Psychiatry Program Research Articles

Translational Quotient as an Innovative Outcome Parameter to Assess the Effectiveness of Training Methods: A Feasibility Study in Assessing the Baseline Psychiatric Skills of Primary Care Doctors in their Real-world Live Outpatient Clinic

Background: The effectiveness of training methods in medical education is critical, particularly for primary care physicians (PCPs) who frequently encounter psychiatric issues in their practice. Traditional assessment methods often fail to evaluate skill acquisition in real-world clinical practice. The Translational Quotient (TQ) is proposed as an innovative outcome measure to assess PCPs’ ability to apply psychiatric skills in their live outpatient consultation among their general patients. This study aims to evaluate the feasibility of using the TQ in real-world outpatient clinics and to understand the baseline psychiatric skills among PCPs using TQ. Methods: Actively practicing MBBS-qualified PCPs enrolled in the Diploma in Primary Care Psychiatry (DPCP) program across various districts were invited to participate. Baseline TQ assessments were conducted in the PCPs’ live clinics, with psychiatrists observing live consultations either remotely or in-person for the first five consecutive general consultations. Each consultation was scored using a standardized TQ proforma, which evaluated six criteria: elicitation of psychiatric symptoms, clinical reasoning, medication choices, counseling, time management, and overall clinical skills. Results: A total of 25 PCPs participated, with an average baseline TQ score of 15.7% (4.72 out of 30). Most participants (72%) scored 5 or less, highlighting significant gaps in psychiatric skills. Analysis revealed no significant associations between TQ scores and PCP demographics such as age, gender, and prior psychiatric training, but regional differences were noted, with lower scores in Karnataka compared to Bihar. Conclusions: The TQ is a feasible and practical tool for assessing real-world psychiatric skills among PCPs. The baseline scores indicate a pressing need for targeted psychiatric training to bridge the treatment gap in primary care. Future training programs should focus on enhancing diagnostic accuracy, treatment planning, and patient communication to improve mental healthcare outcomes in primary care settings.

The Outcome Evaluation and Impact of Tele-mentoring Prison Medical Officers in Primary Care Psychiatry: A Model from Bihar, India

Introduction: As compared to the general population, prison inmates have a high prevalence of mental illness and substance use disorders. The authors designed and implemented a digitally driven, one-year primary care psychiatry program for medical officers in prison and correctional settings to address this need in Bihar, India. Aim: The study aimed to assess the outcome of training given to prison medical officers deputed by the Government of Bihar. Materials and Method: Five medical officers completed training out of the seven deputed. The training contained brief onsite (three-day) training in “Clinical Schedules for Primary Care Psychiatry” and three online (one-year) modules containing tele-psychiatric on-consultation training (tele-OCT), virtual classroom (VCR) sessions, and a public health module. We measured the outcome using translational quotient (TQ) and primary care psychiatry quotient (PCPQ), which were carried out 6 and 12 months after the onset of training. Results: The TQ scores in the first and second tele-OCT evaluations were 64% and 75.2% at 6 and 12 months of the course, suggesting adequate skill retention. Out of 33,565 consultations over 12 months, medical officers identified 2,947 psychiatric disorders requiring treatment, resulting in a PCPQ of 8.7%. Conclusion: Over a year, the training demonstrated efficacy in acquiring primary care psychiatry skills, and these competencies were applied in providing care for those with psychiatric disorders.

Comparing the effect of two systems-level interventions on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms

BackgroundThe Massachusetts Child Psychiatry Access Program (MCPAP for Moms) and PRogram In Support of Moms (PRISM) are designed to help obstetric practices address perinatal depression. PRISM includes the statewide MCPAP for Moms program plus proactive implementation support. ObjectiveThe goal of this study was to understand the impact of these programs on perinatal Generalized Anxiety Disorder (GAD) and Post-traumatic Stress Disorder (PTSD) symptoms among individuals screening positive for depression. Study DesignWe conducted a secondary analysis of 2017–2022 data from a cluster randomized controlled trial of MCPAP for Moms vs. PRISM. We included participants completing a GAD or PTSD screen at baseline (n=254) with antenatal Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. We assessed change in GAD and PTSD symptoms at from pregnancy (4 to <25 weeks Gestational Age (GA) or 32–40 weeks GA), to 4–12 weeks postpartum and 11–13 months postpartum. We conducted a difference-in-difference analysis to compare symptom change from pregnancy to postpartum. We used adjusted linear mixed models with repeated measures to examine the impact of MCPAP for Moms and PRISM on changes in the Generalized Anxiety Disorder 7 (GAD-7) and the PTSD CheckList (PCL-C). Results: Mean GAD-7 scores decreased by 3.6 (MCPAP for Moms) and 6.3 (PRISM) points at from pregnancy to 4-12 weeks postpartum. Mean PCL-C scores decreased by 6.2 and 10.0 points, respectively, at 4–12 weeks postpartum among individuals screening positive on the GAD-7 (n=83) or PCL-C (n=58) in pregnancy. GAD-7 and PCL-C scores decreased among both groups at 11–13 months postpartum. These changes were clinically meaningful. PRISM conferred a statistically significant greater decrease (2.7 points) on the GAD-7 than MCPAP for Moms at 4–12 weeks postpartum. No differences were found between MCPAP for Moms and PRISM in PCL-C or GAD-7 change at 11–13 months, although both were associated with a reduction in GAD and PTSD symptoms at 4–12 weeks and 11-13 months postpartum. ConclusionBoth MCPAP for Moms and PRISM could help to improve symptoms for individuals experiencing co-occurring symptoms of depression, GAD, or PTSD. PRISM may confer additional benefit in the early postpartum period, although this difference was not clinically significant.

Improving the wellbeing of older adults through community-based music and movement programs

Improving the wellbeing of older adults through community-based music and movement programs Find out here about a geriatric psychiatry program at the Music and Mental Health Research Clinic that improves the wellbeing of older adults. How do music and movement affect the mental wellbeing of older adults? The Music and Mental Health Research Clinic at the University of Ottawa Institute of Mental Health Research at the Royal will explore this question with a new geriatric psychiatry program that aims to design and carry on community-based music and movement (COMM) interventions with older adults (55+). The program will examine the benefits of these interventions on the psycho-social conditions of older adults with dementia or experiencing mental illness, including, among others, depression and anxiety. The learnings will support the integration of evidence-informed music interventions into older adults’ social and healthcare.

Subspecialty Selection and Fellowship Training Satisfaction among American and Canadian Geriatric Psychiatry Fellows.

The Geriatric Psychiatry Fellowship Subspecialty survey aimed to identify key motivating factors associated with choosing geriatric psychiatry as a career, and to assess training satisfaction among geriatric psychiatry fellows/residents in Canada and the United States. American and Canadian geriatric psychiatry program directors were asked to distribute an online survey to their fellows. Descriptive statistics for quantitative items and Mann-Whitney U tests were performed to assess for differences by country of training. Thirty-one geriatric psychiatry fellows completed the survey. The most important motivating factors for pursuing a career in geriatric psychiatry were found to be "working with patients and families", "working in an interdisciplinary environment", and "intellectual stimulation". Fellows' overall training satisfaction was high, with American fellows more satisfied than Canadian residents (p = .047) on average, especially with regard to biomedical aspects of training (p = .01).

Effects of TMS on anhedonia and suicidal ideation in treatment-resistant depression: Outcomes from the University of Minnesota Interventional Psychiatry Program

BackgroundA developing literature suggests that transcranial magnetic stimulation (TMS) can target anhedonia and suicidal ideation (SI), core symptoms of treatment-resistant depression (TRD). This present naturalistic study extends the existing literature by investigating the connection between changes in anhedonia and suicidal ideation (SI) related to transcranial magnetic stimulation (TMS), independent of any overall changes in depression. MethodsPre and post treatment PHQ-9 and IDS-SR data were collected from 181 TRD patients who received dorsolateral prefrontal cortex ( dlPFC) TMS using the Figure-8 or H1-coil. Changes in overall depression symptoms, anhedonia, and SI were analyzed using chi square tests, repeated measure ANOVAS, and linear regression for repeated measures. ResultsTMS yielded changes in overall depression symptoms (PHQ-9 Cohen’s d = 1.02; IDS-SR Cohen’s d = 1.05), with 23.9 % and 41.7 % of patients experiencing response as measured by IDS-SR and PHQ-9, respectively. TMS treatment was also associated with large changes in both anhedonia (d = 1.03) and SI (d = 0.88), which were similar in magnitude to changes in all other depression symptoms (d = 0.97). Importantly, changes in anhedonia predicted changes in SI, even after controlling for baseline depression severity and change in other depression symptoms. LimitationsThe lack of a control arm and a neuroimaging measure temper mechanistic conclusion. ConclusionOur results reinforce the effectiveness of TMS in TRD and provide new evidence that anhedonia and SI may belong to a broader symptom cluster potentially undergirded by a shared circuitry accessible to dlPFC TMS.

Predictive modeling of response to repetitive transcranial magnetic stimulation in treatment-resistant depression.

Identifying predictors of treatment response to repetitive transcranial magnetic stimulation (rTMS) remain elusive in treatment-resistant depression (TRD). Leveraging electronic medical records (EMR), this retrospective cohort study applied supervised machine learning (ML) to sociodemographic, clinical, and treatment-related data to predict depressive symptom response (>50% reduction on PHQ-9) and remission (PHQ-9 < 5) following rTMS in 232 patients with TRD (mean age: 54.5, 63.4% women) treated at the University of California, San Diego Interventional Psychiatry Program between 2017 and 2023. ML models were internally validated using nested cross-validation and Shapley values were calculated to quantify contributions of each feature to response prediction. The best-fit models proved reasonably accurate at discriminating treatment responders (Area under the curve (AUC): 0.689 [0.638, 0.740], p < 0.01) and remitters (AUC 0.745 [0.692, 0.797], p < 0.01), though only the response model was well-calibrated. Both models were associated with significant net benefits, indicating their potential utility for clinical decision-making. Shapley values revealed that patients with comorbid anxiety, obesity, concurrent psychiatric medication use, and more chronic TRD were less likely to respond or remit following rTMS. Patients with trauma and former tobacco users were more likely to respond. Furthermore, delivery of intermittent theta burst stimulation and more rTMS sessions were associated with superior outcomes. These findings highlight the potential of ML-guided techniques to guide clinical decision-making for rTMS treatment in patients with TRD to optimize therapeutic outcomes.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey.

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency. We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians. A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents. Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001). Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Perceived opportunities of clinical reasoning learning in postgraduate psychiatry training: Trainees' and faculty's perspectives.

Learning clinical reasoning is less effective in isolation of clinical environments because contextual factors are a significant component in the clinical reasoning process. This study investigated the differences in opinions between novice and expert clinicians on learning clinical reasoning in the workplace. The author used a cross-sectional online survey design to investigate the perceived learning of six clinical reasoning skills in 13 learning opportunities. Questionnaires were emailed to 41 postgraduate psychiatry trainee doctors and 37 faculty members. Data were analyzed descriptively. The Chi-square test was used to compare the responses of the two groups. Statistical significance was set at P < 0.05. The combined response rate was 73.07%. The two groups perceived the learning of advanced clinical reasoning skills to be lower than that of basic skills. There were significant differences in the perceived learning of basic clinical reasoning skills in self-study/exam preparations (P = 0.032), general hospital grand rounds (P = 0.049), and clinical rounds (P = 0.024 for consultant-led rounds and P = 0.038 for senior peer-led rounds). There were also significant differences in the perceived learning of advanced clinical reasoning skills among peer-led tutorials (P = 0.04), journal clubs (P = 0.006), morning reports (P = 0.002), and on-call duties (P = 0.031). The trainees showed a significant preference for structured learning environments rather than clinical environments, especially for advanced clinical reasoning skills. Trainees likely struggled with cognitive overload in clinical environments. Local postgraduate psychiatry programs will likely benefit from implementing multiple educational interventions that facilitate teaching and learning clinical reasoning in complex clinical environments.

Parallel Application to U.S. Psychiatry Residency Programs: Trends in Frequency and Differences by Applicant Group, 2009-2021.

The present study examines trends of percent of applicants, number of specialties, and specialty combinations for psychiatry residency applicants applying to multiple specialties (parallel application). The authors conducted a retrospective analysis of data captured by the Association of American Medical Colleges Electronic Residency Application System for applicants to psychiatry residency between 2009 and 2021. The percent parallel-applying, the mean number of specialties, mean application counts, and frequency of specialty combinations with psychiatry residency were determined. The dataset described 67,261 applicants. The percentage parallel-applying decreased from 73.7% in 2009 to 60.0% in 2021. International Medical Graduates and U.S. International Medical Graduate parallel-applied at the greatest rate in each year. Applicants who were parallel-applying submitted larger numbers of applications compared to those who were single-specialty applying. Parallel application to psychiatry residency appears to be a common practice, but has decreased in frequency. However, the mean numbers of applications submitted to each specialty in parallel application combination and among single-specialty applicants have increased. This practice appears to have a disproportionate impact on international and osteopathic applicants. Additional efforts are needed to develop evidence-based advising tools to reduce the number of residency applications submitted to psychiatry programs.

In Memoriam: Professor Joseph Biederman’s Contributions to Child and Adolescent Psychiatry

Objective: To provide an overview of Joe Biederman’s contributions to child and adolescent psychiatry. Method: Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette’s and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. Results: Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world’s first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. Conclusion: The world is a better place because Joe Biederman was here.

The Father's Part: A Pilot Evaluation of a Father-Centered Family Intervention Group in Child and Adolescent Psychiatry.

Changes in parental roles have renewed the focus on a father's involvement in an offspring's psychological development. However, fathers are still under-represented in family research. There are only a few structured father-centered intervention programs in child and adolescent psychiatry. In a German population sample, a pilot father-centered family intervention program with n = 16 participants, conducted in person (n = 8) and online (n = 8), in a child and adolescent psychiatry inpatient/day clinic setting was evaluated by comparing paternal stress, PSE, and child-rated paternal competence in a pre-post design. Participating fathers showed significant decreases in child-related parenting stress (presence: p = 0.042, online: p = 0.047) and significant increases in PSE (p = 0.006/0.012). Parent-related stress and child-rated paternal competence were unaffected (p = 0.108/0.171; p = 0.167/0.101), while small-to-medium effect size measures pointed in the direction of our hypothesis (d = 0.48/0.36; d = 0.37/0.50). Participant satisfaction was higher in person than online (p = 0.008). As social and biological fathers have important influences on child and adolescent well-being and development, they should be included more frequently in prevention and intervention programs. Fathers seem to benefit from gender-specific intervention programs with regard to stress reduction, as well as experiencing competence- and PSE-increasing effects.

SINGING WITH DEMENTIA: CREATING AND PILOT TESTING A VIDEO TO CHANGE ATTITUDES OF MEDICAL RESIDENTS

Abstract As part of the “Creativity in Aging” project at Yale Geriatrics, we are making a series of short videos highlighting individuals and programs that transcend dementia through music. The target audience includes health trainees and professionals who care for older adults. The first video, made by a PhD candidate and an internal medicine resident physician, features The Recollections: a chorus of community dwelling people with dementia, their caregivers, and college students. Video learning objectives are to 1) change dementia attitudes; 2) demonstrate preserved skills and abilities of persons with dementia; and 3) raise awareness about local initiatives for music in dementia and how to refer patients. We interviewed the chorus founder, a geriatric psychiatrist, who described the creative process, including logistics and vision, and provided advice to caregivers and medical residents. Live clips from chorus rehearsals were shown, including singing and dancing, with voiceovers describing participant stories. Slides reinforced key points. The video was pilot tested on a group of residents from the Internal Medicine and Psychiatry programs. All respondents (N=6) used positive words such as “optimistic” and “inspired” to describe how the video made them feel. Most indicated it was moderately relevant to their care of patients with dementia and several provided suggestions on how to increase relevance. Constructive feedback included parts to compress or expand, overall length, visual aspects, and desire for more ‘how to’ guidance. Future plans include sharing a revised version with the broader residency program with pre-and-post dementia attitudes surveys.

Effectiveness of a coordinated ambulatory care program for patients with mental disorders or multiple sclerosis: results of a prospective non-randomized controlled trial in South Germany.

The Psychiatry, Neurology, Psychosomatics and Psychotherapy (PNP) program of the German statutory health insurance AOK BW promotes coordinated and evidence-based specialist care with the aim of providing individualized, guideline-based outpatient care, strengthening the collaboration between health care providers, as well as reducing care costs. The purpose of this study was to evaluate its effectiveness regarding patient-reported outcomes compared to the less specialized general practitioner program (GP) and usual care (UC). AOK insured patients, who were on sick leave due to a mental disorder (affective disorder, anxiety disorder, adjustment disorder, somatoform disorder, alcohol abuse disorder, schizophrenia) or multiple sclerosis were included in the prospective non-randomized controlled study. All patients either participated in the PNP program (intervention group, IG-PNP), the general practitioner program (control group, CG-GP) or usual care (control group, CG-UC). Entropy balancing was used to adjust for baseline imbalance between groups. Primary outcome was health-related quality of life, assessed by the Short-form health survey (SF-36) 12 months after diagnosis. Secondary outcomes included symptom severity, functional health, and treatment satisfaction. Of the 14,483 insured patients who were contacted, 1,104 patients participated at baseline and 725 at follow-up. The adjusted mean differences of SF-36 sum score did not significantly differ between groups: -1.89 (95%-CI = -4.60; 0.81, p = 0.170) between IG-PNP and CG-GP, and -1.42 (95%-CI = -4.05; 1.22, p = 0.293) between PNP and CG-UC. The adjusted mean differences of secondary outcomes did not differ between groups, except for a slightly higher increase of functional health in CG-UC. We found no evidence that the PNP program is superior to the GP program or to usual care in terms of patient-reported outcomes or treatment satisfaction. The results are limited by the low response rate. Accordingly, future studies should strive for more representative samples. To improve the program, an integration of further collaborative care elements and guideline recommendations might be useful. DRKS (German Clinical Trials Register https://drks.de/search/en); identifier (DRKS00013114).

A virtual mother-infant postpartum psychotherapy group for mothers with a history of adverse childhood experiences: open-label feasibility study

ObjectivesMothers with a history of adverse childhood experiences (ACE) are at elevated risk for postpartum mental illness and impairment in the mother-infant relationship. Interventions attending to maternal-infant interactions may improve outcomes for these parents and their children, but barriers to accessing in-person postpartum care limit uptake. We adapted a postpartum psychotherapy group for mothers with mental illness (e.g., mood, anxiety, trauma-related disorders) and ACE for live video-based delivery, and evaluated feasibility, acceptability, and preliminary efficacy in an open-label pilot study.MethodsWe recruited adults with children (6–18 months) from a perinatal psychiatry program in Toronto, Canada. The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. The primary outcome was feasibility, including feasibility of recruitment and retention, fidelity of the intervention, and acceptability to patients and group providers. Maternal clinical outcomes were compared pre- to post-intervention, as secondary outcomes.ResultsWe recruited 31 participants (mean age 36.5 years (SD 3.9)) into 6 groups; 93.6% (n = 29) completed post-group questionnaires, and n = 20 completed an optional post-group acceptability interview. Mean weekly group attendance was 83% (IQR 80–87); one participant (3.2%) dropped out. All group components were implemented as planned, except for dyadic exercises where facilitator observation of dyads was replaced with unobserved mother-infant exercises followed by in-group reflection. Participant acceptability was high (100% indicated the virtual group was easy to access, beneficial, and reduced barriers to care). Mean maternal depressive [Edinburgh Postnatal Depression Scale: 14.6 (SD 4.2) vs. 11.8 (SD 4.2), paired t, p = 0.005] and post-traumatic stress [Posttraumatic Stress Disorder Checklist for DSM-5: 35.5 (SD 19.0) vs. 27.1 (SD 16.7)], paired t, p = 0.01] symptoms were significantly lower post vs. pre-group. No differences were observed on mean measures of anxiety, emotion regulation or parenting stress.ConclusionsRecruitment and retention met a priori feasibility criteria. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention, with adaptation of dyadic exercises.

What Can You Learn About Psychiatry Programs from Their Website? A Content Evaluation for Potential Applicants.

This project aimed to assess the information contained on general psychiatry program websites and identify common themes that may be useful and informative for residency applicants. A survey study design was used to evaluate all US general psychiatry program websites as listed in the FREIDA database. The evaluation form included 44 binary (yes or no) items. Two reviewers rated each item on all program websites between September 2021 and January 2022. Item discrepancies were settled by a third reviewer. Fisher's exact tests evaluated differences between geographic regions and program types. Multidimensional scaling and Rasch modeling were conducted to examine clustering and the probability of items reported on program websites. A total of 285 websites were identified; 13 were excluded. Internal consistency was high among reviewers, Cronbach's Alpha = 0.927; κ = 0.863. Websites varied considerably in quality. Significant inconsistent reporting was observed by region for current residents' photos and alumni careers (fellowship/jobs); p<0.001. Program types varied regarding information about program faculty, which included significant differences for faculty photo, faculty research interest, and faculty research publications; p<0.001. While inter-rater reliability was high, considerable variation among websites was observed. Residency programs could be improved by consistently reporting resident and faculty information. Results show that applicants may encounter issues finding pertinent information, as programs' FREIDA link did not direct the user to the residency program website two-thirds of the time.

Undergraduate Psychiatry Teaching and Learning in India: A Bumpy Ride

In India, there has been exponential growth in the number of MBBS seats and postgraduate seats over the past two decades. In the year 2021, there were 83,275 MBBS seats and 42,720 postgraduate seats in 554 medical colleges in India.1,2 As of the second week of October 2023, 706 medical colleges are collectively providing 1,08,890 MBBS seats.3 In the same period, 331 medical institutions now offer postgraduate programs in psychiatry, contributing to a total of 1,360 MD seats in psychiatry.4 The change of figures over three years gives an idea about the rapid increment in undergraduate (MBBS) and postgraduate seats in psychiatry in India.

Divergencies between a medical and a psychiatric hospitalization: Admissions, aggressiveness, and characterological suicidality in severe personality disorders

ContextThere have been significant advances in organizational and administrative practices of modern psychiatric institutions. These advances have allowed their capitalization in the therapeutic use of social sub-systems and the interaction between staff and patients, in inpatient hospital programs. The therapeutic use of the interaction between patients and personnel is the essence of contemporary psychiatric divisions: this is what truly distinguishes modern psychiatric services from traditional medical models. However, the enormous gap between these advances and their more universal applications to the contemporary psychiatric hospital is disconcerting. Objectives(a) To raise awareness of the differences between a medical and a psychiatric inpatient program; (b) so as to truly appreciate the importance of the therapeutic use of the interaction between personnel and patients; (c) particularly in the context of treating aggressiveness and characterological suicidality in severe personality disorders. MethodIn this study the divergencies between a medical and a psychiatric hospitalization are critically explored along four dimensions: (1) body versus mind; (2) reasons for admissions; (3) pharmacological approaches; and (4) characterological suicidality and aggressiveness in severe personality disorders. ResultsLamentably, the non-delimited and confusing transposition of traditional and psychiatric models, in inpatient psychiatric programs which do not integrate a comprehensive supraordinate psychotherapeutic framework at the service of their primary tasks, results in the risk of highly restrictive and merely custodial care of patients; unintegrated salads of multiple psychotherapeutic modalities, without a holistic approximation to articulate them; and the mixture of interventions that cancel each other out and could even result iatrogenic for patients and staff. It is precisely in the dimensions of characterological suicidality and aggressiveness, that the overall containment and treatment of suicidal behavior and the rampant infiltration of aggression in severe personality pathology call for a clear demarcation between a medical model and a genuinely psychiatric one. InterpretationsContrary to the erroneous prediction of a few decades ago, about the disappearance of the psychiatric hospital, the need of modern psychiatric institutions and psychiatry programs that integrate the achievements and contemporary proposals in mental health and psychotherapeutic sciences is more imperative than ever. This situation will demand an ongoing effort to explore critically our psychiatric practices and to address the enormous challenges represented by the training of staff, professors, and residents in psychiatry, toward the optimal use and advancement of available hospital resources.

The impact of the integration of telemedicine in a community psychiatry outpatient program during Covid-19

Our study aims to describe the impact of transitioning to telemedicine care during the Covid-19 pandemic in a community psychiatry program. This was a retrospective study comparing no show rates and hospitalization rates pre and post adoption of telemedicine services, as well as evaluating patient satisfaction with telemedicine services. We found that there was a small but significant decrease in the no show rate following the adoption of telemedicine. We found no significant difference in the monthly hospitalization rate. The majority of patients surveyed liked using telemedicine and most preferred it to in-person visits. Patients identified convenience of telemedicine as a major benefit to this format and lack of privacy as a drawback. Telemedicine is an acceptable form of service delivery among this patient population. It decreased no show rates and did not increase hospitalizations. The use of this service delivery model could enhance the patient experience, but consideration should be given to how and when it is used.

Dual Residency Training in Neurology and Psychiatry: History and Current Practice.

In the early 20th century, neurology training included more experience in psychiatry, and psychiatry training included more training in neurology than what is currently required. After World War I, the increased need for differential diagnosis of what might now be called functional neurological disorders resulted in the military encouraging combined residency training in neurology and psychiatry and the promulgation of the term "neuropsychiatry" for this specialty. Thirty-six percent of physicians certified by the American Board of Psychiatry and Neurology in its first decade (1935-1945) held certification in both neurology and psychiatry. However, the term neuropsychiatry gradually became used interchangeably with general psychiatry-to distinguish it from psychoanalysis-and lost its specificity. It is widely held that the popularity of psychoanalysis resulted in psychiatrists perceiving less need for neurological knowledge, and inclusion of neurology content in psychiatry training decreased. Dual residency training programs in neurology and psychiatry began to increase in popularity again in the 1980s as advances in neuroscience, neuroimaging, and pharmacology, paired with the growth of behavioral neurology, laid the foundation for meaningful practice of neuropsychiatry. The author surveyed 207 physicians who graduated from both a neurology and psychiatry residency and 18 current trainees in combined neuropsychiatry residency programs to collect information on their current practice, academic activity, and opinions about their training. The response rate was 64%. Respondents' attitudes toward the value of their dual neurology and psychiatry training were overwhelmingly positive. Reasons for the lack of growth of combined residency programs in neurology and psychiatry are examined.