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Is there social psychiatry beyond psychiatry itself?

The contention of this review is to stress that from its inception psychiatry, as medicine in general, was concerned with social aspects of problems it was called upon primarily to deal with. Social psychiatry can consequently be only a variation of psychiatry in danger of laicization, to the point of becoming a 'false creed' rather than a field of consistent research. The pull, the vague 'social sciences' exert on psychiatry at this instance, could be hazardous.

Community Psychiatry↗

[Biological child and adolescent psychiatry and social psychiatry: controversies and comments].

There is an ongoing debate in the child and adolescent psychiatry on the question of 'nature or nurture', as it was pointed out many years ago by Michael Rutter (1986). Newer studies anchored in both areas support hypotheses of mutual interferences and give biological explanations for social behavior. To date, it is no question anymore, whether biological child and adolescent psychiatry and social psychiatry are contradictory or in line. They are in a steady process, look at the same development, the same symptom from different points of view. They describe it with concepts, which are not understood from the other position, because of different contexts and possible because of ideologic influences. The goal must be to find a common language--especially with respect to the patient.

Adolescent↗

Combined internal medicine-psychiatry and family medicine-psychiatry training programs, 1999-2000: program directors' perspectives.

PURPOSE: Despite tremendous growth in the number of combined-training residency programs, little is known about their directorships, financing, recruitment, curricula, and attrition rates, and the practice patterns of graduates. The authors surveyed residency program directors from combined internal medicine-psychiatry (IM/PSY) and family medicine-psychiatry (FP/PSY) programs to provide initial descriptive information. METHOD: Programs' directors were determined from the American Medical Association's Graduate Medical Education Directory and FREIDA online database. Three mailings of a pretested questionnaire were sent to the 40 identified combined IM/PSY and FP/PSY residency programs. RESULTS: A total of 32 directors from 29 programs responded. Most programs were under the dual directorship of representatives from both the psychiatry department and either the internal medicine or the family medicine program. Although most directors responded that the residency program was based in psychiatry, both departments shared in administrative, recruiting, and financial responsibilities. Curricula varied widely, with limited focus on combined training experiences. Graduates (n = 41) tended to practice in academic settings (37%), where both aspects of training could be used. Others practiced in either community mental health centers or traditional private practice settings. The estimated attrition rate from combined residencies was 11%. CONCLUSIONS: Combined-training programs are directed by a diverse group of individuals, including dual-boarded physicians. Curricula vary widely, but most programs are within recommended guidelines. Further prospective studies are warranted to determine predictors of attrition and future practice plans.

Attitude of Health Personnel↗

What should psychiatry residents be taught about neurology?: A survey of psychiatry residency directors.

OBJECTIVES: To improve our ability to teach psychiatry residents during their required 2 months on neurology rotations, we investigated the perceived needs of psychiatry program training directors. METHODS: We contacted the program directors organization of the American Psychiatric Association and disseminated a web-based survey to all program directors. The survey asked questions about the format and content of neurology training desired for psychiatry residents. The survey was sent a second time to increase response rate. RESULTS: Sixty (32%) training directors responded. Overall satisfaction with neurologic education was rated at 3.6 out of 5 (standard deviation +/- 0.96). The specific content areas which elicited the most interest for focused training modules were differential diagnosis and biologic substrates of dementia, evaluation and treatment of drug-related and spontaneous movement disorders, evaluation and management of sleep disorders, cognitive and mood effects of stroke, and inherited disorders. Many program directors commented on perceived weaknesses of inpatient-based exposure to neurology; 78% of responders favored outpatient and consultation settings. CONCLUSIONS: In an era of deliberation about neurobehavioral integration and cross-training of neurologists and psychiatrists, neurologists should strive to provide the best possible multidisciplinary education to psychiatry trainees.

Attitude of Health Personnel↗

["A research institute for psychiatry...". The development of the German Research Institution for Psychiatry in Munich between 1917 and 1945].

The "Deutsche Forschungsanstalt für Psychiatrie" (DFA) in Munich, one of the most important research institutes in the field of theoretical and clinical psychiatry was founded in 1917 by Emil Kraepelin. Its financial existence between the World Wars was guaranteed by enormous donations from the jewish American James Loeb. The scientific work done by Walther Spielmeyer (neuropathology), Felix Plaut (serology), Kurt Schneider (clinical psychiatry) and Ernst Rüdin (psychiatric genetics) earned the DFA the reputation as an international center for psychiatry and neurology. During the "Third Reich", Ernst Rüdin cooperated with the national socialist health system. His genetic concepts supported eugenic laws such as compulsory sterilization of psychotic patients. These complex interrelations underscore the DFA's importance for the recent history of medical science in Germany.

Academies and Institutes↗

[Social psychiatry and social aspects of psychiatry--on the historical applications of the concepts].

In German language the two terms "Soziale Psychiatrie" and "Sozialpsychiatrie" are used without any clear distinction. In this paper a historical analysis of the connotations of the two terms is made while underlying concepts are not considered. In the 19th century the words social and medicine were connected. At the beginning of the 20th century the terms "Soziale Psychiatrie" and "Sozialpsychiatrie" appeared in German as synonyma. In Germany-unlike, for instance, in the USA-ideas of segregation of the mentally ill and of eugenics were also regarded as "Soziale Psychiatrie". In difference to this connotation "Soziale Psychiatrie" described intentedly ideological positions in the 70's, while a certain of area of research was rather associated with "Sozialpsychiatrie". Finally, a more precise use of the terms is suggested for current discussions.

Community Psychiatry↗

Training general psychiatry residents in child and adolescent psychiatry.

The authors describe the nature of current social and economic forces impacting on the education and future practice of general psychiatry residents in child and adolescent psychiatry. They review theoretical and practical reasons for training in child and adolescent psychiatry, analyze the form and content of what is currently taught based on a national survey of general training programs, and suggest guidelines for the training and postgraduate practice of general psychiatrists in evaluating and treating children and adolescents. The authors conclude that while social and economic changes necessitate general psychiatrists' clinical involvement with children and adolescents, insufficient general training may necessitate postgraduate education and supervision. They pose ethical and professional dilemmas for the field in meeting the national shortage of child and adolescent psychiatrists and propose strategies to enhance recruitment into child and adolescent residency training.

Adolescent Psychiatry↗

Philosophy and psychiatry: a new curriculum for child and adolescent psychiatry.

Residents in psychiatry and child and adolescent psychiatry often seem to their preceptors to have difficulty with critical thinking. The author designed a curriculum for first-year (PGY-4) child and adolescent psychiatry residents with this perceived deficit in mind. The curriculum consisted of a blend of traditional first-year child and adolescent psychiatry didactic curriculum with a curriculum in philosophy. On the Cornell Critical Thinking Test, residents who took this course outscored residents who did not at a statistically significant level. The advantages of such a course are discussed.

Journal Article↗

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study.

OBJECTIVE: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. METHOD: Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. RESULTS: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. CONCLUSIONS: The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Adult↗

Geriatric psychiatry at the interface of consultation-liaison psychiatry and primary care.

OBJECTIVE: This article describes the evolution of a primary care geriatric psychiatry program which serves clinical, educational, and research functions. METHODS: Program development proceeded through stages of liaison using research, focusing on primary care attendings, and developing the common interest of geriatrics. RESULTS: Collaborative research with external funding has continued. A geriatric psychiatry primary care fellowship program was established. Clinical activity is based on consultation-liaison work in nursing homes, an outpatient dementia clinic, a general hospital medical service, and the outpatient clinic. Fellows are involved in training both psychiatry and primary care residents. CONCLUSIONS: Necessary components of a successful collaboration include: 1) primary care physicians with an interest in and aptitude for psychiatric issues; 2) delivery of service and training based on an assessment of the primary care site's needs; 3) a physical presence in the primary care site.

Geriatric Psychiatry↗

[From war psychiatry to disaster and crisis psychiatry].

Psychiatry has derived much benefit from the combat experience of military medicine. The Allies' military psychiatry during the Second World War established cardinal modes of treatment, such as group therapy, the therapeutic community, and crisis intervention. The principles of field psychiatry consist in that the treatment be administered near the scene of the injury, in an early phase, be of short duration, be focused here and now, and be characterised by prognostic optimism; moreover the victim must retain his group identity. Many of these intervention techniques are now successfully used at disaster and crises in peacetime, e.g. at the recent ferry disaster on the Scandinavian Star.

Community Psychiatry↗

The establishment of the department of psychiatry in the Mount Sinai Hospital: a conflict between neurology and psychiatry.

A conflict between neurology and psychiatry and controversies about psychoanalysis played an important role in the establishment of psychiatry in the general hospital. This article reviews the impact of this conflict on the establishment of an independent Department of Psychiatry in the Mount Sinai Hospital in New York during the first half of the twentieth century. A unique opportunity is provided to consider the relationships and personalities of the individuals involved, as well as economic, social, and scientific factors, including the introduction of psychoanalysis as a major psychiatric treatment.

Conflict, Psychological↗

[Wilhelm Griesingers "Magna Charta" of psychiatry. Its reception and impact on modern psychiatry].

The work of Wilhelm Griesinger, really a magna charta of psychiatry, is usually reduced to just one sentence: "Geisteskrankheiten sind Gehirnkrankheiten", roughly: "mental illnesses are brain disorders". However, this is neither explicitly stated in Griesingers work nor does it adequately summarise his conception. This misinterpretation will be questioned by a careful analysis of the literature, and, in addition to that, the dimensions of Griesingers psychiatry including its delayed impact on the development of modern psychiatry will be described.

Germany↗

Is the existence of a forensic psychiatry justified? On forensic psychiatry in the Scandinavian countries.

In Scandinavia during the past decade forensic psychiatry has been the subject of discussions, which have occasionally reached the height of vehement attacks. Changes in penal laws have expressed a declining interest in the cooperation of psychiatrists in the evaluation and treatment of offenders. Scandinavian forensic psychiatrists, lawyers and criminologists have analyzed and discussed the present situation and have found that there is still a need and justification for forensic psychiatry. Higher priority, however, should be given to psychiatric contributions at the stage after disposition, at the post-trial level. The diagnostic activities at the pre-trial level should be limited to what is necessary for further dispositions. The development of forensic (penal) psychiatry and the trends with the individual Scandinavian countries differ considerably.

Forecasting↗

The AMDP modules I-IV: recommendations for a standardized acquisition of EEG data in psychiatry. Association for Methodology and Documentation in Psychiatry.

During the last few years, the working group 'Psychophysiology' of the Association for Methodology and Documentation in Psychiatry (AMDP) discussed the possibility of the establishment of defined EEG modules in psychiatry. It was the aim to create a common data pool in order to be able to have access to larger data sets. The installation of such a common data pool was regarded as an important prerequisite for a future diagnostic application of EEG and EP data in clinical practice. The most relevant arguments are: From a statistical point of view, multivariate investigations can be improved when relatively large data sets are available. Subgrouping of patients is facilitated. Different centers have access to different populations of patients. Furthermore, compliance with the recommendations contributes to a reduction in misunderstanding and false interpretation of other investigators' results. The working group 'Psychophysiology' of the AMDP now recommends EEG modules to be registered in psychiatry. The recommendations are based on investigations using these modules in clinical research and practice as well as several years of discussion within the working group. Four AMDP modules (I-IV) are presented: MI: resting EEG (closed eyes), MII: resting EEG (eyes open), MIII: EEG during videotracking, and MIV: EEG during choice reaction time. Recommendations for additional modules are planned in the near future: MV: EEG during geometry test, MVI: EEG during labyrinth test, and MVII: amplitude stimulus intensity function. MIII-MVI is paralleled by an EEG recording so that psychomotor performance can be measured and EEG data under different activation conditions are available. Compliance with the recommendations guarantees the possibility of access to the common data pool. Computer software is available in Berlin.

Electroencephalography↗

Law & psychiatry: Twenty-five years of law and psychiatry.

Dr. Appelbaum reviews the past 25 years of the Law & Psychiatry column, of which he has been the editor since the column's initiation by John Talbott, M.D. The column has included contributions from Dr. Appelbaum as well as from various other mental health professionals and lawyers with various specializations. Citation of the column in other articles suggests that it is meeting a need for timely description and analysis of major legal developments that affect the field of psychiatry and psychiatric patients. Dr. Appelbaum notes that the 104 columns published thus far reflect the evolution of legal concerns in psychiatry as well as the presence of core issues that have remained unchanged. He raises the question of what the next quarter century will hold, positing that mental health law will continue to reflect a tension between the interests of persons with mental illness and the public's fear of such individuals.

Forecasting↗

[Family psychiatry, transactional systems, and the frontiers of child psychiatry].

Family therapists, seen as emphasizing interventions leading to change in family structure and in sequences of behaviour, have been searching for an integrated concept which transactional systems theory seems to offer. It takes into account small group theory, social role theory, communications theory, and general system theory, which are linked to psychic, somatic, socio-cultural, politico-economic, and ecological factors. This idea of interlinked, open systems which influence each other is used as a viewpoint for examining the frontiers of child psychiatry. Adult patients often have children who are affected by their parents' treatment, and child psychiatrists often intervene with adults. Similarly, the boundaries between psychiatry and the para-medical professions have grown less distinct as we have become aware of more elements to assess in each case, and as the number of therapeutic techniques and possible interventions increase. The problem of defining child psychiatry is discussed, as is psychiatric training, in terms of the difficulty in integrating the many theoretical and practical levels.

Child Psychiatry↗

Who's for psychiatry? United Kingdom medical schools and career choice of psychiatry 1961-75.

The medical schools of origin were identified in 1229 psychiatrists who qualified in the United Kingdom in the years 1961-75. The group was defined operationally as those who had entered for the preliminary test of the membership examination of the Royal College of Psychiatrists. From 1966-75 only 4 per cent of doctors opted for a career in the specialty. There are wide discrepancies between medical schools in the proportion of their graduates who enter psychiatry. The most likely reasons for this have to do with differences in student selection, the models of psychiatry put forward, the enthusiasm of teachers and the career pull from other specialties, notably general practice. A number of suggestions which might help to improve recruitment to psychiatry are put forward.

Career Choice↗