the help-seeking behaviour and its impact on patients attending a psychiatry clinic of the National Hospital of Sri Lanka. A cross sectional study was carried out among 120 attendees of the psychiatry clinic of the National Hospital of Sri Lanka. Sample was selected using systematic sampling. Data was collected using an interviewer administered questionnaire. More than half the participants sought psychiatric care as their first help-seeking behaviour and found it significantly more useful than non-psychiatric care alternatives. The average time to seek psychiatric care, irrespective of the pathway to care, was less than one month. The recommendation of the family and the social support unit and perceiving that the symptoms were due to a mental illness were the key factors in determining help-seeking behaviour. The average expense on alternative care was zero. There was no significant difference on the impact to employment among those that chose psychiatry care initially from those that did not. Our findings suggest that mentally ill patients presenting to a tertiary care hospital in Colombo, are likely to seek psychiatric care early. This is probably due to better recognition and knowledge regarding available treatment.
Full Text Available Background: Children with chronic physical illnesses frequently have psychiatric comorbidities, which often go un-noticed and may lead to more resource utilization and morbidity. Pediatric liaison services can be effectively used to bridge this gap. Literature on pediatric liaison services is sparse. Aims: To study the referral patterns, reasons for referrals, psychiatric diagnoses and interventions in children and adolescents referred to psychiatry department in a tertiary care hospital. Materials and Methods: A retrospective chart analysis of all children and adolescents below 19 years of age, referred to psychiatry department from 2010 to 2015, was done. Data was collected and statistical analysis was done. Results: Two hundred and nine subjects were included in the study. Mean age of sample was 12.15 (±4.20 years, with about 66.02% being males. About 54.06% of the participants were referred from pediatricians. Almost three fourth (72.25% of children had no diagnosable physical illness. Intellectual disability (19.62% was the most common psychiatric diagnosis, followed by depressive disorders (14.35%, and dissociative disorders (12.92%. Conclusions: In our study, majority of the referrals were the adolescent males from pediatric department. Intellectual disability, depressive disorder, and stress-related disorders were the common diagnoses. The fact that three-fourth of the referred children had no physical illness implies lack of awareness, stigma toward mental illness, and pathway of care.
Anckarsäter, Henrik; Radovic, Susanna; Svennerlind, Christer; Höglund, Pontus; Radovic, Filip
The assumption that mental disorder is a cause of crime is the foundation of forensic psychiatry, but conceptual, epistemological, and empirical analyses show that neither mental nor crime, or the causation implied, are clear-cut concepts. "Mental" denotes heterogeneous aspects of a person such as inner experiences, cognitive abilities, and behaviour patterns described in a non-physical vocabulary. In psychology and psychiatry, mental describes law-bound, caused aspects of human functioning that are predictable and generalizable. Problems defined as mental disorders are end-points of dimensional inter-individual differences rather than natural categories. Deficits in cognitive faculties, such as attention, verbal understanding, impulse control, and reality assessment, may be susceptibility factors that relate to behaviours (such as crimes) by increasing the probability (risk) for a negative behaviour or constitute causes in the sense of INUS conditions (Insufficient but Non-redundant parts of Unnecessary but Sufficient conditions). Attributing causes to complex behaviours such as crimes is not an unbiased process, and mental disorders will attract disproportionate attention when it comes to explanations of behaviours that we wish to distance ourselves from. Only by rigorous interpretation of what psychiatry actually can inform us about, using empirical analyses of quantified aggressive antisocial behaviours and their possible explanatory factors, can we gain a clearer notion of the relationship between mental disorder and crime.
Gijswijt-Hofstra, Marijke; Oosterhuis, Harry; Vijselaar, Joost; Freeman, Hugh
The history of mental health care in the twentieth century is a relatively uncharted territory. Exemplifying a new emphasis on the comparative approach, this volume offers overviews of various national psychiatric cultures and explores new research subjects. By confronting Dutch psychiatry with
Lund, Helle Nystrup; Bertelsen, Lars Rye; Bonde, Lars Ole
This article reports on the ongoing project development and research study called “A New Sound and Music Milieu at Aalborg University Hospital”. Based on a number of pilot studies in AUH Psychiatry, investigating how special playlists and sound equipment (“sound pillows” and portable players) can...... in music medicine and music therapy. A special design of software and hardware - ”The Music Star” and directional line array speakers for the patient room – has been developed and recently implemented on two wards at AUH Psychiatry. The aim of the project is to empower patients to choose music suited...
Giasuddin, Noor Ahmed; Levav, Itzhak; Gal, Gilad
The shortage of specialized human resources in mental health in Bangladesh requires active recruitment of psychiatric residents. In addition, the involvement of positively inclined health personnel, for example, medical doctors, emerges as an immediate priority. To explore stigma among medical students toward persons with mental disorders (PMDs) and their attitudes toward psychiatry. A cross-sectional study was conducted at Faridpur Medical College in Bangladesh before (First year) and following psychiatric rotation (Fifth year). Students (N = 200) filled anonymous questionnaires measuring stigma toward PMDs and attitudes to psychiatry. Upper medical school year (p = .028), older age (p = .005), mother's lower academic level (p = .043), upper and lower socioeconomic level affiliation (p = .008) and self-consultation for mental or neurological complaints (p = .032) were associated with increased stigma toward PMDs. More favorable attitudes toward psychiatry were found in upper medical school year (p = .073) and were significantly associated with female gender (p = .018) and middle socioeconomic level affiliation (p = .013). The relative improvement in attitudes toward psychiatry in the upper medical school year is overshadowed by the increased stigma toward PMDs. Specific anti-stigma program in the curriculum and strategies to improve the attitudes are required. © The Author(s) 2014.
Jonker, E.J.; Goossens, P.J.J.; Steenhuis, I.H.; Oud, N.E.
Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and
Jonker, E.J.; Goossens, P.J.J.; Steenhuis, I.H.M.; Oud, N.E.
Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and
Failde, Inmaculada; Salazar, Alejandro; Elorza, Julian; Casais, Leonardo; Pérez, Víctor; Martínez, Luis Caballero; Gilaberte, Inmaculada
The aim of this study is to investigate the attitudes towards mental illness and psychiatry among fifth year Spanish medical students. The study included 171 students from three medical schools located in different areas of Spain: Cádiz; UCA (n = 113), Madrid; San Pablo-CEU (n = 22), and Barcelona; UAB (n = 36). They responded, prior to their undergraduate medical course in psychiatry, to the AMI questionnaire to measure the attitudes towards mental illness and to Balon's adapted questionnaire to investigate their view towards psychiatry. The students (93.4 %) had a positive attitude towards mental illness (AMI). Attitudes towards psychiatry were fairly positive with a few negative views, specifically regarding the role of psychiatrists (items 11 and 13) and the prestige of the specialty (item 16). There were some statistically significant differences between the three medical schools in the perception of psychiatry as a medical discipline. A better attitude towards mental illness was associated with a better view of the overall merits of psychiatry. Findings suggest that Spanish medical students do not have a negative attitude towards mental illness and they have a good perception of psychiatry, although there are still some misconceptions about this specialty. These student's attitudes could favor an appropriate management of patients suffering from mental illness.
Torous, John; Staples, Patrick; Onnela, Jukka-Pekka
Smartphones are now ubiquitous and can be harnessed to offer psychiatry a wealth of real-time data regarding patient behavior, self-reported symptoms, and even physiology. The data collected from smartphones meet the three criteria of big data: velocity, volume, and variety. Although these data have tremendous potential, transforming them into clinically valid and useful information requires using new tools and methods as a part of assessment in psychiatry. In this paper, we introduce and explore numerous analytical methods and tools from the computational and statistical sciences that appear readily applicable to psychiatric data collected using smartphones. By matching smartphone data with appropriate statistical methods, psychiatry can better realize the potential of mobile mental health and empower both patients and providers with novel clinical tools.
As a populated developing country, China may have needs and perspectives similar to some countries from which she could learn, but there are always some differences and China has to create her own way to fit the service. In summary, short of budget, short of professionals and low recognition are the three main obstacles for mental health. The family resource and the traditional Chinese medicine may play valuable role in mental health. It is important to use the rich World heritage and experience of psychiatry to make the right choice for China and provide scientific, equitable and efficient mental health service for one fifth of world population.
Fraguas, D; Díaz-Caneja, C M; State, M W; O'Donovan, M C; Gur, R E; Arango, C
Personalized or precision medicine is predicated on the assumption that the average response to treatment is not necessarily representative of the response of each individual. A commitment to personalized medicine demands an effort to bring evidence-based medicine and personalized medicine closer together. The use of relatively homogeneous groups, defined using a priori criteria, may constitute a promising initial step for developing more accurate risk-prediction models with which to advance the development of personalized evidence-based medicine approaches to heterogeneous syndromes such as schizophrenia. However, this can lead to a paradoxical situation in the field of psychiatry. Since there has been a tendency to loosely define psychiatric disorders as ones without a known aetiology, the discovery of an aetiology for psychiatric syndromes (e.g. 22q11.2 deletion syndrome in some cases of schizophrenia), while offering a path toward more precise treatments, may also lead to their reclassification away from psychiatry. We contend that psychiatric disorders with a known aetiology should not be removed from the field of psychiatry. This knowledge should be used instead to guide treatment, inasmuch as psychotherapies, pharmacotherapies and other treatments can all be valid approaches to mental disorders. The translation of the personalized clinical approach inherent to psychiatry into evidence-based precision medicine can lead to the development of novel treatment options for mental disorders and improve outcomes.
Bär, Karl-Jürgen; Markser, Valentin Z
The prevalence of psychiatric conditions among elite athletes is still under debate. More and more evidence has accumulated that high-performance athletes are not protected from mental disorders as previously thought. The authors discuss the issue of the sport specificity of selected mental diseases in elite athletes. Specific aspects of eating disorders, exercise addiction, chronic traumatic encephalopathy and mood disorders in the context of overtraining syndrome are examined. In particular, the interrelationship between life and work characteristics unique to elite athletes and the development of mental disorders are reviewed. Differences of clinical presentation and some therapeutic consequences are discussed. The authors suggest that the physical and mental strains endured by elite athletes might influence the onset and severity of their psychiatric disorder. Beside the existing research strategies dealing with the amount of exercise, its intensity and lack of recreation experienced by athletes, further research on psycho-social factors is needed to better understand the sport-specific aetiology of mental disorders in high-performance athletes.
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Appelbaum, Paul S
In Atkins v. Virginia the U.S. Supreme Court declared execution of persons with mental retardation to constitute cruel and unusual punishment, and thus to be unconstitutional under the Eighth Amendment. However, the Court left all considerations regarding how to implement the decision explicitly to the states. Since Atkins was decided in 2002, legislatures, courts, and mental health experts have struggled with its implementation, highlighting the complexities that can arise when the courts base legal rules on clinical findings. This column reviews the Atkins case and considers the challenges associated with a clinical determination that can have life-or-death consequences for capital defendants.
Cheetham, R W; Rzadkowolski, A
The problems encountered by Western-trained psychiatrists in crosscultural research in the multicultural South African population are discussed. In particular, attention is paid to the differing concepts of mental health and mental illness in preliterate societies and to problems of mutual understanding. The several dichotomies in the Western concepts, as they apply to rural African communities, are reviewed in brief. It is postulated that, because of its holistic approach, the most acceptable concept is the general systems theory, which is pertinent to the culture. The theory is characterized by the absence of a mind-body dichotomy, and includes physical, psychological, 'religious' and social aspects.
Shatkin, Jess P; Diamond, Ursula
The authors describe an integrated area of study for undergraduate college students that targets an increase in knowledge of mental health issues in children, adolescents, and emerging adults; encourages mental health service utilization on college campuses; and exposes young minds to the possibilities of working with children and adolescents in the mental health field. An overview of the program is provided, including the resources required to oversee and manage the program, student requirements, a description of the role that clinicians and researchers play as the program faculty, and an explanation of the tuition model. The program currently includes 40 courses with an annual enrollment of over 3000 students, resulting in departmental revenues that currently exceed $11 million per year. Student evaluations of the courses are very positive, and in a program survey students reported that their participation in the program had a positive impact on their life (84.2%) and impacted their career choice (60.2%). The benefits of the program include a valuable outreach to college students regarding the importance of seeking help for mental health issues, a positive influence on early career decision-making, opportunities for clinical and research educators to develop their scholarly areas of interest, and a significant source of departmental discretionary revenues.
Paula Peixoto Messias
Full Text Available The present study reports the experience of an academic course during the practice of Nursing Psychiatric Nursing Course and Mental Health Center of Psychosocial Attention (CAPS in southern Bahia. The study is descriptive and participatory method. During practice, we carried out activities aimed at promoting the role of those involved. Such activities were craft workshops, beauty shop, video workshops, conversing, wheels of music, talks about coping with difficult situations and exercise a sense of positivity. Communication and listening therapy has permeated the whole process and the end of the period there was a home visit to the user and his family. I believe that with the activities carried out contributed to the improvement of health and the process of social reinsertion of CAPS. I hope with the information in this report, we enrich the acquis concerning the development of practices of care in mental health within the CAPS and encourage care practices that address the psychosocial rehabilitation of subjects.
Paula Peixoto Messias
Full Text Available The present study reports the experience of an academic course during the practice of Nursing Psychiatric Nursing Course and Mental Health Center of Psychosocial Attention (CAPS in southern Bahia. The study is descriptive and participatory method. During practice, we carried out activities aimed at promoting the role of those involved. Such activities were craft workshops, beauty shop, video workshops, conversing, wheels of music, talks about coping with difficult situations and exercise a sense of positivity. Communication and listening therapy has permeated the whole the user and his family. I believe that with the activities carried out contributed to the improvement of health and the process of social reinsertion of CAPS. I hope with the information in this report, we enrich the acquis concerning the development of practices of care in mental health within the CAPS and encourage care practices that address the psychosocial rehabilitation of subjects.
Sadoff, Robert L; Dattilio, Frank M
The field of forensic mental health has grown exponentially in the past decades to include forensic psychiatrists and psychologists serving as the primary experts to the court systems. However, many colleagues have chosen to pursue the avenue of serving as forensic experts without obtaining formal training and experience. This article discusses the importance of formal education, training and experience for psychiatrists and psychologists working in forensic settings and the ethical implications that befall those who fail to obtain such credentials. Specific aspects of training and supervised experience are discussed in detail. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Introduction. This paper deals with medicolegal aspects of the hospital treatment of patients suffering from severe mental disorders and who are prone to violent behavior, dangerous to self and others. Violent acts in this study were defined as deliberate and nonconsensual acts of actual, attempted or threatened harm to a person or persons, and classified into categories of any type of violence, physical violence and nonphysical violence, which is in accordance with approaches used in other risk assessment researches. Outline of Cases. The authors present four cases of mentally ill inpatients whose violent behavior toward self or other persons resulted in self-destruction and physical aggression against other persons. The presented cases involved: 1 selfinjury in a patient with acute organic mental disorder after jumping through a hospital window, 2 suicide by drowning of a patient with acute mental disorder after escaping from intensive care unit, 3 suicide in a depressive patient after escaping from a low-security psychiatry unit, 4 physical violence against body and life of other persons in a patient with chronic mental disorder. Conclusion. The presented cases are considered to be rare in clinical practice and risk of violent behavior and the consequent danger of mentally ill inpatients may be efficiently predicted and prevented with appropriate hospital management based on 1 repeated escalation of violent behavior and 2 protection of the patient and others. Hence, if the physician, in order to prevent harmful consequences, does not apply all the necessary measures, including appropriate diagnostic and therapeutic procedures, as well as treatment in an adequate setting, such act is against the Criminal Law of the Republic of Serbia which sanctions physician's negligence. Also, according to the Law on Obligations of the Republic of Serbia this presents a legal ground for damage claim and the requirement of liability for nonmaterial damage
Jovanović, Aleksandar; Jasović-Gasić, Miroslava; Lecić-Tosevski, Dusica
This paper deals with medicolegal aspects of the hospital treatment of patients suffering from severe mental disorders and who are prone to violent behaviour, dangerous to self and others. Violent acts in this study were defined as deliberate and nonconsensual acts of actual, attempted or threatened harm to a person or persons, and classified into categories of any type of violence, physical violence and non-physical violence, which is in accordance with approaches used in other risk assessment researches, The authors present four cases of mentally ill inpatients whose violent behaviour toward self or other persons resulted in self-destruction and physical aggression against other persons. The presented cases involved: 1) self-injury in a patient with acute organic mental disorder after jumping through a hospital window, 2) suicide by drowning of a patient with acute mental disorder after escaping from intensive care unit, 3) suicide in a depressive patient after escaping from a low-security psychiatry unit, 4) physical violence against body and life of other persons in a patient with chronic mental disorder. The presented cases are considered to be rare in clinical practice and risk of violent behaviour and the consequent danger of mentally ill inpatients may be efficiently predicted and prevented with appropriate hospital management based on 1) repeated escalation of violent behaviour and 2) protection of the patient and others. Hence, if the physician in order to prevent harmful consequences, does not apply all the necessary measures, including appropriate diagnostic and therapeutic procedures, as well as treatment in an adequate setting, such act is against the Criminal Law of the Republic of Serbia which sanctions physician's negligence. Also, according to the Law on Obligations of the Republic of Serbia this presents a legal ground for damage claim and the requirement of liability for nonmaterial damage within a civil procedure.
Evans, Bonnie; Rahman, Shahina; Jones, Edgar
When opened as a post-graduate teaching and research hospital in 1923, the Maudsley made virtually no provision for the treatment of children. Yet its children's department saw sustained growth during the interwar period. This expansion is explored in relation to novel behaviourist hypotheses and the forging of formal links with local government and charitable bodies. The recruitment of psychologists, educators and specialist social workers fostered a multidisciplinary approach through case conferences. This development would structure the theoretical origins of child psychiatry, in particular influencing the role and interpretation of psychoanalytic theory within it. The theoretical orientation of child psychiatry and the practical treatment of children represented an area of dynamic change and innovation at a time when adult psychiatry struggled to discover effective treatments or achieve breakthroughs in causal understanding.
Full Text Available Background: Research in consultation-liaison psychiatry is important clinically because of high incidence of coexistence of psychiatric and medical disorders in patients attending psychiatry and general healthcare systems. In contrast to west, research about liaison psychiatry in India has been minimal. Thus a study about understanding clinical and sociodemographic profile patterns of inpatient psychiatry referrals was undertaken to enhance our knowledge of this field. Objective: To describe the clinical and socio-demographic profile of inpatient psychiatry referrals in a multispecialty teaching hospital. Materials and methods: The study population comprised all consecutive inpatients who were referred for psychiatric consultation from other departments of a multispecialty teaching hospital over a period of six months. In a semi-structured proforma, socio-demographic profile of patients, referring departments, reason of referral, psychiatric diagnosis, and physical illness diagnosis were recorded and analysed using descriptive statistics. Results: A total of 356 patients were referred for psychiatric consultation, 55.9% were males and 44.1% were females. Majority of patients belonged to 20-40 years age group (37.9%. Department of medicine made majority of the psychiatric referrals (50.6%; commonest reason for referral was abnormal behaviour (30.9%, followed by suicidal/self-harm acts (17.9%, and past psychiatric history (10.9%. The most commonly diagnosed psychiatric disorders were delirium (17.9%, followed by organic psychosis/mood disorder (14.8%, substance related disorder (12.9%, and depression (12.9%. Conclusion: There is an urgent need for raising awareness among all physicians and medical staff regarding early recognition and prompt referral for psychiatric problems. Also further research is warranted, especially longitudinal studies with outcome variables and various clinical processes related to consultation-liaison psychiatry.
Tariq Mahmood Hassan
Conclusions: At the level of residency training, psychiatrists are reporting barriers to disclosure and help-seeking if they were to experience mental illness. A majority of psychiatry residents would only disclose to informal supports. Those with a history of mental illness would prefer formal treatment services over informal services.
Lyons, Zaza; Hood, Sean
The stigmatisation of mental illness in Australian and other Western societies is now well documented. This article presents a description of the "stigmatisation" problem associated with mental illness, and discusses the impact that this problem has had on the demand for Psychiatry as a career. The approach taken at UWA to address the…
Rosso Buckton, Amanda
Conversations between anthropologists and psychiatrists have led to new theoretical trajectories, research agendas and clinical practices as social scientists and medical practitioners forged new understandings about the interaction of culture, personhood and illness. However, the demands of global mental health, coupled with health service provision requirements, mean that mental health interventions set up with the best intentions can fail to take into account the knowledge and expertise that social sciences can contribute to a programme's success. In this paper, I reflect on conversations between an anthropologist and mental health professionals in direct reference to data analysis of an AusAID mental health capacity-building programme undertaken in the Pacific region. Social and cultural perspectives embedded within programmes can provide richer, more contextualised interventions. In drawing on the combined expertise of anthropology and psychiatry, new taken-for-granted reference points embedding cultural approaches form the basis for delivery of global mental health programmes. These perspectives include: Locating mental health programmes within development critiques. Situating the subjects of development within contextualised settings, acknowledging and respecting local knowledge, understandings and practices. A focus on interdisciplinarity as the basis for future practice in global mental health projects. © The Royal Australian and New Zealand College of Psychiatrists 2015.
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Gras, Laura M.; Swart, Marte; Slooff, Cees J.; van Weeghel, Jaap; Knegtering, Henderikus; Castelein, Stynke
This study compares stigmatizing attitudes of different healthcare professionals towards psychiatry and patients with mental health problems. The Mental Illness Clinicians Attitude (MICA) questionnaire is used to assess stigmatizing attitudes in three groups: general practitioners (GPs, n = 55),
Gras, L.M.; Swart, M.; Slooff, C.; van Weeghel, J.; Knegtering, H.; Castelein, S.
Purpose This study compares stigmatizing attitudes of different healthcare professionals towards psychiatry and patients with mental health problems. Methods The Mental Illness Clinicians Attitude (MICA) questionnaire is used to assess stigmatizing attitudes in three groups: general practitioners
Full Text Available Abstract Background Yuli Veterans Hospital (YVH has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Methods Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. Results There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. Discussion There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. Conclusion This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition
Yrondi, A; Petiot, D; Arbus, C; Schmitt, L
In times of fiscal restraint for health structures, apart from the clinical input, it seems important to discuss the economic impact of liaison psychiatry. There are only a few studies on the economic added value provided by a liaison psychiatry team. In addition to this, only a few psychiatric pathologies are coded as they should be, hence we make the assumption of an additional development provided by a specialised team. Over a short period of 4months, in three departments of the Toulouse University Hospital Centre, the added value to the general pricing system of liaison psychiatry was studied. The population was represented by all the consecutive requests for consultations from patients over 18years old, men and women, hospitalised at that time. These three departments frequently request consultations with the psychiatry liaison team. They set a diagnostic, and if this is associated with a higher Homogeneous Group of Patients (HGP), it provides added value. Fifty-two patients benefited from a psychiatric consultation over 4months. The results highlight a development of € 8630.43 for the traumatology department, € 3325.03 for the internal medicine department, and € 513.61 for the haematology department over the study period. The overall development over this period was € 12,469.07. To our knowledge, this approach is one of the first in France to highlight an economic impact of the intervention of liaison psychiatry in the claiming departments. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.
Markser, Valentin Z
Professional athletes are subject to massive somatic, social, and mental stress. Despite great public interest for athletic achievements, the emotional strains thereof are very poorly investigated and discussed. The main reason for this is the widespread assumption that only emotionally very strong athletes are able to compete at the highly professional level and therefore mental disorders do not exist in professional sports. But available research data about the prevalence of mental disorders in this area suggest that this hypothesis must be revised. With respect to depression and the overtraining syndrome, attempts have been made to demonstrate the difficulties with etiology, diagnostics, and treatment for sports psychiatry and psychotherapy. Scientifically, sport psychiatry and psychotherapy can be defined as a discipline, whose focus is the investigation, treatment, and prevention of the extreme and sports-specific emotional strains and disorders. In addition to sport psychology, which focuses mainly on performance enhancement, mental stress, and disorders can hereby be recognized, disorders be treated and the athletic performance sustained. With the foundation of the Task Force for Sports Psychiatry and Psychotherapy at the German Association for Psychiatry and Psychotherapy, scientific research, further education, prevention, and treatment for mental disorders in professional sports will be improved.
Burchard, Falk; Diebenbusch, Teresa
Crisis Intervention in a Health Care Hospital for Child and Adolescent Psychiatry In the past years the pressure in society and psychological problems in Germany have risen up. This can especially be verified by the great influx of utilization of child and adolescent psychiatric clinics through the admission of crisis. In this connection social disadvantaged female adolescents with a low socio-economic status, students of the secondary school, children in care and the ones whose parents have to manage their upbringing alone are preferentially affected. These developments require a fast adaptation of the supply system to the transformed demands, in particular in terms of outpatient treatment, as well as a closely and structured cooperation between the youth welfare and child and adolescent psychiatric clinics in their function as systems of help. In the script statistical data and adaptive approaches of a supply department of child and adolescent psychiatry are presented.
Estrade Espinosa, M
At the ISSSTE, a community psychiatry program was created and is being developed in two areas: the population of beneficiaries who attend two clinics and groups of employees of those same clinics at their respective places of work. The main purpose is to carry out prevention in mental health. In this report only the work in the first session of eight employee operative groups is reported. The method, the difficulties and the characteristics of the groupings are explained. Some theoretical aspects are shown. Results showed: 1. Little correspondence between the internal reality of the beneficiaries. 2. Difficulties in communication which produce differences of criteria with the clinic. 3. Difficulties in the internal distribution of power. 4. Unnecessary expenditure of energy. 5. Suggestions to solve the problems handled in the group. 6. Resistance against responsibilities.
Full Text Available ... Is Psychiatry? Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, ... medical laboratory and psychological tests which, combined with discussions with patients, help provide a picture of a ...
Dallal y Castillo, E
In 1972, prepaid medical care for government employees provided by their social security institute, ISSSTE, was reorganized. A division of planning and technical standards was established, within which a Department of Psychiatry was included. Psychiatric care was restructured at three levels: psychiatric hospital, psychiatric OPD at clinic and hospital level and a pilot program in community psychiatry. A three-year psychiatric residency program was established, in addition to participation in other postgraduate, in-service training and monographic courses. Systematic research was started, as well as a publications program, working relationship with other institutions and societies were enhanced. A descriptive example is Child Psychiatry. Most frequent diagnoses are reviewed, and development of services is followed in relation to pediatric departments.
The Global Mental Health (GMH) movement has raised questions of the translatability of psychiatric concepts and the challenges of community engagement. In Tonga, the local psychiatrist Dr Puloka successfully established a publicly accessible psychiatry that has improved admission rates for serious mental illnesses and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors, and patients since 1998, this article offers an ethnographic contextualization of the development and reception of Puloka's three key interventions during the 1990s: (a) collaboration with traditional healers; (b) translation of psychiatric diagnoses into local cultural concepts; and (c) encouraging freedom of movement and legal appeal to involuntary admission. Dr Puloka's use of medical anthropological and transcultural psychiatry research informed a community-engaged brokerage between the implications of psychiatric nosologies and local needs that can address some of the challenges of the Global Mental Health movement.
Full Text Available Consultation psychiatry plays an important role in developmental medicine. The concept of consultation psychiatry in general medicine includes diagnosis, support and assistance in solving psychiatric, psychological or psychosocial problems of the patient. Child psychopathology, which results from the interaction of biological and psychosocial factors, may be manifested by categorical psychiatric disorders, which may coexist with somatic diseases, and may also be a secondary reaction in response to other illnesses. The disorganisation of behaviour in patients at the developmental period may also result from the response to the disease or hospitalisation. On the other hand, mental disorders can significantly hamper the treatment of somatic diseases. The objective of this study was to determine the spectrum of psychopathology and to analyse the reasons for psychiatric consultation on the multidisciplinary wards of the University Children’s Teaching Hospital. During 9 years, 741 psychiatric consultations were carried out. The results obtained indicate that anxiety, stress-related and somatoform disorders were the most common category of mental disorders (30.5% observed in consulted girls (30.0% and boys (31.5%. Emotional and conduct disorders were found in 22.8% of the consulted children. There was a significant difference (p = 0.02 between boys (31% and girls (18.3%. Eating disorders were identified in 17% of the examined group. This category, which includes anorexia nervosa, atypical anorexia and bulimia, was significantly more frequently (p < 0.001 observed in girls (23.9% than boys (3.6%. A refusal to eat (24.4% was, next to deliberate intake of pharmacological agents (21.7%, the most common reason for psychiatric consultations in the examined group.
Evans, Bonnie; Jones, Edgar
The use of organ extracts to treat psychiatric disorder in the interwar period is an episode in the history of psychiatry which has largely been forgotten. An analysis of case-notes from The Maudsley Hospital from the period 1923–1938 shows that the prescription of extracts taken from animal testes, ovaries, thyroids, and other organs was widespread within this London Hospital. This article explores the way in which Maudsley doctors justified these treatments by tying together psychological theories of the unconscious with experimental data drawn from laboratory studies of human organs. It explores the logic behind these treatments and examines beliefs about their efficacy. The connection between this historical episode and current research in endocrinology and psychology is explored. © 2012 Wiley Periodicals, Inc. PMID:22644956
Perlman Christopher M
Full Text Available Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs using the Resident Assessment Instrument - Mental Health (RAI-MH, a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI and Cognitive Performance Scale (CPS, were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance
Alves de Moura, Pedro; Serranheira, Florentino; Sacadura-Leite, Ema
Medical Doctors (MD), although at the front line of response to patients and their families, are seldom study subjects for occupational psychosocial risks and work related stress. Assess psychiatry and anaesthesiology residents in a central and university Portuguese Hospital for the presence of psychosocial risks at work. We used the Copenhagen Psychosocial Questionnaire version 2 (COPSOQ), which was applied face-to-face in two group settings, in April 2014. It comprised a sample of 19 Psychiatry residents and 20 Anaesthesiology residents. Statistical analysis was done by correlational analysis using Pearson's coefficient (r) and the t-student test for categorical variables. An occupational health risk (red flag) was found for residents in the "Cognitive demands" dimension of COPSOQ and a health risk (red flag) in the "Work influence" dimension for the female Anaesthesiology sub-group. A possible risk (yellow flag) was found in 17 dimensions. Results also showed moderate correlations between various COPSOQ dimensions and the emergency department workload, workload, home study, number of children, year of training and the medical specialty variables. These results suggest that residents have a health risk which derives from the cognitive demands of their work and that it increases with the workload. This implicates the need for occupational health measures to be taken to manage and reduce these psychological risks.
M F Tunde-Ayinmode
Full Text Available Objective . This study aimed to identify the socio-demographic characteristics, pattern of psychiatric disorders and management of children and adolescents before the setting up of a dedicated child and adolescent unit at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Method . A retrospective study, carried out at the Department of Behavioural Sciences of the hospital. Results . The age range of the 94 children seen was 7 - 19 years, with a mean of 16.38 years (standard deviation 2.49; 82% were aged 14 - 19 years and 17% 7 - 13 years, while only 1 child was under 7 years old. The majority of the children lived with their parents in monogamous families with 5 or more children. The majority of the parents were educated and gainfully employed. The major diagnoses were schizophrenia (50%, delirium (15% and seizure disorders (9%. Of the patients 64% were managed as outpatients and 36% as inpatients. Drug therapy was involved in the majority of cases, and the most frequently prescribed medication was haloperidol, atypical antipsychotics such as risperidone being used in only 8% of cases. Most of the patients were referred from the primary care- associated departments of the hospital, i.e. the general outpatient department (40% and the internal medicine and paediatrics departments (29%. Referrals from welfare, judicial and educational institutions were uncommon (3%. Conclusion . The pattern of patient presentation and management had not changed to any great extent over the past two decades. The introduction of a child and adolescent psychiatric unit is expected to improve consultation/liaison psychiatry and also child psychiatric service delivery and research. Understanding of the prevalence and pattern of presentation of mental disorders and their management is also expected to help improve the strategic planning and organisation of the new clinic.
Full Text Available ... clinics, general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, ... of Child and Adolescent Psychiatry American Association of Community Psychiatrists American Association for Geriatric Psychiatry Academy of ...
Full Text Available Integrating spirituality into mental health care, psychiatry and psychotherapy is still controversial, albeit a growing body of evidence is showing beneficial effects and a real need for such integration. In this review, past and recent research as well as evidence from the integrative concept of a Swiss clinic is summarized. Religious coping is highly prevalent among patients with psychiatric disorders. Surveys indicate that 70–80% use religious or spiritual beliefs and activities to cope with daily difficulties and frustrations. Religion may help patients to enhance emotional adjustment and to maintain hope, purpose and meaning. Patients emphasize that serving a purpose beyond one’s self can make it possible to live with what might otherwise be unbearable. Programs successfully incorporating spirituality into clinical practice are described and discussed. Studies indicate that the outcome of psychotherapy in religious patients can be enhanced by integrating religious elements into the therapy protocol and that this can be successfully done by religious and non-religious therapists alike.
Full Text Available Survivor-controlled research in the field of mental health can be perceived as the most extended development of participatory research. This is not only because it does away with the role of research subjects, but because the experiential knowledge (as opposed to clinical acquires a central role throughout the whole research process—from the design to the analysis and the interpretation of outcomes stages. The first part of this article provides some background information about the context and development of user/survivor-controlled research in the UK. In the second part, the discussion focuses on the first two German studies which apply this research methodology in the field of psychiatry. Both studies are used as examples of the approach, which favors closeness to the subject as opposed to "scientific distance." The overall objective of this paper is to outline the general achievements and challenges of survivor-controlled research. Arguing for the value of this research approach I hope to demonstrate the ways in which it raises fundamental issues related to conventional knowledge production and challenges the nature of what counts as psychiatric evidence. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs120187
Mortlock, Anna-Marie; Puzzo, Ignazio; Taylor, Sophie; Kumari, Veena; Young, Susan; Sengupta, Samrat; Das, Mrigendra
The majority of research studies on medical student attitudes toward psychiatry focus on influencing factors and the medical school experience. This study evaluates the effectiveness of a one-day visit to a high secure forensic psychiatric unit on medical students' attitudes towards psychiatry and also assesses career intentions and the factors influencing these. Change in attitudes and career intention were measured by administering a questionnaire, which included the 30-item Attitudes Toward Psychiatry (ATP-30) survey, at the start (time 1) and end (time 2) of the one-day visit. Qualitative data on factors influencing career choice was also gathered. Evaluation of 284 responses revealed a significant increase in positive attitude towards psychiatry from time 1 to time 2 in the sample as a whole. The most influential factor on consideration of psychiatry as a career across all groups was the medical school clinical placement. For those that tended away from choosing psychiatry as a career, patient prognosis was important. Poor recruitment in psychiatry in the UK is already established which will doubtless be compounded by controversies surrounding the proposed new junior doctors' contract. Now more than ever, the need to inspire and motivate those at medical school encountering psychiatry is crucial. Our findings add to the body of evidence that the medical school clinical attachment is fundamental in shaping attitudes. However, these results also show that a well-planned visit to a specialised psychiatric unit outside of traditional placements can have a significant impact on students' attitudes toward psychiatry and mental illness in general. There is limited literature in the UK on enrichment activities within the psychiatry medical school curriculum. We propose that developing opportunities for enrichment activities within psychiatry could increase the scope of how we engage students in this fascinating field of medicine.
Rakesh Kumar Chadda
Full Text Available Preventive psychiatry is one of the most ignored subdiscipline of psychiatry, which has got important role to play in the contemporary psychiatry. Mental disorders are very common with lifetime prevalence of about 25%, and tend to be chronic. Due to the stigma associated with mental disorders, lack of awareness, and also lack of adequate mental health resources, nearly 60%–80% of the persons suffering from mental disorders do not access mental health care services. Mental and substance use disorders have been identified as one of the major contributors to the disease-related burden and disability-adjusted life years. In this background, preventive psychiatry has an important role to play in public health sector. Since etiology of most of the mental disorders is not known, it is not possible to follow here the standard model of primary, secondary, and tertiary prevention of public health. A concept of universal, selective, and indicated prevention has been proposed in primary prevention. Preventive approaches in psychiatry focus on evidence-based risk and protective factors, promoting quality of life, reducing stressors, and improving resilience. Such interventions, when planned targeting at specific mental disorders, have a potential to prevent mental disorders. Thus, preventive psychiatry has a crucial role to play in mental health, considering the high prevalence of mental disorders, the associated disability and burden, and a great drain on human resources.
Park, Jong-Il; Oh, Keun-Young; Chung, Young-Chul
This paper reports the current status of Korean psychiatry. In 2011, there were 3005 psychiatrists and 75,000 psychiatric beds. There were 84 psychiatric residency-training hospitals in 2011, which produced about 150 psychiatry board-certified doctors annually. As for academic activity, there is the Korean Neuropsychiatric Association, a main association for neuropsychiatry, and 21 other research societies. Psychiatric residency is a 4-year training program, with different objectives for each grade. The Korean health system accepts National Health Insurance. When severely mentally ill patients register as having a mental disorder, they pay only 10% of their total medical costs. Private clinics usually see patients with less severe conditions such as anxiety, mood and eating disorders; general and university hospitals and special mental hospitals often deal with severe conditions such as schizophrenia and bipolar disorder. One great concern is an increasing trend to depend upon pharmacotherapy and neglect the role of psychotherapy. Additionally, conflicts among medical sectors are becoming fierce as other doctors request abolition of the current law that restricts them from prescribing anti-depressants for more than 60 days. The average hospitalization period of all mental care institutions was 166 days in 2010, substantially longer compared with developed countries. To win the heart of the general public, cutting edge research to improve the quality of treatment for mental diseases, reformation of psychiatric residency training programs, public campaigns to increase awareness of mental health value, and timely reflection on policy decisions should be pursued persistently. Copyright © 2012 Elsevier B.V. All rights reserved.
Peloso, Paolo Francesco; D'Alema, Marco; Fioritti, Angelo
Mental health (MH) care for Italian prisoners and offenders with mental illness is a paradoxical issue. Theory and practice remained unchanged throughout the 20th century, despite radical changes to general psychiatric care. Until recently, Italy had one of the most advanced National Health Service (NHS)-run community psychiatry care systems and a totally obsolete system of forensic psychiatry managed by criminal justice institutions. Not until 2008, after substantial pressure by public opinion and International Human Rights bodies, did the government approve a major reform transferring health care in prisons and forensic hospitals to the NHS. Forensic hospitals were to be progressively closed, and specialized small-scale facilities were to be developed for discharged offenders with mental illness, along with diversion schemes to ordinary community care. Despite some important achievements, three major problem areas remain: this reform happened without changes to the Criminal Code; regions differ in organization and resources for ordinary psychiatric services; and legal/criminological expertise among NHS MH professionals is limited.
Connor, L H
Rural Balinese conceive of madness as a phenomenon which gives men intimations of another reality transcending the everyday world, and which reveals the possibility of more direct communication with the divine. European views of madness became gradually secularized over a period of several centuries, and were finally absorbed by the predominantly medical models of modern psychiatry. In Bali, this transformation is occurring within a much shorter time span, under different socioeconomic conditions. In this paper, I examine the ideas which traditional healers in Bali and their clients invoke about the influence of the supernatural in worldly affairs. I then contrast traditional classifications and treatments of madness with the version of Western psychiatry currently practised in mental hospitals and out-patient clinics on the island. This section of the paper is based on the author's field study of mental health services in Bali, incorporating a survey of mental hospital inpatients and their families. I conclude with a discussion of the genesis, future development and possible effects of the increase in psychiatric facilities on the island.
Waja T; Ebrahim J; Yohannis Z; Bedaso A
Tsegereda Waja,1 Jemal Ebrahim,2 Zegeye Yohannis,1 Asres Bedaso2 1Department of Psychiatry, Amanuel Mental Specialized Hospital, Addis Ababa, 2School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia Introduction: Alcohol use disorders represent one of the leading causes of preventable death, illness, and injury in many societies throughout the world. Heavy alcohol consumption has multiple negative consequences for people with ep...
Doupnik, Stephanie K; Lawlor, John; Zima, Bonnie T; Coker, Tumaini R; Bardach, Naomi S; Hall, Matt; Berry, Jay G
Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs. Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment. Copyright © 2016 by the American Academy of Pediatrics.
Carabellese, Felice; Felthous, Alan R
Originally a hedge against the death penalty, the insanity defense came to offer hospitalization as an alternative to imprisonment. In the late 19th century Italy opened inpatient services first for mentally ill prisoners and then for offenders found not guilty by reason of insanity. Within the past decade, a series of decrees has resulted in transferring the responsibility for treating NGRI acquittees and "dangerous" mentally ill prisoners from the Department of Justice to the Department of Health, and their treatment from Italy's high security forensic psychiatric hospitals (OPGs) to community regional facilities (REMSs, Residences for the Execution of Security Measures), community mental health facilities, one of which is located in each region of Italy. Today community REMSs provide the treatment and management of socially dangerous offenders. The dynamic evolution of Italy's progressive mental health system for insanity acquittees, to our knowledge the most libertarian, community oriented approach of any country, is retraced. Discussion includes cautionary concerns as well as potential opportunities for improvements in mental health services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Randall, Melinda; Romero-Gonzalez, Mauricio; Gonzalez, Gerardo; Klee, Anne; Kirwin, Paul
psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency level of second-year psychiatric residents in evidence-based treatment of severe mental illness. the study is a prospective, case-control comparison using the validated Competency Assessment Instrument (CAI), which measures 15 provider competencies critical to recovery, rehabilitation, and empowerment for people with severe mental illness, providing a score for each competency. Participants were second-year psychiatric residents attending a 3-month rotation at the Community Reintegration Program, a psychiatric rehabilitation day program. The authors administered the CAI at the beginning and the end of the residents' 3-month rotation in order to assess change in their competency in psychiatric rehabilitation. The authors also administered the CAI to a comparison group of second-year psychiatric residents who did not rotate through the Community Reintegration Program, and therefore had no formal training in psychiatric rehabilitation. a 3-month rotation in psychiatric rehabilitation significantly improved residents' competency in the domains of goal functioning, client preferences, holistic approach, skills, and team value relative to nonrotating residents. a brief community psychiatry rotation in the second year of residency likely improves some skills in the treatment of people with severe mental illness. Future research should evaluate year-long electives and public psychiatry fellowships.
Rhi, B Y
The western medical knowledges of the human anatomy and physiology including knowledges of central nervous system have probably been introduced into Korea by Prince Sohyŏn Seja in 1645. The authentic education for the western medicine at the governmental and private medical schools, however, originated from 1899 and the education of mental disease was included in curriculum of Tai-Han-uiwon, the governmental medical school before 1910. In 1913 the first department of psychiatry (Department of Mental Disease) was established at the Chongdokbu-uiwon, the clinic of the Japanese colonial government, the former Korean governmental hospital which has later developed to the Kyŏngs ŏng Imperial University Hospital. On the other hand, there was in Severance Hospital Medical College, one Australian missionary psychiatrist McLaren, who has served at Paton Memorial Hospital in Jinju, Korea from 1911, taught neurology and psychiatry from 1913 at Severance Hospital Medical College, established psychiatry ward in 1923 at the Hospital, conducted the ward in humanistic way until 1940. It was the German psychiatry which the Japanese psychiatrists have brought to the Korean peninsula and it remained as major trends of psychiatry in Korea during the Japanese occupation between 1911 and 1945. The academic levels of Kyŏngsŏng Imperial University in psychiatry as well as the quality of mental care seemed to be almost equivocal to the psychiatry in Japan. However, psychiatrists scope of social psychiatric issues and of the research interests seemed to be somewhat narrow. Due to the political discrimination for the Korean students, the Koreans had less opportunity for the promotion at the university than Japanese residents in Korea. In 1945, after the end of the Pacific War only about 11 Korean psychiatrists were left in Korea, who organized Korean Neuropsychiatric Association. The Department of Neuropsychiatry of Seoul National University (former Department of Neurology and
Garvey, Marjorie; Avenevoli, Shelli; Anderson, Kathleen
This review discusses the relevance of the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) to clinical research in child and adolescent psychiatry. We summarize the characteristics of the NIMH RDoC project and then provide examples of RDoC designs that are of relevance to clinical investigators in child and adolescent psychiatry. The final section addresses questions regarding the impact of RDoC on clinical care. RDoC encourages investigators to investigate psychopathology dimensionally: greater or lesser degrees of healthy/adapted functioning of neurobiological, cognitive, and behavioral processes (constructs) that cut across current diagnostic categories. Elucidation of the developmental components of RDoC constructs is needed to ensure they are fully validated. Integrating RDoC approaches into clinical research of child and adolescent psychopathology is contributing to our understanding of development as an aspect of the heterogeneity within DSM disorders and commonalities across seemingly disparate disorders. Continued efforts promise to also explain the processes that lead to mental illness in at-risk populations. Incorporating an RDoC approach in clinical research in child and adolescent psychiatry promises to be a fruitful avenue of research into the root causes and manifestations of mental illness, which will eventually lead to more precise treatments. Although the long-term aspiration of RDoC is to help reduce the burden of suffering for those with mental illnesses, it is not intended to be used for practical clinical purposes at this early stage. Published by Elsevier Inc.
Schanda, H; Stompe, T; Ortwein-Swoboda, G
During recent decades, there has been a substantial increase in admissions to forensic mental hospitals in several European countries. It is not known if reforms implemented in mental health policies and practices are responsible for this development. Our study examined the development of mental health care in Austria and the incidence and prevalence of mentally disordered offenders judged not guilty by reason of insanity (NGRI). We analysed data on service provision and data from criminal statistics between 1970 and 2008 from several national sources. During the first decade when reforms to mental health practice were implemented, the incidence and prevalence of offenders judged NGRI remained unchanged, despite a reduction of mental hospital beds by nearly 50% and little outpatient care. Surprisingly, the enormous increase in admissions to forensic inpatient treatment began in Austria only after community mental health services were rolled out across the country in the 1990s. This increase was primarily due to admissions of patients who had committed less severe offences, while rates of those who had committed homicide remained unchanged. Our results cannot be explained by details of the reforms such as the downsizing of mental hospitals or a lack of outpatient facilities, nor by changes to criminal sentencing. Rather, the results provide evidence of an increasingly inadequate provision of comprehensive care for "difficult" but not extremely dangerous psychotic patients living in the community. This may result from the attitudes of mental health professionals who have become less inclined to integrate aggressive behaviour into their understanding of psychosis. As a consequence, increasing numbers of "difficult" patients end up in forensic psychiatric institutions. This development, which can be observed in nearly all European countries, raises concerns with regard to efforts to destigmatize both patients and psychiatry.
Jean Daniel Jacob
Full Text Available Drawing on a situational analysis of a recent anti-stigma campaign in psychiatry (Defeat Denial: Help Defeat Mental Illness this paper seeks to engage with the reader on the use of an expert discourse that focuses on the brain and its disruption as a way to address stigma associated with mental illness. To begin, we briefly highlight key statistics regarding the impact of mental illness in Canada and introduce the concept of stigma. We then introduce the Defeat Denial media campaign and describe the analytical process employed for this paper - Situational Analysis with a specific focus on discourse. We then expand on the use of the expert discourse in the awareness campaign by making connections with Rose’s concept of biological citizen and, in the final sections, present recent studies on stigma that highlight the paradox and contested construction of the (biopsychiatric self
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Chiles, Catherine; Stefanovics, Elina; Rosenheck, Robert
Stigma towards people with mental illness remains a burden for patients and healthcare providers. This study at a large US university examined the attitudes of psychiatry residents and fellows towards mental illness and its causes, and whether their attitudes differed from the medical student attitudes previously studied utilizing the same survey method. An electronic questionnaire examining attitudes toward people with mental illness, causes of mental Illness, and treatment efficacy was used to survey the attitudes of psychiatry residents and fellows. Exploratory factor analysis derived from the authors' medical student survey was used to examine attitudinal factors. The study response rate was 54.2% (n = 94). Factor analysis employed three factors previously identified reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Residents and fellows reporting more personal experiences with mental illness, both as a group and when compared with medical students, were significantly more willing to socialize with the mentally ill. Respondents who had more professional (work) experience other than medical school or post-graduate training were less likely to believe in supernatural causes of mental illness. Female residents and fellows were more willing to socialize with the mentally ill, and were less likely to believe in supernatural causes for mental illness than their male counterparts. In our study, increased social acceptance of the mentally ill relates to having personal experiences, advanced training in psychiatry, and female gender. Both professional experiences outside of training and female gender reduced the belief in supernatural causes.
Woo, Benjamin K P; Ma, Albert Y
The University of California, Los Angeles (UCLA), along with Kern Medical Center (KMC) and Kern County Mental Health (KCMH), established a new psychiatry residency program in 2004. In this study, we compared psychiatric care at a county psychiatric facility serving a population of 760,000 inhabitants before and after the initiation of this psychiatry residency program. Medical charts for all patients admitted to the psychiatric inpatient service during the year before the inception of the psychiatry residency program (2003-2004) and during the first year in which there was full implementation of residents after inception of the psychiatry residency program (2005-2006) were reviewed. Baseline characteristics, demographics, and various outcomes of the two groups were compared. After the residency program was established, the mean length of stay increased from 8.8 to 9.8 days (p psychiatric inpatient setting. More research is needed to identify strategies, such as guidelines to eliminate over-utilization of resources and methods to improve residents' competency, that may successfully enhance the quality of care provided by residents to psychiatric inpatients.
Psychiatry has increasingly devoted its attention to the role of religion and spirituality in mental health and illness. All religions offer explanations for meaning and purpose of life, involving rationales for the reality of human suffering and traumas related to natural disasters, war, civil violence, torture, etc. In many countries different religious organizations have funded and operated mental health services as well as supported better understanding, empathy and compassion among cultures. A rapprochement between psychiatry and religion has been predicated on their overlapping goals to promote individual and community resilience, growth, and well-being. Due to progress in post-secular dialogue, psychiatry, religion and spiritual disciplines have the historical opportunity to shape the future of individual, public and global mental health as well as building compassionate society and empathic civilization.
Aug 18, 1990 ... Mortality of mentally handicapped patients after mass inter-hospital relocation. ,. L. M. HERING, G. G. W. GEORGE. Summary. Patients and methods. In September 1987847 mentally handicapped patients were moved from A. J. Stals Care and Rehabilitation Centre to. Lentegeur Hospital. A study of the ...
The history of British psychiatry is considered from five main viewpoints: clinical practice, the institutional basis, the legislative basis, lay perspectives of-mental disorder, and European influences. Its philosophical basis can be traced back to the work of the seventeenth-century philosophers. Thomas Hobbes and John Locke. In Scotland, both 'philosophy of mind' and new clinical methods flourished during its Enlightenment; the concept of 'neurosis' was developed by William Cullen. Around 1800, James Prichard's concept of 'moral insanity' became the foundation of modern work on personality disorder and psychopathy. The psychotic illness of King George III, beginning in 1788, led to greater public sympathy for the mentally ill. Attitudes since then have varied, with 'antipsychiatry' becoming very influential in the 1960s. By the mid-eighteenth century, specialised institutions for the mentally ill existed in a number of cities, there were also units attached to charitable general hospitals, but none of these continued after about 1830. The neglect of patients in private madhouses, prisons, and poorhouses led to increasing concern by Parliament, which resulted in the development of public asylums throughout the country. Severe legal restrictions on their activities were modified in 1930 and completely reformed in 1959. From the mid-nineteenth century, French and German influences became increasingly strong, but British universities played no active part in psychiatry until the 1950s. Psycho-analysis did not develop strongly in Britain, where the main contribution was through translation and biography, but some leading analysts came as refugees in the 1930s-as did other psychiatrists from central Europe. Another important influence was that of Adolf Meyer at the Institute of Psychiatry, London, particularly through Sir Aubrey Lewis; physical treatment methods also came to Britain from Europe. In the second half of this century, the most important British
Full Text Available Xavier Y Zendjidjian,1,2 Pascal Auquier,1 Christophe Lançon,1,3 Anderson Loundou,1 Nathalie Parola,4 Melanie Faugère,3 Laurent Boyer1 1Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life, Research Unit, Marseille, France; 2Department of Psychiatry, Inpatient Psychiatric Unit, La Conception University Hospital, Marseille, France; 3Department of Psychiatry, Psychiatric Public Sector 6, 4Department of Addictology, Day Hospital, Sainte-Marguerite University Hospital, Marseille, France Background: The aim of our study was to identify patient- and care-related factors that are associated with patients’ satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient’s point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22.Methods: This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels.Results: Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (ß=0.15. Clinical improvement was moderately associated with higher global satisfaction (ß=–0.15, higher satisfaction with quality of care (ß=–0.19, and higher satisfaction with food (ß=–0.18. Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (ß, 0.20–0.43 except food, and for seclusion with global satisfaction (ß=–0.33 and personal experience (ß=–0.32. Patients with previous
Hofmann, Marzellus; Harendza, Sigrid; Meyer, Jelka; Drabik, Anna; Reimer, Jens; Kuhnigk, Olaf
Objective: This study aimed to explore the effect of medical education on students' attitudes toward psychiatry and psychiatric patients, and examined the usefulness of a new evaluation tool: the 6-item Psychiatric Experience, Attitudes, and Knowledge (PEAK-6). Method: Authors studied the attitudes of 116 medical students toward psychiatry…
Shah, Sandip; Desai, Nimisha; Shah, Saurabh; Pathare, Soumitra; Chauhan, Ajay; Sharma, Elavatsla
Dropout from an outpatient clinic is the loss of patient to the scheduled follow-up. Noncompliance in the form of treatment dropouts is a major problem across outpatient mental health settings and can range from 15% to 60%. Follow-up studies provide valuable insights into improving the quality of existing mental health facilities. Quality Rights Gujarat (QRG) is a step toward improving mental health facilities across various centers. This retrospective observational study aims to explore follow-up pattern, predictors and any change after QRG implementation. Pre intervention Group (A) attended psychiatry OPD for 6 months before implementation of QRG project and Post intervention Group (B) attended psychiatry OPD for 3 months after implementation of QRG project. Total 1632 Patients consulted in group A and 926 patients consulted Psychiatry OPD in group B. The most common Psychiatric disorder were Depression (A-19.55%, B-28.62%), Schizophrenia and related disorders (A-14.15%, B-15.01%), Neuropsychiatric disorders like headache and epilepsy (A-14.52%, B-18.68%), substance use disorder (A-15.26%, B-13.71%) and Bipolar disorder (A-11.76%, B-13.17%). 59.56% patients dropped out after the first visit in pre intervention group as compared to 51.94% patients in post intervention group. Significant reduction of about 8% in loss to follow up and 16% increase in follow-ups of initial visits after implementation of Quality Rights Gujarat project. Much can be done to improve attendance in most services. The initiative like QRG significantly has positive results on patient's follow-up. Copyright © 2017 Elsevier B.V. All rights reserved.
Zhang L.; Zhao J.; Xiao H.; Zheng H.; Xiao Y.; Chen M; Chen D
Lulu Zhang,1 Jingping Zhao,1 Huaqing Xiao,3 Hongbo Zheng,2 Yaonan Xiao,3 Miaoyang Chen,3 Dingling Chen31Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, 2Department of Psychiatry, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 3Department of Psychiatry, Luoding Dagang Hospital, Luoding, Guangdong, People's Republic of...
Bardach, Naomi S; Coker, Tumaini R; Zima, Bonnie T; Murphy, J Michael; Knapp, Penelope; Richardson, Laura P; Edwall, Glenace; Mangione-Smith, Rita
Inpatient pediatric mental health is a priority topic for national quality measurement and improvement, but nationally representative data on the patients admitted or their diagnoses are lacking. Our objectives were: to describe pediatric mental health hospitalizations at general medical facilities admitting children nationally; to assess which pediatric mental health diagnoses are frequent and costly at these hospitals; and to examine whether the most frequent diagnoses are similar to those at free-standing children's hospitals. We examined all discharges in 2009 for patients aged 3 to 20 years in the nationally representative Kids' Inpatient Database (KID) and in the Pediatric Health Information System (free-standing children's hospitals). Main outcomes were frequency of International Classification of Diseases, Ninth Revision, Clinical Modification-defined mental health diagnostic groupings (primary and nonprimary diagnosis) and, using KID, resource utilization (defined by diagnostic grouping aggregate annual charges). Nearly 10% of pediatric hospitalizations nationally were for a primary mental health diagnosis, compared with 3% of hospitalizations at free-standing children's hospitals. Predictors of hospitalizations for a primary mental health problem were older age, male gender, white race, and insurance type. Nationally, the most frequent and costly primary mental health diagnoses were depression (44.1% of all mental health admissions; $1.33 billion), bipolar disorder (18.1%; $702 million), and psychosis (12.1%; $540 million). We identified the child mental health inpatient diagnoses with the highest frequency and highest costs as depression, bipolar disorder, and psychosis, with substance abuse an important comorbid diagnosis. These diagnoses can be used as priority conditions for pediatric mental health inpatient quality measurement.
Eack, Shaun M.; Newhill, Christina E.
Racial disparities in mental health outcomes have been widely documented in noninstitutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness was followed for a year after…
Jean-Arthur eMicoulaud Franchi
Full Text Available Neuromodulation therapeutics—as repeated Transcranial Magnetic Stimulation (rTMS and neurofeedback—are valuable tools for psychiatry. Nevertheless, they currently face some limitations: rTMS has confounding effects on neural activation patterns, and neurofeedback fails to change neural dynamics in some cases. Here we propose how coupling rTMS and neurofeedback can tackle both issues by adapting neural activations during rTMS and actively guiding individuals during neurofeedback. An algorithmic challenge then consists in designing the proper recording, processing, feedback, and control of unwanted effects. But this new neuromodulation technique also poses an ethical challenge: ensuring treatment occurs within a biopsychosocial model of medicine, while considering both the interaction between the patients and the psychiatrist, and the maintenance of individuals’ autonomy. Our solution is the concept of Cyborg psychiatry, which embodies the technique and includes a self-engaged interaction between patients and the neuromodulation device.
Wang, Xiao-Jing; Krystal, John H.
Psychiatric disorders such as autism and schizophrenia arise from abnormalities in brain systems that underlie cognitive, emotional and social functions. The brain is enormously complex and its abundant feedback loops on multiple scales preclude intuitive explication of circuit functions. In close interplay with experiments, theory and computational modeling are essential for understanding how, precisely, neural circuits generate flexible behaviors and their impairments give rise to psychiatric symptoms. This Perspective highlights recent progress in applying computational neuroscience to the study of mental disorders. We outline basic approaches, including identification of core deficits that cut across disease categories, biologically-realistic modeling bridging cellular and synaptic mechanisms with behavior, model-aided diagnosis. The need for new research strategies in psychiatry is urgent. Computational psychiatry potentially provides powerful tools for elucidating pathophysiology that may inform both diagnosis and treatment. To achieve this promise will require investment in cross-disciplinary training and research in this nascent field. PMID:25442941
Full Text Available ... in research or clinical practice. Psychologists treat mental disorders with psychotherapy and some specialize in psychological testing and evaluation. More Resources World Psychiatric Association American Association of Child and Adolescent Psychiatry American Association of Community Psychiatrists ...
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Full Text Available ... mental disorders with psychotherapy and some specialize in psychological testing and evaluation. More Resources World Psychiatric Association American Association of Child and Adolescent Psychiatry American Association ...
Full Text Available ... Foundation APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In Join General Residents and Fellows Medical Students International close menu Psychiatrists Education Practice Cultural Competency Awards & Leadership Opportunities Advocacy & APAPAC ...
Appelbaum, Paul S; Swanson, Jeffrey W
This column describes federal and state laws to restrict access to firearms among people with mental illness. The contribution to public safety of these laws is likely to be small because only 3%-5% of violent acts are attributable to serious mental illness, and most do not involve guns. The categories of persons with mental illnesses targeted by the laws may not be at higher risk of violence than other subgroups in this population. The laws may deter people from seeking treatment for fear of losing the right to possess firearms and may reinforce stereotypes of persons with mental illnesses as dangerous.
Inês Guerra Aguiar
Conclusion: Most children referred were under the age of three and presented clinical indicators of mental suffering. In the last years, mental health in early childhood has been an area of growing investment, namely in the early identification of risk groups and signs of mental suffering, allowing mental carers to intervene preemptively.
Masiero, André Luis
.... Also called psycho-surgeries, they were operations that separated the right and left frontal lobes and pre-frontal lobes from the rest of the brains, aiming at modifying behavior or curing mental diseases...
Lyons, Zaza; Janca, Aleksandar
Mental illnesses are a major public health problem around the world and the prevalence and burden of common mental disorders is growing. Psychiatry is an unpopular career choice for many medical students and this impacts negatively on the supply of psychiatrists to the workforce. The psychiatry clerkship can play an important role in influencing students' attitudes towards psychiatry, either positively or negatively. However, stigma towards mental illness detracts students from considering a career in psychiatry. The aim of this study was to assess the impact of an eight week psychiatry clerkship on i) student knowledge and interest in psychiatry; ii) psychiatry as a career choice; iii) attitudes towards psychiatry; and iv) perceptions of stigma towards mental illness. Year 4 medical students at the University of Western Australia completed two questionnaires, the Balon Attitudes Towards Psychiatry and the Mental Illness Clinicians Attitudes (MICA), at the beginning and end of the psychiatry clerkship. Interest in, knowledge of, and consideration of psychiatry as a career were also assessed. Non-parametric tests were used to compare baseline and follow-up differences on the Balon and MICA. Unpaired t-tests compared mean differences for interest, knowledge and psychiatry as a career. Attitudes towards psychiatry were positive at the beginning of the clerkship. Overall, there was a significant decrease in negative and stigmatising views towards mental illness post clerkship measured by the MICA, but the follow-up mean score remained close to the neutral value with views in some areas becoming more negative. There was no significant improvement in students' interest in psychiatry post clerkship, however, knowledge of psychiatry improved significantly. Numbers of students 'definitely considering' psychiatry as a career increased significantly from 7 (4.6%) students at baseline to 17 (10.5%) at follow-up. The clerkship made a modest impact on students' attitudes to
Sheehan, Kathleen A
Compulsory treatment is a common, yet controversial, practice in psychiatry. This paper reviews recent studies on the use of compulsory measures in hospital, the community and special populations. Researchers continue to examine the rates and patterns of involuntary hospitalization. However, they have extended their investigations to care in the community, acknowledging it as the primary locus of treatment for most patients. Research shows that the implementation of community mental health legislation presents complex clinical and practical issues that require further investigation. Recognition that compulsory treatment is an objective event which is subjectively experienced by patients, families and clinicians has led to research investigating stakeholder views. The therapeutic relationship has been found to be an important modifier of the experience of compulsory treatment. Recent studies have also focused on specific coercive practices, such as forced medication and seclusion, and the use of these in patient subgroups, including those with eating disorders and adolescents. The debate about whether compulsory treatment is ethical continues in the literature. Compulsory treatment in psychiatry remains an ethically and clinically contentious issue. As ethical concerns are generally countered by the argument that compulsory measures can lead to beneficial clinical outcomes, further empirical investigation in this area is required.
Kallert, Thomas Wilhelm
This paper highlights issues in the field of coercion in psychiatry which have gained importance in 2007. Reviews on 'involuntary hospital admission' demonstrated negative and positive consequences on various outcome domains. Papers on 'coercion and the law' identified cross-national differences of legal regulations, or addressed justice and equality issues. Studies on the 'patient's perspective', and 'family burden of coercion' showed that involuntariness is associated with feeling excluded from participation in the treatment. A review on 'outpatient commitment' recommended the evaluation of a range of outcomes if this specific legislation is introduced. 'Coercion in special (healthcare) settings and patient subgroups' needs to be assessed in detail. This refers to somatic hospitals, establishments for mentally retarded patients, prisons, forensic settings, and coercion mechanisms for addiction treatment, eating disorders, and minors. Empirical findings in other areas focused on attitudes towards involuntary treatment; decision variables for involuntary commitment; guidelines on the use of coercive measures; and intervention programs for staff victims of patient assaults. Coercion in psychiatry is an important area for future clinical and research initiatives. Because of the linkages with legal, human rights and ethical issues, a huge number of individual questions needs to be addressed.
Full Text Available Background: Mental illness - is a heavy burden of modern society and may be underestimated. There are several reasons: the high prevalence of this category of disorders, high level of stigmatization, treatment gap between those who are mentally ill and those will be treated. The economic crisis and the lack of resources, make psychosocial rehabilitation of mental disorders even more complicated. Methods: This review is based on materials of the 24th Congress of the European Psychiatric Association (April 2016, Madrid, the participants of the "Eastern European Academy of the World Psychiatric Association and "Servier" company specifically for psychiatric journals of WPA Zone 10 (East European Educational WPA-Servier Academy - «EEE WPA-Servier Academy». The review will present materials from several symposiums: "Psychosocial rehabilitation and mental health", "Overcoming the stigma of mental disorders: recent advances and initiatives," "Fight stigma: a global challenge", and state-of-the-art report, "Psychosocial interventions in schizophrenia ». Results: As result, we anticipate that this review will distribute and promote knowledge about high quality standards and evidence-based research and treatment methods among the modern community of mental health experts. Conclusion: Current approach in psychosocial rehabilitation of severe mental disorders has changed significantly due to the data of evidence-based medicine, the use of effective, superior methods suggests a good outcome for a larger number of patients.
Razzouk, Denise; Zorzetto, Ricardo; Dubugras, Maria Thereza; Gerolin, Jerônimo; Mari, Jair de Jesus
To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database). The main topics were: depression (29.1%), substance misuse (14.6%), psychoses (10%), childhood disorders (7%) and dementia (6.7%). Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.
Mehmet Akif Ersoy
Full Text Available This study aimed to report forensic reports of a university psychiatry department. So that comparison with similar other studies later on, will reveal possible extrapolations for standardization of the forensic decision process. Most of the cases were sent from the institutions in the university town and its vicinity. More than half of the cases (%58 were civil law cases. Appointment of a guardian, testamentary and contractual capacity and competence (%42 and criminal responsibility (%22.4 were the most often questions asked by judicial offices. It is noticed that in some cases, psychiatrists could hardly make a definite decisione. It ought to discussed what should be done in such difficult cases. Both psychiatrists and jurists should work on the language and communication problems between institutions. Comparison of the results of this study with similar ones will be very fruitful. Key words: Forensic psychiatry
Sevcan Karakoç Demirkaya
common in child psychiatry referrals. These data may be considered as risk factors for developing protective mental health services.
Gilbert Ballet (1853-1916) was born into a medical family in the French province of Limousin. He completed a brilliant career in Paris hospitals: Resident (1875), Assistant to Professor Charcot of Salpêtrière Hospital (1882), Consultant (1884), Head of the Department of Neurology and Psychiatry (1890), and member of the Franch Academy of Medicine (1812). He had been teaching in the "Brain and mental diseases" course since 1891. In 1909, he held the chair of history of medicine. In 1911, he was Professor of mental diseases. He then advocated that nervous system disorders constituted a single thematic domain with two branches, organic neurology and psychiatry. He wrote a famous report on the forensic medicine assessment of criminal responsibility. His motto was "Let's use psychology as we can, not forgetting that we are physicians".
Full Text Available Abstract Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania. We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental hospitals.
Mass media plays a central role in shaping public discourse on health and illness. In order to examine media representations of mental health and expert knowledge in this field, two major Swedish daily newspapers from the year 2009 were qualitatively analysed. Drawing on the theory of social representations, the analysis focused on how issues concerning mental health and different perspectives are represented. The results show how the concept of mental illness is used in different and often taken-for-granted ways and how the distinction between normal and pathological is a central underlying question. Laypersons' perspectives are supplemented by views of professionals in the newspapers, where signs of confidence and dependence on expert knowledge are juxtaposed with critique and expressions of distrust. The newspaper discourse thus has salient argumentative features and the way that conflicts are made explicit and issues concerning authoritative knowledge are addressed indicates ambivalence towards the authoritative role of expert knowledge concerning mental health. In this way, the newspapers provide a complex epistemic context for everyday sense-making that can be assumed to have implications for relations between laypersons and professionals in the field of mental health.
Dimple D Dadarwala
Full Text Available Introduction: The number of elder patients with severe psychiatric illnesses other than depression is increasing. Electroconvulsive therapy (ECT has a special role in the treatment of late-life depression and other psychiatric conditions in the elderly. Using ECTs in the elderly could be difficult. In an Indian setting, ECT in the geriatric population is used as last resort of treatment which is in contrast to Western countries. There is dearth of data available for the use of ECT in the elderly in India. Methodology: Retrospective data review was carried out to identify patients 55 years or older who had received ECT from January 2014 to June 2016 in tertiary care teaching hospital in a metropolitan city in India. Results: A total of 304 ECTs were administered to 25 elderly aged> 55 years with average of 12 ECTs per patient. Schizophrenia (56% was the most common diagnosis among patients who were considered for ECT, and this was followed by major depression without psychotic features (24% and major depression with psychotic features (8%. The most common indication to start ECT was nonresponsiveness to medications (92%. There was an increase in mean Mini-Mental State Examination (MMSE scores from baseline (23.42 to the end of the sixth (24.60 and last ECT (24.60. Duration of current used during ECT had positive correlation with MMSE. Patients with comorbid medical illness (20% received ECT without any complication. Conclusions: This study adds to scarce database on the use of ECT in old-age patients in India and adds to evidence that ECT is safe and effective treatment in old age with no negative impact on cognition.
Uher, Rudolf; Zwicker, Alyson
Intriguing findings on genetic and environmental causation suggest a need to reframe the etiology of mental disorders. Molecular genetics shows that thousands of common and rare genetic variants contribute to mental illness. Epidemiological studies have identified dozens of environmental exposures that are associated with psychopathology. The effect of environment is likely conditional on genetic factors, resulting in gene-environment interactions. The impact of environmental factors also depends on previous exposures, resulting in environment-environment interactions. Most known genetic and environmental factors are shared across multiple mental disorders. Schizophrenia, bipolar disorder and major depressive disorder, in particular, are closely causally linked. Synthesis of findings from twin studies, molecular genetics and epidemiological research suggests that joint consideration of multiple genetic and environmental factors has much greater explanatory power than separate studies of genetic or environmental causation. Multi-factorial gene-environment interactions are likely to be a generic mechanism involved in the majority of cases of mental illness, which is only partially tapped by existing gene-environment studies. Future research may cut across psychiatric disorders and address poly-causation by considering multiple genetic and environmental measures across the life course with a specific focus on the first two decades of life. Integrative analyses of poly-causation including gene-environment and environment-environment interactions can realize the potential for discovering causal types and mechanisms that are likely to generate new preventive and therapeutic tools. © 2017 World Psychiatric Association.
Smit, H.F.E.; Cuijpers, P.; Oostenbrink, J.; Batelaan, N.M.; de Graaf, R.; Beekman, A.J.
BACKGROUND: Mental disorders are highly prevalent and are associated with substantial disease burden, but their economic costs have been relatively less well researched. Moreover, few cost-of-illness studies used population-based psychiatric surveys for estimating direct medical, direct non-medical
Phenomenological and existential philosophical approaches to mental illness have had great influence on psychiatric research and theory in European psychiatry (Berrios, 1992: 309). Among them, the work of Jürg Zutt (1893-1980), Professor of Psychiatry at University Hospital Frankfurt 1950-63, closely relates to the anthropological psychiatry of Ludwig Binswanger, Victor von Gebsattel and Erwin Straus. Since both anthropological psychiatry and social psychiatry are based on a person-centred approach, it was hypothesized that common roots are to be detected in what is called humanistic psychology. The main finding of the present paper is that there is a strong relationship between Zutt's concept of Comprehending Anthropology and the biopsychosocial model on which social psychiatry is based. However, it cannot be concluded from the existing evidence that the reform of psychiatric services necessarily resulted from the anthropological approach.
Full Text Available Background: The comorbidity of substance abuse and mental disorder is known to exist and may cause many diagnostic, prognostic, and management difficulties. Indian data are sparse in this area. Objectives: The aim of the study was to identify the prevalence and pattern of substance abuse in psychiatric outpatients and to examine the relation between demographic variables and drug abuse pattern. Materials and Methods: Medical records of the patients attending psychiatry outpatient clinic at a tertiary care general hospital over a 3-month period were reviewed. Information was obtained from medical chart and Drug Abuse Monitoring Scale pro forma about substance abuse. Psychiatric diagnosis made by a qualified psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition diagnostic criteria, as recorded in the case record form, was used. Observation: The results revealed that 50.8% (half of all psychiatry outpatients were using one or more substances including tobacco in the last month prior to registration (1 month prevalence and 28.35% were using substances at any time in their life prior to the last month (lifetime prevalence. Male patients had 6 to 8 times higher substance abuse than female patients. Tobacco and alcohol were found to be the most common substances of abuse, followed by cannabis. Part-time and full-time employed male patients consumed more alcohol and tobacco than unemployed patients. Conclusions: Substance abuse was common among mentally ill outpatients and could be the cause of various health hazards and hence requires due attention.
Garrido, Melissa M; Prigerson, Holly G; Neupane, Suvam; Penrod, Joan D; Johnson, Christopher E; Boockvar, Kenneth S
Psychosocial distress among patients with limited life expectancy influences treatment decisions, treatment adherence, and physical health. Veterans may be at elevated risk of psychosocial distress at the end of life, and understanding their mental healthcare needs may help identify hospitalized patients to whom psychiatric services should be targeted. To examine mental illness prevalence and mental health treatment rates among a national sample of hospitalized veterans with serious physical illnesses. Design, Subjects, and Measurements: This was a retrospective study of 11,286 veterans hospitalized in a Veterans Health Administration acute care facility in fiscal year 2011 with diagnoses of advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, and/or advanced HIV/AIDS. Prevalent and incident mental illness diagnoses during and before hospitalization and rates of psychotherapy and psychotropic use among patients with incident depression and anxiety were measured. At least one-quarter of the patients in our sample had a mental illness or substance use disorder. The most common diagnoses at hospitalization were depression (11.4%), followed by alcohol abuse or dependence (5.5%), and post-traumatic stress disorder (4.9%). Of the 831 patients with incident past-year depression and 258 with incident past-year anxiety, nearly two-thirds received at least some psychotherapy or guideline-concordant medication within 90 days of diagnosis. Of 191 patients with incident depression and 47 with incident anxiety at time of hospitalization, fewer than half received mental healthcare before discharge. Many veterans hospitalized with serious physical illnesses have comorbid mental illnesses and may benefit from depression and anxiety treatment.
Full Text Available ... therapy is used to treat seasonal depression. Psychiatric Training To become a psychiatrist, a person must complete ... of psychiatry residency. The first year of residency training is typically in a hospital working with patients ...
Audureau, E; Merle, V; Kerleau, K; Dollois, B; Baugé-Rousseau, M; Théry, S; Tavolacci, M-P; Dubreuil, N; Thillard, D; Gasparin-Grisel, S; Mathieu, M; Augé, C; Czernichow, P
French legislation makes mandatory for healthcare providers the disclosure of hospital infection (HI) risk and actual occurrence to the patient. Given the specific diseases encountered in psychiatry, some difficulties may be expected in practical application of this regulation. The aim of our study was to describe the knowledge, declared practices and opinions of healthcare workers (HCW) in psychiatry concerning information for patients about HI. We randomly selected doctors, nurses and head nurses from four hospitals with psychiatric activity in Normandy. The HCW were asked to self-complete an anonymous questionnaire, including data describing the responding HCW and questions aiming at describing his/her knowledge, attitude in routine daily practice and opinion about information to patients about HI. One hundred and forty-one HCW were initially selected, of which 114 (80.9%) eventually agreed to complete the questionnaire. Only eight HCW (7.0%) were considered to have a correct overall knowledge of legal obligations. Main errors concerned the obligation to inform the patient of the HI risk according to the medical procedures that are to be performed (43.9% of correct answers) and the obligation to inform the patient of the HI risk according to his/her medical condition (46.5%). The obligation to inform the patient of the occurrence of a HI was largely known (84.2%). HCW usually giving information about the risk of HI to patients without HI accounted for 5.3%. Main reasons advocated for not informing patients were a low level risk of HI in psychiatry (80.4%) and the lack of patients' demand (59.8%). In the case of HI occurrence, the percentage of HCW routinely informing patients was 13.2%. HCW systematically informing the patient's family about the occurrence of HI accounted for 9.6%. A large proportion of HCW supported delivering information to patients about HI (86.0%). HCW expected from information better approval of prevention programs by the patients (87
Torres Pique, Ana María; Pontificia Universidad Javeriana; Pinilla Alarcón, Maribel
This situation of mental health of the population in the world and in Colombia, raises great challenges and responsibilities to the nursing professional who as a natural caretaker of health and life, is a main resource for providing restorative help that allows persons, groups and communities to reach integrative wellbeing. The tendencies in health for the next years force us to rethink nursing education and nursing professional roles in order to be able to respond, in a humanistic form to th...
Mikkelsen, Elisabeth Naima; Petersen, Anne; Lyager Kaae, Anne Marie
existed in Danish psychiatry since the 1980s when mental health service provisions were split into two psychiatric systems. Material and methods: We report from two qualitative studies: STUDY#1 (n = 24) consisted of twenty-four individual, qualitative interviews with the staff and management...... during service users’ admission to and discharge from hospital and during hospitalization and measures to increase cross-sector knowledge about each system’s practices and methods. Conclusion: Improvement of cross-sector collaboration in psychiatry should take the form of a multi-faceted approach...
Becerra, Benjamin J; Banta, Jim E; Ghamsary, Mark; Martin, Leslie R; Safdar, Nasia
Empirical evidence demonstrates the comorbidity of asthma and mental illness, though limited studies have evaluated the patient and hospital outcomes associated with such conditions. As such, this study evaluated the burden of this comorbidity on health resource utilization and patient disposition among asthma hospitalizations. A secondary analysis of the Nationwide Inpatient Sample (2009-2011) was conducted, with study population of asthma hospitalizations limited to those 18 years of age and older. International Classification of Disease, 9th Revision, Clinical Modification codes were utilized to identify asthma and mental illness discharges. Length of stay was defined as number of days stayed in the hospital, total charges were inflation-adjusted, and patient disposition was defined as routine versus not routine. All analyses were survey-weighted and adjusted for patient and hospital characteristics. Approximately 29% of the asthma hospitalizations reported mental illness. Any mental illness was associated with increased length of stay in the hospital (10% increase), total costs (11% increase), and lower odds of routine disposition (21% decrease). Substance-related disorder also increased length of stay in the hospital (4% increase), costs (9% increase), and lower odds of routine disposition (29% decrease). Age-stratified analyses further demonstrated similar trends among most age groups. The results of this study complement the extant literature by demonstrating the burden of the asthma-mental health nexus on health resource utilization and patient outcomes. The increased length of stay, cost, and decreased likelihood of routine disposition associated with mental illness highlight the need for integrated care to address mental illness as part of routine care.
Full Text Available ... Schizophrenia Sleep Disorders Somatic Symptom Disorder Specific Learning Disorder More Topics A – Z Ask An Expert Coping After Disaster, Trauma Share Your Story Suicide Prevention Warning Signs of Mental Illness What is Psychiatry? What is Mental Illness? ...
In September 1987847 mentally handicapped patients were moved from A. J. Stals Care and Rehabilitation Centre to Lentegeur Hospital. A study of the death rates of patients for 4 years before the move and 18 months afterwards showed a rise in the death rate in the 6-month interval after the move.
Day, K A
In a study of 99 long-stay hospital residents aged 65 years and over, two thirds were functioning in the moderately to mildly handicapped range, two thirds were under the age of 75 years and there was an overall female to male ratio of 2:1. As in the general population, mobility problems, a tendency to falls and fractures, cardiorespiratory disease, deteriorating eyesight, and hearing and urinary incontinence were commonly found; all increased in frequency with age. A fifth exhibited psychiatric disorder: the commonest conditions, as expected, were the psychoses and dementia. It is suggested that retirement provision for the elderly mentally handicapped should be made within the mental handicap services and that the small group with significant geriatric problems would be most appropriately cared for within the generic geriatric services. A plea is made for evaluative studies before large scale implementation of resettlement programmes for the elderly mentally handicapped in hospital.
Mitjavila,Myriam Raquel; Mathes,Priscilla Gomes
O artigo analisa algumas dimensões socioculturais do campo semântico e dos modos de estruturação dos discursos da psiquiatria forense em torno da periculosidade criminal e de suas conexões com a saúde mental. A partir dos resultados de uma pesquisa baseada na análise de conteúdo de uma amostra de manuais e livros de psiquiatria forense, examinaram-se alguns significados e formas de enunciação da noção de periculosidade criminal, bem como as principais estratégias interpretativas que organizam...
-type disorders such as schizophrenia, other psychoses, and substance abuse ... emotional problems or seek help.14-16 Supernatural beliefs are rife in Nigeria, as in other parts of Africa, and stigma associated with mental illness may also ...
Harnett, P J
The term \\'performance management\\' has an aversive \\'managerial\\' aspect, is unappealing to many public sector staff and has an \\'image problem\\'. Perhaps as a consequence, it has failed to make a significant impact on Irish public sector workers, notably mental health nurses. In this paper, performance management is introduced and examined within an Irish healthcare context and with reference to its use in other countries. Some of the challenges faced by Irish mental health nurses and the potential benefits of working within a performance managed workplace are discussed. The paper concludes that performance management is likely to increasingly affect nurses, either as active agents or as passive recipients of a change that is thrust on them. The authors anticipate that the performance management \\'image problem\\' will give way to recognition that this is a fundamental change which has the potential to enable health services to change. This change will bring high standards of transparency, worker involvement in decision making, an explicit value base for health services and individual teams. It provides the potential for clear practice standards and high standards of transparency as well as worker welfare in all aspects, including supporting employment and career progression.
Nukui, Hiroshi; Murakami, Michio; Midorikawa, Sanae; Suenaga, Minako; Rokkaku, Yuichi; Yabe, Hirooki; Ohtsuru, Akira
The mental health of hospital nurses is a key health issue in public health promotion during the recovery phase following the Fukushima disaster. In this study, conducted 4 years after the disaster, we analyzed the overall mental health, knowledge, risk perception of radiation, and work and daily life burdens of nurses working at medical institutions in the Fukushima Prefecture (collection rate = 89.6%; response number = 730). Overall mental health status was estimated using the 12-item version of the General Health Questionnaire, and 333 respondents (45.6%) scored above the 12-item General Health Questionnaire threshold point (≥4), indicating probable emotional distress compared with the general population under normal circumstances. Multivariate logistic analysis suggested that the ability to cope with daily life and work-related stressors were more important than risk perception and acquisition of knowledge regarding radiation and its control methods for supporting the mental health of nurses following the Fukushima disaster.
Anthony, N; Leff, A M
The publicizing of the abysmal conditions in state mental institutions and the problems precipitated by their deinstitutionalization programs, have challenged local health authorities to develop effective roles in ameliorating these difficulties. Long-view State Hospital is a state mental hospital in Cincinnati, Ohio. The Cincinnati Health Department acted as a change agent to deal with the hospital's many chronic problems and the new difficulties precipitated by moving patients into the community for care. The city conducted its own evaluation of the hospital and its deinstitutionalization program and strongly advocated needed improvements. Problems were encountered in implementing this advocacy role, particularly in relation to the local health department's authority regarding this state-funded and operated institution. However, the many city recommendations that were implemented, the increased funding given the hospital and the community mental health centers, the continuing communication between city and state officials, as well as a follow-up evaluation indicated that the Cincinnati Health Department had played a positive role in the change process. (Am. J. Public Health 69:64-67, 1979.)
Zendjidjian, Xavier Y; Auquier, Pascal; Lançon, Christophe; Loundou, Anderson; Parola, Nathalie; Faugère, Melanie; Boyer, Laurent
The aim of our study was to identify patient- and care-related factors that are associated with patients' satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient's point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22). This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels. Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (β=0.15). Clinical improvement was moderately associated with higher global satisfaction (β=-0.15), higher satisfaction with quality of care (β=-0.19), and higher satisfaction with food (β=-0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (β, 0.20-0.43) except food, and for seclusion with global satisfaction (β=-0.33) and personal experience (β=-0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (β=-0.15). This study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient's satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients' management, and health outcomes in psychiatric hospitals.
Ramos, Marco A
From 1966 to 1983, Argentina underwent a period of political radicalization as fascist regimes used terror to control its citizens and leftist guerrillas resorted to violence to spark revolution. During this politically volatile period, psychiatry transformed from an apolitical clinical specialty into an ideological tool used for both leftist resistance and military oppression. The largest psychiatric organization at the time, the Federación Argentina de Psiquiatras (FAP), became the center for a new politically committed brand of psychiatry in Argentina that united psychoanalysis and community psychiatry with Marxist theory. Though the military targeted and eventually dismantled the FAP and its leftist brand of psychoanalysis and community psychiatry, sectors of the government also paradoxically appropriated and reframed community-based psychiatric perspectives to pathologize leftist subversion and advance their own conservative ideology.
Aruna, G.; Mittal, Shobhana; Yadiyal, Muralidhara B.; Acharya, Chandana; Acharya, Srilekha; Uppulari, Chinmay
Context: Globally, psychiatry as a subject, psychiatrists as professionals, and patients with psychiatric disorders are subjected to cultural stereotypes and negative attitude by the general population. What is of alarming concern is that these prejudices exist within the medical community as well. Aims: This study aims at evaluating the perception, knowledge, and attitude toward psychiatric disorders, therapeutic modalities used in psychiatry, psychiatry as a subject and psychiatrists as professionals among undergraduate medical students in Karnataka. Settings and Design: This is a descriptive, cross-sectional type of study conducted in three medical colleges located in Karnataka. Materials and Methods: A sample of 500 students from all three professional phases of MBBS was selected using purposive sampling. A semistructured prevalidated questionnaire was used to assess the perception, knowledge, and attitude of undergraduate medical students toward psychiatric disorders and psychiatry. Statistical Analysis: Data were analyzed using Statistical Package for Social Sciences, version 16.0. Results: The undergraduate medical student population had significant shortcomings in knowledge and attitude pertaining to psychiatric disorders, more glaring in the initial years of education. A comparatively positive opinion was obtained regarding psychiatry as a subject and psychiatrists as professionals, which may reflect the changing trends and concepts, both in society and medical community. Conclusion: This study highlights the need for better educational measures at undergraduate level in order to shape a positive attitude of the health care providers towards psychiatry, which is essential for ensuring better care for patients as well as reduction of stigma surrounding psychiatric disorders. PMID:26985108
The study of narrative has become increasingly important in the humanities and social sciences and there is a growing use of narrative in the clinical domains of medicine and psychotherapy. Narrative psychiatry is also on the rise and promises to help psychiatry be responsive to increasing critical concerns from inside and outside the field. The field of narrative is vast and cuts across a variety of disciplines. Contemporary scholars in narrative medicine build on 30 years of work in medical humanities and bioethics to rigorously understand human variables in medicine and to improve physician empathy. Narrative psychotherapists have developed a new model of psychotherapy and a meta-narrative theory of diverse mental health interventions. Psychiatrists have picked up these insights and are finding them invaluable for navigating contemporary issues in psychiatry. Narrative theory has become important in the humanities, social sciences, medicine, and psychotherapy for understanding human meaning making. Increasingly, the tools of narrative are proving valuable for psychiatry as well. Narrative psychiatry does not negate or supersede other knowledge and research in psychiatry, but it can help psychiatry understand how people use psychiatric knowledge, among other cultural resources, for making sense of psychic difficulties and psychic differences.
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.
Ana Carolina Santos de Souza
Full Text Available The Custody and Psychiatric Treatment Hospital (CPTH is ambivalent and ambiguous in its essence, because it gathers not only the characteristics of a mental institution, but also those of a prison – epitomized by the security system. By analyzing this context, one can perceive the importance of implementing some knowhow able to attend the real needs of the individuals hospitalized in this type of institution. This interpretation of their needs must be done in association with a work in mental health based on the principles of the Brazilian Psychiatric Reform and Psychosocial Field Practice. The objective of this study is to reflect on the real possibilities of implementing mental health work based on the Brazilian Psychiatric Reform, inserted in the Psychosocial Field, in institutions such as CPTHs. This reflection occurs from the conflicts arisen in the beginning of Occupational Therapy service in a CPTH located in the state of Sao Paulo, Brazil, as well as through the analysis of the reality in which this Custody Hospital is inserted. When studying the Psychiatric Reform Law, ordinance 28.195/1988, which deliberates on the functions of Occupational Therapy in the CPTHs of the state of Sao Paulo, and the Penal Execution Law, the reality was analyzed from its dimensions, to conclude that the institutional forces ruled the work process of occupational therapists. Therefore, the structural, particular, singular dimensions that rule the CPTH were understood and, after that, the “nodes” that hinder the implementation of mental health work in the Psychosocial Field in this type of institution were revealed.
Shamsie, S.J., Ed.
Discussed in a conference report on adolescent psychology are the varieties of behavioral problems and family dynamics by Richard Jenkins, biological growth during adolescence by J.R. Unwin, management of adolescents in a general hospital setting by Henry Kravitz, and educational problems in disturbed adolescents by S.J. Shamsie, Jean-L. Lapointe,…
Objective. This study aimed to identify the socio-demographic characteristics, pattern of psychiatric disorders and management of children and adolescents before the setting up of a dedicated child and adolescent unit at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Method. A retrospective study, carried out at the ...
Aguiar, Inês Guerra; Barroso, Cláudia; Moreira, Filipa; Fonseca, Maria da Luz; Mendes, Patrícia; Pangaio, Nuno; Miranda, Vânia; Fernandes, Graça
Introdução:A Consulta da Primeira Infância do Departamento de Pedopsiquiatria do Centro Hospitalar do Porto foi criada em 2007. Pretendemos caracterizar as crianças observadas em primeiras consultas entre Junho de 2012 e Junho de 2013. Métodos:Consulta de processos e recolha de dados sociodemográficos e clínicos; avaliação diagnóstica através da Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood: Revised Edition; análise estatística com SPS...
Full Text Available Alexandre Andrade LochLaboratory of Neurosciences, Department and Institute of Psychiatry, University of São Paulo, BrazilAbstract: Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue.Keywords: suicide, stigma, rehabilitation, relapse, rehospitalisation
While some countries like Belgium chose a penal system clearly inspired by social-defense theories for mentally disturbed criminals, the French law hasn't been consistent and varies from the enlightened classical law and social-defense law. Indeed paragraph 1 of article 122-1 states that people whose discernment or control is abolished by a psychiatric disorder are non-responsible respecting the classical logic of law. On the other hand, Paragraph 2 of Article 122-1 allows the mentally ill to be judged responsible whereas no institution exists to take care about them. Then the system of psychiatric care in prisons present as a solution for professionals wishing to promote a system where people are punished and socially rehabilitated. Thus these forensic psychiatrists don't refer to paragraph 1 of article 122-1 and even people presenting serious mental disorders are considered responsible. Moreover, if a controversy has always existed between psychiatrists who argue a large conception of mental irresponsibility and professionals who defend the right to punish and to conclude that responsibility even for mentally disturbed criminals, the controversy becomes more important in French forensic psychiatry after the Second World War. If until the 1970s the practice of imposing responsibility for mentally ill individuals shows itself as a humanism, it occurs more within a security perspective today. © 2013.
Full Text Available Objective: To study the prescribing pattern of antipsychotic drugs in the outpatient department of psychiatry in Silchar Medical College and Hospital (SMCH of Assam. Methods: It is a prospective cross-sectional study which was carried out for three months from August to November 2015 in the outpatient department of psychiatry. All patients irrespective of their ages and sexes were included in this study. Inpatients, referred patients, patients not willing to give consent, patients of epilepsy as well as those cases where diagnoses were not certain were excluded from the study. The prescription patterns of antipsychotic drugs and the occurrences of various psychiatric diseases on both the sexes were studied after taking permission from the Institutional Ethical Committee (SMCH. Results: A total of 112 prescriptions were analysed. The most common disease was found to be schizophrenia. Total drugs prescribed were 265 and average number of drugs per prescription was 2.36. It was seen that out of the 112 prescriptions, monotherapy was practiced in 19.64% (22 compared to polytherapy in 80.35% (90. Out of 265 prescribed drugs atypical antipsychotics were 112 (42.26%, typical antipsychotics 12 (4.52%, antiepileptics 57 (21.50%, antidepressants 29 (10.94%, antiparkinsonian 29 (10.94%, and others 26 (9.81%. Antipsychotics given orally were 122 of which olanzapine was 54 (44.26%, risperidone 40 (32.78%, chlorpromazine ten (8.19%, quetiapine eight (6.55%, aripiprazole five (4.09%, amisulpiride five (4.09% were seen. Injectable antipsychotics were two, of which only haloperidol two (100%. Antipsychotics in combination prescription with same groups were 14 (12.5%, with antidepressants, antipileptics, antiparkinsonian were 88 (78.57% and other agents were ten (8.92%, which included pantoprazole, multivitamins, and benfotiamine. Conclusion: This study shows that atypical antipsychotics are the most common drugs prescribed in patients with psychotic illness and
Full Text Available ... training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry Pain medicine Psychosomatic (mind and body) medicine ...
Full Text Available ... certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry Pain medicine Psychosomatic (mind and body) medicine Sleep medicine Some ...
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weight loss in morbidly obeses patients undergoing bariatric surgery. Obes Surg. 2002; 12: 835-40. 11. World Health Organisation. The ICD-10 Classification of Mental and. Behavioural Disorders. Clinical descriptions and diagnostic guidelines. The clinical relevance of weight in psychiatry varies. It may be:- I. an associated ...
Peters, Timothy J; Willis, Clive
Contemporary accounts credit Dr Francis Willis (1718-1807) with facilitating the recovery of King George III from his major episode of acute mania in 1788-9. Subsequently Willis was summoned to Lisbon to advise on the mental health problems of Queen Maria I. This article reports the nature of the illnesses of Maria and her two similarly affected sisters, and uses the program OPCRIT to propose diagnoses of major depressive disorders. The high prevalence of consanguinity and insanity among the Portuguese monarchy and their antecedents probably contributed to their mental health problems. The successive contributions of the Willis family from Thomas Willis (1621-75) to his grand-nephew, Francis Willis (1792-1859), are reviewed; the popular image is somewhat inaccurate and does not highlight their part in the development of psychiatry.
Bourgeois, M; Bénézech, M; Tournier-Zerbid, N; Constant-Boy, M; Benazet-Rissou, J
Cytogenetic survey of 257 mentally retarded individuals. A cytogenetic inquiry was undertaken among 257 patients with mental retardation of two psychiatric hospitals. 25 patients show chromosomes anomalies (10%). We found: --18 trisomy 21 (Down's syndrome); --3 sexual chromosome anomalies: 47, XYY syndrome; 47, XYY/46, XY mosaïcism; 47, XXY, or Klinefelter syndrom; --1 partial delection of long arm of chromosome number 18 (46, XX, 18 q--); --3 translocations; 45, XX, t (1, 13) (p 36, q 11); 46, XX, t (5 p--, 18 p+) (p 12, p 11); 46, XY, t (9, 19) (q 21, p 18). We also found 9 large Y chromosomes (46, XY q+), 8 cases of variant chromosomes, 1 case with chromosomes associations..., we report a case of masculine Turner phenotype or Noonan syndrom.
The Helen Joseph Hospital, a government regional hospital in Johannesburg, South Africa, became aware of patient non-adherence issues at their specialist psychiatric outpatient department. In partnership with the South African Depression and Anxiety Group (SADAG), Africa's largest support network and advocacy group for people affected by mental health problems, and sponsored by Janssen Pharmaceuticals, they aimed to address the issue of non-adherence by developing and implementing a Reminder and Support Adherence Programme (RSAP). By providing a comprehensive service that regularly reminds patients to take their medication, attend their clinic appointments, offers free health information and psychosocial support, this has allowed many patients to benefit from the programme's ability to address the range of problems related to non-adherence.
Ayano, Getnet; Duko, Bereket
Relapse and hospital admission are common among, and carry a heavy burden in, patients with schizophrenia and bipolar disorder. The aim of this study was to assess the risk of relapse and hospitalizations in patients with schizophrenia and bipolar disorder at the St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. A hospital-based comparative cross-sectional study was conducted in June 2016. Systematic random sampling technique was used to recruit 521 (260 schizophrenia cases and 261 bipolar disorder cases) study participants. Face-to-face interviews were conducted by trained psychiatry professionals. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria and Structured Clinical Interview of DSM-IV (SCID) were used. The risk of relapse and hospitalizations was slightly higher in patients with bipolar disorder than in patients with schizophrenia. A majority of schizophrenic (213 [81.92%]) and bipolar (215 [82.37%]) patients had a history of hospital admission, and 228 (87.69%) schizophrenic and 230 (88.12%) bipolar patients had a history of relapse. Patients who had a history of hospitalizations also had co-occurring substance use disorders compared to those who had no history of hospitalizations for schizophrenia (81.5% vs 37.9%) and bipolar disorder (82.56% vs 38.2%), respectively. Similarly, those patients who had a history of relapse had high comorbid substance use disorders than those who had no history of relapse for both schizophrenia (87.88% vs 47.37%) and bipolar disorder (88.37% vs 47.19%), respectively. It is vital that, in the local context, mental health professionals strengthen their therapeutic relationships with patients and their caregivers. This might enable patients and their caregivers to express their needs and concerns to them, as well as help to plan proper interventions for patients. Attention needs to be given to screening for comorbid substance use disorders in patients with
Fernández-Egea, E; Ferrer del Alamo, A; Torrebadell Burriel, M; Carrió Ybáñez, A
Psychotic syndromes secondary to genomic disorders have low prevalence and may easily go unnoticed in the daily clinical practice. The velo-cardio-facial syndrome or DiGeorge syndrome (VCFS/DGS) is the genomic disorder most frequently associated to an interstitial deletion of the 22q11 region, with an incidence of one per every 4,000 newborns. Clinical manifestations constitute a constellation of cardiac, facial, urogenital and psychiatric disorders, among which schizophrenia or schizophreniform disorder stand out with an incidence of about 30% over the lifetime. In the following, we present the case of a 21 year old female patient who was admitted to the hematology service of our hospital due to pancytopenia secondary to metimazole, who had non-specified psychiatric background and who received antipsychotic treatment.
César Augusto Trinta Weber
Full Text Available Summary Introduction: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. Objective: To discuss the guidelines of care in mental health day hospitals (MHDH in contrast to type III psychosocial care centers (CAPS III. Method: Review of mental health legislation from 1990 to 2014. Results: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. Conclusion: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.
Schwartz, Richard H; O'Laughlen, Mary C; Kim, Joshua
There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. A survey was sent to 151 CAP and DBP training directors in the United States. The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. There is support for advanced training for NPs, but funding is needed to make this a reality. Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents. ©2017 American Association of Nurse Practitioners.
Silveira, Celeste; Norton, Andreia; Brandão, Isabel; Roma-Torres, António
The mental health of college students has been raising major awareness, due to the increased prevalence and severity of psychiatric disorders in this population. Higher education is associated with significant stressors that contribute to the development of mental health disturbances, and most college students are in the high-risk age group for the emergence of symptoms of major psychiatric disorders. Early diagnosis and treatment of these disorders in college students are important areas of effort, since they pose a high impact at the educational, economic, and social levels. Thus, specifically planned mental health services play a major role in the management of this population, should be specialized and have easy accessibility. The purpose of this study is to describe and characterize the College Students' psychiatric outpatient clinic of the Department of Psychiatry, Hospital de São João.
Thalitaya, Madhusudan Deepak; Reynolds, Claire
out at induction, followed by an electronic document. 8 trainees were interested in attending clinical sessions in ID and most felt it would be feasible in their posts to get to these. This survey shows that Junior Doctors from different training programmes rate their knowledge of ID psychiatry to be low. This has implications during their rotation in a mental health trust as they are expected to cover an ID ward whilst on call, but also going forward in their careers as all specialties will encounter patients with ID. It is known that awareness of patients with ID is lacking in many healthcare professionals and we know that people with ID are living longer, however continue to have worse health than the general population. The results show trainees would like more education on ID and would be interested in attending clinical sessions in ID psychiatry. The results will enable clinicians in ID services how best to improve the local induction experience for trainees. It also will guide how to educate colleagues outside of the specialty to improve their practice with people with ID, which will improve standards in the quality of care people with ID receive from doctors who treat them.
Religious method of treatment dominated treatments of psychiatric patients until the start of twentieth century. After psychiatry was recognized as a distinct medical discipline, in nineteenth century, it begun to shift away from religious approach to the treatment of mentally ill persons. During the twentieth century, it was enriched using psychotherapy, socio-therapy and biological methods of treatment, and completely secularized. The renaissance of religion and religious influence on secular events in the beginning of 21th century and postsecular atmosphere has launched a process of desecularization of psychiatry. It can best be seen through the changes in attitude towards spiritual and religious in the process of patients' evaluation, quality of life assessment, respect for the spiritual needs of patients in the process of clinical treatment, and objective consideration of the phenomenon of religiosity by psychiatrists and other mental health professionals. Without the ambition to precisely explain and define this notion, the basic sketch of what a postsecular psychiatry is and what it is not will be outlined in this paper. The goal is to open a professional debate over the issue, which would contribute that psychiatry, despite the ongoing challenges and provocations, maintains its essence as a medical discipline and adequately respond to all the needs of its patients, including those related to spirituality and religion. Overcoming rigid secular framework, psychiatry becomes more human and more close to human. In this way, psychiatry does not lose its "scientific component" because the effects of spirituality, beliefs or religious practices on mental health can be scientifically investigated without crossing the boundaries between the natural and spiritual sciences. Although people often consider that science and religion contradict each other, these are by their very nature convergently moving towards the meeting point even if it is located at infinity.
Doupnik, Stephanie K; Henry, M Katherine; Bae, Hanah; Litman, Jessica; Turner, Shanarra; Scharko, Alexander M; Feudtner, Chris
Children and adolescents necessitating hospitalization for physical health conditions are at high risk for mental health conditions; however, the prevalence of mental health conditions and symptoms among hospitalized children and adolescents is uncertain. The objective of this study was to determine the proportion of hospitalized children and adolescents who have diagnosed mental health disorders or undiagnosed mental health problems. In this single-center point prevalence study of hospitalized children between the ages of 4 and 21 years, patients or their parents reported known mental health diagnoses and use of services using the Services Assessment for Children and Adolescent, and they reported patient mental health symptoms using the Pediatric Symptom Checklist, 17-item form (PSC-17). Of 229 eligible patients, 119 agreed to participate. Demographic characteristics of patients who enrolled were not statistically significantly different from those of patients who declined to participate. Among participants, 26% (95% confidence interval [CI], 18%-35%) reported a known mental health diagnosis. On the PSC-17, 29% (95% CI, 21%-38%) of participants had a positive screen for mental health symptoms. Of those with a positive screen, 38% (95% CI, 21%-55%) had no known mental health diagnosis, and 26% (95% CI, 12%-43%) had not received ambulatory mental health services in the 12 months before hospitalization. Mental health conditions and symptoms are common among patients hospitalized in a tertiary children's hospital, and many affected patients are not receiving ambulatory mental health services. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Vivekanantham, Sayinthen; Strawbridge, Rebecca; Rampuri, Riaz; Ragunathan, Thivvia; Young, Allan H
There is an established disparity between physical and mental healthcare. Parity of research outputs has not been assessed internationally across influential medical journals. To assess parity of publication between physical and mental health, and within psychiatry. Four major medical disciplines were identified and their relative burden estimated. All publications from the highest-impact general medical journals in 2001, 2006 and 2011 were categorised accordingly. The frequency of psychiatry, cardiology, oncology and respiratory medicine articles were compared with the expected proportion (given illness burdens). Six subspecialties within psychiatry were also compared. Psychiatry was consistently and substantially underrepresented; other specialties were overrepresented. Dementia and psychosis demonstrated overrepresentation, with addiction and anxiety disorders represented proportionately and other disorders underrepresented. The underrepresentation of mood disorders increased more recently. There appears to be an important element of disparity of esteem; further action is required to achieve equivalence between mental and physical health research publications. © The Royal College of Psychiatrists 2016.
Pedrosa Gil, F; Luderer, H J
Since the 1980's psychiatric care in Spain changed considerably (Reforma psiquiátrica española). In the course of this reform, many positive results were achieved. An extensive community network of mental health centres was build up which resulted in the majority of psychiatric patients being integrated in the Spanish general health care system and making a better organized mental health care structure possible. New legislation also improved the care and civil rights of patients. An analysis of the experiences of the Spanish psychiatric reform shows that the tendency to retain the old mental hospitals, alongside the other institutions still exists. The process of deinstitutionalization and the original aims of the psychiatric reform cannot only be satisfied by the closure of large psychiatric hospitals as during the reform new aspects and problems as well the great complexity of the task have become apparent. This article together with the details of the Spanish sources gives the German public a good overview of the developments in Spanish psychiatry.
Hankir, Ahmed; Brothwood, Phillipa; Crocker, Bethany; Lim, Mao Fong; Lever, Isabel; Carrick, Frederick; Zaman, Rashid; Jones, Charlotte Wilson
On the 9th October 2000, Dr Daksha Emson, a London based psychiatrist with bipolar affective disorder, tragically killed herself and her three-month-old baby daughter during a psychotic episode. An independent inquiry into Dr Emson's death concluded that mental health stigma in the National Health Service was a factor that contributed to her death. Despite the morbidity and mortality attributed to the stigma attached to post-natal mental health problems there are very few programmes that have been developed to challenge it. King's College London Undergraduate Psychiatry Society organized an event entitled, 'A Labour of Love': Perinatal Mental Health to address this issue. The event included a talk from an expert by experience, a mother who developed post-partum mental health problems. We conducted a single-arm, pre-post comparison study on participants who attended the KCL Psych Soc event. Validated stigma scales on knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviour (Reported and Intended Behaviour Scale (RIBS)) were administered before and immediately after exposure to the event. 27/27 (100%) of participants recruited responded. There was a statistically significant difference in the pre-MAKS score compared to the post-MAKS score (p=0.0003), the pre-RIBS score compared to the post-RIBS score (p=0.0068) and in the pre-CAMI score compared to the post-CAMI score (p=0.0042). There were statistically significant reductions in stigma in the domains of knowledge, attitude and behavior following exposure to the KCL Psych Soc event and no adverse effects were reported. Our study revealed that a brief intervention made a highly significant impact and maybe useful in challenging the stigma around post-natal mental illness. However, more research in this area is required to determine if the changes are sustained before we can consider rolling out and scaling up such an initiative nationally and
Appleton, A; Singh, S; Eady, N; Buszewicz, M
There is no consensus regarding the optimal content of the undergraduate psychiatry curriculum as well as factors contributing to young doctors choosing a career in psychiatry. Our aim was to explore factors which had influenced psychiatry trainees' attitudes towards mental health and career choice. Qualitative in-depth interviews with 21 purposively sampled London psychiatry trainees analysed using the Framework method. Early exposure and sufficient time in undergraduate psychiatry placements were important in influencing psychiatry as a career choice and positive role models were often very influential. Integration of psychiatry with teaching about physical health was viewed positively, although concerns were raised about the potential dilution of psychiatry teaching. Foundation posts in psychiatry were very valuable in positively impacting career choice. Other suggestions included raising awareness at secondary school level, challenging negative attitudes amongst all medical educators, and promoting integration within medical specialties. Improvements in teaching psychiatry could improve medical attitudes and promote recruitment into psychiatry.
Full Text Available ... training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry ... World Psychiatric Association American Association of Child and Adolescent Psychiatry American Association of Community Psychiatrists American Association ...
Full Text Available ... general psychiatry training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry ... More Resources World Psychiatric Association American Association of Child and Adolescent Psychiatry American Association of Community Psychiatrists ...
Full Text Available ... may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry Pain medicine ... American Association of Community Psychiatrists American Association for Geriatric Psychiatry Academy of Psychosomatic Medicine American Academy of ...
have an important role in crosscultural diagnosis, psychiatric disorders relating to social deprivation, rehabilitation and enabling social inclusion. The degree to which society is willing to accept people with mental health problems has an obvious impact on their quality of life. We live in a period of cataclysmic social changes with disastrous wars, increased poverty and growing income inequality. The consequences on mental health are phenomenal with epidemics of self-harm and suicidality, higher rates of depression, and intensifying diagnosis of mood and conduct disorders in children and young adults. Other adversities include the disproportional number of people with mental health problems in prisons and penal institutions, the massive escalation of dementia sufferers and the shortcomings of the aspirations of community mental health care. In addition, there is an escalating social pathology with significant numbers of refugees and asylum seekers and rising numbers of homeless particularly in urban areas of the developed world. We should not, however, overlook the better rates of treatment for mental health problems, the emphasis on human rights, the empowerment and the service users' participation and the development in global mental health. All these social factors are important to contemporary psychiatry presenting complex challenges and demanding urgent attention and action.6 There is a need to embrace the development of evidence-based mental health services and a pluralistic approach, which balances appropriately the relevance of biological, psychological and social factors associated with mental health problems. The concept Meta-Community mental health builds on the successes of biological, psychological, social and community psychiatry.7 It incorporates neurosciences, sociology, psychology and anthropology and is delivered wherever the evidence shows that it makes a difference, whether in community or hospital, prisons, schools, court-room, place of work
Geller, J L
The author reviewed the history of American psychiatry for the first 150 years of the American Psychiatric Association's existence (1844-1994) as reflected in remarks of the association's presidents. Presidential addresses or remarks from alternative sources were located for the 120 presidents who served the association between 1844 and 1994. The presidents' remarks on six topics-psychiatric practice, etiology of mental illness, public mental hospitals, alternatives to state hospitals (deinstitutionalization), biologic treatments, and fiscal issues were sampled and arranged chronologically. American psychiatry's history--its innovations, cyclical repetitions, and self-assessments-can be gleaned from this form of data. The presidents' remarks appear to refute the claim that organized American psychiatry has been negligent in criticizing itself.
Rojas-Malpica, Carlos; Portilla-Geada, Néstor de la; Téllez Pacheco, Pedro
Reception of Psychiatry in Venezuela since the 19th Century to the late 20th Century merits a historical approach. The following work proposes to research some of the very origins of Venezuelan psychiatry and its possible influence on contemporary mental health practice. Through documental research, the early works of local authors from the 19th Century through 20th Century finals: Carlos Arvelo, Lisandro Alvarado, Francisco Herrera Luque, Jose Luis Vethencourt and Jose Solanes, are subjected to study. This journey illustrates a descriptive panoramic view which allows to better comprenhend the current state of our psychiatry. In a brief introduction the most important events are described, since the arrival of Pinel's ideas, followed by the early research paperworks published and the beginnings of the academic teachings of this specialty in Venezuela and displaying the main contemporary research groups thorough the country.
On insanity, life crises and the longing for a "right life". A contribution to the discussion on the deviant behavior and mental disorders in the psychiatry of the 19th and 20th centuries using the example of patient stories. History of psychiatry, understood as social and cultural history, provides the framework for this micro-historical article. Using the example of three patients treated in Wuerttemberg or Baden psychiatric asylums between 1875 and 1912, the article focuses on the critical analysis of types of asylums, their practices of admissions, therapies and power relations between patients and staff. Ways of thinking and acting, subjective experiences and emotions are exemplified by patient records, personal testimonials and contemporary publications again by patients and staff. The article examines options of patients to influence the institutional daily asylum routine against the background of its complexity and dynamics. Borders, manipulations, malingering and querulous paranoia are at stake here. Furthermore, the article reflects various forms of social interaction with the power regulating therapeutic and disciplinary aspects against the backdrop of the "canons of rules" of the asylum as well as the contemporary political and legal framework.
Livingston, James D.; Nijdam-Jones, Alicia; Brink, Johann
Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers’ perceptions of safety is needed. PMID:22815648
Full Text Available Actuellement au Québec, les hôpitaux de jour en psychiatrie sont des milieux de jour offrant un programme thérapeutique intensif de courte durée, principalement dans un contexte d'activités de groupe. Alors que les hôpitaux de jour sont des acteurs qui font partie intégrante du système de soins en santé mentale depuis plusieurs décennies, la question de leur rôle et de leur contribution spécifique dans le champ des approches et des pratiques de traitement et pour les personnes qu'ils rejoignent est rarement posée. Cet article s'articule autour de l'hypothèse selon laquelle les repères et les cadres actuellement dominants dans le champ de la psychiatrie et de la santé mentale permettent mal de dégager et de prendre en compte certains des paramètres dont il faut tenir compte pour parvenir à préciser et à situer le rôle et la contribution des hôpitaux de jour, dans le système de soin comme pour les personnes auxquelles ces milieux de pratique s'adressent. À partir des résultats préliminaires d'une étude exploratoire poursuivie dans quatre hôpitaux de jour où différents acteurs ont été rencontrés lors d'entrevues (personnes utilisatrices, intervenants, gestionnaires, cet article propose de dégager quelques pistes d'analyse et de réflexion.
Marková, Ivana S; Berrios, German E
In historical and epistemological terms, psychiatry is a new discipline born during the 19th century. Rooted in both the natural and social sciences, psychiatric objects of inquiry, namely mental symptoms and mental disorders, are hybrid, constituted by the blending of components arising from disparate sources of knowledge ranging from the biological to the semantic in its widest sense. This poses problems for psychiatric research and therapy. Whilst conventional pluralism may be a convenient approach to manage aspects of psychiatric practice, it lacks the capacity to analyse psychiatric objects in their entirety. For the latter, psychiatry demands a new, tailored regional epistemology. This paper outlines the main features of an epistemology specific to the needs of psychiatry. It highlights the relational approach that needs to be taken and illustrates the usefulness of this approach by analysing the structure of psychiatric objects, exploring the manner in which they may be inscribed in the brain, and identifying the need to periodically recalibrate the language of psychiatry. Copyright © 2012 S. Karger AG, Basel.
Andersen, Lise Marie
The view that psychiatry should be elucidating the mechanisms behind mental phenomena is gaining momentum. This view, coupled with an intuition that such mechanisms must, by nature, be biological, has inspired the field to look to cognitive neuroscience for classification of mental illnesses. One...
Doença mental e periculosidade criminal na psiquiatria contemporânea: estratégias discursivas e modelos etiológicos Mental illness and criminal dangerousness in contemporary psychiatry: discursive strategies and etiological models
Myriam Raquel Mitjavila
Full Text Available O artigo analisa algumas dimensões socioculturais do campo semântico e dos modos de estruturação dos discursos da psiquiatria forense em torno da periculosidade criminal e de suas conexões com a saúde mental. A partir dos resultados de uma pesquisa baseada na análise de conteúdo de uma amostra de manuais e livros de psiquiatria forense, examinaram-se alguns significados e formas de enunciação da noção de periculosidade criminal, bem como as principais estratégias interpretativas que organizam os modelos etiológicos da criminalidade predominantes nessa área.This paper analyzes some socio-cultural dimensions of the semantic field and ways of structuring forensic psychiatry discourses in relation to the criminal dangerousness and its connections with mental health. From the results of a research based on content analysis of several handbooks and books in forensic psychiatry, it was possible to examine some meanings and forms of enunciation about the concept of criminal dangerousness as well as the main interpretive strategies that organize the etiological models of criminality prevailing in this area.
Elisa Ansoleaga M
Full Text Available There is growing evidence on the association between exposure to psychosocial risk at work and adverse health outcomes. Objective: to describe and analyze the presence of psychosocial risks at work and mental health symptoms in non-clinical workers from a public hospital. Methods: a crosssectional study was conducted at a public hospital in Santiago (Chile. A self-administered questionnaire was applied to assess exposure to psychosocial risks (demand-control and effort-reward imbalance models. The outcome variables were depression symptoms, anxiety symptoms, and psychotropic drug consumption. The analysis was descriptive and associative (Fisher’s exact test Results: 47% of the workers showed high psychological demands, 46% low autonomy, 61% low social support and 75% imbalance between effort expended and rewards received. The prevalence of depressive and anxious symptoms in the total sample was 10% and 30% respectively, while 25% reported having used psychotropic drugs. The consumption of psychotropic drugs was significantly higher (p < 0.05 among those with low social support and effort-reward imbalance. Discussion: the consumption of psychotropic drugs was associated with low social support and imbalance between efforts expended and rewards received. This might have implications in the workers’ health and performance; therefore, further research is required, particularly on this kind of population, to understand this relationship and thus develop prevention programs in this regard.
Jakovljević, Miro; Tomić, Zoran; Maslov, Boris; Skoko, Iko
The mass media has a powerful impact on public attitudes about mental health and psychiatry. The question of identity of psychiatry as a medical profession as well as of the future of psychiatry has been the subject of much controversial discussion. Psychiatry today has the historical opportunity to shape the future of mental health care, medicine and society. It has gained in scientific and professional status by the tremendous increase of knowledge and treatment skills. Psychiatry should build up new transdisciplinary and integrative image of a specialized profession, promote it and make it public. Good public relations are very important for the future of psychiatry.
Thomsen, Christoffer Torgaard; Benros, Michael Eriksen; Hastrup, Lene Halling
INTRODUCTION: Patient-controlled hospital admission for individuals with severe mental disorders is a novel approach in mental healthcare. Patients can admit themselves to a hospital unit for a short stay without being assessed by a psychiatrist or contacting the emergency department. Previous...
Full Text Available ... of Community Psychiatrists American Association for Geriatric Psychiatry Academy of Psychosomatic Medicine American Academy of Addiction Psychiatry American Association for Emergency Psychiatry ...
Jeste, Dilip V; Palmer, Barton W; Rettew, David C; Boardman, Samantha
Traditionally, psychiatry has been defined and practiced as a branch of medicine focused on the diagnosis and treatment of mental illnesses. Based on growing empirical evidence, we believe that this definition warrants expansion to include the concept of positive psychiatry. In the present article, we provide a critical overview of this emerging field and a select review of relevant scientific literature. Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions involving positive psychosocial characteristics (PPCs) in people who suffer from or are at high risk of developing mental or physical illnesses. It can also benefit nonclinical populations. Positive psychiatry has 4 main components: (1) positive mental health outcomes (eg, well-being), (2) PPCs that comprise psychological traits (resilience, optimism, personal mastery and coping self-efficacy, social engagement, spirituality and religiosity, and wisdom-including compassion) and environmental factors (family dynamics, social support, and other environmental determinants of overall health), (3) biology of positive psychiatry constructs, and (4) positive psychiatry interventions including preventive ones. There are promising empirical data to suggest that positive traits may be improved through psychosocial and biological interventions. As a branch of medicine rooted in biology, psychiatry, especially with the proposed conceptualization of positive psychiatry, is well poised to provide major contributions to the positive mental health movement, thereby impacting the overall health care of the population. © Copyright 2015 Physicians Postgraduate Press, Inc.
This article examines contemporary Ukrainian psychiatry through the voices of patients, practitioners, and advocates, focusing on shifting objects of knowledge, interventions, and institutional transitions. Currently, we are witnessing the reconfiguration of psychiatry on a global scale through neoliberal rhetoric combined with the call for global mental health. The goal of the movement for global mental health is to scale up psychiatric treatments through greater access to psychiatric drugs, justified through the framing of distress as an illness. Neoliberal rhetoric suggests that cutting social service expenditure through the privatization and decentralization of the health care system will stimulate economic growth and, in the long term, combat poverty. This paper traces how these dynamics are playing out in Ukraine, drawing on ethnographic fieldwork conducted at a psychiatric hospital in south-central Ukraine from 2008-2010, while working with a non-governmental organization. © The Author(s) 2016.
Wu, Qiuxia; Luo, Xiaoyang; Chen, Shubao; Qi, Chang; Long, Jiang; Xiong, Yifan; Liao, Yanhui; Liu, Tieqiao
Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals' conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis. In 2014-2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured. Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse. The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals' mental health knowledge in mainland China in order to provide better support for mental health service users.
Barocka, A. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany)); Feistel, H. (Nuklearmedizinische Klinik, Erlangen (Germany)); Ebert, D. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany)); Lungershausen, E. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany))
This review presents Single Photon Emission Computed Tomography (SPECT) as a powerful tool for clinical use and research in psychiatry. Its focus is on regional cerebral blood flow, measured with technetium labelled HMPAO. In addition, first results with brain receptor imaging, concerning dopamin-D[sub 2] and benzodiazepine receptors, are covered. Due to major improvements in image quality, and impressive number of results has been accumulated in the past three years. The authors caution against using SPECT results as markers for disease entities. A finding like 'hypofrontality' is considered typical of a variety of mental disorders. Clearly both, more experience with SPECT and contributions from psychopathology, are needed. (orig.)
Full Text Available Objective: The aim of this study was to access the clinico-psycho-social profile of patients brought under consultation-liaison (CL psychiatry care in a large tertiary care referral hospital. Materials and Methods: This study included all patients who were referred for CL psychiatry from among the inpatients in the hospital and the emergency department (during off working hours of the hospital over a period of 1 year. Data were obtained and analyzed in terms of where was the referral placed, by whom, the reason for placing the referral, the primary medical/surgical diagnosis of the patient, the presenting complaints, any past psychiatric history, the psychiatric diagnosis (as per the International Classification of Diseases, Tenth Edition, the investigations advised and their reports, the treatment advised (psychotherapeutic and psychopharmacological, the sociodemographic profile of the patients, and the follow-up details. Results: A total of 157 patients were referred to the CL unit over the study period. Out of these, 125 patients were referred among the inpatients and 32 from the emergency department of the hospital. Majority of the patients were in the age group of 25–50 years and were male. The majority of the referrals were made by general physician; most of the referrals were placed from emergency department. The most common reason for referral was for altered sensorium and behavioral abnormalities. The most common diagnosis was delirium followed by depressive episode and alcohol dependence syndrome. Conclusion: There was higher representation of delirium and alcohol-related cases in our study compared to older studies.
Dutch child- and adolescent psychiatry (cap) is going through a complex phase now that the Youth Law has decreed that cap is to be placed under control of the municipality (i.e. local government) instead of the national government. To explain and discuss this development from a historical perspective. Information was obtained from historical sources. The municipality, i.e. local government, has played an important role in parts of youth mental health since the beginning of the 20th century. In the 1980s, however, governance was transferred to the national government, only to be passed back to the municipality in the early years of the 21st century. The level of governance, be it local or national, can bring both advantages and disadvantages to the youth mental health services. Up till now there have been several transfers from one level of governance to the other. It would be better if the two levels of governance were combined and the various parts controlled by a combination of the most appropriate types of governance.
Non-mental health workers' attitudes and social distance towards people with mental illness in a. Nigerian teaching hospital. Olatunji F. Ainaa, O. Yewande Oshodia, Adebayo R. Erinfolamia, Joseph D. Adeyemia, and Tajudeen. F Suleimanb a Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, ...
attitude to mental illness in. Ogun State, Nigeria. NC Aghukwa. Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria. Abstract. Objective: Teachers as role models stand in a unique position in the formation of their pupils' set values about mental health issues. The aim of this study ...
Wahlström, Lars; Blomdahl-Wetterholm, Margareta
The mental health needs of patients receiving physical health care often remain undiagnosed and untreated, resulting in significant costs to the health care system. However, some countries have recently seen fast progress with the development of consultation liaison psychiatry. In Sweden, this service has developed quite slowly, but a breakthrough may be imminent. There is evidence that providing better support for co-morbid health problems may improve the psychological quality of care and reduce physical health care costs in acute hospitals. Consultation liaison psychiatry fits well with the current trends of value-based health care, personalized care, and an emphasis on networking in care.
Ditton-Phare, Philippa; Halpin, Sean; Sandhu, Harsimrat; Kelly, Brian; Vamos, Marina; Outram, Sue; Bylund, Carma L; Levin, Tomer; Kissane, David; Cohen, Martin; Loughland, Carmel
Mental health clinicians can experience problems communicating distressing diagnostic information to patients and their families, especially about severe mental illnesses such as schizophrenia. Evidence suggests that interpersonal communication skills can be effectively taught, as has been demonstrated in the specialty of oncology. However, very little literature exists with respect to interpersonal communication skills training for psychiatry. This paper provides an overview of the communication skills training literature. The report reveals significant gaps exist and highlights the need for advanced communication skills training for mental health clinicians, particularly about communicating a diagnosis and/or prognosis of schizophrenia. A new communication skills training framework for psychiatry is described, based on that used in oncology as a model. This model promotes applied skills and processes that are easily adapted for use in psychiatry, providing an effective platform for the development of similar training programs for psychiatric clinical practice. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Full Text Available ... training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry Pain medicine Psychosomatic (mind and body) medicine Sleep medicine Some ...
Full Text Available ... certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry Pain medicine Psychosomatic (mind ... has an advanced degree, most commonly in clinical psychology, and often has extensive training in research or ...
Full Text Available ... training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry Addiction psychiatry Pain medicine Psychosomatic (mind and body) medicine Sleep medicine Some psychiatrists choose additional training in psychoanalysis ...
Full Text Available ... seem to lift or problems functioning, causing everyday life to feel distorted or out of control. Diagnosing ... general psychiatry training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry ...
Full Text Available ... general psychiatry training. They may become certified in: Child and adolescent psychiatry Geriatric psychiatry Forensic (legal) psychiatry ... maintain private practices and many psychiatrists work in multiple settings. There are about 45,000 psychiatrists in ...
Castro-Camacho, Leonidas; Escobar, Juan Manuel; Sáenz-Moncaleano, Camilo; Delgado-Barrera, Lucía; Aparicio-Turbay, Soraya; Molano, Juan Carlos; Noguera, Efraín
Few individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. Detection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). Cross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. 1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. The usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Full Text Available In psychiatry there is a traditional categorical conception stating that several disorders like schizophrenia and bipolar disorder have distinct etiologies. On the other hand, dimensional approach claims that these entities are actually the same disorder reflecting different clinical aspects of same mental disorder in the course of time. ICD and DSM classifications are based on separate categories of different mental disorders. Howewer, it is quite difficult to consider a mental disorder as a discrete entity that has absolute boundaries from other disorders. There are patients manifesting symptoms of two or more categories but do not fulfill all diagnostic criteria for any mental disorder. Dimensional approach handles the psychopathology as a continuing process and establish the patients to the different ongoing points. According to this view, in fact, multiple diagnosis reflect dimensions of the same disease.
Jones, N; Fear, N T; Wessely, S; Thandi, G; Greenberg, N
This observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners. In-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses. Overall 74.8% (n=729) of personnel RTD on completion of care. Of those that underwent evacuation home (n=246), 69.1% (n=170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm. Deployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Full Text Available Abstract Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356 gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298. Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented
Full Text Available Tsegereda Waja,1 Jemal Ebrahim,2 Zegeye Yohannis,1 Asres Bedaso2 1Department of Psychiatry, Amanuel Mental Specialized Hospital, Addis Ababa, 2School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia Introduction: Alcohol use disorders represent one of the leading causes of preventable death, illness, and injury in many societies throughout the world. Heavy alcohol consumption has multiple negative consequences for people with epilepsy such as precipitation of seizure, exacerbation of seizure, poor seizure control, increased side effects of antiepileptic drugs, noncompliance to antiepileptic drugs, alcohol withdrawal seizures, long-term hospital admission, status epilepticus, sudden unexpected death, and premature mortality. Methods: An institution-based cross sectional study was conducted from April 15, 2014 to May 15, 2014 with the aim of assessing prevalence of alcohol use disorders and associated factors among people with epilepsy attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. A total of 413 randomly selected epileptic patients were included in this study. Data were structured using the 10-item Alcohol Use Disorders Identification questionnaire. Data were analyzed using SPSS Version 20. Bivariate and multivariate logistic regression analyses were performed to study the association, and variables with P-value <0.05 were considered as having a statistically significant association at 95% confidence interval. Results: A total of 423 study participants were selected, of whom 413 completely filled the questionnaire making the response rate 97.6%. The mean age of the respondents was 31.9 years with standard deviation of ±10.97, and 248 (60% were males. The prevalence of alcohol use disorder was 17.4%. Educational status (grade 9–12 (adjusted odds ratio [AOR] =3.25, [1.21, 8.69], not living with family members (AOR =1.89, [1.06, 3.39], availability of house (AOR
Renata Marques de Oliveira
Full Text Available Objective: To identify the opinion of patients with mental disorder about tobacco and its prohibition during psychiatric hospitalization. Method: An exploratory study with 96 patients smokers with mental disorders hospitalized in a psychiatric ward of a general hospital. The interviews were conducted individually, using an instrument designed for this study. The content from the interviews was recorded, transcribed and submitted to a thematic content analysis. Results: The patients with mental disorder were identified as perceiving smoking during the psychiatric hospitalization as a help to support the difficulties in socialization and in the lack of activities. The permission for smoking is seen as a signal of respect to their needs. The subjects mentioned to not accept the total smoking prohibition. Conclusion: Tobacco helps to face difficulties and conflicts in the psychiatric hospitalization. There is resistance regarding the possibility to totally withdraw the smoking permission during hospitalization.
Hannibal, Niels Jørgensen; Schwantes, Melody
The mentalization based treatment (MBT) model may be a valuable theoretical perspective for music therapists to consider using with clients in need of mental health care, particularly those with borderline personality disorder. This article explores some of the basic principles of MBT and its...... application to music therapy. We have included a case study and reflections for further consideration. It is our hope that music therapists will begin to incorporate this model within their treatment and care of clients with psychiatric disorders....
Perry, Lin; Lamont, Scott; Brunero, Scott; Gallagher, Robyn; Duffield, Christine
Background Nursing is an emotionally demanding profession and deficiencies in nurses? mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses? health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods A cross sectional survey design was used. The Registered and ...
The journal is the leading psychiatric journal of Africa. It provides open-access scholarly reading for psychiatrists, clinical psychologists and all with an interest in mental health. It carries empirical and conceptual research articles, reviews, editorials, and scientific letters related to psychiatry. It publishes work from various ...
Uchtenhagen, Ambros A.
Social psychiatry started over a century ago under the auspices of mental and racial hygiene, but after World War II it embraced concepts of community-based care and de-institutionalization. The major psychiatric reforms in the second half of the last century were mainly based on such concepts,
Case studies of deaf or hearing impaired persons in institutions for the mentally retarded illustrate the ways in which the "invisible handicap" can mask cognitive ability, causing unnecessary institutionalization. (CL)
Kim, Soung Nam; Lee, Kang Sook; Lee, Seon Young; Yu, Jae Hee; Hong, A Rum
The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.
Full Text Available Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain. To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units. Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.
Full Text Available The recent laws on mental health define psychiatric illness as a loss of consciousness and understanding of consequences of self-behavioral acts, evaluated by loss of discernment. As discernment represents the main criteria of responsibility towards personal actions, this study attempts at presenting the ethical issues related to discernment evaluation from the perspective of forensic medicine. We propose a "mint" representation of the content and consequences of one’s own actions as a new criteria of evaluation, taking into account the modern principles of psychology and psychiatry.
The psychiatry of the 21st century will have to be different from the psychiatry of the 20th century. The latter began its journey in a socially, compartmentalized world in which sharp categories and boundaries for the definition of mental illness were assumed to be relevant. International psychiatry completed its hegemonic hold over the territory of mental health and illness with a commanding home-stretch run of success borne in the confidence and optimism of its neurobiologic and culture free program and agenda. The world in which psychiatry now exists, however is changing rapidly and will continue to change and so of necessity will the practice of psychiatry need to change. This issue offers a guidelines and a vision of the direction that should be followed. Migration and transnational communication and awareness of cultural differences are changing the character of communities around the world. These changes considered in the context of world wide political economic factors are bringing into close physical and symbolic juxtaposition persons from distinct nations and ethnic groups. Clashes in world views, attitudes, spiritual orientation, and general philosophic and moral outlook are becoming ever-present realities of urban centers around the world. In traditional contexts and among persons who do not physically migrate, the power of communications media manages to psychologically migrate them; that is, to challenge their local, native cultural traditions about mental health with the scientific perspectives about mental health and illness. Advances in the social and cultural sciences have underscored ways in which assumptions of reductionism and universalism need to be chastened with an appreciation of human differences and humane considerations as these relate to mental health problems. The science of psychiatry of the 21st century will have to accomodate to this new creolized world of ethnic pluralism, cultural differences, and clashing perspectives between
Nejatisafa, Ali-Akbar; Shoar, Saeed; Kaviani, Hosein; Samimi-Ardestani, Mehdi; Shabani, Amir; Esmaeili, Sara; Moghaddam, Yasaman
Objective We aimed to compare the medical students’ attitude towards psychiatry before and after psychiatry clerkship, and to examine the association of choosing psychiatry as a future career with some personal characteristics. Method In a self-controlled, quasi-experimental study, all of the medical students entering the psychiatry clerkship in three major medical schools of Iran located in Tehran (Tehran, Shahid Beheshti, and Iran University of Medical Sciences) were asked to participate anonymously in the study on the first and the last 3-days of their psychiatry clerkship. From 346 invited 4th-5th year medical students, 225 (65%) completed anonymous self-report questionnaires before and after a 4-week psychiatry clerkship. Results Positive response to choose psychiatry as a career was seen in 13.3% and 18.3% before and after psychiatry rotation, respectively. However, the difference was not statistically significant; about one-quarter of the students were turned on to psychiatry and 25% were discouraged during the clerkship. Individual pair wise comparisons revealed significant improvements only in two out of 13 measured aspects of psychiatry. Seventeen out of 38 (47.7%) students who identified psychiatry as the career of choice or strong possibility reported that one of their family members or close friends’ mental illness had an impact on their choice. Those students who considered psychiatry as the strong possibility claimed that they are more interested in humanities (OR = 2.96; 95% CI: 1.17, 7.49), and playing a musical instrument (OR = 2.53; 95% CI: 1.15, 5.57). Conclusion It may be concluded that exposure to psychiatry clerkship could influence medical students’ opinion about psychiatry positively, or negatively. Personal characteristics and individual interests of students may play an important role in choosing psychiatry as their future career. PMID:23682250
Damjanović, Aleksandar; Vuković, Olivera; Jovanović, Aleksandar A; Jasović-Gasić, Miroslava
As one of the most potent and substantial form of mass communication, film exercises a very significant influence upon the perceptions of the audience, especially in relation to mental illness issues, and that perception is very much blurred with populists' misinterpretation and lack of awareness regarding problems faced by persons suffering from mental disorders. Movies such as "Psycho", "One Flew Over Cuckoo's Nest", "Exorcist", despite being valuable in an artistic sense, corroborated and encouraged confusion and undermined the clarity and certainty concerning the fine line separating mental health from mental illness. Modern film makers and movie theoreticians try to overcome these limitations which are often generated by exploitation of stereotypes and myths referring to mentally ill people. This paper defines and discusses the most frequent thematic stereotypes seen in movies which are perpetuating stigmatization of mentally ill people. They are: free-spirited rebel, maniac on a killing spree, seducer, enlightened member of society, narcissistic parasite, beastly person (stereotype of animal sort). Psychiatry and cinematography are linked inseparably not only because they creatively complement each other, but also as an opportunity of mutual influences blending into didactical categories and professional driving forces, benefiting both the filmmakers' and the psychiatrists' professions.
Gandré, Coralie; Gervaix, Jeanne; Thillard, Julien; Macé, Jean-Marc; Roelandt, Jean-Luc; Chevreul, Karine
International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients', psychiatric sectors' and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients' characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.
Full Text Available ... What Is Psychiatry? Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of ... written examination for a state license to practice medicine, and then complete four years of psychiatry residency. ...
Full Text Available ... Depression Posttraumatic Stress Disorder (PTSD) More What Is Psychiatry? Back to Patients & Families All Topics What Is Psychiatry? Psychiatry is the branch of medicine focused on ...
Goh, Anita M Y; Eagleton, Tamara; Kelleher, Rosemary; Yastrubetskaya, Olga; Taylor, Michael; Chiu, Edmond A M; Hamilton, Bridget; Trauer, Tom; Lautenschlager, Nicola T
Pastoral Care (PC) practitioners respond to the spiritual needs of patients and families of all spiritual orientations. The integrated PC service in an acute psychogeriatric inpatient ward at St Vincent's Aged Mental Health Service, Melbourne, Australia, was examined to investigate how PC was being accessed by inpatients. A retrospective medical record file audit was undertaken of patients admitted over a 16-month period from 1 February 2009 to 30 June 30 2010 (n = 202). Sixty-eight percent were seen by PC practitioners during their admission. Sixty-six percent received PC assessments, 32% received PC ministry, and 10% received PC ritual or worship interventions. Other interventions (counseling/education, crisis situation, grief/ bereavement counseling) occurred infrequently. Seventy-five percent of Roman Catholic patients received PC compared to 57% of those patients with no religious affiliation. However, the overall association between religious grouping and receiving PC was not significant. Gender, religion, marital status, legal status, country of birth, language spoken, living situation, carer needs, or educational level were not related to PC contact. Whether or not an inpatient received PC assessment was unrelated to diagnostic category. Patients seen by PC were significantly more likely to engage in religious practice, have longer length of stay, and have neuropsychological, social work and occupational therapy assessments. Results suggest that PC practitioners can help optimize the clinical care of patients by developing a comprehensive understanding of their spiritual and religious needs and providing a more holistic service. Copyright © 2012 Wiley Publishing Asia Pty Ltd.
Psychiatry and penology are responsible together for adequate therapy of mentally ill and disordered criminals. The increased security demands of current criminal policy on the penal and forensic hospital treatment have to be moderately counteracted. The considerable increase in deculpation according to Section 21 of the German Penal Code (StGB) during the past 30 years should be balanced by more limited application, especially regarding antisocial personality disorder, borderline personality disorder, and sexual identity disorder (paraphilia).
Full Text Available During the last half of the century the researchers have placed a great deal of importance on brain behavior relations. This has brought upon a huge body of knowledge but unfortunately at the cost of culture - the true roots of much of our behaviour. This general disregard of cultural factors has not only led to false generalizations but has also blocked the understanding of the real forces that motivate and shape our perceptions, attitudes, and actions. This paper is therefore an attempt to highlight the trajectory of transcultural psychiatry, right from the conceptions of its idea, through flaws in methodology, assessment, treatment and to its future and its limitations.
Pohl, Christine D
In many ancient cultures, hospitality was a significant moral and religious practice in responding to the needs of strangers. Although largely trivialized in contemporary society, the practice of hospitality continues to create contexts that contribute to individual and communal flourishing and that resist several dehumanizing social trends. A recovery of the practice can help faith communities connect their moral and theological commitments to the needs of children, families, and neighborhoods. © 2011 American Orthopsychiatric Association.
AWARD NUMBER: W81XWH-14-2-0160 TITLE: Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health , and...Decreases Hospital Stay, Improves Mental Health , and Physical Performance 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Oscar E. Suman, PhD...14-Sep-2018 The title of this project is “Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health and
Andlauer, Olivier; Guicherd, William; Haffen, Emmanuel; Sechter, Daniel; Bonin, Bernard; Seed, Kitty; Lydall, Gregory; Malik, Amit; Bhugra, Dinesh; Howard, Rob
There is a need to increase the recruitment to psychiatry in France. Our aim in this study was to compare factors influencing career choice between French medical students considering and not considering psychiatry as a specialty. Quantitative cross-sectional online survey on 145 French students in their last year of medical school. 22.7% of our sample considered choosing a career in psychiatry. A preference for a career in psychiatry was associated with more frequent history of personal/familial mental illness, higher ratings of psychiatric teaching, more weeks of compulsory psychiatry teaching and placement, during which students had more often met patients in recovery and been asked their opinion on patients. Students considering psychiatry as a career also emphasized more the need for a good work-life balance, and presented better attitudes toward psychiatry. Improving opportunities of interactions between students and psychiatrists or psychiatric patients might help to improve recruitment in psychiatry.
The practice in the psychiatric division of Kitasato University East Hospital and Kitasato University Hospital has been emphasizing community psychiatry. The problems and proposed solutions are discussed. 1. Both hospitals are core hospitals located in Sagamihara City (Kanagawa Prefecture), which has no municipal hospital. 2. Kitasato University East Hospital has 94 beds in two closed wards and is one of the hospitals designated for psychiatric emergencies in Kanagawa Prefecture. 3. Over the last 10 years aroud Sagamihara City, cooperation between psychiatric hospitals and outpatient clinics, the treatment of patients with mental and physical diseases, improvement of the quality of psychiatric practice, emergency psychiatry, and imbalances in the incomes and workloads of psychiatrists have been problematic. 4. Problems that need to be solved in practice to treat depression involve inappropriate pharmacotherapy, disease mongering (the practice of widening the diagnostic boundaries of illnesses in order to expand the markets for drug treatment), clinical skills of psychiatrists, profitability, and medical institutions which cannot cope with regular patients in an emergency. 5. Up to now, we have established a consulting service ("Second opinion" clinic) at Sagamihara Mental Health and Welfare Center (Municipal institution), recommended patients' consultation with family pharmacists, and increased the frequency of conferences for doctors without the support of pharmaceutical companies. 6. In order to develop community psychiatric services for patients with depression, the author is preparing a community-based critical path for depression as well as community-based treatment network in the Sagamihara area. 7. The author believes that the urgent issue necessitates transparency and the increased visibility of psychiatric services.
Soerensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter
The aim of this controlled, before-and-after study in the Department of Psychiatry in a university hospital in Denmark, was to examine the potential effects and characteristics of nurses reviewing psychiatric patients' medication records to identify potentially inappropriate prescriptions (PIPs...
Haldar, Partha; Sagar, Rajesh; Malhotra, Sumit; Kant, Shashi
There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis. This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t-test. A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40-F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30-F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40-G47) with 334 cases (12%). We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program.
Kumbier, Ekkehardt; Haack, Kathleen
The extent and boundaries of political influence are a central issue in the history of the German Democratic Republic (GDR). After 1945 socialist leaders attempted to exert political influence on education in the Soviet occupied zone and the later GDR. The Second University Reform in 1951/52 introduced a fundamental break with established university structures. One major aim was the establishment of a "new socialist intelligentsia" that was to spread the Marxist-Leninist theories at universities. Due to a lack of qualified personnel in the medical faculties, this aim was far from being reached until the end of the 1950s. The example of the university lecturer Hans Heygster (1905-1961), who worked at the East-German University Hospital of Psychiatry and Neurology in Rostock between 1946 and 1953, shows how the GDR rulers sought to influence university education. It illustrates the opportunities and restrictions that University lecturers in East Germany faced during this time. Heygster soon found himself in real conflict, namely between political aims and demands set and reality. Based on of archival sources the study elaborates the background, the course of events and the consequences of these conflicts.
Patzer, G L; Rawwas, M Y
The current study provides guidance to hospital administrators in their effort to develop more effective marketing communication strategies. Two types of communication factors are revealed: primary and secondary. Marketers of psychiatric hospitals may use the primary factors as basic issues for their communication campaign, while secondary factors may be used for segmentation or positioning purposes. The primary factors are open wards, special treatment for adolescents, temporary absence, while patient, in-patient care, and visitation management. The secondary factors are temporary absence while a patient, voluntary consent to admit oneself, visitation management, health insurance, open staff, accreditation, physical plant, and credentials of psychiatrists.
The portrayal of mental illness in the media can be negative and stigmatizing. Mental health nurses, therefore, need to be aware of the ways in which the media frame mental illness issues, and should be prepared to challenge inaccuracy. This article examines the changing nature of the UK press's reporting of mental health issues by focusing on two areas. First, the changing terminology the press uses in their attempt to appear more sensitive, exemplified by recent growth in use of the term 'suicide watch'. Secondly, the article examines the press' reporting of the three English high-security special hospitals as an example of how the framing and personalization of stories is used to set the public agenda on mentally disordered offenders.
Bertolín Guillén, J M
The development of psychiatry, as it happens with other medical specialties, has been linked to that of the journals dedicated to it. They are a good exponent of its state of growing or consolidation. The first psychiatric journal in Spain appeared in 1865 and 27 years later the next one was founded. None of the three journals which existed in the 19th century continued at the beginning of the 20th century. During the first three decades of this century, nine specialized journals were founded, among which the "Revista Frenopática Española" in the first place, and the "Archivos de Neurobiología" afterwards, were the most outstanding in our country and the "Revista Frenopática Española" was that of the greatest international projection. Although the importance of a constellation of prestigious journals which were not dedicated to psychiatry was decisive for the development of this discipline in our country, the professionals organized themselves in the monographic journals about this subject, linked to mental hospitals.
Bauer, Leah K; Baggett, Travis P; Stern, Theodore A; O'Connell, Jim J; Shtasel, Derri
The care of homeless persons with serious mental illness remains a common and challenging problem in general hospital settings. This article aims to review data on homelessness and its psychiatric comorbidities, and to expand the skills of providers who encounter homeless individuals in general hospital settings. Literature review reveals patient, provider, and systems factors that contribute to suboptimal health outcomes in homeless individuals. Diagnostic rigor, integrated medical and psychiatric care, trauma-informed interventions, special considerations in capacity evaluations, and health care reform initiatives can improve the treatment of homeless persons with serious mental illness. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Knaeps, J.; Neyens, I.; van Weeghel, Jaap; Van Audenhove, C.
Background: People with mental disorders experience difficulties with finding competitive jobs. In countries with longer psychiatric hospitalization periods, the vocational rehabilitation process can start during hospitalization. Yet, rehabilitation can be hindered by a lack of focus by clinicians
Shumway, Martha; Mangurian, Christina; Carraher, Noah; Momenzadeh, Amanda; Leary, Mark; Lee, Emily K; Dilley, James W
People with serious mental illness (SMI) are at elevated risk of HIV infection, but do not receive HIV tests regularly. Inpatient psychiatric admissions provide opportunities for HIV testing. This study retrospectively examined the impact of three sequential interventions designed to increase HIV testing on an acute inpatient psychiatry service: (1) advocacy by an administrative champion, (2) an on-site HIV counselor, and (3) a clinician championing HIV testing. Demographic and HIV testing data were extracted from hospital data systems for 11,360 admissions of HIV-negative patients to an inpatient psychiatry service between 2006 and 2012. Relationships among interventions, length of stay, patient demographics, and receipt of an HIV test were examined using general estimating equation methods. In the year prior to the intervention, 7.2% of psychiatric inpatients received HIV tests. After 1 year of administrative advocacy, 11.2% received tests. Following the HIV counseling intervention, 25.1% of patients were tested. After the counseling intervention ended, continued administrative and clinical advocacy was associated with further increases in testing. In the final year studied, 30.3% of patients received HIV tests. Patients with shorter inpatient stays and those of Black or Asian race/ethnicity were less likely to be tested. Further, 1.6% of HIV tests were positive. Three interventions of varying intensity were associated with a 5-fold increase in HIV testing on an acute inpatient psychiatry service. Nonetheless, 70% of inpatients were not tested. Continued efforts are needed to increase HIV testing in inpatient psychiatric settings. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Khan, Qasim; Ismail, Mohammad; Haider, Iqbal; Khan, Fahadullah
Background QT prolongation and associated arrhythmias, torsades de pointes (TdP), are considerable negative outcomes of many antipsychotic and antidepressant agents frequently used by psychiatric patients. Objective To identify the prevalence, levels, and predictors of QT prolonging drug-drug interactions (QT-DDIs), and AZCERT (Arizona Center for Education and Research on Therapeutics) classification of drugs involved in QT-DDIs. Setting Psychiatry wards of three major tertiary care hospitals of Khyber-Pakhtunkhwa, Pakistan. Method This was a multicenter cross-sectional study. Micromedex DrugReax was used for identification of QT-DDIs. TdP risks were identified by the AZCERT classification. Multivariate logistic regression analysis was performed to identify predictors of QT-DDIs. Main outcome measure Prevalence of QT-DDIs (overall, age-wise and gender-wise) and their levels of severity and documentation; AZCERT classes of drugs involved in QT-DDIs; and odds ratios for predictors of QT-DDIs. Results Of 600 patients, 58.5% were female. Median age was 25 years (IQR = 20-35). Overall 51.7% patients had QT-DDIs. Of total 698 identified QT-DDIs, most were of major-severity (98.4%) and fair-documentation (93.7%). According to the AZCERT classification, 36.4% of the interacting drugs were included in list-1 (known risk of TdP), 26.9% in list-2 (possible risk of TdP) and 27.5% in list-3 (conditional risk of TdP). Drugs commonly involved in QT-DDI were olanzapine (n = 146), haloperidol (138), escitalopram (122), risperidone (91), zuclopenthixol (87), quetiapine (n80) and fluoxetine (74). In multivariate logistic regression analysis, QT-DDIs were significantly associated with 6-7 prescribed medications (p = 0.04) and >7 medications (p = 0.03). Similarly, there was significant association of occurrence of QT-DDIs with 2-3 QT drugs (p 3 QT drugs (p QT-DDIs in psychiatry. There is a need to implement protocol for monitoring the outcomes of QT-DDIs.
Snorrason, Jón; Grímsdóttir, Gudrún Ulfhildur; Sigurdsson, Jón Fridrik
Special observation (constant observation) of patients is common on psychiatric wards, both in Iceland and abroad, but very few studies have been conducted on their therapeutic value. The objective was to investigate the extent and nature of special observation on emergency wards at the division of psychiatry at the Landspitali-University Hospital in Iceland as well as the attitudes of patients and staff toward special observation. Information about patients on special observation was recorded over a three months period. Patients were interviewed with a standardised eleven questions interview shortly after the observation finished in order to investigate their attitudes toward the observation. Also, members of staff from each ward were asked to answer eight questions about their attitudes toward special observation in general. The Ethics Committee of Landspitali - University Hospital gave its permission for the study. During the research period observation was used for 157 patients, which is 31% of the total number of patients admitted during that period. Most of the patients (83%) were on 5-15 minutes observation, 25 per cent on close observation and 11 percent on suicide or constant observation. The majority of the patients claimed that security was the most important aspect of being on special observation, independent of which type of observation they were, and only one fifth felt that the company of staff was most important. The staff members on the other hand claimed that concern for the patient, respect and companionship were most important for the patients, independent of the type of observation used. The extent, nature and process of observation on acute inpatient wards in Iceland seems to be comparable to other studies from abroad. In view of the importance of special observations in psychiatric emergency care and their influence on patients' private life it is important to develop and implement clinical guidelines about their use.
1977) requires that 'mental disorder', 'mental defect' or 'any other reason' (section 78)2 be present before issues of .... 'self defeating personality disorder'). Apart from advertising psychiatry's ongoing ... will easily distinguish between serial rapists that are just antisocial from those who apparently have a diagnosis and are ...
Yvon, Marianne; Festa, Carole; Hanen, Sylvie; Mercuel, Alain; Monteiro, Michel
A social experiment and pilot project funded by the French Directorate General of Social Cohesion aimed at providing legal aid services ("legal empowerment and mental health") has been conducted since 2009 in three healthcare institutions in Paris (France): the Centre Hospitalier Sainte-Anne, the Groupe Public de Santé Perray-Vaucluse, and the Hôpital Tenon (psychotraumatology unit). Lasting until 2012 and piloted by the NGO Droits d'Urgence, the initiative aims to promote the legal empowerment of socially excluded people suffering from psychiatric or mental disorders and to facilitate access to care. The initiative operates on two levels, providing legal support to vulnerable people and offering legal expertise and advice to medical and social staff. An ad-hoc intervention approach was designed to ensure the implementation of the initiative based on several combined tools: legal aid, technical committees, awareness-raising activities, and pooling of legal resources and information. Developed across the three institutions, this integrated and subsidiary initiative improves our understanding of the complex circumstances of disempowered people ? who are often faced with overlapping social, medical, administrative and legal difficulties ? and helps to take into account their vulnerabilities. The cross-professional and cross-boundary system promoted by this initiative involves medical staff, social workers and lawyers around patients viewed as both actors and legal subjects.
Ballbè, Montse; Gual, Antoni; Nieva, Gemma; Saltó, Esteve; Fernández, Esteve
Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals -the early adopters- based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Absconding from mental hospitals is a topic worth investigating because absconding usually has a variety of adverse consequences, not only for the absconders but also for the public and so forth. From a medical perspective, there have been several studies of absconding by mental patients and the harm they cause to themselves and others while they are at large. However, there is a paucity of such studies from a purely legal perspective. This study aims to contribute to the literature from a legal perspective by focusing on the offender-patient who absconds from hospital. It is argued, inter alia, that given the various ramifications of absconding from hospital, it is unsatisfactory that some offender-patients (specifically those on a hospital order without restrictions; s37 of the Mental Health Act 1983) could only be retaken within 28 days when they abscond from hospital, whereas non-offender patients in hospital under s3 of the same Act could be retaken within six months at least. Recommendations for reform of the law are duly tendered.
Psychiatry has long been prone to fads. The main reason is that mental illness is poorly understood and can be difficult to treat. Most diagnostic fads have involved the extension of well-known categories into broader spectra. The most prominent treatment fads have involved the overuse of pharmacological interventions and a proliferation of methods for psychotherapy. The best antidote to fads is a commitment to evidence-based psychiatry.
Mental disorders lead patients along paths of irrationality. Insanity is perceived as excessiveness, often associated with violence. Risk in psychiatry is omnipresent and nursing practice is performed within a narrow safety zone. The media coverage of sensitive situations does not help. Ensuring the patient's recovery, respecting the fundamental principles of individual freedom while assuring the utmost safety of others is the constant challenge facing caregivers in psychiatry. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Full Text Available Older patients with comorbid mental illness are shown to receive less appropriate care for their medical conditions. This study analyzed Medicare patients hospitalized for acute myocardial infarction (AMI and determined whether those with comorbid mental illness were more likely to present to hospitals with lower quality of AMI care.Retrospective analyses of Medicare claims in 2008. Hospital quality was measured using the five "Hospital Compare" process indicators (aspirin at admission/discharge, beta-blocker at admission/discharge, and angiotension-converting enzyme inhibitor or angiotension receptor blocker for left ventricular dysfunction. Multinomial logit model determined the association of mental illness with admission to low-quality hospitals (rank of the composite process score 90(th percentile, compared to admissions to other hospitals with medium quality. Multivariate analyses further determined the effects of hospital type and mental diagnosis on outcomes.Among all AMI admissions to 2,845 hospitals, 41,044 out of 287,881 patients were diagnosed with mental illness. Mental illness predicted a higher likelihood of admission to low-quality hospitals (unadjusted rate 2.9% vs. 2.0%; adjusted odds ratio [OR]1.25, 95% confidence interval [CI] 1.17-1.34, p<0.01, and an equal likelihood to high-quality hospitals (unadjusted rate 9.8% vs. 10.3%; adjusted OR 0.97, 95% CI 0.93-1.01, p = 0.11. Both lower hospital quality and mental diagnosis predicted higher rates of 30-day readmission, 30-day mortality, and 1-year mortality.Among Medicare myocardial infarction patients, comorbid mental illness was associated with an increased risk for admission to lower-quality hospitals. Both lower hospital quality and mental illness predicted worse post-AMI outcomes.
A programme of mental health education for relatives and family members of both in-patients and out-patients at the Department of Psychiatry, Komfo Anokye Teaching Hospital (KATH) has been described. Essentially the programme entailed a short, about ten minutes of introductory talk, followed by a group discussion on ...
Williams, Arthur Robin; Cohen, Shelly; Ford, Elizabeth B
In New York City, individuals gravely disabled by substance use disorders repeatedly present to emergency rooms yet rarely remain in treatment for more than several days and often sign out against medical advice. Although these individuals are at high risk of death and often lack the capacity to make treatment decisions, the laws in New York State are unclear about whether substance use disorders qualify as mental illnesses for the purpose of involuntary hospitalization. To better understand the national landscape of civil commitment law, with a specific focus on substance use disorders, a review was conducted of mental health statutes in all 50 states and the District of Columbia (D.C.). Two independent reviewers examined all state mental health statutes using LexisNexis and Westlaw search engines. A total of 22 states, including D.C., do not reference substance use disorders in their statutory definitions of mental illness. Of the 29 that do, eight include substance use disorders and 21 explicitly exclude them. In addition, nine states have separate inpatient commitment laws specifically addressing substance use disorders. Civil commitment statutes vary greatly by state in terms of clarity and specificity regarding which mental illnesses are included for the purpose of involuntary hospitalization. Mental health professionals and policy makers should discuss whether individuals gravely disabled by substance use disorders, a complex and vulnerable population, should be more widely included under standard civil commitment law.
Noblett, Joanne E; Lawrence, Robert; Smith, Jared G
What are the attitudes of general hospital doctors toward patients with comorbid mental illness? Do certain characteristics of the health professional related to attitude valence to patients with comorbid mental illness? An anonymous questionnaire was sent out to a cohort of doctors working in three General Hospitals in South West London. The questionnaire included vignettes to assess the respondents' attitudes toward eight patients presenting with a physical compliant with different clinical histories, including depression, schizophrenia, personality disorder, diabetes, and criminal behavior. A total of 52 participants completed the questionnaire; 40 females and 12 males. Across all domains, the most positive attitudes were held toward patients without a diagnosis of mental illness. The least positive attitudes were toward patients with schizophrenia, personality disorder, and those classified as "criminals," and negative attitudes relating to the unpredictability of patients was identified in these categories. There was no statistically significant difference in attitudes depending on age or level of training. However, female participants tended to endorse more positive attitudinal responses, most clearly toward patients with depression and heroin addiction. Negative attitudes of doctors were identified toward certain mental illness diagnoses and are likely to contribute the physical health disparity between patients with and without a comorbid mental illness. This raises the question as to how these attitudes can be changed in order to improve the parity of physical health care between patient with and without mental illness. © The Author(s) 2015.
Gay, James C; Zima, Bonnie T; Coker, Tumaini R; Doupnik, Stephanie K; Hall, Matthew; Rodean, Jonathan; O'Neill, Margaret; Morse, Rustin; Rehm, Kris P; Berry, Jay G; Bardach, Naomi S
To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state. Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases. Discharge to PAC was used as a proxy for transfer to an inpatient mental health facility. We derived adjusted logistic regression models to assess the association of patient and hospital characteristics with discharge to PAC. In 2012, 14.7% of hospitalized children (n = 248 359) had a primary mental health diagnosis. Among these, 72% (n = 178 214) had bipolar disorder, depression, or psychosis, of whom 4.9% (n = 8696) were discharged to PAC. The strongest predictors of PAC discharge were homicidal ideation (aOR, 24.9; 96% CI, 4.1-150.4), suicide and self-injury (aOR, 15.1; 95% CI, 11.7-19.4), and substance abuse-related medical illness (aOR, 5.0; 95% CI, 4.5-5.6). PAC use varied widely by state, ranging from 2.2% to 36.3%. The majority of children hospitalized primarily for a mood disorder or psychosis were not discharged to PAC, and safety-related conditions were the primary drivers of the relatively few PAC discharges. There was substantial state-to-state variation. Target areas for quality improvement include improving access to PAC for children hospitalized for mood disorders or psychosis and equitable allocation of appropriate PAC resources across states. Copyright © 2017 Elsevier Inc. All rights reserved.
Arimura, Mayumi; Imai, Makoto; Okawa, Masako; Fujimura, Toshimasa; Yamada, Naoto
Medical error involving nurses is a critical issue since nurses' actions will have a direct and often significant effect on the prognosis of their patients. To investigate the significance of nurse health in Japan and its potential impact on patient services, a questionnaire-based survey amongst nurses working in hospitals was conducted, with the specific purpose of examining the relationship between shift work, mental health and self-reported medical errors. Multivariate analysis revealed significant associations between the shift work system, General Health Questionnaire (GHQ) scores and nurse errors: the odds ratios for shift system and GHQ were 2.1 and 1.1, respectively. It was confirmed that both sleep and mental health status among hospital nurses were relatively poor, and that shift work and poor mental health were significant factors contributing to medical errors.
Bauer, Jeanett Østerby; Okkels, Niels; Munk-Jørgensen, Povl
of common mental disorders, in particular depression and anxiety. Furthermore, 'new' diagnostic groups are represented in the treatment statistics with steeply increasing incidences, e.g. attention deficit hyperactivity disorder (ADHD) and eating disorders, especially in the outpatient part......Danish psychiatry has gone through profound changes over the past two to three decades, reducing inpatient-based treatment and increasing outpatient treatment markedly. The number of patients treated has almost doubled, and the diagnostic profile has broadened, now including a substantial number...
Religion and psychiatry have had complicated, sometimes neutral or friendly and cooperative, sometimes competitive and antagonistic relations over their long histories. Relations between psychiatry and religion are influenced by complex belief systems, each diverse and changing. Psychiatry has often ignored spiritual and religious dimension in health and illness while religions influenced the treatment of mental disorders directly by defining mental disorders as evil spirit possessions and prescribing exorcism as treatment. It has been a long way to prevail looking for natural over supra-natural explanations for mental disorders. Psychiatry and religion as social practices should be regarded as allies against pseudoscientific nonsense and superstitions. This alliance is based on the next evidence: 1. religious and spiritual well-being is an important component of mental health as well as of health in general; 2. research and empirical evidence reveals that healthy-minded and distorted or sick faith are quite distinct in the effects in the lives of the faithful; 3. psychiatrists are professionally expected to always respect and be sensitive to the spiritual and religious beliefs and practices of their patients; 4. religious and spiritual beliefs and practice is very important aspect of person-centered psychiatry. The enduring task for both psychiatry and religion is to enable human beings to live their lives with courage, sense, and optimism, to strive towards creating conditions of well-being and individual, public and global mental health as well as to dispel beliefs and patterns which trap people in lives of misery and mental disorders. Psychiatry and religion in creative dialogues as allies can significantly contribute to the healing of our broken world and promoting compassionate society and empathic civilization. When psychiatry and religion see each other as opponents or even enemies this is only because of their mutual misreading and pseudoscientific
Harmon, Rebecca Bouterie
This research describes nurses' experiences in administering "the water cure," hot or cold wet sheet packs, and continuous tub baths in state mental hospitals during the early twentieth century. Student and graduate nurses were required to demonstrate competence in hydrotherapy treatments used to calm agitated or manic patients in the era before neuroleptics. The nurses interviewed for this study indicated that, although labor intensive, hydrotherapy worked, at least temporarily. Although no longer used in state hospitals, hydrotherapy is regaining popularity with the general public and may serve as an adjunct to pharmacological treatments to calm hospitalized patients in the future.
Opmeer, Brent C; Hollingworth, William; Marques, Elsa M R; Margelyte, Ruta; Gunnell, David
To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm. Retrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data. A large hospital in South West England. Patients attending the ED for self-harm. Extension of the LPS' working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investment MAIN OUTCOME MEASURES: Number and characteristics of ED attendances for self-harm. The before and after cohorts were compared in terms of key process measures, including proportion of patients receiving a psychosocial assessment, average length of hospital stay, waiting times for assessment, proportion of patients who self-discharged without an assessment, levels of repeat self-harm attendances and mean cost per patient attendance. 298 patients attended ED for self-harm on 373 occasions between January and March 2014, and 318 patients attended on 381 occasions between January and March 2015. The proportion of ED attendances where patients received a psychosocial assessment increased from 57% to 68% (p=0.003), median waiting time decreased by 3 hours and 14 min (p=0.017), and the proportion of episodes where patients self-discharged without a psychosocial assessment decreased from 20% to 13% (p=0.022). The mean cost per patient attendance was marginally lower after the intervention (-£84; 95% CI -£254 to £77). The extended LPS seems to have had a favourable effect on the management and outcomes of self-harm patients. The cost of extending the LPS' working hours might be partially offset by more efficient assessment and discharge. The impact of the extended LPS on the care of hospitalised patients with mental health problems other than self-harm requires further evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the
Smith, G C
To trace the movement from psychosomatic medicine to consultation-liaison psychiatry, the forces at work in shaping the change, and the extent to which the change is reflected in the latest revisions of the International classification of diseases (ICD-10) and the Diagnostic and statistical manual of mental disorders, third revision (DSM-III-R). Identification of important trends in the field was aided by discussions with fellow members of the panel of compilers of the consultation-liaison psychiatry literature review expert list published bi-annually in General Hospital Psychiatry. The expert list is based on appropriate literature searches. Psychosomatic medicine continues as a science, studying the relationships between biological, psychological and social phenomena in health and disease. The main advocates of the clinical application of the concepts and findings of psychosomatic medicine are now the general hospital consultation-liaison psychiatrists and their allied health professional colleagues. The mainstreaming of psychiatry into medicine has accentuated the role of the consultation-liaison psychiatrist. In attempting to translate the advances in the field into a new taxonomy, both ICD-10 and DSM-III-R have created a new language that hinders understanding by a medical profession perhaps now less prone to resistance to holism. There is a need for a valid taxonomy that addresses the most common form of psychiatric presentation in the community, that of physical/psychiatric co-morbidity, and for outcome studies based on such a taxonomy. Consultation-liaison psychiatrists need to educate their colleagues about the changes in concepts and terminology.
Rodrigues, Eder Pereira; Rodrigues, Urbanir Santana; Oliveira, Luciana de Matos Mota; Laudano, Rodrigo Cunha Sales; Sobrinho, Carlito Lopes Nascimento
This study aimed to describe the prevalence of "suspected" of common mental disorders (CMD) in nursing workers at a general hospital in the state of Bahia. It was carried out a cross-sectional epidemiological study with 309 nursing workers, who worked in welfare activities in a large hospital. The nurses mentioned overwork and low pay. The most frequent health complaints were related to body posture and mental health. The overall prevalence of "suspected" of CMD was 35.0%. Regarding the psychosocial aspects of work, it was reported high psychological demand and low control over their work activities. The results indicated that the working and health conditions observed are not suitable for the effective realization of nursing work in the hospital.
Iyus Yosep; Zabidah Putit; Helmy Hazmi; Henny Suzana Mediani
Shortage of nurses and declining interest in becoming a mental health nurse are often attributed to workplace distress and violence. These have become global issues and believed that shortage of nurses decreases the quality of health care services. It leads distress among nurses, which is exposure to violence and traumatic experiences. In addition, nurses are also accused of seizing the rights of patients and committing violence against a patient. This paper focuses on the violenc...
Brittlebank, Andrew; Hermans, Marc; Bhugra, Dinesh; Pinto da Costa, Mariana; Rojnic-Kuzman, Martina; Fiorillo, Andrea; Kurimay, Tamas; Hanon, Cecile; Wasserman, Danuta; van der Gaag, Rutger Jan
Psychiatry is the largest medical specialty in Europe. Despite efforts to bring harmonisation, training in psychiatry in Europe continues to be very diverse. The Union Européenne des Médecins Spécialistes (UEMS) has issued as from 2000 a charter of requirements for the training in psychiatry with an additional European Framework for Competencies in Psychiatry in 2009. Yet these have not been implemented throughout Europe. In this paper, the diversity in training throughout Europe is approached from different angles: the cultural differences between countries with regards to how mental health care is considered and founded on, the cultural differences between people throughout Europe in all states. The position of psychotherapy is emphasised. What once was the cornerstone of psychiatry as medical specialty seems to have become a neglected area. Seeing the patient with mental health problems within his cultural context is important, but considering him within his family context. The purpose of any training is enabling the trainee to gain the knowledge and acquire the competencies necessary to become a well-equipped professional is the subject of the last paragraph in which trainees consider their position and early career psychiatrists look back to see whether what they were trained in matches with what they need in the working situation. Common standard for training and certification are a necessity within Europe, for the benefit of the profession of psychiatrist but also for patient safety. UEMS is advised to join forces with the Council of National Psychiatric Associations (NPAs) within the EPA and trainings and early career psychiatrist, to discuss with the users what standards should be implemented in all European countries and how a European board examination could ensure professional quality of psychiatrists throughout the continent.
Full Text Available Shortage of nurses and declining interest in becoming a mental health nurse are often attributed to workplace distress and violence. These have become global issues and believed that shortage of nurses decreases the quality of health care services. It leads distress among nurses, which is exposure to violence and traumatic experiences. In addition, nurses are also accused of seizing the rights of patients and committing violence against a patient. This paper focuses on the violence that occurred in mental health nurses during working in unpredictable situation. A literature search of systematic review through the CINAHL, Medline, Google scholars and PsycInfo databases, the empirical report using a nursing sample includes data on rates of violence exposure including violence, aggressive behavior, bullying, and sexual harassment. The result, a total of 400 articles provide data on 2742 publications indicates near all of nurses in mental health experienced verbal abuse in the past month, furthermore, most of respondents’ ever experienced psychological abuse, and less of respondents experienced physical violence and sexual harassment. Rates of exposure vary by world region (Developed countries, Asia, Europe and Middle East, with the highest rates for physical violence and sexual harassment in the USA, Australia, United Kingdom, New Zealand region, and the highest rates of psychological violence and bullying in the Middle East. The presence of violence signals an "alarm" that violence against nurses calls for special attention in many countries. Essentially, the world must give a "priority" to handling violence against nurses.
Gomez, Amparo; Canales, Antonio
This article analyses the child psychiatry and psychology developed during the Spanish Civil War and immediate postwar period. The aim is to demonstrate that, despite the existence of a certain degree of disciplinary continuity in relation to the pre-war period, both disciplines were placed at the service of Francoism. This meant that the…
Cape, J; Parham, A
BACKGROUND: Although reduction in the use of secondary care mental health services is a suggested benefit of counselling in general practice, there has been little empirical investigation of this relationship. AIM: To investigate the relationship between the provision of counselling in general practice and the use of outpatient psychiatry and clinical psychology services across a geographical area. METHOD: Information on referrals to outpatient psychiatry and clinical psychology from all general practices in the London Borough of Islington over one year (October 1993 to September 1994) was collected from the routine information systems of the main hospital departments serving this area. Referral rates per 1000 practice population were compared for practices with and without a practice-based counsellor. RESULTS: Fifteen (35%) of the 43 practices had a counsellor based in the practice. The median referral rate to clinical psychology was higher in practices with a counsellor (4.1 per 1000) than in practices without a counsellor (0.8 per 1000). There was no relationship between the provision of practice counselling and median referral rates to outpatient psychiatry (1.8 per 1000 with a counsellor, 1.7 per 1000 without a counsellor). CONCLUSION: Provision of practice counselling in the study was associated with higher referral rates to clinical psychology and no difference in referral rates to outpatient psychiatry. This is in contrast to the hypothesis that counselling reduces the use of secondary care mental health services. PMID:10024705
Møllerhøj, Jette; Stølan, Liv Os; Brandt-Christensen, Anne Mette
PURPOSE: To illuminate whether and how taking care of forensic inpatients is experienced as a burden among staff and managers in general psychiatry. DESIGN AND METHODS: Qualitative analytical strategies based on interviews and questionnaires. FINDINGS: The interplay between physical environment...... sufficient mental health care. PRACTICE IMPLICATIONS: Nationwide training and teaching as well as knowledge exchange between specialized forensic psychiatry and general psychiatry are recommended. Further exploration is needed on patient perspectives and on avenues to increase efficiency and decrease...
Ioana Mihaela Tomulescu
Full Text Available This study is about the incidence of hearing-speaking disorders in a population with mental deficiency. We studied 596 children interned in Neurology and Psychiatry Clinical Hospital of Oradea during the 1999 - 2001 period. In 596 children, 393 presented different types of mental deficiency. The most frequent disorders observed are hearing loss or deafness, deaf-mutism, mutism and speaking retardation. Also, we related an increased frequency in rural area and in group of children with severe mental deficiency.
Psiquiatria, saúde mental e biopoder: vida, controle e modulação no contemporâneo Psiquiatría, salud mental y bio-poder: vida, control y modulación en el contemporáneo Psychiatry, mental health and bio-power: life, control and modulation in contemporary society
Full Text Available O trabalho consiste em uma análise sobre os impasses que enfrentam atualmente as instituições de saúde mental no contexto da reforma psiquiátrica brasileira. Os dispositivos de saúde mental podem funcionar como uma nova expansão da psiquiatria no espaço extramuros, agindo com métodos mais sutis de controle e operando tanto a partir das instituições de saúde quanto da própria subjetividade dos usuários. São utilizadas referências do campo da filosofia na construção de uma clínica transdisciplinar capaz de incluir os aspectos políticos envolvidos no atendimento em saúde mental, superando os impasses que levam a práticas redutoras e estigmatizantes.Un análisis acerca de los obstáculos presentes en las instituciones de salud mental en el contemporaneo y en el contexto de la reforma psiquiátrica brasileña. Los dispositivos de salud mental pueden funcionar como una nueva expansión de la psiquiatría fuera del espacio del asilo actuando por métodos mas sutiles de control. Estos métodos operan tanto a partir de las propias instituciones de salud cuanto a partir de la subjetividad de los usuarios. Son utilizadas referencias del campo de la filosofía en la construcción de uma clínica transdisciplinar capaz de incluir los aspectos políticos envueltos en la asistencia en salud mental, superandolos obstáculos que llevan a prácticas reductoras yestigmatizantes.An analysis of the impasses faced by Brazilian mental health institutions in the context of contemporary Brazilian psychiatric reform is provided. The institutions of mental health may operate as a new expansion of psychiatry outside the asylum, acting through more subtle methods of social control working in mental health institutions themselves or within the subjectivity of the clientele. References from the field of philosophy are employed to build a transdisciplinary approach. Political aspects involved in mental health practices may than be taken into consideration
Makushkin, E V; Oskolkova, S N; Fastovtsov, G A
The success and achievements in the area of neurosciences due to the development of neuroimaging, neurochemical and genome studies provide tasks for psychiatry determined by the necessity to develop new classifications of mental diseases, primarily ICD-11, specify clinical diagnostic criteria and rethink the essence of some mental disorders. In spite of the multiple direction of scientific opinions on the discussed issues, the development of modern psychiatry is characterized by intensive search of biological background of psychiatric disorders and elaboration of effective approaches to the diagnosis and treatment of mental diseases, including medical rehabilitation of patients.
Rios, Francisco Javier Mesa; Munoz, Maria Del Carmen Lara
Background: Various rates of alcoholism, drug abuse, mental illness, and suicide among physician have been reported, generally higher than those in the general population. Psychiatry residents, as other specializing physicians, seem to be prone to suffering them. The prevalence of psychological symptoms among psychiatry residents has not been…
This paper examines the tendency for general psychiatry to ignore somatization and hypochondriasis. These disorders are rarely included in national surveys of mental health and are not usually regarded as a concern of general psychiatrists; yet primary care doctors and other physicians often feel let down by psychiatry's failure to offer help in this area of medical practice. Many psychiatrists are unaware of the suffering, impaired function and high costs that can result from these disorders, because these occur mainly within primary care and secondary medical services. Difficulties in diagnosis and a tendency to regard them as purely secondary phenomena of depression, anxiety and related disorders mean that general psychiatry may continue to ignore somatization and hypochondriasis. If general psychiatry embraced these disorders more fully, however, it might lead to better prevention and treatment of depression as well as helping to prevent the severe disability that may arise in association with these disorders. PMID:17139341
The situation of present day psychiatry is described as being dominated by an empiricist perspective. The limitations of this perspective are analyzed and a rough sketch of the hermeneutical approach in psychiatry is offered. It is argued that a fully developed hermeneutical psychiatry implies a
Thibault, Dylan P; Mendizabal, Adys; Abend, Nicholas S; Davis, Kathryn A; Crispo, James; Willis, Allison W
Reducing the burden of pediatric mental illness requires greater knowledge of mental health and substance abuse (MHSA) outcomes in children who are at an increased risk of primary psychiatric illness. National data on hospital care for psychiatric illness in children with epilepsy are limited. We used the Kids' Inpatient Database (KID), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality from 2003 to 2009 to examine MHSA hospitalization patterns in children with comorbid epilepsy. Nonparametric and regression analyses determined the association of comorbid epilepsy with specific MHSA diagnoses and examined the impact of epilepsy on length of stay (LOS) for such MHSA diagnoses while controlling for demographic, payer, and hospital characteristics. We observed 353,319 weighted MHSA hospitalizations of children ages 6-20; 3280 of these involved a child with epilepsy. Depression was the most common MHSA diagnosis in the general population (39.5%) whereas bipolar disorder was the most common MHSA diagnosis among children with epilepsy (36.2%). Multivariate logistic regression models revealed that children with comorbid epilepsy had greater adjusted odds of bipolar disorder (AOR: 1.17, 1.04-1.30), psychosis (AOR: 1.78, 1.51-2.09), sleep disorder (AOR: 5.90, 1.90-18.34), and suicide attempt/ideation (AOR: 3.20, 1.46-6.99) compared to the general MHSA inpatient population. Epilepsy was associated with a greater LOS and a higher adjusted incidence rate ratio (IRR) for prolonged LOS (IRR: 1.12, 1.09-1.17), particularly for suicide attempt/ideation (IRR: 3.74, 1.68-8.34). Children with epilepsy have distinct patterns of hospital care for mental illness and substance abuse and experience prolonged hospitalization for MHSA conditions. Strategies to reduce psychiatric hospitalizations in this population may require disease-specific approaches and should measure disease-relevant outcomes. Hospitals caring for large numbers of
Full Text Available The present study is concerned with the stigma of mental illness. It examines the subjective element of the experience of stigma among a sample of in-patients with different mental disorders. The sample was taken from consecutive admissions of in-patients meeting ICD-10 criteria for mental disorders who had capacity to decide on participation in the study and were willing to respond to the structured interview. The study was undertaken in an Egyptian private psychiatric hospital. The structured clinical interview included aspects of the emotional, behavioral and cognitive effects of having a psychiatric diagnosis on in-patients with various diagnostic labels in an Egyptian psychiatric hospital. It also studied whether this effect changes with specific disorders, total duration of illness or sociodemographic variables as gender, age or educational level. The study illustrated the core items of stigmatization attached to the diagnosis of mental illness (Sidhom et al, 2012, which more than half of the participants responded affirmatively. The study aimed to explore the most prevailing aspects of stigma or social disadvantage; hoping that this may offer a preliminary guide for clinicians to address these issues in their practice.
Burgut, F. Tuna; Polan, H. Jonathan
Objective: To assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries. Methods: A…
Full Text Available Abstract The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry.
Bayardo, Sergio Javier Villaseñor
Mexican psychiatry initiated since pre-Hispanic times. Historically, treatments were a mixture of magic, science and religion. Ancient Nahuas had their own medical concepts with a holistic view of medicine, considering men and cosmos as a whole. The first psychiatric hospital appeared in 1566 and a more modern psychiatric asylum emerged until 1910. International exchanges of theoretical approaches started in the National University with the visit of Pierre Janet. There were other important figures that influenced Mexican psychiatry, such as Erich Fromm, Henri Ey, Jean Garrabé and Yves Thoret. Regarding Mexican psychiatrists, some of the most important contributors to Mexican psychiatry were José Luis Patiño Rojas, Manuel Guevara Oropeza and Ramón de la Fuente Muñiz. This article includes excerpts from "Clinical Psychiatry", a book by Patiño Rojas where he tries to understand and describe the inner world experienced by patients with schizophrenia; also, the thesis conducted by Guevara Oropeza ("Psychoanalisis"), which is a critical comparison between the theories of Janet and Freud. Finally, we include "The study of consciousness: current status" by Ramón de la Fuente, which leads us through the initial investigations concerning consciousness, its evolution, and the contributions made by psychology, philosophy and neurobiology.
Rüsch, Nicolas; Müller, Mario; Lay, Barbara; Corrigan, Patrick W; Zahn, Roland; Schönenberger, Thekla; Bleiker, Marco; Lengler, Silke; Blank, Christina; Rössler, Wulf
Compulsory admission to psychiatric inpatient treatment can be experienced as disempowering and stigmatizing by people with serious mental illness. However, quantitative studies of stigma-related emotional and cognitive reactions to involuntary hospitalization and their impact on people with mental illness are scarce. Among 186 individuals with serious mental illness and a history of recent involuntary hospitalization, shame and self-contempt as emotional reactions to involuntary hospitalization, the cognitive appraisal of stigma as a stressor, self-stigma, empowerment as well as quality of life and self-esteem were assessed by self-report. Psychiatric symptoms were rated by the Brief Psychiatric Rating Scale. In multiple linear regressions, more self-stigma was predicted independently by higher levels of shame, self-contempt and stigma stress. A greater sense of empowerment was related to lower levels of stigma stress and self-contempt. These findings remained significant after controlling for psychiatric symptoms, diagnosis, age, gender and the number of lifetime involuntary hospitalizations. Increased self-stigma and reduced empowerment in turn predicted poorer quality of life and reduced self-esteem. The negative effect of emotional reactions and stigma stress on quality of life and self-esteem was largely mediated by increased self-stigma and reduced empowerment. Shame and self-contempt as reactions to involuntary hospitalization as well as stigma stress may lead to self-stigma, reduced empowerment and poor quality of life. Emotional and cognitive reactions to coercion may determine its impact more than the quantity of coercive experiences. Interventions to reduce the negative effects of compulsory admissions should address emotional reactions and stigma as a stressor.
Grover, Sandeep; Sahoo, Swapnajeet; Aggarwal, Shivali; Dhiman, Shallu; Chakrabarti, Subho; Avasthi, Ajit
Background: Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams. Aim: This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team. Materials and Methods: Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team. Results: In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable. PMID:28827863
van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K
Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.
Chowanec, G D
Public mental health care is undergoing a period of fundamental change as it attempts to adapt to an environment characterized by increasing fiscal constraints, the need to demonstrate effectiveness of services, and consumer empowerment. Total quality management (TQM) provides a framework that enables mental health care to meet these demands. The author provides his perspective on a public, multipurpose psychiatric hospital's (Georgia Regional Hospital at Augusta) experience in making the transition from quality assurance to TQM. Successful implementation of TQM rests on clinical staff's viewing TQM as a useful mechanism for achieving agreed-on patient/customer goals. Staff cannot simply do what they have been doing, but now do it better; there needs to be an understanding of what "better" means. TQM'S INTRODUCTION AND REINTRODUCTION: When first introduced in 1992, TQM was viewed by staff as the latest variant of quality assurance--and was therefore unsuccessful. When reintroduced in 1993, TQM contributed to the development of a psychosocial rehabilitation program. The staff's active involvement in establishing patient-specific goals was critical to the program's success. The hospital's Performance Improvement Committee has spearheaded the monitoring of treatment programs and the development of critical paths. In developing critical paths, the treatment team sets goals for patients' improvement both within the hospital and postdischarge and for treatment processes. The keys to a successful TQM program are effective leadership, a clear organizational mission, customer-oriented performance goals, staff empowerment, and the application of the scientific method to the workings of the organization.
Perry, Lin; Lamont, Scott; Brunero, Scott; Gallagher, Robyn; Duffield, Christine
Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. A cross sectional survey design was used. The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected. A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month. Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating. Nurses and their managers should strive to create workplaces where working practices promote nurses' health
. Current prescribing practices for obsessive-compulsive disorder in South Africa: Controversies and consensus C Lochner, L Taljaard, D J Stein 16. Correlates of emotional and behavioural problems in children with preinatally acquired HIV in Cape Town, South Africa K-A Louw, N Phillips, JIpser, J Hoare 17. The role of non-coding RNAs in fear extinction S Malan-Muller, L Fairbairn, W M U Daniels, M J S Dashti, E J Oakleley, M Altorfer, J Harvey, S Seedat, J Gamieldien, S M J Hemmings 18. An analysis of the management og HIV-mental illness comorbidity at the psychiatric unit of the Dr George Mukhari Academic Hospital M L Maodi, S T Rataemane, T Kyaw 19. The identification of novel genes in anxiety disorders: A gene X environment correlation and interaction study N W McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D J Stein, V Russel, C Lochner 20. Collaborations between conventional medicine and traditional healers: Obstacles and possibilities G Nortje, S Seedat, O Gureje 21. Thought disorder and form perception: Relationships with symptoms and cognitive function in first-episode schizophrenia M R Olivier, R Emsley 22. Investigating the functional significance of genome-wide variants associated with antipsychotic treatment response E Ovenden, B Drogemoller, L van der Merwe, R Emsley, L Warnich 23. The moral and bioethical determinants of "futility" in psychiatry W P Pienaar 24. Single voxel proton magnetic resonance spectroscopy (1H-MRS and volumetry of the amylgdala in social anxiety disorder in the context of early developmental trauma D Rosenstein, A T Hess, J Zwart, F Ahmed-Leitao, E Meintjies, S Seedat 25. Schizoaffective disorder in an acute psychiatric unit: Profile of users and agreement with Operational Criteria (OPCRIT R R Singh, U Subramaney 26. The right to privacy and confidentiality: The ethics of expert diagnosis in the public media and the Oscar Pistorius trial C Smith 27. A birth cohort study in South Africa: A psychiatric perspective D J Stein 28. 'Womb
Arena Ventura, Carla Aparecida; Fernandes Moll, Marciana; Correia, Rubens; Oyan de Moraes, Viviana Carolina; Duarte Silva, Lucas; Costa Mendes, Isabel Amélia
A descriptive and exploratory study with a qualitative approach was undertaken to describe the knowledge of health professionals at a psychiatric hospital about involuntary hospitalization. Health professionals from the admission ward of a psychiatric hospital located in an inner city of the state of São Paulo, Brazil, participated in the study. Data were collected through semistructured interviews with sixteen health professionals and the analysis was based on thematic analysis. The professionals' lack of knowledge about involuntary hospitalizations was evidenced, including unfamiliarity with the modalities of psychiatric hospitalization, confusion to understand involuntary and compulsory hospitalization as well as the role of the public prosecutor in these cases. In that sense, the study participants' lack of knowledge and, on the other hand, the inertia of the public prosecutor's office can hamper the full enjoyment of rights by persons with mental disorders. In this scenario, psychiatric health professionals should know and understand the legislation as well their responsibility according to it, combining political with theoretical-technical knowledge. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Feb 17, 2004 ... generally poor, increasing stigma with both the mentally ill and intellectually disabled discriminated against. Diagnosis in psychiatry includes a whole range of conditions and se- .... community without the ability to cope or with the occurrence of risk behaviour places even more strain on limited resources.
Focus and Scope. The journal is the leading psychiatric journal of Africa. It provides open-access scholarly reading for psychiatrists, clinical psychologists and all with an interest in mental health. It carries empirical and conceptual research articles, reviews, editorials, and scientific letters related to psychiatry. It publishes ...
Forensic Psychiatry has a history that dates back almost two thousand years, and has evolved into a recognised discipline with a robust background of scientific enquiry, mostly because mental health care has always had an important interface with the law.1 Nevertheless, even in the developed world there are differences ...
Nijdam-Jones, Alicia; Livingston, James D; Verdun-Jones, Simon; Brink, Johann
For people living with mental illness, recovery involves learning to overcome and manage their symptoms and striving to live fulfilling lives. The literature on achieving recovery emphasises the importance of social connections and positive role models. Hirschi's social bonding theory posits that an individual's attachment to others, belief in social norms, and their commitment and involvement in conventional activities are the major contributors to normalising social behaviour. The aim of this study is to understand the qualities of service identified by patients in a forensic hospital as being important and meaningful to recovery. Semi-structured interviews with 30 inpatients in a forensic mental health hospital in British Columbia, Canada, were audio recorded, and the transcriptions were analysed using thematic analysis. Five themes emerged: involvement in programmes, belief in rules and social norms, attachment to supportive individuals, commitment to work-related activities and concern about indeterminacy of stay. The first four themes map closely onto Hirschi's criminologically derived social bonding theory; however, indeterminacy of stay also arose as a common theme. In addition, the theory was too simple in its separation of elements; our data suggested the complex integration of themes. Our findings may be useful for informing evaluation of forensic mental health services. Copyright © 2014 John Wiley & Sons, Ltd.
Laguna-Parras, Juan Manuel; Jerez-Rojas, María Ramona; García-Fernández, Francisco Pedro; Carrasco-Rodríguez, M Dolores; Nogales-Vargas-Machuca, Inmaculada
To determine the effectiveness of the 'sleep enhancement' nursing intervention (Nursing Interventions Classification) in patients hospitalized with mental illness and having a disturbed sleep pattern and to identify the possible effect of psycho-active medications on this disturbed sleep pattern. A quasi-experimental pretest-posttest type study without control group. The study was conducted in all patients admitted to the mental health inpatient unit of University Hospital of Spain from 1 March 2007-31 May 2008. The effectiveness of the 'sleep enhancement' nursing intervention was measured using the Oviedo Sleep Questionnaire score and Nursing Outcome Classification sleep scores at admission and discharge. Psycho-active medication was considered an intervening variable and data were analysed by multivariate analysis of variance for repeated measures. The study included 291 patients. Consumption of psycho-active medications did not change between admission and discharge and was not statistically significantly different in the multivariate analysis of variance. Oviedo Sleep Questionnaire and Nursing Outcome Classification sleep scores at admission and discharge demonstrated significant sleep improvement after the nursing intervention. This nursing intervention could be implemented in patients admitted to a mental health inpatient unit with disturbed sleep pattern, regardless of their consumption of psycho-active medications. © 2012 Blackwell Publishing Ltd.
Al-Yateem, Nabeel; Rossiter, Rachel; Robb, Walter; Ahmad, Alaa; Elhalik, Mahmoud Saleh; Albloshi, Sumaya; Slewa-Younan, Shameran
In the United Arab Emirates (UAE) 35% of the population are aged 0-24 years. A significant proportion of these young people are living with chronic conditions (e.g., asthma, type 1 diabetes, cardiac conditions, and genetically-transmitted conditions such as thalassemia and cystic fibrosis). This group has increased vulnerability to developmental delays and mental health problems, and is increasingly coming to the attention of service providers in mainstream schools, primary healthcare centers, and pediatric hospitals. Despite the government directing attention to improving the mental health of the UAE population, there is concern that mental health services are not growing at the rate needed to meet the mental health needs of children and young people with chronic conditions. A cross sectional survey design was used to determine the mental health literacy of nurses and other healthcare professionals working with children with chronic illnesses. Participants completed a culturally-adapted mental health literacy questionnaire comprising three vignettes of fictional characters meeting diagnostic criteria for posttraumatic stress disorder, psychosis, and depression with suicidal thoughts. Participants also completed the Kessler Psychological Distress Scale (K10). Participants were 317 healthcare professionals from across the UAE. The majority were nurses. Correct identification of the diagnosis for each vignette was limited, with the highest level of accuracy achieved for the psychosis vignette (n = 113, 54.3%). Accurate identification of appropriate evidence-based interventions was also limited. K10 scores indicated 40% of participants had moderate to high levels of psychological distress. These findings are concerning and provide important data to inform the development of undergraduate and continuing education programs for nurses. The K10 scores suggest healthcare professionals are under considerable stress, highlighting the need to support healthcare
Keers, R N; Williams, S D; Vattakatuchery, J J; Brown, P; Miller, J; Prescott, L; Ashcroft, D M
When compared to general hospitals, relatively little is known about the quality and safety of discharge prescriptions from specialist mental health settings. We aimed to investigate the quality and safety of discharge prescriptions written at mental health hospitals. This study was undertaken on acute adult and later life inpatient units at three National Health Service (NHS) mental health trusts. Trained pharmacy teams prospectively reviewed all newly written discharge prescriptions over a 6-week period, recording the number of prescribing errors, clerical errors and errors involving lack of communication about medicines stopped during hospital admission. All prescribing errors were reviewed and validated by a multidisciplinary panel. Main outcome measures were the prevalence (95% CI) of prescribing errors, clerical errors and errors involving a lack of details about medicines stopped. Risk factors for prescribing and clerical errors were examined via logistic regression and results presented as odds ratios (OR) with corresponding 95% CI. Of 274 discharge prescriptions, 259 contained a total of 1456 individually prescribed items. One in five [20·8% (95%CI 15·9-25·8%)] eligible discharge prescriptions and one in twenty [5·1% (95%CI 4·0-6·2%)] prescribed or omitted items were affected by at least one prescribing error. One or more clerical errors were found in 71·9% (95%CI 66·5-77·3%) of discharge prescriptions, and more than two-thirds [68·8% (95%CI 56·6-78·8%)] of eligible discharge prescriptions erroneously lacked information on medicines discontinued during hospital admission. Logistic regression analyses revealed that middle-grade [whole discharge prescription level OR 3·28 (3·03-3·56)] and senior [whole discharge OR 1·43 (1·04-1·96)] prescribers as well as electronic discharge prescription pro formas [whole discharge OR 2·43 (2·08-2·83)] were all associated with significantly higher risks of prescribing errors than junior prescribers and
Reynolds, Charles F.; Lewis, David A.; Detre, Thomas; Schatzberg, Alan F.; Kupfer, David J.
Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics. The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry’s mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management. PMID:19318776
Aggarwal, Neil K
The spread of neuroimaging technologies around the world has led to diverse practices of forensic psychiatry and the emergence of neuroethics and neurolaw. This article surveys the neuroethics and neurolegal literature on the use of forensic neuroimaging within the courtroom. Next, the related literature within medical anthropology and science and technology studies is reviewed to show how debates about forensic neuroimaging reflect cultural tensions about attitudes regarding the self, mental illness, and medical expertise. Finally, recommendations are offered on how forensic psychiatrists can add to this research, given their professional interface between law and medicine. At stake are the fundamental concerns that surround changing conceptions of the self, sickness, and expectations of medicine.
A new remuneration system is currently being developed for the hospital care of people with mental disorders. Last year, because of sharp criticism the option phase of the planned Flat-rate Charges in Psychiatry and Psychosomatics (Pauschalierende Entgelte Psychiatrie und Psychosomatik, PEPP) was extended by 2 years. During this time the Federal Ministry of Health wants to look for alternatives and possible starting points for the further development of care. Now, 16 scientific professional associations and organisations have presented a joint concept for a sustainable solution: the budget-based remuneration system. The system is suitable for ensuring that people with mental disorders are treated according to their particular needs and for promoting the appropriate further development of regional care in all treatment settings. It corresponds with the objectives as formulated in Section 17d of the Hospital Finance Act (Krankenhausfinanzierungsgesetz, KHG) and translates the PEPP system, which is currently being developed and focusses on average prices, into a performance-oriented, transparent budgetary system. The fundamental principle is the separation of the individual hospitals' budgeting on the basis of evidence-based, feature- and performance-related modules and billing in the form of advance payments from the agreed budget.
Pai, Brahmavar Nagesh; Vella, Shae-Leigh Cynthia
This paper provides a review of the importance of primary care psychiatry within an Australian context. The aims of this review are: (1) to emphasize the integral role of mental health in overall health and well-being, (2) to elucidate the factors that make the provision of primary care psychiatry essential, and (3) to review the impact of the Australian government's mental health policy initiatives on the mental health of the Australian population as well as on the practice of primary care psychiatry. From this review, it is evident that the discipline of psychiatry is integral to the overall health of the community. Furthermore, it is apparent that primary care psychiatry has a large and pivotal role to play in the prevention, treatment, and early detection of mental disorders in Australia and worldwide. The article concludes with some simple, actionable recommendations for the practice of primary care psychiatry.
Goldman, Stuart; Demaso, David R.; Kemler, Beth
Objective: This study assessed the implementation of psychiatry morbidity and mortality rounds (M&Ms) on the clinical and educational practice in a children's hospital. Methods: Attendees to monthly M&Ms between July 2005 and May 2007 included staff and trainees from psychiatry, psychology, nursing, and social work. Cases were selected based on a…
Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina
Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…
Casacchia, Massimo; Malavolta, Maurizio; Bianchini, Valeria; Giusti, Laura; Di Michele, Vittorio; Giosuè, Patricia; Ruggeri, Mirella; Biondi, Massimo; Roncone, Rita
The date of March 31, 2015, following the Law 81/2014, has marked a historical transition with the final closure of the six forensic psychiatric hospitals in Italy. This law identifies a new pathway of care that involves small-scale high therapeutic profile facilities (Residenze per la Esecuzione della Misura di Sicurezza, REMS) instead of the old forensic psychiatric hospitals. The Law promotes a new recovery-oriented rehabilitation approach for the persons with mental disorders who committed a criminal offence, but lack criminal responsibility and deemed as socially dangerous. After a brief description of what happens abroad, this article highlights the positive aspects of the law that, as a whole, has to be considered innovative and unavoidable. The main debated problems are also reviewed, including the lack of changes to the Criminal Code; the improper equation between insanity and mental illness and social dangerousness; the evaluation of "socially dangerousness", based solely on "subjective qualities" of the person, assessed out of his/her context, without paying attention to family and social conditions suitable for discharge; the expensive implementation of the REMS, mainly based on security policies and less on care and rehabilitation, the delay in their construction, and the search for residential alternatives structures; the uncertain boundaries of professional responsibility. Finally, several actions are suggested that can support the implementation of the law: information programs addressed to the general population; training activities for mental health professionals; systematic monitoring and evaluation of the outcomes of the care provided to the forensic psychiatric population; implementation of Agreement Protocols and a better cooperation with the judiciary. Scientific societies dealing with psychosocial rehabilitation need to be involved in such issues relating to the identification of the best care and rehabilitation pathways, which should be
Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios
Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically
Full Text Available The aim of the paper is reassessment of the role of psychiatry in the treatment of family violence within the context of contemporary approaches and researches. There are prejudices in the general and professional public that perpetrators of family violence are usually persons with mental disorders and that psychiatry is primarily in charge of their treatment; it has been shown that severe mental disorders do not increase the risk of violence. Application of classical psychiatrics approach to family violence treatment is discussed, as well as the roles of psychiatry in current theoretical and therapeutic approaches to this issue, including systemic family therapy, social psychiatry primarily concerned with their treatment. Studies have shown that severe mental disorders do not increase ecology, unwillingness therapy and model of protection of family violence victims that is developed in Serbia. [Projekat Ministarstva nauke Republike Srbije, br. 47021
Koren E V; Kupriyanova, T A; Dubinskaya, A O; Khairetdinov, O Z
To specify parent reaction to a mental disorder in the child and to develop differential approaches to psychosocial family interventions. Authors studied parents (mostly mothers) of 140 children with schizophrenia spectrum disorders, 100 children with autistic disorders and 85 children with mental retardation. Along with psychiatric examination of the parents, it was used psychometric scales ECI and CGSQ. Authors specified emotional and behavioral characteristics of the parents' reaction as common for all diseases studied as well peculiar for separated forms of mental diseases in children. The factors (cognitive, emotional and behavioral) determining the targets of differentiated therapeutic interventions were singled out. The stress coping strategies for parents are formulated.
The origin of Keijo Imperial University, Medical School, Psychiatry course, and presentation at the Annual Meetings of the Japanese Society of Psychiatry and Neurology and The Japanese Society of Psychiatry and Neurology were investigated from its establishment to 1945. Keijo was the name used for the capital city of Korea, Seoul, when Korea was under Japanese rule. We believe the Keijo Imperial University evolved out of the Governor-General of Korea Hospital and Keijo Medical Professional School. The first Professor at the University was Shinji Suitsu, who studied under Shuzo Kure. He visited Shizuoka prefecture when he collaborated in Kure's "Actual situation and statistical observation on home custody of mental patients" (1918). This was confirmed by photographic materials from this time. The year after the visit to Shizuoka, Suitsu was sent to the Korean Peninsula. In 1913, Suitsu established the Department of Psychiatry at the Governor-General of Korea Hospital, and the institution had 500 tsubo (approximately 1,650 m2) of land within Keijo (Seoul), with floor space of 160 tsubo (approximately 528 m2) and 24 beds. Treatments were performed by Suitsu, an assistant, and 8-9 nurses. The number of hospitalized patients was 30-50 patients per year. Cells had floor heating. Keijo Imperial University was established in 1924, and was called Jodai. In 1925, Suitsu retired from his Professorship of Psychiatry at Keijo Medical Professional School. Suitsu was from Kyoto Imperial University, and had studied abroad. In 1925, Suitsu's father-in-law, and a long-time friend of Shuzo Kure, Seiji Yamane, passed away. The professor who took up the position after Suitsu was Kiyoji Kubo, who was originally supposed to go to Hokkaido Imperial University. When the medical school was established at Keijo Imperial University in 1926, Kubo was offered a professorship there. Jodai was under the jurisdiction of the Governor-General of Korea, and not the Ministry of Education. Later
Yoon, Hyun-Suk; Cho, Young-Chae
The present study was intended to assess the mental health of nurses working for university hospitals and to establish which factors determine their mental health. Self-administered questionnaires were given to 1,486 nurses employed in six participating hospitals located in Daejeon City and Chungnam Province between July 1st and August 31st, 2006. The questionnaire items included sociodemographic, job-related, and psychosocial factors, with job stress factors (JCQ) as independent variables and indices of mental health status (PWI, SDS and MFS) as dependent variables. For statistical analysis, the Chi-square test was used for categorical variables, with hierarchical multiple regression used for determining the factors effecting mental health. The influence of psychosocial and job-related factors on mental health status was assessed by covariance structure analysis. The statistical significance was set at pcoworker support; and psychosocial factors such as self-esteem, locus of control and type A behavior patterns. Psychosocial factors had the greatest impact on mental health. Covariance structure analysis determined that psychosocial factors affected job stress levels and mental health status, and that the lower job stress levels were associated with better mental health. Based on the study results, improvement of mental health status among nurses requires the development and application of programs to manage job stress factors and/or psychosocial factors as well as sociodemographic and job-related characteristics.
Full Text Available Cultural psychiatry concerns itself with the cultural aspects of aetiology, frequency and nature of mental illness and the care and after-care of the mentally ill within the confines of a given cultural unit.
Seyed Saeed Sadr
Full Text Available Objective: The aim of this study was to investigate the current factors affecting the choice of psychiatry as a specialty and to detect the main factors in their choice.Method: This descriptive study included 75 first year psychiatry residents in the academic year of 2014/2015. A Likert-type anonymous questionnaire consisting of academic and demographic data with 43 questions, which evaluated the reason for choosing psychiatry as a specialty, was given to the residents.Results: The participants had a positive opinion about 28 items of the questionnaire, meaning that these items had a positive effect in choosing psychiatry as a specialty (questions with P value less than 0.05 and a positive mean. More than 80% of the residents had a positive opinion about six items of the questionnaire (amount of intellectual challenge, variety of knowledge fields relevant to psychiatry, emphasis on the patient as a whole person, the importance of treating mental illnesses in the future, work pressure and stress of the field during residency and coordinating with the person's life style. The participants had a negative opinion about two items of the questionnaire (questions with a P value less than 0.05 and a negative mean. They included experiencing mental illness personally through relatives or close friends as well as the income in psychiatry. Moreover, 36% of the residents with a more definite opinion mentioned that they chose psychiatry as a specialty because of the limitations in residency exam.Conclusion: Assistants had a positive opinion about most of the questions and this positive attitude seemed to be an important factor in their specialty choice. However, attending to the preventing factors may increase the selection of psychiatry as a specialty.
Molteno, C; Smit, I; Mills, J; Huskisson, J
To investigate the general nutritional status of patients in Alexandra Hospital, Cape Town, and to determine whether dietary copper deficiency was causing anaemia in hospital patients. Descriptive and cross-sectional analytical studies. A long-stay hospital for people with mental handicap. Information was obtained from the total hospital population. In addition, groups of 15 patients were selected from each of two specific wards, one with active and the other inactive patients. To determine whether copper deficiency was causing anaemia, a sample of 30 patients, divided into three groups (a hypochromic microcytic, a normochromic anaemic and a non-anaemic group) was studied. Body mass indices (BMI) and daily dietary intakes were compared with Recommended Daily Allowance (RDA) values. Serum copper and serum caeruloplasmin levels were used to detect possible copper deficiency. A considerable number of patients were found to be underweight (32% of males and 26% of females had BMIs 30). Poor nutrition was more common in severely handicapped patients and those with acquired causes of their mental handicap. Subjects with Down syndrome were generally well nourished and occasionally obese. Poor dietary intakes of biotin, pantothenic acid, vitamin D and copper were encountered. The serum copper and caeruloplasmin values were found to be within normal limits. Patients with hypochromic, microcytic anaemia had higher serum copper and caeruloplasmin levels than those with normochromic anaemia and the control group. A number of nutritional problems among the inpatient population were found. Many were undernourished, while a smaller number of patients were overweight. In both the active and inactive wards macronutrient intakes were generally within normal limits. However, some micronutrient nutritional deficiencies were encountered. We were unable to establish that dietary copper deficiency was the cause of anaemia in our patients. Elevated serum copper and caeruloplasmin levels
Cooke, Brian K.; Cooke, Erinn O.; Sharfstein, Steven S.
Objective: The purpose of this study was to review the workload inventory of on-call psychiatry residents and to evaluate which activities were associated with reductions in on-call sleep. Method: A prospective cohort study was conducted, following 20 psychiatry residents at a 231-bed psychiatry hospital, from July 1, 2008 through June 30, 2009.…
Möller-Leimkühler, A M; Möller, H-J; Maier, W; Gaebel, W; Falkai, P
This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.
Historically, compulsory hospital admission led to discrimination for service users. For example, until recently detention under the Mental Health Act 1983 (England and Wales) would disqualify a person from being a Member of Parliament. There is a belief among mental health professionals that compulsory hospital admission will result in service users being refused a tourist visa. However, there is a paucity of literature on this topic, particularly from an international perspective. Based on the information reviewed in this study, there is no evidence to support this belief. Of 262 travel destinations, 96 (36.6%) require British citizens to obtain a tourist visa. Six (2.3%) destinations require applicants to declare a mental health condition in order to obtain a tourist visa. None of these destinations ask applicants to declare a history of compulsory hospital admission. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health nurses require education to ensure that their knowledge of mental health legislation is up to date. This education should include information on the potential consequences of compulsory hospital admission for the service user's social life following discharge. Service users and their families should be provided with written information on the potential social impact of detention along with a list of organizations that can provide advice on specific issues. This study sought to establish whether a history of compulsory hospital admission prevented a person from obtaining a tourist visa. A visa application form and/or other relevant information were obtained for 262 travel destinations visited by British citizens. Ninety-six (36.6%) destinations require British citizens to obtain a tourist visa. All visas are issued subject to travellers meeting a number of conditions, for example being in possession of travel insurance
Otsuka, Kotaro; Kawanishi, Chiaki
Suicide prevention is promoted nationally in Japan. In the General Principles of Suicide Prevention Policy determined in 2007, the areas in which, psychiatry contributed were shown to be important, for example, psychiatric care, suicide, aftercare program for suicide attempters, mental health promotion, and actual elucidation of the cause of suicide. At a part of these national measures, guidelines on suicide attempters' care are devised by the Japanese Society for Emergency Medicine and the Japanese Association for Emergency Psychiatry, and a training workshop on caring for suicide attempters was held by the Ministry of Health, Labour and Welfare. The Japanese society for Emergency Medicine devised an educational program of care for patients with mental health problems in emergency care in cooperation with the Japanese Association for Emergency Psychiatry and Japanese Society of General Hospital Psychiatry. On the other hand, suicide prevention and staff care at hospitals are important problems, and the Japan Council for Quality Health Care devised a program and conducted a training workshop. Also, the Japanese Association for Suicide Prevention conducted workshops for both the educational program of cognitive-behavioral therapy and facilitator training program for gatekeeper. The Japanese Society of Mood Disorders conducted a training workshop involving clinical high-risk case discussion. Also, the Japanese Society of Psychiatry and Neurology devised clinical guidelines for suicide prevention and distributed them to all society members. In this society, on-site discussion of the guidelines and the holding of workshops are expected in the future. It is hoped that these guidelines will be utilized and training workshops will be held in the future.
Full Text Available Background. Individuals with multimorbidity are vulnerable to poor quality of care due to issues related to care coordination. Ambulatory care sensitive hospitalizations (ACSHs are widely accepted quality indicators because they can be avoided by timely, appropriate, and high-quality outpatient care. Objective. To examine the association between multimorbidity, mental illness, and ACSH. Study Design. We used a longitudinal panel design with data from multiple years (2000–2005 of Medicare Current Beneficiary Survey. Individuals were categorized into three groups: (1 multimorbidity with mental illness (MM/MI; (2 MM/no MI; (3 no MM. Multivariable logistic regressions were used to analyze the association between multimorbidity and ACSH. Results. Any ACSH rates varied from 10.8% in MM/MI group to 8.8% in MM/No MI group. Likelihood of any ACSH was higher among beneficiaries with MM/MI (AOR = 1.62; 95% CI = 1.14, 2.30 and MM (AOR = 1.54; 95% CI = 1.12, 2.11 compared to beneficiaries without multimorbidity. There was no statistically significant difference in likelihood of ACSH between MM/MI and MM/No MI groups. Conclusion. Multimorbidity (with or without MI had an independent and significant association with any ACSH. However, presence of mental illness alone was not associated with poor quality of care as measured by ACSH.
McLoughlin, Kris A; Du Wick, Amanda; Collazzi, Charlene M; Puntil, Cheryl
There is a national initiative to integrate recovery-oriented practices into the delivery of mental health services. Few empirical studies have been conducted to measure these practices in psychiatric-mental health (PMH) nursing, particularly in short-term acute hospital settings. This study examined the reliability of the Recovery Self Assessment-Registered Nurse Version (RSA-RN) and explored recovery practices of PMH nurses and nursing staff in an acute treatment setting. A descriptive one-group design with convenience sampling was employed. One hundred and five participants completed the RSA-RN and the demographic data form. The RSA-RN full-scale instrument demonstrated excellent internal consistency, and the five subscales demonstrated acceptable internal consistency. Significant, favorable relationships were found between RSA-RN scores and nursing staff who (a) had formal education in mental health recovery, (b) considered themselves knowledgeable about recovery, and (c) considered their place of work to be "recovery-oriented." The RSA-RN is a useful tool in measuring recovery-oriented practice. Formal education should be considered as an intervention to increase recovery-oriented practices in PMH nursing.
Weigl, Matthias; Müller, Andreas; Angerer, Peter; Hoffmann, Florian
Pediatricians' workload is increasingly thought to affect pediatricians' quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians' attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts. In an Academic Children's Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians' workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration. Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload. The findings provide insights into specific pathways between different types of interruptions and pediatricians' mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care.
Dement, John M; Lipscomb, Hester J; Schoenfisch, Ashley L; Pompeii, Lisa A
While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized. We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims. Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed. Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events. © 2014 Wiley Periodicals, Inc.
Alejandro Salazar Bermúdez
Full Text Available In this article we analyze 159 clinical records of patients with diagnoses related to alcohol at the Departamental Mental Hospital of Antioquia, between the years of 1920 and 1930. In that decade an institutional transformation began with the arrival at the direction of Dr. Lázaro Uribe Calad. Besides it was very discussed in the medical and political sector the idea of the racial degeneracy, a matter in which alcoholism played a central role. It is observed in medical publications a constant concern due to the terrible consequences that the high consumption of alcohol could bring in society. However, a deeper review of sources such as the annual Statistics of the Mental Hospital and the clinical records, shows how clinical practice reflected another reality. It is concluded that both, the number of patients who were diagnosed as alcoholic or whose etiology was related to the drink, were much lower than those indicated by the doctors. These incomes mainly responded to moral and social problems, but not to psychiatric issues.
Wolfman, Samuel; Shaked, Tali
Mentally ill patients whose reality judgements are severely impaired by reason of their illness and consequently present a danger to themselves and others, may be involuntarily admitted to a secure psychiatric ward for the safety of both themselves and the public. The Israeli Statute for the Treatment of Mentally Ill Patients, enacted in 1955 and amended in 1991, sets out rules and procedures for such involuntary confinement, and grants authority to the MOH District Psychiatrist to issue initial involuntary admission orders. However, a patient can appeal a District Psychiatrist order before a judicial statutory committee, comprising two senior psychiatrists and a legal expert in the capacity of magistrate. Such committee is also the statutory forum for determining whether involuntary hospitalization should be extended. The committee may quite often face ethical dilemmas when, on the one hand, there is no question that the patient's judgement is severely impaired but on the other hand, his/her condition does not fully meet the criteria of the statutory requirements for involuntary confinement. This paper discusses the legal aspects and requirements of involuntary admissions vis-a-vis the ethical dilemmas that such Statutory Committees may face when deciding to extend hospitalization or to release the patient from committal. The paper shall also illustrate dilemmas actually brought before the Committee that have ended in a final ruling that balances moral ethical dilemmas with the strict statutory requirements.
Tzeferakos, Georgios; Douzenis, Athanasios
From the ancient times, there are three basic approaches for the interpretation of the different psychic phenomena: the organic, the psychological, and the sacred approach. The sacred approach forms the primordial foundation for any psychopathological development, innate to the prelogical human mind. Until the second millennium B.C., the Great Mother ruled the Universe and shamans cured the different mental disorders. But, around 1500 B.C., the predominance of the Hellenic civilization over the Pelasgic brought great changes in the theological and psychopathological fields. The Hellenes eliminated the cult of the Great Mother and worshiped Dias, a male deity, the father of gods and humans. With the Father's help and divinatory powers, the warrior-hero made diagnoses and found the right therapies for mental illness; in this way, sacerdotal psychiatry was born.
Falkai, P. (Rheinische Landes- und Hochschulklinik Duesseldorf, Psychiatrische Klinik der Heinrich-Heine-Universitaet (Germany)); Bogerts, B. (Rheinische Landes- und Hochschulklinik Duesseldorf, Psychiatrische Klinik der Heinrich-Heine-Universitaet (Germany))
Computed tomography has gained importance as a diagnostic tool in psychiatry to exclude structural brain pathology, but has passed on its role in research to magnetic resonance tomography. It helps to distinguish between senile dementia of Alzheimer type and multi-infarct dementia. The enlargement of the ventricular system and cortical sulci is well established in schizophrenic and affective psychosis. Some alcohol addicts show a considerable degree of cerebral atrophy, only exceeded by demented patients, but this condition is potentially reversible. To screen psychiatric patients by CT is recommendable, as 2-10% of hospitalized psychiatric patients have structural brain disease. (orig.)
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, ...
ing of research on every aspect of psychiatry. A few areas where Australian research has achieved interna- tional recognition include the classification of depression, the concept of abnormal illness behaviour, treatment of anxiety disorders, schizophrenia, eating disorders and perinatal psychiatry. In the past it was common ...
May 20, 2004 ... 13th National Psychiatry Congress. The EEG in psychiatry. Roland Eastman. Division of Neurology, University of Cape Town, Cape Town, South Africa orders. Epilepsy is primarily a clinical diagnosis, but the EEG may provide strong support by the finding of inter-ictal epi- leptogenic discharges and also be ...
The Nigerian Journal of Psychiatry publishes original scientific papers, review articles, short reports and opinion papers in all areas of psychiatry and related fields, such as sociology, applied anthropology and neurosciences. Vol 14, No 1 (2016). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT ...
Full Text Available The idea that psychiatry contains, in principle, a series of levels of explanation has been criticised both as empirically false but also, by Campbell, as unintelligible because it presupposes a discredited pre-Humean view of causation. Campbell’s criticism is based on an interventionist-inspired denial that mechanisms and rational connections underpin physical and mental causation respectively and hence underpin levels of explanation. These claims echo some superficially similar remarks in Wittgenstein’s Zettel. But attention to the context of Wittgenstein’s remarks suggests a reason to reject explanatory minimalism in psychiatry and reinstate a Wittgensteinian notion of level of explanation. Only in a context broader than the one provided by interventionism is the ascription of propositional attitudes, even in the puzzling case of delusions, justified. Such a view, informed by Wittgenstein, can reconcile the idea that the ascription mental phenomena presupposes a particular level of explanation with the rejection of an a priori claim about its connection to a neurological level of explanation.
The idea that psychiatry contains, in principle, a series of levels of explanation has been criticized not only as empirically false but also, by Campbell, as unintelligible because it presupposes a discredited pre-Humean view of causation. Campbell's criticism is based on an interventionist-inspired denial that mechanisms and rational connections underpin physical and mental causation, respectively, and hence underpin levels of explanation. These claims echo some superficially similar remarks in Wittgenstein's Zettel. But attention to the context of Wittgenstein's remarks suggests a reason to reject explanatory minimalism in psychiatry and reinstate a Wittgensteinian notion of levels of explanation. Only in a context broader than the one provided by interventionism is that the ascription of propositional attitudes, even in the puzzling case of delusions, justified. Such a view, informed by Wittgenstein, can reconcile the idea that the ascription mental phenomena presupposes a particular level of explanation with the rejection of an a priori claim about its connection to a neurological level of explanation.
Meise, Ullrich; Frajo-Apor, Beatrice; Stippler, Stippler; Wancata, Johannes
History shows that the discussion concerning coercive measures against mentally ill is as old as psychiatry itself. The dilemma of psychiatry lies in its double role - having both a therapeutic and a regulatory function. Violence against sick and disabled people conflicts with the ethical principles of helping professions. This, however, is where the danger lies: that the violent parts of psychiatric work - which in the opinion of experts cannot be entirely avoided - are repressed or seen as taboo and are therefore more difficult to control. Comparisons between EU countries of the nature, frequency and duration of coercive measures are difficult because of the heterogeneity of regulation and differences in established practice. Scientific examination of this issue seems to be insufficient. There are only a few studies on important issues such as how patients rate these measures. An open and thorough debate about the meaning and meaninglessness of coercion and violence in psychiatric treatment would be necessary to prevent "routine violence" or the excessive use of force against the mentally ill.
Huang, Xuan-Yi; Lin, Mei-Jue; Yang, Tuz-Ching; Sun, Fan-Ko
The purpose of this study is to generate a substantive theory of hospital-based home care for people with severe mental illness in Taiwan. Despite the documented advantages of hospital-based home care services, there is a lack of information and understanding regarding the practices, functions and limitations. Currently, there is no model for how those services are to be provided and what factors will affect these services. The grounded theory method of Strauss and Corbin (Basics of Qualitative Research: Grounded Theory Procedures and Techniques, SAGE Publications, 1990) was used to develop a substantive theory through a paradigm model, including causal conditions, context, intervening conditions, action/interaction strategies and consequences. This study was conducted in six different hospital areas in Central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. A substantive theory of hospital-based home care for people with severe mental illness in Taiwan was developed. The core category was the process of hospital-based home care in helping people with severe mental illness, with 15 categories and 33 sub-categories of the substantive theory. The substantive theory is the first to emerge from hospital-based home care services in Taiwan. Results showed those services had several effective functions for helping people with severe mental illness and their families. The recommendations based on the findings of this research can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling people with severe mental illness and their carers.
David E Linden
Full Text Available This perspective considers the present and the future role of different neuroimaging techniques in the field of psychiatry. After identifying shortcomings of the mainly symptom-focussed diagnostic processes and treatment decisions in modern psychiatry, we suggest topics where neuroimaging methods have the potential to help. These include better understanding of the pathophysiology, improved diagnoses, assistance in therapeutic decisions and the supervision of treatment success by direct assessment of improvement in disease-related brain functions. These different questions are illustrated by examples from neuroimaging studies, with a focus on severe mental and neuropsychiatric illnesses such as schizophrenia, depression and dementia. Despite all reservations addressed in the article, we are optimistic, that neuroimaging has a huge potential with regard to the above-mentioned questions. We expect that neuroimaging will play an increasing role in the future refinement of the diagnostic process and aid in the development of new therapies in the field of psychiatry.
Ang, Giap Kian; Pridmore, Saxby
'Theory of mind' (ToM) arose from the study of primates and their social organization, and scholars in many fields - philosophy, anthropology, psychology, psychiatry and neuroscience - have contributed to this expanding topic. In this paper, we provide an overview of aspects of ToM of relevance to psychiatry. We briefly describe the origins of ToM in primates and humans and some relevant neurobiology, and then touch on possible contributions to psychopathology. We searched for articles on PubMed and Medline, using the terms 'theory of mind', 'mirror neuron system' and 'psychiatry'. There is evidence that ToM deficits are important in certain psychiatric disorders. While more research is required, an appreciation of ToM will have an impact on our further understanding and management of at least some mental disorders, including autism and schizophrenia.
Full Text Available Tony B Benning Maple Ridge Mental Health Centre, Maple Ridge, BC, Canada Abstract: A commitment to an integrative, non-reductionist clinical and theoretical perspective in medicine that honors the importance of all relevant domains of knowledge, not just “the biological,” is clearly evident in Engel’s original writings on the biopsychosocial model. And though this model’s influence on modern psychiatry (in clinical as well as educational settings has been significant, a growing body of recent literature is critical of it - charging it with lacking philosophical coherence, insensitivity to patients’ subjective experience, being unfaithful to the general systems theory that Engel claimed it be rooted in, and engendering an undisciplined eclecticism that provides no safeguards against either the dominance or the under-representation of any one of the three domains of bio, psycho, or social. Keywords: critique of biopsychosocial psychiatry, integrative psychiatry, George Engel
Purpose of review The present review examines recent contributions to the evolving field of historical writing in psychiatry. Recent findings Interest in the history of psychiatry continues to grow, with an increasing emphasis on topics of current interest such as the history of psychopharmacology, electroconvulsive therapy, and the interplay between psychiatry and society. The scope of historical writing in psychiatry as of 2007 is as broad and varied as the discipline itself. Summary More than in other medical specialties such as cardiology or nephrology, treatment and diagnosis in psychiatry are affected by trends in the surrounding culture and society. Studying the history of the discipline provides insights into possible alternatives to the current crop of patent-protected remedies and trend-driven diagnoses. PMID:18852567
Frierson, Richard L; Boyd, Mary S; Harper, Angela
As the number of state mental hospital beds declines, persons with persistent mental illness are increasingly encountered by those working in the legal system. Attorneys may have little experience in working with this population. This research involved a 32-item written survey of the 492 members of the criminal bar in South Carolina. Demographic variables were surveyed, and attorneys were asked to define two common terms describing mental illnesses (delusion and psychosis) and the legal criteria for verdicts of not guilty by reason of insanity and guilty but mentally ill. They were also asked to identify the most severe mental illness (schizophrenia). Attitudes about these verdicts and about working with defendants who are mentally ill were also surveyed. Results indicate that attorneys are fairly knowledgeable about mental illness, but not verdicts involving mental illness, particularly the verdict of guilty but mentally ill. Most attorneys prefer to work with clients who do not have mental illness. However, as they become more experienced interacting with defendants who are affected by mental illness, they become more knowledgeable and are more willing to defend them. A large majority believe that their law school education about mental illness was inadequate. When comparing attorney occupations, public defenders were the most knowledgeable about mental illness and mental health defenses, followed by prosecutors and private defense attorneys. Judges were the least knowledgeable group. © 2015 American Academy of Psychiatry and the Law.
Full Text Available This paper is aimed at analyzing the procedure of involuntary hospitalization of persons with mental disorder. Considering the fact that enforced hospitalization interferes with the fundamental human rights and individual freedoms, the rules of involuntary hospitalization procedure have to provide for the legality of decisions, prevent possible abuses and enable the exercise of legitimate rights and interests of persons with mental disorder confined to treatment in psychiatric institutions. Bearing in mind the significance of the involuntary hospitalization procedure, the author of this paper provides a critical analysis of the national regulation on involuntary hospitalization. The aim of this analysis is to observe whether the rules of involuntary hospitalization procedure comply with the generally recognized international and European standards on the human rights protection of persons with mental disorder, and to identify the shortcomings of the existing mechanism of involuntary hospitalization. Taking into consideration the results of this analysis, the author points to the necessity of reforming the involuntary hospitalization procedure and proposes possible directions for a further improvement of this legal institute.
Little is known about the factors that increase the risk for enacted mental illness stigma (i.e. rejection, devaluation and exclusion) as perceived by the stigmatized person. This is particularly true for the population of adolescents diagnosed with a mental illness. The aim of this study was to address this question and examine select social and clinical factors that predict enacted stigma (self-reported) with research that follows eighty American adolescents for 6 months following a first psychiatric hospitalization. Drawing on social identity theory, and research on stigma-threatening environments, social group identification and social support, this study tested four hypotheses: affiliation or identification with higher status and lower status peers predicts more and less stigma respectively (H1); a greater and more supportive social network, and more perceived family support predict less stigma (H2); greater severity of internalizing and externalizing symptoms predicts more stigma (H3); and poorer school functioning predicts more stigma (H4). Results indicated that about 70% of adolescents reported experiencing enacted stigma (at 6 months); disrespect or devaluation was more common than outright social rejection. Using OLS regression analyses, the results provided partial support for H1, H3 and H4, while H2 was not supported. The baseline factors found to be most predictive of enacted stigma ratings at 6-months were: affiliating with more friends with mental health problems, identifying with the 'populars' peer group, higher internalizing symptom ratings, and self-reported disciplinary problems at school. These four factors remained significant when controlling for initial enacted stigma ratings, pointing to their importance in determining changes in social stigma experiences in the follow-up period. They also remained significant when controlling for perceived public stigma ratings at follow-up, indicating that the findings were not due to generalized
Rancāns, Elmārs; Tērauds, Elmārs; Taube, Māaris
While there is close contact established between Latvia and the Nordic psychiatric community now, there are many pages of our history we have not had opportunity to share. The aim of this article is to highlight the most important facts of more than 200 years of history of psychiatry in Latvia. The development of the psychiatric services in Latvia started with the building of an asylum-type establishment at the end of the 1700s. To address the increasing needs, psychiatric hospitals of various size and quality were gradually opened all over the country. Psychiatry as a field of science emerged in Latvia after the Declaration of Independence in 1918. Active and progressive development of services and the academic environment took place between the World Wars. During the Soviet regime, psychiatric services were rebuilt within the frameworks and guidelines of the existing system. Following the restoration of Independence in 1991, a number of rapid and positive changes took place. There was a gradual decrease in the number of hospital beds, outpatient services were developed and modern treatment methods were established. Policy documents in the field of mental health were developed and legislation improved. Active collaboration with other, particularly Scandinavian, countries was developed. Academic education continued and specialist training was provided following European standards. The role of the psychiatric professional organization was strengthened. Many positive changes in the mental healthcare in Latvia have taken place, but there are still some aspects to be addressed. The strengthening of our regional collaboration could be crucial for our future development.
Parameshvara Deva, M
Malaysia is a tropical country in the heart of south east Asia with a population of 24 million people of diverse ethnic, cultural and religious backgrounds living in harmony in 330,000 km(2) of land on the Asian mainland and Borneo. Malaysia, which lies on the crossroads of trade between east and west Asia, has an ancient history as a centre of trading attracting commerce between Europe, west Asia, India and China. It has had influences from major powers that dominated the region throughout its history. Today the country, after independence in 1957, has embarked on an ambitious development project to make it a developed country by 2020. In this effort the economy has changed from one producing raw material to one manufacturing consumer goods and services and the colonial health system has been overhauled and social systems strengthened to provide better services for its people. The per capita income, which was under 1,000 US dollars at independence, has now passed 4,000 US dollars and continues to grow, with the economy largely based on strong exports that amount to over 100 billion US dollars. The mental health system that was based on institutional care in four mental hospitals at independence from British colonial rule in 1957 with no Malaysian psychiatrists is today largely based on over 30 general hospital psychiatric units spread throughout the country. With three local postgraduate training programmes in psychiatry and 12 undergraduate departments of psychiatry in the country--all started after independence--there is now a healthy development of mental health services. This is being supplemented by a newly established primary care mental health service that covers community mental health by integrating mental health into primary health care. Mental health care at the level of psychiatrists rests with about 140 psychiatrists most of whom had undertaken a four-year masters course in postgraduate psychiatry in Malaysia since 1973. However, there continues to be
In her book 'An Unquiet Mind' the psychologist Kay Jamison gives a moving ... Department of Psychiatry, University of Pretoria, Weskoppies Hospital, Pretoria, South Africa. Abstract: This ... psychodynamic formulation is unfortunately seldom incorporated in the psychiatric presentation of patients; guidelines are therefore ...
Lauber, Christoph; Nordt, Carlos; Haker, Helene; Falcato, Luis; Rössler, Wulf
Mental health authorities must know the public's attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry. To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland. Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n = 1737). Most respondents have positive attitudes to community psychiatry. In the regression analysis (R2 adjusted = 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence. In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.
Pedersen, Liselotte; Rasmussen, Kirsten; Elsass, Peter
People with a major mental disorder are at increased risk of committing crimes, especially violent crimes, compared with the general population. Sub-groups have been identified based on age of onset of anti-social or violent behaviour. Mentally disordered offenders with early onset anti-social be...
Al-Sharbati, Marwan M.; Al-Farsi, Yahya M.; Al-Sharbati, Zena M.; Fatima Al-Sulaimani; Allal Ouhtit; Samir Al-Adawi
Objectives Early diagnosis and prompt treatment of mental and behavioral disorders in preschoolers is critical for a better prognosis, ultimately leading to improved quality of life for both the child and the family. Our study investigated the clinical profile of mental and behavioral disorders in children < 7 years of age, seeking consultation at Sultan Qaboos University Hospital, Muscat, Oman, between 1 June 2006 and 31 December 2010. The objective was to explore demographic variables, ...
Ser, Gloria; Robertson, Ann; Sheikh, Aziz
To investigate the perceptions and reported practices of mental health hospital staff using national hospital electronic health records (EHRs) in order to inform future implementations, particularly in acute mental health settings. Thematic analysis of interviews with a wide range of clinical, information technology (IT), managerial and other staff at two early adopter mental health National Health Service (NHS) hospitals in London, UK, implementing national EHRs. We analysed 33 interviews. We first sought out examples of workarounds, such as delayed data entry, entering data in wrong places and individuals using the EHR while logged in as a colleague, then identified possible reasons for the reported workarounds. Our analysis identified four main categories of factors contributing to workarounds (i.e., operational, cultural, organisational and technical). Operational factors included poor system integration with existing workflows and the system not meeting users' perceived needs. Cultural factors involved users' competence with IT and resistance to change. Organisational factors referred to insufficient organisational resources and training, while technical factors included inadequate local technical infrastructure. Many of these factors, such as integrating the EHR system with day-to-day operational processes, staff training and adequate local IT infrastructure, were likely to apply to system implementations in various settings, but we also identified factors that related particularly to implementing EHRs in mental health hospitals, for example: EHR system incompatibility with IT systems used by mental health-related sectors, notably social services; the EHR system lacking specific, mental health functionalities and options; and clinicians feeling unable to use computers while attending to distressed psychiatric patients. A better conceptual model of reasons for workarounds should help with designing, and supporting the implementation and adoption of, EHRs for
Krasnov, Valery N; Gurovich, Isaak
Russian psychiatry has a dramatic history, and until now has been at a transitional stage of development. It is facing problems not only common in world psychiatry, but also specific to eastern Europe, in particular Russia. Starting from the beginning of the 1990s, considerable changes have occurred in psychiatry, especially after 1992 when the law on psychiatric care and guarantees of citizens' rights in its provision was adopted. It became the ideological and legislative basis for reforms. However, there are definite obstacles to structural reforms in psychiatry. They are unfavourable technical conditions in many psychiatric clinics, hypercentralization of psychiatric services, shortage of clinical psychologists and social workers in psychiatry, some difficulties in cooperation between psychiatric and general medical institutions. Economic difficulties in the transition period of Russia's social development prevent the overcoming of these problems. They are being actively discussed and some of them are being gradually solved, e.g. the organization of team work in mental health services, the increasing number of specialists on social work, and the involvement of non-government organizations in psychosocial rehabilitation.
Full Text Available Background: Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. Objectives: To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. Methods: A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egypt. All participants were invited to complete a structured questionnaire through a semi-structured interview which included the self-reporting questionnaire 20 items (SRQ-20 and the work stress scale. Assessment of drug use included urine-based screening tests for common substances abused. Results: The prevalence of job stress, common mental disorders and substance abuse, particularly tramadol and cannabis (Bango, was significantly higher in the studied temporary cleaners compared to permanent cleaners. Risk factors associated with increased susceptibility of the temporary cleaners to common mental disorders were family history of substance abuse, high crowding index, history of physical illness, low educational level, and smoking; while being unmarried, male sex, family history of mental disorder, age ≥40 years, smoking, and length of service ≥8 years, were associated with substance abuse among the same group. Conclusion: Temporary hired hospital cleaners suffered from impaired mental health more than permanent cleaners. Therefore, expanding the coverage of current laws and occupational safety and health standards to cover workers in the informal sector especially in developing countries is recommended.
Grendas, Leandro; Rodante, Demián; Rojas, Sasha; Puppo, Soledad; Vidjen, Patricia; Lado, Gisela; Portela, Alicia; Daray, Federico M
The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications. Copyright © 2017 Elsevier B.V. All rights reserved.
Saúde mental na atenção básica como processo histórico de evolução da psiquitria comunitária Salud mental en la atención básica como porceso histórico de evolución de la psiquiatría comunitaria Mental health in the basic attention as historical process of community psychiatry evolution
Amanda Márcia dos Santos Reinaldo
Full Text Available O artigo se propõe a analisar aspectos teóricos sobre a saúde mental na atenção básica e sua interface com a psiquiatria comunitária a partir de uma reflexão sobre a produção científica relacionada ao tema. Para tanto, foi realizada uma revisão bibliográfica no período de maio a julho de 2005, quando foram consultadas as bases de dados (Biblioteca Virtual em Saúde, Bireme, Scielo, Lilacs e fontes primárias que versam sobre o tema, utilizando as palavras-chave: saúde mental, atenção primária, psiquiatria, comunidade, atenção básica. Foram encontradas 142 ocorrências e, destas, utilizadas 20 de acordo com o objetivo do estudo. A análise do material compilado subsidia a discussão de que efetivamente há uma interface entre a saúde mental na atenção básica e a psiquiatria comunitária que se reflete na atual política de saúde mental.La finalidad del artículo es analizar aspectos teóricos sobre la salud mental en la atención básica y su interfaz con la psiquiatría comunitaria a partir de una reflexión sobre la producción científica relacionada al tema. Para tanto fue realizada una revisión bibliográfica en el período de mayo a julio de 2005, donde fueron consultadas las bases de datos (Biblioteca Virtual en Salud, Bireme, Scielo, Lilacs y fuentes primarias sobre el tema, utilizando las palabras-clave: salud mental, atención primaria, psiquiatría, comunidad, atención básica. Fueron encontradas 142 ocurrencias y, de estas, utilizadas 20 de acuerdo con el objetivo del estudio. El análisis del material compilado subsidia la discusión de que efectivamente existe una interfaz entre la salud mental en la atención básica y la psiquiatría comunitaria que se refleja en la actual política de salud mental.This article aims to analyze theoretical aspects of mental health in basic care and its interface with community psychiatry, based on a reflection about scientific production related to the theme. Therefore
Tordeurs, D; Janne, P; Appart, A; Zdanowicz, N; Reynaert, C
There is a general belief that physical activity and exercise have positive effects on mood and anxiety. Intervention studies describe an anxiolytic and antidepressive effect of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological inconsistencies. Our review of the literature showed the importance of distinguishing three items in studies regarding efficacy of physical exercise in psychiatry: operationalisation of concepts (duration, frequency, intensity, type of exercise), the type of disorder, the diagnosis, and exploratory hypotheses. The aim of this article is to demonstrate that physical exercise in the psychiatry department contributes to the improvement of the mental health of in-hospital patients. Sociodemographical data, the diagnosis and the physical exercise (duration, distance, type and frequency) of 283 in-hospital patients in the psychiatry department were listed. Physical exercise (cycling, long walks, short walks, soft and hard gymnastics) included in a database has been proposed to patients for many years in this hospital. After their hospitalisation, the members of the medical staff (20 persons) evaluated the patients on a visual analogic scale from 1 to 10 related to the improvement of their mental health. No experimental manipulation was made. One hundred and twenty-eight men, mean age: 45.67 years (± 13.59) exhibited the following disorders: major depressive disorder (117), anxious disorders (25), alcoholic addiction (85), toxicomania (10), psychotic decompensation (33), bipolar disorder (3) and others (10). Patients practised at least one exercise during their hospitalisation, mean duration of 15.93 (± 9.18) working days. The frequency of physical exercises per patient was 5.65 (± 6.20). The improvement of each patient was evaluated around six times (6.16 ± 3.83). The average amelioration score for all the patients was close to 50% (4.99 ± 1.65). Correlations between the
Heydari, Abbas; Moghaddam, Kokab Basiri; Manzari, Zahra Sadat; Mahram, Behrooz
The unlearning process is complex and sometimes painful in nature. This process usually occurs in social interactions and is very dependent on social contexts and the work environment. To explore the concerns and mental challenges in facing unlearning situations in nurses. This qualitative study using content analysis was conducted in 2013-2015. Participants were 25 people, and research environment was hospitals in Mashhad and Gonabad. The method of data collection was unstructured interview, and sampling was continued until data saturation. First, the recorded interviews were transcribed and reviewed several times. Then open codes were extracted and after reviewing several times, were classified into subcategories based on semantic similarity. Finally, the similar subcategories were put into the main categories semantically. Data analysis led to the emergence of 1,180 initial codes and 8 categories and 3 themes. Our themes were discouraging/encouraging situation, double-edged sword colleagues, and organizational policies paradox, that the central theme of progressive and suppressor organizational climate paradox were derived from them. Exposure to unlearning situations is a complex process of which its adoption and implementation is difficult and challenging. This suggests that supporting nurses and attention to their mental concerns and providing favorable learning conditions is required.
Pedersen, Liselotte; Rasmussen, Kirsten; Elsass, Peter
People with a major mental disorder are at increased risk of committing crimes, especially violent crimes, compared with the general population. Sub-groups have been identified based on age of onset of anti-social or violent behaviour. Mentally disordered offenders with early onset anti-social...... behaviour tend to have a lifelong pattern of it, but in a clinical setting, are they easily identifiable as a distinct sub-group?...
Singh, Ajai R; Singh, Shakuntala A
THE FIRST PART CALLED THE PREAMBLE TACKLES: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, non-malfeasance, autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline.THE SECOND PART CALLED THE ISSUES DEALS WITH: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry.The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry.The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity.The fifth part is called The Role of Philosophy
Singh, Ajai R.; Singh, Shakuntala A.
The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, non-malfeasance, autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy
Atbaşoğlu, E Cem; Gülöksüz, Sinan
The upcoming publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides an opportunity to revisit the seldom-addressed methodological issues in contemporary psychiatry. We think that DSM widely determines the scientific and clinical orientation of the discipline, and therefore provides a good vantage point to critique the current psychiatric methodology. The main scientific problem is a perseverative attempt at validating descriptively defined disorders that are standardized and simplified to achieve diagnostic reliability. Lack of a single psychiatric phenomenon that is valid, i.e. natural, for initiating any reduction limits research to inductive-probabilistic methods, basically correlational analyses. Furthermore, reduction in psychiatry is typically directed at basic sciences, neglecting general medical diagnoses as possible intermediary correlates. The subcategory "Due to a General Medical Condition" is elusive, and the biopsychosocial approach does no more than strengthen the brain-disease illusion surrounding DSM definitions by justifying psychiatry as a branch of medicine while failing to stipulate detailed medical assessment and discouraging psychopathology-based clinical reasoning. It is therefore no surprise that, although our understanding of the neural basis and mechanisms of behavior has improved along with advances in the neurosciences, not a single DSM disorder has been validated by the discovery of a specific cause, pathophysiology, or structural abnormality since the adoption of the descriptive approach in 1980. New knowledge involves single traits or dimensions of mood, thought, or behavior, none of which are specific to any disorder. The optimum approach today would be to redefine the discipline as neuropsychiatry.
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.
Keogh, B; Callaghan, P; Higgins, A
What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms. Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the
Nalliah, Romesh P; Da Silva, John D; Allareddy, Veerasathpurush
There is a paucity of knowledge regarding nationally representative estimates of hospital-based emergency department (ED) visits for dental problems made by people with mental health conditions. The authors conducted a study to provide nationwide estimates of hospital-based ED visits attributed to dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess made by people with mental health conditions. The authors used the Nationwide Emergency Department Sample, which is a component of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. ED visits attributable to dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess were identified by the emergency care provider by using diagnostic codes in International Classification of Diseases, Ninth Revision, Clinical Modification. The authors examined outcomes, including hospital charges. They used simple descriptive statistics to summarize the data. In 2008, people with mental health conditions made 15,635,253 visits to hospital-based ED in the United States. A diagnosis of dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess represented 63,164 of these ED visits. The breakdown of the ED visits was 34,574 with dental caries, 25,352 with pulpal and periapical lesions, 9,657 with gingival and periodontal lesions, and 2,776 with mouth cellulitis/abscess. The total charge for ED visits in the United States was $55.46 million in 2008. In 2008, people with mental health conditions made 63,164 visits to hospital-based EDs and received a diagnosis of dental caries, pulpal and periapical lesions, gingival and periodontal lesions or mouth cellulitis/abscess. These ED visits incurred substantial hospital charges. Programs designed to reduce the number of ED visits made by this population for common dental problems could have a
Full Text Available ... meet with their psychiatrist periodically to monitor the effectiveness of the medication and any potential side effects. ... written and oral examination given by the American Board of Psychiatry and Neurology to become a "board ...
Full Text Available ... and insomnia. Hypnotics – used to induce and maintain sleep. Mood stabilizers – used to treat bipolar disorder. Stimulants – ... psychiatry Pain medicine Psychosomatic (mind and body) medicine Sleep medicine Some psychiatrists choose additional training in psychoanalysis ...
Full Text Available ... order or perform a full range of medical laboratory and psychological tests which, combined with discussions with ... written examination for a state license to practice medicine, and then complete four years of psychiatry residency. ...
Full Text Available ... illnesses and the relationships with genetics and family history, to evaluate medical and psychological data, to make ... written examination for a state license to practice medicine, and then complete four years of psychiatry residency. ...
Full Text Available ... become a psychiatrist, a person must complete medical school and take a written examination for a state ... A psychiatrist is a medical doctor (completed medical school and residency) with special training in psychiatry. A ...
Ilieva, Mirolyba; Fex Svenningsen, Åsa; Thorsen, Morten
Autism spectrum disorders are a group of pervasive neurodevelopmental conditions with heterogeneous etiology, characterized by deficits in social cognition, communication, and behavioral flexibility. Despite an increasing scientific effort to find the pathophysiological explanations for the disea...... engineering tool in psychiatry....
Background Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. Methods Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students’ career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students’ attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. Results 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were “quite likely”, and 25% were “definitely not” considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry. Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p psychiatry before medical school, OR 10.8 (5.38 to 21.8, p psychiatry special study module, OR 1.45 (1.05 to 2.01, p = 0.03) or elective OR 4.28 (2.87- 6.38, p psychiatry club, OR 3.25 (2.87 to 6.38, p psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally. PMID
Ebrahimi, Hossein; Namdar, Hossein; Vahidi, Maryam
Stigma is one of the obstacles in the treatment and regaining the mental health of people with mental illness. The aim was determination of mental illness stigma among nurses in psychiatric wards. This study was conducted in psychiatric wards of teaching hospitals in Tabriz, Urmia, and Ardabil in the north-west of Iran. This research is a descriptive analysis study in which 80 nurses participated. A researcher-made questionnaire was used, which measured demographic characteristics and mental illness stigma in the three components of cognitive, emotional, and behavioral. All data were analyzed using SPSS13 software and descriptive and analytical statistics. Majority of nurses (72.5%) had medium level of stigma toward people with mental illness. About half of them (48.8%) had great inclination toward the social isolation of patients. The majority of them (62.5%) had positive emotional responses and 27.5% had stereotypical views. There was a significant correlation between experience of living with and kinship of nurses to person with mental illness, with prejudice toward and discrimination of patients. There was also a significant correlation between interest in the continuation of work in the psychiatric ward and prejudice, and also between educational degree and stereotypical views. The data suggest there is a close correlation between the personal experience of nurses and existence of mental illness stigma among them. Therefore, the implementation of constant educational programs on mental illness for nurses and opportunities for them to have direct contact with treated patients is suggested.
Nizamie, Shamsul Haque; Tikka, Sai Krishna
Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry...
The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.
N A Uvais
Full Text Available Background: The belief that jinn can cause mental illness in human through afflictions or possession is widely accepted among Muslims. Belief about jinn in Muslim medical professionals, especially medical doctors has not been studied till date. Aim: To explore the belief among Muslim doctors regarding jinn and psychiatry. Materials and Methods: We conducted a cross-sectional study among Muslim doctors using a study questionnaire. Results: Majority of the participants believed in the existence of jinn and a significant proportion of the sample believed in jinn possessing humans and jinn causing mental illness in humans and recommended treatment by doctor and religious figures together for jinn afflictions. Conclusion: The belief in jinn and jinn causing mental illness are common among Muslims and remain intact even after medical education. It deserves attention from practitioners in the field of mental health care and demand strengthening of liaison between religious leaders and mental health services.
Wu, Ying; Duan, Zhiguang
With the dramatic rise in mental disorders and mental illnesses, psychiatry has become one of the fastest growing clinical medical disciplines. This has led to a rise in the number of scientific research papers being published in this field. We selected research papers in ten psychiatric journals that were published during 1983 to 2012. These ten journals were those with the top Impact Factor (IF) as indicated by the Science Citation Index Expanded (SCI-Expanded). We utilized information visualization software (CiteSpace) to conduct co-citation and Hierarchal clustering analysis to map knowledge domains to determine the evolution and the foci of research in this field. In the evolution of the field of psychiatry, there were four stages identified. The result of hierarchal clustering analysis revealed that the research foci in the psychiatric field were primarily studies of child and adolescent psychiatry, diagnostic and classification criteria, brain imaging and molecular genetics. The results provide information about the evolution and the foci of the research in the field of psychiatry. This information can help researchers determine the direction of the research in the field of psychiatry; Moreover, this research provides reasonable suggestions to guide research in psychiatry field and provide scientific evidence to aid in the effective prevention and treatment of mental disorders.
Laurence J Kirmayer
Full Text Available Psychiatry has invested its hopes in neuroscience as a path to understanding mental disorders and developing more effective treatments and ultimately cures. Recently, the U.S. NIMH has elaborated this vision through a new framework for mental health research, the Research Domain Criteria (RDoC. This framework aims to orient mental health research toward the discovery of underlying neurobiological and biobehavioral mechanisms of mental disorders that will eventually lead to definitive treatments. In this article we consider the rationale of the RDoC and what it reveals about implicit models of mental disorders. As an overall framework for understanding mental disorders, RDoC is impoverished and conceptually flawed. These limitations are not accidental but stem from disciplinary commitments and interests that are at odds with the larger concerns of psychiatry. A multilevel, ecosocial approach to biobhavioral systems is needed both to guide relevant neuroscience research and insure the inclusion of social processes that may be fundamental contributors to psychopathology and recovery.
Baur, Nicole; Melling, Joseph
Abstract Scholars of insanity and its historical antecedents have paid very little attention to personal and institutional clothing. Such dress, distributed to patients in mental institutions, has always been inscribed with the conflicting narratives of the period in which it was made and worn. The language of civil and medical authority is more evident than personal choice in the shape and address of the attire. This article examines clothing worn by patients in three Devon mental hospitals during the century before 1960. We consider the ways in which institutional clothing formed part of a hospital regimen of overt control, as well as suiting considerations of economy and employment that figured in these institutions. PMID:26989271
Uvais, N. A.
Background: The belief that jinn can cause mental illness in human through afflictions or possession is widely accepted among Muslims. Belief about jinn in Muslim medical professionals, especially medical doctors has not been studied till date. Aim: To explore the belief among Muslim doctors regarding jinn and psychiatry. Materials and Methods: We conducted a cross-sectional study among Muslim doctors using a study questionnaire. Results: Majority of the participants believed in the existence...
Psychiatry as a professional and scientific enterprise developed in Norway in the middle of the 19th century. During the last part of this century, four state asylums were erected, followed by several county asylums during the first part of the 20th century. From the 1870 s, institutions for private care were established, usually in the vicinity of the asylums. During the middle of the 19th century, psychiatry in Norway was influenced by "moral treatment", but during the end of the century somatic ideas prevailed. After the Second World War, Norwegian psychiatry was influenced by Dutch and British social psychiatry, followed by American psychoanalytic-oriented psychiatry during the 1960-70s. Since the 1980s, the climate changed, with more emphasis on classification and drug therapy. The new American DSM-III also influenced Norwegian psychiatry, and cognitive-behavioral therapies became more prevalent. Norwegian psychiatric research has during the last few decades been characterized by epidemiological studies, clinical follow-ups and twin research.
Bales, D.L.; Timman, R.; Andrea, H.; Busschbach, J.J.V.; Verheul, R.; Kamphuis, J.H.
The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who
Bales, D.; Timman, R.; Andrea, H.; Busschbach, J.J.V.; Verheul, R.; Kamphuis, J.
The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who
Brolese, Débora Felippe; Lessa, Greice; Santos, José Luís Guedes Dos; Mendes, Jucimara da Silva; Cunha, Kamylla Santos da; Rodrigues, Jeferson
Evaluating and understanding the resilience process of the health team in caring for people with mental disorders in a psychiatric hospital. A mixed-method study with concomitant triangulation of data from a cross-sectional study, with health professionals, and Grounded Theory in the data. Quantitative data were collected using the Resilience Scale and analyzed using descriptive and inferential statistics. Qualitative data were obtained from interviews and analyzed using initial and focused coding. 40 health professionals participated in the study. Mean responses of the participants in the resilience scale were 99.80 ± 12.86 points, with a minimum of 35 and a maximum of 114 points. From the qualitative data, we can highlight the professionals' commitment in developing competencies in caring for people with mental disorders; valorization of teamwork and positive impact on work for the re-signification of the meaning of life. Understanding this process of resilience enables developing strategies to improve the quality of life of workers in psychiatric hospitals. Avaliar e compreender o processo de resiliência da equipe de saúde no cuidado a pessoas com transtornos mentais em um hospital psiquiátrico. Estudo de método misto com triangulação concomitante de dados de um estudo transversal, com profissionais de saúde, e uma Teoria Fundamentada nos Dados. Os dados quantitativos foram coletados a partir da Escala de Resiliência e analisados por meio de estatística descritiva e inferencial. Os dados qualitativos foram obtidos a partir de entrevistas e analisados mediante codificação inicial e focalizada. Participaram da pesquisa 40 profissionais de saúde. Na escala de resiliência, a média das respostas dos participantes foi 99,80±12,86 pontos, o mínimo foi de 35 e o máximo de 114 pontos. Nos dados qualitativos, destacaram-se o empenho dos profissionais para o desenvolvimento de competências para o cuidado de pessoas com transtornos mentais, a valoriza
Taube-Schiff, Marlene; Ruhig, Megan; Mehak, Adrienne; Deathe van Dyk, Melanie; Cassin, Stephanie E; Ungar, Thomas; Koczerginski, David; Sockalingam, Sanjeev
WHAT IS KNOWN ON THE SUBJECT?: Psychiatric day hospital (DH) treatment has been offered since the 1930s and is appropriate for individuals experiencing intense psychiatric symptoms without requiring 24-hour inpatient care. No empirical research has examined the specific purpose of DH treatment from the perspectives of healthcare providers within these programs. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study was the first to address the question of the purpose and function of DH treatment from the outlook of frontline workers within this setting, and confirmed anecdotal observations that DH treatment provides an alternative to intensive psychiatric care, and also operates as "bridge" between these intensive services and purely outpatient treatment. Additional information emerged, such as the importance of the name of DH programs avoiding connotations of illness, the benefits and skills that draw patients to these programs, and challenges that staff and patients experience within DH programs (e.g. short length of treatment, barriers to treatment access). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This information can enhance curriculum development within these settings. For example, given the importance of skill building, it is essential to integrate the provision of skill building and coping strategies within these settings. In addition, given that the name of the setting can impact staff (and perhaps service users as well), ensuring that the name of such program highlight wellness and recovery may enable a different type of therapeutic community to develop within these settings. Introduction Despite the benefits of psychiatric day hospitals (DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care
Lee, Bang Hyun
Literature produced by the government and the private sector in the colonial era was reviewed to determine the knowledge of the people of colonial Chosun of mental illness and mental patients and the mental patient management system that they implemented or intended to implement. The results of this study show that the people of Chosun realized the need to sterilize mental patients because they considered mental patients very violent, dangerous and eugenically inferior and they believed that mental patients would eventually impede the prosperity of Chosun. The people of colonial Chosun had learned about the lifelong mental hygiene movement, which had knowledge of mental illness prevention. However, they also recognized that people who developed mental illness despite efforts to prevent such condition needed help from the modern system, especially from modern Western psychiatry. The primary responsibility to attend to mental patients was imposed on their family. The family had to understand the symptoms of mental illness according to the modern medical classification and how to deal with them. When the family could not afford to take care of its mentally ill family member due to the increase in the member's risk behavior such as frenzied-convulsive excitement, paranoia and delusion of jealousy, the family was also responsible for isolating him and connecting him with a mental hospital. The police and social workers were also responsible for observing and monitoring mental patients in their community and for connecting them with a mental hospital. The police made a list of mental patients within their area of jurisdiction and prohibited them from wandering based on the law. It was also considered desirable for mental patients who could not identify their family members to be sent to a mental hospital. Social workers were responsible for managing mental patient sanatoriums, and district commissioners sent to the police mental patients who had no family to look after
Schmeltz, Michael T; Gamble, Janet L
Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States. To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis. This study uses hospitalization data from the Nationwide Inpatient Sample (2001-2010). Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR) were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI. Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06), African Americans (RR, 1.16), Native Americans (RR, 1.70), uninsured (RR, 1.92), and those 40 years and older, compared to MBD hospitalizations alone. Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies.
Ruitenburg, Martijn M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
Background: We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods: A questionnaire was sent to all (n = 958) hospital physicians of one
O preparo de enfermeiros que atuam em grupos na área de saúde mental e psiquiatria La preparación de enfermeros que realizan trabajo en grupo en el area de salud mental y psiquiatría The preparation of teamwork nurses in the area of mental health and psychiatry
Luciene Simões Spadini
finales: existe la necesidad de hacer mayores inversiones durante la formación del enfermero en lo que a la coordinación de grupos se refiere, lo que no difiere de los datos encontrados en la bibliografía a este respecto.Introduction: Teamwork has been emphasized to enable the promotion of psychosocial rehabilitation of people with psychic disturbances. Objective: to identify how nurse team education happens in the Psychiatric and Mental Health areas. Methodology: qualitative study of descriptive-exploratory. 26 nurses were participants in this research, all of them from the psychiatry and mental health services chain. The data were collected by means of individual interviews, followed by an outline of orientating questions. For the data analysis, the ordination and classification of the data and the final analysis were applied. Results and discussion: the analyses indicated that nurses develop themselves for teamwork mostly in an experience-based way; some take extracurricular courses and do specific readings. Final considerations: there is a need for more investment during the nurses' training while they are undergraduates, in relation to team coordination, and this does not differ from the data found in the pertinent literature.
Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function.
Over the years Consultation-Liaison (C-L) psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill. In India, although the General Hospital Psychiatric units were established in 1930s, C-L Psychiatry has never been the main focus of training and research. Hence there is an urgent need to improve C-L Psychiatry services and training to provide best and optimal care to the patients and provide best education to the trainees. PMID:22135437
Full Text Available OBJECTIVE: To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. METHODS: Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. RESULTS: In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database. The main topics were: depression (29.1%, substance misuse (14.6%, psychoses (10%, childhood disorders (7% and dementia (6.7%. Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. CONCLUSIONS: There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.OBJETIVO: Mapear a produção científica brasileira em saúde mental no período 1999-2003 e identificar a natureza das publicações geradas, suas fontes de financiamento e as formas de divulgação pública dos resultados. MÉTODOS: As buscas dos artigos foram realizadas nas bases de dados do PsychInfo e Medline no período 1999-2003. Um questionário semi-estruturado, desenvolvido por uma
Iannucci, Rocco; Sanders, Kathy; Greenfield, Shelly F.
Objective: The authors describe an addiction psychiatry curriculum integrated in a general psychiatry training program to demonstrate comprehensive and practical approaches to educating general psychiatric residents on the recognition and treatment of substance use disorders. Methods: The Massachusetts General Hospital/McLean Hospital adult…
Full Text Available Norio Sugawara,1,2 Kazuma Danjo,3 Hanako Furukori,4 Yasushi Sato,2,5 Tetsu Tomita,2,6 Akira Fujii,7 Taku Nakagami,2,8 Kazuyo Kitaoka,9 Norio Yasui-Furukori2 1Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 2Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Aomori, 3Mizoguchi Mental Hospital, Shizuoka, 4Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi, 5Department of Psychiatry, Mutsu General Hospital, Mutsu, 6Department of Psychiatry, Hirosaki-Aiseikai Hospital, Kitazono, Hirosaki, 7Department of Psychiatry, Seihoku-Chuoh Hospital, Goshogawara, Aomori, 8Department of Psychiatry, Odate Municipal General Hospital, Odate, Akita, 9Mental Health Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan Background: Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work–family conflict (WFC in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan. Methods: In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work–Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis. Results: The relationship between emotional exhaustion and occupational factors, including
While there has been some research into Francoist psychiatry, much work still needs to be done on the reorganization of the mental health profession within the new state. Held in Barcelona on 12, 13 and 14th January 1942, the National Neurology and Psychiatry Conference undoubtedly played a major role in the attempt to overthrow the dominant ideas in the field of Spanish psychiatry and displace its most influential figures. This article seeks to analyse the Conference's main organizational features and examine its most significant content, with the aim of evaluating its strategic importance in the context of both the psychiatrists' professional and scientific interests and their ideological and political concerns. Conference papers tackled issues such as neurology and psychiatry in wartime, vitamin deficiency and the nervous system, and new psychiatric treatments, including shock therapy. The Conference's marked ideological nature represented the beginning of a new professional dynamic, featuring the emergence or establishment of new leaders intent on laying the foundations of psychiatry during the early years of the Franco regime.
Prochaska, Judith J.; Fromont, Sebastien C.; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.
Objective Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. Method The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. Results Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. Conclusions The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders. PMID:17021144
Farooq, Kitty; Lydall, Gregory J; Malik, Amit; Ndetei, David M; Bhugra, Dinesh
Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students' career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students' attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were "quite likely", and 25% were "definitely not" considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p student selection and psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally.
Better understanding of the individual and environmental factors that promote adolescents' use of more or less adaptive coping strategies with mental illness stigma would inform interventions designed to bolster youth resilience. This cross-sectional study draws on data from research on adolescents' well-being after discharge from a first psychiatric hospitalization to explore the relationships between anticipated coping in reaction to a hypothetical social stigma scenario, and various factors conceptualized as 'coping resource' and 'coping vulnerability' factors. Focusing on coping strategies also identified in the companion article, we hypothesize that primary and secondary control engagement coping would relate to more coping resource and less coping vulnerability factors, and the opposite would be true for disengagement, aggression/confrontation and efforts to disconfirm stereotypes. Data were elicited from interviews with 102 adolescents within 7 days of discharge. Hypothesized coping resource factors included social resources, optimistic illness perceptions, better hospital experiences and higher self-esteem. Vulnerability factors included more previous stigma experiences, desire for concealment of treatment, more contingent self-worth, higher symptom levels and higher anticipated stress. Multivariate ordinary least squares (OLS) regression was used to analyze associations between coping strategy endorsement and correlates. Although some coping correlates 'behaved' contrary to expectations, for the most part, our hypotheses were confirmed. As expected, youth anticipating reacting to the stigmatizing situation with greater disengagement, aggression/confrontation or efforts to disconfirm stenotypes rated significantly lower on 'coping resources' such as self-esteem and higher on vulnerability factors such as symptom severity. The opposite was true for youth who anticipated exercising more primary and secondary control engagement coping. This study begins to
Marwan M. Al-Sharbati
Full Text Available Objectives: Early diagnosis and prompt treatment of mental and behavioral disorders in preschoolers is critical for a better prognosis, ultimately leading to improved quality of life for both the child and the family. Our study investigated the clinical profile of mental and behavioral disorders in children < 7 years of age, seeking consultation at Sultan Qaboos University Hospital, Muscat, Oman, between 1 June 2006 and 31 December 2010. The objective was to explore demographic variables, intervention types, and annual trends. Methods: This retrospective, descriptive study was conducted by reviewing the electronic records of preschoolers seeking consultation on mental and behavioral disorders at the Department of Behavioral Medicine. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria. Results: The total number of cases was 466, the majority (77.9% being boys. The cumulative frequencies and annual hospital-based prevalence rates were estimated for each category of mental and behavioral disorders. Our findings showed increased service utilization among preschoolers, as reflected in the annual trend and case-specific prevalence rates. While comorbidity was common, the most frequent disorders encountered were attention deficit hyperactivity disorder (70.8%, developmental language disorder (23.6%, autism spectrum disorders (20.2%, and disruptive behavior disorders (11.6%. The most commonly prescribed drugs/supplementation were risperidone (18.7%, atomoxetine (9.7%, omega-3 (8.8%, and methylphenidate (6.2%. Conclusions: Consultations for mental and behavioral disorders are being sought for Omani preschoolers. Beside pharmacotherapy, other interventions, which are an integral part of a much desired multidisciplinary approach should be introduced. Readdressing the missing needs is essential for a comprehensive approach to managing mental and behavioral disorders.
Starting from a sketch of the basic view points from which the topic will be elucidated, the author focuses on the different logics of psychiatry and psychotherapies. The connections between the topic and the somatopsychosocial model, the intercorrelation of psycho-genetic interpretative models and indication for psychotherapy indicate an approach which is oriented towards the disordered person (and not the disorder). This concept is compared with the often used definition of psychotherapy by Strotzka. The dependence of the concept on traditions in psychiatry (Krafft-Ebing, Jaspers, Kretschmer, E. Bleuler, and M. Bleuler) and its consistency with modern multiaxial diagnostic systems (Frances et al.) are stressed. Finally the border to psychotherapeutic medicine outside psychiatry, both in theory and practice, is stressed.
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Torous, John; Friedman, Rohn; Keshavan, Matcheri
Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in "real time" and "real life." However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. This paper aims to provide data on psychiatric patients' prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Ninety-seven percent of patients reported owning a phone and 72% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50% interest in using a mobile application on a daily basis to monitor their mental health condition. Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions.
Bernazzani, Odette; Rondeau, Alain
The Mental Health Action Plan maps out the reorganization of mental health services in the province of Quebec. Accordingly, this paper presents the transformation process of the mental health program at the Maisonneuve-Rosemont hospital in Montreal. The authors discuss, on the one hand, the challenges that were met and, on the other hand, the model of care and organisational choices that were adopted. This article is divided in three parts. The first part describes the two main guiding principles underlying the Mental Health Action Plan. The second part examines the context surrounding the arrival of the Action Plan at the Maisonneuve-Rosemont Hospital. The third part describes the hospital transformation process that evolved in relation with: 1- the new centralized access points for mental health services; 2- the support for first line (or primary care) services; 3- the second line services for the specialized treatment of complex mental health problems.
Nordentoft, Merete; Mortensen, Preben Bo; Pedersen, Carsten Bøcker
Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up.......Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up....
(before 1960); b) the psychiatry community (1960-2000); and c) the differentiated system (since 2000). The essay will evidence the long march towards hospitals without walls, interdisciplinary work, tension between cure and rehabilitation and a relative decreasing budget. This in conjunction with vulnerability in organisation and leadership, attributed to tension or burn out has revealed system deficits like the trans-institution towards homelessness or towards the judiciary system. The essay will conclude with a discussion on the opportunities and challenges of the very new Law 10 that reforms the general governance of the provincial and regional health and social services and hopes for a more balanced mental health care system in Quebec.
Lolas Stepke, F
The need for a theory is grounded on the heterogeneity of Medicine: Of basic situation, of medical subsystems and of praxis. The relationship between theory and practice in Medicine should be considered as a task of theoretical reflection, beyond contexts, application, and orientation. As a theory of theories--metatheory--its model lies closer to a "science of actions" than a "science of objects", considered as paradigmatic forms of Medicine. The relevance of these concepts to Psychiatry is illustrated on the basis of the influence of behavioral sciences upon biomedicine, whose advancement rests with Psychiatry.
Wells, Lloyd A
I discuss the lack of precision in the term 'clinical reasoning' and its relationship to evidence-based medicine and critical thinking. I examine critical thinking skills, their underemphasis in medical education and successful attempts to remediate them. Evidence-based medicine (and evidence-based psychiatry) offer much but are hampered by the ubiquity and flaws of meta-analysis. I explore views of evidence-based medicine among psychiatry residents, as well as capacity for critical thinking in residents before and after a course in philosophy. I discuss decision making by experienced doctors and suggest possible futures of this issue. © 2015 John Wiley & Sons, Ltd.
Lund, Lasse Wegener; Winther, Jeanette; Dalton, Susanne Oksbjerg
Survivors of childhood cancer are known to be at risk for long-term physical and mental effects. However, little is known about how cancers can affect mental health in the siblings of these patients. We aimed to assess the long-term risks of mental disorders in survivors of childhood cancer...
recruitment of medical graduates into psychiatry takes place. Factors such as personality, previous experience with a person with mental illness, medical school experiences, including influence of faculty members have been found to affect the attitude of medical students towards psychiatry.3-5. The potential impact of ...
Declaração de consenso da seção de psiquiatria geriátrica da Associação Mundial de Psiquiatria sobre ética e capacidade em pessoas idosas com doença mental World Psychiatric Association section of old age psychiatry consensus statement on ethics and capacity in older people with mental disorders
Full Text Available CONTEXTO: A Seção de Psiquiatria Geriátrica da Associação Mundial de Psiquiatria (AMP, desde 1997, vem desenvolvendo Declarações de Consenso relevantespara a prática da Psiquiatria Geriátrica. Desde 2006, a Seção vem trabalhando para desenvolver uma Declaração de Consenso sobre Ética e Capacidade em pessoas idosas com transtornos mentais. MÉTODO: Uma Conferência de Consenso foi realizada em Praga em setembro de 2008. Organizada pela Seção de Psiquiatria da Pessoa Idosa da AMP, ela contou com a participação do International Council of Nurses, Alzheimer Europe e Alzheimer Disease International. Os participantes foram reconhecidos pela sua perícia nesse domínio e vieram de 11 países. Incluíam psiquiatras, uma neurologista, um enfermeiro e representantes de cuidadores familiares. RESULTADOS: Após dois dias de reuniões e debate, redigiu-se um rascunho da declaração que foi submetida para análise nas diversas organizações/associações que participaram da reunião. Após as sugestões finais recolhidas, um texto definitivo foi preparado em inglês e publicado. A presente versão em português é da responsabilidade de dois participantes lusófonos da reunião, que são também coautores da declaração de consenso final. CONCLUSÕES: Essa Declaração de Consenso oferece aos clínicos em saúde mental que cuidam de pessoas idosas com transtornos mentais, cuidadores, outros profissionais da saúde e o público em geral as definições e o debate sobre os princípios éticos que podem frequentemente ser complexos e desafiadores, apoiados em orientações práticas para satisfazer tais necessidades e padrões éticos e encorajar a boa prática clínica.BACKGROUND: The World Psychiatric Association (WPA Section of Old Age Psychiatry, since 1997, has developed Consensus Statements relevant to the practice of Old Age Psychiatry. Since 2006 the Section has worked to develop a Consensus Statement on Ethics and Capacity in older
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Brittlebank, A.; Hermans, M.; Bhugra, D.; Costa, M.; Rojnic-Kuzman, M.; Fiorillo, A.; Kurimay, T.; Hanon, C.; Wasserman, D.; Gaag, R.J. van der
Psychiatry is the largest medical specialty in Europe. Despite efforts to bring harmonisation, training in psychiatry in Europe continues to be very diverse. The Union Europeenne des Medecins Specialistes (UEMS) has issued as from 2000 a charter of requirements for the training in psychiatry with an
Forensic psychiatry is still obscure a discipline amongst the practising psychiatrists; so awareness should be created in the young residents pursuing this stream. It is prudent of setting a curriculum for the general psychiatry residents to learn the relevant topics of forensic psychiatry through didactic lectures, seminars, case-discussions and witnessing case proceedings. This topic could enable budding psychiatrists to acquire the skills of the legal aspects of psychiatry. This challenging yet little known branch of medicine can rejuvenate trainee psychiatry residents to specialise further orconduct research activities.
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.
Griffith, James L
Psychiatry residencies with a commitment to humanism commonly prioritize training in psychotherapy, cultural psychiatry, mental health policy, promotion of human rights, and similar areas reliant upon dialogue and collaborative therapeutic relationships. The advent of neuroscience as a defining paradigm for psychiatry has challenged residencies with a humanistic focus due to common perceptions that it would entail constriction of psychiatric practice to diagnostic and psychopharmacology roles. The author describes a neuroscience curriculum that has taught psychopharmacology effectively, while also advancing effectiveness of language-based and relationship-based therapeutics. In 2000, the George Washington University psychiatry residency initiated a neuroscience curriculum consisting of (1) a foundational postgraduate year 2 seminar teaching cognitive and social neuroscience and its integration into clinical psychopharmacology, (2) advanced seminars that utilized a neuroscience perspective in teaching specific psychotherapeutic skill sets, and (3) case-based teaching in outpatient clinical supervisions that incorporated a neuroscience perspective into traditional psychotherapy supervisions. Curricular assessment was conducted by (1) RRC reaccreditation site visit feedback, (2) examining career trajectories of residency graduates, (3) comparing PRITE exam Somatic Treatments subscale scores for 2010-2012 residents with pre-implementation residents, and (4) postresidency survey assessment by 2010-2012 graduates. The 2011 RRC site visit report recommended a "notable practice" citation for "innovative neurosciences curriculum." Three of twenty 2010-2012 graduates entered neuroscience research fellowships, as compared to none before the new curriculum. PRITE Somatic Treatments subscale scores improved from the 23rd percentile to the 62nd percentile in pre- to post-implementation of curriculum (p neuroscience curriculum for a residency committed to humanistic psychiatry
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.
Psychiatric patients of non-western origin leave treatment against the advice of their clinicians far more often than do their western counterparts. This article presents a theoretical framework for better understanding such clinical cases, developed from examples of psychiatric practice in different cultures. The theory is based on two meanings of the concept of culture, an elaboration of the universality-relativity dichotomy, and a view of the work of mental health care providers as involving three components: (1) building a trusting relationship with the patient; (2) making a diagnosis and treatment plan; and (3) carrying out treatment that is acceptable and meaningful to the patient. The article argues that all psychiatry is transcultural psychiatry, because a cultural gap always exists between the psychiatrist and the patient.
The author has argued that existential psychology and psychiatry are not consistent with existential philosophy, from which they derive their basic concepts. Existential philosophy treats consciousness as an epistemic and ontological absolute while existential psychology and psychiatry acknowledge the existence of unconscious mental processes. It is not possible to base a viable concept of psychodynamic psychotherapy, the nature of transference, or the efficacy of interpretation upon the radical concept of freedom, which is basic to existential philosophy. If psychiatrists wish to experiment with nonpsychoanalytic dynamic psychologies, then it is the author's opinion that the advancement of knowledge would be better served either by using existentialist concepts and principles consistently or by explicitly altering them in clearly defined ways for stated reasons, or by formulating psychodynamic hypotheses that do not lay claim to any foundation in existential philosophy.
Kurt, H; Büchi, S; Haring, C; Pycha, R
As a medical topic psychosomatic medicine is able to look back on an almost 100-year-old tradition. Nevertheless, questions about its definition, area of application and by whom it should be practiced remains unsolved. This causes considerable tension with the field of psychiatry which has always seen psychosomatic medicine as a subspecialty of its own discipline. In the article, the development and current position of psychosomatic medicine in German speaking countries other than Germany (Austria, Switzerland and South Tyrol) is presented. While psychosomatic care is currently planned and also partially already executed in Austria, psychosomatic medicine in Switzerland is located with general practitioners on the one hand and consultation-liaison psychiatry on the other. After the radical psychiatric reform of the late 1970s in South Tyrol psychosomatic medicine proved to be a means to remove taboos regarding psychiatric institutions and the mentally ill.
Fineberg, Sarah K; Stahl, Dylan; Corlett, Philip
We review the literature on the use and potential use of computational psychiatry methods in Borderline Personality Disorder. Computational approaches have been used in psychiatry to increase our understanding of the molecular, circuit, and behavioral basis of mental illness. This is of particular interest in BPD, where the collection of ecologically valid data, especially in interpersonal settings, is becoming more common and more often subject to quantification. Methods that test learning and memory in social contexts, collect data from real-world settings, and relate behavior to molecular and circuit networks are yielding data of particular interest. Research in BPD should focus on collaborative efforts to design and interpret experiments with direct relevance to core BPD symptoms and potential for translation to the clinic.
Quinn, Chris; Happell, Brenda
To explore perceptions of privacy and dignity for sexual relationships in a Forensic mental health hospital. The role of nurses in forensic mental health hospitals is frequently complicated by opposing expectations of therapeutic relationships and maintaining security. What can result is an over-emphasis on risk reduction by controlling patient behaviour, which can extend to patient intimacy and sexual relationships. An exploratory, qualitative approach. Individual interviews were conducted with 12 nurses and 10 patients in a forensic mental health hospital. Thematic data analysis was undertaken to identify the main themes. The need for a private and dignified place for patient intimacy was one major theme to emerge from this research from both nurse and patient participants and is the focus of this article. A disparity is reported between the level of support reported by nurse participants with the experience of the patient participants. Sexual intimacy and sexual relationships are important components of normal human behaviour. Institutional rules and rule adherence create barriers for patients, forcing their intimacy and sexual relationships into secrecy. There is a need for further research to consider the benefits and risks of patient intimacy and sexual relationships for long-term patients in forensic mental health settings. Patients in forensic hospitals are sexually active and seek support from nurses. Nurses are in an ideal role to recognise the important part they can play in supporting the intimacy and sexual relationship needs of patients. Strategies to assist in developing confidence in responding to normal human behaviour is a matter of priority. © 2015 John Wiley & Sons Ltd.
Telo, Selda; KAMAN, Dilara; Korkmaz, Sevda
Objectives: To investigate the illicit substance use trends by gender and year in Eastern Turkey, Elaz??. Methods: This is a retrospective study designed to assess the drug use prevalence in persons who admitted to the Probation Policlinic of Elazig Mental Health Hospital between January 2011 and December 2014 in Eastern Turkey, Elaz??. Laboratory screening tests for drugs were studied using the cloned enzyme donor immunoassay technique in urine. Results: The study consisted of 10267 males (9...
Wu, Heng; Zhao, Xudong; Fritzsche, Kurt; Salm, Florian; Leonhart, Rainer; Jing, Wei; Yang, Jianzhong; Schaefert, Rainer
In western countries, negative illness perceptions are associated with poor health status and affect health outcomes in primary care populations. The aim of this study is to examine the relationship between illness perception and mental and physical health status in general hospital outpatients in China. This multicentre, cross-sectional study analysed a total of 281 consecutive patients from four general hospital outpatient departments of internal medicine and traditional Chinese medicine in Beijing and Kunming. The patients answered questionnaires concerning illness perception (Brief-IPQ), somatic symptom severity (Patient Health Questionnaire-15), illness behaviour (Scale for the Assessment of Illness Behaviour), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (Twelve-Item Short Form Health Survey). Negative illness perception, especially negative emotional reactions, perceived illness consequences, encumbering illness concerns, and strong illness identity were significantly associated with high emotional distress, impairing illness consequences, and a low mental and physical quality of life. Using a multiple linear regression model, five strongest correlates of negative illness perception were high anxiety, seeking diagnosis verification, low mental and physical quality of life and high somatic symptom severity. The variance explained by this model was 35%. Chinese general hospital outpatients showed associations between negative illness perceptions and poor mental and physical health status that were similar to those of primary care patients in western countries. The main difference was that no association with perceived illness control was found in Chinese patients. Chinese physicians should be sensitised to their patients' negative illness perceptions and should focus on helping patients cope with uncertainty and anxiety by providing an understandable illness model and increasing control beliefs.
measles and smallpox decimated their numbers. In Tasmania the Aboriginal people were wiped out (although their genes live on in many locals, and in recent years there has been a resurgence of cultural pride in Tasmanian Aboriginal descen- dants). The 20th century. By the start of the 20th century, psychiatry in Australia ...
resurgence of cultural pride in Tasmanian Aboriginal descen- dants). The 20th century. By the start of the 20th ... administered by the Royal Australian and New Zealand. College of Psychiatrists. There are over 2 000 ... psychiatry in Australia followed suit, picking up new ideas and trends. After World War I this included fever ...
Robert M Kaplan
Full Text Available Psychiatry has been practised in Australia in one form or another since the peopling of the continent, originally with the practices of the Aboriginal shamans, and later with the psychiatric treatment necessitated by convict transportation. Over most of the last half-century psychiatry has been administered by the Royal Australian and New Zealand College of Psychiatrists. There are over 2 000 psychiatrists in Australia, and num- bers are expected to increase in future. As in many other countries, there is ongoing pressure between the private and public sectors, with endemic under- funding of public and community services. Despite its small number of practitioners and relative isola- tion from major centres, Australian psychiatry has a distin- guished record in the field of research. The most famous dis- covery, by John Cade, was the use of lithium for treatment of mania. Recently governments at state and federal level have acknowledged the effect of psychiatric illness on patients and their families. This has led to the development of pro- grammes to improve public information and eliminate preju- dice. It is anticipated that the practice of psychiatry will flourish in Australia and that the country will remain a leading centre of excellence in psychiatric research and training.
Weissman, Myrna M.; Brown, Alan S.; Talati, Ardesheer
Translational research generally refers to the application of knowledge generated by advances in basic sciences research translated into new approaches for diagnosis, prevention, and treatment of disease. This direction is called bench-to-bedside. Psychiatry has similarly emphasized the basic sciences as the starting point of translational research. This article introduces the term translational epidemiology for psychiatry research as a bidirectional concept in which the knowledge generated from the bedside or the population can also be translated to the benches of laboratory science. Epidemiologic studies are primarily observational but can generate representative samples, novel designs, and hypotheses that can be translated into more tractable experimental approaches in the clinical and basic sciences. This bedside-to-bench concept has not been explicated in psychiatry, although there are an increasing number of examples in the research literature. This article describes selected epidemiologic designs, providing examples and opportunities for translational research from community surveys and prospective, birth cohort, and family-based designs. Rapid developments in informatics, emphases on large sample collection for genetic and biomarker studies, and interest in personalized medicine—which requires information on relative and absolute risk factors—make this topic timely. The approach described has implications for providing fresh metaphors to communicate complex issues in interdisciplinary collaborations and for training in epidemiology and other sciences in psychiatry. PMID:21646577
Mundt, A; Heinz, A; Ströhle, A
The center of a national medical identity in Uzbekistan is Abu Ali Ibn Sina born in 980 AD representing Islamic medicine and scientific universalism. Psychiatric institutions were founded under Russian influence starting in the late 19th century. Today, the great challenge in psychiatry is the development of a post-Soviet identity integrating Russian and Islamic traditions.
Behavioural Disorders. Clinical descriptions and diagnostic guidelines. The clinical relevance of weight in psychiatry varies. It may be:- I. an associated clinical feature, either primary, as in anorexia nervosa, or secondary as in mood, anxiety or psychotic disorders. II. a related clinical issue, as in bulimia nervosa or an eating ...
Het doel van dit onderzoek is geweest de bestudering van de bijdrage die de hedendaagse psychiatrie aan de reclassering van met de justitie in aanraking gekomen delinquenten kan leveren. In de inleiding wordt erop gewezen hoe de reclassering zich in ons land heeft ontwikkeld van een persoonlijk
Full Text Available Charlotte Guest,1 Fabian Sobotka,2 Athina Karavasopoulou,3 Stephen Ward,3 Carsten Bantel4,5 1Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 2Division of Epidemiology and Biometry, Department of Health Services Research, Faculty 6, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany; 3Pain Service, Barts Health, St Bartholomew’s Hospital, London, UK; 4Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Oldenburg University, Klinikum Oldenburg Campus, Oldenburg, Germany; 5Department of Surgery and Cancer, Anaesthetics Section, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK Objective: Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses’ mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors. Material and methods: A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses’ mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580 and one German (n=799 hospital between September 2014 and February 2015. Results: A total of 511 (37.1% questionnaires were returned. Mean (standard deviation age of participants were 37 (11 years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87
Dick P. Ravelli
Full Text Available Objective: The objective of this policy paper is to put recent developments in Dutch mental health reform in an international perspective and draw conclusions for future directions in policy. Context of the case: The practice of Western psychiatry in the second half and particularly in the last decade of the 20th century has fundamentally changed. Dutch psychiatry has traditionally been prominently bed-based and various policies in the last ten years have been intended to reduce the influence of the mental hospitals. Until the mid-1990s, this had not resulted in reducing the psychiatric bed rate in comparison to other countries. Since then, there have been rapid, dramatic changes. Data sources: We summarised two recent national studies on this subject and placed them in a national and international context, using documents on psychiatric reforms, government and advisory board reports and reviews on deinstitutionalisation in different countries. Case description: The practice of psychiatry in the second half, and particularly in the last decade, of the 20th century has fundamentally changed. This has resulted in a spectacular decline in the number of beds in mental hospitals, increased admissions, decreased length of stay, closure of the large asylums and in community treatment away from asylums and in society, although this is a reform process. This article examines how the Dutch mental health care system has developed at the national level. The main topics cover the size, nature, aims and effects of the process of deinstitutionalisation and how alternative facilities have been developed to replace the old-fashioned institutes. Conclusions and discussion: There are two contrasting aspects of deinstitutionalisation in Dutch mental health care: the tendency towards rehospitalisation in relation to the sudden, late, but rapid reduction of the old mental hospitals and their premises; and a relatively large scale for community-based psychiatry in
Sadr, Seyed Saeed; Nayerifard, Razieh; Samimi Ardestani, Seyed Mehdi; Namjoo, Massood
Objective: The aim of this study was to investigate the current factors affecting the choice of psychiatry as a specialty and to detect the main factors in their choice. Method: This descriptive study included 75 first year psychiatry residents in the academic year of 2014/2015. A Likert-type anonymous questionnaire consisting of academic and demographic data with 43 questions, which evaluated the reason for choosing psychiatry as a specialty, was given to the residents. Results: The participants had a positive opinion about 28 items of the questionnaire, meaning that these items had a positive effect in choosing psychiatry as a specialty (questions with P value less than 0.05 and a positive mean). More than 80% of the residents had a positive opinion about six items of the questionnaire (amount of intellectual challenge, variety of knowledge fields relevant to psychiatry, emphasis on the patient as a whole person, the importance of treating mental illnesses in the future, work pressure and stress of the field during residency and coordinating with the person's life style). The participants had a negative opinion about two items of the questionnaire (questions with a P value less than 0.05 and a negative mean). They included experiencing mental illness personally through relatives or close friends as well as the income in psychiatry. Moreover, 36% of the residents with a more definite opinion mentioned that they chose psychiatry as a specialty because of the limitations in residency exam. Conclusion: Assistants had a positive opinion about most of the questions and this positive attitude seemed to be an important factor in their specialty choice. However, attending to the preventing factors may increase the selection of psychiatry as a specialty..
Sadr, Seyed Saeed; Nayerifard, Razieh; Samimi Ardestani, Seyed Mehdi; Namjoo, Massood
Objective: The aim of this study was to investigate the current factors affecting the choice of psychiatry as a specialty and to detect the main factors in their choice. Method: This descriptive study included 75 first year psychiatry residents in the academic year of 2014/2015. A Likert-type anonymous questionnaire consisting of academic and demographic data with 43 questions, which evaluated the reason for choosing psychiatry as a specialty, was given to the residents. Results: The participants had a positive opinion about 28 items of the questionnaire, meaning that these items had a positive effect in choosing psychiatry as a specialty (questions with P value less than 0.05 and a positive mean). More than 80% of the residents had a positive opinion about six items of the questionnaire (amount of intellectual challenge, variety of knowledge fields relevant to psychiatry, emphasis on the patient as a whole person, the importance of treating mental illnesses in the future, work pressure and stress of the field during residency and coordinating with the person's life style). The participants had a negative opinion about two items of the questionnaire (questions with a P value less than 0.05 and a negative mean). They included experiencing mental illness personally through relatives or close friends as well as the income in psychiatry. Moreover, 36% of the residents with a more definite opinion mentioned that they chose psychiatry as a specialty because of the limitations in residency exam. Conclusion: Assistants had a positive opinion about most of the questions and this positive attitude seemed to be an important factor in their specialty choice. However, attending to the preventing factors may increase the selection of psychiatry as a specialty. PMID:27928251
Salerno, Silvana; Dimitri, Laura; Livigni, Lucilla; Magrini, Andrea; Talamanca, Irene Figà
Nurses mental health is still a major and unachieved goal in many public hospital settings. Hospital work organization analysis shows differences in health professions, hospital units, age and gender. To analyse work organisation and its effects on nurses mental health in three high risks hospital units (Oncoematology, First Aid, General Medicine) in order to improve good practices for nurses health. The Method of Organizational Congruences (72 hours of observation) has been used to detect organizational constraints and their possible effects on nurses' mental health. General Health Questionnaire (Goldberg D., 12 items) and the Check up Surveys for burnout (Leiter MP and Maslach C.) have been used to evaluate the mental health status of the 80 nurses employed (78% women). High emotional work load in oncoematology Unit, high monotony and repetitiveness with lower emotional load in first Aid Unit, High mental and physical workload in General Medicine Unit. Burnout was significantly higher in General Medicine Unit, followed by First Aid Unit and oncoematology Unit. Female nurses reported more chronic diseases than males. The GHQ showed high frequency of minor psychiatric disorders (58%) in all units, higher in General Medicine Unit (78%). The overall results show how organizational constraints and mental health conditions differ per hospital units, age groups and gender. Good nursing practices, to prevent mental health problems, should therefore be developed specifically in each hospital unit according to these results.
Full Text Available One of the motivations for the new philosophy of psychiatry is the need to understand changing ideas in mental health care. In the last century, changes in both physical and biological theory prompted work in philosophy of physics and philosophy of biology to understand those fields better, attempts which were continuous with empirical work. At the start of this century, changes in psychiatry promise increased interest in the philosophy of psychiatry as an attempt, alongside empirical research, to understand the conceptual underpinnings of mental heath care. While philosophical methods are distinct from empirical methods, the work is truly interdisciplinary, growing organically from the complexities of demand on psychiatric care and, although philosophical, carried out by philosophers and psychiatrists alike. One focus is the nature of clinical judgement in psychiatric diagnosis. In this short note I will briefly sketch some issues that arise from a current idea: that psychiatric diagnosis should include idiographic elements.
1. What is usually taught as biological psychiatry in psychiatric residency training is mainly psychopharmacology, but biology has a lot more to offer to psychiatry educators. 2. The main thesis of this article is that an introductory course on the applications to psychiatry based on the theory of the evolution of the species by natural selection and mutation, along with a comprehensive theory of mind, may contribute to: (i) helping young physicians to integrate the diverse and extensive knowledge acquired during the residency training; (ii) aid in keeping the psychiatrist within the medical approach to mental illnesses while promoting the specific features of the specialty, and (iii) perhaps developing a general theoretical framework that allows psychiatrists to maintain a prominent role in the mental health staff. 3. The author describes how he has conducted such training in Venezuela. It is expected that the author's ideas will serve as a forum for discussion of this pivotal subject.
Doença mental e periculosidade criminal na psiquiatria contemporânea: estratégias discursivas e modelos etiológicos Mental illness and criminal dangerousness in contemporary psychiatry: discursive strategies and etiological models
Myriam Raquel Mitjavila; Priscilla Gomes Mathes
O artigo analisa algumas dimensões socioculturais do campo semântico e dos modos de estruturação dos discursos da psiquiatria forense em torno da periculosidade criminal e de suas conexões com a saúde mental. A partir dos resultados de uma pesquisa baseada na análise de conteúdo de uma amostra de manuais e livros de psiquiatria forense, examinaram-se alguns significados e formas de enunciação da noção de periculosidade criminal, bem como as principais estratégias interpretativas que organizam...
Guest, Charlotte; Sobotka, Fabian; Karavasopoulou, Athina; Ward, Stephen; Bantel, Carsten
Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses' mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors. A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses' mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580) and one German (n=799) hospital between September 2014 and February 2015. A total of 511 (37.1%) questionnaires were returned. Mean (standard deviation) age of participants were 37 (11) years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87% did not regard opioids as drugs to help patients die, and 72% did not view them as drugs of abuse. More English (41%) than German (28%) nurses were afraid of criminal investigations and were constantly aware of side effects (UK, 94%; Germany, 38%) when using opioids. Four latent variables were identified which likely influence nurses' mental models: "conscious decision-making"; "medication-related fears"; "practice-based observations"; and "risk assessment". They were predicted by strength of religious beliefs and indicators of informal learning such as experience but not by indicators of formal learning such as conference attendance. Nurses in both countries employ analytical and affective mental models when administering the opioids and seem to learn from experience
Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L.; Serrano, Neftali
After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.
Zeidler Schreiter, Elizabeth A; Pandhi, Nancy; Fondow, Meghan D; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L; Serrano, Neftali
After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.
Objective: To clarify monist, dualist, and pluralist philosophy that could help psychiatrists to explain how mental and physical states relate in general. Method: Varieties of monism and dualism are summarised and the problems that they entail for psychiatry are briefly described. Pluralism in the mind-body debate is reviewed ...
Ekblad, Solvig; Kastrup, Marianne Carisius
anthropologists, as well as other clinicians and policy planners. Research includes work with migrants and indigenous minorities in the Nordic countries, as well as comparisons with mental health in postconflict countries. We conclude by suggesting future directions for transcultural psychiatry research...
Biological psychiatry deals with abnormalities of brain and genetic functioning and how they interact with environmental factors to underlie the genesis, manifestation, and response to treatment of mental disorders. These issues have not featured significantly in the Nigerian psychiatric scene. Hence, we are witnessing a ...
Carney, Stuart; Bhugra, Dinesh K.
Background/Objective: Recent training and education changes have raised important issues in delivery of psychiatric education at all levels. In this article, the authors describe the current status of mental health education in the training of all doctors and postgraduate training and education in psychiatry in the U.K. Method: The authors explore…
objectively evaluated predetermined risk factors, and thereby apparently provided an assessment of the degree of risk any individual posed. This promise has not been. When coercion meets hope: Can forensic psychiatry adopt the recovery model? SZ Kaliski, HG de Clercq. Forensic Mental Health Services, Department of ...
teaching and general mental health training to general health students or staff were excluded. Evaluation of videoconference-based Education Program. In 2008, videoconferencing commenced for psychiatry registrar education consisting of two sessions per week from the Medical School to three and four distant sites.
Gitimbwa, Siméon Sebatukura
Hospitalizing mental patients in the same rooms with somatic patients is one of the consequences of the decentralization of mental health units in all hospitals of Rwanda. There is a necessity to discover and to analyze advantages and disadvantages of this practice. Mental health staffs of 31 general and referral hospitals have been interviewed on questions about disadvantages and advantages to hospitalize mental patients together with somatic patients. Results show these disadvantages: a therapeutic environment not appropriate or a lack of harmony in the rooms (58.1% of respondents); a lack of bodily safety for somatic patients (51.6%); a lack of safety on the properties of somatic patients (45.2%); a lack of psychological wellbeing of somatic patients (29%); a lack of safety for mental patients (29%). About the main advantages, 100% of respondents pointed out the treatment of mental patients followed even during the week-end and the break time by the guard nurses doing the ward round visit or the guard; 72.2% said it prevents discrimination, because mental patient feel that he is a patient like others; 50% said it prevents stigmatization (to avoid for example, the expression "he is mad"); 16.7% said that mental patients receive help from somatic patients.
Full Text Available Objective: Mental health is an important part of individual, social and occupational life. World Health Organization defines mental health as absolute ability of performing social, physical and mental roles. Inattention to mental health is one of the important factors that lowers efficacy, uses up human powers, causes physical and mental complications and job exhaustion, especially in professional services. As health personnel is major part of health services and their high job incentive is a necessity for their health insurance, this research was implemented to assess their mental health quality. Materials and Methods: This is a descriptive cross-sectional, correlative study which is conducted on 190 health personnel. The questionnaire consisted of two parts: Demographic characteristics and Goldenberg general health questionnaire-28 data analysis was performed by using SPSS and statistical methods were independent samples t-test, chi-square, one-way ANOVA and Pearson correlative index. Results: Two-third of cases were female, mean age was 32.22. 76.3% were married, 49.5% had no child, and most of the others had one child. 32.2% of cases had mental disorders (score > 23. Conclusion: Mean score of cases was 21, this score comparing with the general population of Iran is high. Mental health of health personnel for many reasons is at risk. According to these findings, great stressors of such jobs are: Facing with unexpected situations, work turns, especially night turns, organizational and individual factors.
Various mental disorders are encountered at the maternal clinic. Pregnancy predisposes to some mental disorders, most commonly depressive and anxiety disorders. The recognition of substance use disorders during pregnancy is very important, but difficult owing to the associated disgrace. An eating disorder with an onset preceding the pregnancy may cause problems for growth and development of the fetus and should thus be identified early enough. The rare but severe postpartum psychosis may often break out only after discharge from the maternity hospital. Drug therapy during pregnancy requires careful consideration and clear-cut reasoning.
Peng, Zhuoxin; Wang, Qi; Kan, Haidong; Chen, Renjie; Wang, Weibing
Evidence for extreme ambient temperature effects on the risk of mental disorders (MDs) is limited. In this study, we evaluated the short-term effects of daily mean temperature on hospital admissions of MDs in Shanghai, China. We obtained daily hospital admission data for MDs, daily meteorological and ambient pollution data in Shanghai from January 2008 to December 2015. Adjusted for time trend, air pollution, relative humidity and other confounders, a quasi-Poisson generalized additive model (GAM) combined with a distributed lag non-linear model (DLNM) was used to analyze the lag-exposure-response relationship between daily mean temperature and hospital admissions for MDs. Total daily hospital admissions for MDs during the study period were 93,971. With a reference of median temperature (18.3°C), there was a significant positive association between the temperature above threshold (24.6°C) and MD hospital admission visits at a lag of 0-1days. The relative risks of extreme hot temperatures (33.1°C, 99% percentile) over the lag 0-1days compared to median temperature were 1.266 (95% confidence intervals: 1.074-1.493). No effect of cold weather on the hospital admissions for MDs was observed. This study suggests that extreme hot temperature poses significant risks on MD; health counseling and cooling measures should be considered for the susceptible population. Copyright © 2017 Elsevier B.V. All rights reserved.
Sarıkoç, Gamze; Öz, Fatma
This study was planned to determine internalized stigma of patients who were monitored in the psychiatry clinics due to mental problems. It was determined that there was significant difference between the patients' mean internalized stigma total scores between subscale scores and their gender, job, the place that the patient was raised in, educational status, working status, income level, the period spent after the diagnosis, hospitalization status, the hospital monitoring the patient and the diagnosis. It is suggested that counseling services should be planned in order to identify negative impact of the factors that influence coping with internalized stigma.
This article introduces the reader to mental health in the Middle East with an Egyptian perspective, from the Pharaonic era through the Islamic Renaissance, up until the current state. During Pharaonic times, mental illness was not known as such, as there was no separator between Soma and Psyche. Actually, mental disorders were described as symptoms of the heart and uterine diseases, as stated in Eber's and Kahoun's papyri. In spite of the mystical culture, mental disorders were attributed and treated on a somatic basis. In the Islamic era, mental patients were never subjected to any torture or maltreatment because of the inherited belief that they may be possessed by a good Moslem genie. The first mental hospital in Europe was located in Spain, following the Arab invasion, and from then on it propagated to other European countries. The 14th century Kalawoon Hospital in Cairo had four departments, including medicine, surgery, ophthalmology, and mental disorders. Six centuries earlier, psychiatry in general hospitals was recognized in Europe. The influence of Avicenna and Elrazi and their contributions to European medicine is well-known. This article discusses further the current state of the mental health services in Egypt and the transcultural studies of the prevalence and phenomenology of anxiety, schizophrenia, depression, suicide, conversion, and obsessive compulsive disorders. An outline of psychiatric disorders in children is discussed. The problem of drug abuse is also addressed, especially that in Egypt after 1983, where drugs like heroine replaced the common habit of hashish.
A família e o doente mental usuário do hospital-dia: estudo de um caso La familia y el enfermo mental usuário del hospital/día: estudo de un caso The family and the mentally-ill user of day-hospitals: a case study
Ana Ruth Macêdo Monteiro
Full Text Available O hospital-dia, como modalidade de assistência psiquiátrica, proporciona a família a possibilidade de vivenciar junto ao seu familiar doente uma maior convivência durante o tratamento, e a leva a buscar junto a esse familiar formas de facilitar o processo adaptativo de interação na família. A proposta deste estudo se configura na busca de compreender de que modo a família e o usuário do hospital-dia interagem no recesso do lar e descrever a experiência narrada por uma família. A família deste estudo foi selecionada a partir de um usuário do hospital-dia que possuísse ou possua história anterior de internações psiquiátricas. Foram entrevistados cinco membros da família em estudo. A partir das experiências descritas pelos sujeitos emergiram duas grandes categorias temáticas: A família vivenciando junto ao seu familiar o hospital-dia , A convivência família ¾ usuário. As experiências relatadas pelos sujeitos neste estudo são bastante significativas para a construção de novas possibilidades na assistência à família do doente mental.El hospital-día como modalidad de atención psiquiátrica, proporciona a la familia la posibilidad de tener una mayor convivencia con su familiar enfermo durante el tratamiento y la lleva a buscar de forma conjunta con éste, formas para facilitar el proceso de adaptación e interacción en la familia. El estudio pretende comprender la manera como la familia y usuario del hospital-día interactuan en el ambiente del hogar y describir la experiencia narrada por una familia. La familia de este estudio fue seleccionada de un usuario del hospital-día que tuviese historia anterior de hospitalizaciones psiquiátricas. Fueron entrevistados cinco familiares. A partir de las experiencias descritas por los sujetos se formaron dos grandes categorías temáticas: La familia conviviendo con su familiar en el hospital-día y la convivencia familia/usuario. Las experiencias relatadas por los sujetos en
Chikara, F; Manley, M R
Like many developing countries, Zimbabwe has a shortage of trained mental health professionals. The country is coping by developing an expanded role for nurses and other nonphysician mental health workers and by emphasizing use of medication in treating mental illnesses. The authors review traditional Zimbabwean beliefs about mental illness and healing and describe culturally specific patterns of illness presentation. To reverse the historic pattern in which psychiatric care was centralized in cities, Zimbabwe is establishing a countrywide system of primary health clinics, part of whose role is to screen and treat common mental disorders, educate communities about mental illness, and promote prevention of illness.
Nizamie, Shamsul Haque; Tikka, Sai Krishna
Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry and music, neural processing underlying music, music's relation to classical psychology and psychopathology and scientific evidence base for music therapy in major psychiatric disorders. We highlight the role of Indian forms of music and Indian contribution to music therapy. PMID:24891698
Wayne, George J.
Psychiatry in the Soviet Union is essentially conservative, middle-of-the-road and eclectic. It rejects both extremes: radical surgical treatment such as prefrontal lobotomy, and Freudian psychoanalysis. It is Pavlovian and neurophysiological in its orientation and closely linked to Marxian philosophy; most personal problems are believed to be sociocultural in origin, and they are expected to diminish as the country moves closer toward its political and economic goals, making psychiatry progressively more circumscribed in its applications. The varieties of therapy include work therapy, aimed toward returning patients to society quickly and productively; electrosleep therapy and electroconvulsive therapy, both of which seem to be falling into disrepute; insulin-coma therapy, widely used in psychosis; hunger therapy; pharmacotherapy similar to our own but lacking in the large numbers of drugs we use; tissue therapy; psychotherapy, of limited depth and chiefly concerned with the rational, conscious elements in the patient's life. PMID:13783499
Nizamie, Shamsul Haque; Tikka, Sai Krishna
Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry and music, neural processing underlying music, music's relation to classical psychology and psychopathology and scientific evidence base for music therapy in major psychiatric disorders. We highlight the role of Indian forms of music and Indian contribution to music therapy.
Blazek, Mary C; Dantz, Bezalel; Wright, Mary C; Fiedorowicz, Jess G
Traditionally, medical students on clinical rotations receive instruction on principles of mental health only during the psychiatry clerkship. We used emails to insert teaching of psychiatric concepts beyond the psychiatry clerkship into other rotations using the method of spaced learning, the delivery of brief morsels of information repeated over time intervals. We predicted that the intervention would improve attitudes and confidence towards the integration of psychiatry and knowledge retention. We developed and distributed a series of emails relating key psychiatric concepts targeted to the other core clerkships. In a cluster-randomized trial over one academic year (intervention group n = 71, control group n = 61), scores on the Attitudes and Confidence in the Integration of Psychiatry scale and on the knowledge quiz did not differ significantly. Students who actively engaged with the emails demonstrated significantly higher scores on the knowledge test. Email users valued the timing, format of delivery and application of psychiatric principles outside the psychiatric setting. Participants recommended simplifying the format and previewing the benefits of spaced learning to increase utilization. Delivering spaced learning through emails, within a curriculum designed to foster engagement, may provide an efficient means of addressing the widely-recognized but elusive goal of integrating teaching across medical disciplines.
Wu, Ying; Duan, Zhiguang
Mental disorder is harmful to human health, effects social life seriously and still brings a heavy burden for countries all over the world. Scientific collaboration has become the indispensable choice for progress in the field of biomedicine. However, there have been few scientific publications on scientific collaboration in psychiatry research so far. The aim of this study was to measure the activities of scientific collaboration in psychiatry research at the level of authors, institutions and countries. We retrieved 36557 papers about psychiatry from Science Ciation Index Expanded (SCI-Expanded) in web of science. Additionally, some methods such as social network analysis (SNA), K-plex analysis and Core-Periphery were used in this study. Collaboration has been increasing at the level of authors, institutions and countries in psychiatry in the last ten years. We selected the top 100 prolific authors, institutions and 30 countries to construct collaborative map respectively. Freedman, R and Seidman, LJ were the central authors, Harvard university was the central institution and the USA was the central country of the whole network. Notably, the rate of economic development of countries affected collaborative behavior. The results show that we should encourage multiple collaboration types in psychiatry research as they not only help researchers to master the current research hotspots but also provide scientific basis for clinical research on psychiatry and suggest policies to promote the development of this area.
Tapiainen, V; Hartikainen, S; Taipale, H; Tiihonen, J; Tolppanen, A-M
Studies investigating psychiatric disorders as Alzheimer's disease (AD) risk factors have yielded heterogeneous findings. Differences in time windows between the exposure and outcome could be one explanation. We examined whether (1) mental and behavioral disorders in general or (2) specific mental and behavioral disorder categories increase the risk of AD and (3) how the width of the time window between the exposure and outcome affects the results. A nationwide nested case-control study of all Finnish clinically verified AD cases, alive in 2005 and their age, sex and region of residence matched controls (n of case-control pairs 27,948). History of hospital-treated mental and behavioral disorders was available since 1972. Altogether 6.9% (n=1932) of the AD cases and 6.4% (n=1784) of controls had a history of any mental and behavioral disorder. Having any mental and behavioral disorder (adjusted OR=1.07, 95% CI=1.00-1.16) or depression/other mood disorder (adjusted OR=1.17, 95% CI=1.05-1.30) were associated with higher risk of AD with 5-year time window but not with 10-year time window (adjusted OR, 95% CI 0.99, 0.91-1.08 for any disorder and 1.08, 0.96-1.23 for depression). The associations between mental and behavioral disorders and AD were modest and dependent on the time window. Therefore, some of the disorders may represent misdiagnosed prodromal symptoms of AD, which underlines the importance of proper differential diagnostics among older persons. These findings also highlight the importance of appropriate time window in psychiatric and neuroepidemiology research. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Confidentiality stands out in psychiatry through its multiple connotations as an intrinsic necessity in the ethics of professional relationships. Thus it represents an important characteristic of this profession and at the same time a stringent request which, through its specificity, implies a direct contact with persons in need for help. Despite being inserted in professional codes and legislative systems, confidentiality in psychiatry is far from being considered a clarified matter and does not stand aside from ethical controversy. Keeping the professional secret is often a hard task due to the pressure of the law or of other professional groups who can bring multiple justifications, including that of action for the benefit of society. The therapist is often sub- mitted to a tension caused on the one hand by the promise of keeping the professional secret and on the other hand by multiple requests of breaking the confidentiality. So the problem of confidentiality in Psychiatry deserves special attention because in this profession, more than in other branches of medicine, the gain of the patient's trust is essential in the psychotherapeutic relationship.
Sadler, John Z
In his response to Reynolds and colleagues' "The Future of Psychiatry as Clinical Neuroscience," the author considers three themes prominent in the history of psychiatry: stigma, conscience, and science, considering each in the past, present, and into the future. A series of conclusions follow these historical perspectives. One, unraveling the web of stigma in the future depends more on moral, educational, and political achievements than neuroscientific ones. Two, psychiatry's future depends upon the public trust, which has fluctuated over its history and into the present era, during which legacies of undue influence and failed regulation have damaged this trust. While explaining the mechanisms for mental disorders is crucial, the returns from these scientific investments are decades away, and failures of conscience today undermine the vital public trust and impede psychiatry's abilities to immediately address the plight of the mentally ill. Three, the researcher-entrepreneur in perennial search of funding has replaced the old model of the curious researcher-practitioner. This drive for funding promotes hubris and failures of conscience in psychiatric science. Moreover, the information explosion and superspecialization of contemporary academic medicine has led to an intellectual fragmentation analogous to the service fragmentation at the beginnings of psychiatry. Attention to integrative synthesis of research information, as well as conscientious moral reflection on scientific advances, will promote humility over hubris: enhancing the public trust, assuring public confidence in psychiatric science, and empowering patients.
Full Text Available Issues related to the mental health of women are a priority these days. Many international organisations working in the field of psychiatry are having sections on it now. This approach can go a long way in the improvement of the available mental health services for this population.
Pedersen, Inge Nygaard
This special feature is a series of papers from a symposium held on 15th April 2016 at Aalborg University, Denmark on the topic: ‘Music therapy: A profession for the future’. The two core questions listed in the title: ‘Why music? Why and when is a music therapist needed?’ were the vehicle...... wondered if common answers to the two core questions in the profession of music therapy would emerge at an international base during the day, or if multiple ideas and subjective answers to the questions would come up. As the contributions show, it is mostly multiple ideas; yet with regard to case material......, the way of carrying out music therapy in a relationship with the users of music therapy is very similar. The theoretical understanding and ideological positions are different. There still seems to be, however, a growing integration of theories and ideas by many presenters and discussion partners...
Full Text Available ... Registry Residents & Medical Students Residents Medical Students Patients & Families Mental Health Disorders/Substance Use Find a Psychiatrist ... Postpartum Depression Posttraumatic Stress Disorder (PTSD) More Patients & Families Patients & Families Mental Health Disorders/Substance Use Find ...
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Full Text Available ... are qualified to assess both the mental and physical aspects of psychological problems. People seek psychiatric help ... patients, help provide a picture of a patient's physical and mental state. Their education and clinical training ...
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Full Text Available ... is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders. ... spends at least three additional years learning the diagnosis and treatment of mental health, including various forms of psychotherapy ...
Full Text Available ... D. or D.O.) who specializes in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems. People seek psychiatric help ...
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Singh, Ajai R
This paper outlines six important tasks for psychiatry today, which can be put in short as: Spread and scale up services;Talk;Science,Psychotherapy;Integrate; andResearch excellence. As an acronym, STSPIR. Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:Mental disorders are leading cause of ill health but bottom of health agenda;Patients face widespread discrimination, human rights violations and lack of facilities;Need to stem the brain drain from developing countries;At any given point, 10% of the adult population report having some mental or behavioural disorder;In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.TALK: Speaking to a wider audience about positive contributions of psychiatry:Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;Defining normality and abnormality;Bringing about greater precision in diagnosis and care;Motivating those helped by psychiatry to speak up;Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;Setting up regular columns in psychiatry journals around the globe, called 'Patients Speak', or something similar, wherein those who have been helped get a chance to voice their
It can be said that (re)integration of mental patients is the basic goal of psychiatry as a medical discipline. Throughout the history of psychiatry different approaches to treatment and rehabilitation of mental patients and their social (re)integration have been identified and monitored. There have always existed different impediments to the (re)integration of mental patients, as a manifestation of the times when treatment and rehabilitation took place. In the beginning of psychiatric development, the principal goal, in line with the social development and social awareness of human rights, was to isolate the patient away from his/her social environment and place him/her into a psychiatric hospital, preferably for life. Lately, as fighting for human rights grew into a matter of fashion and prestige rather than an ethical and legal issue, the media have often spoken about the human rights of mental patients and, explicitly or implicitly, advocated their social (re)integration. This cry for human rights of mental patients has virtually rooted out the advocates for permanent social isolation, even in this region. However, the Croatian media often give out the so called mixed messages when it comes to treating mental patients. This article analyzes such contradictory communication and attempts to offer certain solutions.
María Cristina Quijano M.
Full Text Available Las investigaciones han demostrado que la enfermedad mental es causa de disfunciones cognoscitivas, manifestadas en desorden de las ideas y de los sentimientos con trastornos graves del razonamiento, del comportamiento, de la facultad de reconocer la realidad y de adaptarse a los retos normales de la vida. El objetivo de este estudio fue describir, mediante la evaluación neuropsicológica, los cambios cognoscitivos en un grupo de pacientes con enfermedad mental que asistían a un programa de Hospital Día, espacio terapéutico diseñado para la rehabilitación, el cuidado y el acompañamiento del paciente. Se tomaron al azar 25 pacientes entre los 16 y 61 años de edad con una escolaridad mínima de cinco años, y se realizó una valoración neuropsicológica al ingreso (pre y cinco meses después de dar inicio al tratamiento (pos con la Evaluación Neuropsicológica Breve en Español, Neuropsi (Ostrosky, Ardila y Roselli, 1994. Los resultados en la preevaluación mostraron que los pacientes con enfermedad mental presentan cambios cognoscitivos en atención, memoria inmediata, evocación con clave semántica, evocación por reconocimiento, memoria visual, comprensión verbal, fluidez verbal semántica, habilidad visoconstruccional, función ejecutiva conceptual y motora; sin embargo, estas funciones cognoscitivas mejoran cuando se asiste disfuncioregularmente al programa de Hospital Día. Estos resultados hacen evidente la importancia del trabajo terapéutico interdisciplinario, sumado a la farmacoterapia, con el fin de obtener cambios cognoscitivos más estables.
The main hypothesis of this paper is the presence of malaise in psychiatry. The malaise has two sides: on one hand, the end of psychiatry hegemony that dominated the theoretical field of psychiatry until the 1990s. The loss of influence of psychoanalysis is due to its inability to be submitted to any kind of assessment. On the other hand, the supremacy of neurosciences. The idea is not to underestimate the importance of neurosciences but rather to affirm that they occupy the whole theoretical field of psychiatry. This is an unusual situation that is specific to our time. Indeed, this monism has succeeded to an epistemological dualism that has existed throughout the history of psychiatry. In this article, we'll try to draw a history of dualism in psychiatry. Firstly, with Pinel, we find a tension between a metaphysical philosophical pole and a physiological one. Pinel's philosophy has something to do with Condillac's ideology as Pinel applies the analytical method to mental diseases. Under Cabanis's influence, the author of the famous Rapports du physique et du moral de l'homme, this ideology is under pressure with physiologism. As a materialist, he gives an essential part to the brain that distributes pieces of information throughout the body because he thinks that mind influences body. Secondly, dualism lies between the doctrine of localizations defended by Gall and the theory of degeneration elaborated by Magnan. Gall, in Anatomie et physiologie du système nerveux en général, seeks to know how bumps or hollows that are found on the skull are shaped. Gall is for the theory of delocalizations. He is the counterpart of Magnan who wrote a work about Les Dégénérés, that takes its part in the physiological trend with the famous theory of degeneration. For him, degeneration means the imperfect state of a subject whose cerebral functions are in a noticeably imperfect state. Thirdly, with Henry Ey, dualism starts to be less important. Indeed, he tends a monist
After experiencing the catastrophic Great East Japan Earthquake and Tsunami disaster in 2011, Tohoku University founded the International Research Institute of Disaster Science (IRIDeS) in April, 2012. IRIDeS, comprising 7 divisions and 36 laboratories with broad areas of specialization, from the humanities to natural sciences, aims to become a global center for the study of disasters and disaster mitigation, learning from and building upon past lessons in disaster management from Japan and around the world. In IRIDeS, the Department of Disaster Psychiatry is in charge of dealing with issues related to disaster psychiatry, including the psychosocial impact of disasters. Now, at more than 2 and a half years after the catastrophic disaster, the psychological impact actually seems to be getting stronger and wider, whereas the memory of the disaster seems to be waning in other areas of the country. In such a situation, where a number of problems need to be resolved, what can/should we do as psychiatrists? On the other hand, other natural disasters, such as storms and floods, have kept hitting Japan, and catastrophes seem to strike somewhere in the world every year. In addition, we need to prepare for the possibility of a Nankai Trough Quake and an earthquake directly hitting the Tokyo area, which may occur sometime in the future. Considering the situation, we need to establish an education system for disaster psychiatry, and proceed with research to collect useful information to prepare for coming disasters. The aim of our department is to integrate multi-faceted basic and clinical research approaches to investigate the following topics: 1) to identify social, psychological, and biological factors involved in the pathophysiology of and recovery from disaster-related mental health problems; 2) to develop systems for disaster prevention, disaster response, and recovery, considering disaster-related psychiatric and psychological issues; 3) to develop useful tools for the
Full Text Available As psychiatrists, we are often obliged to provide non-consensual treatment. This institute comprises the rights of the patients with mental health disorders. The aim of this paper is to explain the contemporary mental health legislation in our country the Republic of Macedonia and the problems with the implementation of involuntary hospitalisation. This could be overcome with close cooperation between the judicial and health care system.
Principal Contact. Andrew Thomas Division of Psychiatry, Department of Neurosciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, SOUTH AFRICA Email: firstname.lastname@example.org ...
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry\\'s identity as essentially \\'applied neuroscience\\'. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
Mhango, S N; Kalimbira, A; Mwagomba, B
To determine the prevalence of overnutrition and undernutrition among neuropsychiatric inpatients and outpatients at Zomba Mental Hospital in Zomba, Malawi. In this analytical cross-sectional study (n = 239), data were collected from psychiatric patients who were either inpatients (n = 181) or outpatients (n = 58) at Zomba Mental Hospital, which is the largest mental health facility in Malawi. Information was collected about patient demographics, anthropometric data, dietary information, and tobacco and alcohol use, among other variables. Data were entered and analysed in SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Means were generated and compared between male and female patients, and between inpatients and outpatients. The study recruited 158 male and 81 female patients, with mean ages of 31.24 ± 11.85 years and 33.08 ± 15.18 years (p = 0.328), respectively. Male patients were significantly taller (165.27 ± 7.25 cm) than female patients (155.30 ± 6.56 cm) (p underweight. There were no significant differences in the prevalence of overweight, obesity, and underweight between male and female participants, or between inpatients and outpatients. Our study-the first one of its kind in Malawi-characterised the anthropometry of neuropsychiatric patients at a major metal health facility in Malawi, and has shown a high proportion of overweight patients and a notable presence of underweight patients among them. Being overweight or obese is a risk factor for metabolic disorders. Being underweight may aggravate mental illness or disturb the effect of medication. There is need, therefore, to include nutrition screening and therapeutic or supplementary feeding as part of a comprehensive care and treatment plan for neuropsychiatric patients.
Full Text Available Background: There are few studies in Indian context on factors affecting generalized help-seeking behaviors in the relatives of persons with mental illness. Hence, the present study was undertaken. Materials and Methods: This is a cross-sectional, purposive sampling, comparative study. Sociodemographic profile, illness details, treatment, compliance, reactions to mental illness scale, and cope inventory scores were compared between the low and high help-seeking groups on General Help-seeking Questionnaire divided on the lower 25th and upper 75th quartiles, respectively, for the groups. The data were statistically analyzed on SPSS-17. Results: Out of a total of 100 patients, 25 and 28 subjects in the low and high help-seeking groups, respectively, were included in the study. In the low help-seeking group, drug compliance was good and caregivers' education level was higher compared to the high help-seeking group. High help-seeking group was characterized by higher scores of hope and compassion on reactions to mental illness scale and the coping mechanisms of humor, denial, use of instrumental and emotional support, acceptance, and planning were frequently used. Conclusions: There is a need to develop awareness about mental illness in the general population and improve the available social support systems to the patients with mental illness and their family members. The help-seeking behaviors could be improved by training the personnel at primary health centers about the treatment of mental illness and importance of drug compliance and regular follow-up.
Borzenko, A S; Zubova, E Iu; Iaitskiĭ, Iu A
The analysis of the results of treatment of two groups of patients from psychotuberculosis units of a mental hospital has shown the advantages of long-term continuous hospital treatment in these patients. In the patients receiving continuous hospital treatment for 3 years, positive changes in the course of pulmonary tuberculosis were observed in 83.5 +/- 2.8% of cases, which is 8 times more frequently than a progressive process (17 (10 +/- 2.3%) patients), p mental state, improvement was achieved in 57.4 +/- 6.3% and the chronic undulating course of the process was observed in 32.8 +/- 6%. It is stated that it is necessary to develop new statutory acts regulating the discharge of patients with active pulmonary tuberculosis and mental disorders (including chronic alcoholism) depending not only their mental state, but also the epidemic hazard they pose.
Duque Ossa, Diego José
Full Text Available El alcoholismo era un problema real en la ciudad de Medellín y en el departamento de Antioquia (Colombia durante las tres primeras décadas del siglo XX; se lo enfocaba desde la perspectiva de un hábito que termina por dominar a quien lo asume; además, de acuerdo con los conocimientos médicos de ese período, era considerado como una enfermedad social, con connotaciones morales, físicas y sobre todo mentales. Las posibilidades médicas del momento eran escasas, el manicomio de la ciudad no contaba con las instalaciones adecuadas y las terapias disponibles para el alcoholismo eran limitadas; por lo tanto, se trataba de una enfermedad de pésimo pronóstico con pocas posibilidades de curación. Se presentan en este artículo los resultados de una investigación histórica sobre los primeros diagnósticos de psicosis alcohólica en el departamento de Antioquia, entre 1900 y 1930, incluyendo los diferentes enfoques clínicos y los recursos disponibles para su tratamiento. Se pretendió en el estudio evaluar los conocimientos médicos de la época sobre este asunto así como los primeros pasos del centro psiquiátrico más importante de la región.
Qureshi, A; Collazos, F; Ramos, M; Casas, M
Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.
Cowan, W M; Kandel, E R
Neurological and psychiatric illnesses are among the most common and most serious health problems in developed societies. The most promising advances in neurological and psychiatric diseases will require advances in neuroscience for their elucidation, prevention, and treatment. Technical advances have improved methods for identifying brain regions involved during various types of cognitive activity, for tracing connections between parts of the brain, for visualizing individual neurons in living brain preparations, for recording the activities of neurons, and for studying the activity of single-ion channels and the receptors for various neurotransmitters. The most significant advances in the past 20 years have come from the application to the nervous system of molecular genetics and molecular cell biology. Discovery of the monogenic disorder responsible for Huntington disease and understanding its pathogenesis can serve as a paradigm for unraveling the much more complex, polygenic disorders responsible for such psychiatric diseases as schizophrenia, manic depressive illness, and borderline personality disorder. Thus, a new degree of cooperation between neurology and psychiatry is likely to result, especially for the treatment of patients with illnesses such as autism, mental retardation, cognitive disorders associated with Alzheimer and Parkinson disease that overlap between the 2 disciplines.
Sam Chidi Ibeneme
Full Text Available Purpose. To identify stroke survivors with symptoms of poststroke depression and the extent of psychiatry needs and care they have received while on physiotherapy rehabilitation. Participants. Fifty stroke survivors (22 females and 28 males at the outpatient unit of Physiotherapy Department, University of Nigeria Teaching Hospital, Enugu, who gave their informed consent, were randomly selected. Their age range and mean age were 26–66 years and 54.76±8.79 years, respectively. Method. A multiple case study of 50 stroke survivors for symptoms of poststroke depression was done with Beck’s Depression Inventory, mini mental status examination tool, and Modified Motor Assessment Scale. The tests were performed independently by the participants except otherwise stated and scored on a scale of 0–6. Data were analyzed using Z-test for proportional significance and chi-square test for determining relationship between variables, at p<0.05. Results. Twenty-one (42.0% stroke survivors had symptoms of PSD, which was significantly dependent on duration of stroke (χ2 = 21.680, df = 6, and p=0.001, yet none of the participants had a psychiatry review. Conclusions. Symptoms of PSD may be common in cold compared to new cases of stroke and may need psychiatry care while on physiotherapy rehabilitation.
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...
Over the last 30 years psychiatry and psychoanalysis have moved in substantially divergent directions. Psychiatry has become rich in methodology but conceptually limited, with a drift toward biological reductionism. Psychoanalysis has remained relatively limited in methodology, but conceptually rich. The rich methodology of psychiatry has led to major contributions in discovering gene by environment interactions, the importance of early adversity, and to recognition of the serious problem posed by treatment resistance. However, psychiatry's biologically reductionistic conceptual focus interferes with the development of a nuanced clinical perspective based on emerging knowledge that might help more treatment resistant patients become treatment responders. This article argues that recognition of the problem of treatment resistance in psychiatry creates a need for it to reconnect with the conceptual richness of psychoanalysis in order to improve patient care. Psychodynamic psychiatry is defined as the relevant intersection of psychiatry and psychoanalysis where this reconnection can occur. I will suggest selected aspects of psychoanalysis that are especially relevant to psychiatry in improving outcomes in work with treatment resistant patients.
Reiter-Theil, Stella; Schürmann, Jan; Schmeck, Klaus
Overview on Clinical Ethics Consultation in Psychiatry. Systematic literature search in data bases (PubMed, Web of Knowledge, SpringerLink, PubPsych, PsychSpider und PsycINFO) against the background of practical experiences with pilot model of implementation of Ethics Consultation in one psychiatric university hospital. Reports on Ethics Consultation in Psychiatry were published only sporadically. This is contrasted by recent experiences showing considerable needs for ethics support in Child and Adolescent Psychiatry, Adult as well as Forensic Psychiatry. This somewhat "late" development of Ethics Consultation in Psychiatry (compared with somatic medicine) might have structural reasons (lacking resources), be related to strong compensatory competencies of psychiatric staff, esp. regarding communication or legal knowledge, but could also relate to an under-estimation ("under-diagnostic") of ethical problems in psychiatric patient care - both, in the eyes of psychiatric insiders, as well as seen from the outside. Needs for model projects and accompanying research on Ethics Consultation in Psychiatry. Proved in practice: patient- as well as team-oriented ethics support. © Georg Thieme Verlag KG Stuttgart · New York.
Coid, J; Kahtan, N; Gault, S; Jarman, B
Treatment of patients with personality disorder remains controversial and severe mental illness is prioritized in secure forensic psychiatry services. To compare patients with personality disorder and mental illness according to demography, referral, criminality, previous institutionalisation and diagnostic comorbidity. A record survey of 511 patients with personality disorder and 2575 with mental illness admitted to secure forensic psychiatry services between 1 January 1988 and 31 December 1994 from half of England and Wales. Personality disorder admissions declined over time; more were female, White, younger and extensively criminal (specifically, sexual and arson offences). Personality disorder was highly comorbid; antisocial, borderline, paranoid and dependent personality disorder were most prevalent. Patients with personality disorder were highly selected and previously known to psychiatric services. Referrer, diagnostic comorbidity and behavioural presentation determined their pathways into care. Future research must determine whether their continuing admission represents effective use of scarce resources and whether new services are required.
Wium-Andersen, Ida Kim; Vinberg, Maj; Kessing, Lars Vedel
Background: Personalized medicine is a model in which a patient’s unique clinical, genetic, and environmental characteristics are the basis for treatment and prevention. Aim, method, and results: This review aims to describe the current tools, phenomenological features, clinical risk factors......, and biomarkers used to provide personalized medicine. Furthermore, this study describes the target areas in which they can be applied including diagnostics, treatment selection and response, assessment of risk of side-effects, and prevention. Discussion and conclusion: Personalized medicine in psychiatry....... The discussion proposes possible solutions to narrow this gap and to move psychiatric research forward towards personalized medicine....
Ventriglio, A; Bhugra, D
René Descartes described the concept of mind-body dualism in the 16th century. This concept has been called his error but we prefer to call it his dogma because the error was recognised much later. We studied the original writings translated by various scholars. We believe that his dogma has caused tremendous amount of damage to Western psychiatry. This dualism has created boundaries between mind and body but as we know they are inextricably interlinked and influence each other. This has affected clinical practice and has increased the dichotomy between psychiatric services and the physical health care services in the West at least. This dualism has also contributed to stigma against mental illness, the mentally ill and the psychiatric services. We propose that it is time to abandon this mind-body dualism and to look at the whole patient and their illness experiences as is done in some other health care systems such as Ayurveda.
Jilek, W G
Emil Kraepelin, well known as the principal designer of modern psychiatric nosology, is less well known for his pioneering work in comparative sociocultural psychiatry. This paper is trying to document Kraepelin's role as the inaugurator of systematic investigations into culture-dependent differences in psychopathology. Despite his many responsibilities as clinician, teacher, hospital administrator and scientific author, Kraepelin considered cross-cultural comparison of such importance that he spent considerable time on the preparation of then very cumbersome overseas expeditions. His first research journey in 1904 to Southeast Asia led to the programmatic formulation of comparative psychiatry as a scientific endeavour designed to contribute to the better understanding of psychopathological processes and to a comprehensive comparative ethnopsychology ("Voelkerpsychologie"). Kraepelin's main cross-cultural research project, planned to extend to seven non-European countries and to involve many foreign colleagues, was prevented by World War I and postwar complications. One year before his unexpected death, Kraepelin conducted comparative studies with American Indian, Afro-American and Latin American patients at psychiatric institutions in the United States, Mexico and Cuba in 1925. In his writings Kraepelin commented on certain differences in the incidence and presentation of psychopathological phenomena that he considered to be due to ethnic-cultural characteristics or social conditions. This paper discusses in detail Kraepelin's observations on the pathoplastic and pathogenic effects of cultural and social factors, and demonstrates the influence of his ideas on the development of modern social and transcultural psychiatry.
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