Narcolepsy Masquerading as Depression: An Often-missed Diagnosis in Psychiatric Practice

Barriers and facilitators to integrating academic nursing roles into psychiatric practice: Partial results of the AkaPP study

This study examined diagnoses of patients treated by psychiatrists in private practice in Denmark and identified predictors of dropout. Between 1996 and 2006, a total of 37 psychiatrists contributed data about treatment episodes to a quality assurance database. The diagnostic distribution was determined, and univariate and backward stepwise regression analysis was used to identify dropout predictors. Among 41,462 episodes (35,205 patients), 39%-41% were for an ICD-10 diagnosis of affective disorders, 30%-35% for nervous and stress-related disorders, and 10% for personality disorders. For episodes involving these diagnoses, 26,443 were terminated; 26.2% ended in dropout, which was predicted by the patient's being male, younger age (< or =44 years), presence of personality disorder, shorter treatment duration (< or =111 days), use of psychotropic medication, and a larger population per psychiatrist in the catchment area. Attention should be given to younger male patients treated for personality disorders, because they are at higher risk of treatment dropout.

Udgivelsesdato: 2009-Dec

The study was designed to identify to attitude of nursing students to psychiatric nursing practice through Q-methodology. A sample was development through a review literature, indepth interviews and open questionnaire. Thirty four statements made up the finalized Q-sample. The P sample consisted of 40 nursing students in J College. Q statements were written separate cards and were given to the 34 subjects sort acc이'ding to degree of agreement and disagreement. The Q-sort by each subject were coded and analyzed with QUANL PC program. The analysis discovered five major attitudes, "type 1 - passive demand", "type 2-development-oriented', "type 3- respect for humanity", ’type 4: positive acceptance', "type 5: realistic flexibility".The results revealed five different types psychiatric nursing practice attitude:1. Passive demand type: Non-educational practical setting and knowledge deficit would negatively affect on experience of clinical practice. They presented anxiety and worry through psychiatric practice.2. Developmental-oriented type: Knowledge deficit would negatively affect on experience of clinical practice. But the desirable role model would formulate a positive nursing view.3. Respect for humanity type- They could accept the psychiatric patients as the person and they respect intimacy, identifying, the sense of value with patient.4. Positive acceptance type: The knowledge of clinical practice and understanding about clinical setting would positively affect on experience of clinical practice 5. Realistic flexibility type: They were not satisfied with their nursing practice but were responsible for nursing and studied hard.In conclusion, the researchers suggest that the education program would be more effective if it was planned considering to each types of experience of nursing students for psychiatric nursing practice.

Coronavirus and Its Implications for Psychiatry: A Rapid Review of the Early Literature

Structural racism has received renewed focus over the past year, fueled by the convergence of major political and social events. Psychiatry as a field has been forced to confront a legacy of systemic inequities. Here, we use examples from our clinical and supervisory work to highlight the urgent need to integrate techniques addressing racial identity and racism into psychiatric practice and teaching. This urgency is underlined by extensive evidence of psychiatry's long-standing systemic inequities. We argue that our field suffers not from a lack of available techniques, but rather a lack of sustained commitment to understand and integrate those techniques into our work; indeed, there are multiple published examples of strategies to address racism and racial identity in psychiatric clinical practice. We conclude with recommendations geared toward more firmly institutionalizing a focus on racism and racial identity in psychiatry, and suggest applications of existing techniques to our initial clinical examples.

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Mental health clinicians should appreciate that sleep is a fundamental human behavior and that inadequate sleep has adverse medical, psychiatric, and psychosocial consequences. Sleep disturbances interact with common mental disorders; the two are mutually exacerbating, and both must be appropriately addressed to ensure optimal outcomes for our patients. Sleep is by the brain, of the brain, and for the brain.

Introduction. Elevated serum CK levels often occur in psychiatric in-patient practice. Although the majority of cases are benign and temporary, it is important to recognize and treat these conditions. Aims. To discuss the etiology, the clinical significance and the management of elevated creatine kinase levels in psychiatric in-patient practice, focusing on antipsychotic-induced rhabdomyolysis. To compare the pathogenesis and the clinical features of rhabdomyolysis and neuroleptic malignant syndrome. Methods. Review of the literature. Results. A brief, practical guideline is introduced, which may help clinicians in the differential diagnosis and in the management of patients with elevated creatine kinase activity in emergent psychiatric practice. Conclusions. The most common etiologic factors (prescription drugs, alcohol, physical reasons, cardiac etiology) and clinical syndromes (rhabdomyolysis, neuroleptic malignant syndrome, acute coronary syndrome) should be considered, when elevated creatine kinase levels are encountered in psychiatric in-patients. Routine creatine kinase measurements in asymptomatic patients on antipsychotic medications are not recommended, but patients should be carefully followed for the development of rhabdomyolysis, when muscular symptoms arise. Careful monitoring of symptoms and potential complications is critical in order to avoid devastating clinical consequences. Cautiously challenging patients with another antipsychotic after an antipsychotic-induced rhabdomyolysis is recommended to decrease the possibility of recurrence.

Integrating positive and negative models of suffering: a proposal for a unified approach in psychiatric practice I was prompted by the recent publication in the BJPsych Bulletin by Huda, 'Positive models of suffering and psychiatry', 1 to express my views regarding the juxtaposition of negative and positive models of suffering within psychiatric practice. Although Huda provides a nuanced discussion on the traditional approach to alleviating suffering versus a perspective that sees potential value in suffering, the delineation offers a critical reflection yet also suggests a potential area of confusion for both practitioners and patients. The discourse sets a foundational understanding that whereas the alleviation of suffering is a cornerstone of medical practice, as echoed in the ethos of clinical epidemiology, 2 there exists a parallel narrative that suffering may serve as a conduit for personal growth and enlightenment, aligning with broader existential and psychological theories. 3, 4 This dichotomy, although enriching, may inadvertently complicate the therapeutic landscape, suggesting a necessity for a more integrated approach that harmonises these models to enhance patient care. Accordingly, I propose the consideration and development of a unified model that assimilates the ethical imperative to mitigate suffering with a recognition of the transformative potential inherent in the experience of suffering. This model would aim to: (a) prioritise the immediate and compassionate alleviation of suffering as a primary objective of psychiatric intervention, in line with traditional medical practice; 2 (b) acknowledge the potential for suffering to catalyse personal growth, transformation and the acquisition of new perspectives, as detailed in the literature on post-traumatic growth; 3 (c) empower patients by involving them in treatment decisions, echoing the principles of narrative medicine and patient-centred care; 5 (d) foster treatment flexibility, recognising the individual's unique experience of suffering and the dynamic nature of their needs and potential for growth. 4 Such a unified model proposes a more holistic and nuanced approach to psychiatric care, one that not only seeks to alleviate pain but also respects the complex, multifaceted nature of human suffering. The implementation of this model would necessitate a shift towards a more integrative psychiatric education and practice, one that values the depth of human experience as much as the alleviation of symptoms. The dialogue initiated by Huda is invaluable, and it is within this context that I propose a further exploration of how we, as a psychiatric community, can better integrate these models to serve our patients. This endeavour would not only clarify our therapeutic objectives but also potentially enrich psychiatric practice with a deeper understanding and respect for the intricacies of the human condition.

Objectives This study is to understand in-depth the nature of these experiences by confirming and describing the semantic structure of nursing students' introspection experiences. Methods This study is a qualitative study to reveal the subjective meaning of perceived and experienced contents in the psychiatric ward practice of nursing students using the Interpretive Phenomenological Analysis(IPA) re-search method. The subjects of this study were 10 third-year nursing students who experienced the practice of psychiatric wards at one university in Gyeongsangbuk-do. The data were collected from July 20 to September 20, 2019. Data were analyzed using IPA. Results As for the research results, 10 sub-themes and three sub-themes were derived. The first upper theme was ‘A wall of prejudice against psychiatry’, which was different from the existing practice, had prejudice against psychiatric patients, and even had distrust of oneself. The second upper theme is ‘Experience of criticism and un-derstanding’. The study participants experienced various and complex changes of emotions and thoughts while facing psychiatric patients for the first time, and named them ‘observation and understanding of patients’. The third upper theme is ‘Growth through psychiatric practice’. Participants in the study reported that they felt different through the process of self-reflection and that their relationship with patients changed positively. Conclusions The result suggests that, the essence of nursing college students' self-reflection experience not only helps students grow positively, but also provides the basis for the development of the curriculum for more sub-stantial practical education by presenting educational goals of psychiatric nursing. Therefore, efforts should be made to develop educational and program data that can promote self-reflection of nursing students based on the research results.

Background: Knowledge-based practice integrates the three aspects research-based, experience-based and user-based knowledge. The aim of the study was to investigate how nursing students reflect these three aspects in their reflection notes when students were in their psychiatric clinical practice. Methods: During psychiatric practice, 13 nursing students wrote 110 reflection notes. The notes were analyzed using direct content analysis. Results: The notes were found to contain 1,643 knowledge-based statements. The statements were mostly experience-based (n = 835), followed by research-based (n = 518) and user-based (n = 290). The experience-based statements mirrored students’ encounters with patients and students interpretations to their experiences. Students references in reflection notes were cited from textbooks and with at least use of one research article. The references mirrored use of research-based knowledge. The user-knowledge was inconspicuous in the students- reflection notes in the beginning of their clinical practice but after a week in the clinic their reflection notes contained user-based statements. These mirrored patients statements as students expressed them and students perceptions about patients perspective. Conclusions: The students reflect within all the three areas, but the use of research-based knowledge should be improved.

Integrating positive and negative models of suffering: a proposal for a unified approach in psychiatric practice I was prompted by the recent publication in the BJPsych Bulletin by Huda, 'Positive models of suffering and psychiatry', 1 to express my views regarding the juxtaposition of negative and positive models of suffering within psychiatric practice. Although Huda provides a nuanced discussion on the traditional approach to alleviating suffering versus a perspective that sees potential value in suffering, the delineation offers a critical reflection yet also suggests a potential area of confusion for both practitioners and patients. The discourse sets a foundational understanding that whereas the alleviation of suffering is a cornerstone of medical practice, as echoed in the ethos of clinical epidemiology, 2 there exists a parallel narrative that suffering may serve as a conduit for personal growth and enlightenment, aligning with broader existential and psychological theories. 3, 4 This dichotomy, although enriching, may inadvertently complicate the therapeutic landscape, suggesting a necessity for a more integrated approach that harmonises these models to enhance patient care. Accordingly, I propose the consideration and development of a unified model that assimilates the ethical imperative to mitigate suffering with a recognition of the transformative potential inherent in the experience of suffering. This model would aim to: (a) prioritise the immediate and compassionate alleviation of suffering as a primary objective of psychiatric intervention, in line with traditional medical practice; 2 (b) acknowledge the potential for suffering to catalyse personal growth, transformation and the acquisition of new perspectives, as detailed in the literature on post-traumatic growth; 3 (c) empower patients by involving them in treatment decisions, echoing the principles of narrative medicine and patient-centred care; 5 (d) foster treatment flexibility, recognising the individual's unique experience of suffering and the dynamic nature of their needs and potential for growth. 4 Such a unified model proposes a more holistic and nuanced approach to psychiatric care, one that not only seeks to alleviate pain but also respects the complex, multifaceted nature of human suffering. The implementation of this model would necessitate a shift towards a more integrative psychiatric education and practice, one that values the depth of human experience as much as the alleviation of symptoms. The dialogue initiated by Huda is invaluable, and it is within this context that I propose a further exploration of how we, as a psychiatric community, can better integrate these models to serve our patients. This endeavour would not only clarify our therapeutic objectives but also potentially enrich psychiatric practice with a deeper understanding and respect for the intricacies of the human condition.

BackgroundSchizophrenia spectrum disorders (SSD) are severe, persistent mental illnesses resulting in considerable disability and premature mortality. Emerging evidence suggests that diet may be a modifiable risk factor in mental illness; however, use of nutritional counselling as a component of psychiatric clinical practice is limited. The objective of this project is the design and evaluate a worksheet and clinician guide for use in facilitating nutritional counseling in the context of existing mental health care.MethodsThe worksheet and clinician guide were developed based on the results of a recent scoping review on the relationship between diet and mental health symptoms among individuals with SSD. A feedback process involved a focus group with psychiatrists and interviews with individuals with lived experience with psychosis. Participants were asked a series of structured and open-ended questions. Interviews were transcribed and data units were allocated to categories from an existing framework. The comments were used to guide modifications to the worksheet and clinician guide. A brief interview with all participants was completed to gather feedback on the final version.ResultsFive psychiatrist participants and six participants with lived experience completed interviews. Participants provided positive comments related to the worksheet design, complexity and inclusion of interactive components. A novel theme emerged relating to the lack of nutritional counselling in psychiatric training and clinical practice. Many constructive comments were provided which resulted in meaningful revisions and improvements to the worksheet and clinician guide design and content. All participants were satisfied with the final versions.ConclusionsA worksheet and clinician guide designed to facilitate nutritional counselling with individuals with SSD was found to be acceptable to all participants following a process of feedback and revision. Further research and dissemination efforts aimed at increasing the use of nutritional counselling in psychiatric practice are warranted.

Sudden unexpected death in Epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy (PWE). Awareness and taking adequate preventive measures are pivotal to reducing SUDEP. Nearly 80% of PWE live in lower-middle-income countries (LMICs) such as India where for many, epilepsy management is by psychiatrists.To evaluate the knowledge, attitude and practices of Indian psychiatrists on SUDEP and seizure risk.A cross-sectional online survey of 12 Likert response questions using validated themes, was circulated among Indian Psychiatric Society members. Non-discriminatory exponential snowballing technique leading to convenience non-probability sampling was used. The inquiry involved SUDEP-related topics including the need for and importance of counselling. Descriptive statistics and the chi-square test were used for analysis.The psychiatrists responding (n = 134) were likely to be males (72.4 %), urban (94 %) and affiliated to academic institutions (76.1 %). Nearly all saw PWE monthly with over half (54 %) seeing more than 10. Nearly two-third (64.17 %) did not counsel PWE regarding SUDEP, due to fear of raising concerns in caregivers/family (33.3 %), patients (38.9 %) or lack of time (35.6 %), though 37 % had lost patients due to SUDEP. Over two-third (66.7 %) agreed risk counselling was important. Barriers included fear of raising concerns, limited time, and training. A strong need for national SUDEP guidelines (89 %) and suitable training (75.4 %) was expressed.Though epilepsy care is provided by a considerable number of psychiatrists, there is a poor understanding of SUDEP. Enhancing the awareness and understanding of SUDEP is likely to enhance epilepsy care.