Predispose, precipitate, perpetuate, and protect: how diet and the gut influence mental health in emerging adulthood.

Medicine often employs the 4Ps of predisposing, precipitating, perpetuating, and protective factors to identify salient influences on illness states, and to help guide patient care. Mental illness is a significant cause of morbidity and mortality worldwide. Mental health is a complex combination of biological, psychological, environmental, and social factors. There is growing interest in the gut-brain-microbiome (GBM) axis and its impact on mental health. We use the medical model of the 4Ps to explore factors involving the connection between nutrition and the GBM axis and their associated risks with mental health problems in emerging adults (EAs), a life stage when mental illness onset is the most common. We review the impact of current dietary trends on the GBM and on mental health, and the role that gut microbiome-based interventions can have in modulating the GBM axis of EAs. We discuss the implications of gut health on the GBM and areas for clinical intervention.

A web-enabled, school-based intervention for bullying prevention (LINKlusive): a cluster randomised trial.

Background: There is a need for more sustainable interventions and for assessing the effectiveness of school-based universal anti-bullying programmes in vulnerable populations. We assessed the efficacy of a multicomponent, web-enabled, school-based intervention that aims to improve school climate and reduce bullying (LINKlusive) relative to conventional practices (control condition). Methods: We conducted a cluster randomised controlled trial in primary and secondary schools in Madrid, Spain. The primary outcome measure was peer-reported bullying victimisation after the 12-week intervention (study endpoint). We analysed data using longitudinal mixed-effects models. The trial was registered with the ISRCTN registry (15719015). Findings: We included 20 schools (10 in each group); 6542 students participated at baseline; 6403 were assessed at study endpoint. After the intervention, there was a statistically significant reduction in bullying victimisation in both the intervention (OR 0.61, 95% CI [0.41, 0.90]) and control groups (OR 0.69, 95% CI [0.51, 0.92]), with no evidence of differences in the whole sample (OR 0.89, 95% CI [0.58, 1.36]; aOR 0.89, 95% CI [0.58, 1.37]). Subgroup analyses showed a statistically significant effect of LINKlusive on bullying victimisation in primary education (aOR 0.68, 95% CI [0.47, 0.98]). In students with peer-reported bullying victimisation at baseline, LINKlusive showed a statistically significant effect on depression (-1.43, 95% CI [-2.46, -0.40], adjusted standardised mean difference (SMD) -0.41) and quality of life (2.18, 95% CI [0.80, 3.56], adjusted SMD 0.45). Interpretation: LINKlusive could be effective in reducing bullying victimisation in primary school students. Sustainable whole-school interventions to promote mental health and reduce risk factors are warranted to improve outcomes in young people, especially in the early years of education. Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.

Acceptance and Commitment Therapy for individuals at risk for psychosis or with a first psychotic episode: A qualitative study on patients' perspectives.

AIM: The aim of this qualitative study is to explore patients' perspectives on Acceptance and Commitment Therapy for early stages of psychosis. Therefore, we interviewed participants of the INTERACT study, that quantitatively investigated Acceptance and Commitment Therapy in Daily Life (ACT-DL) in combination with treatment as usual, for early stages of psychosis, comparing it to treatment as usual. METHODS: Within 6 months after finishing ACT-DL, we conducted semi-structured, individual interviews with 19 participants. All interviews were audio-recorded and transcribed. Thematic analysis was used for coding and analysis. RESULTS: Two overarching themes were formed: 'the meaning of ACT' and 'what to improve'. Considering the first, participants generally understood and connected with the meaning of ACT, noticing more awareness and acceptance of their thoughts and feelings, and living more in line with their personal values. The second theme included comments on the protocol not being personal or psychosis specific enough and some elements of ACT being too difficult to understand when having active psychotic symptoms. CONCLUSIONS: This study suggests that ACT is an acceptable and promising new form of treatment for early stages of psychosis, and it provides relevant information to further develop ACT for this group.

The effectiveness of telehealth interventions in suicide prevention: A systematic review and meta-analysis.

BACKGROUND: Suicidal attempt is a significant risk factor for future attempts, with the highest risk during the first-year post-suicide. Telepsychiatry has shown promise by providing easy access to evidence-based interventions during mental health crises. AIMS: investigation the effectiveness of telehealth interventions in suicide prevention. METHODS: Four electronic databases (PubMed, Scopus, Web of Science, and Ovid) were systematically searched for studies on patients undergoing telepsychiatry intervention (TPI) up to June 2022. Following PRISMA guidelines, a systematic review and meta-analysis were conducted to investigate the effectiveness of telehealth interventions in suicide prevention. Continuous data were pooled as standardised mean difference (SMD), and dichotomous data were pooled as risk ratio using the random effects model with the corresponding 95% confidence intervals (CI). RESULTS: Sixteen studies were included in the review. Most studies were case-control and randomised controlled trials conducted in Europe and North America. The findings of the studies generally showed that TPIs are effective in reducing suicide rates (odds ratio = 0.68; 95% CI [-0.47, 0.98], p = .04) and suicidal reattempts. The interventions were also found to be well-accepted, with high retention rates. CONCLUSION: Our results suggest that TPIs are well-accepted and effective in reducing suicide rates and reattempts. It is recommended to maintain telephone follow-ups for at least 12 months. Further research is needed to understand the potential of telepsychiatry in suicide prevention fully.

Development of Mental Healthcare Model in Seoul.

OBJECTIVE: To develop an integrated and comprehensive community-based mental healthcare model, opinions were collected on various issues from practitioners in mental health service institutions currently offering mental healthcare services in Seoul through a focus group interview, qualitative research method, and Delphi survey. METHODS: The focus group interview was conducted with six practitioners from mental health welfare centers and six hospital-based psychiatrists. A questionnaire of opinions on the mental healthcare model was filled by these practitioners and psychiatrists. A Delphi survey was additionally conducted with a panel of 20 experts from a community mental health welfare center and hospital-based psychiatrists. RESULTS: The focus group interview results showed the need for integrated community-based mental healthcare service and the need to establish a system for managing mental and physical health in an integrated manner. Based on the survey results, the current status of community-based mental healthcare services was investigated, and the direction of the revised model was established. The Delphi survey was then conducted to refine the revised model. CONCLUSION: The present study presents the Seoul-type community-based mental healthcare model with integrated services between a psychiatric hospital with a mental health welfare center as well as combined mental and physical health services. This is ultimately expected to help people with mental illnesses live healthy lives by meeting their needs as community members.

Psychosocial factors predicting symptoms of depression and anxiety in allogeneic hematopoietic stem cell transplant recipients in Japan.

OBJECTIVE: We explored whether a patient's psychosocial background before allogeneic hematopoietic stem cell transplantation (allo-HSCT) could predict the occurrence of psychiatric symptoms during treatment and after hospital discharge. METHOD: Logistic regression analysis was performed using INTERMED, a scale that comprehensively evaluates psychological factors such as psychiatric history, current mental status, and coping skills, and social factors such as social participation status, relationships with others, and living environment, which were used as independent variables. The Center for Epidemiologic Studies Depression Scale was used to measure depression, while the Profile of Mood States was used to measure anxiety and other symptoms. Both measures were used as dependent variables and were administered upon clean room admission, during clean room stay, at clean room discharge, and at 3, 6, and 12 months after hospital discharge. RESULTS: Participants included 70 patients (45 males and 25 females, mean age 53.3 ± 12.3 years). Thirty-eight patients participated in the program for the entire period, up to 12 months after hospital discharge. The total score on the Japanese version of the INTERMED and psychological factor scores assessed at baseline were significant predictors of depressed mood on discharge; however, there were no significant predictors of scores on the Profile of Mood States. CONCLUSIONS: A comprehensive pretransplant evaluation of psychosocial background can help predict the appearance of psychiatric symptoms after allo-HSCT. In patients who are expected to develop psychiatric symptoms after allo-HSCT, it is important to consider early intervention by a specialist and close monitoring by a medical team.

Impact Analysis of the Brazilian Suicide Prevention Campaign "Yellow September": an Ecological Study.

INTRODUCTION: Yellow September (YS) is a Brazilian suicide prevention campaign implemented in 2015, however, its effectiveness in reducing mortality is still unknown. MATERIAL AND METHODS: This is an ecologically interrupted time series study that analyses the evolution of suicide rates in Brazil between 2011 and 2019 and its association with the implementation of YS at a national level. Data was provided by the Mortality Information System. A segmented interrupted series regression analysis was performed, using a generalized linear Poisson model, with correction for seasonal trends. RESULTS: There was an increase in the annual rates of suicide deaths between 2011 and 2019, with 4.99 and 6.41 suicides per 100,000 inhabitants, respectively. The null hypothesis, that the YS did not change the historical trend of growth in suicides in Brazil after its implementation, was affirmed. However, there was an eventual significant increase of 6.2% in the risk of mortality in 2017 and of 8.6% in 2019. DISCUSSION: The results are consistent with the literature, which proposes that campaigns focused solely on publications through the media generate unsound findings regarding the effective reduction in the number of deaths by suicide. Conclusions: The lack of initiative in multisectoral actions may explain the failure of YS on changing deaths by suicide, therefore the development of new lines of action focused on training professionals and expanding the care network could make it an effective instrument in reducing mortality from suicide. CONCLUSIONS: The lack of initiative in multisectoral actions may explain the failure of YS on changing deaths by suicide, therefore the development of new lines of action focused on training professionals and expanding the care network could make it an effective instrument in reducing mortality from suicide.

Functional impairment and post-stroke depression: a 6-month longitudinal study.

BACKGROUND: In recent decades, considerable advances have been made in the treatment of acute ischemic stroke (IS) and its prevention. However, even after treatment, approximately two-thirds of patients with IS have some degree of disability that requires rehabilitation, along with an increased possibility of developing psychiatric disorders, particularly depression. OBJECTIVE: To determine the predictors of post-stroke depression in a 6-month period in patients with IS. METHOD: Ninety-seven patients with IS without previous depression were included in the study. The study protocol was applied during hospitalization and at 30, 90, and 180 days after hospital discharge. A binary logistic regression was then used. Age, sex, marital status, occupation, education, thrombolysis, National Institute of Health Stroke Scale, modified Rankin scale (mRS) score, Barthel index, and Mini-Mental State Examination score were included as independent variables. RESULTS: Of the 97 patients, 24% of patients developed post-stroke depression. In the longitudinal follow-up, an mRS score of > 0 was the lone significant predictor of depression development (odds ratio = 5.38; 95% confidence interval: 1.25-23.12; p < 0.05). CONCLUSION: Our results showed that in patients without previous depression, functional impairment of any degree has a 5-fold greater chance of leading to depression development in the first 6 months post-stroke as compared to that in patients without functional impairment.

Analyzing User-Generated Web-Based Posts of Adolescents' Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis.

BACKGROUND: Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking. OBJECTIVE: This study aimed to fill this knowledge gap through a new understanding of adolescents' cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice. METHODS: The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression. RESULTS: Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts. CONCLUSIONS: These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action.

Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet.

Introduction: The use of child sexual abuse material (CSAM) is an international public health and child protection challenge. Objective: To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users. Methods: We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019-2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre- to post-treatment, according to the Sexual Child Molestation Risk Assessment+. Results: A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18-29 [49]; 30-39 [30]; 40-49 [15]; 50-59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre- to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate -0.25, 95 % CI, -0.46 to -0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events. Conclusion: We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.

Mental Health Prevention and Promotion-A Narrative Review.

Extant literature has established the effectiveness of various mental health promotion and prevention strategies, including novel interventions. However, comprehensive literature encompassing all these aspects and challenges and opportunities in implementing such interventions in different settings is still lacking. Therefore, in the current review, we aimed to synthesize existing literature on various mental health promotion and prevention interventions and their effectiveness. Additionally, we intend to highlight various novel approaches to mental health care and their implications across different resource settings and provide future directions. The review highlights the (1) concept of preventive psychiatry, including various mental health promotions and prevention approaches, (2) current level of evidence of various mental health preventive interventions, including the novel interventions, and (3) challenges and opportunities in implementing concepts of preventive psychiatry and related interventions across the settings. Although preventive psychiatry is a well-known concept, it is a poorly utilized public health strategy to address the population's mental health needs. It has wide-ranging implications for the wellbeing of society and individuals, including those suffering from chronic medical problems. The researchers and policymakers are increasingly realizing the potential of preventive psychiatry; however, its implementation is poor in low-resource settings. Utilizing novel interventions, such as mobile-and-internet-based interventions and blended and stepped-care models of care can address the vast mental health need of the population. Additionally, it provides mental health services in a less-stigmatizing and easily accessible, and flexible manner. Furthermore, employing decision support systems/algorithms for patient management and personalized care and utilizing the digital platform for the non-specialists' training in mental health care are valuable additions to the existing mental health support system. However, more research concerning this is required worldwide, especially in the low-and-middle-income countries.

Finding Relevant Psychoeducation Content for Adolescents Experiencing Symptoms of Depression: Content Analysis of User-Generated Online Texts.

BACKGROUND: Symptoms of depression are frequent in youth and may develop into more severe mood disorders, suggesting interventions should take place during adolescence. However, young people tend not to share mental problems with friends, family, caregivers, or professionals. Many receive misleading information when searching the internet. Among several attempts to create mental health services for adolescents, technological information platforms based on psychoeducation show promising results. Such development rests on established theories and therapeutic models. To fulfill the therapeutic potential of psychoeducation in health technologies, we lack data-driven research on young peoples' demand for information about depression. OBJECTIVE: Our objective is to gain knowledge about what information is relevant to adolescents with symptoms of depression. From this knowledge, we can develop a population-specific psychoeducation for use in different technology platforms. METHODS: We conducted a qualitative, constructivist-oriented content analysis of questions submitted by adolescents aged 16-20 years to an online public information service. A sample of 100 posts containing questions on depression were randomly selected from a total of 870. For analysis, we developed an a priori codebook from the main information topics of existing psychoeducational programs on youth depression. The distribution of topic prevalence in the total volume of posts containing questions on depression was calculated. RESULTS: With a 95% confidence level and a ±9.2% margin of error, the distribution analysis revealed the following categories to be the most prevalent among adolescents seeking advice about depression: self-management (33%, 61/180), etiology (20%, 36/180), and therapy (20%, 36/180). Self-management concerned subcategories on coping in general and how to open to friends, family, and caregivers. The therapy topic concerned therapy options, prognosis, where to seek help, and how to open up to a professional. We also found young people dichotomizing therapy and self-management as opposite entities. The etiology topic concerned stressors and risk factors. The diagnosis category was less frequently referred to (9%, 17/180). CONCLUSIONS: Self-management, etiology, and therapy are the most prevalent categories among adolescents seeking advice about depression. Young people also dichotomize therapy and self-management as opposite entities. Future research should focus on measures to promote self-management, measures to stimulate expectations of self-efficacy, information about etiology, and information about diagnosis to improve self-monitoring skills, enhancing relapse prevention.

Delirium awareness day: a portuguese perspective.

Delirium is a syndrome characterized by impairment of awareness and inattention, that represents a change from the patient's baseline cognitive functioning. It is triggered by an underlying medical condition, reaching a prevalence of 24.7% in geriatric wards. However, undiagnosed delirium remains a reality among inpatient individuals, with an estimated frequency of 24.1%. The inappropriate knowledge of diagnostic criteria and standard screening tools was pointed out as a relevant contributing factor to this paradigm. Liaison Psychiatry Services guarantee psychiatric approach and treatment to patients attending general hospitals. Considering that older adult patient care requires a well-trained and skilled team, the Centro Hospitalar e Universitário de Coimbra has a Geriatric Psychiatry Liaison Service, where delirium is one of the prevailing clinical conditions assessed by this team. The International Delirium Awareness Day is going to be worldwide celebrated on the 11th of March. Given that delirium has been consistently associated with the economic burden and adverse outcomes this symbolic day works as a huge opportunity to raise insight into the preventive strategies that could be implemented among healthcare professionals, patients, and caregivers. Within the Portuguese National Health System there is a need to build a set of systematic epidemiological data about delirium prevalence and incidence in the different settings and it would be essential the employment of a multicomponent intervention package delivered by a multidisciplinary team trained and competent in delirium prevention into routine care.

Evaluation of a Digital Health Initiative in Illicit Substance Use: Cross-sectional Survey Study.

BACKGROUND: The Cracks in the Ice (CITI) community toolkit was developed to provide evidence-based, up-to-date information and resources about crystal methamphetamine to Australians. Given the high rates of internet use in the community and the potential for misinformation, CITI has the potential to play an important role in improving knowledge and challenging misconceptions surrounding crystal methamphetamine. OBJECTIVE: This study aims to determine (1) whether the CITI toolkit is achieving its aim of disseminating evidence-based information and resources to people who use crystal methamphetamine, their family and friends, health professionals, and the general community and (2) examine the association between the use of CITI and the knowledge and attitudes about crystal methamphetamine. METHODS: A cross-sectional web-based survey, open to Australian residents (aged ≥18 years), was conducted from November 2018 to March 2019. People who had previously visited the website (referred to as "website visitors" in this study) and those who had not ("naïve") were recruited. At baseline, knowledge, attitudes, and demographics were assessed. CITI website visitors then completed a series of site evaluation questions, including the System Usability Scale (SUS), and naïve participants were asked to undertake a guided site tour of a replicated version of the site before completing the evaluation questions and repeating knowledge and attitude scales. RESULTS: Of a total 2108 participants, 564 (26.7%) reported lifetime use of crystal methamphetamine, 434 (20.6%) were family/friends, 288 (13.7%) were health professionals, and 822 (38.9%) were community members. The average SUS score was 73.49 (SD 13.30), indicating good site usability. Health professionals reported significantly higher SUS scores than community members (P=.02) and people who used crystal methamphetamine (P<.001). Website visitors had significantly higher baseline knowledge than naïve participants (P<.001). Among naïve participants, knowledge scores increased following exposure to the website (mean 15.2, SE 0.05) compared to baseline (mean 14.4, SE 0.05; P<.001). The largest shifts in knowledge were observed for items related to prevalence, legal issues, and the effects of the drug. Stigmatizing attitude scores among the naïve group were significantly lower following exposure to CITI (mean 41.97, SE 0.21) compared to baseline (mean 44.3, SE 0.21; P<.001). CONCLUSIONS: This study provides an innovative evaluation of a national eHealth resource. CITI is achieving its aim of disseminating evidence-based, nonstigmatizing, and useful information and resources about crystal methamphetamine to key end user groups and has received good usability scores across its target groups. Interaction with CITI led to immediate improvements in knowledge about crystal methamphetamine and a decrease in stigmatizing attitudes. CITI demonstrates the important role of digital information and support platforms for translating evidence into practice and improving knowledge and reducing stigma.

Preventive psychiatry: a blueprint for improving the mental health of young people.

Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.

[Preventive psychiatry directions of early childhood]. / Napravleniya profilakticheskoi psikhiatrii rannego detskogo vozrasta.

Due to the increase in the frequency of mental pathology in the child population the issues of preventing mental disorders and protecting the mental health of early age children are becoming particularly relevant. To substantiate a new interdisciplinary direction of scientific and practical research-preventive psychiatry of early childhood and to identify priority areas for its development. The problems that arise when working with young children are analyzed. Algorithms for identifying deviations in mental development in young children and the gradual participation of psychiatrists in the interdepartmental provision of early care to children with the proposed author's diagnostic methods and methodological approaches are presented. The author substantiates the need to identify a new direction - early childhood psychiatry and identifies its main interdisciplinary areas, including: analysis of risk factors and prediction of developmental deviations, identification of children at risk; medical examinations, identification and diagnosis of developmental disorders in young children, the introduction of innovative diagnostic methods; dynamic monitoring of identified children at risk and assistance by an interdisciplinary team of specialists; support for families raising children at risk; training of specialists.

Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective.

As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients' home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients' home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.

Need to establish a new adolescent suicide prevention programme in South Korea.

Adolescent suicide is the leading cause of death among South Korean (Korean) youth. Despite great efforts being made towards suicide prevention in Korea, the suicide rate has not decreased significantly. There is an urgent need for a new adolescent suicide prevention strategy. This paper describes the seriousness of the issue of adolescent suicide in Korea, evaluates its current management by the SWOT analysis (strengths, weaknesses, opportunities and threats) and further recommends a new suicide prevention programme that integrates national/social involvement (State Suicide Intervention Committee, suicide posts' monitoring, parental divorce information sharing and Adolescence Mental Health Promotion Foundation), school-based programmes (continuous monitoring system, psychology consultation team and mental health educational curricula) and family-based programmes (parental education and family-school communication). In addition, genetic analysis, biochemical tests and psychological disease registration are the indispensable elements that aid in suicidal behaviour prevention and prediction.

O preventivismo e os homossexuais no contexto da ditadura militar brasileira: uma análise a partir das contribuições de Sérgio Arouca / Preventivism and homosexuals in the context of the Brazilian military dictatorship: An analysis based on Sérgio Aroucas contributions / El preventivismo y los homosexuales en el contexto de la dictadura militar brasileña: un análisis a partir de las contribuciones de Sérgio Arouca

No Brasil, a reforma da escola médica ancorada na medicina preventiva difundiu-se, em grande medida, durante a ditadura militar (1964-1985). O projeto preventivista é investigado aqui para além de uma reorganização curricular, estando imbuído de um papel social e político evidenciado, especificamente, pelo modo como caracterizou os homossexuais na ditadura militar. Foram analisadas publicações do "Jornal do Brasil" sobre congressos científicos que tematizaram o preventivismo no combate aos comportamentos desviantes na juventude, com destaque ao homossexualismo. A tese de Sérgio Arouca estruturou as principais discussões presentes e embasou a análise das publicações coletadas. Como resultado, os homossexuais, tidos como degenerados desde o século XIX, foram descritos como ameaças patológicas à família, à moral e à segurança nacional, sendo necessária a sua profilaxia a partir de recomendações médico-preventivas no ambiente escolar e familiar e da repressão política direta do Estado.(AU)

In Brazil, the medical school reform grounded on preventive medicine was disseminated, to a large extent, during the military dictatorship (1964-1985). The preventivist project is investigated here beyond a curricular reorganization, as it had a social and political role. This role was clearly visible, specifically, in the way in which it characterized homosexuals in the military dictatorship. We analyzed publications of the newspaper "Jornal do Brasil" about scientific conferences that focused on preventivism in the fight against youth's deviant behaviors, emphasizing homosexuality. Sérgio Arouca's doctoral dissertation structured the main discussions and grounded the analysis of the collected publications. As a result, homosexuals, seen as degenerate since the 19th century, were described as pathological threats to the family, morals and national security; thus, prophylaxis was necessary through medical-preventive recommendations in the school and family environments and through the State's direct political repression.(AU)

En Brasil, la reforma de la escuela médica anclada en la medicina preventiva se difundió, en gran medida, durante la dictadura militar (1964-1985). El proyecto preventivista se investiga aquí más allá de una reorganización curricular, incorporando un papel social y político. Este evidenciado, específicamente, por el modo en que caracterizó a los homosexuales en la dictadura militar. Se analizaron publicaciones del "Jornal do Brasil" sobre congresos científicos que tuvieron como tema el preventivismo en el combate a los comportamientos desviantes en la juventud con destaque para la homosexualidad. La tesis de Sérgio Arouca estructuró las principales discusiones presentes y sirvió de base al análisis de las publicaciones colectadas. Como resultado, los homosexuales, considerados como degenerados desde el siglo XIX se describieron como amenazas patológicas a la familia, a la moral y a la seguridad nacional, siendo necesaria su profilaxis por medio de recomendaciones médico-preventivas en el ambiente escolar y familiar y de la represión política directa del Estado.(AU)

Attitudes Toward Psychiatric Genetic Testing and Research: A Comparative Study Between Denmark and Cuba.

Introduction: Psychiatric genetic research has seen progress in identifying genetic risk variants associated with major mental disorders. Testing with preventive purposes is likely to be offered to high-risk individuals in the near future. It is important that genetic testing and counseling align with the interests of the patients, and these interests are likely to vary among countries and cultures. Aim: The present study aimed to compare the attitudes toward psychiatric genetic research and genetic testing in Denmark and Cuba. Materials and Methods: A survey, culturally adapted for each country, was administered to a pool of students, patients with depression, and the closest relatives of these patients. A total of 491 stakeholders from Denmark and 720 from Cuba were included in the study. Results: Significant differences between the two populations were found for general knowledge about psychiatric genetic research, whom to offer genetic testing, and to whom to entrust with psychiatric genetic information. Cuban stakeholders were more likely to feel uncomfortable about psychiatric genetic research than the Danish stakeholders. This difference might be driven by the characteristics of the health systems, sociocultural factors, and lower genetic literacy in the Cuban population. Conclusion: This study is the first to compare attitudes toward psychiatric genetic testing between a Latin American country and a Nordic country. The results reported could be valuable when designing general guidelines for psychiatric genetic testing in the future.