Search

Aim Methods Results Conclusions To characterise key features of young people presenting to the emergency department (ED) with a mental health complaint when comparing children (aged 7 to 12 years) and teenagers (13 years and greater).Retrospective review of all ED mental health presentations in children aged 7–17 years presenting over a 12‐month period in 2018 to a tertiary children's hospital in Victoria, Australia. Univariate analyses were carried out to examine the relationship between children and teenagers and a number of key presentation variables. Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated for ED management outcomes.There were 1691 ED mental health presentations in 2018. Of these presentations, 407 (24%) were children aged 12 years or less. The remaining 76% (1284) were teenagers. The younger aged cohort were more likely to be male (OR 2.43, CI 1.92–3.08) and have a past history of autism spectrum disorder (OR 1.92, CI 1.45–1.84). They were more likely to have a presenting complaint of acute behavioural disturbance (OR 2.03, CI 1.59–2.60), be physically restrained (OR 2.01, CI 1.18–3.37) and have sedative medication provided (OR 2.87, CI 1.63–5.04). The older aged cohort were more likely to have a past history of depression (OR 0.19, CI 0.12–0.29) and a presenting complaint of intentional self‐poisoning (OR 0.33, CI 0.15–0.65).Children aged 12 years or less represent one‐quarter of all young people presenting to the ED with a mental health concern. They experience high rates of acute behavioural disturbance and are more likely to require restrictive interventions during their presentation. [ABSTRACT FROM AUTHOR]

Background: Physician assistants/associates (PAs) provide services in diverse medical specialties globally, including psychiatry. While health professionals in psychiatry have been described for many years, little is known about PAs practicing in this discipline. Methods: We describe US PAs practicing in psychiatry using robust national data from the National Commission on Certification of Physician Assistants (NCCPA). Analyses included descriptive and inferential statistics comparing PAs in psychiatry to PAs in all other medical and surgical specialties. Results: The percentage of PAs practicing in psychiatry has increased from 1.1% (n = 630) in 2013 to 2.0% (n = 2 262) in 2021. PAs in psychiatry differed from PAs practicing in all other specialties in the following: they identified predominately as female (71.4% vs. 69.1%; p = 0.016), were more racially diverse (Asian [6.6% vs. 6.0%], Black/African American [5.5% vs. 3.4%], multi-race [2.8% vs. 2.1%], and other races [Native Hawaiian/Pacific Islander, American Indian/Alaska Native, or other; 3.7% vs. 3.6%]; p < 0.001), and resided in the South (43.8% vs. 34.1%; p < 0.001). PAs in psychiatry vs. all other specialties were more likely to work in office-based private practice settings (41.6% vs. 37.3%; p < 0.001) and nearly twice as likely to provide telemedicine services for their patients (62.7% vs. 32.9%; p < 0.001). While one-third (31.9%) of PAs in psychiatry experienced one or more burnout symptoms, and 8.1% considered changing their current position, the vast majority of PAs in psychiatry (86.0%) were satisfied with their position. Conclusions: Understanding the attributes of PAs in psychiatry is essential in medical labor supply and demand research. Our findings suggest that the number of PAs working in psychiatry is steadily increasing. These PAs were predominantly female, exhibited greater racial diversity, and were primarily located in the South and Midwest regions of the US. A striking difference was that PAs in psychiatry were almost twice as likely to provide telemedicine services for their patients. Although nearly a third of PAs in psychiatry acknowledged having one or more symptoms of burnout, few were considering changing their employment, and the vast majority reported high job satisfaction. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Knowledge graphs (KGs) remain an underutilized tool in the field of psychiatric research. In the broader biomedical field KGs are already a significant tool mainly used as knowledge database or for novel relation detection between biomedical entities. This review aims to outline how KGs would further research in the field of psychiatry in the age of Artificial Intelligence (AI) and Large Language Models (LLMs).We conducted a thorough literature review across a spectrum of scientific fields ranging from computer science and knowledge engineering to bioinformatics. The literature reviewed was taken from PubMed, Semantic Scholar and Google Scholar searches including terms such as “Psychiatric Knowledge Graphs”, “Biomedical Knowledge Graphs”, “Knowledge Graph Machine Learning Applications”, “Knowledge Graph Applications for Biomedical Sciences”. The resulting publications were then assessed and accumulated in this review regarding their possible relevance to future psychiatric applications.A multitude of papers and applications of KGs in associated research fields that are yet to be utilized in psychiatric research was found and outlined in this review. We create a thorough recommendation for other computational researchers regarding use‐cases of these KG applications in psychiatry.This review illustrates use‐cases of KG‐based research applications in biomedicine and beyond that may aid in elucidating the complex biology of psychiatric illness and open new routes for developing innovative interventions. We conclude that there is a wealth of opportunities for KG utilization in psychiatric research across a variety of application areas including biomarker discovery, patient stratification and personalized medicine approaches. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral measurement‐based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation. Methods: This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider‐reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites. Results: Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient‐level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients. Conclusions: There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations. [ABSTRACT FROM AUTHOR]

Multivariate techniques better fit the anatomy of complex neuropsychiatric disorders which are characterized not by alterations in a single region, but rather by variations across distributed brain networks. Here, we used principal component analysis (PCA) to identify patterns of covariance across brain regions and relate them to clinical and demographic variables in a large generalizable dataset of individuals with bipolar disorders and controls. We then compared performance of PCA and clustering on identical sample to identify which methodology was better in capturing links between brain and clinical measures. Using data from the ENIGMA‐BD working group, we investigated T1‐weighted structural MRI data from 2436 participants with BD and healthy controls, and applied PCA to cortical thickness and surface area measures. We then studied the association of principal components with clinical and demographic variables using mixed regression models. We compared the PCA model with our prior clustering analyses of the same data and also tested it in a replication sample of 327 participants with BD or schizophrenia and healthy controls. The first principal component, which indexed a greater cortical thickness across all 68 cortical regions, was negatively associated with BD, BMI, antipsychotic medications, and age and was positively associated with Li treatment. PCA demonstrated superior goodness of fit to clustering when predicting diagnosis and BMI. Moreover, applying the PCA model to the replication sample yielded significant differences in cortical thickness between healthy controls and individuals with BD or schizophrenia. Cortical thickness in the same widespread regional network as determined by PCA was negatively associated with different clinical and demographic variables, including diagnosis, age, BMI, and treatment with antipsychotic medications or lithium. PCA outperformed clustering and provided an easy‐to‐use and interpret method to study multivariate associations between brain structure and system‐level variables. Practitioner Points: In this study of 2770 Individuals, we confirmed that cortical thickness in widespread regional networks as determined by principal component analysis (PCA) was negatively associated with relevant clinical and demographic variables, including diagnosis, age, BMI, and treatment with antipsychotic medications or lithium.Significant associations of many different system‐level variables with the same brain network suggest a lack of one‐to‐one mapping of individual clinical and demographic factors to specific patterns of brain changes.PCA outperformed clustering analysis in the same data set when predicting group or BMI, providing a superior method for studying multivariate associations between brain structure and system‐level variables. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to analyze the real‐time variability of suicidal ideation intensity and the relationship between real‐time and retrospective reports of suicidal ideation made on the Beck Scale for Suicidal Ideation (BSS), among young people with borderline personality disorder (BPD). Methods: Young people (15–25‐year olds) with BPD (N = 46), recruited from two government‐funded mental health services, rated the intensity of their suicidal ideation six times per day for 7 days before completing the BSS. Results: For 70% of participants, suicidal ideation changed in intensity approximately five times across the week, both within and between days. BSS ratings were most highly correlated with the highest real‐time ratings of suicidal ideation. However, this was not significantly different from the relationship between the BSS and both the average and most recent ratings. Median ratings of suicidal ideation intensity were higher on the BSS compared with an equivalent question asked in real time. Conclusion: Findings suggest that young people with BPD experience high levels of fluctuation in their intensity of suicidal ideation across a week and that retrospective reports of suicidal ideation might be more reflective of the most intense experience of suicidal ideation across the week. [ABSTRACT FROM AUTHOR]

There is currently insufficient evidence for the use of a specific pharmacological treatment for personality disorders (PD). The research literature lacks a systematic exploration of clinicians' experiences of pharmacological treatment of PD. The aim of the qualitative study was to examine how psychiatrists make decisions about pharmacological treatment for patients with PD. The interviews were analyzed using inductive thematic analysis. The results showed that ambiguous guidelines had the effect that the psychiatrists often relied on their own experience, or that of their colleagues. As a basis for decisions concerning drug treatment, an interpersonal component was also identified. Some of the psychiatrists in the current study argued that medications may be part of the alliance-building with the patient and that medications were a way of tying the patient to the clinic. Our findings show that it is important to work on how the clinical guidelines should be implemented in practice. [ABSTRACT FROM AUTHOR]

Background: Treatment of refractory bipolar disorder (BD) is extremely challenging. Deep brain stimulation (DBS) holds promise as an effective treatment intervention. However, we still understand very little about the mechanisms of DBS and its application on BD. Aim: The present study aimed to investigate the behavioural and neurochemical effects of ventral tegmental area (VTA) DBS in an animal model of mania induced by methamphetamine (m‐amph). Methods: Wistar rats were given 14 days of m‐amph injections, and on the last day, animals were submitted to 20 min of VTA DBS in two different patterns: intermittent low‐frequency stimulation (LFS) or continuous high‐frequency stimulation (HFS). Immediately after DBS, manic‐like behaviour and nucleus accumbens (NAc) phasic dopamine (DA) release were evaluated in different groups of animals through open‐field tests and fast‐scan cyclic voltammetry. Levels of NAc dopaminergic markers were evaluated by immunohistochemistry. Results: M‐amph induced hyperlocomotion in the animals and both DBS parameters reversed this alteration. M‐amph increased DA reuptake time post‐sham compared to baseline levels, and both LFS and HFS were able to block this alteration. LFS was also able to reduce phasic DA release when compared to baseline. LFS was able to increase dopamine transporter (DAT) expression in the NAc. Conclusion: These results demonstrate that both VTA LFS and HFS DBS exert anti‐manic effects and modulation of DA dynamics in the NAc. More specifically the increase in DA reuptake driven by increased DAT expression may serve as a potential mechanism by which VTA DBS exerts its anti‐manic effects. [ABSTRACT FROM AUTHOR]

Phenomenon:As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning. [ABSTRACT FROM AUTHOR]

Objective: This novel study sought to understand lived experience and carer perspectives on the use of adaptive trials to evaluate interventions for eating disorders, in addition to understanding the factors and outcomes of most importance in eating disorder research and treatments from a lived experience perspective. Method: A total of 73 people with either lived or carer experience consented, 70 started the questionnaire, and 36 (51%) completed all questions. Participants were asked Likert scale and open‐ended questions to understand what factors and outcomes of eating disorder interventions were most important to them and understand their pre‐existing knowledge of clinical trials. Two videos were then used to explain randomized controlled trials (RCTs) and adaptive trials and participants were asked their opinions, including perceived benefits and concerns, of each trial type. Results: The thematic analysis found two key themes regarding factors important in eating disorder treatment: Person‐centred care and Evidence‐based and effective treatment; and two key themes regarding outcomes of treatment: Sustained, full recovery and The bigger picture. Both RCTs and adaptive trials were viewed favorably, however, there was a slight preference for adaptive trials. Key themes for both demonstrated perceived benefits and ethical, practical, and scientific considerations unique to each. Discussion: Findings demonstrate the support of adaptive trials in eating disorder interventions from people with lived experience and their carers. It is recommended that researchers consider the use of adaptive designs and the incorporation of lived experience perspectives when designing future intervention trials. Public Significance: This novel study found that the use of adaptive trials in eating disorder intervention research is supported by people with lived experience and carers. Furthermore, the factors and outcomes of most importance to participants in this study are comparable to those previously identified in the emerging literature. The use of adaptive designs and the incorporation of lived experience are recommended in further clinical trials. [ABSTRACT FROM AUTHOR]

This paper investigates the trends in erectile dysfunction research by integrating individual keywords such as COVID-19, mental health, psychiatry, and drug use. The study spans a six-year period from September 21, 2017, to September 21, 2023, and utilizes resources from the National Library of Medicine. For instance, the quantity of relevant documents is determined using the Google search engine. A custom date range can be set on the browser via tools, and the search is limited to the nih.gov site domain. The phrase-site search command used is executed with "erectile dysfunction" COVID-19 site:nih.gov. The result revealed that from Sept 2021 to 2022, research on COVID-19 and erectile dysfunction spiked. However, the previous year saw a rise in studies linking drugs or mental health with erectile dysfunction. Meanwhile, psychiatry-focused publications have consistently grown. The time-series trends of erectile dysfunction linked to COVID-19 are substantiated by a comprehensive literature review. [ABSTRACT FROM AUTHOR]

Les activités à médiations artistiques et les soins culturels sont devenus une composante de la plupart des institutions hospitalières pour enfants et adolescents. Pourtant leur financement n'est pas spécifié. À partir de l'expérience d'un service hospitalo-universitaire, nous souhaitons réfléchir aux mesures qui pourraient favoriser leur maintien. Nous avons conduit une étude observationnelle et des entretiens (n = 15) pour colliger l'ensemble des activités conduites par un intervenant extérieur en 2023, leur thématique, le public visé, leurs objectifs, la nature des intervenants, l'existence d'une convention formalisée, d'un financement, et également leurs fréquence et durée. Trente-quatre partenaires différents ont mené 685 actions en 2023 dont 10 % ont pu être réalisées à l'extérieur de l'hôpital. Les thématiques abordées sont extrêmement variées (sports, arts de la scène, littérature, arts visuels...). Ces activités représentent 210 interventions en moyenne par unité, soit 4 par semaine. Elles sont néanmoins moins nombreuses dans l'unité de soins intensifs et les unités pour patients autistes avec comportements défis, et quasiment absente des unités extrahospitalières. Enfin, financement spécifique ou convention sont souvent absents. Malgré leur fréquence et un investissement de l'équipe et des partenaires conséquents, on constate de nombreuses fragilités. Nous développons l'idée que la création d'une politique culturelle co-construite entre une direction de la culture et du mécénat et les composantes cliniques (pour nous pédopsychiatriques) permettrait de résoudre certaines de ces fragilités et de promouvoir leur inscription dans le tissu de soin. Art-mediated activities and cultural care have become a component of most hospital institutions for children and adolescents. Yet their funding is not specified. Based on the experience of a university hospital department, we would like to consider measures that might encourage their continuation. We conducted an observational study and interviews (n = 15) to list all the activities carried out by an external contributor in 2023, their themes, the target audience, their objectives, the nature of the contributors, the existence of a formalized agreement, funding, as well as their frequency and duration. Thirty-five different partners carried out 685 actions in 2023, 10% of which were carried out outside the hospital. The themes addressed are extremely varied (sports, performing arts, literature, visual arts, etc.). These activities represent an average of 210 interventions per unit, or 4 per week. However, they are less numerous in the intensive care unit and units for autistic patients with challenging behaviors, and virtually absent from outpatient units. Finally, specific funding or agreements are often absent. Despite their frequency and the substantial investment made by the team and its partners, there are a number of weaknesses. We are developing the idea that the creation of a cultural policy co-constructed between a cultural and sponsorship department and the clinical components (in our case, child psychiatry) would make it possible to resolve some of these weaknesses and promote a better inclusion in patient care. [ABSTRACT FROM AUTHOR]

The article highlights the intersection of global mental health with the United Nations' Sustainable Development Goals (SDGs), emphasizing the critical role of psychiatrists in addressing geopolitical challenges and promoting social justice. Topics discussed include the importance of mental health within the SDG framework, the impact of geopolitical uncertainties on mental health advancements, and the potential of geopsychiatry in guiding interventions and policies.

We have evaluated the final-year Psychiatry and Addiction Medicine (PAM) summative Objective Structured Clinical Examination (OSCE) examinations in a four-year graduate medical degree program, for the previous three years as a baseline comparator, and during three years of the COVID-19 pandemic (2020–2022). A de-identified analysis of medical student summative OSCE examination performance, and comparative review for the 3 years before, and for each year of the pandemic. Internal reliability in test scores as measured by R-squared remained the same or increased following the start of the pandemic. There was a significant increase in mean test scores after the start of the pandemic compared to pre-pandemic for combined OSCE scores for all final-year disciplines, as well as for the PAM role-play OSCEs, but not for the PAM mental state examination OSCEs. Changing to online OSCEs during the pandemic was related to an increase in scores for some but not all domains of the tests. This is in line with a nascent body of literature on medical teaching and examination following the start of the pandemic. Further research is needed to optimise teaching and examination in a post-pandemic medical school environment. [ABSTRACT FROM AUTHOR]

Clinical trials of pharmacological candidates targeting the core features of autism have largely failed. This is despite evidence linking differences in multiple neurochemical systems to brain function in autism. While this has in part been explained by the heterogeneity of the autistic population, the field has largely relied upon association studies to link brain chemistry to function. The only way to directly establish that a neurotransmitter or neuromodulator is involved in a candidate brain function is to change it and observe a shift in that function. This experimental approach dominates preclinical neuroscience, but not human studies. There is little direct experimental evidence describing how neurochemical systems modulate information processing in the living human brain. Thus, our understanding of how neurochemical differences contribute to neurodiversity is limited, impeding our ability to translate findings from animal studies into humans. Here, we introduce our 'shiftability' paradigm, an approach to bridge the translational gap in autism research. We provide an overview of the guiding principles and methodologies we use to directly test the hypothesis that neurochemical systems function differently in autistic and non‐autistic individuals. [ABSTRACT FROM AUTHOR]

Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a "medical model," may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice. [ABSTRACT FROM AUTHOR]

The late Habsburg period (1867–1918) created a constitutional dual monarchy of Austria-Hungary. This paper discusses the role of psychiatry in Cisleithania, both as a developing profession and as a distinct 'policy field'. Tension between psychiatry's academic professionalisation and the creation of public institutions as signature projects by individual crownlands created complex relationships between psychiatry and politics. In federalist Cisleithania, psychiatrists became very 'political': whether employed by the state or a crownland influenced their position on policy, despite claiming that their expert knowledge was 'scientific' and 'objective'. The conflicts between asylum-based and academic psychiatrists mirrored those between the central state and the crownlands. This led to intractable delays in mental health law reform, eventually resolved by Imperial decree in 1916. [ABSTRACT FROM AUTHOR]

Charles Lloyd Tuckey (1854–1925) was one of the leaders of the British 'New Hypnotism' movement of the late nineteenth century. This neglected figure is important because of his contributions to the early psychotherapies in Britain, ushering in the concept of suggestion to British medicine from Europe. Through his networks and clubs, Tuckey demonstrates the bewildering range of institutions that shaped and spread the novel theory of suggestion and the nascent talking therapies at this time. His affiliations to psychic investigation and ceremonial magic societies demonstrate his intellectual curiosity rather than backwards primitivism. Tuckey played an important role in establishing the term 'psychotherapeutics' and legitimising medical hypnotism, a precursor of the psychological therapies of the early twentieth century. [ABSTRACT FROM AUTHOR]

Summary: Previous research has revealed that stigma is not restricted to people with mental health problems but extends to the professionals involved in their care and treatment. Unlike other artistic manifestations, the study of the depictions of psychiatry in popular music is still a less-explored topic. This article addresses the subcultural portrayals of the psychiatrist and psychiatric treatments within Spanish popular music. The predominance of negative depictions of mental health professionals as social control agents was a striking finding, given the topicality that characterises punk music. It is suggested that the allegorical role assigned to the psychiatrist in such a specific narrative framework, marked by ideological factors, could potentially explain these findings. In contrast to other cultural manifestations that show a tendency towards more balanced views of psychiatric treatment and practice, the negative representations in Spanish punk songs seem to have evolved little over decades, reflecting outdated views of the psychiatric approach. [ABSTRACT FROM AUTHOR]

Aims and method: There are numerous challenges in the recruitment and retention of the medical workforce in psychiatry. This mixed-methods study examined the role of psychiatry clinical attachments for international medical graduates (IMGs) to enhance recruitment and retention. An online survey was launched to capture views and perceptions of IMGs about clinical attachments. The quantitative and qualitative responses were analysed to elicit findings. Results: In total, 92 responses were received, with respondents commonly from India, Pakistan and Egypt. Respondents were mostly aged 25–34, with ≥3 years of psychiatry experience. Over 80% expressed strong interest in completing a psychiatry clinical attachment and believed it would support career progression. Qualitative data indicated that IMGs hoped to gain clinical experience and understanding of the National Health Service (NHS). They wished for a clearer, simpler process for clinical attachments. Clinical implications: Clinical attachment can be mutually beneficial, providing IMGs with opportunity to confidently start their psychiatry career in the UK and enhance medical recruitment in mental health services across the NHS. [ABSTRACT FROM AUTHOR]

This article explores the development of psychiatric interest in the Ainu people of Hokkaidō Island within the socio-political context of Japan's colonial expansion and the eugenics movement from the late nineteenth century to the end of the Second World War. Japanese researchers reinterpreted data on the Ainu – particularly as this related to racial categorization and blood-mixing – in reaction to the passing of the 1940 National Eugenics Law and the Japanese Empire's geographic expansion. Their studies negated colonial reality and attributed psychiatric degeneracy to a racialized Ainu constitution, building off and reinforcing preexisting anticipated futures for Ainu people. The article ends by raising questions about the impact of eugenics ideology, its practices, and related laws on minoritized groups in the post-war period. [ABSTRACT FROM AUTHOR]

Background: The experiences of pager use among trainees across medical specialties is underexplored. The aim of this study was to assess experiences of pager burden and communication preferences among trainees in different specialties. Methods: An online survey was developed to assess perceived pager burden (eg, pager volume, mistake pages, sleep, and off-time interruptions) and communication preferences at a tertiary center in the United States. All residents and fellows were eligible to participate. Responses were grouped by specialty: General surgery [GS], Surgical subspecialty [SS], Medicine, Anesthesiology, and Psychiatry. Multivariable linear regression was used to assess factors associated with pager burden. Free text responses were analyzed using open coding methods. Results: Of the total 306 responses, the majority were female (58.8%), 30-39 years (59.2%), and White (70.6%). Specialty breakdown was: Medicine (40.2%), Psychiatry (10.8%), SS (18.0%), GS (5.6%), and Anesthesiology (3.6%). GS respondents reported receiving more mistake pages (P <.001), spending more time redirecting mistake pages (P =.003), and having the highest sleep time disruptions (P <.001). For urgent communications, surgical trainees preferred physical pagers, while nonsurgical trainees preferred smartphone pagers (P =.001). "Receive fewer nonurgent pages" was the most common change respondents desired. Discussion: In this single center study, subjective experiences of pager burden were disproportionately high among GS trainees. Reducing nonurgent and mistake pages are potential targets for improving trainee communication experiences. Hospitals should consider incorporating trainee preferences into paging systems. Additional studies are warranted to increase the sample size, assess generalizability of the findings, and contextualize trainee experiences with objective hospital-level paging data. [ABSTRACT FROM AUTHOR]

Abstract: This practice-oriented paper extends the utility of the perspectives of psychiatry model originally developed at Johns Hopkins University to clinical neuropsychology, focusing particularly on its relevance for post-COVID condition (PCC). By integrating the model's four key perspectives – disease, dimension, behavior, and life story – it offers a nuanced and comprehensive understanding of the neuropsychological and somatic symptoms associated with PCC. Our arguments are substantiated by empirical evidence and clinical case studies that demonstrate the model's applicability in crafting targeted therapeutic strategies based on a multidimensional case conceptualization. Overall, the perspectives of psychiatry model emerges as a valuable framework for clinical neuropsychologists, enriching both diagnostic and treatment approaches for complex conditions such as PCC. [ABSTRACT FROM AUTHOR]

The clinician who adopts a psychoanalytic approach in a psychiatric context often regards the encounter between two individuals as an interplay of subjectivities, whose mode of being-in-the-world is shaped by their unique historical experiences. Despite some psychoanalytic authors exploring the concept of "contact", it has often been reduced to its similarity with transference and countertransference, with little attention given to its distinctive qualities. This limits psychoanalysis in its ability to conceptualize an unmediated, preverbal encounter between two individuals. In this article, we argue that the dimension of "contact" cannot be equated with transference, and that it constitutes a vital tool for diagnosing and guiding therapy for various clinical conditions commonly encountered in psychiatry. This article is based on theoretical considerations. We first worked on the history of the concept of contact, then of Praecox Gefühl in the works of H.C. Rümke, to which we added the findings of current studies on the relevance of Praecox Gefühl in the diagnosis of schizophrenia and the study of the works of the great phenomenological psychiatrists. In so doing, we aimed to show that contact could be a tool of great use for psychiatric diagnosis, insofar that it allows for a typification of the forms of existence of different patients. H.C. Rümke's investigation of the concept of Praecox Gefühl highlights the unique mode of contact observed in schizophrenia. It is distinct from the feeling of strangeness and involves an intuitive observation of a perceived distance within the clinical relationship. Given that many psychiatric pathologies can cause patients to withdraw from the shared world, we suggest that the notion of Praecox Gefühl , beyond its original designation of the clinician's experience of schizophrenic dissociation and the particularities of the schizophrenic mode of being-in-the-world, may be applicable to other pathologies studied in psychiatric phenomenology. We propose four main forms of contact: the loss of vitality in schizophrenia, the untraceable authenticity of the hysteric, the impossible fluidity in the melancholic, and the failure of anchorage in mania. By approaching contact as a fractal form that reveals the entire mode of the subject's being-in-the-world, this typifying approach goes beyond a purely semiological or etiological reflection and can be diagnostically useful in guiding therapeutic efforts to enhance the subject's capacity to truly engage with others. Our paper focuses on the relationship between contact and what clinicians commonly refer to as an "encounter." It is important to recognize that contact is not always equivalent to an encounter, and that assuming otherwise risks overlooking the possibility that certain relational modalities could actively prevent such an encounter from taking place. These "anti-contact" modalities, exemplified by the Praecox Gefühl , necessitate a focus on the very possibility of being in a therapeutic relationship with the clinician. Therefore, we suggest that clinicians should work to establish the possibility of being in a relation with the patient, prior to attempting to create an encounter. This approach allows for a more nuanced understanding of the ways in which patients can either facilitate or hinder the development of an encounter, and highlights the importance of working on establishing the possibility of a real encounter and being-with the clinician. This paper has sought to challenge the prevailing assumption among psychoanalytically oriented clinicians that contact is merely a sub-dimension of the transferential dynamic. Instead, we have argued that contact warrants specific attention as a tool for both diagnosis and therapy in psychiatry. By examining the example of the Praecox Gefülh , we have proposed a typifying approach that could be applied to the most common clinical entities encountered in psychiatry, based on the clinician's perception of specific modalities of contact within the therapeutic consultation. This reflection on contact and anti-contact is a necessary and contemporary contribution to the psychiatric field, which is increasingly embracing a dimensional approach to psychological pathologies. By prioritizing the dimension of contact, we can deepen our understanding of the nuances of the therapeutic relationship and can enhance our ability to help patients overcome barriers to connection and encounter. [ABSTRACT FROM AUTHOR]

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is recommended to optimize well-functioning in people with schizophrenia. PA has been found to improve quality of life, general symptomatology, depression, anxiety and stress symptoms, global and social functioning. In PA research, most of the interventions are based on one-on-one interventions but there is poor information about group-based PA interventions. Using a randomized controlled, clinician-blinded trial, subjects are randomized into two arms: the PA group or control group. Our first objective is about to evaluate the effects of a multimodal 6 week collective PA intervention on depression, anxiety, and stress symptoms in people with schizophrenia. Our second objective is about to evaluate these effects on secondary outcomes especially smoking, well-being, physical fitness and on care utilization. All participants are evaluated before and after the 6 week intervention period, and only participants in the PA group are called in a follow-up interview 3 and 6 months after the intervention. Trial registration Individual Protection Committee of Ile-de-France II, n ID RCB: 2018- A00583-52. Registered on 8 April 2018. [ABSTRACT FROM AUTHOR]

Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation method that, through its manipulation of endogenous oscillations, can affect cognition in healthy adults. Given the fact that both endogenous oscillations and cognition are impaired in various psychiatric diagnoses, tACS might represent a suitable intervention. We conducted a search of Pubmed and Web of Science databases and reviewed 27 studies where tACS is used in psychiatric diagnoses and cognition change is evaluated. TACS is a safe and well-tolerated intervention method, suitable for multiple-sessions protocols. It can be administered at home, individualized according to the patient''s anatomical and functional characteristics, or used as a marker of disease progression. The results are varying across diagnoses and applied protocols, with some protocols showing a long-term effect. However, the overall number of studies is small with a great variety of diagnoses and tACS parameters, such as electrode montage or used frequency. Precise mechanisms of tACS interaction with pathophysiological processes are only partially described and need further research. Currently, tACS seems to be a feasible method to alleviate cognitive impairment in psychiatric patients; however, a more robust confirmation of efficacy of potential protocols is needed to introduce it into clinical practise. [ABSTRACT FROM AUTHOR]

Objective: This article explores the transformative impact of OpenAI and ChatGPT on Australian medical practitioners, particularly psychiatrists in the private practice setting. It delves into the extensive benefits and limitations associated with integrating ChatGPT into medical practice, summarising current policies and scrutinising medicolegal implications. Conclusion: A careful assessment is imperative to determine whether the benefits of AI integration outweigh the associated risks. Practitioners are urged to review AI-generated content to ensure its accuracy, recognising that liability likely resides with them rather than with AI platforms, despite the lack of case law specific to negligence and AI in the Australian context at present. It is important to employ measures that ensure patient confidentiality is not breached and practitioners are encouraged to seek counsel from their professional indemnity insurer. There is considerable potential for future development of specialised AI software tailored specifically for the medical profession, making the use of AI more suitable for the medical field in the Australian legal landscape. Moving forward, it is essential to embrace technology and actively address its challenges rather than dismissing AI integration into medical practice. It is becoming increasingly essential that both the psychiatric community, medical community at large and policy makers develop comprehensive guidelines to fill existing policy gaps and adapt to the evolving landscape of AI technologies in healthcare. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to provide an introductory resource for beginner peer reviewers in psychiatry and the broader biomedical science field. It will provide a concise overview of the peer review process, alongside some reviewing tips and tricks. Conclusion: The peer review process is a fundamental aspect of biomedical science publishing. The model of peer review offered varies between journals and usually relies on a pool of volunteers with differing levels of expertise and scope. The aim of peer review is to collaboratively leverage reviewers' collective knowledge with the objective of increasing the quality and merit of published works. The limitations, methodology and need for transparency in the peer review process are often poorly understood. Although imperfect, the peer review process provides some degree of scientific rigour by emphasising the need for an ethical, comprehensive and systematic approach to reviewing articles. Contributions from junior reviewers can add significant value to manuscripts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Telehealth utilization exploded during the COVID‐19 pandemic, including within school‐based health programs. School‐based tele‐behavioral health can help programs overcome barriers of access to care, but the current state and effectiveness of such programs are unknown. METHODS: A scoping literature review was conducted. Studies were included if they described in‐school behavioral health services delivered via telehealth for children ages 5 to 18. From the included studies, population, location, setting, intervention, telehealth modality, clinician type, and outcomes assessed were extracted. FINDINGS: Eighteen studies met inclusion criteria. All described psychotherapy or medication management delivered by psychologists (n = 7) and/or psychiatrists (n = 11). Treatment included psychotherapy (N = 8), psychiatric consultation (N = 7), medication management (N = 4), crisis stabilization (N = 1), and caregiver education (N = 1). Eight studies provide qualitative or quantitative outcomes, with 4 examining clinical effectiveness. CONCLUSIONS: Despite limited findings in the literature, school‐based tele‐behavioral health is feasible, effective, and acceptable for delivery of behavioral health care to children and adolescents. [ABSTRACT FROM AUTHOR]

Advanced practice nurses constitute a new professional group within the French health care system. Advanced practice nurses specialise in one of five disciplines including Psychiatry/Mental‐Health. This specific discipline is strongly marked by stigmatising representations by healthcare users and other health professionals (including other advanced practice nurses), whose consequences have a deleterious effect. The aim was to highlight all advanced practice nurses representation of Psychiatry/Mental‐Health advanced practice nurses. An observational descriptive survey, based on an anonymous online questionnaire was conducted in April 2022 among qualified and student advanced practice nurses from the five specialist disciplines. Overall, 356 advanced practice nurses completed the survey questionnaire. No significant difference in stigmatising representations of Psychiatry/Mental‐Health advanced practice nurses versus other advanced practice nurses was observed. Only 3.3% of other advanced practice nurses thought that Psychiatry/Mental‐Health advanced practice nurses are often 'strange'. Psychiatry/Mental‐Health advanced practice nurses and other advanced practice nurses appeared to have similar representations of the professional roles of advanced practice nurses in general and of advanced practice nurses APN specifically. Unlike other professionals in the psychiatric field (e.g. medical interns, nurses), very little stigmatisation of Psychiatry/Mental‐Health advanced practice nurses by their colleagues (i.e. other advanced practice nurses) was observed. This could be partly due to the fact that advanced practice nurses professional identity appeared to be built collectively around the concept of advanced practice. Advanced practice nurses constitute a professional group that is fully involved in contemporary transformations in care and organisational innovation. The very low level of stigmatisation of Psychiatry/Mental‐Health advanced practice nurses by other advanced practice nurses in our study suggests that these new healthcare actors could play a crucial role in the improvement of professional health practices, particularly in terms of improved coordination between psychiatric‐care and physical‐care. [ABSTRACT FROM AUTHOR]

Mechanical restraint is a commonly used restrictive practice worldwide, although reducing its use is an international priority. Interventions to reduce mechanical restraint are needed if reducing mechanical restraint is to succeed. Therefore, this systematic review aimed to examine evaluated evidence‐based interventions that seek to reduce the incidence of and/or time in mechanical restraint in adult mental health inpatient settings. The JBI framework was used to guide this systematic review. The search strategy included peer‐reviewed primary research literature published between 1999 and 2023. Two authors independently conducted the systematic search, selection process and data extraction process. Forty‐one studies were included in this review. Using content analysis, we grouped interventions into four categories: (I) calm‐down methods, (II) staff resources, (III) legal and policy changes and (IV) changing staff culture. Interventions to reduce mechanical restraint in adult mental health inpatient settings have shown some promise. Evidence suggests that a range of interventions can reduce the incidence of and/or time in mechanical restraint. However, controlled trials were lacking and consensus was lacking across studies. Furthermore, specific findings varied widely, and reporting was inconsistent, hampering the development of interventions for this issue. Further research is needed to strengthen the evidence base for reducing mechanical restraint in mental health inpatient settings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their careerNorway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals What the paper adds to existing knowledge: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translationWe have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool. What are the implications for nurses: Applying the 'Global Trigger Tool—Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers.Implementing 'Global Trigger Tool—Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden. Introduction: There is little consensus on cross‐cultural and cross‐national adaptation of research instruments. Aim/Question: To translate and validate a Swedish research tool (GTT‐P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process. Method: The GTT‐P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross‐cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records. Results: We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co‐production was essential for both the translation and adaptation of the research instrument. Discussion: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT‐P in hospital‐based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses. Implications for practice: When translating and validating the GTT‐P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT‐P can promote greater patient safety in hospital settings. [ABSTRACT FROM AUTHOR]

AbstractThe work methods of eminent psychiatrist Emil Kraepelin (1856–1926) and of literary and cultural critic Walter Benjamin (1892–1940) are described based on the literature describing their ways of working. Kraepelin’s approach of cross-sectional observation of symptoms and the longitudinal study of illness course in distinguishing ‘disease entities’ as well as his research strategy of investigating causes and correlates using methods of experimental psychology, pathology and neurobiology are described. Critical statements (on Kraepelin’s work) highlighting preconceived concepts, ideological positions and a lack of critical reflection are reported. Walter Benjamin’s use of citation and ‘collage’ in literary and cultural criticism, his use of the concepts of allegory, ‘figures of thought’ and ‘dialectical images’ is described. His theory of the past impacting on our understanding of present and immediate future is discussed. Benjamin’s thinking is centered around the concept of ‘experience’. The relevance of both scientists to current challenges is discussed referring to current psychiatric research and peer support, a key concept in discussions on mental health care. The paper argues that Kraepelin and Benjamin could be considered complementary in their approaches to mental health matters taking into account wider cultural contexts. (189 words) [ABSTRACT FROM AUTHOR]

Background: Bipolar disorder (BD) is a severe psychiatric disorder characterized by changes in mood that alternate between (hypo) mania or depression and mixed states, often associated with functional impairment and cognitive dysfunction. But little is known about biomarkers that contribute to the development and sustainment of cognitive deficits. The aim of this study was to review the association between neurocognition and biomarkers across different mood states. Method: Search databases were Web of Science, Scopus and PubMed. A systematic review was carried out following the PRISMA guidelines. Risk of bias was assessed with the Newcastle–Ottawa Scale. Studies were selected that focused on the correlation between neuroimaging, physiological, genetic or peripheral biomarkers and cognition in at least two phases of BD: depression, (hypo)mania, euthymia or mixed. PROSPERO Registration No.: CRD42023410782. Results: A total of 1824 references were screened, identifying 1023 published articles, of which 336 were considered eligible. Only 16 provided information on the association between biomarkers and cognition in the different affective states of BD. The included studies found: (i) Differences in levels of total cholesterol and C reactive protein depending on mood state; (ii) There is no association found between cognition and peripheral biomarkers; (iii) Neuroimaging biomarkers highlighted hypoactivation of frontal areas as distinctive of acute state of BD; (iv) A deactivation failure has been reported in the ventromedial prefrontal cortex (vmPFC), potentially serving as a trait marker of BD. Conclusion: Only a few recent articles have investigated biomarker-cognition associations in BD mood phases. Our findings underline that there appear to be central regions involved in BD that are observed in all mood states. However, there appear to be underlying mechanisms of cognitive dysfunction that may vary across different mood states in BD. This review highlights the importance of standardizing the data and the assessment of cognition, as well as the need for biomarkers to help prevent acute symptomatic phases of the disease, and the associated functional and cognitive impairment. [ABSTRACT FROM AUTHOR]

AbstractThis review aimed to systematically identify and appraise available evidence on the effectiveness of clinical psychiatric posting on the attitudes of health science students toward mental illness and psychiatry. The data were sourced from Scopus, ScienceDirect and PubMed. The references of the included studies were searched using Google Scholar. The search was done across the above databases from 20th October to 21st December, 2023. This review followed the preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) outline. The quality of the articles was assessed using critical appraisal tool for Cross-Sectional Studies. The review showed mixed results. Clinical psychiatric posting is effective in attitudinal changes toward mental illness and psychiatry when the duration is six weeks or longer (p < 0.001). When the posting followed teachings in psychiatry and anti-stigma orientation, it had more significant impacts on the attitudes (p < 0.001). This review highlights the importance of the duration of clinical psychiatric posting, teaching in psychiatry and anti-stigma orientation in improving the effectiveness of the training modality. Longer duration of postings (six weeks or more) that followed teachings in psychiatry and anti-stigma orientation has been shown to be more effective. This calls for curricular reform and policy formation. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Measurements Findings Conclusions High‐potency cannabis has been associated with increased risk of psychosis, but a lack of prospective data hinders understanding of causality in this relationship. This study aimed to combine prospective report of cannabis use with retrospective report of potency to infer the potency of cannabis used in adolescence and explore whether use of cannabis, and the use of high‐potency cannabis, in adolescence is associated with incident psychotic experiences.Population‐based birth cohort study.United Kingdom.n = 5570 participants who reported on any cannabis use (yes/no) age 16 and 18 years, and n = 1560 participants from this group who also retrospectively reported on cannabis potency.In questionnaires at ages 16 and 18, individuals self‐reported lifetime cannabis use, and at age 24, participants reported the type of cannabis they most commonly used in the whole time since first using cannabis. Psychotic experiences were assessed at age 24 years using the semi‐structured Psychosis‐Like Symptom Interview, with incident defined as new‐onset occurring between ages 19 and 24 years.Use of high‐potency cannabis at age 16 or 18 was associated with twice the likelihood of experiencing incident psychotic experiences from age 19–24 (Odds Ratio 2.15, 95% Confidence Intervals 1.13–4.06). There was less evidence for an effect of any cannabis use on incident psychotic experiences (Odds Ratio 1.45, 95% Confidence Intervals 0.94–2.12).Use of high‐potency cannabis appears to be associated with increased likelihood of psychotic experiences. [ABSTRACT FROM AUTHOR]

Patient educator programmes have become a fundamental part of medical student education, delivering rich and transformative learning. However, little is known about the barriers and facilitators to implementing patient educator programmes for medical students in psychiatry and specifically forensic psychiatry. A systematic search of three databases with no date parameters was undertaken in November 2022, using keywords related to medical education, coproduction, patient involvement, and psychiatry. Five papers on patient educator programmes in psychiatry were located. No literature related to patient educator programmes in forensic psychiatry was identified. Facilitators include a robust policy infrastructure and transparent arrangements for safe educational practices alongside a commitment to coproduction and relational working. Barriers include epistemic injustice, the skills of professional facilitators, and a lack of supporting educational theory. There appears to be scope to deliver high-quality medical student education in forensic psychiatry through patient educator programmes with reciprocal benefits for educators such as rehabilitation, skills development, and possibly therapeutic benefits. The educational and therapeutic value of patient as educator programmes in forensic psychiatry are under-researched. Patient as educator programmes in forensic psychiatry require careful consideration regarding risk, while patients’ prior involvement with the criminal justice system may increase stigma and discrimination. The complexity and risks have seldom been considered. It appears a priority to address the knowledge gap identified by this review. [ABSTRACT FROM AUTHOR]

Moral aspects are closely related to psychiatric assessment. Personality disorders, especially, form a morally loaded category, as the diagnostic process involves questioning behaviors that go against social norms. Consequently, being interviewed about these matters may be face‐threatening for the patients. However, the study of the role of morality in psychiatric face‐to‐face interactions has been scarce. This paper explores how the patients and nurses orient themselves to moral matters during personality disorder interviews in two Finnish psychiatric outpatient clinics. This article uses Erving Goffman's frame theory to differentiate how different orientations come into play during the interviews. Conversation analysis forms the methodological basis for the work. In personality disorder interviews, it is possible to observe information‐gathering, moral, and everyday interaction frames. The nurses have different approaches in receiving the patients' moral considerations. They may maintain a rather neutral approach, but there are also cases of both challenging tones and more supportive and affiliating responses. Making visible how moral themes are discussed in real life enables a nuanced evaluation of psychiatric practices. [ABSTRACT FROM AUTHOR]

While First Nations Peoples in Australia experience high rates of criminal justice contact, there is limited research on their experiences of the forensic mental health system. This study aims to develop new understandings of how First Nations Peoples experience and understand the forensic mental health system in NSW. Interviews were conducted with ten First Nations Peoples in contact with the forensic mental health system, including forensic patients and their family members. Participants described challenging life experiences prior to their contact with the forensic mental health system, with community services often failing to respond to their mental health needs. While participants reported some positive experiences with the forensic mental health system, they ultimately described an urgent need for culturally appropriate programs that facilitate connections to family and Community. Forensic mental health services should be co-designed alongside First Nations Peoples and communities to improve outcomes and avoid re-traumatisation through contact with services. [ABSTRACT FROM AUTHOR]

Introduction: Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes. Methods: A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population. Results: There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient's diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment. Conclusion: Individualized care can help provide effective, tailored treatments based on an individual's clinical characteristics, disease trajectory, family and social environment, and goals and preferences. [ABSTRACT FROM AUTHOR]

The article explores the concept of staging in psychiatry, which involves categorizing different phases of mental disorders and predicting their progression. The authors developed staging systems for various disorders and found that residual symptoms were indicative of relapse. Staging can be used to assess treatment response and potentially prevent the progression of mental illness. The article also discusses the importance of achieving a balanced mood and the potential benefits of psychotherapy. The author highlights the need for a comprehensive staging framework in psychotraumatology and identifies limitations in current approaches to treatment-resistant depression. A more thorough clinical evaluation and consideration of psychosocial factors are recommended for treatment evaluation and planning. [Extracted from the article]

Introduction Lifetime and past-year alcohol use disorder (AUD) prevalence is significantly higher in US Armed Services Veterans than in non-veterans across adulthood. This study examined the associations of perceived transformational leadership styles (TLS) experienced during military service and anhedonic depression and self-efficacy related to confidence to abstain or reduce alcohol consumption in Veterans seeking treatment for AUD. The ramifications of perceived leadership styles on multiple aspects of follower psychiatric functioning, including depressive and PTSD symptomatology, during and after military service, may be substantial and enduring. Higher anhedonic depression and lower abstinence self-efficacy are related to increased risk of relapse after treatment. We predicted Veterans, in treatment for AUD, who reported higher perceived levels of transformational leadership during military service, demonstrate lower anhedonic depressive symptoms and higher alcohol abstinence self-efficacy. Materials and Methods Veterans with AUD (n  = 60; 50 ± 14 years of age) were recruited from residential treatment at the VA Palo Alto Health Care System. All procedures were approved by the VA Palo Alto Health Care System and Stanford University institutional review boards. A series of mediation analyses were completed with The Multifactor Leadership Questionnaire measures of TLS (average across leadership measures [transformational leadership average; TLS average]) as predictor and the Alcohol Abstinence Self-Efficacy Scale, Mood and Anxiety Symptom Questionnaire, anhedonic depression subscale, as dependent measures. PTSD Checklist for DSM-5 score was tested as a mediator variable. Results Higher reported perceived TLS average during military service was significantly related to lower anhedonic depressive symptoms. Higher TLS average was related to higher self-efficacy to resist alcohol use in contexts involving experience of physical issues and withdrawal/cravings and urges. These relationships were not mediated by PTSD symptomatology or duration of military service, age, education, time since military service, military branch, combat exposure, or current psychiatric diagnosis. Conclusions The significant associations of perceived TLS during military service with anhedonic depression and alcohol use self-efficacy are clinically relevant because these measures are associated with relapse risk after AUD treatment. Further study of the implications of perceived TLS during military service for AUD and other substance use disorder treatment outcome is warranted in Veterans. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence for the therapeutic effects of the psychedelic drug psilocybin for major depression. However, due to the lack of safety data on combining psilocybin with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and concerns that there may be a negative interaction on efficacy, participants enrolling in psychedelic trials are usually required to discontinue SNRI/SNRIs prior to enrolling. Aims: Using data from a recent clinical trial examining the comparative efficacy the psychedelic drug psilocybin (P) combined with approximately 20 h of psychological support to a 6-week (daily) course of the SSRI escitalopram plus matched psychological support for major depressive disorder, we explored the effects of discontinuing SSRI/SNRIs prior to study enrolment on study outcomes. Methods: Exploratory post hoc analyses using linear mixed effects model were performed to investigate the discontinuation effect on various validated depression symptom severity scales and well-being. The impact of SSRI/SNRIs discontinuation on the acute psychedelic experience was also explored. Results/outcomes: In the psilocybin group, there was a reduced treatment effect on all outcome measures for SSRI/SNRIs discontinuers compared with unmedicated patients at trial entry. However, no effects of discontinuation on measures of the acute psychedelic experience were found. Conclusion: Discontinuation of SSRI/SNRIs before psilocybin might diminish response to treatment; however, as we did not test SSRI/SNRI continuation in our trial, we cannot infer such causation. Moreover, the exploratory nature of the analyses makes them hypothesis generating, and not confirmatory. A controlled trial of SSRI/SNRI discontinuation versus continuation prior to psilocybin is urgently required. [ABSTRACT FROM AUTHOR]

This paper describes the implementation of curricula for Liberia's first-ever psychiatry training programme in 2019 and the actions of the only two Liberian psychiatrists in the country at the time in developing and executing a first-year postgraduate psychiatry training programme (i.e. residency) with support from international collaborators. It explores cultural differences in training models among collaborators and strategies to synergise them best. It highlights the assessment of trainees' (residents') basic knowledge on entry into the programme and how it guided immediate and short-term priority teaching objectives, including integrated training in neuroscience and neurology. The paper describes the strengths and challenges of this approach as well as opportunities for continued growth. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. Methods: A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Results: Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40 mg diazepam equivalents) to post (14.61 mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. Conclusion: It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders. [ABSTRACT FROM AUTHOR]

To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use. Participants were asked to rate and rank the interventions based on their viewpoints regarding the relevance and importance of each intervention. A total of 128 mental health staff members from general and forensic mental health inpatient units across the Mental Health Services in the Region of Southern Denmark completed the questionnaire (response rate = 21.3%). A total of 90.8% of the ratings scored either 'agree' (45.2%) or 'strongly agree' (45.6%) concerning the relevance of the interventions in reducing MR use. Overall and in the divided analysis, interventions labelled as 'building relationship' and 'patient-related knowledge' claimed high scores in the staff's rankings of the interventions' importance concerning implementation. Conversely, interventions like 'carers' and 'standardised assessments' received low scores. The staff generally considered that the interventions were relevant. Importance rankings were consistent across the divisions chosen, with a range of variance and dispersion being recorded among certain groups. [ABSTRACT FROM AUTHOR]

Arthur Schopenhauer (1788–1860) was one of the most important thinkers of the 19th century. Although his writings have exerted great influence in many different disciplines, his epistemological concepts and analysis of the body and self-experience were rarely considered in the context of psychiatric research of schizophrenia spectrum disorders (SSD) and depression (MDD). The method applied for the study of anomalous self and body-experience first consists in the close reading and analysis of Schopenhauer's most influential writings, namely his opus magnus "The World as Will and Representation" and his dissertation "On the Fourfold Root of the Principle of Sufficient Reason". Second, psychopathological and phenomenological aspects of the anomalous body and self, as well as altered space and time experience, are discussed by means of Schopenhauer's philosophy and four patient cases. Schopenhauer's insights contribute to contemporary psychiatry by (1) unifying materialistic (neurobiological) and idealistic (subjective) conceptions of psychiatric disorders and improving the awareness of methods in psychiatric research; (2) emphasizing the integral significance of the body as a gateway to the surrounding world and basal self-experience; (3) delineating subjective space and time -experience as crucial dimensions of the conditio humana in SSD and MDD; and (4) demonstrating the feasibility of transferring his theories directly to clinical case vignettes stemming from the daily clinical routine. Close reading of Schopenhauer's texts might help bridge the gap between different scientific methods in psychiatry and overcome the translational crisis of contemporary psychiatry by unifying neurobiological and subjective approaches to SSD and MDD. [ABSTRACT FROM AUTHOR]

Psychiatric treatment of psychosis often comprises therapeutic and psychotropic combinations. Dramatherapy is often utilised in health services with this population, particularly when clients struggle to engage with talking therapies because of complex presentations, experience preverbal trauma, neurodiversity challenges and/or communication difficulties. Dramatherapy as a therapeutic intervention is recognised by health regulating bodies but as yet has not yet been systematically reviewed. To synthesise existing peer-reviewed empirical research literature and gather evidence regarding dramatherapy used to support adults with psychosis; To collate and understand the intervention methods of dramatherapy as a treatment to support adults experiencing psychosis; To assess the effect of dramatherapy on adults with psychosis, by collating qualitative and quantitative outcome measures, where reported in included research. Literature was sourced through database searches (CINAHL, EMBASE, COCHRANE, PsycINFO, PubMed, Scopus, and APA PsycNet) and hand searches. 8541 papers were screened, and 11 met inclusion criteria for synthesis. Findings related to aims were narratively synthesised, before being thematically analysed. Participant characteristics of age, gender, ethnicity, and socio-economic background were heterogeneous. Participants across studies often had multiple diagnoses, and unknown complexities making recovery through standard treatment unachievable. Presentations included episodes of psychosis, schizophrenia, and dual-diagnoses of mental health challenges and intellectual difficulties. Positive effects found the use of dramatherapy include: New perspectives; Improved relationships; Ability to make choices with reduced anxiety; Understanding of self; Reduced psychotic symptoms. Quantitative data substantiated qualitative findings, and effect indicated changes in social functioning, behaviours, and symptoms following dramatherapy intervention. Systematic findings will support practitioners to implement evidence-based practice and to improve treatment provision for adults with psychosis. Further methodologically sound research into the field is encouraged to advance understanding of dramatherapy interventions for adults with psychosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Lindane induces severe side effects, including fatality, while Cetrimide causes esophageal damage. With no antidotes available, our patient ingested both, requiring prompt gastric lavage and comprehensive treatment. [ABSTRACT FROM AUTHOR]