World Psychiatry 18:3 October 2019 group-level rates of non-response, it is difficult to translate this information into meaningful clinical recommendations for individual patients. An important developing area of research is early detection of risk for non-response. Conventionally, nonresponse studies are conducted after the trial has closed and patients are no longer receiving treatment; i.e. treatment failure is studied retrospectively. We propose that efforts should be focused on detecting non-response or deterioration early on, after the first several sessions. Then, a stepwise treatment approach could be used in order to intervene (e.g., augment specific treatment components or shifting towards a different treatment focus). Data from RCTs are valuable as they provide opportunities to test various treatment components and outcomes over time within distinct controlled treatments. However, as funding for psychotherapy research rapidly declines in the US and around the world, researchers are faced with a significant crisis. Some are shifting towards naturalistic studies through the development of practice research networks. Such networks are based on the premise that research thrives on true continuous communication between stakeholders and collaboration between clinicians in the community and researchers in academia. Studies developed are informed and guided by clinicians’ observations and input, and findings are integrated in clinical settings. These studies also promote greater diversity and representation of individuals from minority groups, who often do not have access to academic medical centers where RCTs are conducted. We anticipate that, in the future, more of our data will emerge from such studies. Overall, future research should include combinations of rigorous method ologies and personalized approaches to psychotherapy. Studies should identify non-responders early on and develop protocols to address risk of non-response or deterioration before the trial ends. These studies should be done in collaboration between clinicians, researchers, policy makers and patients. Outcomes should include not only symptomatic changes but also a range of intermediate outcomes/mechanisms that may go beyond the researcher’s theoretical orientation. Such collaboration can expand our understanding of the complex and nuanced aspects of “therapeutic change” and move us closer towards answering the question: “what makes psychotherapy work?” .
{"title":"Putting the psychotherapy spotlight back on the self-reflecting actors who make it work.","authors":"Jim van Os, David Kamp","doi":"10.1002/wps.20667","DOIUrl":"https://doi.org/10.1002/wps.20667","url":null,"abstract":"World Psychiatry 18:3 October 2019 group-level rates of non-response, it is difficult to translate this information into meaningful clinical recommendations for individual patients. An important developing area of research is early detection of risk for non-response. Conventionally, nonresponse studies are conducted after the trial has closed and patients are no longer receiving treatment; i.e. treatment failure is studied retrospectively. We propose that efforts should be focused on detecting non-response or deterioration early on, after the first several sessions. Then, a stepwise treatment approach could be used in order to intervene (e.g., augment specific treatment components or shifting towards a different treatment focus). Data from RCTs are valuable as they provide opportunities to test various treatment components and outcomes over time within distinct controlled treatments. However, as funding for psychotherapy research rapidly declines in the US and around the world, researchers are faced with a significant crisis. Some are shifting towards naturalistic studies through the development of practice research networks. Such networks are based on the premise that research thrives on true continuous communication between stakeholders and collaboration between clinicians in the community and researchers in academia. Studies developed are informed and guided by clinicians’ observations and input, and findings are integrated in clinical settings. These studies also promote greater diversity and representation of individuals from minority groups, who often do not have access to academic medical centers where RCTs are conducted. We anticipate that, in the future, more of our data will emerge from such studies. Overall, future research should include combinations of rigorous method ologies and personalized approaches to psychotherapy. Studies should identify non-responders early on and develop protocols to address risk of non-response or deterioration before the trial ends. These studies should be done in collaboration between clinicians, researchers, policy makers and patients. Outcomes should include not only symptomatic changes but also a range of intermediate outcomes/mechanisms that may go beyond the researcher’s theoretical orientation. Such collaboration can expand our understanding of the complex and nuanced aspects of “therapeutic change” and move us closer towards answering the question: “what makes psychotherapy work?” .","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"292-293"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fidelity vs. flexibility in the implementation of psychotherapies: time to move on","authors":"P. Fonagy, P. Luyten","doi":"10.1002/wps.20657","DOIUrl":"https://doi.org/10.1002/wps.20657","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49432587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Linardon, P. Cuijpers, P. Carlbring, Mariel Messer, M. Fuller‐Tyszkiewicz
Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
{"title":"The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials","authors":"J. Linardon, P. Cuijpers, P. Carlbring, Mariel Messer, M. Fuller‐Tyszkiewicz","doi":"10.1002/wps.20673","DOIUrl":"https://doi.org/10.1002/wps.20673","url":null,"abstract":"Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47988649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
edge about specific medication effects and greater attention to the possible impact of psychotropic medications on the physical health of people with SMI can aid psychiatrists in selecting appropriate treatment. The same is true for primary care providers. Some primary care professionals hold negative attitudes toward this vulnerable group, or wrongly attribute physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions. It seems that there still is a lack of awareness among these providers that people with SMI face a greater risk of developing physical illnesses, such as heart disease, obesity and diabetes. Primary care providers may also not be knowledgeable about the health risks associated with psychotropic medications and the resulting health monitoring that is indicated for persons with SMI. They therefore should specifically be trained to identify and treat physical health problems in people with SMI. It is clear that deficiencies in the care of those with SMI, due to cultural and educational factors and unclear roles and responsibilities of their providers, continue to leave many service users with SMI vulnerable to serious physical health issues, which may limit their recovery. We can change these aspects through educational innovations. Only then we can leave the road of Cheshire cat and will multilevel interventions or strategies, as those proposed by Liu et al, result in improved outcomes for people with SMI.
{"title":"Perspectives from resource poor settings","authors":"P. Sharan","doi":"10.1002/wps.20380","DOIUrl":"https://doi.org/10.1002/wps.20380","url":null,"abstract":"edge about specific medication effects and greater attention to the possible impact of psychotropic medications on the physical health of people with SMI can aid psychiatrists in selecting appropriate treatment. The same is true for primary care providers. Some primary care professionals hold negative attitudes toward this vulnerable group, or wrongly attribute physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions. It seems that there still is a lack of awareness among these providers that people with SMI face a greater risk of developing physical illnesses, such as heart disease, obesity and diabetes. Primary care providers may also not be knowledgeable about the health risks associated with psychotropic medications and the resulting health monitoring that is indicated for persons with SMI. They therefore should specifically be trained to identify and treat physical health problems in people with SMI. It is clear that deficiencies in the care of those with SMI, due to cultural and educational factors and unclear roles and responsibilities of their providers, continue to leave many service users with SMI vulnerable to serious physical health issues, which may limit their recovery. We can change these aspects through educational innovations. Only then we can leave the road of Cheshire cat and will multilevel interventions or strategies, as those proposed by Liu et al, result in improved outcomes for people with SMI.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48629496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The WPA website: newly designed with state-of-the-art features, carrying out the mission of WPA.","authors":"R. Kallivayalil","doi":"10.1002/WPS.20400","DOIUrl":"https://doi.org/10.1002/WPS.20400","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"16 1","pages":"114-114"},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/WPS.20400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51240738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Calkins, T. Moore, T. Satterthwaite, D. Wolf, B. Turetsky, D. Roalf, K. Merikangas, K. Ruparel, C. Kohler, R. Gur, R. Gur
Prospective evaluation of youths with early psychotic‐like experiences can enrich our knowledge of clinical, biobehavioral and environmental risk and protective factors associated with the development of psychotic disorders. We aimed to investigate the predictors of persistence or worsening of psychosis spectrum features among US youth through the first large systematic study to evaluate subclinical symptoms in the community. Based on Time 1 screen of 9,498 youth (age 8‐21) from the Philadelphia Neurodevelopmental Cohort, a subsample of participants was enrolled based on the presence (N=249) or absence (N=254) of baseline psychosis spectrum symptoms, prior participation in neuroimaging, and current neuroimaging eligibility. They were invited to participate in a Time 2 assessment two years on average following Time 1. Participants were administered the Structured Interview for Prodromal Syndromes, conducted blind to initial screen status, along with the Schizotypal Personality Questionnaire and other clinical measures, computerized neurocognitive testing, and neuroimaging. Clinical and demographic predictors of symptom persistence were examined using logistic regression. At Time 2, psychosis spectrum features persisted or worsened in 51.4% of youths. Symptom persistence was predicted by higher severity of subclinical psychosis, lower global functioning, and prior psychiatric medication at baseline. Youths classified as having psychosis spectrum symptoms at baseline but not at follow‐up nonetheless exhibited comparatively higher symptom levels and lower functioning at both baseline and follow‐up than typically developing youths. In addition, psychosis spectrum features emerged in a small number of young people who previously had not reported significant symptoms but who had exhibited early clinical warning signs. Together, our findings indicate that varying courses of psychosis spectrum symptoms are evident early in US youth, supporting the importance of investigating psychosis risk as a dynamic developmental process. Neurocognition, brain structure and function, and genomics may be integrated with clinical data to provide early indices of symptom persistence and worsening in youths at risk for psychosis.
{"title":"Persistence of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort: a prospective two‐year follow‐up","authors":"M. Calkins, T. Moore, T. Satterthwaite, D. Wolf, B. Turetsky, D. Roalf, K. Merikangas, K. Ruparel, C. Kohler, R. Gur, R. Gur","doi":"10.1002/wps.20386","DOIUrl":"https://doi.org/10.1002/wps.20386","url":null,"abstract":"Prospective evaluation of youths with early psychotic‐like experiences can enrich our knowledge of clinical, biobehavioral and environmental risk and protective factors associated with the development of psychotic disorders. We aimed to investigate the predictors of persistence or worsening of psychosis spectrum features among US youth through the first large systematic study to evaluate subclinical symptoms in the community. Based on Time 1 screen of 9,498 youth (age 8‐21) from the Philadelphia Neurodevelopmental Cohort, a subsample of participants was enrolled based on the presence (N=249) or absence (N=254) of baseline psychosis spectrum symptoms, prior participation in neuroimaging, and current neuroimaging eligibility. They were invited to participate in a Time 2 assessment two years on average following Time 1. Participants were administered the Structured Interview for Prodromal Syndromes, conducted blind to initial screen status, along with the Schizotypal Personality Questionnaire and other clinical measures, computerized neurocognitive testing, and neuroimaging. Clinical and demographic predictors of symptom persistence were examined using logistic regression. At Time 2, psychosis spectrum features persisted or worsened in 51.4% of youths. Symptom persistence was predicted by higher severity of subclinical psychosis, lower global functioning, and prior psychiatric medication at baseline. Youths classified as having psychosis spectrum symptoms at baseline but not at follow‐up nonetheless exhibited comparatively higher symptom levels and lower functioning at both baseline and follow‐up than typically developing youths. In addition, psychosis spectrum features emerged in a small number of young people who previously had not reported significant symptoms but who had exhibited early clinical warning signs. Together, our findings indicate that varying courses of psychosis spectrum symptoms are evident early in US youth, supporting the importance of investigating psychosis risk as a dynamic developmental process. Neurocognition, brain structure and function, and genomics may be integrated with clinical data to provide early indices of symptom persistence and worsening in youths at risk for psychosis.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45821570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Lovelace’s 17th century poem To Althea, from Prison alludes to the ability of a “quiet” mind to transcend the imposition implied by institutions which deprive people of their liberty. But our prisons are not full of “minds innocent and quiet”; rather they are overloaded by minds troubled by the experience of mental illness. There is a need to reach into prisons to address mental health needs, but “stone walls” and “iron bars” constitute barriers to this intent. Systems designed to care for and treat mental illness struggle in institutions designed to punish, deter and incapacitate. Yet people are sent to prison as punishment, not for punishment, which requires us to understand how humane treatment can be delivered in such environments. The existence of various international human rights instruments (such as the International Covenant on Civil and Political Rights, and the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment) are necessary, but not sufficient by themselves, to ensure appropriate and humane care for some of the most vulnerable members of our citizenry. Worldwide more than 10 million people are held in penal institutions at any given time and more than 30 million people pass through prisons each year, with some regions experiencing prison growth well above population growth. There is an elevated risk of all-cause mortality, including suicide, for prisoners in custody and for ex-prisoners soon after release. We therefore have a collective interest in ensuring that health related need is identified and effective care is delivered during incarceration and the critical period of transition to community life. Research in this area has yielded increasing clarity about the central issues that need to be addressed to provide a comprehensive model of care for mentally unwell prisoners. First, the prison must screen for mental illness, at reception and at other critical times. At least five such screening instruments have been developed. However, additional triage and casefinding measures are needed to ensure comprehensive case identification. Once need is identified, hospital transfer may be required for the most unwell. Mental health legislation needs to accommodate such transfers. For others, prison-based care is often delivered through mental health in-reach teams, which have become increasingly systematic in creating care and treatment pathways for prisoners with serious mental illness, including contribution to release processes to enable sustained clinical involvement on release. Systems of prison mental health care are not bereft of innovation. Multi-disciplinary teams can address complex mental health and social care needs and include cultural expertise in jurisdictions where indigenous populations or ethnic minorities are over-represented in prisoner populations. Release planning constitutes an opportunity for “critical time intervention”, focusing on ensuring continuity of care across a range
{"title":"Mental health care and treatment in prisons: a new paradigm to support best practice","authors":"B. McKenna, J. Skipworth, K. Pillai","doi":"10.1002/wps.20395","DOIUrl":"https://doi.org/10.1002/wps.20395","url":null,"abstract":"R. Lovelace’s 17th century poem To Althea, from Prison alludes to the ability of a “quiet” mind to transcend the imposition implied by institutions which deprive people of their liberty. But our prisons are not full of “minds innocent and quiet”; rather they are overloaded by minds troubled by the experience of mental illness. There is a need to reach into prisons to address mental health needs, but “stone walls” and “iron bars” constitute barriers to this intent. Systems designed to care for and treat mental illness struggle in institutions designed to punish, deter and incapacitate. Yet people are sent to prison as punishment, not for punishment, which requires us to understand how humane treatment can be delivered in such environments. The existence of various international human rights instruments (such as the International Covenant on Civil and Political Rights, and the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment) are necessary, but not sufficient by themselves, to ensure appropriate and humane care for some of the most vulnerable members of our citizenry. Worldwide more than 10 million people are held in penal institutions at any given time and more than 30 million people pass through prisons each year, with some regions experiencing prison growth well above population growth. There is an elevated risk of all-cause mortality, including suicide, for prisoners in custody and for ex-prisoners soon after release. We therefore have a collective interest in ensuring that health related need is identified and effective care is delivered during incarceration and the critical period of transition to community life. Research in this area has yielded increasing clarity about the central issues that need to be addressed to provide a comprehensive model of care for mentally unwell prisoners. First, the prison must screen for mental illness, at reception and at other critical times. At least five such screening instruments have been developed. However, additional triage and casefinding measures are needed to ensure comprehensive case identification. Once need is identified, hospital transfer may be required for the most unwell. Mental health legislation needs to accommodate such transfers. For others, prison-based care is often delivered through mental health in-reach teams, which have become increasingly systematic in creating care and treatment pathways for prisoners with serious mental illness, including contribution to release processes to enable sustained clinical involvement on release. Systems of prison mental health care are not bereft of innovation. Multi-disciplinary teams can address complex mental health and social care needs and include cultural expertise in jurisdictions where indigenous populations or ethnic minorities are over-represented in prisoner populations. Release planning constitutes an opportunity for “critical time intervention”, focusing on ensuring continuity of care across a range ","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41600274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In two earlier papers on physical diseases in people with severe mental illness (SMI) which appeared in this journal, we indicated that the screening, assessment and management of physical health aspects in these patients were poor, even in developed countries. Although (young and adult) people with SMI are entitled to the same standards of care as the rest of the population, Liu et al report now, half a decade later, that little to no progress has been made. Moreover, it seems that the mortality gap between these people and the general population is only increasing over time. Thus, despite numerous calls to take their physical health seriously, people with SMI still suffer excess morbidity and mortality from physical causes and receive inferior physical health care. It is a fact that the integration of physical and mental health care systems is still a long way from becoming a reality and that poor or absent liaison links limit the ability of most psychiatrists to focus beyond their own specialty. Moreover, in several countries, reforms in mental health, emphasizing on community care and ambulant therapies, have led to shorter and infrequent hospital admissions with less time available to deal with physical health problems. In their paper, Liu et al propose a multilevel model of interventions to reduce the excess mortality in people with SMI. This model assumes that an effective approach must comprehensively implement interventions or strategies that focus on the individual, the health system, and the community. Although we believe that the adoption of this model would contribute to a significant improvement in the physical and related mental health of people with SMI (despite that actions are not easy to realize at a system level, especially for developing countries), there is more than meets the eye. The physical health of people with SMI is an issue that should concern both primary and secondary care services. However, it seems that most psychiatrists and primary care providers or general practitioners are wandering on the road of the Cheshire cat. Like the conversation between Alice and the Cheshire cat in the famous novel Alice’s Adventures in Wonderland, there still seems to be a lot of confusion and uncertainty. Before interventions or strategies can result in improved outcomes for people with SMI, it is important that both know which way they have to go. According to a 2014 report of the UK National Audit of Schizophrenia, the monitoring of people with SMI for physical health problems falls well below agreed standards. Only about one fifth of people with schizophrenia had had their physical health properly monitored – following the clinical guidelines on schizophrenia of the UK National Institute for Health and Care Excellence (NICE) – by their general practitioner and, of those with documented evidence of risk factors, many were not receiving appropriate treatment. Recently, the NICE published a new set of quality standards which specif
{"title":"Reversing the downward spiral for people with severe mental illness through educational innovations","authors":"M. De Hert, J. Detraux","doi":"10.1002/wps.20377","DOIUrl":"https://doi.org/10.1002/wps.20377","url":null,"abstract":"In two earlier papers on physical diseases in people with severe mental illness (SMI) which appeared in this journal, we indicated that the screening, assessment and management of physical health aspects in these patients were poor, even in developed countries. Although (young and adult) people with SMI are entitled to the same standards of care as the rest of the population, Liu et al report now, half a decade later, that little to no progress has been made. Moreover, it seems that the mortality gap between these people and the general population is only increasing over time. Thus, despite numerous calls to take their physical health seriously, people with SMI still suffer excess morbidity and mortality from physical causes and receive inferior physical health care. It is a fact that the integration of physical and mental health care systems is still a long way from becoming a reality and that poor or absent liaison links limit the ability of most psychiatrists to focus beyond their own specialty. Moreover, in several countries, reforms in mental health, emphasizing on community care and ambulant therapies, have led to shorter and infrequent hospital admissions with less time available to deal with physical health problems. In their paper, Liu et al propose a multilevel model of interventions to reduce the excess mortality in people with SMI. This model assumes that an effective approach must comprehensively implement interventions or strategies that focus on the individual, the health system, and the community. Although we believe that the adoption of this model would contribute to a significant improvement in the physical and related mental health of people with SMI (despite that actions are not easy to realize at a system level, especially for developing countries), there is more than meets the eye. The physical health of people with SMI is an issue that should concern both primary and secondary care services. However, it seems that most psychiatrists and primary care providers or general practitioners are wandering on the road of the Cheshire cat. Like the conversation between Alice and the Cheshire cat in the famous novel Alice’s Adventures in Wonderland, there still seems to be a lot of confusion and uncertainty. Before interventions or strategies can result in improved outcomes for people with SMI, it is important that both know which way they have to go. According to a 2014 report of the UK National Audit of Schizophrenia, the monitoring of people with SMI for physical health problems falls well below agreed standards. Only about one fifth of people with schizophrenia had had their physical health properly monitored – following the clinical guidelines on schizophrenia of the UK National Institute for Health and Care Excellence (NICE) – by their general practitioner and, of those with documented evidence of risk factors, many were not receiving appropriate treatment. Recently, the NICE published a new set of quality standards which specif","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"16 1","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51240525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Electronic communication is paramount in today’s world, its importance rising day by day. The WPA website (www.wpanet.org) has now been thoroughly re-designed with state-of-the-art features and with useful, attractive and up-to-date content, utilizing the latest technology. The website currently has a responsive design, which means that the size and dimensions of its pages now get automatically modified so as to make them properly fit the screens of various devices like smart phones and tablets. The website is also integrated with Google Translate, which can automatically translate its content to 103 different languages. The site is also integrated with popular social media sites. The home page prominently displays the latest news from WPA Member Societies, Scientific Sections, Zonal Representatives, and Affiliated Associations. WPA position papers on various issues can be downloaded from the site. Their translations in several languages are also available. Past issues of the WPA Newsletter, from way back in 1997, are available for download. The E-Learning section features more than 30 educational videos of clinically relevant presentations by some of the leaders in psychiatry today. The Public Education Gallery has articles on the most common mental disorders. The Education section features downloadable materials such as the WPA Template for Undergraduate and Graduate Psychiatric Education and the Essentials of the WPA International Guidelines for Diagnostic Assessment. One of the most popular sections of the website is that including World Psychiatry, the WPA official journal. The new impact factor of the journal is 20.205. It ranks now no. 1 among psychiatry journals worldwide! Issues of the journal, from way back in 2002, are provided for free download, along with translations in Spanish, Russian, Japanese, Romanian, French, Polish, Chinese, Turkish and Arabic. Recent additions to the website include the WPA Position Statements on Spirituality and Religion in Psychiatry, on Gender Identity and Same-Sex Orientation, Attraction and Behaviours, on Europe Migrant and Refugee Crisis, and on Intimate Partner Violence and Sexual Violence Against Women; as well as the WPA Curriculum on Intimate Partner Violence and Sexual Violence Against Women, and updates on WPA Scientific Sections and publications. The relevance and attractiveness of the site’s contents are proven by the fact that it now has a Google Page Rank of 6, a measure of how many other important websites have provided links to its pages. The usage data from January 1 to October 24, 2016 reveal that the site has been visited from 199 countries and 7023 cities across the world. The total number of visitors has been 67,947, and the total number of page views has been 263,742. In tune with the changing times, more exposure will be given in the future to the site’s content, for both the professional and lay audiences, in the social media. Provision will be developed for live streaming of variou
{"title":"Update on WPA Operational Committee on Scientific Publications","authors":"M. Riba","doi":"10.1002/wps.20401","DOIUrl":"https://doi.org/10.1002/wps.20401","url":null,"abstract":"Electronic communication is paramount in today’s world, its importance rising day by day. The WPA website (www.wpanet.org) has now been thoroughly re-designed with state-of-the-art features and with useful, attractive and up-to-date content, utilizing the latest technology. The website currently has a responsive design, which means that the size and dimensions of its pages now get automatically modified so as to make them properly fit the screens of various devices like smart phones and tablets. The website is also integrated with Google Translate, which can automatically translate its content to 103 different languages. The site is also integrated with popular social media sites. The home page prominently displays the latest news from WPA Member Societies, Scientific Sections, Zonal Representatives, and Affiliated Associations. WPA position papers on various issues can be downloaded from the site. Their translations in several languages are also available. Past issues of the WPA Newsletter, from way back in 1997, are available for download. The E-Learning section features more than 30 educational videos of clinically relevant presentations by some of the leaders in psychiatry today. The Public Education Gallery has articles on the most common mental disorders. The Education section features downloadable materials such as the WPA Template for Undergraduate and Graduate Psychiatric Education and the Essentials of the WPA International Guidelines for Diagnostic Assessment. One of the most popular sections of the website is that including World Psychiatry, the WPA official journal. The new impact factor of the journal is 20.205. It ranks now no. 1 among psychiatry journals worldwide! Issues of the journal, from way back in 2002, are provided for free download, along with translations in Spanish, Russian, Japanese, Romanian, French, Polish, Chinese, Turkish and Arabic. Recent additions to the website include the WPA Position Statements on Spirituality and Religion in Psychiatry, on Gender Identity and Same-Sex Orientation, Attraction and Behaviours, on Europe Migrant and Refugee Crisis, and on Intimate Partner Violence and Sexual Violence Against Women; as well as the WPA Curriculum on Intimate Partner Violence and Sexual Violence Against Women, and updates on WPA Scientific Sections and publications. The relevance and attractiveness of the site’s contents are proven by the fact that it now has a Google Page Rank of 6, a measure of how many other important websites have provided links to its pages. The usage data from January 1 to October 24, 2016 reveal that the site has been visited from 199 countries and 7023 cities across the world. The total number of visitors has been 67,947, and the total number of page views has been 263,742. In tune with the changing times, more exposure will be given in the future to the site’s content, for both the professional and lay audiences, in the social media. Provision will be developed for live streaming of variou","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47550735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Victimization of persons with severe mental illness: a pressing global health problem","authors":"M. Swartz, Sayanti Bhattacharya","doi":"10.1002/wps.20393","DOIUrl":"https://doi.org/10.1002/wps.20393","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45284118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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