Place In Psychiatry Research Articles

Medical Students' Attitudes toward Self-harm, and Curricular Influences on Attitude Development.

The authors explore attitudes that first and final year medical students have toward self-harm, and examine how the curriculum may influence the development of these attitudes. Six focus groups, involving a total of 21 medical students, were used to explore the objectives. Thematic framework analysis was used to analyze the data through iterative development of a coding framework and identification of themes. Medical students demonstrated simultaneously positive and negative attitudes. Students reported minimal exposure to self-harm through the formal curriculum and being exposed to negative attitudes exhibited by healthcare professionals through the informal curriculum. Students felt that self-harm was not as important as other subjects competing for their attention in their curriculum. Many students were discouraged by healthcare staff from seeing people who self-harm, in particular on psychiatry placements. The hidden curriculum may be encouraging negative attitudes toward people who self-harm; students learn that self-harm is "not important." Findings from this study identify how the curriculum might influence the development of negative attitudes toward self-harm. Students would benefit from being encouraged to interact with people who self-harm and then having the opportunity to discuss the emotions these interactions create.

PSYCHIATRY POSTING AMONG NURSING STUDENTS: ATTITUDE TO MENTAL ILLNESS

Background: Attitude towards mental illness influence the nursing students’ choice to take up training and placement in psychiatry as a specialty. The aim of the study was to examine nursing students' attitudes towards mental illness in terms of aetiology, social relations with patients and self-disclosure regarding mental illness.
 Methods: This was a descriptive quasi-experimental study conducted among all the sixty nursing students attending a 6-week psychiatry posting at Federal Neuropsychiatry Hospital Kware, Sokoto State and Psychiatry unit of General Hospital Katsina, Northwest Nigeria in July 2018. Attitudes toward Mental Illness (ATMI), a self-administered questionnaire was given to the participants before and after six-week posting in psychiatry. Data was analyzed using SPSS version 23. 
 Results: After 6 weeks posting in psychiatry there was improvement in the participants’ positive attitude towards social relation in person with mental illness, willingness to self-disclosure regarding mental illness and etiology of mental illness compare to before the commencement of psychiatry posting. Majority (81%) reported that movies have negative influence on their attitude toward mental illness.
 Conclusion: The 6-week psychiatry posting has positive effects on nursing students' attitudes towards mental illness. Movies contribute negatively towards majority of the participants’ attitude to mental illness. Use of psychodrama is being suggested to educate people on the etiology and treatment of mental illness. This study provides evidence-based recommendation for mandatory psychiatry posting among other health workers under training and use of psychodrama to educate the public on mental illness.

A few reflective remarks on the notion of consent

Medical paternalism has given way to the autonomy of the patient, who remains master of the decisions he makes concerning his health. His consent, free and informed, has no value unless it is preceded by information adapted to his degree of understanding. The notion of consent raises the question of freedom, and therefore of the autonomy left to patients in their choices. Individual freedom occupies a particular place in psychiatry where itcomes into confrontation with constraint. The tensions generated must lead caregivers toask themselves the right questions in accordance with the principles of medical ethics.

ПСИХИАТРИЧЕСКИЙ ПАЦИЕНТ КАК ХУДОЖНИК: ФОРМИРОВАНИЕ ДИСКУРСА АУТСАЙДЕРСКОГО ИСКУССТВА В ПЕРВОЙ ЧЕТВЕРТИ ХХ ВЕКА

The author of the article studies the discourse of outsider art and refers to the beginning of its formation: the phenomenon of the art of the mentally ill, which is delineated and legitimized at the early twentieth century. Following the conceptual apparatus of Michel Foucault, the surfaces of emergence and the authorities of delimitation of the art of outsiders (in the early stage of the art of the mentally ill) are initially marginal in relation to the field of art. Instead of traditional instances of art –critics, museums, art critics – in the case of the art of outsiders, the discourse of outsider art was formed by psychiatrists, philosophers, and leftist artists. The transformation of the traditional way of legitimizing the phenomena of art was largely due to the change in the philosophy of culture and, on the one hand, the emergence of the idea of Dionysian values, irrational in culture, on the other, with the emergence of the concepts of the unconscious and the designation of its meaning in the context of personality and culture. The latter has made the field of psychiatry valuable, and psychiatrists new levels of differentiation in culture and art. But it is important to note the cardinal changes that took place in psychiatry in the period of the turn of the XIX–XX century. Including as a result of the activities of the German and Swiss schools, psychiatry becomes complex, multi-component scientific knowledge, was striving to study various aspects of the human psyche. On the other hand, in Germany and Switzerland interest in the art of the mentally ill was formed largely as a result of the active influence of expressionist painting, literature and aesthetics and other avant-garde tendencies; all this sets the stage for significant success in understanding and evaluating the art of psychiatric patients. It is also important that the actual process of legitimizing the art of the mentally ill in the texts of Walter Morgenhalter and Hans Prinzhorn had gone through the using by psychiatrists of the description’s language and analysis’s logic of the indicated phenomena inherent in the contemporary critical art theory.

Critical Psychiatry Debates; A Neglected Tool in Undergraduate Medical Education.

This article was migrated. The article was marked as recommended. Background: Healthcare professionals must adapt to everyday clinical controversies using their critical thinking and communication skills. Educational debates nurture these skills producing a well-rounded clinician. Their value is well established in healthcare education, yet they are not commonly employed, and there is no literature on their use in undergraduate Psychiatry teaching. Methods: We planned and implemented a one-off educational debate lesson as part of the teaching program of fourth-year medical students on their Psychiatry clinical placements. We collected and analyzed the students' feedback. Results: Although most students had no experience of debates, 79% found the learning event positive. The students also reported improvement in their confidence (58%), oral presentation skills (37%), critical thinking skills (71%) and the ability to cope with conflict (54%). In addition, there was a positive shift in their attitude towards Psychiatry (71%) and the chances of choosing it as a future speciality (33%). Conclusion: Our results showcase the benefit of using debates in shaping future doctors' non-clinical skills and practice attitudes. In this paper, we discuss a thematic analysis of students' feedback comments and reflect on several points in the planning and delivering educational debates. We also include practical recommendations for future applications.

Peer learning in clinical placements in psychiatry for undergraduate nursing students: preceptors and students' perspective.

AimTo describe the experiences of peer learning in psychiatric inpatient settings during clinical placement of undergraduate nursing students and to highlight the possibility for peer learning in psychiatric outpatient settings.DesignA qualitative inductive design.MethodQuestionnaires with 14 students and 12 preceptors in inpatient and outpatient care and interviews with one student and one preceptor in outpatient care were analysed with content analysis.ResultsStudents and preceptors perceived learning benefits with peer learning. They described how learning increased through exchange of knowledge and how collaboration created security and independence, structured learning activities were appreciated as a learning tool. Incompatibility of students was an issue that could be overcome. Peer learning was perceived to contribute to a secure learning atmosphere, increased self‐confidence and to provide a deeper understanding of psychiatric nursing. Peer learning was described as promoting discussion and reflection on practice and preparing nursing students for their future profession.

Effects of contact-based, short-term anti-stigma training for medical students : Results from arandomized controlled trial.

Mental health stigma (MHS) places aburden on those affected that far exceeds psychosocial harms. Contact-based anti-stigma work has been found effective for several target groups. For medical students however, its efficacy remains unclear. The purpose of this study was to examine the efficacy of contact-based, trialogic anti-stigma training for medical students. Arandomized controlled trial (RCT) was conducted, controlling for standard clinical placement in psychiatry. External validity was maximized by including all students (n = 204) who started their 6‑week obligatory psychiatry course during the study period between March and July 2018. Assessments were conducted at the beginning of each of the two covered terms and immediately postintervention. Students who received the anti-stigma training displayed significantly less stigmatizing attitudes after the intervention, measured using the MICA (Mental Illness-Clinicians' Attitudes) scale as primary outcome. Analogous findings were noted for social distance and stereotypes, whereas these could not be observed for emotional reactions. All significant changes were independent of gender and age. The positive results underpin the research in this field and point towards the inclusion of comparable interventions in regular student curricula. Given the limitation of amissing late follow-up, however, further research regarding the persistence of stigma reduction is needed.

Who wants to be a psychiatrist? Northern Ireland foundation doctors (2006-2018) are positive toward psychiatry as career choice.

Northern Ireland presents itself as an anomaly - a region in which only 31.8% of doctors enter into any training programme after completion of the Foundation Programme, but where Core Psychiatry has been consistently oversubscribed. Here, we aim to find what other regions can learn from this success. All doctors of any grade, working in psychiatry, who had been though the Foundation Programme were questioned on their motivations for becoming a psychiatry trainee. Sixty-two doctors currently working in psychiatry responded, including over 60% of current trainees, and 45% stated they had not considered a career in psychiatry before their foundation attachment. Over 80% preferred foundation placements in FY2 only, rather than in either foundation year 1 or FY2. This survey identifies that for the majority of people who ultimately chose to train in psychiatry, in a region that has consistently attracted candidates to core and higher level training, completion of a foundation psychiatry post was an influencing factor in this decision. A strong majority of doctors prefer the foundation psychiatry placement to be offered in FY2.

Medical student perceptions of physical and emotional safety before and after 5-week mental health placements.

Understanding whether medical students feel safe in mental health placements is important to delivering effective and engaging training experiences. Second year students completed anonymous online surveys before (n = 37) and after (n = 41) mental health placements, to gather qualitative and quantitative data about their sense of physical and emotional safety, and factors that positively and negatively influenced their experiences. Data were analysed using chi square and content analysis. There was a disparity between students' expectations of physical and emotional safety before placements and their actual experience. Following placement, no students reported that they felt physically 'unsafe' or 'very unsafe'. Conversely, over 20% of students indicated that they had felt emotionally unsafe during their placement. When asked to compare their expectations prior to placement with their actual experience, over 13% felt 'much less safe' emotionally, where no participants felt 'much less safe' physically. Qualitative content identified included exposure to patients' tragic life stories, aggression, the physical ward environment and adequacy of supports. The distinction between physical and emotional safety is a valuable framework through which to understand the student experience of clinical placements in psychiatry and to seek to best support students. The data provide rich insight into students' experiences, particularly emotional challenges, on psychiatry wards.

Improving the provision of clinical skills teaching for undergraduate medical students during their psychiatry placement: a trainee-led quality improvement project.

To increase the provision of clinical skills training during their psychiatry placement by providing a new teaching course to enhance both their clinical knowledge and communication skills. We delivered a pilot teaching course consisting of five workshops (incorporating facilitated, 'near peer' role-play) during the students' psychiatry placement. Qualitative and quantitative feedback was collected pre- and post-course to allow for development of the course. Data collected indicated that all students found the course a valuable addition to their usual teaching. They indicated that their confidence in their ability to assess patients with common clinical problems improved. This trainee-led course was easily integrated into the curriculum and received positive feedback from students. It may have enhanced students' confidence and readiness for exams but this will require further examination of objective assessments and ongoing research to establish this.

Is Psychedelic Medicine on the Horizon?

Is Psychedelic Medicine on the Horizon?

Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness \u2013 study protocol for an international multisite non-randomised controlled study

BackgroundStigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students’ ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding.Methods/designREAD training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students’ knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention.DiscussionThis is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients’ experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed.

Irish general practitioners' view of perinatal mental health in general practice: a qualitative study

BackgroundIdentification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources.MethodIn-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework.ResultsData were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions.ConclusionsGPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.

The DSM-ICD diagnostic approach as an essential bridge between the patient and the "big data".

The use of diagnostic manuals in psychiatry is generally necessitated by the lack of tests that would corroborate psychiatric diagnosis. Criticism towards the today prevailing DSM-ICD diagnosis traditionally regards among others such problems as hyponarrativity, biologism, "death of phenomenology", and a questionably valid over-fragmentation of diagnosis. Lately, and especially after the appearance of the 5th edition of DSM (2013), criticism focuses at such issues as lack of validity, having failed to adopt a dimensional model, not adequately relying on genetics and neurobiology, and impeding, rather than facilitating, research into the etiology of mental disorders, the DSM becoming an "epistemic prison". The former problems seem to derive from the fact that the operationalist criteria are often uncritically adopted as the ultimate authority in diagnosis, instead of being merely guides, as intended originally and explicitely; the latter problems have been made more evident since the emergence of the American RDoC research initiative, which not only points to an alternative, more valid classification of mental disorders, but also aspires to signal a move of psychiatry tοwards precision medicine, having as its main dogma that mental disorders are disorders of brain circuits, which are expressed as complex syndromes. In this paper, the historical and epistemological context of the emergence of DSM is examined; its achievement in terms of diagnostic reliability as well as clinical utility is not negligible, especially taken into consideration the climate of virtual diagnostic arbitrariness which characterized the (American) psychiatry before 1980, with obvious consequences for the authority of the specialty. Then, the potential of the new era of genetics, neurobiology and analysis of the "big data" for generating a novel approach to psychiatric diagnosis and classification is put into consideration, while it remains unknown in what way the findings of RDoC could lead and be translated into a new classification system. Moreover, the particularity of the psychiatric object, the clinical significance of the categorical approach to diagnosis, as well as the need for a "irreducible psychological level of explanation" are discussed. In our view, today, the DSM-ICD diagnosis lies between two different and potentially opposing demands and tendencies: on the one hand, the demand for the individual, subjective and phenomenological particularity of the mentally ill to be taken into consideration (a demand that sometimes underestimates the need for clinical communication); on the other hand, the (largely future) vision for more and more analysis of biological data in the name of a yet to be clarified personalized therapy (the very notion of diagnosis becoming potentially redundant). Finally, considering the particularity of the psychiatric object, we conclude that matthe DSM-ICD approach, with its categorical diagnoses and its descriptive operational criteria, despite its inherent imperfections and inadequacies, continues to have a place in psychiatry as an essential bridge/interface between clinic and research data, as a common clinical language, and as an epistemic hub; and that prerequisites for diagnostic validity should be sought both in the cells of RDoC and in those theoretical approaches which examine human subjectivity as such, included phenomenology and psychoanalysis.

General Practitioner (GP) trainees’ experience of a ‘1-h protected supervision model’ given during psychiatry placements in the United Kingdom

BackgroundA ‘1-hour protected supervision model’ is well established for Psychiatry trainees. This model is also extended to GP trainees who are on placement in psychiatry. Aim: To explore the experiences of the ‘1-hour protected supervision model’ for GP trainees in psychiatry placements in the UK.MethodsUsing a mixed methods approach, an anonymous online questionnaire was sent to GP trainees in the North West of England who had completed a placement in Psychiatry between February and August 2015.ResultsDiscussing clinical cases whilst using the e-portfolio was the most useful learning event in this model. Patient care can potentially improve if a positive relationship develops between trainee/supervisor, which is impacted by the knowledge of this model at the start of the placement. Trainees found that clinical pressures were impacting on the occurrence of supervision.ConclusionThe model works best when both GP trainees and their supervisors understand the model. The most frequently used and educationally beneficial aspect for GP trainees in psychiatry is the exploration of clinical cases using the learning portfolio as an educational tool. For effective delivery of this model of supervision, organisations must reflect on the balance between service delivery and allowing the supervisor and trainee adequate time for it to occur.

Medical Students' Beliefs and Attitudes towards Schizophrenia before and after Psychiatric Training in Almaarefa Colleges, Riyadh, Saudi Arabia

Background: Public surveys have shown that the general population has limited knowledge about mental illness and holds unfavorable attitudes towards the people who suffer from it in various, culturally diverse, countries. Aims: The aim of the present study was to explore medical students’ beliefs and attitudes towards people with schizophrenia (PwS) prior to receiving any training in psychiatry and to assess the impact of the psychiatric placement on changing them. Methods: A questionnaire addressing beliefs, attitudes and desired social distance from PwS was distributed to all final year medical students before the beginning of their 4-week undergraduate psychiatric placement and upon its completion. Results: Students did not endorse stereotypes commonly attached to PwS, such as being dangerous, lazy or of lower intelligence, but they held the view that PwS are unpredictable and suffer from split personality. Furthermore, the baseline level of desired social distance was found to increase as the intimacy of the interaction increased, and the only variable associated with it was personal experience of serious mental illness. Moreover, the placement was found to have either no influence at all or in a negative direction. Upon its completion more students were found to believe that PwS couldn’t recover, have no insight into their condition, cannot make reasonable decisions, cannot work in regular jobs and are dangerous to the public. No difference was recorded in social distance scores. Conclusions: A close and critical examination of the various elements of the undergraduate placement in psychiatry is needed in order to develop an evidence based, fully rounded education with an anti-stigma orientation.

Foundation trainees and changes in career intentions.

To understand whether foundation trainees change their career intentions during psychiatry placements and explore what factors influence such changes. Over a two-year period, foundation trainees completed questionnaires at the beginning, middle and end of their four-month placement. There were two questions, the first as to how likely they were to pursue a career in psychiatry and the second openly asked them to elaborate on their reasons. Twenty-one out of 41 eligible trainees returned all three questionnaires. The number of trainees 'highly likely' to choose psychiatry increased over the four-month period, from 4.5% to 19%. The number of trainees 'highly unlikely' to choose psychiatry decreased, from 27.3% to 9.5%. An increasingly positive intention towards a psychiatry career appeared to relate to enjoyment of the placement and the quality of supervision. The most common reason for not choosing psychiatry was a pre-existing interest in another specialty. Undertaking a psychiatry placement during the foundation programme continues to increase the likelihood of a positive attitude towards psychiatry as a career. The findings of our study suggest good practice in providing foundation placements in psychiatry includes identifying medical school experience, enjoyment, quality weekly supervision and mindful experiential design of placements.

Diagnostic Classification Systems Based on Psychoanalytical Principles.

The diagnostic classification systems in psychiatry practice which are used worldwide extensively, The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) are far away from the psychoanalytical point of view. It is thought that this gap results in the difficulty to understand psychiatric patients in clinical practice for many years. It has also created an obstacle to scientific researches addressing the validity and reliability of the psychoanalytical principles. On the other hand, psychoanalysis has been much criticised for years due to the lack of empirical foundations. As a result of this paucity, psychiatry is led by the biomedical approach. Without enough grounds in evidence-based medicine, psychoanalytical principles could not become widespread in psychiatric practice. To survive criticism and strengthen its place in contemporary psychiatry, empirical research in psychoanalytical discipline has gained momentum in the last two decades. Development of objective psychodynamic diagnostic tools enabled the design of such studies. The aim of this review is to introduce such diagnostic tools, namely Psychodynamic Diagnostic Manual (PDM) and Operationalized Psychodynamic Diagnosis (OPD), and to discuss the possible contributions they provide for psychoanalytical perspective to take its deserved place in the psychiatry discipline.

Junior doctor psychiatry placements in hospital and community settings: a phenomenological study

ObjectivesThe proportion of junior doctors required to complete psychiatry placements in the UK has increased, due in part to vacant training posts and psychiatry career workforce shortages, as can be...

Why did you choose psychiatry? a qualitative study of psychiatry trainees investigating the impact of psychiatry teaching at medical school on career choice

BackgroundThere is no consensus regarding the optimal content of the undergraduate psychiatry curriculum as well as factors contributing to young doctors choosing a career in psychiatry. Our aim was to explore factors which had influenced psychiatry trainees’ attitudes towards mental health and career choice.MethodQualitative in-depth interviews with 21 purposively sampled London psychiatry trainees analysed using the Framework method.ResultsEarly exposure and sufficient time in undergraduate psychiatry placements were important in influencing psychiatry as a career choice and positive role models were often very influential. Integration of psychiatry with teaching about physical health was viewed positively, although concerns were raised about the potential dilution of psychiatry teaching. Foundation posts in psychiatry were very valuable in positively impacting career choice. Other suggestions included raising awareness at secondary school level, challenging negative attitudes amongst all medical educators, and promoting integration within medical specialties.ConclusionsImprovements in teaching psychiatry could improve medical attitudes and promote recruitment into psychiatry.