State Of Psychiatry Research Articles

Wakefield's Harm-Based Critique of the Biostatistical Theory.

Jerome Wakefield criticizes my biostatistical analysis of the pathological-as statistically subnormal biological part-functional ability relative to species, sex, and age-for its lack of a harm clause. He first charges me with ignoring two general distinctions: biological versus medical pathology, and disease of a part versus disease of a whole organism. He then offers 10 counterexamples that, he says, are harmless dysfunctions but not medical disorders. Wakefield ends by arguing that we need a harm clause to explain American psychiatry's 1973 decision to declassify homosexuality. I reply, first, that his two distinctions are philosophic fantasies alien to medical usage, invented only to save his own harmful-dysfunction analysis (HDA) from a host of obvious counterexamples. In any case, they do not coincide with the harmless/harmful distinction. In reality, medicine admits countless chronic diseases that are, contrary to Wakefield, subclinical for most of their course, as well as many kinds of typically harmless skin pathology. As for his 10 counterexamples, no medical source he cites describes them as he does. I argue that none of his examples contradicts the biostatistical analysis: all either are not part-dysfunctions (situs inversus, incompetent sperm, normal-flora infection) or are indeed classified as medical disorders (donated kidney, Typhoid Mary's carrier status, latent tuberculosis or HIV, cherry angiomas). And if Wakefield's HDA fits psychiatry, the fact that it does not fit medicine casts doubt on psychiatry's status as a medical specialty.

Alan F. Schatzberg, MD, on the state of psychiatry

Alan F. Schatzberg, MD, on the state of psychiatry

"НЕ СЛЕДУЕТ МЕШАТЬ ЛЮДЯМ СХОДИТЬ С УМА": МЕДИКО-СОЦИАЛЬНЫЙ И ХУДОЖЕСТВЕННЫЙ ДИСКУРСЫ В ПОВЕСТЯХ А.П. ЧЕХОВА "ПАЛАТА № 6" И "ЧЕРНЫЙ МОНАХ"

The focus of our attention is Chekhov’s attitude to the institute of psychiatry as а part of Russian social system at the end of the 19th century. “Ward No. 6” is an invaluable material on the history of social medicine, comparable with the few documentary evidence of zemstvo (the county) doctors about the state of psychiatry in the Russian province of the late nineteenth century. The story “The Black Monk” draws increasing attention to the discussion around the topic of genius and madness, which received a new impetus in the fin de siècle era.

Maria A. Oquendo, MD, PhD, on the state of psychiatry

Maria A. Oquendo, MD, PhD, on the state of psychiatry

Attitude of Non-Psychiatry Residents towards Psychiatry: A Cross-Sectional Study

Background and Aim: The attitude of Non Psychiatry Post Graduate Residents towards Psychiatry is crucially important because of its influence on impressionable medical students and the large number of psychiatric patients who present to Non Psychiatry Doctors like General Practitioners. Present study was done with an aim to study the Non-Psychiatric Doctor Attitude towards Psychiatry.
 Material and Methods: Present study was Conducted at two Major Institute: K. M School Post-Graduate medicine and Research and B.J. Medical College at Ahmedabad, Gujarat. At Both Institute Psychiatric lectures during 1st MBBS, lectures on Psychiatry during final MBBS and 2 week clinical rotation during final MBBS. Modified version of attitude towards Psychiatry questionnaire (Nielsen and Eaton, 1981) was the study instrument. The non- Psychiatry post-graduate students were asked to fill the Questionnaire. Questionnaire consists of 21 statements to be responded with one of the three alternate responses- Agree, neutral and disagree.
 Results: Most P.G. thought that Psychiatry is making advancement and most was positive about psychoanalysis. Only 6.6% of P.G.s thought that Psychiatry is unscientific and inexact. With respect of therapeutic efficacy 83.8% would refer emotionally upset family members for Psychiatry consultation. Psychiatrist were considered as unclear thinker by 8% and overly apologetic in teaching. 40% agreed that psychiatrist tended to over analyze human behaviour.27% of P.G.s thought that on an average psychiatrist make less money than other physician.31% of P.G.s viewed that Psychiatry status as low compared to other specialties. 47% agreed that Psychiatry are often rightly seen by others as odd, peculiar and emotionally disturb them.
 Conclusion: Non Psychiatry Post-Graduates at a tertiary hospital in Gujarat have a moderately positive attitude to Psychiatry. However some erroneous beliefs are still prevalent among the consultants. The attitude of Non-Psychiatry consultants directly/indirectly affects the development of Psychiatry as a discipline.

Altha J. Stewart, MD, on the state of psychiatry

For this Psychiatry Leaders’ Perspectives, Awais Aftab, MD, interviewed Altha J. Stewart, MD. Dr. Stewart is Senior Associate Dean for Community Health Engagement at the University of Tennessee Health Science Center (UTHSC)–Memphis.

Paul Summergrad, MD, on the state of psychiatry

Paul Summergrad, MD, on the state of psychiatry

Dilip V. Jeste, MD, on the state of psychiatry

Dilip V. Jeste, MD, on the state of psychiatry

Medical Students' Career Choice and Attitudes Toward Psychiatry: Case of the Czech Republic.

A survey among medical students of all medical schools in the Czech Republic was conducted to investigate attitudes and views of psychiatry and career choice of psychiatry. A Czech version of the Attitudes to Psychiatry Scale (APS) and a questionnaire surveying demographic characteristics and choices of future specialty were distributed to all medical students of eight medical schools in the Czech Republic via the schools' internal communication systems in the form of an anonymous online questionnaire. Out of a total of 10,147 medical students in the Czech Republic (academic year 2019/2020), 2418 students participated in the survey (response rate 23.8%). Psychiatry as a non-exclusive career choice was considered by 31.3% respondents; child and adolescent psychiatry was considered by 15.4% respondents. Psychiatry as the only choice was considered by 1.6%, and child and adolescent psychiatry was not considered at all. The interest in both specialties was declining since the first year of study. The status of psychiatry among other medical specialties was perceived as low; students were rather discouraged from entering psychiatry by their families. They did not feel encouraged by their teachers to pursue career in psychiatry despite the fact that they were interested in psychiatry. They also felt uncomfortable with patients with mental illness. Despite high enthusiasm for psychiatry in the first year of medical school, only a small proportion of medical students consider to choose psychiatry, and especially child and adolescent psychiatry, as a career at the end of medical school.

Doctors without ‘Disorders’

Abstract On one influential view, the problems that should attract medical attention involve a disorder, because the goals of medical practice are to prevent and treat disorders. Based on this view, if there are no mental disorders then the status of psychiatry as a medical field is challenged. In this paper, I observe that it is often difficult to establish whether the problems that attract medical attention involve a disorder, and argue that none of the notions of disorder proposed so far offers a successful demarcation criterion between medical and non-medical problems. As an illustration, I consider why delusions are considered pathological and whether they attract medical attention in virtue of being pathological, where ‘pathological’ stands for ‘being caused by a disorder’. Although there are several promising answers to what makes delusions pathological, available accounts of the pathological nature of delusions fail to distinguish delusions from other irrational beliefs that are not typically thought of as pathological; and cannot explain why delusions typically attract medical attention whereas other irrational beliefs do not.

State of Psychiatry in America.

State of Psychiatry in America.

Everett Sums Up State of Psychiatry in America and Where Profession Is Headed

One of the keys to psychiatry’s future is the development of innovative technologies that will reduce administrative burdens and improve patient care.

Are psychiatrists an endangered species?

IntroductionRecruitment of young doctors into psychiatry is declining in many countries, which might become a threat to the survival of the profession.ObjectivesTo identify potential reasons for this threat.AimsTo look at psychiatry with concepts used by the sociology of professions.MethodsProfessions are characterized – and these concept will be used for analysis here – by (1) ownership of a specialized body of knowledge and skills, which defines the field of competence and the scope of potential clients, including the demarcation from other professions; (2) holding a high status in society; (3) being granted autonomy by society, e.g. in recruiting and excluding members; and (4) being obliged, in return for the above, to guarantee high quality standards in providing services and following ethical rules.ResultsSix intertwined areas of concern are identified: three of them, the increasing criticism by users and carers, the intrusion of other professions, and psychiatry's negative image in society, can be traced back to problems with the other three concerning the “ownership of a specialized body of knowledge and skills”. With the preparation and advent of DSM-5, discussions about the lack of validity of psychiatric disease entities have gone viral in the time of the internet. The attempts to “carve nature at its joints” have failed, and this is more and more perceived from outside, threatening psychiatry's status in society and potentially turning away to be psychiatrists.ConclusionLooking at psychiatry as a profession may help to better understand its current situation.Disclosure of interestThe author has not supplied his declaration of competing interest.

EMIL KRAEPELIN’S INAUGURAL LECTURE IN DORPAT: CONTEXTS AND LEGACIES

1. Introduction The psychiatrist Emil (1856-1926) is today best known for having distinguished between what we have come to call schizophrenia on the one hand, and manic-depressive illness on the other. This basic dichotomy has been enormously influential in the history of twentieth century psychiatry. Over the past several decades, with the rise of biological psychiatry and--especially in the United States--the displacement of psychoanalytic psychiatry, has become an icon. His legacy has been appropriated by so-called neo-Kraepelinian psychiatrists who have repeatedly evoked his name in support of efforts to strengthen the biomedical model of mental disorders and to reinforce psychiatry's status as a research-based medical specialty within the mental health professions (Mayes and Horowitz 2005, McCarthy and Gerring 1994). Indeed, what some have described as a 'revolutionary' (Compton and Guze 1995, Klerman 1989:31) paradigm shift toward 'biological psychiatry' in the late twentieth century has gone hand-in-hand with recourse to Kraepelin's work. In the words of a former editor of the American Journal of Psychiatry, in moving forward, psychiatric research has found itself returning to the past and coming back full circle to the work of Kraepelin (Andreasen 1997:108). Emil Kraepelin's enormous influence in psychiatry is commonly put down to his clinical methods and nosology. According to advocates and detractors alike, his empirical research techniques and unique powers of observation were decisive factors in the delineation of schizophrenic and manic-depressive forms of mental illness. So it is hardly surprising--and certainly not without justification--that we have come to view him as a grand clinical nosologist. But in the 1880s, was not yet the clinical nosologist that he later became. Rather, a far more apt description of him at that stage in his career would be an experimental psychologist. worked in the famous laboratory of Wilhelm Wundt (1832-1920) in Leipzig, where he conducted psycho-physical experiments on the effects of various pharmacological and other stimulants. And over the course of his entire career, strove to establish the Wundtian psychological experiment as part of psychiatry's diagnostic repertoire. He created laboratories for psychological research at the university clinics he headed in Dorpat, Heidelberg, and Munich, as well as at the German Research Institute in Munich which he founded in 1917. For well over forty years, up to the very end of his career, conducted psychological research and remained convinced of its importance and usefulness in the development of psychiatric science (Kraepelin 1920:359-360, 1983:218). In general, historians of psychiatry have tended to ignore Kraepelin's laboratory research and it has come to be seen as little more than an awkward appendage to his clinical work (Gaupp 1939:68, Birnbaum 1928:42, Gruhle 1929:46, Ackerknecht 1985:78). From the perspective of clinical medicine, never succeeded, as he had hoped, in integrating psychological research into his broader nosological scheme. His enormously influential textbook Psychiatry was all but silent on the relevance of experimental psychology in psychiatric practice. Hence, it is not surprising that it has been largely purged from historical memory, while at the same time his pragmatic taxonomy was readily canonized by clinical psychiatry. My aim in this article is to reflect on Kraepelin's research in experimental psychology and its relationship with his nosology. Much of his early experimental research took place at the University of Dorpat, where from 1886 to 1891 he was a member of the medical faculty and director of the psychiatric clinic. In his inaugural lecture of 1886, he articulated the significance of experimental psychology in his early research agenda (Kraepelin 1887a). 2. Historical contexts: unitary psychosis and neuropsychiatry To fully appreciate the importance of Kraepelin's inaugural lecture, it is worth recalling two especially noteworthy historical contexts. …

Teaching Psychiatry on the Global Scene: The Cornell University Experience.

Qatar is a small country located on the eastern coast of the Arabian Peninsula inWestern Asia. With a surface area barely exceeding 10,000 km and a population of about two million people, it is currently one of the largest exporters of liquid natural gas globally. Because of the sudden rise in revenues from energy resources, Qatar has the highest per capita income in the world. Rather than depending on a fuel-based economy alone, however, the political leadership plans to transform Qatar into a “knowledge-based economy” by investing in people and services. To that end, Qatar Foundation for Education, Science and Community Development (QF) partnered with several renowned universities to establish branches in Qatar. In collaboration with QF, Cornell University in New York established the first medical school in Qatar in 2002. Like the main campus in NewYork, theWeill Cornell Medical College in Qatar (WCMC-Q) has a tripartite mission of fostering excellence in medical education, research, and clinical care [1]. Students are admitted with the same admission criteria and follow the same curriculum as students at Weill Cornell Medical College (WCMC) in New York City. They also take the same exams and adhere to the same criteria for evaluation, promotion, and graduation. The inaugural class, graduating in 2008, had 15 students (nine women and six men) representing seven different nationalities. In 2015, the number rose to 43, and the trend of diversity in gender, nationality, religion, and native languages continues. Stakeholders in Qatar hope that many of the alumni will train in the USA but eventually return to practice in Qatar. Because psychiatry relates more to culture than most other medical specialties, teaching psychiatry has been somewhat of a challenge. We have earlier reported on the state of psychiatry in Qatar [2]. Here we describe our experience teaching psychiatry at WCMC-Q since its inception several years ago. Although there is much written about psychiatric education internationally, teaching at WCMC-Q offers the additional challenge of transferring a US curriculum to the Middle East.

In India, psychiatry has come a long way.

This Presidential Address of the Bombay Psychiatry Society covers the state of psychiatry in India in 1997. It posits that with the advent of newer brain imaging technologies in India such as computerised tomography, magnetic resonance imaging, single photon emission computerised tomography and brain electrical activity mapping, an era of evidence-based psychiatry in India has arrived. The Address cautions against the dehumanising potential of excessive reliance on technology. The need for a greater emphasis on psychiatry during undergraduate medical education is discussed along with the need to destigmatise psychiatric disorders. Finally, the need to encourage quality research in psychiatric disorders is stressed.

Diagnosing Madness The Book of Woe The DSM and the Unmaking of Psychiatry by Gary Greenberg Blue Rider Press (Penguin), New York, 2013. 411 pp. $28.95, C$31. ISBN 9780399158537.

Greenberg provides an insider's critique of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the current state of psychiatry.

The state of psychiatry in the Czech Republic

This overview of Czech psychiatry begins with a brief review of its history; outlines its social, political and economic determinants and then describes the field itself. Both epidemiological and service-related information are discussed, together with the issues for mental health personnel, education and research. The heavy burden of communist history pervades most areas and must be taken into account in the specific characteristics that influence both the current situation and future prospects of Czech psychiatry. This consideration is essential for orientation in the field and to understand Czech particularities. The greatest challenges, however, originate from the fundamental changes that are going on in the world today. These challenges reach beyond national boundaries and include such phenomena as globalization, migration, ageing population, growing burden of mental ill health, the still prevailing stigma towards psychiatry, and the psychological roots and consequences of current financial and societal crises.

The state of psychiatry in Europe: Facing the challenges, developing consensus

All European countries are facing the challenge to address the very high prevalence of mental disorders with limited mental health resources, resulting in a treatment gap. Countries have drafted mental health strategies, replacing institutions with community based models of care with the aim to offer good and decent care. Psychiatry across Europe is very diverse, whether one considers models of care, resources, ways of working or training. Variation within countries, due to regionalization, can be as large as across frontiers. Valid comparisons of service delivery and their outcomes is essential for identification and dissemination of effective and efficient practice, but hampered by widely used but poorly defined terminology such as ‘primary care’ and ‘community services’, or assumptions about common ways of working. There is also still a lack of standardisation of outcome indicators. The combination of high morbidity and low supply in the presence of effective interventions is a strong argument in favour of investment, especially at times of growing need. It is necessary to support this argument with consistent evidence of improved outcome. It is essential that international groups now accept the challenge to reach consensus in order to advocate for more mental health resources.

The state of psychiatry in Sweden

The number of practising psychiatrists in Sweden has increased by nearly 30% between the years 1995–2009; however, the profession has suffered serious recruitment difficulties. The Swedish National Board of Health and Welfare estimated that about 5–10% of the population is in need of psychiatric treatment, but only 3–4% seek psychiatric care. Among patients who receive psychiatric care, approximately 47% are treated with psychopharmacology, 13% are treated with psychotherapy and 40% receive both treatments. There are still challenges facing Swedish psychiatry: reduction in waiting times for psychiatric care, broader accessibility of evidence-based treatment methods for all groups of psychiatric patients both in rural and urban areas, and targeting the needs of immigrants and refugees. The allocation of resources to psychiatric research, and development of novel treatment methods are crucially needed. The Swedish government is strongly committed to decreasing the number of suicides, as there are approximately 1,400 individuals lost to suicide every year in a country with a population of around 10 million. Given that nearly 20% of all suicides are amongst psychiatric inpatients, a regulation has been passed regarding the analysis of all completed suicides in the healthcare system. Results from these analyses can be used for increasing quality of treatment.