"Otherness", otherism, discrimination, and health inequalities: entrenched challenges for modern psychiatric disciplines.

Identity is a complex concept that can be informed by various factors, involving biological, psychological, experiential, and social influences. Specifically, one's social identity refers to the ways in which individuals can adopt attributes from established collective categories, like cultural identities, ethnic identities, gender identities, and class identities, amongst others. Social identity can encompass unique and diverse interactions at an individual level, known as micro-identities, that may be selectively expressed, hidden, or downplayed, contingent on distinct sociocultural settings. However, the formation of social identity is recurrently defined in opposition to perceptions of the Other, which can entail adverse paradigms of marginalisation, stigma, and discrimination. Although this theory of Otherness has been developed across different fields, particularly sociology, it may be important in psychiatric contexts as it can engender inherent risk factors and mental health inequalities. Consequently, this paper seeks to bring attention towards these issues, exploring the construction of Otherness and its detrimental outcomes for psychiatry, such as systemic discrimination and disparities in therapeutic support, alongside recommended initiatives to mitigate against the effects of Otherness. This may require multifactorial approaches that include cultural competency training, interventions informed by micro-identities and intersectionality, patient advocacy, and structural changes to mental health policy.

Outside/inside: social determinants of mental health.

Individuals' mental health and wellbeing are dependent on many social factors including housing, employment, education and adequate nutrition among others. These factors can influence at personal, family and community levels. The interlinked and cumulative impact of these social determinants needs to be ascertained to aid appropriate patient management, as well as to establish prevention and health education programmes. Some of these determinants also have to be recognised at policy level. It is crucial for clinicians to understand the role social determinants play in the genesis and perpetuation of mental and physical illnesses, so that appropriate social interventions can be set in place. Clinicians have a role to play in their clinical practice, as well as advocates for their patients and policy leaders. In order to ensure that health is joined up with other sectors, such as education, employment, judiciary and housing, policy-makers must avoid silos. Every policy must have an impact assessment on physical health and mental health. Policy-makers need to understand scientific evidence and must work with researchers, clinicians, communities and patients to help develop and implement rights-based policies.

Psychological therapies and non-suicidal self-injury in LGBTIQ in accident and emergency departments in the UK: a scoping review.

BACKGROUND: To identify psychological interventions that improve outcomes for those who overdose, especially amongst Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning populations. OBJECTIVE: To recognize and assess the results from all studies including randomized control trials (RCTs) that have studied the efficiency of psychiatric and psychological assessment of people who have depression that undergo non-suicidal self-injury (NSSI) by self-poisoning, presenting to UK Accident and Emergency Departments. METHOD: A scoping review of all studies including RCTs of psychiatric and psychological therapy treatments. Studies were selected according to types of engagement and intervention received. All studies including RCTs available in databases since 1998 in the Wiley version of the Cochrane controlled trials register in 1998 till 2021, Psych INFO, Medline, Google Scholar and from manually searching of journals were included. Studies that included information on repetition of the NSSI behaviour were also included. Altogether this amounts to 3900 randomized study participants with outcome data. RESULTS: Seven trials reported repetition of NSSI as an outcome measure which were classified into four categories. Problem-solving therapy is indicated as a promising therapy and has shown to significantly reduce repetition in participants who NSSI by overdosing than patients in the control treatment groups consisting of standard after care. CONCLUSION: The data show that manualized cognitive therapy psychological intervention was more effective than TAU after care. However, these differences are not statistically significant with p = .15; CI 0.61, 1.0 which crosses the line of no effect. And psychodynamic interpersonal therapy is more effective than the standard treatment. Despite being only one study in this subgroup the analysis shows a statistical significance with p = .009, CI 0.08; 0.7.

International medical graduates: challenges and solutions in psychiatry.

International medical graduates provide a valuable service to the healthcare of their adopted countries. However, there remain a significant number of challenges in their adjustment and acculturation in the post-migration phase. We believe that the cultural capital these doctors bring with them can act as a support as well as a challenge. They are likely to face subtle and not-so-subtle, covert and overt discrimination at a number of levels. In this brief report, we highlight some of the issues faced by them and some potential solutions.

Prevalence of burnout in medical students in Guatemala: Before and during Covid-19 pandemic comparison.

Burnout is a syndrome consisting of physical, emotional, and mental exhaustion along with depersonalization and poor sense of personal accomplishment. Often related to work conditions. Several recent studies from around the world have shown high rates of burnout among medical students in different countries. In Guatemala City, we decided to assess levels of burnout in 2017 and then again in December 2020. In the first wave from one private medical school, we had a total of 159 respondents (response rate of 56.7%) and 132 (48.5%) in the second wave. Not surprisingly rates of burnout were higher during the pandemic even though response rate is lower. Surprisingly we found that rates of depersonalization had not increased, and levels of personal accomplishment had. These findings present a mixed picture of levels of burnout in Guatemala City. Further qualitative research is indicated to explore cultural differences in order to set up appropriate and suitable intervention strategies.