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Women in academic publishing and academic psychiatry face many challenges of gender inequality, including significant pay differentials, poor visibility in senior positions and a male-dominated hierarchical system. We discuss this problem and outline how the BJPsych plans to tackle these issues it in its own publishing.
Psychiatrists may be daunted by the prospect of undertaking a neurological examination. In this article we briefly review the neurological signs that may be seen in the context of some common neurological disorders of cognition and movement which may present with neurobehavioural symptoms and therefore may be seen initially by psychiatrists. This approach emphasises that neurological examination is not simply an operationalised procedure but an interpretative process. We propose a minimum neurological examination suitable for use by psychiatrists. Many of the signs included are relatively simple to observe or elicit, require no special equipment, and the examination techniques involved are easy to master.
To investigate the association between newly developed type 2 diabetes (T2D) and incident psychopharmacological treatment and psychiatric hospital contact.
Via Danish registers, we identified all 56,640 individuals from the Central- and Northern Denmark Regions with newly developed T2D (defined by the first HbA1c measurement ≥6.5%) in 2000-2016 as well as 315,694 age and sex matched controls (without T2D). Those having received psychopharmacological treatment or having had a psychiatric hospital contact in the five years prior to the onset of T2D were not included. For this cohort, we first assessed the two-year incidence of psychopharmacological treatment and psychiatric hospital contact. Secondly, via Cox regression, we compared the incidence of psychopharmacological treatment/psychiatric hospital contact among individuals with T2D to propensity score matched controls – taking a wide range of potential confounders into account. Finally, via Cox proportional hazards regression, we assessed which baseline (T2D onset) characteristics were associated with subsequent psychopharmacological treatment and psychiatric hospital contact.
A total of 8.3% of the individuals with T2D initiated psychopharmacological treatment compared to 4.6% of the age and sex matched controls. Individuals with T2D were at increased risk of initiating psychopharmacological treatment compared to the propensity score matched controls (HR=1.51, 95% CI=1.43-1.59), whereas their risk of psychiatric hospital contact was not increased to the same extent (HR=1.14, 95% CI=0.98-1.32). Older age, somatic comorbidity, and being divorced/widowed was associated with both psychopharmacological treatment and psychiatric hospital contact following T2D.
Individuals with T2D are at elevated risk of requiring psychopharmacological treatment.
A hospital built environment can affect patients’ treatment satisfaction, which is, in turn, associated with crucial clinical outcomes. However, little research has explored which elements are specifically important for psychiatric in-patients. This study aims to identify which elements of the hospital environment are associated with higher patient satisfaction with psychiatric in-patient care.
The study was conducted in Italy and the United Kingdom. Data was collected through hospital visits and patient interviews. All hospitals were assessed for general characteristics, aspects specific to psychiatry (patient safety, mixed/single-sex wards, smoking on/off wards), and quality of hospital environment. Patients’ treatment satisfaction was assessed using the Client Assessment of Treatment Scale (CAT). Multi-level modelling was used to explore the role of environment in predicting the CAT scores adjusted for age, gender, education, diagnosis, and formal status.
The study included 18 psychiatric hospitals (7 in Italy and 11 in the United Kingdom) and 2130 patients. Healthcare systems in these countries share key characteristics (e.g. National Health Service, care organised on a geographical basis) and differ in policy regulation and governance. Two elements were associated with higher patient treatment satisfaction: being hospitalised on a mixed-sex ward (p = 0.003) and the availability of rooms to meet family off wards (p = 0.020).
As hospitals are among the most expensive facilities to build, their design should be guided by research evidence. Two design features can potentially improve patient satisfaction: family rooms off wards and mixed-sex wards. This evidence should be considered when designing or renovating psychiatric facilities.
This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm.
All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the three months from 1st March to 31st May 2020. These data were compared with presentations in the same months in the three years preceding (2017-2019). Data were obtained from the anonymised service database.
This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a four-year period were examined, there was a significantly higher lethality of attempt (p<0.001), and significant differences in diagnosis (p=0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p=0.036). There were also significant differences in the underlying psychiatric diagnoses(p=0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period.
COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of the restrictions and changes due to Covid-19, especially with respect to self-harm.
We examine epidemiological evidence for the central role of inequalities (principally economic) in driving the onset of mental disorders, physical ill health and premature mortality. We locate the search for solutions in current UK contexts, and include known and likely effects of the COVID-19 pandemic. Prevention of mental disorders and adverse outcomes such as premature mortality must begin with efforts to mitigate rising poverty-inequality.
The COVID-19 pandemic has and will have a huge impact on mental health, especially in countries that have been significantly affected, such as Spain.
Here we aim to provide the perspectives of a group of psychiatrists from Barcelona, one of the epicentres of the pandemic so far, to highlight the potential fatality of a virus that caught us unaware and unprepared, and hopefully this article will be of aid to countries about to face the pandemic.
The unprecedented situations that we have been faced with so far have included reconfiguring hospitals and the redeployment of healthcare professionals, with flexibility and adaptability key to managing the overload in demand. This has led to healthcare professionals being exposed to extremely stressful situations and they have had impossible decisions to make that may have mental health consequences, some of which may be severe and long lasting.
A rebound effect on mental health problems is to be expected in the medium and long term, especially for healthcare professionals and psychiatric patients, necessitating a strengthening of preventive approaches and policies for mental health along with a prompt reopening of mental health services. Ways to provide psychiatric healthcare in the immediate future need to be re-evaluated, and the development of telepsychiatry services is probably to be expected.
Religious concerns, manifested in thought and behaviour, have a complex, bidirectional and sometimes conceptually overlapping relationship with mental health and mental disorder. Psychiatry, concerning itself with what is measurable in research, and with the relief of distress in clinical practice, has a different perspective on these complex interrelationships than does theology or religion. That which is transcendent, and therefore not measurable, is often important to patients, and sometimes distress may (theologically) be a sign of human well-being. The giving of careful attention to transcendence and distress may variously be conceived of as prayer, religious coping or clinical care. Applications of research to clinical practice, addressing as they do a sensitive and controversial boundary between psychiatry and religion, must therefore be patient centred and culturally sensitive.
Cluster analyses have become popular tools for data-driven classification in biological psychiatric research. However, these analyses are known to be sensitive to the chosen methods and/or modelling options, which may hamper generalizability and replicability of findings. To gain more insight into this problem, we used Specification-Curve Analysis (SCA) to investigate the influence of methodological variation on biomarker-based cluster-analysis results.
Proteomics data (31 biomarkers) were used from patients (n = 688) and healthy controls (n = 426) in the Netherlands Study of Depression and Anxiety. In SCAs, consistency of results was evaluated across 1200 k-means and hierarchical clustering analyses, each with a unique combination of the clustering algorithm, fit-index, and distance metric. Next, SCAs were run in simulated datasets with varying cluster numbers and noise/outlier levels to evaluate the effect of data properties on SCA outcomes.
The real data SCA showed no robust patterns of biological clustering in either the MDD or a combined MDD/healthy dataset. The simulation results showed that the correct number of clusters could be identified quite consistently across the 1200 model specifications, but that correct cluster identification became harder when the number of clusters and noise levels increased.
SCA can provide useful insights into the presence of clusters in biomarker data. However, SCA is likely to show inconsistent results in real-world biomarker datasets that are complex and contain considerable levels of noise. Here, the number and nature of the observed clusters may depend strongly on the chosen model-specification, precluding conclusions about the existence of biological clusters among psychiatric patients.
Considerations around the dynamics of medicalization and social suffering are at the heart of working with refugees, as is attention to and advocacy for families’ social and settlement needs. In this chapter, the authors describe one particular form of advocacy: the generation of medico-legal reports to accompany asylum claims. The authors argue that the increasing medicalization of the refugee experience has led to widespread dissemination of this practice, and suggest that leveraging psychiatric language in a medico-legal report is not without risk to children and families. They cite the emergence of a significant culture-bound syndrome in Sweden, Uppgivenhetssyndrom, felt to be partly related to the language applied by advocating physicians. The United States of America’s recent policy of forcibly separating migrant families has also seen physician activists discuss “toxic stress” and warn of future pathology. The authors discuss the complexity of using psychiatric language for advocacy and suggest some ways of mitigating negative impacts on families. They suggest that physicians consider moving beyond the clinical encounter to advocate for refugee rights on a broader scale.
This chapter explores how Charles Darwin’s ideas about structural and functional anomalies in plants, animals and humans inspired the new Gothic monsters to be found in the work of Grant Allen, H. G. Wells, Robert Louis Stevenson, Bram Stoker and Arthur Machen. It traces the ways in which these writers reimagined human genealogies in light of evolutionary biology, materialism and Darwinist criminal anthropology. Sadistic criminals whose degenerate minds and bodies threatened civilised society, and atavistic flesh-eating plants whose natural ‘criminality’ was coaxed out by sadistic experimental scientists, are part of a significant reimagining of both biological and cultural history in the last half of the century. Indeed, through these types of biological monsters, Gothic writers challenged some of the most cherished ideas that Victorians held about their cultural heritage. Knowledge about human descent, the biology of human and animal abnormality, and criminal compulsions that dwelt in the ‘protoplasm’, largely negated the ideals of the age of chivalry – the medieval origins of the higher-order values that supposedly defined the human as exceptional.
Region Jönköping County (RJC) in Sweden is a healthcare system that is characterised by sustainable work with quality in healthcare and long-term system-wide improvement. This article describes important factors behind the improvement work in RJC, and how the improvement methods and initiatives have been adopted also in mental healthcare. For example, patients otherwise eligible for admission to a psychiatric department were treated at home after introduction of home treatment teams. Patient satisfaction was high and the number of visits to the emergency department, hospital admissions and hospital stay decreased.
The jíbaro—the emblematic figure of Puerto Rico—has long been at the center of the archipelago's political and professional discussions. Building on the work of scholars who have traced the jíbaro's history, this article complicates the tension between the politically nationalistic definition of humble jíbaros working in the countryside and scientific observations of jíbaros within the confines of the criminal-legal system. By the mid twentieth century, mainstream understandings of jíbaros were increasingly fashioned by psychiatry, social science, and social work, all of which connected jíbaros to other rural identities. These projections of the jíbaro powerfully materialized in Puerto Rico's premier biosocial laboratory, the Insular Penitentiary at Río Piedras (popularly known as Oso Blanco). An analysis of the work of penitentiary psychiatrists and social health professionals with prison inmates reveals a more complex, troubling image of redeemable Puerto Rican men with rural roots and sensibilities than the idyllic representations of jíbaros circulating at the time suggest. Oso Blanco health practitioners pathologized the jíbaro to identify and mend his perceived psychosocial shortcomings, and to diminish any defiance he harbored. In so doing, they reinforced the notion that jíbaros were racialized living artifacts central to colonial-populist designs and constituency-building.
This paper considers certain specific issues that will be faced by low- and middle-income countries when treating psychiatric patients who test positive for COVID-19. The need for both medical and psychiatric units to do the same and challenges in the treatment and management of positive-testing patients are discussed.
Euthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.
Following the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.
We included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.
The ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.
The COVID-19 pandemic has disrupted the traditional practice of psychiatric assessment and treatment via face-to-face interaction. Telepsychiatry, the delivery of psychiatric care remotely through telecommunications technology, is an existing and under-utilised tool that may help to minimise disruption to patient care. Technological advancement is at a stage where it can facilitate widespread use of this practice; however, concerns that limited its expansion previously were not unfounded. This article discusses the use of telepsychiatry in the context of the COVID-19 pandemic.
COVID-19 or ‘Coronavirus’ has become a global pandemic since its initial report in Wuhan, China, on November 17, 2020. It is highly infectious and poses significant health risks for those in vulnerable populations. This article aims to provide perspective into an Irish experience, through the eyes of a practicing psychiatric nurse, who has recently graduated medical school and intends to work as an intern doctor.
Treatment with psychotropic medication may sometimes be jeopardised because of the COVID-19 pandemic. One underlying reason is the lack of COVID-19-specific psychopharmacology guidelines. Here, we discuss five considerations arising from our clinical experience and pharmacological background knowledge to enable safe and well-informed psychopharmacotherapy during the COVID-19 pandemic.