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Academic Psychiatry : the Journal of... Oct 2023
Topics: Humans; Palliative Care; Psychiatry
PubMed: 36447070
DOI: 10.1007/s40596-022-01733-x -
Psychological Medicine Jun 2024Precision psychiatry is an emerging field that aims to provide individualized approaches to mental health care. An important strategy to achieve this precision is to... (Review)
Review
Precision psychiatry is an emerging field that aims to provide individualized approaches to mental health care. An important strategy to achieve this precision is to reduce uncertainty about prognosis and treatment response. Multivariate analysis and machine learning are used to create outcome prediction models based on clinical data such as demographics, symptom assessments, genetic information, and brain imaging. While much emphasis has been placed on technical innovation, the complex and varied nature of mental health presents significant challenges to the successful implementation of these models. From this perspective, I review ten challenges in the field of precision psychiatry, including the need for studies on real-world populations and realistic clinical outcome definitions, and consideration of treatment-related factors such as placebo effects and non-adherence to prescriptions. Fairness, prospective validation in comparison to current practice and implementation studies of prediction models are other key issues that are currently understudied. A shift is proposed from retrospective studies based on linear and static concepts of disease towards prospective research that considers the importance of contextual factors and the dynamic and complex nature of mental health.
Topics: Humans; Precision Medicine; Psychiatry; Mental Disorders; Machine Learning; Prognosis
PubMed: 38497091
DOI: 10.1017/S0033291724000370 -
Psychodynamic Psychiatry Dec 2023Indonesia, a country with a vast population of approximately 275 million people on over 17,000 islands, currently has 1,221 psychiatrists nationwide. Psychodynamic...
Indonesia, a country with a vast population of approximately 275 million people on over 17,000 islands, currently has 1,221 psychiatrists nationwide. Psychodynamic psychiatry and psychoanalysis are integral to the practice of psychiatry in Indonesia, primarily because of the charismatic influence of Bachtiar Lubis, who trained in Canada in the early 1960s. Upon his return to Indonesia, Bachtiar Lubis supervised a generation of psychiatrists, including two of this article's authors, who carried on his pedagogical work. The psychodynamic model and treatments have faced obstacles limiting their acceptance in Indonesia, including importing a Western model that has not been culturally adapted to treat patients in the East, the stigma of mental illness in local communities, and the complex comorbidities of persons who seek psychiatric care. Psychodynamic psychotherapy in Indonesia is presently taught in university-based residency programs for eight semesters. A psychodynamic psychotherapy competency-based curriculum was adopted nationwide. The dissemination of psychotherapy knowledge and skills is greatly assisted by an active psychiatric professional association-the Indonesian Psychiatric Association Psychotherapy Section, a member society of the World Federation for Psychotherapy. The authors propose international and regional academic collaborations to maintain enthusiasm among trainees and improve quality of care.
Topics: Humans; Psychoanalysis; Indonesia; Psychotherapy, Psychodynamic; Clinical Competence; Psychiatry; Psychotherapy; Internship and Residency
PubMed: 38047668
DOI: 10.1521/pdps.2023.51.4.401 -
Pharmacopsychiatry May 2024
Topics: Medical Marijuana; Humans; Psychiatry; Mental Disorders
PubMed: 38714200
DOI: 10.1055/a-2290-6470 -
Harvard Review of PsychiatryThe field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing... (Review)
Review
The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians' lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.
Topics: Humans; Transgender Persons; Mental Disorders; Psychiatry; Self-Injurious Behavior; Hormones
PubMed: 37437250
DOI: 10.1097/HRP.0000000000000373 -
American Journal of Public Health Mar 2024Antecedents of racist treatments of Black patients by the psychiatric profession in the United States affect the way they view treatment today. Specifically, in this...
Antecedents of racist treatments of Black patients by the psychiatric profession in the United States affect the way they view treatment today. Specifically, in this essay, we explore the enduring consequences of racial science on various treatment practices. We examined a range of primary sources on the history of racial theories about the mind, medical and psychiatric publications, and hospitals. We contextualize this analysis by examining the secondary literature in the history and sociology of psychiatry. Through analyzing racial thinking from the antebellum through the Jim Crow periods, we show how US medicine and psychiatry have roots in antebellum racial science and how carceral logics underpinned the past and present politics of Black mental health. Changing this trajectory requires practitioners to interrogate the historical foundations of racist psychiatric concepts. This essay urges them to reject biological racial realism, which bears reminiscences to 19th-century racial science, and embrace the variable of race as a social construct to study social inequalities in health as a first step toward moving away from the legacies of past injustices in medicine. (. 2024;114(S3):S250-S257. https://doi.org/10.2105/AJPH.2023.307554).
Topics: Humans; Enslavement; Mental Health; Psychiatry; Socioeconomic Factors; United States; Black or African American
PubMed: 38537165
DOI: 10.2105/AJPH.2023.307554 -
Revista Colombiana de Psiquiatria... 2024
Topics: Humans; Neuropsychiatry; Psychiatry; Mental Disorders
PubMed: 38658282
DOI: 10.1016/j.rcpeng.2024.04.001 -
Sante Publique (Vandoeuvre-les-Nancy,... 2024Informal caregivers play a vital role in supporting people with severe mental illness. However, this role can leave informal caregivers with significant unmet needs. The...
INTRODUCTION
Informal caregivers play a vital role in supporting people with severe mental illness. However, this role can leave informal caregivers with significant unmet needs. The aim of this qualitative study is to identify the extent to which the support offered to informal caregivers in adult psychiatry in French-speaking Switzerland meets their needs.
METHOD
Individual semi-structured interviews and focus groups were conducted with informal caregivers, mental health professionals, and service providers. The data were analyzed by theme.
RESULTS
The need for assistance and the need for information are two themes identified as prevalent among informal caregivers. Despite a consensus on the need for more support and information, informal caregivers, service providers, and health professionals do not assign the same importance to specific aspects of these themes. Suggestions for improving practices at the institutional, socio-political, and civil-society levels are put forward. Given the diversity of viewpoints on the priority needs of informal caregivers, there is a risk of offering support that only partially corresponds to the difficulties encountered by informal caregivers.
CONCLUSIONS
Matching support and needs remains a major challenge. Agreeing on a consensual definition of support and information needs and proposing tailored approaches could make it possible to develop support services that meet the actual needs of informal caregivers.
Topics: Humans; Caregivers; Female; Switzerland; Male; Mental Disorders; Middle Aged; Adult; Focus Groups; Health Services Needs and Demand; Social Support; Psychiatry; Needs Assessment; Qualitative Research; Aged
PubMed: 38834524
DOI: 10.3917/spub.242.0045 -
Adages, Aphorisms, and Proverbs in Psychiatry and Psychotherapy: Tools for Assessment and Treatment.American Journal of Psychotherapy Dec 2023This study aimed to examine how adages, aphorisms, and proverbs arise in psychiatric management and psychotherapy and how they might be used to assist assessment and... (Review)
Review
OBJECTIVE
This study aimed to examine how adages, aphorisms, and proverbs arise in psychiatric management and psychotherapy and how they might be used to assist assessment and treatment.
METHODS
A selective narrative literature review was conducted to supplement clinical observations and case vignettes.
RESULTS
Adages appear to act as heuristic cognitive structures that serve as shortcuts for assessing situations, educating, persuading, aiding emotional self-regulation, and influencing courses of action. Some types of psychotherapy-such as dialectical behavior therapy, rational emotive behavior therapy, and acceptance and commitment therapy-and self-help programs such as Alcoholics Anonymous routinely utilize adages. The extent to and contexts in which adages spontaneously arise during general psychiatric and psychotherapeutic interactions have not been systematically studied. Clinicians can ascertain patients' favorite adages and appraise how patients respond to other sayings through exploratory questioning and by evoking responses to stock series of adages. As therapeutic tools, adages may help patients more easily conceptualize clinicians' interpretations and insights and may serve as encouraging affirmations.
CONCLUSIONS
Considering the potential utility of adages as therapeutic cognitive scaffolds, how patients and clinicians spontaneously use adages, how adages are used therapeutically, and the adages most suitable for particular patients in particular circumstances deserve further study. In psychiatric management and psychotherapy, clinicians' sensitivity to timing and patients' circumstances, culture, and receptivity may determine whether introducing a particular aphorism or proverb will have a positive impact or come across as a vapid and potentially harmful platitude.
Topics: Humans; Acceptance and Commitment Therapy; Psychotherapy; Psychiatry
PubMed: 37248709
DOI: 10.1176/appi.psychotherapy.20230007 -
Australasian Psychiatry : Bulletin of... Dec 2023The aim is to identify and illustrate the place of psychodynamic practice and the therapeutic relationship in psychiatry, including consideration of the need for...
OBJECTIVE
The aim is to identify and illustrate the place of psychodynamic practice and the therapeutic relationship in psychiatry, including consideration of the need for psychodynamic formulation and longer-term psychotherapies, in the context of debate over guidelines for depression management.
CONCLUSIONS
Effective psychiatric practice requires a working understanding of psychodynamic principles. Effective management planning is underpinned by psychodynamic formulation. A full range of therapeutic options need to be available for optimal care.
Topics: Humans; Psychotherapy; Psychiatry; Psychotherapy, Psychodynamic
PubMed: 37899537
DOI: 10.1177/10398562231211108