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1.
Prax Kinderpsychol Kinderpsychiatr ; 69(7): 643-665, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33146088

RESUMO

Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized Previous research proved a greater prevalence of mental health problems among children in residential youth care. In the present study, based on the KiGGS study, the prevalence of mental health problems is analyzed using the German version of the Strengths and Difficulties Questionnaire (SDQ) for those children and adolescents seeking youth welfare services, compared to those children not seeking youth welfare service. The possible differences between these two groups were tested using multivariate regression. The study covers two survey periods of KiGGS at intervals of six years. The result shows a significantly higher prevalence for mental health problems in adolescents seeking youth welfare services. The regression analysis shows that the association with mental health problems in these children persists even after adjusting for socioeconomic and demographic factors. There are hardly any changes in the results within the trend analysis. This indicates a high temporal stability of the association.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Transtornos Mentais/epidemiologia , Adolescente , Criança , Alemanha/epidemiologia , Humanos , Transtornos Mentais/diagnóstico , Inquéritos e Questionários
2.
Rev Esp Salud Publica ; 942020 Oct 16.
Artigo em Espanhol | MEDLINE | ID: mdl-33063746

RESUMO

The pandemic produced by COVID-19 has a significant impact on society and has also affected childhood and adolescence, which, in general, has been the most silenced group. This article addresses the contents that affect the mental health of children and adolescents in the heart of the COVID-19 pandemic, it is located in the "fourth wave of care" in category F54 of the ICD-10 ("Behavioral and psychological factors in disorders or diseases classified elsewhere"). The presentation mechanism is: reactive-adaptive to the pandemic; triggering factor, before a previous affective-emotional instability; decompensation of a pre-existing process. The clinical features have had their initial phase, fundamentally, in confinement: somatoform disorders, behavioral disorders, emotional symptoms, reactivation of child abuse and dysfunctional grief reactions. The most prevalent symptoms are of the anxious or anxious-depressive type. The response to chronic stress, including that of low profile and intensity but maintained over time, has significant repercussions for childhood and adolescence. Few percentage that present prominent mental disorders, but we must recognize that when projected to the whole the child-adolescent population, there could be a significant number that could be subsidiary of a more specific help. The return to schooling is going to represent another important moment, the repercussions of confinement being of capital importance, especially in terms of addictive behaviors with information and communication technologies. Intervention by professionals trained in childhood and adolescent mental health is a priority to avoid unwanted clinical evolutions or iatrogenesis.


Assuntos
Saúde do Adolescente , Betacoronavirus , Saúde da Criança , Infecções por Coronavirus/psicologia , Transtornos Mentais/etiologia , Saúde Mental , Pneumonia Viral/psicologia , Saúde Pública , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevalência , Quarentena/psicologia , Fatores de Risco , Isolamento Social/psicologia , Espanha/epidemiologia
3.
Transl Psychiatry ; 10(1): 339, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33024072

RESUMO

There were several studies about the psychiatric and mental health issues related to the severe adult respiratory syndrome (SARS) outbreak in 2003, however, the association between SARS and the overall risk of psychiatric disorders and suicides has, as yet, to be studied in Taiwan. The aim of this study is to examine as to whether SARS is associated with the risk of psychiatric disorders and suicide. A total of 285 patients with SARS and 2850 controls without SARS (1:10) matched for sex, age, insurance premium, comorbidities, residential regions, level of medical care, and index date were selected between February 25 and June 15, 2003 from the Inpatient Database Taiwan's National Health Insurance Research Database. During the 12-year follow-up, in which 79 in the SARS cohort and 340 in the control group developed psychiatric disorders or suicide (4047.41 vs. 1535.32 per 100,000 person-years). Fine and Gray's survival analysis revealed that the SARS cohort was associated with an increased risk of psychiatric disorders and suicide, and the adjusted subdistribution HR (sHR) was 2.805 (95% CI: 2.182-3.605, p < 0.001) for psychiatric disorders and suicide. The SARS cohort was associated with anxiety, depression, sleep disorders, posttraumatic stress disorder/acute stress disorder (PTSD/ASD), and suicide. The sensitivity analysis revealed that the SARS group was associated with anxiety, depression, sleep disorders, PTSD/ASD, and suicide after the individuals with a diagnosis of psychiatric disorders and suicide were excluded within the first year, and with anxiety, depression, and sleep disorders, while those in the first five years were excluded. In conclusion, SARS was associated with the increased risk of psychiatric disorders and suicide.


Assuntos
Infecções por Coronavirus , Transtornos Mentais , Saúde Mental/estatística & dados numéricos , Pandemias , Pneumonia Viral , Síndrome Respiratória Aguda Grave , Suicídio/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Bases de Dados Factuais , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/virologia , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medição de Risco , Fatores de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/psicologia , Síndrome Respiratória Aguda Grave/terapia , Taiwan/epidemiologia
4.
Evid Based Ment Health ; 23(4): 161-166, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32998937

RESUMO

Experiencing continued growth in demand for mental health services among students, colleges are seeking digital solutions to increase access to care as classes shift to remote virtual learning during the COVID-19 pandemic. Using smartphones to capture real-time symptoms and behaviours related to mental illnesses, digital phenotyping offers a practical tool to help colleges remotely monitor and assess mental health and provide more customised and responsive care. This narrative review of 25 digital phenotyping studies with college students explored how this method has been deployed, studied and has impacted mental health outcomes. We found the average duration of studies to be 42 days and the average enrolled to be 81 participants. The most common sensor-based streams collected included location, accelerometer and social information and these were used to inform behaviours such as sleep, exercise and social interactions. 52% of the studies included also collected smartphone survey in some form and these were used to assess mood, anxiety and stress among many other outcomes. The collective focus on data that construct features related to sleep, activity and social interactions indicate that this field is already appropriately attentive to the primary drivers of mental health problems among college students. While the heterogeneity of the methods of these studies presents no reliable target for mobile devices to offer automated help-the feasibility across studies suggests the potential to use these data today towards personalising care. As more unified digital phenotyping research evolves and scales to larger sample sizes, student mental health centres may consider integrating these data into their clinical practice for college students.


Assuntos
Infecções por Coronavirus , Transtornos Mentais/diagnóstico , Transtornos Mentais/genética , Transtornos Mentais/terapia , Pandemias , Pneumonia Viral , Smartphone , Estudantes/psicologia , Telemedicina/métodos , Adulto , Betacoronavirus , Variação Biológica da População , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
5.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 443-462, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886045

RESUMO

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Cognitivo-Comportamental , Governo , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Pais/psicologia , Adolescente , Adulto , Áustria , Criança , Pré-Escolar , Suscetibilidade a Doenças , Alemanha , Humanos , Lactente , Transtornos Mentais/diagnóstico , Poder Familiar/psicologia
7.
Crim Behav Ment Health ; 30(5): 256-267, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32896935

RESUMO

Liaison and Diversion (L&D) has twin objectives: improving mental health outcomes and reducing re-offending. Early diversion from police custody seems promising, but evidence of benefit is required to sustain such programmes. To test the hypothesis that contact with L&D services while in police custody would lead to improved mental health outcomes and a reduction in type and level of offending, we used a pre-post service use design. National Health Service (NHS) records in two counties were searched for evidence that patients had been involved with L&D services while in police custody during the period July 2009-December 2017. We defined January 2009-July 2014 as the pre-intervention period and any time after contact as the post-intervention period. Data from the Police National Computer were gathered for each period for these individuals, to assess their pre-post L&D contact offending histories. NHS Trust data were similarly gathered to assess their pre-post use of mental health legislation. 4,462 individuals were identified who had used L&D services in police custody. There were statistically significant reductions in the amount of offending following contact with the L&D service (whether one or two contacts), regardless of offence type. Statistically significant reductions were also observed in use of the four most commonly used legislative powers for detaining patients in hospital on mental disorder grounds, regardless of offending status (prolific/non-prolific). Our results indicate positive associations between the L&D interventions and change in offending and use of compulsory hospital detention. Whilst our research does not allow a direct causal relationship to be established in either area, the findings go beyond other impact assessments of L&D which have either been with small samples or relied only on qualitative data or expert opinion.


Assuntos
Criminosos/psicologia , Aplicação da Lei , Pessoas Mentalmente Doentes/psicologia , Polícia , Prisioneiros/psicologia , Adulto , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/diagnóstico , Saúde Mental , Serviços de Saúde Mental , Transtornos Psicóticos , Medicina Estatal , Reino Unido
8.
PLoS Med ; 17(9): e1003306, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32941435

RESUMO

BACKGROUND: The higher mortality rates in people with severe mental illness (SMI) may be partly due to inadequate integration of physical and mental healthcare. Accurate recording of SMI during hospital admissions has the potential to facilitate integrated care including tailoring of treatment to account for comorbidities. We therefore aimed to investigate the sensitivity of SMI recording within general hospitals, changes in diagnostic accuracy over time, and factors associated with accurate recording. METHODS AND FINDINGS: We undertook a cohort study of 13,786 adults with SMI diagnosed during 2006-2017, using data from a large secondary mental healthcare database as reference standard, linked to English national records for 45,706 emergency hospital admissions. We examined general hospital record sensitivity across patients' subsequent hospital records, for each subsequent emergency admission, and at different levels of diagnostic precision. We analyzed time trends during the study period and used logistic regression to examine sociodemographic and clinical factors associated with psychiatric recording accuracy, with multiple imputation for missing data. Sensitivity for recording of SMI as any mental health diagnosis was 76.7% (95% CI 76.0-77.4). Category-level sensitivity (e.g., proportion of individuals with schizophrenia spectrum disorders (F20-29) who received any F20-29 diagnosis in hospital records) was 56.4% (95% CI 55.4-57.4) for schizophrenia spectrum disorder and 49.7% (95% CI 48.1-51.3) for bipolar affective disorder. Sensitivity for SMI recording in emergency admissions increased from 47.8% (95% CI 43.1-52.5) in 2006 to 75.4% (95% CI 68.3-81.4) in 2017 (ptrend < 0.001). Minority ethnicity, being married, and having better mental and physical health were associated with less accurate diagnostic recording. The main limitation of our study is the potential for misclassification of diagnosis in the reference-standard mental healthcare data. CONCLUSIONS: Our findings suggest that there have been improvements in recording of SMI diagnoses, but concerning under-recording, especially in minority ethnic groups, persists. Training in culturally sensitive diagnosis, expansion of liaison psychiatry input in general hospitals, and improved data sharing between physical and mental health services may be required to reduce inequalities in diagnostic practice.


Assuntos
Hospitalização/tendências , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Comorbidade , Grupos Étnicos , Feminino , Hospitais Gerais , Humanos , Masculino , Transtornos Mentais/psicologia , Grupos Minoritários , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Sistema de Registros , Fatores Socioeconômicos , Reino Unido/epidemiologia
10.
Lancet Public Health ; 5(10): e543-e550, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32979305

RESUMO

BACKGROUND: To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population. METHODS: We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period. FINDINGS: Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, -18·1 to 36·6) during this time period was not statistically significant. INTERPRETATION: In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health. FUNDING: National Institute of Health Research.


Assuntos
Infecções por Coronavirus/epidemiologia , Diagnóstico , Pandemias , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/diagnóstico , Transtornos Cerebrovasculares/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Modelos Estatísticos , Neoplasias/diagnóstico , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
11.
Nervenarzt ; 91(11): 1025-1031, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32897391

RESUMO

Homelessness is an expression of marked social exclusion phenomena and often particularly affects people with mental disorders. Mental disorders often precede the onset of homelessness but can also be a result of homelessness. Different forms of therapeutic and social support interventions have been evaluated in various countries, predominantly with an outreach treatment approach. These interventions were often combined with low threshold availability of housing programs. These showed positive effects on housing stability and reduction of psychiatric symptoms but not in reduction of substance use disorders. Peer support strategies and the use of digital media are possible options for future therapeutic strategies.


Assuntos
Pessoas em Situação de Rua , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Habitação , Humanos , Internet , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia
12.
Paediatr Drugs ; 22(5): 511-524, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32936413

RESUMO

Human immunodeficiency virus (HIV) is a neurotropic virus that has a detrimental impact on the developing central nervous system (CNS) of children growing up with perinatal HIV (PHIV) due to a combination of pathophysiological processes related to direct viral cytopathic effects and immune activation. This leads to a spectrum of neurocognitive impairment ranging from severe encephalopathy to subtle domain-specific cognitive impairments, as well as psychological disorders that are compounded by HIV-related stigma and sociodemographic factors that disproportionately affect PHIV children. Early commencement and consistent use of combination antiretroviral therapy (cART) has resulted in a dramatic improvement in neuropsychological outcomes for PHIV children; however, they remain vulnerable to cognitive impairment and psychological disorders, as evidenced by imaging findings, randomised clinical trials and observational studies. An optimal neuroprotective cART regimen remains elusive in children, but systemic viral suppression, regular neurocognitive and psychological screening and ready access to neuropsychological management strategies are key components for optimising neuropsychological outcomes. However, a lack of standardised and validated screening tools, particularly in resource-limited settings, hinders a precise understanding of the nature, prevalence and associations between neuropsychological symptomatology and HIV health. This article reviews the natural history, cellular pathophysiology and structural and functional imaging findings for children growing up with HIV, as well as summarising management strategies related to antiretroviral therapy, screening tools and specific interventions for neurocognitive impairments and psychological disorders.


Assuntos
Infecções por HIV , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Encéfalo/virologia , Criança , Infecções por HIV/complicações , Infecções por HIV/diagnóstico por imagem , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Prevalência
13.
Int J Law Psychiatry ; 71: 101595, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768117

RESUMO

Due to the present COVID-19 pandemic, forensic mental telehealth assessment (FMTA) is an increasingly utilized means of conducting court-sanctioned psychiatric and psychological evaluations. FMTA is not a novel development, and studies have been published during the past two decades that opine on the positive and negative implications of conducting testing and interview procedures online, in forensic and traditionally clinical matters alike. The present article examines prospects for eventual legal challenges to FMTA, describes considerations for conducting FMTA in both institutional and residential settings, and concludes that FMTA is now-due to predicted accommodations on the part of courts, attorneys, institutions, and professional guilds-a permanent part of the forensic evaluation landscape, even once the present COVID-19 pandemic has subsided.


Assuntos
Infecções por Coronavirus/epidemiologia , Psiquiatria Legal/legislação & jurisprudência , Transtornos Mentais/diagnóstico , Pneumonia Viral/epidemiologia , Telemedicina/legislação & jurisprudência , Betacoronavirus , Prova Pericial/legislação & jurisprudência , Humanos , Pandemias
14.
Nat Commun ; 11(1): 4179, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32826918

RESUMO

Symptom expression in psychiatric conditions is often linked to altered threat perception, however how computational mechanisms that support aversive learning relate to specific psychiatric symptoms remains undetermined. We answer this question using an online game-based aversive learning task together with measures of common psychiatric symptoms in 400 subjects. We show that physiological symptoms of anxiety and a transdiagnostic compulsivity-related factor are associated with enhanced safety learning, as measured using a probabilistic computational model, while trait cognitive anxiety symptoms are associated with enhanced learning from danger. We use data-driven partial least squares regression to identify two separable components across behavioural and questionnaire data: one linking enhanced safety learning and lower estimated uncertainty to physiological anxiety, compulsivity, and impulsivity; the other linking enhanced threat learning and heightened uncertainty estimation to symptoms of depression and social anxiety. Our findings implicate aversive learning processes in the expression of psychiatric symptoms that transcend diagnostic boundaries.


Assuntos
Afeto , Ansiedade/diagnóstico , Ansiedade/psicologia , Transtornos Mentais/diagnóstico , Adolescente , Adulto , Idoso , Transtornos de Ansiedade , Teorema de Bayes , Biologia Computacional , Medo , Feminino , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Incerteza , Adulto Jovem
16.
PLoS One ; 15(8): e0236688, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750072

RESUMO

BACKGROUND: The current study aimed to assess prevalence of mental disorders during Covid-19 pandemic- and respective lockdown in Germany, and potential behaviors/states that can have protective functions on preventing severe mental problems. Assessing prevalence of mental disorders, as well as to find potential protective variables is very important in order to determine people's psychological suffering. It provides the basis for teaching possible coping styles in order to prevent a major breakdown on mental health. Prevalence on mental disorders was expected to increase during the pandemic, especially depression, (general-/and health-) anxiety, panic attacks- and disorder, as well as obsessive-compulsive disorder. Additionally, potentially protective variables, such as resilience and coping, were included. METHODS: N = 949 subjects completed an online-survey that asked for symptoms regarding depression, (health) anxiety, panic disorder, obsessive-compulsive disorder, and lock-down related behavior-starting 14 days after lockdown in Germany. RESULTS: Prevalence of mental disorders in the current sample was much higher than usual prevalence of mental disorders, with 50.6% expressing at least one mental disorder. Resilience was associated with lower risks for any mental disorder (OR = 4.23, p < .0001, 95%CI = 3.21-5.57), as well as with any other measured mental illness (all ORs between = 2.82 for obsessive-compulsive disorder and OR = 41.44 for panic disorder, all p < .001). Similar results were obtained regarding coping (focus on positive). CONCLUSION: Results are highly relevant in order to provide a glance on what substantial influence the current pandemic- and lockdown situation has on mental health across the country, and possibly across the world. Possible ways in order to prevent deterioration and help coping with the current situation are being elaborated and discussed.


Assuntos
Infecções por Coronavirus/patologia , Saúde Mental , Pneumonia Viral/patologia , Adaptação Psicológica , Adulto , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Feminino , Alemanha/epidemiologia , Humanos , Internet , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/etiologia , Razão de Chances , Pandemias , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/etiologia , Pneumonia Viral/virologia , Inquéritos e Questionários , Adulto Jovem
17.
Gen Hosp Psychiatry ; 66: 89-95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750604

RESUMO

The COVID-19 pandemic has dramatically transformed the U.S. healthcare landscape. Within psychiatry, a sudden relaxing of insurance and regulatory barriers during the month of March 2020 enabled clinicians practicing in a wide range of settings to quickly adopt virtual care in order to provide critical ongoing mental health supports to both existing and new patients struggling with the pandemic's impact. In this article, we briefly review the extensive literature supporting the effectiveness of telepsychiatry relative to in-person mental health care, and describe how payment and regulatory challenges were the primary barriers preventing more widespread adoption of this treatment modality prior to COVID-19. We then review key changes that were implemented at the federal, state, professional, and insurance levels over a one-month period that helped usher in an unprecedented transformation in psychiatric care delivery, from mostly in-person to mostly virtual. Early quality improvement data regarding virtual visit volumes and clinical insights from our outpatient psychiatry department located within a large, urban, tertiary care academic medical center reflect both the opportunities and challenges of virtual care for patients and providers. Notable benefits have included robust clinical volumes despite social distancing mandates, reduced logistical barrieres to care for many patients, and decreased no-show rates. Finally, we provide clinical suggestions for optimizing telepsychiatry based on our experience, make a call for advocacy to continue the reduced insurance and regulatory restrictions affecting telepsychiatry even once this public health crisis has passed, and pose research questions that can help guide optimal utilization of telepsychiatry as mainstay or adjunct of outpatient psychiatric treatment now and in the future.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções por Coronavirus , Transtornos Mentais , Serviços de Saúde Mental/organização & administração , Pandemias , Pneumonia Viral , Psiquiatria/organização & administração , Telemedicina/organização & administração , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia
19.
PLoS One ; 15(8): e0237853, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834012

RESUMO

Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi- and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low- and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing long-term funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to reduce the burden of these disorders by encouraging their timely and context-sensitive prevention and management.


Assuntos
Cultura , Países em Desenvolvimento , Programas de Rastreamento , Transtornos Mentais/diagnóstico , Saúde Mental/ética , Comportamento Social , Adolescente , Criança , Feminino , Humanos , Masculino , Adulto Jovem
20.
PLoS One ; 15(8): e0237698, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842139

RESUMO

With brief psychiatric hospitalizations, the extent to which symptoms change is rarely characterized. We sought to understand symptomatic changes across Research Domain Criteria (RDoC) dimensions, and the extent to which such improvement might be associated with risk for readmission. We identified 3,634 individuals with 4,713 hospital admissions to the psychiatric inpatient unit of a large academic medical center between 2010 and 2015. We applied a natural language processing tool to extract estimates of the five RDoC domains to the admission note and discharge summary and calculated the change in each domain. We examined the extent to which symptom domains changed during admission, and their relationship to baseline clinical and sociodemographic features, using linear regression. Symptomatic worsening was rare in the negative valence (0.4%) and positive valence (5.1%) domains, but more common in cognition (25.8%). Most diagnoses exhibited improvement in negative valence, which was associated with significant reduction in readmission risk. Despite generally brief hospital stays, we detected reduction across multiple symptom domains, with greatest improvement in negative symptoms, and greatest probability of worsening in cognitive symptoms. This approach should facilitate investigations of other features or interventions which may influence pace of clinical improvement.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/diagnóstico , Readmissão do Paciente/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Processamento de Linguagem Natural , Admissão do Paciente/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Tempo , Resultado do Tratamento
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