A Qualitative Investigation Into Faith and LGBTQ Identities in a Nonclinical Sample of Readers of the Dear Abby Column: The Dear Abby Project.

ABSTRACT: To better understand the relationship between faith and LGBTQ+ identity, we conducted a qualitative analysis of 86 respondents to a general question posed through the Dear Abby column. Responses were anonymized and analyzed using a grounded theory approach. Analysis revealed six themes, reflecting a diversity of lived experience from community rejection to acceptance, and self-rejection to feelings of acceptance by God. Despite frequent media portrayals of conflict between faith and LGBTQ+ identity, the reality is more complex, and faith and LGBTQ+ identity development can be complementary.

From Information to Simulation: Improving Competency in ECT Training Using High-Fidelity Simulation.

OBJECTIVE: This study was intended to develop a new educational model that supplements ECT didactics with simulation-based procedural training and to evaluate the learning gains conferred by such a curriculum. METHODS: Two types of curricula were evaluated for educational efficacy in this prospective randomized controlled trial. Psychiatry residents (n = 35) completed surveys to ascertain their baseline experience, knowledge, and proficiency with the ECT procedure. They were then block-randomized to receive either a didactic ECT curriculum (non-SIM) or one augmented by simulation training (SIM). Three months post-completion of the two types of instruction, all residents were re-administered the surveys and a procedural post-assessment. RESULTS: The median number of ECTs performed prior to the study was similar between the two groups (SIM group = 3, non-SIM group = 4.) The SIM group showed significant improvement on pre- and post- survey theoretical knowledge scores: 51% (95% CI = 41 to 61%) and 69% (95% CI = 64 to 74%), respectively, p = .02; this difference was not significant in the non-SIM group, p = .2. Improvement between pre- and post- proficiency scores were seen in the SIM group: 22% (95% CI = 13 to 32%) and 51% (95% CI = 53 to 59%), p < .001 while the effect was less pronounced in the non-SIM group. Inter-rater agreement for the proficiency assessment was excellent: k, = .9. CONCLUSIONS: Residents showed significant improvement in knowledge, comfort, and skills following ECT simulation training. With the proposed curriculum, residents would receive comprehensive education not only in the theory behind ECT but also in procedural skills. This curriculum can be modeled in other programs that do not have extensive ECT facilities.

Understanding Patterns of Intimate Partner Abuse in Male-Male, Male-Female, and Female-Female Couples.

Intimate Partner Abuse (IPA), a major social problem, can lead to mental health conditions and is implicated in 30 % of female and 5 % of male homicide deaths. We hypothesized that due to distinct relationship structures and power dynamics which are immersed in varying sociocultural contexts, victims of male-male, female-female and female-male dyads experience different patterns of IPA. Our objectives were: (1) To examine the demographic and clinical characteristics of victims of male victim-male abuser (M-M), female victim-male abuser (F-M), male victim-female abuser (M-F), and female victim-female abuser (F-F) dyads. (2) To compare patterns of IPA reported by the victims in these groups. Out of 397 subjects in the general population that attempted this Internet-based study, 214 English-speaking subjects were older than 18 years, had experienced IPA, and provided complete information for the analysis. Victims of IPA were screened and specific methods of abuse were evaluated. M-Ms were significantly more educated (70 %) than other groups. F-Fs experienced more abuse before age 18 by a parent or relative. F-Fs experienced the most physical abuse while M-Ms the least (p = 0.004). Physical abuse or threats of abuse in front of children was reported more in F-Fs (p < 0.01) and least in M-Ms. IPA patterns differ significantly with F-Fs presenting the most physical profile and M-Ms presenting the least.

The Growing Regulation of Conversion Therapy.

Conversion therapies are any treatments, including individual talk therapy, behavioral (e.g. aversive stimuli), group therapy or milieu (e.g. "retreats or inpatient treatments" relying on all of the above methods) treatments, which attempt to change an individual's sexual orientation from homosexual to heterosexual. However these practices have been repudiated by major mental health organizations because of increasing evidence that they are ineffective and may cause harm to patients and their families who fail to change. At present, California, New Jersey, Oregon, Illinois, Washington, DC, and the Canadian Province of Ontario have passed legislation banning conversion therapy for minors and an increasing number of US States are considering similar bans. In April 2015, the Obama administration also called for a ban on conversion therapies for minors. The growing trend toward banning conversion therapies creates challenges for licensing boards and ethics committees, most of which are unfamiliar with the issues raised by complaints against conversion therapists. This paper reviews the history of conversion therapy practices as well as clinical, ethical and research issues they raise. With this information, state licensing boards, ethics committees and other regulatory bodies will be better able to adjudicate complaints from members of the public who have been exposed to conversion therapies.

Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units.

Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.

A proposed role for the psychiatrist in the treatment of adolescents with type I diabetes.

Type I diabetes is a chronic illness that most frequently develops during childhood. As a medical doctor with an understanding of psychology and human development, the psychiatrist is in a unique position to guide the child or adolescent with diabetes and his family through the typical lifestyle adjustments that are encountered when diagnosed with diabetes. This article presents an overview of the diagnosis and management of type I diabetes, reviews the ways in which diabetes will interact with child development, and discusses the increased rates of eating disorders and mood disorders among children with type I diabetes. There is a distinct role for the psychiatrist to be involved in the diabetes care team of children and adolescents diagnosed with type I diabetes and this role can be medically crucial.

Ground one.

The events of September 11th, 2001, have had long-lasting effects on our culture, interpersonal relationships, understanding of evil intent and terrorism, and approach to and treatment of trauma states. This article is a personal account of September 11th by a junior attending psychiatrist as he experienced it from St. Vincent's Hospital, the closest level-one trauma center and coordinated medical response center to the World Trade Center.