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1.
BMC Med Educ ; 24(1): 669, 2024 Jun 17.
Article in English | MEDLINE | ID: mdl-38886678

ABSTRACT

BACKGROUND: Clinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives of the study were to identify the potential curricula content, training sites, and teaching modalities for undergraduate and potential postgraduate clinical associate mental health training and to identify the tasks that they should perform based on these curricula. METHODS: We utilised the Delphi method to reach consensus on items with the panel comprising psychiatrists and family physicians. The first round questionnaire of the Delphi survey was developed based on a literature review and the results from earlier phases of the overall study. The survey was administered electronically and consisted of three rounds. Following both the first and second rounds, an updated questionnaire was constructed omitting the items on which consensus was reached. The questionnaire consisted primarily of nine-point scales with consensus based on 70% of participants rating 1,2,3 or 7,8,9. RESULTS: There were 26 participants in the first round with this number falling to 23 in later rounds. There was strong consensus on a training attachment to a mental health clinic at a community health centre (CHC) at undergraduate (96.2%) and postgraduate level (100%). Consensus was reached on the importance of training on the management of six categories of disorders at the undergraduate level and nine categories of disorders at the postgraduate level. Clerking patients as a teaching modality reached 100% consensus at both undergraduate and postgraduate levels. PHC clinics, CHCs and district hospitals reached consensus as appropriate settings for clinical associates to provide mental health services. In addition, GP practices and secondary hospitals reached consensus for those with postgraduate training. Consensus was reached on ten of the 21 listed tasks that could be performed based on undergraduate training and 20 of the 21 tasks based on a postgraduate qualification in mental health. CONCLUSIONS: The Delphi panel's recommendations provide a clear roadmap for enhancing mental health curricula for clinical associates, enabling their utilisation in mental health service provision. A future postgraduate mental health qualification for clinical associates would allow for expanded task sharing.


Subject(s)
Curriculum , Delphi Technique , Psychiatry , South Africa , Humans , Psychiatry/education , Mental Health Services , Physicians, Family/education , Surveys and Questionnaires , Male , Mental Health , Female , Consensus , Education, Medical, Graduate , Education, Medical, Undergraduate , Psychiatrists
2.
Hum Resour Health ; 22(1): 40, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38890630

ABSTRACT

BACKGROUND: Physician assistants/associates (PAs) provide services in diverse medical specialties globally, including psychiatry. While health professionals in psychiatry have been described for many years, little is known about PAs practicing in this discipline. METHODS: We describe US PAs practicing in psychiatry using robust national data from the National Commission on Certification of Physician Assistants (NCCPA). Analyses included descriptive and inferential statistics comparing PAs in psychiatry to PAs in all other medical and surgical specialties. RESULTS: The percentage of PAs practicing in psychiatry has increased from 1.1% (n = 630) in 2013 to 2.0% (n = 2 262) in 2021. PAs in psychiatry differed from PAs practicing in all other specialties in the following: they identified predominately as female (71.4% vs. 69.1%; p = 0.016), were more racially diverse (Asian [6.6% vs. 6.0%], Black/African American [5.5% vs. 3.4%], multi-race [2.8% vs. 2.1%], and other races [Native Hawaiian/Pacific Islander, American Indian/Alaska Native, or other; 3.7% vs. 3.6%]; p < 0.001), and resided in the South (43.8% vs. 34.1%; p < 0.001). PAs in psychiatry vs. all other specialties were more likely to work in office-based private practice settings (41.6% vs. 37.3%; p < 0.001) and nearly twice as likely to provide telemedicine services for their patients (62.7% vs. 32.9%; p < 0.001). While one-third (31.9%) of PAs in psychiatry experienced one or more burnout symptoms, and 8.1% considered changing their current position, the vast majority of PAs in psychiatry (86.0%) were satisfied with their position. CONCLUSIONS: Understanding the attributes of PAs in psychiatry is essential in medical labor supply and demand research. Our findings suggest that the number of PAs working in psychiatry is steadily increasing. These PAs were predominantly female, exhibited greater racial diversity, and were primarily located in the South and Midwest regions of the US. A striking difference was that PAs in psychiatry were almost twice as likely to provide telemedicine services for their patients. Although nearly a third of PAs in psychiatry acknowledged having one or more symptoms of burnout, few were considering changing their employment, and the vast majority reported high job satisfaction.


Subject(s)
Physician Assistants , Psychiatry , Humans , Female , Physician Assistants/statistics & numerical data , Physician Assistants/supply & distribution , Male , United States , Adult , Middle Aged , Health Workforce/statistics & numerical data , Workforce
4.
Tunis Med ; 102(6): 360-365, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38864200

ABSTRACT

INTRODUCTION: Telemedicine has become a fundamental pillar of the evolution of healthcare worldwide. In Tunisia, the challenges of the health system, amplified by the COVID-19 pandemic, have highlighted the urgency to adopt innovative solutions. In this regard, the publication of Presidential Decree No. 318/2022 on April 8 in the Official Journal of the Tunisian Republic represents a significant advance in the regulation of telemedicine. AIM: To assess the knowledge of Tunisian psychiatrists and child psychiatrists regarding telemedicine, its legal framework, and their perceptions of this new medical practice. METHODS: A descriptive cross-sectional study was conducted 8 months after the issuance of the presidential decree. The survey was conducted online through an electronic questionnaire on Google Forms. RESULTS: A total of 68 participants were included in this survey. The median number of professional years was 5±7 years. Among the participants, 82% worked in psychiatry and 18% worked in child psychiatry. The sector of practice was public in 69% and private in 31% of cases. Most of them (62%) did not know about the different telemedicine acts, and 57% of doctors were unaware of the existence of the presidential decree. The majority of doctors (84%) expressed a favorable opinion regarding the adoption of telepsychiatry, regardless of sex (p=0.69), professional status (p=0.512), specialty (p=1), years of experience (p=0.83), and practice sector (p=1). CONCLUSION: Despite a low level of knowledge regarding telemedicine, the study highlights the interest of the participants in integrating telepsychiatry into their clinical practices.


Subject(s)
Health Knowledge, Attitudes, Practice , Psychiatry , Telemedicine , Humans , Tunisia , Telemedicine/statistics & numerical data , Psychiatry/statistics & numerical data , Cross-Sectional Studies , Female , Male , Adult , Surveys and Questionnaires , COVID-19/epidemiology , Middle Aged , Attitude of Health Personnel , Psychiatrists
6.
Psychodyn Psychiatry ; 52(2): 150-172, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38829230

ABSTRACT

Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a "medical model," may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice.


Subject(s)
Psychiatry , Psychotherapy , Transference, Psychology , Humans , Psychotherapy/methods , Personality Disorders/therapy , Narcissism
7.
BMC Psychiatry ; 24(1): 430, 2024 Jun 10.
Article in English | MEDLINE | ID: mdl-38858711

ABSTRACT

OBJECTIVE: In a growing list of countries, patients are granted access to their clinical notes ("open notes") as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians' notes. More research is needed to optimize the benefits and mitigate the risks. METHODS: Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis. RESULTS: We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts. CONCLUSION: Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.


Subject(s)
Attitude of Health Personnel , Psychiatry , Qualitative Research , Humans , Male , Female , Germany , Adult , Middle Aged , Physician-Patient Relations , Electronic Health Records , Mental Disorders/psychology , Mental Disorders/therapy , Psychiatrists
8.
Transl Psychiatry ; 14(1): 232, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38824136

ABSTRACT

The explosion and abundance of digital data could facilitate large-scale research for psychiatry and mental health. Research using so-called "real world data"-such as electronic medical/health records-can be resource-efficient, facilitate rapid hypothesis generation and testing, complement existing evidence (e.g. from trials and evidence-synthesis) and may enable a route to translate evidence into clinically effective, outcomes-driven care for patient populations that may be under-represented. However, the interpretation and processing of real-world data sources is complex because the clinically important 'signal' is often contained in both structured and unstructured (narrative or "free-text") data. Techniques for extracting meaningful information (signal) from unstructured text exist and have advanced the re-use of routinely collected clinical data, but these techniques require cautious evaluation. In this paper, we survey the opportunities, risks and progress made in the use of electronic medical record (real-world) data for psychiatric research.


Subject(s)
Electronic Health Records , Psychiatry , Humans , Biomedical Research , Mental Disorders/therapy , Mental Disorders/diagnosis
10.
Am J Psychiatry ; 181(6): 474-475, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38822587
11.
Lancet Psychiatry ; 11(7): 481, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38879268
12.
Sante Publique ; 36(2): 45-56, 2024.
Article in French | MEDLINE | ID: mdl-38834524

ABSTRACT

INTRODUCTION: Informal caregivers play a vital role in supporting people with severe mental illness. However, this role can leave informal caregivers with significant unmet needs. The aim of this qualitative study is to identify the extent to which the support offered to informal caregivers in adult psychiatry in French-speaking Switzerland meets their needs. METHOD: Individual semi-structured interviews and focus groups were conducted with informal caregivers, mental health professionals, and service providers. The data were analyzed by theme. RESULTS: The need for assistance and the need for information are two themes identified as prevalent among informal caregivers. Despite a consensus on the need for more support and information, informal caregivers, service providers, and health professionals do not assign the same importance to specific aspects of these themes. Suggestions for improving practices at the institutional, socio-political, and civil-society levels are put forward. Given the diversity of viewpoints on the priority needs of informal caregivers, there is a risk of offering support that only partially corresponds to the difficulties encountered by informal caregivers. CONCLUSIONS: Matching support and needs remains a major challenge. Agreeing on a consensual definition of support and information needs and proposing tailored approaches could make it possible to develop support services that meet the actual needs of informal caregivers.


Subject(s)
Caregivers , Mental Disorders , Humans , Female , Switzerland , Male , Mental Disorders/therapy , Middle Aged , Adult , Focus Groups , Health Services Needs and Demand , Social Support , Psychiatry , Needs Assessment , Qualitative Research , Aged
13.
Article in Russian | MEDLINE | ID: mdl-38884427

ABSTRACT

Presently, there is an increased interest in expanding the range of diagnostic and scientific applications of electroencephalography (EEG). The method is attractive due to non-invasiveness, availability of equipment with a wide range of modifications for various purposes, and the ability to track the dynamics of brain electrical activity directly and with high temporal resolution. Spectral, coherency and other types of analysis provide volumetric information about its power, frequency distribution, spatial organization of signal and its self-similarity in dynamics or in different sections at a time. The development of computing technologies provides processing of volumetric data obtained using EEG and a qualitatively new level of their analysis using various mathematical models. This review discusses benefits and limitations of using the EEG in scientific research, currently known interpretation of the obtained data and its physiological and pathological correlates. It is expected to determine the complex relationship between the parameters of brain electrical activity and various functional and pathological conditions. The possibility of using EEG characteristics as biomarkers of various physiological and pathological conditions is being considered. Electronic databases, including MEDLINE (on PubMed), Google Scholar and Russian Scientific Citation Index (RSCI, on elibrary.ru), scientific journals and books were searched to find relevant studies.


Subject(s)
Brain , Electroencephalography , Humans , Electroencephalography/methods , Brain/physiology , Psychiatry/methods , Mental Disorders/physiopathology , Mental Disorders/diagnosis
14.
J Pers Disord ; 38(3): 225-240, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38857158

ABSTRACT

There is currently insufficient evidence for the use of a specific pharmacological treatment for personality disorders (PD). The research literature lacks a systematic exploration of clinicians' experiences of pharmacological treatment of PD. The aim of the qualitative study was to examine how psychiatrists make decisions about pharmacological treatment for patients with PD. The interviews were analyzed using inductive thematic analysis. The results showed that ambiguous guidelines had the effect that the psychiatrists often relied on their own experience, or that of their colleagues. As a basis for decisions concerning drug treatment, an interpersonal component was also identified. Some of the psychiatrists in the current study argued that medications may be part of the alliance-building with the patient and that medications were a way of tying the patient to the clinic. Our findings show that it is important to work on how the clinical guidelines should be implemented in practice.


Subject(s)
Attitude of Health Personnel , Personality Disorders , Psychiatry , Qualitative Research , Humans , Female , Male , Adult , Middle Aged , Clinical Decision-Making , Practice Patterns, Physicians' , Practice Guidelines as Topic , Psychiatrists
16.
Neuropsychiatr ; 38(2): 104-106, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38819595
17.
Neurodiagn J ; 64(2): 69-74, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38772013

ABSTRACT

A century ago, it was a challenge for neuroscientists to decipher the mysteries of human brain functioning until German psychiatrist Hans Berger discovered what is now one of the most well-known electrophysiological recording techniques to examine brain function, EEG. He is rightly regarded as the Father of The Electroencephalogram (EEG), since he performed the first human electroencephalogram in 1924. Berger attempted to investigate the connection between psychology and physiology and to solve the "psychic energy" enigma. Despite turbulence in his professional life and slow progress in his research, he persevered and succeeded in giving humankind an indispensable technique that is now widely used in clinical and research practice. His publications on EEG provide valuable insight into our current understanding of several of the brain's responses to physiological and pathological phenomena. In July 2024, it will be 100 years since Berger recorded the first human EEG, and that calls for a celebration among EEG researchers, neuroscientists, psychiatrists, and neurologists. This article presents a brief account of his journey and commemorates Hans Berger's contributions to the field of neurodiagnostics.


Subject(s)
Electroencephalography , Electroencephalography/history , Electroencephalography/methods , Humans , History, 20th Century , History, 21st Century , Brain/physiology , Psychiatry/history , Germany
20.
Eur Psychiatry ; 67(1): e38, 2024 May 07.
Article in English | MEDLINE | ID: mdl-38712570

ABSTRACT

BACKGROUND: Codes of ethics provide guidance to address ethical challenges encountered in clinical practice. The harmonization of global, regional, and national codes of ethics is important to avoid gaps and discrepancies. METHODS: We compare the European Psychiatric Association (EPA) and the World Psychiatric Association (WPA) Codes of Ethics, addressing main key points, similarities, and divergences. RESULTS: The WPA and EPA codes are inspired by similar fundamental values but do show a few differences. The two codes have a different structure. The WPA code includes 4 sections and lists 5 overarching principles as the basis of psychiatrists' clinical practice; the EPA code is articulated in 8 sections, lists 4 ethical principles, and several fundamental values. The EPA code does not include a section on psychiatrists' education and does not contain specific references to domestic violence and death penalty. Differences can be found in how the two codes address the principle of equity: the EPA code explicitly refers to the principle of universal health care, while the WPA code mentions the principle of equity as reflected in the promotion of distributive justice. CONCLUSIONS: We recommend that both WPA and EPA periodically update their ethical codes to minimize differences, eliminate gaps, and help member societies to develop or revise national codes in line with the principles of the associations they belong to.Minimizing differences between national and international codes and fostering a continuous dialogue on ethical issues will provide guidance for psychiatrists and will raise awareness of the importance of ethics in our profession.


Subject(s)
Codes of Ethics , Psychiatry , Societies, Medical , Humans , Psychiatry/ethics , Psychiatry/standards , Europe
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