International Review of Psychiatry最新文献

In low- and middle-income countries (LMICs), mental health systems face persistent challenges in access, coverage, and quality, especially for vulnerable groups such as perinatal women. This case study from Pakistan describes an innovative, system-level model for scaling up a psychosocial intervention for perinatal depression - the World Health Organization Thinking Healthy Programme (THP). Originally designed for delivery by Community Health Workers, THP was adapted for delivery by trained lived-experience peers using a social franchise model led by a local non-governmental organization (NGO). The model integrated several innovations: public-private partnerships that leveraged the comparative strengths of government institutions, tertiary mental health services, and community organizations; a stepped-care service delivery framework embedded in primary health care; and digital platforms for intervention-delivery, training, supervision, and quality assurance. Community-based identification through informants and structured screening using PHQ-9 facilitated early detection. Health information generated by the NGO-led franchise was aligned with primary care data standards and partially integrated into the District Health Information System, enhancing accountability and visibility. This case-study illustrates how strategic innovation across multiple health system building blocks can enable the delivery of scalable, community-anchored mental health care in LMICs, offering a replicable model aligned with global goals for Universal Health Coverage and mental health equity.

History of Psychiatry can be of help, not only not to repeat the mistakes of the past, but also to find good heuristic sources in old books. A constant feature of medicine that goes back to the foundation of its scientific roots, thousands of years ago, is the fact that the body cannot be separated from the mind, and the individual cannot be separated from the group. Hence, the bio-psycho-social triangle will stay and be reinforced in the future. Promotion of health and prevention of illnesses are an absolute necessity in the whole of medicine, especially in Psychiatry. A good healthy lifestyle is not only a must for physical health, but also for mental health. If the source of illnesses is not turned off, then, whatever numbers of health (including mental) workers we have available, it will never be enough. Among the 3 main components of mental health, the social and cultural one is of essence and will probably prevail in the future, especially in low- and middle-income countries. Finally, physical exercise is essential for a good mental health and will stay as such. Artificial intelligence will also become a major player in our profession.

Immigrants in Germany experience elevated rates of mental health challenges, often stemming from identity confusion and acculturative stress. Addressing the critical shortage of culturally sensitive mental health services, this study investigates the efficacy of integrating Acceptance and Commitment Therapy (ACT) into an immersive art exhibition as a low-intensity intervention. Ten young adult immigrants residing in Bremen participated in a four-station audiovisual experience designed to physically manifest ACT principles: Creative Hopelessness (process of recognizing controlling experiences leads to suffocation), Acceptance (process of making space for any emotions), Cognitive Defusion (ability to distance thoughts from self), and Values (what matters in life). Reflexive Thematic Analysis of post-intervention interviews revealed that the immersive environment successfully facilitated psychological flexibility. Participants reported a shift from cognitive entanglement to flow of mind, noting that multisensory aesthetics helped externalize difficult thoughts and foster an 'Observer Self' perspective. However, limitations regarding cultural personalization and sensory intensity were identified. The findings suggest that immersive arts can effectively translate abstract therapeutic rationales (i.e. ACT) into tangible experiences and conclude that ACT-integrated immersive art represents a promising alternative to bridge the service gap for minority populations. Nevertheless, future research is required to optimize personalization and quantify efficacy.

South African higher education is characterized by profound cultural and linguistic diversity, shaped by historical inequality and unequal access to educational resources. Within these contexts, intercultural competence is often assumed to develop through exposure alone; however, such exposure may coexist with comfort zones that limit deeper understanding. This manuscript adopts an Intercultural Positive Autoethnography (IcPosAE) to examine the development of intercultural competence across my life course, culminating in a critical incident during my role as a university tutor in a culturally and linguistically diverse South African institution. Drawing on autobiographical memory, reflexive narrative and positive reflexivity, the autoethnography traces my socialization within an Indian-Muslim household, early encounters with diversity, periods of cultural insulation, and the disruption of these assumptions through a tutoring encounter. Rather than framing this moment as an individual failure, the narrative situates the experience within broader dynamics of language, power, privilege, and institutional responsibility in higher education. Through thick description and analytic reflexivity, this manuscript aims to illustrate how discomfort and miscommunication can become sites of positive intercultural transformation.

Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. Care pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.

Major socioeconomic trends - including rapid urbanization, internal and international migration, changes of value systems, digitalization as well as changes of the demographic and family structure - place new tasks before psychiatry as a medical discipline and before mental health care programs as its field of work. To be able to face its new challenges it will be necessary to change the way in which psychiatrists are selected and educated, examine and possibly revise legal provisions concerning the care for the mentally ill and accept to deal with diseases comorbid with mental disorders. Psychiatry will also have to find effective ways of using knowledge about mental illness and mental health in settings such as that of perinatal care, and other frameworks of preventive and other public health intervenitions.

Egypt's mental-health landscape represents a unique continuum in which ancient cultural heritage, community-based healing traditions, and contextually adapted psychiatric strategies intersect with modern psychiatric innovations. This review explores how deeply rooted explanatory models continue to define help-seeking pathways and patient expectations. These cultural foundations exist alongside contemporary systemic challenges. In response, Egypt has pioneered contextually grounded adaptive approaches, such as task shifting, integrating mental health into primary care, and developing culturally-adapted psychosocial interventions led by trained non-specialists.

The COVID-19 pandemic accelerated this trajectory of modernization. Telepsychiatry services, nationwide psychosocial support hotlines, AI-driven tools, and the establishment of Egypt's dedicated psychiatric COVID-19 hospital highlight the country's capacity for rapid, context-sensitive adaptation to innovate while remaining anchored in its cultural fabric. Together, these developments illustrate how mental health systems can evolve by embracing tradition as a resource rather than a barrier, and by leveraging technology to expand equity, accessibility, and cultural relevance. This review positions Egypt as a powerful case study of how cultural heritage and adaptive, problem-driven strategies can be innovatively harmonized to shape the future of mental health care in the region, where originality lies in contextual responses rather than technological novelty.

Climate change is increasingly recognized as a major driver of global instability, understood here as the interconnected disruption of social, economic, political, and security systems, acting as a threat multiplier that intensifies existing vulnerabilities. Its mental health impacts emerge through direct exposures-such as extreme heat, wildfires, floods, and other disasters-and through indirect pathways, including livelihood disruption, resource insecurity, displacement, and social fragmentation. These pressures contribute to heightened risks of post-traumatic stress disorder, depression, anxiety, suicidality, cognitive distress, and substance use, particularly in conflict-affected settings. This narrative review synthesizes evidence on how climate change amplifies conflict dynamics and inequities, and how these mechanisms shape mental health outcomes. A focused search was conducted in Web of Science, PubMed/MEDLINE, and Scopus for peer-reviewed literature published from 2015 onward, and findings were examined using an inductive thematic approach. Results show that vulnerable groups-including children, adolescents, women, Indigenous peoples, migrants, individuals with low socioeconomic status, and those with preexisting mental disorders-face disproportionately high risks. Significant gaps persist in longitudinal research, standardized exposure assessment, intervention evaluation, and policy integration. Addressing the mental health consequences of climate change requires coordinated action across clinical care, community resilience efforts, and public policy, with mental health firmly embedded in climate adaptation and disaster preparedness strategies.

First published in 2016, this paper revisits a dialogical autoethnography (DAE) about being the sister of a woman with disabilities, by re-reading the same materials through a positive autoethnography (PosAE) lens. Methodologically, it shows how re-reading a prior DAE through PosAE enables interpretive moves that broaden the interpretive horizon. The original study examined how I understood my sister's interdependent subjectivity and oscillated between family-based and societal value systems. These central insights continue to be meaningful. However, the re-reading brought additional dimensions into view. Scenes of everyday coexistence, relational warmth, and small moments of shared humour became clearer. My sister's interdependent way of living appeared not only as a theoretical counterpoint to independence but also as an affirmative mode of being grounded in connection. Previously treated mainly as signs of tension, tears and bodily reactions emerged as generative signals that opened the space for alternative interpretations. This re-reading also shifted my relationship with my past self as a researcher: rather than correcting an 'incomplete' analysis, I regarded the earlier text as a necessary layer that made later insights possible. Overall, the paper illustrates how PosAE can extend DAE by illuminating resilience, relational vitality, and multiple coexisting meanings within lived experience.