Academic Psychiatry Research Articles

Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision

BackgroundThe SARS-CoV-2 pandemic has led to drastic changes in how psychiatric consultation-liaison (C-L) services conduct business and required rapid transition to telepsychiatry. We describe the practice changes implemented to rapid transition to virtual care in a large, academic psychiatry C-L service in response to the pandemic.ObjectiveTo describe clinical service structural changes, timelines and impacts on consultation volume as well as present quantitative and qualitative data regarding the experience of this transition from the standpoints of both psychiatric trainees and attending physicians.MethodsWe present the narrative descriptions of transition details based on focused interviews with inpatient C-L leadership. Inpatient consult volume and charge data were gathered using analysis of health system data. Attending and trainee experience of the transition to virtual care were assessed using anonymous, online surveys.ResultsDuring the pandemic, the average weekly consultation volume and average weekly charges were significantly lower compared with prepandemic. Both volume and charges were affected by addition of video consultation capability. Both attendings and trainees had moderate or high comfort and moderate satisfaction with telephone and video consultations. Overall, the trainee satisfaction with supervision, learning, and their consult psychiatry experience did not seem to be affected by the pandemic.ConclusionsOur results support the feasibility of the rapid implementation of virtual care in a psychiatric academic C-L service without negatively impacting the learner's consult psychiatry experience. This should provide comfort to academic C-L services that required rapid implementation of virtual care.

A journey through psychiatry - A personal perspective.

A journey through psychiatry - A personal perspective.

The Burnout Phenomenon: A Résumé After More Than 15,000 Scientific Publications.

The “burnout” phenomenon, supposedly caused by work related stress, is a challenge for academic psychiatry both conceptually and professionally. Since the first description of burnout in 1974 until today, more than 140 definitions have been suggested. Burnout–symptomatology's main characteristic, the experience of exhaustion, is unspecific. Different development–models of burnout were proposed, assumed to depict a quasi-natural process. These could not be confirmed empirically. An expert consensus on the diagnostic criteria and the conceptual location, whether as an independent disorder or as a risk, could not be agreed on. Nevertheless, the phenomenon of burnout in the ICD-11 is considered to be categorized as a work-related disorder. Psychiatric research on the burnout–phenomenon ignores problems of definition resulting from different perspectives: It may meet societal expectations, but does not fulfill scientific criteria, and therefore is not suitable to establish an objective diagnosis and treatment. Parallel detection of ICD/DSM diagnoses from an expert perspective and subjective perturbation models are considered appropriate.

Gender equality in academic publishing: action from the BJPsych.

Women in academic publishing and academic psychiatry face many challenges of gender inequality, including significant pay differentials, poor visibility in senior positions and a male-dominated hierarchical system. We discuss this problem and outline how the BJPsych plans to tackle these issues it in its own publishing.

Gender equality in academic psychiatry in the UK in 2019.

To investigate whether gender balance in academic psychiatry in the UK has improved since a 2005 initiative to encourage career progression for female academics in UK universities. We surveyed the gender of academic psychiatrists across the UK and compared our findings with our previous 2003 London-wide survey and with the Royal College of Psychiatrists' 2001 workforce census. The percentage of women in academic psychiatry posts in the UK more than doubled, from 20% in 2001 to 40% in 2019, with increases at senior lecturer (from 25 to 50%), reader/associate professor (from 29 to 48%) and professor level (from 11 to 21%). Outside London, men occupy 72% of all posts and 89% of professorial posts. Within London, men occupy 45% of all posts and 74% of professorial posts. The representation of women in academic psychiatry has improved but men continue to dominate at professorial level. Gender equality appears worse outside London. The situation is exacerbated by the diminishing availability of posts across the UK.

Academic Psychiatry Department Names: Reflections on Research, Practice, and Education.

Medical schools' departments reflect changes in health care and medical school organization. The authors reviewed psychiatry department name categories associated with school age, research, and primary care focus. Department names were identified and categorized for US allopathic and osteopathic medical schools. A multinomial regression model analyzed the relationship between department name category and established year, adjusted for school type. Fisher's exact tests analyzed the relationships between name category and research/primary care foci. Among 147 allopathic schools, 52% had departments with names limited to psychiatry, 42% had names with psychiatry plus other terminology, and 5% had no identified psychiatry department. In 34 osteopathic schools, 12% had psychiatry departments, 12% had departments named psychiatry plus other terminology, and 75% had no identified psychiatry department. Age of school was related to departmental name: for a 1-year increase in the school's established year, the odds of having a department name other than psychiatry were 1.02 times the odds (p < 0.001) of having the name psychiatry. Newer schools were less likely to have departments with "psychiatry" in their name. Associations were found between department name and research and primary care rankings. Variability in the names of psychiatry departments in medical schools may suggest changing views within and about academic psychiatry. The limited presence of formal psychiatry departments in newer schools raises questions about psychiatry's impact on educational pathways, the future workforce, and participation in schools' research mission and clinical enterprise.

Development of a Virtual Consultation-Liaison Psychiatry Service: A Multifaceted Transformation

In response to the coronavirus disease 2019 (COVID-19) pandemic, our NYU Langone Health Tisch/Kimmel/Orthopedic Hospital Consultation-Liaison (CL) Psychiatry service underwent a multifaceted transformation to become a primarily Virtual CL Psychiatry service. We aimed to provide the hospital system with comprehensive psychiatric consultation for all patients, regardless of isolation status, while preserving personal protective equipment and avoiding unnecessary exposure to COVID-19 for our team members. In this article, we discuss harnessing technology for video consultations and transforming the multiple facets of an academic CL Psychiatry Service to become a comprehensive, functioning virtual consultation team during the COVID-19 pandemic. We review the history, best practices, legal, and regulatory considerations of using telepsychiatry for psychiatric consultations, challenges to implementation across multiple clinical sites, and expansion of the liaison role to include support of frontline colleagues. Finally, we provide the physician, trainee, and psychiatric nurse perspective as it relates to this transition. [ Psychiatr Ann . 2020;50(7):279–287.]

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

1185 Developing A Care Pathway For Insomnia In Older Adults And Adults With Dementia: Results Of A Consensus Meeting

Abstract Introduction Insomnia among older adults and dementia patients carries a high public health burden. Yet, treatment is inconsistent or absent. Standardized, programmatic carepaths can be implemented in clinics/systems/communities to address this after tailoring to local environments. To determine what elements should be included, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building among diverse stakeholders. Methods Participants represented a wide range of stakeholders and specialties, including academic research, clinical care, industry, government, payors, sleep medicine, primary care, geriatrics, psychiatry, neurology, nursing, pharmacy, quality, and implementation science. 27 statements regarding key components of carepaths for insomnia in elderly and dementia populations were presented and discussed. These represented items addressing identification of patients, screening and assessment, deciding treatment modality and delivery, providing behavioral treatment, providing pharmacotherapy, addressing combined therapy, addressing comorbidities, and incorporating outcome evaluation. All N=20 participants voted individually whether they agreed or disagreed with each statement. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree. Results Despite diversity among attendees, median rate of agreement was 95% (IQR=85-95%). Mean score was 0.69 (SD=0.31). 95%CIs were computed for each proportion and compared to the mean. The following elements were significantly different from the mean (p&amp;lt;0.05): medication decision trees (M=0.25), accounting for comorbidities (M=0.26), include outcome evaluation (M=0.30), utilization of EMR (M=0.40), incorporate caregiver (M=0.42), and differ across parts of the system (M=1.79). Conclusion Insomnia carepaths for older adults should address identification, screening and assessment, treatment decisions, treatment type and delivery, and evaluation. Organizations should consider these elements when designing carepaths for insomnia among older adults and dementia patients. Consensus-building should begin during the process of prioritizing care path components. Support Merck Research Labs provided support

In Case You Haven't Heard…

A new study of 588 millennial and Generation X residents and fellows did not show increased vulnerability to burnout or different empathy skills in millennial physicians in training compared to a demographic‐matched sample of Generation X physicians, according to a Northwestern University press release. The study, published May 5 in Academic Psychiatry, is the first to evaluate the impact of generation affiliation (millennial vs. Generation X) on physician qualities, specifically empathy and burnout. “As millennial physicians are increasingly entering the workforce, people seem to be wondering what millennial doctors will be like, and I've heard older physicians opine that physician burnout is a bigger problem now due to generation vulnerability,” said lead author Brandon Hamm, M.D., instructor of psychiatry and behavioral sciences in the Northwestern University Feinberg School of Medicine. Hamm conducted the research while he was at the Cleveland Clinic. “Our study provides a little more transparency that it's medical‐system exposure — not generational traits — that is more likely to contribute to the burnout seen in today's doctors.”

Paranoia Querulans in the First Half of the 20th Century: The Case of Elsa Asenijeff (1867-1941) and the German Psychiatric Literature of that Time

The writer Elsa Asenijeff was placed under guardianship based on the diagnosis paranoia querulans in 1921. The aim of this study was to commemorate her case and to question how this clinical picture was understood at the time in order to contribute to the history of this little researched disorder. We illustrate the essence of Asenijeffs forensic examinations and of the descriptions of paranoia querulans in selected German psychiatric literature of the beginning of the 20th century. The literature describes paranoia querulans as a delusional disorder provoked by judicial conflict. The selected authors offer different theories of its genesis and classification. The symptoms described in the forensic examinations are in accordance with the doctrine of academic psychiatry of the time. The chosen literature also illustrates the difficulties of a clear distinction between mental health and illness.

US Psychiatry Faculty: Academic Rank, Gender and Racial Profile.

The gender and racial underrepresentation persist in academic psychiatry faculty appointments. Our study investigated the gender and racial distribution and its temporal trends in academic psychiatry faculty positions across the USA over a 12-year period. Using the annual reports of the Association of American Medical Colleges (AAMC), a retrospective cross-sectional study was conducted. Simple descriptive statistics analyzed the time trends and the distribution of gender and race across academic ranks, tenure, and degree types. Over the 12-year study period, the White race was the most represented at each rank. In the lower academic ranks, there was an increased representation of Asians, while the minority race/ethnicities experienced minimal increment. Similarly, males were overrepresented at higher academic ranks, with females increasing in proportion at lower academic ranks. Females and minorities remain underrepresented in academic psychiatry faculty positions, especially among senior academic and leadership positions. Differences in tenure tracks and degree types may contribute to the overrepresentation of White and male academic physicians.

HOW TO PEER REVIEW A PAPER

At the beginning of a career in academic psychiatry, new attending psychiatrists do not have all the skills necessary to advance towards promotion. For instance, attendings are most likely well versed in reading and perhaps in writing medical literature, but may not have the knowledge, skills or attitudes to provide a meaningful peer review to a publication. Aside from providing an important, meaningful service to medical science, reviewing articles prior to publication can allow novice researchers and writers to gain important skills in writing for publication and critical thinking. It also allows one to keep up to date on the latest science, and build your CV. This interactive workshop will give participants the opportunity to work in small groups to review an article, present their evaluation and compare their findings with experts.Dr. Nery Diaz and Dr. Paroma Mitra will discuss the basic process of peer review, why participants should accept requests to review articles and provide a “how to” guide. Then, participants will form small groups and group review a section of an article using the guidelines discussed previously. After, the groups will report out their findings. The results from the official review of the article will be shared so that participants can compare findings. Dr. Jordan Karp will provide insights into the process of publication from the viewpoint of a member of the editorial board of the American Journal of Geriatric Psychiatry. Finally, Dr. Popeo will provide a brief summary.

Spirituality and mental health: challenges and opportunities

Spirituality encompasses connection—religious or otherwise—with a non-physical reality as perceived by the individual. Sigmund Freud famously considered this domain a form of neurosis. Although others such as Carl Jung, Viktor Frankl, and William James had more favourable opinions, spirituality remains at the side lines of mental health science to this day. Private and philanthropic foundations are the largest supporters of research on spirituality and mental health, as federal agencies in almost all developed countries, including the USA and UK, have yet to issue any formal requests for funding proposals. Yet, 84% of the world's population is religiously affiliated, and 68% of unaffiliated individuals believe in a higher power. 1 The global religious landscape: a report on the size and distribution of the world's major religious groups as of 2010. Pew Research Center, 2012https://assets.pewresearch.org/wp-content/uploads/sites/11/2014/01/global-religion-full.pdfDate accessed: January 31, 2020 Google Scholar No other social phenomenon is so widespread, yet all but ignored by academic psychiatry.

Robert Bruce Sloane and the mid-twentieth-century struggles of academic psychiatry.

In 1957, British-born R Bruce Sloane became the founding head of a Canadian academic department of psychiatry in a city that had already been served by a busy asylum for more than a century. He plunged into the work with enthusiasm, but encountered blatant opposition and skepticism, prompting his departure. He went on to conduct research in the United States. Archives and oral testimony reveal the attitudes thwarting Sloane's plans to improve teaching, research, and service-attitudes that may typify a general hostility toward psychiatry in other centers at that time.

Professional experiences of early career academic psychiatrists in Turkey: a qualitative study

Objective: Defining job experience for a psychiatrist has always been a matter of debate and describing the work done by a psychiatrist is often challenging. Furthermore, cultural differences and variance in health policies across countries may complicate psychiatrists' subjective experiences of their work. The authors aimed to provide insight into the personal experience of those who become psychiatrists and are in active practice in academic settings. Methods: In-depth interviews were held with 16 psychiatrists working in various university and research health care services in Ankara, Turkey. Two questions were asked to the participants: a. How did you decide to become a psychiatrist? b. What can you tell us about your experiences as a psychiatrist throughout your career? Recordings were transcribed for coding and analysis; the encoding processes included the initial coding, separating the concepts into themes, editing the codes and themes, identifying the findings, and interpreting the results. Results: Intellectual curiosity (such as the desire to understand humanity or research how the brain works) was the most commonly reported reason for choosing the field. Helping psychiatric patients, the most common motive reported in previous questionnaire-based studies was the least mentioned theme in this study. Problems specific to the practice of psychiatry, such as etiological debates, were a less important factor in posi-tive or negative feelings about the profession; competency and the feeling of being autonomous were among the more important factors. Discussion: Personal curiosity seems to precede the basic need to practice medicine for those in academic psychiatry. One subjective experience that seems fairly widespread is developing modest atti-tudes towards psychiatry. Minimizing targets and learning to be satisfied with the limits of what psychiatry can do for certain patients seems to provide a solution for omnipotence anxiety.

How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication

Coming off psychotropic drugs can cause physical as well as mental withdrawal, resulting in failed withdrawal attempts and unnecessary long-term drug use. The first reports about withdrawal appeared in the 1950s, but although patients have been complaining about psychotropic withdrawal problems for decades, the first tentative acknowledgement by psychiatry only came in 1997 with the introduction of the ‘antidepressant-discontinuation syndrome’. It was not until 2019 that the UK Royal College of Psychiatrists, for the first time, acknowledged that withdrawal can be severe and persistent. Given the lack of a systematic professional response, over the years, patients who were experiencing withdrawal started to work out practical ways to safely come off medications themselves. This resulted in an experience-based knowledge base about withdrawal which ultimately, in The Netherlands, gave rise to the development of person-specific tapering medication (so-called tapering strips). Tapering medication enables doctors, for the first time, to flexibly prescribe and adapt the medication required for responsible and person-specific tapering, based on shared decision making and in full agreement with recommendations in existing guidelines. Looking back, it is obvious that the simple practical solution of tapering strips could have been introduced much earlier, and that the traditional academic strategy of comparisons from randomised trials is not the logical first step to help individual patients. While randomised controlled trials (RCTs) are the gold standard for evaluating interventions, they are unable to accommodate the heterogeneity of individual responses. Thus, a more individualised approach, building on RCT knowledge, is required. We propose a roadmap for a more productive way forward, in which patients and academic psychiatry work together to improve the recognition and person-specific management of psychotropic drug withdrawal.

Negative and positive disorders of schizophrenia (issues of co-dependence, psychopathology and pathogenesis)

The authors consider current and own conceptions about correlations of the processes underlying the pathogenesis of schizophrenia presented by negative and positive disorders. With growth of academic psychiatry, evaluation of a correlation between positive and negative dimensions has changed dramatically: on the one hand presenting in clinical unity - simultaneous psychopathologic structures, and on the other hand being clinically and pathogenetically heterogenic in dimensional structure. According to our clinical and biological findings and an analysis of fundamental neurobiological studies, positive and negative disorders present in the clinical picture of schizophrenia as two separate psychopathological and pathogenetic structures. A new paradigm of the correlation between positive and negative structures - the interaction between positive and deficit symptoms - reveals psychopathological functions differentiated for each of dimensional structures. Negative disorders act as «transformers» modifying characteristics of primary transnosological positive disorders to the level of psychopathological structures preferable for schizophrenia; positive disorders, in their turn, act as «moderators» augmenting, amplifying manifestations of negative symptoms. This psychopathological construct of the correlation between dimensional structures paves a way for the development of a new concept of psychopharmacological treatment of schizophrenic deficit: both negative symptoms and amplifying positive symptoms are considered as «target symptoms» for pharmacological interventions.

Entrustable Professional Activities in Psychiatry: A Systematic Review.

Entrustable professional activities (EPAs) represent discrete clinical tasks that can be entrusted to trainees in psychiatry. They are increasingly being used as educational framework in several countries. However, the empirical evidence available has not been synthesized in the field of psychiatry. Therefore, the authors conducted a systematic review in order to summarize and evaluate the available evidence in the field of EPAs in undergraduate and graduate medical education in psychiatry. The authors searched PubMed, Cochrane Library, ERIC, Embase, PsycINFO, all Ovid journals, Scopus, Web of Science, MedEdPORTAL, and the archives of Academic Psychiatry for articles reporting quantitative and qualitative research as well as educational case reports on EPAs in undergraduate and graduate psychiatry education published since 2005. All included articles were assessed for content (development, implementation, and assessment of EPAs) and quality using the Quality Assessment Tool for Studies with Diverse Designs. The authors screened 2807 records and included a total of 20 articles in the final data extraction. Most studies were expert consensus reports (n = 6, 30%) and predominantly conducted in English-speaking countries (n = 17, 85%). Papers reported mainly EPA development and/or EPA implementation studies (n = 14, 70%), whereas EPA assessment studies were less frequent (n = 6, 30%). Publications per year showed an increasing trend both in quantity (from 1 in 2011 to 7 in 2018) and quality (from a QATSDD score of 27 in 2011 to an average score of 39 in 2018). The main focus of the articles was the development of individual EPAs for different levels of training for psychiatry or on curricular frameworks based on EPAs in psychiatry (n = 10, 50%). The lack of empirical controlled studies does currently not allow for meta-analyses of educational outcomes. The concept of EPA-based curricula seems to become increasingly present, a focus in the specialty of psychiatry both in UME and GME. The lack of empirical research in this context is an important limitation for educational practice recommendations. Currently there is only preliminary but promising data available for using EPAs with regard to educational outcomes. EPAs seem to be effectively used from a curriculum design perspective for UME and GME in psychiatry.

Turning Oral Presentations at the Academy of Consultation-Liaison Psychiatry's Annual Meeting Into Published Articles: A Review and Analysis

Oral presentations at academic conferences typically describe recent or ongoing research projects or provide literature reviews. However, conversion of these presentations into full-length journal articles is not routine. We sought to assess the frequency with which oral presentations at the Academy of Consultation-Liaison Psychiatry's annual meetings from 2012 to 2018 were turned into peer-reviewed publications and review the factors that affected publication of them. Conferencepresentation titles and authors from the 2012-2018 Academy of Consultation-Liaison Psychiatry Annual Meetings were searched using PubMed to find corresponding published reports by the presenters. Data were organized in an Excel spreadsheet, and the time to publication, the journals in which they were published, and general content areas were recorded and analyzed. Of the 287 oral presentations delivered during the study period, 47% were published in a peer-reviewed journal. Articles were published in 72 different journals; the journals that published the most articles were Psychosomatics, General Hospital Psychiatry, Psycho-oncology, Academic Psychiatry, and the Journal of General Internal Medicine. The most common subspecialty topics of the published articles were neuropsychiatry, psycho-oncology, surgery and transplantation, and delirium. The mean time to publication after presentation was 1 year. Knowledge of the rate at which presentations are converted into peer-reviewed publications can be used to enhance the academic success of presenters, and strategies to enhance the rate of publication (e.g., by coaching on scientific writing or by selecting oral presentations with the highest publication potential) can be established.