Mental health practitioners' use and attitudes regarding the Internet and social media.

OBJECTIVE: Internet-based technologies, such as email and social media, are being increasingly used by mental health providers. The authors created a survey to better understand mental health providers' practices and attitudes regarding these platforms. METHODS: Psychiatrists and psychologists at Columbia and the New York State Psychiatric Institute completed a 24-item multiple choice and free-text survey about their use of and attitudes toward Internet technologies. RESULTS: One hundred and thirty faculty responded to the survey: 70% percent of respondents reported that they were somewhat or more familiar with social media; 20% reported that they sometimes or often searched for information about their patients online; and 60% said that searching for patients online could have a positive role in ongoing psychiatric care. Respondents with fewer years of practice were significantly more likely to use Facebook/Google Plus, texting, and instant messenger in their personal lives, while those with more years of practice were more likely to use Skype professionally. Practitioners who worked in hospital settings were more likely to search online for information about their patients. Practitioners working in outpatient clinics, private practices, and research settings were more likely to use websites, email, and Skype in their practices. CONCLUSIONS: Mental health care professionals are starting to incorporate Internet technologies into their professional lives, but they remain divided on the ethics and utility of using these technologies in clinical care. There appear to be differences in practices and attitudes toward the Internet among clinicians with different levels of experience and in different practice settings.

Points of contact: using first-person narratives to help foster empathy in psychiatric residents.

OBJECTIVE: The authors aimed to determine if writing narratives in psychiatric training can foster empathy for severely and persistently mentally ill patients. METHODS: One resident wrote first-person narrative pieces about three different patients at a community mental health clinic. She reviewed these pieces with a writing supervisor weekly. The supervisor and resident examined the style of writing, choice of words, and story line to help the resident learn about her feelings about the patient. RESULTS: In each narrative, different choices were made that provided clues about that particular resident-patient relationship. These writing exercises helped the resident become more connected to her patients, develop interviewing skills, and engage in more self-reflection. CONCLUSION: Narrative writing effectively fostered empathy in a PGY-1 psychiatric resident working with severely and persistently mentally ill patients. This exercise also fostered understanding of countertransference and improved psychiatric history-taking skills. Psychiatry training programs may want to consider incorporating narrative writing exercises into their curriculum.

Clinical predictors of early second event in patients with clinically isolated syndrome.

This study aimed to determine the predictors of increased risk of a second demyelinating event within the first year of an initial demyelinating event (IDE) suggestive of early multiple sclerosis (MS). Patients with MS or clinically isolated syndrome (CIS) seen at the UCSF MS Center within one year of the IDE were studied. Univariate and multivariate Cox models were used to analyze predictors of having a second event within 1 year of the IDE. Of 330 patients with MS/CIS, 111 had a second event within 1 year. Non-white race/ethnicity (HR = 2.39, 95% CI [1.58, 3.60], p < 0.0001) and younger age (HR for each 10-year decrease in age = 1.51, 95% CI [1.28, 1.80], p < 0.0001) were strongly associated with an increased risk of having a second event within one year of onset. Having a lower number of functional systems affected by the IDE was also associated with an increased risk of early second event (HR for every one less FS involved = 1.31, 95% CI [1.06, 1.61], p = 0.011). These results were similar after adjusting for treatment of the IDE with steroids and disease-modifying therapy. Non-white race/ethnicity, younger age, and a lower number of FS affected by the IDE are associated with a substantially increased hazard ratio for a second demyelinating event within 1 year. Since early relapse is predictive of worse long-term outcome, identifying and treating such patients after the IDE may be of benefit to them.