Harvard Review of Psychiatry最新文献

{"title":"Bedside Teaching and Feedback in Psychiatry: Using Open Dialogue Strategies on an Inpatient Psychotic Disorders Unit.","authors":"Cordelia Ross, Adrienne T Gerken, Joseph B Stoklosa","doi":"10.1097/HRP.0000000000000472","DOIUrl":"10.1097/HRP.0000000000000472","url":null,"abstract":"<p><p>Bedside teaching is essential to instilling clinical and communication skills, and its benefits to both learners and patients are particularly notable in psychiatry. Bedside rounding has declined in teaching hospitals, however, a trend that may reflect constraints on teaching and clinical time, perceived inefficiency, and awkwardness for trainees. Creating safe and nonpunitive learning environments, maximizing efficiency, and formatting rounds to support learners are strategies that may reduce these barriers. In this column, the authors describe using dialogic practice, a method of communication derived from Finland's Open Dialogue approach, to integrate bedside teaching into psychiatry inpatient rounds. This is the first description of dialogic practice as a teaching tool rather than a clinical approach. In this model, teaching is integrated directly into the patient interview. The attending psychiatrist may step in to make an intervention or teaching point, then hand the interview back to the trainee. The authors demonstrate this method using example cases. The use of dialogic practice, which incorporates multiple voices in each encounter, allows for integrating feedback and teaching into clinical care. Patients benefit by feeling fully included in discussions about their care, while learners receive valuable real-time feedback that they can immediately integrate into the ongoing interview. Dialogic teaching is highly efficient while modeling valuable skills and respecting both the patient and the learner. It must, however, be implemented in a psychologically safe learning environment.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"369-373"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Curbside Consultation in Psychiatry: A Primer.","authors":"Samuel P Greenstein, Thomas M Soeprono, Ann C Schwartz, David C Fipps, Thomas W Heinrich, Joshua R Jackson, Scott R Beach","doi":"10.1097/HRP.0000000000000473","DOIUrl":"10.1097/HRP.0000000000000473","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this CME activity, the psychiatrist should be better able to:• Evaluate the appropriateness of curbside consultation requests in inpatient psychiatry by analyzing case complexity, information quality, urgency, and the need for direct patient assessment.• Identify the major limitations and medicolegal risks associated with curbside consultation.</p><p><strong>Objective: </strong>This perspective summarizes the literature on curbside consultation (CC) across medical specialties to develop recommendations for its use in inpatient consultation-liaison psychiatry. We address CC's benefits, challenges, and limitations in clinical practice.</p><p><strong>Method: </strong>We conducted a narrative review via PubMed using the terms \"curbside\" AND \"consult,\" and included English-language articles that discuss CC use in any setting, within any discipline, and for any purpose. Then we screened included articles for references that met the same criteria.</p><p><strong>Results and discussion: </strong>We included 43 articles and extracted data from 25 of the included studies. The literature indicates that CCs can serve as valuable tools for clinicians seeking informal advice on patient management or wanting to increase general medical knowledge. Significant challenges regarding CC use exist, however, including the potential for inaccurate data exchange, consultant time burden, lack of reimbursement, and liability concerns.</p><p><strong>Conclusions: </strong>While CCs facilitate communication and collaboration among health care professionals, their use requires careful consideration based on the clinical situation. This perspective provides guidance for inpatient psychiatric consultants on assessing CC request appropriateness and effective CC performance in inpatient settings.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"324-344"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Psychiatry Measures, and What It Misses: Flourishing as a Blind Spot in Patient-Centered Care.","authors":"Tyler J VanderWeele, Omar S Haque, John R Peteet","doi":"10.1097/HRP.0000000000000477","DOIUrl":"10.1097/HRP.0000000000000477","url":null,"abstract":"<p><p>In psychiatry, judgments are routinely made that extend beyond symptom assessment and reduction to areas such as functioning, agency, responsibility, relationships, and meaning in life. Yet standard outcome measures focus narrowly on symptoms, sometimes implicitly treating these broader dimensions as peripheral or outside the scope of psychiatric care. Thus, there is a mismatch between what psychiatric practice actually influences and what it formally measures. The result is not value-neutral care, but rather value-laden care without explicit acknowledgment. We argue that measures of flourishing do not expand psychiatry's scope so much as make explicit the dimensions of patients' lives psychiatry already shapes. We suggest that incorporating flourishing measures into psychiatry can help align assessment with patient-centered care without requiring clinicians to adopt a comprehensive moral framework or exceed the boundaries of their professional expertise.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 5","pages":"277-280"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of mHealth Approaches to Increase Access to and Engagement of Mental Health Treatment Among Underserved Communities.","authors":"Daniel A Pineiro, Nubia A Mayorga, Jenny Zhen-Duan","doi":"10.1097/HRP.0000000000000464","DOIUrl":"10.1097/HRP.0000000000000464","url":null,"abstract":"<p><p>Across the United States, significant disparities persist in mental health care. Individuals with lower socioeconomic status (SES) face increased barriers to accessing and engaging in treatment. In response, mobile health (mHealth) advancements have emerged as promising tools to address practical and clinical barriers to mental health care access. While mHealth has enabled greater access, strategies for sustaining mHealth engagement need more attention, as increased engagement is associated with improved outcomes. In this article, we present four innovative mHealth approaches and discuss strategies to increase engagement among individuals with low SES: (1) guided mHealth, combining asynchronous telehealth with clinician supervision; (2) simulated therapeutic communication via generative artificial intelligence; (3) real-time, personalized support with just-in-time adaptive interventions; and (4) streamlined clinician referrals via artificial intelligence software. We detail advantages that facilitate engagement, limitations that risk early drop-off, and suggestions for improving equity and cultural relevance in mHealth tools and platforms. We also outline ethical considerations, cultural and place-based adaptations, and community-engaged participatory design, as these efforts are paramount for aligning mHealth with the needs of under-resourced communities.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"217-219"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Is It Still So Difficult to Acknowledge the Reality of Borderline Personality Disorder?","authors":"Mark L Ruffalo, Alessandra D'Agostino","doi":"10.1097/HRP.0000000000000465","DOIUrl":"10.1097/HRP.0000000000000465","url":null,"abstract":"<p><p>Borderline personality disorder (BPD) has emerged as a major clinical and societal challenge since its mid-twentieth-century conceptualization. This paper addresses four persistent obstacles to effective care: diagnostic complexity, interpersonal dysfunction and risk behaviors, high societal burden, and pervasive stigma. We argue that despite recent critiques, many of which propose replacing the diagnosis with trauma-related formulations, BPD remains a valid, coherent, and clinically indispensable construct. Misdiagnosis contributes to iatrogenic harm, while accurate diagnosis enables targeted, evidence-based treatments, including dialectical behavior therapy, good psychiatric management, and mentalization-based and transference-focused psychotherapy. Ironically, calls to eliminate the diagnosis have accelerated just as treatment options have become more effective and widely available. As psychiatry prepares for the Diagnostic and Statistical Manual of Mental Disorders, 6thEdition, we advocate for preserving the BPD construct, expanding access to specialized care, and confronting structural stigma to improve outcomes for this complex but treatable condition.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 4","pages":"248-255"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Management of Benzodiazepine Withdrawal: A Narrative Review of a Systematic, Individualized Taper Design.","authors":"Zoe Karavolis, Reuben Hendler, Amanda Sedgewick, Matthew Mosquera, R Kathryn McHugh, Jungjin Kim","doi":"10.1097/HRP.0000000000000469","DOIUrl":"10.1097/HRP.0000000000000469","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this CME activity, the psychiatrist should be better able to.</p><p><strong>Background: </strong>Benzodiazepines are widely prescribed, yet long-term use carries risks of adverse clinical outcomes and challenging withdrawal syndromes. Although gradual outpatient tapering remains the standard recommendation for discontinuation, a subset of patients may require more rapid discontinuation in inpatient settings due to complex factors, such as misuse of multiple substances, prior failed tapering attempts, or co-occurring medical and psychiatric conditions.</p><p><strong>Methods: </strong>This narrative review synthesizes contemporary literature on inpatient benzodiazepine withdrawal. We conducted a targeted review of clinical studies, guidelines, and expert opinion pieces published from 2000-2024, with a focus on real-world applicability.</p><p><strong>Discussion: </strong>We assess recent findings and best-practice recommendations on benzodiazepine discontinuation and propose a systematic, individualized tapering strategy to guide inpatient withdrawal management. Additionally, we review medication selection, long-acting benzodiazepines and phenobarbital protocols, adjunctive pharmacotherapy, and behavioral interventions while emphasizing co-occurring disorders, risk management, and protracted withdrawal symptoms.</p><p><strong>Conclusion: </strong>Our proposed approach may enhance systematic and safe management of inpatient benzodiazepine withdrawal, especially for complex patient populations.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"237-247"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Long Road Back: An Integrative and Interdisciplinary Approach to Care After Traumatic Brain Injury.","authors":"Yelu Zhang, Kevin Majeres, Alejandro Dan Mendoza, Hsueh-Sheng Chiang","doi":"10.1097/HRP.0000000000000457","DOIUrl":"10.1097/HRP.0000000000000457","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is frequently associated with significant neuropsychiatric sequelae. Recovery trajectories are highly variable; injury severity is only one influence. Other factors, including preexisting psychiatric or psychological factors and psychosocial contexts also influence recovery. In this clinical challenge, we present the case of a young woman with a history of psychiatric comorbidity who developed complex neuropsychiatric symptoms after sustaining a TBI following a motor vehicle accident. Her clinical presentation included posttraumatic headache, chronic pain, visual disturbances, difficulty returning to work, and prominent anxiety and posttraumatic stress disorder symptoms. These challenges required a coordinated, multidisciplinary approach to treatment, focused both on symptom management and functional recovery. Psychotherapy played a central role, with a modified exposure-based approach augmented by biofeedback tools and pharmacotherapy. Over time, this integrative strategy resulted in meaningful improvement in the patient's neuropsychiatric symptoms and functional recovery. This case highlights the role of collaborative, tailored treatment for patients with overlapping neurological and psychiatric sequelae of TBI. It also underscores the unique contribution of psychotherapy when combined with medication and technology-enabled interventions, demonstrating how these strategies can optimize recovery in complex outpatient presentations of TBI.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"267-275"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Student-Faculty Collaboration: Embedding Trauma-Informed Care in Medical Education.","authors":"Nhi-Ha Trinh, Sarah Berman, Taylor Brown, Celeste Royce, Eve Rittenberg, Sadie Elisseou, Nomi Levy-Carrick, David A Hirsh, Emeline Jarvie, Jennifer Potter","doi":"10.1097/HRP.0000000000000470","DOIUrl":"10.1097/HRP.0000000000000470","url":null,"abstract":"<p><p>Trauma-informed medical education (TIME) applies trauma-informed care (TIC) frameworks to address the long-term effects of potentially traumatic events and better serve patients, learners, and faculty. Because exposure to trauma and adversity has been linked to negative clinical and educational outcomes, medical educators have the dual responsibilities of teaching students about the effects of trauma and adversity on patients while using TIME methods to support student learning and psychological safety. Despite increasing recognition of the importance of trauma-informed curricular content and educational context, many medical schools have yet to incorporate longitudinal trauma-informed instruction to ensure student clinical competency in TIC practices. As members of an inaugural student-faculty collaborative and resulting medical school-wide TIC curricular theme committee, we reflect on our student and faculty curricular co-creation journeys, including the challenges encountered and strategies employed. Drawing from TIC curricular development literature, we provide suggestions for medical schools and institutions embarking on comprehensive integration of TIME.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"256-266"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Climate Change and Mental Health into Medical Education: A Narrative Review of Interventions and Assessment Tools.","authors":"David R A Coelho, Elizabeth G Pinsky, James McKowen, Katherine A Koh, Oliver Freudenreich, Joshua D Salvi, Richard O Bido Medina, Alex S Keuroghlian","doi":"10.1097/HRP.0000000000000468","DOIUrl":"10.1097/HRP.0000000000000468","url":null,"abstract":"<p><strong>Background: </strong>Climate change is a global health crisis with substantial mental health consequences. Despite its growing impact, climate-related mental health topics remain insufficiently integrated into medical education. This review synthesizes studies describing educational interventions and assessment tools that address the intersection of climate change and mental health.</p><p><strong>Method: </strong>We conducted a narrative literature review across PubMed, Education Resources Information Center, and PsycINFO in March 2025. Studies were included if they described an educational intervention related to climate-health topics with mental health content or relevance, involved learners in health-related fields, and reported outcomes using validated or author-developed instruments.</p><p><strong>Results: </strong>Fifteen studies met inclusion criteria. Seven described educational interventions, including longitudinal curricula, clerkship sessions, telementoring, and innovative formats such as narrative medicine and reflective tool kits. Fourteen studies included assessment tools, though only one reported psychometric validation (Cronbach's α=0.90). To characterize heterogeneity, studies were grouped by type of climate-health educational focus: direct clinical mental health education (n=9), general climate health education with mental health implications (n=3), and climate-health curricular gap analyses (n=3). Across interventions, outcomes demonstrated improved knowledge, confidence, and preparedness to address climate-related psychological impacts, but barriers remain, particularly limited faculty training, institutional constraints, and absence of validated evaluation frameworks.</p><p><strong>Conclusion: </strong>Current efforts to integrate climate-mental health topics into medical education are promising but still fragmented. Advancing the field requires standardized curricula with explicit and related mental health content, validated assessment tools, interdisciplinary faculty development, learner-centered approaches, climate justice and health equity principles in training, inclusion in board exams, and long-term evaluation.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":" ","pages":"220-236"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Patienthood to Active Collaboration: Advancing Lived Experience Expertise in Addressing the Economic Determinants of Mental Health.","authors":"Oscar Jiménez-Solomon, Laura López-Aybar","doi":"10.1097/HRP.0000000000000466","DOIUrl":"10.1097/HRP.0000000000000466","url":null,"abstract":"<p><p>Economic hardship-including poverty, housing insecurity, unemployment, food insecurity, and debt-is among the most consistently documented determinants of mental health. Extensive epidemiologic and social science research shows that adverse economic conditions increase the risk, severity, and persistence of depression, anxiety, suicidality, and severe mental illness. Although social policies can improve mental health outcomes, relatively few interventions within mental health systems target economic determinants. Those that do are often professionally designed and limited in scope. In this perspective article, we argue that advancing effective and equitable interventions that address economic determinants of mental health requires meaningful participation of people with lived experiences of economic hardship and mental health challenges. Drawing on epistemological and empirical literatures, we conceptualize lived experience as a form of expertise and contend that its systematic exclusion constitutes epistemic injustice and a barrier to intervention relevance and effectiveness. Using the International Association for Public Participation's Spectrum of Public Participation, we propose a framework for integrating lived experience expertise across the intervention cycle (i.e., needs assessment, design, implementation, and evaluation). Emphasizing collaboration and empowerment, we illustrate this framework with examples from the literature and highlight both its promise and limitations. We then identify systemic factors underlying these challenges-such as funding structures, governance, regulatory constraints, and capacity gaps-and offer practice-informed recommendations to address them. We conclude with a call to psychiatry and clinical professions to act as allies in redistributing epistemic and decision-making authority, positioning lived expertise as essential to interventions addressing economic determinants of mental health.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"34 3","pages":"189-209"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}