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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 Medical Internet Research Mar 2022Mental health disorders are a leading cause of medical disabilities across an individual's lifespan. This burden is particularly substantial in children and adolescents... (Review)
Review
BACKGROUND
Mental health disorders are a leading cause of medical disabilities across an individual's lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising.
OBJECTIVE
This study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry.
METHODS
This scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus.
RESULTS
The initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals.
CONCLUSIONS
Our scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials.
Topics: Adolescent; Adolescent Psychiatry; Artificial Intelligence; Autism Spectrum Disorder; Child Psychiatry; Humans; Wearable Electronic Devices
PubMed: 35285812
DOI: 10.2196/33560 -
Journal of Patient Safety Dec 2021The past 20 years have seen the emergence of a national movement to improve hospital-based healthcare safety in the United States. However, much of the foundational work...
OBJECTIVES
The past 20 years have seen the emergence of a national movement to improve hospital-based healthcare safety in the United States. However, much of the foundational work and subsequent research have neglected inpatient psychiatry. The aim of this article was to advance a comprehensive approach for conceptualizing patient safety in inpatient psychiatry as framed by an application of the Institute of Medicine patient safety framework.
METHODS
This article develops a framework for characterizing patient safety in hospital-based mental health care. We discuss some of the conceptual and methodological issues related to defining what constitutes a patient safety event in inpatient psychiatry and then enumerate a comprehensive set of definitions of the types of safety events that occur in this setting.
RESULTS
Patient safety events in inpatient psychiatry are broadly categorized as adverse events and medical errors. Adverse events are composed of adverse drug events and nondrug adverse events, including self-harm or injury to self, assault, sexual contact, patient falls, and other injuries. Medical errors include medication errors and nonmedication errors, such as elopement and contraband. We have developed clear definitions that would be appropriate for use in epidemiological studies of inpatient mental health treatment.
CONCLUSIONS
Psychiatry has not been an integral part of the national safety movement. As a first step toward breaching this chasm, we have considered how psychiatric events fit into the safety framework adopted across much of medicine. Patient safety should become a key part of inpatient psychiatry's mission and pursued rigorously as the subject of research and intervention efforts.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Inpatients; Medication Errors; Patient Safety; Psychiatry; United States
PubMed: 30020194
DOI: 10.1097/PTS.0000000000000520 -
Der Nervenarzt Aug 2022
Topics: COVID-19; Humans; Neurology; Psychiatry; Syndrome
PubMed: 35943531
DOI: 10.1007/s00115-022-01320-3 -
History and Philosophy of the Life... Mar 2023Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the...
Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper method, and on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders.
Topics: Humans; Mental Disorders; Psychiatry; Philosophy; Metaphysics
PubMed: 36947297
DOI: 10.1007/s40656-023-00562-x -
Tijdschrift Voor Psychiatrie 2021
Topics: Humans; Psychiatry; Psychotherapy
PubMed: 34647296
DOI: No ID Found -
Tijdschrift Voor Psychiatrie 2021
Topics: Humans; Psychiatry
PubMed: 33913139
DOI: No ID Found -
Culture, Medicine and Psychiatry Sep 2021In the mid-twentieth century, in the aftermath of WWII and the Nazi atrocities and in the midst of decolonisation, a new discipline of transcultural psychiatry was being...
In the mid-twentieth century, in the aftermath of WWII and the Nazi atrocities and in the midst of decolonisation, a new discipline of transcultural psychiatry was being established and institutionalised. This was part and parcel of a global political project in the course of which Western psychiatry attempted to leave behind its colonial legacies and entanglements, and lay the foundation for a more inclusive, egalitarian communication between Western and non-Western concepts of mental illness and healing. In this period, the infrastructure of post-colonial global and transcultural psychiatry was set up, and leading psychiatric figures across the world embarked on identifying, debating and sometimes critiquing the universal psychological characteristics and psychopathological mechanisms supposedly shared among all cultures and civilisations. The article will explore how this psychiatric, social and cultural search for a new definition of 'common humanity' was influenced and shaped by the concurrent global rise of social psychiatry. In the early phases of transcultural psychiatry, a large number of psychiatrists were very keen to determine how cultural and social environments shaped the basic traits of human psychology, and 'psy' practitioners and anthropologist from all over the world sought to re-define the relationship between culture, race and individual psyche. Most of them worked within the universalist framework, which posited that cultural differences merely formed a veneer of symptoms and expressions while the universal core of mental illness remained the same across all cultures. The article will argue that, even in this context, which explicitly challenged the hierarchical and racist paradigms of colonial psychiatry, the founding generations of transcultural psychiatrists from Western Europe and North America tended to conceive of broader environmental determinants of mental health and pathology in the decolonising world in fairly reductionist terms-focusing almost exclusively on 'cultural difference' and cultural, racial and ethnic 'traditions', essentialising and reifying them in the process, and failing to establish some common sociological or economic categories of analysis of Western and non-Western 'mentalities'. On the other hand, it was African and Asian psychiatrists as well as Marxist psychiatrists from Eastern Europe who insisted on applying those broader social psychiatry concepts-such as social class, occupation, socio-economic change, political and group pressures and relations etc.-which were quickly becoming central to mental health research in the West but were largely missing from Western psychiatrists' engagement with the decolonising world. In this way, some of the leading non-Western psychiatrists relied on social psychiatry to establish the limits of psychiatric universalism, and challenge some of its Eurocentric and essentialising tendencies. Even though they still subscribed to the predominant universalist framework, these practitioners invoked social psychiatry to draw attention to universalism's internal incoherence, and sought to revise the lingering evolutionary thinking in transcultural psychiatry. They also contributed to re-imagining cross-cultural encounters and exchanges as potentially creative and progressive (whereas early Western transcultural psychiatry primarily viewed the cross-cultural through the prism of pathogenic and traumatic 'cultural clash'). Therefore, the article will explore the complex politics of the shifting and overlapping definitions of 'social' and 'cultural' factors in mid-twentieth century transcultural psychiatry, and aims to recover the revolutionary voices of non-Western psychiatrists and their contributions to the global re-drawing of the boundaries of humanity in the second half of the twentieth century.
Topics: Community Psychiatry; Cross-Cultural Comparison; Ethnicity; Ethnopsychology; Humans; Mental Disorders
PubMed: 33905076
DOI: 10.1007/s11013-021-09719-4 -
Psychological Medicine May 2022Codes of ethics in medicine have an ancient tradition, extending back to the Oath of Hippocrates. Yet it was only in the early 1970s that the speciality of psychiatry... (Review)
Review
BACKGROUND
Codes of ethics in medicine have an ancient tradition, extending back to the Oath of Hippocrates. Yet it was only in the early 1970s that the speciality of psychiatry developed a specific code to address the unique ethical dilemmas and complexities arising in psychiatric practice. As the 50th anniversary of the publication of psychiatry's first code of ethics approaches, it is timely to reflect on the progress, role, and impact of such codes.Our aim is to provide a historically informed review of codes of ethics in psychiatry - their origins and evolution, the current picture, and the possibilities for future development.
METHODS
We conducted a selective review of relevant literature (including all codes of ethics accessible on the websites of World Psychiatric Association members states), analysis of the form and content of codes and related documents in psychiatry, and interviews of psychiatrists who have played central roles in their evolution.
RESULTS
Of the 143 WPA member states, only 15 codes of ethics for psychiatrists were identified, and few of these were associated with professional disciplinary processes. We found that these codes are rarely revised and sometimes supplemented with other statements and guidelines.
CONCLUSIONS
While there are difficulties in measuring the direct effectiveness of codes of ethics on the practice of psychiatrists, we conclude that these codes help to (1) promote professional solidarity and autonomy, (2) enhance moral sensitivity, and (3) aid in psychiatric education and training.
Topics: Codes of Ethics; Ethics, Medical; Humans; Psychiatry
PubMed: 35132951
DOI: 10.1017/S0033291722000125 -
Psychological Medicine Oct 2021
Topics: Cooperative Behavior; Data Interpretation, Statistical; Genomics; Humans; Psychiatry
PubMed: 33431078
DOI: 10.1017/S0033291720004900