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OBJECTIVES: Violence by patients against health care professionals has been widely described. Although psychiatric trainees are particularly exposed, little is known about the extent, context, and impact of violence toward them in Europe. METHODS: A cross-sectional online survey was distributed between June 2018 and December 2019 among European psychiatric trainees through professional networks, using a snowball approach. The questionnaire asked about experiences of verbal abuse and physical and sexual assaults, as well as their context and impact. Descriptive analyses of the obtained data were conducted. RESULTS: The survey was completed by 827 trainees from 39 countries (68.4% females). Most (83.6%) reported having been abused/assaulted at least once (of these, 92% verbally, 44.1% physically, and 9.3% sexually). Emergency rooms and inpatient units were the most frequent settings. Psychological impact of these events was commonly reported. Most respondents did not report abuses and assaults to their supervisors. They also described a lack of training for staff and aggression management plans at their institutions or of being unaware of their existence. CONCLUSIONS: Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults. Particularly concerning are the low proportion of trainees reporting to authorities, the lack of staff training and management protocols, and trainees' lack of awareness about those resources. Despite the study limitation of a small response rate, these results support a call for urgent efforts to address this problem in Europe, and possibly beyond.
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Agressão , Violência , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Inquéritos e Questionários , Violência/psicologiaRESUMO
Network meta-analysis is a methodology for comparing different treatments or modalities including both direct comparisons and indirect comparisons based on a common comparator. While this provides a wealth of opportunities in psychiatric research, both designing a network meta-analysis and interpreting the same requires meticulous care. This brief reports lists key features of a network meta-analysis and highlights the importance of careful interpretation with a few examples from recent psychiatric research.
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Pesquisa Biomédica/métodos , Transtornos Mentais/terapia , Metanálise em Rede , Psiquiatria , HumanosRESUMO
OBJECT: Obsessive compulsive disorder (OCD) is the fourth most common psychiatric disorder characterized by recurrent, intrusive thoughts and repetitive, ritualistic behaviors that are debilitating to the patient. Despite its high prevalence and the attendant morbidity, the pathophysiology of OCD remains unclear. Magnetic resonance spectroscopy (MRS) provides a noninvasive method to characterize the molecular biochemistry that may contribute to the pathophysiology of OCD. This study aimed to identify alterations in neurochemical measures that are specific to OCD using in vivo proton ((1)H) MRS of the caudate nucleus, anterior cingulate cortex, and medial thalamus in these patients, and to identify their role as vulnerability markers by comparing them with the healthy first degree relatives of these patients and healthy controls. MATERIALS AND METHODS: Appropriate psychometric instruments were applied in the study population followed by (1)H- MRS. The absolute neurochemical measures were quantified using a linear combination model. RESULTS: Significant differences in neurochemical measures were demonstrated in two of the three candidate regions (except the medial thalamus) between the three study groups. CONCLUSIONS: Our results lend support to the neurodegenerative hypothesis of OCD, and also raise the possibility of exploring these neurochemical measures (as measured by MRS) as putative vulnerability biomarkers in OCD that may aid in early identification and devising early prevention or management strategies for the population vulnerable to OCD.
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Biomarcadores/metabolismo , Química Encefálica , Espectroscopia de Ressonância Magnética/métodos , Transtorno Obsessivo-Compulsivo/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PsicometriaRESUMO
Background: Mental Health apps (MH apps) could help address the huge unmet mental health care need of developing countries. This study aimed to explore potential ethical, data safety, and privacy issues associated with using MH apps for depression. Methods: A cross-sectional assessment of the top 50 MH apps (by Google Play store search result ordering) for depression available in India was conducted in November 2021. Results: Most apps were listed under the category of health and fitness (54%). The median number of total and dangerous permissions requested at the time of download was nine and three, respectively. Privacy policy in English was available for 76%. The average length of the privacy policy was 2171 words, and the mean Flesch-Kincaid reading grade level was 12 (much higher than the recommended cut-off of eight). Important features relevant to safeguarding consumer confidentiality, including names of third parties with which user data could be shared (42%), explicit consent before sharing data with third parties (16%), and assurance regarding the collection of de-identifiable data (11%), were missing from the majority of privacy policies. Conclusion: There is an urgent need to improve the accessibility and usability of privacy policies by app developers, with the active involvement of other stakeholders.
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Background: Violence against psychiatry trainees is an important issue to the medical profession. However, this matter has been under researched, especially in Asian countries. Aim: We aimed to explore the rates and factors associated with violence against psychiatric trainees in Asian countries. Methods: An online, 15 item cross sectional pilot survey was designed and disseminated among psychiatric trainees in Asia through the World Network of Psychiatric Trainees, national and local networks of trainees, and social media. The questionnaire sought to enquire about the experience of physical, verbal, and sexual assaults and its impact. Data were analyzed using Statistical Package for the Social Sciences (SPSS) V20.0. Results: A total of 467 responses were obtained from psychiatric trainees in 16 countries in Asia. More than two thirds of participants (n = 325, 69.59%) reported a history of assault. Psychiatry inpatient units were the most common setting (n = 239, 73.54%). A relatively lower proportion of participants from the East Asian countries reported an assault, compared to other countries (χ2 = 13.41, P = 0.001). Sexual assault was more common among women compared to men (χ2 = 0.94, P = 0.002). Conclusion: Violence against psychiatric trainees seems common across Asian countries. Our findings call for further systematic investigation of the phenomenon and suggest the need to develop programs to protect psychiatric trainees against the threat of violence and its subsequent psychological complications.
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Child mental health professionals have an extremely important role to play in their distinct roles as clinicians, therapists, researchers, policy makers, advocates, preventative public health professionals and service developers pertaining to eco-crisis in the child and adolescent populations. This article provides examples of how this can be done.
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This article is a summary of perspectives on training curricula from child and adolescent psychiatry trainees globally. We aimed to identify the relative strengths, weaknesses and gaps in learning needs from a trainee's perspective. The 20 early-career child psychiatrists who contributed are from 16 countries and represent all the five continents. We could identify some global challenges as well as local/regional challenges that need to be addressed to develop competent child psychiatrists.
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Autoanticorpos/sangue , Encefalopatias , Canais de Potássio de Abertura Dependente da Tensão da Membrana/imunologia , Transtornos Psicóticos/etiologia , Encefalopatias/sangue , Encefalopatias/complicações , Encefalopatias/diagnóstico , Encefalopatias/imunologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnósticoRESUMO
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood. It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents. This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders, learning disorders, externalising and internalising disorders. Challenges in screening for, diagnosing and managing comorbidity with ADHD are summarised. Also, methodological challenges and future directions in research in this interesting field are highlighted.
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In this case series, we report three cases of alopecia associated with use of methylphenidate for ADHD (Attention deficit hyperactivity disorder), that reversed with discontinuation of methylphenidate.
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AIM: To ascertain performance against the standards set by National Institute for Clinical Excellence (NICE) guidelines on physical health monitoring of thirty children and adolescents prescribed antipsychotics in neurodevelopmental clinics in Northumberland and identifying areas for improvement in practice. METHODS: The audit involved a review of recorded documentation pertaining to physical health monitoring in patient electronic records pertaining to children and adolescents attending neurodevelopmental clinics in Northumberland prescribed antipsychotics. Clients were also contacted by telephone if relevant documentation could not be identified or retrieved to confirm the details. 32 case notes were perused of which 2 were excluded as they had refused to have venepuncture which was documented in the electronic records. RESULTS: The overall audit results demonstrated partial compliance with NICE guidelines on physical health monitoring in children and adolescents prescribed antipsychotics. Bi-annual recording of height, weight, blood pressure, pulse rate and review of side effects was completed in 100% of subjects. However, annual monitoring for blood tests including liver function, renal function full blood count as well as biannual monitoring of serum prolactin, serum lipid profile was completed only in 56% of subjects. Comparative baseline characteristics between the two groups (compliant and non-compliant with guidelines) found no differences based on any socio-demographic or clinical variables. However, the proportion of patients in the group compliant to guidelines was higher in the age group of 12-17 years as compared to < 12 years (70.58% vs 38.46%), though not statistically significant (χ2 = 1.236; P = 0.24). CONCLUSION: Development of tailored and specific guidelines for physical health monitoring in children and adolescents prescribed antipsychotics taking into consideration clinical effectiveness and safety profile is likely to improve adherence rates.
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Chromosome 15 duplication has been associated with a number of psychiatric illnesses including psychosis and autism. However, literature on association with attention-deficit hyperactivity disorder (ADHD) is scant. This case report describes a patient with chromosome 15 duplication diagnosed with ADHD in our neurodevelopmental clinic. The possible biological underpinnings are discussed along with possible challenges in diagnosis and management. The need for better understanding ADHD as a behavioral phenotype in such cases along with need for tailored management strategies is emphasized.
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The genetics of neurodevelopmental disorders have long intrigued clinicians and researchers alike. In this case report, we report a rare case of neurodevelopmental disorders associated with icthyosis with an underlying SHOX (short stature homeobox) gene mutation.
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Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Espectro Autista/genética , Ictiose/genética , Proteína de Homoeobox de Baixa Estatura/genética , Criança , Humanos , MasculinoRESUMO
A mentally retarded 7-year-old male child presented with inattention and hyperactivity which was initially diagnosed as attention deficit hyperactivity disorder (ADHD). However, a careful evaluation of symptomatology along with clues provided by specific features of facial dysmorphism in this case along with genetic testing clinched the diagnosis of Smith-Magneis syndrome the behavioural phenotype of which closely resembles ADHD.