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The Psychiatric Clinics of North America Mar 2022Many mental health practitioners, including psychiatrists, have suffered multiple social and mental health impacts from COVID-19. A range of actions are described that... (Review)
Review
Many mental health practitioners, including psychiatrists, have suffered multiple social and mental health impacts from COVID-19. A range of actions are described that health care organizations and individuals can take to mitigate these impacts. There will likely be substantial positive short- and long-term outcomes for psychiatrists individually and as a profession post-COVID-19. These include improved professional well-being and more efficient practice modalities through the development of hybrid care clinical approaches integrating technologies into practice, and a greater focus on providing better care for diverse racial and ethnic communities.
Topics: COVID-19; Ethnicity; Humans; Mental Health; Psychiatry; SARS-CoV-2
PubMed: 35219432
DOI: 10.1016/j.psc.2021.11.007 -
Psychiatric Services (Washington, D.C.) Aug 2023Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage (MA) plan for individuals who have both Medicare and Medicaid coverage. The authors compared...
OBJECTIVE
Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage (MA) plan for individuals who have both Medicare and Medicaid coverage. The authors compared the breadths of psychiatrist and nonpsychiatrist provider networks in D-SNPs and other MA plans.
METHODS
MA plan provider network data were merged with plan service areas and a nationwide provider database to form a data set with 843 observations on networks subclassified by state and network type (D-SNP or other MA) covering 42 U.S. states and Washington, D.C. Network breadth measured the in-network fraction of clinically active Medicare-accepting psychiatrists and other physician providers in the plans' service areas in each state. Regression analyses were used to compare psychiatrist and nonpsychiatrist network breadth and psychiatrist-nonpsychiatrist breadth differences between D-SNPs and other MA plans, after adjustment for state-level differences.
RESULTS
Mean psychiatrist network breadth was 0.319 in D-SNPs and 0.299 in other MA plans, and nonpsychiatrist network breadth was 0.346 in D-SNPs and 0.358 in other MA plans. Psychiatrist networks were narrower than nonpsychiatrist networks (0.303 vs. 0.355, p<0.001), but mean psychiatrist network breadth did not differ between D-SNPs and other MA plans. In regression analyses, the psychiatrist-nonpsychiatrist breadth difference was smaller in D-SNPs (-0.031) than in other MA plans (-0.060) (p0.002).
CONCLUSIONS
Psychiatrist provider networks in a nationwide sample of D-SNPs had similar breadth as psychiatrist networks used in other MA plans. Special provider network adequacy requirements for psychiatrists in D-SNP networks may be worthy of further consideration given D-SNPs' disproportionate enrollment of adults with serious mental illness who have dual Medicare-Medicaid insurance coverage.
Topics: Aged; Humans; United States; Medicare Part C; Medicaid; Physicians; Psychiatry; Insurance Coverage
PubMed: 36789608
DOI: 10.1176/appi.ps.20220239 -
Journal of the American Academy of... Aug 2022There are not enough of us. That was true even before the COVID-19 pandemic, which has only made the need for mental health services more acute. There are roughly 30,500...
There are not enough of us. That was true even before the COVID-19 pandemic, which has only made the need for mental health services more acute. There are roughly 30,500 practicing psychiatrists in the United States, and 106,000 licensed psychologists, and perhaps a million mental health practitioners worldwide. That translates to roughly one psychologist per 3,000 persons in the United States, one psychiatrist per 11,000 persons in the United States, and one provider per 8000 persons globally. That is obviously inadequate. Ramping up the training of professionals is not a sufficient solution. Even large percentage increases in the number of freshly minted providers still miss the mark by several orders of magnitude.
Topics: COVID-19; Humans; Mental Health; Mental Health Services; Pandemics; Psychiatry; United States
PubMed: 35301073
DOI: 10.1016/j.jaac.2022.03.006 -
Tijdschrift Voor Psychiatrie 2023Language is the most important tool for every psychiatrist and psychotherapist. Metaphors can enhance the effect of language.
BACKGROUND
Language is the most important tool for every psychiatrist and psychotherapist. Metaphors can enhance the effect of language.
AIM
To stimulate reflection on the role of metaphors in psychiatric discourse.
METHOD
Discuss illustrative examples and some relevant studies.
RESULTS
Psychotherapeutic schools each have their own way of using metaphors. Many psychiatrists also like to use them. A successful metaphor refers to the main clinical problem in treatment, contains an element that the patient is still missing, and are adapted to the patient’s person.
CONCLUSION
A personalized application of metaphors works best. Well-chosen metaphors lead to recognition, inspiration and satisfaction for both patient and therapist.
Topics: Humans; Metaphor; Language
PubMed: 36951768
DOI: No ID Found -
The British Journal of Psychiatry : the... Apr 2020There are few topics that divide public opinion as sharply as the use of psychoactive substances and it is easy to see why. Substance use is complex and can be examined...
There are few topics that divide public opinion as sharply as the use of psychoactive substances and it is easy to see why. Substance use is complex and can be examined from numerous perspectives, including legal, health, economic, cultural and ethical. These varying approaches can lead to a range of different conclusions. Here we explore some of the common approaches adopted towards drug policy and suggest a number of principles, which may inform a psychiatrist's own view.
Topics: Humans; Illicit Drugs; Legislation, Drug; Mentally Ill Persons; Psychiatry; Substance-Related Disorders
PubMed: 31685040
DOI: 10.1192/bjp.2019.208 -
BJPsych Bulletin Jul 2023Professional statements suggest that psychiatrists engage in media work to supply a general audience with medical knowledge informed by relevant professional expertise.... (Review)
Review
Professional statements suggest that psychiatrists engage in media work to supply a general audience with medical knowledge informed by relevant professional expertise. However, media work may be motivated by interests other than disinterested service to the well-being of the public, such as fame, money and a platform for one's wider views. The role of media psychiatrist is also crucially shaped by the unpredictable needs of a complex media ecology and marketplace. Furthermore, the properties of the media, and different forms within them, bring implicit meanings such as the wider authorisation of therapeutic self-reflection or the promotion of para-social intimacy. Finally, the media psychiatrist may function as an entrepreneur, converting the currency of celebrity into new forms of cultural, social and political capital. Professional guidelines for media work should be updated in light of such observations.
PubMed: 37519270
DOI: 10.1192/bjb.2023.63 -
The Journal of the American Academy of... Jun 2021Clinical medical ethics are ruled by the principles of beneficence and non-maleficence. In forensic psychiatry, however, the duty to serve as an agent of the justice... (Review)
Review
Clinical medical ethics are ruled by the principles of beneficence and non-maleficence. In forensic psychiatry, however, the duty to serve as an agent of the justice system overrules these principles; thus, examination subjects may indeed experience harms incurred by the psychiatrist's testimony. Alan Stone argued more than 30 years ago that the participation of psychiatrists in legal proceedings runs two essential and opposing risks: skewing justice to serve patients and deceiving patients to serve justice. In this article, we review the major lines of response and critique stemming from Stone's article. We focus on the use of empathy in examination and evaluation, a topic central to the ongoing discussion and debate. We then describe detached concern, a concept with a long history in medical education but new to discussions of ethics and empathy in forensic psychiatry. We conclude by proposing this concept as a useful addition to thought, discussion, and, above all, practice. We argue specifically that detached concern can help practitioners, seasoned and novice alike, to avail the benefits and manage the ethics risks of using empathy in evaluations.
Topics: Empathy; Ethics, Medical; Forensic Psychiatry; Humans; Professional Role
PubMed: 33771910
DOI: 10.29158/JAAPL.200106-20 -
Epilepsy & Behavior : E&B Sep 2019In patients with refractory epilepsy, there is a significant risk of postoperative psychiatric complications after epilepsy surgery. The main risk factors for this... (Review)
Review
In patients with refractory epilepsy, there is a significant risk of postoperative psychiatric complications after epilepsy surgery. The main risk factors for this phenomenon include a lifetime or family history of psychiatric illness; these risk factors can be easily identified through a preoperative evaluation performed by a psychiatrist. Despite this, very few comprehensive epilepsy centers include a psychiatrist on the treatment team. Preoperative evaluations often fail to identify patients at risk of postoperative psychiatric complications, thus missing the opportunity to counsel and prophylactically treat patients at risk. In this article, we review the risk factors for the development of postoperative psychiatric complications and discuss the reasons why epilepsy centers continue to perform presurgical evaluations without psychiatrists. Additionally, we provide practical solutions for neurologists in the identification and management of postoperative psychiatric disorders. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
Topics: Comorbidity; Drug Resistant Epilepsy; Humans; Interprofessional Relations; Mental Disorders; Neurologists; Perioperative Care; Physician's Role; Postoperative Complications; Practice Patterns, Physicians'; Psychiatry; Risk Assessment; Risk Factors
PubMed: 30658895
DOI: 10.1016/j.yebeh.2018.12.009 -
Tijdschrift Voor Psychiatrie 2023The high demand for mental health care is increasing the pressure on Dutch basic and specialized mental health care. Consultative psychiatry in primary care may help to...
BACKGROUND
The high demand for mental health care is increasing the pressure on Dutch basic and specialized mental health care. Consultative psychiatry in primary care may help to support primary mental health care. These consultations are increasingly used nationwide. However, little is known about how this help takes shape in practice and what the experiences of both patients and caregivers are.
METHOD
We carried out a database and file study into the characteristics of the patients who received psychiatric consultation, in which we also examined the consultation questions of the general practitioners (GP) and the given advice. In addition, 15 semi-structured in-depth interviews were conducted with patients, general practitioners, mental healthcare nurse practitioners and psychiatrists, after which the transcripts were coded and analyzed thematically.
AIM
To explore for which patients the GP requests a psychiatric consultation, what the consultation questions are and the advice given, and to identify the experiences of patients and healthcare providers with consultative psychiatry in general practice.
RESULTS
The database study showed that consultative psychiatry was mainly used for patients with a psychiatric history, multiple psychiatric diagnosis and current psychopharmaceutical use. The consultation question usually concerned medication or treatment advice. In addition to advice regarding the consultation question, the psychiatrist often gave additional advice. Consultative psychiatry was experienced positively by both health care providers and patients due to the low threshold of the general practice, the mutual trust that is involved, the short waiting times compared to the second and third line psychiatry and the expertise of the psychiatrist.
CONCLUSION
Consultative psychiatry in general practice is widely applicable, but is mainly applied to patients with multiple psychiatric diagnoses and current psychopharmaceutical use. It is experienced as positive by both patients and healthcare providers.
Topics: Humans; Psychiatry; General Practice; Mental Disorders; Referral and Consultation; Psychotropic Drugs
PubMed: 37947465
DOI: No ID Found -
Journal of the Academy of... 2023Ketamine is a noncompetitive N-methyl-D-aspartate-receptor antagonist often used for sedation and management of acute agitation in general hospital settings. Many... (Review)
Review
BACKGROUND
Ketamine is a noncompetitive N-methyl-D-aspartate-receptor antagonist often used for sedation and management of acute agitation in general hospital settings. Many hospitals now include ketamine as part of their standard agitation protocol, and consultation-liaison psychiatrists frequently find themselves treating patients who have received ketamine, despite lack of clear recommendations for management.
OBJECTIVE
Conduct a nonsystematic narrative review regarding the use of ketamine for agitation and continuous sedation, including benefits and adverse psychiatric effects. Compare ketamine to more traditional agents of agitation control. Provide consultation-liaison psychiatrists with a summary of available knowledge and recommendations for managing patients receiving ketamine.
METHODS
A literature review was performed using PubMed, querying published articles from inception to March 2023 for articles related to use of ketamine for agitation or continuous sedation and side effects including psychosis and catatonia.
RESULTS
A total of 37 articles were included. Ketamine was found to have multiple benefits, including shorter time to adequate sedation for agitated patients when compared to haloperidol ± benzodiazepines and unique advantages for continuous sedation. However, ketamine carries significant medical risks including high rates of intubation. Ketamine appears to induce a syndrome that mimics schizophrenia in healthy controls, and such effects are more pronounced and longer-lasting in patients with schizophrenia. Evidence regarding rates of delirium with ketamine for continuous sedation is mixed and requires further investigation before the agent is widely adopted for this purpose. Finally, the diagnosis of "excited delirium syndrome" and use of ketamine to treat this controversial syndrome warrants critical evaluation.
CONCLUSIONS
Ketamine carries many potential benefits and can be an appropriate medication for patients with profound undifferentiated agitation. However, intubation rates remain high, and ketamine may worsen underlying psychotic disorders. It is essential that consultation-liaison psychiatrists understand the advantages, disadvantages, biased administration, and areas of limited knowledge regarding ketamine.
Topics: Humans; Ketamine; Psychomotor Agitation; Referral and Consultation; Delirium
PubMed: 37301324
DOI: 10.1016/j.jaclp.2023.06.001