Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Peruvian psychiatry in America and the world: its journey in search of an identity.

Throughout history, Latin American psychiatry has followed a variety of routes as its mythic-religious origins experienced the various influences of European and North American ideas of the last three centuries. In its modern trajectory, a post-colonial subordination was followed by a more selective import of ideas and a critical approach to their application in the New Continent. At one point, the identity of Latin American psychiatry was essentially considered mestiza, social and critical, reflecting a search for autonomy and originality. In this journey, Peruvian psychiatry has been considered one of the most representative versions of the history and position of the discipline. This article attempts to detail the identity-seeking process of Peruvian and Latin American Psychiatry through the life and work of three notable Peruvian figures: Honorio Delgado, Carlos Alberto Seguín and Humberto Rotondo. Delgado fostered the need for scientific evidence in support of any piece of knowledge, as well as humanism as essential component of best service and optimal patient care. Seguín led studies on folkloric and ethnic psychiatry, stimulated integrated approaches to care, and advocated in favour of a regional identity for psychiatry.

Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial.

BackgroundThere is a need for clinical tools to identify cultural issues in diagnostic assessment.AimsTo assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.MethodMixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.ResultsMixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.ConclusionsThe CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial.

OBJECTIVE: This study's objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. METHOD: The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians' first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. RESULTS: Most frequently, clinicians named case-based behavioral simulations as "most helpful" and video as "least helpful" training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician's age was associated with a preference for behavioral simulations: OR = 1.05 (95 % CI: 1.01-1.10; p = 0.025). CONCLUSIONS: Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.

[Cultural components within DSM-5: achievements, hopes, and expectations]. / Componentes culturales en DSM-5: logros, ilusiones y esperanzas.

Cultural Psychiatry deals with the description, definition, evaluation and management of psychiatric conditions as a clinical reflection of cultural factors within an integral context, and as an explanatory, interpretative, nosological, therapeutic and preventive attribute in professional practice. This article attempts to analyze that link in the context of the dominant classification in our era, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA), with emphasis on the development of its latest version, DSM-5. The cultural content of the International Classification of Diseases (ICD) of the World Health Organization (WHO) can be the subject of further analysis, even when it can be said that, in general, it seemingly has less reach than the American classification. The author's participation, work and reflections about the DSM-5 Committee, created by the APA at the beginning of this century, constitute the basis of the presentation and discussion of concrete achievements, more or less idealized hopes, and more or less realistic expectations with a view to the future. Conclusions will also try to cover implications of DSM-5 cultural components in the field of Latin American and spanish-speaking psychiatry.

Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study.

BACKGROUND: The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations. METHODS: Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them. RESULTS: The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use. CONCLUSIONS: Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research. LIMITATIONS: Online data collection may have resulted in the underrepresentation of certain population groups.

GAP-REACH: a checklist to assess comprehensive reporting of race, ethnicity, and culture in psychiatric publications.

Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-item GAP-REACH checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article.

Cultural psychiatry: a general perspective.

The current scene in the field of cultural psychiatry shows a vigorous growth, multifaceted conceptual and research developments and more relevant clinical presence. After a pertinent definition of the discipline, this chapter examines the contribution of cultural psychiatry to the etiopathogenesis of mental disorders, to the variations of clinical presentations in numerous entities, to psychiatric diagnosis and treatment and to the relatively unexplored rubric of preventive psychiatry. Advanced concepts of neurosciences and technology-based research can find a place in the realm of biocultural correlates. The role of culture in the definition of mental illness, the renewed notions of the old 'culture-bound syndromes', hope, cognition and culture in psychiatric treatments (including the so-called 'cultural therapies'), and resiliency are areas duly examined and discussed. Cultural psychiatry has re-emerged as a reliable body of knowledge aimed at a comprehensive assessment of human beings as patients.

Educating psychiatry residents about cultural aspects of care: a qualitative study of approaches used by U.S. expert faculty.

BACKGROUND/OBJECTIVE: Almost no literature compares current approaches to teaching cultural issues across U.S. psychiatry residency programs; the authors addressed this comparison. METHODS: The authors administered semistructured interviews of 20 instructors with substantial experience in the teaching of cultural issues in U.S. psychiatry residency programs, regarding the content, teaching techniques, institutional context, and evaluation of their curricula over time. RESULTS: Approaches varied according to the local populations served and the background of the instructors, all of whom were either cross-trained in social sciences and humanities or were themselves ethnic, racial, or sexual minorities. Common themes emerged, including the use of experiential approaches, the lack of integration of cultural issues into clinical supervision or courses on other topics, and the absence of formal course evaluation. DISCUSSION: Findings indicate a need for integration of cultural concepts into a variety of settings throughout residency, for development of faculty who are cross-trained in social sciences and humanities, and for curriculum-evaluation strategies.

Debates on the narcissism conundrum: trait, domain, dimension, type, or disorder?

The clinical implications of the term narcissism are a matter of continuous debate. This article critically examines pertinent literature of the last 12 years using a set of validators and attempting to identify narcissism as a trait, a domain, a dimension, or a personality disorder/type. Narcissistic personality disorder (NPD)-specific literature (particularly in epidemiological, developmental, and laboratory-testing areas) is scarce when compared with other personality disorders. A tendency to ideologically dominated clinical reports is observed with individual cases or small samples of nonclinical populations. Clinical descriptions of the condition vary within a wide range of descriptors, superficial or ambiguous conceptualizations, different subtypes, and inconclusive meta-analytical findings. Comorbidity with many Axes I and II conditions and the presence of narcissistic behavioral and emotional manifestations in other DSM conditions were frequent findings. The reintroduction of NPD in the personality disorders DSM-5 proposal seems to be related to nonclinical or heuristic considerations. It is concluded that NPD as such shows nosological inconsistency and that its consideration as a trait domain with needed further research would be strongly beneficial to the field.

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study.

INTRODUCTION: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question. MATERIAL AND METHODS: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small. CONCLUSIONS: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

Using game format to teach psychopharmacology to medical students.

BACKGROUND: Most psychiatric programs provide lectures on basic principles of psychopharmacology. Yet, this traditional approach has been criticized due to excessive information and passive transfer of expert knowledge. An alternative teaching method is the use of "academic games." AIMS: To investigate medical students' acquisition of knowledge on psychopharmacology, and their perception of a game playing approach compared to traditional lectures. METHODS: Two senior residents designed, implemented, and executed a randomized pretest-posttest study to teach psychopharmacology, using an academic game and a lecture format, to third-year medical students during a 6-week Psychiatry clerkship. Both didactic interventions were delivered concurrently for five consecutive weeks covering five psychopharmacology modules: antidepressants I (selective serotonin reuptake inhibitors and atypical antidepressants), antidepressants II (monoamine oxidase inhibitors and tricyclic antidepressants), mood stabilizers, antipsychotics, and anti-anxiety agents/sedatives/hypnotics. The game follows similar rules of the famous TV show, "Jeopardy" using a power point grid and a multiple choice question format. RESULTS: Forty-three medical students participated (29 assigned to the game approach, 14 to the traditional lecture approach). None of the demographic variables (age, gender, years after graduation, Graduate Point Averages, and United States Medical Licensing Examination 1) were significantly associated with the pre/posttest score difference between groups. Both groups improved their knowledge on psychotropic drugs [(game group t = 10.86, p < 0.001); control t = 4.82, p < 0.001)] throughout the 6-week Psychiatry rotation. Students in the game group had a better perception of this educational method as measured by perceived enjoyment, increased knowledge of psychopharmacology, and stimulating interest in the subject compared to those in the lecture group (p < 0.05). CONCLUSIONS: Teaching psychopharmacology in medical students by using academic games can make the learning experience more enjoyable and motivating; however, future studies with higher quality methodology and design are needed to determine the role of educational games in acquiring new psychopharmacological knowledge.

Time for healing: somatization among chronically mentally ill immigrants.

In a cross-sectional study, we examined demographic factors and acculturation level with somatization among chronically mentally ill groups of immigrants (Russians and Latinos). Ninety Russian and 90 Latino patients attending a university affiliated Day Treatment Program were assessed on somatoform symptoms and acculturation by the 12-item somatization subscale of the SCL-90-R and by a 12- items short acculturation scale, respectively. Higher somatization was significantly associated to women, Russian ethnicity, high school or above level of education, shorter length of residence in the U.S., and lower acculturation. Interaction by ethnic group showed that somatization was influenced by the length of residence in the U.S. among Russians but not among Hispanics. In a multivariate model, higher somatization corresponds to female, Russian, and shorter residence in the U.S. (only among Russians). Length of stay in the host country rather than the level of acculturation influence the frequency of somatic complaints, modified by ethnicity.

Self-report screening instruments differentiate bipolar disorder and borderline personality disorder.

BACKGROUND: Bipolar disorder (BD) and borderline personality disorder (BPD) share overlapping phenomenology and are frequently misdiagnosed. This study investigated the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) and McLean Screening Instrument for Borderline Personality Disorder (MSI) in a clinical inpatient setting and whether individual screening items could differentiate BD from BPD. METHODS: 757 sequential inpatients admitted to a Mood Disorder Unit completed both the MDQ and MSI. Screen positive for the MDQ was defined as ≥7/13 symptoms endorsed with concurrence and at least moderate impact. Screen positive for the MSI was defined as a score of ≥7. The clinical discharge summary diagnosis completed by a board-certified psychiatrist was used as the reference standard to identify concordance rates of a positive screen with clinical diagnosis. Individual items predicting one disorder and simultaneously predicting absence of other disorder by odds ratio (OR>and <1) were identified. RESULTS: Both screening instruments were more specific than sensitive (MDQ 83.7%/ 67.8%, MSI 73.2% / 63.3%). MDQ individual items (elevated mood, grandiosity, increased energy, pressured speech, decreased need for sleep, hyperactivity) were significant predictors of BD diagnosis and non-predictors of BPD diagnosis. Whereas MSI subitem, self-harm behaviors/suicidal attempts predicted BPD in the absence of BD; distrust and irritability were additional predictors of BPD. CONCLUSION: While this study is limited by the lack of structured diagnostic interview, these data provide differential symptoms to discriminate BD and BPD. Further work with larger datasets and more rigorous bioinformatics machine learning methodology is encouraged to continue to identify distinguishing features of these two disorders to guide diagnostic precision and subsequent treatment recommendations.

Crossroads: Identity struggles in Latin America and Latin American psychiatry.

Identity can be defined from different perspectives such as those from philosophy, social sciences and phenomenology. The latter entails sameness, uniqueness, distinctiveness, continuity, diversity, universality and equality connotations to define characteristics of the existence and action of individuals, institutions, entities, organizations and collectivities. In order to elaborate on the identity of Latin American Psychiatry, this chapter deals first with the identity of the Latin American continent, the result of a 'collision of cultures' with mestizaje as its most prominent collective contribution. In turn, the Latin American population (and its 'Hispanic' equivalent in other countries and regions of the world) has been the subject of a pluralistic search, and played a combined role of hope and conflict, advances and setbacks in a fascinating historical process. In such context, Latin American psychiatry offers a mixed identity, resulting from a succession of mythic-religious, moral, phenomenologico-existential, biological and social/community-based routes. Each of them are assessed, and the contributions of two eponymous figures, Honorio Delgado and Gregorio Bermann, are duly delineated. Current realities in Latin American psychiatry and mental health in socio-political, conceptual, professional, ideological, academic and heuristic areas, are examined. The chapter ends with considerations of the future of psychiatry in the continent, the postulation of a 'new synthesis' embracing the essence of contemporary neurobiological knowledge and a new, revitalized humanism in the context of a healthy eclecticism, progressive educational training and didactic programmes, and concrete contributions embodying the promise of well justified expectations.

Selection factors among international medical graduates and psychiatric residency performance.

OBJECTIVE: The authors examine the association between the selection factors used in a psychiatric residency program and subsequent clinical and academic performance among international medical graduate (IMG) candidates. METHODS: The authors completed a retrospective review of application files and residency evaluations of 50 IMG residents who completed the 4-year psychiatry training in a university-affiliated program from July 1994 through June 2004. RESULTS: United States Medical Licensing Examination (USMLE) Step 1 and personal interview appear associated with residents' performance determined by the program director's ranking. Standardized examinations before (USMLE Step 1 and 2) and during the residency (PRITE) were significantly correlated (USMLE 1, r=0.37; USMLE 2, r=0.40, p<0.003). Personal interview scores and psychotherapy treatment session evaluations were also significantly associated (r=0.38, p<0.003). CONCLUSION: Further research is necessary to determine predictive factors related to psychiatric residents' performance, especially among IMGs. Adjusting current selection criteria may result in better outcomes for training programs and future psychiatrists.

Latin American and Spanish-speaking perspectives on the challenges of global psychiatry.

The multi-faceted phenomenon known as globalization has a particular impact on the conceptual and practical development of mental health disciplines in general, and psychiatry in particular, across different world regions. To be theoretically and functionally effective, global psychiatry requires an integration of its different components. To such objective, and after a brief review of continental European and Anglo-Saxon contributions, this article examines the history, characteristics, and contributions of Latin/Iberian American and Spanish-speaking psychiatry, in order to substantiate its role in world psychiatry. The Latin American proper (including Portuguese-speaking Brazil), Spain, and U.S.-based Hispanic components are described, revealing an identity that is based on a humanistic tradition, a value-based, culturally-determined clinical approach to patient care, and a pragmatic adaptation of different treatment resources and techniques. These may constitute supportive elements of an instrumental inter-regional bond in the present and future of our discipline.