The development of mental health care in Guangzhou, China

As an upper-middle-income country, China has a vast territory, a large population and substantial variations in the nature of mental health service provision. Guangzhou, one of the five biggest cities in China, is considered as indicative of the current development of mental health services in a more economically developed part of China. In this paper, we first introduce mental health services in Guangzhou and their historical development: from the rising development of mental health care (1949 to the mid-1960s), the stagnant development period of the psychiatric hospitals (1966-1976), the rapid development period of the psychiatric hospitals (1978 to the 1990s), to the integrated development period of community mental health care (2000-2020). This historical trajectory partly reflects the development of mental health services across China. Second, from the public health perspective, we introduce the current mental health care delivery system and resources in Guangzhou, including the psychiatric specialist hospitals, psychiatric units of general hospitals, and community mental health care. Third, based on the current mental health service system, we highlight community mental health care in Guangzhou. We will describe these elements of the mental health system under the following headings: organizational setup, management, and services. We also explore the design of community mental health service models and the challenges in the post-covid-19 era. Finally, we provide considerations and recommendations for mental health service delivery in Guangzhou in the future.Copyright © 2023 The Authors

De l'aliénation mentale de l'enfant et de l'adolescent à la pédopsychiatrie dans les communications à la Société Médico-Psychologique de 1852 à 1937

Fondée en 1848, la Société Médico-Psychologique s'est donné pour but l'étude de la pathologie mentale et le perfectionnement de son traitement. François Arnaud (1858–1927), Claude-Étienne Bourdin (1815–1886), Michel Catsaras (1860–1939), Louis Delasiauve (1804–1893), Eugène Dally (1833–1887), Jules Fournet (1812–1888), Paul Garnier (1848–1905), Valentin Magnan (1835–1916), Jacques-Joseph Moreau de Tours (1805–1884), Emmanuel Régis (1855–1918), Paul Sollier (1861–1933), Édouard Toulouse (1865–1947), Auguste Voisin (1829–1898) et Jules Voisin (1844–1920), pour la plupart aliénistes, se sont succédé au cours du XIXe siècle à la tribune de la Société afin d'y présenter des observations d'enfants ou d'adolescents. D'autres aliénistes, neuropsychiatres puis pédopsychiatres, nourriront les séances des XXe et XXIe siècles par leurs communications portant sur la pathologie mentale du bébé à l'adolescent. Ces communications et leurs auteurs appartiennent à leur époque, mais aussi au lieu où elles ont émergé. Ainsi, au-delà de l'inventaire des thèmes abordés (la déficience, la démence précoce, l'encéphalite épidémique, l'autisme...) est esquissé ici un travail de contextualisation de 170 ans de communications de pédopsychiatrie à la Société Médico-Psychologique. In 1848, the Société Médico-Psychologique was founded. Its aims is to promote the study and improvement of mental pathology. During the 19th century, François Arnaud (1858–1927), Claude-Etienne Bourdin (1815–1886), Michel Catsaras (1860–1939), Louis Delasiauve (1804–1893), Eugène Dally (1833–1887), Jules Fournet (1812–1888), Paul Garnier (1848–1905), Valentin Magnan (1835–1916), Jacques-Joseph Moreau De Tours (1805–1884), Emmanuel Régis (1855–1918), Paul Sollier (1861–1933), Edouard Toulouse (1865–1947), Auguste Voisin (1829–1898) and Jules Voisin (1844–1920) were the alienists or not, French or foreigners who succeeded at the chair of the Société Médico-Psychologique. This later presented observations of children or teenagers. The communications and discussions but also the issues raised by the alienists, neuro-psychiatrists then child psychiatrists will contribute to the reflections of members of the Société Médico-Psychologique over the course of the last century. But, they also forced us to take a more perceptive look at the child's mental health. Its communications and their authors belong to their time and to a time or even a place where they emerged. Apart from to looking into the topics pursued (deficiency, dementia praecox, epidemic encephalitis, autism, etc.) concerning the infantojuvenile psychiatry, we will carry out a work of communications contextualization focused on the child's mental health at the Société Médico-Psychologique during 170 years. [ FROM AUTHOR]

Comment les Annales Médico-Psychologiques parlaient-elles de l'encéphalite léthargique voici cent ans ?

Voici un siècle, alors que se répandait l'épidémie de grippe dite espagnole, René Cruchet, en France, et Constantin von Economo, en Autriche, attiraient l'attention des médecins militaires et civils sur l'apparition d'une autre pandémie, l'encéphalite léthargique. Après une phase de somnolence irrépressible plus ou moins prolongée, ceux qui survivaient développaient, progressivement, des séquelles permanentes de type syndrome parkinsonien ou paroxystiques à type de dystonies variées. Les patients étaient souvent des enfants et de jeunes adultes. De 1920 à 1946, la Société Médico-Psychologique consacre vingt séances à l'étude des séquelles neuropsychiatriques de ces encéphalites. À côté des mouvements anormaux, les psychiatres prennent en charge des délires hallucinatoires, des comportements violents et agressifs avec désinhibition sexuelle, des épilepsies myocloniques, etc. Il ressort des présentations cliniques résumées ici que cette pandémie permet aux psychiatres de rapporter à des lésions diencéphaliques et mésencéphaliques des détériorations psychiatriques comme jamais ils ne l'avaient fait auparavant. L'hypothèse étiologique actuelle conclut cette présentation. A century ago, when the so-called Spanish flu epidemic was spreading, René Cruchet in France and Constantin von Economo in Austria drew the attention of military and civilian physicians to the existence of another pandemic, encephalitis lethargica. After a more or less prolonged phase of irrepressible drowsiness, those who survived progressively developed permanent sequelae, i.e. parkinson' syndrome, or various types of paroxysmal dystonia. The patients were often children and young adults. From 1920 to 1946, the Société Médico-Psychologique devoted twenty sessions to the study of the neuropsychiatric sequelae of these encephalitides. In addition to abnormal movements, psychiatrists treated hallucinatory delusions, violent and aggressive behaviors with sexual disinhibition, myoclonic epilepsy, etc. The clinical presentations summarized here seem to demonstrate that this pandemic allowed psychiatrists to relate psychiatric deterioration to diencephalic and mesencephalic lesions in a way that they had never done before. The current etiological hypothesis concludes this presentation. [ FROM AUTHOR]

Psychiatry: From its historical and philosophical roots to the modern face

This book was the end product of life experiences, thoughts and intellectual wanderings of the author, who through his career and for the last twenty years was always serving all the three aspects of a Psychiatrist: He is a clinician, a researcher and an academic teacher. The book includes a comprehensive history of Psychiatry since antiquity and until today, with an emphasis not only on main events but also specifically and with much detail and explanations, on the chain of events that led to a particular development. At the center of this work is the question 'What is mental illness?' and 'Does free will exist?'. These are questions which tantalize Psychiatrists, neuroscientists, psychologists, philosophers, patients and their families and the sensitive and educated lay persons alike. Thus, the book includes a comprehensive review and systematic elaboration on the definition and the concept of mental illness, a detailed discussion on the issue of free will as well as the state of the art of contemporary Psychiatry and the socio-political currents it has provoked. Finally the book includes a description of the academic, social and professional status of Psychiatry and Psychiatrists and a view of future needs and possible developments. A last moment addition was the chapter on conspiracy theories, as a consequence of the experience with the social media and the public response to the COVID-19 outbreak which coincided with the final stage of the preparation of the book. Their study is an excellent opportunity to dig deep into the relation among human psychology, mental health, the society and politics and to swim in intellectually dangerous waters. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Telepsychiatry: What clinicians need to know about digital mental healthcare

SUMMARY The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A familiar species of Crank: Anti-Vaccinationists in medical history.

Vaccination, health psychology and mental health make for three well-established and prestigious topoi in medical history. An in-depth look at their historical intersections remains forthcoming, however. Vaccinology's psychological turns merit historians' attention, all the more in the light of more recent, post-psychological and infodemiological, perspectives in vaccine acceptance research. Historiography at this point may help appreciating the present, and future, standing of psychological profiling in terms of its explanatory merits and policy uses. Of specific, critical interest is the motif of mental illness historically shared by vaccine advocates and contrarians. Mock-psychiatric nosology was a favored framing device for vaccination polemicists early on, indeed before vaccines were called vaccines and before psychiatry came to be called psychiatry. Though long anticipated, substantive historical-sociological and empirical approaches to vaccine non-acceptance were seen only from the 1920s and 1930s, respectively. Today, spirited animosity over vaccination continues to invite both professional and public debate about the founding concepts, the basic tenets, and the defining boundaries, of the mental health sciences.

From knowledge to belief or the misguidance of Jules Luys, an intellectual journey still relevant

A contemporary of Jean-Martin Charcot, Jules Bernard Luys was a neurologist and psychiatrist who remains known for having described the corpus Luysii, a grey subthalmic formation which became the subthalmic nucleus. His work as an anatomist is preserved in two innovative books, the first designed to give a three-dimensional view of the nervous system in 1865, and the second ushering in anatomical illustration using photography and introducing micro-photography in 1873. Splitting his time between La Salpêtrière Hospital and the Ivry asylum, Luys presented brain physiology in his book Le cerveau et ses fonctions (the brain and its functions) to shine light on its disorders, as an introduction to his voluminous Traité clinique et pratique des maladies mentales (clinical and practical treatise on mental illnesses), which already showed the work of a fertile imagination attempting to connect mental illnesses with anatomical observations expressly interpreted. His 1886 appointment at La Charité Hospital provided him with an opportunity to imitate Charcot's Lessons, so he immersed himself in the study of hysteria. With the help of a fervent believer in occultism, Gérard Encausse, who, unbeknownst to him, manipulated the young women he ran his experiments on, Luys made the most extravagant observations, believing naively in his findings and proceeding without critical analysis. This story of a great scientist, slipping into irrational thinking by abandoning the benefits of doubt, is an opportunity to explore the mechanisms leading to this deviation, which is not without parallels with more recent deviations during the AIDS and Covid-19 pandemics. © 2022 Elsevier Masson SAS

De la connaissance à la croyance ou l’égarement de Jules Luys, un cheminement intellectuel toujours d’actualité

Résumé Contemporain de Jean-Martin Charcot, Jules Bernard Luys, neurologue et psychiatre, reste célèbre pour avoir décrit le Corpus Luysii, formation grise sous-thalamique devenue le nucleus subthalamicus. Deux livres novateurs nous gardent son travail d’anatomiste, l’un tentant, grâce au dessin, de donner une vue en trois dimensions du système nerveux en 1865, l’autre inaugurant l’illustration anatomique grâce à la photographie et initiant la micro-photographie en 1873. Partageant son temps entre La Salpêtrière et la Maison de santé d’Ivry, il propose une exposition de la physiologie cérébrale, dans son livre Le cerveau et ses fonctions, afin d’éclairer ses désordres, en introduction à son volumineux Traité clinique et pratique des maladies mentales où déjà transparaît une imagination fertile tentant de rapporter les maladies mentales à des constatations anatomiques interprétées à dessein. Sa nomination en 1886 à l’Hôpital de La Charité est pour lui l’occasion de tenter d’imiter les Leçons de Charcot, alors qu’il se plonge dans l’étude de l’hystérie. Secondé par un fervent de l’occultisme, Gérard Encausse, qui manipule, à son insu, les jeunes femmes sur lesquelles il expérimente, Luys produit les plus extravagantes constatations avec une foi naïve, sans autocritique. Ce parcours d’un grand scientifique, sombrant dans l’irrationnel en abandonnant la prudence du doute, est l’occasion d’explorer les mécanismes conduisant à cette déroute qui n’est pas sans analogie avec quelques-unes, plus récentes, lors des pandémies de sida et de Covid-19. A contemporary of Jean-Martin Charcot, Jules Bernard Luys was a neurologist and psychiatrist who remains known for having described the corpus Luysii, a grey subthalmic formation which became the subthalmic nucleus. His work as an anatomist is preserved in two innovative books, the first designed to give a three-dimensional view of the nervous system in 1865, and the second ushering in anatomical illustration using photography and introducing micro-photography in 1873. Splitting his time between La Salpêtrière Hospital and the Ivry asylum, Luys presented brain physiology in his book Le cerveau et ses fonctions (the brain and its functions) to shine light on its disorders, as an introduction to his voluminous Traité clinique et pratique des maladies mentales (clinical and practical treatise on mental illnesses), which already showed the work of a fertile imagination attempting to connect mental illnesses with anatomical observations expressly interpreted. His 1886 appointment at La Charité Hospital provided him with an opportunity to imitate Charcot's Lessons, so he immersed himself in the study of hysteria. With the help of a fervent believer in occultism, Gérard Encausse, who, unbeknownst to him, manipulated the young women he ran his experiments on, Luys made the most extravagant observations, believing naively in his findings and proceeding without critical analysis. This story of a great scientist, slipping into irrational thinking by abandoning the benefits of doubt, is an opportunity to explore the mechanisms leading to this deviation, which is not without parallels with more recent deviations during the AIDS and Covid-19 pandemics.

Transforming MRCPsych theory examinations: digitisation and very short answer questions (VSAQs).

Many examinations are now delivered online using digital formats, the migration to which has been accelerated by the COVID-19 pandemic. The MRCPsych theory examinations have been delivered in this way since Autumn 2020. The multiple choice question formats currently in use are highly reliable, but other formats enabled by the digital platform, such as very short answer questions (VSAQs), may promote deeper learning. Trainees often ask for a focus on core knowledge, and the absence of cueing with VSAQs could help achieve this. This paper describes the background and evidence base for VSAQs, and how they might be introduced. Any new question formats would be thoroughly piloted before appearing in the examinations and are likely to have a phased introduction alongside existing formats.