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2.
Indian J Med Res ; 155(1): 197-199, 2022 01.
Article in English | MEDLINE | ID: covidwho-2201749

ABSTRACT

Novel coronavirus disease (COVID-19) pandemic has affected the mental well-being of the population and posed many challenges in availing mental healthcare. Telepsychiatry has been proven to be an effective route for the delivery of mental healthcare. We share our experience of using the telemedicine approach in providing mental health services at a tertiarycare hospital in India during the COVID-19 pandemic, following the break in routine outpatient services during the national lockdown. The telepsychiatry approach helped in ensuring the maintenance of mental healthcare. The utility of telepsychiatry as an option for such future situations and for its use in routine follow up care in indicated cases, have also been discussed.


Subject(s)
COVID-19 , Psychiatry , Telemedicine , Communicable Disease Control , Developing Countries , Humans , Mental Health , Pandemics/prevention & control
3.
Psychiatr Clin North Am ; 45(4): 765-777, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2182473

ABSTRACT

The older adult population in the United States is poised to reach 83.7 million by 2050, and up to 20% will suffer from cognitive and mental illnesses. We do not have the workforce available to meet this need; therefore, general psychiatrists will care for many older psychiatric patients. Enhancing learning opportunities during general medical education and residency could improve the knowledge of general psychiatrists and encourage recruitment into geriatric psychiatry. This article outlines geriatric psychiatry education in medical school, residency, and geriatric psychiatry fellowship with suggestions for recruitment into the field, along with recommendations for enhanced learning for general psychiatrists.


Subject(s)
Internship and Residency , Psychiatry , Students, Medical , Humans , United States , Aged , Geriatric Psychiatry , Psychiatry/education , Workforce
4.
Psychiatr Clin North Am ; 45(1): xv-xvii, 2022 03.
Article in English | MEDLINE | ID: covidwho-2182472
5.
BMC Psychiatry ; 22(1): 380, 2022 06 06.
Article in English | MEDLINE | ID: covidwho-1881211

ABSTRACT

BACKGROUND: Demand for mental health services in New Zealand and internationally is growing. Little is known about how psychiatrists are faring in this environment. This study aimed to investigate wellbeing of psychiatrists working in the public health system in New Zealand, identify the main risk factors for work-related stress, gauge perceptions of how workload has changed over time, assess job satisfaction and whether individuals intend or desire to leave their work. METHODS: Psychiatrists working in New Zealand who were also members of the Association of Salaried Medical Specialists were invited to participate in an online survey. Main outcome measures were degree of burnout and stress experienced at work. Supplementary measures included perceived workplace demands and levels of support. Predictor variables included perceptions of changes to workloads over time, degree of job satisfaction and intentions to leave work. Logistic regression assessed characteristics associated with burnout and job satisfaction as well as intentions to leave work. Free text comments were analysed thematically alongside quantitative trends. RESULTS: 368/526 responded (70% response rate). 34.6% met the criteria for burnout and 35.3% scored with high work stress. There were no significant patterns of association with demographic variables but significant correlation with all but one predictor variable; having experienced a change to the demands of the on-call workload. 45% agreed they would leave their current job if able and 87% disagreed that they are working in a well-resourced mental health service. Respondents emphasised the impact of growing workloads and expressed concerns about their ability to provide optimal care in these circumstances. CONCLUSIONS: High burnout appears to affect one in three psychiatrists in New Zealand. Many attribute their feelings of burnout to demand for their services. These findings may assist with better workforce planning for psychiatry and emphasises potential consequences of demand for and poor resourcing of mental health services for the retention and wellbeing of doctors in psychiatry worldwide.


Subject(s)
Burnout, Professional , Occupational Stress , Psychiatry , Burnout, Professional/psychology , Cross-Sectional Studies , Humans , Intention , Job Satisfaction , New Zealand , Surveys and Questionnaires
6.
Psychiatry Res ; 316: 114728, 2022 10.
Article in English | MEDLINE | ID: covidwho-1955792

ABSTRACT

INTRODUCTION: With the start of the COVID-19 pandemic, the various social distancing policies imposed have mandated psychiatrists to consider the option of using telepsychiatry as an alternative to face-to-face interview in Hong Kong. Limitations over sample size, methodology and information technology were found in previous studies and the reliability of symptoms assessment remained a concern. AIM: To evaluate the reliability of assessment of psychiatric symptoms by telepsychiatry comparing with face-to-face psychiatric interview. METHOD: This study recruited a sample of adult psychiatric patients in psychiatric wards in Queen Mary Hospital. Semi-structural interviews with the use of standardized psychiatric assessment scales were carried out in telepsychiatry and face-to-face interview respectively by two clinicians and the reliability of psychiatric symptoms elicited were assessed. RESULTS: 90 patients completed the assessments The inter-method reliability in Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Columbia Suicide Severity Rating Scale and Brief Psychiatric Rating Scale showed good agreement when compared with face-to-face interview. CONCLUSION: Symptoms assessment by telepsychiatry is comparable to assessment conducted by face-to-face interview.


Subject(s)
COVID-19 , Psychiatry , Telemedicine , Adult , Humans , Pandemics , Psychiatric Status Rating Scales , Psychiatry/methods , Reproducibility of Results , Symptom Assessment
7.
Prim Care Companion CNS Disord ; 24(5)2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2163863

ABSTRACT

Objective: To assess user perception regarding different aspects of the telepsychiatry process.Methods: This cross-sectional survey study was conducted between July and September 2020 with follow-up patients attending teleconsultation at a tertiary care center (N = 108). The online survey included questions about the user's experience such as the appointment process and different aspects of teleconsultation, as well as perceived benefits, difficulties experienced, and suggestions for improvement. The sociodemographic and clinical data were retrieved from the electronic record.Results: The majority of patients expressed satisfaction with teleconsultation. The patients who were living far from the center (> 100 km) and those with psychotic illness favored telepsychiatry. Patients with nonpsychotic illnesses reported significantly less satisfaction with counseling in teleconsultation.Conclusions: The findings substantiate the acceptance of telepsychiatry services and emphasize the need for a tailor-made hybrid form of consultation as per the patient's profile.


Subject(s)
Psychiatry , Remote Consultation , Telemedicine , Cross-Sectional Studies , Humans , Patient Satisfaction , Perception , Telephone
8.
BMC Psychiatry ; 22(1): 370, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-2139195

ABSTRACT

BACKGROUND: The use of formal coercion such as seclusion, mechanical restraint, and forced medication is one of the most challenging and complex issues in mental health care, on the clinical, the legal, and the ethical level. Clinical ethics support aims at assisting healthcare practitioners in determining the morally most justifiable course of action in these situations. However, the effectiveness of clinical ethics support has hardly been studied so far. METHODS: Monthly moral case deliberation (MCD) was implemented in two acute wards of two different psychiatric hospitals in Switzerland. Frequency and intensity of coercion was measured on ward level (npatients = 405), and the Moral Attentiveness Scale, Knowledge on Coercion Scale, and Staff Attitudes towards Coercion Scale were applied on healthcare practitioner level (nHP = 46). Pre-post-comparisons were conducted using multi-level modeling where appropriate. RESULTS: After implementation of MCD, formal coercion was less frequent (particularly seclusion, small effect size; 9.6 vs. 16.7%, p = .034, Cramér's V = .105) and less intense (particularly mechanical restraint, large effect size; 86.8 ± 45.3 vs. 14.5 ± 12.1 h, exact p = .019, r = -.74), and approval for coercive measures among healthcare practitioners was lower when controlling for the number of MCD sessions attended. CONCLUSIONS: Clinical ethics support such as MCD may be a hitherto underutilized service for the reduction of coercion, complementing existing strategies and programs. Implementing clinical ethics support may help improve quality of care for persons suffering from severe mental illness.


Subject(s)
Coercion , Psychiatry , Ethics, Clinical , Hospitals, Psychiatric , Humans , Pilot Projects
9.
J Psychiatr Pract ; 28(6): 492-496, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2117109

ABSTRACT

Demands for telepsychiatry have increased due to the challenges of COVID-19. The global pandemic caused a significant increase in anxiety and depression and a worsening of eating disorder symptoms, while the implementation of social distancing both exacerbated these mental health issues and disrupted the in-person delivery of mental health services. Rapid adaptation of telepsychiatry in the acute inpatient setting has been reported with favorable outcomes in patient experiences. This article reports our experience with a transition to telepsychiatry services on an acute eating disorder unit and the impact on quality of care. Forty-two inpatients on an eating disorders unit completed 410 surveys evaluating their experience with telepsychiatry. Simultaneously, surveys were distributed to physicians to identify technical and connectivity issues. Our experience showed that patients on an eating disorder unit, who had an average length of stay of 22 days, were very satisfied with telepsychiatry, with few technical or safety issues.


Subject(s)
COVID-19 , Psychiatry , Telemedicine , Humans , Inpatients/psychology , Surveys and Questionnaires
10.
Psychiatr Clin North Am ; 45(2): 283-295, 2022 06.
Article in English | MEDLINE | ID: covidwho-1849572

ABSTRACT

The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.


Subject(s)
COVID-19 , Internship and Residency , Psychiatry , Ethnicity , Humans , Minority Groups , Pandemics , Psychiatry/education , Workforce
11.
Psychiatr Danub ; 32(3-4): 536-548, 2020.
Article in English | MEDLINE | ID: covidwho-2100776

ABSTRACT

BACKGROUND: Many research has indicated that, during the COVID-19 pandemic, health care workers are under greatly increased pressure and at increased risk for the development of mental health problems. Furthermore, previous research has indicated that psychiatrists are exposed to a number of unique stressors that may increase their risk for poor mental health. The aims of the present study were to assess the level of COVID-19 related concerns, psychological distress and life satisfaction among psychiatrists and other physicians during the first period of the pandemic and to examine whether individual differences in COVID-19 concerns, psychological flexibility, psychological resilience and coping behaviors account for differences in mental health indicators. SUBJECTS AND METHODS: The sample consisted of N=725 physicians, among whom 22.8% were psychiatrists. This study was conducted online during the first lockdown in Croatia and collected data regarding COVID-19 related concerns, coping behaviors and mental health indicators (Psychological Distress and Life Satisfaction). RESULTS: Physicians of other specialties had higher scores on a measure of COVID-19 anxiety than psychiatrists (p=0.012). In addition, a number of differences in coping behaviors are evident. Specifically, psychiatrists were less likely than physicians of other specializations to believe that being informed about COVID-19 is an effective coping strategy (p=0.013), but more prone to using sedatives and drugs as a coping strategy (p=0.002; p=0.037). CONCLUSIONS: Psychiatrists are at special risk for substance abuse. Younger age, psychological inflexibility, low resilience and greater COVID-19 concerns might act as specific risk factors for distress. Our findings highlight the need for promoting a healthy lifestyle and psychological flexibility as universal protective factors.


Subject(s)
COVID-19 , Physicians , Psychiatry , Communicable Disease Control , Croatia , Humans , Mental Health , Pandemics , Protective Factors , SARS-CoV-2
12.
Psychiatr Danub ; 32(2): 229-235, 2020.
Article in English | MEDLINE | ID: covidwho-2100751

ABSTRACT

COVID-19 or Coronavirus pandemic has generated a very serious and grave global concern regarding the health of every person in the whole world. Besides, due to the rapid diffusion of the viral infection, there are already alarms on how to deal with the psychiatric aspects of COVID-19 pandemic in persons with an established diagnosis of psychiatric disorders, staff, and those in self-isolation. What is the influence of COVID-19 on mental health? The current study will review the psychiatric implications of COVID-19 pandemic on the general population, the bearing of social isolation, the prevention behaviours, and clinical cases of people who required psychiatric admission to hospital due to the emotional impact of COVID-19 social circumstances.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Psychiatry , COVID-19 , Humans
13.
Psychiatr Danub ; 32(2): 221-228, 2020.
Article in English | MEDLINE | ID: covidwho-2100750

ABSTRACT

Blame games tend to follow crisis, be they at local, national or international level related to political, financial or health issues. COVID-19 crisis from the very beginning has been followed by divisive and disruptive psychosocial and political blame games. Active or passive blaming is an inherent feature of human beings in order to shift responsibilities onto others, single out a culprit, find a scapegoat and pinpoint a target. Finger pointing, blame games and scapegoating are associated with creation of binaries that identify agency as good or bad, right or wrong, moral or immoral. The scapegoat is expectedly always bad, wrong and immoral, commonly black evil. The detrimental effects of the COVID-19 blame games are seen in a lack of cohesion and coherence in the anti-COVID-19 solving strategies. Fighting the COVID-19 crisis all countries and nations need to join efforts on defeating it and to shift from a destructive blaming and zero-sum type of thinking to a much more creative, systemic and humanistic type. Effective response to COVID-19 is related to sowing the seeds for humanistic self and empathic civilization, rather than blaming, scapegoating and xenophobia.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Global Health , Mental Health , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Psychiatry , Public Health , COVID-19 , Empathy , Humans , Pandemics
14.
Psychiatr Danub ; 32(1): 25-31, 2020.
Article in English | MEDLINE | ID: covidwho-2100748

ABSTRACT

Deep emotional traumas in societies overwhelmed by large-scale human disasters, like, global pandemic diseases, natural disasters, man-made tragedies, war conflicts, social crises, etc., can cause massive stress-related disorders. Motivated by the ongoing global coronavirus pandemic, the article provides an overview of scientific evidence regarding adverse impact of diverse human disasters on mental health in afflicted groups and societies. Following this broader context, psychosocial impact of COVID-19 as a specific global human disaster is presented, with an emphasis on disturbing mental health aspects of the ongoing pandemic. Limited resources of mental health services in a number of countries around the world are illustrated, which will be further stretched by the forthcoming increase in demand for mental health services due to the global COVID-19 pandemic. Mental health challenges are particularly important for the Republic of Croatia in the current situation, due to disturbing stress of the 2020 Zagreb earthquake and the high pre-pandemic prevalence of chronic Homeland-War-related posttraumatic stress disorders. Comprehensive approach based on digital psychiatry is proposed to address the lack of access to psychiatric services, which includes artificial intelligence, telepsychiatry and an array of new technologies, like internet-based computer-aided mental health tools and services. These tools and means should be utilized as an important part of the whole package of measures to mitigate negative mental health effects of the global coronavirus pandemic. Our scientific and engineering experiences in the design and development of digital tools and means in mitigation of stress-related disorders and assessment of stress resilience are presented. Croatian initiative on enhancement of interdisciplinary research of psychiatrists, psychologists and computer scientists on the national and EU level is important in addressing pressing mental health concerns related to the ongoing pandemic and similar human disasters.


Subject(s)
Coronavirus Infections/psychology , Disasters , Mental Health Services , Mental Health , Pneumonia, Viral/psychology , Psychiatry , Telemedicine , Artificial Intelligence , Betacoronavirus , COVID-19 , Croatia , Humans , Internet , Pandemics , Psychiatry/trends , SARS-CoV-2 , Telemedicine/trends , User-Computer Interface
16.
Int J Environ Res Public Health ; 19(21)2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2099501

ABSTRACT

BACKGROUND: The COVID-19 pandemic and associated restrictive measures have substantially affected educational processes around the globe, resulting in psychological distress among students. The mental health of students in higher education is of paramount importance, and the COVID-19 pandemic has brought this vulnerable population into renewed focus. In this context, the evaluation of students' mental health at educational institutes has gained invaluable popularity during the COVID-19 pandemic. This study aimed to ascertain the psychological health and coping strategies among students from a higher education institute in Saudi Arabia. METHODS: An online study instrument was used to assess anxiety (Generalized Anxiety Disorder-7, GAD-7), depression (Patient Health Questionnaire-9, PHQ-9), post-traumatic stress disorder-PTSD (Impact of Event Scale-Revised, IES-R) and coping strategies (Brief-COPE). The severity of the psychological distress was classified as per the scoring criteria and correlated with demographics using appropriate statistical methods. RESULTS: Of 1074 students (age 21.1 ± 2.1 years), 12.9% and 9.7% had severe anxiety and depression, respectively. The mean anxiety and depression scores were 7.50 ± 5.51 and 9.31 ± 6.72, respectively. About one-third (32%) of students reported suicidal ideation, with 8.4% students having such thoughts nearly every day. The average PTSD score was 21.64 ± 17.63, where avoidance scored higher (8.10 ± 6.94) than intrusion and hyperarousal. There was no association of anxiety, depression and PTSD score with the demographics of the study participants. Religious/spiritual coping (5.43 ± 2.15) was the most adoptive coping mechanism, followed by acceptance (5.15 ± 2.10). Male students were significantly (p < 0.05) associated with active copings, instrumental support, planning, humor, acceptance and religious coping. Substance use was the least adopted coping strategy but practiced by a considerable number of students. CONCLUSIONS: The long-lasting pandemic situation, onerous protective measures and uncertainties in educational procedures have resulted in a high prevalence of psychological ailments among university students, as indicated in this study. These findings accentuate the urgent need for telepsychiatry and appropriate population-specific mental health services to assess the extent of psychological impairment and to leverage positive coping behaviors among students.


Subject(s)
COVID-19 , Psychiatry , Telemedicine , Humans , Male , Young Adult , Adult , COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Universities , Saudi Arabia/epidemiology , Adaptation, Psychological , Anxiety/epidemiology , Anxiety/psychology , Students/psychology , Depression/epidemiology , Depression/psychology , Stress, Psychological/epidemiology
17.
Ir J Psychol Med ; 38(2): 108-115, 2021 06.
Article in English | MEDLINE | ID: covidwho-2096537

ABSTRACT

OBJECTIVES: To determine if the initial COVID-19 societal restrictions, introduced in Ireland in March 2020, impacted on the number and nature of psychiatry presentations to the emergency department (ED) of a large academic teaching hospital. METHODS: We examined anonymised clinical data of psychiatry presentations to the ED during the initial 8-week period of COVID-19 restrictions. Data from corresponding 8-week periods in 2018 and 2019 were also extracted for comparison. RESULTS: Psychiatry presentations to ED reduced by 21% during the COVID-19 restrictions, from 24/week to 19/week when compared with corresponding periods in 2018/2019 (Poisson's Rate Test estimate of difference -5.2/week, 95% CI 1.3-9.1, p = 0.012). Numbers attending for out-of-hours assessment remained unchanged (81 v. 80), but numbers seeking assessment during normal hours decreased (71 v. 114). We observed increased presentations from the <18 age group, but decreased presentations from the 18 to 29 age group (Pearson's Chi-Square 20.363, df = 6, p = 0.002). We recorded an increase in anxiety disorders during the initial COVID-19 restrictions (31 v. 23), and a reduction in alcohol disorders (28 v. 52). The proportion of presentations with suicidal ideation (SI) or self-harm as factors remained unchanged. CONCLUSIONS: Rates of emergency presentation with mental illness reduced during the initial COVID-19 restrictions. This may represent an unmet burden of mental health needs. Younger people may be experiencing greater distress and mental illness during the current crisis. More people sought help for anxiety disorders during the COVID-19 restrictions compared with corresponding data from 2018 and 2019.


Subject(s)
COVID-19 , Psychiatry , Emergency Service, Hospital , Hospitals, Teaching , Humans , Ireland , Retrospective Studies , SARS-CoV-2
18.
Ir J Psychol Med ; 38(2): 93-98, 2021 06.
Article in English | MEDLINE | ID: covidwho-2096534

ABSTRACT

The medium- to long-term consequences of COVID-19 are not yet known, though an increase in mental health problems are predicted. Multidisciplinary strategies across socio-economic and psychological levels may be needed to mitigate the mental health burden of COVID-19. Preliminary evidence from the rapidly progressing field of psychedelic science shows that psilocybin therapy offers a promising transdiagnostic treatment strategy for a range of disorders with restricted and maladaptive habitual patterns of cognition and behaviour, notably depression, addiction and obsessive compulsive disorder. The COMPASS Pathways (COMPASS) phase 2b double-blind trial of psilocybin therapy in antidepressant-free, treatment-resistant depression (TRD) is underway to determine the safety, efficacy and optimal dose of psilocybin. Results from the Imperial College London Psilodep-RCT comparing the efficacy and mechanisms of action of psilocybin therapy to the selective serotonin reuptake inhibitor (SSRI) escitalopram will soon be published. However, the efficacy and safety of psilocybin therapy in conjunction with SSRIs in TRD is not yet known. An additional COMPASS study, with a centre in Dublin, will begin to address this question, with potential implications for the future delivery of psilocybin therapy. While at a relatively early stage of clinical development, and notwithstanding the immense challenges of COVID-19, psilocybin therapy has the potential to play an important therapeutic role for various psychiatric disorders in post-COVID-19 clinical psychiatry.


Subject(s)
COVID-19 , Hallucinogens , Psychiatry , Hallucinogens/therapeutic use , Humans , Psilocybin/therapeutic use , SARS-CoV-2
19.
Ir J Psychol Med ; 38(2): 132-139, 2021 06.
Article in English | MEDLINE | ID: covidwho-2096524

ABSTRACT

OBJECTIVE: In response to the COVID-19 pandemic, there has been a shift globally from face-to-face consultations to remote consultations. In our department, remote consultations have taken in the form of telephone consultations. In this paper, we set out to study a group of Irish psychiatrists' experience of these consultations. METHODS: We identified recurrent themes in the existing literature on doctors' experience of telephone consultations with a view to determining the applicability of these themes to a group of Irish psychiatrists. A questionnaire was developed based on themes in the literature. This was sent to all psychiatrists working in a busy psychiatric service in Dublin. RESULTS: The questionnaire response rate was 72% (n = 26/35). Diagnostic challenges, the effect of phone consultation on the therapeutic alliance, challenges associated with the use of technology and ethical concerns were identified as issues. Flexibility in the working day and convenience were identified as possible benefits to telephone consultations. CONCLUSIONS: The group that participated in this research study identified a number of challenges to carrying out successful phone consultations. This study highlights the need at our clinical site for interventions to address the issues identified by staff. The findings also highlight the requirement for larger studies with stronger methodologies to determine the generalisability of our results.


Subject(s)
COVID-19 , Psychiatry , Remote Consultation , Humans , Outpatients , Pandemics , SARS-CoV-2 , Telephone
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