Academic Psychiatrist Research Articles

Cultivating Common Ground: The Intersection of Mental Health and Faith.

During and following the COVID-19 pandemic, the world experienced a significant increase in the prevalence of mental health problems along with a concomitant increase in mental health service utilization rates. Even though the stigma associated with mental health problems has been decreasing and service utilization rates have increased, these have not been seen in all segments of the population; for instance, some religious beliefs have been associated with less frequent and lower rates of mental health service use. In this commentary, the authors, an academic psychiatrist and a community-based pastor, describe how their informal academic-community collaboration led to a series of speaking opportunities to help an international group of clergy members develop a better understanding of mental health and how mental health problems may intersect with faith. They reflect on lessons learned from these opportunities and their professions, discuss opportunities for academic faculty to apply these lessons in their daily practices, and encourage academic faculty to consider a "common ground" approach in their own community outreach efforts. The authors underscore the importance of building connections with people who might have beliefs, views, or understandings of medical concepts that differ from academic medicine's and of teaching trainees how to build these connections. They challenge individual clinicians and academic faculty to identify spheres of influence that they have in their own lives through which they can create a positive impact for medicine and public health by finding shared experiences and common ground, clarifying misunderstandings, educating where needed, and serving as role models to encourage trainees to do the same.

Fifty Years of Change: A Shared Journey.

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.

Trainees' Perspectives on Components of Sickle Cell Specific Education

Background Sickle cell disease (SCD) is at the intersection of social, racial, and healthcare equity in the US. It is a socially and medically complex disease associated with increased morbidity and mortality when compared to age, race, and sex matched persons without SCD. Despite a historically high prevalence, it has not been a priority in healthcare, which contributes to healthcare inequities in this population. Patients and clinicians consistently identify lack of clinician knowledge about SCD as a barrier to quality care. Providers describe discomfort managing patients and have a poor understanding of its complications. The number of physicians trained and available to treat adults with SCD is insufficient to meet population needs. With most hematology/oncology trained physicians choosing careers in oncology, the pool of practitioners with expertise in SCD is shrinking. This underscores the time-sensitive need for building an effective, sustainable, and patient-centered sickle cell educational curriculum early in training. At present, there is no widely used resource for SCD-specific education, and little research has been published describing physician education for this complex disease. This qualitative study is the first part of a two-part study which aims to serve as a needs assessment to understand the SCD specific educational demands of trainees and set the stage for survey development for wider distribution. Methods Residents applying for hematology/oncology fellowship and current fellows were recruited to participate in focus groups to explore trainees' preferences and attitudes for education on the management of patients with SCD. Trainees were recruited via email from seven academic institutions in the US from regions with a high prevalence of SCD. A focus group guide was developed inquiring about trainee perspectives on facilitators and barriers to obtaining sickle cell specific education. Using an inductive and iterative thematic analysis coding approach, all focus group transcripts were coded by an academic hematologist specializing in SCD (LV) and an academic psychiatrist specializing in SCD (EP). Codes were categorized and themes and subthemes developed. Results Four focus groups were conducted with a total of 15 participants (2 PGY 3 residents, and 13 hematology/oncology fellows PGY 4-6). Three themes were identified (Table): 1. Discomfort caring for patients with SCD. Trainees experienced feelings of fear, frustration, and powerlessness when caring for patients with SCD. 2. Challenges managing SCD. Trainees described the complexity of SCD management, limited treatment options and evidence-based practice, and navigating bias in healthcare as contributing to the challenge of treating patients with SCD. 3. Desire for SCD specific education during fellowship.Trainees noted ideal components of education should include exposure to patients longitudinally and in multiple settings, access to SCD expertise in the form of experts and expert guidelines, and SCD specific didactic content. Conclusions This study examined the experience of trainees with regards to SCD education and clinical care. Participants described how a lack of SCD specific education reinforced a cycle of discomfort and difficulty caring for patients with SCD (Figure). Lack of exposure to patients and access to experts impedes developing a sense of mastery in treating SCD. SCD education was underemphasized even at institutions with a high prevalence of SCD and a SCD program. Evidenced-based guidelines based on low evidence hinders self-directed learning. Overall, SCD specific education is under-emphasized in fellowship. Trainees who felt the most comfortable had a SCD specific curriculum integrated throughout the fellowship experience. A SCD specific curriculum in the form of case-based didactics and a SCD rotation, where feasible, should be built into hematology/oncology fellowship training to increase trainees' knowledge, comfort and therefore desire in caring for patients with SCD. This qualitative research study is the first of its kind and serves to set the stage for survey development to capture a larger needs assessment of the SCD specific educational demands of hematology/oncology fellows. Optimizing the care of persons with SCD requires a competent and confident workforce. This study provides key insights into the development of infrastructure to support such training.

Recovery 101: A Community Psychoeducation Program on Mental Health Recovery and Peer Support Services Created by an Academic Psychiatrist and Delivered by Peers.

Despite the ongoing growing interest and established benefits of mental health recovery and peer support services, little is known about the effects of mental health recovery and peer support services specifically in community education programs. Seeking to further expand this scope, this article details the development, implementation, and evaluation of a recovery and peer services community psychoeducation program created by an academic psychiatrist and delivered by trained mental health peers. A community psychoeducation intervention on recovery and peer services was provided in 2 different series: 5-session and 1-session series. Participants in the intervention were recruited from 2 local nonprofit recovery-oriented organizations and a public mental health service agency. Surveys were administered before and after each presentation session and analyzed both quantitatively and qualitatively. Quantitative survey items covering knowledge, awareness, interest, and likelihood of involvement in peer services for recovery all showed statistically significant gains from before to after the sessions. The qualitative data provided information about the participants' interests in the program in terms of knowledge of recovery, self-improvement, advocacy, resources, support, and nonspecific positive comments. An essential contribution of the program was to introduce participants to recovery and peer services. It also provided them with foundational knowledge that placed participants in a position to begin to practice the concepts of recovery. According to the participants' comments in the surveys, the program imbued a sense of hope and motivation; support and fellowship; and, importantly, role modeling and wisdom from the presenters.

Completing the RANZCP scholarly project in a rural/regional setting: a practical example.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) scholarly project (SP) is a major hurdle for trainees completing psychiatric training - intensified for those working in rural settings. Whilst strategies to overcome this challenge have been proposed, there are few examples of how these have been successfully implemented. This report will describe the completion of a RANZCP SP in a regional setting, with supervision and support provided by an academic psychiatrist working within a metropolitan research centre. Trainees in remote geographical locations can utilise expert supervision from academic psychiatrists to successfully complete the SP. Key components are support from both the trainee and supervisor's employers, utilisation of a range of supervision modalities and a clear pragmatic memorandum of understanding between the supervisor and trainee. This initiative had widespread benefits beyond completion of the SP for all parties involved.

The masks of Lorenzo Tenchini: their anatomy and surgical/bioengineering clues.

An academic, anatomist, and Lombrosian psychiatrist active at the University of Parma in Italy at the end of the 19th century, Lorenzo Tenchini produced ceroplastic-like masks that are unique in the anatomical Western context. These were prepared from 1885 to 1893 with the aim of 'cataloguing' the behaviour of prison inmates and psychiatric patients based on their facial surface anatomy. Due to the lack of any reference to the procedure used to prepare the masks, studies were undertaken by our group using X-ray scans, infrared spectroscopy, bioptic sampling, and microscopy analysis of the mask constituents. Results showed that the masks were stratified structures including plaster, cotton gauze/human epidermis, and wax, leading to a fabrication procedure reminiscent of 'additive layer manufacturing'. Differences in the depths of these layers were observed in relation to the facial contours, suggesting an attempt to reproduce, at least partially, the three-dimensional features of the facial soft tissues. We conclude the Tenchini masks are the first historical antecedent of the experimental method for face reconstruction used in the early 2000s to test the feasibility of transferring a complete strip of face and scalp from a deceased donor to a living recipient, in preparation for a complete face transplant. In addition, the layering procedure adopted conceptually mimics that developed only in the late 20th century for computer-aided rapid prototyping, and recently applied to bioengineering with biomaterials for a number of human structures including parts of the skull and face. Finally, the masks are a relevant example of mixed ceroplastic-cutaneous preparations in the history of anatomical research for clinical purposes.

A Dark Spot on a White Canvas: Thoughts on Being a Black Academic Psychiatrist.

A Dark Spot on a White Canvas: Thoughts on Being a Black Academic Psychiatrist.

Psychiatry: My Answer to Reincarnation

Psychiatry: My Answer to Reincarnation

Evidence-Based Practice in the Evaluation and Treatment of Sexual Offenders

This editorial addresses evidence based medical practice in forensic psychiatry and particularly in the field of paraphilia. John M. Bradford is a Professor in the Department of Psychiatry and Behavioural Neurosciences, McMaster University. He is an Emeritus Professor at the University of Ottawa where he was a founder of the Royal Ottawa Institute of Mental Health Research. He is a Founder of Forensic Psychiatry, granted by the Royal College of Physicians and Surgeons of Canada. Abdullah H Alqahtani is an Assistant Professor and Consultant Psychiatrist at King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. He is currently completing a clinical fellowship in forensic psychiatry at McMaster University - St. Joseph’s Healthcare Hamilton. Andrew T. Olagunju is an academic psychiatrist with a Senior Lecturer position at the College of Medicine, University of Lagos, Nigeria. He is also completing a clinical fellowship at McMaster University - St. Joseph’s Healthcare Hamilton.

Antonio Vallejo-Nágera (1889-1960) and Juan Antonio Vallejo-Nágera Botas (1926-1990).

Antonio Vallejo-Nágera (1889-1960) and Juan Antonio Vallejo-Nágera Botas (1926-1990).

Women in Academic Psychiatry: A Mind to Succeed Edited by Sophia Frangou Springer 2016, £33.99, 176pp. ISBN: 9783319321752

Women in Academic Psychiatry: A Mind to Succeed Edited by Sophia Frangou Springer, 2016, £33.99, 176pp. ISBN: 9783319321752 As a female academic psychiatrist I asked two questions of myself about this book. Did I identify with the problems described here? And second, would I have found it

‘Subordination, authority, psychotherapy’

This article explores the history of ‘subordination-authority-relation’ (SAR) psychotherapy, a brand of psychotherapy largely forgotten today that was introduced and practised in inter-war Vienna by the psychiatrist Erwin Stransky (1877–1962). I situate ‘SAR’ psychotherapy in the medical, cultural and political context of the inter-war period and argue that – although Stransky’s approach had little impact on historical and present-day debates and reached only a very limited number of patients – it provides a particularly clear example for the political dimensions of psychotherapy. In the early 20th century, the emerging field of psychotherapy was largely dominated by Freudian psychoanalysis and its Adlerian and Jungian offshoots. Psychotherapists’ relations with academic psychiatry were often uneasy, but the psychodynamic schools succeeded in establishing independent institutions for training and treatment. However, as this article shows, the gulf between mainstream psychiatry and psychotherapy was not as wide as many histories of the psy-disciplines in the early 20th century suggest. In inter-war Vienna, where these conflicts raged most fiercely, Stransky’s ‘SAR’ psychotherapy was intended as an academic psychiatrist’s response to the challenge posed by the emerging competitors. Moreover, Stransky also proposed a political alternative to the existing psychotherapeutic schools. Whereas psychoanalysis was a liberal project, and Adlerian individual psychology was closely affiliated with the socialist movement, ‘SAR’ psychotherapy with its focus on authority, subordination and social hierarchy tried to translate a right-wing, authoritarian understanding of society into a treatment for nervous disorders.

Improving Health Equity Through Minority Psychiatry Trainees: One Journey to Becoming an Academic Psychiatrist of Indigenous Ancestry.

Improving Health Equity Through Minority Psychiatry Trainees: One Journey to Becoming an Academic Psychiatrist of Indigenous Ancestry.

Bringing Back Ubuntu.

I awoke to the sound of drums at 6:30 a.m. Despite an exhausting journey of over 10,000 miles, I had not slept well. Countless stray dogs had howled back and forth to each other long into the night. Unfortunately, the prospect of getting more sleep was out of the question; the drums were even more persistent than the barking. I rolled out of bed, threw on another sweatshirt, replaced my pajama bottoms with a pair of jeans, and grabbed an apple as I headed for the door. I could hear a faint swell of voices begin to join the drums in rhythmic song. As I hurried along the well-worn path between the banana field and the compound wall, I heard shrill, exuberant ululations periodically pierce the growing chorus and felt the sun begin to push back the chill of night. I turned a final corner and joined the stream of people making their way to the outdoor auditorium for the morning devotional. I found an open seat and began to clap along. My fatigue was replaced by anticipation of what the day might bring as I was swept along by the energy of the song. A smile crept over my face. Ayear had passed since my last visit, and it felt good to be back. I was at Kafakumba Training Center (Kafakumba) in the Copperbelt Region of northern Zambia, just south of the border with the Democratic Republic of the Congo (DRC) and west of Tanzania. Prior to boarding the plane 2 days earlier, my role as an academic psychiatrist had focused primarily on medical education and community engagement at an academic health center in the USA. Once I set foot on the tarmac in Zambia, however, my role transitioned to a visiting faculty member for the annual Kafakumba Pastors’ School. Sincemoving to Zambia from the DRC in the late 1990s, Kafakumba has hosted pastors for 6 weeks annually to complete a curriculum that spans 8 years. They travel from the DRC, Tanzania, and throughout Zambia to study theology and learn skills related to leadership, communication, economic development, and health. During the remaining 46 weeks, they serve as trusted leaders who, due to their positions as faith leaders and the limited access to local health care, are often approached by individuals seeking guidance about both spiritual and physical health in their communities [1]. Explanatory models of ill health in many of the region’s rural communities are commonly rooted in traditional beliefs that involve evil spirits, conflict between the physical and spiritual realms, and failure to appease one’s ancestors [2]. The pastors straddle worldviews shaped by traditional beliefs and Christianity, the latter providing an opportunity to understand disease and illness in a manner that does not rely solely on spiritual and magical causes. In the late 1990s, many people were succumbing to AIDS despite the advice of traditional healers and the prayers of the Christian community. In this context, the Director of Kafakumba invited me in 2001 to provide a different perspective on the health issues confronting the pastors, thereby offering an alternative explanatory model through which to understand disease, illness, and death. That visit was the first of many. Cultural humility and mutual respect guide my interactions with these faith leaders, with most of their worldviews differing significantly from mine. Upon arriving each year, I spend the first couple of classes listening to them share their pressing health education needs. We then prioritize these topics and create a curricular framework to focus our sessions. During my first few years, basic education regarding HIV/AIDS dominated the curriculum.More recently, however, neglected tropical diseases, mental illness, gender-based violence, and the * Mary Kay Smith marykay.smith@utoledo.edu

Reflections on a Career in Epilepsy

I would not myself claim or admit to have had a ’career in epilepsy’ because I would not have known that such a career could exist. My career, properly speaking, was that of an academic psychiatrist in child and adolescent psychiatry. Butmany of my patients suffered frommanifest brain diseases and dysfunctions, and among that group were a number who also suffered epileptic seizures. As is so often the case, I had not planned such a career. It is true that, asmy experience and publications developed, it was evident that I had things to say about people with epilepsy, especially young people. But how did it come about? I was the youngest of five children born to striving parents who ran newsagent and tobacconist shops in central London. The one over which we lived was on the rear edge of the garden of Buckingham Palace. At the outset of the 1939–45 war, aged six, I was subject to mandatory “evacuation” from London. My ten-year-old brother and I were placed with a lovely family in rural midWales where we soon becameWelsh speaking. My parents also evacuated themselves to Wales in 1941 after a “near miss” from a bomb, and they farmed until 1944 when we all returned to London. But the arrival of V1 and later V2 rockets required me to return again to Wales. In 1946, I was sent to boarding school, “Allhallows” in Devon, since defunct. I came to medicine late, after two years of mandatory military “national service” spent mostly as an officer in the Nigeria Regiment where I added the experience of managing the battalion's “signals” and then managing its “transport” to my background helping in managing the family business. I had also worked briefly, clerking for Unilever Raw Materials. My applications on paperwere rejected by a large number of London medical schools (I was unaware that there might be others elsewhere) before I appeared in person to inquire about training at Charing Cross Hospital. The person who saw me was helpful but inquired whether, given my considerable height, I might play rugby (I did play rugby and said so but did not explain that my playing weight of 168 lb had been reduced to 140 lb by amoebic dysentery during threemonths in hospital in Nigeria). My first post, after qualifying at Charing Cross Hospital, (notably, at that time, located near London's Charing Cross) was as houseman to the consultant neurologist, the consultant psychiatrist, and the senior general physician. I was also to be present should the visiting neurosurgeon admit or be called to visit a patient. This broad remit, taxing at the time, proved useful over the years. The psychiatrist was impressed by my work, so after the mandatory six-month spell as a house surgeon, he facilitated me for a six-month postwithWilliam Sargant, probably the best-known British psychiatrist of his era. His view was that psychiatric disorders were of the brain rather than the mind, and he pressed hard with physical treatments and drugs. His therapeutic optimismwas astounding. He then facilitated

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios.

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

Why I Like Being an Academic Psychiatrist

Why I Like Being an Academic Psychiatrist

Commentary on suicide and homelessness: What differentiates homeless persons who died by suicide from other suicides in Australia? A comparative analysis using a unique mortality registry

Several years ago I published an essay lamenting the lack of research addressing the issue of suicide within the homeless population [1]. As an academic community psychiatrist in the United States (US) I have spent over 25 years providing clinical care to homeless persons who are experiencing the effects of mental illness and/or substance use disorders. What prompted my plea for more research was the suicide of a young adult male patient who was under my care for schizophrenia and polysubstance abuse. His name was Thomas. He had spent much of his adult life on the streets and in shelters. He was in his late 20s when he suicided, just a day after I had seen him in my clinic. Incredulously, prior to taking his own life he had appeared to be doing very well from the rough clinical and social measures we use in this imprecise practice of medicine and rehabilitation. His suicide forced me to ask those painful questions every clinician performs through a selfadministered cross-examination following such a tragic event: what forces conspired that to led to this final act of self-destruction? What risk factors went undetected? What did I miss? What could I have done better? My search of the literature provided a wealth of information on suicide among patients with psychiatric illness, as well as comorbid substance use disorders, but I found precious little on the impact homelessness might have upon the risk of suicide. The piece published in this issue of Social Psychiatry and Psychiatric Epidemiology, entitled, ‘‘What differentiates homeless persons who died by suicide from other suicides in Australia? A comparative analysis using a unique mortality registry’’, is a tremendous first step in bridging a long-neglected gap in the body of health care research for persons experiencing homelessness [2]. This study by Arnautovska, Sveticic and De Leo is an interesting, timely and well-written endeavor to identify the most prominent demographic and clinical characteristics of homeless people who died by suicide in Queensland, Australia, over a 20-year period (1990–2009). Utilizing a mortality dataset derived from the Queensland Suicide Registry, the investigators determined that homeless persons had a suicide rate that was nearly twice higher than their non-homeless counterparts. The risk profile that emerged among this cohort of homeless persons was one that identified gender as significant (males completed more suicides than females), being of young age, unemployed, being single or never married, and having at least one physical illness. Not surprisingly, substance use disorders and untreated mental illness were prominent characteristics among those who took their own lives. In the US, on any given night, there are nearly 650, 000 individuals who live in shelters, on the streets, in abandoned buildings, or move from one unstable residence to another as ‘‘couch surfers’’ [3]. Nearly 25–28 % have a serious mental illness and it has been estimated that 50 % suffer from a substance use disorder [4]. In the large Florida city within which I practice, 70 % of the population of homeless persons is male, unmarried, and have an average age of 40 years. 90 % of our local homeless population report being unemployed [5]. Like so many others in this country who live in extreme poverty, persons who are homeless have little access to formal primary and mental health services since they lack employer-based or public health care insurance. Hence, when I reflect upon the implications of this study in my own clinical practice I recognize that nearly all my patients are at increased risk for suicide compared to their counterparts in the general R. C. Christensen (&) Department of Psychiatry, University of Florida College of Medicine, Gainesville, USA e-mail: rchris@ufl.edu

Why I Like Being an Academic Psychiatrist

Why I Like Being an Academic Psychiatrist

Why I Like Being an Academic Psychiatrist

Why I Like Being an Academic Psychiatrist