Psychiatric research and clinical practice最新文献

{"title":"Scaling Up Task-Shared Depression Care in Texas: Evaluating the Preliminary Effectiveness and Acceptability of a Digital Program for Training Non-Specialist Providers.","authors":"Sarah Taha, Natali Carmio, Emma Hill, Kyle Floyd, Berta Rodriguez, Brittany Meredith, Rebecca Brune, Andrew Keller, Vikram Patel, Katherine Sanchez, John A Naslund","doi":"10.1176/appi.prcp.20240088","DOIUrl":"10.1176/appi.prcp.20240088","url":null,"abstract":"<p><strong>Objective: </strong>Digital technologies hold promise for building capacity of non-specialist providers to scale-up access to depression care. This study evaluated the preliminary effectiveness and acceptability of a digital program to train non-specialists in the delivery of an evidence-based behavioral activation (BA) intervention for depression.</p><p><strong>Methods: </strong>Non-specialist providers without prior mental health counseling experience employed within the Baylor Scott & White Health system in Texas were recruited to complete a two-course digital training, and knowledge assessments-at baseline and follow up-to determine preliminary effectiveness. Acceptability and feasability were assessed through focus groups.</p><p><strong>Results: </strong>Of 73 non-specialist providers enrolled in the program, 42 completed both courses. Intent-to-treat analysis showed pre-post improvement in knowledge assessment scores (mean difference = 5.4; 95% CI: 1.6, 9.2; <i>t</i>(53) = 2.87, <i>p</i> = 0.006). Subgroup analyses demonstrated that participants who fully completed the training had pre-post improvement in knowledge scores (mean difference = 6.8; 95% CI = 2.8, 10.8; <i>t</i>(39) = 3.46, <i>p</i> = 0.001), whereas those who did not start or who only partially completed the training did not show improved knowledge scores. Framework analysis of the focus groups revealed four themes: training program evaluation, participant feedback and improvements, communication strategies, and support and resources.</p><p><strong>Conclusions: </strong>This digital program shows potential for building skills and knowledge of non-specialist providers in delivering BA. Continued efforts are needed to support these providers in practice, and ensure quality through supervision.</p><p><strong>Relevance to clinical practice: </strong>The program offers a scalable solution to expanding the behavioral health workforce, representing an opportunity to overcome the significant mental health workforce shortages and ensuring access to quality mental health services.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"8 1","pages":"17-29"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the Non-Clinical Mental Health Workforce: Protocol for a Randomized Controlled Trial of a Psychological Intervention Delivered by Community-Based Organizations in New York City (RECOUP-NY).","authors":"Brandon A Kohrt, Manaswi Sangraula, Elizabeth L Turner, Kendall Pfeffer, Chynere Best, James Caracoglia, Alejandra Cid-Vega, Wilfred Gwaikolo, Caroline McEneaney, Alyssa Platt, Cheenar Shah, Shifeng Sun, Janus Wong, Kala Ganesh, Eliot Assoudeh, Eva Wong, Alastair van Heerden, Adam D Brown","doi":"10.1176/appi.prcp.20250027","DOIUrl":"10.1176/appi.prcp.20250027","url":null,"abstract":"<p><strong>Objective: </strong>In 2022, half a million residents of New York City reported being unable to access mental health services. One solution to combat this service gap is community-initiated care (CIC), in which staff, who are not mental health specialists, at community-based organizations (CBOs) identify clients experiencing distress and then deliver a brief psychological intervention. CIC is intended to reduce barriers to accessing care, lessen costs, and prevent stigma. In this protocol, we describe a trial designed to evaluate implementation of CIC in New York City using a psychological intervention that has been successful globally for rapid deployment by people who are not licensed mental health clinicians.</p><p><strong>Methods: </strong>This protocol describes a cluster randomized controlled trial that will compare CBOs where non-clinical staff are trained to deliver the World Health Organization's Problem Management Plus (PM+) intervention versus CBOs providing care as usual. Forty-two CBO sites, the unit of clustering, will be randomized 1:1 to either condition. Approximately 1000 CBO clients (26-28 per site) will be recruited. Approximately 45 CBO staff (2-3 per site) in the intervention arm will be trained to deliver PM+. The primary outcome is distress at 20 weeks post-baseline, assessed with a personalized measure of psychological distress (the Psychological Outcome Profiles Questionnaire). Cost-effectiveness will be evaluated. Ethical approval: August 3, 2022.</p><p><strong>Conclusions: </strong>The study described in this protocol will yield evidence on effectiveness of CIC delivered by non-clinical staff. Findings will help policymakers determine how to invest in and support non-clinicians in the United States and globally.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 3","pages":"200-212"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eleven-Month Arrest Outcomes Among Three Crisis Response Models in Michigan.","authors":"Leonard Swanson, Catherine Zettner, Amy Watson, Melanie Hinojosa, Juliette Roddy, Sheryl Kubiak","doi":"10.1176/appi.prcp.20240100","DOIUrl":"10.1176/appi.prcp.20240100","url":null,"abstract":"<p><strong>Objective: </strong>Mobile crisis and co-response models are increasingly popular mental health crisis response alternatives to law enforcement. In theory, crisis response models could increase behavioral health treatment connections and divert people with mental illnesses from jails. This exploratory study compares post-year arrests of individuals who received services from three crisis response models (co-response, mobile crisis, and office-based crisis) against individuals who received law enforcement-only responses in five communities.</p><p><strong>Methods: </strong>Medicaid billing data and clinician service records identified (<i>n</i> = 474) crisis service recipients of two co-response models, two mobile crisis models, and one office-based crisis model in Michigan. Researchers collected law enforcement reports (<i>n</i> = 690) of mental health crises in the respective jurisdictions. Michigan State Police data revealed subject-level pre- and post-year arrests. Inverse probability of treatment weighting accounted for differences between crisis response and law enforcement groups by age, sex, prior-year arrest, and jurisdiction. A weighted Poisson regression examined each crisis response model's impact on post-year arrest rate relative to law enforcement-only responses.</p><p><strong>Results: </strong>Bivariate analyses supported the inclusion of response types in a regression. All three crisis models showed fewer post-year arrests than their respective law enforcement-only comparisons, but only the mobile crisis response predicted a statistically significant reduced incidence rate of arrest (incidence rate ratio 0.548; <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>This study is the first to assess post-year arrest outcomes of mobile crisis teams and adds to the null arrest literature of co-response teams. Mobile crisis teams may divert future crisis service pathways away from 911, decreasing law enforcement involvement and arrest risk.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 3","pages":"182-190"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of a Lifestyle-Focused Approach on Cardiovascular Risk in Inpatients With Mental Illness: Analyzing Effectiveness and Fidelity in a Stepped Wedge Cluster Randomized Trial (MULTI+ Study V).","authors":"Natascha M den Bleijker, Myrthe M E van Schothorst, Johannes B Reitsma, Ingrid J M Hendriksen, Wiepke Cahn, Jeroen Deenik","doi":"10.1176/appi.prcp.20240150","DOIUrl":"10.1176/appi.prcp.20240150","url":null,"abstract":"<p><strong>Objective: </strong>People with mental illness have worse health outcomes and up to 20 years shorter life expectancy than the general population. Lifestyle interventions are promising to improve their physical and mental health but implementing these in real-world practice remains challenging. This study evaluated the impact of a multidisciplinary lifestyle-focused approach (MULTI+) on cardiovascular risk among inpatients with mental illness.</p><p><strong>Methods: </strong>In an open-cohort stepped wedge cluster randomized controlled trial, we compared changes in estimated 10-year risk of a cardiovascular event (QRISK3) between MULTI+ and care as usual (CAU) across inpatient wards at GGz Centraal (the Netherlands). Using linear mixed models, we assessed intervention effectiveness and explored whether implementation fidelity influenced outcomes.</p><p><strong>Results: </strong>We included 3603 individuals, with an unadjusted mean QRISK3 score of 15.1% in CAU and 15.4% in MULTI+. After adjusting for confounders, there was a small but statistically significant increase in the logit-transformed QRISK3 score in MULTI+ (OR = 1.1; 95% CI: [1.05-1.17], <i>p</i> < 0.001). Exploratory analyses suggested no association between implementation fidelity and cardiovascular risk.</p><p><strong>Conclusions: </strong>In this large-scale study, we observed no improvements-and even slight deterioration-in cardiovascular risk among people receiving MULTI+ compared to CAU. Challenges in implementation likely contributed to these outcomes. More intensive, tailored, and sustained implementation efforts, alongside broader systemic and societal support, may be required to reduce cardiovascular risk in this population.</p><p><strong>Relevance to clinical practice: </strong>The large-scale real-world setting provides valuable insights into MULTI+'s effectiveness, highlighting challenges in improving cardiovascular risk and the need for sustained efforts for successful integration.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 3","pages":"191-199"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Social Functioning Outcomes of Assisted Outpatient Treatment: Results From a Multisite Evaluation.","authors":"Kiersten L Johnson, William J Parish, Elysha Theis, Richard A Van Dorn, Lisa Callahan, Jeffrey W Swanson, Marvin S Swartz","doi":"10.1176/appi.prcp.20240162","DOIUrl":"10.1176/appi.prcp.20240162","url":null,"abstract":"<p><strong>Objective: </strong>This study used data from a multi-site evaluation of six assisted outpatient treatment (AOT) programs to assess the effectiveness of AOT on treatment adherence, clinical functioning, and social functioning outcomes.</p><p><strong>Methods: </strong>Sites provided primary data (e.g., structured client interviews across multiple timepoints) and subsets of secondary data on Medicaid/non-Medicaid service encounters, local/state arrest records, and public/private hospitalizations. One of the six sites provided primary data for a comparison population. Pre-post analyses pooled data across each of the six AOT sites and incorporated robustness checks using comparison and secondary data.</p><p><strong>Results: </strong>Among 392 AOT clients, appointment and treatment adherence increased by more than 24% and 20%, respectively, in 6- and 12-month follow-up windows relative to baseline. Symptomology, perceived mental health ratings, life satisfaction, and therapeutic alliance scores all improved significantly. Violent behavior was reduced by more than 19%, and suicidal ideation decreased by more than 24%. There was more than a 40% reduction in the percentage of clients with any psychiatric inpatient episodes, and more than an 8-night reduction in the number of nights spent in psychiatric inpatient care. The proportion of clients with arrests decreased by more than 19%, those with any illicit drug use decreased by more than 14%, and in the 6 months following entry into AOT, there was a 12% reduction in the proportion of clients experiencing any homelessness.</p><p><strong>Conclusions: </strong>Findings point to significant improvements across a range of client outcomes upon receipt of AOT, spanning domains of treatment adherence, clinical functioning, and social functioning outcomes.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 3","pages":"174-181"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Psychiatry Patient Reported Outcomes: Adolescent Emotional Distress, Suicidal Thoughts and Behaviors.","authors":"Patricia Ibeziako, Katy Kaufman, Annmarie Caracansi, Yohanis Anglero-Diaz, Ethan Anglemyer, Sherry Paden, Billy Zou, Emily Campbell, Carl Waitz","doi":"10.1176/appi.prcp.20240127","DOIUrl":"10.1176/appi.prcp.20240127","url":null,"abstract":"<p><strong>Objective: </strong>The youth mental health crisis, exacerbated by the COVID-19 pandemic, has increased the demand for pediatric inpatient psychiatry units (IPUs) in the United States despite critical bed shortages, yet they remain an understudied treatment model. This study examines patient-reported outcomes (PROs) of clinical symptoms and functioning for adolescents treated on a pediatric IPU from September 1, 2021 to September 1, 2023.</p><p><strong>Methods: </strong>Retrospective reviews of 218 adolescent admissions (12-17 years) were conducted. Adolescents completed PROs upon admission and discharge measuring depression, suicidal thoughts and behaviors (STBs), anxiety, emotion dysregulation, family functioning, and quality of life. Paired <i>t</i>-tests on admission and discharge scores were used to determine treatment effects.</p><p><strong>Results: </strong>Most adolescents (93%) had depressive disorders; 76% reported a lifetime history of suicide attempts, and 68% endorsed suicidal ideation within the past 2 weeks on admission PROs. Discharge PRO scores revealed improvements in depression, STBs, anxiety, emotional regulation, family functioning and quality of life from admission to discharge (<i>p</i> < 0.01 for all measures). Effect size was large for depression (<i>d</i> = 1.00) with improvement on all depression subscales (all <i>p</i> < 0.01), and robust effect sizes related to mood (<i>d</i> = 0.724) and suicidal ideation (<i>d</i> = 0.682) symptoms.</p><p><strong>Conclusions: </strong>Pediatric IPU is a vital and effective treatment model whose importance in delivering life-saving care suggests further resources-including increased research and improved access to care-are warranted.</p><p><strong>Relevance to clinical practice: </strong>These findings support the use of IPU care for adolescents experiencing severe mental health crises, particularly depression and STBs.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 3","pages":"165-173"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Relationship Between Narcissism and Maladaptive Daydreaming? The Role of Defense Mechanisms as Mediators.","authors":"Alessia Renzi, Rachele Mariani","doi":"10.1176/appi.prcp.20250018","DOIUrl":"10.1176/appi.prcp.20250018","url":null,"abstract":"<p><strong>Objective: </strong>Maladaptive daydreaming (MD) is a recently defined clinical condition characterized by an excessively immersive use of fantasy and imagination, which can significantly impact both professional and social life. The primary aim of this study is to examine potential associations between MD levels, narcissistic personality traits, and defense mechanisms. Additionally, the study aims to test mediation models to explore the direct and indirect roles of narcissism on MD levels through defense mechanisms.</p><p><strong>Methods: </strong>A total of 562 participants (mean age = 27.16 years; SD = 10.21; 68% female) completed an online survey comprising a socio-demographic questionnaire, the Maladaptive Daydreaming Scale (MDS), the Pathological Narcissism Inventory (PNI), and the Defense Mechanisms Rating Scales-Self Report-30 item (DMRS-SR-30).</p><p><strong>Results: </strong>The MDS score was positively related to the PNI total and subscales. Moreover, there were negative associations with mature defenses, and a positive association with neurotic and immature defenses. Age showed a weak negative association with MDS. A direct effect of narcissism on MD levels and an indirect impact through immature and neurotic defense and direct trough mature defenses, emerged.</p><p><strong>Conclusions: </strong>The significant associations found in this study support a link between narcissistic personality traits and MD, where defenses seem to play a relevant role.</p><p><strong>Relevance to clinical practice: </strong>These findings underscore the potential benefits of treatments and clinical interventions aimed at fostering mature defense mechanisms. Such approaches can be particularly valuable for young adults in managing psychological distress linked to narcissistic vulnerability, which directly contributes to maladaptive fantasies and social withdrawal.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 3","pages":"156-164"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic and Environmental Epidemiology of Autism Spectrum Disorder: A Critical Gap of Interest in Global Psychiatry.","authors":"Mónica Acuña-Rodríguez, Ornella Fiorillo-Moreno, Patricia Delgado","doi":"10.1176/appi.prcp.20250030","DOIUrl":"10.1176/appi.prcp.20250030","url":null,"abstract":"<p><p>Recently, the lack of evidence regarding primary data on the epidemiology of autism spectrum disorder (ASD) in Brazil has been highlighted. The discussion underscores the concerning rise in autism diagnoses over recent decades, based on data from the United Kingdom. Although various factors have been proposed to explain this phenomenon, much of the available information remains inconclusive and restricted to specific geographic regions. This raises concerns about the validity of published findings, given the reported influence of genetic and environmental factors, both of which are key risk determinants for ASD and vary across regions and populations.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 2","pages":"91-93"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major Depressive Disorder in Long COVID and Exposure to Pro-Inflammatory Cytokines During Infection by SARS-CoV-2.","authors":"Hernan F Guillen-Burgos, Juan F Gálvez-Flórez, Sergio Moreno-López, Sabrina Wong, Angela T H Kwan, Mariana Ramirez-Posada, Juan-Manuel Anaya, Roger S McIntyre","doi":"10.1176/appi.prcp.20240112","DOIUrl":"10.1176/appi.prcp.20240112","url":null,"abstract":"<p><strong>Objective: </strong>Major Depressive Disorder (MDD) is common in long COVID syndrome; however, the neurobiological mechanisms are unclear. An immune activation response has been associated with COVID-19 severity as well as in MDD. We hypothesize that high levels of pro-inflammatory cytokines during SARS-CoV-2 infection may be associated with new-onset MDD and severe outcomes such as treatment-resistant depression (TRD) and risk of suicide ideation and behavior (SI/SB).</p><p><strong>Methods: </strong>A case-control nested to a cohort study was carried out on a total of 678 COVID-19 survivors (MDD = 184 vs. non-MDD = 494). A pro-inflammatory panel of serum levels of cytokines (IL-1β, IL-4, IL-6, IL-8, IL-13, IL-17α, TNF-α) was evaluated during COVID-19 hospitalization and severe outcomes such as TRD and SI/SB were assessed in individuals with new onset of MDD after hospital discharge compared to non-MDD COVID-19 survivors.</p><p><strong>Results: </strong>High levels of pro-inflammatory cytokines during SARS-CoV-2 infection were identified in MDD participants compared to non-MDD subgroups during long COVID. These differences were sustained also for TRD and SI/SB severity outcomes. There is a mild association of high levels of pro-inflammatory cytokines and MDD, TRD, and SI/SB.</p><p><strong>Conclusion: </strong>High levels of pro-inflammatory cytokines during severe or critical COVID-19 exposure may explain long COVID associated MDD and thus severe outcomes such as TRD and SI/SB.</p><p><strong>Relevance to clinical practice: </strong>Identifying elevated pro-inflammatory cytokines during COVID-19 as a risk factor for MDD and severe outcomes underscores the need for early screening and targeted treatments in long COVID. Monitoring cytokine levels may help clinicians predict and manage TRD and SI/SB in this population, improving long-term psychiatric outcomes.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 2","pages":"139-149"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of the Psychiatrist.","authors":"James B Potash, Alex McClanahan, Jay Davidson, William Butler, Nathan Carroll, Anne Ruble, Mary Yaden, Darlene King, John Torous, Peter P Zandi, Katherine G Kennedy, Thomas E Smith, Arpan Waghray, Robert Trestman, Marketa Wills","doi":"10.1176/appi.prcp.20240130","DOIUrl":"10.1176/appi.prcp.20240130","url":null,"abstract":"<p><strong>Objective: </strong>The American Psychiatric Association (APA) issued a 2023 report on the future of psychiatry, focusing on how the organization should position itself in relation to coming developments over the next 10 years. Here, we follow up with a discussion of how the psychiatrist's role needs to evolve to adapt to the changes ahead.</p><p><strong>Methods: </strong>We drew on senior experts and junior trainees within the APA's Council on Healthcare Systems and Financing, along with additional content experts, to choose areas of focus and discuss their interrelationships. Literature review focused on publications with implications of these areas for future training and practice.</p><p><strong>Results: </strong>We are only ∼5% of the mental health work force, and we have unique strengths, including training providing us the ability to discern the varied factors contributing to distress, and direct and apply interventions across all available modalities. Psychiatrists make best use of our capabilities when we lead the process of comprehensively formulating patients' problems and generating a multi-faceted treatment approach. We have chosen six areas where we envision new developments impacting how psychiatrists will practice and residents should train: digital data and precision medicine, measurement-based care, artificial intelligence (AI), psychotherapy, integrated care, and care for the seriously mentally ill. We provide suggestions regarding next steps that will allow us to make the best use of our training and expand access to high quality diagnosis and care.</p><p><strong>Conclusions and relevance to clinical practice: </strong>We will need to handle the most challenging cases: the most psychiatrically complex, medically complex, and treatment-resistant. We must preserve our skill, unique among physicians, in psychotherapeutic approaches, even as we manage psychiatric illness. We must also adapt and become more tech-savvy, as digital data, mobile and computer-based treatments, electronic medical records, and AI algorithms take on increasing prominence in our field.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":"7 2","pages":"80-90"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}