Acta Psychiatrica Scandinavica最新文献

In their remarkable paper, Castellini et al¹ provide us with not so much a survey but a census of psychiatric trainees in Italy with a remarkable response rate of over 80% compared with a more quotidian comparison group of medical trainees at a similar point of their professional development. The comprehensiveness of their approach permits a tentative conclusion about the average mental state of psychiatric residents—it seems young doctors do not generally go into the mental health specialty to address their own psychological needs; trainee psychiatrists are, on average, less neurotic, notwithstanding above-average childhood adversity. The report also adds to the growing literature that trainees who feel supported and mentally well will perform better in the workplace in the long run,² at least in terms of symptoms of burnout.

The study, being cross-sectional and relying solely on self-report data, inherently restricts the extent to which we can confidently infer causality from the observed associations. However, with the authors' indication that future longitudinal data might be provided, it is worthwhile to cautiously consider the implications of the reported correlations. For this purpose, we shall make the generous assumption that these correlations represent authentic associations and are not skewed by factors like recall bias, social desirability bias or the impact of any unmeasured confounding variables. The correlations, albeit tentative, provide a starting point for deeper investigation into the factors contributing to burnout and the potential avenues for intervention, while fully recognising their limitations we can acknowledge the value they add to the ongoing discourse on mental health and resilience in medical training.

Work-related burnout syndrome, characterised by the triad of emotional exhaustion, cynicism and low sense of professional efficacy³ has been associated with stress-related health problems,⁴ broken personal relationships,⁵ inadequate patient care⁶ and reduced learning capacity.⁷ Medical doctors experience higher rates of burnout syndrome than the general population⁵ likely because a critical factor in the development of burnout is the sustained mismatch between job demands and resources available. Training years, more than any other stage in physicians' career, are characterised by this type of imbalance due to long and irregular work hours⁸ and high levels of responsibility combined with lack of professional experience.⁹ Psychiatry itself adds several very specific stressors such as perceived stigma of this profession, demanding therapeutic relationships, personal threats from violent patients and the risk of patient suicide.¹⁰

The repor

Autism is one of most common disabilities, with recent estimates that 1 in 36 children¹ have an autism diagnosis and late diagnoses in adults also increasing. The DSM-5 diagnostic criteria for autism now include sensory sensitivities alongside the long-established criteria of social and communication challenges and repetitive and restrictive behaviours and interests. Most clinicians no longer view autism as something to be cured or treated, instead providing support for the challenges that autistic people experience and treatments or interventions for any co-occurring conditions, while respecting their unique differences and strengths. As the prevalence of autism, who is being diagnosed with autism, and clinical understanding of autism are changing, so are perspectives on what it means to be autistic.

One field aiming to shift scientific perspectives on how we think about autism is evolutionary psychiatry,² a relatively new discipline that now has its own special interest group within the Royal College of Psychiatrists in the UK as well as dedicated textbooks. Like the related field of evolutionary medicine, evolutionary psychiatry sets its focus beyond biomedical causes (e.g., genetic and environmental factors), instead asking the “ultimate” question of why neurodevelopmental and psychiatric conditions have persisted in the human population over time. At first glance, autism presents an evolutionary paradox³: it is a highly heritable condition that affects “reproductive success” yet is relatively prevalent. Evolutionary psychiatry proposes possibilities that move us away from viewing autism as a disorder or disease to one that considers the role of crucial adaptations that have shaped the evolution of the human brain and our complex cognitive abilities. In this article, we consider several evolutionary explanations of autism, the supporting evidence, and how embracing an evolutionary perspective could influence clinical practice in psychiatry.

Most evolutionary theories conceptualise autism as a specialised neurocognitive profile characterised by a trade-off between costs (social cognition) and benefits (non-social cognition). The empathising-systemizing theory⁴ was the first to suggest this, framing autism as enhanced motivation to systemize (the ability to analyse the variables in a system and derive the underlying rules that govern it) paired with challenges in empathising (the ability to imagine another person's thoughts and feelings and respond with an appropriate emotion). The link between autism and occupations that require a high level of systemizing ability⁵—such as science, technology, engineering, and mathematics—provides further support for the theory that autism reflects a brain specialised in rule-based thinking. Similarly, the “diametric model” of autism⁶ highlights e