Psychiatrist's opinion as a premise for legal termination of pregnancy. / Orzeczenie lekarza psychiatry jako przeslanka legalnego przerwania ciazy.

The article presents the provisions currently in force in Polish legislation regarding legal termination of pregnancy. In particular, it refers to the premise of a psychiatrist's decision that the health of a pregnant woman is at risk. Under Polish law, termination of pregnancy is generally prohibited and penalized. However, there are two exceptions to this prohibition. Such a procedure is permitted if: the pregnancy poses a threat to the life or health of the pregnant woman, or if there is a reasonable suspicion that the pregnancy was the result of a prohibited act. The text presents an overview of the relevant regulations and tips on their interpretation and application in everyday medical practice. This issue is particularly important for psychiatrists consulting maternity wards. In addition, the most important mental disorders related to pregnancy and childbirth are described. The clinical features and prevalence of perinatal mood disorders and psychoses are presented. The issue of suicide among pregnant and postpartum patients was also discussed. A sample certificate template was proposed, and guidelines were discussed as to what information and conclusions should be included in the opinion of a psychiatrist.

Nutrition in Mental Health: Insight from a Survey Among Psychiatrists and Psychologists.

INTRODUCTION: There is growing evidence supporting dietary interventions in major depressive disorders and other mental disorders. The WPA Action Plan 2023-2026 prioritises several actions including the improvement and the preservation of mental health through the adoption of healthy lifestyle choices illustrated in the Healthy Lifestyles Hub and research. Greater emphasis on physical activity, nutrition and sleep hygiene between patients and psychiatric staff is an objective of WPA Action Plan 2023-2026. METHODS: The survey was conducted from May to June 2024 using Google Forms. A questionnaire was administered to a sample of mental health professionals and consisted of statements investigating specific knowledge in nutritional Psychiatry and adoption of strategies to improve nutritional interventions in mental health. With this study, we aimed to investigate insight and attitudes on nutrition in mental health among a sample of psychiatrists and psychologists resident in Italy. RESULTS: 110 participants (61 psychologists, 46 adult psychiatrists and 3 child psychiatrists) agreed to participate in our survey. 89.2% (n=91) of them worked in southern Italy. The majority of participants were female (77.98%) and reported working in a Mental Health Centre (n=41, 37,27%), followed by psychiatric residential facilities (n=22, 20%), private practice (n=19, 17.27%), hospital (n=14, 12.73%), university research centre (n=4. 3.64%), other non specified institute (n=10; 9.09%). When asked the importance of a nutritional approach in the context of mental disorders no difference was found between the professional groups (p-value 0.653). Female gender is most represented, although not significantly (p-value 0.161). The need for further research in the field of nutritional psychiatry is widely considered by all mental health professionals, but without professional (p-value=0.416) and gender differences (p-value=0.426). Psychologists statistically significantly reported the need for specific training in nutritional psychiatry (p-value 0.004). We found a significant coefficient between number of years of working experience and nutritional training needs among all health professionals (tau -0.169; p-value = 0.022). CONCLUSIONS: Specific nutrition training courses both for adult and child psychiatrists and psychologists are needed in order to increase awareness on nutrition as a well-being contributing factor in the biopsychosocial model.

Perspectives on the Practice of Collaborative Care: Topical Themes and Future Directions From the Lens of a Collaborative Care Child Psychiatrist.

The increasing shortage of psychiatrists in the workforce is a well-documented and alarming trend. In light of this workforce shortage, psychiatrists bear a professional and ethical responsibility to identify strategies to increase access to mental health treatment and thereby reduce the impact of the psychiatrist shortage on patients and on the greater health system. One such strategy is the collaborative care model (CoCM), which has demonstrated efficacy in the mental health treatment of both pediatric and adult populations. In this article, the CoCM is presented as one effective strategy to address the behavioral workforce shortage. Current themes observed from the clinical practice of psychiatric collaborative care in a pediatric collaborative care setting are discussed with contemplation of future directions.

Phytotherapy in psychiatry: why psychiatrists should know about it.

There is a substantial use of Complementary and Alternative Medicine (CAM) among both the general population and psychiatric patients, with only a minority of these users disclosing this information to their healthcare providers, including physicians and psychiatrists. This widespread use of CAM can impact positively or negatively on the clinical outcomes of psychiatric patients, and it is often done along with conventional medicines. Among CAM, phytotherapy has a major clinical relevance due to the introduction of potential adverse effects and drug interactions. Thus, the psychiatrist must learn about phytotherapy and stay up-to-date with solid scientific knowledge about phytotherapeutics/herbal medicines to ensure optimal outcomes for their patients. Furthermore, questions about herbal medicines should be routinely asked to psychiatric patients. Finally, scientifically sound research must be conducted on this subject.

It looks like nature - a phenomenological study of the built environment in psychotherapy from psychologists' and psychiatrists' perspective.

INTRODUCTION: The study aims to examine psychologists' and psychiatrists' experiences of built environments, indoors and outdoors, in providing psychotherapy. The research explores how the environment matters in clinical practice from the perspective of psychologists and psychiatrists and seeks to comprehend the significance of the facilities where psychotherapy takes place. METHODS: This study design is explorative and qualitative. Data is generated by eight in-depth interviews with six clinical psychologists and two psychiatrists and was analyzed using an interpretative phenomenological approach. RESULTS: Our findings revealed that the built environment matters in clinical practice as it appears to be closely linked to fostering a more comprehensive approach and facilitating various associations and themes in psychotherapy. Three superordinate themes emerged from the data: Design as therapeutic tool, Nature as a co-therapist, and lastly, Expanding the therapeutic space, highlights the participants' perspective on the transformative potential of the built environment to become therapeutic. CONCLUSION: The findings reveal how built environments can be actively utilized as tools in psychotherapy. Environments are not to be considered merely as neutral and passive spaces for conducting and receiving psychotherapy rather than experienced as places that may regulate and impact both therapists and patients, the relationship between them.

Psychiatrists effect on positive symptom severity and daily functioning during pharmacotherapy for first-episode psychosis patients.

Clinical outcomes after a first-episode of psychosis (FEP) are heterogeneous. Many patient-related factors such as gender and comorbidity have been studied to predict symptomatic outcomes. However, psychiatrist-related factors such as prescription behaviour and gender have received little attention. We assessed the relationship between patients' psychiatrists, psychosis severity and daily functioning in 201 patients remitted from an FEP for a duration of one year, treated by 18 different psychiatrists. We controlled for baseline severity, dose and type of antipsychotic medication, frequency of visits, and patients' education. Symptom severity, daily functioning, and antipsychotic drug use were assessed at baseline and at 3, 6, and, 12 months follow-up. We found that psychiatrists accounted for 9.1% of the explained variance in patients' symptom severity and 10.1% of the explained variance in daily functioning.These effects persisted even when controlling for factors such as baseline severity and the prescribed dose. The effect of prescribed dose on symptom severity and daily functioning differed between psychiatrists. Treatment centre, session frequency, and medication nonadherence were not related to symptom severity. Our results emphasize the importance of individual psychiatrist factors in symptomatic outcomes after an FEP. Further identification of psychiatrist-related factors such as the quality of therapeutic alliances and shared decision-making, may optimize psychiatrists' training with the goal of improving patient outcomes.

[Disciplinary cases against psychiatrists and medical residents, 2020-2023]. / Tuchtzaken tegen psychiaters en a(n)iossen, 2020-2023.

BACKGROUND: Recent years, there has been increasing attention to disciplinary law, both in (mental) healthcare and in society. Specific quantitative data are limitedly available. AIM: Gaining insight into disciplinary jurisprudence, particularly the number/type of complaints, concerning psychiatrists and medical residents working in psychiatry. METHOD: Descriptive retrospective study. All published decisions of regional disciplinary tribunals from the period 2020-2023 concerning psychiatrists and psychiatric medical residents were examined. RESULTS: During the research period, regional disciplinary tribunals handled 190 unique disciplinary complaints; an average of 47.5 per year. 176 complaints concerned a psychiatrist and 14 complaints a medical resident. Most complaints were about ‘incorrect treatment/wrong diagnosis’, ‘other complaints’, or ‘incorrect statement or report’. 15.3% resulted in a sanction, mainly warnings. CONCLUSION: Over the past four years, there have been fewer disciplinary complaints annually against psychiatrists and psychiatric medical assistants compared to the five years before that. The nature of the complaints has remained largely unchanged, but fewer complaints resulted in a sanction. This exploratory analysis suggests the need for periodic follow-up research.

[Risk management of violence: a core professional activity of every psychiatrist]. / Het inschatten van risico op geweld naar anderen: een kernactiviteit van iedere psychiater.

BACKGROUND: Risk management is an entrustable professional activity in the Dutch curriculum for psychiatrists in training. However, many psychiatrists feel they lack the training and experience needed to conduct an adequate risk assessment of violence. AIM: Theoretical reflection on methods and practical techniques to adequately assess violence in patients with severe mental disorders. METHOD: Review of the international literature to deliver recommendations for (non-forensic) clinical practitioners. RESULTS: Risk assessment starts with contact and a trusting therapeutic relationship, followed by a thorough mental health evaluation, screening questions to explore thoughts and history of harming others, and examination of predisposing, triggering and sustaining risk and protective factors, and warning signs. Structured tools can help to ensure that all critical items are addressed. Risk management should be incorporated whenever indicated in a treatment and safety plan, aimed to the patient’s struggles and suffering in interpersonal functioning. CONCLUSION: Violence is an important adverse outcome in clinical services for patients with severe mental illness. Risk management of violence, integrated in the general diagnostic process and treatment plan, contributes to compassionate mental health care, and increase safety of family members, fellow patients, health professionals, and others.

The Neurocircuitry of Substance Use Disorder, Treatment, and Change: A Resource for Clinical Psychiatrists.

Substance use disorder (SUD) is common in psychiatric patients and has a negative impact on health and well-being. However, SUD often goes untreated, and there is a need for psychiatrists, of all specialties, to address this pervasive clinical problem. In this review, the authors' goal is to provide a resource that describes treatments for SUD, using neuroscience as a framework. They discuss the effect of pharmacotherapy on craving, intoxication, and withdrawal and its ability to interrupt the cycle of substance use in SUD. The neuroscience of stress is reviewed, including medications targeting neurotransmitter systems activated by alarm and fear. Neuroplasticity and promising treatments that use this mechanism, including ketamine, psilocybin, and transcranial magnetic stimulation (TMS), are discussed. The authors conclude by listing resources and practice guidelines for physicians interested in learning more about treatments for SUD.

Hans Berger (1873-1941): the German psychiatrist who recorded the first electrical brain signal in humans 100 years ago.

In 1924, at the University Hospital of Jena, Hans Berger first recorded an electrical brain signal in humans. This discovery revolutionized clinical neuroscience and neurotechnology, as it contributed to both electrophysiology and the development of the electroencephalogram (EEG). This article provides a historical overview of Hans Berger's seminal contributions, highlighting the importance of his early recordings, the motivations that drove him, and the scientific problems he had to initiate and solve, in a historical context of profoundly changing circumstances. He also faced low acceptance of his works initially, and only belatedly did they become accepted by the scientific community. Berger was known to be a humble but tenacious person who believed in his convictions to the core, and this strength of will is an example of passion for students and scholars of neuroscience.NEW & NOTEWORTHY In 1924, at the University Hospital in Jena, Hans Berger first recorded human brain electrical signals, revolutionizing clinical neurophysiology and neurotechnology. He developed the electroencephalogram (EEG) and identified alpha waves in the human scalp. Although initially met with skepticism, his work was later recognized as fundamental. Berger's perseverance and conviction in his research serve as an inspiring example of dedication for students and scientists in neuroscience.

Borderlines of psychosis - nosological propositions of Polish psychiatrists of the interwar period. / Pogranicza psychozy ­ nozologiczne propozycje polskich psychiatrów dwudziestolecia miedzywojennego.

This paper examines nosological categories relating to borderlines between psychosis and other clinical categories, introduced by Polish psychiatrists in the interwar period. In the United States, the discussion about the borderline between neuroses and psychoses was urged by the 1938 article by psychoanalyst Adolph Stern. In Poland, nosological categories regarding the borderline between neuroses and psychoses were proposed by Adam Wizel, Maurycy Bornsztajn, Jan Nelken, and Wladyslaw Matecki. Wizel coined the term 'underdeveloped schizophrenia', Bornsztajn introduced 'schizothymia reactiva' and 'hypochondriac (somatopsychic) schizophrenia', Nelken described 'mild schizophrenia', first introduced by Moscow psychiatric school of Rosenstein, and Matecki presented the category of neurosis-like (pseudo-neurotic) schizophrenia. Additionally, Julian Dretler, after studying the borderline between schizophrenia and manic-depressive psychosis, coined the term 'mixed psychosis' and expressed conviction that it is an independent nosological entity. Like in the United States, the majority of Polish pioneers of the nosological studies of borderline cases were influenced by psychoanalysis. As a consequence of World War II and the new regime, which forced dialectical materialism and Pavlovism as an official ideology of psychiatry and condemned psychoanalysis, the categories presented in the article became forgotten and have not impacted Polish psychiatric nosology.

Skills Needed in Psychiatrist Leadership for Building and Sustaining Child Mental Health Systems of Care.

Systems of care (SOC) is a proven and community-based service network addressing the mental health needs of children and families. Child and adolescent psychiatrists play a crucial role in leading SOCs, utilizing skills such as partnership building and strategic planning. Barriers to mental health care, including access issues and stigma, can be tackled through multisector collaboration. Overcoming challenges such as cultural differences and fragmented systems requires effective leadership. In a SOC, core principles involve culturally competent care, evidence-based practices, collaborative decision-making, and smooth transitions of care. Championing these principles fosters a holistic and supportive environment for those facing mental health challenges.

Factors affecting psychiatrist hesitation towards epilepsy care and care for patients with epilepsy transitioning from pediatric to adult care: A survey by the Japanese Society of General Hospital Psychiatry.

OBJECTIVE: This study was undertaken by the Epilepsy Subcommittee of the Japanese Society of General Hospital Psychiatry (JSGHP) to explore the challenges faced by psychiatrists in treating epilepsy and the difficulties encountered during the transition of patients with epilepsy (PWE) from pediatric to adult care. METHODS: An online survey targeting 1,980 JSGHP-affiliated psychiatrists was conducted from May to July 2022. The participants were asked to complete a questionnaire on epilepsy care. We analyzed the factors associated with participant hesitancy to treat epilepsy and their professional characteristics. RESULTS: Responses were obtained from 545 of the 1,980 solicited psychiatrists (response rate: 27.5 %). The mean number of years of clinical experience in psychiatry was 20.9 ± 10.3 years. A majority of the psychiatrists were hesitant toward treating epilepsy (89.2 %) and managing the transition of PWE from pediatric services to adult care (83.3 %). Logistic regression analysis showed that the absence of hesitation toward epilepsy treatment was significantly associated with years of clinical experience in psychiatry (OR: 1.05, p = 0.002), being a board-certified epileptologist (OR: 4.36, p = 0.037), having colleagues who are specialists in epilepsy care that may be consulted in the workplace (OR: 2.12, p = 0.027), and general confidence in managing PWE transition from pediatric to adult care (OR 3.54, p < 0.001). Confidence in managing the transition was positively correlated with being a board-certified psychiatrist of the Japanese Society of Psychiatry and Neurology (OR: 4.55, p = 0.048), being a board-certified psychiatrist of the JSGHP (OR: 1.75, p = 0.034), treating six or more PWE per month (OR: 3.54; 95 % CI, p < 0.001), and overall confidence in treating epilepsy (OR: 3.38, p < 0.001). CONCLUSIONS: Alleviation of reluctance to providing epilepsy care and managing the process of transition are correlated; however, the factors influencing each are distinct. To reduce resistance to epilepsy treatment, enhancing the knowledge of epilepsy and creating an environment conducive to consultations are essential. Improving transition-related outcomes, having substantial psychiatric expertise, and increasing opportunities to treat PWE are of great significance. The integration of these approaches may enable psychiatrists to alleviate hesitancy towards epilepsy care and enhance both treatment and transitional care modalities.

Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

Perceptions of bias and credibility of male and female clinical psychologist and psychiatrist expert witnesses presenting clinical information in the courtroom.

Expert witness credentials and gender have independently been shown to influence jurors' perceptions of expert witness credibility and legal decision-making. This study examined how manipulations of expert witness gender (Male/Female) and profession (Consultant Clinical Psychologist/Consultant Psychiatrist) together affected mock jurors' perceptions of expert witness credibility, judgements, and decision-making. Mock jurors (N = 182; 80.9 % were White) were recruited from England and Wales and were randomly assigned to watch a video-recorded mock expert witness testimony. Participants rated the expert witness using the Witness Credibility Scale and reported the likelihood of assigning the defendant to a guilty verdict. Results showed significant interaction effects of expert witness gender and profession on jurors' perceptions of their likeability, trustworthiness, knowledge, and total credibility. Male psychiatrists, followed by female clinical psychologists, received the highest scores in most credibility variables. Varied main effects of expert witness gender and profession on credibility were also found. Overall, jurors' ratings of expert witness credibility, when controlled by the expert's gender and profession, predicted jurors' determination of guilt. This study provides evidence of a potential interaction effect between profession and gender in expert witness credibility and supports existing research linking credibility with ultimate decision-making. More research is needed to understand jurors' unconscious biases and cognitive processes in making legal decisions.