LGBT-Specific Education in General Psychiatry Residency Programs: a Survey of Program Directors.

OBJECTIVE: Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs. METHODS: An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs. RESULTS: Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤ 5 h of LGBT-specific training ("lower-hour programs"). Lower- and higher-hour (> 5 h of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training. CONCLUSIONS: Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise.

The Psychiatric Assessment and Brief Intervention Program: Partnering With Primary Care Providers.

OBJECTIVE: To present the structure and outcomes to date for the Psychiatric Assessment and Brief Intervention (PABI), a pilot program developed at University of California, San Francisco, to improve access of primary care patients to mental health services. PABI offers diagnostic evaluations and brief (up to 3 months) evidence-based treatment, including pharmacologic management and psychotherapy, to medical patients 18 years of age and older. Core PABI features are ensuring prompt access, actively partnering with patients and referring providers, and coordinating seamless transitions of care. METHODS: Demographic and clinical variables and outcome indicators were collected for all patients seen in PABI from October 2015 to June 2017. Descriptive statistics and mixed-effects linear models were used to analyze the data. RESULTS: During the study period, 139 patients (54% women, mean [SD] age of 48.2 [17.5] years) with a mean of 2 DSM-5 psychiatric diagnoses each (range, 1-5) were seen. Mean time to access was 8 days, with a mean length of stay in the program of 11 weeks. Compared to baseline, final behavioral health measure scores showed significant improvement: the mean Patient Health Questionnaire-9 score decreased by 5.9 points (95% CI, 4.6-7.2), and the mean 7-item Generalized Anxiety Disorder scale score was 4.4 points lower (95% CI, 3.2-5.6; both P values < .0001). CONCLUSIONS: This brief psychiatric treatment program provides prompt access to quality mental health care for patients with medical comorbidities. Results to date suggest that this program leads to significantly improved clinical outcomes. Further research is needed to determine its long-term sustainability and generalizability.

Teaching evidence-based approaches to suicide risk assessment and prevention that enhance psychiatric training.

This report describes one in a series of National Institute of Health (NIH) supported conferences aimed at enhancing the ability of leaders of psychiatry residency training to teach research literacy and produce both clinician-scholars and physician-scientists in their home programs. Most psychiatry training directors would not consider themselves research scholars or even well-schooled in evidence based practice. Yet they are the front line educators to prepare tomorrow's psychiatrists to keep up with, critically evaluate, and in some cases actually participate in the discovery of new and emerging psychiatric knowledge. This annual conference is meant to help psychiatry training directors become more enthusiastic, knowledgeable and pedagogically prepared to create research-friendly environments at their home institutions, so that more trainees will, in turn, become research literate, practice evidence-based psychiatry, and enter research fellowships and careers. The overall design of each year's meeting is a series of plenary sessions introducing participants to new information pertaining to the core theme of that year's meeting, integrated with highly interactive small group teaching sessions designed to consolidate knowledge and provide pragmatic teaching tools appropriate for residents at various levels of training. The theme of each meeting, selected to be a compelling and contemporary clinical problem, serves as a vehicle to capture training directors' attention while teaching relevant brain science, research literacy and effective pedagogy. This report describes the content and assessment of the 2011 annual pre-meeting, "Evidence-based Approaches to Suicide Risk Assessment and Prevention: Insights from the Neurosciences and Behavioral Sciences for use in Psychiatry Residency Training."

Coping with a patient's suicide: a curriculum for psychiatry residency training programs.

OBJECTIVE: The suicide of a patient is often experienced as a traumatic event by the clinician involved. Many articles have identified the need for education to guide clinicians through the aftermath of patient suicide; however, little has been published on development of such a curriculum, particularly for residents. This article describes one residency training program's development of an organized curriculum on coping with patient suicide and evaluates the impact of a core aspect of the training on clinicians' knowledge about and confidence with coping with patient suicide. METHODS: The training includes a biennial half-day workshop for all trainees plus an "as-needed curriculum" used after a completed suicide. A total of 42 clinicians (39 psychiatry residents and 3 psychiatry faculty) participated in a workshop on coping with patient suicide. Their attitudes and knowledge about the topic were assessed before and after the training. RESULTS: Participation in the workshop was associated with large and statistically significant increases in knowledge and self-perceptions of competence in coping with patient suicide. CONCLUSIONS: The addition of a curriculum on coping with patient suicide has the potential to significantly enhance psychiatric residency training.

Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations.

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Pharmacologic treatment for postpartum depression: a systematic review.

During the past decade, the medical community has expressed a growing concern over the high prevalence of postpartum depression and the tragic repercussions of untreated illness. However, many questions persist about the pathogenesis of postpartum depression, the natural course of the illness, and the safety and effectiveness of available treatments. To summarize the data on pharmacologic treatments for postpartum depression, we performed a systematic review of four major databases to identify original research published from 1960-September 2009 that featured pharmacologic treatments for depression detected in women during the 12 months after delivery. Pharmacologic treatments included prescription drugs (antidepressants and hormones), herbal remedies, and dietary supplements. Case reports, studies examining the prevention of postpartum depression, and those including diagnosed episodes of depression preceding the postpartum period (i.e., antepartum onset) were excluded. Treatment randomization or the presence of a control group was not required for inclusion in this review. Fourteen investigations met inclusion criteria. Nine studies examined the effects of prescription antidepressants, two investigated hormones, and three featured omega-3 fatty acid supplementation. Significant heterogeneity was evident in study design and prevented a pooled quantitative analysis of treatment effects. The power of most investigations was limited, and numerous confounding biases were evident. Therapeutic effects were documented for prescription antidepressants and hormone supplementation (estrogen derivatives). Tolerability of the interventions in depressed mothers and breastfed infants was not well described. The effectiveness of omega-3 fatty acids was not evident in postpartum depression trials, although significant limitations in study methodology were apparent. Postpartum depression is a common and serious medical problem, but most cases go undetected and untreated. The need to identify safe, effective, and convenient treatments for postpartum depression is urgent, but the current state of the medical literature describing pharmacologic interventions is not impressive. Preliminary evidence documenting the effectiveness of serotonergic antidepressants and hormone supplementation should serve as an impetus for rigorous controlled investigations in the future.

A clinical comparison of lesbian and heterosexual women in a psychiatric outpatient clinic.

Previous research has reported that when compared to heterosexual women, lesbians may use alcohol and illicit substances to a greater degree and may experience greater psychiatric symptomatology. This study sought to describe any differences in clinical diagnoses, familial histories, and substance usage between lesbian and heterosexual women in a psychiatric outpatient clinic. A chart review was conducted and a sample of 455 heterosexuals and 75 lesbians was obtained. Data, where available, included demographic information, clinical diagnoses, time in treatment, sexual orientation, past and present substance use, and familial substance abuse and psychiatric history. Lesbians were found to have greater past illicit substance use but less current use. No significant differences were found for alcohol use. Similarly, no significant differences in clinical diagnoses were found. Significant differences were found among families. Family members of lesbians had greater substance use and psychiatric histories. These findings both support and dispute some previous research and suggest areas for future researchers to explore.

Implementing interpersonal psychotherapy in a psychiatry residency training program.

OBJECTIVE: Interpersonal psychotherapy (IPT) for depression is a brief, well researched treatment for acute major depression. This article describes the implementation of IPT as an evidence-based treatment for depression in a psychiatry residency program. METHOD: The authors tracked the implementation process over 5 years as interpersonal psychotherapy was systematically incorporated into residency training. RESULTS: The authors outline key ingredients for and challenges to effecting change. CONCLUSIONS: Implementation of interpersonal psychotherapy in psychiatry residency training was a cornerstone for learning evidence-based treatment approaches as well as for conveying core psychotherapy concepts.