Psychiatric Experience Research Articles

Involvement of representatives of patients and relatives in guideline processes : S3 guidelines on psychosocial therapies for severe mental illnesses breaks new ground

The participation of representatives of patients and relatives in the development of guidelines is of central importance for the quality, feasibility and acceptance of guidelines. In Germany this has not been sufficiently implemented in the discipline of psychiatry, although in practice there are many examples for the benefits of the expertise of people with psychiatric experience. The article describes the development and a first process evaluation of a trialogical working group (AG Impuls) accompanying the guideline process. Possibilities for further development and implementation are discussed. Description of the working process of the Impuls working group as well as the results of the satisfaction survey after 18months and summarised content analysis. Concept: during the further development of the S3 guidelines on psychosocial therapies, the expertise of 12experts is bundled in the Impuls working group and supported by the members of the steering group. An open discussion takes place in regular digital working meetings and face to face meetings are held once ayear as part of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) congress. The results are presented to the guideline committee at the consensus conferences. Text boxes from the Impuls working group constitute an important tool. the following topics were identified in connection with the participatory work: (a)exchange at eye level, broadening perspectives and contributing impulses, (b)giving avoice to experienced experts, (c)implementation requirements and possibilities and (d)limitations of the cooperation. Various preconditions and implementation requirements for long-term successful participation in guideline development were identified. The Impuls working group can be used to specifically address insufficient participation in guideline processes. The structured approach could form ablueprint for other guideline processes.

"To go mad". The Generation of Feminist Criticism of Psychiatry: The Example of the Magazine Courage, 1978-1980

Using the example of the feminist magazine Courage, the article shows how its participatory production process enabled apsy-feminist knowledge generation that also included women with psychiatric experience. The magazine makers combined the women's observations, perceptions and interpretations with visual representations and acanon of literature that extended far beyond the field of psychiatry (criticism). Instead of medical psychopathologies, the women of Courage implemented writing styles and visual languages, which emphasised the experience of mental suffering and alterity and related it to the social position of women. At the same time, Courage also presented alternative feminist treatments and therapies. The Courage's critique of psychiatry was characterised by amulti-perspective approach that removed the topic of "women in psychiatry" from the narrow field of psychiatry, psychology and psychotherapy and expanded it to include artistic, patient- and experience-oriented and socio-critical perspectives.

Impact of Stigma Towards Mental Illnesses and Measures to Reduce Stigmatization

There is a chance for anyone to experience mental illness. Despite this prevalence, there are still many social misconceptions, stereotypes, prejudices, and even discrimination against mental illness and those who experience it. Mental illness stigma is the bias and discrimination that results from the perception that a person or group has traits that are perceived to be different from and unacceptable to others. Because of the stigma, seemingly ordinary social lives, jobs, and different rights can become difficult for people with psychiatric experiences. This article will look at destigmatization, which is how to remove stereotypical images of mental illness and examine the causes and solutions of stigma.

Telephone-based telepsychiatry consultations: a qualitative exploration of psychiatrists’ experiences in Oman

ObjectivesThe utilisation of tele-mental health services has the potential to address challenges in mental health services within the Eastern Mediterranean Region. However, the adoption of tele-mental health in Oman remains...

“She was not an outsider artist”

This interview was conducted with Dr. Thomas Röske, director of the Prinzhorn Collection Museum on May 30th, 2023, focusing on three main issues: introducing the artist Elfriede Lohse-Wächtler and her oeuvre in relation to her history as a visual artist in the nineteen-twenties and thirties; discussing her status as an artist affected by psychiatric experience [psychiatrisch Erfahrung], and reporting on the acquisition process of this significant estate for the museum.

Beyond the asylum

AbstractMy research is situated within the literature looking at the processes of deinstitutionalisation of the mental health system through the lived geographies placed in between the walls of the asylum. It addresses mental health geographers' call for a situated knowledge about mental health and, by using the Italian psychiatric experience of the 1960s and 1970s as an example, stresses the importance of looking at care in both spatial and relational terms. Through a geographical understanding of the Italian psychiatric reform, that goes from Franco Basaglia's renowned work to the underrepresented experience of Turin, in northwest Italy, I will examine how space is intertwined with processes of mental health care. Additionally, I assess the role played by the interaction between spatial and relational elements in potentially enabling patients' self‐determination, empowerment and inclusion. The case of Turin—the story of which will be told through the analysis of archival material from a grassroots association called Associazione per la Lotta contro le Malattie Mentali—will serve to expand the common narrative around the Italian lesson and to give resonance to the instrumental role played at the time by both patients and civil society. By looking at the key events that led to the gradual dismantlement of the traditional psychiatric institutions in the metropolitan area of Turin, this paper contributes to the spatial turn in mental health studies, calling upon researchers to look at past achievements as something we still need to learn from and safeguard.

P208: The activities of Initial- phase Intensive Support Team for Dementia (IPIST) in Japan

Objective:The Intensive Initial Support Team for Dementia (IPIST) is a multidisciplinary outreach team that provides intensive initial assessment and support for dementia in Japan, introduced based on the Memory Service in the UK. All municipalities are required to establish at least one team, which consists of at least one physician and two professional staffs such as public health nurses and care workers. IPIST usually complete the work within approximately six months, including consultation with medical specialists and introduction of public supports. IPIST sometimes faces “complex case” that is difficult to manage. Because complex cases often have psychiatric problems, accessibility to psychiatric resources is important for IPIST. This study investigated the percentage of psychiatric professionals among IPIST members and the characteristics of complex cases they face.Methods:Through all 1741 municipalities in Japan, a questionnaire was distributed to each IPIST regarding the complex cases they experienced during April-September 2020. The questionnaire asked for the characteristics of each IPIST (e.g., specialty of the team physician, availability of staff with psychiatric expertise, etc.) and which of the 12 categories each complex case fit into, allowing multiple choice.Results:We could collect responses from 1291 IPISTs. 43.3% of IPISTs had a psychiatrist, 43.1% had an internal medicine physician, 13.4% had a neurologist, and 17.0% had some other physician as their team physician. In addition, 59.4% of the teams had medical staff members with psychiatric experience, including psychiatrists. A total of 7340 cases were reported as complex cases. While the most common category for difficulties in case management was “refusal of services” (19.5%), factors requiring psychiatric intervention such as “behavioral and psychological symptoms of dementia” (16.0%), “co-occurring mental illness” (7.3%), “complaints from neighbors” (7.1%), and “trash-house” (4.3%) were also frequently observed.Conclusion:The survey revealed that many IPISTs already had psychiatrists and other professionals with clinical psychiatric experience, and that they managed a lot of complex cases with issues that would be the target of psychiatric intervention. We believe early psychiatric engagement is important in many complex cases in outreach support for community residents with suspected dementia.

The bodily self from psychosis to psychedelics

The sense of self is a foundational element of neurotypical human consciousness. We normally experience the world as embodied agents, with the unified sensation of our selfhood being nested in our body. Critically, the sense of self can be altered in psychiatric conditions such as psychosis and altered states of consciousness induced by psychedelic compounds. The similarity of phenomenological effects across psychosis and psychedelic experiences has given rise to the “psychotomimetic” theory suggesting that psychedelics simulate psychosis-like states. Moreover, psychedelic-induced changes in the sense of self have been related to reported improvements in mental health. Here we investigated the bodily self in psychedelic, psychiatric, and control populations. Using the Moving Rubber Hand Illusion, we tested (N = 75) patients with psychosis, participants with a history of substantial psychedelic experiences, and control participants to see how psychedelic and psychiatric experience impacts the bodily self. Results revealed that psychosis patients had reduced Body Ownership and Sense of Agency during volitional action. The psychedelic group reported subjective long-lasting changes to the sense of self, but no differences between control and psychedelic participants were found. Our results suggest that while psychedelics induce both acute and enduring subjective changes in the sense of self, these are not manifested at the level of the bodily self. Furthermore, our data show that bodily self-processing, related to volitional action, is disrupted in psychosis patients. We discuss these findings in relation to anomalous self-processing across psychedelic and psychotic experiences.

Trends in the multiple prescriptions of hypnotic drugs in a university outpatient in Japan.

In Japan, the daily dosage of hypnotic drugs for insomnia treatment is increasing year by year, and over-dependence on treatment with hypnotic drugs is a major problem. This study aimed to examine the factors related to the elimination of prescriptions of three or more hypnotic drugs within 1 year in our clinic. We conducted two surveys. Survey ① assessed the frequency of prescriptions of three or more hypnotic drugs by retrospectively reviewing the medical records of all patients who visited general and psychiatric outpatient clinics from January 2013 to March 2019. Survey ② assessed changes in prescriptions of hypnotic and psychotropic drugs within the subsequent year by retrospectively reviewing the medical records of all patients prescribed three or more hypnotic drugs who visited neuropsychiatric outpatient clinics multiple times between April 2013 and March 2019. The frequency of prescribing three or more hypnotic drugs was six to nine times higher in psychiatry than in other departments. Flunitrazepam and brotizolam were the most common drugs prescribed and had the second lowest discontinuation rate after zolpidem. Conversely, eszopiclone, zopiclone, and suvorexant had the highest discontinuation rates. The success factors for drug reduction were age (odds ratio [OR]: 0.97, p < 0.0037), trazodone addition (OR: 12.86, p < 0.0194) and number of years of psychiatric experience. The characteristics and success factors in relation to drug reduction in patients with multiple prescriptions of hypnotic drugs identified in this study may contribute to solving the problem of multiple prescriptions of hypnotic drugs.

Being a psychiatrist in the evaluation process of a gun license report: morally challenging experience – a qualitative study from Turkey

Many psychiatrists in Turkey participate in evaluating health board reports regarding gun licensing in their daily practice. There is no relevant study on the experiences of psychiatrists in this process. In addition, there is no other country where psychiatrists participate in the gun licensing process as in Turkey. In this context, the psychiatrists’ relevant experiences, their views on their roles in this process and their understanding of the ethical dimension are considered important issues. To investigate the experiences of psychiatrists, a qualitative study has been conducted. The study included 19 psychiatrists who actively participated in evaluating gun license reports. Taking part in the gun license report process for psychiatrists is a highly challenging experience professionally, morally and emotionally. Psychiatrists resort to various functional and dysfunctional strategies to address problems in this process. However, there are structural and general solutions suggested for the future.

Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic

BackgroundElectroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020).MethodsA multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada).ResultsClinical operations of ECT programs were disrupted across all four regions – however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases.ConclusionsThe results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians’ activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.

Benefits and Challenges of Video Consulting for Mental Health Diagnosis and Follow-Up: A Qualitative Study in Community Care.

Mental health services continue to experience rising demand that exceeds capacity. The COVID-19 pandemic exacerbated this crisis, with access to services being reduced. Although video consultations (VCs) are a solution, usage in UK community mental healthcare settings remains limited. This study aims to investigate psychiatrists' and general practitioners' (GPs) perceptions of the benefits and challenges of VC for the diagnosis and follow-up of general adult mental health patients in the community during the COVID-19 pandemic. Semi-structured interviews in NHS community mental healthcare settings were conducted. Psychiatrists (n = 11) and GPs (n = 12) were recruited through purposive sampling. An explorative qualitative approach was employed. Data were analysed using thematic analysis. Four key themes were identified: (1) patient access to VC, (2) suitability of VC for mental health consultations, (3) information gathering with VC and (4) clinician satisfaction with VC. This study provides valuable insights into the experiences of psychiatrists and GPs working in the UK during the COVID-19 pandemic. To facilitate a digital-first future for the NHS, greater investment in remote technologies is required, particularly in the context of growing mental healthcare demand. Though face-to-face consultations remain the gold standard, VC provides an efficient way of communicating with patients, particularly those with less severe forms of mental illness.

Impact of an Alcohol-based hand sanitizer usage during COVID-19 pandemic on disulfiram treatment: A South Indian psychiatrist's practice experiences

Background: Alcohol-based hand sanitizer (ABHS) usage has become one of the COVID-19 pandemic-related adapted responses. Some disulfiram-ethanol reactions are reported in people who use alcohol-based hand rub/sanitizer and take Disulfiram as a treatment for their alcohol use disorders. Aim &amp; Objective: To determine the practice experiences of psychiatrists on disulfiram prescription to alcohol use disorder victims. Methodology: A cross-sectional study on the psychiatrists to find the experiences of disulfiram prescription to their clients with alcohol use disorders during the COVID-19 pandemic. Results: Nearly 84 (51%) were reverted with a completed questionnaire. Among the respondents, 28 (33.3%) of the respondents decreased to prescribe Disulfiram, 48 (57.1%) reported that their patients stopped using ABHS due to fear of Disulfiram-Ethanol Reaction (DER), and 20 (23.8%) responders notified that their patients were expressed their worry on DER with Disulfiram and ABHS. Conclusion: Disulfiram prescribed for alcohol use disorders; treatment got peculiar experiences with the incidences of DER reported with Alcohol-based hand sanitizer. Many practitioners were scared to prescribe disulfiram due to DER with ABHS. The prevailing evidence that there is no possibility of cutaneous application of ABHS producing enough significant DER. Hence using ABHS is not a contraindication for disulfiram prescription.

The relationship between family functioning and psychotic-like experiences of college students: Chain multiple mediating effects.

To explore the mechanism of the relationship between college students' family functioning and psychotic-like experiences, a chain multi-intermediary model is constructed to investigate the multiple mediating effects of interpersonal adaptation, sleep quality and loneliness on college students' family functioning and psychotic-like experiences. Seven hundred seven college students in China were surveyed by using the Family Care Index Questionnaire, Loneliness Scale, Pittsburgh Sleep Quality Index Questionnaire, College Students' Interpersonal Adaptability Subscale and Community Assessment of Psychiatric Experiences. (a) The detection rate of psychotic-like experiences among college students is 72.14%, of which 6.93% reported frequent psychotic-like experiences; (b) There is a significant correlation between family functioning, sleep quality, loneliness, interpersonal adaptation and psychotic-like experiences of college students; (c) Interpersonal adaptation, loneliness and sleep quality of college students have chain multiple mediating effect in the relationship between family functioning and psychotic-like experiences. The results reveal the mechanism of the relationship between family functioning and psychotic-like experiences, which helps us to better understand how family functioning affects the occurrence and development of college students' psychotic-like experiences.

The Use of Standardized Patients as an Educational Strategy in Baccalaureate Psychiatric Nursing Simulation: A Mixed Method Pilot Study.

Prior psychiatric simulation experiences required our nursing students to role-play in an unknown area of nursing. Students confidence, clinical satisfaction, and use of clinical skills were negatively impacted leading to unmet course objectives. The aim of this pilot study was to strengthen our baccalaureate senior nursing students' simulation experience in their psychiatric nursing course with the use of standardized patients (SPs) instead of student role-play and measure the impact of this strategy on students' learning, satisfaction, and confidence in an unfamiliar area of nursing. A mixed method explanatory sequential design was used. Participants consisted of a convenience sample of senior nursing students enrolled in their psychiatric nursing course. A quantitative simulation tool and a four-item questionnaire were analyzed after completion of the simulations (n = 47). Findings of this study identified greater than 80% of students had increased level of learning, confidence, and satisfaction with the SP simulation experience. Nurse faculty were able to overcome simulation barriers, that is, a patient hearing voices, non-verbal signs of depression, and evaluate students meeting course learning outcomes. Findings from this study highlight students' positive simulation experiences. Using SPs as an educational strategy can be effective for students to reach competency, achieve higher knowledge, and improve confidence. It is believed the use of SPs as a simulation strategy in psychiatric nursing will assist students with clinical judgment and better prepare them to meet the needs of vulnerable persons with psychiatric conditions.

Recovery-Oriented Cross-Sectoral Network Meetings between Mental Health Hospital Professionals and Community Mental Health Professionals: A Critical Discourse Analysis.

Aims and objectives: In the medical field, we lack knowledge on how interprofessional collaboration across sectors is carried out. This paper explores how healthcare professionals and users perceive recovery-oriented cross-sectoral discharge network meetings between mental health hospital professionals and community mental health professionals and which discourses manifest themselves within the field of mental healthcare. Method: Ten professionals from a mental health hospital and eight community mental health professionals participated. In addition, five users with experience in mental health services in both sectors participated. Fairclough’s discourse analysis framework was used to explore their experiences. The study was designed following the ethical principles of the Helsinki Declaration and Danish law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study). Results: The healthcare professionals in both sectors are governed by steering tools, legislation and a strong biomedical tradition to solve illness-related problems, such that users must be offered treatment and support to achieve self-care as soon as possible. This can be seen as a reflection of, and a driving force in, a change in the wider social practice that Fairclough terms the ‘marketisation of discourse’—a social development in late modernity, whereby market discourse colonises the discursive practices of public institutions. The user of psychiatric and social services experiences a structured system that does not offer the necessary time for deep conversations. Users do not consider recovery as something that is only seen in relation to the efforts of the professionals, as recovery largely takes place independently of professionals. Recovery depends on users’ internal resources and a strong network that can support them on the journey. Conclusion: Healthcare professionals perceive recovery-oriented cross-sectoral discharge network meetings to reflect paternalistic and biomedical discourses. Users want to be seen more as whole persons and did not experience sufficient involvement in the intersectoral care. Relevance to clinical practice: Healthcare professionals need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit

BackgroundEnhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area.MethodsThis study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment.ResultsA high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered.ConclusionsPatients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate.Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT02745067

Internalized stigma and self-presentation strategies of persons with psychotic and psychiatric experiences.

Stigma is detrimental to persons experiencing mental distress, as it impacts on their social inclusion, quality of life, and recovery. In this article, we present the self-presentation strategies employed by persons with psychosis to manage internalized stigma. A study of the life trajectories of persons with psychosis analyzed 27 biographical interviews and identified five types of biographical trajectories. This article focuses on one biographical type, represented by six narratives. Participants placed in this biographical type struggle to portray a socially acceptable self through concealing experiences of distress and distancing the self from the psychiatric label they entail. This was achieved through several strategies, including the normalization of prior life, unwillingness to disclose psychotic experiences, unquestioning compliance with psychiatric medication, and presenting oneself as an ordinary person. Fostering more adaptive coping strategies to reduce internalized stigma may be a potential goal for psychosocial interventions.

The Interface of Mad Studies and Indigenous Ways of Knowing: Innovation, Co-Creation, and Decolonization

This paper explores the interface between Mad Studies and Indigenous ways of knowing, and argues that the dialogical expanse that exists between these two fields could be a site for innovation, co-creation, and decolonization. Mad Studies is a radical approach to studying the ways we organize and respond to mental health experiences. The field questions and unsettles biomedical understandings of mental illness, and frames psychiatric experiences as diverse forms of human emotional or spiritual expression. Indigenous perspectives on disability describe mental health using a holistic, wellness-based lens, with many scholars highlighting the link to colonial violence and oppression. The interface of Mad Studies and Indigenous ways of knowing could provide a unique platform for gaining a broader understanding of Indigenous mental health while resisting Western, psy explanations of emotional distress. Different interpretations and understandings can be discussed and debated, and through ethical spaces (Ermine, 2007) new understandings or ideas may emerge. These, in turn, may help decolonize some of the dominant biomedical biases that underpin many contemporary psychiatric treatment approaches.Social workers have a particularly important role to play in these conversations. Our professional commitment to anti-oppression and social justice implores us to take an active role in these debates. Through our workplaces we can problematize dominant discourses from within dominant systems, and make our contribution to decolonization.

Clinician's experience of telepsychiatry consultations with elderly patients

Background: During the coronavirus disease-2019 pandemic, telepsychiatry became a norm as a primary method of health-care delivery across India. However, not much evidence is available regarding the experience of psychiatrists in providing a telepsychiatry consultation. Objective: This study aims to assess the experience and satisfaction of the clinician in providing teleconsultations to elderly patients/their caregivers. Methodology: Clinicians scored their experience, satisfaction, and their perception of therapeutic alliance in providing the teleconsultation to patients of age 60 years or more, in a detailed Google Forms-based questionnaire. Results: Ninety-eight teleconsultations were assessed by clinicians. The patients had a mean age of 69.5 years, with an equal number of males and females. In more than 80% of the teleconsultations, patients were accompanied by their relatives. In about one-fourth of the consultations, psychiatrists encountered connectivity issues from the patient side. Overall, for three-fourth (72%) of the teleconsultations, clinicians reported being satisfied to a large extent; for two-thirds (66%) of the consultations, the clinicians rated their teleconsultation experience as that of providing an in-person consultation; and for about 10% of consultations, the experience was rated as better than the in-person consultation. In terms of a therapeutic alliance, in almost 85%–90% of consultations, the clinicians noted that they could build a rapport, empathize with their patients, and build a relationship of trust with the patients and their caregivers. Conclusions: Teleconsultation with the elderly might not be as difficult as intuitively thought and clinicians are in general satisfied with the same and consider that they can establish a good therapeutic alliance with the patients and their caregivers.