Psychiatry In Relation Research Articles

The Transdiagnostic Connectome Project: a richly phenotyped open dataset for advancing the study of brain-behavior relationships in psychiatry.

An important aim in psychiatry is the establishment of valid and reliable associations linking profiles of brain functioning to clinically relevant symptoms and behaviors across patient populations. To advance progress in this area, we introduce an open dataset containing behavioral and neuroimaging data from 241 individuals aged 18 to 70, comprising 148 individuals meeting diagnostic criteria for a broad range of psychiatric illnesses and a healthy comparison group of 93 individuals. These data include high-resolution anatomical scans, multiple resting-state, and task-based functional MRI runs. Additionally, participants completed over 50 psychological and cognitive assessments. Here, we detail available behavioral data as well as raw and processed MRI derivatives. Associations between data processing and quality metrics, such as head motion, are reported. Processed data exhibit classic task activation effects and canonical functional network organization. Overall, we provide a comprehensive and analysis-ready transdiagnostic dataset, which we hope will accelerate the identification of illness-relevant features of brain functioning, enabling future discoveries in basic and clinical neuroscience.

Revisiting psychiatry's relationship with spirituality.

Revisiting psychiatry's relationship with spirituality.

Tracing Care Relationships in Psychiatry

Tracing Care Relationships in Psychiatry

Psychodynamic practice in psychiatry.

The aim is to identify and illustrate the place of psychodynamic practice and the therapeutic relationship in psychiatry, including consideration of the need for psychodynamic formulation and longer-term psychotherapies, in the context of debate over guidelines for depression management. Effective psychiatric practice requires a working understanding of psychodynamic principles. Effective management planning is underpinned by psychodynamic formulation. A full range of therapeutic options need to be available for optimal care.

Close Enemies: The Relationship of Psychiatry and Psychology in the Assessment of Mental Disorders

Close Enemies: The Relationship of Psychiatry and Psychology in the Assessment of Mental Disorders

Palliating in Avoidable Death: Reconciling Psychiatrists' Roles as Treaters on Death Row With Participation in a System of Overt Harm

Abstract Although nations across the globe have eliminated capital punishment, the United States remains one of the few countries in the Americas and Europe that still uses execution. There has been little discussion around the implications of psychiatry's involvement in providing care to incarcerated individuals awaiting death. The following perspective examines the United States as an example of a democratic and highly developed country where the death penalty remains an undeniable reality; the piece provides a brief discussion on psychiatry's relationship with end-of-life care to provide context for subsequent discussion on the role of the psychiatrist on death row in the United States. Medicolegal and ethical considerations are further outlined to identify specific concessions that might be made by the US criminal justice system to truly allow death row psychiatrists to practice to the highest standard of compassionate care.

Epistemic injustice in the therapeutic relationship in psychiatry

The notion of epistemic injustice was first applied to cases of discrimination against women and people of color but has since come to refer to wider issues related to social justice. This paper applies the concept of epistemic injustice to problems in the therapeutic relationship between psychiatrists and psychiatric patients. To this end, it is necessary to acknowledge psychiatrists as professionals with expertise in treating mental disorders, which impair the patient’s rationality, sometimes leading to false beliefs, such as delusions. This paper classifies the characteristic features of the therapeutic relationship in psychiatry into three stages: those of a professional–client relationship, those of a doctor–patient relationship, and those of a psychiatrist–psychiatric patient relationship. Epistemic injustice is prevalent in psychiatric care owing to prejudice against patients with mental disorders. However, it is also predisposed by the roles that psychiatrists play in relation to psychiatric patients. This paper suggests some ameliorative measures based on the analysis.

The ethics of psychiatrists’ political involvement: A reassessment in the Trump era

Psychiatry's relationship with politics has been historically problematic. There has been extensive debate about whether psychiatry's own origins as a medical specialty were political themselves. But, it is beyond dispute that the Soviet Union did use psychiatry for political purposes, and currently Russia and China do the same. On the basis of this historical experience, there has been a consensus that psychiatrists must be very careful not to mingle with politics. In the United States, this has been enshrined in the Goldwater rule. But, the election of Donald Trump as US President, and questions about his mental stability, have motivated a reassessment of the status quo. This article considers the ethics of psychiatrists’ political involvement. It concludes that, despite understandable concerns, psychiatry must remain fundamentally apolitical. La relation de la psychiatrie avec la politique a toujours été problématique. La question de savoir si les origines de la psychiatrie en tant que spécialité médicale étaient elles-mêmes politiques a fait l’objet d’un vaste débat. Mais il est incontestable que l’Union soviétique a utilisé la psychiatrie à des fins politiques, et actuellement la Russie et la Chine font de même. Sur la base de cette expérience historique, il y a eu un consensus sur le fait que les psychiatres doivent faire très attention à ne pas se mêler à la politique. Aux États-Unis, cela a été inscrit dans la règle Goldwater. Mais l’élection de Donald Trump à la présidence des États-Unis, et les questions relatives à sa stabilité mentale, ont motivé une réévaluation du statu quo. Cet article examine l’éthique de l’engagement politique des psychiatres. Il conclut que, malgré des préoccupations compréhensibles, la psychiatrie doit rester fondamentalement apolitique.

Using relational mindfulness to facilitate safety in the clinical encounter.

The therapeutic relationship in psychiatry is reliant upon first establishing a sense of interpersonal safety. This paper explores relational mindfulness as a way to facilitate safety in the clinical encounter, as well as proposes factors that enhance a clinician's capacity to remain mindfully present. Through the ongoing practice of mindful awareness, self-care and self-awareness all clinicians can benefit from increased capacity for relational mindfulness to enhance interpersonal safety. This is then likely to benefit not only the patient and the therapeutic relationship but also the clinician.

Second Opinions in Psychiatry: A Review.

Background:Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field.Objective:In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry.Methods:Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers.Conclusions:Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to achieve a coordinated approach in psychiatric care. However, we have found no convincingly good reason why second opinions have not been at least discussed in psychiatry. Psychiatry could benefit from ongoing discussions concerning the outcomes of second opinions in other medical disciplines.

Considerations on Medical-Patient Relationship in Psychiatry. Anthropo-Medical Implications

Considerations on Medical-Patient Relationship in Psychiatry. Anthropo-Medical Implications

Psychiatry and LGBT Patients: Reflecting on the Past to Provide Better Psychiatric Care to LGBT Patients in the Future

Back to table of contents Next article EditorialNo AccessPsychiatry and LGBT Patients: Reflecting on the Past to Provide Better Psychiatric Care to LGBT Patients in the FutureMark Messih, M.D., M.Sc.Mark MessihSearch for more papers by this author, M.D., M.Sc.Published Online:1 May 2017https://doi.org/10.1176/appi.ajp-rj.2017.120501AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail “The appearance in nineteenth-century psychiatry … of a whole series of discourses on the species and subspecies of homosexuality … made possible a strong advance of social controls into this area of “perversity”; but it also made possible the formation of a “reverse” discourse: homosexuality began to speak in its own behalf, to demand that its legitimacy or “naturality” be acknowledged”—Michel Foucault. (1)Psychiatry and the LGBT community have a long-standing history as reflected in the works of Foucault, a noted French scholar. The way in which mental health professionals understand LGBT identity influences the quality of care such patients receive and informs broader social perceptions. Accordingly, looking at from where psychiatry has come informs where the field needs to go. LGBT identity was first discussed as pathology, then as sexual immaturity, and ultimately as “normal variation” (2). Later, Freud would discuss homosexuality as being “produced by a certain arrest of sexual development” (3). He would ultimately argue against its classification as illness. Subsequent psychoanalysts disagreed with Freud’s work, viewing homosexuality as pathology, treatable with “cures” (4). This led to the addition of homosexuality as “sociopathic personality disturbance” in DSM-I in 1952, then as “sexual deviation” in DSM-II in 1968. In the context of social and political upheaval of the 1960s and 1970s, and the activism of psychiatrists, homosexuality was removed from DSM-III in 1973. Building on this progress, there is growing support for LGBT communities emerging from medical disciplines. Organizations such as the Association of Gay and Lesbian Psychiatrists show the significant advances made. Moving forward, psychiatrists are positioned to fight ongoing challenges. By taking a moment to reflect on the history of psychiatry in relation to LGBT communities, and the significant accomplishments we have made, we can improve the therapeutic alliance and empower patients.As clinicians, we have the ability to learn from past experiences and current successes, to do better for our patients. What “better” consists of is debatable, but raises multiple questions. How well are psychiatrists trained about the challenges specific to LGBT patients? What are unique stressors and barriers to care? Subsequently, how can psychiatrists empower and advocate for patients and assist them in meeting treatment goals?In this issue of the Residents’ Journal, authors approach such questions from a variety of perspectives, from a case report on transgender mental health to topic reviews on aging LGBT individuals and substance use. These articles reflect the scale and scope needed to move forward. The field of psychiatry has taken significant steps forward in the treatment, and advocacy of, LGBT patients. This issue reflects these advances and seeks to carry that tradition into the next generation of psychiatrists.Dr. Messih is a second-year resident in the Department of Psychiatry, Drexel University-Friends Hospital, Philadelphia, and Guest Editor for this issue of the Residents’ Journal.

Psychiatry's and psychiatrists’ contract with society

IntroductionThe World Psychiatric Association (WPA) is a world-wide association of national psychiatric associations, aiming to increase knowledge and skills necessary for work in the field of mental health and care of the mentally ill. It was suggested that Psychiatry's relationship with society should be seen as a contract [1]. This implicit understanding usually specifies the scope, principles, quality and outcome of this agreement. It also implies a series of reciprocal rights and duties, privileges and obligations, as well as expectations from both sides.AimTo investigate the extent of existing social contracting of WPA Member Associations (MAs) and WPA structures regarding:– communities they serve;– general public;– medical institutions;– other practitioner groups in the multidisciplinary team;– administrations, managers and funders.ObjectivesInclude to describe the current scope of psychiatric practice across WPA regions and the content of existing social contracts.MethodsA mixed–methods, explorative, descriptive, theory generating inquiry, with different phases, including a systematic review of literature and WPA documentation, electronic questionnaires to MAs and focus group discussions with WPA ZS chairs/representatives.ResultsMA profiles and progress indicators were identified and summarised. A transcription of group discussions was made, while pertaining documents, questionnaires and in depth/focus group interview content was analysed.ConclusionsThis presentation will report on progress with this study to date.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Foucault and the Madness of Classifying Our Madness

This paper notes the re-ignited controversy surrounding the publication of a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), suggesting that the early work of Michel Foucault can explain why the mere diagnosis of or criteria for mental illness remains a heated flashpoint. In particular, it argues that Foucault articulates a common issue within the philosophical foundations of psychiatry and psychology that the paper terms the ‘subjectivity problem.’ It observes, using Foucault’s work, that these disciplines treat not just simple objects but complex subjects that are capable of interacting with that labelling and who are shaped by it. Drawing on the related work of Ian Hacking on kind-making as world-making, the article fleshes out why the subjectivity problem remains persistent within psychiatry and psychology as forms of knowledge, preventing them from operating as many commentators might desire them to – as pure and objective sciences. Finally, the paper reflects on the relationship of psychiatry and psychology as forms of knowledge, the manner in which they constitute their objects, and how this might shape the biopolitical episteme in which we find ourselves today.

On the history of cultural psychiatry: Georges Devereux, Henri Ellenberger, and the psychological treatment of Native Americans in the 1950s.

Henri Ellenberger (1905-1993) wrote the first French-language synthesis of transcultural psychiatry ("Ethno-psychiatrie") for the French Encyclopédie Médico-Chirurgicale in 1965. His work casts new light on the early development of transcultural psychiatry in relation to scientific communities and networks, particularly on the role of Georges Devereux (1908-1985). The Ellenberger archives offer the possibility of comparing published texts with archival ones to create a more nuanced account of the history of transcultural psychiatry, and notably of the psychological treatment of Native Americans. This paper examines some key moments in the intellectual trajectories of Devereux and Ellenberger, including Devereux's dispute with Ackerknecht, the careers of Devereux and Ellenberger as therapists at the Menninger Foundation (Topeka, Kansas) in the 1950s, and their respective positions in the research network developed by McGill University (Montreal, Quebec) with the newsletter Transcultural Research in Mental Health Problems Finally, I consider their ties to other important figures in this field as it transitioned from colonial medicine to academic medicine, including Roger Bastide (France), Henri Collomb and the Ortigues (France and Africa), as well as Eric Wittkower and Brian Murphy (Canada) and Alexander Leighton (United States and Canada).

Mindful medical practice and the therapeutic alliance

This review article focuses on how the therapeutic relationship is central to clinician-client/patient relationships in psychiatry as well as other medical and psychotherapeutic encounters. Crucial to this relationship is the alliance formed between the caregiver and the person who seeks their care. The threats to the therapeutic alliance in psychiatry are discussed as is the importance of facing them. How mindfulness enables clinicians to build such bonds and foster well-being in themselves and in those they treat is examined in the context of quantitative and qualitative studies.

"The time is now": Integrating neuroscience into psychiatry training.

This is an extraordinary time for psychiatry, as new research in neuroscience is re-defining the essence of how we conceptualize psychiatric illness. In this issue, Torous et al. (2015) have written a significant paper that captures at once the excitement of new work in the field and the importance of meaningfully incorporating this perspective into both clinical and educational settings. The authors also review some of the many challenges to doing so effectively. The authors’ work comes at a time when many academics are wrestling with this same question and the authors refer to various ongoing efforts seeking to address this practice gap. One such program is the National Neuroscience Curriculum Initiative (Ross et al., 2015; www.NNCIonline.org). The NNCI was formally launched in March of 2014 with the overarching goal of creating a set of open resources that will help improve the teaching of neuroscience in psychiatry. Similar to Torous et al.’s goal of helping trainees ‘‘bridge, in real-time, brain-symptom relationships in psychiatry’’, the NNCI sets as a central objective that ‘‘residents will incorporate a modern neuroscience perspective as a core component of every formulation and treatment plan.’’ Additional learning objectives relate to relevant knowledge, attitudes towards neuroscience, and specific behavioral skills – including that residents will be able to serve as Ambassadors of Neuroscience who can thoughtfully communicate findings from the field to different audiences. The core work of the NNCI has been the creation of educational resources that can be used as in-class teaching and learning activities for residency programs. The guiding principles for these resources are: to maintain an integrative, patient centered approach; to teach well, by applying adult learning theory; and

Russian and Soviet forensic psychiatry: Troubled and troubling

Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent “totalitarian” regime, reformed and stagnated under “mature socialism” and then embraced capitalism and “managed democracy” at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the second half of the nineteenth century debates about the role of psychiatry in criminal justice took place against a backdrop of increasingly alarming terrorist activity, and call for revolution. While German influence, with its preference for hereditarianism, was strong, Russian psychiatry was inclined toward social and environmental explanations of crime. When revolution came in 1917, the new communist regime quickly institutionalized forensic psychiatry. In the aftermath of revolution, the institutionalization of forensic psychiatry “advanced” with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. The abuses of Soviet psychiatry under Stalin and more intensively after his death in the 1960s–80s remain under-researched and key archives are still classified. The return to democracy since the late 1980s has seen mixed results for fresh attempts to reform both the justice system and forensic psychiatric practice.

Evaluation of an Intensive Treatment Program for Disrupted Patient-Staff Relationships in Psychiatry

Some patients in psychiatric treatment are considered extremely difficult to treat because of the disruptive nature of their relationships with treatment staff. In this paper, we describe and evaluate a specialist inpatient treatment program for these patients. Data were collected from medical records and daily reports of patients (n = 108). Pretest–posttest measurements were used to evaluate the treatment. The main treatment method consists of the provision of safety, structure, and cooperation. Treatment results show statistically significant changes from admittance to discharge. The collaborative and consistent manner in which nurses approach the patients is crucial for quality of care.

Building our identity of psychiatry in the past, present and future South Africa

This issue of the South African Journal of Psychiatry celebrates the 60th anniversary of the South African Society of Psychiatrists (SASOP) and its 17th national congress. It reflects on the past of psychiatry, ponders on what psychiatry has become, and looks ahead, particularly in South Africa. Doing so says something of the identity of psychiatry in South Africa, which is crucially about people--our people. Our people have built the identity of psychiatry in South Africa by doing things, and doing things in certain ways--actions that say much more about the identity of the profession than honorary tributes to individuals. Individuals contributed remarkably, of course, and we can identify them gratefully; our professional identity has certainly been built in adding-up these contributions, that is, collectively--but that is not all. Our professional identity has especially been built communally by what we have been doing in SASOP and in our relations with fellow psychiatrists, colleagues from other professions, patients, patients' families, and other societies in South Africa and internationally. Building the identity of psychiatry in South Africa, individually, collectively and communally by our actions, commenced even before the word 'psychiatry' was coined in 1808 by Professor Johann Christian Reil, (1) as reflected upon in this issue by one of our veteran psychiatrists, Professor Lynn Gillis. (2) A reflection on the building of our identity in our history is important for our professional identity in the present and for the future building thereof--as many cultures in the world have recognised: know your historical roots, and cherish them, as they tell who you are, at least in part. I urge you, thus, for the sake of our present and future professional identity! Our identity-building actions of the past decade are considered in this issue by the current president of SASOP, Dr Ian Westmore. (3) Under his leadership and that of Dr Bernard Janse van Rensburg, an impressive milestone in the building of our current professional identity has been achieved: that is, the nationally collaborative work by which well-articulated goals for psychiatric care in the public services have been set, as reported in this issue on the activities of the SASOP State Employed Special Interest Group (SESIG) and in the special supplement to this issue. (4,5) Our identity-building actions in the present have to address contemporary challenges in South Africa and internationally, as reflected upon in this issue by Drs David Swingler (6) and Franco Colin. (7) No less so, I wish to plead for us to think about the identity that we want for our future, as this is shaped and made possible by the ways in which we think about ourselves, at least in part. In particular, for the sake of building our identity, I urge us to (re)consider carefully how we think about (and practise) psychiatry in relation to other medical specialities. Do we really want to maintain and even propagate a'last-born'attitude, trapped in continuous aspirations to live up to an (presumed) agenda of'big brother'; for example, by continuing to aspire to the discovery of biomarkers, as if only that would mark our becoming mature? Now, the discovery of biomarkers is very worthy to aspire towards; and our speciality is perhaps one of the younger ones neither is denied, nor is the point here. The point is that we should recognise and materialise our maturity in other ways than merely in terms of the biological underpinnings of psychiatry. …