Senior Psychiatrists Research Articles

Autistic psychiatrists' experiences of recognising themselves and others as autistic: a qualitative study.

Diagnosis of autism falls under the remit of psychiatry. Recognition that psychiatrists could be autistic is recent. Psychiatrists are the second largest specialty group in Autistic Doctors International, a peer support group for autistic doctors. To explore the experiences of autistic psychiatrists in relation to recognising themselves and others as autistic. This was a qualitative study using loosely structured interviews and an interpretive phenomenological analysis. Eight autistic senior psychiatrists based in the UK participated. One had a childhood diagnosis, two had been diagnosed in adulthood and the remainder self-identified as autistic as adults. Recognition of autism followed diagnosis of their children or encounters with autistic patients. Barriers to self-recognition included lack of autism training, the deficit-based diagnostic criteria and stereotypical views of autism. Recognising that they were autistic led to the realisation that many colleagues were also likely to be autistic, particularly in neurodevelopmental psychiatry. All participants reported the ability to quickly recognise autistic patients and to develop a good rapport easily, once they were aware of their own autistic identity. Difficulties recognising patients as autistic occurred before self-recognition when they shared autistic characteristics and experiences. 'If we don't recognise ourselves as autistic how on earth can we diagnose patients accurately?' Autistic psychiatrists face multiple barriers to recognising that they are autistic. Lack of self-recognition may impede diagnostic accuracy with autistic patients. Self-recognition and disclosure by autistic psychiatrists may be facilitated by reframing the traditional deficit-based view of autism towards a neurodiversity-affirmative approach, with consequent benefits for autistic patients.

Psychiatrists’ beliefs, awareness, and attitudes toward gender variance: A French cross-sectional study

ObjectivesThe evolution of knowledge and recommendations concerning transgender health has led to various representations, especially for health professionals, that can influence the medical management of transgender individuals. The main objective of this study was to explore the representation of psychiatrists in France regarding gender variance. The secondary objective was to compare these data based on their characteristics. MethodsThis is a cross-sectional observational study based on the distribution in April 2022 of a questionnaire to psychiatrists and psychiatric residents in France. The questionnaire was developed after exploring the results of qualitative studies in the scientific literature. ResultsAmong 359 respondents, 181 were psychiatric residents and 178 were senior psychiatrists. Ninety percent had already met a transgender person in their professional practice. The representations observed among the respondents were heterogeneous. Most respondents did not consider “transgenderism” a symptom of a psychiatric disorder, and nearly all respondents used the gender and name their patients ask for. About 60% reported insufficient knowledge about “transgenderism”, with 86% considering that they had not been trained to adequately support transgender people. ConclusionsThe study reveals that representations, although weakened by a lack of knowledge recognized by psychiatrists, favor a non-pathologizing apprehension of gender variance and recognition of the importance of respecting gender diversity and self-determination. The heterogeneity of representations, as well as the high prevalence of professionals who describe a lack of knowledge, skills, and training, support the need for guidelines and the integration of evidence-based knowledge about gender variance into the psychiatric curriculum.

Bias related to overweight and obesity among French psychiatrists: Results of a national survey

BackgroundAccording to people with a higher weight, physicians are the second most stigmatizing group related to excess weight. As a result of these weight-related biases, the therapeutic relationship with the patient and the quality of care would be negatively affected. In addition, this stigma could negatively impact the clinical practice related to higher weight and avoidance of care. ObjectivesThe objective of this study was to assess the stigma of overweight and obesity among psychiatric residents and psychiatrists in France. Specifically, the study aimed to assess factors that may influence weight-related bias among psychiatrists, to explore the relevance of visual assessment of body mass index, and to determine how they this feature is integrated into their practice. MethodAn online questionnaire including sociodemographic items, the Fat Phobia Scale, the Beliefs About Obese Persons Scale, the Body Shape Scales, and questions about their clinical practice was distributed via national professional mailing lists and social networks. ResultsThe survey was answered by 271 seniors or residents in psychiatry. The results indicated a moderate level of weight-related bias among psychiatrists as assessed by the Fat Phobia Scale which was higher in residents than in senior psychiatrists. Over a third of the respondents had no material to assess their patient's weight, and two thirds did not systematically assess overweight or obesity. Finally, the results demonstrate that psychiatrists failed to accurately evaluate overweight or obesity based on male or female silhouettes. ConclusionIt appears that measures should be taken to raise awareness among psychiatrists of the stigmatization of individuals living with a higher weight, as well as to enhance the quality of weight gain care in psychiatry.

Translation and validation of the hindi version of the HEXACO personality inventory-revised.

Recent lexical research in different languages has revealed that there are six personality dimensions instead of the previously proposed five dimensions. To address this issue, the HEXACO Personality Inventory-Revised (HEXACO PI-R), a self-rating scale to assess personality characteristics, was constructed. However, researchers in India faced a language barrier because it was only available in English. To evaluate the validity and reliability of the Hindi translation of the HEXACO PI-R. We followed WHO guidelines for the translation and adaptation of instruments. In forward translation, the scale was translated to Hindi independently by two independent bi-lingual authors. Both versions were reviewed, and a common Hindi version was made. Then, in the second step, an expert panel was formed comprising psychologists, authors, and senior psychiatrists. All the shortcomings were addressed, which resulted in a final Hindi version of the scale. Subsequently, a Hindi Professor, who had no background knowledge of the scale, was consulted to check the Grammar and meaning of the scale. Finally, an independent English Professor with no background knowledge of this scale was consulted to translate the Hindi version to English back. A small pilot study was conducted and a resultant Hindi version of the self-report HEXACO was applied to 10 patients to see the shortcomings, which resulted in the final Hindi version. By convenience sampling 300 volunteers, conversant in both the English and Hindi languages were included. The subjects were initially administered alternately the original English version or the Hindi version of the scale. Then after a gap of 14 days, those who initially received the English version filled up the Hindi translation, while those who received the Hindi version initially filled up the English version of the scale. The scores on the original English scale and the Hindi versions were significantly positively correlated (Spearman's rho 0.900; P < 0.001). The translated scale showed a high degree of internal consistency and acceptable reliability. An exploratory factor analysis with varimax rotation yielded 6 factors, which were found to have a further 24 facets. The fitness of the model for the overall scale and its sub-factors was found to be acceptable. Results of the Rasch analysis showed the scale had good infit and outfit values. The person's reliability was good. The Wright map showed a good distribution of the items. The Hindi translation of the HEXACO PI-R is a valid and reliable tool to gauge the personality dimensions of the Hindi-speaking population of India.

Long-term efficacy of a continuity-of-care treatment model for patients with severe mental illness who transition from in-patient to out-patient services.

Despite its significance, ensuring continuity of care demands substantial resources, which might not be readily accessible in many public healthcare systems. Studies indicate that continuity of care remains uncertain in numerous healthcare systems. This study aimed to assess the effectiveness of a continuity-of-care model for patients with severe mental illness (SMI), providing seamless treatment from discharge from a closed ward to subsequent psychiatric, psychological and rehabilitation services. Data from patients discharged before (1 January to 31 December 2018) and after (1 June 2021 to 31 May 2022) full implementation of the model were analysed and compared in terms of average duration of hospital stay, emergency department visits within 90 days of discharge, readmission rate within a year post-discharge and initiation of rehabilitation process. In the post-implementation period (n = 482), the average admission time significantly decreased from 30.51 ± 29.72 to 26.77 ± 27.89 days, compared with the pre-implementation period (n = 403) (P = 0.029). Emergency department visits within 90 days following discharge decreased from 38.70 to 26.35% of discharged patients (P < 0.001). The rate of readmission decreased from 50.9 to 44.0% (P = 0.041) for one readmission and from 28.3 to 22.0% (P = 0.032) for two readmissions in the year following discharge. Additionally, the proportion of patients entering formal rehabilitation increased from 7.94 to 12.03% (P = 0.044). This study highlights the effectiveness of a continuity-of-care model spearheaded by senior psychiatrists and involving paramedical personnel. These findings underscore the significant potential of the model to substantially enhance mental health services and outcomes. Moreover, they emphasise its relevance for patients, clinicians and policy makers.

Shared Fragility-Contemplating the Impact of Patients' Suicides on Clinicians.

The experience of patient suicide can have a profound impact on clinicians, yet there are limited opportunities for them to express and process their emotional responses. We organized a reflective group session for psychiatrists in Singapore who had encountered patient suicides. Ten psychiatrists participated, with five in the "inner" group (those who had experienced patient suicide) and the remaining five forming the "outer" group. Led by a senior psychiatrist trained in psychodynamic psychotherapy, the inner group shared their reflections on patient suicides, while the outer group provided their insights thereafter. Participants provided written feedback about their session experiences. The session was recorded, transcribed, and analyzed to identify key themes. Three main narrative themes emerged from the analysis. Firstly, there was the acute response to the suicide, involving intense emotional reactions. Secondly, the relationship between clinicians and patients with suicidal thoughts was explored, encompassing countertransferential responses, superego defenses, and resulting anxiety. Lastly, the study examined how clinicians feel about suicidality itself, shedding light on complex attitudes and perceptions. Our findings confirm previous research, indicating that the response to patient suicide is stressful and traumatic for clinicians, who grapple with emotions such as grief, guilt, incompetence, and fear. Moreover, we delve into the intricate connections clinicians have with the concept of suicidality, shaped not only by their own experiences but also by the insights of those who have yet to confront patient suicide. The reflections shared by the participants emphasize the significance of establishing therapeutic spaces for clinicians to process these complex emotions effectively.

Maria Lymberis, M.D., Honored With Berson Senior Psychiatrist Award

Maria Lymberis, M.D., Honored With Berson Senior Psychiatrist Award

The development of clinical reasoning throughout the training and career of psychiatrists in Singapore.

The current study sought to explain how different professional experiences led Singaporean psychiatrists to alter their clinical reasoning processes as their careers evolved from psychiatry residents to senior consultant psychiatrists. The current qualitative study interviewed 26 clinicians at various stages of their psychiatric career, spanning residents to senior psychiatrists. The authors used a constructivist grounded theory approach to structure the collection and analysis of data. Analyses produced a dense theoretical explanation rooted in the experiences of participants. Several differences emerged between the way psychiatry residents and senior psychiatrists explained their reasoning process and the experiences on which they based their preference. Residents preferred using deductive logic-driven frameworks that were diagnosis-centric, because of the pressures they experienced during their training and assessments. Senior psychiatrists emphasized a more holistic and problem-centric approach. Participants attributed the changes that occurred over time to practical experiences, such as their greater clinical responsibility and independence, and individual experiences, such as growing sensitivity to the clinical reasoning process or their growing propensity for professional reflectiveness. These changes manifest as an increase in repertoire and flexibility in deployment of different clinical reasoning strategies. It is important for trainees to be aware of the deductive and inductive modes of clinical reasoning during supervision and to be comfortable with shifting clinical focus from diagnoses to specific individual problems. Training programs should provide and plan adequate longitudinal clinical exposure to develop clinical reasoning abilities in a way that allows consequences of decisions to be explored. Continued faculty development to ease the diversification of clinical reasoning skills should be encouraged, as should reflectivity in the learners during clinical supervision.

Validation of the Generalized Anxiety Disorder-7 in patients with COPD: a cross-sectional study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often have comorbid generalized anxiety disorder (GAD), which requires early screening in respiratory clinics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire is a brief and commonly used screening tool for GAD but has not been validated among patients with COPD in China.MethodsStable patients with COPD from a cross-sectional observational study were assessed using the GAD-7 questionnaire and then assessed by a senior psychiatrist to confirm a diagnosis of GAD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographic characteristics, spirometry, and patient-reported outcomes were collected. Cronbach’s α coefficient was calculated, and receiver operating curve (ROC) analysis was performed to validate the GAD-7.ResultsA total of 226 patients with COPD were enrolled, and 50 (22.1%) of these patients were diagnosed with GAD. The Cronbach’s α coefficient for the GAD-7 was 0.869, which indicated good internal consistency. ROC curve analysis showed that the GAD-7 had an area under the curve (AUC) value of 0.829 (95% CI: 0.774–0.876) for identifying GAD. The optimal cut-off score was ≥ 4, with a sensitivity of 66.0% and a specificity of 89.2%. Higher GAD-7 scores were significantly associated with health-related quality of life and the symptom burden of COPD. The discriminatory power of GAD-7 did not differ statistically when stratified by COPD severity.ConclusionsThe GAD-7 was shown to be a reliable and valid screening tool for patients with COPD in China, and its screening performance for GAD was not influenced by disease severity.

The impact of post-traumatic stress on the clinical outcome in a cohort of patients with knee osteoarthritis and knee arthroplasty: A prospective study

BackgroundKnee osteoarthritis (KOA) is one of the most common musculoskeletal disorders and commonly occurs in older adults, predominantly female populations. Both populations have intimate links with trauma-related stress. Therefore, we intended to evaluate the prevalence of post-traumatic stress disorder (PTSD), which arises from KOA and determine its effects on the postoperative results in patients undergoing total knee arthroplasty (TKA). MethodsThe patients who fulfilled the diagnosis of KOA from February 2018 to October 2020 were interviewed. Patients were interviewed by a senior psychiatrist about evaluating their overall experience during their most difficult or stressful situations. KOA patients who underwent TKA were further analyzed to investigate whether PTSD influences the postoperative results. The PTSD Checklist–Civilian Version (PCL-C) and Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index were used to assess PTS symptoms and clinical outcomes after TKA, respectively. Results212 KOA patients completed this study with a mean follow-up of 16.7 months (7–36 months). The mean age was 62.5 ± 12.3 years, and 53.3% (113/212) were women. 64.6% of the sample (137/212) underwent TKA to relieve the symptoms of KOA. Patients with either PTS or PTSD tended to be younger (P < 0.05), female (P < 0.05) and undergo TKA (P < 0.05) than their counterparts. WOMAC-pain (P < 0.05), WOMAC-stiffness (P < 0.05), and WOMAC-physical function (P < 0.05) both before TKA and 6 months after TKA in the PTSD group is significantly higher compared to their counterparts. Logistic regression analysis showed that a history of OA-inducing trauma (adjusted OR = 2.0, 95% CI = 1.7–2.3, P = 0.003), posttraumatic KOA (adjusted OR = 1.7, 95% CI = 1.4–2.0, P < 0.001), and invasive treatment (adjusted OR = 2.0, 95% CI = 1.7–2.3, P = 0.032), were significantly associated with PTSD in KOA patients. ConclusionsPatients with KOA, especially those undergoing TKA, are associated with PTS symptoms and PTSD, indicating the need to evaluate it and offer care for them.

Validity of biopsychosocial model of intervention in contemporary medical practice: Walking a few extra miles

Validity of biopsychosocial model of intervention in contemporary medical practice: Walking a few extra miles

Gender differences in income among psychiatrists in China: Findings from a national survey.

Gender income disparity in healthcare settings is a longstanding issue around the globe, but such evidence among Chinese psychiatrists is scarce. This study investigated whether gender income differences exist among physicians in China. Data came from the 2019 national survey data of 4,520 psychiatrists in major public psychiatric hospitals across China. Self-reported monthly income after tax (in Chinese Yuan, CNY) by participants at all professional ranks was assessed. Average monthly income by gender was reported. Adjusted income differences between male and female psychiatrists were examined using multivariable regression models, adjusting with inverse probability of treatment weights and controlling for psychiatrist demographics (e.g., gender, professional rank, marital status, educational level, and work hours) and hospital fixed effects. The unadjusted mean difference in monthly income after tax by gender was 555 CNY (about $86; 95% CI, -825 to -284; mean [SD] for men: 8,652 [4,783] CNY and for women: 8,097 [4,350] CNY) in all psychiatrists. After regression adjustments, the income difference by gender among all psychiatrists reduced substantially and became insignificant. However, gender income difference was still observed among senior-level psychiatrists, where female psychiatrists earned 453 CNY (about $70; 95% CI, -810 to -95) significantly less than male psychiatrists. China achieved gender equity in income for psychiatrists overall, the observed income differences among senior level psychiatrists, however, reveal the persistence of gender inequity at the highest level of professional hierarchy. These findings call for policy attention to the issue of gender income disparity among psychiatrists in China's healthcare system.

Development of Internet suicide message identification and the Monitoring-Tracking-Rescuing model in Taiwan

BackgroundSuicide messages can be transmitted infinitely online; the Internet is influential in suicide prevention. Identifying suicide risks online via artificial technological advances may help predict suicide. MethodsWe built a classifier that detects open messages containing suicidal ideation or behavior-related words in social media via text mining methods and developed the Monitoring-Tracking-Rescuing model, which links data monitoring and tracking to high-risk suicide rescues. Natural language processing (NLP) techniques such as Long Short-Term Memory and Bidirectional Encoder Representations from Transformers were applied to online posts of common social media sites in Taiwan. This model uses a two-step high-risk identification procedure: an automatic prediction process using NLP to classify suicide-risk levels, followed by professional validation by a senior psychiatrist and a nursing faculty specialized in suicidology. ResultsFrom a dataset containing 404 high-risk and 2226 no- or low-risk articles, the sensitivity and specificity of our model reached 80 %. LimitationsThe model is limited to data platforms that can be “crawled” and excludes suicide-risk content from graphics, video and audio files. Additionally, machine learning does not provide the best recognition rate from complex online messages. Keywords for high-risk suicide in long articles are difficult to interpret using this model. Finally, the model lacks keywords for suicide-protective factors. ConclusionsArtificial intelligence techniques may help detect and monitor high-risk suicide posts and inform mental health professionals of these posts. Periodic tracking plus manual validation to determine risk levels are recommended to enhance the reliability and effectiveness of Internet suicide-prevention tasks.

Gender Differences in Psychiatric Symptoms and the Social Functioning of 610 Patients with Schizophrenia in Urban China: A 10-Year Follow-Up Study.

PurposeTo explore the different outcomes between male and female patients with schizophrenia after long-term follow-up.Patients and MethodsSchizophrenia patients were participants in our study. First, two senior psychiatrists collected data on the demographic characteristics and clinical symptoms of patients from the Hospital Information System between February 2009 and January 2010. Second, two other senior psychiatrists called the patients and their guardians between February 2019 and January 2020 to get general information on the patients and assess their psychiatric symptoms and social functioning using the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance (PSP) scale.ResultsOf the 610 participants, the 306 female participants were younger (48.32 ± 12.99 vs 49.84 ± 12.60) and had received more education (8.08 ± 3.76 vs 7.94 ±3 0.73). After 10 years, women were found to have more outpatient visits than men (20.86 ± 22.21 vs 16.11 ± 16.87, P < 0.05). However, there was no significant gender difference in number of hospitalizations (3.12 ± 5.34 vs 2.77 ± 5.84, P > 0.05). The PANSS scores were lower for both groups at the 10-year follow-up. Women had significantly lower scores than men after the 10-year period (P < 0.05). With regard to social functioning, there was a significant difference in social functioning between baseline scores and 10-year follow-up scores indicating an improvement in social functioning. PSP scores had significantly increased in women (P < 0.01) but not in men (P > 0.05).ConclusionFemale patients had significantly lower levels of psychiatric symptoms and higher levels of social functioning at 10-year follow-up than male patients. They also reported more outpatient visits, which may have contributed to the gender differences in outcomes. Family members and doctors of patients should urge patients to make regular outpatient visits for better outcomes after hospitalization.

Changes in psychiatric emergencies during COVID-19 pandemic lockdown in El Bierzo (Spain)

IntroductionThe interest have focused in the effects of COVID-19 in mental symptoms. However, the pandemic and restrictions such as the lockdown decreed in Spain limited access to resources and lead to a change in assistance organization.Objectivesto compare the incidence and characteristics of psychiatric emergencies during the Spanish 2020 Lockdown with the same period in 2019MethodsAll the emergencies attended the the emergency room (Hospital El Bierzo) From 01/02/2019 to 30/06/2019 and those from 01/02/2020 to 30/06/2020 were analysed by two senior psychiatrists. Cases were selected if attended by any psychiatric reason. The cases were evalueated identifying ICD-10 diagnosis (according to clinical records and best criteria matching), sociodemographics, factors associated to the emergency and resolution.Results23360 cases were attended in 2019 (799 psychiatric), 14907 (578) in 2020. That means a 36.19% of reduction in general emergencies and 27.66% in psychiatric emergencies (psychiatric emergencies proportion increased form 3.42% to 4.03%). The reduction started the week just before the lockdown declaration, minimal records coincided with the highest COVID-19 incidence and the recovery starts in early june for psychiatric and late June for general emergencies (figure 1). A decrease of 62.79% of anxiety cases and 45.9% of depresion was observed with no incresaes in any diagnosis. A slight increase in suicide attempts (two cases) was observed.ConclusionsThe lockdown seem to decrease psychiatric emergency care. Only suicidability was maintained/increased during the period. Psychiatry services must be aware of the risk of unattended inicidence that may cause an increase of cases after the lockdown.DisclosureNo significant relationships.

Symposium

BackgroundAbout 4% Alcohol dependence syndrome (ADS) suffer complicated withdrawal. Nearly all evidence based treatment for ADS originated as individual interventions, and most major treatment research studies have been limited to individual-based treatments e.g., COMBINE and Project MATCH studies. However this is a challenge to implement Individual therapy in our country where treatment gap is 70-90%. It has been found that group-based interventions have strong experimental support. Department of psychiatry KIMS hubli explored the utility of group therapy in general hospital psychiatry unit (GHPU) setting for patients with ADS.Aims1. Need of resource efficient psychosocial intervention in ADS in relapse prevention.2. Utility of group therapy in ADSMethods92 consenting individuals along with their primary care giver were enrolled in group therapy. A total of 6 sessions of structured group therapy, one session monthly for 6 months. There were 9 closed groups and each group consisted of less than males. Individuals were assessed for relapse and care givers knowledge attitude and practices (KAP) towards ADS were assessed at baseline, end of 6 sessions and after 6 months of follow-up. Under supervision of senior psychiatrist post graduates students in MD Psychiatry conducted the Group therapy sessions.Results and Conclusion18 individuals dropped out. Attrition rate of 19.5%. Relapse rate was 40%. Early identification and intervention of relapses. Most patients and their care givers were retained in the treatment loop. KAP were favourable in the caregivers. It is a challenge to provide Individual psychotherapy for ADS where mental health care services are scare. However group interventions are promising as they are effective and economical relapse prevention strategy. It is acceptable by the caregivers and feasible in GHPU. Prospective research and controlled trials to be considered in the future.

Lyfas, A Smartphone-Based Subclinical Depression Tracker

Background: Subclinical traces of depression are difficult to diagnose; although, it influences other mental faculties. Lyfas is a smartphone-based ubiquitous and non-invasive biomedical application that captures Heart Rate Variability (HRV) and its associated Cardiovascular biomarkers (CVb), which might help detect such traces as mind and body are intertwined through autonomic modulation. Aim: Using Lyfas, an attempt has been made to (i) screen Subclinical depression states in adults by assessing the CVb scores, and (ii) analyze the psychophysiological effects of Subclinical depression on other mental faculties for establishing a correlation. Methods: The paper presents a retrospective observational study of 86 adults, comprised of 52 males and 36 females who took the Lyfas test. Lyfas findings are validated by an established questionnaire-based instrument under the supervision of a senior psychiatrist. Results: The study found that 77% of the subjects (84% females and 72% males) showed traces of Subclinical depression, further validated by a senior psychiatrist through a series of consultations. ‘Insomnia’ (males 36% and females 71%) and ‘Negative thoughts’ (males 36% and females 46%) were the two correlated high-rank effects of the Subclinical depression in the sample. Conclusion: The paper proposes that Lyfas can detect the traces of Subclinical depression in adults by capturing and interpreting CVb scores that surrogate for the Cardiac Autonomic Modulation (CAM) and provide the snapshot of the mind-body state of homeostasis.

Teaching psychiatry in a low-income country during the COVID-19 pandemic: A hybrid collaborative psychiatry course.

Amoud University in Borama is located in the self-declared state of Somaliland, in the Horn of Africa. Past conflicts and resulting economic hardship have led to a lack of local academic psychiatry faculty and resources. Amoud has been for some years partnering with voluntary faculty in the United Kingdom to teach psychiatry to its medical students through in-person "teaching missions." This was recently led by a Borama-native psychiatry resident in Ethiopia. COVID-19 added further hardships due to restrictions to travel and in-person gatherings. These challenges also created the opportunity for the development of an innovative, international, hybrid (online onsite), self-sustaining partnership model which has been successful in improving psychiatry teaching for undergraduate students in 2020-2021 and will continue in 2021-2022. An international, 'online-connected' department of psychiatry comprising a primary care physician in Somaliland, three postgraduate trainees in Ethiopia and the United States, and three senior psychiatrists in the United Kingdom developed a local faculty-led, hybrid-delivered, dynamic curriculum (bedside teaching, in person and online lecturing) that adapted to the needs, resources, faith and culture of Somaliland. While 2020-2021 has been the pilot year for the program, the overall experience has been enriching for students and faculty, leading to valuable cross-cultural conversations with impact on teaching and research. While learning about Somalilanders' and trauma, the program leads, also the authors of this article, have identified ways to harness the resilience and faith of students to bring about improvements in global mental health.

Donor Screening for Fecal Microbiota Transplantation in China: Evaluation of 8483 Candidates

Donor Screening for Fecal Microbiota Transplantation in China: Evaluation of 8483 Candidates

Bridging the gap between the emergency department and outpatient care: feasibility of a short-term psychiatric crisis intervention for children and adolescents.

Child and adolescent mental health systems are facing limited resources of available psychosocial interventions, often leading to long waiting lists for acceptance to treatment. We describe the feasibility of a short-term (8–10 sessions) psychological crisis intervention (CI) protocol for children and adolescents aged 8–17 years (n = 30, mean ± standard deviation 12.9 ± 2.4 years) who were referred to an outpatient mental health clinic due to suicidal ideation, aggression, severe anxiety, or extreme family conflict. The participants were assessed before and after the CI, and at a 3–6-months follow-up visit. The psychiatric assessments included clinical evaluation by a senior psychiatrist, and the completion of self-report questionnaires by both the participants and their parents. Following the establishment of the CI unit, the waiting lists for urgent cases were reduced from a median of 84 days in the two preceding years to 23 days in the following 3 years (H[2] = 18.5, p < 0.0001) for patients of the CI unit. A 1-year psychiatric follow-up after the end of the CI revealed that 72% did not require additional psychotherapy. The overall clinical evaluation measures (clinical evaluation, parents-report and child report) improved and had been preserved at the 3–6-months follow-up. Our results demonstrate the feasibility of a short-term CI protocol for expediting admission to treatment for urgent psychiatric cases.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-021-01896-2.