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BJPsych Open Jun 2022The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg and MDcpg) provide evidence-based and...
BACKGROUND
The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg and MDcpg) provide evidence-based and consensus-based recommendations for managing mood disorders.
AIMS
We examined Australian real-world prescribing habits to determine whether management in clinical practice aligned with MDcpg recommendations.
METHOD
A retrospective analysis of a cohort of patients ≥16 years old who had been dispensed a Pharmaceutical Benefits Scheme (PBS)-listed antidepressant between July 2013 and June 2019 was conducted using Australian Commonwealth Department of Human Services PBS 10% sample data.
RESULTS
Between July 2013 and June 2019, 239 944 patients in Australia commenced antidepressant treatment. Of these, 22% (52 694 patients) received a second treatment (a new class of treatment after a period of discontinuation or additional antipsychotic therapy) and 6% (15 741 patients) received a third treatment. Patients were initially prescribed primarily selective serotonin reuptake inhibitors (SSRIs; 52% of prescriptions) or tricyclic antidepressants (TCAs; 25%), even though TCAs are not recommended for first-line treatment. Fewer than one-quarter of patients were prescribed serotonin-noradrenaline reuptake inhibitors (13%) or other agents (10%). General practitioners (GPs) were more likely to initiate TCAs than psychiatrists (22% . 7%).Once initiated, the overall median time patients remained on treatment was 4.5 months; this was highest with SSRIs (5.8 months) and lowest with TCAs (0.9 months).
CONCLUSIONS
First-line prescribing broadly follows guidelines. GP and psychiatrist prescribing patterns differ, perhaps reflecting different patient groups and the need to tailor treatment to individuals. Future guidelines should aim to capture the different presentations and complexity of depression.
PubMed: 35770420
DOI: 10.1192/bjo.2022.522 -
Canadian Geriatrics Journal : CGJ Sep 2020The number of older adults with complex health needs in Ontario is growing. The Ministry of Health and Long-Term Care requested a resource mapping project to assess the... (Review)
Review
BACKGROUND
The number of older adults with complex health needs in Ontario is growing. The Ministry of Health and Long-Term Care requested a resource mapping project to assess the current 2018 and projected 2025 number of specialist physician resources.
METHODS
Geriatric specialist physicians were defined as geriatricians, geriatric psychiatrists, and Care of the Elderly (COE) physicians. We determined the current number of geriatricians, geriatric psychiatrists, and COEs and clinical full-time-equivalent complement (CFTE) for geriatric medicine and geriatric psychiatry specialists. We projected the number of new trainees expected to enter practice and the number of physicians expected to retire by 2025. We compared these numbers and projections against established specialist/population ratios for geriatricians and geriatric psychiatrists.
RESULTS
There was a deficit of geriatricians and geriatric psychiatrists (geriatricians: CFTE deficit of 150.5; geriatric psychiatrists: CFTE deficit of 116.3). In 2025, the projected CFTE deficit of geriatricians will increase to at least 210.35 and geriatric psychiatrists to 194.6. Only about 30% of COE physicians work in direct support of specialized services for the elderly.
CONCLUSIONS
There is significant current and anticipated undersupply in the required number of geriatricians, geriatric psychiatrists, and COE physicians to meet anticipated population demand.
PubMed: 32904648
DOI: 10.5770/cgj.23.448 -
Psychopathology 2022In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may... (Review)
Review
In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may represent the joints of a phenomenologically oriented diagnosis. The "tightrope walking" attitude refers to the psychiatrist's ability to swing between 2 different and sometimes contrasting tendencies (e.g., engagement and disengagement). The "holistic experience" includes all those intuitive, nonverbal, and pre-thematic elements that emerge in the early stages of the clinical encounter as an emanation of the atmospheric quality of the intersubjective space. The "co-construction of symptoms" regards the hermeneutic process behind psychiatric symptoms, involving both the patient as a self-interpreting agent and the clinician as a translator of his/her experience. Finally, by the "evolving typification" we mean that the closer the relationship becomes with the patient, the more specific and nuanced becomes the typification behind psychiatric diagnosis. Each of these concepts will be accompanied by an extract from a clinical case deriving from one of the authors' most recent clinical experiences.
Topics: Female; Humans; Male; Mental Disorders
PubMed: 34965532
DOI: 10.1159/000520334 -
Missouri Medicine 2024Technologies in the 21st century provide increasingly detailed and accurate maps of brain structure and function. So why don't psychiatrists order brain imaging on all... (Review)
Review
Technologies in the 21st century provide increasingly detailed and accurate maps of brain structure and function. So why don't psychiatrists order brain imaging on all our patients? Here we briefly review major neuroimaging methods and some of their findings in psychiatry. As clinicians and neuroimaging researchers, we are eager to bring brain imaging into daily clinical practice. However, to be clinically useful, any test in medicine must demonstrate adequate test statistics, and show proven benefits that outweigh its risks and costs. In 2024, beyond certain limited circumstances, we have no imaging tests that can meet those standards to provide diagnosis or guide treatment. This cold fact explains why for most psychiatric patients, neuroimaging is not currently recommended by professional organizations or the National Institute of Mental Health.
Topics: Humans; Mental Disorders; Brain; Neuroimaging; Psychiatry; Psychiatrists
PubMed: 38404436
DOI: No ID Found -
Tijdschrift Voor Psychiatrie 2021Moral courage is the courage to do what you morally believe to be right, despite the presence of danger. Courage is certainly important in critical situations where... (Review)
Review
BACKGROUND
Moral courage is the courage to do what you morally believe to be right, despite the presence of danger. Courage is certainly important in critical situations where moral values are at stake. Reflection is not enough, you have to act wisely. Moral courage bridges the gap between thinking and doing. This article first characterizes moral courage and then provides tools that can help psychiatrists to show moral courage.
AIM
To provide tools that can help psychiatrists in their professional practice to show moral courage.
METHOD
Characterizing moral courage on the basis of a case study and literature review.
RESULTS
Psychiatrists can learn courage by preparing for the dangers inherent in the job, by thinking about situations in advance, and going through and practicing possible scenarios and consequences. They can also discuss the subject in peer-to-peer meetings.
CONCLUSION
Courage is certainly important in critical situations where moral values are at stake. Reflection is then not enough, and one must act wisely. Moral courage bridges the gap between thinking and doing. Professionals are assisted in this when (professional) organizations invest in a safe and stimulating context.
Topics: Courage; Ethics, Nursing; Humans; Learning; Morals; Psychiatry
PubMed: 34757608
DOI: No ID Found -
BJPsych Bulletin Oct 2021
PubMed: 34556201
DOI: 10.1192/bjb.2021.78 -
BJPsych International Feb 2021With rapid growth and development in recent decades, the State of Qatar has been redefining strategies and policies towards building a world-class healthcare system.... (Review)
Review
With rapid growth and development in recent decades, the State of Qatar has been redefining strategies and policies towards building a world-class healthcare system. Mental health has emerged as a priority area for development. As a result, mental health services in the region are being redefined and expanded, and this was realised with the launching of the ambitious National Mental Health Strategy in 2013. Traditionally, mental healthcare in Qatar had been considered to be the remit of psychiatrists within secondary care. The new strategy supported the transition towards community-based care. It outlined a plan to design and build a comprehensive and integrated mental health system, offering treatment in a range of settings. In this article, we provide an overview of the advent of primary care mental health services in Qatar. We discuss the historical aspects of psychiatric care and development of primary care mental health services in Qatar.
PubMed: 34287398
DOI: 10.1192/bji.2020.45 -
Innovations in Clinical Neuroscience 2023Medical schools around the globe canceled in-person classes and switched to virtual classrooms shortly after the COVID-19 pandemic began. The shift to online platforms... (Review)
Review
Medical schools around the globe canceled in-person classes and switched to virtual classrooms shortly after the COVID-19 pandemic began. The shift to online platforms posed serious challenges to medical education. During normal conditions, medical school is viewed as a challenging time during which resilience is critically important. There is an intense workload, increasing the risk of burnout and difficulties in work/life balance. In addition to the intensity of the curriculum and clinical rotations, most students accumulate loans that further increase the pressure to succeed. All medical schools are required to offer mental health services for their students. Psychiatrists and other mental health professionals providing care to medical students must consider the unique circumstances during an unprecedented time in the patient's educational life. This article will review the treatment dynamics created by the medical student-patient and the evidence-based approaches that the psychiatrist can utilize in a psychotherapy setting.
PubMed: 37387704
DOI: No ID Found -
BJPsych International Aug 2022We describe mental health services in Luxembourg and how they have evolved over the past 50 years. Health services in Luxembourg are provided through a social health... (Review)
Review
We describe mental health services in Luxembourg and how they have evolved over the past 50 years. Health services in Luxembourg are provided through a social health insurance-based system and mental health services are no exception. Additional services are offered through mixed-funding avenues drawing on social care budgets in the main. Luxembourg is closely connected with neighbouring countries, where a large proportion of its workforce live. No run-through medical training exists and the entire medical workforce, including psychiatrists, have trained in other countries. This is reflected in a rich but often non-uniform approach to the provision of psychiatric care.
PubMed: 36287821
DOI: 10.1192/bji.2021.58 -
Psychiatria Danubina 2022COVID-19 is a global public health crisis, and is turning to be a major mental health problem. This review provides a broad overview of mental health situations during... (Review)
Review
COVID-19 is a global public health crisis, and is turning to be a major mental health problem. This review provides a broad overview of mental health situations during COVID-19 pandemic in Africa and globally, while some preventive methods to improve mental health conditions during the pandemic were provided. In the Africa context, various government authorities must ensure the provision and accessibility to mental health care services such as routine preventive information, mental health counseling and self help measures, and social supports such as palliatives, basic needs and special financial assistance to the public during the pandemic. Generally, coping strategies such as personal care-based measures (adequate nutrition, personal hygiene, adequate sleep and rest) activity-based measures (regular physical exercise, learning new tasks and engaging in novel adventures and mindfulness meditation) and behavioral-based measures (avoidance of psychoactive substances, taking breaks from COVID-19-related information, social connectedness and showing supports to others, setting achievable targets, help seeking measures and psychiatrist's visitations, adherence to all COVID-19 preventive measures and uptake of the COVID-19 vaccines) are all viable preventive methods against mental health conditions during the pandemic globally. It is recommended that researchers should conduct more studies on the impacts of COVID-19 on mental health status in Africa populations to ensure a valid basis for proper interventions during and post pandemic era. Also, African countries should seek supports and routine guidance from appropriate international health organizations to ensure an updated and frequent mental health care delivery to the public.
Topics: Adaptation, Psychological; COVID-19; COVID-19 Vaccines; Humans; Mental Health; Pandemics; SARS-CoV-2
PubMed: 35772154
DOI: 10.24869/psyd.2022.325