Intersection of anxiety and negative coping among Asian American medical students.

Purpose: Asian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students. Materials and methods: A survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American Medical Students Association enrolled in a United States medical school during the 2016-2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping. Results: A total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills. Conclusion: Professionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population.

Structural Barriers Associated with the Intersection of Traumatic Stress and Gun Violence: A Case Example of New Orleans.

Gun violence drastically increased in urban cities following the ease of shutdown restrictions associated with the Coronavirus Pandemic. The association of gun violence and COVID-19 has highlighted the importance of taking a public health perspective, particularly as it relates to impacts on the Black community. In this article we discuss macro-level factors and community traumas in the city of New Orleans, an area that has had longstanding issues related to gun violence. Community structural issues, traumatic stress from disasters, and recommendations to address disparities in social determinants of health are discussed.

Psychiatry's Dark Secrets: Black Lives Don't Matter.

There have been significant advances in the diagnosis and treatment of psychiatric disorders; however, racial disparities continue to create inequity in mental health care. In this commentary, we explore mental health disparities disfavoring African Americans in the psychiatric literature. We discuss how discrimination over time has resulted in a difference of perception, misdiagnoses, and conflicts in patient care. The literature reviewed reveals a pattern wherein African Americans are more likely to be misdiagnosed for all types of mental illness compared with other ethnicities due to fallacies perpetuated throughout the history of African Americans. In addition, the aggregation of current information and research on the current COVID-19 pandemic will justify future research on the epidemic of police brutality and shootings of unarmed African Americans. If we address this issue, we will reduce medical mistrust and ultimately reduce racial health inequities.

Ten-Year Review of the Extern Program: a Solution to an Unsuccessful Match?

OBJECTIVE: This paper presents an extern program, developed 10 years ago, which recruited unmatched medical graduates and involved them in publishing articles in academic journals, presenting poster presentations, writing grants, and networking with psychiatrists. The study examined how involvement in the extern program affected the candidates' Match reapplication outcome. METHODS: Respondents were previous externs who joined the extern program. They were sent questionnaires on how the program affected their Match reapplication outcome. RESULTS: Out of 22 externs surveyed, 15 completed the questionnaire. Results showed that the externship offered graduates opportunities in academic and clinical work, which improved their chances of getting a Match. The 15 respondents had a 100% match rate into a psychiatry residency program upon completing an average of 16 months of academic work in the externship. Respondents agreed that the extern program was beneficial, and they would highly recommend it to struggling medical graduates. CONCLUSIONS: Unmatched graduates urgently need guidance during the critical gap year. They should be given options and interventional plans, such as Dr. Rahn K. Bailey's extern program. The externship provides participants exposure to research and the scientific underpinnings of clinical medicine. It continues to expand and grow, serving unmatched medical graduates and students who need help getting into medical school or a PhD program. Further studies should be conducted on unmatched candidates, in particular, international medical graduates, who reapply and eventually match. This will provide information and insight into what they can do to advance themselves during the intervening period.

Racial and ethnic differences in depression: current perspectives.

Major depressive disorder (MDD) is among the most prevalent disorders in the US that often goes underdiagnosed and untreated. The burden of disability among those untreated is heaviest among untreated minority populations. Recent studies show that among African Americans, those with socioeconomic stress are less likely to report psychological symptoms or remain compliant with initiated treatment. While minority populations are less likely to suffer from acute episodes of MDD than Caucasians, they are more likely to suffer from prolonged, chronic, and severely debilitating depression with heavy consequences on their level of daily functioning. Part of the problem of underdiagnoses lies with the provider. Many providers today are unable to notice subtleties in presentation or recognize uncommon presentation of disease. This paper focuses on discrepancies in the presentation of depression among minorities when compared to Caucasians as well as factors that serve as boundaries for successful treatment.

Early Combination Therapy for Type 2 Diabetes Mellitus and Common Comorbid Mental Disorders.

The relationship between type 2 diabetes mellitus and antipsychotic use by schizophrenia patients is recognized but not well understood. This article reviews the literature regarding metabolic interactions, pathological pathways, and protocols for screening, monitoring, and using combination therapy for individuals with type 2 diabetes mellitus and common comorbid mental health conditions. Because primary care physicians manage patients with both mental and general medical illnesses, such as diabetes, understanding their perspectives on the challenges and facilitators of the care of these patients is critical to improving clinical outcomes. Although the relationship between type 2 diabetes mellitus and antipsychotic use by schizophrenia patients has been recognized, clinical guidelines for their treatment are not recent. Individuals with mental disorders present a vulnerable population with high medical needs that are often mistreated or missed. Given the significant contribution of metabolic syndrome and comorbid diabetes mellitus to morbidity and mortality of such patients, ongoing primary care should be coordinated between general practitioners and mental health professionals to prevent serious complications and adverse medication side effects.

Racial and Ethnic Disparity in Major Depressive Disorder.

Major depressive disorder (MDD) is one of the most common and disabling psychiatric disorders in the USA. Early diagnosis and appropriate treatment are extremely important to prevent disability and improve quality of life. Recent studies have demonstrated racial and ethnic disparities in the diagnosis and treatment of MDD. African Americans (AA), Hispanics, and Asian Americans were significantly less likely to receive a depression diagnosis from a health-care provider than were non-Hispanic whites. The underdiagnosis of MDD in minority groups may be due to differences in socioeconomic status (SES), care affordability, cultural beliefs about depression, help-seeking patterns, access to culturally and linguistically appropriate care, patient-physician relationship, clinical presentation of depression, etc. Meanwhile, the likelihood of both having access to and receiving adequate care for depression was significantly low for AA, Hispanics, and Asian Americans, in contrast to whites. Similar disparities also exist in treatment outcomes. Besides the reasons for MDD underdiagnosis, additional contributing factors include access barriers to preferred mode of treatment, cultural concerns about antidepressants and different metabolism of antidepressants, etc. There are many ways to address these disparities and improve MDD care in minority populations, including universal depression screening, public financial incentives to ensure access to care in low-income and minority neighborhoods, quality improvement programs, cultural competency of mental health professionals, collaborative care management, community engagement and planning, and enhanced participation of minorities in clinical research.

Frendak to phenis to breivik: an examination of the imposed insanity defense.

The imposition of the insanity defense is a complicated psycho-legal scenario. Globally, definitions of insanity differ from country to country. In a multitude of cases, a determination of insanity at the time of a criminal act means the offender will not be considered responsible for his or her action(s). In many jurisdictions, concerns have been raised that the insanity defense has been used to mitigate punishment, usually after a particularly heinous crime. In this review, the authors use three cases - Frendak, Phenis, and Breivik to demonstrate how the imposition of the insanity defense has been used for legal purposes in the past and present. In an effort to give more background to each of the above-mentioned cases, the writers have provided some details to aid comprehension. The authors offer recommendations for the ethical forensic evaluator unburdened by partisan allegiance and invested in the search for truth. This review article relies on peer-reviewed articles available from PubMed, Meharry Online Library, and legal dictionaries. We also cross-referenced reputable news sources to ensure the validity of the facts we present.

Misconceptions of depression in african americans.

Major depression is a very common disabling disorder. Although the relationship between race and depression is complex, depression affects all races, all ethnic and geographic locations as well as all age groups. The prevalence of depression in African Americans is controversial, due to the paucity of research. The deficit in the knowledge and skills in treating depression in African Americans have not been adequately addressed so far. Inadequate and insufficient data on African Americans contributes to the problems of under diagnoses, misdiagnosis, and under treatment of depression. This article will highlight the existing problem of depression in Afro American with a focus on diagnostic and treatment issues.

How to evaluate disability.

A disability assessment for non-therapeutic reasons is the most common evaluation requested of treating psychiatrists. Mental disorders affect approximately 20 percent of Americans each year. People who are unable to work need some financial assistance. As part of the system, it's our goal to assist them in this process. When a disability claim is filed, psychiatrists take into account the individual's impairments and disabilities. A psychiatrist's evaluation of disability involves knowledge and experience. There are many ethics related challenges, especially when performing disability evaluation of their own patients. Disability training should therefore be part of residency curriculum for training of psychiatry residents.

Collaboration: The Paradigm of Practice Approach between the Forensic Psychiatrist and the Forensic Psychologist.

The importance and relevance of forensic practice to societal evolution has increased exponentially in recent years. As society evolves in its understanding of the complex relationships between mankind and society, we rely more and more on the services of forensic experts. This article elucidates the professions of forensic psychiatry and forensic psychology. We examine the two distinct professions from the spectrum of collaboration, integration of services, differences, and similarities. We also compare and contrast the educational background and training requirements for these two professions; and present illustrative scenarios and real life examples of the daily functions of both professionals. Lastly, we present demographic data for the areas of employment, numbers, and geographic distribution of the two professions. Forensic psychiatry is the interface between medicine and law, while forensic psychology is the interface between psychology and law. As such, these professions are mired with complexities and challenged by vulnerabilities. Professionals from both fields can serve as expert witnesses in court and therefore face similar challenges in their course of professional practice. Collaboration between these two professions has the potential to increase both the credibility and utility of forensic services to the courts, the individuals served, and the general public.

Major depressive disorder in the African American population: meeting the challenges of stigma, misdiagnosis, and treatment disparities.

This article examines major depressive disorder (MDD) in the African American population. As prevalence rates and severity of depression in African Americans are investigated, the findings indicate many blacks are underdiagnosed. Further, African Americans seem to have more severe episodes of depression compared to Caucasians. Explanations for this difference are that African Americans with MDD often present with somatic symptoms, leading physicians to miss a MDD diagnosis. Depression is often stigmatized in the African American population, seen as a "personal weakness." Educating the community about depression and educating physicians to make cultural competent diagnoses are necessary. Treatment disparities emerge as African Americans are more likely uninsured, and many are nonresponsive to traditional pharmacological interventions for depression. African American and other ethnic groups differ in the way they metabolize selective serotonin reuptake inhibitors, leading physicians to have less of an understanding of how to treat the African American patients. The lack of minorities in research trials limits the number of effective medication to treat this population of patients.

Atypical psychotropic medications and their adverse effects: a review for the African-American primary care physician.

There are now five new-generation atypical psychiatric medications currently available. As these new treatments have become more common, they have grown to account for a significant percentage of all psychiatric medications prescribed. This is because of their efficacy in the treatment of several psychiatric disorders, ease of administration, and absence of the well-known extrapyramidal adverse effects long-attributed to the standard dopamine blocking anti-psychotic medications. As these medications have become treatments of choice, we have discovered additional information about their respective side effects. Issues such as bone marrow suppression, endocrine abnormalities, and most recently cardiac arrhythmia have produced concern. This paper will address all in an attempt to inform the primary care physician of the most prominent and clinically relevant adverse effects of these agents. A particular focus will address the increasing concern that these new medications can produce hyperglycemia and diabetes mellitus.

The civil commitment of sexually violent predators: a unique Texas approach.

Numerous states have enacted statutes focusing on the civil commitment of sexually violent predators. The Texas statute, like many others, calls for the involuntary commitment of those with a mental abnormality--specifically in Texas, a behavioral abnormality--who are likely to engage in predatory acts of sexual violence. All of these states, except Texas, have passed legislation creating inpatient treatment for those persons committed. Texas, instead, has focused exclusively on the use of outpatient treatment and supervision as an alternative to the route of inpatient commitment This article is focused on the development and implementation of the Texas statute with an emphasis on forensic assessment, expert testimony, and risk assessment.