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1.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31995679

RESUMO

Valbenazine and deutetrabenazine are FDA-approved as treatment for tardive dyskinesia (TD). Both medications are vesicular monoamine transporter type 2 (VMAT2) inhibitors, and both are effective for reducing TD symptoms. Clinicians need to be aware of the adverse effects of valbenazine and deutetrabenazine, as well as other key differences between the two, in order to individualize treatment. Using the Abnormal Involuntary Movement Scale assists clinicians in assessing progress for each patient. Treating TD effectively with these new medications will reduce the burden of the condition for patients.


Assuntos
Exame Neurológico/métodos , Discinesia Tardia , Tetrabenazina/análogos & derivados , Valina/análogos & derivados , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores , Monitoramento de Medicamentos/métodos , Humanos , Conduta do Tratamento Medicamentoso , Moduladores de Transporte de Membrana/administração & dosagem , Moduladores de Transporte de Membrana/efeitos adversos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Psiquiatria/educação , Discinesia Tardia/induzido quimicamente , Discinesia Tardia/diagnóstico , Discinesia Tardia/tratamento farmacológico , Tetrabenazina/administração & dosagem , Tetrabenazina/efeitos adversos , Resultado do Tratamento , Valina/administração & dosagem , Valina/efeitos adversos
3.
Psychiatr Hung ; 34(4): 393-402, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31767799

RESUMO

This is a discussion paper on research in clinical pharmacology in the field of psychiatry. In addition to other factors the decline in discovery and development of new drugs in the field of psychiatry and the developments and growing complexity in the field of clinical trial technology, including outsourcing and risk based monitoring, reduced the number of young clinical researchers interested in this important field. The challenges posed by the restructuring within the pharmacological industry - including digitalization - should induce changes in the structure and in the processes of clinical pharmacology research and in the training of clinical research staff members. The approval of esketamine nasal spray for treatment resistant depression by the FDA and the results of research with psychedelics call for more education and training in this specific field.


Assuntos
Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/organização & administração , Psiquiatria/educação , Pesquisadores/educação , Pesquisadores/provisão & distribução , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Humanos , Ketamina/administração & dosagem , Ketamina/uso terapêutico , Sprays Nasais , Serviços Terceirizados
5.
N Engl J Med ; 381(12): 1099-1101, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31532958
6.
Psychiatr Danub ; 31(Suppl 3): 242-248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488734

RESUMO

BACKGROUND: Psychiatrists play a multifaceted and critical role in improving the lives of people with mental illness. However, despite how rewarding, important and thrilling a career in mental health is, there continues to remain a shortage of psychiatrists in Low-, Middle- and High-Income Countries. There has been resurgence in interest in improving the image of psychiatry over recent years and several initiatives have been launched to increase recruitment into the specialty at Sixth Form level in the UK. DESIGN: We conducted a single-arm, pre-post, comparison study with Sixth Form students at an inner-city school in London. Students were invited to complete a survey before and after exposure to an assembly on mental health that was delivered by an Expert by Personal and Professional Experience (EPPE). Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if there was an increase in interest in pursuing this profession as a career in this group. RESULTS: 63 out of 123 participants completed the before and after survey (51% response rate). Following exposure to the assembly, there were statistically significant improvements between the pre- and post- intervention means for, "Psychiatry has a positive impact on peoples' lives" (p value <0.0001), "People with mental illness can achieve success and be the best at what they do" (p value <0.0001) and, "I would consider psychiatry as a career" (p value <0.0001). CONCLUSION: Notwithstanding the limitations of this pilot study, our findings suggest that an assembly on mental health delivered by an EPPE (i.e. 'Wounded Healer') might be effective at increasing interest in psychiatry as a career at Sixth Form level. We suggest that assemblies on mental health and psychiatry be delivered by 'Wounded Healers' in schools and colleges nationwide to help drive recruitment into psychiatry.


Assuntos
Escolha da Profissão , Transtornos Mentais , Saúde Mental/educação , Seleção de Pessoal/métodos , Psiquiatria/educação , Estudantes de Medicina/psicologia , Humanos , Londres , Transtornos Mentais/psicologia , Projetos Piloto , Inquéritos e Questionários
7.
Psychiatr Danub ; 31(Suppl 3): 294-298, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488743

RESUMO

INTRODUCTION: Despite the launching of multiple initiatives to increase recruitment into psychiatry, the profession continues to remain undersubscribed. Studies have shown that teaching on global mental health can improve attitudes toward psychiatry in medical students. To the best of our knowledge, no studies have been published hitherto that evaluate if a brief teaching session (i.e. 60 minutes in duration) on global mental health improves perceptions of psychiatry and increases interest in this specialty as a career. SUBJECTS AND METHODS: We conducted a single-arm, pre- post- comparison study on participants who attended a King's College London Global Health Society event on Global Mental Health. Participants completed a survey before and after exposure to the event. Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if a brief teaching session on global mental health would increase interest in pursuing psychiatry as a career. RESULTS: 71 out of 90 participants responded (77.8% response rate). Following exposure to the event, there were statistically significant improvements in the scores for, "Psychiatry is interesting" (pre-event score 4.41, post-event score 4.66 p value <0.001), "I would talk positively about psychiatry to other people" (pre-event score 4.02, post-event score 4.48 p value <0.00001), and, "I would consider psychiatry as a career" (pre-event score 3.24, post-event score 3.72 p value <0.001). CONCLUSION: The results of our pilot study suggest that a brief lecture on global mental health may improve perceptions of psychiatry and increase interest in this specialty as a career. We recommend that global mental health be introduced into the medical school curriculum since this may help to increase recruitment into psychiatry.


Assuntos
Escolha da Profissão , Saúde Global , Saúde Mental , Psiquiatria/educação , Estudantes de Medicina , Humanos , Londres , Projetos Piloto
8.
J Grad Med Educ ; 11(4 Suppl): 85-90, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428263

RESUMO

Background: High rates of burnout have been reported in physicians in training, with contributing factors including stress, lack of coping skills, and attributes of the learning environment. The interrelationships among these factors and how they affect versus mitigate burnout in an international cohort of residents have not been studied. Objective: We examined the interrelationships between stress, perceptions of the learning environment, and coping strategies used in a cohort of psychiatry residents in Singapore, using burnout as the dependent variable. We hypothesized that perceptions of the learning environment and coping strategies influence the relationship between residency-related stress and burnout in psychiatry residents. Methods: From June 2016 to September 2017, 67 of 75 (89%) psychiatry residents from a single program in Singapore were assessed on their levels of stress and burnout, perceptions of their learning environment (including role autonomy, teaching, and social support), and the coping mechanisms they used. Results: Psychiatry residents in this Singaporean program perceived their overall learning environment to be positive. Perceptions of the learning environment, not coping strategies, significantly mediated the relationship between stress and burnout. Conclusions: Findings from this study suggest that perceptions of the learning environment mediate the relationship between stress and burnout. Approaches to evaluate and improve resident perceptions of aspects of their learning environment may be an effective strategy to manage burnout in psychiatry residency programs.


Assuntos
Esgotamento Profissional/psicologia , Internato e Residência , Aprendizagem , Psiquiatria/educação , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Singapura , Inquéritos e Questionários
10.
BMC Med Educ ; 19(1): 283, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345198

RESUMO

BACKGROUND: Physical and psychological health problems are prevalent in older adults and rarely exist in isolation. Treating these problems in isolation is resourceful and can be potentially harmful to patients due to delays in diagnosis and treatment and incomplete holistic care plans. Historically, trainees in geriatric medicine and old age psychiatry within the United Kingdom have completed very different training programmes. METHODS: We undertook a pre-feasibility pilot study of collaborative postgraduate training between trainees in geriatric medicine and old age psychiatry within the West Midlands training region, United Kingdom. Trainees in each specialty were paired with each other and advised to arrange appropriate training opportunities for their counterpart; these included shadowing each other in their workplace and arranging opportunities to attend training opportunities with their consultants. Pre- and post-pilot surveys were completed by all trainees and reflections from trainees were collated. RESULTS: Five trainee pairs were formed and arranged shadowing and training opportunities between October 2017 and May 2018. This included a combination of inpatient, outpatient, and community work. For both specialties, trainees' confidence in topics relating to their counterparts' specialty increased between the pre- and post-pilot surveys. Recurrent themes included within reflections included the benefits of collaborative training. CONCLUSIONS: Our pilot has demonstrated that it is feasible to implement a programme of joint training into postgraduate medical training, and that this can have a positive impact upon the confidence of both specialties. An extended pilot is planned for the training year 2018-2019.


Assuntos
Comportamento Cooperativo , Educação de Pós-Graduação em Medicina , Geriatria/educação , Psiquiatria/educação , Idoso , Estudos de Viabilidade , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Reino Unido
11.
Adv Exp Med Biol ; 1138: 17-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31313255

RESUMO

Obsessive compulsive disorder (OCD) is a neuropsychiatric disorder with a global prevalence of 2-3%. OCD can have an enormous impact on the lives of those with the disorder, with some studies suggesting suicidal ideation is present in over 50% of individuals with OCD, and other data showing a significant number of individuals attempt suicide. It is therefore important that individuals with OCD receive the best possible treatment. A greater understanding of the underlying pathophysiology of neuropsychiatric disorders among professionals and future clinicians can lead to improved treatment. However, data suggests that many students and clinicians experience "neurophobia", a lack of knowledge or confidence in cases involving the nervous system. In addition, research suggests that the relationship many students have with neurological conditions deteriorates over time, and can persist into practice.If individuals living with conditions such as OCD are to receive the best possible treatment, it is crucial that those administering care are equipped with a thorough understanding of such disorders. While research has shown that the use of interactive 3D models can improve anatomy education and more specifically neurology education, the efficacy of using of such models to engage with neuropsychiatric conditions, specifically OCD, has not been assessed. This study seeks to address this gap.In this study an interactive application for Android devices was designed using standardised software engineering methods in order to improve neuropsychiatry literacy by empowering self-pace learning through interactive 3D visualisations and animations of the neural circuitry involved in OCD. A pilot test and a usability assessment were conducted among five postgraduate life science students. Findings relating to user experience were promising, and pre-test vs. post-test evaluation suggested encouraging outcomes regarding the effectiveness of the application in improving the knowledge and understanding of OCD. In short, this study suggests that interactive 3D visualisations can improve neuropsychiatry education. For this reason, more efforts should be made to construct similar applications in order to ensure patients always receive the best possible care. Fig. 2.1 A diagrammatic representation of the CSTC circuit, based on a similar diagram by Robertson et al. (2017).


Assuntos
Imagem Tridimensional , Modelos Anatômicos , Neurologia/educação , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Psiquiatria/educação , Humanos , Estudantes de Medicina
12.
Australas Psychiatry ; 27(4): 404-408, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31264890

RESUMO

OBJECTIVE: This paper attempts to address whether the Royal Australian and New Zealand College of Psychiatrists (RANZCP) have implemented a competency-based continuing professional development (CPD) programme. CONCLUSION: The RANZCP have implemented a competency-based CPD programme, but a number of areas, especially assessment, can strengthen the competency-based approach.


Assuntos
Educação Baseada em Competências/métodos , Avaliação de Programas e Projetos de Saúde , Psiquiatria/educação , Desenvolvimento de Pessoal , Austrália , Educação Médica Continuada/métodos , Avaliação Educacional , Humanos , Nova Zelândia , Sociedades Médicas
15.
BMC Med Educ ; 19(1): 204, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196080

RESUMO

BACKGROUND: Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. METHODS: A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. RESULTS: Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. CONCLUSION: Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training.


Assuntos
Serviços de Saúde Mental , Transferência de Pacientes , Psiquiatria/educação , Adolescente , Educação , Europa (Continente) , Humanos
16.
Australas Psychiatry ; 27(4): 366-368, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31179717

RESUMO

OBJECTIVE: This paper outlines the current psychiatry workforce shortages experienced by rural and remote communities in Australia and argues that postgraduate training in psychiatry may play a role in rectifying these healthcare access inequities. CONCLUSION: Funding for postgraduate medical specialist training in Australia is undergoing a shift away from solely metropolitan-centric training schemes, based on substantial evidence over the past two decades in undergraduate medical training. Psychiatry is well placed to lead the development of dedicated postgraduate rural training pathways to enhance recruitment and retention of an urgently required rural and remote psychiatry workforce.


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Mão de Obra em Saúde , Psiquiatria/educação , Serviços de Saúde Rural , Austrália , Humanos , Desenvolvimento de Pessoal/organização & administração
18.
Ir J Psychol Med ; 36(2): 89-98, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31187719

RESUMO

OBJECTIVES: Improving knowledge about delirium care is a key target for health care. We describe the implementation of a four-part workshop focusing upon key aspects of delirium care. METHODS: Attitudes towards and understanding of delirium diagnosis and management amongst psychiatrists were surveyed before and immediately after an educational workshop. RESULTS: There were 62 participants. Pre-workshop, delirium was rated highly relevant to psychiatry. Overall level of confidence in diagnosis was modest, with the behavioural and psychological symptoms of dementia considered the most challenging differential diagnosis. Only nine participants (15%) correctly identified DSM-5 delirium criteria. Preferred assessment of attention varied with six different approaches endorsed. Confidence was higher for managing hyperactive compared with hypoactive delirium (p<0.001). Pharmacotherapy was more frequently endorsed for hyperactive compared with hypoactive presentations, with haloperidol the most popular agent (p<0.001). A total of 41 (66%) participants completed post-workshop assessments. Post-workshop, there were significant increases to the perceived relevance of delirium (p = 0.003), confidence in overall diagnosis (p<0.001) accuracy of awareness of DSM-5 criteria (p<0.001), and confidence in treating different presentations (p<0.001). The Months Backward Test was the preferred bedside test of attention (38/40 respondents). CONCLUSIONS: This interactive educational intervention impacted positively upon knowledge and attitudes amongst psychiatrists towards key aspects of delirium care. Further investigation can examine the impact upon longer term knowledge and behaviour.


Assuntos
Delírio/tratamento farmacológico , Haloperidol/uso terapêutico , Psiquiatria/educação , Idoso , Atitude do Pessoal de Saúde , Delírio/diagnóstico , Demência , Diagnóstico Diferencial , Humanos , Irlanda , Inquéritos e Questionários
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