Attitudes and Confidence in Communication Skills of Fourth-Year Medical Students After Online Small Group Discussion and Peer Role-Play: A Survey Study.

OBJECTIVE: This study investigated the impact of online small group discussions and peer role-play on medical students' attitudes toward and confidence in communication skills. METHODS: The study involved a 3-hour instructional design that integrated small group discussions and role-plays to enhance the communication abilities of fourth-year medical students. The data were obtained from students through a post-activity online survey. Likert scale responses were quantified as percentages. Students' narrative feedback on their learning achievements was subjected to content analysis. Codes and categories were agreed upon by investigators and reviewed by an external auditor. RESULTS: A total of 151 medical students responded to the survey, representing a 47.94% response rate. The majority strongly agreed that good communication skills help physicians obtain reliable information (94.00%) and that practicing questioning skills is essential (92.1%). Content analysis revealed that nearly half (48.34%) considered that the learning activities fostered positive attitudes toward communication. These attitudinal improvements included increased empathy and emotional care (37.75%), recognition of communication as a trainable skill (10.57%), and recognition of the necessity of communication skills for physicians (8.61%). Additionally, most students (75.5%) reported increased confidence in their communication skills. CONCLUSIONS: In alignment with transformative learning theory, online small group discussions combined with peer role-play may potentially enhance the attitudes and confidence of medical students in relation to communication skills.

Mental Health Diagnoses on the Mini International Psychiatric Interview Are Associated With Higher Scores on the Edinburgh Postnatal Depression Scale.

OBJECTIVE: To understand if Mini International Psychiatric Interview (MINI) scores in pregnancy are associated with higher scores on the Edinburgh Postnatal Depression Scale (EPDS). DESIGN: Cross-sectional pilot study of participants who completed the EPDS during pregnancy and were then invited to complete the MINI. SETTING/LOCAL PROBLEM: An urban outpatient clinic at an academic medical setting from November 2020 to June 2021. PARTICIPANTS: Convenience sample of 20 pregnant people. INTERVENTION/MEASUREMENTS: Analysis of variance was used to examine differences based on EPDS scores and MINI symptom burden. Nonparametric tests (Mann-Whitney U or Kruskal-Wallis test) were used if assumptions were violated. Descriptive statistics were used to describe sample characteristics. RESULTS: Nine participants screened 9 or higher on the EPDS and completed the MINI. There were no significant differences in demographic variables by EPDS score. There were significant differences between demographic variables, including employment status (p = .003) and type of health insurance (p = .019), between participants who met criteria for at least one diagnosis on the MINI and those who did not. Participants with public health insurance met the criteria for four more diagnoses compared to people with private insurance. Participants not employed full-time had nearly five more diagnoses compared to those employed full-time. Higher EPDS scores were correlated with all measured MINI symptoms or diagnoses. Higher EPDS scores were significantly correlated with and showed a moderate to strong positive correlation to suicidality and antisocial personality disorder. CONCLUSION: Pregnant individuals who score 9 or higher on the EPDS may also have other severe mental health diagnoses. Recognizing perinatal mood and anxiety disorders in this population can inform the development of screening protocols and interventions during pregnancy to improve maternal access to mental health treatment and symptom reduction.

Simulation-based teaching of psychiatric interviewing to residents: A comparison of peer-to-peer and teacher role-play on confidence in clinical skills.

OBJECTIVE: To compare the effects of two simulation-based teaching programs of psychiatric interviewing using two role-play modalities on first-year psychiatry residents' confidence in their psychiatric clinical skills. METHODS: The teaching program consisted of seven 2-hour sessions per month led by two psychiatrists and academic teachers. In the peer-to-peer role-play group, students played either the patient's or doctor's role, and case scenarios were proposed by the students; in the teacher role-play group, a teacher played the patient' role and case scenarios were written by teachers. Simulation debriefing was teacher-guided in both groups. Confidence was measured with the Confidence in Psychiatric Clinical Skills Questionnaire (CPCQ) before and after the teaching program. RESULTS: Both strategies induced a significant improvement in the CPCQ total score. However, the peer-to-peer role-play program induced a significantly larger improvement in the CPCQ total score. DISCUSSION: Compared to teacher role-play, peer-to-peer role-play may enable a better comprehension of the patient perspective, reduce performance anxiety during the simulated scenario, and provide a partly improvised scenario that is more transferable to real-life clinical experiences. CONCLUSION: Teaching psychiatric interviewing using the peer-to-peer role-play approach enables greater improvement in confidence in clinical skills than teacher role-play.

Evaluating the development and well-being assessment (DAWBA) in pediatric anxiety and depression.

Enhancing screening practices and developing scalable diagnostic tools are imperative in response to the increasing prevalence of youth mental health challenges. Structured lay psychiatric interviews have emerged as one such promising tool. However, there remains limited research evaluating structured psychiatric interviews, specifically their characterization of internalizing disorders in treatment-seeking youth. This study evaluates the relationship between the Development and Well-Being Assessment (DAWBA), a structured psychiatric interview, and established measures of pediatric anxiety and depression, including the Screen for Child Anxiety Related Disorders (SCARED), the Pediatric Anxiety Rating Scale (PARS), and the Mood and Feelings Questionnaire (MFQ). The study comprised two independent clinical samples of treatment-seeking youth: sample one included 55 youth with anxiety and 29 healthy volunteers (HV), while sample two included 127 youth with Major Depressive Disorder and 73 HVs. We examined the association between the DAWBA band scores, indicating predicted risk for diagnosis, the SCARED and PARS (sample one), and the MFQ (sample two). An exploratory analysis was conducted in a subset of participants to test whether DAWBA band scores predicted the change in anxiety symptoms (SCARED, PARS) across a 12-week course of cognitive behavioral therapy. The results revealed that the DAWBA significantly predicted the SCARED, PARS and MFQ measures at baseline; however, it did not predict changes in anxiety symptoms across treatment. These findings suggest that the DAWBA may be a helpful screening tool for indexing anxiety and depression in treatment-seeking youth but is not especially predictive of longitudinal trajectories in symptomatology across psychotherapy.

Using HIPAA (Health Insurance Portability and Accountability Act)-Compliant Transcription Services for Virtual Psychiatric Interviews: Pilot Comparison Study.

BACKGROUND: Automatic speech recognition (ASR) technology is increasingly being used for transcription in clinical contexts. Although there are numerous transcription services using ASR, few studies have compared the word error rate (WER) between different transcription services among different diagnostic groups in a mental health setting. There has also been little research into the types of words ASR transcriptions mistakenly generate or omit. OBJECTIVE: This study compared the WER of 3 ASR transcription services (Amazon Transcribe [Amazon.com, Inc], Zoom-Otter AI [Zoom Video Communications, Inc], and Whisper [OpenAI Inc]) in interviews across 2 different clinical categories (controls and participants experiencing a variety of mental health conditions). These ASR transcription services were also compared with a commercial human transcription service, Rev (Rev.Com, Inc). Words that were either included or excluded by the error in the transcripts were systematically analyzed by their Linguistic Inquiry and Word Count categories. METHODS: Participants completed a 1-time research psychiatric interview, which was recorded on a secure server. Transcriptions created by the research team were used as the gold standard from which WER was calculated. The interviewees were categorized into either the control group (n=18) or the mental health condition group (n=47) using the Mini-International Neuropsychiatric Interview. The total sample included 65 participants. Brunner-Munzel tests were used for comparing independent sets, such as the diagnostic groupings, and Wilcoxon signed rank tests were used for correlated samples when comparing the total sample between different transcription services. RESULTS: There were significant differences between each ASR transcription service's WER (P<.001). Amazon Transcribe's output exhibited significantly lower WERs compared with the Zoom-Otter AI's and Whisper's ASR. ASR performances did not significantly differ across the 2 different clinical categories within each service (P>.05). A comparison between the human transcription service output from Rev and the best-performing ASR (Amazon Transcribe) demonstrated a significant difference (P<.001), with Rev having a slightly lower median WER (7.6%, IQR 5.4%-11.35 vs 8.9%, IQR 6.9%-11.6%). Heat maps and spider plots were used to visualize the most common errors in Linguistic Inquiry and Word Count categories, which were found to be within 3 overarching categories: Conversation, Cognition, and Function. CONCLUSIONS: Overall, consistent with previous literature, our results suggest that the WER between manual and automated transcription services may be narrowing as ASR services advance. These advances, coupled with decreased cost and time in receiving transcriptions, may make ASR transcriptions a more viable option within health care settings. However, more research is required to determine if errors in specific types of words impact the analysis and usability of these transcriptions, particularly for specific applications and in a variety of populations in terms of clinical diagnosis, literacy level, accent, and cultural origin.

Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation.

BACKGROUND: Studies have demonstrated that patients who have experienced acute coronary syndrome (ACS) have an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing worse survival outcomes than those who do not develop PTSD. Nevertheless, the prevalence rates of PTSD following ACS vary widely across studies, and it is noteworthy that in most cases, the diagnosis of PTSD was based on self-report symptom questionnaires, rather than being established by psychiatrists. Additionally, the individual characteristics of patients who develop PTSD after ACS can differ widely, making it difficult to identify any consistent patterns or predictors of the disorder. AIM: To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation (CR) after ACS, as well as their characteristics in comparison to a control group. METHODS: The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia, the Special Hospital for Medical Rehabilitation Krapinske Toplice. Patient recruitment for the study took place over the course of one year, from January 1, 2022, to December 31, 2022, with a total of 504 participants. The expected average follow-up period for patients included in the study is about 18 mo, and currently ongoing. Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview, a group of patients with a PTSD diagnosis was identified. From the participants who do not have a PTSD diagnosis, patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups. RESULTS: A total of 507 patients who were enrolled in the CR program were approached to participate in the study. Three patients declined to participate in the study. The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients. Out of the total sample of 504 patients, 74.2% were men (n = 374) and 25.8% were women (n = 130). The mean age of all participants was 56.7 years (55.8 for men and 59.1 for women). Among the 504 participants who completed the screening questionnaire, 80 met the cutoff criteria for the PTSD and qualified for further evaluation (15.9%). All 80 patients agreed to a psychiatric interview. Among them, 51 patients (10.1%) were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria. Among the variables analyzed, there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups. Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group (P = 0.035). CONCLUSION: The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment. Furthermore, the data suggest that these patients may exhibit reduced physical activity levels, which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population. Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.

'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders.

What does it mean to claim that somebody's personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians' and the patients' approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.

Adapting a first- and second-year medical student psychiatric interview course for virtual learning.

Background: In response to the COVID-19 pandemic, a first- and second-year psychiatric interviewing course was converted to a virtual platform with interviews performed via video conferencing. Telepsychiatry has been shown to be an effective modality for patient care, but little is known about the effectiveness of using this modality to teach the psychiatric interview. We sought to examine how switching to remote learning would affect the quality of the course. Methods: We compared student course evaluations from 2019 (in-person) with evaluations from the 2020 (virtual). Using Likert scales, students were asked to rate their comfort in interviewing patients, discussing emotional and psychological topics, and documenting the encounter. Student responses were supplemented with qualitative feedback and input from faculty facilitators. Results: We found no significant difference in student reports of their overall experience with the course, comfort with interviewing patients or with discussing emotional and psychological issues. The course reduced student self-reported stigma toward mental illness. Conclusions: The virtual delivery of this course offers learners a very similar experience to an in-person course. Looking beyond the pandemic, this model could have applications in other institutions where geographic or other logistical considerations would impede the implementation of such a course in-person.

Assessing Patients Who Seek Help Ending Their Lives.

As a result of end-of-life movements in a number of states, psychiatrists may be drawn into the capacity assessment of patients requesting assistance to end their lives. Such assessments cannot follow the mere technicalities of common clinical interviews, not simply because of the finality of the choice, but also because of the limitations of common cognitive assessments. The Committee on Professionalism and Ethics of the Group for the Advancement of Psychiatry consequently proposes an interview for such purposes that explores a patient's emotional capacity through a narrative inquiry about the patient's life, past coping, and reversible emotional states. It is a neutral approach that seeks to understand the patient rather than judge the appropriateness of an end-of-life request.

Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey.

BACKGROUND: Current research suggests that there is a nuanced relationship between mental well-being and social media. Social media offers opportunities for empowerment, information, and connection while also showing links with depression, high-risk behavior, and harassment. As this medium rapidly integrates into interpersonal interactions, incorporation of social media assessment into the psychiatric evaluation warrants attention. Furthermore, the COVID-19 pandemic and containment measures (ie, social distancing) led to increased dependence on social media, allowing an opportunity to assess the adaptation of psychiatric interviews in response to sociocultural changes. OBJECTIVE: The first aim of this study was to evaluate if general psychiatry residents and child and adolescent psychiatry fellows assessed social media use as part of the clinical interview. Second, the study examined whether changes were made to the social media assessment in response to known increase of social media use secondary to social distancing measures during the COVID-19 pandemic. METHODS: As part of a quality improvement project, the authors surveyed general psychiatry residents and child psychiatry fellows in a university-based training program (n=21) about their assessment of social media use in patient evaluations. Soon after the survey closed, "stay-at-home" orders related to the COVID-19 pandemic began. A subsequent survey was sent out with the same questions to evaluate if residents and fellows altered their interview practices in response to the dramatic sociocultural changes (n=20). RESULTS: Pre-COVID-19 pandemic survey results found that 10% (2/21) of respondents incorporated social media questions in patient evaluations. In a follow-up survey after the onset of the pandemic, 20% (4/20) of respondents included any assessment of social media use. Among the 15 participants who completed both surveys, there was a nonsignificant increase in the likelihood of asking about social media use (2/15, 13% vs 4/15, 27%, for pre- and during COVID-19, respectively; McNemar χ21=0.25, P=.617, Cohen d=0.33). CONCLUSIONS: These small survey results raise important questions relevant to the training of residents and fellows in psychiatry. The findings suggest that the assessment of social media use is a neglected component of the psychiatric interview by trainees. The burgeoning use and diversity of social media engagement warrant scrutiny with respect to how this is addressed in interview training. Additionally, given minimal adaptation of the interview in the midst of a pandemic, these findings imply an opportunity for improving psychiatric training that incorporates adapting clinical interviews to sociocultural change.

Validation of the Greek version of the distress thermometer compared to the clinical interview for depression.

BACKGROUND: The Distress Thermometer (DT) is worldwide the most commonly used instrument for quick screening of emotional burden in patients with cancer. In order to validate the Greek version of the DT in the Greek population we aimed to explore the capacity of the DT to identify patients with comorbid depressive diagnosis. METHODS: We analyzed the routinely collected clinical data from 152 patients with cancer who had been evaluated by the consultation-liaison psychiatric service and had received a diagnosis of either depressive disorder or no psychiatric diagnosis. The score of the DT accompanied by the list of problems in the Problem List, the depression status, and the clinical and demographic characteristics entered the data sheet. RESULTS: The ROC analysis revealed that the DT achieved a significant discrimination with an area under the curve of 0.79. At a cut-off point of 4, the DT identified 85% of the patients with an ICD-10 depressive diagnosis (sensitivity) and 60% of the patients without a psychiatric diagnosis (specificity). The positive predictive value was 44%, the negative predictive value 92% and the diagnostic odd ratio 8.88. Fatigue and emotional difficulties were the most commonly reported problems by the patients. CONCLUSION: The Greek version of the DT has a sufficient overall accuracy in classifying patients regarding the existence of depressive disorders, in the oncology setting. Therefore, it can be considered as a valid initial screening tool for depression in patients with cancer; patients scoring ≥4 should be assessed by a more thorough mental evaluation.

Evidence of Validity of the Autism Mental Status Examination (AMSE) in a Brazilian Sample.

This study investigated the psychometric properties of the Autism Mental Status Examination (AMSE) in a Brazilian sample of children and adolescents with autism spectrum disorder (ASD). A sample of 260 children and adolescents, comprising 56 (21.5%) females and 204 (78.5%) males, was assessed. The participants were submitted to both the childhood autism rating scale (CARS-BR) and the AMSE. The CARS-BR was used to estimate ASD severity and the cutoff point on the AMSE. Spearman's correlation test was employed to determine the correlation between the AMSE and CARS-BR scales. The cutoff values were calculated using the ROC (receiver operating characteristic) curve, identifying the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The homogeneity of the items of the AMSE was determined using Cronbach´s alpha. The AMSE exhibited good internal consistency (0.74), sensitivity (0.91) and specificity (0.98); and high correlation with the CARS-BR (ρ = 0.91, p < 0.01). Preliminary results showed that the AMSE is a tool with good psychometric properties for ASD screening.

Evaluation of a virtual agent to train medical students conducting psychiatric interviews for diagnosing major depressive disorders.

BACKGROUND: A psychiatric diagnosis involves the physician's ability to create an empathic interaction with the patient in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) can be used to train these skills but need to be evaluated in terms of accuracy, and to be perceived positively by users. METHODS: We recruited 35 medical students who interacted in a 35-min psychiatric interview with a VP simulating major depressive disorders. Semiology extraction, verbal and non-verbal empathy were measured objectively during the interaction. The students were then debriefed to collect their experience with the VP. RESULTS: The VP was able to simulate the conduction of a psychiatric interview realistically, and was effective to discriminate students depending on their psychiatric knowledge. Results suggest that students managed to keep an emotional distance during the interview and show the added value of emotion recognition software to measure empathy in psychiatry training. Students provided positive feedback regarding pedagogic usefulness, realism and enjoyment in the interaction. LIMITATIONS: Our sample was relatively small. As a first prototype, the measures taken by the VP would need improvement (subtler empathic questions, levels of difficulty). The face-tracking technique might induce errors in detecting non-verbal empathy. CONCLUSION: This study is the first to simulate a realistic psychiatric interview and to measure both skills needed by future psychiatrists: semiology extraction and empathic communication. Results provide evidence that VPs are acceptable by medical students, and highlight their relevance to complement existing training and evaluation tools in the field of affective disorders.

The Standard for Clinicians' Interview in Psychiatry (SCIP): A Clinician-administered Tool with Categorical, Dimensional, and Numeric Output-Conceptual Development, Design, and Description of the SCIP.

Existing standardized diagnostic interviews (SDIs) were designed for researchers and produce mainly categorical diagnoses. There is an urgent need for a clinician-administered tool that produces dimensional measures, in addition to categorical diagnoses. The Standard for Clinicians' Interview in Psychiatry (SCIP) is a method of assessment of psychopathology for adults. It is designed to be administered by clinicians and includes the SCIP manual and the SCIP interview. Clinicians use the SCIP questions and rate the responses according to the SCIP manual rules. Clinicians use the patient's responses to questions, observe the patient's behaviors and make the final rating of the various signs and symptoms assessed. The SCIP method of psychiatric assessment has three components: 1) the SCIP interview (dimensional) component, 2) the etiological component, and 3) the disorder classification component. The SCIP produces three main categories of clinical data: 1) a diagnostic classification of psychiatric disorders, 2) dimensional scores, and 3) numeric data. The SCIP provides diagnoses consistent with criteria from editions of the Diagnostic and Statistical Manual (DSM) and International Classification of Disease (ICD). The SCIP produces 18 dimensional measures for key psychiatric signs or symptoms: anxiety, posttraumatic stress, obsessions, compulsions, depression, mania, suicidality, suicidal behavior, delusions, hallucinations, agitation, disorganized behavior, negativity, catatonia, alcohol addiction, drug addiction, attention, and hyperactivity. The SCIP produces numeric severity data for use in either clinical care or research. The SCIP was shown to be a valid and reliable assessment tool, and the validity and reliability results were published in 2014 and 2015. The SCIP is compatible with personalized psychiatry research and is in line with the Research Domain Criteria framework.

[A Teaching Experience: Psychiatric Interview on a Simulated Scenario With the Participation of Actors of the Altergesto Theater Group]. / Experiencia pedagógica: escenario de simulación de entrevista psiquiátrica con la participación de actores del grupo de teatro representativo Altergesto.

INTRODUCTION: Simulation has been used as a learning tool in different disciplines and professions, including medicine and its specialties. Its usefulness is directly related to the integration of objectives, contents, methodologies and specific resources in each area of knowledge. OBJECTIVE: To describe the development of an educational experience implemented in the Pontificia Universidad Javeriana Cali (Cali, Colombia) with medical students of Human Behavior II program, between 2012 and 2013. This experience was performed with simulated patients played by actors of the Altergesto theater group, that were interviewed by students under the supervision of psychiatrists and teachers of the subject, using the Simulated Hospital of the University. METHODS: A historical development recall of the teaching sequence was made from the first half of 2012 to the second half of 2013, a statement of pedagogical objectives, and a description of the teaching-learning strategies. RESULTS: 158 interviews were conducted over a period of two years during which it was necessary to raise methodological solutions to adapt this teaching sequence to the content and objectives of the subject. CONCLUSIONS: The high-fidelity simulation, integrating actors who represent psychiatric patients mixed with the technology of a Simulated Hospital was useful to achieve compliance with the objectives proposed in the course of Human Behavior II, as a part of the program of Medicine at the Pontificia Universidad Javeriana Cali. In parallel, the construction of experience as an interdisciplinary project and the practical approach of this strategy may impact on cognitive, emotional, behavioral dimensions of the participants, encouraging meaningful learning. An easy access database for the collected material and the study of the effects of this strategy in the formation of long-term students is needed.

Experiencia pedagógica: escenario de simulación de entrevista psiquiátrica con la participación de actores del grupo de teatro representativo Altergesto / A Teaching Experience: Psychiatric Interview on a Simulated Scenario With the Participation of Actors of the Altergesto Theater Group

Introducción: La simulación se ha empleado como herramienta de aprendizaje en diferentes disciplinas y profesiones, como la medicina y sus especialidades. Su utilidad está directamente relacionada con la integración a los objetivos, contenidos, metodologías y recursos específicos en cada área del conocimiento. Objetivo: Describir el desarrollo de una experiencia pedagógica implementada en la Pontificia Universidad Javeriana Cali con los estudiantes de Conducta Humana II del programa de Medicina entre 2012 y 2013. Dicha experiencia se apoyó en la participación de pacientes simulados por actores del grupo representativo Altergesto, que fueron entrevistados por los estudiantes con la supervisión de los psiquiatras docentes de la materia, utilizando el Hospital Simulado de la Universidad. Métodos: Recuento histórico del desarrollo de la secuencia didáctica desde el primer semestre de 2012 hasta el segundo semestre de 2013, planteamiento de los objetivos pedagógicos y descripción de la estrategia de enseñanza-aprendizaje. Resultados: Se realizaron 158 entrevistas en un periodo de 2 años, en el transcurso de los cuales fue necesario plantear soluciones metodológicas para adaptar la secuencia pedagógica a los contenidos y los objetivos de la materia. Conclusiones: La simulación de alta fidelidad, integrando a actores que representan a los pacientes psiquiátricos y la tecnología del Hospital Simulado, resultó útil para lograr el cumplimiento de los objetivos propuestos en el curso de Conducta Humana II del programa de Medicina de la Pontificia Universidad Javeriana Cali. Paralelamente, la construcción de la experiencia como un proyecto interdisciplinario y el enfoque práctico de esta estrategia pueden impactar en las dimensiones cognitivas, emocionales y conductuales de los significativo. Es necesario construir una base de datos de fácil acceso con el material recopilado y estudiar los efectos de esta estrategia en la formación de los estudiantes a largo plazo.

Introduction: Simulation has been used as a learning tool in different disciplines and pro-Simulation scenario fessions, including medicine and its specialties. Its usefulness is directly related to the Psychiatric interview integration of objectives, contents, methodologies and specific resources in each area of Simulated patient actor knowledge. Objective: To describe the development of an educational experience implemented in the Pontificia Universidad Javeriana Cali (Cali, Colombia) with medical students of Human Behavior II program, between 2012 and 2013. This experience was performed with simulated patients played by actors of the Altergesto theater group, that were interviewed by students under the supervision of psychiatrists and teachers of the subject, using the Simulated Hospital of the University. Methods: A historical development recall of the teaching sequence was made from the first half of 2012 to the second half of 2013, a statement of pedagogical objectives, and a description of the teaching-learning strategies. Results: 158 interviews were conducted over a period of two years during which it was necessary to raise methodological solutions to adapt this teaching sequence to the content and objectives of the subject. Conclusions: The high-fidelity simulation, integrating actors who represent psychiatric patients mixed with the technology of a Simulated Hospital was useful to achieve compliance with the objectives proposed in the course of Human Behavior II, as a part of the program of Medicine at the Pontificia Universidad Javeriana Cali. In parallel, the construction of experience as an interdisciplinary project and the practical approach of this strategy may impact on cognitive, emotional, behavioral dimensions of the participants, encouraging meaningful learning. An easy access database for the collected material and the study of the effects of this strategy in the formation of long-term students is needed.

The Prevalence of Depression among Untreated Obstructive Sleep Apnea Patients Using a Standardized Psychiatric Interview.

STUDY OBJECTIVES: The aims of this study were: (1) to use a standardized psychiatric interview, conducted by a trained psychologist to assess the prevalence of depression among patients with untreated OSA, and (2) to identify if OSA severity or other comorbid disorders (insomnia, hypertension, and diabetes) are related to depression among patients with untreated OSA. METHODS: Participants were newly diagnosed patients with OSA (n = 284) waiting to start positive airway pressure (PAP) treatment. The Mini International Neuropsychiatric Interview (MINI) was used to assess depression. RESULTS: Overall, 15.5% of the sample met the diagnosis for dysthymia. Women had a significantly higher prevalence (29.5% versus 11.7% among men, p < 0.001). The prevalence of major depression was 6% in the overall sample and there was no difference in the prevalence among sexes (5.8% among men versus 6.6 % among women). Obesity, daytime sleepiness, low physical activity, initial and late insomnia, low quality of life, and sleep medication and antidepressant use were all related to depression, whereas OSA severity, as measured by apnea-hypopnea index or oxygen desaturation index, was not. Daytime sleepiness, initial insomnia, and sleep medication use were the strongest predictors of depression in multivariable analyses. CONCLUSIONS: Sleep medication use, daytime sleepiness, and symptoms of initial insomnia were independently related to depression but OSA severity was not. Increased awareness of the relationship between depression and OSA and the appropriate use of assessment tools might substantially improve diagnostic accuracy as well as treatment outcome for both disorders.

Modality resources in Spanish during psychiatric interviews with Mexican patients.

This study examines modality in doctor-patient interactions during psychiatric interviews. Twenty three interviews were conducted in Spanish and were video-recorded. The patients are members of a small community in rural California. Using the interpersonal metafunction (Eggins 2004; Halliday 1994) and approaches in pragmatics literature this work reveals the lexicogrammatical choices the patients and the doctor make using both qualitative analysis and quantitative analysis. Spanish modalization can be realized through modal operators (e.g. might), mood adjuncts (e.g. possibly), and the conditional and future tenses. In addition to these, oral contexts have alternative forms of expressing modalization such as using the preposition como 'like' and tag questions (e.g. right?) as the pragmatics literature has described. This work makes a methodological contribution by highlighting the analytical tools that alternative approaches to discourse analysis (pragmatics in this case) make available and how they complement the interpersonal metafunction. The results of this study reveal that patients use modalization at particular moments in the interview, for instance when discussing their symptoms and conditions to deliver their information carefully and to recognize the social status of the doctor. The doctor also strategically uses modalization when he asks sensitive questions in order to displace responsibility from the patients and avoid a face-threatening situation.

The reliability of the standard for clinicians' interview in psychiatry (SCIP): a clinician-administered tool with categorical, dimensional and numeric output.

BACKGROUND: Existing standardized diagnostic interviews are not used by psychiatrists in clinical settings. There is an urgent need for a clinician-administered tool for assessment of adult psychopathology that produces dimensional measures, in addition to categorical diagnoses. METHODS: The Standard for Clinicians' Interview in Psychiatry (SCIP) was designed to be used in clinical settings and generates dimensional measures. The reliability of the SCIP was tested at six sites: one hospital and two clinics in USA, two hospitals in Egypt and one clinic in Canada. Participants were adult patients who were admitted for inpatient psychiatric treatment or came for regular office visits in the outpatient clinic. Refusal rate was <1%. Missing data were <1.1%. Patients with dementia, mental retardation or serious medical conditions were excluded. A total of 1,004 subjects were interviewed between 2000 and 2012. RESULTS: Inter-rater reliability (Kappa) was measured for 150 SCIP items: 116 items (77.3%) had good reliability (Kappa>0.7), 28 items (18.7%) had fair reliability (Kappa ranges from 0.5 to 0.7) and six items (4%) had poor reliability (Kappa<0.5). Cronbach's alpha for internal consistency was measured for the SCIP dimensions: anxiety, posttraumatic stress, depression, mania, hallucinations, Schneider first-rank symptoms, delusions, disorganized thoughts, disorganized behavior, negative symptoms, alcohol addiction, drug addiction, attention and hyperactivity. All of the SCIP dimensions had substantial Cronbach's alpha values (>0.7) with the exception of disorganized thoughts (Cronbach's alpha=0.375). CONCLUSIONS: The SCIP is a reliable tool for assessing psychological symptoms, signs and dimensions of the main psychiatric diagnoses.