Sarah El Halabi, Zargham Abbas, Fisayo Adesokun, Frances Adiukwu, Agaah Ashrafi, Renato de Filippis, Jibril Handuleh, Florence Jaguga, Ruta Karaliuniene, Ozge Kilic, Sachin Nagendrappa, Margaret Ojeahere, Oluseun Peter Ogunnubi, Dorottya Őri, Laura Orsolini, Victor Pereira-Sanchez, Mariana Pinto da Costa, Ramdas Ransing, Sheikh Shoib, Irfan Ullah, Ramya Vadivel, Bita Vahdani, Rodrigo Ramalho
There is an increasing movement toward international collaboration and global discussion in mental health. If provided with the right opportunities, early career psychiatrists (ECPs) and researchers in mental health can contribute meaningfully to this discussion. However, they often experience multiple barriers when attempting to add their voices via academic publications. We represent a diverse group of ECPs and researchers from all six World Health Organization regions. In this piece, we discuss these barriers, grounded in our first-hand experiences, and put forth a series of recommendations. The most potentially beneficial and immediate way forward is ensuring a much-needed mentorship and support, particularly for low- and middle-income countries. In this regard, international organizations, especially those with a particular focus on education, such as the Section on Education in Psychiatry of the World Psychiatric Association, can play a pivotal role.
{"title":"How to overcome barriers to publication in low- and middle-income countries: Recommendations from early career psychiatrists and researchers from around the world","authors":"Sarah El Halabi, Zargham Abbas, Fisayo Adesokun, Frances Adiukwu, Agaah Ashrafi, Renato de Filippis, Jibril Handuleh, Florence Jaguga, Ruta Karaliuniene, Ozge Kilic, Sachin Nagendrappa, Margaret Ojeahere, Oluseun Peter Ogunnubi, Dorottya Őri, Laura Orsolini, Victor Pereira-Sanchez, Mariana Pinto da Costa, Ramdas Ransing, Sheikh Shoib, Irfan Ullah, Ramya Vadivel, Bita Vahdani, Rodrigo Ramalho","doi":"10.1111/appy.12495","DOIUrl":"10.1111/appy.12495","url":null,"abstract":"<p>There is an increasing movement toward international collaboration and global discussion in mental health. If provided with the right opportunities, early career psychiatrists (ECPs) and researchers in mental health can contribute meaningfully to this discussion. However, they often experience multiple barriers when attempting to add their voices via academic publications. We represent a diverse group of ECPs and researchers from all six World Health Organization regions. In this piece, we discuss these barriers, grounded in our first-hand experiences, and put forth a series of recommendations. The most potentially beneficial and immediate way forward is ensuring a much-needed mentorship and support, particularly for low- and middle-income countries. In this regard, international organizations, especially those with a particular focus on education, such as the Section on Education in Psychiatry of the World Psychiatric Association, can play a pivotal role.</p>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"13 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39788122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Romania has been a member of the European Union since 2007. According to the World Health Organization, the national burden of mental disorders is high, with 2743.69 disability-adjusted life years per 100.000 population. Moreover, in a country of 19 million people, Romania's mental health system is currently functioning at capacity, with 5.66 adult psychiatrists/100.000 population and only 0.56 child and adolescent psychiatry (CAP) doctors per 100.000 population.
Method
we conducted a simple narrative review of the current literature on the topic of training of psychiatry trainees in Romania.
Results
Undergraduate training consists of only 4 weeks of clinical and theoretical work for adult and CAP. Psychiatry postgraduate training lasts 5 years and is still duration-oriented. Psychiatric trainees mostly spend their clinical work in inpatient units due to the scarcity of other services or the lack of integration of training programs in the existing psychiatric services. Theoretical training is not nationally formalized, and, during training, yearly assessments tend to be neglected. An ongoing challenge in Romania has been retaining young career psychiatrists.
Conclusion
Although in a trend toward improvement of health services, "brain drain" has been and continues to be a massive phenomenon among Romanian psychiatrists, mainly driven to Western-European countries due to financial reasons, various shortcomings in overall infrastructure, and because of the lack of continuous professional and personal development opportunities. As the world is currently facing an unprecedented mental health crisis, steps must be taken to improve psychiatric training, retain psychiatrists in Romania, and provide better national mental health services.
{"title":"Training and retaining mental health professionals: The Romanian experience in the European Union","authors":"Ana Giurgiuca MD, PhD, Catalina Giurgi-Oncu MD, PhD, Valentin Petre Matei MD, PhD","doi":"10.1111/appy.12498","DOIUrl":"10.1111/appy.12498","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Romania has been a member of the European Union since 2007. According to the World Health Organization, the national burden of mental disorders is high, with 2743.69 disability-adjusted life years per 100.000 population. Moreover, in a country of 19 million people, Romania's mental health system is currently functioning at capacity, with 5.66 adult psychiatrists/100.000 population and only 0.56 child and adolescent psychiatry (CAP) doctors per 100.000 population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>we conducted a simple narrative review of the current literature on the topic of training of psychiatry trainees in Romania.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Undergraduate training consists of only 4 weeks of clinical and theoretical work for adult and CAP. Psychiatry postgraduate training lasts 5 years and is still duration-oriented. Psychiatric trainees mostly spend their clinical work in inpatient units due to the scarcity of other services or the lack of integration of training programs in the existing psychiatric services. Theoretical training is not nationally formalized, and, during training, yearly assessments tend to be neglected. An ongoing challenge in Romania has been retaining young career psychiatrists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although in a trend toward improvement of health services, \"brain drain\" has been and continues to be a massive phenomenon among Romanian psychiatrists, mainly driven to Western-European countries due to financial reasons, various shortcomings in overall infrastructure, and because of the lack of continuous professional and personal development opportunities. As the world is currently facing an unprecedented mental health crisis, steps must be taken to improve psychiatric training, retain psychiatrists in Romania, and provide better national mental health services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"13 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39788123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the start of COVID-19 pandemic in March 2020, training of psychiatry and mental health has been impacted considerably. We illustrated the change of academic and clinical psychiatric residency training procedure at Chulalongkorn University in Bangkok, Thailand, a developing country situated in South East Asia which is categorized in the low and middle income category of countries. The training setting has set up a task force responsible to set various strategies in response to the COVID-19 measure of social and physical distancing to maintain standard of care for psychiatric patients and educational experience for psychiatric residents. The strategies include online education, service team separation, and avoidance of contact between teams, reduction of non-urgent clinical activities, and the use of telemedicine for psychiatric patients. Despite exposure to the difficulties of training during the pandemic, all senior residents were qualified and licensed at the national examination. Residents reported that pandemic did affect the academic activities and services and also the quality of living and satisfaction. Academic issues, including the inconvenience of studying online, were the most concerned problems among psychiatric residents at the time of pandemic.
{"title":"Training of psychiatry and mental health in a low- and middle-income country: Experience from Thailand before and after COVID-19 outbreak","authors":"Rasmon Kalayasiri MD, Sorawit Wainipitapong MD","doi":"10.1111/appy.12493","DOIUrl":"10.1111/appy.12493","url":null,"abstract":"<p>Since the start of COVID-19 pandemic in March 2020, training of psychiatry and mental health has been impacted considerably. We illustrated the change of academic and clinical psychiatric residency training procedure at Chulalongkorn University in Bangkok, Thailand, a developing country situated in South East Asia which is categorized in the low and middle income category of countries. The training setting has set up a task force responsible to set various strategies in response to the COVID-19 measure of social and physical distancing to maintain standard of care for psychiatric patients and educational experience for psychiatric residents. The strategies include online education, service team separation, and avoidance of contact between teams, reduction of non-urgent clinical activities, and the use of telemedicine for psychiatric patients. Despite exposure to the difficulties of training during the pandemic, all senior residents were qualified and licensed at the national examination. Residents reported that pandemic did affect the academic activities and services and also the quality of living and satisfaction. Academic issues, including the inconvenience of studying online, were the most concerned problems among psychiatric residents at the time of pandemic.</p>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"13 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8720059/pdf/nihms-1744597.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39952436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martine Stecher Nielsen, Carolyn E. Clausen, Tomoya Hirota, Hojka Kumperscak, Anthony Guerrero, Hitoshi Kaneko, Norbert Skokauskas
Introduction
Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies.
Methods
This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data.
Results
This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals.
Discussion
There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy.
{"title":"A comparison of child and adolescent psychiatry in the Far East, the Middle East, and Southeast Europe","authors":"Martine Stecher Nielsen, Carolyn E. Clausen, Tomoya Hirota, Hojka Kumperscak, Anthony Guerrero, Hitoshi Kaneko, Norbert Skokauskas","doi":"10.1111/appy.12490","DOIUrl":"10.1111/appy.12490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/appy.12490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39527431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shuang Zhao BM, Longfei Ren MS, Qiong Wang MS, Meijun Long BA, Hui Wu PhD, Yang Wang PhD
Introduction
Parents who have lost their only child and over the age of 60 are known as elderly shidu parents. This study aimed to investigate predictors of prolonged grief disorder (PGD) among Chinese elderly shidu parents.
Methods
Two hundred and ninety-eight elderly shidu parents from Shenyang were included in this cross-sectional study. Participants completed a questionnaire including the Prolonged Grief questionnaire-13 (PG-13), the PTSD (post-traumatic stress disorder) Checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies Depression Scales (CES-D), the Self-Rating Anxiety Scale (SAS), and the Perceived Stress Scale-10 (PSS-10). Multiple linear regression was used to examine socio-demographic, bereavement-related and perceived stress associated with PGD symptoms.
Results
The prevalence of PGD among Chinese elderly shidu parents was 13.8%. Among the 41 PGD patients, 29, 39, 36 patients had comorbidity of PTSD, depressive symptoms and anxiety, respectively. Perceived stress, higher educational level, lower annual household income, perceived stigma, violent death of the child, and being in debt were associated with severer PGD symptoms.
Discussion
The present study revealed the prevalence of PGD and the important role of PGD in diagnosing other mental disorders in Chinese elderly shidu parents. Providing financial help, eliminating social stigma, and stress should be included in PGD prevention among Chinese elderly shidu parents.
{"title":"Predictors of prolonged grief disorder in Chinese elderly shidu parents: The role of perceived stigma and perceived stress","authors":"Shuang Zhao BM, Longfei Ren MS, Qiong Wang MS, Meijun Long BA, Hui Wu PhD, Yang Wang PhD","doi":"10.1111/appy.12489","DOIUrl":"10.1111/appy.12489","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Parents who have lost their only child and over the age of 60 are known as elderly shidu parents. This study aimed to investigate predictors of prolonged grief disorder (PGD) among Chinese elderly shidu parents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two hundred and ninety-eight elderly shidu parents from Shenyang were included in this cross-sectional study. Participants completed a questionnaire including the Prolonged Grief questionnaire-13 (PG-13), the PTSD (post-traumatic stress disorder) Checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies Depression Scales (CES-D), the Self-Rating Anxiety Scale (SAS), and the Perceived Stress Scale-10 (PSS-10). Multiple linear regression was used to examine socio-demographic, bereavement-related and perceived stress associated with PGD symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of PGD among Chinese elderly shidu parents was 13.8%. Among the 41 PGD patients, 29, 39, 36 patients had comorbidity of PTSD, depressive symptoms and anxiety, respectively. Perceived stress, higher educational level, lower annual household income, perceived stigma, violent death of the child, and being in debt were associated with severer PGD symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The present study revealed the prevalence of PGD and the important role of PGD in diagnosing other mental disorders in Chinese elderly shidu parents. Providing financial help, eliminating social stigma, and stress should be included in PGD prevention among Chinese elderly shidu parents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39495915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After extensive research, this study explored whether high-dose prescriptions and polypharmacy remain more frequent in Japan than elsewhere. If confirmed, we aimed to identify the factors that contributed to this unique trend.
Methods
The psychotropic drug prescription patterns for patients with schizophrenia in Japan were reviewed. This was based on a large sample collected from surveys of the Research on Asian Psychotropic Prescription Patterns, an international collaborative research project conducted by Asian psychiatrists to monitor prescriptions of psychotropic drugs for people with mental disorders, in 2001, 2004, 2008, and 2016.
Results
The 2016 Research on Asian Psychotropic Prescription Patterns survey revealed that Japan continued to demonstrate the highest rate of polypharmacy and the highest dosages of psychotropic prescription drugs for patients with schizophrenia among the 15 countries and areas that participated in the survey.
Discussion
The Research on Asian Psychotropic Prescription Patterns surveys demonstrated that science plays a limited role in the decision-making process for prescriptions of psychotropic medications. Such prescriptions are influenced by a wide range of factors, such as the national mental health policy, prescription-financing systems, the history of psychiatry in each country, and the prevailing culture. Hospital-based national mental health policies and mental health financing systems have been the primary obstacles to reducing polypharmacy in Japan.
{"title":"Analysis of the trends of polypharmacy and high-dose prescriptions in Japan","authors":"Naotaka Shinfuku M.D. Ph.D.","doi":"10.1111/appy.12488","DOIUrl":"10.1111/appy.12488","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>After extensive research, this study explored whether high-dose prescriptions and polypharmacy remain more frequent in Japan than elsewhere. If confirmed, we aimed to identify the factors that contributed to this unique trend.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The psychotropic drug prescription patterns for patients with schizophrenia in Japan were reviewed. This was based on a large sample collected from surveys of the Research on Asian Psychotropic Prescription Patterns, an international collaborative research project conducted by Asian psychiatrists to monitor prescriptions of psychotropic drugs for people with mental disorders, in 2001, 2004, 2008, and 2016.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 2016 Research on Asian Psychotropic Prescription Patterns survey revealed that Japan continued to demonstrate the highest rate of polypharmacy and the highest dosages of psychotropic prescription drugs for patients with schizophrenia among the 15 countries and areas that participated in the survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The Research on Asian Psychotropic Prescription Patterns surveys demonstrated that science plays a limited role in the decision-making process for prescriptions of psychotropic medications. Such prescriptions are influenced by a wide range of factors, such as the national mental health policy, prescription-financing systems, the history of psychiatry in each country, and the prevailing culture. Hospital-based national mental health policies and mental health financing systems have been the primary obstacles to reducing polypharmacy in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/appy.12488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39414346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wen-Hao Chen MD, Ming H. Hsieh MD, PhD, Shih-Cheng Liao MD, PhD, Chen-Chung Liu MD, PhD, Chih-Min Liu MD, PhD, Chi-Shin Wu MD, PhD, Yi-Ting Lin MD, Tzung-Jeng Hwang MD, PhD, Yi-Ling Chien MD, PhD
Introduction
Previous studies demonstrated a trend of increasing common mental disorders among the Emergency Department (ED) visitors in Western countries. Little is known about the current conditions of the emergency psychiatric services in Asian countries. This study aims to survey the current epidemiology and the changing ecology of emergency psychiatry services in Taiwan.
Methods
A total of 804 psychiatry consultations were initiated at the ED during the 1-year period from July 1, 2014 to June 30, 2015 in a medical center in northern Taiwan. Clinical data of gender, age, chief complaints, tentative diagnoses, dispositions, and ED staying hours were compared to a previous report in the same hospital in 1988.
Results
Psychiatry consultation was initiated in 0.72% of all ED visits (804/111,923). Among these visits, females were 1.73 times of the males. The most common chief complaints were psychosis/mania (33.5%) and suicide/self-harm (33.2%), followed by homicide/violence (12.8%) and anxiety/depression (10.3%). Top tentative diagnoses were schizophrenia spectrum and other psychotic disorders (31.3%), trauma- and stressor-related disorders (17.5%), bipolar disorders (15.9%), and depressive disorders (14.2%). Compared to 1988, there are three major changes: (1) over-representation of female patients, (2) an increase of “neurosis” patients, and (3) an increase of suicide/self-harm as chief problem.
Discussion
This study portrays the current epidemiology and changing ecology of psychiatric emergency in Taiwan. The increase of neurotic and suicide/self-harm patients requires more services and clinical training in managing common mental disorders and suicide in the ED.
{"title":"A quarter of century after: The changing ecology of psychiatric emergency services","authors":"Wen-Hao Chen MD, Ming H. Hsieh MD, PhD, Shih-Cheng Liao MD, PhD, Chen-Chung Liu MD, PhD, Chih-Min Liu MD, PhD, Chi-Shin Wu MD, PhD, Yi-Ting Lin MD, Tzung-Jeng Hwang MD, PhD, Yi-Ling Chien MD, PhD","doi":"10.1111/appy.12487","DOIUrl":"10.1111/appy.12487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Previous studies demonstrated a trend of increasing common mental disorders among the Emergency Department (ED) visitors in Western countries. Little is known about the current conditions of the emergency psychiatric services in Asian countries. This study aims to survey the current epidemiology and the changing ecology of emergency psychiatry services in Taiwan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 804 psychiatry consultations were initiated at the ED during the 1-year period from July 1, 2014 to June 30, 2015 in a medical center in northern Taiwan. Clinical data of gender, age, chief complaints, tentative diagnoses, dispositions, and ED staying hours were compared to a previous report in the same hospital in 1988.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Psychiatry consultation was initiated in 0.72% of all ED visits (804/111,923). Among these visits, females were 1.73 times of the males. The most common chief complaints were psychosis/mania (33.5%) and suicide/self-harm (33.2%), followed by homicide/violence (12.8%) and anxiety/depression (10.3%). Top tentative diagnoses were schizophrenia spectrum and other psychotic disorders (31.3%), trauma- and stressor-related disorders (17.5%), bipolar disorders (15.9%), and depressive disorders (14.2%). Compared to 1988, there are three major changes: (1) over-representation of female patients, (2) an increase of “neurosis” patients, and (3) an increase of suicide/self-harm as chief problem.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study portrays the current epidemiology and changing ecology of psychiatric emergency in Taiwan. The increase of neurotic and suicide/self-harm patients requires more services and clinical training in managing common mental disorders and suicide in the ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/appy.12487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39407503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jerry Jay Yeo MBBS Candidate, Qian Hui Chew B.Soc.Sci (Hons), Kang Sim MBBS, MMed (Psychiatry), Grad Dip Psychotherapy (Distinction), MS-HPEd, FAMS
Background
Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter-relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors.
Methods
A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020.
Results
Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self-esteem), and psychosocial functioning (better overall, real-life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions.
Discussion
Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter-relationships with carer resilience, and evaluate the efficacy of suitable resilience-targeted interventions in schizophrenia.
{"title":"Resilience and its inter-relationship with symptomatology, illness course, psychosocial functioning, and mediational roles in schizophrenia: A systematic review","authors":"Jerry Jay Yeo MBBS Candidate, Qian Hui Chew B.Soc.Sci (Hons), Kang Sim MBBS, MMed (Psychiatry), Grad Dip Psychotherapy (Distinction), MS-HPEd, FAMS","doi":"10.1111/appy.12486","DOIUrl":"10.1111/appy.12486","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter-relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self-esteem), and psychosocial functioning (better overall, real-life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter-relationships with carer resilience, and evaluate the efficacy of suitable resilience-targeted interventions in schizophrenia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/appy.12486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39342177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dhenni Hartopo MD, Royke Tony Kalalo MD, Sp.KJ(K), FISCM
A language disorder is a significant symptom of schizophrenia. A psychiatrist can find this disorder when interviews with a patient. Screening and diagnosis in patients with schizophrenia alone rely heavily on interviews conducted on patients and any instructions captured from patients both verbally and nonverbally. A psychiatrist can also analyze the language aspects in schizophrenia from a language level perspective ranging from phonetic to pragmatic. This analysis paves the way for the process of interference detection since the prodromal phase. Language disorder in schizophrenia is often associated with impaired thinking processes. However, with the development of science and technology today, there is an objective and quantitative method of computational analysis of language through the Natural Language Processing process with a semantic space model that allows a psychiatrist to learn aspects of the human language process, especially in semantic and pragmatic aspects. The review provides a groundbreaking proposal for biomarkers for schizophrenia that have not been available so far through the assessment of language disorders in patients with schizophrenia. Objective and accurate detection of language disorders in schizophrenia can be a modality for psychiatrists to screen, make diagnoses, determine prognosis, evaluate therapies, and monitor recurrence using existing technology media.
{"title":"Language disorder as a marker for schizophrenia","authors":"Dhenni Hartopo MD, Royke Tony Kalalo MD, Sp.KJ(K), FISCM","doi":"10.1111/appy.12485","DOIUrl":"10.1111/appy.12485","url":null,"abstract":"<p>A language disorder is a significant symptom of schizophrenia. A psychiatrist can find this disorder when interviews with a patient. Screening and diagnosis in patients with schizophrenia alone rely heavily on interviews conducted on patients and any instructions captured from patients both verbally and nonverbally. A psychiatrist can also analyze the language aspects in schizophrenia from a language level perspective ranging from phonetic to pragmatic. This analysis paves the way for the process of interference detection since the prodromal phase. Language disorder in schizophrenia is often associated with impaired thinking processes. However, with the development of science and technology today, there is an objective and quantitative method of computational analysis of language through the Natural Language Processing process with a semantic space model that allows a psychiatrist to learn aspects of the human language process, especially in semantic and pragmatic aspects. The review provides a groundbreaking proposal for biomarkers for schizophrenia that have not been available so far through the assessment of language disorders in patients with schizophrenia. Objective and accurate detection of language disorders in schizophrenia can be a modality for psychiatrists to screen, make diagnoses, determine prognosis, evaluate therapies, and monitor recurrence using existing technology media.</p>","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/appy.12485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39260041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriel Ivbijaro MBE, MBBS, MA, MMedSci, PhD, FRCGP, FWACPsych, IDFAPA
There have been many suicide prevention initiatives, some focused on the individual, some on the environment, some on systems and some on carers and caregivers, with each contributing to reducing suicide risk. Suicide is preventable and prevention should be everybody's business. We are grateful to Wiley, the Asia-Pacific Psychiatry and the Editor in Chief, Professor Allan Tasman for commissioning this special issue of the journal focused on suicide prevention. I am also grateful to Michelle Riba, Lakshmi Vijayakumar, Tsuyoshi Akiyama, Soumitra Pathare, Danuta Wasserman, Norman Sartorius and David Goldberg for the support that they have provided in preparing this special issue, and to all our peer reviewers for their contribution. Suicide prevention in childhood and adolescence (Wasserman et al., 2021) highlights some of the key papers in the field providing the building blocks for understanding what is required to prevent suicide in this age group noting that many countries have achieved reductions in rates of suicide. This reduction is not universal, and those countries that have increased rates need to look at what interventions have been successful in other parts of the world to reduce rates of suicide in childhood and adolescence further. Adopting the concept that suicide prevention is everybody's business is likely to be helpful because it will enable a holistic approach to addressing this problem. Suicide prevention in psychiatric patients (Wasserman, Carli, et al., 2021) highlights that the provision of cognitive behavior therapy and other brief interventions, including psychoeducation to people with a diagnosis of schizophrenia can decrease the risk of suicide and provides a summary of interventions that reduce risk of suicide in a range of mental disorders recommending a comprehensive suicide risk assessment as the first step in providing effective suicide prevention in psychiatric patients. Suicide prevention in older adults (de Mendoça Lima et al., 2021) in this special issue brings together the dynamic interaction of community, systems and individuals and its importance in reducing rates of suicide in older adults, noting that a public health approach is essential. Reducing access to methods of suicide is also important. In his review, McInnis et al. (2021) examine the issue of access to firearms suggesting self-exclusion agreements as a potential way forward. This is innovative, non-stigmatizing and gives the power to an individual with a known mood disorder to protect themselves and society and is especially important for countries where issues of gun control can be divisive and political. Families and carers matter and should not be forgotten as part of a of protective network that can support an individual during periods when they are at increased risk of suicide. Edwards et al. (2021) propose a practical way of history taking, including emotional engagement, that enables the family member who is feeling suicidal to feel respected
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