International Review of Psychiatry最新文献

Armed conflict remains a major determinant of global mental ill-health, particularly in low- and middle-income countries. Recent international resolutions have expressed deep concern about the growing but unmet mental health and psychosocial support needs of populations affected by armed conflict and other humanitarian crises, emphasizing the urgency of strengthening prevention, protection, and care through evidence-based and rights-based approaches. Although progress has been made in closing historic gaps-such as the inclusion of mental health indicators in global humanitarian health systems-significant disparities persist between global commitments and the delivery of effective, contextually relevant interventions. Despite increasing policy recognition, mental health services in conflict-affected settings often lack sustainable integration, cultural adaptation, and coordination across humanitarian and health sectors. This paper critically examines contemporary approaches to the treatment of mental health conditions in conflict zones, with a particular focus on conflicts in the Middle East, Sub-Saharan Africa and Eastern Europe. Drawing on recent empirical and policy developments from these regions, it proposes a conflict-sensitive mental health systems framework that bridges humanitarian, clinical and public health perspectives to inform scalable and contextually grounded strategies for improving mental health outcomes among populations affected by armed conflict.

Warfare has repeatedly reshaped psychiatry, compelling societies to confront the psychological, moral, and social consequences of organised violence. This review traces how ideas about war-related mental disorders have evolved from antiquity to today. Conditions once seen as moral weakness or imbalance (such as melancholia, nostalgia, and 'soldier's heart') were reinterpreted over time through medical and social change, leading to modern concepts like post-traumatic stress disorder (PTSD) and moral injury. While clinical attention historically centred on soldiers, modern conflicts demonstrate that civilians-particularly women, children, and displaced populations- bear disproportionate and enduring burdens, with high rates of depression, psychosis, substance misuse, and complex grief. Paradoxical patterns, including wartime declines in suicide linked to social cohesion, highlight the interplay between individual distress and collective purpose. The post-Vietnam recognition of PTSD advanced legitimacy and care but also exported a Western diagnostic lens that can obscure local expressions of suffering and structural determinants. Case studies from late twentieth- and twenty-first-century conflicts (e.g. the Balkans, Iraq-Afghanistan, Ukraine, Gaza) reveal persistent inequities in access to services, the politicisation of psychiatric categories, and the salience of community, faith, and meaning-making for recovery. Across eras, war psychiatry has oscillated between compassion and control, prevention and surveillance. Bridging historical insight with contemporary practice can better address the diverse and enduring psychological legacies of war, while foregrounding resilience and moral repair alongside symptom reduction.

The article employs a strategy of thinking as dialogue that permeates various levels: reflexive thinking (internal dialogue), face-to-face conversation, and email correspondence. Navigating the complex experiential-discursive fabric, the authors move between the spheres of lived experience, memory, contemplation, analysis, and interpretation of what is connected with the habilitation process (becoming professors) in Polish and German academic contexts. Harnessed to the dialogical universe, autoethnographic theory, existential philosophy, and Kafka's literary work serve here as a means to demonstrate the transformative power of shared suffering, pain, and vulnerability. The goal is to launch the process of forming new Academia, based on the idea of humanizing academic practices, taking into account the subjectivity of those who participate in them. On another level, the presented article demonstrates the "power of weakness" by "overcoming Kafka" together, leading towards activity as a form of positive autoethnography that aims at resistance and healing, in both personal and collective dimensions.

Armed conflicts are major global determinants of illness, producing acute and chronic burden across mental health, population wellbeing, and societal stability. Current surveillance highlights high lethality in Myanmar, Sudan, the Palestinian Territories, and the Russia-Ukraine regions, alongside persistent low-intensity violence in Afghanistan, Mexico, and Yemen. Beyond mortality and physical injury, conflicts generate complex psychological, social, and structural sequelae across the life span. Contemporary war psychiatry has expanded from a narrow focus on trauma to an integrated biopsychosocial and socioecological framework. Epidemiological evidence shows substantially elevated rates of depressive, anxiety, post-traumatic, and severe mental disorders in conflict-exposed populations, with increased vulnerability among children, women, older adults, displaced persons, and humanitarian workers. Neurobiological studies document disruptions in stress-regulatory systems and corticolimbic circuits, while psychosocial research highlights cumulative adversity, social fragmentation, and moral injury. Conflicts also undermine the social determinants of health, destabilizing livelihoods, education, communities, and national health systems, thereby widening inequities and deepening the mental health treatment gap. Effective responses require culturally informed, scalable, and contextually grounded interventions, including trauma-focused therapies, community-based psychosocial approaches, and digital platforms, embedded within broader humanitarian, policy, and reconstruction strategies. A coordinated, multidisciplinary approach is essential to mitigate psychiatric morbidity and support long-term societal recovery.

Psychiatry in the UK stands at a cross-roads, and this has significant implications for training. On the one hand the profession may have reached a limit in terms of of what can be achieved in a National Health Service now increasingly modelled on quasi- industrial processes designed to achieve ever greater effciencies. On the other hand, any return to the traditional idea of the stand-alone physician working in isolation in the clinic is untenable as it would obviously be unable to accommodate wider population needs, namely, the rising demand for mental health services, and an increasingly diverse and complex set of patients. In this paper we look to the past as well as the present, in order sketch out the future for training in psychiatry. An assortment of potential new 'horizons' are identified including integrative service models, transdiagnostic approaches, digital technologies, and psychometrics. There will need also to be an increased emphasis on 'system' skills eg advocacy, leadership, team working, network and cross-cultural working. Paradoxically, there is at the same time a strong appetite to reprise of some of the 'old' ways of working and training: greater flexibility and support for learners, the primacy of the therapeutic relationship, the importance of embedding discovery and research within practice, and the strengthening of a professional identity based on both the 'art and science' of psychiatry, as a branch of medicine. Combined with the 'new', the 'old' ways' will require shifts in training too.

Given the rising prevalences of psychologically ascribed crises, we need new forms of care that attach to and extend the processes of deinstitutionalization of the 1970ies in various countries around the globe. This article intends to re-activate trust in these potentials by delineating ways of moving forwards towards a 'citizen psychiatry' support that in part or substantially is organized and or implemented by citizens as well as civil initiatives and institutions, both on a volunteer or paid basis. Possible components for such citizen psychiatry are outlined, drawing on various developments in the psychiatric hospital department in Geesthacht/Germany and the surrounding care sector. After presenting these developments, thereby focusing on the presentation of agile teams, real estate therapy, hybrid forms of support for living and working, these components will be discussed and then placed in an ecological frame of reference that may be perceived as its paradigmatic foundation.

Psychiatry is undergoing a global reconfiguration driven by social, technological, and environmental transformations. This paper examines the future of psychiatry through a comparative analysis of international frameworks and the current Brazilian context. It highlights the need to integrate neuroscience with social and cultural psychiatry, emphasising ethics, diversity, and the participation of people with lived experience as essential components of education and practice. Although national guidelines provide a structured framework for competency-based training, they remain limited in addressing emerging challenges such as inequality, climate change, migration, and the geopolitical determinants of mental health. To translate these advances into real-world impact, implementation science must guide the adaptation of evidence-based interventions to diverse sociocultural contexts. The paper advocates for an expanded biopsychosocial model that explicitly includes dimensions of social justice and public mental health. Brazil's complex sociocultural landscape offers a unique opportunity to align psychiatric education and practice with these global perspectives, bridging knowledge and practice to foster a more equitable, humanistic, and context-responsive psychiatry.

Psychiatry education, encompassing undergraduate and postgraduate training, has evolved markedly over recent decades, shaping how clinicians deliver evidence-based, compassionate, and culturally sensitive care. Despite its importance, psychiatry has historically received less emphasis than other medical specialties, with considerable variability in training worldwide. Traditional approaches, including lectures, bedside teaching, case discussions, and clinical rotations, have provided the foundation of learning. Innovations including interactive online platforms, gamification, simulation, virtual reality, and artificial intelligence can expand opportunities to build clinical skills, empathy, communication, leadership, and interprofessional collaboration. This article reflects on the evolution of psychiatry education, examining established practices, emerging needs, pedagogical innovations, evaluation strategies, and evolving competencies. It highlights the importance of competency-based assessment, structured feedback, and mentorship alongside flexible, locally adapted programmes and equitable global partnerships. Looking to the future, psychiatry education must integrate digital skills, leadership, advocacy, and collaborative practice, to prepare future psychiatrists for the societal, technological, and global health challenges of future decades.

Psychiatrists have advanced peacemaking initiatives by collaborating with diplomats to differentiate between official Track I and unofficial Track II diplomacy. For decades, psychiatrists have researched the psychological factors of Track II diplomacy while largely remaining silent about Track I. This article presents a psychological framework to advance peacebuilding in Track I diplomacy by analyzing scholarship from the psychiatrist, psychoanalyst, and politician Lord John Alderdice. Lord Alderdice played a seminal role in the Irish Peace Process which culminated in the 1998 Good Friday Agreement. We analyze his scholarship through inductive content analysis and triangulate findings against primary sources from that period to classify psychological factors under four domains that are crucial to successful negotiations: social conditions that stimulate an interest in peace, the political and economic incentives of negotiations, the structure of peace negotiations, and the communication process in negotiations. We show how this framework can be applied to other violent political conflicts such as the wars between Israel-Palestine and Russia-Ukraine. We hope that our framework stimulates interest on the psychological factors of peacemaking in Track I diplomacy.

Management of patients with schizophrenia is a useful case study of future trends within wider clinical psychiatry. Recent scientific advances in the understanding of schizophrenia neuropathology, combined with work across pharmacology, psychology and biomarker discovery provide fertile ground for change. Future psychosis researchers and clinicians can transform the schizophrenia care model into one which delivers for patients and allows healthcare professionals to manage increasing workloads. In this article, the author highlights the most significant recent developments in the study of schizophrenia and suggests areas in which early-career psychiatrists can contribute to generational change in psychosis management.