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Background: It is unavoidable for learners undergoing health professions training to encounter different complex clinical scenarios related to diagnoses, treatment and ethical dilemmas. The lack of standard answers to such clinical challenges can cause uncertainty in the process of teaching, learning and assessment as learners grapple with the need to critically appraise the specific context, past practices and extant literature to arrive at a thoughtful decision. In this aspect, debate can be a useful pedagogical tool to consider multiple, different perspectives regarding these issues. As the use of debate within the health professions education has not been reviewed, we conducted a systematic review of the current literature on the adoption of debate as a pedagogical tool to clarify the specific context of use as well as its effectiveness in the learning of skills and content within the health professions education. Methods: A systematic review was conducted on relevant published literature in English within journal databases until September 2018 that employed debate as a pedagogical tool within health professions education. Results: Out of 626 screened articles, 12 studies were finally included based on inclusion/exclusion criteria. The 12 studies (9 undergraduate, 3 postgraduate) covered a diverse range of disciplines and debate in health professions education was adopted for acquisition of skills (such as critical thinking, communication skills, teamwork), or learning of specific topics (such as patient safety, ethical issues, teaching of new topics) as well as to examine evidence based practice. In the majority of studies (10 of 12 studies, 83.3%), debate has been deemed by the learners to be effective in facilitating the learning of new content and skills such as communication and critical thinking, which are related to processes aligned with adult learning, motivational, reflective and social learning theories.Conclusion: Overall, sparse studies to date with relatively low risk of bias found debate to be effective in enabling the learning of skills and content within health professions education. Future studies may want to incorporate more objective measures of the learning outcomes of learners following the adoption of debate as a teaching tool as well as to examine the combinatorial use of debate with other pedagogical tools and their longitudinal impact on learners and learning.

BackgroundMorphology of the human cerebral cortex differs across psychiatric disorders, with neurobiology and developmental origins mostly undetermined. Deviations in the tangential growth of the cerebral cortex during pre/perinatal periods may be reflected in individual variations in cortical surface area later in life.MethodsInterregional profiles of group differences in surface area between cases and controls were generated using T1-weighted magnetic resonance imaging from 27,359 individuals including those with attention-deficit/hyperactivity disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, schizophrenia, and high general psychopathology (through the Child Behavior Checklist). Similarity of interregional profiles of group differences in surface area and prenatal cell-specific gene expression was assessed.ResultsAcross the 11 cortical regions, group differences in cortical area for attention-deficit/hyperactivity disorder, schizophrenia, and Child Behavior Checklist were dominant in multimodal association cortices. The same interregional profiles were also associated with interregional profiles of (prenatal) gene expression specific to proliferative cells, namely radial glia and intermediate progenitor cells (greater expression, larger difference), as well as differentiated cells, namely excitatory neurons and endothelial and mural cells (greater expression, smaller difference). Finally, these cell types were implicated in known pre/perinatal risk factors for psychosis. Genes coexpressed with radial glia were enriched with genes implicated in congenital abnormalities, birth weight, hypoxia, and starvation. Genes coexpressed with endothelial and mural genes were enriched with genes associated with maternal hypertension and preterm birth.ConclusionsOur findings support a neurodevelopmental model of vulnerability to mental illness whereby prenatal risk factors acting through cell-specific processes lead to deviations from typical brain development during pregnancy.

It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Previous studies have found that the inclusion of medical humanities in medical education was associated with improvements in learner reflectivity and empathy. There is less data, however, on the impact of medical humanities on perceived patient care and mediators of learner outcomes. Our study aimed to determine the impact of medical humanities on perceived learner well-being and patient care, and the mediators of these outcomes in medical undergraduates undergoing psychiatric training. METHODS: This cross-sectional study was conducted from August 2021 to December 2022 within undergraduate medical students undergoing psychiatry rotations and who attended sessions entitled "Humanities in Psychiatry." Both quantitative and qualitative data were obtained through anonymized online feedback forms. Path analysis was performed to examine the relationship between learners' perception of the medical humanities writing activity and its potential to improve their well-being, patient care, as well as mediators of these outcomes. RESULTS: Overall, 97 medical undergraduates (response rate 67.4%) participated in the study and more than four-fifths reported improvements in listening, reflection, empathy, personal well-being, and perceived patient care. Males showed more interest in additional medical humanities sessions (mean rank 57.9 vs 42.5, P =.005) and greater improvements in personal well-being (mean rank 55.1 vs 44.5, P =.044). Path analysis showed that reflective capacity of learners mediated the relationship between reflective writing and perceived improvements in learner well-being (β = 0.596, 95% CI = 0.409-0.737) and patient care (β = 0.557, 95% CI = 0.379-0.702). CONCLUSIONS: Our study found that the majority of learners responded positively to the medical humanities sessions, which suggests that its use could be beneficial in fostering empathy, reflection, learner well-being, and improved patient care. Using the PRISM model, we present practical implications for educators to consider when using medical humanities in relation to psychiatry training. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter‐relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors. Methods: A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020. Results: Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self‐esteem), and psychosocial functioning (better overall, real‐life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions. Discussion: Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter‐relationships with carer resilience, and evaluate the efficacy of suitable resilience‐targeted interventions in schizophrenia. [ABSTRACT FROM AUTHOR]

The rapid spread of coronavirus disease 2019 (COVID-19) has a potentially significant impact on not only physical health but also psychological well-being. To our best knowledge, no review thus far has consolidated the psychological impact of COVID-19 across different subpopulations. A systematic search of the literature until 15 June 2020 found 150 empirical papers pertinent to the mental health consequences of the pandemic. The majority (87.3%) were from China (45.3%), the rest of Asia (22.0%) and Europe (20.0%), and mostly examined the general population (37.3%), healthcare workers (31.3%) and those with pre-existing mental and physical illnesses (14.7%). The most common psychological responses across these subpopulations were anxiety (overall range 24.8%-49.5%), depression (overall range 18.6%-42.6%) and traumatic stress symptoms (overall range 12.7%-31.6%). Healthcare workers and those with pre-existing physical and mental illnesses were more severely affected. Future studies are needed on under-examined subgroups such as the elderly and recovered COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Burnout during residency training is associated with various factors. Within the context of stress/coping transactional model in which one's personality can influence stress appraisal and coping, there is limited evidence examining the relationship between burnout and personality factors amongst psychiatry residents. Objectives: We aim to evaluate the prevalence of burnout within a cohort of psychiatry residents and its relationship with personality factors, demographic, work‐related factors and coping features. Methods: We conducted a cross‐sectional study involving 50 out of 77 eligible residents (response rate 64.9%) and administered the Oldenberg Burnout Inventory (OLBI), NEO‐Five Factor Inventory (NEO‐FFI) and Brief COPE Inventory. Burnout was defined as crossing the thresholds for exhaustion (≥2.25) and disengagement (≥2.1) scores. We compared the burnout vs nonburnout groups and examined the relationship between burnout, personality factors and coping strategies using correlational and mediational analyses. Results: Overall, 78% of our cohort met criteria for burnout. Burnout was correlated with hours of work per week (rs =.409, P =.008), neuroticism (OR 1.2, 95% CI 1.01‐1.43, P =.041) and avoidance coping (OR 1.61, 95% CI 1.06‐2.46, P =.025). Neuroticism was significantly correlated (all P <.001) with all coping domains (Seeking Social Support, rs = 0.40; Problem Solving, rs = 0.52; Avoidance, rs = 0.55; Positive thinking, rs = 0.41) and was a partial mediator between avoidance coping and burnout (β of indirect path = 0.168, [SE = 0.066]; P =.011). Conclusions: We found a considerable burnout rate amongst psychiatry residents which was associated with neuroticism and avoidance coping, and suggest ways to better tackle occupational burnout during residency training. [ABSTRACT FROM AUTHOR]