Academic literature on the topic 'Psychiatry – Research'
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Journal articles on the topic "Psychiatry – Research"
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Whitley, Rob, and Mike Crawford. "Qualitative Research in Psychiatry." Canadian Journal of Psychiatry 50, no. 2 (February 2005): 108–14. http://dx.doi.org/10.1177/070674370505000206.
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This paper is an overview of qualitative research and its application to psychiatry. It is introductory and attempts to describe both the aims of qualitative research and its underlying philosophical basis. We describe the practice and process of qualitative research and follow this with an overview of the 3 main methods of inquiry: interviews, focus groups, and participant observation. Throughout the paper, we offer examples of cases where qualitative research has illuminated, or has the potential to illuminate, important questions in psychiatric research. We describe methods of sampling and follow with an overview of qualitative analysis, appropriate checks on rigour, and the presentation of qualitative results. The paper concludes by arguing that qualitative methods may be an increasingly appropriate methodology to answer some of the demanding research questions being posed in 21st century psychiatry.
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van Praag, H. M. "Biological psychiatry marching towards the future and the perils of progress." Acta Neuropsychiatrica 3, no. 3 (September 1991): 36–41. http://dx.doi.org/10.1017/s0924270800034190.
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SummaryThe study of the biological determinants of abnormal behavior is not anymore psychiatry's stepchild, but a respected branch of that discipline. There is every reason to be optimistic over the future of biological psychiatry. The brain sciences are developing with astounding speed and the systematic attention for psychiatric-diagnosis and differential diagnosis renders biological psychiatry an unprecedented vitality.One should, however, not ignore some disquieting prospects. The following points of concern are discussed: the alarming shortage of young research psychiatrists; the deficiencies in the teaching of biological psychiatry; the hesitancy to utilize the fruits of brain and behavior research in clinical practice; the shortcomings in psychiatric diagnosing; nosological tunnel vision and, finally, the danger of overrating biological psychiatry with the inevitable disappointment reaction that will follow. The scientific maturation of psychiatry is contingent on a balanced development of its constituents.
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Castle, DJ, S. Refault, and RM Murray. "Research during psychiatric training as a predictor of future academic research career: the Maudsley experience." European Psychiatry 6, no. 3 (1991): 115–18. http://dx.doi.org/10.1017/s092493380000095x.
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SummaryJunior doctors who trained in psychiatry at the Maudsley Hospital between 1965 to 1975 were followed up at a mean of 17 years to ascertain whether pre-psychiatric experience or performance during training could predict future career paths. The most consistent predictor of a career in academic psychiatry was involvement in research during training.
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Kleinman, Arthur. "Anthropology and Psychiatry." British Journal of Psychiatry 151, no. 4 (October 1987): 447–54. http://dx.doi.org/10.1192/bjp.151.4.447.
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To illustrate the contribution anthropology can make to cross-cultural and international research in psychiatry, four questions have been put to the cross-cultural research literature and discussed from an anthropological point of view: ‘To what extent do psychiatric disorders differ in different societies?’ ‘Does the tacit model of pathogenicity/pathoplasticity exaggerate the biological aspects of cross-cultural findings and blur their cultural dimensions?’ ‘What is the place of translation in cross-cultural studies?’ and ‘Does the standard format for conducting cross-cultural studies in psychiatry create a category fallacy?’ Anthropology contributes to each of these concerns an insistence that the problem of cross-cultural validity be given the same attention as the question of reliability, that the concept of culture be operationalised as a research variable, and that cultural analysis be applied to psychiatry's own taxonomies and methods rather than just to indigenous illness beliefs of native populations.
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Double, D. B. "Research in psychiatry." Psychiatric Bulletin 14, no. 6 (June 1990): 364. http://dx.doi.org/10.1192/pb.14.6.364.
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Caldieraro, Marco Antonio. "The future of psychiatric research." Trends in Psychiatry and Psychotherapy 38, no. 4 (December 2016): 185–89. http://dx.doi.org/10.1590/2237-6089-2016-0046.
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Abstract Psychiatric disorders place considerable burden on individuals and on public health. Funding for research in psychiatry is less than ideal, but even so high quality research is being conducted at many centers. However, these studies have not impacted clinical practice as much as expected. The complexity of psychiatric disorders is one of the reasons why we face difficulties in translating research results to patient care. New technologies and improved methodologies are now available and must be incorporated to deal with this complexity and to accelerate the translational process. I discuss the application of modern techniques for data acquisition and analysis and also the new possibilities for performing trials in virtual models of biological systems. Adoption of new technologies is necessary, but will not reduce the importance of some of the fundamentals of all psychiatry research, such as the developmental and translational perspectives. Psychiatrists wishing to integrate these novelties into their research will need to work with contributors with whom they are unaccustomed to working, such as computer experts, a multidisciplinary team, and stakeholders such as patients and caregivers. This process will allow us to further understand and alleviate the suffering and impairment of people with psychiatric disorders.
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Dawson, John, Michael King, Alexia Papageorgiou, and Oliver Davidson. "Legal pitfalls of psychiatric research." British Journal of Psychiatry 178, no. 1 (January 2001): 67–70. http://dx.doi.org/10.1192/bjp.178.1.67.
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BackgroundThe increasing complexity of psychiatric research, including recent attempts to evaluate mental health legislation, suggests legal advice may be valuable in a wide range of research contexts.AimsWe aim to illustrate both the legal pitfalls of research in psychiatry and the potential for solutions if the methods are carefully chosen.MethodTwo examples of research are subject to legal analysis, one involving advance directives, the other the random discharge of compulsory out-patients.ResultsThis analysis illustrates that participation in research may expose clinicians to additional forms of liability, but the legal risks can be minimised through changes in the methods or additional safeguards.ConclusionsCollaboration between academic law and psychiatry can enrich research agendas and avoid serious legal pitfalls. We argue that sound legal advice should be sought at the planning stage of research in psychiatry, but the fear of liability should not lead to overly defensive research practices. The aim should be to strike the right balance between avoiding unacceptable exposure to liability and stifling innovative research.
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Peitl, Vjekoslav. "Archives of Psychiatry Research, a new name for a steadfast focus on psychiatric research." Archives of Psychiatry Research 55, no. 1 (June 15, 2019): 5–6. http://dx.doi.org/10.20471/may.2019.55.01.00.
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Galeazzi, Gian Maria, and Stefan Priebe. "Italian social psychiatry research: What gets published in peer reviewed journals?" Epidemiologia e Psichiatria Sociale 16, no. 3 (September 2007): 212–24. http://dx.doi.org/10.1017/s1121189x00002311.
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SummaryAims– To explore the current state of Italian social psychiatry research as evidenced by original papers published in peer-reviewed journals 2004-2006.Methods– Electronic databases and hand searches of leading peer-reviewed journals were used to identify original research papers published in 2004-2006, addressing a social psychiatric issue, having at least one Italian author, and reporting data from Italian samples.Results– A total of 174 papers were identified. A substantial proportion reported findings of international collaborative research. Quantitative methods dominated, with 86 papers on cross-sectional surveys. Only 18 papers showed results of intervention trials with pre and post measures. Most common target group were psychiatric patients in community mental health services which featured in 93 papers.Conclusions– There is a critical mass of Italian social psychiatry research, dominated by a few research centres and with considerable amount of international collaboration. The findings of this survey might reflect the relative shortage of national funding for social psychiatry research.Declaration of Interest: None.
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AKRAM, FAISAL, and JAMES GIORDANO. "Research Domain Criteria as Psychiatric Nosology." Cambridge Quarterly of Healthcare Ethics 26, no. 4 (September 22, 2017): 592–601. http://dx.doi.org/10.1017/s096318011700010x.
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Abstract:Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks. However, conceptual, methodological, neuroethical, and social issues inherent in and/or derived from the use of RDoC need to be addressed before any attempt is made to implement their use in clinical psychiatry. This article describes current progress in RDoC; defines key technical, neuroethical, and social issues generated by RDoC adoption and use; and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectivization of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes normality, what constitutes a disorder, and what represents a treatment, enablement, and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and phenotypes in predicting and treating mental disorders, and what such definitions, predictions, and interventions portend for concepts and views of sickness, criminality, professional competency, and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC-oriented research can—and arguably should—be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere.
Dissertations / Theses on the topic "Psychiatry – Research"
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Gilbody, Simon Martin. "Outcomes measurement in psychiatry : a critical review of patient based outcomes measurement in psychiatric research and practice." Thesis, University of York, 2001. http://etheses.whiterose.ac.uk/9753/.
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Bjørngaard, Johan Håkon. "Patient satisfaction with outpatient mental health services - the influence of organizational factors." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Det medisinske fakultet, 2008. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-2227.
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Pasienttilfredshet med polikliniske tilbud i det psykiske helsevernet – betydningen av organisatoriske faktorer Pasientenes opplevelse og tilfredshet med behandlingstilbudet har i økende grad blitt vektlagt ved evaluering av tjenester til mennesker med psykiske lidelser. Systematiske målinger av brukererfaringer i det psykiske helsevernet skal inngå som en av flere kvalitetsindikatorer for spesialisttjenesten. Dette skal blant annet gi brukerne beslutningsgrunnlag for å kunne velge hvor man ønsker å behandles, fagfolkene innspill til egen kvalitetsutvikling og staten nødvendig styringsinformasjon. Hensikten med avhandlingen var å undersøke i hvilken grad organisatoriske forhold har betydning for pasientenes tilfredshet med behandlingstilbudet. Resultatene i avhandlingen bygger på analyser av data fra flere større undersøkelser med spørreskjema til pasienter om deres erfaringer med det psykiske helsevernet. Samlet sett viser resultatene at misnøye eller tilfredshet med tjenestetilbudet i liten grad var avhengig av hvor behandlingen fant sted. Det vil si at pasientene var fornøyd eller misfornøyd relativt uavhengig av hvor de ble behandlet. For eksempel blant pasienter i poliklinikker for voksne kunne bare om lag to prosent av variansen i tilfredshet knyttes til hvilken behandlingsenhet som sto for behandlingen. Resultatene viste også at ulike mål på den psykiske lidelsens alvorlighet var assosiert med pasienttilfredshet, noe som vil ha betydning ved sammenlikning av behandlingsenheter med til dels ulike behandlingsoppgaver. Avhandlingen viser at aggregerte mål for pasienttilfredshet har klare begrensninger som indikator på organisatorisk kvalitet. Det er grunn til å tvile på om gjennomsnittlig tilfredshet ved for eksempel en poliklinikk er egnet som styringsinformasjon. Det synes som om metoden i liten grad er egnet til å identifisere poliklinikker med dårlig kvalitet og det er også usikkert om de poliklinikkene som metoden beskriver som dårlige, faktisk er dårlige. Kandidat: Johan Håkon Bjørngaard, Institutt for samfunnsmedisin Veiledere: Jon Magnussen, Torleif Ruud og Svein Friis Finansieringskilde: Rådet for psykisk helse og Stiftelsen Helse og Rehabilitering
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Cahill, John. "Using the concept of complexity to guide translational research in psychiatry." Thesis, University of Huddersfield, 2018. http://eprints.hud.ac.uk/id/eprint/34543/.
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The presented work unites several distinct lines of research, asserting that the broader construct of complexity (with its various connotations) may be uniquely relevant and informative to our understanding and management of psychotic disorders. Part 1 outlines the candidate’s contributions to the development of EEG methodology in clinical populations in an effort to most directly capture neural noise and complexity. The advent of oscillatory analysis facilitated the study of ongoing background activity of the EEG. Further exploration of this background activity demonstrated that increased neural noise (as quantified by Lempel-Ziv complexity) is highly correlated with, and conceptually very relevant to, positive symptoms of psychosis. Part 2 describes how considering the complexity of clinical psychosis states justifies the use of human laboratory studies using psychotomimetic drugs such as tetrahydrocannabinol and ketamine. Part 3 explains how the ideas and inferences from the work in Parts 1 and 2 can inform the environment of psychotic disorders, specifically the candidate’s work in prescribing practices and first episode psychosis service design. The thesis concludes that EEG studies of clinical populations face particular methodological challenges, however the resultant technical advancements have expanded our view of neural function to the particular benefit of our understanding of psychosis. EEG measures of complexity may be amongst the most sensitive biomarkers associated with positive symptoms, however more empirical research is called for to confirm this observation. Human laboratory studies of psychotomimetic drugs in healthy humans may continue to prove useful, in circumventing the phenomenological and patho-etiological complexity of clinically occurring psychosis. As a next step, multi-modal studies (combining biophysical signals, individual phenomenology and even population level outcomes) in combination with data mining techniques might further characterize the complexity within psychosis. Psychotic disorders, as complex problems, warrant framing and intervention informed by complexity.
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Thomas, Rhys Huw. "Phenotyping paroxysmal conditions to empower genetic research." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/44849/.
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I describe the process of preparing cohorts of individuals with two paediatric onset paroxysmal disorders – hyperekplexia and juvenile myoclonic epilepsy – for second generation sequencing. This involves: i) listening to the individual; ii) identifying subgroups; iii) using non-‐core features to create subgroups; iv) and assessing the importance of copy number variation. Using focus groups and an interpretative phenomenological approach clinicians and people with epilepsy produced 398 questions focused on epilepsy treatment. The most important themes for the professionals were – teatment pogrammes or non-‐epileptic attack disorder and concerns about side effectsinutero.For patients cognitive drug side effects and managing the consequences of drug side effects were most important. Studying ninety-‐seven individuals with hyperekplexia confirmed that all gene-‐positive cases present in the neonatal period and that clonazepam is the treatment of choice (95% found it efficacious). Patients with SLC6A5 and GLRB mutations were more likely to have developmental delay (RR1.5 p<0.01; RR1.9 p<0.03) than those with GLRA1 mutations; 92% of GLRB cases reported a mild to severe delay in speech acquisition. Juvenile myoclonic epilepsy is challenging to subdivide based on seizure and EEG features. The neuropsychological profile of limited number of patients 39) as examined in great detail including tests Q WAIS), emory TYM,WMS),executive function (BADS, DKEFS), affect (HADS). TYM was as sensitive as a full WMS for identifying cognitive errors and the zoo map and key search tests were performed particularly poorly. Personality profiling (EPQ-‐BV) identifies the cohort as having high levels of neurotic and introvert traits. Three atypical ‘hyperekplexia’ cases had alternative diagnoses suggested by copy number analysis. The juvenile myoclonic epilepsy patients had an 8% frequency of recognised pathogenic CNVs– but no recurrent variants were identified.A number of non-‐epilepsy related findings were identified including a potentially preventable cause of SUDEP.
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Rawlings, Nancy. "The role of the 5-HT2C receptor in emotional processing in healthy adults." Thesis, University of Oxford, 2010. http://ora.ox.ac.uk/objects/uuid:9bb98eb2-b753-466e-bec2-b199ad14ea34.
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Serotonin (5-HT) has long been implicated in the pathophysiology of depression and anxiety, and the therapeutic effect of treatments. Several drugs useful in treatment produce either acute or neuroadaptive changes in 5-HT2C receptor activity, and there has been growing interest in how alterations in the 5-HT2C receptor might be important in mediating antidepressant and anxiolytic activity. The neuropsychological hypothesis of drug action implies that the clinical effects of medications active in anxiety and depression are best understood through the effects of these agents on the processing of emotional information. Thus far, however, there has been no systematic attempt to identify the role of the 5-HT2C receptor in drug-induced changes in emotional processing in humans. The current research therefore investigated the effects of drug treatments with 5-HT2C blocking properties on neural and behavioural responses to emotional information in healthy volunteers. An fMRI study demonstrated that a single dose of mirtazapine, an antidepressant with action at the 5-HT2C receptor, reduces activation in regions important in emotional processing, such as the amygdala and the fusiform gyrus, to threat-relevant stimuli. A series of behavioural studies utilized drugs acting, at least in part, as 5-HT2C antagonists and agonists to show that these drugs are able to alter emotional processing, particularly emotional memory. A seven-day administration of mirtazapine was shown to increase the recall of positive versus negative personality characteristics. A single dose of agomelatine, also an antidepressant with putative action at the 5-HT2C receptor, did not increase slow wave sleep, suggesting, the drug had no effect of 5-HT2C blockade in the brain. In Chapter 4, agomelatine and mCPP, a 5-HT2C agonist, also shown to had no significant effect on emotional processing measures, but there was a statistical trend for agomelatine to increase memory for positive stimuli, and for mCPP to increase memory for negative stimuli. These findings suggest that antidepressants may work by altering the bias in emotional processing. Overall, the results of this exploration of the role of the 5-HT2C receptor in emotional processing have contributed to the understanding of antidepressant treatment, and raise new possibilities for the continuation of study in this field.
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Mugno, Diego Filadelfo Maria. "Validazione della versione italiana della Developmental Disability Child Global Assessment Scale (DD-CGAS)." Thesis, Università degli Studi di Catania, 2011. http://hdl.handle.net/10761/243.
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Obiettivo: scopo del presente lavoro è di validare la versione italiana della Developmental Disability Child Global Assessment Scale (DD-CGAS), una scala per la valutazione del funzionamento globale di bambini con diagnosi di disturbi dello spettro dell'autismo (ASD). Metodi: seguendo le procedure di validazione utilizzate per la versione in lingua inglese sono state valutate la inter-rater reliability, la stabilita' temporale e la validita' convergente in un gruppo di 48 soggetti in eta' evolutiva con diagnosi di ASD e la sensibilita' al cambiamento in un sottogruppo di 42 soggetti.
Risultati: la inter-rater reliability e la stabilita' temporale (ICC) sono risultate rispettivamente .78 e .79; l'effect size per la validita' era da moderato ad ampio; l'effect size per il cambiamento della DD-CGAS era di .59 Conclusioni: la versione italiana della DD-CGAS ha dimostrato di essere uno strumento affidabile per misurare il funzionamento globale di bambini con diagnosi di ASD.Objective: aim of this study is to validate the Italian version of the Developmental Disability Child Global Assessment Scale (DD-CGAS), a scale developed to assess global functioning in children with Autism Spectrum Disorders (ASDs) Methods: following the validation procedures used for the English version of the scale, inter- rater reliability, temporal stability and convergent validity were assessed in a group of 48 children with ASD and temporal stability in a subset of 42 subjects. Results: Inter-rater reliability and temporal stability (ICC) were respectively .78 and .79; effect size for convergent validity were moderate to large; the pre-post DD-CGAS change had an effect size of .59. Conclusions: the Italian version of the DD-CGAS is a reliable instrument for measuring global functioning of children with ASD.
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Sibeoni, Jordan. "L’apport des méthodes qualitatives dans la recherche sur les soins en psychiatrie de l’adolescent." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS425/document.
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Les méthodes qualitatives visent à décrire, comprendre et approfondir un phénomène observé. Elles sont encore peu développées dans la recherche en psychiatrie de l’adolescent. Les objectifs de cette thèse sont à la fois méthodologiques et thérapeutiques. Il s'agit d'illustrer à partir de trois études qualitatives l'intérêt des méthodes qualitatives dans la recherche clinique sur les soins en psychiatrie de l'adolescent. Ces études ont en commun d'explorer la question des soins et en particulier celle de la perception des soins en psychiatrie de l'adolescent par les adolescents, leurs familles et leurs soignants, et de croiser ces perspectives. La première étude consiste en une métasynthèse -revue systématique et analyse de la littérature qualitative concernant l'anorexie mentale à l'adolescence. La deuxième étude se focalise sur l'utilisation de l'outil photographique et de son efficacité dans la recherche qualitative en psychiatrie de l'adolescent. Il s'agit d'une étude qualitative explorant le fonctionnement et les interactions familiales autour de la nourriture et du repas à l’aide de la photographie. Enfin la troisième recherche qualitative explore l'efficacité perçue des soins chez des adolescents suivis en psychiatrie dans le cadre d'un refus scolaire anxieux et chez leurs parents. Ces trois études nous permettent de discuter l’intérêt des méthodes qualitatives dans la recherche sur les soins en psychiatrie de l’adolescent et également la nécessité du développement de ces méthodes dans la recherche clinique en santé publiqueQualitative methods aim to describe, understand and deepen an observed phenomenon. Our objectives are both methodological and therapeutic. We illustrate the contribution of qualitative methods in research from three qualitative studies. These studies will jointly explore the issue of care and especially the perception of psychiatric care from adolescents, their families and caregivers. The first study is a metasynthesis - systematic review and analysis of qualitative literature- on anorexia nervosa in adolescence. The second study will focus on the use of the photographic tool and its effectiveness in qualitative research in adolescent psychiatry. This qualitative study will explore the functioning and family interactions around food and meals using Photo-elicitation. Finally, the third qualitative research will explore the perceived efficacy of care among adolescents receiving a treatment for school refusal, and their parents. These three studies enable us to discuss the contribution of qualitative methods in adolescent psychiatry care research and also the need of developing such methods in the field of clinical research in public health
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Chermá, Yeste Maria Dolores. "Therapeutic Drug Monitoring in Psychiatry : Some aspects of utility in clinical practice and research." Doctoral thesis, Linköpings universitet, Klinisk farmakologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-52107.
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Background and objectives: Several new psychoactive drugs for the treatment of psychiatric disorders have been introduced onto the market since the late 1980s. Basic aspects of pharmacodynamics and pharmacokinetics (PK) are investigated before approval for general prescription. Thus, a limited number of subjects are exposed to the drug before it is marketed and only sparse measurements of drug concentration are performed during phases II and III of drug development. The objective of this thesis was to provide further descriptive PK and linked patients data in naturalistic clinical settings. The PK of psychoactive drugs was also studied in the elderly and the young, major risk groups that are exposed in normal everyday clinical practice but that are underrepresented in the phases of drug development. The PK-data were to be assessed by samples sent to the Therapeutic Drug Monitoring (TDM) laboratory service. In a subset of individuals, the genotypes of the cytochrome P450 (CYP) enzymes were described. Results: Serum concentration of the parent compound and its metabolites was provided from TDM-data on antidepressant escitalopram (Paper I) and antipsychotic ziprasidone (Paper II). A large interindividual PK variability was found. The daily dose of the drug was higher than the defined daily dose (DDD) for both escitalopram and ziprasidone (median dose 20 mg and 120 mg, respectively). The median number of drugs per patient, apart from the studied drug, was 4 and 3, respectively (range 1-18). If repeated eligible TDM-data were available, change in treatment strategies could be seen between the first and second sample for the patient, and the metabolite/parent compound (M/P) ratio had lower intraindividual than interindividual variation in the escitalopram study but opposite results were found in the ziprasidone study. The prescription of antidepressant drugs (ADs) in the nursing homes studied was 38 % (Paper III). The concentration of the ADs was higher, or much higher, than could be expected from the dose administered in 73 %. The majority of the elderly people were treated with citalopram. No clear time schedule for how long the drug treatment should continue was found in the patients’ current medical record. The median number of drugs per patient apart from the AD was 11 (range 4-19), no monotherapy was found in these patients. The genetically impaired metabolic activity of CYP enzymes correlated to higher drug concentration as expected, in patients medicated with an AD that is substrate for the CYP enzyme genotype. The concentrations of ADs were as expected from the dose administered in 63 % of the children/adolescents evaluated (Paper IV). The majority of TDM samples requested sertraline. PK outcome of sertraline was similar to the results in adult populations. Monotherapy was documented in 49 % (median number of drugs apart from AD was 1 per patient, range 1-7). Changes in treatment strategies were also shown, if repeated TDM-samples were available. The median variation of the M/P ratio for sertraline between the first and the last samples within the same patient was 20 % (the interindividual variation was 37 %). The poor metabolizers (PM) for CYP2D6 medicated with a CYP2D6 substrate had a lower dose than did non-PM for the same drug. Conclusion: These studies provide reference data for the evaluation of the therapeutic response, i.e. a reference range of what is to be expected in a normal clinical setting, as well as the toxicological information concerning the psychoactive drugs studied. When available, the M/P ratio between two patients’ samples may assess patient compliance, as well as drug-drug interactions. Thus, the use of TDM can be beneficial for individual dose optimisation and drug safety, above all in the studied populations, elderly people and children/adolescents, when the selection of doses requires a consideration of PK parameters. TDM may be a tool for research, increasing knowledge of the psychoactive drug in TDM service, as well as toxicology. A more frequent clinical use of TDM and pharmacogenetic testing in clinical practice would contribute to a better quality when treating with psychoactive drugs.
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Tajika, Aran. "Replication and contradiction of highly cited research papers in psychiatry: 10-year follow-up." Kyoto University, 2016. http://hdl.handle.net/2433/215410.
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This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.org.Kyoto University (京都大学)
0048
新制・課程博士
博士(医学)
甲第19584号
医博第4091号
新制||医||1014(附属図書館)
32620
京都大学大学院医学研究科医学専攻
(主査)教授 中山 健夫, 教授 小西 靖彦, 教授 村井 俊哉
学位規則第4条第1項該当
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Abu, Ghazal Yazan. "The classification of psychoses and the detours of psychiatric research at the end of the nineteenth century." Thesis, Paris, Ecole normale supérieure, 2015. http://www.theses.fr/2015ENSU0050.
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Le présent thèse cherche à explorer le statut épistémologique de la Psychiatrie. En prenant la question de la méthode (“Methodenfrage”) comme fil directeur, nous discuterons la question de savoir dans quelle mesure la Psychiatrie, entendue comme une discipline clinique, est autorisée à emprunter les principes méthodologiques en usage dans les sciences humaines. Dans ce contexte une importance capitale sera accordée à l’analyse des développements conceptuels de la Psychopathologie de langue allemande dans la période suivant la Deuxième Guerre Mondiale. Le point de départ de ce travail sera l’analyse de la dichotomie introduite par Karl Jaspers entre “Erklären” (expliquer) et “Verstehen” (comprendre) ainsi que celle des limites épistémologiques de ces deux modes d’accès à l’anormalité psychique qu’est la schizophrénie. La deuxième partie de ce travail sera consacrée à l’analyse de l’élargissement sur le plan méthodologique des limites du “Verstehen” dans la psychopathologie de la schizophrénie. Dans ce cadre nous analyserons les conséquences de l’introduction de la “Situation analyse” et du concept d’“ordre” (comme principe organisateur de la vie psychique et sociale) pour la psychopathologie de la schizophrénie. A la lumière des résultats acquis nous analyserons les apports de ce développement conceptuel de la psychopathologie allemande pour les tentatives de conceptualisation des normes dans les théories psychiatriques sur la schizophrénieThis thesis explores the ways in which psychiatrists and researchers have developed new tools to deal with the unknown in psychiatric classifications. In the following four chaptersI seek to understand why the modes of thinking that dominated late nineteenth century psychiatry have proved to be durable and stable, and why the history of what is now called schizophrenia is the history of psychiatry itself.In this context, I situate my argument within the debates regarding the historiography of psychiatry, and more specifically the historiography of schizophrenia.My approach can be understood as an attempt to move away from common approaches to the history of psychiatric classifications.In my view, the influence of German psychiatry, from Griesinger’s unitary psychosis to Bleuler’s schizophrenia tells us more about psychiatry and its modes of conceptualization, than thus far recognized.Against the narratives that presuppose a direct line of development, I argue that the path starting with primäre Verrücktheit—one of the most commonly diagnosed psychic diseases in 1870s – leading to ”paranoia”—a term used as synonym for insanity by most authors in the1880s and 1890s – and ending in “dementia praecox” and schizophrenia was not a linear one.By tracing the detours followed by psychiatric research in the last three decades of the nineteenth century, I show how, paradoxically, the progress in the special nosology delayedconsiderably the future development in psychiatric theories
Books on the topic "Psychiatry – Research"
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M, Montez Daniella, ed. Psychiatric research trends: Dreams and geriatric psychiatry. Hauppauge, N.Y: Nova Science, 2010.
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1926-, Häfner H., and Wolpert E. M, eds. New research in psychiatry. Seattle, USA: Hogrefe & Huber, 1996.
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Hsu, L. K. George, and Michel Hersen, eds. Research in Psychiatry. Boston, MA: Springer US, 1992. http://dx.doi.org/10.1007/978-1-4899-0688-5.
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Mendlewicz, Julien, Hanns Hippius, Brigitta Bondy, Manfred Ackenheil, and Merton Sandler, eds. Genetic Research in Psychiatry. Berlin, Heidelberg: Springer Berlin Heidelberg, 1992. http://dx.doi.org/10.1007/978-3-642-46762-2.
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Levine, Nicole M., and Donna J. Campbell. Perspectives in psychiatry research. Hauppauge, N.Y: Nova Science Publishers, 2011.
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C, Browne Raymond, ed. Forensic psychiatry research trends. New York: Nova Science Publishers, 2007.
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Chris, Freeman, and Tyrer Peter J, eds. Research methods in psychiatry. 3rd ed. London: Gaskell (Royal College of Psychiatrists), 2006.
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1951-, Pincus Harold Alan, and Pardes Herbert 1934-, eds. Clinical research careers in psychiatry. Washington, DC: American Psychiatric Press, 1986.
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1947-, Mitchell James E., ed. Elements of clinical research in psychiatry. Washington, DC: American Psychiatric Press, 2000.
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J, Hursch Carolyn, and Gordon Katherine K, eds. An introduction to psychiatric research. Cambridge [England]: Cambridge University Press, 1988.
Find full textBook chapters on the topic "Psychiatry – Research"
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Weiss, Daniel S. "Research Methodology and Statistics." In Psychiatry, 2619–34. Chichester, UK: John Wiley & Sons, Ltd, 2008. http://dx.doi.org/10.1002/9780470515167.ch128.
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Weiss, Daniel S., and Kevin L. Delucchi. "Research Methodology and Statistics." In Psychiatry, 2575–92. Chichester, UK: John Wiley & Sons, Ltd, 2015. http://dx.doi.org/10.1002/9781118753378.ch131.
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Goldberg, David P. "Teaching Research Methods: ‘Doing Your Own Research’." In Teaching Psychiatry, 125–34. Chichester, UK: John Wiley & Sons, Ltd, 2011. http://dx.doi.org/10.1002/9780470974544.ch11.
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Goodwin, Donald W. "New Research on Heredity and Alcoholism." In Psychiatry, 133–41. Boston, MA: Springer US, 1985. http://dx.doi.org/10.1007/978-1-4613-2365-5_21.
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Barber, Jacques P., and Lester B. Luborsky. "Psychotherapy Research." In Research in Psychiatry, 331–57. Boston, MA: Springer US, 1992. http://dx.doi.org/10.1007/978-1-4899-0688-5_13.
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Zinn, Mark A., and Estate M. Sokhadze. "Research Methodology and Statistics." In Tasman’s Psychiatry, 1–25. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-030-42825-9_55-1.
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Tennen, Howard, Paulette Marie Gillig, Marcella H. Boynton, and Ross E. O'Hara. "Social Psychology: Theory, Research, and Mental Health Implications." In Psychiatry, 453–62. Chichester, UK: John Wiley & Sons, Ltd, 2015. http://dx.doi.org/10.1002/9781118753378.ch27.
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Bourin, Michel. "Animal Research in Psychiatry." In Frontiers in Psychiatry, 283–96. Singapore: Springer Singapore, 2019. http://dx.doi.org/10.1007/978-981-32-9721-0_14.
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Bertelsen, A. "Twin Research." In Genetic Research in Psychiatry, 234–44. Berlin, Heidelberg: Springer Berlin Heidelberg, 1992. http://dx.doi.org/10.1007/978-3-642-46762-2_19.
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Loewenstein, David A., and Carl Eisdorfer. "Issues in Geriatric Research." In Research in Psychiatry, 427–43. Boston, MA: Springer US, 1992. http://dx.doi.org/10.1007/978-1-4899-0688-5_17.
Full textConference papers on the topic "Psychiatry – Research"
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Stahl, Daniel, and Daniel Stamate. "Data Science Challenges in Computational Psychiatry and Psychiatric Research." In 2018 IEEE 5th International Conference on Data Science and Advanced Analytics (DSAA). IEEE, 2018. http://dx.doi.org/10.1109/dsaa.2018.00067.
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MENDLEWICZ, J. "MOLECULAR GENETICS IN PSYCHIATRY RESEARCH." In IX World Congress of Psychiatry. WORLD SCIENTIFIC, 1994. http://dx.doi.org/10.1142/9789814440912_0004.
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Tasenko, M. V. "Artificial intelligence in psychiatry: possibilities of use." In GLOBAL MODERN TRENDS IN RESEARCH. Baltija Publishing, 2024. http://dx.doi.org/10.30525/978-9934-26-446-7-21.
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RAPAPORT, MARK HYMAN, and LEWIS L. JUDD. "NEW SUBTYPES OF DEPRESSION: IMPLICATIONS FOR RESEARCH." In IX World Congress of Psychiatry. WORLD SCIENTIFIC, 1994. http://dx.doi.org/10.1142/9789814440912_0070.
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LOLAS, FERNANDO. "RESEARCH ON HUMAN SUBJECTS: A CHALLENGE IN PSYCHIATRY." In IX World Congress of Psychiatry. WORLD SCIENTIFIC, 1994. http://dx.doi.org/10.1142/9789814440912_0314.
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BRADWEJN, JACQUES. "THE ROLE OF CCK IN PANIC: CLINICAL RESEARCH." In IX World Congress of Psychiatry. WORLD SCIENTIFIC, 1994. http://dx.doi.org/10.1142/9789814440912_0007.
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SARWER-FONER, GERALD J. "SCHIZOPHRENIA: A HUMAN DISEASE — CLINICAL, RESEARCH, AND HUMAN REHABILITATION ASPECTS." In IX World Congress of Psychiatry. WORLD SCIENTIFIC, 1994. http://dx.doi.org/10.1142/9789814440912_0097.
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Jorge, Beatriz, Juliana Carvalho, Catarina Pedro, and Sara Carneiro. "FORENSIC PSYCHIATRY AND DUAL DIAGNOSIS." In 23° Congreso de la Sociedad Española de Patología Dual (SEPD) 2021. SEPD, 2021. http://dx.doi.org/10.17579/sepd2021o034.
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1.Objective: Dual diagnosis patients perpetrate crime more often than healthy individuals and is of great importance for forensic mental health services. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. This work aims to summarize the epidemiological and clinical approach of dual diagnosis patients, focusing on the Iberian Peninsula scope. Aditionaly, it aims to analyse the state of the art regarding associations between demographic and clinical factors and perpetration of crime in dual disorder patients. 2. Method: A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE and Google Scholar. 3. Results and conclusions: Perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. The three drugs most commonly associated with the drugs–crime connection are heroin, crack and cocaine. A study conducted in penitentiary centers of the Interior in Spain found a high percentage of dual pathology (81.4%) In the portuguese largest security ward, in Coimbra, 40.5% of the sample had dual diagnosis disorders. Forensic units must take an integrated approach to addressing substance-use disorders. It is needed to consider not only the complexities of the substance misuse and the mental disorder, but also the offending behaviour that brought them into the forensic services. Also, social skills can effectively be improved in dual diagnosis patients. Further research is required to identify additional risk factors, such as individual substances of abuse, and establish a causal model leading to criminal perpetration.
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Everard, Kelly, Joanne Salas, and Megan Ferber. "Behavioral Health, Psychiatry, and Social Service Referrals from Family Medicine and Internal Medicine." In NAPCRG 51st Annual Meeting — Abstracts of Completed Research 2023. American Academy of Family Physicians, 2023. http://dx.doi.org/10.1370/afm.22.s1.5082.
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Macak, Tomas. "SYNERGY OF TEACHING AND RESEARCH ACTIVITIES." In SGEM 2014 Scientific SubConference on PSYCHOLOGY AND PSYCHIATRY, SOCIOLOGY AND HEALTHCARE, EDUCATION. Stef92 Technology, 2014. http://dx.doi.org/10.5593/sgemsocial2014/b13/s3.110.
Full textReports on the topic "Psychiatry – Research"
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Li, Wen, and Chen Chen. The application of micro-expression recognition technique in psychiatry research: A systematic review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, December 2021. http://dx.doi.org/10.37766/inplasy2021.12.0122.
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Cations, Monica, Bethany Wilton-Harding, Brian Draper, Kate Laver, Henry Brodaty, and Lee-Fay Low. Psychiatric service delivery for older people with mental disorders and dementia in hospitals and residential aged care. The Sax Institute, December 2021. http://dx.doi.org/10.57022/piul1022.
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This Evidence Check aimed to summarise the evidence on effective models of psychiatry service delivery for older people in four types of hospital and residential / long-stay care services. The review found that hospital mental health wards for older people were effective in improving neuropsychiatric symptoms, mood, anxiety and quality of life. Specialist consultations and liaison services enhanced the quality of hospital care and the adoption of best practice approaches by clinicians. They also reduced hospital stay and carer stress, and increased patient satisfaction with care. The authors compared outcomes for older people being treated in dedicated mental health services with mainstream (or ‘ageless’) mental health services and identified a gap in evidence. The review found the need for more research on psychiatric services in residential and long-stay care settings, and effective care models in particular populations, such as Aboriginal and Torres Strait Islander peoples.
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Lee, Hee Jin, Min Cheol Chang, Yoo Jin Choo, and Sae Yoon Kim. The Associations between Headache (Migraine and Tension-type Headache) and Psychotic Symptoms (Depression and Anxiety) in Pediatrics: A Systematic Review and Meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0078.
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Review question / Objective: The purpose of this study was to investigate the association with specific psychiatric symptoms such as depression and anxiety in pediatric patients suffering from migraine and TTH. In our meta-analysis for a detailed evaluation of depression and anxiety, we attempted to review the research using various psychodiagnostic tools. Eligibility criteria: The detailed inclusion criteria for the network meta-analysis were studies with (1) inclusion of pediatric patients; (2) patients with migraine and TTH; (3) evaluation of association between headache (migraine or TTH) and psychotic symptoms (depression and anxiety); (4) comparison between group with headache (migraine or TTH) and control group; (5) using tools for evaluating degree of depression or anxiety; and (6) written in English. Review articles, case reports, letters, and studies with insufficient data or results were excluded.
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Whelan, Sally, Gabriella Ledis, Alayna Menecola, Madie Schulte, Giavanna Semiao, Arlene Mannion, and Geraldine Leader. Exploring the resilience of adults with autism spectrum disorder: A Scoping Review protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, April 2022. http://dx.doi.org/10.37766/inplasy2022.4.0049.
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Review question / Objective: This review aims to explore resilience in the context of autistic adults. To fulfil this aim, the review has the following objectives: • To explore how adults with autism experience and perceive their resilience. • To identify how empirical research has defined and measured resilience in populations of adults with autism. • To identify how resilience in autistic adults can be understood in terms of the resilience process. • To identify factors that can support the resilience of adults with autism. Condition being studied: Autism is a lifelong neurodevelopmental condition that has core features of intense interests, affective and social interaction difficulties, and a preference for repetitive behaviours (American Psychiatric Association, 2013). Resilience has been defined as an outcome, and/or a process through which people use resources to adapt positively to adversity, stress, or trauma (Windle, 2011).
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Totten, Annette, Dana M. Womack, Marian S. McDonagh, Cynthia Davis-O’Reilly, Jessica C. Griffin, Ian Blazina, Sara Grusing, and Nancy Elder. Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication. Agency for Healthcare Research and Quality, December 2022. http://dx.doi.org/10.23970/ahrqepccer254.
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Objectives. To assess the use, effectiveness, and implementation of telehealth-supported provider-to-provider communication and collaboration for the provision of healthcare services to rural populations and to inform a scientific workshop convened by the National Institutes of Health Office of Disease Prevention on October 12–14, 2021. Data sources. We conducted a comprehensive literature search of Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL. We searched for articles published from January 1, 2015, to October 12, 2021, to identify data on use of rural provider-to-provider telehealth (Key Question 1) and the same databases for articles published January 1, 2010, to October 12, 2021, for studies of effectiveness and implementation (Key Questions 2 and 3) and to identify methodological weaknesses in the research (Key Question 4). Additional sources were identified through reference lists, stakeholder suggestions, and responses to a Federal Register notice. Review methods. Our methods followed the Agency for Healthcare Research and Quality Methods Guide (available at https://effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview) and the PRISMA reporting guidelines. We used predefined criteria and dual review of abstracts and full-text articles to identify research results on (1) regional or national use, (2) effectiveness, (3) barriers and facilitators to implementation, and (4) methodological weakness in studies of provider-to-provider telehealth for rural populations. We assessed the risk of bias of the effectiveness studies using criteria specific to the different study designs and evaluated strength of evidence (SOE) for studies of similar telehealth interventions with similar outcomes. We categorized barriers and facilitators to implementation using the Consolidated Framework for Implementation Research (CFIR) and summarized methodological weaknesses of studies. Results. We included 166 studies reported in 179 publications. Studies on the degree of uptake of provider-to-provider telehealth were limited to specific clinical uses (pharmacy, psychiatry, emergency care, and stroke management) in seven studies using national or regional surveys and claims data. They reported variability across States and regions, but increasing uptake over time. Ninety-seven studies (20 trials and 77 observational studies) evaluated the effectiveness of provider-to-provider telehealth in rural settings, finding that there may be similar rates of transfers and lengths of stay with telehealth for inpatient consultations; similar mortality rates for remote intensive care unit care; similar clinical outcomes and transfer rates for neonates; improvements in medication adherence and treatment response in outpatient care for depression; improvements in some clinical monitoring measures for diabetes with endocrinology or pharmacy outpatient consultations; similar mortality or time to treatment when used to support emergency assessment and management of stroke, heart attack, or chest pain at rural hospitals; and similar rates of appropriate versus inappropriate transfers of critical care and trauma patients with specialist telehealth consultations for rural emergency departments (SOE: low). Studies of telehealth for education and mentoring of rural healthcare providers may result in intended changes in provider behavior and increases in provider knowledge, confidence, and self-efficacy (SOE: low). Patient outcomes were not frequently reported for telehealth provider education, but two studies reported improvement (SOE: low). Evidence for telehealth interventions for other clinical uses and outcomes was insufficient. We identified 67 program evaluations and qualitative studies that identified barriers and facilitators to rural provider-to-provider telehealth. Success was linked to well-functioning technology; sufficient resources, including time, staff, leadership, and equipment; and adequate payment or reimbursement. Some considerations may be unique to implementation of provider-to-provider telehealth in rural areas. These include the need for consultants to better understand the rural context; regional initiatives that pool resources among rural organizations that may not be able to support telehealth individually; and programs that can support care for infrequent as well as frequent clinical situations in rural practices. An assessment of methodological weaknesses found that studies were limited by less rigorous study designs, small sample sizes, and lack of analyses that address risks for bias. A key weakness was that studies did not assess or attempt to adjust for the risk that temporal changes may impact the results in studies that compared outcomes before and after telehealth implementation. Conclusions. While the evidence base is limited, what is available suggests that telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents. Most barriers to implementation are common to practice change efforts. Methodological weaknesses stem from weaker study designs, such as before-after studies, and small numbers of participants. The rapid increase in the use of telehealth in response to the Coronavirus disease 2019 (COVID-19) pandemic is likely to produce more data and offer opportunities for more rigorous studies.
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Leavy, Michelle B., Danielle Cooke, Sarah Hajjar, Erik Bikelman, Bailey Egan, Diana Clarke, Debbie Gibson, Barbara Casanova, and Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Report on Registry Configuration. Agency for Healthcare Research and Quality (AHRQ), November 2020. http://dx.doi.org/10.23970/ahrqepcregistryoutcome.
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Background: Major depressive disorder is a common mental disorder. Many pressing questions regarding depression treatment and outcomes exist, and new, efficient research approaches are necessary to address them. The primary objective of this project is to demonstrate the feasibility and value of capturing the harmonized depression outcome measures in the clinical workflow and submitting these data to different registries. Secondary objectives include demonstrating the feasibility of using these data for patient-centered outcomes research and developing a toolkit to support registries interested in sharing data with external researchers. Methods: The harmonized outcome measures for depression were developed through a multi-stakeholder, consensus-based process supported by AHRQ. For this implementation effort, the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, each recruited 10 pilot sites from existing registry sites, added the harmonized measures to the registry platform, and submitted the project for institutional review board review Results: The process of preparing each registry to calculate the harmonized measures produced three major findings. First, some clarifications were necessary to make the harmonized definitions operational. Second, some data necessary for the measures are not routinely captured in structured form (e.g., PHQ-9 item 9, adverse events, suicide ideation and behavior, and mortality data). Finally, capture of the PHQ-9 requires operational and technical modifications. The next phase of this project will focus collection of the baseline and follow-up PHQ-9s, as well as other supporting clinical documentation. In parallel to the data collection process, the project team will examine the feasibility of using natural language processing to extract information on PHQ-9 scores, adverse events, and suicidal behaviors from unstructured data. Conclusion: This pilot project represents the first practical implementation of the harmonized outcome measures for depression. Initial results indicate that it is feasible to calculate the measures within the two patient registries, although some challenges were encountered related to the harmonized definition specifications, the availability of the necessary data, and the clinical workflow for collecting the PHQ-9. The ongoing data collection period, combined with an evaluation of the utility of natural language processing for these measures, will produce more information about the practical challenges, value, and burden of using the harmonized measures in the primary care and mental health setting. These findings will be useful to inform future implementations of the harmonized depression outcome measures.
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Leavy, Michelle B., Costas Boussios, Robert L. Phillips, Jr., Diana Clarke, Barry Sarvet, Aziz Boxwala, and Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Final Report. Agency for Healthcare Research and Quality (AHRQ), June 2022. http://dx.doi.org/10.23970/ahrqepcwhitepaperdepressionfinal.
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Objective. The objective of this project was to demonstrate the feasibility and value of collecting harmonized depression outcome measures in the patient registry and health system settings, displaying the outcome measures to clinicians to support individual patient care and population health management, and using the resulting measures data to support patient-centered outcomes research (PCOR). Methods. The harmonized depression outcome measures selected for this project were response, remission, recurrence, suicide ideation and behavior, adverse effects of treatment, and death from suicide. The measures were calculated in the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, and displayed on the registry dashboards for the participating pilot sites. At the conclusion of the data collection period (March 2020-March 2021), registry data were analyzed to describe implementation of measurement-based care and outcomes in the primary care and behavioral health care settings. To calculate and display the measures in the health system setting, a Substitutable Medical Apps, Reusable Technology (SMART) on Fast Healthcare Interoperability Resource (FHIR) application was developed and deployed at Baystate Health. Finally a stakeholder panel was convened to develop a prioritized research agenda for PCOR in depression and to provide feedback on the development of a data use and governance toolkit. Results. Calculation of the harmonized outcome measures within the PRIME Registry and PsychPRO was feasible, but technical and operational barriers needed to be overcome to ensure that relevant data were available and that the measures were meaningful to clinicians. Analysis of the registry data demonstrated that the harmonized outcome measures can be used to support PCOR across care settings and data sources. In the health system setting, this project demonstrated that it is technically and operationally feasible to use an open-source app to calculate and display the outcome measures in the clinician’s workflow. Finally, this project produced tools and resources to support future implementations of harmonized measures and use of the resulting data for research, including a prioritized research agenda and data use and governance toolkit. Conclusion. Standardization of outcome measures across patient registries and routine clinical care is an important step toward creating robust, national-level data infrastructure that could serve as the foundation for learning health systems, quality improvement initiatives, and research. This project demonstrated that it is feasible to calculate the harmonized outcome measures for depression in two patient registries and a health system setting, display the results to clinicians to support individual patient management and population health, and use the outcome measures data to support research. This project also assessed the value and burden of capturing the measures in different care settings and created standards-based tools and other resources to support future implementations of harmonized outcome measures in depression and other clinical areas. The findings and lessons learned from this project should serve as a roadmap to guide future implementations of harmonized outcome measures in depression and other clinical areas.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.
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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Journal of Child Psychology and Psychiatry – Annual Research Review Pt. 2. ACAMH, May 2018. http://dx.doi.org/10.13056/acamh.3781.
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More research is needed into effective interventions for sensory symptoms. ACAMH, June 2020. http://dx.doi.org/10.13056/acamh.12312.
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Professor Alison Lane at the University of Newcastle, Australia, has compiled a practitioner review for the Journal of Child Psychology and Psychiatry on how to effectively manage functional difficulties associated with sensory symptoms in children and adolescents.