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1.
Perspect Biol Med ; 64(4): 587-591, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840158

RESUMO

Depression is a word used to describe a mood. It is also a diagnosis. The same word, depression, straddles many meanings across time and from place to place. It is at once a medical illness and a universal human experience. Jonathan Sadowsky's Empire of Depression (2021) traces the evolution of the concept of depression from ancient descriptions of melancholia to modern diagnostic criteria. Writings at least as far back as Hippocrates distinguish the sadness that occurs after a loss from the more pervasive and persistent unhappiness that came to be known as melancholia and then depression. This history is more than a chronicle; it draws on a number of sources to illustrate and illuminate how depression has been variously understood and particularly how psychiatrists attempt to help people suffering from a recognizable but complex disorder.


Assuntos
Transtorno Depressivo , Psiquiatria , Depressão , Humanos , Tristeza
2.
J Am Assoc Nurse Pract ; 33(11): 849-851, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34747904

RESUMO

ABSTRACT: Psychiatric pharmacogenetic testing is commonly used by providers in primary care and mental health settings. The purpose of this article is to describe the extent to which psychiatric pharmacogenetic testing supports clinical practice. human leukocyte antigen (HLA)-A and HLA-B should be tested before initiating carbamazepine and oxcarbazepine due to risk of serious skin reactions. For psychotropic medications metabolized through the liver, limited evidence suggests testing for variation in metabolism through CYP2D6 and CYP2D19. For specific medication and genotype-phenotype variations, guidance through the Clinical Pharmacogenetics Implementation Consortium (CPIC) or the International Society of Psychiatric Genetics (ISPG) should be reviewed. Commercial tests interpret this information differently and should not be used for broad guidance. Clinicians should follow current guidelines from professional bodies such as CPIC or ISPG and test for HLA-A or HLA-B before initiating carbamazepine or oxcarbazepine. Evidence is limited for psychiatric pharmacogenetic testing. Clinicians should continue to follow best practice and clinical practice guidelines.


Assuntos
Testes Farmacogenômicos , Psiquiatria , Citocromo P-450 CYP2D6/genética , Humanos , Farmacogenética
5.
Front Public Health ; 9: 679041, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34805060

RESUMO

Background: The previous and current studies highlight the psychological distress caused by coronavirus disease 2019 (COVID-19)-associated restrictions among the general population, especially among children and adolescents; however, few studies have examined children and adolescents with a mental disorder. The current study aimed to explore whether youth with mental disorders show a higher pandemic-associated psychological burden than healthy children and adolescents and to determine which psychiatric diagnoses are particularly associated with a higher distress level. Methods: In this study, 144 children and adolescents between the ages of 6 and 18 years with a mental disorder and 48 children and adolescents within the same age range without a mental disorder, and their caregivers, completed questionnaires assessing the pandemic-associated trauma symptoms (the Child Report of Post-Traumatic Symptoms [CROPS] and the Parents Report of Post-Traumatic Symptoms [PROPS]). Additionally, we asked specific questions about the pandemic-associated stress factors, such as financial problems, prolonged screen times, or loneliness. Results: Children and adolescents with a mental illness showed a significantly higher psychological burden than their mentally healthy peers. Female gender was a risk factor for a higher self-reported psychological burden, and younger age was associated with a more extensive parent-reported psychological burden. The patients with a depressive disorder showed significantly higher levels of psychological distress associated with the COVID-19 pandemic than the patients with an attention deficit and/or a conduct disorder. Conclusions: Children and adolescents with a mental illness, particularly, female children and individuals with a depressive disorder, are at an increased risk of suffering from pandemic-associated psychological distress. Adequate mental health care options, such as telepsychiatry, are indispensable.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , COVID-19 , Psiquiatria , Telemedicina , Adolescente , Criança , Feminino , Humanos , Pandemias , SARS-CoV-2
6.
Tijdschr Psychiatr ; 63(10): 711-716, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757609

RESUMO

BACKGROUND: The waiting list of the expertise center euthanasia (EE) in the Netherlands for patients requesting euthanasia on the basis of psychiatric suffering has increased to two years in a short space of time. AIM: Clarity about the causes and direct consequences of the EE waiting list and an answer to the question: what now? METHOD: We analyzed the EE waiting list based on various media reports, annual reports from the EE and scientific studies. RESULTS: The EE waiting list arose because, on the one hand, the demand for euthanasia among patients with a mental illness has increased, while on the other hand, the willingness to perform euthanasia among psychiatrists appears to be declining. The reasons for both trends seem multifactorial. The direct consequence of the waiting list is that patients with a mental illness have less access to euthanasia, which in itself can also have harmful and protective consequences. CONCLUSION: The EE waiting list is the result of an increasing number of requests and an apparent decrease in psychiatrists' willingness to perform euthanasia. In response to this situation, roughly three ways forward are conceivable: first the mental health care sector can assign itself a more active role in the field of euthanasia, second a further demedicalisation of the end of life is possible, or third a choice can be an amendment to EE's referral procedure. All of these options have potential pros and cons.


Assuntos
Eutanásia , Transtornos Mentais , Psiquiatria , Humanos , Países Baixos , Encaminhamento e Consulta , Listas de Espera
7.
Tijdschr Psychiatr ; 63(10): 717-722, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757610

RESUMO

BACKGROUND: In the new Compulsory Mental Health Care Act (Wvggz), patient competence has a more central position. AIM: To describe the new position of patient competence in the Wvggz and to reflect on related moral questions. METHOD: Discussion of relevant legal texts and publications. RESULTS: In case of incompetency of a patient, a surrogate decision-maker has to attempt what decision the patient would make if he or she were competent. A new element in the Wvggz is that grandparents and grandchildren can also act as surrogate decision-makers. A competency judgment is mandatory in every decision on involuntary treatment, with the exception of involuntarily commitment. Competent refusal of care has to be respected, unless the patient is in a life threatening situation or there is a risk of other people getting harmed. CONCLUSION: The question is whether the changed position of patient competence in the new law will contribute to the aim of maintaining and enhancing patients' autonomy. Due care in competency judgments is complex and remains important.


Assuntos
Tratamento Involuntário , Psiquiatria , Feminino , Humanos , Princípios Morais
8.
Tijdschr Psychiatr ; 63(10): 745-749, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757616

RESUMO

BACKGROUND: Coercion is much discussed topic in psychiatry. AIM: Presentation of an ethics of care perspective on coercion, focusing on the moral aspects of the relationship between care recipient and caregiver, and the prevention and reduction of coercion. METHOD: Clarification of the care-ethical aspects of the high and intensive care (HIC) model and discussion of the Compulsory Mental Health Care Act (Wvggz). RESULTS: In the HIC model, ethics of care underlies three cultural changes: from control to contact, from reactive to proactive, from individuality to solidarity. More than the older Bopz Act, the Wvggz pays attention to relational aspects of coercion, but the procedures endanger care contact. CONCLUSION: Ethics of care - in which the care relationship is the starting point - offers a perspective that is of great value to psychiatry. The development of HIC is a concrete example of this. The Wvggz emphasizes collaboration in care, but care contact is hindered in practice by a multitude of procedures.


Assuntos
Transtornos Mentais , Psiquiatria , Coerção , Cuidados Críticos , Humanos
9.
Rev Colomb Psiquiatr (Engl Ed) ; 50(4): 260-272, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34728177

RESUMO

OBJECTIVE: To describe pharmacological and non-pharmacological practices for delirium, carried out by psychiatry residents and psychiatrists in Colombia. METHODS: An anonymous survey was conducted based on the consensus of experts of the Liaison Psychiatry Committee of the Asociación Colombiana de Psiquiatría [Colombian Psychiatric Association] and on the literature review. It was sent by email to the association members. RESULTS: 101 clinicians participated. Non-pharmacological preventive measures such as psychoeducation, correction of sensory problems or sleep hygiene are performed by 70% or more. Only about 1 in 10 participants are part of an institutional multi-component prevention programme. The preventive prescription of drugs was less than 20%. Regarding non-pharmacological treatment, more than 75% recommend correction of sensory difficulties, control of stimuli and reorientation. None of the participants indicated that the care at their centres is organised to enhance non-pharmacological treatment. 17.8% do not use medication in the treatment of delirium. Those who use it prefer haloperidol or quetiapine, particularly in hyperactive or mixed motor subtypes. CONCLUSIONS: The practices of the respondents coincide with those of other experts around the world. In general, non-pharmacological actions are individual initiatives, which demonstrates the need in Colombian health institutions to commit to addressing delirium, in particular when its prevalence and consequences are indicators of quality of care.


Assuntos
Delírio , Psiquiatria , Colômbia , Delírio/prevenção & controle , Humanos , Inquéritos e Questionários
10.
Rev Colomb Psiquiatr (Engl Ed) ; 50(4): 308-311, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34742695

RESUMO

Dystonia is a movement disorder characterised by sustained muscle contractions that produce repetitive twisting movements or abnormal postures. It can be classified according to the aetiology as primary (idiopathic and genetic forms), or secondary. The presentation associated with generalised, intense episodes and with exacerbation of severe muscle contractures and usually refractory to traditional pharmacotherapy is known as dystonic status or dystonic storm. In the present article, a case is presented of a 33-year-old patient with a history of congenital deafness, stimulant use disorder and on psychopharmacological treatment with antipsychotics, who presented with a severe dystonic reaction that evolved to a status dystonicus.


Assuntos
Distonia , Distúrbios Distônicos , Psiquiatria , Adulto , Distonia/tratamento farmacológico , Distúrbios Distônicos/tratamento farmacológico , Humanos , Contração Muscular , Encaminhamento e Consulta
11.
Ther Adv Cardiovasc Dis ; 15: 17539447211058892, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34841978

RESUMO

BACKGROUND: Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients. METHODS: This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions. RESULTS: A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with 'known', 'possible', and 'conditional risk of TdP', respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H2 receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015. CONCLUSION: Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.


Assuntos
Preparações Farmacêuticas , Psiquiatria , Torsades de Pointes , Idoso , Estudos Transversais , Interações Medicamentosas , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Polimedicação , Estudos Prospectivos , Fatores de Risco
12.
Rev Infirm ; 70(275): 43-45, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34752362

RESUMO

Health professionals have been mobilised to contribute to the emergency vaccination campaign deployed since the end of 2020 to combat the Covid-19 pandemic. In a mental health institution of the Grand-Est region, a vaccination centre has been implemented in emergency to contribute to the collective public health effort. Feedback from a hospital health executive.


Assuntos
COVID-19 , Psiquiatria , Vacinas contra COVID-19 , Humanos , Programas de Imunização , Pandemias , SARS-CoV-2 , Vacinação
13.
Tijdschr Psychiatr ; 63(10): 707-710, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757608

RESUMO

BACKGROUND: Moral courage is the courage to do what you morally believe to be right, despite the presence of danger. Courage is certainly important in critical situations where moral values are at stake. Reflection is not enough, you have to act wisely. Moral courage bridges the gap between thinking and doing. This article first characterizes moral courage and then provides tools that can help psychiatrists to show moral courage. AIM: To provide tools that can help psychiatrists in their professional practice to show moral courage. METHOD: Characterizing moral courage on the basis of a case study and literature review. RESULTS: Psychiatrists can learn courage by preparing for the dangers inherent in the job, by thinking about situations in advance, and going through and practicing possible scenarios and consequences. They can also discuss the subject in peer-to-peer meetings. CONCLUSION: Courage is certainly important in critical situations where moral values are at stake. Reflection is then not enough, and one must act wisely. Moral courage bridges the gap between thinking and doing. Professionals are assisted in this when (professional) organizations invest in a safe and stimulating context.


Assuntos
Coragem , Ética em Enfermagem , Psiquiatria , Humanos , Aprendizagem , Princípios Morais
14.
J Med Internet Res ; 23(11): e22369, 2021 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-34762054

RESUMO

BACKGROUND: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. OBJECTIVE: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. METHODS: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform's configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. RESULTS: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users' data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser-based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. CONCLUSIONS: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health-related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population.


Assuntos
Aplicativos Móveis , Psiquiatria , Telemedicina , Adolescente , Humanos , Saúde Mental , Inquéritos e Questionários
15.
Soins Psychiatr ; 42(336): 44-46, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34763768

RESUMO

The care of patients, especially in the field of agitation or psychiatry, requires close coordination between different actors. Interdisciplinarity makes it possible to analyse and harmonise the links between various disciplines with the common aim of solving complex problems. This interdisciplinarity must now become a fundamental in the teaching of health sciences and a prerequisite for the functioning of hospital services, in particular in the formalisation of acute care pathways.


Assuntos
Psiquiatria , Serviço Hospitalar de Emergência , Humanos , Psicoterapia
17.
Psychiatr Hung ; 36(3): 255-260, 2021.
Artigo em Húngaro | MEDLINE | ID: mdl-34738521

RESUMO

Bertalan Petho passed away in the Spring of 2020. The genius investigator was an enthusiastic and dedicated follower of Karl Leonhard, one of the German psychiatrists, who developed his own nosology which remained largely hidden from broad recognition. Bertalan Petho verified the validity and supplemented the Leonhard nosology: e.g. completed their "premorbid" personality concept and entered some psychosocial criteria in the etiology of the endogenous psychoses. His results and treatises were published in English and German in numerous and renowned periodicals. Summarized studies emerged in books. In light of trauma studies and new research on neurocognitive and epigenetic topics, traditional psychiatric classification seems to lose its validity. On the one hand, transgenerational trauma influences gene expression as an epigenetic factor. On the other hand, it also affects psycho-social development and growth of the individuum. Dimensional diagnostic approaches and non-categorical disease classification appears to be more natural and plausible in the state of science. WKL nosology will remain a part of psychiatry􀀀 s history as well as a wonderful theory with practicality - for the knowledgeable.


Assuntos
Psiquiatria , Transtornos Psicóticos , Humanos , Personalidade
18.
Psychiatr Hung ; 36(3): 285-288, 2021.
Artigo em Húngaro | MEDLINE | ID: mdl-34738524

RESUMO

Following Wernicke and Kleist's footsteps, Karl Leonhard developed a detailed nosology of psychomotor disturbances occurring in endogenous/functional psychoses. In Leonhard's classification the good prognosis cycloid motility psychosis is distinguished from the group of systemic and non-systemic catatonic schizophrenias. The diag - no sis of both types of catatonic schizophrenias is based on the recognition of a specific catatonic sign/symptom coupled with less specific, yet relatively stable other psychiatric symptoms forming unique Gestalts of psychiatric syndromes, or disease entities. These catatonic subtypes can be easily identified with practice and guidance by an experienced clinician. Apart from periodic catatonia, the other Leonhardian catatonia subtypes have never been subjected to syste - matic validation studies. The late Bertalan Petho refined the clinical description of catatonia in Leonhard's nosology and contributed to their clinical validation by conducting long-term follow-up studies.


Assuntos
Catatonia , Psiquiatria , Transtornos Psicóticos , Esquizofrenia , Humanos , Instituições Acadêmicas
19.
Psychiatr Hung ; 36(3): 336-350, 2021.
Artigo em Húngaro | MEDLINE | ID: mdl-34738528

RESUMO

The use of virtual reality (VR) technology in psychiatry and psychotherapy has spread continiously over the last two decades. Researches has mainly focused on the VR-based therapy of anxiety disorders, but encouraging results have also been published in the field of diagnosis and therapy of eating disorders, addictions, autism, and ADHD. There have been fewer reports on the therapy of schizophrenia yet. In these cases VR interventions cover a wide range of symptoms. VR based interventions have already been developed for cognitive and social abilities that are more difficult to alleviate by medication. Among positive symptoms, the developed methods mainly focus on auditory hallucinations and delusions. In general, the current results confirm the effectiveness of VR-based therapeutic interventions and justify the need for further research. Research and therapy on this fieed at the VR Laboratory of the Department of Psychi - atry and Psychotherapy, Semmelweis University also support literature data. However, the widespread use of VRbased interventions requires further well-designed, blinded, randomized, long-term follow-up studies.


Assuntos
Psiquiatria , Esquizofrenia , Terapia de Exposição à Realidade Virtual , Realidade Virtual , Humanos , Psicoterapia
20.
Psychiatr Hung ; 36(3): 353-369, 2021.
Artigo em Húngaro | MEDLINE | ID: mdl-34738529

RESUMO

Anne Sexton began writing poetry during psychiatric treatment following a severe episode of depression, on the advice of her psychiatrist, and went on to become one of the most celebrated among the so-called confessional poets. Her oeuvre offers insight into the emotional struggles of a middle-class woman living in 1950s and 1960s Ame - rica, with poems exploring previously scandalous themes such as female sexuality, domestic violence and mental ill - ness. The latter is the focus of this paper. Anne Sexton suffered from mental problems, more specifically bipolar disorder, which was accompanied by addiction to alcohol and various medicines. She was unable to come to terms with the trauma she may have suffered in childhood, and she herself abused her children later on. Her inner struggles are reflected in her poetry, which she began to write as a therapeutic acticity. Her poems give us a glimpse into the more intimate struggles of her being, which she was unable to resolve in this way - and so she ended her life.


Assuntos
Transtorno Bipolar , Psiquiatria , Criança , Feminino , Humanos , Mães , Psicoterapia , Redação
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