Psychiatric Training Research Articles

Beyond the Unknown: Navigating the Transformative Journey of Caregiving through Rare Cancer

This article explores the intricate journey of caregiving amid the complexities of rare cancer, emphasizing the transformative impact on individuals and family dynamics. Told through the lens of the author—a doctor, psychiatrist, and current psychoanalyst in training, as well as a sibling and caregiver—it explores the investigative, treatment, and acceptance phases. This narrative serves as a case study, reflecting the author's personal journey through the complexities of caregiving in the context of rare cancer. Highlighting the importance of grief processing and honoring the autonomy of the sick, the article explores the underlying reasons behind the caregiver's desire for control. Advocating for self-care as a significant factor, it provides a list of practical strategies and closes by underlining the step-by-step process of acceptance. It underscores the diverse journey of caregiver navigating rare cancer, weaving together life's complexities with resilience, love, and the enduring power of the human spirit.

Experience of students who participated in psychiatric nursing educational program aiming at competency development.

Purpose: To clarify experience of students who participated in psychiatric nursing educational program aiming at competency development. Methods: We conducted a semi-structured interview with five students who participated in a psychiatric nursing educational program and analyzed the results qualitatively and descriptively. Results: We generated 19 categories and 39 subcategories. The students reached [acquisition of diversity and multi-phase viewpoint] through team discussion and attempted to understand patients holistically, including [acquisition of patient's viewpoints]. Moreover, they formed supportive relationships while [repeating trial and error] and gained self-understanding based on [egocentrism awareness]. Conclusion: Participation in this program increased students' preparedness for psychiatric nursing practical training, believed to contribute to competency development. Some students had difficulty relating to patients and hesitated to express negative emotions while establishing supportive relationships. This indicates the need for an educational approach that encourages students to express negative emotions easily.

Evidence-Based Practices: An Opportunity to Enhance Psychiatric Residency Training

Staring back at me through the Zoom interface was a small, thin-faced boy, too nervous and overwhelmed to tell me anything more than his own name and the name of his dog: Cooper. This was the first child therapy case I was assigned as a resident trainee. He was a young adolescent with acute lymphoblastic leukemia. Two years ago, he was outgoing, playful, and sociable. Now he apprehensively stared at me, underweight and highly anxious. He was experiencing medical trauma through countless hospital admissions for chemotherapy and opportunistic infections during the ongoing global pandemic. At the time he was transferred to my care, he carried multiple psychiatric diagnoses, including generalized anxiety disorder, major depressive disorder, and posttraumatic stress disorder. I had no idea where to begin. Though I was in my third year of Triple Board training, which includes adult psychiatry, pediatrics, and child psychiatry fellowship, I felt unprepared. My education and exposure to psychotherapy had been somewhat limited; but even still, I knew that learning effective, evidence-based therapeutic skills would not be straightforward.

Psychotherapy training in postgraduate psychiatry training in Nigeria - Are we doing enough?

Nigeria, with an estimated 40 million people living with mental disorders, faces a critical shortage of psychiatrists to address the significant burden. Despite psychotherapy being integral to psychiatric training, it lacks structure, consistency and adequate supervision. This is alarming, particularly given the substantial demand for specialized psychotherapeutic support among those with mental illness. A cross-sectional study utilised an online survey targeting early career psychiatrists recruited from the Early Career Psychiatrists section of the Association of Psychiatrists in Nigeria. The questionnaire was distributed to 252 early career psychiatrists across Nigeria, with a 42.9% response rate, of which 50% were male, with 73.2% trainees and 26.8% early career psychiatrists. While 52.8% had received some psychotherapy training, only 2.8% were qualified psychotherapists. Notably, only 27.6% of those with psychotherapy training had over 100 hours of training. Factors such as receiving psychotherapy training during postgraduate training and having supervised psychotherapy training were found significant for having independent psychotherapy training. There is little emphasis on psychotherapy training in the postgraduate training in Nigeria. Those who had full training in psychotherapy were self-sponsored. Structured, supervised and mandatory psychotherapy within psychiatry training curriculum is recommended.

Machine learning algorithm-based estimation model for the severity of depression assessed using Montgomery-Asberg depression rating scale.

Depressive disorder is often evaluated using established rating scales. However, consistent data collection with these scales requires trained professionals. In the present study, the "rater & estimation-system" reliability was assessed between consensus evaluation by trained psychiatrists and the estimation by 2 models of the AI-MADRS (Montgomery-Asberg Depression Rating Scale) estimation system, a machine learning algorithm-based model developed to assess the severity of depression. During interviews with trained psychiatrists and the AI-MADRS estimation system, patients responded orally to machine-generated voice prompts from the AI-MADRS structured interview questions. The severity scores estimated from two models of the AI-MADRS estimation system, the max estimation model and the average estimation model, were compared with those by trained psychiatrists. A total of 51 evaluation interviews conducted on 30 patients were analyzed. Pearson's correlation coefficient with the scores evaluated by trained psychiatrists was 0.76 (95% confidence interval 0.62-0.86) for the max estimation model, and 0.86 (0.76-0.92) for the average estimation model. The ANOVA ICC rater & estimation-system reliability with the evaluation scores by trained psychiatrists was 0.51 (-0.09 to 0.79) for the max estimation model, and 0.75 (0.55-0.86) for the average estimation model. The average estimation model of AI-MADRS demonstrated substantially acceptable rater & estimation-system reliability with trained psychiatrists. Accumulating a broader training dataset and the refinement of AI-MADRS interviews are expected to improve the performance of AI-MADRS. Our findings suggest that AI technologies can significantly modernize and potentially revolutionize the realm of depression assessments.

The impact of Patient Suicide on Psychiatric Trainees and Early Career Psychiatrists: a qualitative analysis of feelings and unmet needs from an Italian survey

The experience of patient suicide (PS) represents a challenging event that most psychiatrists may deal with during their careers. We conducted a qualitative study to evaluate the emotional impact and reactions to PS, in a small sample of psychiatric trainees and early career psychiatrists (n=15) in one university hospital in Italy. Psychiatric trainees and early career psychiatrists working at the Clinical Psychiatry Unit of Polytechnic University of Marche (Ancona, Italy) were surveyed to assess emotional impact of PS, influence on future work, perceived support, and how the PS experience should be managed. An online survey was conducted, and a qualitative approach (thematic analysis) was used to analyse the data. Fifteen professionals completed the survey. Sadness (47%) and shock (33%) were the most reported emotions, along with feelings of guilt, impotence and inadequacy, disappointment, frustration, and anger. PS seemed to have a strong influence on clinical activity, increasing attention towards the patient and commitment, although the impression of being of limited help to the patient was commonly reported. Albeit valuing the opportunity to share their emotional experience with peers, the respondents highlighted the lack of professional support and the relevant need to implement discussion and interventions to deal with PS. Overall, our findings support the importance of addressing the strong emotional effect of PS on psychiatric trainees and early career psychiatrists as well as the necessity for more structured support strategies in the aftermath of PS. Larger investigations on this topic are warranted.

Psychiatric trainees as second victims after exposure to patient suicide: a French qualitative study.

The exposure to patient suicide (PS) has been identified as one of the most frequent and troubling professional experience for psychiatric trainees. Further studies are needed to better understand how residents cope with these experiences and the association between perceived support and the impacts of PS. In this qualitative study, we aimed to assess the impact of exposure to PS during psychiatric residency on trainees' professional career and practical experience. A total of 19 French psychiatric residents participated in 4 focus-groups performed between November 2017 and May 2019. A total of 4 thematic clusters were identified through a five-step content analysis, namely: (a) reactions to the exposure; (b) coping strategies; (c) professional impact; and (d) prevention and postvention proposals. All participants described the critical impact of the support provided after PS, especially by their senior staff. Those who felt supported by their superior reported less negative impact, both in emotional and professional dimensions. Participants also shared proposals to improve the prevention and postvention issues related to the exposure to PS. We performed the first qualitative study based on focus groups on the impact of PS on psychiatric residents, which allowed for an in-depth understanding of the participants' lived experiences of the exposure to PS. The narratives inform the need and means to implement prevention and postvention strategies designed to buffer the negative impact of the exposure to PS in psychiatric trainees.

Not niche: eating disorders as an example in the dangers of overspecialisation.

Labelling specific psychiatric concerns as 'niche' topics relegated to specialty journals obstructs high-quality research and clinical care for these issues. Despite their severity, eating disorders are under-represented in high-impact journals, underfunded, and under-addressed in psychiatric training. We provide recommendations to stimulate broad knowledge dissemination for under-acknowledged, yet severe, psychiatric disorders.

Psychotherapy training in Brazil: Experiences of psychiatric trainees and early career psychiatrists.

Understanding and skills in psychotherapy are fundamental aspects of clinical psychiatry practice. Learning about psychotherapy during the training of psychiatrists offers solid opportunities for developing high standards of psychiatric practice and providing better outcomes for patients. However, little is known about the extent that psychotherapy training is available to psychiatrists in America. This study aimed to analyze the status of psychotherapy training in Brazil through the experiences of early-career psychiatrists. This is a cross-sectional survey conducted between July and November 2021. A 16-item questionnaire was used to investigate: the quality of psychotherapy training; the organizational aspects of psychotherapy training; and satisfaction with training in psychotherapy. The majority of participants reported having mandatory training in psychotherapy, mainly in cognitive-behavioral therapy and psychodynamic therapy. However, only had some practical experience with psychotherapy training. This study highlights the frequent use of psychotherapy training among Brazilian early career psychiatrists. The consensus on the necessity of mandatory psychotherapy training underscores its importance in shaping psychiatric practice. While participants express satisfaction with psychotherapy supervision, the financial burden for advanced training raises concerns. These findings advocate for the improvement of the quality of psychotherapy training in Brazil.

Impulsivity and attention deficit-hyperactivity symptoms among patients with relapsing-remitting multiple sclerosis: a case-control study

ABSTRACT Background and objectives Multiple sclerosis(MS) is a progressive, autoimmune, neurodegenerative disease.Studies have suggested that autoimmune diseases play a role in the pathogenesis of Attention deficit and hyperactivity disorder(ADHD).We aim to evaluate ADHD symptoms among patients with RRMS(pwRRMS). Methods The study included 48 RRMS patients and 54 healthy controls. ADHD symptoms were assessed by self-report questionnaires and performance tests.Beck Depression Inventory (BDI), Turgay’s Turkish version of Adult-ADD/ADHD (A-ADHD), Barratt Impulsivity Scale (BIS-11), and World Health Organization Quality of Life-Short Form (WHOQoL-Bref) were completed by the participants.Stroop Colour and Word Interference Test – TBAG Form (SCWT); was used for assessing cognitive function by a trained psychiatrist. Fatigue Severity Scale (FSS) and Expanded Disability Status Scale (EDSS) were used to evaluate by pwRRMS. Results PwRRMS had significantly higher attention-deficit scores and poor performance in all SCWT subtests.All SCWT scores were positively correlated with MS duration.A-ADHD-Total scores were negatively correlated with the age of MS diagnosis.A moderate positive correlation was found between falls and A-ADHD-total scores, and psychomotor speed.A moderate negative correlation was found between WHOQoL-Bref scores and BID, FSS, ADHD-Attention Deficit, SCWT-3, SCWT-5, and SCWT-interference.In multivariate linear regression analyzes, attention-deficit predicted EDSS positively, while depressive symptoms, attention-deficit, and psychomotor speed time were negative predictors of physical health quality. Conclusions In pwRRMS, cognitive dysfunctions such as response inhibition and intervention control, which are symptoms of attention deficit and impulsivity, have been shown to reduce the overall QoL. Among the strategies to reduce the impact of RRMS disease on patients’ lives, it is essential to implement programs to prevent depression and increase cognitive reserve.

Impact of Psychiatric Internship on Medical Graduates: Quasi Experimental Study

Background: Physical health is incomplete without mental health; despite this fact Psychiatric teaching and training of medical health professionals is an undermined area especially in developing countries like Pakistan. This study is aimed to determine the impact of knowledge, attitude and perception towards Psychiatry and also possible change in the career choice of medical graduates (house job interns) of public sector hospital of Karachi after doing internship in Psychiatry Methods: This Quasi experimental study was conducted in 40 medical graduates house job interns who were doing 12 weeks internship in Psychiatry department of Dow Medical College & Dr Ruth K.M.Pfau Civil Hospital Karachi from April 2020 to March 2021 on quarterly basis. A Self synthesized pretested questionnaire was employed twice at pre internship and post internship levels and two semi structured questions were also administered to qualitatively compare their responses. SPSS-19 was applied to
 statistically analyze the result and paired sample t-test was used to compare both pre and post internship scores Results: There was found statistically significant impact of psychiatric internship on medical graduates (preinternship; M=52.2, SD=10.8 and post internship M=60.6, SD=8.3); t(39)=-4.6,p=

Mental Health Provider Training to Improve LGBTQ Competence and Reduce Implicit and Explicit Bias: A Randomized Controlled Trial of Online and In-Person Delivery.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals in most countries face strong stigma and often rely on affirmative mental health care to foster coping and resilience. We tested an LGBTQ-affirmative mental health training for psychologists and psychiatrists by comparing in-person versus online modalities and the added benefit of supervision. Participants were randomized to a two-day training either in-person (n = 58) or via live-stream online broadcast (n = 55). Outcomes were assessed at baseline and 5, 10, and 15 months posttraining. Optional monthly online supervision was offered (n = 47) from months 5 to 15. Given the substantial need for LGBTQ-affirmative expertise in high-stigma contexts, the training took place in Romania, a Central-Eastern European country with some of the highest LGBTQ stigma in Europe. Participants (M age = 35.1) were mostly cisgender female (88%) and heterosexual (85%). Trainees, regardless of whether in-person or online, reported significant decreases from baseline to 15-month follow-up in implicit and explicit bias and significant increases in LGBTQ-affirmative clinical skills, beliefs, and behaviors. LGBTQ-affirmative practice intentions and number of LGBTQ clients did not change. Participants who attended at least one supervision session demonstrated greater reductions in explicit bias and increases in LGBTQ-affirmative behaviors from baseline to 15-month follow-up than participants who did not attend supervision. LGBTQ-affirmative mental health training can efficiently and sustainably improve LGBTQ competence and reduce provider bias in high-stigma contexts. Future research can identify additional ways to encourage mental health providers' outreach to LGBTQ clients in need of affirmative care.

The role of Neuroimaging in Patient Selection and Safety Monitoring during Lecanemab Treatment

AbstractBackgroundLecanemab (Leqembi) is a monoclonal antibody therapy approved in the United States for the treatment of Alzheimer’s disease (AD). Administration of lecanemab in community settings will be guided by the appropriate use recommendations (AURs) that are soon to be published.MethodThe lecanemab AUR’s use clinical trial data as well as evidence from research and clinical practice regarding AD to inform clinicians how to administer lecanemab with optimal safety and opportunity for efficacy. Neuroimaging will play a significant role in selecting the appropriate patients for administration of lecanemab as well as in safety monitoring for adverse events such as amyloid related imaging abnormalities (ARIA). In this presentation we will review the selection and monitoring guidelines for lecanemab as detailed in the AURs.ResultMost ARIA are asymptomatic, but a few cases are serious or fatal. While micro‐ and macrohemorrhages are rare, they can occur in patients receiving lecanemab. Patients who are apolipoprotein E4 (APOE4) gene carriers, and especially those that are APOE4 homozygotes, are at higher risk for ARIA than APOE4 non‐carriers. The AURs recommends genotyping to better inform risk discussions with patients who are candidates for lecanemab therapy. The AURs recommends a screening MRI and periodic along with symptom‐triggered MRI surveillance to detect asymptomatic and symptomatic ARIA and address it appropriately.ConclusionClinician and institutional preparedness are mandatory for the use of lecanemab. This includes training of neurologists, geriatric psychiatrists, radiologists, primary care, emergency room and intensive care physicians, and stroke neurologists in safety monitoring and treatment of symptomatic ARIA.

Screening for Emotional Problems in Pediatric Hospital Outpatient Clinics: Psychometric Traits of the Pediatric Symptom Checklist (Hebrew Version).

This study assessed feasibility and psychometric properties of the Hebrew parent version of the Pediatric Symptom Checklist (PSC-17), aiming to improve treatment access for children and adolescents with behavioral and mental needs through early screening. The PSC-17 and the Strengths and Difficulties Questionnaire (SDQ) were filled in the waiting room, at three ambulatory clinics in a tertiary pediatric center, by 274 parents using a tablet or their cellphone. Demographic and clinical data were retrieved from patients' files. PSC results were compared to SDQ results and assessed vis-a-vis a psychiatric diagnosis, determined previously and independently by trained pediatric psychiatrists for 78 pediatric patients who attended these clinics. Construct and discriminant validity of the PSC-17 Hebrew version were good. Sensitivity, specificity, and positive and negative predictive values are presented. The PSC-17 (Hebrew version) was found to be a feasible tool for mental health screening at pediatric ambulatory care clinics.

The Influence and Enlightenment of Neuroimaging Science on Psychiatric Teaching

Psychiatry belongs to the category of cognitive neuroscience, with its development being greatly influenced by neuroscience. Currently, undergraduate teaching in psychiatry still adopts the teacher-centered indoctrination model, leading to ineffective integration of neuroimaging science into the teaching process. In order to improve the quality of psychiatric talent training, the talent training model needs to be adjusted. This article analyzes the current situation of psychiatric teaching, outlines neuroimaging science, summarizes the impact of neuroimaging science on psychiatric teaching, and analyzes the strategies for applying neuroimaging science in psychiatric teaching, with the hope to provide a guideline for relevant teachers.

A psychiatric trainee perspective on community-based mental health interventions in Portugal

Psychiatric and substance use disorders contribute significantly to the burden of years lived with disability in Portugal. Various cultural, social, and geographical factors seem to contribute to this disease burden, including rural-to-urban migration, social isolation, alcohol use, and psychiatric care stigma. For this reason, mental health policies under the National Mental Health Program have been implemented, particularly in developing community mental health teams (CMHTs) at the national level. As psychiatry trainees, this time of change in the organisation of services is also a learning opportunity, so this article aims to reflect on some of the national problems that seem to contribute to the state of national mental health and how current policies might be the appropriate response.

Undergraduate Training in Psychiatry: Observational Perspective of Medical Officers Working at Primary Health-care Settings

Abstract Background: Primary care physicians are not adequately trained to tackle mental health problems. The study aimed to evaluate undergraduate training in Psychiatry: An observational perspective of medical officers. Materials and Methods: It was a cross-sectional study conducted in North India. Participants were assessed on a self-designed questionnaire developed by the Indian psychiatric society to assess various aspects of undergraduate training. Other questionnaires measured residents’ satisfaction with the quality of training programs and perceived need for psychiatric training in undergraduate courses. Results: The participant’s mean age was 32.4 years; majorities were male medical officers. About one-tenth reported that there were no separate psychiatry departments and designated psychiatry consultants in their college. Approximately 50% reported: No regular supervision by any psychiatric faculty or having psychiatric disorders discussions in clinical rounds. More than half (50.9%) were not confident enough to identify common signs and symptoms of psychiatric problems. From one-third to half of the participants were unsatisfied with various aspects of the training program, like teaching skills, diagnostic interviews, clinical posting, etc. Majority (77.3%–83.7%) agreed that there is a need to improve the psychiatry training program; during the clinic rounds, psychiatric diagnosis should be discussed, and psychiatry should be a separate subject in under-graduation. Conclusion: Primary health-care physicians were unsatisfied with an undergraduate psychiatry training program. Hence, psychiatry should be an independent subject during the undergraduate training program, with dedicated theoretical and clinical hours for psychiatry training and a separate paper for evaluation.

Australian Psychiatrists and Trainee Psychiatrists’ Perceptions of Chemical Restraint of Adults with Intellectual Disability

ABSTRACT Background Psychiatrists prescribe the psychotropic medication that is usedto manage behaviors of concern (BOC) in people with intellectual disability(ID) (i.e., chemical restraint), and their attitudes and perceptions towardsthis treatment are important topics for study. Methods 133 Queenslandpsychiatrists and psychiatry trainees completed a survey on attitudes andperceptions of ID and psychotropic medication. Exploratory cluster analysis wasperformed on 14 Likert items from this survey to detect groupings within thedata. Results Cluster analysis indicated the existence of two distinct clusters.While both groups were willing to be involved in the treatment of adults with ID,Cluster 1 held attitudes that showed inconsistencies with human rights principlesand with international guidelines regarding psychotropic medication use for BOC. Conclusions Our study highlights that the attitudes and perceptions ofa significant subgroup of psychiatrists may contribute to the overprescribingof psychotropics for BOC.

Better adherence to guidelines among psychiatrists providing pharmacological therapy is associated with longer work hours in patients with schizophrenia

Schizophrenia is a psychiatric disorder that is associated with various social dysfunctions, including shorter work hours. To measure the degree to which psychiatrists adhere to guidelines for pharmacological therapy of schizophrenia, we recently developed the individual fitness score (IFS) for adherence among psychiatrists in each patient. However, it remains unclear whether better adherence among psychiatrists is associated with higher patients’ social functional outcomes, such as work hours. In this study, we examined the relationship between adherence to guidelines among psychiatrists and work hours in patients with schizophrenia. To evaluate the association between adherence to guidelines for pharmacological therapy among psychiatrists for treating schizophrenia and work hours, we used the IFS and social activity assessment, respectively, in 286 patients with schizophrenia. The correlation between IFS values and work hours was investigated in the patients. The adherence among psychiatrists to guidelines was significantly and positively correlated with work hours in patients with schizophrenia (rho = 0.18, p = 2.15 × 10−3). When we divided the patients into treatment-resistant schizophrenia (TRS) and nontreatment-resistant schizophrenia (non-TRS) groups, most patients with TRS (n = 40) had shorter work hours (0–15 h/week). Even after excluding patients with TRS, the positive correlation between adherence to guidelines among psychiatrists and work hours in patients with non-TRS (n = 246) was still significant (rho = 0.19, p = 3.32 × 10−3). We found that work hours were longer in patients who received the guideline-recommended pharmacotherapy. Our findings suggest that widespread education and training for psychiatrists may be necessary to improve functional outcomes in patients with schizophrenia.

Mental illness through the perspective of undergraduate medical students in Greece: a cross-sectional study at Aristotle University of Thessaloniki.

Numerous studies reveal that mental health-related stigma, stereotypes, and prejudices negatively affect the patients, jeopardizing their health, prognosis, and social opportunities. Healthcare professionals, who are in the first line of combating mental disease, are expected to play a significant role in drastically changing discriminatory and stigmatizing attitudes toward psychiatric patients and in diminishing the existing healthcare and social disparities. In this study, we aimed to explore and highlight the views of Greek medical students-that is of the future physicians-toward mental illness and people suffering from it. It is a cross-sectional, observational study, in which 324 undergraduate students from the most populous Greek medical school of the Aristotle University of Thessaloniki, participated online, during the spring semester of 2022. The tools used were the Opinions about Mental Illness Scale (OMI) that assesses one's viewpoints about mental illness, the Social Distance Scale (SDS) that captures the desired degree of social distancing from patients with mental disorders, and the Level of Contact Report (LCR-12) that estimates the level of familiarity with them. Participants displayed rather positive attitudes regarding the etiology of mental illness, social integration, and discrimination toward psychiatric patients [as evaluated with the respective OMI subscales; Etiology mean score (μ):8.87 ± 4.68, Social Integration (μ):17.79 ± 5.42, Social Discrimination (μ):13.54 ± 11.17], and more clearly favorable opinions concerning the need for social provision or the enactment of restrictive measures [as expressed with the relative OMI subscales; Social Care (μ):22.74 ± 4.56, Social Restriction (μ):13.27 ± 8.98], while claiming to be quite familiar with mental disorders and individuals experiencing them (as assessed with LCR; μ: 8.71 ± 2.16), and relatively willing to interact with them (as measured with SDS; μ:8.95 ± 4.23). Degree of familiarity with mental illness was directly proportional to the desire for contact with patients living with it, while the higher both were, the more improved most of the aforementioned OMI sectors were found to be. Female sex, clinical medical education, previous clinical psychiatric training, and living with or being a person with a mental disorder were the factors that defined a statistically refined profile in many of the aspects above. Our findings are in accordance with many prior and recent studies, while showing improved opinions compared to those of previous research in Greek student and healthcare population. They are calling for vigilance, rather than complacency, as well as educational and social interventions, in order to enable current and future healthcare professionals to perform their function to its fullest extent. Implications of our results and further research suggestions are included.