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1.
Workplace Health Saf ; 70(1): 43-49, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35037513

RESUMO

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.


Assuntos
COVID-19 , Medicina do Trabalho , Psiquiatria , Telemedicina , Feminino , Pessoal de Saúde , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Quarentena , SARS-CoV-2
2.
J Psychiatr Pract ; 28(1): 62-66, 2022 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-34989347

RESUMO

Clozapine is the antipsychotic of choice in treatment-resistant schizophrenia. Serum clozapine concentration testing is essential to monitor adherence, adjust dosing, and ensure treatment safety. However, patients who are acutely unwell are frequently reluctant to undergo blood testing requiring venipuncture. Also, conventional laboratory-based measurement of clozapine plasma levels can take days, thus contributing to the suboptimal use of clozapine when it is most needed. We pioneered clozapine whole-blood point of care (POC) testing in the acute inpatient setting in the treatment of a group of actively psychotic patients receiving clozapine during the outbreak of the COVID-19 pandemic. POC clozapine testing using automated homogenous immunoassay requires only finger prick blood sampling and is more acceptable to patients. As it produces results in minutes, clozapine POC testing serves to promptly ascertain adherence with treatment and inform therapeutic dosing. POC testing offered a more practical, less invasive, and quicker alternative to conventional methods of monitoring clozapine levels. Near immediate availability of clozapine levels expedited clinical decisions and helped ensure safe clozapine prescribing to our severely psychotic patients in a time of crisis. By facilitating patients' early safe discharge from the hospital, clozapine POC testing also reduced length of hospitalization.


Assuntos
Antipsicóticos , COVID-19 , Clozapina , Psiquiatria , Antipsicóticos/uso terapêutico , Clozapina/efeitos adversos , Humanos , Pacientes Internados , Pandemias , Testes Imediatos , SARS-CoV-2
6.
Neuropsychopharmacol Hung ; 23(4): 347-362, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34971399

RESUMO

Objective: Medication adherence in bipolar disorder (BD) may be influenced by 6 selfreported dimensions: 1) high/low psychological reactance, 2) high/low internal healthlocus of control (HLOC), 3) high/low doctor HLOC, 4) pharmacophobia, 5) pharmacophilia, and 6) skepticism about a specific medication. This study in Spain, Argentina, and Venezuela included 142 outpatients with BD prescribed 320 psychiatric medications and 1230 other psychiatric outpatients prescribed 2134 medications. Methods: Logistic regression models included adherence for each psychiatric medication, measured by the Sidorkiewicz Adherence Tool as the dependent variable. The models provided adjusted odds ratios (ORs) of dichotomous independent variables: clinical variables and 6 self-reported dimensions. Results: ORs significant in both groups were: 1) high doctor HLOC (OR=1.87 in BD, OR=1.25 in other patients), 2) high psychological reactance (respectively OR=0.572, OR=0.798), 3) pharmacophobia (respectively OR=0.361, OR=0.614), and 4) skepticism about a specific medication (respectively OR=0.300, OR=0.556). Two ORs were only significant in BD patients: medication duration > 1 year (OR=0.449), and extreme polypharmacy (OR=2.49). The study included 104 BD patients prescribed 122 mood stabilizers and 136 other patients prescribed 140 mood stabilizers. Two ORs were significant for mood stabilizer adherence only in BD patients: high doctor HLOC and skepticism (respective ORs=2.38, OR=0.390). The study included 87 BD patients prescribed 97 antipsychotics and 417 other patients prescribed 458 antipsychotics. Four ORs were significant for antipsychotic adherence only in the BD group. Conclusions: Future studies of adherence to all/specific medications should explore the specific city/commonality of these dimensions, particularly doctor HLOC, in BD versus other psychiatric patients. (Neuropsychopharmacol Hung 2021; 23(4): 347-362).


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtornos Mentais , Psiquiatria , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Adesão à Medicação , Transtornos Mentais/tratamento farmacológico
7.
Fam Syst Health ; 39(4): 551-562, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34914460

RESUMO

What is the Primary Care Behavioral Health (PCBH) model of service delivery? Clinician innovators, administrators, and researchers have continued to refine the answer to this question. In the same way a recipe for mac n cheese provides the resources needed (i.e., ingredients), processes to make the dish, and expected outcomes (e.g., number of servings), a comprehensive operational definition for PCBH is needed to help improve the rigor of research being conducted. This recipe can also help clinicians/administrators identify a basic recipe for PCBH that standardizes the necessary components and amounts to achieve the expected outcomes. In this editorial, we provide a comprehensive operational recipe for PCBH based on current research. We are calling people to assist us by (a) utilizing the recipe to help improve the reporting and rigor of PCBH research and (b) applying the proposed operational definitions and targets within the recipe to help us refine and validate them. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Medicina do Comportamento , Psiquiatria , Pesquisa sobre Serviços de Saúde , Humanos , Atenção Primária à Saúde
8.
Fam Syst Health ; 39(4): 665-669, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34914464

RESUMO

Barriers to the spread of integrated behavioral health and primary care continue to limit progress on meeting critical needs for mental health and substance use disorder services. The recent Bipartisan Policy Center Report (2021) provides key policy recommendations to address these barriers and accelerate the adoption of integrated behavioral health in Medicaid and Medicare. Having bipartisan support presents a policy window of opportunity to advance integrated behavioral health through advocacy for implementation of these recommendations, parallel changes to occur in employer-based and other commercial insurance plans, and development of operationalized standards for core service delivery elements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Medicare , Psiquiatria , Idoso , Humanos , Medicaid , Saúde Mental , Atenção Primária à Saúde , Estados Unidos
9.
Soins Psychiatr ; 42(337): 12-15, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34895688

RESUMO

Access to care has always been at the heart of the concerns of the actors of psychiatry. History reminds us of this, from the alienist Philippe Pinel and his moral treatment to the creation of the Sector in 1960. The principle of sectorisation is the very organisational intelligence of French psychiatry. By proposing a continuity of care, in and out of hospital, by the same team, and a major focus on the prevention of disorders, the Sector guarantees access to care for all. This success is now being undermined. The reduction of beds accompanied by a financial loss, budget cuts or the demographic decline of practitioners are the main ills of psychiatry, which must face the explosion of needs and demands for care.


Assuntos
Psiquiatria , Orçamentos , Acesso aos Serviços de Saúde , Humanos , Princípios Morais
10.
Soins Psychiatr ; 42(337): 42-45, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34895694

RESUMO

The notion of dignity is not synonymous with autonomous freedom (autonorma). It has an objective dimension, which is based on the individual's belonging to humanity. This is often neglected in psychiatry, even though it is what leads to the universal prevailing over singular preferences when a value specific to the human condition and to the suffering that inhabits it is at stake. To be of this universality while being a clinic of singularity representes the nobility of psychiatry and its vocation to make mental health live.


Assuntos
Psiquiatria , Respeito , Liberdade , Acesso aos Serviços de Saúde , Humanos , Pessoalidade
11.
Lit Med ; 39(2): 273-295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34897128

RESUMO

With careful attention to nineteenth-century race science's psychiatric discourses about slavery and insanity that led to the management and containment of African Americans in or on plantations, asylums, and society writ large, this article examines various themes, narrative sketches and intertextualities in Incidents that illustrate Harriet Jacobs's theoretical conceptions about the devastating mental harm caused by forms of violence that were integral to the practice of slavery vis-à-vis black women-sexualized violence, forced and controlled reproduction, separation from children between and within plantations, runaway attempts, witnessing violence, and hazardous labor conditions. I argue that Jacobs's narrative troubles visions of resiliency and resistance during slavery that elide the impact of the institution's routinized violence. It demonstrates that enslaved women's embodied experiences of psychological suffering were vexed, multilayered, and ongoing.


Assuntos
Pessoas Escravizadas , Escravização , Psiquiatria , Afro-Americanos , Criança , Feminino , Humanos
12.
Psychiatr Danub ; 33(4): 532-540, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34928901

RESUMO

BACKGROUND: This study aimed to compare the hospitalization rates and social functioning of patients receiving Community Mental Health Center (CMHC) services and those treated in the psychiatry policlinics of hospitals. SUBJECTS AND METHODS: A total of 145 patients who were diagnosed with schizophrenia or schizoaffective disorder according to DSM-V criteria were included in the study. Of them, 81 received CMHC services at least for one year (CMHC group) and 64 were followed-up in psychiatry policlinics (hospital group). A personal information form containing socio-demographic and disease/treatment characteristics and hospitalization counts in the last year, Social Functioning Assessment Scale (SFAS) and Positive and Negative Syndrome Scale (PANSS) were used to collect data. The hospital group received antipsychotic medication therapy while a semi-structured psycho-social intervention program combined with antipsychotic drug therapy was applied in the CMHC group. The hospitalization counts, SFAS and PANSS scores of the groups were compared and the correlation of related factors were evaluated. RESULTS: Hospitalization rates were 0.21±0.56 in the CMHC group and 1.03±1.31 in the hospital group. The mean hospitalization rate was significantly lower in the CMHC group (p<0.001). The mean scores for the overall SFAS and its interpersonal relationships and entertaining subscale; were significantly higher in the CMHC. The mean overall PANSS scores were 84.23±15.28 and 99.50±15.99 in the CMHC and hospital groups, respectively (p<0.05). There was a moderate positive relationship between hospitalization rates and all PANSS scores. CONCLUSIONS: CMHC services led to a serious decrease in hospitalization rates, increased the psychosocial functioning of patients and improved their compliance to treatment. Transition to a community-based mental health model should be accelerated for holistic treatment. Further longitudinal studies with a control group should be conducted.


Assuntos
Serviços Comunitários de Saúde Mental , Psiquiatria , Hospitalização , Humanos , Pacientes Ambulatoriais , Interação Social
13.
Artigo em Inglês | MEDLINE | ID: mdl-34915601

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.


Assuntos
Abuso Sexual na Infância , Psiquiatria , Criança , Atenção à Saúde , Hospitais Gerais , Humanos , Pacientes Internados
15.
Psychiatr Hung ; 36(4): 504-517, 2021.
Artigo em Húngaro | MEDLINE | ID: mdl-34939569

RESUMO

The "Act on the Development of the Health Care System, CXXXII/2006" ordered a general reduction in the number of hospital beds, which sensitively affected the care of psychiatric inpatients, too. In this wave of downsizing, the National Institute of Psychiatry and Neurology, an institute with the traditions of one and a half centuries, also ceased to exist. Based on statistical data, the article examined the effect of the law on inpatient and outpatient psychiatric/ addictological care. The reduction in the number of beds had a long-term effect only upon the reduction in the capacity of acute inpatient care; while the number of acute patients treated decreased, the number of involuntary hospital admissions increased and oddly enough, bed occupancy also decreased. This last phenomenon can in part be attributed to a reduction in nursing time. The patient care decreased in both adult and pediatric psychiatric out - patient care, as did similarly the turnover of outpatient clinics for addicts. However, the changes observed in outpatient care were not related to the bed number reduction, but rather meant the continuation of previously started decline in psychiatric/addictological care. There were no detectable changes in the trends for other examined characteristics, such as homelessness and involuntary treatment. A temporary increase was observed only in the number of completed suicides, but the previously seen decreasing trend was restored in this respect after 2011. All in all, the reduction in the number of beds forced by law caused only temporary care disruptions and had no significant effect, either positive or negative, on the negative trends in psychiatric/addictological care that started earlier. However, the reasons for these negative trends observed in Hungarian psychiatric/addictological care, and which still persist to this day, are unclear.


Assuntos
Transtornos Mentais , Neurologia , Psiquiatria , Suicídio , Adulto , Criança , Hospitais Psiquiátricos , Humanos , Hungria , Transtornos Mentais/terapia
16.
Psychiatr Hung ; 36(4): 536-545, 2021.
Artigo em Húngaro | MEDLINE | ID: mdl-34939571

RESUMO

Electroconvulsive therapy (ECT) is one of psychiatry's most long-standing and criticized treatments. Some of the criticisms come from the ethical aspect of ECT. The authors review the ethical issues of clinical application and research of ECT. ECT in the treatment of psychiatric patients is considered ethical, if it is conducted according to the four main principles of bioethics (beneficence, non-maleficence, autonomy and justice). ECT research should also comply with other international guidelines and research ethics codes. In recent decades, the principle of informed consent has become widespread in psychiatry, which requires objective information from the attending doctor according to the most reliable scientific information. The UN Convention on the Rights of Persons with Disabilities considers psychiatric disorders to be part of the concept of disability. For disabled psychiatric patients, assisted decision-making is a desirable way of self-determination. In doing so, it is important to use decision support instead of decision-substituting mechanisms, although for patients lacking insight, decisionsubstituting mechanisms are unavoidable.


Assuntos
Eletroconvulsoterapia , Transtornos Mentais , Psiquiatria , Humanos , Consentimento Livre e Esclarecido , Autonomia Pessoal
17.
Health Hum Rights ; 23(2): 239-251, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34966239

RESUMO

Despite the imperatives to reduce coercive practices such as substitute decision-making, seclusion, and restraint, the psychiatric profession has struggled to realize these aspirations. Education delivered by people with lived experience of mental distress can help facilitate change. We introduced a service user-led academic program for psychiatry residents focused on promoting human rights and reducing coercive practices in mental health care. Few published reports of such service user-led education exist. In this qualitative study, we analyze data exploring this new program's impact in practice. Four major themes were identified. Service user-led training was challenging but highly valued and prompted a paradigm shift, changing residents' thinking. Residents had so much promise in their early intentions to reduce coercive practices. However, numerous barriers impeded them from implementing these intentions. Power differentials that existed at multiple levels caused residents to experience themselves as "pawns" playing set roles working under a system with entrenched hierarchies, resource limitations, legislative frameworks, and public expectations operating to maintain the status quo. The apprenticeship model under which psychiatry residents work is a significant socializing influence. If only the "old paradigm" is modeled and taught, then this hinders more progressive thinking. Service user-led education should be offered more broadly.


Assuntos
Transtornos Mentais , Psiquiatria , Coerção , Direitos Humanos , Humanos , Restrição Física
18.
Asia Pac Psychiatry ; 13(4): e12503, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34967115

RESUMO

Amoud University in Borama is located in the self-declared state of Somaliland, in the Horn of Africa. Past conflicts and resulting economic hardship have led to a lack of local academic psychiatry faculty and resources. Amoud has been for some years partnering with voluntary faculty in the United Kingdom to teach psychiatry to its medical students through in-person "teaching missions." This was recently led by a Borama-native psychiatry resident in Ethiopia. COVID-19 added further hardships due to restrictions to travel and in-person gatherings. These challenges also created the opportunity for the development of an innovative, international, hybrid (online onsite), self-sustaining partnership model which has been successful in improving psychiatry teaching for undergraduate students in 2020-2021 and will continue in 2021-2022. An international, 'online-connected' department of psychiatry comprising a primary care physician in Somaliland, three postgraduate trainees in Ethiopia and the United States, and three senior psychiatrists in the United Kingdom developed a local faculty-led, hybrid-delivered, dynamic curriculum (bedside teaching, in person and online lecturing) that adapted to the needs, resources, faith and culture of Somaliland. While 2020-2021 has been the pilot year for the program, the overall experience has been enriching for students and faculty, leading to valuable cross-cultural conversations with impact on teaching and research. While learning about Somalilanders' and trauma, the program leads, also the authors of this article, have identified ways to harness the resilience and faith of students to bring about improvements in global mental health.


Assuntos
COVID-19 , Psiquiatria , Estudantes de Medicina , Humanos , Pandemias , SARS-CoV-2
19.
Asia Pac Psychiatry ; 13(4): e12507, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34967116

RESUMO

INTRODUCTION: To evaluate the situation of migration of psychiatrists from Romania and a prioritization exercise of main factors related with psychiatric residents' decision to emigrate could be a starting point of elaboration of a strategy of reforms. Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinions was checked. METHODS: This is a cross sectional evaluation study on a randomized selected sample of Romanian psychiatric residents' opinions on factors that influence decision of migration in EU countries in two time points, 2015 and 2020. RESULTS: Thirty-eight percent of residents intend to work abroad comparing with 78% before the economic changes (25.8% vs. 71.7% for a limited period of time and 15.7% vs. 28.3% intend to emigrate) and 2% vs. 5% intend to leave the specialty. The important factors for decision to emigrate changed from "Better working conditions" (15.7% vs. 37.3% residents) to "Better training"; the factor "respect and appreciation by colleagues" remained important for 19.1% versus 17.9%. "Lack of working place for partner" was considered by 26.7% of responders as an important disadvantage of working abroad. "Being far from family members", which was considered 5 years ago by 64.2% of responders as an important disadvantage of working abroad, nowadays concerns only 6.7%, probably because it seems easier to go abroad together with the family members. CONCLUSIONS: The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) that influence the residents' decision to emigrate represent the starting points for future reforms in educational and medical system in psychiatry.


Assuntos
Internato e Residência , Psiquiatria , Estudos Transversais , Seguimentos , Humanos , Psiquiatria/educação , Romênia , Inquéritos e Questionários
20.
Artigo em Inglês | MEDLINE | ID: mdl-34942063

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.


Assuntos
Transtornos Mentais , Esclerose Múltipla , Psiquiatria , Hospitais Gerais , Humanos , Pacientes Internados , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/terapia , Encaminhamento e Consulta
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