Mental Health Care Professionals Research Articles

The Association between Early Life Trauma and Veteran Reintegration to Civilian Life

The rate of early life trauma (ELT) is higher among military service members than civilians. While ELT is associated with higher post-traumatic stress disorder following deployment, it is unknown whether other reintegration difficulties are associated with various types of ELT. The present study investigated the relationship between ELT and reintegration difficulties among veterans. Additionally, the influence of the desire to escape ELT as enlistment motivation on this relationship was examined. Data were obtained from 257 veterans between the ages of 20 and 76 years who served in the U.S. Armed Forces during the Global War on Terrorism. Results revealed a significant positive relationship between emotional abuse, sexual abuse, physical abuse, and physical neglect with veterans’ reintegration difficulties. Additionally, enlisting as motivation to escape ELT significantly influenced the relationship between emotional abuse and physical neglect with intimate relationship problems and career challenges, respectively. These findings help facilitate our understanding of factors contributing to reintegration difficulties. In particular, information about the individual history of veterans’ ELT and their enlistment motivation can be used by social workers and other mental health care professionals to successfully assist veterans with the transition to civilian life.

Health questions on medical licensure applications: effective or counterproductive? A systematic review

Many medical regulatory authorities (MRAs) require their members and applicants to report information about their health on their medical licensure application and renewal forms. We wanted to determine whether this practice is effective in identifying physicians who have a health concern impacting their professional capacity and whether it influences members to seek treatment for their health concerns. Methods: A literature search was conducted in accordance with PRISMA publications standards. Results: From 7998 references found in all databases, after removal of duplicates and screening, five studies were included in this systematic review. None addressed the question of how effective health questions on licensure application forms are in identifying relevant health concerns. Stigma and fear of perceived ramifications of reporting mental health illness to MRAs were common reasons for physicians and medical students not seeking professional mental health care. Significance: MRAs who include health questions on their medical licensure applications should consider their effectiveness in identifying members who have health concerns that may impact their fitness to practise. Contrarily, these questions may deter members from seeking professional treatment for their own mental health. This is an important consideration, especially as burnout is prevalent among practising physicians and medical trainees.

Social VR: A Promising Platform for Enhancing Mental Wellness among College Students

ABSTRACTIn recent decades, there has been an alarming increase in the number of university and college students struggling with intensifying psychological distress, which has become a mental health crisis on campuses. To address this issue, this study proposes social VR as a potential platform to promote social interaction and improve mental well‐ being for college students. In this study, 68 students explored a variety of social VR applications in a classroom setting. Results showed that a) virtual space, audio, avatar, communication types, and activities were key contributing features that facilitated social interaction among college students in social VR and have the potential to enhance mental wellness, and b) the anonymous nature, communicative cues, and designated private areas provided by social VR platforms were effective in facilitating self‐disclosure, indicating social VR's potential in delivering mental health services such as individual and group counseling and therapy. This study provides evidence that social VR can enhance social interaction and communication while serving as a platform for professional mental health care, a venue that has yet to be explored in previous studies.

‘Clients are the problem owners’: a qualitative study into professionals’ and clients’ perceptions of smoking cessation care for smokers with mental illness

ABSTRACT Objective To understand mental healthcare professionals’ and clients’ needs and preferences regarding smoking cessation care in mental healthcare settings. Method Individual semi-structured interviews conducted in the Netherlands between March and July 2021, with 18 mental healthcare professionals and 16 people with a DSM 5 diagnosis who smoked. Qualitative analysis followed the framework approach. Results Both professionals and clients reported that successful smoking cessation would benefit client’s health, but was difficult to achieve. There were different views on who was responsible for smoking cessation care. Clients do not often initiate or bring up smoking cessation, although they often want to quit smoking to improve their overall (mental) health. Most clients stressed the need for support in quitting smoking, provided by an active, experienced professional who takes the initiative to discuss cessation. Conversely, professionals indicated that they rarely initiate this discussion, because they believe that clients should decide the focus of treatment, and that addressing smoking cessation may harm the therapeutic relationship. Professionals perceived clients as carrying the ultimate responsibility for smoking cessation. Discussion Professionals and clients agree that smoking cessation care should be tailored to the client’s needs. However, as both clients and professionals wait for the other party to initiate a discussion about cessation, the issue often remains unaddressed. To increase chances of successful smoking cessation, clearly defined responsibilities regarding initiation and provision of smoking cessation care are required.

Professionals' treatment goals for long-term benzodiazepine and Z-drugs management: a qualitative study.

Benzodiazepines and Z-drugs (BZD/Z) are frequently prescribed for longer than recommended. Through their interactions with patients taking BZD/Z, primary care and mental health professionals play a key role in the management of this medication. To explore how primary care and mental health care professionals set treatment goals with users of long-term BZD/Z. A qualitative study using semi-structured interviews with professionals from mental health, addiction care, and primary care practices in Belgium. Semi-structured interviews were conducted, online and in person, with 24 professionals working in mental health and primary care. Inductive thematic content analysis was performed. Seven themes were identified from the analysis. Professionals tended not to use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) standard to diagnose a BZD/Z substance use disorder. They described criteria based on their experience. They identified diverse types of patients that influence their choice of treatment goals. Professionals appeared to position themselves according to their own treatment goals for their patients, either by promoting the goal of abstinence or harm reduction. Some of them reported feeling trapped into continuing to prescribe and considered BZD/Z withdrawal to be difficult. Some were afraid to engage in a conversation that might break the bond of trust with the patient. Few professionals mentioned patient participation in the treatment goal setting. They asked for targeted withdrawal recommendations, perceiving the current recommendations to be too broad. Whether primary care or mental health care professionals are more in favour of a total abstinence or a harm reduction approach to BZD/Z, professionals should be guided towards greater patient participation in setting and evaluating goals with patients taking BZD/Z.

Unraveling complexity in changing mental health care towards person-centered care.

Mental health care (MHC) needs to shift towards person-centered care to better meet people's individual needs. Open Dialogue (OD) is well-aligned with this perspective and brings it into practice. This study focuses on exploring the change process within a pilot project involving three MHC teams as they transition to a person-centered OD practice. Our aim is to identify and reflect on the challenges faced by MHC professionals in adopting person-centered care, and shedding light on the underlying complexity of these challenges. By gaining a better understanding of these obstacles, we hope to contribute to the adoption of the person-centered approach in MHC practice. Our research employed a qualitative design, involving a total of 14 semi-structured interviews with MHC professionals who were either trained in OD, OD trainees, or MHC professionals without OD training. To analyze the data, we utilized a hybrid approach that combined deductive - and inductive thematic analysis. We identified four distinctive challenges: (1) understanding and knowledge transfer, (2) (inter)personal process, (3) emotional discomfort, and (4) the need for multi-stakeholder participation and support. In practice, these challenges intersect and the appearance of and relationships between these challenges are not linear or disentangleable. Upon careful consideration of these interdependent challenges, it became evident that embedding a person-centered approach like OD brings about systemic change, leading to an unfamiliar situation X. The research findings indicated that understanding and conveying the concept of person-centered care in practical settings poses significant challenges. The field of knowledge management helps to capture the complexity of understanding and transferring this knowledge. The change process necessitates an (inter)personal process and elicits emotional discomfort, as person-centered OD practice confronts a deeply entrenched paradigm in MHC. Achieving a shared understanding of person-centered care requires dedicated time and attention, while introducing this approach prompts broader discussions on underlying values and human rights in MHC. Current implementation efforts may underestimate or overlook these underlying values, but initiating an open dialogue can serve as an initial step in addressing the complexities.

Attitude of mental healthcare providers toward tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia

IntroductionHealth systems around the world are struggling with the massive numbers of people with mental disorders who require professional care. The treatment gap for mental disorders is high all over the world, with between 76 and 85% of people in low- and middle-income countries with severe mental disorders receiving no treatment for their mental health conditions. Tele-psychiatry is used as an alternative solution to the problem of limited mental health services and effective Tele-psychiatry service use may be achievable if mental health providers have a good attitude towards it.ObjectiveTo assess the attitude of mental healthcare providers toward Tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia, 2022.MethodA Multicenter institution-based cross-sectional study was conducted among 413 mental health professionals working in public referral hospitals in Addis Ababa city, from May 04 to June 10, 2022. Data were collected by using a structured and self-administered questionnaire prepared by reviewing previous related studies. Epi Data version 3.1 and Stata version 14 were used for data entry and analysis respectively. Bivariate and multivariable logistic regression analyses were used to identify factors associated with attitudes toward Tele-psychiatry services. A statistical significance was declared at p-value < 0.05.ResultA total of 413 Participants were enrolled with a response rate of 91.8%. The majority of respondents 230 (55.69%) were male and the mean age of participants was 29 years (SD + 5.02). In this study the majority (49%) of mental health care professionals had a poor attitude toward Tele-psychiatry. Having electronic health technology experience [AOR 16.79; 95% CI (4.26, 29.3)], lack of training in telemedicine applications [(AOR 0.1; 95% CI (0.01, 0.41)], a good computer uses for daily work activities [AOR 3.65; 95% CI (1.14, 11.60)], availability of e-Health technology awareness program [AOR 0.16; 95% CI (0.03, 0.90)], having a positive perception about the importance of e-Health technologies[AOR 0.041; 95% CI (0.01, 0.29)] and having good knowledge of Tele-psychiatry services [AOR 6.89; 95% CI (1.8, 12.0)] were significantly associated with attitude towards Tele-psychiatry services.ConclusionThis study found that mental healthcare providers at a public referral hospital in Addis Ababa city generally had poor attitudes regarding Tele-psychiatry services. Considering the significant factors will improve the attitude to use tele-psychiatry services in Ethiopia.

Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial

Background Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months.Methods The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants’ primary relative will be evaluated.DiscussionThe results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness.Trial registrationClinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271–9928.

Understanding pandemic resilience: a mixed-methods exploration of burdens, resources, and determinants of good or poor well-being among Austrian psychotherapists.

The COVID-19 pandemic has exacerbated the mental health burden on the general population, resulting in increased demands on mental healthcare professionals, including psychotherapists. This cross-sectional study assessed the challenges and resources encountered by 513 psychotherapists based on an online survey conducted between April and May 2022. Qualitative methods content analysis of written reports was employed to investigate the emerging challenges and sources of support during the pandemic. A comparative analysis of burdens, resources, sociodemographic factors and daily physical activity was conducted to discern patterns of good and poor well-being. The predominant burden identified was mental health-related issues, followed by global crises and government-imposed restrictions to mitigate virus transmission. Essential resources encompassed social connections, mindfulness, work satisfaction, and internal processes. Notably, psychotherapists demonstrating good well-being were older, more physically active, had a lower proportion of females, were employed in private practices rather than in institutionalized settings, had more years of professional experience and treated more patients weekly than their counterparts with poor well-being. Furthermore, they exhibited greater optimism, health focus, and satisfaction with their coping methods. These findings can help develop support systems, policies, and educational programs to better support mental health professionals during global crises and offer strategies for individual practitioners to maintain their well-being.

Deep neural network technique for automated detection of ADHD and CD using ECG signal

Background and objectiveAttention Deficit Hyperactivity problem (ADHD) is a common neurodevelopment problem in children and adolescents that can lead to long-term challenges in life outcomes if left untreated. Also, ADHD is frequently associated with Conduct Disorder (CD), and multiple research have found similarities in clinical signs and behavioral symptoms between both diseases, making differentiation between ADHD, ADHD comorbid with CD (ADHD+CD), and CD a subjective diagnosis. Therefore, the goal of this pilot study is to create the first explainable deep learning (DL) model for objective ECG-based ADHD/CD diagnosis as having an objective biomarker may improve diagnostic accuracy. MethodsThe dataset used in this study consist of ECG data collected from 45 ADHD, 62 ADHD+CD, and 16 CD patients at the Child Guidance Clinic in Singapore. The ECG data were segmented into 2 s epochs and directly used to train our 1-dimensional (1D) convolutional neural network (CNN) model. ResultsThe proposed model yielded 96.04% classification accuracy, 96.26% precision, 95.99% sensitivity, and 96.11% F1-score. The Gradient-weighted class activation mapping (Grad-CAM) function was also used to highlight the important ECG characteristics at specific time points that most impact the classification score. ConclusionIn addition to achieving model performance results with our suggested DL method, Grad-CAM's implementation also offers vital temporal data that clinicians and other mental healthcare professionals can use to make wise medical judgments. We hope that by conducting this pilot study, we will be able to encourage larger-scale research with a larger biosignal dataset. Hence allowing biosignal-based computer-aided diagnostic (CAD) tools to be implemented in healthcare and ambulatory settings, as ECG can be easily obtained via wearable devices such as smartwatches.

Sexual Orientation, Mental Health Characteristics, and Self-Care in Professional Psychology Training and Employment

Although self-care practice is critical for mental healthcare professionals (MHP) to buffer against the impact of stressors and to prevent psychiatric symptoms and functional impairment, effective self-care may be more difficult for those at greater risk of developing mental health conditions due to sexual minority stress. The present study aimed to examine mental health characteristics, engagement in, and value obtained from self-care, and perceptions about training programs’ encouragement of self-care in trainees and professionals of different sexual orientations. Data were collected from MHP trainees and practitioners (n = 547) using an anonymous online survey including measures assessing stress, depression, anxiety, resilience, coping self-efficacy, and self-care strategy usage. Analyses revealed that bisexual individuals reported significantly greater mental health symptoms and self-care strategy usage as compared to heterosexual and gay/lesbian participants. Analyses also revealed lower levels of daily functioning and resilience in bisexual vs. heterosexual or gay/lesbian participants, and that bisexual participants reported obtaining less value from self-care practices than other subgroups. These results suggest that bisexual individuals may experience a unique set of minority stressors which affect their engagement with and benefit from self-care. Implications and suggestions for promoting inclusiveness and positive alterations in self-care engagement in training programs and professional institutions are discussed, including engendering coping self-efficacy through individual skill development, nurturing environments that reinforce self-care, ensuring access to culturally competent services, and promoting engagement in supportive groups and organizations.

Digital interventions in mental health: challenges and perspectives

The high prevalence, burden and social impact of mental disorders, the lack of mental health care professionals and services around the world, the improvement and dissemination of digital technologies are the factors that have provided increased attention to the process of digital transformation in mental health care recently. The COVID-19 pandemic has increased the importance of remote interaction between different participants in the therapeutic process. Digital technologies in mental health care can bring significant advances in both clinical and scientific psychiatry. The article presents the most promising digital solutions for the diagnosis, therapeutic interventions and prevention of mental disorders. The technologies by which they are implemented are described, including computer programs, virtual and augmented reality, internet resources. The advantages and disadvantages of digital technologies usage in psychiatric practice are analyzed. The article described the main barriers that stand in the way of digital transformation in mental health, including insufficient scientific and practical support of the developed digital products, the lack of methodological foundations, the regulatory framework, and legislation.

Conventional and living guideline for schizophrenia: barriers and facilitating factors in guideline implementation

This study aims to investigate the barriers and facilitators to guideline adherence for the print format of the German schizophrenia guideline as well as for the concept of a digital living guideline for the first time. For this purpose, the schizophrenia guideline was transferred to a digital guideline format within the web-based tool MAGICapp. An online survey was performed under participation of mental healthcare professionals (medical doctors, psychologists/psychotherapists, psychosocial therapists, caregivers) in 17 hospitals for psychiatry in Southern Germany and a professional association for German neurologists and psychiatrists. 524 participants opened the survey, 439 completed the demographic questions and commenced the content-related survey and 309 provided complete data sets. Results indicate a higher occurrence of knowledge-related barriers for the living guideline. The print version is associated with more attitude-related and external barriers. Older professionals reported more attitude-related barriers to a living guideline compared to younger professionals. Differences between professions regarding barriers were found for both formats. Various barriers exist for both guideline formats and a need for facilitators was expressed across professions. Many of the mentioned obstacles and facilitators can be more easily addressed with living guidelines. However, also living guidelines face barriers. Thus, the introduction of these new formats alone cannot lead to sustainable behavior change regarding guideline adherence. Yet, living guidelines seem to be a cornerstone to improved and tailored guideline implementation as they facilitate to keep recommendations up to date and to address the need of individual professional groups.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.

Pyschological traumatic perinatal experiences during the Covid-19 pandemic, epigenetic hypothesis and protective suggestions

AbstractWhether Covid-19 will continue with different viral mutations it will last is not yet known. For this reason, correct management of the process becomes important in order to ensure that future generations are least affected by this experience. This literature review aims to discuss hypotheses for the epigenetic effect of perinatal experiences affecting mental health during the Covid-19 pandemic and protective intervention recommendations. A comprehensive understanding of epigenetic mechanisms can allow early risk detection and directed prevention and intervention strategies. There is a need for epigenetic studies that monitor the short- and long-term effects in women/infants going through the perinatal period during the Covid-19 pandemic. Epigenetic studies are costly and take a long time. At this time where the pandemic is still ongoing, it is predicted that the negative effects will be reduced by predicting epigenetic effects and taking protective approaches in line with the results obtained from previous studies. These will be possible with the collective work of multidisciplinary team members. Mental health care professionals should receive training on epigenetics in the perinatal period and should be able to integrate it into counseling processes.

Contextual factors influencing the use of coercive measures in Portuguese mental health care

The use of coercive measures in mental health care is an important indicator of the quality of care being provided, and non-patient-related factors are increasingly recognized to contribute to their use. The study aimed to explore the perspectives of mental health care professionals who have first-hand experience with the use of coercion on the contextual factors that influence the use of coercion in the Portuguese mental health care. Five focus group discussions were conducted among 23 doctors and 17 nurses from five psychiatric departments in urban and rural regions of Portugal. Discussions were audio recorded, transcribed, and analyzed with the aid of MAXQDA. Four broad themes related to insufficient resources, staff-related factors, inefficient services, and socio-legal factors were derived. Participants highlighted how inadequate structures, staff shortages, staff attitudes, a lack of training, restrictive ward rules, an inefficient organization of services, the mental health legislation, and public attitudes contributed to the use of coercive measures. The COVID-19 pandemic complicated existing shortfalls in the system and increased the use of coercive measures. The study confirms that the use of coercive measures in mental health care is influenced by factors that are independent of patient characteristics. Addressing existing systemic problems is crucial for the successful implementation of interventions to reduce coercion in mental health care.

Comparison of Electronic Health Record Messages to Mental Health Care Professionals Before vs After COVID-19 Pandemic

This qualitative improvement study examines the change in electronic health record messaging from patients to mental health professionals before vs after the COVID-19 pandemic.

Stigmatization and Self-Perception regarding issues related to Mental Health: A qualitative survey from a lower and middle-income country.

To assess the understanding of the patients with common mental disorders, towards issues related to their mental health. This qualitative study was conducted from December 2018 to April 2020. Thirty-four patients, suffering from common mental disorders, were interviewed in public and private sector hospitals of Peshawar. The interviews were recorded, transcribed, translated into English, and themes were generated from their responses. Content analysis was carried out on the data obtained. The themes resulting from each interview were then further comparatively analyzed. The mean age of the sample was 31.9±10.61 years. Most of the patients (n=24, 70.6%) were aware that the nature of their illness was a psychological one with a majority (n=17, 50%) describing it with the symptoms of headache or burden on the head. Most of the patients (n=14, 41.1%) were unaware of the general public opinion towards mental disorders but those who were aware described these with stigmatizing descriptions e.g., "people call them crazy" etc. Most of the patients (n=20, 58.8%) were unaware about their own opinion regarding their illness and some said that they tried to conceal their illness from others. Unfortunately, most of the patients (n=19, 55.8%) were not aware of mental healthcare professionals or the existence of psychiatry as a profession. Stigma, both public and personal, was quite high, which caused patients to feel compelled to conceal their illness. There was also a general lack of knowledge with regard to mental disorders in our society. The general public opinion about mental health professionals was not favorable.

Older age bipolar disorder.

Older age bipolar disorder (OABD) refers to patients with bipolar disorder aged 50 years and over. There is a paucity of evidence-based guidelines specific to OABD, but in recent years, several studies have been published on OABD. The current review synthesizes previous literature (up to January 1, 2021) as well as most recent literature on OABD (since January 1, 2021). This review covers the following themes: diagnosis and specifiers, clinical course, psychosocial functioning, cognition, physical comorbidities, and pharmacotherapy. On the basis of the latest data, specific clinical recommendations are proposed for each theme. OABD forms a more complex subgroup of bipolar disorder, with an increased risk of cognitive deficits, physical comorbidities, impaired psychosocial functioning, and premature death. The distinctions between BD-I and BD-II and between EOBD and LOBD do not clinically represent relevant subtypes for OABD patients. Mental healthcare professionals should treat all OABD patients with an integrative care model that takes into account cognitive and physical comorbidities and that contains elements aimed at improvement of psychosocial functioning and quality of life. Older age itself should not be a reason to withhold lithium treatment. Future research should collect data on essential data domains using validated measurement scales.

Tools of genomic medicine for clinical practice: The example of psychiatry.

Most psychiatric disorders are moderate to highly heritable, often with different genetic architectures. Although genetic research in psychiatry has progressed, its findings, interpretation, and impact on clinical psychiatry are unknown to most mental healthcare professionals. This article addresses key genetic concepts to understand some clinical entities, emphasizing genetic terminology and types of mutations. Particularly, we describe the role of heritability in the early days of psychiatry genetic research, the most used study designs, and their main objectives. On the other hand, we review some genetic and genomic databases useful for clinical practice. These include Online Mendelian Inheritance in Man, ClinVar, Ensembl, and The Single Nucleotide Polymorphism Database. Finally, a clinical vignette is presented in which we can apply genomic medicine tools. Since the evidence in psychiatric genetics is based on studies carried out in European or North American ancestral populations, we must develop local studies to increase the knowledge and application of genomic medicine on underrepresented populations.