Videos for Psychiatric Education: Could Deidentification Technology Make it Possible to Use Video Recordings of Patients for Psychiatric Education?

ABSTRACT: The field of psychiatry has been limited in its use of patient videos for educational purposes because essential facial information must be obscured to protect patient privacy, confidentiality, and dignity. This article calls attention to emerging technologies for deidentification of patients in video recordings while still preserving facial expression. Fully anonymized videos could be used to augment the education of psychiatric residents and for continuing education of the psychiatric workforce. This article suggests projects that deidentification technology could make possible; it also outlines some complex problems that would need to be addressed before the field could use this potentially transformative technology.

What caused Joan of Arc's neuropsychiatric symptoms? Medical hypotheses from 1882 to 2016.

Between 1882 and 2016, the medical literature offered a variety of etiologic hypotheses to explain Joan of Arc's voices, visions, and unwavering belief that she was the instrument of God. Although Joan lived from 1412 to 1431, there is extensive primary documentation of her life, including transcripts of her testimony during the Trial of Condemnation. Once this source material was compiled and made available, physician-authors began to theorize about Joan's neuropsychiatric symptoms in the context of her remarkable achievements. This article summarizes all papers written by physician-authors about Joan of Arc. The historical flow of diagnostic speculation in the medical literature reflects the cultural context in which it was produced as well as the emergence of novel ideas and new technologies in psychiatry, neurology, and neuropsychiatry. The early literature offered psychological theories and addressed the question of whether Joan was sane. The later literature focused on the possibility that Joan might have had epilepsy, with discussions of seizure etiology and possible cerebral focus, and also reflections on the purview of science as well as spirituality and the brain. This article offers the first comprehensive review of the medical literature about Joan of Arc, making this scholarship more accessible.

Life-long deficits in social adaptation and the frontal lobes: New evidence, seventy-five years after Ackerly and Benton's landmark case report of JP.

The case of JP, reported by Ackerly and Benton in 1948 with a detailed follow-up by Ackerly in 1964, stands as the index case of developmental prefrontal damage and its impact on social adaptation. Although the 1948 case report included findings from a 1933 pneumoencephalogram and exploratory craniotomy, a definitive cause was never established for JP's prefrontal damage. Etiologies were never determined for the left-sided seizures that occurred when JP was age four, nor for the progressive anterograde amnesia that JP developed in middle age. Given Ackerly's thoroughness and long-term follow-up of his patient, it was hoped that a brain cutting would have been done, though no report of a post-mortem examination was published. The lead author of this paper (SB) set out to discover what had happened to JP after Ackerly's 1964 report and whether a brain cutting had in fact occurred. Using a variety of investigative approaches, it was discovered that a post-mortem brain examination had taken place. Those present at the brain cutting were identified, and the still-living witnesses to the brain cutting were interviewed. Previously unpublished, relevant materials were uncovered from archival sources. A film of the brain cutting, as well as photos, were located. A film of Ackerly interviewing JP prior to JP's death at age sixty-four also was found. The authors studied autopsy findings in the newly discovered video and still images. These findings were judged consistent with massive perinatal hemorrhagic damage to both frontal lobes. JP's left-sided seizures were likely due to activation of a focus from his congenital brain damage. The anterograde amnesia that was documented when JP was twenty-five and that was noted to worsen when he was forty-nine remains unexplained but may have been related to slowly progressive hydrocephalus. This paper expands what is known about the case of JP, making it the only report of a person with congenital frontal injury followed for their entire life including post-mortem brain examination.

Photography's Underappreciated Contributions to Neuropsychiatry: The Photographs of W. Eugene Smith in Minamata, Japan.

Photographers and filmmakers have made important contributions to the international mental health community through documentation and social commentary, leveraging the power of visual imagery. To illustrate, this article uses the example of W. Eugene Smith who photographed the catastrophic effects of methylmercury poisoning from industrial pollution in the region around Minamata Bay, Japan. Although many art forms have been comfortably integrated into mainstream psychiatry and neuropsychiatry, photography has been underappreciated and underutilized.

Six Landmark Case Reports Essential for Neuropsychiatric Literacy.

Well-described clinical case reports have been a core component of the neuropsychiatry literature and have led to: a deepened understanding of brain-behavior relationships and neuropsychiatric phenomenology, new paths for research, and compelling material for physicians who are studying neurology and psychiatry. Six landmark neuropsychiatry cases were selected for being well described, paradigmatic, and illuminating of brain-behavior correlations: Phineas Gage, Louis Victor Leborgne ("Tan"), Auguste Deter, Solomon Shereshevsky ("S"), "JP," and Henry Gustav Molaison ("HM"). Each case and its neuropsychiatric lessons are summarized from primary sources, highlighting some less appreciated aspects. Case reports continue to be a valuable resource for neuropsychiatric education. Yet only four of the 10 highest impact factor psychiatry journals accept case reports for publication.

Complexities of the Diagnostic Process.

The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates. This article uses clinical examples to illustrate and discuss the numerous areas of competence that are involved in coming to a diagnosis. The dual-process cognition model for understanding diagnostic decision making is introduced; the role of creativity is emphasized. Psychiatrists have important contributions to make in understanding the diagnostic process, given the field's long history of valuing self-reflection and conceptualizing clinician-patient dynamics.

How to Move Beyond the Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases.

A new nosology for mental disorders is needed as a basis for effective scientific inquiry. Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases diagnoses are not natural, biological categories, and these diagnostic systems do not address mental phenomena that exist on a spectrum. Advances in neuroscience offer the hope of breakthroughs for diagnosing and treating major mental illness in the future. At present, a neuroscience-based understanding of brain/behavior relationships can reshape clinical thinking. Neuroscience literacy allows psychiatrists to formulate biologically informed psychological theories, to follow neuroscientific literature pertinent to psychiatry, and to embark on a path toward neurologically informed clinical thinking that can help move the field away from Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases conceptualizations. Psychiatrists are urged to work toward attaining neuroscience literacy to prepare for and contribute to the development of a new nosology.

Integrating Neuroscience Knowledge and Neuropsychiatric Skills Into Psychiatry: The Way Forward.

Increasing the integration of neuroscience knowledge and neuropsychiatric skills into general psychiatric practice would facilitate expanded approaches to diagnosis, formulation, and treatment while positioning practitioners to utilize findings from emerging brain research. There is growing consensus that the field of psychiatry would benefit from more familiarity with neuroscience and neuropsychiatry. Yet there remain numerous factors impeding the integration of these domains of knowledge into general psychiatry.The authors make recommendations to move the field forward, focusing on the need for advocacy by psychiatry and medical organizations and changes in psychiatry education at all levels. For individual psychiatrists, the recommendations target obstacles to attaining expanded neuroscience and neuropsychiatry education and barriers stemming from widely held, often unspoken beliefs. For the system of psychiatric care, recommendations address the conceptual and physical separation of psychiatry from medicine, overemphasis on the Diagnostic and Statistical Manual of Mental Disorders and on psychopharmacology, and different systems in medicine and psychiatry for handling reimbursement and patient records. For psychiatry residency training, recommendations focus on expanding neuroscience/neuropsychiatry faculty and integrating neuroscience education throughout the curriculum.Psychiatry traditionally concerns itself with helping individuals construct meaningful life narratives. Brain function is one of the fundamental determinants of individuality. It is now possible for psychiatrists to integrate knowledge of neuroscience into understanding the whole person by asking, What person has this brain? How does this brain make this person unique? How does this brain make this disorder unique? What treatment will help this disorder in this person with this brain?