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1.
BMC Res Notes ; 12(1): 558, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484585

RESUMO

OBJECTIVES: Medical records are critical to patient care, but often contain incomplete information. In UK hospitals, record-keeping is traditionally undertaken by junior doctors, who are increasingly completing early-career placements in psychiatry, but negative attitudes towards psychiatry may affect their performance. Little is known about the accuracy of medical records in psychiatry in general. This study aimed to evaluate the accuracy of Electronic Medical Records (EMRs) pertinent to clinical decision-making ("rationale") for prescribing completed by junior doctors during a psychiatry placement, focusing on the differences between psychotropic vs. non-psychotropic drugs and the temporal association during their placement. RESULTS: EMRs of 276 participants yielding 780 ward round entries were analysed, 100% of which were completed by Foundation Year or General Practice specialty training junior doctors rather than more senior clinicians. Compared with non-psychotropic drugs, documentation of prescribing rationale for psychotropic drugs was less likely (OR = 0.24, 95% CI 0.16-0.36, p < 0.001). The rate of rationale documentation significantly declined over time especially for psychotropic drugs (p < 0.001). Prescribing documentation of non-psychotropic drugs for people with mental illness is paradoxically more accurate than that of psychotropic drugs. Early-career junior doctors are therefore increasingly shaping EMRs of people receiving psychiatric care.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Psiquiatria/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Educação de Pós-Graduação em Medicina/normas , Registros Eletrônicos de Saúde/normas , Feminino , Grupos Focais/métodos , Grupos Focais/estatística & dados numéricos , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Masculino , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/normas , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Psiquiatria/estatística & dados numéricos , Reprodutibilidade dos Testes , Estresse Psicológico/psicologia , Reino Unido , Adulto Jovem
2.
Psychiatr Danub ; 31(Suppl 3): 395-399, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488759

RESUMO

BACKGROUND: According to the United Nations High Commissioner for Refugees the number of people forced to leave their home as a result of conflict, persecution, violence or human rights violations remains high with 68.5 million forcibly displaced people worldwide. Asylum seekers are vulnerable in terms of mental health but they receive very little specific psychiatric care. The purpose of this literature review is to examine current situation regarding asylum seekers' psychiatric healthcare. SUBJECTS AND METHODS: This research was conducted using a keyword search on Medline, PubMed and Google Scholar. RESULTS: The literature on the management of the mental health of asylum seekers focuses on the issue of post-traumatic stress disorder. There is little data on other forms of mental illness in this population. The prevalence of post-traumatic stress disorder among asylum seekers is higher than in the general population and its clinical expression is varied and often complex because it involves various vulnerability factors. Guidelines for post-traumatic stress disorder recommend cognitive behavioral therapy with, in some cases, the use of pharmacotherapy. Given the specificities of the asylum seekers' population, in many cases it is not possible to set up such therapy immediately. Asylum seekers face a number of challenges in accessing mental healthcare. CONCLUSION: Management of the mental health of asylum seekers requires special attention and guidelines for the general population are not directly applicable to this specific population. The literature focuses on the issue of post-traumatic stress disorder. This review was not able to analyse the state of existing care offer in Belgium for managing the mental health of asylum seekers and the care pathways they take.


Assuntos
Saúde Mental , Psiquiatria , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Bélgica , Humanos , Saúde Mental/estatística & dados numéricos , Prevalência , Psiquiatria/organização & administração , Psiquiatria/estatística & dados numéricos
3.
Australas Psychiatry ; 27(5): 528-531, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267760

RESUMO

OBJECTIVE: To describe the workforce of career medical officers (CMOs) working in psychiatry and addiction medicine across New South Wales (NSW) and to explore their training and education needs, and experience of their role. METHOD: A cross-sectional survey of CMOs in NSW working in psychiatry or addiction medicine. The survey consisted of quantitative data and free-text responses, and was conducted online in late 2017. RESULTS: Of the 41 CMOs identified and sent the survey link, 25 CMOs completed the survey (61% RR). Almost half had worked as a CMO for 11 years or longer. Only six respondents held a recognised senior CMO position. Common areas of expertise were clozapine, metabolic health, and electroconvulsive therapy (ECT). One-quarter of respondents did not receive supervision. Suggested education and training improvements included an annual 1-day training symposium and monthly peer review group for CMOs. CONCLUSION: CMOs are an often senior group of clinicians working in important areas of service provision. Ongoing educational support for this group of medical practitioners is prudent to ensure the delivery of best practice mental health and drug health care.


Assuntos
Educação Médica Continuada/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Médicos/provisão & distribução , Psiquiatria/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Transtornos Relacionados ao Uso de Substâncias/terapia
4.
Australas Psychiatry ; 27(5): 513-518, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31294610

RESUMO

OBJECTIVES: This study aimed to examine the training experiences of and determine capacity to train future Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health. METHODS: Australian and New Zealand psychiatrists with expertise or interest in intellectual and developmental disability mental health completed an online survey detailing their training pathway, support for subspecialty training and capacity to provide rotations in this area. RESULTS: Psychiatrists (n=71) indicated the most common reasons they started practicing in intellectual and developmental disability mental health, and these included seeing people with intellectual or developmental disability in a service in which they worked, or personal experience with intellectual or developmental disability. Compared to those trained overseas, psychiatrists trained in Australia or New Zealand had lower ratings of the sufficiency of education received in intellectual and developmental disability mental health. Of the total respondents, 80% supported the development of subspecialty training. Augmentation of intellectual and developmental disability mental health content in the intermediate stage of training was also strongly supported. Participants identified 80 potential six-month training rotations in this area. CONCLUSIONS: Psychiatrists working in intellectual and developmental disability mental health strongly support enhancements to intellectual or developmental disability training, including the development of subspecialty training, and can identify potential training capacity if such subspecialty training was developed.


Assuntos
Escolha da Profissão , Deficiências do Desenvolvimento , Educação de Pós-Graduação em Medicina , Mão de Obra em Saúde , Deficiência Intelectual , Médicos , Psiquiatria/educação , Adulto , Idoso , Austrália , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Médicos/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos
5.
Australas Psychiatry ; 27(5): 506-512, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31294611

RESUMO

OBJECTIVE: To describe the characteristics and clinical capacity of Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health (IDDMH). METHOD: Consultant psychiatrists (n=71) with an interest or expertise in IDDMH completed an online survey about their roles, experience and time spent in intellectual developmental disability (IDD)-related activities. RESULTS: Psychiatrists had worked in IDDMH for a median of 11.34 years and half (53.5%) reported expertise in the area. One-fifth of psychiatrists reported IDDMH as their main area of practice. The majority of respondents (85.1%) reported that they were working clinically with people with IDD. Respondents practicing clinically worked a median of 8 hours in clinical and 3 hours in non-clinical IDD-related work per week. CONCLUSIONS: Surveyed psychiatrists had considerable experience in IDDMH. However, their work in IDDMH represented a relatively small proportion of their overall work hours, and a minority of respondents were responsible for a large proportion of clinical work. Exploring ways to broaden capacity is crucial to ensuring the mental health needs of people with IDD are met.


Assuntos
Deficiências do Desenvolvimento , Mão de Obra em Saúde/estatística & dados numéricos , Deficiência Intelectual , Serviços de Saúde Mental/estatística & dados numéricos , Médicos/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Adulto , Idoso , Austrália , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia
6.
Rev Epidemiol Sante Publique ; 67(5): 345-350, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31204150

RESUMO

INTRODUCTION: Research addressing the perception of liaison psychiatry by caregivers is still limited in Morocco. Collaboration between practitioners in liaison psychiatry is necessary, and the perception of physicians influences their implications in liaison psychiatry. OBJECTIVES: To evaluate the perception of this activity among the various medical and surgical units, determine the involvement, level of collaboration and expectations of practitioners, as well as the difficulties and constraints encountered. METHODOLOGY: A survey was carried out among medical personnel at the Hassan II University Hospital Centre in Fez in 2016, through a self-questionnaire determining the perception and position of carers with regard to liaison psychiatry. The data are collected using an anonymous self-administered questionnaire, consisting of 27 items. We included in this study a targeted population: interns, residents and professors. RESULTS: The total population of caregivers participating in this survey was 615 physicians, including 111 professors, 436 residents, and 68 interns. The participation rate was 80.32%. The average age was 30.25 years, with 47.6% (236) women and 52.4% (258) men. The percentage of doctors who obtained their doctorates in medicine in Morocco was 89.3% (85.9% at the Faculty of Medicine in Fez) and 92.3% had received a unique internship in the psychiatry department during their university studies, while 98.7% never received any continuing training in the field of psychiatry. Half of responding physicians reported difficulties in managing psychiatric disorders diagnostically, and 59.5% (292) reported difficulties in treating patients with psychiatric disorders, while 90% (444) reported that they are unable to provide therapeutic follow-up. Only 35.6% of the doctors surveyed were informed about the establishment of liaison psychiatry, but only 10% of these doctors were informed about the procedure for requesting a psychiatric opinion. Faced with a psychiatric disorder, 98% of doctors managed the situation by seeking psychiatric advice, 87.1% considered this request urgent. The reasons for not soliciting q psychiatrist were divided between difficulties in identifying a psychiatric disorder (51%) and difficulties in requesting an opinion (49%). CONCLUSION: Our study showed several difficulties perceived by practitioners, whether in the diagnosis, treatment or follow-up of patients with psychiatric manifestations. Collaboration between different practitioners is an indispensable element of patient management. Improving knowledge through awareness-raising and the organization of scientific days bringing together the different specialties will help to improve doctors' perceptions.


Assuntos
Atitude do Pessoal de Saúde , Transtornos Mentais/psicologia , Percepção , Psiquiatria , Encaminhamento e Consulta , Adulto , Comportamento Cooperativo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Departamentos Hospitalares/estatística & dados numéricos , Hospitais Universitários , Humanos , Comunicação Interdisciplinar , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Marrocos/epidemiologia , Médicos/psicologia , Médicos/normas , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos , Adulto Jovem
7.
Acad Psychiatry ; 43(5): 488-493, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31037653

RESUMO

OBJECTIVE: This study determines the extent to which residents and their program directors have discordant perceptions regarding wellness, support, and treatment opportunities for trainees. In addition, the authors examined whether psychiatry residents differed in their perceptions compared with residents in other specialties. METHODS: Residents and their program directors from each of 10 specialties were electronically surveyed after IRB approval and giving informed consent. RESULTS: Of 42 program directors responding, over 92% indicated they provided wellness education and programming; however, a significantly lower percentage of 822 trainees were aware of this (81.2% and 74.9%, respectively). A similar disparity existed between program directors (PDs) who knew where to refer depressed residents for help (92.9%) and residents who knew where to seek help (71%). Moreover, 83.3% of program directors believed they could comfortably discuss depression with a depressed resident, but a lower percentage of their trainees (69.1%) felt their training directors would be supportive. A significantly greater percentage of program directors (40.5%) believed seeking treatment for depression might compromise medical licensure than did residents (13.0%). Psychiatry residents were significantly more aware of wellness, support, and access than were residents from other specialties. CONCLUSIONS: The availability of wellness education, programming, program director accessibility, and knowing where to ask for help if depressed does not seem to be adequately communicated to many residents. Moreover, program directors disproportionately see depression treatment as a risk to medical licensure compared with their residents. Psychiatry residents seem to be more aware of program director support and access to care than their colleagues.


Assuntos
Depressão/terapia , Promoção da Saúde , Acesso aos Serviços de Saúde , Internato e Residência/estatística & dados numéricos , Diretores Médicos/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Adulto , Depressão/psicologia , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Medicina , Ohio , Percepção , Psiquiatria/educação
8.
Encephale ; 45(4): 297-303, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30961972

RESUMO

INTRODUCTION: The injunction to care (IC) is a new compulsory treatment created by the Act of June 17, 1998. Initially, this judicial tool concerned mainly sex offenders, but then the number of overall crimes requiring an IC began to dramatically rise. The judge can order this measure only if a psychiatric expertise has concluded to its potential opportunity. Then the convict must undergo a psychiatric follow-up after having served the sentence. The creation of a court-ordered treatment is based on the premise that many offenders are affected by psychiatric disorders. For the lawmaker, the aim is to lower the risk of recidivism. PURPOSES: The main purpose of this study is to assess the convicts concerned by the IC describing their sociodemographic characteristics, psychiatric diagnostics and criminal characteristics. The second purpose is to assess the efficiency of this measure regarding re-offending and specifically legal recidivism. METHODS: This is a retrospective and descriptive study concerning 119 subjects followed-up by two "coordinating doctors" in the department of Sarthe who could assess their psychiatric diagnostics and sociodemographic characteristics. They could also compare medical data with the judicial data for 78 of the subjects. RESULTS: The population was composed of 117 men (98.3%) aged 45 years old on average. They had a job in 37% of cases (n=44) and were single in 56.3% of cases (n=67). According to the DSM-IV-TR, only 29 subjects (24.4%) had an axis I disorder and 37.8% of the population had a pathological personality trait (non DSM-IV-TR categorized disorder). Furthermore, 51.3% (n=61) of the subjects were addicted (mainly alcohol). The medical follow-up was carried out by a psychiatrist in 83.2% of cases (n=99). The average duration of follow-up was five years. Among the 78 subjects for whom there was access to juridical data, 13 (16.7%) had committed a new offense during follow-up. Among them, seven had recidivated six of whom were initially sentenced for sexual offense. CONCLUSIONS: Most of the subjects in injunction to care had no axis I disorder but addictions and/or pathological personality traits. Nevertheless, the expert concluded the need of an IC. Personality and behavior disorders do not always require psychiatric care, and the management must be multidisciplinary. In France, the psychiatrist remains at the center of injunction to care measure. The addictology care is not developed whereas it is a population at risk and there is a lack of interactions between professionals (medical, social and judicial professionals). The IC is a measure that needs to be improved by means of better communication among the different professionals and a better global assessment of the subjects. Medical care must be a possible option but not a systematic treatment.


Assuntos
Transtornos Mentais , Padrões de Prática Médica , Prisioneiros/psicologia , Psiquiatria/estatística & dados numéricos , Psicoterapia , Delitos Sexuais , Adolescente , Adulto , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/estatística & dados numéricos , Criminosos/legislação & jurisprudência , Criminosos/psicologia , Criminosos/estatística & dados numéricos , Feminino , Medicina Legal/normas , Psiquiatria Legal , Humanos , Legislação Médica , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Padrões de Prática Médica/legislação & jurisprudência , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Prisioneiros/legislação & jurisprudência , Prisioneiros/estatística & dados numéricos , Psicoterapia/legislação & jurisprudência , Psicoterapia/normas , Psicoterapia/estatística & dados numéricos , Estudos Retrospectivos , Prevenção Secundária/métodos , Delitos Sexuais/prevenção & controle , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Adulto Jovem
10.
Asian J Psychiatr ; 42: 34-41, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30951931

RESUMO

There is an exponential growth in the field of biomedical literature over the years. Although numerous articles are published every year, few of them present important conceptual advances in that particular field and are found to be influential in the evolution of the field. The number of citations a publication receives can be used as a proxy marker of its impact on the field. Hence we aimed to analyze the top cited articles (n = 100) on obsessive compulsive disorder (OCD) as of July 2018. Google scholar database was searched using a freely available software, Publish or Perish. Information related to number of citations, publication title, publication year, name of the journal, country of origin, author details, institution of origin, article type, and article design. The original research articles were further classified into descriptive/epidemiology, mechanism, management, scale/measurement, imaging and medical psychiatry. The citation classics suggest that clinical trials/management, epidemiology and neuroimaging were the most researched areas in the OCD research. These citation classics provide an important insight into the historical developments, like the role of serotonin and caudate in OCD. This approach of citation analysis provides an opportunity to retrieve the classic articles on OCD, and describes the trends in OCD research.


Assuntos
Bibliometria , Transtorno Obsessivo-Compulsivo , Psiquiatria/estatística & dados numéricos , Bases de Dados Bibliográficas , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/terapia
11.
Acad Psychiatry ; 43(4): 411-416, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30891683

RESUMO

OBJECTIVE: Psychopharmacology requires practitioners to continually upgrade knowledge and skills, but attendance at live continuing medical education events presents many barriers. In addition, technology has generated new learning approaches. In response, a videoconference-based course on psychopharmacology was developed and evaluated for feasibility and acceptability. Specific goals included whether learners would engage and whether the technology would work well for both learners and instructors. Additional aims included providing guideline-concordant psychopharmacology training, enhancing patient safety, and fostering case discussion. METHODS: The course used BlueJeans® videoconferencing technology. Each of the six weekly sessions was taught by a facilitator and a speaker. Every class incorporated a 1-h interactive didactic presentation, followed by 1 h for case reviews. Topics included six major psychiatric disorders, managing key drug interactions, and pharmacogenomics. Three types of online self-report evaluations were conducted-individual session evaluation, overall evaluation, and faculty speaker evaluation. RESULTS: Nineteen participants enrolled, with 85% of respondents reporting course objectives were met as "very good" or "excellent." Moreover, 92% of respondents rated the course as "very good" or "excellent." Sixty percent of the faculty were "somewhat satisfied" and 40% were "extremely satisfied" with the videoconferencing tool. Qualitative responses from both participants and faculty were positive overall. CONCLUSIONS: This course provides preliminary evidence that an online, live longitudinal course in psychopharmacology is both acceptable and effective, both for CME learners and teachers. The authors plan to disseminate this model of CME to other institutions while extending the reach of the present course to more diverse practitioners.


Assuntos
Educação a Distância , Conhecimentos, Atitudes e Prática em Saúde , Psiquiatria/educação , Psicofarmacologia/educação , Videoconferência , Interações de Medicamentos , Educação Médica Continuada , Docentes de Medicina/psicologia , Humanos , Segurança do Paciente , Projetos Piloto , Psiquiatria/estatística & dados numéricos
12.
Psychiatry Res ; 275: 155-161, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30913436

RESUMO

OBJECTIVES: Clozapine is the most effective treatment for refractory schizophrenia, yet it remains underused in clinical practice. The current study examined the awareness, familiarity and attitude of a nationwide sample of Israeli psychiatrists regarding the use of clozapine. METHODS: Data were collected using questionnaires, completed by 295 psychiatrists. Participants were asked to score questions regarding clozapine procedures; familiarity with guidelines, drug properties, prescription and attitude towards specialized clozapine resources. RESULTS: About half (53.3%) of the psychiatrists reported initiating treatment with clozapine according to the guidelines, whereas 33% reported that they administered clozapine only after three or more unsuccessful antipsychotic treatments. Surprisingly, availability of specialized resources for clozapine treatment (such as clozapine clinics) was associated with delayed initiation of clozapine treatment, and a lower rate of clozapine administration. Barriers to clozapine use included concerns about patient adherence, side effects and partial compliance with the required blood monitoring. CONCLUSIONS: Delaying or avoiding clozapine treatment to potentially eligible patients, despite familiarity with the drug efficacy and treatment guidelines, is a major mental health concern. However, executive allocation of resources to support the use of clozapine may be ineffective in promoting clozapine use.


Assuntos
Antipsicóticos/uso terapêutico , Atitude do Pessoal de Saúde , Clozapina/uso terapêutico , Psiquiatria/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários
13.
Tijdschr Psychiatr ; 61(3): 205-207, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-30896033

RESUMO

BACKGROUND: In Belgium, the number of medical students that can start a psychiatry residency is defined by a fixed number.
AIM: To present this calculation process.
METHOD: To reconstruct this process based on documents published by the planning committee, a federal committee comprised of a representation from different universities, several ministries, and Belgian communities.
RESULTS: With the help of an algorithm, the expected number of psychiatrists needed in the future is calculated by the planning committee and shared to be implemented by the communities.
CONCLUSION: The planning committee estimates the number of psychiatrists needed by an algorithm that uses both historical tendencies and more rapidly changing parameters. However, the incorporation of predicted epidemiological changes remains limited.


Assuntos
Psiquiatria/estatística & dados numéricos , Psiquiatria/tendências , Bélgica , Previsões , Humanos , Recursos Humanos/estatística & dados numéricos , Recursos Humanos/tendências
14.
Psychogeriatrics ; 19(4): 310-319, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30723980

RESUMO

BACKGROUND: Dementia with Lewy bodies (DLB) is a progressive form of dementia, accompanied by a range of behavioural and psychological symptoms. The aim of this study was to identify current clinical practice for the treatment of DLB in Japan. METHODS: We conducted a survey of medical doctors engaged in the management of dementia in Japan. Participants were divided into two groups: psychiatrists (Group P) and neurologists or neurosurgeons (Group NS). Doctors completed a questionnaire and we analysed their responses to compare the two groups with regard to diagnosis and treatment of DLB, and in particular the treatment of behavioural and psychological symptoms of dementia (BPSD). RESULTS: Responses suggested that Group P conducted biomarker examinations less frequently and decided on their own therapeutic strategies more frequently than did Group NS. Both groups most frequently selected hallucinations/delusions as the symptoms given highest treatment priority. More than 70% of respondents in both groups reported having difficulties in treating BPSD. Atypical antipsychotics were more frequently prescribed by Group P, but were also prescribed in 70% of patients in Group NS. A third of patients received atypical antipsychotics for more than 1 year. CONCLUSIONS: The responses to this survey highlighted the difficulties faced by clinicians managing patients with DLB and identified the need to effectively treat BPSD in such patients.


Assuntos
Antipsicóticos/administração & dosagem , Delusões , Alucinações , Doença por Corpos de Lewy , Médicos/estatística & dados numéricos , Adulto , Delusões/diagnóstico , Delusões/tratamento farmacológico , Delusões/etiologia , Feminino , Alucinações/diagnóstico , Alucinações/tratamento farmacológico , Alucinações/etiologia , Humanos , Japão , Doença por Corpos de Lewy/complicações , Doença por Corpos de Lewy/diagnóstico , Doença por Corpos de Lewy/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neurologistas/estatística & dados numéricos , Neurocirurgiões/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Inquéritos e Questionários
15.
Psychogeriatrics ; 19(4): 345-354, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30784148

RESUMO

BACKGROUND: We performed a questionnaire survey of medical doctors engaged in the management of dementia to identify the actual status of treatment for dementia with Lewy bodies (DLB) in Japan. METHODS: Among participating medical doctors, we selected neurologists (Group N) and psychiatrists (Group P) because these physicians are usually involved in the management of DLB patients. The two groups were compared based on their diagnosis and treatment of DLB and in particular, parkinsonism. RESULTS: Neurological examinations and biomarker tests were less frequently performed by Group P than Group N. Antipsychotics and other psychotropics excluding anti-dementia drugs were significantly more frequently administered by Group P than Group N. The proportion of physicians who selected L-dopa as a first-line therapy for parkinsonism was significantly higher in Group N than in Group P. Despite these between-group differences, the following findings were common to the two groups: there was a discrepancy between the symptom that patients expressed the greatest desire to treat, and the awareness of physicians regarding the treatment of these symptoms; the initial agent was L-dopa; and physicians exercised caution against the occurrence of hallucinations, delusions, and other adverse drug reactions. CONCLUSIONS: The results of the present survey offer valuable insight for the formulation of future DLB therapeutic strategies.


Assuntos
Antiparkinsonianos/uso terapêutico , Levodopa/uso terapêutico , Transtornos Parkinsonianos/diagnóstico , Transtornos Parkinsonianos/tratamento farmacológico , Médicos/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adulto , Antipsicóticos/uso terapêutico , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/tratamento farmacológico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hipocinesia/diagnóstico , Hipocinesia/tratamento farmacológico , Hipocinesia/etiologia , Doença por Corpos de Lewy/complicações , Doença por Corpos de Lewy/diagnóstico , Doença por Corpos de Lewy/tratamento farmacológico , Pessoa de Meia-Idade , Rigidez Muscular/diagnóstico , Rigidez Muscular/tratamento farmacológico , Rigidez Muscular/etiologia , Neurologistas/estatística & dados numéricos , Transtornos Parkinsonianos/complicações , Equilíbrio Postural/efeitos dos fármacos , Psiquiatria/estatística & dados numéricos , Tremor/diagnóstico , Tremor/tratamento farmacológico , Tremor/etiologia
16.
J Affect Disord ; 247: 156-160, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30665077

RESUMO

INTRODUCTION: Selective serotonin (norepinephrine) reuptake inhibitors (SS(N)RIs) are used in the treatment of depression. The aim of this study was to assess the persistence with SS(N)RIs in outpatients treated by general practitioners (GP) or psychiatrists (PSY) in Germany, and to investigate the association between persistence and the following factors: age, gender, specialty of the physician initiating treatment, initial molecule, and prior antidepressant prescription. METHODOLOGY: A longitudinal pharmacy database (IMS LRx®) was used to identify patients (>18 years old) who had received an initial prescription (Rx) of an SS(N)RI between January 2014 and December 2016 (index date) from a GP or a PSY. Patients were only included if they had at least one year of pre-index observation time. The primary outcome was the rate of patients without SS(N)RI treatment discontinuation in the 12 months following the index date. Persistence was assessed using the Kaplan-Meier method. Cox regression was used to determine the impact of covariates on persistence. RESULTS: A total of 1,213,344 patients were eligible to be included (mean age: 55.9 years, 67% women). Twelve months after initiation of SS(N)RI therapy, 28.3% of patients were persistent. Higher age was significantly associated with a lower discontinuation risk. In addition, female gender, treatment initiation by a PSY, and treatment with other antidepressants at the index date were associated with a slightly higher persistence. There were significant associations for the different molecules; however, the absolute differences were small (below 5%). CONCLUSION: The results show that the proportion of patients receiving long-term SS(N)RI therapy (at least 12 months) was low. Discontinuation depended mainly on age and, to a lesser degree, on gender, the specialty of the physician initiating treatment, other antidepressant prescription at the index date, and initial molecule.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Norepinefrina/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Assistência à Saúde/métodos , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Clínicos Gerais/estatística & dados numéricos , Alemanha , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Psiquiatria/estatística & dados numéricos , Estudos Retrospectivos
17.
Health Aff (Millwood) ; 38(1): 24-28, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615523

RESUMO

Office-based visits involving a buprenorphine prescription increased significantly among primary care and specialist physicians from 2006 to 2014. The growing involvement of nonpsychiatry physicians in buprenorphine prescribing has the potential to provide better access to care for people with opioid use disorders.


Assuntos
Buprenorfina/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Padrões de Prática Médica/tendências , Feminino , Humanos , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos
18.
Australas Psychiatry ; 27(1): 64-68, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30047793

RESUMO

OBJECTIVE:: Examine knowledge, opinions and practices of psychiatrists and trainees in responding to domestic violence (DV). METHOD:: Online survey including two sub-scales from PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey): knowledge (10 items) and preparedness (10 items). RESULTS:: Of psychiatrists completing the survey (216), 47% had received less than 2 hours of training in DV. PREMIS findings showed moderate knowledge of, and preparedness to deal with, DV. Participants with more clinical experience had significantly more knowledge and preparedness to deal with DV. CONCLUSIONS:: Findings suggest more training in DV for psychiatrists is needed.


Assuntos
Atitude do Pessoal de Saúde , Violência Doméstica , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psiquiatria/educação , Inquéritos e Questionários
20.
Encephale ; 45(2): 139-146, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30126611

RESUMO

OBJECTIVES: The UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA. METHODS: A descriptive study was carried out through a survey of the nine facilities. RESULTS: All UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations. CONCLUSION: Based on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration.


Assuntos
Medicina Geral , Hospitais Especializados , Transtornos Mentais/terapia , Prisioneiros , Unidade Hospitalar de Psiquiatria , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Internação Compulsória de Doente Mental/estatística & dados numéricos , Psiquiatria Legal/métodos , Psiquiatria Legal/organização & administração , Psiquiatria Legal/normas , Psiquiatria Legal/estatística & dados numéricos , França/epidemiologia , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Unidades Hospitalares/estatística & dados numéricos , Hospitais Especializados/métodos , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Hospitais Especializados/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Prisões/organização & administração , Prisões/normas , Prisões/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/organização & administração , Unidade Hospitalar de Psiquiatria/normas , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
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