Harvard Review of Psychiatry最新文献_第7页

Applications of Speech Analysis in Psychiatry: Erratum. 语音分析在精神病学中的应用：勘误。

IF 2.5 4区医学

Harvard Review of Psychiatry Pub Date : 2023-03-01 DOI: 10.1097/HRP.0000000000000357

引用次数: 0

Challenges of Agitation in Dementia: A Plea for Early Discussion. 痴呆症中躁动的挑战:早期讨论的请求。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-01-01 DOI: 10.1097/HRP.0000000000000352

Leah G Richler, Mariko Shimizu, Hsiang Huang, Rachel Kester

{"title":"Challenges of Agitation in Dementia: A Plea for Early Discussion.","authors":"Leah G Richler, Mariko Shimizu, Hsiang Huang, Rachel Kester","doi":"10.1097/HRP.0000000000000352","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000352","url":null,"abstract":"Abstract Behavioral and psychological symptoms of dementia (BPSD) occur frequently among people with dementia and are known precipitants for placement in care facilities. Despite the social, financial, and psychological impact on dementia care, education and discussions on BPSD have not been routinely included in advance care planning (ACP). As a result, families can face great challenges in making complex medical decisions when their loved ones are admitted to the geriatric psychiatric inpatient unit with refractory BPSD. We present the case of an 83-year-old gentleman with BPSD to illustrate universal struggles in dementia care experienced by many families, which could have been alleviated by education and discussions around BPSD earlier in the patient’s dementia course. A literature search did not yield any articles that mention discussions of BPSD in ACP. The lack of literature referencing BPSD in ACP supports our clinical experiences with the case and highlights the need for improvement in current dementia care. We propose a guideline for providers to facilitate conversations around BPSD as an integral part of ACP, including discussions of four key points related to the progressive nature of dementia, the commonality of BPSD, the lack of FDA-approved treatment for BPSD, and the difficulty in balancing agitation and sedation to allow safe placement. We firmly believe it is important to start discussion on BPSD as part of ACP as early as possible. Early education and discussion will help to facilitate meaningful care decisions as patients and families navigate the challenges associated with this progressive disease.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 1","pages":"22-27"},"PeriodicalIF":3.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/bc/hrp-31-22.PMC9855747.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10730331","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}

引用次数: 0

Clinical Implications of the Neurosteroid Allopregnanolone in Reproductive Depression. 神经类固醇异孕酮治疗生殖抑郁症的临床意义。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-01-01 DOI: 10.1097/HRP.0000000000000354

Leah C Susser

引用次数: 1

Clinical and Ethical Dilemmas in the Involuntary Treatment of Anorexia Nervosa. 神经性厌食症非自愿治疗的临床与伦理困境。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-01-01 DOI: 10.1097/HRP.0000000000000355

Jenny Tumba, Megan Smith, Kyle E Rodenbach

{"title":"Clinical and Ethical Dilemmas in the Involuntary Treatment of Anorexia Nervosa.","authors":"Jenny Tumba, Megan Smith, Kyle E Rodenbach","doi":"10.1097/HRP.0000000000000355","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000355","url":null,"abstract":"Learning objectives: After completing this activity, practitioners will be better able to:• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)• Outline and discuss the legal, ethical, and medical challenges inpatient providers face when treating patients with SE-AN.Abstract: Patients with severe and enduring anorexia nervosa (SE-AN) present numerous clinical and ethical challenges for the hospital psychiatrist. Patients typically come to the hospital in a state of severe medical compromise. Common difficulties in the period of acute medical stabilization include assessment of decision-making capacity and the right to decline treatment, as well as legally complex decisions pertaining to administering artificial nutrition over the patient's objection. Following acute medical stabilization, the psychiatric consultant must decide whether psychiatric hospitalization for continued treatment is indicated, and if so, whether involuntary hospitalization is indicated. The standard of care in these situations is unclear. Pragmatic issues such as lack of appropriate facilities for specialized treatment are common. If involuntary hospitalization is not approved or not pursued, there may be difficulty in determining whether, when, and how to involve palliative care consultants to guide further management. These cases are complex and largely reside in a medico-legal and ethical gray area. This article discusses the difficulties associated with these cases and supports a growing body of literature emphasizing moderation and harm-reduction in patients with SE-AN. Physician-assisted dying (PAD) is also discussed.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 1","pages":"14-21"},"PeriodicalIF":3.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10730330","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}

引用次数: 0

Applications of Speech Analysis in Psychiatry. 语音分析在精神病学中的应用。

IF 2.5 4区医学

Harvard Review of Psychiatry Pub Date : 2023-01-01 DOI: 10.1097/HRP.0000000000000356

Katerina Dikaios, Sheri Rempel, Sri Harsha Dumpala, Sageev Oore, Michael Kiefte, Rudolf Uher

{"title":"Applications of Speech Analysis in Psychiatry.","authors":"Katerina Dikaios, Sheri Rempel, Sri Harsha Dumpala, Sageev Oore, Michael Kiefte, Rudolf Uher","doi":"10.1097/HRP.0000000000000356","DOIUrl":"10.1097/HRP.0000000000000356","url":null,"abstract":"Abstract: The need for objective measurement in psychiatry has stimulated interest in alternative indicators of the presence and severity of illness. Speech may offer a source of information that bridges the subjective and objective in the assessment of mental disorders. We systematically reviewed the literature for articles exploring speech analysis for psychiatric applications. The utility of speech analysis depends on how accurately speech features represent clinical symptoms within and across disorders. We identified four domains of the application of speech analysis in the literature: diagnostic classification, assessment of illness severity, prediction of onset of illness, and prognosis and treatment outcomes. We discuss the findings in each of these domains, with a focus on how types of speech features characterize different aspects of psychopathology. Models that bring together multiple speech features can distinguish speakers with psychiatric disorders from healthy controls with high accuracy. Differentiating between types of mental disorders and symptom dimensions are more complex problems that expose the transdiagnostic nature of speech features. Convergent progress in speech research and computer sciences opens avenues for implementing speech analysis to enhance objectivity of assessment in clinical practice. Application of speech analysis will need to address issues of ethics and equity, including the potential to perpetuate discriminatory bias through models that learn from clinical assessment data. Methods that mitigate bias are available and should play a key role in the implementation of speech analysis.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 1","pages":"1-13"},"PeriodicalIF":2.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9498436","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}

引用次数: 0

Psychotic Misdiagnosis of Racially Minoritized Patients: A Case-Based Ethics, Equity, and Educational Exploration. 少数族裔患者的精神病误诊:基于个案的伦理、公平与教育探索。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-01-01 DOI: 10.1097/HRP.0000000000000353

Anita M Jegarl, Oluwole Jegede, Jessica Isom, Nicole Ciarleglio, Carmen Black

{"title":"Psychotic Misdiagnosis of Racially Minoritized Patients: A Case-Based Ethics, Equity, and Educational Exploration.","authors":"Anita M Jegarl, Oluwole Jegede, Jessica Isom, Nicole Ciarleglio, Carmen Black","doi":"10.1097/HRP.0000000000000353","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000353","url":null,"abstract":"Abstract: The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic disorder is one of psychiatry's longest-standing inequities born of real-time clinician racial bias. Evidence suggests that providers assign a diagnosis of schizophrenia and/or schizoaffective disorder according to race more than any other demographic variable, and this inequity persists even in the absence of differences in clinician symptom ratings. This case report describes the journey of one young Black woman through her racialized misdiagnosis of schizophrenia and the process by which interdisciplinary, health equity-minded providers across the spectrum of medical education and practice joined together to provide a culturally informed, systematic rediagnosis of major depressive disorder and post-traumatic stress disorder. Expert discussion is provided by three Black academic psychiatrists with expertise in social justice and health equity. We provide an evidence-based exploration of mechanisms of clinician racial bias and detail how the psychosis misdiagnosis of racially minoritized groups fails medical ethics and perpetuates iatrogenic harm to patients who truly need help with primary mood, trauma, and substance use disorders.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 1","pages":"28-36"},"PeriodicalIF":3.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10730332","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}

引用次数: 1

Methemoglobinemia in a Patent Presenting with an Undisclosed Intentional Overdose. 高铁血红蛋白血症的一项专利显示未公开的故意过量用药。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2022-11-01 DOI: 10.1097/HRP.0000000000000348

Claire L Gibson, Sarah B Abdallah, Natalie R Neumann, Hun Millard, Sarah Riley

引用次数: 0

Unremitting Suicidality in Borderline Personality Disorder: A Single Case Study and Discussion of Technology in Clinical Care. 边缘型人格障碍患者持续自杀:个案研究及临床护理技术探讨。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2022-11-01 DOI: 10.1097/HRP.0000000000000351

Lois W Choi-Kain, Grace E Murray, Mark J Goldblatt, Chelsey R Wilks, Ipsit V Vahia, Daniel D L Coppersmith, Gabrielle S Ilagan, Boyu Ren

{"title":"Unremitting Suicidality in Borderline Personality Disorder: A Single Case Study and Discussion of Technology in Clinical Care.","authors":"Lois W Choi-Kain, Grace E Murray, Mark J Goldblatt, Chelsey R Wilks, Ipsit V Vahia, Daniel D L Coppersmith, Gabrielle S Ilagan, Boyu Ren","doi":"10.1097/HRP.0000000000000351","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000351","url":null,"abstract":"CASE HISTORYAND TREATMENT This report presents the case of a young woman, “Jane.” The case is followed by commentary from three experts in suicidal or self-destructive behavior and the use of technology in clinical care. Jane is a college-aged female with a diagnosis of borderline personality disorder (BPD) and a history of repetitive self-harm, including head banging and cutting, as well as chronic, unremitting suicidal ideation. Jane had been in an intensive residential program for many months, and during this time she was stepped up to inpatient psychiatric hospitalization multiple times due to concerns about safety. Jane had a history of multiple suicide attempts while in outpatient, residential, and inpatient settings.Most of these attempts occurred on hospital units using methods like self-strangulation with available objects, self-suffocation, and self-starvation. Upon discharge from her last inpatient psychiatric admission, Jane was admitted to an intensive specialized residential program for adult women with borderline and other severe personality disorders. This unit integrates evidence-based treatments includingdialectical behavior therapy (DBT),mentalization based treatment (MBT), and good psychiatric management (GPM). The standard treatment protocol includes daily DBT diary cards, check-ins with the program’s 24-hour counselors,","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"30 6","pages":"350-360"},"PeriodicalIF":3.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/b0/hrp-30-350.PMC9770128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10846269","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}

引用次数: 0

Structural and Functional Brain Alterations in Populations with Familial Risk for Depression: A Narrative Review. 具有家族性抑郁风险人群的大脑结构和功能改变:一项叙述性综述。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2022-11-01 DOI: 10.1097/HRP.0000000000000350

Birce Begum Burhanoglu, Ali Saffet Gonul

{"title":"Structural and Functional Brain Alterations in Populations with Familial Risk for Depression: A Narrative Review.","authors":"Birce Begum Burhanoglu, Ali Saffet Gonul","doi":"10.1097/HRP.0000000000000350","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000350","url":null,"abstract":"Learning objectives: After completing this activity, practitioners will be better able to:• Discuss the association between brain alterations and vulnerability or resilience to MDD in people with familial risk• Define how structural and functional brain alterations associated with vulnerability or resilience could lead to a better understanding of the pathophysiology of MDD.Aim: Familial history is associated with an increased risk for major depressive disorder (MDD). Despite the increased risk, some members of the familial high-risk population remain healthy, that is, resilient. Defining the structural and functional brain alterations associated with vulnerability or resilience could lead to a better understanding of the pathophysiology of MDD. This study aimed to review the current literature and discuss the association between brain alterations and vulnerability or resilience to MDD in people with familial risk.Methods: A literature search on MRI studies investigating structural and functional alterations in populations at familial risk for MDD was performed using the PubMed and SCOPUS databases. The search was conducted through June 13, 2022.Results: We reviewed and summarized the data of 72 articles (25 structural MRI, 35 functional MRI, 10 resting-state fMRI, one structural/functional MRI combined, and one structural/functional/resting-state fMRI combined). These findings suggested that resilience in high-risk individuals is related to the amygdala structure, frontal lobe activity, and functional connectivity between the amygdala and multiple frontal regions.Conclusion: Resilient and vulnerable individuals exhibit structural and functional differences in multiple frontal and limbic regions. However, further systematic longitudinal research incorporating environmental factors is required to validate the current findings.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"30 6","pages":"327-349"},"PeriodicalIF":3.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10553183","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}

引用次数: 0

(In)Equality and Beyond: Achieving Justice in Gender-Affirming Hormone Initiation. (三)平等及超越:在性别确认激素启动中实现公正。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2022-11-01 DOI: 10.1097/HRP.0000000000000349

Christina L Macenski, Alex S Keuroghlian, Christopher G AhnAllen, Genny Beemyn, Eli Erlick, Jules Gill-Peterson, Joanna Marie Harper, Rebeca Ramos, Daphna Stroumsa, Fernando J Benetti, John A Fromson

{"title":"(In)Equality and Beyond: Achieving Justice in Gender-Affirming Hormone Initiation.","authors":"Christina L Macenski, Alex S Keuroghlian, Christopher G AhnAllen, Genny Beemyn, Eli Erlick, Jules Gill-Peterson, Joanna Marie Harper, Rebeca Ramos, Daphna Stroumsa, Fernando J Benetti, John A Fromson","doi":"10.1097/HRP.0000000000000349","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000349","url":null,"abstract":"Abstract: The World Professional Association for Transgender Health (WPATH) is an international organization that aims to advocate for transgender and gender-diverse (TGD) people by promoting safe and effective ways to access and deliver healthcare to maximize psychological health and well-being. One way this is achieved is through the WPATH's published Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, a set of guidelines for gender-affirming care that is based on the available science and expert consensus. In anticipation of the release of updated guidelines (Standards of Care Version 8) in 2022 the Radcliffe Institute for Advanced Study at Harvard University hosted an Exploratory Seminar in December 2021 that brought together experts from the United States, Mexico, and the United Kingdom to share knowledge across disciplines in order to propose revisions to the WPATH's updated guidelines. This article shares the workgroup's high-level consensus and recommendations.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"30 6","pages":"369-372"},"PeriodicalIF":3.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10553181","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}

引用次数: 0