This is an invited commentary on the paper by Zou et al,accepted for publication in World Journal of Psychiatry.It reflects the findings of the authors in the broader context of the search for scientifically sound and...This is an invited commentary on the paper by Zou et al,accepted for publication in World Journal of Psychiatry.It reflects the findings of the authors in the broader context of the search for scientifically sound and evidence based nomothetic system for diagnosis and treatment in psychiatry,with a special focus on the application of translational neuroimaging in that effort.展开更多
A recent meta-analysis has suggested a 5-HTR1A promoter variant may predict antidepressant response.The present review comments on the claims made in view of sensitivity issues and issues pertaining to genetic exposur...A recent meta-analysis has suggested a 5-HTR1A promoter variant may predict antidepressant response.The present review comments on the claims made in view of sensitivity issues and issues pertaining to genetic exposure.We also alert to errors in the original data that had been carried over.Specifically,primers meant to amplify the HTR1A gene aligned to the BDNF gene sequence.Alleles had been confounded owing to DNA strand ambiguities and demographic information proved inaccurate.In the light of these findings,adherence to PRISMA guidelines and use of the Newcastle-Ottawa Scale did not safeguard against bias.More after action reviews are encouraged to identify factors likely to interfere with estimates of genetic risk in large data sets.These may result from pooling of ethnic groups,the use of binary data or other formats that are not human-readable,the introduction of surrogate identifiers and a failure to reverseengineer previously published experimental protocols.Unless the above challenges are met,sequence variants are unlikely to inform personalized medicine strategies in psychiatry.展开更多
Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote p...Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.展开更多
BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education ...BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.展开更多
Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to ot...Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to other routes of medication administration such as oral and intramuscular routes in the management of various psychiatric conditions.In this editorial,we examine the advantages of transdermal medications with a brief overview of transdermal being used in psychiatry and other medical specialties.We discuss the factors that play a role in their limited usage in psychiatry.We highlight certain patient categories who can specifically benefit from them and discuss potential solutions that can broaden the perspective of treating clinicians making this an intriguing avenue in the field of psychiatry.展开更多
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that v...Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencingbased telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.展开更多
Psychiatry remains in a permanent state of crisis,which fragmented psychiatry from the field of medicine.The crisis in psychiatry is evidenced by the many different competing approaches to psychiatric illness includin...Psychiatry remains in a permanent state of crisis,which fragmented psychiatry from the field of medicine.The crisis in psychiatry is evidenced by the many different competing approaches to psychiatric illness including psychodynamic,biological,molecular,pan-omics,precision,cognitive and phenomenological psychiatry,folk psychology,mind-brain dualism,descriptive psychopathology,and postpsychiatry.The current“gold standard”Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases taxonomies of mood disorders and schizophrenia are unreliable and preclude to employ a deductive reasoning approach.Therefore,it is not surprising that mood disorders and schizophrenia research was unable to revise the conventional classifications and did not provide more adequate therapeutic approaches.The aim of this paper is to explain the new nomothetic network psychiatry(NNP)approach,which uses machine learning methods to build data-driven causal models of mental illness by assembling risk-resilience,adverse outcome pathways(AOP),cognitome,brainome,staging,symptomatome,and phenomenome latent scores in a causal model.The latter may be trained,tested and validated with Partial Least Squares analysis.This approach not only allows to compute pathway-phenotypes or biosignatures,but also to construct reliable and replicable nomothetic networks,which are,therefore,generalizable as disease models.After integrating the validated feature vectors into a well-fitting nomothetic network,clustering analysis may be applied on the latent variable scores of the R/R,AOP,cognitome,brainome,and phenome latent vectors.This pattern recognition method may expose new(transdiagnostic)classes of patients which if cross-validated in independent samples may constitute new(transdiagnostic)nosological categories.展开更多
Traditional therapeutic methods in psychiatry,such as psychopharmacology and psychotherapy help many people suffering from mental disorders,but in the long-term prove to be effective in a relatively small proportion o...Traditional therapeutic methods in psychiatry,such as psychopharmacology and psychotherapy help many people suffering from mental disorders,but in the long-term prove to be effective in a relatively small proportion of those affected.Therapeutically,resistant forms of mental disorders such as schizophrenia,major depressive disorder,and bipolar disorder lead to persistent distress and dysfunction in personal,social,and professional aspects.In an effort to address these problems,the translational approach in neuroscience has initiated the inclusion of novel or modified unconventional diagnostic and therapeutic techniques with promising results.For instance,neuroimaging data sets from multiple modalities provide insight into the nature of pathophysiological mechanisms such as disruptions of connectivity,integration,and segregation of neural networks,focusing on the treatment of mental disorders through instrumental biomedical methods such as electro-convulsive therapy(ECT),transcranial magnetic stimulation(TMS),transcranial direct current stimulation(tDCS)and deep brain stimulation(DBS).These methodologies have yielded promising results that have yet to be understood and improved to enhance the prognosis of the severe and persistent psychotic and affective disorders.The current review is focused on the translational approach in the management of schizophrenia and mood disorders,as well as the adaptation of new transdisciplinary diagnostic tools such as neuroimaging with concurrently administered psychopathological questionnaires and integration of the results into the therapeutic framework using various advanced instrumental biomedical tools such as ECT,TMS,tDCS and DBS.展开更多
Objectives:In 2019,the Insititue for Health Metrics and Evaluation reported that 16%of life lost were attributed to mental health.As a result,global shortage of psychiatrists is a pressing issue due to the increasing ...Objectives:In 2019,the Insititue for Health Metrics and Evaluation reported that 16%of life lost were attributed to mental health.As a result,global shortage of psychiatrists is a pressing issue due to the increasing burden of mental illness.In 2016,a mere 5%of US medical students chose psychiatry as a career,a trend mirrored in Germany and Italy.As the medical students of 2016 have graduated or transitioned into residency in 2023,their attitudes towards psychiatry could have contributed to today’s shortage of psychiatrists.The global mental health burden has only been exacerbated by the COVID-19 pandemic.This study explores the attitudes of German and Italian medical students towards psychiatry,their career aspirations,and the influence of factors such as personal experience and education on their interest in the field.Methods:A cross-sectional survey was conducted among 799 medical students in two European countries in 2016.Participants answered questions about their attitudes towards psychiatry,their psychiatric education,and personal experiences.Inferential analyses were performed using chi-square tests and a significance level of 0.05.Results:The number of years in medical school,personal experiences,and perceived quality of education significantly affected specialty choice and ranking of psychiatry compared to other specialties.Internships,psychiatric placements,and views on psychiatric instructors also played a significant role in choosing psychiatry as a career.Conclusions:Assessing medical students’attitudes towards psychiatry and the factors that influence their career choices,such as psychiatric education and personal experiences,can inform changes to attract students to the field.Addressing the worldwide shortage of psychiatrists is crucial to reduce the burden of mental health and substance use disorders.展开更多
The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issue...The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three-drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq;mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%;poly-therapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.展开更多
In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the ...In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the worldwide media, that it was positive to treat anxiety symptoms by regulating intestinal flora (RIF).展开更多
Objective: The forensic mental health system in Japan changed dramatically with the enforcement of the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity”...Objective: The forensic mental health system in Japan changed dramatically with the enforcement of the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity” or MTS Act, in 2005. The aim of this study is to evaluate the changes in attitude and behavior of general psychiatrists, towards forensic psychiatry. Methods: We conducted a questionnaire survey in 2010 on forensic psychiatry for Japanese psychiatrists, mirroring a previous study from 2007. Results: Comparing the results from both questionnaires, it is not evident that awareness of forensic mental health has improved among psychiatrists in the intervening three years. Conclusion: Further education about forensic mental health needs to be considered inJapan.展开更多
The coronavirus disease 2019 pandemic has significantly altered many aspects of our professional lives,including how psychiatry as a medical discipline is taught and learnt.Training in psychiatry relies on developing ...The coronavirus disease 2019 pandemic has significantly altered many aspects of our professional lives,including how psychiatry as a medical discipline is taught and learnt.Training in psychiatry relies on developing competencies through observing and interacting with patients,developing empathic consultation skills and seeking feedback from colleagues derived from cognitive and constructivist theories of learning,in a time-bound manner.The pandemic has drawn attention to the dual role of psychiatry residents as both trainees and physicians,with a pressing identity crisis at an inopportune time.This paper aims to illustrate some of the emerging themes in psychiatry training during the pandemic and some solutions for the same.展开更多
<strong>Background and Objectives:</strong> Neuroleptics have revolutionized pharmacological management in psychiatry. The advent of atypical neuroleptics constitutes a major turning point in this therapeu...<strong>Background and Objectives:</strong> Neuroleptics have revolutionized pharmacological management in psychiatry. The advent of atypical neuroleptics constitutes a major turning point in this therapeutic challenge. The objective of our study was to determine the prescription of these atypical neuroleptics in Fann’s psychiatry department. <strong>Methodology:</strong> It was a descriptive retrospective cross-sectional study that involved 223 patients hospitalized in the psychiatry department of Fann Hospital during the period from January 2015 to December 2017. <strong>Results:</strong> Our study shows a majority prescription of classic neuroleptics in combination Haloperidol-Chlorpromazine 53% and 14% in monotherapy and a prescription of atypical neuroleptics at 4%. They are prescribed in combination with the classics at 4%. <strong>Conclusion:</strong> These results show a still low prescription of atypical neuroleptics which raises questions about the availability and affordability of such drugs, but also about prescription habits in the context of developing country.展开更多
Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by ...Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.展开更多
Background: Measuring cognition in clinical practice is clearly essential to the appropriate characterisation of patients’ clinical status and to the development of a personalised care plan. The Screen for Cognitive ...Background: Measuring cognition in clinical practice is clearly essential to the appropriate characterisation of patients’ clinical status and to the development of a personalised care plan. The Screen for Cognitive Impairment in Psychiatry (SCIP) has been developed in order to provide a brief and accessible tool allowing the evaluation of cognitive function in psychiatric conditions. Objective: We present a validation of a French version of the SCIP. Method: Translation from English into French is carried out using the accepted back-translation method. Seventy-two healthy volunteers are characterised by demographic questionnaires and a neuropsychological battery. The French version of the SCIP is then administered on two separate occasions separated by at least a one-week interval. Results: High internal consistencies as well as strong correlations with comparable neuropsychological tests are obtained. A normalised Cronbach’s α = 0.66 is obtained. Conclusions: The French version of the SCIP (SCIP-F) yields results comparable to the English version. The SCIP represents an essential tool for the preliminary evaluation of cognition. Its characteristics, brevity and the lack of need for a technological platform, allow for its integration into clinical practice. Further testing of SCIP-F in various psychiatric conditions will yield valuable information on its potential in clinical settings.展开更多
Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developi...Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developing countries,as well as infectious causes,like Tuberculosis(TB)in developing countries,contribute to significant disease burden.The literature points towards the coexistence of psychiatric disorders with respiratory disorders responsible for poorer outcomes.Despite the extensive burden of respiratory disorders and the presence of concurrent psychiatric disorders,studies focusing on their prevalence are limited in India.Methods:A cross-sectional psychiatric screening was carried out on sequential patients attending the tertiary respiratory unit over eight months.Those screened positive were interviewed in detail for psychiatric diagnosis and challenges in the management were discussed.Psychiatric diagnosis,pulmonary TB and medical comorbidity were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20.Results:Psychiatric morbidity was present in 100 out of 350 patients(28.57%).Tuberculosis was the most common diagnosis(46%)in subjects attending the respiratory clinic services while common mental disorders like depression,anxiety,and insomnia were the most common psychiatric concern(88%)in this study.Conclusion:Psychiatric disorders and medical morbidities are common in patients with respiratory disorders.Multiple factors determine the treatment adherence in both respiratory and psychiatric disorders.Screening for psychiatric disorders with the help of a consultation-liaison psychiatrist in respiratory units is recommended.Future studies should focus on developing dedicated psychiatry services to enhance overall outcomes in patients with respiratory disorders.展开更多
Military psychiatry, a new subcategory of psychiatry, has become an invaluable, intangible effect of the war. In this review, we begin by examining related military research, summarizing the related epidemiological da...Military psychiatry, a new subcategory of psychiatry, has become an invaluable, intangible effect of the war. In this review, we begin by examining related military research, summarizing the related epidemiological data, neuropathology, and the research achievements of diagnosis and treatment technology, and discussing its comorbidity and sequelae. To date, advances in neuroimaging and molecular biology have greatly boosted the studies on military traumatic brain injury(TBI). In particular, in terms of pathophysiological mechanisms, several preclinical studies have identified abnormal protein accumulation, blood–brain barrier damage, and brain metabolism abnormalities involved in the development of TBI. As an important concept in the field of psychiatry, TBI is based on organic injury, which is largely different from many other mental disorders. Therefore, military TBI is both neuropathic and psychopathic, and is an emerging challenge at the intersection of neurology and psychiatry.展开更多
There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding ...There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.展开更多
Training course at the Shanghai Mental Health Center,July 4-6,2015This course will be conducted by the editorial team of the Shanghai Archives of Psychiatry(SHARP).This journal is the first psychiatric journal publish...Training course at the Shanghai Mental Health Center,July 4-6,2015This course will be conducted by the editorial team of the Shanghai Archives of Psychiatry(SHARP).This journal is the first psychiatric journal published in both English and Chinese and is indexed in several international databases,so the editorial team,which includes several native-English speakers,has rich experience in translating,writing,and revising academic articles about psychiatric topics in English.In展开更多
基金Supported by Innovation Program for the Development of MU-PLOVDIV(SRIPD-MUP),Creation of a Network of Research Higher Schools,National Plan for Recovery and Sustainability,European Union(NextGenerationEU),No.BG-RRP-2.004-0007-C01.
文摘This is an invited commentary on the paper by Zou et al,accepted for publication in World Journal of Psychiatry.It reflects the findings of the authors in the broader context of the search for scientifically sound and evidence based nomothetic system for diagnosis and treatment in psychiatry,with a special focus on the application of translational neuroimaging in that effort.
文摘A recent meta-analysis has suggested a 5-HTR1A promoter variant may predict antidepressant response.The present review comments on the claims made in view of sensitivity issues and issues pertaining to genetic exposure.We also alert to errors in the original data that had been carried over.Specifically,primers meant to amplify the HTR1A gene aligned to the BDNF gene sequence.Alleles had been confounded owing to DNA strand ambiguities and demographic information proved inaccurate.In the light of these findings,adherence to PRISMA guidelines and use of the Newcastle-Ottawa Scale did not safeguard against bias.More after action reviews are encouraged to identify factors likely to interfere with estimates of genetic risk in large data sets.These may result from pooling of ethnic groups,the use of binary data or other formats that are not human-readable,the introduction of surrogate identifiers and a failure to reverseengineer previously published experimental protocols.Unless the above challenges are met,sequence variants are unlikely to inform personalized medicine strategies in psychiatry.
文摘Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.
文摘BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.
文摘Transdermal medications are an useful yet underutilized tool in the field of psychiatry.Despite numerous advantages of using this route of medication delivery,transdermal medications remain less popular compared to other routes of medication administration such as oral and intramuscular routes in the management of various psychiatric conditions.In this editorial,we examine the advantages of transdermal medications with a brief overview of transdermal being used in psychiatry and other medical specialties.We discuss the factors that play a role in their limited usage in psychiatry.We highlight certain patient categories who can specifically benefit from them and discuss potential solutions that can broaden the perspective of treating clinicians making this an intriguing avenue in the field of psychiatry.
文摘Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencingbased telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
文摘Psychiatry remains in a permanent state of crisis,which fragmented psychiatry from the field of medicine.The crisis in psychiatry is evidenced by the many different competing approaches to psychiatric illness including psychodynamic,biological,molecular,pan-omics,precision,cognitive and phenomenological psychiatry,folk psychology,mind-brain dualism,descriptive psychopathology,and postpsychiatry.The current“gold standard”Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases taxonomies of mood disorders and schizophrenia are unreliable and preclude to employ a deductive reasoning approach.Therefore,it is not surprising that mood disorders and schizophrenia research was unable to revise the conventional classifications and did not provide more adequate therapeutic approaches.The aim of this paper is to explain the new nomothetic network psychiatry(NNP)approach,which uses machine learning methods to build data-driven causal models of mental illness by assembling risk-resilience,adverse outcome pathways(AOP),cognitome,brainome,staging,symptomatome,and phenomenome latent scores in a causal model.The latter may be trained,tested and validated with Partial Least Squares analysis.This approach not only allows to compute pathway-phenotypes or biosignatures,but also to construct reliable and replicable nomothetic networks,which are,therefore,generalizable as disease models.After integrating the validated feature vectors into a well-fitting nomothetic network,clustering analysis may be applied on the latent variable scores of the R/R,AOP,cognitome,brainome,and phenome latent vectors.This pattern recognition method may expose new(transdiagnostic)classes of patients which if cross-validated in independent samples may constitute new(transdiagnostic)nosological categories.
文摘Traditional therapeutic methods in psychiatry,such as psychopharmacology and psychotherapy help many people suffering from mental disorders,but in the long-term prove to be effective in a relatively small proportion of those affected.Therapeutically,resistant forms of mental disorders such as schizophrenia,major depressive disorder,and bipolar disorder lead to persistent distress and dysfunction in personal,social,and professional aspects.In an effort to address these problems,the translational approach in neuroscience has initiated the inclusion of novel or modified unconventional diagnostic and therapeutic techniques with promising results.For instance,neuroimaging data sets from multiple modalities provide insight into the nature of pathophysiological mechanisms such as disruptions of connectivity,integration,and segregation of neural networks,focusing on the treatment of mental disorders through instrumental biomedical methods such as electro-convulsive therapy(ECT),transcranial magnetic stimulation(TMS),transcranial direct current stimulation(tDCS)and deep brain stimulation(DBS).These methodologies have yielded promising results that have yet to be understood and improved to enhance the prognosis of the severe and persistent psychotic and affective disorders.The current review is focused on the translational approach in the management of schizophrenia and mood disorders,as well as the adaptation of new transdisciplinary diagnostic tools such as neuroimaging with concurrently administered psychopathological questionnaires and integration of the results into the therapeutic framework using various advanced instrumental biomedical tools such as ECT,TMS,tDCS and DBS.
文摘Objectives:In 2019,the Insititue for Health Metrics and Evaluation reported that 16%of life lost were attributed to mental health.As a result,global shortage of psychiatrists is a pressing issue due to the increasing burden of mental illness.In 2016,a mere 5%of US medical students chose psychiatry as a career,a trend mirrored in Germany and Italy.As the medical students of 2016 have graduated or transitioned into residency in 2023,their attitudes towards psychiatry could have contributed to today’s shortage of psychiatrists.The global mental health burden has only been exacerbated by the COVID-19 pandemic.This study explores the attitudes of German and Italian medical students towards psychiatry,their career aspirations,and the influence of factors such as personal experience and education on their interest in the field.Methods:A cross-sectional survey was conducted among 799 medical students in two European countries in 2016.Participants answered questions about their attitudes towards psychiatry,their psychiatric education,and personal experiences.Inferential analyses were performed using chi-square tests and a significance level of 0.05.Results:The number of years in medical school,personal experiences,and perceived quality of education significantly affected specialty choice and ranking of psychiatry compared to other specialties.Internships,psychiatric placements,and views on psychiatric instructors also played a significant role in choosing psychiatry as a career.Conclusions:Assessing medical students’attitudes towards psychiatry and the factors that influence their career choices,such as psychiatric education and personal experiences,can inform changes to attract students to the field.Addressing the worldwide shortage of psychiatrists is crucial to reduce the burden of mental health and substance use disorders.
文摘The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three-drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq;mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%;poly-therapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.
文摘In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the worldwide media, that it was positive to treat anxiety symptoms by regulating intestinal flora (RIF).
文摘Objective: The forensic mental health system in Japan changed dramatically with the enforcement of the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity” or MTS Act, in 2005. The aim of this study is to evaluate the changes in attitude and behavior of general psychiatrists, towards forensic psychiatry. Methods: We conducted a questionnaire survey in 2010 on forensic psychiatry for Japanese psychiatrists, mirroring a previous study from 2007. Results: Comparing the results from both questionnaires, it is not evident that awareness of forensic mental health has improved among psychiatrists in the intervening three years. Conclusion: Further education about forensic mental health needs to be considered inJapan.
文摘The coronavirus disease 2019 pandemic has significantly altered many aspects of our professional lives,including how psychiatry as a medical discipline is taught and learnt.Training in psychiatry relies on developing competencies through observing and interacting with patients,developing empathic consultation skills and seeking feedback from colleagues derived from cognitive and constructivist theories of learning,in a time-bound manner.The pandemic has drawn attention to the dual role of psychiatry residents as both trainees and physicians,with a pressing identity crisis at an inopportune time.This paper aims to illustrate some of the emerging themes in psychiatry training during the pandemic and some solutions for the same.
文摘<strong>Background and Objectives:</strong> Neuroleptics have revolutionized pharmacological management in psychiatry. The advent of atypical neuroleptics constitutes a major turning point in this therapeutic challenge. The objective of our study was to determine the prescription of these atypical neuroleptics in Fann’s psychiatry department. <strong>Methodology:</strong> It was a descriptive retrospective cross-sectional study that involved 223 patients hospitalized in the psychiatry department of Fann Hospital during the period from January 2015 to December 2017. <strong>Results:</strong> Our study shows a majority prescription of classic neuroleptics in combination Haloperidol-Chlorpromazine 53% and 14% in monotherapy and a prescription of atypical neuroleptics at 4%. They are prescribed in combination with the classics at 4%. <strong>Conclusion:</strong> These results show a still low prescription of atypical neuroleptics which raises questions about the availability and affordability of such drugs, but also about prescription habits in the context of developing country.
文摘Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.
文摘Background: Measuring cognition in clinical practice is clearly essential to the appropriate characterisation of patients’ clinical status and to the development of a personalised care plan. The Screen for Cognitive Impairment in Psychiatry (SCIP) has been developed in order to provide a brief and accessible tool allowing the evaluation of cognitive function in psychiatric conditions. Objective: We present a validation of a French version of the SCIP. Method: Translation from English into French is carried out using the accepted back-translation method. Seventy-two healthy volunteers are characterised by demographic questionnaires and a neuropsychological battery. The French version of the SCIP is then administered on two separate occasions separated by at least a one-week interval. Results: High internal consistencies as well as strong correlations with comparable neuropsychological tests are obtained. A normalised Cronbach’s α = 0.66 is obtained. Conclusions: The French version of the SCIP (SCIP-F) yields results comparable to the English version. The SCIP represents an essential tool for the preliminary evaluation of cognition. Its characteristics, brevity and the lack of need for a technological platform, allow for its integration into clinical practice. Further testing of SCIP-F in various psychiatric conditions will yield valuable information on its potential in clinical settings.
文摘Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developing countries,as well as infectious causes,like Tuberculosis(TB)in developing countries,contribute to significant disease burden.The literature points towards the coexistence of psychiatric disorders with respiratory disorders responsible for poorer outcomes.Despite the extensive burden of respiratory disorders and the presence of concurrent psychiatric disorders,studies focusing on their prevalence are limited in India.Methods:A cross-sectional psychiatric screening was carried out on sequential patients attending the tertiary respiratory unit over eight months.Those screened positive were interviewed in detail for psychiatric diagnosis and challenges in the management were discussed.Psychiatric diagnosis,pulmonary TB and medical comorbidity were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20.Results:Psychiatric morbidity was present in 100 out of 350 patients(28.57%).Tuberculosis was the most common diagnosis(46%)in subjects attending the respiratory clinic services while common mental disorders like depression,anxiety,and insomnia were the most common psychiatric concern(88%)in this study.Conclusion:Psychiatric disorders and medical morbidities are common in patients with respiratory disorders.Multiple factors determine the treatment adherence in both respiratory and psychiatric disorders.Screening for psychiatric disorders with the help of a consultation-liaison psychiatrist in respiratory units is recommended.Future studies should focus on developing dedicated psychiatry services to enhance overall outcomes in patients with respiratory disorders.
基金supported by the Zhejiang Provincial Key Research and Development Program (2021C03107)。
文摘Military psychiatry, a new subcategory of psychiatry, has become an invaluable, intangible effect of the war. In this review, we begin by examining related military research, summarizing the related epidemiological data, neuropathology, and the research achievements of diagnosis and treatment technology, and discussing its comorbidity and sequelae. To date, advances in neuroimaging and molecular biology have greatly boosted the studies on military traumatic brain injury(TBI). In particular, in terms of pathophysiological mechanisms, several preclinical studies have identified abnormal protein accumulation, blood–brain barrier damage, and brain metabolism abnormalities involved in the development of TBI. As an important concept in the field of psychiatry, TBI is based on organic injury, which is largely different from many other mental disorders. Therefore, military TBI is both neuropathic and psychopathic, and is an emerging challenge at the intersection of neurology and psychiatry.
文摘There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.
文摘Training course at the Shanghai Mental Health Center,July 4-6,2015This course will be conducted by the editorial team of the Shanghai Archives of Psychiatry(SHARP).This journal is the first psychiatric journal published in both English and Chinese and is indexed in several international databases,so the editorial team,which includes several native-English speakers,has rich experience in translating,writing,and revising academic articles about psychiatric topics in English.In
