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1.
Praxis (Bern 1994) ; 110(1): 30-36, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33406929

RESUMO

Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept Abstract. Entrustable Professional Activities (EPAs) are competency-based learning goals derived from observable clinical activities. In undergraduate medical education, they have now been adopted throughout Switzerland as part of the so-called PROFILES catalog (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland). The nine core EPAs to be mastered in undergraduate medical education can serve as a basis for introducing EPAs in graduate medical education as well. We will discuss this approach in the context of graduate medical education in psychiatry and psychotherapy from the perspective of different training contexts and a pilot example. In this position paper, we describe a promising opportunity to improve graduate medical training through the implementation of EPAs, both in terms of the quality of training and thus of patient care, as well as in terms of the attractiveness of the specialty for future residents.


Assuntos
Educação de Graduação em Medicina , Internato e Residência , Psiquiatria , Competência Clínica , Educação Baseada em Competências , Educação de Pós-Graduação em Medicina , Avaliação Educacional , Humanos , Suíça
2.
Int J Clin Pract ; 75(1)2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32946641

RESUMO

BACKGROUND: At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS: In this paper, we discuss the potential role of telepsychiatry (TP) and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS: Telemental health services may be particularly feasible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION: Telepsychiatry is a promising and growing way to deliver mental health services but is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.


Assuntos
/psicologia , Transtornos Mentais/terapia , Psiquiatria/métodos , Psicoterapia/métodos , Telemedicina , Inteligência Artificial , Assistência à Saúde/métodos , Família/psicologia , Pessoal de Saúde/psicologia , Humanos , Transtornos Mentais/virologia , Serviços de Saúde Mental/ética , Aplicativos Móveis , Privacidade , Telemedicina/ética , Realidade Virtual
3.
J Nerv Ment Dis ; 209(1): 85-87, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33323794

RESUMO

In the last half of the 20th century, psychiatry lost many of the conditions needed for unhindered practice. I compiled from searches of the literature the 20th century changes in the arenas of psychiatric practice and the sources of these changes. I determined how these changes are shaping 21st century health and well-being. The neglect of the severely mentally ill, first in Bedlams and now on Boulevards, reflects a wide loss of resources. Psychiatry's patients have lost a past of community-based mental health services, interdisciplinary care teams, preventive consultation with social agencies, and, with reimbursements targeted for 15-minute visits, time adequate with the physician to individualize diagnosis and treatment. With the Covid-19 and other epidemics, economic inequalities, an economic crisis, unrest over police violence, and racism, psychiatry can find in its past the resources to engage 21st century psychiatric and other problems.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/história , Psiquiatria/história , /história , História do Século XX , História do Século XXI , Humanos , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/tendências , Psiquiatria/economia , Psiquiatria/tendências
4.
Psychiatr Hung ; 35(4): 493-514, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-33263299

RESUMO

The new psychiatry classification systems, despite long lasting preparation and broad consensus, do not provide an answer to the fundamental dilemmas of modern psychiatry. This is because categorical approaches are independent of the underlying neurobiological and genetic factors and cannot integrate the results of modern research, which is a big barrier of the neuroscientific development. Recent neuroscience research, with revolutionary new methods and tools and the analysis of huge databases, provides more and more information about the normal and abnormal functioning of the central nervous system. It is an enor - mous challenge to interpret these new findings, so there is a growing need to develop theoretical models that help to better understand the complexity of mental disorders and the mechanism of their development. In my paper, I summarize recent research methods related to the symptomatic heterogenity and etiological back - ground of mental disorders and present the results of some new transdiagnostic studies, in order to illustrate the key aspects of the Research Domain Criteria (RDoC) system developed to integrate the new results. The RDoC framework helps to interpret the results of neuroscience research in a complex way and facilitates the detec - tion of differences in genotypes and (endo)phenotypes, as well as a better understanding of the pathophysiological mechanisms and developmental differences responsible for the development of mental disorders. This can mean signi ficant progress not only in renewing psychiatric nosology, but also in identifying new preventive and therapeutic targets.


Assuntos
Transtornos Mentais/diagnóstico , Neurociências , Psiquiatria , Consenso , Humanos , Projetos de Pesquisa
5.
Neuropsychopharmacol Hung ; 22(4): 166-171, 2020 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-33257594

RESUMO

The COVID-19 epidemic has had an extraordinary impact on mental health. In addition to the direct effect of the virus, we must take into account increasing disease anxiety due to the risk of infection, insecurity, confusing media activity, social isolation due to quarantine, socioeconomic impact, and the reduced capacity of the health-care system. In this paper, we present our experiences with the patient information telephone service operated by the psychotherapy department of the Nyíro Gyula National Institute of Psychiatry and Addiction (Nyíro-OPAI). Clinical psychologists and psychotherapists received the calls. The vast majority of the 264 phone calls registered during the two months of the pandemic (62%) were initiated by treated patients (availability of a doctor, questions related to the operation of the health-care system, prescribing medications). Still, we could also help patients and their families in potentially dangerous situations (21%): suicidal intentions, alcohol- and drug-related crises, severe neurocognitive disorders (dementias) with acute behavioural and psychological symptoms. In all cases, the telephone consultation led to the successful resolution of the crisis (low-threshold psychological intervention, counselling, assistance in admission to the institution). A relatively small number of calls (7%) were related to more complex psychotherapeutic needs. In summary, our experience shows that in extreme social situations, direct telephone assistance is suitable for supporting registered patients in the mental health system. This type of service also provides an opportunity to address acute crises and cases requiring more complex psychotherapeutic interventions.


Assuntos
Psiquiatria , Humanos , Hungria , Serviços de Informação , Pandemias , Encaminhamento e Consulta , Telefone
6.
Psychiatr Danub ; 32(3-4): 536-548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370764

RESUMO

BACKGROUND: Many research has indicated that, during the COVID-19 pandemic, health care workers are under greatly increased pressure and at increased risk for the development of mental health problems. Furthermore, previous research has indicated that psychiatrists are exposed to a number of unique stressors that may increase their risk for poor mental health. The aims of the present study were to assess the level of COVID-19 related concerns, psychological distress and life satisfaction among psychiatrists and other physicians during the first period of the pandemic and to examine whether individual differences in COVID-19 concerns, psychological flexibility, psychological resilience and coping behaviors account for differences in mental health indicators. SUBJECTS AND METHODS: The sample consisted of N=725 physicians, among whom 22.8% were psychiatrists. This study was conducted online during the first lockdown in Croatia and collected data regarding COVID-19 related concerns, coping behaviors and mental health indicators (Psychological Distress and Life Satisfaction). RESULTS: Physicians of other specialties had higher scores on a measure of COVID-19 anxiety than psychiatrists (p=0.012). In addition, a number of differences in coping behaviors are evident. Specifically, psychiatrists were less likely than physicians of other specializations to believe that being informed about COVID-19 is an effective coping strategy (p=0.013), but more prone to using sedatives and drugs as a coping strategy (p=0.002; p=0.037). CONCLUSIONS: Psychiatrists are at special risk for substance abuse. Younger age, psychological inflexibility, low resilience and greater COVID-19 concerns might act as specific risk factors for distress. Our findings highlight the need for promoting a healthy lifestyle and psychological flexibility as universal protective factors.


Assuntos
Médicos , Psiquiatria , Controle de Doenças Transmissíveis , Croácia , Humanos , Saúde Mental , Pandemias , Fatores de Proteção
8.
Soins Psychiatr ; 41(331): 21-24, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33357663

RESUMO

The health crisis has radically changed psychiatric units. In order to react, a crisis unit was established, comprising the director, management team and medical staff. Its aim was to apply the necessary adaptation measures with regard to staff organisation and management. However, these measures have had a specifc and significant impact on patients' freedom to come and go, which must be medically justified. This crisis has highlighted more than ever the importance of coordination across the territory.


Assuntos
/prevenção & controle , Transtornos Mentais/terapia , Psiquiatria/organização & administração , /epidemiologia , França/epidemiologia , Humanos
9.
BMC Psychiatry ; 20(1): 593, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33327940

RESUMO

BACKGROUND: To date, very few nationwide studies addressing the way in which mental health services are addressing the current pandemics have been published. The present paper reports data obtained from a survey relating to the Italian mental health system conducted during the first phase of the Covid-19 epidemic. METHODS: Two online questionnaires regarding Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW), respectively, were sent to the Heads of all Italian Mental Health Departments (MHDs). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed. RESULTS: Seventy-one (52.9%) of the 134 MHDs and 107 (32.6%) of the 318 GHPWs returned completed questionnaires. Less than 20% of CMHCs were closed and approx. 25% had introduced restricted access hours. A substantial change in the standard mode of operation in CMHCs was reported with only urgent psychiatric interventions, compulsory treatments and consultations for imprisoned people continuing unchanged. All other activities had been reduced to some extent. Remote contacts with users had been set up in about 75% of cases. Cases of COVID positivity were reported for both staff members (approx. 50% of CHMCs) and service users (52% of CHMCs). 20% of CMHCs reported cases of increased aggressiveness or violence among community patients, although only 8.6% relating to severe cases. Significant problems emerged with regard to the availability of personal protective equipment (PPE) for staff members. A reduced number of GHPWs (- 12%), beds (approx.-30%) and admissions were registered (87% of GHPWs). An increase in compulsory admissions and the rate of violence towards self or others among inpatients was reported by 8% of GHPWs. Patient swabs were carried out in 50% of GHPWs. 60% of GHPWs registered the admission to general COVID-19 Units of symptomatic COVID+ non-severe psychiatric patients whilst COVID+ severe psychiatric patients who were non-collaborative were admitted to specifically set up "COVID-19" GHPWs or to isolated areas of the wards purposely adapted for the scope. CONCLUSIONS: The pandemic has led to a drastic reduction in levels of care, which may produce a severe impact on the mental health of the population in relation to the consequences of the expected economic crisis and of the second ongoing wave of the pandemic.


Assuntos
Psiquiatria , Humanos , Itália/epidemiologia , Saúde Mental , Pandemias , Inquéritos e Questionários
15.
Ideggyogy Sz ; 73(11-12): 379-387, 2020 Nov 30.
Artigo em Húngaro | MEDLINE | ID: mdl-33264537

RESUMO

Background and purpose: Nowadays, the focus of genetic, neurobiological, neuropsychological and psychosocial research is on a more accurate discovery of the etiology of mental illnesses, especially with regard to the role and complex interactions of certain risk factors. It is increasingly challenging to interpret the results of different aspects and methodologies in a coherent theoretical framework, as this can only lead to a more accurate understanding of the complexity and mechanism of the psychiatric disorders. The main aim of this paper to overview recent studies on etiological background of mental disorders and to present the most important aspects of the Research Domain Criteria (RDoC) system. Methods: Review of reports from comprehensive studies published in the most important psychiatric journals over the past five years summarizing new findings on the etio-logy of mental disorders. Results: Although current classifications indicate that mental disorders are strictly distinct diagnostic categories, new findings suggest that these marked differences in symptomatic, genetic, and neurobiological backgrounds are not detectable, as many mental disorders have been identified as having common molecular genetic risk factors, which may indicate common neurobiological pathomechanisms. Conclusion: Research results support the need for a rethinking of psychiatric nosology on an etiological basis and represent an important step forward in the more accurate exploration of the neurobiological background factors of mental disorders and thus in the development of more targeted therapeutic approaches. The development of the RDoC system can be a great help in this, as this dimensional approach offers the possibility of integrating the - often diffuse or even contradictory - neuroscientific research findings into a unified theoretical framework for the etiology, nosology and treatment of mental disorders.


Assuntos
Transtornos Mentais/etiologia , Neurociências , Psiquiatria , Humanos , Transtornos Mentais/diagnóstico , Neurociências/tendências , Pesquisa
16.
Fortschr Neurol Psychiatr ; 88(12): 778-785, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33307561

RESUMO

'Precision Psychiatry' as the psychiatric variant of 'Precision Medicine' aims to provide high-level diagnosis and treatment based on robust biomarkers and tailored to the individual clinical, neurobiological, and genetic constitution of the patient. The specific peculiarity of psychiatry, in which disease entities are normatively defined based on clinical experience and are also significantly influenced by contemporary history, society and philosophy, has so far made the search for valid and reliable psychobiological connections difficult. Nevertheless, considerable progress has now been made in all areas of psychiatric research, made possible above all by the critical review and renewal of previous concepts of disease and psychopathology, the increased orientation towards neurobiology and genetics, and in particular the use of machine learning methods. Notably, modern machine learning methods make it possible to integrate high-dimensional and multimodal data sets and generate models which provide new psychobiological insights and offer the possibility of individualized, biomarker-driven single-subject prediction of diagnosis, therapy response and prognosis. The aim of the present review is therefore to introduce the concept of 'Precision Psychiatry' to the interested reader, to concisely present modern, machine learning methods required for this, and to clearly present the current state and future of biomarker-based 'precision psychiatry'.


Assuntos
Transtornos Mentais , Psiquiatria , Biomarcadores , Humanos , Neuroimagem , Psicopatologia
17.
J Clin Psychiatry ; 81(6)2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-33238081

RESUMO

Sleep disorders such as narcolepsy can cause excessive daytime sleepiness (EDS). The diagnosis of narcolepsy is often delayed by years. Clinicians can improve the recognition of EDS and diagnosis of sleep disorders using screening tools such as the Epworth Sleepiness Scale and other tests. By following up with patients who present with EDS and continuing to assess until a cause is found, clinicians can lessen the time to diagnosis and initiate appropriate treatment. Fortunately, existing pharmacologic interventions are effective in reducing EDS for many patients, but elimination of EDS for most patients has not been achieved. Some interventions also show efficacy in cataplexy. Nonpharmacologic strategies should also be discussed with patients. Clinicians must monitor EDS during ongoing treatment so that residual symptoms can be addressed. Research suggests a causative role for hypocretin deficiency in narcolepsy, and treatments ameliorating this deficiency are needed. ​.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/tratamento farmacológico , Orexinas/deficiência , Adulto , Idade de Início , Comorbidade , Diagnóstico Diferencial , Humanos , Narcolepsia/diagnóstico , Narcolepsia/tratamento farmacológico , Psiquiatria/educação , Qualidade de Vida
19.
J Clin Psychiatry ; 81(6)2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33147658

RESUMO

​​​​​​ Clinicians now have 2 effective and well-tolerated vesicular monoamine transporter 2 (VMAT2) inhibitors-valbenazine and deutetrabenazine-for the treatment of patients with tardive dyskinesia (TD), a severe and potentially irreversible side effect associated with dopamine receptor blocking agents. Clinicians should use measurement-based care, eg, the Abnormal Involuntary Movement Scale with activation maneuvers, to assess and document TD symptoms and treatment progress. Each follow-up visit should be personalized with questions related to patients' functioning and level of distress regarding their specific TD symptoms. Family members, if available, can provide information on symptom changes and assistance with medication adherence. With continued treatment and measurement-based care, patients can experience improvement in their TD symptoms.


Assuntos
Inibidores da Captação Adrenérgica/farmacologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Discinesia Tardia/diagnóstico , Discinesia Tardia/tratamento farmacológico , Tetrabenazina/análogos & derivados , Valina/análogos & derivados , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores , Adulto , Humanos , Psiquiatria/educação , Tetrabenazina/farmacologia , Valina/farmacologia
20.
J Clin Psychiatry ; 81(6)2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33147659

RESUMO

​​​​​​​​ Behavioral and psychological symptoms are common in patients with dementia. Especially troublesome are the delusions and hallucinations of dementia-related psychosis (DRP) due to their negative impact on both patients and their carers and family members. This report reviews the impact of DRP on patients and carers, assessment tools, and coping strategies and techniques to help care partners manage DRP.


Assuntos
Cuidadores/psicologia , Delusões/diagnóstico , Demência/diagnóstico , Família/psicologia , Alucinações/diagnóstico , Escalas de Graduação Psiquiátrica , Psicoterapia , Transtornos Psicóticos/diagnóstico , Estresse Psicológico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Delusões/etiologia , Demência/complicações , Alucinações/etiologia , Humanos , Pessoa de Meia-Idade , Psiquiatria/educação , Transtornos Psicóticos/etiologia
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