Participation Of Psychiatrists Research Articles

Justice Department, States Sue to Block Health Insurance Mergers

Justice Department, States Sue to Block Health Insurance Mergers

Big data for bipolar disorder.

The delivery of psychiatric care is changing with a new emphasis on integrated care, preventative measures, population health, and the biological basis of disease. Fundamental to this transformation are big data and advances in the ability to analyze these data. The impact of big data on the routine treatment of bipolar disorder today and in the near future is discussed, with examples that relate to health policy, the discovery of new associations, and the study of rare events. The primary sources of big data today are electronic medical records (EMR), claims, and registry data from providers and payers. In the near future, data created by patients from active monitoring, passive monitoring of Internet and smartphone activities, and from sensors may be integrated with the EMR. Diverse data sources from outside of medicine, such as government financial data, will be linked for research. Over the long term, genetic and imaging data will be integrated with the EMR, and there will be more emphasis on predictive models. Many technical challenges remain when analyzing big data that relates to size, heterogeneity, complexity, and unstructured text data in the EMR. Human judgement and subject matter expertise are critical parts of big data analysis, and the active participation of psychiatrists is needed throughout the analytical process.

Forensic psychiatric aspect of battered women syndrome: The cycle of violence

Introduction Domestic violence against women is a burning problem in Russia. Forensic psychiatrists found out that domestic abuse against women is often one of the main causes of crimes of violence in women. Aims To find out clinical and social factors contributing to aggressive crimes committed by women who are victims of intrafamily violence. Methods Clinical, psychological, statistical. Details of background, psychiatric and offending history were extracted. Each item was assessed with the help of descriptive statistics. Results A cohort of 12 females was examined by forensic psychiatrists. All women were victims of violence by their husbands or partners. Domestic abuse resulted in long-term mental problems of women. Clinical assessment has revealed depression, anxiety, fear, low self-esteem, PTSD, alcohol abuse. All women had committed murders. The research has revealed two types of homicides. Women of the first subgroup displayed pathological altruistic motivation of murder of their children (4 females). Women of the second subgroup (8 females) had committed homicides of their husbands or partners. Conclusion The research shows the necessity of domestic violence prevention by legal provisions and multidisciplinary research with the participation of psychiatrists, psychologists, social workers.

Fight Against Misuse of Psychiatry Wins Sharfstein Award for Courage

Fight Against Misuse of Psychiatry Wins Sharfstein Award for Courage

Ethical use of the media by psychiatrists: towards an antipodean formulation of the "Goldwater Rule".

To review the ethical problems posed by the participation of psychiatrists in various forms of lay media and propose a method of resolving quandaries in this area. We review the potential ethical problems that arise when psychiatrists make contributions to the lay media, particularly when commentary and opinion reflects the views of the individual rather than the profession. The issues raised by the North American injunction known as the "Goldwater Rule" are pertinent to Australasia, particularly when media statements made by psychiatrists may seem to diminish the profession through politicisation, polemic, or bringing the profession and the field into disrepute. We propose a series of reflective questions to assist psychiatrists in Australasia to deliberate on the potential ethical problems arising from their participation in media activities. We conclude that it is for the Royal Australian and New Zealand College of Psychiatrists to formulate an approach to situations where the media activities of Fellows raise such problems.

Ethical Commitments and Social Issues in Psychiatry

Sound, ethical decision making is essential to astute and compassionateclinical care. Wisepractitioners readily identify and reflect on the ethical aspects of their work. They engage, often intuitively and without much fuss, in careful habits—in maintaining therapeutic boundaries, in seeking consultation from experts when caring for patients with difficult or especially complex conditions, in safeguarding against danger in highrisk situations, and in endeavoring to understand more about mental illnesses and their expression in the lives of patients of all ages, in all places, and from all walks of life. These habits of thought and behavior are signs of professionalism and help ensure ethical rigor in clinical practice. Psychiatry is a specialty of medicine that, by its nature, touches on big moral questions. The conditions we treat often threaten the qualities that define human beings as individual, autonomous, responsible, developing, and fulfilled. Furthermore, the conditions wetreat often are characterized by great suffering, disability, and stigma, and yet individuals with these conditions demonstrate such tremendous adaptation and strength as well. If all work by physicians is ethically important, then our work is especially so. As a service toFocusreaders,thiscolumn provides ethics commentary on topics in clinical psychiatry. It also offers clinical ethics questionsandexpertanswersinordertosharpenreaders’decisionmaking skills and to advance astute and compassionate clinical care in our field. Laura Weiss Roberts, M.D., M.A.

Ethics, Interrogation, and the American Psychiatric Association.

Recently, it has been alleged that the American Psychological Association colludedwith the GeorgeW. Bush administration to allowpsychologist participation in enhanced interrogations of detainees in the war on terror. James Risen writing in The New York Times (1) asserted that a recent review of emails suggests that the American Psychological Association policy that supported this interrogation was adopted with the direct involvement of psychologists whoworked in the U.S. national securityapparatusandstructuredtoovercomeobjections from the Office of Legal Counsel in the Department of Justice over the continuation of the enhanced interrogation program. The American Psychological Association Board of Directors in late 2014 announced an independent legal review of these allegations tobeoverseenbyaspecial committeeof theirboard(2). These reports ledus to review thehistory of the adoption in 2006 of the formal position of the American Psychiatric Association that states categorically that psychiatrists should not participate in such enhanced interrogations (3). Sharfstein served as President of the American Psychiatric Association in 2005–2006 when the position statement was written and adopted; Summergrad served as President in 2014–15 when these new allegations regarding the American Psychological Association arose, and worked to make the American Psychiatric Association’s long-standing opposition to psychiatrist involvement in interrogations clear to the general public (4). Looking back on the 2005–2006 period, the question of whether physicians, especially psychiatrists, were participating in the interrogation of detainees had become a particular focus of concern at the Guantanamo Naval Base in Cuba in 2005. Concerns about national security and possibility that enhanced interrogationmight foil further terrorist attacks seemed to take priority over other concerns. Upon reading 2006 reports in The New Yorker magazine and theNewEngland Journal ofMedicine alleging psychiatrist participation in so-called “behavioral science consultation teams”, Sharfsteinwrote toAssistant Secretary forDefense for Health Affairs WilliamWinkenwerder, MD, stating that such participation “could be construed as facilitating treatment of prisoners in amanner inappropriate topsychiatryandpossibly in violation of medical ethics” (5). The American Psychiatric Association formally requestedavisit to theGuantanamoBase. This request led to an October 19, 2005 visit that included Department of Defense personnel; Steven Sharfstein, MD, in his role asPresidentof theAmericanPsychiatricAssociation; the President of the American Psychological Association; the Surgeon General of the United States; and the Surgeons General of the Army, Navy, and Air Force. The day-long visit included discussionswiththebasecommanderaswellasawalkthroughof the prison complex, observation of the detainee hospital, and atourof thenearly$3millionpsychiatricwing.Upontheirreturn at 8 p.m. to Andrews Air Force Base, participants engaged in aspiritedthree-hourdiscussion.Sharfsteindistributedaposition paper developed by the American Psychiatric Association Council of Psychiatry and Law that raised concerns regarding psychiatric participation in the interrogation of detainees. This statement had been developed after a two-day meeting of the American Psychiatric Association’s Council of Psychiatry and Law, Ethics Committee, the Committee on Judicial Action, the Committee on Misuse and Abuse of Psychiatry, and representatives of military psychiatry. It was clear at this postvisit dinner that the American Psychiatric Association position contrasted sharply with the position of the American Psychological Association. In 2005 the American Psychological Association had taken the position that “Psychologists may serve in various national security roles, such as consultants to an interrogation, in a manner that is consistent with their ethics code...”(6).Themilitaryhealthleadersatthemeetingaskedwhy psychiatristsmightobject toparticipation in these interrogations but not psychologists. Emphasizing our Hippocratic oath, our profoundethical obligations topatients, andourabidingconcern that such consultation could involve psychiatrists in facilitating deception and cruel and degrading treatment, we argued that it was wrong to permit skills that offer healing to ever be used for gaining intelligence. The difference between psychiatry and psychologywasclear in thedeeprootingof thepsychiatriccanon in medical ethics. Sharfstein then took the statement craftedby theCouncil of Psychiatry and Law to the American Psychiatric Association Board of Trustees for final debate and action. Therewas again spirited and open discussion that included both our national security role as psychiatrists and the ethics of psychiatric care. The position statement was passed by the American Psychiatric Association Assembly in May 2006, adopted later that afternoon by the American Psychiatric Association Board of Trustees, and immediatelymadepublic. It states:“TheAmerican Psychiatric Association reiterates its position that psychiatrists should not participate in, or otherwise assist or facilitate, the

Legal and Psychological Aspects of the Protection of the Victim's Rights Showing Signs of Mental Illness in the Criminal Proceedings.

Research of the offender by expert psychiatrists and psychologists is a regular part of the criminal proceedings. The necessity for a suspect present research is one part of the protection of his rights. In any situation where there is doubt as to the sanity of a suspect at the time of the offense, the examination is mandatory. The study of victims of crime by expert psychiatrists or psychologist is carried out in exceptional cases. Analysis of records of criminal cases in which the victim showed signs of mental disorder or mental illness leads to the conclusion that it is necessary to introduce mandatory participation expert psychiatrists or psychologists in the event of doubt as to the mental health of the victim. Psychiatric or psychological opinion is essential for assessing the reliability, suitability testimony of victims of crime. It also allows you to provide appropriate support, allowing the elimination of re-victimization of the victim. Research has shown that the participation of psychiatrists or psychologist during the preparatory proceedings, allows the elimination of unjustified accusations before the case goes to court.

Rates of Psychiatrists’ Participation in Health Insurance Networks

Rates of Psychiatrists’ Participation in Health Insurance Networks

Integrating Psychiatric Services into Comprehensive Dementia Care in the Community

Purpose: This study was conducted to clarify the utility of patient-held records as an integrated care approach for patients with dementia in the community. Method: We analyzed the family-held/patient-held records of patients with dementia in the community. The inclusion criteria in the study were as follows: 1) patient-held/family member-held records of patients with dementia in the community; 2) patient-held records designed to share information across different professionals, direct-care staff members, and local government staff; and 3) the continuous participation of psychiatrists in the development and use of the patient-held records. Results: We identified eight sets of family-held/patient-held records in Japanese communities of various sizes, all of which were aimed at integrating information from various services, including information provided by medical and psychiatric professionals to the family and patient. Innovative tools have been available in the areas of the hopes and preferences of the patient, medication and monitoring, sharing information, and the use of information technology. Conclusion and Discussion: Family-held/patient-held records have potential as a tool to enhance the integrated care of people with dementia in the community.

Cultivating the Next Generation of Psychiatrists

Cultivating the Next Generation of Psychiatrists

She Sought Volunteer Clinicians, and Hundreds Answered the Call

Psychiatrists are needed to donate their time and skills to help soldiers piece their lives back together upon returning to the United States from Iraq and Afghanistan.

The Truth About Psychiatry and Health Care Insurance

The Truth About Psychiatry and Health Care Insurance

Collaborative Care Well Suited to New Medicaid Health Home Option

Collaborative Care Well Suited to New Medicaid Health Home Option

A review of the experience, the effectiveness and the spread of behavioral-cognitive group intervention in psychiatric ward

The use of Cognitive-Behavioral Group Intervention (CBGI) in Psychiatric Ward (SPDC) in Italy began in the year 2000 and it became more and more popular in different geographic areas of our country. In this paper we briefly describe the intervention, the theoretical framework, the effectiveness and efficiency in Italy as well as in the international context. Based on the theoretical model "stress-vulnerability-coping", the ICCG is a manualized treatment, innovative and effective in the acute care, using the group setting to foster a climate of collaboration between users and operators, to raise awareness, the adherence to the treatment plan and the satisfaction. This article provides an overview of studies of effectiveness, in particular those performed in Rome, Campobasso, Foggia, Arezzo which are of different lengths (1, 2, 4 and 5 years of follow-up). The results showed a reduction in voluntary as well as compulsory treatment (p<.01), an increase of ward's atmosphere and of the user satisfaction (p<.01), and also decreased aggressive acts (p.01). Finally, the results obtained through a survey of the various experiences, of the diffusion and how the intervention is applied in the various SPDC Italians are shown. The CBGI is more popular in the North of Italy, according with an increasing demand for training. The practical benefits observed by data collected are also illustrated; they mainly consist in improving the climate of the ward, in a better positive communication among users and between them and the professionals, in the fastest adherence to the treatment and of the active participation and informed care. Are also discussed factors that hinder the use in routine, including the low participation of psychiatrists and the difficulty in changing the organizational style of work in the ward.

Helping Residents Make ‘Good’ or ‘Bad’ Decisions

Helping Residents Make ‘Good’ or ‘Bad’ Decisions

APA to Survey Members About EHR Use

Back to table of contents Previous article Next article Professional NewsFull AccessAPA to Survey Members About EHR UseMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Jan 2013https://doi.org/10.1176/appi.pn.2013.12b18AbstractThe survey should help inform the design of future electronic health record (EHR) systems for psychiatrists and minimize or avoid pitfalls associated with EHRs.Are you using an electronic health record (EHR), and if so what kind? APA wants to know and will be surveying its members early this year to find out.In conjunction with AmericanEHR Partners and the American College of Physicians (ACP), APA is participating in a nationwide survey of physicians from every major specialty group. The survey, which is being e-mailed to members this month, is designed to ascertain the extent to which physicians are using electronic health records, the kinds of products they use, and their opinions about them.Members who complete the survey will be entered into a drawing for a new Apple mini-tablet computer.Robert Plovnick, M.D., M.S., director of APA’s Office of Quality Improvement and Psychiatric Services, said the survey will take approximately 50 minutes to complete. It consists of a set of questions that every physician, regardless of specialty, will be asked; a second set of questions targeting those who are currently using some kind of EHR product; and a third set of questions specifically for psychiatrists.Responses to the survey will be confidential, and physician identities will not be used in reporting survey results.“The goal is to get a sense of EHR usage and collect detailed information on the products currently used by psychiatrists,” Plovnick told Psychiatric News. “This is directly responsive to requests we have received from all areas of the organization. Everyone wants to know which EHRs psychiatrists are using and what they think of them, so we can have a sense of the state of the EHR market and help our members make their own purchasing decisions.“So far we have had to rely on anecdotal evidence, so the survey is an opportunity to provide more-robust information about available EHR products to our members,” he said. “The more feedback we get, the more useful it will be to the field.”(According to its Web site, AmericanEHR Partners has been developed by Cientis Technologies and ACP; it provides physicians, state and federal agencies, vendors, and funding organizations with tools to identify, implement, and effectively use electronic health records and other health care technologies.)The psychiatry-specific questions gauge clinician satisfaction with the ability of an EHR to use DSM diagnoses and coding; ability to create or customize templates for psychiatry specific documentation; ability to manage separate psychotherapy notes; ability to create and share records with members of a treatment team, including other physicians, psychologists, and social workers; and ability to record substance use, among other issues.Psychiatrist Daniel Balog, M.D., a member of APA’s Committee on Electronic Health Records, said psychiatrist participation in the survey can also help influence the design of EHR products in the future.“The majority of current EHR systems were designed with a predominance of medical input, so APA’s involvement in this clinical survey provides member psychiatrists a platform to share their EHR experiences,” Balog told Psychiatric News. “The survey includes specialty questions designed by the APA EHR Committee to target information relevant to member psychiatrists who are shopping for EHR systems or who are in a position to influence purchasing decisions made by larger organizations.” ■More information about EHRs is posted on the APA Web site at http://www.psychiatry.org/ehr. Information about American EHR Partners, including information about EHR products derived from responses from physicians who have completed the survey, is posted at http://www.americanehr.com. ISSUES NewArchived

Stomatologic complications of eating disorders

Since the 1990s numerous international experts have reported about the somatic complications of eating disorders including those having a dental and stomatological nature. Several reports emphasised that deformations in the oral cavity resulting from this grave nutritional disease typical of the young generation could already appear in the early stage and, therefore, dentists are among the first to diagnose them. Dentists are still often unaware of the importance of their role in multidisciplinary treatment. Even if they knew what the disease was about and recognised it on the basis of deformations in the oral cavity in time, their advice that their patients should brush their teeth more often would fail to eliminate the root cause of the problem. Not only the earliest possible treatment of the complications of the bingeing-purging mechanism and the maintenance of oral hygiene are important, but controlling and curing pathological habits with active participation of psychiatrists are also required to ensure full recovery. Due to the multidisciplinary nature of the disease, manifold communication is required. For this reason, publishing the dental ramifications of organic and systemic diseases at dental conferences and in technical journals, as well as providing information about oral complications of eating disorders for general practitioners and specialists are particularly important.

Collaborative-Care Models Prove Cost-Effective

Back to table of contents Previous article Next article Professional NewsFull AccessCollaborative-Care Models Prove Cost-EffectiveMark MoranMark MoranSearch for more papers by this authorPublished Online:7 Sep 2012https://doi.org/10.1176/pn.47.17.psychnews_47_17_4-aAbstractModels of “collaborative chronic care” can improve mental and physical outcomes for individuals with psychiatric disorders across a wide variety of care settings, and they provide a robust clinical and policy framework for care integration, according to a meta-analysis published July 12 in AJP in Advance.Investigators performing a literature search found 161 analyses from 57 trials involving care of a mental disorder (depression, n=40; bipolar disorder, n=4; anxiety disorders, n=3; multiple/other disorders, n=10). The meta-analysis indicated significant effects across disorders and care settings for depression as well as for mental and physical quality of life and social-role function.Moreover, total health care costs did not differ between collaborative-care models and comparison models.The report was titled “Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions Across Primary, Specialty, and Behavioral Health Care Settings: Systematic Review and Meta-Analysis.” The analysis was conducted by Emily Woltman, Ph.D., of the Brown School of Social Work at Washington University, and colleagues.Collaborative care—also known as “integrated care”—is a feature of the delivery-system reforms in the new health care reform law, and policymakers and many clinicians have converged on the idea that the full range of medical services should be brought together in patient-centered locations. Integrated care was the theme of immediate past APA President John Oldham, M.D.’s presidential year. And today, a small but dedicated cadre of psychiatrists is advancing the cause of integrated care and the participation of psychiatrists in collaborative-care models (Psychiatric News, October 21, 2011).Integrated-care models have evolved from the traditional consultative role that consultation-liaison psychiatrists have practiced, to a “co-located” model in which psychiatrists see individual patients in a primary care clinic, to a fully collaborative care model in which a psychiatrist takes responsibility for a caseload of primary care patients and works closely with primary care clinicians and other primary care–based mental health care providers. Though models may differ, the core principles of collaborative care are constant: patient-centered care teams providing evidence-based treatments to a defined population of patients using a measurement-based “treat-to-target” approach. (The latter refers to the use of tested instruments so that symptoms can be measured with numerical targets established for clinical treatment goals.)In the AJP in Advance analysis, randomized, controlled trials comparing collaborative-care models (CCMs) with other care conditions, published or in press by August 15, 2011, were identified in a literature search and through contact with investigators. CCMs were defined as interventions with at least three of the six components of the Improving Chronic Illness Care initiative developed by the Robert Wood Johnson Foundation. Those components include patient self-management support, clinical information systems, delivery-system redesign, decision support, organizational support, and community resource linkages. (Details about the initiative are posed at www.improvingchroniccare.org/.)Articles were included if the CCM effect on mental health symptoms or mental quality of life was reported. Data extraction included analyses of these outcomes plus social-role function, physical and overall quality of life, and costs.An example of a trial of collaborative care that was included in the analysis was a report titled “Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized, Controlled Trial,” which appeared in the Journal of the American Medical Association (December 11, 2002).In that trial, patients were randomly assigned to a collaborative-care intervention or to usual care. Patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert. Services included education, care management, and support of antidepressant management or a brief psychotherapy. The report found that at 12 months, intervention patients had a significantly greater reduction in depressive symptoms from baseline compared with usual-care participants. Intervention patients also experienced greater rates of depression treatment, more satisfaction with depression care, lower depression severity, less functional impairment, and greater quality of life.Woltman and colleagues said that the analysis demonstrates the cost-effectiveness and outcome-enhancing utility of chronic-care models. “CCM effects were robust across populations, settings, and outcome domains, achieving effects at little or no net treatment costs,” they wrote. “Thus, CCMs provide a framework of broad applicability for management of a variety of mental health conditions across a wide range of treatment settings, as they do for chronic medical illnesses.” “Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions Across Primary, Specialty, and Behavioral Health Care Settings: Systematic Review and Meta-Analysis” is posted at http://ajp.psychiatryonline.org/Article.aspx?ArticleID=1213771. ISSUES NewArchived

Geriatric Psychiatrist Honored for Innovative Care Strategies

The vision of Yeates Conwell, M.D., dovetails with the movement toward “integrated care,” merging primary and mental health care with social services to improve service coordination and lower costs.