Place In Psychiatry Research Articles

Complicated grief: Is there a place in psychiatry?

IntroductionGrief is as normal reactive to a significant personal loss. It is characterized by affective, cognitive, behavioural and physiological symptoms. The grieving process is usually divided in five different stages, but in most cases presents a benign course, with decreased suffering and better adaptation to the new context. However, when high levels of emotional suffering or disability persist over a long time period, it becomes a case of complicated grief (CG), which should be adequately addressed.ObjectivesTo review the characteristics of CG, the evidence that supports it as an individual pathological entity, and its place in current classification systems.MethodsWe performed a bibliographic search in Pubmed and PsychInfo, of articles written in English, Portuguese and Spanish, containing the key words: grief, bereavement, psychiatry, classification.ResultsThe main issue regarding grief is the degree to which it is reasonable to interfere with a usually benign process. Since DSM-III bereavement has been referred to as an adaptive reaction to an important loss, which should not be diagnosed as major depressive disorder or adjustment disorder. However, DSM-5 has stated persistent complex bereavement disorder as an independent entity. In fact, CG fulfils the general criteria of every psychiatric syndrome, namely regarding specific diagnosis criteria, differential diagnosis from depressive disorders and post-traumatic stress disorder, and improvement with adequate treatment.ConclusionIt is important to correctly approach CG, since it presents with characteristic diagnosis features and much improvement may be achieved once adequate treatment is provided.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatry in the Foundation Programme: An overview for supervisors

SummaryHealth Education England's 2014 reportBroadening the Foundation Programmehas led to a rapid increase in the number of psychiatry placements for foundation doctors. This will have implications for existing psychiatrists in that they will start to teach, train and supervise foundation doctors. This article outlines how to develop high-quality foundation posts and how to support doctors in meeting the foundation curriculum competencies, which include experience of working in multidisciplinary teams and developing communication skills. The knowledge and skills gained in psychiatry placements will be valuable to all doctors, no matter what their future career intentions.Learning Objectives• Describe the recent changes to the Foundation Programme in psychiatry and how they will affect supervisors• Learn how high-quality placements for foundation doctors can be developed• Recognise how foundation doctors can be supported to achieve the generic and mental health-specific competencies of the foundation curriculum in psychiatry placements

Psychedelics in the treatment of unipolar mood disorders: a systematic review.

Unipolar mood disorders, including major depressive disorder and persistent depressive disorder (dysthymia), confer high rates of disability and mortality and a very high socioeconomic burden. Current treatment is suboptimal in most cases and there is little of note in the pharmaceutical development pipeline. The psychedelic drugs, including lysergic acid diethylamide and psilocybin, were used extensively in the treatment of mood disorders, and other psychiatric conditions, before their prohibition in the late 1960s. They are relatively safe when used in medically controlled environments, with no reported risk of dependence. Here, we present a systematic review of published clinical treatment studies using psychedelics in patients with broadly defined UMD, and consider their place in psychiatry. Whilst all of the included studies have methodological shortcomings, of 423 individuals in 19 studies, 335 (79.2%) showed clinician-judged improvement after treatment with psychedelics. A recently completed pilot study in the UK favours the use of psilocybin with psychological support in treatment resistant depressive disorder. The evidence overall strongly suggests that psychedelics should be re-examined in modern clinical trials for their use in unipolar mood disorders and other non-psychotic mental health conditions.

The Foundation Programme in psychiatry: a qualitative study into the effects of a foundation placement.

Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry.Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects.Clinical implications Those developing foundation placements will need to ensure they are of high quality.

Predictors of Comfort and Confidence Among Medical Students in Providing Care to Patients at Risk of Suicide.

The aim of this study was to identify factors associated with comfort and confidence in providing care to patients at risk of suicide, in a sample of Australian medical students. An online cross-sectional survey was completed by 116 current medical students (42% male) aged between 20 and 41years (M = 25, SD = 3.8). Greater personal experience of suicide and previous contact with patients with psychiatric problems were significantly associated with both increased perceived comfort and increased confidence in providing care for individuals with suicidal thoughts or behaviors, based on self-report. However, these effects may not reflect objective measures of competency and additional research is needed to assess generalizability of the findings due to the sampling method. Increasing medical student contact with patients at risk of suicide through the implementation of psychiatry placements, gateway programs, and early year exposure to patients with psychiatric problems may increase perceived confidence and comfort in providing care to individuals at risk of suicide. Further research should evaluate the impact of such programs on behavioral indices of clinical competency.

Psychiatry training experiences: a narrative synthesis.

In Australia and internationally, psychiatry has struggled to fill training places to keep up with demand for service. The objective of this study was to review the components of psychiatry terms and placements that determine a positive experience and potentially influence interest in vocational training in psychiatry. A literature review and narrative synthesis was undertaken on 20 papers identified as meeting inclusion criteria. The top themes contributing to positive experiences during the psychiatry term were: receiving high quality supervision; supported autonomy; and witnessing patient recovery. There was a paucity of Australian literature preventing investigation of the Australian context alone. There is a need to better understand how the junior doctor and medical student psychiatry experience influences perceptions of psychiatry and intention to specialise, especially in the Australian context.

A clinical induction workshop for new starters in psychiatry

As more foundation doctors are encouraged to undertake placements in psychiatry, Antonina Ingrassia describes an induction programme that helps prepare doctors with no experience of the specialty

Before and after: Effect of 4-week psychiatry attachment on medical students’ attitude to psychiatry as a career choice

BackgroundPsychiatry is historically unpopular amongst medical students. The perception that psychiatry is remote from the rest of medicine and not evidence-based has been identified. However, there is evidence that psychiatry placement has positive effects on students. There are reports that medical students experience a positive change of attitude towards psychiatry following their undergraduate psychiatric attachment. There is evidence that medical students experience a positive change of attitude towards psychiatry following their undergraduate psychiatric attachment.AimTo determine the effect of a four-week psychiatry placement on 3rd year medical students’ attitudes towards psychiatry.MethodsPre-and post-attachment questionnaires were administered to four cohorts of 3rd year students. Responses were anonymised and based on Yes/No, free-text, order of preference and Likert scale. Analysis was by basic statistical methods.ResultsA total of 98 pre- and 81 post-placement students responded. Mean positive attitude increased by 6% and the percentage of students choosing psychiatry in their top three career choices increased from 7 to 20%. Ninety percent of students post-attachment thought that psychiatry is relevant to their future jobs, compared to 86% pre-attachment. The percentage of students who think that psychiatry makes little use of medical training decreased from 20% to 16%.ConclusionsThe survey showed a period of 4 weeks psychiatry placement has a positive effect on the attitudes of medical students towards psychiatry. It also increases the number of students wanting to pursue a career in psychiatry.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Lessons from a Balint group scheme led by psychiatry trainees for year 3 bristol medical students on their medicine/surgery placements

BackgroundThe UK General Medical Council highlights the centrality of effective communication, reflective practice and the doctor-patient relationship in medical practice. A decline in empathy has been documented as occurring within clinical and early postgraduate years, potentially affecting diagnostic processes and patient engagement. Access to Balint groups can enhance awareness of the patient beyond the medical model, but remains limited at many UK medical schools. This scheme offered Balint groups to Bristol medical students in their first clinical year, demonstrating that this method is relevant beyond psychiatry.MethodsInitial focus groups with medical students indicated that many felt unable to discuss distressing aspects of clinical encounters. During 2013-2014, a Balint scheme run by psychiatry trainees was started for 150 students in their psychiatry placements. During 2014-15, the scheme was introduced to all third-year medical students on their medicine/surgery placement. Balint leaders have group supervision with a psychoanalytic psychotherapist. Evaluation of the scheme was based on pre-and post-group questionnaires and leaders’ process notes.ResultsSixteen groups led by 12 trainees were run twice over the year to serve 246 medical students. Two example cases are discussed here. Students appreciated the chance to discuss complex encounters with patients in a supportive peer environment, and work through a range of emotionally challenging issues.ConclusionsNovel aspects of this work include the implementation of Balint groups within medicine and surgery placements; the enrolment of psychiatry trainees as leaders with group supervision and leadership training workshops from the UK Balint Society; and the scale of the scheme.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evaluation of psychiatry attachment on medical students’ attitude to mental illness

BackgroundMental illness is subject to stigma, discrimination and prejudice by both healthcare professionals and public. Fortunately, students are still flexible in their beliefs and there is evidence that education in psychiatry may help to positively alter these beliefs. This survey looks into how psychiatry placement positively influences attitudes of medical students to mental illness.AimsTo elicit the effect of clinical attachment in psychiatry on 3rd year medical students’ attitudes toward mental illness.MethodsQuestionnaires were administered to four cohorts of students pre- and post-attachment. Responses were anonymised. Responses were based on Yes/No, free text, order of preference and Likert scale. Analysis was with basic statistical analysis.ResultsNinety-eight pre- and 81 post-placement students responded. There was a 4% increase in mean positive attitude scores following the placement. There was no significant difference in the medical students’ attitudes to violence in mental illness and that patients with mental illness do not want you to help them. Students post-attachment were more likely to disagree with the statement, ‘Psychiatric patients are difficult to like’. However, 6% more students agreed with the statement ‘Alcohol abusers have no self-control’ after the placement!Conclusions and recommendationFollowing the 4-week attachments, the percentage of students reporting more positive attitudes to mental illness showed only a marginal increase. A possible explanation may be insufficient contacts with patients and a feeling of not been part of the treating team.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Improving the quality of psychiatry teaching within the UK undergraduate medical curriculum.

Dear editor We read with great interest the article by Shah,1 which outlines various approaches to increase the exposure of undergraduate medical students to specialties such as psychiatry. While Shah1 makes valid suggestions to tackle this issue without altering the undergraduate medical school curriculum, we believe that there is scope for significant improvements within the curriculum for psychiatry in particular. To initiate this process, the first step may be to acknowledge the intrinsic attitudes of medical students toward psychiatry. Misconceptions among medical students include perceiving psychiatry as emotionally challenging with difficult patients, being taught from an insufficient evidence base, and having a lack of prestige within the medical profession.2 The extracurricular exposure to psychiatry proposed by Shah1 would mainly target students with a pre-existing interest in psychiatry. In comparison, fundamental changes within the psychiatry curriculum of medical schools may have an impact on a larger proportion of the student body. Typically, psychiatry is taught in the later years of medical school. However, an early exposure to this vital specialty can be achieved via the integration of psychiatric components into teaching of other specialties. For example, medical students can be encouraged to adopt a more holistic approach during problem-based learning (PBL) sessions by considering the pertinent psychiatric aspects as learning objectives. McParland et al3 compared the effectiveness of PBL with traditional undergraduate psychiatry teaching at University College London and concluded that students showed better academic performance with the PBL course. In this case, although the attitudes of students toward psychiatry remained largely unchanged, the PBL teaching style enabled more effective learning of the subject, which translated into an improved clinical performance and knowledge base. Additionally, teaching of psychiatric conditions could be incorporated into the preclinical neuroscience course in order to explore the scientific basis of psychiatry. With the development of psychiatric neuroscience, residency training programs in the US have also started placing more importance on neuroscience education within psychiatry.4 Similar incorporation of psychiatry into neuroscience teaching in medical schools would allow students to appreciate the role of neuroscience in psychiatric practice early in their medical training. Importantly, this may also allow misconceptions about psychiatry to be dispelled early in medical school. Furthermore, Manassis et al5 highlighted that initial interest is a major factor influencing the choice of psychiatry as a specialty. Thus, early exposure to psychiatry in medical schools would also enable earlier identification of interested students, who can then be encouraged to pursue psychiatry. Other novel teaching techniques include the use of popular media such as clips from television programs6 to encourage discussion about the widespread presence of mental illness, alongside textbooks to consolidate learning. This was adopted in the development of a seminar program, at the University of Nebraska by McNeilly and Wengel,6 utilizing short vignettes from the television program “ER” to effectively demonstrate the practical applications of psychotherapeutic techniques and communication skills to medical students. Finally, an effective way to enhance the quality of psychiatry placements would be to involve teaching-oriented psychiatrists, without necessarily increasing the length of placements. To support this, a survey conducted among medical students reported that their attitudes toward psychiatry improved with encouragement from senior psychiatrists or if they were particularly inspired by a member of the psychiatric team during clinical attachments.7 Hence, practising physicians may be encouraged to reflect upon their impact on the attitudes of students and their future interest in pursuing psychiatry. We believe these suggestions would ultimately have minimal logistical and financial implications and can be easily incorporated into the curriculum of medical students. As junior doctors, we are highly likely to encounter patients with mental illnesses, as it affects over 25% of the population.8 Therefore, a solid understanding of psychiatry is crucial, regardless of the speciality that we ultimately pursue.

Preceptors’ Expectations of Nursing Students’ Preparation before Placement in Psychiatry: Ability and Will to Reflect on and Exercise Knowledge

Nursing students must be prepared to provide nursing care regardless of the patient's illness. This requires that nursing education, including clinical placements, strengthen knowledge and skills in mental health nursing. The aim of this qualitative study was to describe 15 preceptors’ expectations of nursing students’ preparedness before they entered the psychiatric field. Data was collected with focus group interviews and analysed using conventional content analysis. The findings show that preceptors are concerned about the nursing students’ will and ability to reflect on and exercise knowledge for managing the student role and themselves; for adapting their perspective on humanity; for their understanding of illness and how they are interacting with persons with mental illness. The conclusion is that the preceptors expect the educators to give sufficient theoretical knowledge and assess the students’ personal maturity prior to entering the psychiatric field.

Training across boundaries.

This project arises from recent literature that has challenged a conventional view of training as being professional-specific or 'silo' based. Various authors have recommended that to train psychiatrists for the future, it will be helpful to provide opportunities for exposure to different medical specialties, including general practice. Training Across Boundaries (TAB) started in February 2013, aiming to develop training links between core psychiatry and medical specialties and primary care. The project encouraged the use of up to six sessions in a medical speciality or in primary care during a 6-month core psychiatry placement, and evaluated the benefits gained from this experience. Feedback was obtained from all the participants by means of structured interviews. To train psychiatrists it will be helpful to provide opportunities for exposure to different medical specialties Results from the structured interviews with the participants are presented. Overall the project seems to have broadly achieved its aims, in the first year of activity. The pilot programme seems to have opened up opportunities for cooperation and learning between doctors from different disciplines. The experience of TAB has helped trainees to see many of the commonalities of practice, but also the cultural differences that operate in different parts of the health service. The results of the project show us that we need to think more about the potential value of bringing training in psychiatry, primary care and medical specialties closer, to improve the breadth and quality of training and patient care.

‘Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school’

BackgroundThe use of simulated patients to teach in psychiatry has not been reported from low-income countries. This is the first study using simulation teaching in psychiatry in Africa. The aim of this study was to introduce a novel method of psychiatric teaching to medical students at the University of Zimbabwe and assess its feasibility and preliminary effectiveness. We selected depression to simulate because students in Zimbabwe are most likely to see cases of psychoses during their ward-based clinical exposure.MethodsZimbabwean psychiatrists adapted scenarios on depression and suicide based on ones used in London. Zimbabwean post-graduate trainee psychiatrists were invited to carry out the teaching and psychiatric nursing staff were recruited and trained in one hour to play the simulated patients (SPs). All students undertaking their psychiatry placement (n = 30) were allocated into groups for a short didactic lecture on assessing for clinical depression and then rotated around 3 scenarios in groups of 4–5 and asked to interview a simulated patient with signs of depression. Students received feedback from peers, SPs and facilitators. Students completed the Confidence in Assessing and Managing Depression (CAM-D) questionnaire before and after the simulation session and provided written free-text feedback.ResultsPost-graduate trainers, together with one consultant, facilitated the simulated teaching after three hours training. Student confidence scores increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation teaching session. Free-text feedback was positive overall with students commenting that it was “helpful”, “enjoyable” and “boosted confidence”.ConclusionsIn Zimbabwe, simulation teaching was acceptable and could be adapted with minimal effort by local psychiatrists and implemented by post-graduate trainees and one consultant, Students found it helpful and enjoyable and their confidence increased after the teaching. It offers students a broader exposure to psychiatric conditions than they receive during clinical attachment to the inpatient wards. Involving psychiatry trainees and nursing staff may be a sustainable approach in a setting with small number of consultants and limited funds to pay for professional actors.

Availability of work experience placements in psychiatry: the real picture.

We congratulate Kennedy & Belgamwar[1][1] for adding to the evidence base for the beneficial effects of work experience placements (WEPs) for secondary school pupils on stigma and recruitment, the two major problems facing psychiatry. We searched the websites of all 54 mental health trusts (MHTs)

Experience of psychiatry in foundation years

There has been considerable discussion in this and other journals about the negative perception of psychiatry among medical students.[1][1],[2][2] I am approximately 1 month into my foundation year 1 placement in liaison psychiatry, and would like to share my experiences. Undergraduate psychiatry

Encouraging French medical students to choose a career in psychiatry: How and why?

There is an increasing demand for psychiatrists in France. This paper reviews the reasons for French medical students choosing psychiatry and the rationale and mechanisms for encouraging them towards this medical speciality. The main factors associated with choosing psychiatry as a career are the quantity and quality of undergraduate training and placements in psychiatry, better attitudes towards psychiatry and more emphasis on a positive life/work balance. The quality of postgraduate training can also influence students’ decisions. Medical students should be encouraged to choose psychiatry first to counterbalance the existing stigma towards mental illness within the society, but also towards psychiatry within the medical profession, and second because of the current decline in French medical demography. Ways to improve recruitment are a selection process that favours a large number of psychiatric trainees, and an increase in the quality and quantity of training. Providing medical students with relevant information about training in psychiatry, notably through a national trainees’ association, will not only improve the quality of care by increasing recruitment in psychiatry, but also ensure that all future doctors are familiar with and develop positive attitudes towards mental health issues.

Why psychiatry isn't sexy …

I am 2 weeks into my psychiatry placement, and have been forced to ask myself some uncomfortable questions.[1][1] As many of my fellow students, I began with a negative view of psychiatry based almost entirely on our formal (and more importantly, informal) medical training. Although I am

Recruitment to psychiatry in the Czech Republic: ‘Waiting for resuscitation’?

Recruitment to psychiatry is becoming a serious obstacle in providing first-class mental health treatment in many countries worldwide. We attempt to address this burning issue by examining medical student's attitudes towards psychiatry and factors influencing their career choice in the Czech Republic. In 2010, 71 students in their last year of medical school at the First Faculty of Medicine, Charles University, Prague were recruited in this quantitative cross-sectional online study. From the sample, 16% (n = 11) of students were considering psychiatry as a career path. An important factor in choosing psychiatry as a career path was personal/family presence of mental illness. Longer experience with psychiatry placement also contributed to the choice of psychiatry, as well as participation in elective courses or psychiatric research projects. Students considering psychiatry were less systematic compared to the group not considering psychiatry. Low reported levels of recruitment to psychiatry present a problematic issue in the Czech Republic. To make psychiatry more appealing to medical students, proactive steps by the relevant stakeholders need to be implemented. These strategies should include steps such as allocating more time for psychiatry in the medical curriculum, better quality of lectures, and the inclusion of additional elective courses.

Further Integration for Students on Psychiatry Placement with Professionals Other than Doctors

Further Integration for Students on Psychiatry Placement with Professionals Other than Doctors