Psychiatric services最新文献

{"title":"Digital Terror: Its Striking Impact on Public Mental Health.","authors":"David Roe, Eva Gilboa-Schechtman, Amit Baumel","doi":"10.1176/appi.ps.20240169","DOIUrl":"https://doi.org/10.1176/appi.ps.20240169","url":null,"abstract":"<p><p>Digital terror refers to the use of digital technology to disseminate graphic images of acts of violence to frighten the public. On October 7, 2023, militants of the Palestinian organization Hamas launched a brutal attack on Israel and used digital terror to magnify their acts. Although the purposeful spreading of terror via digital means is not new, the Hamas attack was significant for the scope, immediacy, and widespread dissemination of its digital content. This column aims to describe and analyze the psychological significance of this new form of terror, the public mental health challenges raised, and the interventions needed to assist those exposed to digital terror.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis.","authors":"Christin Hempeler, Lydia Schneider-Reuter, Anne-Sophie Windel, Jona Carlet, Lea Philipsen, Georg Juckel, Jakov Gather, Amma Yeboah, Mirjam Faissner","doi":"10.1176/appi.ps.20230252","DOIUrl":"https://doi.org/10.1176/appi.ps.20230252","url":null,"abstract":"<p><strong>Objective: </strong>Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care.</p><p><strong>Methods: </strong>The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed.</p><p><strong>Results: </strong>Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices.</p><p><strong>Conclusions: </strong>Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Involvement in Routine Services for Individuals With Severe Mental Illness: Scoping Review of Barriers and Strategies.","authors":"Suzanne S Tham, Phyllis Solomon","doi":"10.1176/appi.ps.20230452","DOIUrl":"https://doi.org/10.1176/appi.ps.20230452","url":null,"abstract":"<p><strong>Objective: </strong>The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment.</p><p><strong>Methods: </strong>Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used.</p><p><strong>Results: </strong>Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies.</p><p><strong>Conclusions: </strong>A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second Opinions for Diagnoses of Psychotic Disorders: Delivering Stage-Specific Recommendations.","authors":"Carol Lim, Abigail L Donovan, Sophie Freudenreich, Corinne Cather, Sarah Maclaurin, Oliver Freudenreich","doi":"10.1176/appi.ps.20230623","DOIUrl":"https://doi.org/10.1176/appi.ps.20230623","url":null,"abstract":"<p><strong>Objective: </strong>The impact of obtaining second-opinion consultations on diagnoses of schizophrenia spectrum disorders was evaluated.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for 177 patients referred to a psychosis consultation service at an academic medical center from January 1, 2017, to October 1, 2023; these consultations aimed to clarify a diagnosis of psychosis. Diagnoses made before and after consultations were compared, and treatment recommendations resulting from the consultation visit were summarized.</p><p><strong>Results: </strong>Among patients without a preconsultation diagnosis of schizophrenia, 28% (N=28 of 100) received a postconsultation diagnosis of schizophrenia. Among 62 patients with a postconsultation diagnosis of treatment-resistant schizophrenia (TRS), 56% (N=35) received this diagnosis only after consultation. Nearly all of these patients were advised to begin taking clozapine, and electroconvulsive therapy was less commonly recommended.</p><p><strong>Conclusions: </strong>Expert consultation facilitates timely identification and optimal treatment of schizophrenia and its more severe subtype, TRS.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating Racial Bias in Health Care Algorithms: Improving Fairness in Access to Supportive Housing.","authors":"Krista R Noam, Timothy Schmutte, Christopher Bory, Robert W Plant","doi":"10.1176/appi.ps.20230359","DOIUrl":"https://doi.org/10.1176/appi.ps.20230359","url":null,"abstract":"<p><p>Algorithms for guiding health care decisions have come under increasing scrutiny for being unfair to certain racial and ethnic groups. The authors describe their multistep process, using data from 3,465 individuals, to reduce racial and ethnic bias in an algorithm developed to identify state Medicaid beneficiaries experiencing homelessness and chronic health needs who were eligible for coordinated health care and housing supports. Through an iterative process of adjusting inputs, reviewing outputs with diverse stakeholders, and performing quality assurance, the authors developed an algorithm that achieved racial and ethnic parity in the selection of eligible Medicaid beneficiaries.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Guidelines and Federal Psychotropic Medication Labels for the Treatment of Medicaid-Insured Children With ADHD","authors":"Daniel Kim, Steven P. Cuffe, Pinar Keskinocak, Michael W. Naylor, Nicoleta Serban","doi":"10.1176/appi.ps.20230369","DOIUrl":"https://doi.org/10.1176/appi.ps.20230369","url":null,"abstract":"<h3>Objective:</h3><p>This study examined adherence to clinical practice guidelines (CPGs) and U.S. Food and Drug Administration (FDA) medication labels when prescribing psychotropic medications to Medicaid-insured children with attention-deficit hyperactivity disorder (ADHD).</p><h3>Methods:</h3><p>A retrospective analysis was conducted with 2016–2018 Medicaid claims data across 46 states for children with an ADHD diagnosis and at least one psychotropic medication prescription (N=1,236,068 children). Medications recommended for pediatric use were identified with CPGs from the American Academy of Child and Adolescent Psychiatry and the Florida Medicaid Drug Therapy Management Program for Behavioral Health.</p><h3>Results:</h3><p>Across 46 states, 86.7% of children received guideline-recommended and FDA-approved medications for the treatment of ADHD and comorbid mental disorders. Antidepressants, antihistamines, and second-generation antipsychotics that were not included in CPGs were prescribed for 23.4% of children.</p><h3>Conclusions:</h3><p>High adherence to CPGs and FDA medication labels for medications prescribed for ADHD was observed, suggesting the effectiveness of guidelines in driving evidence-based care.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141529000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivations for and Experiences With Antipsychotic Tapering Among Patients With Schizophrenia Seeking Guided Dose Reduction","authors":"Alexander Nøstdal, Rikke Hilker, Jimmi Nielsen, Mette Ødegaard Nielsen","doi":"10.1176/appi.ps.20230641","DOIUrl":"https://doi.org/10.1176/appi.ps.20230641","url":null,"abstract":"<h3>Objective:</h3><p>Over time, most patients with schizophrenia wish to reduce or discontinue their antipsychotic medication treatment. In Denmark, a specialized government-funded outpatient clinic was established to offer guided antipsychotic dose reduction. This study aimed to provide data on motivations for and previous experiences with antipsychotic tapering among patients attending the clinic.</p><h3>Methods:</h3><p>Patients completed an open-ended survey on their motivations for discontinuing or tapering antipsychotic medication and recorded their expectations about these outcomes. They also provided information on previous experiences with discontinuing medication and their level of symptoms, functioning, and side effects.</p><h3>Results:</h3><p>The survey was completed by 76 (86%) of 88 patients. The main motivations for discontinuing antipsychotics were adverse effects (71%) and uncertainty about the necessity of taking antipsychotics (29%). Other factors included concerns about long-term effects, disagreeing with the diagnosis, experiencing an insufficient effect, and feeling stigmatized by taking medication. Previous experience with discontinuation of antipsychotics was reported by 42 patients, of whom 23 reported relapse as the outcome. Most patients believed they could succeed in dose reduction (N=73 of 75, 97%) or discontinuation (N=62 of 75, 83%).</p><h3>Conclusions:</h3><p>Motivational factors reported for professionally guided antipsychotic dose reduction align with previous studies examining patients choosing to discontinue these medications. Despite reports of relapse during prior discontinuation attempts, most patients still reported motivation for and belief in successful dose reduction or discontinuation. An understanding of patients’ motivations and beliefs is paramount to an optimal treatment alliance. Offering guided dose reduction may reduce sudden and unsupported discontinuation of antipsychotics.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141504726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review","authors":"Madison Jupina, Michelle Mercer, Jeremy Weleff, Loren Hackett, Julio C. Nunes, Dale Sebastian, Akhil Anand","doi":"10.1176/appi.ps.20230351","DOIUrl":"https://doi.org/10.1176/appi.ps.20230351","url":null,"abstract":"<h3>Objective:</h3><p>This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts.</p><h3>Methods:</h3><p>An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool.</p><h3>Results:</h3><p>Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±&lt;1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%–100% of professionals in these samples. Perceptions of support ranged widely, with 11%–87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%–82%), more suicide prevention or postvention training (4%–70%), debriefing or supervision (41%–75%), formal case review (18%–20%), time off (12%), and legal assistance (4%).</p><h3>Conclusions:</h3><p>HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs’ needs.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Can I Call You Back?”: A Medical Student’s Reflections on Research Recruitment in a Black Community","authors":"Christopher Ricard Lea","doi":"10.1176/appi.ps.20230372","DOIUrl":"https://doi.org/10.1176/appi.ps.20230372","url":null,"abstract":"<p>Historical mistreatment of Black persons in research settings has had lasting impacts on their recruitment into present-day studies. A medical student recruited Black individuals for a qualitative study aiming to improve the experiences of Black patients treated in a psychiatric emergency department of a large tertiary care setting. The lessons learned, including the nuanced power dynamics present when a Black student is recruiting Black patients, highlight opportunities for addressing racial inequities through empowerment of the Black community and for requiring investigators to create racially conscious recruitment plans.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-Affirming Psychotherapy (GAP): Core Principles and Skills to Reduce the Mental Health Care “GAP” for Transgender Youths","authors":"Maggi A. Price, Marina Rakhilin, Kara Johansen, Lisa Collins, John E. Pachankis, Aaron R. Lyon, Marissa Allen","doi":"10.1176/appi.ps.20230460","DOIUrl":"https://doi.org/10.1176/appi.ps.20230460","url":null,"abstract":"<h3>Objective:</h3><p>Transgender youths are more likely than cisgender youths to need mental health care because of their high exposure to discrimination and victimization, including within health care systems. Accordingly, transgender youths have low care satisfaction and high rates of treatment dropout, further exacerbating existing mental health inequities. To reduce these inequities, mental health providers need knowledge and skills to enhance transgender youths’ treatment engagement and benefits. However, a comprehensive set of practices addressing the needs of transgender youth patients and their providers does not exist. The authors developed gender-affirming psychotherapy (GAP), an evidence-informed set of skills and principles to augment mental health treatments for transgender youths.</p><h3>Methods:</h3><p>GAP was developed by using a human-centered design, a methodological approach for creating interventions that prioritize the needs of key stakeholders, which in this study included mental health providers and transgender youths and their parents (N=36). A scoping review of the literature and stakeholder focus groups were conducted to create GAP, which encompasses core principles and skills to enhance mental health services for transgender youths.</p><h3>Results:</h3><p>GAP encompasses 27 principles and 38 skills, organized within 10 domains. All principles and skills were designed to be relevant for various provider types (e.g., psychiatrists and social workers) and to be flexibly adapted to meet diverse patient needs.</p><h3>Conclusions:</h3><p>GAP offers a scalable and flexible approach to addressing the growing mental health care needs of transgender youths. The findings of this study suggest that a human-centered design is a feasible and efficient method for developing interventions to address health inequities.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141504728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}