Psychiatric Subspecialty Research Articles

Teaching, assessment and best practice in undergraduate psychiatry education in the UK: cross-sectional survey.

We conducted a cross-sectional survey to examine how undergraduate psychiatry is taught and assessed across medical schools in the UK that have at least one cohort of graduated students. In total, 27 medical schools completed the survey. Curriculum coverage of common mental disorders, assessment skills and mental health law was broadly consistent, although exposure to psychiatric subspecialties varied. Significant variation existed regarding the duration of psychiatry placements and availability of enrichment activities. Small-group teaching, lectures and e-learning were the most frequent teaching modalities and various professionals and lived experience educators (patient and/or carers) contributed to teaching. Objective structured clinical examinations and multiple-choice questions dominated assessments. Medical schools should consider increasing students' exposure to different psychiatric subspecialties and integrating physical and mental health training to address comorbidity and promote holistic care. Future research should explore whether specific undergraduate experiences promote greater career interest and skills in psychiatry.

Analysis of Kampo case reports from the viewpoint of “Yasui Classification”

AbstractBackgroundThe “Yasui Classification” categorizes the indication for Kampo medicine into four main types in the medical field where standard treatment of Western medicine exists regardless of the school of Kampo medicine. We aimed to elucidate how Kampo case reports are presented from the viewpoint of the Yasui Classification.MethodsUsing the general presentations at the 69th Japan Society for Oriental Medicine (JSOM) Academic Meeting held in Osaka in June 2018, the contents of each abstract were analyzed with the Yasui Classification.ResultsThere were 289 abstracts. The numbers of included abstracts was 140 (48.4%), and their breakdown was as follows: Type 1: 97, Type 2: 27, Type 3: 12, and Type 4: 4. Therefore, Kampo monotherapy yielded the greatest number of presentations where Western medicine‐refractory cases were treated with Kampo medicine. In Type 2, which is the combination of Kampo and Western medicines, there were various applications of Kampo medicine in clinical fields such as pain control, respiratory, cardiovascular, and psychiatric subspecialties. Furthermore, in Type 3, which is also the combination of Kampo and Western medicines, 7 of 12 presentations were related to the alleviation of the side effects of cancer therapy.ConclusionsKampo monotherapy is most popularly reported at the Congress of JSOM in various fields of medicine, whereas the concurrent use of Kampo and Western medicines is also reported in a variety of clinical subspecialties. A new horizon of clinical significance for Kampo medicine will be opened with the Yasui Classification.

Broadening the state of play - the second national survey of Consultation-Liaison Psychiatry services in New Zealand, 2021.

The original national survey of Consultation-Liaison Psychiatry (CLP) services in New Zealand (NZ) that was undertaken in 2018 (CLPSNZ-1) established a baseline but was limited in scope. The aim of the current study was to conduct a more in-depth national survey. A 44-question survey was emailed to clinicians at each of the 16 general hospitals in NZ with specialist adult CLP services in 2021. Responses were obtained from all 16 CLP services. These services were found to be under-resourced (with mean total full-time equivalents of 0.26 psychiatrists and 1.10 clinicians per 100 inpatient beds, respectively), operate with highly variable service models (with major variations in operating hours and coverage of age groups, the Emergency Department and outpatients) and provide a predominantly consultation service. While many of the findings from CLPSNZ-1 remain relevant, the current survey has extended our understanding of the circumstances, achievements and challenges of this psychiatric subspecialty in NZ.

Reflecting on a Big Year for Mental Health

Reflecting on a Big Year for Mental Health

Abstracts of the 54th Annual General and Scientific Meeting of the Association of Psychiatrists in Nigeria (APN), KANEM 2023.

This book of abstracts encapsulates the collective insights and research findings presented at the 54th Annual General and Scientific Meeting of the Association of Psychiatrists in Nigeria (APN), held from 26th November to 1st December 2023, at the Professor Emeritus Umaru Shehu Centre for Mental Health and Psychosocial Support, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria. Centred around the theme "National Mental Health Reforms: Prospects and Strategies of Implementation of the National Mental Health Act 2021," the conference engaged over one hundred and thirty professionals in a vital discourse on mental health reforms in Nigeria, touching on subthemes like 'Brain Drain, Brain Gain and Brain Circulation' and 'Post-conflict Resettlement and Stabilization.' The compilation features twenty-six diverse abstracts from national and international experts, covering a wide range of psychiatric subspecialties including Addiction Psychiatry, Biological Psychiatry, and more. This collection serves not only as a testament to the vibrant exchange of ideas at the conference but also as a valuable resource for advancing psychiatric practice and patient care in Nigeria and beyond.

An Interventional Psychiatry Track.

"Interventional psychiatry" has been proposed as a name for the emerging psychiatric subspecialty of neuromodulation, or brain stimulation. The practices of electroconvulsive therapy and transcranial magnetic stimulation are rapidly expanding. Moreover, research techniques, such as neuronavigation and electrophysiology, are already translating to the clinic, further emphasizing the need for training paradigms to keep pace. The purpose of this article is to provide practical guidance for psychiatry residents who seek further training in this emerging subspecialty. It describes a training track developed at the Medical University of South Carolina that can be adopted by residents at other institutions.

Recruitment into old age psychiatry

This research aimed to explore the trainee perspective on factors affecting recruitment into old age psychiatry higher training in the UK. A qualitative survey was created by the Faculty of Old Age Psychiatry and distributed to current higher trainees in all psychiatric subspecialties. A total of 324 higher trainees responded to the survey, representing a broad demographic range. Thematic analysis was carried out, with sufficient responses to achieve saturation. Key themes included concerns about the future of the specialty, issues with social care, lack of support with patients’ physical health needs, issues with training posts, and workload. The need to improve core trainees’ experience of the specialty was highlighted. Many positive themes arose from the data; however, a number of barriers to recruitment were also identified. The findings have implications for recruitment to the specialty and should be used to inform recruitment strategy moving forward.Declaration of interestNone.

Forensic Psychiatry and Consultation-Liaison Psychiatry: Exciting Subspecialties with Bright Futures

Additional training in psychiatric subspecialties has been increasingly recognized as a way to prepare psychiatrists to successfully manage more difficult and complex patient circumstances. This article describes the practice activities and scope of training for forensic psychiatry and consultation-liaison (CL) psychiatry. Forensic psychiatry fellowship training prepares psychiatrists to manage medical/psychiatric legal scenarios, ranging from patient-care legal issues to performing legal expert witness consultations for third parties, including courts and attorneys, as well as correctional mental health. CL psychiatry training prepares psychiatrists to master the care of patients with complex medical and psychiatric illnesses as well as to work effectively in multidisciplinary medical teams and integrated medical psychiatric care settings. [ Psychiatr Ann . 2018;48(11):509–515.]

La psychiatrie de liaison au Centre Hospitalier Universitaire Mohammed VI d’Oujda, Maroc : étude transversale sur dix mois

In Morocco, liaison psychiatry is a relatively new activity and is not currently recognized as a psychiatric sub-specialty. However, several university psychiatric teams have started this activity in a more or less structured manner (Fès, Casablanca, Rabat and Oujda). ObjectivesThe objective of this study is to describe the development and organization of the psychiatric liaison activity in the psychiatry department of the Mohamed VI University Hospital Center in Oujda and to evaluate it from a preliminary study. Through this study, we evaluated the reasons for psychiatric consults, requesting services and the most frequent psychiatric disorders. MethodsThis is a cross-sectional descriptive and analytical primary study over a period of 10 months between May 2016 and February 2017. The study recruited 60 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fès. The psychiatric assessment was based on a psychiatric interview using DSM-5 diagnostic criteria. The data were collected by a certified psychiatrist using a medical psychiatric record. ResultsDuring this study, 17 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (28%), gastroenterology (13%), and nephrology (11%). Depressive symptoms (54%) and assessment of suicidal behavior (19%) were the most common motivations for psychiatric consultations. Depressive disorder (58%) and adjustment disorder (18.7%) were the most frequent psychiatric diagnoses in patients from medical and surgical departments. ConclusionPsychiatry liaison is an activity in full evolution in Morocco, the structuring and organization of this activity is paramount, given its clinical, pedagogical, research and even economic interest.

Between Don Quixote and Hamlet: vicissitudes of contemporary Cultural Psychiatry

Background. Although Cultural Psychiatry (CP) has emerged as a significant discipline and body of knowledge in recent decades, it finds itself in a current intense debate about its identity, its contributions, and its future. Objective. To examine conflictive areas of historical, epistemological, clinical, educational, and research interest in the present and future development of CP. Method. A narrative review of outstanding sources, articles, and textbooks on CP that reflect its current vicissitudes; for each area, adequate quotations of Cervantes’ Don Quixote and Shakespeare’s Hamlet are used. Results. In addition to updating definitions and content, discussions about whether CP is a psychiatric subspecialty, the scope of its diagnostic, clinical and therapeutic applications, evaluation of criticisms and strengths, interactions with other disciplines, as well as reflective speculations about its future, are outlined. Discussion and conclusion. CP is considered the receptacle of many disciplines, the last bastion of humanistic medicine in a globalized world, although its development will always be marked by scholarly debates about contexts, meanings, identities, and competencies regarding its ontological and epistemological components.

Trinucleotide repeat disorders: An interesting interface between psychiatry and medicine

SummaryThe discovery of conditions resulting from the expansion of unstable trinucleotide repeats, with their neuropsychiatric presentations crossing the boundaries of different specialties, provides ample opportunity for research and liaison work between medical and psychiatric subspecialties. Clinicians’ awareness of the presentations and genetic basis of these conditions improves management strategies and the quality of life of patients and their carers.

The American Association for Geriatric Psychiatry's Scholars Program: A Model Program for Recruitment into Psychiatric Subspecialties.

The American Association for Geriatric Psychiatry's Scholars Program: A Model Program for Recruitment into Psychiatric Subspecialties.

Quality improvement project: Mentoring, career advice and placement introduction session for year 5 imperial college medical students. Should induction go beyond facts and numbers?

IntroductionFeedback received from previous rotations of year 5 Imperial College medical students in West London Mental Health NHS Trust has consistently shown that medical students feel uncertain about what to expect in their psychiatric placements and are sceptical about psychiatry as a future career option. This prevents them from maximizing the educational benefit and potential in their training.Aims and objectivesTutorial aims to prepare medical students for their psychiatric placements and create the opportunity for informal discussion about psychiatry as future career option. The session aspires to motivate students to be more involved and active participants and invite them to think about their future career option at an early stage.MethodologyA 1-hour tutorial has been added to medical students’ induction in two successive rotations (July–October 2016). Thirty-seven (37) medical students have attended the tutorial so far. Tutorial provides information about psychiatric placements, learning opportunities as well as structural and operational issues. Besides, it encourages discussions about psychiatry as a future career option, informing students about psychiatric sub-specialties, career pathways and NHS operational structure. Feedback questionnaire is handed over at the end.ResultsData were collected and analysed and findings are outlined in the diagram below (Fig. 1).Conclusions and recommendationThe majority of medical students have feedback they found tutorial relevant and useful. Current tutorial formula will be revised based on feedback collated so far.Findings are going to be shared with local Undergraduate Educational Committee and Imperial College medical school board.Disclosure of interestThe authors have not supplied their declaration of competing interest.Fig. 1Imperial College medical students’ feedback.

Medical Marijuana and the Treatment of Post Traumatic Stress Disorder: A Survey of Michigan Psychiatrists’ Opinions

CONTEXTAlthough recent studies have indicated a potential mechanism of action through which medical marijuana (MM) and its derivatives may treat Posttraumatic Stress Disorder (PTSD) symptoms, definitive evidence is still lacking. Few studies concerning physician attitudes regarding MM and/or marijuana-derived medications for PTSD are found in the psychiatric literature.METHODSA non-probability convenience sample of psychiatric physicians in Michigan was surveyed during 2016. The 12-item survey questionnaire asked respondents a series of questions about their personal characteristics, prior experiences of treating PTSD and opinions concerning the use/potential use of MM for treatment of PTSD.RESULTSA total of 83 psychiatrists (11.7% of total invited) responded to the survey. Several statistically significant correlations between respondent characteristics and other key measures (e.g., Age Category, Gender, Years of Psychiatric Practice, Psychiatric Practice Role (i.e., resident vs. attending), Number of Psychiatric Subspecialties, and Number of PTSD Patients Diagnosed and/or Treated to date) were found. A composite summary score was also formulated from questions related to opinion regarding the use of MM for PTSD and categorized into three comparison groups. The final stepwise multinomial logistic model demonstrated three statistically significant factors influencing what response category respondents fell into regarding MM use for PTSD: a) how often respondents had been exposed to recommendations concerning the use of MM for PTSD (p < 0.001), b) Age Category (p = 0.001) and how frequently respondents had recommended MM for treatment of PTSD (p < 0.001).CONCLUSIONSThe results from this smaller sample indicate that the majority of psychiatrist respondents did not support MM for the treatment of PTSD. Judging from these results, Michigan psychiatrists may be extremely conservative regard the prospective use of MM for PTSD. Few sample respondents indicated that they had been exposed to professional literature detailing MM and derivatives as a treatment for PTSD. Most respondents also indicated that they were Unsure/There is Not Enough Research concerning the scientific evidence for the use of MM for PTSD. Based on these findings from a smaller sample, the use of MM and its derivatives for treatment of PTSD may not currently be supported by the majority of Michigan psychiatrists.

The Road Ahead in Education: Milestones for Geriatric Psychiatry Subspecialty Training

The Accreditation Council of Graduate Medical Education (ACGME) Milestone Project is the next step in a series of changes revamping the system of graduate medical education. In 2013 the ACGME completed the general psychiatry milestones. The ACGME then pursued creation of milestones for accredited psychiatric subspecialty fellowships. This article documents the work of the geriatric psychiatry subspecialty milestones work group. It reports the history and rationale supporting the milestones, the milestone development process, and the implications for geriatric psychiatry fellowship training. In consultation with the American Association for Geriatric Psychiatry, the American Board of Psychiatry and Neurology, and the ACGME Psychiatry Residency Review Committee, the ACGME appointed a working group to create the geriatric psychiatry milestones using the general psychiatry milestones as a guide. The geriatric psychiatry milestones are the result of an iterative process resulting in the definition of the characteristics vital to a fellowship-trained geriatric psychiatrist. It is premature to assess their effect on psychiatric training. The true impact of the milestones will be determined as each training director uses the milestones to re-evaluate their program curriculum and the educational and clinical learning environment. The ACGME is currently collecting the information about the milestone performance of residents and fellows to further refine and determine how the milestones can best be used to assist programs in improving training.

L’éclosion de la gérontopsychiatrie à l’Université de Montréal, une histoire à découvrir

Geriatric psychiatry became an official psychiatric subspecialty in Canada in 2009. The first board examinations from the Royal College of Physicians and Surgeons of Canada (RCPSC) took place in 2013. Geriatric Psychiatry focuses on the assessment, diagnosis, and treatment of complex mental disorders in late life, a time when the interface between physical and mental health issues often adds a new level of complexity.Little has been written on the history of geriatric psychiatry in Québec and in Canada. A lesser-known aspect is that from the 1970's onwards, the department of psychiatry at the Université de Montréal (UdeM) and its network of teaching hospitals have played a pioneering role in the development of geriatric psychiatry services and training. We seek to recount the history of geriatric psychiatry at UdeM, by tracing the milestones and identifying the main actors responsible for its development, from the inception of the department of psychiatry 50 years ago. This leads us to share reflections on some of the issues geriatric psychiatry is facing in Québec. We interviewed several key actors, past and present, of geriatric psychiatry at UdeM. We read through relevant sources such as articles and monographs on the local history of psychiatric services, information bulletins and annual reports from hospitals and from UdeM, as well as other documentation from personal archives. One of the very first geriatric psychiatry services in Canada was founded in 1978 at the Institut universitaire en santé mentale de Montréal, with a dedicated inpatient unit for new admissions of elderly psychiatric patients. A geriatric psychiatry outpatient clinic was inaugurated the same year at the Pavillon Albert-Prévost. Throughout the years, geriatric psychiatry services were also developed in the remaining hospital sites affiliated with the department of psychiatry at the UdeM (Hôpital Maisonneuve-Rosemont, Centre hospitalier de l'Université de Montréal, Institut universitaire de gériatrie de Montréal), driven by dedicated individuals, in accordance with their respective historical background and mission. Clinical training is provided in each of these sites for medical students, psychiatry residents and more recently, for future geriatric psychiatrists. In 2014, the geriatric psychiatry residency program at UdeM was the first to be accredited in Québec by the RCPSC, as well as the first French language geriatric psychiatry program in North America. Geriatric psychiatry in 2015 is a burgeoning field, in a challenging demographic context. Despite the clinical need, major obstacles remain, particularly in the absence of specific geriatric psychiatry positions. Furthermore, the Québec healthcare system is going through a major restructuration in 2015, adding to the uncertainty. The 50th anniversary of the department of psychiatry at UdeM is an opportunity to underline the contribution of UdeM to the development of geriatric psychiatry in Québec, and to emphasize the specific needs of the elderly in terms of mental health care and geriatric psychiatry services.

Consultation-Liaison Psychiatry in the General Hospital: the Experience of UK, Italy, and Japan.

Consultation-liaison psychiatry (CLP) is a psychiatric subspecialty addressing the psychological care of medically ill patients as well as the relationship between medical and psychiatric disorders. As a specialty, it has developed over the last 30 years. Yet several cultural and organizational problems in different countries have emerged, including differences regarding implementing CLP services and in the application of CLP guidelines. This paper examines the progress and challenges of CLP in three culturally diverse countries: the UK, Italy, and Japan. In all three countries, the provision of CLP service remains insufficient, and the application of officially acknowledged standards of care is necessary.

Are curriculum changes the ideal method for increasing undergraduate exposure to tomorrow's specialties?

Dear editor Smaller specialties such as dermatology, psychiatry, and radiology have often received less teaching time within the undergraduate medical curriculum.1 Some critics argue that this may be responsible for the low intake rates within postgraduate training for these specialties. The Royal College of Psychiatrists reported that only 83% of core training post vacancies were filled after two rounds of recruitment in 2012.2 Furthermore, the National Health Service identified a shortfall of 220 interventional radiologists in the UK.3 Similar workforce problems have been encountered in the USA.4 It has been suggested that increasing exposure to these specialties in medical school may allow students to gain a better insight into the specialty and consider it as a viable future career choice.1 Although incorporating more dedicated teaching time for small specialties within the curriculum may help to meet future workforce demands, there are strong arguments against implementing it. First of all, teaching time would have to be taken away from the core specialties to accommodate more teaching for smaller specialties. However, knowledge and skills within the core specialties is more important for building a strong foundation for any future career choice. There is no robust evidence to suggest that students would still receive adequate training in core specialties if smaller specialties are given more time. Second, the overall workforce requirements are much greater for the core specialties and the majority of graduates are more likely to enter the core rather than the smaller specialties. Perhaps a different approach is required. In order to tackle the current shortfall in psychiatrists, the Royal College of Psychiatrists has adopted a particularly strong strategy.2 This includes setting up/supporting medical school societies, regular career fairs, annual summer schools, intercalated Bachelor of Science programs, and student elective modules to engage and educate medical students. In addition, financial incentives (including bursaries/grants for conferences, electives, and research, essay prizes, and fellowships) have been used to promote and reward student activity across the variety of psychiatric subspecialties. Although these methods may not have the direct impact of dedicated teaching, they provide ample opportunity for students to explore the smaller specialties without detracting unnecessarily from the core curriculum.

The Milestones for Psychosomatic Medicine Subspecialty Training

The Accreditation Council of Graduate Medical Education Milestones project is a key element in the Next Accreditation System for graduate medical education. On completing the general psychiatry milestones in 2013, the Accreditation Council of Graduate Medical Education began the process of creating milestones for the accredited psychiatric subspecialties. With consultation from the Academy of Psychosomatic Medicine, the Accreditation Council of Graduate Medical Education appointed a working group to create the psychosomatic medicine milestones, using the general psychiatry milestones as a starting point. This article represents a record of the work of this committee. It describes the history and rationale behind the milestones, the development process used by the working group, and the implications of these milestones on psychosomatic medicine fellowship training. The milestones, as presented in this article, will have an important influence on psychosomatic medicine training programs. The implications of these include changes in how fellowship programs will be reviewed and accredited by the Accreditation Council of Graduate Medical Education and changes in the process of assessment and feedback for fellows.

New APA Award Recognizes Emerging Field of Pharmacogenomics

New APA Award Recognizes Emerging Field of Pharmacogenomics