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Current Psychiatry Reports Mar 2024Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This... (Review)
Review
PURPOSE OF REVIEW
Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry.
RECENT FINDINGS
PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
Topics: Humans; Aged; Palliative Care; Psychiatry; Delivery of Health Care
PubMed: 38329570
DOI: 10.1007/s11920-024-01485-5 -
Child and Adolescent Psychiatric... Jul 2024Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate... (Review)
Review
Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.
Topics: Humans; Adolescent; Adolescent Psychiatry; Child Psychiatry; Child; Physician's Role; Psychiatrists
PubMed: 38823812
DOI: 10.1016/j.chc.2024.03.006 -
Psychosomatics 2020Approximately 4.5% of the population live with serious mental illness (SMI), a term referring to mental health disorders that are chronic, impair function, and require... (Review)
Review
BACKGROUND
Approximately 4.5% of the population live with serious mental illness (SMI), a term referring to mental health disorders that are chronic, impair function, and require ongoing treatment. People living with SMI are at risk of premature mortality relative to people without SMI. Chronic medical illnesses contribute significantly to mortality among individuals with SMI. The standard of care for individuals with serious medical illnesses includes palliative care. However, the provision of palliative care has not been operationalized for individuals with SMI.
OBJECTIVES
To review existing data on end-of-life and palliative care for individuals with serious medical illness and comorbid serious mental illness. To operationalize the role of the consultation-liaison (C-L) psychiatrist in such care, with a particular eye towards redressing disparities.
METHODS
In this narrative review, we draw upon a review of the literature on end-of-life and palliative care provision for individuals with serious medical illness and comorbid serious medical illness. We also draw upon the experiences of the authors in formulating best practices for the care of such patients.
RESULTS
Individuals with SMI are at risk of suboptimal end-of-life care. Patient, clinician, and system-level factors all contribute to disparities including decreased access to palliative care, uneven continued engagement with mental health services, and low rates of advance care planning. C-L psychiatrists can use their expertise at the intersection of medicine and psychiatry to address such disparities by (1) correcting misassumptions, (2) promoting advance care planning, (3) engaging long-term caregivers, (4) recognizing social needs, (5) ensuring ongoing access to psychiatric treatment, and (6) addressing suffering.
CONCLUSIONS
There are significant disparities in the end-of-life care of individuals with SMI. C-L psychiatrists have expertise to ally with medical providers and redress these disparities.
Topics: Female; Humans; Male; Mental Disorders; Palliative Care; Quality of Life; Terminal Care
PubMed: 32660874
DOI: 10.1016/j.psym.2020.06.003 -
History of Psychiatry Mar 2021In the late 1930s, when colonial psychiatry was well established in the Maghreb, the diagnosis 'psychosis of civilization' appeared in some psychiatrists' writings....
In the late 1930s, when colonial psychiatry was well established in the Maghreb, the diagnosis 'psychosis of civilization' appeared in some psychiatrists' writings. Through the clinical case of a Libyan woman treated by the Italian psychiatrist Angelo Bravi in Tripoli, this article explores its emergence and its specificity in a differential approach, and highlights its main characteristics. The term applied to subjects poised between two worlds: incapable of becoming 'like' Europeans - a goal to which they seem to aspire - but too far from their 'ancestral habits' to revert for a quiet life. The visits of these subjects to colonial psychiatric institutions, provided valuable new material for psychiatrists: to see how colonization impacted inner life and to raise awareness of the long-term socio-political dangers.
Topics: Acculturation; Civilization; Colonialism; Fascism; Female; History, 20th Century; Hospitalization; Humans; Italy; Libya; Male; Medicine, Traditional; Psychiatry; Psychotic Disorders
PubMed: 33207959
DOI: 10.1177/0957154X20968063 -
AJOB Neuroscience 2024
Topics: Humans; Medical Futility; Psychiatrists; Psychiatry; Patients; Patient Care
PubMed: 38207194
DOI: 10.1080/21507740.2023.2292508 -
Journal of the Formosan Medical... Oct 2022The number of psychiatrists working in community clinics in Taiwan has increased dramatically in the recent decade. This study aimed to investigate the trend of...
BACKGROUND/PURPOSE
The number of psychiatrists working in community clinics in Taiwan has increased dramatically in the recent decade. This study aimed to investigate the trend of prevalence and incidence of depressive disorders and assess the quality of depression care between 2007 and 2016 in Taiwan.
METHODS
We used the claims database derived from Taiwan's National Health Insurance (NHI) program, in which approximately 23.0 million individuals were enrolled, translating to a coverage rate of 99%. Patients with depressive disorders were identified based on International Classification of Diseases codes. The process indicators of depression care quality included visit, duration, and dose adequacy. The outcome indicators included the rate of psychiatric hospitalisation, emergency visit, self-harm hospitalisation, and suicide.
RESULTS
The prevalence of treated depressive disorders increased from 1.61% in 2007 to 1.92% in 2016, i.e., a 25% increase, whereas the incidence of first-ever or recurrent depressive disorder did not change significantly. The number of patients treated by psychiatrists and in community clinics also increased. The quality of depression care improved, the proportion of patients receiving minimum psychiatric clinic follow-up and adequate medication increased, and the rate of emergency visits, psychiatric hospitalisation, and self-harm hospitalisation declined.
CONCLUSION
The community-based psychiatric services increased and the quality indicators of depression care in Taiwan improved during 2007-2016. The causality warrants further investigations.
Topics: Databases, Factual; Depression; Humans; Incidence; National Health Programs; Taiwan
PubMed: 35227586
DOI: 10.1016/j.jfma.2022.02.011 -
Frontiers in Psychiatry 2021Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and... (Review)
Review
Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.
PubMed: 34421677
DOI: 10.3389/fpsyt.2021.691377 -
CMAJ Open 2020Psychotherapy is recommended as a first-line treatment for the management of common psychiatric disorders. The objective of this study was to evaluate the availability...
BACKGROUND
Psychotherapy is recommended as a first-line treatment for the management of common psychiatric disorders. The objective of this study was to evaluate the availability of publicly funded psychotherapy provided by physicians in Ontario by describing primary care physicians (PCPs) and psychiatrists whose practices focus on psychotherapy and comparing them to PCPs and psychiatrists whose practices do not.
METHODS
This was a population-based retrospective cohort study. We included all PCPs and psychiatrists in Ontario who submitted at least 1 billing claim to the Ontario Health Insurance Plan between Apr. 1, 2015, and Mar. 31, 2016, and categorized them as psychotherapists if at least 50% of their outpatient billings were related to the provision of psychotherapy. We measured practice characteristics such as total number of patients and new patients, and average visit frequency for 4 physician categories: PCP nonpsychotherapists, PCP psychotherapists, psychiatrist nonpsychotherapists and psychiatrist psychotherapists. We also measured access to care for people with urgent need for mental health services.
RESULTS
Of 12 772 PCPs, 404 (3.2%) were PCP psychotherapists; of 2150 psychiatrists, 586 (27.3%) were psychotherapists. Primary care physician nonpsychotherapists had the highest number of patients and number of new patients, followed by psychiatrist nonpsychotherapists, PCP psychotherapists and psychiatrist psychotherapists. Primary care physician nonpsychotherapists had the lowest average annual number of visits per patient, whereas both types of psychotherapists had a much greater number of visits per patient. Primary care physician and psychiatrist nonpsychotherapists saw about 25% of patients with urgent needs for mental health services, whereas PCP and psychiatrist psychotherapists saw 1%-3% of these patients.
INTERPRETATION
Physicians who provide publicly funded psychotherapy in Ontario see a small number of patients, and they see few of those with urgent need for mental health services. Our findings suggest that improving access to psychotherapy will require the development of alternative strategies.
Topics: Adult; Aged; Female; Health Services Accessibility; Health Workforce; Humans; Male; Mental Disorders; Mental Health Services; Middle Aged; Ontario; Physicians; Population Surveillance; Practice Patterns, Physicians'; Psychiatry; Psychotherapy; Retrospective Studies
PubMed: 32161044
DOI: 10.9778/cmajo.20190094 -
Turk Psikiyatri Dergisi = Turkish... 2023In this review, we aimed to outline the scientific advances and service capacity in Turkish psychiatry within the century-long history of the Republic. We propose that... (Review)
Review
In this review, we aimed to outline the scientific advances and service capacity in Turkish psychiatry within the century-long history of the Republic. We propose that the history of Turkish Psychiatry also sheds light on the history of our country. We have reviewed significant milestones in Turkish Psychiatry; the establishment of psychiatric hospitals, the development of formal psychiatry training, academic and scientific proceedings and the founding of professional organizations in the Republic era. We aimed to offer insights into the role of psychiatry in the modernization of our country, as well as to establish a foundation for future improvements by evaluating the progress made in the field of mental health services. The story that began with 20 neuropsychiatrists and 300 psychiatric beds in one mental hospital has now reached over 4000 psychiatrists and twenty-thousand psychiatric beds. Psychiatry in Türkiye continues its historical evolution with expansion in size and advancements in quality. Keywords: History of Psychiatry in Türkiye, History of the Republic of Türkiye, History of Medicine.
Topics: Humans; Anniversaries and Special Events; Turkey; Psychiatry; Mental Health Services; Psychiatrists
PubMed: 38173329
DOI: 10.5080/u27437 -
Australasian Psychiatry : Bulletin of... Oct 2023To identify the level of training of Australian psychiatrists in Attention Deficit Hyperactivity Disorder (ADHD), and to compare the number of psychiatrists specialising...
OBJECTIVE
To identify the level of training of Australian psychiatrists in Attention Deficit Hyperactivity Disorder (ADHD), and to compare the number of psychiatrists specialising in ADHD versus other psychiatric conditions on the basis of the prevalence of conditions, by interrogating the RANZCP 'Find a Psychiatrist' database.
CONCLUSION
Fewer psychiatrists listed in the RANZCP database specialise in ADHD than in many other psychiatric conditions. Given that 5% of the Australian population suffers from ADHD, the condition can have significant adverse outcomes and is a common comorbidity with other psychiatric conditions, the RANZCP Training Program would be improved by requiring an in-depth knowledge of ADHD. Further training in ADHD would assist many practising psychiatrists.
Topics: Humans; Attention Deficit Disorder with Hyperactivity; Australia; Psychiatry; Comorbidity; Prevalence
PubMed: 37376892
DOI: 10.1177/10398562231186140