Subspecialty Of Psychiatry Research Articles

On drug treatment and social control: Russian narcology's great leap backwards

The medical discipline of narcology in Russia is a subspecialty of psychiatry from the Soviet era and it is given warrant to define the scope of health activities with regard to alcohol and other drug use, drug users, and related problems. Narcological practice is in turn constrained by the State. The emergence of widespread injection opiate use and associated HIV morbidities and mortalities during the first decade following the collapse of the Soviet Union has brought the contradictions in Russian narcological discourse into high relief. Narcology officials in the Russian Federation have consistently opposed substitution treatment for opiate dependence – the replacement of a short-acting illegal substance with a longer acting prescribed drug with similar pharmacological action but lower degree of risk. Thus, despite the addition of methadone and buprenorphine to WHO's list of essential medicines in 2005 and multiple position papers by international experts calling for substitution treatment as a critical element in the response to HIV (IOM, 2006; UNODC, UNAIDS, and WHO, 2005), methadone or buprenorphine remain prohibited by law in Russia.The authors detail Russian opposition to the prescription of methadone and buprenorphine, describing four phenomena: (1) the dominance of law enforcement and drug control policy over public health and medical ethics ; (2) the conflation of Soviet era alcoholism treatment with treatment for opiate dependence; (3) the near universal representation of detoxification from drugs as treatment for dependence; and (4) a framework for judging treatment efficacy that is restricted to "cure" versus "failure to cure," and does not admit its poor outcomes or recognize alternative frameworks for gauging treatment of opiate dependence. In keeping with this position, Russian narcology officials have taken an implacable ideological stance toward illicit drug use, the people who use drugs, and their treatment. By adopting policies and practices totally unsupported by scientific evidence and inquiry, officials in Russia have rendered narcology ( and medical practice) insensitive to the alarming rates and continued spread of HIV, with its dire morbidity and mortality rates in the Russian Federation, turning their backs on all the other health problems posed by opiate use and dependence itself.

At APA Communication Is a Two-Way Street

Back to table of contents Previous article Next article From the PresidentFull AccessAt APA Communication Is a Two-Way StreetCarolyn Robinowitz, M.D.Carolyn RobinowitzSearch for more papers by this author, M.D.Published Online:7 Dec 2007https://doi.org/10.1176/pn.42.23.0003©Sylvia Johnson Photography 2007A major focus of my presidential year has been communication. APA has strengthened our public affairs efforts to improve interactions with national policymakers (Congress and the executive branch) as well as the media. Our Office of Minority and National Affairs has built alliances with the faith community (where many people first turn for help with mental health issues). Our workplace initiative, known as the Partnership for Workplace Mental Health, continues to reach employers (Psychiatric News, October 19), and research increasingly documents the impact of psychiatric care on businesses' bottom line.Knowing the importance of physicians in identifying and treating mental disorders, we have enhanced our work with the medical community both through organizations such as the AMA and the Council of Medical Specialty Societies (CMSS, the umbrella organization for the major medical specialties) and through specific educational and research efforts. These efforts are paying off; our communication and impact in the AMA continue to grow in effectiveness, and with the election of our medical director/CEO, Dr. Jay Scully, as president-elect of the CMSS, we have another strong voice in organized medicine.Our other important focus is communicating with members. It often has been stated that one of the best-kept secrets is what APA does to help psychiatrists care for patients. How do we best inform psychiatrists about issues that affect us and our patients? As a clinician in private practice, I constantly struggle to keep up with developments in science and policy. Reading Psychiatric News certainly makes this task easier, but I know all too well that time is precious and claimed by many other demands.Our Assembly can be of great assistance in the communication process. Its members are elected by local colleagues and serve as conduits both to and from the grass roots of the Association. As such, they are activists—bringing important matters to the attention of their colleagues and the national organization, as well as educators. Our Assembly members are knowledgeable about overall APA programs and efforts; they participate in advocacy, support professionalism, promote psychiatry's “causes,” and encourage and assist other psychiatrists to do so. They participate in outreach to medical students, psychiatry residents, and early career psychiatrists, serving as mentors in these psychiatrists' professional development. Many in the Assembly are active in their local medical societies, as well as other community programs.While APA works to be open and responsive, it is impossible to have a personal dialogue with each of our more than 38,000 members. Through Assembly representatives as well as Area trustees, individual psychiatrists have a more direct voice in our representational governance. Just as we visit and inform our legislators, so can members work with their elected Assembly representatives to raise questions and concerns, as well as initiate ideas and possible actions.As leaders, Assembly members have a responsibility to help set priorities and to respond to important questions: What are the issues that APA must address? What are the issues that only APA can address? What are the issues that APA should address? What are the issues that APA can address collaboratively with other organizations? Where should our energy and resources go? There are lots of wonderful opportunities and causes—many of which we share with other groups. But if we do not focus on our profession and our patients, who will? Consequently, we must make the difficult decision of allocating limited resources (we have not increased national dues for more than a decade) with our professional focus and priorities in mind, to do what we must do and what no one else can or will do.We are a large organization serving diverse interests and needs. We come from different ethnic and cultural backgrounds and work in different settings— private practice, community and state clinics and hospitals, academic medical centers, the military, and the VA. We also serve subspecialty populations— children and adolescents, the elderly, and people from diverse ethnic and cultural backgrounds—and care for those with a broad array of mental disorders including substance abuse. Each brings special concerns and demands for attention and resources.As the overarching organization for all of psychiatry, APA must address the important needs of the field, as well as work collaboratively with psychiatry's subspecialty organizations and interest groups to achieve our priorities. Call or e-mail your Assembly representatives to ensure that your voice informs our actions to serve our profession and our patients. ▪ ISSUES NewArchived

Effectiveness of a Low-Cost Curriculum Among Entry-Level Psychiatric Rehabilitation Workers

Effectiveness of a Low-Cost Curriculum Among Entry-Level Psychiatric Rehabilitation Workers

Psychosomatic medicine: A new psychiatric subspecialty in the U.S. focused on the interface between psychiatry and medicine

Background and Objectives: In the past, Psychosomatic Medicine (PM) has had ambiguous connotations, and there have been many other names for this specialized fields, including Consultation-Liaison Psychiatry. The objective of this report is to briefly review the background, the history and current status of PM, which recently was recognized in the U.S. a psychiatric subspecialty. Methods: Historical review and review of the literature. Results: PM has a rich history. Psychoanalysts and psychophysiologists pioneered the study of mind-body interactions, and crucial events in the development include the funding of PM units in several U.S. teaching hospitals by the Rockefeller Foundation, and the training grants and a research development program funded by the National Institute of Mental Health. By the 1980s, all psychiatry residency programs were requiered to provide substancial clinical experience in the field, and as of 2005 there were 32 fellowship programs in the Academy of Psychosomatic Medicine's (APM) directory. In 2001, The Academy of Psychosomatic Medicine (APM) applied for the recognition of PM as a subspecialty of psychiatry, and formal approval was granted by the American Board of Medical Specialties (ABMS) in March 2003.The foundation of PM is a specialized body of scientific knowledge regarding psychiatric aspects of medical illness. This has been articulated in contemporary textbooks, journals and regular scientificic meetings of national and international societies A cadre of scholars and researchers has emerged, and important contributions have occurred. A major goal of the PM field is to improve the psychiatric care of patients with complex medical conditions. There are a number of obstacles and challenges ahead in pursuing optimal integration of PM services into existing service delivery systems of care, but anticipated expansion of accredited fellowship programs in PM will hopefully help address this shortfall. In the past 20 years an international PM network has developed with increasing scientific exchanges, and the US paradigm is regarded as important for the development of PM as a subspecialty internationally. Conclusion: Formal recognition as a subspecialty in the U.S. has and will strengthen PM and will enhance its growth internationally.

Abraham Arden Brill, 1874–1948

Back to table of contents Previous article Next article Images in PsychiatryFull AccessAbraham Arden Brill, 1874–1948Arnold D. Richards, M.D., and Paul W. Mosher, M.D.Arnold D. RichardsSearch for more papers by this author, M.D., and Paul W. MosherSearch for more papers by this author, M.D.Published Online:1 Mar 2006https://doi.org/10.1176/appi.ajp.163.3.386AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail A.A. Brill was one of the most influential American psychiatrists of the past century. His efforts and personal views were major factors in the development of psychiatry, psychotherapy, and psychoanalysis in the United States during the century’s first half. Brill left the Eastern European village of his childhood at the age of 14 and came, alone and without resources, to the United States and New York City to seek his fortune. By the time he was 29, he had graduated from the Columbia University College of Physician and Surgeons and then trained in psychiatry and neurology. In 1907, he traveled to Europe to pursue the latest advances in psychiatry and became acquainted with the work of Sigmund Freud. Upon his return to New York City, he began what was the first private practice of psychoanalysis in the United States (1).Brill became Freud’s first English translator, and Brill’s translations played a major role in the popularization of psychoanalysis in the United States. In 1911, Brill organized a group of 20 physician colleagues to found the first American psychoanalytic organization, the New York Psychoanalytic Society. Brill thought of himself as the father of American psychoanalysis, writing in 1938:Psychoanalysis was unknown in this country until I introduced it in 1908.…[psychoanalytic terminology], some of which I was the first to coin into English expression, can now be found in all standard English dictionaries. Words like abreaction, transference, repression, displacement, unconscious, which I introduced as Freudian concepts, have been adopted and are used to give new meanings, new values to our knowledge of normal and abnormal behavior. (2)Throughout his career, Brill was unalterably opposed to the practice of psychoanalysis and psychotherapy by nonphysicians and worked diligently to promote psychoanalysis as a subspecialty of psychiatry. In 1931, he helped to found the New York Psychoanalytic Institute, devoted to training physicians in psychoanalysis. As a result of almost a decade of Brill’s efforts, the American Psychiatric Association established a Section on Psychoanalysis in 1934 with Brill as its first head. Address correspondence and reprint requests to Dr. Mosher, 6 Woodlawn Ave., Albany, NY 12208; [email protected] (e-mail). Figure 1.

“Psychosomatic”: A Systematic Review of Its Meaning in Newspaper Articles

In this study, the authors describe the meaning of the word "psychosomatic" in U.S. and U.K. newspaper articles using a systematic text word search and a consensus rating of the contextual meaning of all articles published in 14 U.S. and U.K. newspapers between 1996 and 2002. The survey was limited to broadsheet newspapers. "Psychosomatic" had a pejorative meaning, such as "imaginary" or "made up," in 74 of 215 (34%) of the articles in which the meaning could be judged. Most commonly, "psychosomatic" was used to describe a problem that was psychological or in which the mind affects the body (56%) rather than as a reciprocal interaction (5%). "Psychosomatic medicine" is the new name for the seventh subspecialty of psychiatry. More needs to be done to educate the media about its actual meaning to make it attractive to patients.

What are the subspecialties of psychiatry?

What are the subspecialties of psychiatry?

Cross-cultural issues in forensic psychiatry training.

Forensic psychiatry was officially recognized as a subspecialty by the American Board of Medical Specialties in the 1990's. In 1994, the American Board of Psychiatry and Neurology (ABPN) gave its first written examination to certify forensic psychiatrists. In 1996, the Accreditation Council for Graduate Medical Education (ACGME) began to officially accredit one-year residency experiences in forensic psychiatry, which follow a 4-year residency in general psychiatry. The extra year of training, colloquially known as a fellowship, is required for candidates who wish to receive certification in the subspecialty of forensic psychiatry; since 2001, completion of a year of training in a program accredited by ACGME has been required for candidates wishing to take the ABPN forensic psychiatry subspecialty examination. With the formal recognition of the subspecialty of forensic psychiatry comes the need to examine special issues of cultural importance which apply specifically to forensic psychiatry training. This paper examines the current literature on cross-cultural issues in forensic psychiatry, sets out several of the societal reasons for the importance of emphasizing those issues in forensic psychiatric training, and discusses how those issues are addressed in the curriculum of one forensic psychiatry fellowship at the Medical College of Wisconsin (MCW). While much has been written about cross-cultural issues in general psychiatry, very little has appeared in the literature on the topic of cross-cultural issues in forensic psychiatry.

THE REDUCTION OF STIGMA AND DISCRIMINATION AGAINST OLDER PEOPLE WITH MENTAL DISORDERS: A CHALLENGE FOR THE FUTURE

Aging of the world population risks to be accompanied by an increase of chronic health problems, and most particularly of mental health problems. To face these problems the organization of care and education in old age psychiatry is still quite low. If at inter -national level the body of knowledge and skills of the psychiatry of the elderly is today enough recognized it is very difficult to convince authorities at national and local level to recognize this discipline as a sub-specialty of psychiatry. Even when some resources exist at local level to support old people with mental disorders, very often these old persons do not look for care as consequence of the prevailing double stigma attached to mental disorders in general and to the end of life in particular. In order to promote changes of this situation, the World Health Organization (WHO) Collaborating Centre of Lausanne realized a WHO-World Psychiatric Association (WPA) consensus meeting and statement on how to reduce the stigma and the discrimination against old persons with mental disorders, as well it has realized a survey in Europe on this specific subject of stigma and discrimination against these old persons. As education is one of the most important components of the strategy to reduce stigma and discrimination, 3 recent developments were done to promote this. The first one is a survey conducted by the section of old age psychiatry of WPA. The second one is the consensus statement on education in psychiatry of the elderly jointly published by WHO and WPA, and finally was the recent publication of a skill -based objectives for the training in the discipline. These efforts will be completed by some actions to strengthen the impact of all these documents.

Candidate for Trustee-at-Large

Back to table of contents Previous article Next article INFORMATION ON THE CANDIDATESFull AccessCandidate for Trustee-at-LargeRenée L. Binder, M.D., Renée L. BinderSearch for more papers by this author, M.D., Distinguished Fellow (Member Since 1975)Published Online:5 Dec 2003https://doi.org/10.1176/pn.38.23.0034About the CandidateRenée L. Binder, M.D.Distinguished Fellow (Member Since 1975)•. Professor, Department of Psychiatry, and Director of Psychiatry and Law Program, University of California, San Francisco, 1999-•. APA Assembly: Area 6 Representative, 2002- ; Deputy Representative, 2000-02•. Chair, APA Commission/Committee on Judicial Action, 2000-•. Chair, APA Council on Psychiatry and Law, 1997-2000•. ABPN: Senior Examiner, 1999- ; Forensic Psychiatry Subspecialty Steering Committee, 2001-•. President, American Academy of Psychiatry and Law, 1997-98Candidates’ ViewsIt would be a great honor for me to be able to serve the members of APA as trustee-at-large. APA is the premiere organization for psychiatrists. I have been a member since 1975 and have appreciated how much APA has given to me in terms of professional identity and professional development and as a forum for advocacy for my patients. I have been president of my district branch, president of my state association, Area 6 representative and deputy representative in the Assembly, and chair of three components: Committee on Confidentiality, Council on Psychiatry and Law, and Committee on Judicial Action.I have learned that organized psychiatry can be incredibly effective. When I was president of my district branch, I heard many concerns about the difficulties that our members had in terms of working with the regional Medicare office. I helped organize a meeting with key Medicare personnel, and this led to increased communication and facilitation of billing and the utilization review process. The district branch, representing more than 1,300 psychiatrists, was able to do more than any individual psychiatrist could do.From June to mid-December, I have been on a professional development leave and am working in the U.S. Senate as a health policy fellow. I have learned to appreciate how members of Congress and their staff want to hear from their constituents and professional organizations about the impact of proposed legislation. APA is very well respected and has done an excellent job of advocating for improvements in mental health services. As a member of the Board of Trustees, I will work to continue to support the efforts of APA in advocacy and in public affairs, especially in educating the public about the advances in psychiatry and treatments for mental disorders. I also will work to communicate the successes of our organization to our members. This will help with retention of our members who are unsure about what APA is doing for them.One of the important tasks of APA is to encourage the involvement of our young psychiatrists in organized psychiatry. During my tenure as president of the California Psychiatric Association, I helped organize a conference that was specifically geared to residents and early career psychiatrists. The focus was on improving skills in advocacy and working with the media. We had legislators, lobbyists, and media representatives give presentations. We also were able to offer scholarships to support the attendance of residents and early career psychiatrists. The conference was extremely successful, and our young psychiatrists learned how they could work with organized psychiatry to impact legislation and the public’s perception of psychiatry. This is the type of project that we need to support in other state associations and district branches and nationally.I believe that the job of the trustee-at-large is to represent all of our members to the Board of Trustees and ensure that all concerns are heard and addressed by the Board of Trustees. The job includes advocating for the Assembly, the components, women, minorities, underrepresented groups, international medical graduates, allied organizations, and our younger members. If elected, I will devote my efforts toward ensuring that all of these voices will be heard by the Board of Trustees.Primary Loci of Work and Sources of IncomeWork: 100%—Langley Porter Psychiatric Institute, University of California, San FranciscoIncome: 100%—University of California academic salary (includes faculty practice with outpatients, inpatients, and forensic consultations) ISSUES NewArchived

Subspecialty Certification in Geriatric Psychiatry

<h3>Objective</h3> The authors describe the development of certification and recertification processes for geriatric psychiatry, the American Board of Psychiatry and Neurology's second subspecialty in psychiatry. <h3>Methods</h3> Authors referenced databases of the certifying organizations and consulted published surveys of examinees. <h3>Results</h3> Since the first certification examination was administered in 1991, 2,595 certificates have been awarded. Because the certificates are time-limited, diplomates must sit for recertification every 10 years. Thus far, about 63% of the diplomates who have needed to do so have been recertified. <h3>Conclusion</h3> It is estimated that 5,000 geriatric psychiatrists will be needed to meet future healthcare needs. Thus, the demand for this expertise will be increasing, and it is anticipated that board-certified geriatric psychiatrists will continue to play leading roles in educating practitioners from multiple disciplines.

Subspecialty Certification in Geriatric Psychiatry

The authors describe the development of certification and recertification processes for geriatric psychiatry, the American Board of Psychiatry and Neurology's second subspecialty in psychiatry. Authors referenced databases of the certifying organizations and consulted published surveys of examinees. Since the first certification examination was administered in 1991, 2,595 certificates have been awarded. Because the certificates are time-limited, diplomates must sit for recertification every 10 years. Thus far, about 63% of the diplomates who have needed to do so have been recertified. It is estimated that 5,000 geriatric psychiatrists will be needed to meet future healthcare needs. Thus, the demand for this expertise will be increasing, and it is anticipated that board-certified geriatric psychiatrists will continue to play leading roles in educating practitioners from multiple disciplines.

Drs. Yudofsky and Hales Reply

Back to table of contents Previous article Next article Letter to the EditorFull AccessDrs. Yudofsky and Hales ReplySTUART C. YUDOFSKY, M.D., , and ROBERT E. HALES, M.D., STUART C. YUDOFSKYSearch for more papers by this author, M.D., Houston, Tex., and ROBERT E. HALESSearch for more papers by this author, M.D., Davis, Calif.Published Online:1 Mar 2003https://doi.org/10.1176/appi.ajp.160.3.596-bAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We thank Drs. Ross and Cooper for their replies to our editorial and understand full well that the issues they raise would be shared by many other of our thoughtful and concerned colleagues in psychiatry and neurology.Dr. Ross’s assertion that “physicians who treat patients with brain disorders are typically interested only in treating a subset of patients with these disorders using a subset of the available treatment options” and Dr. Cooper’s questions, “Have Drs. Yudofsky and Hales asked neurologists if they wish to attend to problems with affect, cognition, and behavior? Do they or other psychiatrists wish to attend to problems of the senses or extremities or the peripheral nervous system that are remote from their customary clinical problems?” highlight precisely why we believe the fields of psychiatry and neurology should move more closely together under the conceptual scaffolding of neuropsychiatry.Let us consider the example of a neurologist’s treatment of a 17-year-old boy with grand mal seizures. Without an intensive emphasis in his or her residency education on the psychosocial aspects of care, the neurology practitioner might regard the localization of the underlying lesion in the patient’s brain and prescribing the appropriate anticonvulsant as adequate treatment. However, what about the young man’s complex emotional and behavioral sequelae to having had a grand mal seizure—with incontinence—in front of his entire 11th-grade class, and how will he respond to no longer being able to drive a car like the rest of his peers? Our experience from having spent significant parts of our careers in hospitals that specialize in the care of patients with neurological and neurosurgical disorders is that such a patient would most likely be discharged without full consideration of these issues or without a referral to a psychiatrist—often with dire consequences for the recovery of the patient. In our editorial, we referenced the unfortunate history and attendant damage to our patients and to the field of psychiatry when the neurobiological aspects of causality and treatment of people with mental illness have been neglected by psychiatrists.Perhaps the following comparison will help Drs. Ross and Cooper understand better the point that we endeavored to make in our editorial. It has been suggested by others, using hauntingly similar arguments to those posited by Drs. Ross and Cooper, that psychopharmacology and psychotherapy should become separate subspecialties of psychiatry approved by the American Board of Psychiatry and Neurology. We are sure that Drs. Ross and Cooper would agree with us that this is a dangerous idea and that these therapeutic (and somewhat theoretical) realms have been and should remain fundamental to the education and clinical repertoire of every psychiatrist. Similarly, in the mid-19th century, psychiatry and neurology were much more closely aligned (1). We maintain the firm conviction, as delineated in our editorial, that the subsequent separation of neurology and psychiatry into discrete specialties has tenuous conceptual validity and deleterious consequences for the patients served by both fields.Reference1. Yudofsky SC: Images in psychiatry: Wilhelm Griesinger, M.D., 1817-1868. Am J Psychiatry 1995; 152:1203Link, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 160Issue 3 March 2003Pages 596-b-597 Metrics History Published online 1 March 2003 Published in print 1 March 2003

N.Y. Residents Graduate Into Bountiful Job Market

Back to table of contents Previous article Next article Education & TrainingFull AccessN.Y. Residents Graduate Into Bountiful Job MarketEve KupersaninEve KupersaninSearch for more papers by this authorPublished Online:21 Jun 2002https://doi.org/10.1176/pn.37.12.0032A new survey of graduating residents in New York state finds that there is great demand for psychiatrists fresh out of training programs in that state.In particular, child and adolescent psychiatrists finishing programs in New York received more job offers than any of their physician colleagues did.Researchers from the Center for Health Workforce Studies, which is based at the State University of New York at Albany, surveyed residents from 27 medical specialties graduating from programs in New York in spring 2001. They did so with the help of training directors and graduate medical education directors in university programs and hospitals across the state. They released their results in May.The researchers surveyed 4,407 medical residents in the final months of training and received 2,845 responses, for a 65 percent response rate. Among the respondents were 186 psychiatry residents, including 123 adult and 38 child psychiatrists. (The remaining respondents were in a variety of psychiatry subspecialty programs.)The findings provide a snapshot of graduating residents in New York. Researchers asked residents about their demographics, views of the job market, and practice plans.The survey showed that 44 percent of psychiatry respondents were women. There was a significant proportion of international medical graduates (IMGs), 63 percent, and 24 percent of them held temporary J-1 visas, which require that the physician return to his or her country of origin after training.Overall, psychiatry residents exiting programs in New York fared well in terms of career prospects. In particular, child and adolescent psychiatrists in New York had the highest mean number of job offers, with 5.4 per person. Residents completing adult psychiatry programs in New York received an average of 3.5 job offers each. Pathologists, in contrast, received only 1.6 job offers each, ranking last in this respect.Researchers asked residents to rate their perceptions of the national job market on a scale of -2 (no jobs on the national market) to +2 (many jobs on the market).Adult psychiatry residents in New York gave the national job market high marks (1.9), while child and adolescent psychiatrists felt nearly the same (1.8). Physicians in general surgery expressed the most pessimistic views of the national job market, giving it a score of .73.Other results from the survey were not as encouraging, however. Psychiatrists who had secured postresidency work reported that they expected to earn what they considered to be relatively low starting salaries. The expected median starting income for adult psychiatrists in New York last year was $120,000, while child and adolescent psychiatrists expected to earn $116,000 annually. Only primary care physicians reported a lower starting income than psychiatrists. Primary care physicians expected to make $109,500 after completing residency training. Radiologists in New York reported expecting the highest starting annual wages. They expected to earn $186,000.Edward Salsberg, M.P.A., executive director of the center, predicted that salaries for psychiatrists will increase along with demand for their services.“Even if you train the best psychiatrists in the world, if you don’t train enough of them, you will have serious problems with access to care,” he told Psychiatric News. “In particular, marketplace demand indicates that this country can use more child psychiatrists.”The high percentage of IMGs in New York psychiatry residency programs reinforced for Sidney Weissman, M.D., a former member of APA’s Committee on Workforce Issues, the vital role that IMGs play in that state. “In the absence of IMGs, health care in New York would grind to a halt,” he told Psychiatric News.Weissman said that while the survey results show that psychiatrists receive a relatively high number of job offers compared with other specialists, the nature of these jobs is not known. “It is true that every psychiatrist I know who graduates is employed—the question is, Do they like their jobs?”Weissman said it would be useful to gather information on the nature of the employment opportunities for early career psychiatrists. He suspects that the majority of job offers reflected in the New York survey are in the public sector, where the psychiatrists’ chief responsibility is medication management.“While there may be no shortage of jobs, these jobs may not be desirable for those psychiatrists who want to practice psychotherapy, for instance,” Weissman said. “These data warrant further investigation on the quality and number of jobs available to psychiatrists.”A copy of the report is posted on the Web site of the Center for Health Workforce Studies at chws.albany.edu. ▪ ISSUES NewArchived

Forensic psychiatry as a subspecialty of psychiatry

A model of magma propagation in the crust is presented using a series of analogue experiments, where dyed water is injected at a constant flux into layers of solidified gelatine. The gelatine layers are transparent and, when intruded, deform in an almost ideal-elastic manner under the experimental conditions (low gelatine concentration: 2.5 or 3 wt%, and low temperature: 5–10 °C). The upper gelatine layer was 1.0 to 1.5 times stiffer than the lower layer, with either a ‘weak’ or ‘strong’ interface strength between the gelatine layers. The gelatine is seeded with 20–50 μm-diameter PMMA-RhB neutrally buoyant particles that are fluoresced by a pulsed, vertical laser sheet centred on the injection point. Digital image correlation (DIC) is used to calculate incremental strain and finite strain in the deforming host material as it is intruded. This is mapped in 2D for the developing experimental volcanic plumbing system that comprises a feeder dyke and sill. Since the gelatine deforms elastically, strain measurements correlate with stress. Our results indicate that, for constant magma flux, the moment of sill inception is characterised by a significant magmatic pressure decrease of up to ∼60%. This is evidenced by the rapid contraction of the feeder dyke at the moment the sill forms. Sill propagation is then controlled by the fracture properties of the weak interface, with fluid from the feeder dyke extracted to help grow the sill. Pressure drops during sill inception and growth are likely to be important in volcanic systems, where destabilisation of the magmatic plumbing system could trigger an eruption.

Quality of life in forensic psychiatry: an unreclaimed territory?

This article focuses on the role of the quality of life concept in forensic psychiatry and the aim is to find out whether quality of life is regarded as an important outcome measure in this subspecialty of psychiatry. To this end, a brief description is given of how the quality of life-concept is dealt with in general psychiatry and what the status of the 'quality of life' concept is in the forensic psychiatric field. One of the major conclusions is that the operationalization and measurement of quality of life in forensic psychiatry is still in its infancy: there are only a couple of publications pertaining to theoretical and/or empirical issues of quality of life for mentally disordered offenders. Therefore, much can be gained from the experience and knowledge in general psychiatry and medicine.

Traditional mental health practitioners in Kwara State, Nigeria.

To assess the knowledge, practice and attitude of traditional mental health practitioners (TMHPs) in four Local Government Areas (LGAs) in Kwara State, Nigeria, on mental health care; to organise training sessions aimed at improving their knowledge base, practice and; to evaluate such training after allowing for a period of practice. STUDY DESIGN/INTERVENTION: Pre-training evaluation phase: TMHPs were assessed in the area of knowledge, attitude and practice of mental health, with the use of a questionnaire. They were then trained in the concepts of normality and abnormality, types of mental illness, treatment of mental illness including follow up, after-care, relapse prevention, other primary preventive measures, and some introductory talks on some sub-specialties of psychiatry, for example, child psychiatry, old age psychiatry, forensic psychiatry, drug and alcohol abuse and; after a free-practice period of two months, the TMHPs were again reassessed for the impact of the training. Pre-intervention phase: TMHPs could easily recognise most symptoms of mental illness except undue sadness. The TMHPs also expressed strong belief in the supernatural factor as a cause of mental illness. Some of them beat their patients for therapeutic reasons and; Post-intervention phase: there was a widening of the sense of recognition of TMHPs of important mental symptoms such as undue sadness, social withdrawal and elation. There was a better understanding of the aetiological concepts of mental illness. There was also a reduction in the habit of beating their patients as a form of treatment. The use of information, education and communication intervention techniques could lead to more positive and less hazardous forms of practice among TMHPs and; The high level of cooperation achieved in this study would indicate a bright chance for future collaborative activities between orthodox and traditional healthcare providers.

Part I: Further evolution of a literature database: the international use of a common software structure and methodology for the establishment of national consultation/liaison databases

Every day there are 6000–7000 papers published in science. Since the C-L psychiatrist may be asked to consult on a patient with any medical illness, and who may be on any medical drug, methods need to be developed to review the recent literature and have an awareness of current findings. At the same time, teachers need to develop a current listing of seminal papers for trainees and practitioners of this subspecialty of psychiatry. Experts chosen because of their writings and acknowledged contributions to their subspecialty interests have sifted through thousands of articles to select the ones they regard as the most important for trainees in C-L psychiatry. In addition, certain countries—Spain, Portugal, Germany, Mexico, Australia and Brazil are developing national databases of C-L literature not only for their own use, but also to bring them to the attention of other parts of the world. This fifth iteration of the C-L literature database has especially targeted the period of 1996–1999—the millennium issue—in order to have easier access to contemporary essential studies on common problems. Part II of this issue describes the seminal cardiac drug-psychotropic drug interactions that the C-L psychiatrist may encounter in the most common medical disease in the United States—coronary heart disease—with advise to the practitioner as to their management. The use of the Internet and institutional Intranets is described.

Survey of undergraduate teaching of old age psychiatry in the United Kingdom

Old age psychiatry has been steadily developing as a specialty in the United Kingdom. In 1978 the Royal College of Psychiatrists established a specialist section for old age psychiatry, and since October 1989 it has been formally recognised as a sub-specialty of psychiatry. In 1989 the Royal College of Physicians and the Royal College of Psychiatrists published a joint report entitled ‘Care of Elderly People with Mental Illness’ in which recommendations were made about both postgraduate and undergraduate training.

A new tool for consultation-liaison funding: Modified DRGs to reflect psychiatric comorbidity

Funding for consultation-liaison (C-L) psychiatry remains an overriding obstacle to its implementation and practice. Several methods have been described to access funds for this subspecialty of psychiatry, but none has been enacted as a policy by third party payers to reimburse adequately for the service. In addition, although the consultation portion of the effort can be reimbursed in part in some cases through fee for services, the liaison portion is dependent on the donation of psychiatry time or the largesse of the host department. The efforts at Stanford to capitalize on the findings that psychiatric and medical comorbidity results in prolonged length of hospital stay and increased health resource utilization suggest that specific DRGs would be important patient groups to screen and charge for psychiatric services. Furthermore, DRGs that are accompanied by a high frequency of psychiatric comorbidity are a “target” for an additional funding aliquot to assess and manage the patient's psychiatric status.