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1.
Psychiatry ; 84(1): 21-32, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33848227
2.
Neurosciences (Riyadh) ; 26(2): 152-157, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33814367

RESUMEN

OBJECTIVES: To examine the prescribing patterns of antidepressants among a sample of psychiatrists working in Oman and to compare these practices to the current evidence for prescribing specific antidepressant in particular clinical situations. METHODS: This retrospective cross sectional study. Massachusetts General Hospital Psychopharmacology Questionnaire, a 10-item questionnaire listing factors that might have influenced the choice of antidepressant medication, was sent to 83 psychiatrists working in governmental health sectors in Oman. The study was done from March to July 2019. RESULTS: A total number of 78 psychiatrists responded to the questionnaire. Of these, 44 of the psychiatrists (56.4%) believed that one type of antidepressant is more efficacious than others, while 74 psychiatrists (94.9%) indicated that selective serotonin reuptake inhibitors (SSRIs) were their first-line treatment preference. Mirtazapine was chosen as the most likely antidepressant to cause weight gain by two-thirds of the participants. For the treatment of anxious depression and depression with melancholic feature, SSRIs were the first choice of treatment for 64.1% and 7% of respondents, respectively. For depression with atypical features, 42.3% indicated that a monoamine oxidase inhibitor would be their first option. CONCLUSION: There is a discrepancy between the current antidepressant prescribing practices in Oman and empirical antidepressant-prescribing evidence, and this finding is consistent with previous studies.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Prescripciones de Medicamentos , Pautas de la Práctica en Medicina , Inhibidores de la Captación de Serotonina/uso terapéutico , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Omán , Psiquiatría , Estudios Retrospectivos
4.
Adv Exp Med Biol ; 1305: 515-533, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834416

RESUMEN

The volume of research on the therapeutic use of psychedelic drugs has been increasing during the last decades. Partly because of the need of innovative treatments in psychiatry, several studies have assessed the safety and efficacy of drugs like psilocybin or ayahuasca for a wide range of mental disorders, including major depression. The first section of this chapter will offer an introduction to psychedelic research, including a brief historical overview and discussions about appropriate terminology. In the second section, the recently published clinical trials in which psychedelic drugs were administered to patients will be analysed in detail. Then, in the third section, the main neurobiological mechanisms of these drugs will be described, noting that while some of these mechanisms could be potentially associated with their therapeutic properties, they are commonly used as adjuvants in psychotherapeutic processes. The last section suggests future challenges for this groundbreaking field of research and therapy.


Asunto(s)
Trastorno Depresivo Mayor , Alucinógenos , Psiquiatría , Depresión , Trastorno Depresivo Mayor/tratamiento farmacológico , Alucinógenos/uso terapéutico , Humanos , Psilocibina/uso terapéutico
5.
Hum Resour Health ; 19(1): 46, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33823857

RESUMEN

Very few studies have been concerned with assessing the prevalence of burnout and depressive symptoms, especially during an infectious outbreak on non-frontline health care workers, such as a psychiatrist. In such instances, the role of psychiatrists and other mental health providers as a source of psychological support to the public and frontline workers is indispensable and valuable. This study aims to assess the prevalence of burnout and depressive symptoms, and their correlation, during the COVID-19 pandemic among psychiatry residents in Saudi Arabia. A total of 121 out of 150 psychiatry residents in Saudi Arabia completed the Maslach Burnout Inventory and Patient's Health Questionnaire for the assessment of burnout and depressive symptoms. Burnout symptoms were found in 27.3%, and another 27.3% reported having depression symptoms. In addition, 16.5% reported having both burnout and depressive symptoms, with a significant relationship between them. Participants in the first 2 years of training and having a history of receiving mental health treatment in the past 2 years were at higher risk. The need is urgent to increase investment in mental health services and to construct a plan to reduce this risk of burnout and depression among psychiatrists by developing preventative strategies to prevent burnout and promote wellness is more important than ever.


Asunto(s)
Agotamiento Psicológico/epidemiología , Depresión/epidemiología , Personal de Salud/psicología , Internado y Residencia , Pandemias , Psiquiatría , Adulto , Agotamiento Profesional , Femenino , Humanos , Masculino , Salud Mental , Prevalencia , Arabia Saudita , Adulto Joven
7.
Adv Exp Med Biol ; 1305: 463-492, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834413

RESUMEN

Depression as a multifactorial, polygenic mental disorder with thousands faces, poorly defined endophenotypes and characterized with high rate of morbidity, comorbidity, disability, mortality, and treatment failures, remains a relentless illness with heavy burden on patients, their families, and society. Therapeutic outcome of depression needs to be significantly improved and overcome the 65% barrier. The best treatments are those that utilize and integrate multiple modalities. The time is ripe for psychiatry to find its transdisciplinary integrative soul and increase treatment effectiveness. Creation and fostering hope, meaning, personal responsibility, spirit of optimism, and commitment can significantly contribute to overall positive response to pharmacotherapy, but in the other way round drug treatment can also contribute to creation and fostering hope, meaning, personal responsibility, spirit of optimism, and commitment. This chapter addresses the concept of creative person-centered narrative psychopharmacotherapy (CP-CNP) as a transdisciplinary integrative strategy for improvement of the therapeutic effectiveness in patients with depression.


Asunto(s)
Psiquiatría , Trastornos Psicóticos , Depresión/tratamiento farmacológico , Esperanza , Humanos , Resultado del Tratamiento
8.
Adv Exp Med Biol ; 1305: 535-563, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834417

RESUMEN

Depression contributes greatly to global disability and is a leading cause of suicide. It has multiple etiologies and therefore response to treatment can vary significantly. By applying the concepts of personalized medicine, precision psychiatry attempts to optimize psychiatric patient care by better predicting which individuals will develop an illness, by giving a more accurate biologically based diagnosis, and by utilizing more effective treatments based on an individual's biological characteristics (biomarkers). In this chapter, we discuss the basic principles underlying the role of biomarkers in psychiatric pathology and then explore multiple biomarkers that are specific to depression. These include endophenotypes, gene variants/polymorphisms, epigenetic factors such as methylation, biochemical measures, circadian rhythm dysregulation, and neuroimaging findings. We also examine the role of early childhood trauma in the development of, and treatment response to, depression. In addition, we review how new developments in technology may play a greater role in the determination of new biomarkers for depression.


Asunto(s)
Trastorno Depresivo Mayor , Psiquiatría , Biomarcadores , Niño , Preescolar , Depresión , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/genética , Humanos , Medicina de Precisión
9.
Artículo en Ruso | MEDLINE | ID: mdl-33834725

RESUMEN

Most mental disorders occur before the age of 25 years, and if left without intervention, they can transform into more severe mental disorders. Despite the great need to protect the mental health of children and adolescents, in Russia and most countries of the world, there is a shortage of qualified personnel in this area. The article presents data on the availability of personnel in different countries of the world, including Russia. The issues of organizing the training of child and adolescent psychiatrists in Russia and various countries are examined, and the available data on training programs are analyzed. Educational opportunities for child and adolescent psychiatry in Russia are examined in detail.


Asunto(s)
Trastornos Mentales , Psiquiatría , Adolescente , Psiquiatría del Adolescente , Adulto , Niño , Humanos , Federación de Rusia , Especialización
12.
Artículo en Inglés | MEDLINE | ID: mdl-33922054

RESUMEN

The potential consequences of the COVID-19 outbreak are multifarious and remain largely unknown. Deaths as a direct result of the condition are already in the millions, and the number of indirect deaths is likely to be even higher. Pre-existing historical inequalities are compounded by the virus, driving increased rates of infection and deaths amongst people who use drugs and alcohol, those belonging to racial-ethnic minority groups, poorer communities, LBGTQ+ populations, healthcare workers, and other members of the care economy; all of whom are already at increased risk of adverse mental health effects. In this paper we suggest that a central role of mental health practitioners is advocacy: both for people who use psychiatric services and for those who, due to the effects of the pandemic, are at an increased risk of needing to do so.


Asunto(s)
Psiquiatría , Brotes de Enfermedades , Grupos Étnicos , Humanos , Salud Mental , Grupos Minoritarios
13.
Psychopharmacol Bull ; 51(1): 59-68, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33897063

RESUMEN

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine. Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole. Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care. Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high. Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Telemedicina/estadística & datos numéricos , Prestación de Atención de Salud/métodos , Encuestas de Atención de la Salud , Humanos , Psiquiatría/métodos , Psiquiatría/estadística & datos numéricos
15.
Psychiatr Prax ; 48(S 01): S11-S15, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33652481

RESUMEN

The article summarizes various publications on the application of "learning algorithms" and "artificial neural networks" in psychiatry to describe a dystopian future scenario. The draft of a nosology based on molecular biology is opposed to the ecological disturbance concept of psychiatry developed from the critical examination of history and in dialogue with the stakeholders.


Asunto(s)
Inteligencia Artificial , Psiquiatría , Algoritmos , Alemania , Humanos , Aprendizaje Automático , Redes Neurales de la Computación
16.
Psychiatr Prax ; 48(S 01): S16-S20, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33652482

RESUMEN

This article focuses on hopes and expectations that are discursively linked to computational technologies in the face of the current "crisis of psychiatric diagnostics". On the basis of document analyses, expert interviews as well as laboratory and conference ethnographies, the fiction of an "unprejudiced gaze" is worked out. According to this imagination, the procedures of "artificial intelligence" may let the data - and ultimately the facts - speak for themselves. However, since "data-driven" research is also determined by conceptual and normative decisions, this fiction could obscure epistemic hierarchizations and ontological prioritizations in psychiatric discourse. Against this backdrop, dependencies and selectivities of research should not be denied but made transparent allowing for a controversial debate.


Asunto(s)
Trastornos Mentales , Psiquiatría , Alemania , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia
17.
Psychiatr Prax ; 48(S 01): S21-S25, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33652483

RESUMEN

OBJECTIVE: Identifying ethical problems arising from AI research and Computational Psychiatry for psychiatric research and practice. METHODS: Conceptual analysis and discussion of ethically relevant projects within Computational Psychiatry. RESULTS: Computational Psychiatry promises a contribution to improving diagnostics and therapy (prediction). Ethical problems include dealing with data protection, consequences for our self-image, as well as the risk of biologization and the neglect of conscious experience. CONCLUSION: It is necessary to consider possible applications of AI and Computational Psychiatry now in order to create the conditions for responsible use in the future. This requires a basic understanding of how AI applications work and of the associated ethical problems.


Asunto(s)
Estado de Conciencia , Psiquiatría , Inteligencia Artificial , Alemania , Humanos
18.
Psychiatr Prax ; 48(S 01): S51-S57, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33652489

RESUMEN

The structure of relationships in the past, the present and the future is shaped by the idea of humanism. Based on this construct, the article illuminates various aspects and configurations of humanism on a timeline from "here and now" to "there and then". The current reality of care goes hand in hand with an emotional alienation of relationships. Advances in technology and reductionist neurobiological ideas can make it difficult to look at a person's mental illness as a whole. Any (communication) technology that has been developed in the past or will be developed in the future will sooner or later find its way into psychiatry and psychotherapy and change relationships. Transhumanism runs the risk that people will become alienated from each other and their species. Neural networks are algorithms that work regardless of the hardware used, be it based on organic carbon units such as humans or non-organic silicon units such as the computer/cyborg. There will be different ways to achieve super intelligence. Intelligence is a "must" and consciousness is a "can". If there is a change from a homocentric to a data-centered world view and the power of humans is transferred to the algorithms, humans could lose their economic value and the humanistic goals of health and happiness would be lost.


Asunto(s)
Inteligencia Artificial , Psiquiatría , Algoritmos , Inteligencia Emocional , Alemania , Humanos
19.
Psychiatr Prax ; 48(S 01): S58-S64, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33652490

RESUMEN

The ethical discourse addresses the following aspects: What do we need ethics for? Man's disposition to morality, natural ethics. Morality as a social norm. Morality to maintain an inhuman, superhuman power structure. Morality as an artifact of the brain, as a hindrance to new developments. Unity of ethics and aesthetics. "Zoon politikon", "Robinson Crusoe". Does Artificial Intelligence (AI) need new ethics? Characteristics of an AI, developed for loneliness, as a servant or with Christian software, group ability, own emotions, awareness and own ethics, as a supplement. Should AI be expected to have human emotions? Emotional intelligence, language as a mediator of emotions and empathy, the ability to mentalize, artificial (general) emotional intelligence, "Terminator", "L'Eve future".


Asunto(s)
Inteligencia Artificial , Psiquiatría , Emociones , Alemania , Humanos , Principios Morales
20.
Trials ; 22(1): 186, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673867

RESUMEN

BACKGROUND: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. METHODS: This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms. DISCUSSION: The SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04153864 . Registered on November 6, 2019.


Asunto(s)
Ansiedad/terapia , Depresión Posparto/terapia , Depresión/terapia , Accesibilidad a los Servicios de Salud , Complicaciones del Embarazo/terapia , Psicoterapia/métodos , Telemedicina/métodos , Prestación de Atención de Salud/métodos , Estudios de Equivalencia como Asunto , Femenino , Humanos , Servicios de Salud Materna , Servicios de Salud Mental/organización & administración , Partería , Enfermeras y Enfermeros , Ensayos Clínicos Pragmáticos como Asunto , Embarazo , Escalas de Valoración Psiquiátrica , Psiquiatría , Psicología , Trabajadores Sociales , Especialización
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