Harvard Review of Psychiatry最新文献_第8页

Why Don't You Take This to a Friend? A Question Psychotherapists Should Ask More Often. 你为什么不把这个告诉你的朋友呢?心理治疗师应该经常问的问题。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-03-01 DOI: 10.1097/HRP.0000000000000359

Jacqueline Olds, Richard S Schwartz

{"title":"Why Don't You Take This to a Friend? A Question Psychotherapists Should Ask More Often.","authors":"Jacqueline Olds, Richard S Schwartz","doi":"10.1097/HRP.0000000000000359","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000359","url":null,"abstract":"Since 1996, we have been studying loneliness and the decrease in the average number of confidants that most people have. We are gratified that the topic of loneliness is now less taboo, thanks in large part to press coverage during the pandemic about how difficult the isolation was for everyone. But we have also noticed how much Americans rely on their therapists to help themwith their most intimate conundrums. We could not be more grateful to our patients who have entrusted us with their confidences over many years. But we also worry: have we contributed to a fraying of the social fabric by implying that confidences about the usual human conundrums are better saved for the ears of a therapist than shared with a close friend? Too many Americans are lonely “frequently” or “almost all the time or all the time” 36% in a recent study, including 61% of young people aged 18–25 and 51% of mothers of young children.We hear from our patients that it is often a friend who says the equivalent of “This is too much for me to handle; maybe you should see a therapist.” And despair and suicidal depression increase while our nation turns increasingly to the mental health profession rather than friends and relatives to help them with life’s knotty problems. We have noted in our previous work on social isolation that the culture of most Americans includes a deep distaste for depending on others, and an over-valuing of independence and “having things one’s own way.” Even college students have the notion that only after successfully living alone and learning to enjoy their own company will they be well suited for a love relationship with someone else. Yet many of them get snagged by depression along this journey.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"47-49"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/0f/hrp-31-47.PMC9997617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131282","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

Hikikomori Syndrome and Digital Technologies: A Systematic Review. “隐蔽青年综合征”与数字技术:系统综述。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-03-01 DOI: 10.1097/HRP.0000000000000362

Gabriel S Sales-Filho, Igor D Bandeira, Nayara Argollo, Rita Lucena

{"title":"Hikikomori Syndrome and Digital Technologies: A Systematic Review.","authors":"Gabriel S Sales-Filho, Igor D Bandeira, Nayara Argollo, Rita Lucena","doi":"10.1097/HRP.0000000000000362","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000362","url":null,"abstract":"Abstract: Hikikomori syndrome (HS) is a voluntary prolonged social isolation associated with personal and community impact. Previous evidence pointed out a possible relationship between this syndrome with addiction to digital technologies. Here we aim to understand the relationship between HS and digital technology use, overuse, and addictive behaviors, as well as potential therapeutic approaches.We conducted a systematic review of observational and intervention studies available in PubMed/MEDLINE, LILACS, IBECS, Embase, PsycINFO, and SciELO databases, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA 2020) criteria. The risk of bias was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Consensus-based Clinical Case Reporting Guideline Development (CARE). Eligibility criteria were pre-, at-risk populations, or those with HS diagnosis, and any kind of technological overuse. Seventeen studies were included in the review, of which eight were cross-sectional, eight were case reports, and one was quasi-experimental. Hikikomori syndrome was associated with addition to digital technologies; no cultural differences were found. Environmental factors, such as a history of bullying, low self-esteem, and grief were identified as precursors of addictive behaviors. The included articles addressed addiction to digital technologies, electronic games, and social networks, among others, in HS. HS is cross-culturally associated with such addiction. The management of these patients remains challenging, and no target evidence-based treatments have been developed. The studies included in this review had several limitations, and more studies with a higher level of evidence are needed to support the results.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"50-59"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131285","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

Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions. 共同发生的自闭症谱系和边缘型人格障碍:寻求知情干预的新临床挑战。

IF 3.8 4区医学

Harvard Review of Psychiatry Pub Date : 2023-03-01 DOI: 10.1097/HRP.0000000000000361

Lukas Cheney, Robert B Dudas, Jenna M Traynor, Josephine A Beatson, Sathya Rao, Lois W Choi-Kain

{"title":"Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.","authors":"Lukas Cheney, Robert B Dudas, Jenna M Traynor, Josephine A Beatson, Sathya Rao, Lois W Choi-Kain","doi":"10.1097/HRP.0000000000000361","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000361","url":null,"abstract":"INITIAL CASE PRESENTATION Brittany, a 21-year-old woman with borderline personality disorder (BPD), was referred to our specialist personality disorder service, with a presentation distinguished by high-lethality suicidal behaviors including ingestion of toxic substances and dangerous objects. She frequently ran to train stations and bridges. Brittany also engaged in daily cutting. Due to her high level of risk, she was increasingly restricted within her family home. She was not allowed into the backyard for fear that she would elope and engage in high lethality behavior. Brittany is an only child, conceived via in vitro fertilization. Diagnosed with Asperger’s Syndrome at age six, Brittany displayed early restricted interests, desire for routine, and sensory difficulties, accompanied by a high level of social interest. Multi-disciplinary assessments showed pragmatic language impairment and social difficulties that included inflexibility and egocentricity in her play. Brittany demonstrated difficulty with sharing, losing in games, and when not able to take first turn. High levels of emotional distress were reported when she did not get what she wanted. Brittany worked with a speech pathologist during this childhood period. She was subsequently diagnosed with obsessive compulsive disorder (OCD) and generalized anxiety. Restricted eating and self-injurious behaviors began in her early teen years.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":"31 2","pages":"83-91"},"PeriodicalIF":3.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/54/hrp-31-83.PMC9997622.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9187154","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: 2

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