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1.
Artigo em Inglês | MEDLINE | ID: mdl-38395108

RESUMO

BACKGROUND: There is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education. Although professional medical organizations' annual meetings play an instrumental role in continuing medical education for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for consultation-liaison psychiatrists. OBJECTIVE: To examine the ACLP annual meeting titles using Content Analysis. METHODS: We examined the publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. National DEI leaders from ACLP's DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting's content was independently coded by 2 members of the DEI subcommittee with discrepancies adjudicated by 2 additional members. Descriptive statistics were used to characterize the content of the annual meeting. RESULTS: Of the 2615 annual meeting titles from 2010 to 2021 that were analyzed, 2531 were not coded to have DEI themes. Three percent (n = 84) of titles were coded to have a DEI theme as follows: Culture/diversity (n = 20, 24%), bias/disparities (n = 17, 20%), race/racism (n = 17, 20%), social justice (n = 12, 14%), gender/sexism (n = 10, 12%), and LGBTQ+ (n = 8, 10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021) with an increase in DEI content in 2021 (n = 24, 17%). CONCLUSIONS: Although professional medical organizations like the ACLP are poised to leverage their continuing medical education platforms embedded in annual meeting programming to train consultation-liaison psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI-focused educational programming for their annual meetings.

3.
J Acad Consult Liaison Psychiatry ; 64(6): 574-575, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38065654
4.
J Acad Consult Liaison Psychiatry ; 64(4): 371-382, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36494065

RESUMO

Psychiatric comorbidities are common among patients approaching the end of life, often necessitating the involvement of consultation-liaison psychiatrists. We present the case of a patient with advanced metastatic prostate cancer and a complicated hospital course who made suicidal remarks and requested a hastened death. This common and challenging clinical scenario requires a multidisciplinary approach. In this article, experts in consultation psychiatry, palliative care, and psycho-oncology describe helpful diagnostic and therapeutic strategies for such cases. The key learning points are the differential diagnoses in end-of-life patients endorsing suicidal ideation, the psychiatric management of oncological and palliative care patients, the implementation of a safe discharge plan, and the role of the consultation-liaison psychiatrist in hospice care.

5.
J Acad Consult Liaison Psychiatry ; 64(3): 199-208, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36521681

RESUMO

BACKGROUND: In 2010, the Academy of Consultation-Liaison (then Academy of Psychosomatic Medicine) surveyed US residency programs to understand training in consultation-liaison (CL) psychiatry, leading to recommendations in 2014. Since then, residency training in CL has evolved in the context of competing training demands, increased prioritization of electives, and reactions to coronavirus 2019. OBJECTIVE: To determine the current state of residency training in CL across the United States, including the structure of core and elective resident rotations in CL, attending physician staffing, presence of fellows and other trainees, didactic curriculum, and impact of coronavirus 2019. METHODS: Members of the Academy of Consultation-Liaison Residency Education Subcommittee designed and piloted an 81-question survey tool that was sent to program directors of 269 US general psychiatry training programs for voluntary completion. RESULTS: One hundred three of 269 programs responded to the survey, yielding a response rate of 38.3%. Responding programs were larger and more likely to have a CL fellowship than nonresponding programs. Of the 103 responding programs, 82.5% have more than the minimally required time on CL, with 46.6% reporting an increase in total CL time in the past decade. Since 2010, 18.4% of responding programs changed the placement of the CL rotation, with 43.7% now adherent to the 2014 Academy of Psychosomatic Medicine recommendation to include core CL training in the second half of residency. Thirty-five percent of responding programs require residents to rotate on more than 1 CL service, and 19.4% have a required outpatient CL component. Faculty full-time equivalent varies widely. Of all services included, 33.8% report that all CL faculty are board-certified in CL psychiatry, whereas 18.7% have no board-certified faculty. Of the 103 responding programs, 36.9% offer a CL fellowship, but 31.1% report no residency graduates pursuing CL fellowships in the past 5 years. Of the included programs, 77.7% have a formal CL curriculum for residents, with 34.0% reporting a separate didactic series during the CL rotation. CONCLUSIONS: Among the responding programs, the amount of time spent on core CL rotations has increased in the past decade, but programs have also shifted CL training earlier in the course of residency. Residency programs are increasingly challenged to provide an optimal CL experience, and updated guidance from Academy of Consultation-Liaison may be appreciated.


Assuntos
Internato e Residência , Psiquiatria , Estados Unidos , Seguimentos , Psiquiatria/educação , Currículo , Encaminhamento e Consulta
6.
Psychosomatics ; 61(6): 645-654, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32778423

RESUMO

BACKGROUND: Determining the optimal timing and structure for a core residency rotation in consultation-liaison psychiatry (CLP) remains a key challenge for program directors and rotation leaders. Previous surveys have been conducted regarding these questions, and guidelines from national organizations have been issued, but practices remain varied among institutions. METHODS: We conducted a narrative review of the literature related to the timing of CLP rotations and generated consensus recommendations based on our experience as program directors, rotation leaders, and residents. RESULTS: Explicit goals of CLP training in residency include identifying and treating psychiatric manifestation of medical illness and communicating effectively with primary teams. Implicit goals of training may includeconflict management, limit setting, and "thinking dirty." DISCUSSION: Although CLP rotations earlier in residency often create a better fit within the overarching curriculum and allow for generating early interest in the field, significant amounts of supervision are required, and consultees may look to attendings as the primary consultant. Conversely, while later rotations are sometimes challenging to structure with other outpatient responsibilities, they allow for greater autonomy and may map better onto the informal curriculum. A hybrid model, with training spread across multiple years, is another approach that may mitigate some of the disadvantages of confining consultation-liaison training to a single year. Compelling arguments can be made for placing the core CLP rotation in postgraduate year 2 or 3 or using a hybrid model. Regardless of placement, program directors and rotation leaders should be mindful of tailoring the rotation to the trainees' developmental stage.


Assuntos
Educação Médica , Internato e Residência , Psiquiatria , Currículo , Humanos , Psiquiatria/educação , Encaminhamento e Consulta
7.
Psychosomatics ; 61(5): 436-449, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32650995

RESUMO

BACKGROUND: As mental health services in outpatient medical clinics expand, psychiatrists must be trained to practice in these settings. OBJECTIVES: The Academy of Consultation-Liaison Psychiatry residency education subcommittee convened a writing group with the goal of summarizing the current evidence about outpatient consultation-liaison psychiatry (CLP) training and providing a framework for CLP educators who are interested in developing outpatient CLP rotations within their programs. METHOD: MEDLINE (via PubMed), Embase, and PsycINFO (via OVID) were reviewed each from inception to December 2019, for psychiatric CLP services in ambulatory settings that involved residents or fellows. The CLP education guidelines were reviewed for recommendations relevant to outpatient CLP. We also searched MedEd portal for published curriculums relevant to CLP. The group held 2 conferences to reach consensus about recommendations in setting up outpatient CLP rotations. RESULTS: Seventeen articles, 3 Academy of Consultation-Liaison Psychiatry-supported guidelines, and 8 online didactic resources were identified as directly reporting on the organization and/or impact of an outpatient CLP rotation. These manuscripts indicated that residents found outpatient CLP rotations effective and relevant to their future careers. However, the literature provided few recommendations for establishing formal outpatient CLP training experiences. CONCLUSIONS: Outpatient CLP rotations offer multiple benefits for trainees, including exposure to specific clinical scenarios and therapeutic interventions applicable only in the outpatient setting, increased continuity of care, and the unique experience of providing liaison and education to non-mental health providers. The article outlines recommendations and examples for developing outpatient CLP rotations which CLP educators can incorporate in their programs.


Assuntos
Instituições de Assistência Ambulatorial , Internato e Residência/normas , Serviços de Saúde Mental , Pacientes Ambulatoriais , Psiquiatria/educação , Encaminhamento e Consulta/normas , Currículo/normas , Prestação Integrada de Cuidados de Saúde , Educação Médica , Humanos
8.
Psychosomatics ; 61(5): 411-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32425246

RESUMO

Background: With the rapid, global spread of severe acute respiratory syndrome coronavirus 2, hospitals have become inundated with patients suffering from coronavirus disease 2019. Consultation-liaison psychiatrists are actively involved in managing these patients and should familiarize themselves with how the virus and its proposed treatments can affect psychotropic management. The only Food and Drug Administration-approved drug to treat COVID-19 is remdesivir, and other off-label medications used include chloroquine and hydroxychloroquine, tocilizumab, lopinavir/ritonavir, favipiravir, convalescent plasma therapy, azithromycin, vitamin C, corticosteroids, interferon, and colchicine. Objective: To provide an overview of the major safety considerations relevant to clinicians who prescribe psychotropics to patients with COVID-19, both related to the illness and its proposed treatments. Methods: In this targeted review, we performed structured literature searches in PubMed to identify articles describing the impacts of COVID-19 on different organ systems, the neuropsychiatric adverse effects of treatments, and any potential drug interactions with psychotropics. The articles most relevant to this one were included. Results: COVID-19 impacts multiple organ systems, including gastrointestinal, renal, cardiovascular, pulmonary, immunological, and hematological systems. This may lead to pharmacokinetic changes that impact psychotropic medications and increase sensitivity to psychotropic-related adverse effects. In addition, several proposed treatments for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropics. Conclusions: Clinicians should be aware of the need to adjust existing psychotropics or avoid using certain medications in some patients with COVID-19. They should also be familiar with neuropsychiatric effects of medications being used to treat this disease. Further research is needed to identify strategies to manage psychiatric issues in this population.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Psicotrópicos/uso terapêutico , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Corticosteroides/efeitos adversos , Alanina/efeitos adversos , Alanina/análogos & derivados , Alanina/uso terapêutico , Amidas/efeitos adversos , Amidas/uso terapêutico , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/efeitos adversos , Ácido Ascórbico/efeitos adversos , Ácido Ascórbico/uso terapêutico , Azitromicina/efeitos adversos , Azitromicina/uso terapêutico , Betacoronavirus , COVID-19 , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Colchicina/efeitos adversos , Colchicina/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/terapia , Combinação de Medicamentos , Interações Medicamentosas , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Interferons/efeitos adversos , Interferons/uso terapêutico , Lopinavir/efeitos adversos , Lopinavir/uso terapêutico , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/complicações , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Psicotrópicos/efeitos adversos , Psicotrópicos/metabolismo , Pirazinas/efeitos adversos , Pirazinas/uso terapêutico , Ritonavir/efeitos adversos , Ritonavir/uso terapêutico , SARS-CoV-2 , Vitaminas/efeitos adversos , Vitaminas/uso terapêutico
9.
Focus (Am Psychiatr Publ) ; 17(3): 249-258, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32047370

RESUMO

The safety of pharmacotherapy for bipolar disorder during pregnancy and lactation remains a subject of debate and uncertainty. Clinicians must balance concerns about anatomical and behavioral teratogenicity, maternal mental health, exposure to multiple drugs, and heightened risks for peripartum mood episodes. Risk-benefit analyses must consider factors such as illness severity, past pregnancy treatment outcomes, known drug responsivity, psychosocial supports, and key windows during fetal development. Pharmacological decision making usually changes over the course of pregnancy, given developments in maternal physiology and critical relapse risk periods. Among mood stabilizers, given current research, many experts eschew divalproex and carbamazepine, consider lamotrigine relatively benign, and voice strong opinions for or against lithium. Most second-generation antipsychotics are considered relatively safe, apart from possible extrapyramidal and other motor signs of withdrawal after delivery. In this review, the authors analyze the practical questions, current controversies, and available evidence regarding psychotropic drug therapy during pregnancy and lactation in bipolar disorder.

10.
Clin Obstet Gynecol ; 61(3): 544-561, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29561284

RESUMO

Perinatal depression is associated with serious risks for the mother, baby, and family. When considering treating perinatal depression with a drug indicated for the treatment of depression, the major concerns are whether the drug increases the risks of teratogenicity, pregnancy complications, poor neonatal adaptation, or neurodevelopmental disorders. Although different studies have produced different results, the majority have not shown increases in risk for selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, or the noradrenergic/dopaminergic drug bupropion. In this review we will discuss the reproductive safety data for these medications as well as monoamine oxidase inhibitors and benzodiazepines.


Assuntos
Depressão/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos , Aborto Espontâneo , Antidepressivos Tricíclicos/uso terapêutico , Transtorno do Espectro Autista , Benzodiazepinas/uso terapêutico , Bupropiona/uso terapêutico , Desenvolvimento Infantil , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Inibidores da Monoaminoxidase/uso terapêutico , Síndrome da Persistência do Padrão de Circulação Fetal , Hemorragia Pós-Parto , Gravidez , Complicações na Gravidez/psicologia , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico
11.
Psychiatr Clin North Am ; 39(3): 375-89, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27514295

RESUMO

Adverse effects from psychiatric drugs can profoundly influence treatment adherence and outcomes. Good care involves addressing adverse effects no differently than any other component of treatment. Knowledge about adverse effect assessment and management fosters a proper context that helps clinicians not sacrifice a drug's potential therapeutic benefits because of greater concerns about its tolerability. This article provides an overview of basic concepts related to the assessment and management of suspected adverse effects from psychotropic drugs. Key points are discussed regarding clinical, pharmacogenetic, pharmacokinetic, and pharmacodynamic risk factors for treatment-emergent adverse effects, alongside recommendations for their systematic assessment.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Psicotrópicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Humanos
12.
Curr Psychiatry Rep ; 18(2): 13, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26781551

RESUMO

Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Bipolar/terapia , Eletroconvulsoterapia , Lactação , Período Pós-Parto , Complicações na Gravidez/terapia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Lamotrigina , Compostos de Lítio/uso terapêutico , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Risco , Triazinas/uso terapêutico , Ácido Valproico/uso terapêutico
13.
Fed Pract ; 33(Suppl 2): 26S-33S, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30766209

RESUMO

When does mania signal bipolar disorder, another medical illness, or the adverse effects of a prescribed antidepressant? And what are the next steps to manage this development?

14.
Psychosomatics ; 55(5): 438-49, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25016348

RESUMO

BACKGROUND: The Accreditation Council of Graduate Medical Education (ACGME) mandates that residents in psychiatry training programs learn to provide psychiatric consultation to other medical and surgical services. The ACGME, however, offers little information to instruct academic faculty and institutions to what constitutes a quality educational experience in psychosomatic medicine/consultation-liaison psychiatry for the resident trainee. METHODS: These recommendations were developed through a collaborative process between educators in C-L psychiatry and members of the Academy of Psychosomatic Medicine's Residency Education Subcommittee. RESULTS: This manuscript provides a broad framework for what constitutes a well-rounded clinical and academic resident rotation on psychiatric consultation-liaison services. A rotation that is viewed positively by residents is important as it likely provides a foundation for a growing interest in Psychosomatic Medicine and the development of future fellows and subspecialty trained physicians.


Assuntos
Educação de Pós-Graduação em Medicina/normas , Internato e Residência , Medicina Psicossomática/educação , Currículo/normas , Humanos , Estados Unidos
16.
Psychiatr Serv ; 58(4): 561-5, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17412862

RESUMO

OBJECTIVE: Suicidal ideation frequently prompts visits to psychiatric emergency departments, and more information is needed about factors that mediate clinicians' decisions to hospitalize or discharge patients with suicidal ideation. METHODS: The authors reviewed records for 257 patients presenting with suicidal ideation to a psychiatric emergency service. Demographic and clinical correlates of hospitalization were examined by backward stepwise binary logistic regression. RESULTS: Hospitalization occurred for 70% of suicidal persons and was significantly associated with psychosis, a history of attempted suicide, and a suicidal plan. With potential confounding factors controlled, these variables correctly classified 80% of hospitalization decisions. CONCLUSIONS: Psychosis, past suicide attempts, and the presence of a suicide plan robustly predicted the decision to hospitalize suicidal persons seen in psychiatric emergency services. Diagnosis, pharmacotherapy, having a psychiatrist, and insurance subtype were unrelated to hospitalization decisions, suggesting that psychiatric emergency department staff perceive few alternatives to hospitalization when psychosis and suicide plans accompany suicidal ideation.


Assuntos
Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Prevenção do Suicídio , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Comorbidade , Feminino , Hospitais Comunitários , Hospitais de Ensino , Humanos , Masculino , Massachusetts , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Estatística como Assunto , Suicídio/psicologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
17.
J Clin Psychiatry ; 67(5): 720-6, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16841621

RESUMO

OBJECTIVE: Considerable debate exists about the value and wisdom of initiating "definitive" pharmacotherapies, particularly antidepressants, in the psychiatric emergency setting. We evaluated the nature and prevalence of medication prescriptions for patients discharged from an urban psychiatric emergency service and the extent to which pharmacotherapy initiation was predictive of follow-through with aftercare. METHOD: Records were reviewed for 675 consecutive individuals evaluated and discharged from a community-based psychiatric emergency service over a 3-month period (January 2003-March 2003). Information was obtained regarding diagnoses, past and current treatments, and demographic and clinical features, as well as outcomes for the subgroup of patients who received aftercare appointments within the institutional system. RESULTS: Fifty-five percent of psychiatric emergency service visits resulted in discharge, with psychotropic drug prescriptions given to about 30% of this group. Prescriptions most often included antidepressants (64%), benzodiazepines (25%), nonbenzodiazepine sedatives (20%), anti-psychotics (18%), and mood stabilizers (10%). After controlling for potential confounders, the decision to prescribe was significantly associated with a clinical diagnosis of major depressive disorder or bipolar disorder and the preexisting use of psychotropic medications. Nonprescribing occurred most often in discharged patients who had suicidal ideation, substance abuse or dependence, and an existing outpatient psychiatrist. Follow-up emergency service and new outpatient appointments were more often given to patients discharged with a prescription, but follow-through with aftercare was not more likely in this group. CONCLUSIONS: Psychiatrists in an emergency service prescribe antidepressants or other major psychotropics for about one third of discharged patients, rarely in the presence of suicidality or substance abuse or dependence, and with little evidence that initiating such medications in the emergency setting promotes more successful bridging to outpatient treatment.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adulto , Assistência ao Convalescente/métodos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Agendamento de Consultas , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Uso de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Massachusetts/epidemiologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Alta do Paciente , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/métodos , Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Suicídio/psicologia
18.
Am J Physiol Regul Integr Comp Physiol ; 291(5): R1457-64, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16840656

RESUMO

For both different individuals and modes of locomotion, the external forces determining all-out sprinting performances fall predictably with effort duration from the burst maximums attained for 3 s to those that can be supported aerobically as trial durations extend to roughly 300 s. The common time course of this relationship suggests a metabolic basis for the decrements in the force applied to the environment. However, the mechanical and neuromuscular responses to impaired force production (i.e., muscle fatigue) are generally considered in relation to fractions of the maximum force available, or the maximum voluntary contraction (MVC). We hypothesized that these duration-dependent decrements in external force application result from a reliance on anaerobic metabolism for force production rather than the absolute force produced. We tested this idea by examining neuromuscular activity during two modes of sprint cycling with similar external force requirements but differing aerobic and anaerobic contributions to force production: one- and two-legged cycling. In agreement with previous studies, we found greater peak per leg aerobic metabolic rates [59% (+/-6 SD)] and pedal forces at VO2 peak [30% (+/-9)] during one- vs. two-legged cycling. We also determined downstroke pedal forces and neuromuscular activity by surface electromyography during 15 to 19 all-out constant load sprints lasting from 12 to 400 s for both modes of cycling. In support of our hypothesis, we found that the greater reliance on anaerobic metabolism for force production induced compensatory muscle recruitment at lower pedal forces during two- vs. one-legged sprint cycling. We conclude that impaired muscle force production and compensatory neuromuscular activity during sprinting are triggered by a reliance on anaerobic metabolism for force production.


Assuntos
Ciclismo/fisiologia , Metabolismo/fisiologia , Fadiga Muscular/fisiologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Resistência Física/fisiologia , Adulto , Limiar Anaeróbio/fisiologia , Eletromiografia , Humanos , Masculino , Contração Muscular/fisiologia , Consumo de Oxigênio/fisiologia
19.
Am J Psychiatry ; 163(5): 919-26, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16648336

RESUMO

OBJECTIVE: With the explosion of research in psychiatric neuroscience, the extent and means by which neuroscientific progress will translate into clinical care remains largely uncertain. The authors sought to determine how this dilemma is currently being played out in residency training programs, in which training directors must decide how best to integrate neuroscience teaching in a rapidly changing clinical landscape. METHOD: The authors surveyed U.S. and Canadian psychiatry residency training directors to characterize current and future trends in neuroscience education and to examine training directors' views on the relevance of neuroscience to clinical practice. RESULTS: The amount of neuroscience in residency curricula has increased significantly over the past 5 years, and further increases are expected in each specific neuroscience content area examined. While most training directors agreed that training in neuroscience was important for all residents, even those becoming primarily psychotherapists, relevance to future (but not current) practice was consistently cited as a motivating factor. CONCLUSIONS: While psychiatric residency programs continue to increase the neuroscience content of their curricula, it remains unclear how this added training will influence clinical work. Reframing current practices, including psychotherapy, into a neuroscientific context may ultimately prove more useful to trainees.


Assuntos
Internato e Residência/tendências , Neurociências/educação , Psiquiatria/educação , Ensino/tendências , Canadá , Competência Clínica/normas , Currículo/normas , Currículo/tendências , Humanos , Internato e Residência/organização & administração , Neurociências/tendências , Prática Profissional/tendências , Avaliação de Programas e Projetos de Saúde , Psiquiatria/tendências , Psicoterapia/educação , Inquéritos e Questionários , Ensino/organização & administração , Estados Unidos
20.
Curr Psychiatry Rep ; 8(3): 215-22, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19817072

RESUMO

This article takes stock of how far the field of consultation-liaison psychiatry has come since its inception in the 20th century. In order to do this, we review its past in terms of its knowledge base in psychosomatic medicine and in terms of its practice at the bedside in the general hospital setting. We also offer a contemporary account of the field and finish with a subjective view of the opportunities and pitfalls faced during the next phase of consultation-liaison psychiatry in the 21st century.


Assuntos
Hospitais Gerais/história , Unidade Hospitalar de Psiquiatria/história , Psiquiatria/história , Medicina Psicossomática/história , Encaminhamento e Consulta/história , Pesquisa Biomédica/tendências , Previsões , História do Século XIX , História do Século XX , História do Século XXI , Hospitais Gerais/tendências , Humanos , Unidade Hospitalar de Psiquiatria/tendências , Psiquiatria/tendências , Medicina Psicossomática/tendências , Encaminhamento e Consulta/tendências , Apoio à Pesquisa como Assunto/tendências , Estados Unidos
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