Subspecialty Of Psychiatry Research Articles

An Online Curriculum for Geriatric Psychiatry Subspecialty Residents.

An Online Curriculum for Geriatric Psychiatry Subspecialty Residents.

Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program.

Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.

“Engaging, interactive, not boring” – A new innovative tutorial programme for medical students with promising longevity at the University of East Anglia.

Introduction Medical students at the University of East Anglia (UEA) complete a psychiatry rotation in the fourth year of their MBBS degree. There are four rotations each academic year, in 2022-2023 there were 24 students per rotation. The rotation consists of two weeks of lectures, a four-week clinical placement, and then a further two weeks of lectures. Students are based across Norfolk and Suffolk for their clinical placements. Although case-based discussions occurred every Wednesday morning via Teams, there were no face-to-face small group teaching sessions during placement.ObjectivesTo design an interactive set of tutorials for medical students covering a wide range of psychiatric topics which can be easily delivered by other facilitators.MethodsThree 1.5 hour tutorials were created: 1)” Psychotic Bingo” - Students have a unique card with terms used in descriptive psychopathology to play Bingo, 2) “Medical ethics, mental health and the law” – Explores the case of Kerrie Wooltorton to discuss the mental capacity act, advanced decisions, and the mental health act, 3) “Team Quiz” – Played in groups and covers the different sub-specialties of psychiatry and pharmacology. Tutorials were only mandatory for students in Norwich (average 11 students per tutorial) due to a large geographical area across placements. Tutorials were delivered for three rotations between December 2022 – May 2023, the initial two rotations by the first author and the third rotation by other facilitators. Facilitators were provided with a tutorial guidance document to ensure consistency. The same feedback form was used to obtain qualitative and quantitative feedback from students at all tutorials.ResultsThe table below shows that feedback from students was consistently high, and there was little difference in average students rating between tutorials delivered by the first author and other facilitators. The predominant qualitative feedback was that the tutorials were “very interactive”, “engaging” and “fun”.Image:ConclusionsThis tutorial programme consistently received excellent feedback. The results show that the tutorials can be effectively delivered by other facilitators whilst maintaining a high standard, which ensures the programmes longevity. The tutorial programme is being formally implemented for all medical students at UEA from October 2023.Disclosure of InterestNone Declared

Resident Attitudes Toward Geriatric Psychiatry Subspecialty and Needs Assessment for a Geriatric Psychiatry Curriculum: A Qualitative Study

Resident Attitudes Toward Geriatric Psychiatry Subspecialty and Needs Assessment for a Geriatric Psychiatry Curriculum: A Qualitative Study

Addressing Issue of Fast-Tracking in Consultation-Liaison Psychiatry Fellowship Training: Expanding Access or Undermining Competence?

Fast-tracking is the option for residents to pursue fellowship training in place of their final residency year. It is currently permissible to fast-track into a child and adolescent psychiatry fellowship, but this remains a controversial idea for other psychiatry subspecialties. In 2022, the Annual Meeting of the Academy of Consultation-Liaison Psychiatry (ACLP) featured a plenary session debate about the pros and cons of fast-tracking. Here, the authors present some of the information discussed at that session and highlight the potential benefits and pitfalls of fast-tracking into consultation-liaison (C-L) psychiatry.

Palliative Care Psychiatry: Building Synergy Across the Spectrum.

Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Assessment of Psychiatry Trainees Satisfaction towards Postgraduate Psychiatry Clinical MD in Sudan

Background Assessment of trainees and graduate’s satisfaction in medical education and clinical training is an important guide for the improvement of educational and training programs. Local information is scarce on psychiatry trainees' satisfaction to their training program. Objective To assess psychiatry trainees satisfaction towards postgraduate program in Clinical MD in Psychiatry at the Sudan Medical Specialization Board in 2021. Method This is a cross-sectional observational study conducted at the Sudan Medical Specialization Board / psychiatry council/ Clinical MD in Psychiatry program, within the period from August 2021 to January 2022. 137 of current psychiatry trainees and graduates were surveyed using a closed-ended unipolar 5 grade Likert’s scale, through adapted a self -administered questionnaire covering eight dimensions and variety of psychiatry training items. Areas covered were curriculum coverage, research involvement and training assessment methods, clinical experiences, academic experiences, supervision, training centers support and training environment. Result The overall trainee's satisfaction with the provided training program was reported in 35%. The satisfaction score was observed to be more common in the graduates (62%) compared to the current trainees (38%). The areas of good satisfaction include: training in adult general psychiatry (69.6%), diversity of patients' population (72%), part-1 exam (77.5%) and level of support from peers (75.2%). while areas of low level satisfaction include: quality of physical facilities(10.4%),education prioritization over service(11.2%) training in psychiatry subspecialties(12.6%), learning resources(13.6%), safety of environment(14.2%). overall research experiences(21.9%), academic activity at training centers(24.8%), organization of learning activities(24.8%), responsiveness of program to feedback from residents(24%), frequency of supervision received(30.4%) continuous assessment(36.4%), received constructive feedback(37.6%) and training in emergency room(40%). Conclusion The frequency of satisfaction was found to be alarmingly low among psychiatry trainees in the variety of training constructs used in the study, and the results were in agreement with many international studies.

The historiography of puerperal psychosis: a Cinderella sub-specialty

This article discusses the historiography of puerperal psychosis and how it mirrors the historiography of the development of psychiatry as a discipline. The article defines the meaning of the term ‘puerperal psychosis’ and explores the way that this condition has been dealt with in texts from the pre-modern era. It developed in the 19th century when numerous stakeholders lay claim to being the appropriate professional for management of women affected by this condition. Its decline as a term came about by the end of the century, as the result of Krapelinian nosology, although it subsequently rose in importance towards the end of the 20th century. It can be likened to a Cinderella sub-specialty in psychiatry.

Caveats of mental healthcare act-2017: Recommendation for amendments.

Dear Sir, The rights-based framework in the current Mental Healthcare Act 2017 (MHA-2017) has received a wider acceptance in the minds of policymakers, patients, caregivers, judicial officers, and mental health professionals.[1,2] However, there appears to be a huge gap between acceptance in our minds and implementation at the ground level. Theoretical knowledge of MHA-2017 and the inability to translate it into practice in most of the general hospitals in the country due to systemic issues has created a dilemma in the minds of psychiatry residents. Therefore, it is necessary to have periodic sensitization programs for psychiatry trainees as well as psychiatrists to learn about changing scenarios in mental health legislation in the past five years.[3] The only discipline of Medicine that carries special significance beyond ethical practice involving beneficence, autonomy, non-maleficence, and justice is psychiatry. This practice and the respect for the rights of a person to bring about optimum mental health outcomes have been legally guided. Forensic psychiatry has started to evolve as a subspecialty of psychiatry.[4] However, are psychiatrists in the country confident in dealing with legal issues evolving in the aftermath of MHA-2017 and imparting this practice to postgraduate trainees? Is clinical practice synchronizing with the legal framework? Are we dealing with the paradox of MHA-2017? Are budding psychiatrists across the country in dilemma with regard to MHA-2017? The response of different states is varied in terms of readiness of infrastructure, the constitution of the State Mental Health Authority (SMHA), the functioning of Mental Health Review Boards (MHRB), and overall dismal application of MHA-2017. Are there hasty translations of Western World rules on the infertile grounds of India? More than four years after passing the act, the current level of functional implementation does not appear to be a healthy indicator for the growth of mental health services in the country. This could provoke lawmakers to bring out the amendments to MHA-2017 to best suit the mental health services and practices of the country. In the absence of functional MHRBs, the practical caveats that may require amendments may include providing electroconvulsive therapy (ECT) to children and use of hospital beds for day-care procedures in psychiatry that include but are not limited to the somatic therapies in psychiatry such as administration of electroconvulsive therapy and repetitive transcranial magnetic stimulation (rTMS). It also includes short-term observation for a few hours in a general hospital following administration of long-acting injectables (LAI) antipsychotics and assessment for the appearance of acute side effects such as post-injection delirium sedation syndrome, and acute dystonia and oculogyric crisis. The other concerns requiring immediate attention for the functioning of MHRB include notifying advance directives, continuing admission under special circumstances, and provision of separate wards for children and women under psychiatry in a general hospital. These amendments could also add the role of MHRBs for adolescents involved in juvenile delinquency, child custody, termination of parental rights, and other related issues.[5] The protection of the rights of a person with mental illness should not be viewed as safeguarding oneself from the practice of psychiatry in the absence of full-fledged implementation of MHA-2017. This could be important for making a provision for the psychiatrist witnessing nonsexual or sexual boundary violation to notify the MHRB in advance, a point not placed in MHA-2017. The spirit of the MHA-2017 also does not clarify the role of the Consultation Liaison Psychiatrist and its effective practice in different departments under general hospital units. Further, the role of the psychiatrist in cases requiring cognizance of other specified acts such as the Prevention of Child Sexual Offense (POCSO) Act, Narcotics and Psychoactive Substances (NDPS) Act, The Rights of Persons with Disabilities (RPwD) Act, Right To Information (RTI) Act, etc. should also be viewed in parallel with MHA-2017. Authors emphasize the opportunity of teaching programs to highlight the gaps in training and implementation of MHA-2017.[6] The absence of functional implementation of MHA-2017 requires the churning of thoughts of stakeholders to amend a few provisions such as the formation of the transitional local hospital review board till formal MHRBs are functional.[7] This letter encourages clinicians and researchers to assess the compliance status of Indian states with MHA-2017 and to provide feasible solutions through systematic scientific research. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Overview of practice of Consultation-Liaison Psychiatry.

Overview of practice of Consultation-Liaison Psychiatry.

CLINICAL AND SOCIODEMOGRAPHIC PROFILE OF PATIENTS PRESENTING TO CONSULTATION LIAISON PSYCHIATRY CARE IN A TERTIARY CARE HOSPITAL IN SOUTH KASHMIR

Background: Consultation-liaison psychiatry is a sub specialty of Psychiatry that involves the study, practice and teaching of the relation between medical and psychiatric disorders. There is relatively insufficient data that studies the profile of consultation-liaison psychiatry across developing nations. Aims:To study the clinical and sociodemographic profile of patients presenting to consultation-liaison psychiatry care in a tertiary care hospital in south Kashmir. Materials & Methods:The present study included all the patients who were referred to Psychiatric department ,both inpatients as well as outpatients ,over a period of one year from January 2020 to December 2020.Data was collected using a semi structured pro forma and diagnosis was made using ICD-10 diagnostic criteria. Results:600 patients were included in our study, 332 of whom were females. Majority of patients belonged to age group of 21-40 and were residents of urban areas. The most common source of referrals included Cardiology followed by General Medicine. Depressive symptoms followed by suicidal attempts formed the majority of reasons for referral. The most common diagnosis established was Major Depression followed by Substance Use disorders. Conclusion: C L Psychiatry plays a significant role in bridging the gap between physical and mental illness and is vital for providing an integrated health service to the patients.

Message from the President.

Dear Members and Fellows of the Indian Psychiatric Society, Greetings to you from the Desk of the President! Indian Psychiatric Society has for many years been at the helm of publishing Clinical Practice Guidelines (CPG) in many important clinical disorders. This year sees another outstanding contribution from our CPG Committee on Forensic Psychiatry led by Prof. Shiv Gautam (Chairperson, CPG Committee), Prof. Jhanavi Kedare (Co-Chairperson, CPG Committee), Prof. Sandeep Grover (EC Coordinator, CPG Committee), and Dr. Siddharth Sarkar (Convener, CPG Committee). I am indebted to the team for their tremendous contribution and dedication. I extend my deepest gratitude to Prof. Ajit Avasthi for his selfless contribution to this Committee in the past and to Prof. O. P. Singh for his excellent leadership as the Editor of the Indian Journal of Psychiatry in bringing out the Supplement with the CPG. American Board of Forensic Psychiatry and the American Academy of Psychiatry and Law define Forensic Psychiatry as “a subspecialty of psychiatry in which scientific and clinical expertise is applied to legal issues in legal context, embracing civil, criminal, correctional, or legislative matters.” Forensic psychiatry is comparatively a new upcoming and developing field in India and should be practiced in accordance with guidelines and ethical principles enunciated by the profession of Psychiatry. The World Health Organization and the International Guiding Principles for Mental Health Care mandate that all human rights, including the right to privacy, informed consent, confidentiality, freedom from cruel and unusual treatment, and nondiscrimination, should be guaranteed through mental health legislation. It is important to remember the history of Forensic Psychiatry to fully appreciate why we need to immensely focus on this specialty. Law relating to custody of lunatics and management of their estates was introduced in India through three separate Acts: (1) the Lunacy (Supreme Court) Act, 1858 relating to judicial inquisition as to lunacy in presidency towns, (2) the Lunacy (District Courts) Act, 1858 relating to proceedings outside presidency towns, and (3) the Lunatic Asylum Act, 1858 relating to confinement of lunatics in asylums. The English Acts of 1853 after frequent amendments were replaced by the Lunacy Act, 1890 and amended by the Lunacy Act, 1891. The Indian Lunacy Bill, 1911 was enacted within 1 year as the Indian Lunacy Act, 1912 (Act IV of 1912), and much later, we had the Mental Health Act of 1987 and The Mental Health Care Act, 2017. Not all practicing Psychiatrists and Postgraduates (PGs) in Psychiatry have adequate practical knowledge of Forensic Psychiatry. Most private and government medical college psychiatry units do not have much exposure to Forensic Psychiatry, except a few. Hence, teaching and training in Forensic Psychiatry are not adequate for Psychiatry PGs throughout the country. Many practicing psychiatrists, especially youngsters, find it difficult to handle cases related to psychiatry and law. Today’s psychiatry is involved in very, many spheres of our day-to-day life and not only restricted to criminology. I am very confident that the CPG in Forensic Medicine will provide us with the necessary guidelines to provide our patients with evidence-based treatment while at the same time being sensitive and compassionate toward their issues. I congratulate and thank all members for their sterling contribution and request all members of our society to refer to the guidelines in their clinical practice. With best wishes to all!

Forensic Psychiatry in Pakistan: An Update

Pakistan is a lower-middle income country in South Asia where forensic psychiatry is often not recognized as a distinct subspecialty of psychiatry. Although evolution toward this direction has begun, more development in this field is needed. Before Pakistan’s Mental Health Ordinance of 2001, much of the mental health legislation and intitutional infrastructure pertaining to the mentally ill offender can be traced back to the Indian Lunacy Act of 1912. The past two decades have witnessed important legal developments in the role of psychiatry in Pakistan’s criminal justice system. This has been seen through the devolution of health-care provision and by an extension of psychiatric service provision from the federation (federal government) to the four provinces. Despite the sparse resources allocated to psychiatry, competent yet scarce psychiatry residents are graduating from Pakistan’s accredited residency programs with an interest in forensic psychiatry. The objective of this article is to reflect on the past, while examining the current state of existing forensic mental health in Pakistan. This article will also address the future trajectory of forensic psychiatry in Pakistan and supports the establishment of forensic psychiatry as a subspecialty in Pakistan.

‘The medical gaze’: Foucault, anthropology and contemporary psychiatry in Ireland

Michel Foucault developed the concept of ‘the medical gaze’, describing how doctors fit a patient’s story into a ‘biomedical paradigm, filtering out what is deemed as irrelevant material’ (Misselbrook, 2013). Doctors are perceived within this model to focus on selecting the biomedical elements of patients’ problems only, filtering out all other elements of a person’s life story, but this paper argues that in the subspecialty of psychiatry, this is not the case, and such a filter is not so easily applied.

Factors associated with interest in psychiatry in UK medical students: qualitative study.

This study aimed to explore factors that positively influence UK medical students' interest in psychiatry. Delegates and committee members of the National Student Psychiatry Conference 2018 were invited to participate in individual semi-structured interviews. Nine interviews were conducted. Qualitative data were analysed using thematic analysis. Four core themes emerged: psychiatry education and exposure, role of a psychiatrist, fitting in, and factors external to medical school. All students had some degree of interest in mental health before medical school, but placement and extra-curricular factors were strongly influential. Interest in psychiatry may be promoted by facilitating student exposure to enthusiastic psychiatrists and psychiatry subspecialties, encouraging extra-curricular activities and identifying early those with pre-existing interest in mental health on admission to medical school. Aspects of psychiatry that should be promoted include the potential to make a positive difference to patients' lives and the teamworking elements of the specialty.

Predictors for Matriculation into Geriatric Psychiatry Fellowship: Data from a 2019-2020 National Survey of U.S. Program Directors.

ObjectiveWith the number of geriatric psychiatry fellows declining from a peak of 106 during 2002–2003 to 48 during 2020–2021, this study aims to investigate characteristics of the geriatric psychiatry training requirement across U.S. psychiatry residency programs and to identify specific factors which may influence residents to pursue geriatric psychiatry subspecialty training.MethodsThe authors queried the American Medical Association’s Fellowship and Residency Electronic Interactive Database Access system to compile a list of program directors from the Accreditation Council for Graduate Medical Education sponsored general adult psychiatry residency programs. Program directors were emailed an anonymous multiple-choice survey to ascertain specific characteristics of their program’s geriatric psychiatry training experiences. This study’s primary outcome was the percentage of residents entering geriatric psychiatry fellowship after completion of general psychiatry training. Linear regression analysis determined which variables may be associated with this primary outcome.ResultsOf 248 surveyed, 60 programs (24%) responded to the survey. Only one of the independent variables revealed a statistically significant association with the percent of residents that became geriatric psychiatry fellows: the number of geriatric psychiatrists at the residents’ home institution (p=0.002).ConclusionsConsistent with previous data, the presence of geriatric psychiatry faculty members is strongly associated with the decision to pursue subspecialty training in geriatric psychiatry.

Consultation-liaison psychiatry training in Europe: where do we stand?

Consultation-liaison psychiatry is a subspecialty of psychiatry that focuses on the interface between mental health and general medical care. In Europe, consultation-liaison psychiatry has a long history and is an established field of practice. The primary goal of consultation-liaison psychiatry is to provide psychiatric assessment, diagnosis, and treatment to patients with medical or surgical conditions that impact their mental health. Consultation-liaison psychiatrists work collaboratively with medical teams to manage the psychological and emotional aspects of illness and its treatment. In addition to providing direct patient care, consultation-liaison psychiatrists also participate in research, teaching, and advocacy activities related to the interface between medicine and psychiatry.

Patterns Of Psychiatric Referrals In A Tertiary Hospital

Introduction: Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to patients under non-psychiatric care. Despite evidence of benefits of CLP for patients with psychiatric comorbidities, referral rates from hospital doctors remain low. This has prompted the present study, to assess the frequency and the pattern of psychiatric referral in a tertiary hospital in Nepal.
 Material And Method: This was a descriptive cross‑sectional study conducted in a tertiary care hospital. The study comprised of 108 patients referred for psychiatric consultation from various out-patient departments (OPD) to C‑L services of psychiatry department. Information was collected using semi‑structured proforma, and diagnosis was made based on Diagnostic Criteria for Research (ICD-10 DCR)and the data were analyzed.
 Results: A total of 108 patients, male 41(38%) and female: 67(62%) were referred to CLP, the Medicine department sent the maximum number of consultations (57.4%), followed by E.N.T (25.9%), Surgery (16.7%). Psychiatric consultation was sought for various reasons including decreased sleep (37%), appears anxious (27.8%), appears depressed (15.7%), foreign body sensation (11.1%), and mass moving in abdomen (8.3%).The most prevalent ICD-10 diagnosis was depressive episode (44.4%) followed by anxiety disorder (27.8%) and somatoform disorder (19.4%).
 Conclusion: Our study illustrates the importance of CLP through referral pattern from various OPD in a tertiary care hospital. Majority of referrals were from Medicine department andthe most common reason of referral was decreased sleep. The commonest diagnosis seen in the referred out-patients was depression followed by anxiety disorder and somatoform disorder.

Interface between community intellectual disability and general adult psychiatry services

SUMMARYPeople with intellectual disability can have a range of common mental health difficulties that sit at the interface of two psychiatry subspecialties: intellectual disability and general adult psychiatry. Clinical presentations, comorbidities and complexities can affect the setting of boundaries between the two disciplines. This article touches on current concepts, drives for inclusion of people with intellectual disability in mainstream psychiatry services and some of the difficulties at the interface. It focuses on potential solutions for managing this interface between the two subspecialties.

Challenges of Establishing a de novo Consultation-Liaison Psychiatry Service in a Tertiary Hospital: Practical considerations and challenges

Consultation-liaison psychiatry (CLP), also known as psychosomatic medicine, is a subspecialty of psychiatry that focuses on the care of patients with mental health disorders and general medical/surgical conditions. Integrating CLP services facilitates diagnosis and management of patients with complex comorbidities. This article aimed to report the practical considerations and challenges associated with establishing a de novo CLP service in a tertiary hospital in the Gulf region. This includes discussing the rationale and clinical and educational benefits as well as the resources required for establishing a CLP service.