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1.
Lakartidningen ; 1212024 Apr 04.
Artigo em Sueco | MEDLINE | ID: mdl-38572715

RESUMO

In the last 20 years there has been an increased interest in research on psychedelic compounds for treatment of psychiatric conditions such as depression, anxiety and substance use disorders. Despite existing treatments being efficacious for many patients, this is not the case for up to a third of the patients with depression. Additionally, treatments are often long and associated with side effects. This review focuses on the psychedelic compound psilocybin, a serotonin-2A-receptor agonist that has been seen to reduce depression and anxiety in patients after administration of only a single dose, with effects lasting several weeks. Recent findings from phase II studies suggest that psilocybin treatment for depression is safe and efficacious. A phase III study is currently recruiting. Whether psychedelics will become a part of standard healthcare remains to be seen, but findings do give rise to cautious optimism.


Assuntos
Alucinógenos , Psiquiatria , Humanos , Alucinógenos/efeitos adversos , Psilocibina/efeitos adversos , Transtornos de Ansiedade
2.
Health Aff (Millwood) ; 43(4): 557-566, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38560809

RESUMO

Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.


Assuntos
Serviços de Saúde Mental , Psiquiatria , Gravidez , Feminino , Humanos , Estados Unidos , Encaminhamento e Consulta , Saúde Mental , Telefone
3.
JMIR Med Educ ; 10: e54067, 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38596832

RESUMO

Background: Undergraduate medical studies represent a wide range of learning opportunities served in the form of various teaching-learning modalities for medical learners. A clinical scenario is frequently used as a modality, followed by multiple-choice and open-ended questions among other learning and teaching methods. As such, script concordance tests (SCTs) can be used to promote a higher level of clinical reasoning. Recent technological developments have made generative artificial intelligence (AI)-based systems such as ChatGPT (OpenAI) available to assist clinician-educators in creating instructional materials. Objective: The main objective of this project is to explore how SCTs generated by ChatGPT compared to SCTs produced by clinical experts on 3 major elements: the scenario (stem), clinical questions, and expert opinion. Methods: This mixed method study evaluated 3 ChatGPT-generated SCTs with 3 expert-created SCTs using a predefined framework. Clinician-educators as well as resident doctors in psychiatry involved in undergraduate medical education in Quebec, Canada, evaluated via a web-based survey the 6 SCTs on 3 criteria: the scenario, clinical questions, and expert opinion. They were also asked to describe the strengths and weaknesses of the SCTs. Results: A total of 102 respondents assessed the SCTs. There were no significant distinctions between the 2 types of SCTs concerning the scenario (P=.84), clinical questions (P=.99), and expert opinion (P=.07), as interpretated by the respondents. Indeed, respondents struggled to differentiate between ChatGPT- and expert-generated SCTs. ChatGPT showcased promise in expediting SCT design, aligning well with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, albeit with a tendency toward caricatured scenarios and simplistic content. Conclusions: This study is the first to concentrate on the design of SCTs supported by AI in a period where medicine is changing swiftly and where technologies generated from AI are expanding much faster. This study suggests that ChatGPT can be a valuable tool in creating educational materials, and further validation is essential to ensure educational efficacy and accuracy.


Assuntos
Educação de Graduação em Medicina , Psiquiatria , Humanos , Inteligência Artificial , Aprendizagem , Canadá
5.
Rev. esp. sanid. penit ; 26(1): 25-34, Ene-Abr. 2024. tab, graf
Artigo em Inglês, Espanhol | IBECS | ID: ibc-231144

RESUMO

Introducción: En el entorno penitenciario, hay una elevada incidencia de conductas autolesivas, con una tasa de suicidio superior a la existente en la población general. Estudios previos describen la asociación de factores sociodemográficos, clínicos y criminológicos, con el riesgo de suicidio en la población penitenciaria masculina, pero hay pocas investigaciones centradas en el análisis de la conducta suicida entre mujeres. El objetivo del trabajo es analizar las características de las internas que ingresan en una unidad psiquiátrica por presentar ideas de suicidio o haber realizado tentativas.Material y método: Análisis descriptivo y comparativo de 97 internos (68 hombres, 29 mujeres) ingresados en la Unidad de Hospitalización Psiquiátrica de la Penitenciaria de Cataluña (UHPP-C), por ideas de suicidio, entre el 1 de enero de 2017 y el 31 de diciembre de 2022. Resultados: Se encuentran diferencias respecto al lugar de nacimiento, con mayor presencia de nacionalidades africanas en varones no nacionales, mientras que las internas extranjeras suelen ser originarias de países latinoamericanos. Los hombres tienen menor edad media, con ingresos más prolongados y una mayor tasa de reingreso. También padecen más trastornos psicóticos y adictivos. Las mujeres presentan mayor prevalencia de trastornos de personalidad y cuadros afectivos. Conclusiones: Hay diferencias sociodemográficas y clínicas entre hombres y mujeres internos en prisión que requieren ingreso por ideación suicida. Incluir la perspectiva de género en los estudios sobre el riesgo suicida en la población penitenciaria puede proporcionar una base sólida para futuros estudios, permitiendo así una comprensión más completa de la ideación suicida y las necesidades de intervención en la población penitenciaria.(AU)


Introduction: There is a high incidence of self-harming behavior in the prison setting, with a suicide rate that is higher than that of the general population. Previous studies describe the association of sociodemographic, clinical, and criminological factors with the risk of suicide in the male prison population, but there is little research that specifically analyses suicidal behavior among women. The objective of this study is to analyze the characteristics of inmates who are admitted to a psychiatric unit for suicidal thoughts or attempted suicide. Material and method: Descriptive and comparative analysis of 97 inmates (68 men, 29 women) admitted to the Unidad de Hospitalización Psiquiátrica Penitenciaria de Cataluña (UHPP-C), for suicidal ideation, between January 1, 2017, and December 31, 2022. Results: There are differences in terms of place of birth, with a more significant presence of African nationalities in non-national males, while foreign inmates tend to come from Latin American countries. Men have a lower mean age, longer admissions, and a higher readmission rate. They also suffer from more psychotic and addictive disorders. Women have a higher prevalence of personality disorders and affective symptoms. Conclusions: There are sociodemographic and clinical differences between male and female prison inmates who require admission for suicidal ideation. Including a gender perspective in studies on suicide risk in the prison population can provide a solid foundation for future studies, thus allowing a more complete understanding of suicidal ideation and intervention needs in theprison population.(AU)


Assuntos
Humanos , Masculino , Feminino , Prisioneiros/psicologia , Perspectiva de Gênero , Comportamento Autodestrutivo , Suicídio , Ideação Suicida , Tentativa de Suicídio , Prisões , Espanha , Psiquiatria , Saúde Mental , Epidemiologia Descritiva
6.
Pap. psicol ; 45(1): 48-55, Ene-Abr, 2024. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-229716

RESUMO

Borderline personality (BPD) features and intimate partner violence (IPV) have been seen associated, focusing the research specially into perpetrators. The achievement of this systematic review is to analyze this relation in both victims and perpetrators, using 17 scientific articles published between 2017 and 2021 from different data bases. Most studies were focused on perpetrators, in which both men and women were equally represented as perpetrators. Instead, studies about victims were focused on women. Throughout this review, different factors observed in people with BPD traits who are victims or perpetrators of IPV are mentioned, finding particularities in each profile. These findings allow increase knowledge about the relationship between BPD and IPV, promoting a greater understanding that impacts positively on clinical intervention in this population.(AU)


Los rasgos límites de personalidad (TLP) se han visto asociados a violencia en la pareja, con investigaciones centradas especialmente en quienes la ejercen. El objetivo de esta revisión sistemática es analizar esta relación tanto en víctimas como en perpetradores, utilizando 17 artículos científicos publicados entre 2017 y 2021 en distintas bases de datos. Los estudios analizados se centraron mayoritariamente en perpetradores, encontrándose tanto hombres como mujeres igualmente representadas. En cambio, los estudios sobre víctimas atendían por lo general a mujeres. A lo largo de esta revisión, se mencionan distintos factores observados en personas que presentan rasgos TLP y ejercen o son víctimas de violencia de pareja, encontrando particularidades en cada perfil. Este trabajo permite incrementar el conocimiento sobre la relación existente entre TLP y violencia de pareja, fomentando una mayor comprensión que repercuta positivamente en la intervención clínica de esta población.(AU)


Assuntos
Humanos , Masculino , Feminino , Saúde Mental , Vítimas de Crime , Violência por Parceiro Íntimo , Transtorno da Personalidade Borderline , Psicologia , Psiquiatria
7.
Artigo em Alemão | MEDLINE | ID: mdl-38502362

RESUMO

The interdisciplinary care of children and adolescents with mental disorders requires services from various German codes of social law and-within the medical care system-enclosing inpatient and outpatient services. The increasing demand, the increase in severity of disorders, and the general shortage of staff in social services put pressure on the structures of the interdisciplinary service networks resulting in long waiting periods, long distances, and regionally insufficient care. The medical field of child and adolescent psychiatry and psychotherapy (CAPP) plays the central and coordinating role within the cooperative care for children and adolescents with mental disorders. The CAPP is in clear need of reforms; however, these are markedly different from the reform needs of the German somatic medical care system and differ substantially from those of the (adult) psychiatry, psychotherapy, and psychosomatics disciplines. This discussion paper describes the reform requirements, the specifics of the CAPP structures, and suggestions to overcome sectors of service provision, enhance networking, intensify telemedicine, and develop evidence-based prevention and early recognition of child mental disorders.


Assuntos
Transtornos Mentais , Psiquiatria , Criança , Adulto , Humanos , Adolescente , Alemanha , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Assistência Ambulatorial , Psicoterapia
8.
Ann Palliat Med ; 13(2): 433-439, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38509645

RESUMO

BACKGROUND: Palliative psychiatry is an emerging field that suggests a role for palliative interventions in the management of severe and persistent mental illness (SPMI). Current literature describes using a palliative approach for patients with severe anorexia nervosa. To our knowledge, this is the first case report describing end-of-life care in a patient with treatment-refractory catatonic schizophrenia. CASE DESCRIPTION: We describe the case of a 49-year-old man with schizophrenia and severe chronic agitated/malignant catatonia who was hospitalized for ten months. Multiple treatment trials including medication such as neuroleptics and benzodiazepines, electroconvulsive therapy, and empiric interventions such as intravenous immunoglobulins were either not tolerated or did not result in clinically significant improvement. The patient continued to intermittently require intubation and sedation to control intractable behavioral and psychiatric disturbances. Ultimately, with collaboration of psychiatry, neurology, ethics, intensive care, and palliative care teams, the patient's parents decided to forgo further diagnostic testing and life-sustaining treatments. The patient died weeks later of aspiration pneumonia with good symptom control. CONCLUSIONS: This case permits discussion of palliative interventions in patients with SPMI such as treatment-refractory psychotic disorders who likely cannot achieve a quality of life that is acceptable to them. Here, it can be justified to prioritize relief of suffering and prevention of further burdensome interventions over treatment of the SPMI symptoms such as catatonia and even over keeping the patient alive.


Assuntos
Catatonia , Psiquiatria , Esquizofrenia , Masculino , Humanos , Pessoa de Meia-Idade , Catatonia/diagnóstico , Catatonia/tratamento farmacológico , Esquizofrenia/terapia , Esquizofrenia/tratamento farmacológico , Esquizofrenia Resistente ao Tratamento , Qualidade de Vida/psicologia
9.
Ann Palliat Med ; 13(2): 415-427, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38509651

RESUMO

BACKGROUND: Current literature highlights the need for psychological support of adolescents and young adults (AYAs) with serious illness, for which pediatric palliative care (PPC) teams are often responsible. This scoping review aims to inventory the most current literature based on discipline, geography, population, methodology, and themes among interdisciplinary PPC teams and the management of psychological distress in AYAs. METHODS: Using a scoping review design, a protocol was registered in Open Science Framework (https://osf.io/fb48n/). Sources for evidence included online databases (Scopus, PubMed, Embase, PsycInfo, CINAHL), Google Scholar, clinical manuals, texts, national organization webpages, and reference lists, all searched June, 2023. Interviews with content experts and authors identified additional sources. Those describing interdisciplinary palliative care (PC) and management of psychological/psychiatric distress in seriously ill AYAs, written in English, and completed in the U.S. between 2018-2023 were included. International citations were included if American literature was reviewed, or if authors described internationally developed PC standards by which American providers must practice. Clear and comprehensive data charting was completed by an independent reviewer, using a deductive approach with a standardized data-charting form developed prior to extraction. RESULTS: Sixty-five references met inclusion criteria. Psychologists most frequently published in the past 5 years regarding integration of their care into palliative teams. Authors wrote from eastern U.S., qualitatively studying the PC team in the oncology space. Of eight themes identified, barriers, facilitators, and interventions were most frequently reported. CONCLUSIONS: Role delineation among PPC teams can be difficult in the management of psychological distress, due to lack of training and consistent collaboration models among cancer and non-cancer populations. Current literature highlights a large gap in psychological/psychiatric training. However, optimized pain control, routine screening of distress, open/honest/developmentally appropriate communication, and early advance care planning are interventions by which palliative providers can begin managing psychological distress in seriously ill AYAs. While the presence of psychologists and psychiatrists is widely variable among PPC teams, their expertise can vastly advance the field of PC, through collaboration, education, research, and advocacy.


Assuntos
Planejamento Antecipado de Cuidados , Neoplasias , Psiquiatria , Adolescente , Adulto Jovem , Humanos , Criança , Cuidados Paliativos/métodos , Neoplasias/psicologia , Oncologia
11.
AMA J Ethics ; 26(3): E219-224, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38446726

RESUMO

Patients often report experiencing boredom during inpatient psychiatry stays. Because patients' vulnerabilities and conditions can be exacerbated when they feel bored, this article considers ethical dimensions of inpatient units' designs that limit patients' autonomy or access to activities or interactions with others. This commentary on a case also considers whether and how boredom should be considered an iatrogenic harm and influence discharge planning.


Assuntos
Pacientes Internados , Psiquiatria , Humanos , Tédio , Emoções , Doença Iatrogênica
12.
AMA J Ethics ; 26(3): E237-247, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38446729

RESUMO

This article canvasses extant literature about values, evidence, and standards for inpatient psychiatry units' design. It then analyzes apparent trade-offs between quality of care and access to care using empirical and ethical lenses. From this analysis, the authors conclude that standards for the built environment of inpatient psychiatric care should align with patient-centeredness, even if a downstream consequence of implementing new patient-centered designs is a reduction in beds, although this secondary outcome is unlikely.


Assuntos
Pacientes Internados , Psiquiatria , Humanos , Ambiente Construído , Assistência Centrada no Paciente
13.
AMA J Ethics ; 26(3): E205-211, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38446724

RESUMO

Therapeutic security in inpatient psychiatric settings requires careful planning and implementation if it is to support patients' safety and dignity. This commentary on a case considers patients' dignity experiences when restrictions on their freedom are used to keep them safe.


Assuntos
Pacientes Internados , Psiquiatria , Humanos , Respeito , Segurança do Paciente
14.
AMA J Ethics ; 26(3): E257-263, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38446731

RESUMO

Since the Joint Commission shifted its focus to suicide mitigation strategy implementation in behavioral health units in 2007, examining modern design trends in historical context is more clinically and ethically important than ever. This article considers architectural evolutions in how health care organizations have used structure and space designs to balance safety and healing when housing patients who are suicidal.


Assuntos
Psiquiatria , Suicídio , Humanos , Pacientes Internados , Ideação Suicida
15.
Artigo em Inglês | MEDLINE | ID: mdl-38442071

RESUMO

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2024;26(2):23f03584.Author affiliations appear at the end of this article.


Assuntos
Transtorno do Espectro Autista , Psiquiatria , Humanos , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Hospitais Gerais , Pacientes Internados , Encaminhamento e Consulta
18.
Psychodyn Psychiatry ; 52(1): 25-45, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38426757

RESUMO

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.


Assuntos
Psiquiatria , Psicanálise , Humanos , Feminino , Estados Unidos , Psicoterapia
19.
Psychodyn Psychiatry ; 52(1): 1-7, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38426754

RESUMO

The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed. Common psychotherapy themes in the treatment of persons who experience vision loss from systemic illness include reactivation of memories of past traumas resulting in avoidance, social withdrawal, depressive states, catastrophic thinking, a sense of foreshortened future, anhedonia, and fear of disintegration and invisibility. Psychotherapy also serves to correct negative introjects from ableist societal attitudes.


Assuntos
Psiquiatria , Psicoterapia Psicodinâmica , Humanos , Psicoterapia/métodos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Cegueira , Psicoterapia Psicodinâmica/métodos
20.
Harv Rev Psychiatry ; 32(2): 70-75, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38452287

RESUMO

ABSTRACT: The culture around personality disorder treatment has changed drastically in the past generation. While once perceived as effectively untreatable, there are now numerous evidence-based treatment approaches for personality disorders (especially borderline personality disorder). The questions, however, of who should be matched to which treatment approach, and when, remain largely unanswered. In other areas of psychiatry, particularly substance use disorders and eating disorders, assessing patient treatment readiness is viewed as indispensable for treatment planning. Despite this, relatively little research has been done with respect to readiness and personality disorder treatment. In this article, we propose multiple explanations for why this may be the case, relating to both the unique features of personality disorders and the current cultural landscape around their treatment. While patients with personality disorders often face cruel stigmatization, and much more work needs to be done to expand access to care (i.e., our system's readiness for patients), even gold-standard treatment options are unlikely to work if a patient is not ready for treatment. Further study of readiness in the context of personality disorders could help more effectively match patients to the right treatment, at the right time. Such research could also aid development of strategies to enhance patient readiness.


Assuntos
Transtorno da Personalidade Borderline , Transtornos da Alimentação e da Ingestão de Alimentos , Psiquiatria , Transtornos Relacionados ao Uso de Substâncias , Humanos , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/terapia , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/terapia
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