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PubMed1993

Geriatric psychiatry: training guidelines and their application. Section on Geriatric Psychiatry of the Canadian Psychiatric Association.

Geriatric psychiatry is now a mandatory part of psychiatric residency education in Canada. Educational requirements in geriatric psychiatry were updated by the Royal College of Physicians and Surgeons of Canada in 1988, and guidelines were developed in more detail in 1989 by the Section on Geriatric Psychiatry of the Canadian Psychiatric Association (CPA). These guidelines are presented here together with a survey, conducted in the fall of 1991, of all 16 Canadian psychiatry residency programs. Thirteen of the training centres now require residents to have a formal rotation in geriatric psychiatry, generally three months in length. Residents are exposed to elderly patients in other services, such as consultation/liaison, but these services may not include formal teaching in geriatric psychiatry. Most programs have a seminar series in geriatric psychiatry and have training guidelines similar to those of the CPA. However, it is not clear how closely these are being followed, since it was felt in almost one-third of all programs that there was an insufficient number of teachers to fulfill the training requirements. In addition, a number of training directors felt that the objectives were too comprehensive to be met in the three month period. Earlier studies in the field are reviewed, implications of the current findings are discussed, and suggestions are made for further research.

Canada↗
PubMed2004

Emergency psychiatry training for third-year medical students as reported by directors of medical student education in psychiatry.

BACKGROUND: Physicians can expect to confront a variety of psychiatric emergencies during their careers. However, medical schools are not required to teach emergency psychiatry and little is known about the content of existing instruction. PURPOSES: We conducted this survey to better understand the emergency psychiatry experiences provided to 3rd-year medical students. METHODS: Directors of medical student education in psychiatry at U.S. medical schools were mailed a 1-page questionnaire about their school's instruction in emergency psychiatry. RESULTS: We received 74 responses from the 122 U.S. medical schools (61%). All but 4 reported emergency psychiatry instruction. The number of hours and type of settings students were on-call varied greatly from school to school, as did the scope of faculty supervision. CONCLUSIONS: Most schools provide emergency psychiatry instruction, but methods vary among institutions. Given its importance, medical schools should work to provide uniformity in the way emergency psychiatry is taught.

Analysis of Variance↗
PubMed2005

The effect of a clinical posting in psychiatry on the attitudes of medical students towards psychiatry and mental illness in a Malaysian medical school.

INTRODUCTION: The stigma attached to mental illness and the mentally ill is a universal phenomenon and a major barrier to the provision of mental health services. Stigmatising attitudes among doctors themselves can result in compromised patient care. The aim of this research project is to study the impact of a clinical posting in psychiatry on the attitudes of medical students to mental illness and to psychiatry. This paper reports the results of the first phase of a longitudinal study. MATERIALS AND METHODS: A total of 122 year 4 medical students responded to this study. The Attitudes Towards Mental Illness (AMI) and Attitudes Towards Psychiatry (ATP) questionnaires were administered before and after an 8-week attachment in psychiatry. RESULTS: We found that students had somewhat favourable attitudes towards psychiatry and mental illness at the start of their attachment, with a mean score of 108.34 on ATP (neutral score, 90) and 68.24 on AMI (neutral score, 60). There was a significant increase in the mean scores of both scales following the psychiatric attachment for female students (ATP: P = 0.003; AMI: P <0.0005), but not male students (ATP: P = 0.435; AMI: P = 0.283). CONCLUSIONS: An 8-week clinical posting of fourth-year medical students in psychiatry was associated with an increase in positive attitudes to mental illness and to psychiatry among female students but not among male students.

Attitude of Health Personnel↗
PubMed2004

Geriatric psychiatry versus general psychiatry inpatient treatment of the elderly.

OBJECTIVE: The authors compared the clinical treatment given older psychiatric inpatients on a geriatric psychiatry unit and a general psychiatry unit. METHOD: The charts of 50 randomly selected general psychiatry inpatients over the age of 65 years and 50 inpatients from the geriatric psychiatry unit who were matched for age, gender, and primary diagnosis were reviewed. RESULTS: Significantly greater percentages of older inpatients treated on the geriatric psychiatry unit received complete organic medical workups, structured cognitive assessment, aging-sensitive aftercare referral, and monitoring of psychopharmacological side effects and blood levels than comparable patients on a general psychiatry unit. CONCLUSIONS: Geriatric psychiatry subspecialty inpatient care appears to be associated with distinct clinically relevant assessment and treatment advantages. Continuing geropsychiatric education of general psychiatrists is indicated.

Aged↗
PubMedDate not supplied

Child and adolescent psychiatry in general children's hospitals. A survey of chairs of psychiatry.

This article characterizes the academic, administrative, clinical service, and fiscal characteristics of departments of psychiatry in traditional children's hospitals to determine the characteristics of fiscally successful programs. A survey of chairs of psychiatry from short-term general children's hospitals was conducted based on 38 questions addressing the descriptive characteristics of their respective departments. The characteristics of psychiatry programs identified as fiscally successful were compared to those of programs that required subsidy. Nine of 45 eligible children's hospitals (20%) did not have a department or section of psychiatry, and surveys were returned by 35 of 36 department chairs (97% response). Considerable variation exists in the academic, administrative, clinical services, and fiscal characteristics of programs, although over half are operating at a deficit. Fiscal success was associated with availability of inpatient and intermediate levels of psychiatric care, better integration of the psychiatry program within the children's hospital, and adequate fiscal information being provided to the psychiatry chair. Additional research regarding the potential of psychiatric services to generate clinical success and cost savings is warranted. Pediatric health care professionals and third-party payers should be educated regarding the relevance of psychiatric services within children's hospitals and in physically ill children.

Adolescent↗
PubMed1989

Psychiatry and internal medicine resident education in an acute care medical-psychiatry unit.

A Medical-Psychiatry Program has been developed at the University of Iowa. It includes a medical-psychiatry unit, a medical-psychiatry lecture series, a medical-psychiatry residency program, and a medical-psychiatry fellowship. The program enables residents pursuing straight psychiatry or internal medicine training to participate in a rotational experience requiring that they evaluate and treat patients for illnesses in both specialties under the supervision of both a staff psychiatrist and internist. During the rotation the resident learns how psychiatric and medical disease in the same patient complicates patient care and the skills needed to diagnose and treat such patients in the climate of their own specialty. The rotation is considered a valuable training experience by the majority of residents going through the rotation.

Combined Modality Therapy↗
PubMed2002

Shrinking away from psychiatry? A survey of Australian medical students' interest in psychiatry.

OBJECTIVE: We sought to examine the attitudes of newly recruited medical students towards psychiatry and other specialties to determine what factors influence their career choice options. METHOD: We surveyed the attitudes of 655 medical students using a 31-item self-report questionnaire. RESULTS: Australian medical students rated the ability to help patients as the most important aspect of a specialty in determining their choice. Attraction to psychiatry was based on the specialty being interesting and intellectually challenging,and providing a career that promised job satisfaction with good prospects and enjoyable work. Females expressed a greater interest in psychiatry and were more likely to consider pursuing it as a career, principally due to a greater interest in the subject matter and a stronger desire for interaction with patients. The least attractive aspects of psychiatry were its lack of prestige among the medical community and a perceived absence of a scientific foundation. CONCLUSION: The attitudes of medical students can perhaps be modified and recruitment into psychiatry enhanced by presenting the reality of psychiatry today - namely the wide range of available therapeutic processes, the predominantly positive outcomes, the interesting and intellectually challenging nature of the subject and its nurturing and accommodating work environment.

Adult↗
PubMedDate not supplied

Medical students' perceptions of child psychiatry: pre- and post-psychiatry clerkship.

OBJECTIVE: The U.S. is facing a severe shortage of child and adolescent psychiatrists (CAPs). While medical students have been relatively disinterested in psychiatry, little research has examined their perceptions of CAP. The present study examined student perceptions of CAP and general psychiatry, and whether these perceptions changed during the psychiatry clerkship. METHODS: Students completed questionnaires assessing their perceptions of CAP and general psychiatry as a career choice on the first and last day of their clerkship. RESULTS: The opportunity to help children was most frequently perceived to be a positive aspect of CAP. The most frequently reported negative aspects were that CAP is emotionally stressful, a perception that decreased during the clerkship, and that there is a lack of family/societal support for children, a perception that increased during the clerkship. More students reported that CAP is respected compared to general psychiatry. Students estimated CAP salaries to be higher than general psychiatry salaries, but only at the end of the clerkship. CONCLUSIONS: Implications for the recruitment of medical students into CAP are discussed, including the potential importance of exposing students to diverse patient populations and requiring a CAP experience during the clerkship.

Adult↗
PubMed2003

Psychiatry beyond the asylum: the origins of German military psychiatry before World War I.

This study examines the co-operation between psychiatry and the army in Germany between 1870 and 1914, leading to the establishment of military psychiatry as an independent discipline. Arguing that military psychiatry played a key role in the history of modern clinical psychiatry, the paper points out how the first generation of military psychiatrists developed innovative diagnostic technologies, such as the intelligence test, and established crucial institutional alliances between psychiatric clinics, military authorities, and local and national administrations. The early history of military psychiatry marks the transition of psychiatry from a medical sub-discipline to a more generally applicable "social technology" assessing the borderline between normality and abnormality in multiple social contexts.

Germany↗
PubMed1998

From consultation-liaison psychiatry to psychosocial advocacy: maintaining psychiatry's scope.

OBJECTIVE: To review the status of consultation-liaison (C-L) psychiatry and the forces shaping it, and to propose strategies for dealing with the crisis in which it finds itself. METHOD: A Medline search of C-L psychiatry and related terms, together with hand-searching of C-L psychiatry and psychosomatic journals and bibliographies of found articles, was used for the literature base. The experience of membership of the committees of national and international C-L psychiatry organisations and their interaction with health care administrators was used as the basis for the discussion of strategies. RESULTS: It is argued that patients with physical/psychiatric comorbidity and somatisation have been marginalised by application of narrow definitions of what constitutes 'serious mental disorder' in the public sector. Evidence is presented to support the argument that physical/psychiatric comorbidity is the most common form of psychiatric presentation in the community, that such comorbidity has serious consequences in terms of morbidity, mortality and health-care costs, and that even subthreshold psychiatric symptoms have serious implications when physical comorbidity exists. CONCLUSION: It is concluded that a number of strategies, including pre-admission screening, integrated discharge planning, liaison, as well as shared care with general practitioners, advanced training in C-L psychiatry and more research to establish practice guidelines, are required if psychiatry is to remain a broad-based discipline rather than retreat to being a specialty for psychosis. Consultation-liaison psychiatrists must become the advocates for the psychosocial system.

Australia↗
PubMed2005

[Forensic psychiatry. Its relations to clinical psychiatry and criminology].

A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

[Social psychiatry in the field of contrasting context between psychiatry and Social Medicine].

OBJECTIVE: There has been a discussion going on that Social Psychiatry has entered a state of crisis in terms of its socio-scientific roots. Little is known, however, about its relationship to Social Medicine. The question is whether Social Psychiatry, having grown apart from Sociology, has also lost its scientific relation to Social Medicine. METHOD: A systematic literature analysis of all works published in "Psychiatrische Praxis" - PP and "Das Gesundheitswesen"--GHW in the years 2004/2005 was done. All works concerning Social Psychiatry were analysed. The same procedure was applied to all abstracts, posters and presentations for the annual meetings of the German Society of Social Medicine and Prevention (DGSMP). RESULTS: 10 % off all articles published in GHW and 97 % in PP address issues of Social Psychiatry. Apart from similarities in terms of their theoretical, practical and institutional background and the research methods applied, there are a number of differences. CONCLUSIONS: Social Psychiatry has not lost its scientific relation to Social Medicine, however, the scientific cooperation between the two needs to be intensified.

Community Psychiatry↗
PubMed1976

Comparison of the psychiatry learning system and traditional teaching of psychiatry.

Pressures of time, changing curricula, and increased enrollment in medical schools require the development of more efficient teaching methods to replace or supplement the traditional lecture format. The faculty of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina has developed an individualized course in basic psychiatry which can replace approximately 50 hours of lectures ordinarily delivered to students during the rotation on clinical psychiatry. The individualized course, referred to as the Psychiatry Learning System (PLS), was received by half the class during the year 1973-74, and the lecture course was delivered to the other half. These two groups were compared on several learning outcomes, including attainment of theoretical knowledge about psychiatry, observational skills, interviewing ability, and problem-solving ability. Overall performance ratings by clinical supervisors were also obtained. The PLS group scored no worse on any of the measures but statistically better on half of them than did the lecture group.

Education, Medical, Undergraduate↗
PubMed1996

How well does the psychiatry residency in-training examination predict performance on the American Board of Psychiatry and Neurology. Part I. Examination?

OBJECTIVE: Scores on the American College of Psychiatrists' Psychiatry Residency In-Training Examination (PRITE) were correlated with scores on the American Board of Psychiatry and Neurology (ABPN) Part I examination in psychiatry. METHOD: Pearson correlations between 1992 PRITE scores and 1994 ABPN Part I psychiatry scores were calculated. Analyses were based on 701 examinees. RESULTS: There was a moderate correlation between scores on the PRITE and ABPN Part I examination in psychiatry and a low correlation of neurology scores. CONCLUSIONS: These correlations were observed even though the two examinations differ in their purposes, content outlines, development, and administration.

Educational Measurement↗
PubMedDate not supplied

Training in tobacco treatments in psychiatry: a national survey of psychiatry residency training directors.

OBJECTIVE: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. METHOD: The authors recruited training directors to complete a survey of their program's curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents' skills for addressing nicotine dependence in psychiatric patients. RESULTS: Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents' skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. CONCLUSIONS: The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.

Adult↗
PubMedDate not supplied

Quo vadis, psychiatry? Problems and potential for the future of medical student education in psychiatry.

Psychiatric education occupies a relatively low status level in most academic departments of psychiatry. This problem may be in part because career teachers rarely generate sustained external grant support. Their salaries may be regarded as perpetual drains on the budgets of department chairs. The author explores a possible relationship between the decline in the emphasis on psychiatric education and the decline in the number of medical students entering psychiatric residency programs. Recommendations for improvement in the support of psychiatric education are made that focus on greater accountability of how tuition fees are distributed to support the salaries of faculty educators. The unique role that consultation-liaison (C-L) psychiatry occupies in psychiatric education, the effects of managed care on C-L psychiatry, and the special problems that C-L psychiatry currently faces with its strong emphasis on non-reimbursable educational activities are discussed. Revitalization of the importance of education in undergraduate medical education is vital for the future of psychiatry.

Career Choice↗
PubMed2005

Race, culture and psychiatry: a history of transcultural psychiatry.

The term 'transcultural psychiatry' has encompassed changing notions of race, culture and psychiatry and, as a result, it is a difficult concept to define. For a long time psychiatrists and social scientists have been commenting on how the psyches and psychiatric illnesses differ in non-White populations. However, transcultural psychiatry was not created as a distinct discipline until after World War II. This article will attempt to tell the story of transcultural psychiatry, charting its genesis in the aftermath of World War II, and then go on to describe how it has taken different forms in response to developments within psychiatry and wider sociocultural changes.

Cross-Cultural Comparison↗
PubMed1989

Forensic psychiatry: a subspecialty. The presidential address at the nineteenth annual meeting of the American Academy of Psychiatry and the Law.

The implications of the definition of forensic psychiatry are explored, with particular reference to the field as a subspecialty of general psychiatry. The allegation of undue moral uncertainty in forensic psychiatry is denied and the moral issues are revealed to be related to the status of the underlying philosophical disputes. An outline for the organization of the forensic psychiatric assessment is presented. The charge that forensic psychiatry is not as "hard" a science as the other forensic sciences is denied. The administrative and political organizational problems facing the subspecialty are explored. The practitioners in the field are encouraged to recognize that forensic psychiatry is a subspecialty and to work for official subspecialty status. Cautious predictions about the future of the field are provided.

Academies and Institutes↗