Psychiatric Program Research Articles

Adverse childhood experiences in forensic psychiatric patients: Prevalence and correlates from two independent Canadian samples

ABSTRACT There is a lack of research examining Adverse Childhood Experiences (ACEs) in forensic psychiatric patients despite research consistently demonstrating a relationship between ACEs and later life mental and physical health issues and likelihood of incarceration. The current study sought to examine the relationships between ACEs and indicators of health and offending among forensic psychiatric patients. Medicolegal files were reviewed and coded for 313 patients from two independent high and low/medium security Canadian forensic psychiatric programs. Findings from both samples revealed higher than previously reported average and cumulative rates of childhood adversity compared to the general population, and rates which were comparable to other forensic samples. Both samples revealed positive relationships between ACEs and both mental health and offending history, while differential patterns between samples emerged for physical health outcomes. Results are interpreted via comparisons between the samples, as well as in reference to previous forensic, correctional, clinical, and community research findings. Although it is clear from these results that ACEs are a significant factor in the forensic psychiatric population, more research is needed to better understand the interactions among, and mechanisms through which, ACEs contribute to offending onset and risk, treatment response, and both mental and physical health outcomes.

Spirituality in the line of duty: Perspectives from first responders with acute posttraumatic stress disorder and alcohol use disorder.

Spirituality/religion is clinically relevant to patients experiencing posttraumatic stress disorder (PTSD) and/or alcohol use disorder (AUD). Despite the comorbidity of PTSD and AUD among first responders (i.e., firefighters, law enforcement, paramedics, corrections officers), relatively little research has investigated the lived experience of first responders with PTSD and AUD as it related to spirituality and religion. As such, 12 (100% cisgender men, 91.7% White/European American) first responder psychiatric patients with comorbid PTSD and AUD were recruited from a psychiatric program serving first responders in the Northeast. Participants completed a semistructured interview, and transcripts were coded and thematically analyzed. The following themes and subthemes were identified: spiritual/religious distress (subthemes: abandonment, progressive deterioration of moral certainty, and loss of faith/doubt), spiritual/religious coping (subthemes: supporting sobriety and coping with PTSD), spirituality/religion in treatment, spirituality as distinct from religion, and spirituality and first responder culture. Findings highlight the need for additional research examining the role of spirituality/religion at the intersection of PTSD and AUD among first responders as well as the development of spiritually integrated treatment for this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Scaling a behavioral weight-loss intervention for individuals with serious mental illness using the enhanced replicating effective programs framework: A preconditions phase proof-of-concept study.

Given the obesity's high prevalence among individuals with serious mental illness (SMI), translating weight-loss interventions with demonstrated effectiveness is needed. This study describes the initial translation phase of such an intervention using the Enhanced Replicating Effective Programs (REP) Framework for delivery by mental health program staff. The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial intervention was preliminarily adapted to create the ACHIEVE-Dissemination (ACHIEVE-D) curriculum. A treatment-only study was conducted to rapidly evaluate the curriculum using a mixed-methods approach including surveys and focus groups. A study coach delivered an abbreviated curriculum to individuals with SMI from a single psychiatric program. Among all participants with SMI (n=17), outcomes were attendance and satisfaction; 14 participated in a focus group. The program staff observed curriculum delivery and participated in a focus group (n=3). Overall, 23 group sessions were delivered. Median attendance was 78.6% across participants with SMI; 92.9% would recommend ACHIEVE-D to others. The staff found the curriculum acceptable, particularly its structured nature, inclusion of weight management and exercise, and integrated goal setting and tracking. These improvements recommended by participants and/or staff were to assess participant readiness-to-change prior to enrollment, change the frequency of weigh-ins, and train staff coaches on anticipated challenges (e.g., exercise engagement, weight fluctuations). During this first REP phase, individuals with SMI and program staff were satisfied with ACHIEVE-D. Additional refinements will aid future implementation and improve participant experience.

Study finds training in ASD and ID at psychiatry programs deficient

The journal Autism recently published a study about the quality of training that psychiatric program residents receive in autism spectrum disorder and intellectual disability, as measured by lectures and patient contact. Psychiatrists are one of the care professionals with whom students with autism and ID frequently interact. However, the study concludes that there is a shortage of psychiatrists to treat such conditions — and a lack of adequate training/education on these conditions in many psychiatric residency programs.

The perils of boarding: A call to achieve parity in the delivery of acute psychiatric services for children with COVID-19.

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic. From the published literature, two healthcare systems have initiated long-term planning, development, and implementation of biodome psychiatric units for patients with COVID-19 in need of acute crisis stabilization services. We sampled 100 acute inpatient child and adolescent psychiatric programs to discern their post-COVID positive clearance policies for admission. Findings were mixed among days of quarantine required, symptomology, covid-designated spaces vs. self-isolated rooms for psychiatric treatment, number of COVID negative retests, and additional considerations. We also review a range of considerations and recommendations for clinical practice and the health system in achieving parity in mental health care for these patients which in turn could contribute towards mitigating the rising global mental health crisis. Furthermore, increasing access to acute psychiatric services for these patients will also contribute towards the larger goal of the World Health Organization, Sustainable Developmental Goals of the United Nations, and Healthy People 2030 in increasing accessibility, quality and equity of mental health care for individuals on both global and national frontiers.

The Psychiatric Evaluation and Treatment of Refugees. Edited by J. David Kinzie and George A. Keepers.

It is universally acknowledged that due to factors including war, starvation, collapsed civil societies, genocide, religious cleansing, and many other unbearable stressors, asylum seekers regularly experience mental disorders and Post-Traumatic Stress Disorder (PTSD) in one way or another even prior to their forced migration. Worse still, protracted detention and screening before they are granted entry, and overwhelming hatred, discrimination, stigmatization, hostility, as well as xenophobic reactions from natives in the host country, can then further traumatize these individuals. It is in this context that Kinzie and Keepers’ edited collection The Psychiatric Evaluation and Treatment of Refugees is published, which brings together scholars and psychotherapists to draw worldwide attention to the ongoing psychological struggles of this population. What gives this volume an urgency often lacking in literature on psychiatric interventions with refugees is its emphasis on assessing and treating refugees’ psychiatric problems from a socio-cultural perspective instead of amplifying psychopharmacological remedies. Based on the belief that ‘culture has an important role in the presentation of illness, and cultural differences impact upon the diagnosis and treatment of migrant populations in part due to linguistic, religious and social variation from the clinician providing care’ (Bhugar and Becker 2005: 18), chapters in this volume focus on symptoms, diagnosis, and therapies of patients’ psychosis from cross-cultural perspectives within the framework of the Intercultural Psychiatric Program (IPP) launched at the Oregon Health & Science University (OHSU) in Portland, Oregon. Through this program, the authors have had the opportunity to learn more about the psychological plight of specific refugee populations, including children and adolescents, geriatric patients, and immigrants at the US-Mexico Border. The abundant clinical case examples illustrate the cultural barriers these displaced groups are confronted with when seeking psychiatric help.

Healthcare practitioners' views of comprehensive care to mental healthcare users in a community setting.

Comprehensive care means ensuring quality services, protecting rights, promoting available social services and using protocols and standards that emphasise quality assurance for all mental healthcare users (MHCUs). It also involves advocacy, early detection and rehabilitation, as well as encouraging appropriate patient-centred care to ensure adequate psychiatric care. However, according to research, there is a vacuum in the provision of comprehensive mental healthcare to MHCUs. As a result, there is an immediate need to consult healthcare providers on providing comprehensive community-based care to MHCUs. The purpose of this study was to explore and describe the views of healthcare practitioners on the aspects that hinder providing comprehensive care for MHCUs, the role players needed to execute comprehensive care and what can be done to improve comprehensive care for MHCUs in the community setting in one of the subdistricts of the North West province (NWP), South Africa (SA). A qualitative research design that was exploratory, descriptive and contextual was adopted. The healthcare practitioners that took part in the study were chosen through purposive sampling. The sample size was established through data saturation, and 19 telephonic semistructured individual interviews were held with registered nurses and one medical doctor. Tesch's eight steps were used to analyse the data. The four main themes identified were: (1) healthcare practitioners' understanding of comprehensive care to MHCUs, (2) factors hindering comprehensive care to MHCUs, (3) stakeholders needed for providing comprehensive care to MHCUs and (4) suggestions for improving comprehensive care to MHCUs. Healthcare practitioners in the community advocate for the need for comprehensive psychiatric treatment. They are of the view that greater coordination of psychiatric services will improve mental treatment and minimise relapse in MHCUs. To sustain integrated psychiatry, stakeholders and other psychiatric programmes must be included.Contribution:The findings and conclusions of this study indicated that improvement is needed in mental healthcare in general, and all relevant aspects to improve comprehensive care among MHCUs in a community setting should be given full attention.

The Burden of Leadership: a Survey of Burnout Experiences Among Psychiatry Program Directors.

The objectives of this study were to examine the prevalence of burnout, specify contributors to and protective factors against burnout, and gather suggestions to improve well-being in psychiatry Program Directors. A survey regarding burnout and wellness was distributed to psychiatric Program Directors through the email listserv of the American Association of Directors of Psychiatric Residency Training (AADPRT). The survey response rate was 273 responses out of 880 members surveyed (31%). The majority of respondents were current residency or fellowship Program Directors or Associate Program Directors or had another current educational role (93%, 227/245). Almost half of current Program Directors or Associate Program Directors reported feeling burned out almost daily or once a week (44%, 93/210). These Program Directors reported a desire to resign (77%), experienced discrimination within the past 5 years (66%), and struggled with finding meaning in their job (44%). The most frequently endorsed contributors to burnout were increasing administrative burden and insufficient support. The survey findings confirm that burnout characteristics are common among respondents, associated with a desire to resign and a struggle to find meaning in the highly demanding position of Program Director or Associate Program Director. Advocacy for resources, decreased administrative overload, and increased protected time would enhance well-being in Program Directors. Most striking was the frequency of discrimination reported and its relationship to burnout. Departments may benefit from a careful review of policies, procedures, and training to decrease hostile workplaces for women, international medical graduate, and under-represented in medicine Program Directors.

Trajectories of psychiatric care in an innovative outpatient program designed for transitional age youth (16 to 24 years old) in French-speaking Belgium: results of a retrospective study

IntroductionTransitional age youth (TAY), from 16 to 24 years old, are a particularly at-risk population in mental health. They have specific needs, not currently covered between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), mainly because of existing barriers.ObjectivesThis retrospective study was carried out to describe sociodemographic and clinical characteristics of 243 patients who attended a new TAY-tailored outpatient psychiatric program.MethodsOutcomes related to trajectories of psychiatric care were analysed, such as leading symptom, consultation’s referral and requester, and final orientation.ResultsThe sample was mainly composed by female; the average age was 18.7 (± 2.0) years. Leading symptoms were divided into three dimensions: internalizing (67.5%), externalizing (21.8%) and psychotic (10.7%). Leading symptom differed according to sex (p<0.001), with internalizing symptoms more frequent in women, externalizing and psychotic symptoms more frequent in men. Patients presenting psychotic symptoms were significantly older than both those with internalizing (p=0.016) and externalizing symptoms (p=0.008). After first assessment, 81.5% of youth were followed-up in our specific outpatient program, without any difference according to sex (p=0.081) or leading symptom (p=0.092). Overall and final psychiatric orientation are showed in the flowchart.Conclusions This TAY-tailored psychiatric outpatient program represents an innovative contribution to reinforce CAMHS-AMHS interface in French-speaking Belgium. This study enlightens the importance to enhance clinical expertise in youth mental health. Classical boundaries, determined by artificial variables such as age or type of psychopathology, do not seem to be efficient criteria to achieve a good quality psychiatric evaluation and continuity of care in TAY.Disclosure The authors declare no potential conflicts of interest. The study was carried out as part of the University Chair “Psychiatry in Transition in a World in Transition” (Université Libre de Bruxelles - ULB) with the support of Julie Renson Fund, the Queen Fa

Six-year changes of posttraumatic stress symptoms and depressive symptoms among Chinese earthquake survivors: A network analysis

BackgroundThe risk factors of Posttraumatic Stress Symptoms (PTSS) and depressive symptoms have been well-established, but whether the network structure of their symptoms changes over time remains unclear. This study aims to examine the six-year changes of network structure of PTSS and depressive symptoms among Wenchuan earthquake adult survivors in China. MethodsIn this pooled cross-sectional study, respondents were sampled from the same population at each of the five waves (N = 1343, 1205, 1177, 1376, and 1339). The network structure of them was investigated using network analyses. ResultsThe study shows network connections stable across waves were the positive connections between hyperarousal and intrusions, hyperarousal and somatic symptoms, and two dimensions of positive effects. Stable negative connections were those between depressed affects and positive effects, avoidance and depressed affects, avoidance with interpersonal symptoms and avoidance with somatic symptoms. Across waves, fearful emotion consistently was the strongest bridge symptom connecting with PTSS symptoms. However, for PTSS the strongest bridge symptom varied across time as it was avoidance in wave 1 but were hyperarousal in other four waves. LimitationsThis study was based on a pooled cross-sectional survey, which inhibits conclusions regarding causal influences between symptoms at the individual patient level. ConclusionsThe network structure of PTSS and depressive symptoms was partly stable, yet also varied across survey waves. Core symptom clusters for PTSS and depressive symptoms were avoidance and depressed affect, respectively. The central role of these clusters in PTSS and depressive symptoms has important implications to future psychiatric programs.

Legally involved individuals in state hospitals and community mental health settings: Introduction to the special section.

Over the past several years, individuals with serious mental illness (SMI) have become involved with the legal system at an increasing rate. State psychiatric hospitals and community mental health programs have seen a high number of referrals and admissions at a time when resources and staffing have been challenges. Individuals with SMI continue to be highly represented among those incarcerated in jails and prisons, often for minor charges. This article serves as an introduction to a special section of Psychological Services on innovations in assessment and treatment of legally involved patients in state hospitals and community mental health settings. Data are presented on the prevalence of legal involvement among individuals with serious mental illness, including the exponential growth in individuals evaluated and found incompetent to stand trial. A brief summary of the articles in the special section is presented, broken down by themes of assessment, treatment, and policy. We hope that the studies described in this issue will lead to further exploration of problems, barriers, and potential solutions for individuals with SMI who become involved with the legal system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Response of US psychiatric programs to the COVID-19 pandemic and the impact on trainees

BackgroundMedical training program and hospital response to the COVID-19 pandemic has varied greatly and has impacted trainee well-being. Which factors have specifically related to trainee wellness, however, has not yet been examined in depth. The aim of the study was to understand trainee perspectives on the individual psychiatry trainee programs’ hospitals’ objective COVID-19 preparedness management. We also sought and to gauge how program changes, and general pandemic-related concerns, have been associated with trainee satisfaction and burnout.MethodsA cross-sectional survey study of psychiatric trainees was distributed electronically throughout the country via various psychiatry residency program listservs in April 2020. Statistical analyses were performed utilizing simple linear regression.ResultsFrom 352 respondents (346 complete responses and 6 partial responses), the most frequent program changes were “decreased number of rotations requiring in-person patient care” and “increased call hours or duties.” Of pandemic-related concerns surveyed, the two greatest were “spreading COVID-19 to family/friends” and “co-residents’ burnout and anxiety.” A positive relationship was found between trainee satisfaction with perceived COVID-19 departmental response and comfort level of residents/fellows in expressing concerns with attending clinicians and department leadership.ConclusionsSince the start of the COVID-19 pandemic, trainees have experienced a variety of changes to trainee program policies and guidelines. Overall, poor communication and trainee dissatisfaction with departmental response correlated with concern of infection and anxiety/burnout. Insights garnered from this study could provide scaffolding for the best practices to reduce trainee physician anxiety/burnout for the current and future pandemics of this variety and magnitude.

Youth mental health-related presentations at a quaternary centre: Who comes, What are their needs, and Can we meet their needs.

Mental health issues are increasingly prevalent across Canada, reflected in rising presentations to emergency departments. To effectively address the needs of children and youth seeking mental health-related care in the emergency department and to judiciously use scarce mental health-related resources, we need to better identify the specific areas of psychosocial needs and accessibility of associated services. To describe the types and severity of paediatric mental health-related presentations evaluated at a quaternary paediatric emergency department, and to explore the accessibility of community mental health-related resources. We conducted a retrospective cohort study of children and youth presenting to a quaternary paediatric emergency department who were assessed using HEARTSMAP, a validated mental health assessment and management tool. We reported the proportion who sought care for a psychiatric, social, or youth health-related mental health complaint. We contacted community mental health-related resources for their estimated wait times to determine accessibility. Of 1,530 paediatric emergency presentations, 98.8% of patients had psychiatric issues (40.1% were severe), 78.0% of patients had social issues (17.1% were severe), and 71.5% had youth health issues (18.1% were severe). We contacted 123 community mental health-related resources. Community youth health and social services were somewhat accessible, with 50.0% and 38.7%, respectively, able to intake youth within a week of referral. Community psychiatric programs were least accessible, with 59.3% having wait times greater than 1 month. Many psychiatric concerns presenting in paediatric emergency departments have complex psychosocial challenges requiring non-psychiatric support. A need exists for improved accessibility to community psychiatric programs.

The Impact of the Community Psychiatric Treatment Program on the User's Quality of Life - experience of the Study Participants.

Community psychiatric treatment (CPT) is a novelty in the primary health care system for the people with mental health problems. The service operates according to the Flexible Assertive Community Treatment (FACT) model. FACT is a rehabilitation-oriented clinical case management model based on the ACT model (Assertive Community Treatment). This study aimed to assess how involvement in a community psychiatry program affects the quality of life of program participants. Between December 2020 and March 2021 we conducted a qualitative study. To obtain information, semi-structured interviews with twelve patients treated in the Community Psychiatric Treatment program were conducted. All restriction regarding COVID pandemic were considered at the research. Content analysis of the text was used for data analysis, which means that we interpreted the analysed text and determine the meaning of individual parts of the text. Twelve persons participated in the interviews, six of which were women (50%) and six men (50%). All the participants were of Slovenian nationality. They were from 28 to 80 years old, with a mean age of 47 years. We identified twelve categories and four themes: treatment problems, principles of operating of CPT program, satisfaction with inclusion in the CPT and improvement of quality of life through inclusion in the program. Quality of life is essential for every individual, as well as for people with mental health problems. In our study we have proved that the Community psychiatric programs could significantly impact the quality of life of people with mental health problems.

The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study

We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program’s effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program’s cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.

Project CHOICE: Choosing healthy options in coping with emotions, an EMA/EMI plus in-person intervention for alcohol use

Background: Emerging adulthood (18–25 years) represents a risky time for mental health and substance use. Emerging adults are particularly susceptible to problematic patterns of substance use, especially if they experience anxiety and/or depression and use substances as a way to cope with such issues. However, many mental health treatments do not address substance use. We developed an ecological momentary assessment and intervention (EMA/EMI) to specifically target the motive of drinking to cope with anxiety/depression. Methods: Project CHOICE was a 6-week intervention that paired in-person normative feedback with daily EMA and, if an individual reported negative affect and intent to drink, an EMI was immediately sent to their phone (a personally-chosen coping skill). We recruited n = 20 (55% female, mean age 21.74, 85% Caucasian and 75% non-Hispanic/Latino) individuals from a psychiatric partial hospitalization program for a 6-week open trial of the CHOICE intervention and re-assessed at the 6-week follow-up point. Results: Results indicated that drinking variables and coping motives were highly correlated at baseline. Days of drinking, alcohol-related problems, and coping motives significantly decreased over time following the intervention. Results indicated high levels of feasibility and acceptability. Conclusions: This open pilot represents a feasible, acceptable, and promising direction in delivering interventions in the moment when risk is highest, utilizing smartphone capabilities.

Unnecessarily prolonged suffering: a case of missed diagnosis of post-traumatic stress disorder in a teaching hospital

ABSTRACT We described a case in which a heavily-traumatized patient had been under psychiatric treatment for seven years (five of them in a university mental health clinic) but was never diagnosed with PTSD and, therefore, did not receive the proper treatment for a very long period. After the correct diagnosis was made and personalized treatment instituted, the patient has shown marked improvement in functionality and wellbeing. The key element in this case, was the adequacy of psychiatric training. Our report suggests that psychiatrists are not being adequately trained to identify traumatic events and to diagnose atypical cases of PTSD. With that in mind, we emphasize that theoretical modules on trauma and trauma-related disorders and practical training in specialized PTSD clinics should be incorporated into the psychiatric residency training programs wherever they may be missing, particularly in countries most impacted by violence. Furthermore, continuing medical education on trauma and PTSD should be provided by medical associations and journals to keep physicians updated on recent progress in the field.

Incidence rates and employment trends in schizophrenia spectrum disorders, bipolar affective disorders and recurrent depression in the years 2000–2013: a Danish nationwide register-based study

Aims The study aimed to investigate time trends in incidence rates in schizophrenic spectrum disorders (ICD-10: F20–F29), bipolar affective disorder (ICD-10: F30, F31), and recurrent depression (ICD-10: F33) and to investigate the rates of employment for all incident cases. Method We used nationwide longitudinal data from 2000 to 2013 on all psychiatric inpatients and outpatients contacts in Denmark. Age-adjusted incidence rate ratios were calculated for the three diagnostic groups, and rates of employment, education, and disability pension were measured 1 year before and 2 years after the diagnosis for all the incident cases. Results The incidence rates increased significantly in all diagnostic groups and both sexes. Comparing the incidence rates in 2013 with 2000 yielded an incidence rate ratio of 1.67 (95% CI 1.51–1.84) for schizophrenic spectrum disorders, 3.82 (95% CI 3.23–4.52) for bipolar affective disorder, and 2.80 (95% CI 2.58–3.04) for recurrent depression. During the same observation period, the employment rates decreased, both 1 year before and 2 years after diagnosis in all three subgroups. In the year 2002, employment rates, 2 years after diagnosis, were 24.6% for schizophrenia spectrum disorder, 35.0% for bipolar affective disorder and 47.1% for recurrent depression. These rates had declined to 15.8%, 26.8%, and 34.7%, respectively, in 2013. Conclusion This study of three severe mental illness subgroups shows significant increasing incidence rates and decreasing employment rates both before and after the diagnosis between 2000 and 2013, highlighting the importance of timely and correct volume of the psychiatric treatment and vocational rehabilitation programs.

Exploring Technology-Based Enhancements to Inpatient and Residential Treatment for Young Adult Women with Co-Occurring Substance Use

Objectives Young adults have the highest rates of substance use of any age group. Although men historically have higher rates of substance use disorders (SUDs) than women, research shows this gender gap is narrowing. Young adults with comorbid psychiatric disorders are at increased risk for developing a SUD. Co-occurring psychiatric disorders such as depression, anxiety, eating and post-traumatic stress disorders are more prevalent in women than men with SUDs, yet mental health treatment often does not adequately address substance use in patients receiving care for a comorbid psychiatric disorder. Tailored gender-responsive interventions for women with psychiatric disorders and co-occurring SUD have gained empirical support. Digital interventions tailored to young adult women with co-occurring disorders have the potential to overcome barriers to addressing substance use for young adult women in a psychiatric treatment setting. This study utilized a user-centered design process to better understand how technology could be used to address substance use in young adult women receiving inpatient and residential psychiatric care. Methods: Women (N = 15; age 18–25 years), recruited from five psychiatric treatment programs, engaged in a qualitative interview and completed self-report surveys on technology use and acceptability. Qualitative interviews were coded for salient themes. Results: Results showed that few participants were currently using mental health web-based applications (i.e., “apps”), but most participants expressed an interest in using apps as part of their mental health treatment. Participants identified several important topics salient to women their age including substance use and sexual assault, stigma and shame, difficulties abstaining from substance use while maintaining social relationships with peers, and negative emotions as a trigger for use. Conclusions: These data provide preliminary evidence that a digital intervention may be a feasible way to address co-occurring substance use problems in young adult women receiving care in a psychiatric setting.