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Background: Pediatric oncology patients encounter substantial psychosocial and psychiatric challenges alongside physical illness and treatment burdens. Consultation-Liaison Psychiatry (CLP) is critical for addressing these young patients' mental health needs within a broader healthcare framework. Socioeconomic disparities, family dynamics, and educational interruptions further complicate the psychiatric landscape in pediatric oncology., Aims: This study aims to explore the sociodemographic and psychiatric profiles of pediatric oncology patients referred to CLP services., Methods: A retrospective cross-sectional study was conducted on 97 pediatric oncology patients who received CLP consultations over two years. Data included sociodemographic details, clinical history, and psychiatric diagnoses based on structured clinical interviews. Statistical analyses, including multivariate logistic regression, examined relationships between psychiatric outcomes and variables such as SES, educational status, and clinical factors., Results: The sample was predominantly of low SES (72.2%), with depression, adjustment disorders, and sleep disorders frequently observed. Patients unable to continue formal education due to their oncological disease and treatment process showed higher rates of depression. Significant associations emerged between psychopathology and factors such as lower SES, older parental age, and steroid use, although the predictive strength was modest. Most psychiatric consultations occurred due to observed psychiatric complaints rather than proactive psychosocial support, highlighting a reactive rather than preventive approach in CLP practice., Conclusions: Findings highlight the importance of early, structured psychiatric intervention and a proactive CLP approach to mitigate the psychiatric impact on pediatric oncology patients. Addressing SES-based disparities and supporting educational continuity are essential for holistic pediatric cancer care., (© 2025 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Importance: The rising incidence of mental illness in the US underscores the need for timely access to psychiatric care, especially for vulnerable populations such as older adults and individuals with mental and physical disabilities who receive Medicare., Objective: To assess changes in the number and proportion of active psychiatrists providing professional services to traditional Medicare Part B enrollees from 2014 to 2022., Design, Setting, and Participants: This repeated cross-sectional study of Medicare Part B enrollees used publicly available data (for January 1, 2014, through December 31, 2022) from the Centers for Medicare & Medicaid Services and the Kaiser Family Foundation. Data from all traditional Medicare Part B enrollees in all 50 states and the District of Columbia were analyzed., Main Outcomes and Measures: Primary outcomes included changes in (1) the proportion of active psychiatrists billing traditional Medicare and (2) the number of psychiatrists providing care relative to the number of Medicare Part B enrollees nationally, regionally, and by state., Results: The study population comprised 291 748 472 Medicare Part B enrollee-years (33 042 936 in 2014: 5 800 903 [17.6%] eligible due to disability alone and 27 242 030 [82.4%] eligible due to age). From 2014 to 2022, the number of Medicare Part B enrollees decreased by 3 497 942 enrollee-years (10.6%), while the number of psychiatrists submitting more than 10 claims to Medicare Part B decreased by 3772 (16.8%). The nationwide proportion of professionally active psychiatrists submitting claims to Medicare Part B for professional services during this period declined from 22 409 of 50 416 (44.4%) in 2014 to 18 637 of 56 492 (33.0%) in 2022 (P < .001 on univariable regression). From 2014 to 2022, state-level changes in Medicare Part B-serving psychiatrists per enrollee ranged from a 31.7% increase in Alabama (from 36.5 to 48.1 psychiatrists per 100 000 enrollees) to a 67.8% decrease in Wyoming (from 42.9 to 13.8 psychiatrists per 100 000 enrollees). Every state and district assessed saw a decrease in the percentage of active psychiatrists who billed Medicare Part B for professional services over the study period., Conclusions and Relevance: In this study of Medicare Part B acceptance among active US psychiatrists, declining acceptance of Medicare Part B for professional services among psychiatrists was observed nationally and across all states. During a time of psychiatrist workforce growth, the number of psychiatrists accepting traditional Medicare decreased, indicating potential challenges in providing equitable access to psychiatric care.

Introduction: Psychiatric comorbidities such as depression and anxiety disorders are highly prevalent among people with epilepsy (PWE). These two co-occurring chronic illnesses could lead to double stigma and negatively impact every aspect of psychiatric and epilepsy care for PWE, especially in help-seeking behavior. We aimed to identify the socio-demographic and clinical factors contributing to reluctance to be referred to a psychiatrist among PWE., Methods: A prospective cross-sectional study was conducted at a tertiary teaching hospital in Kuala Lumpur, Malaysia. Psychological screening was done using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and General Anxiety Disorder (GAD-7) questionnaire. Patients screened positive were offered psychiatric referrals and given an early psychiatric clinic appointment if they agreed to the referral. The reasons for those who refused the referral were noted., Results: Out of 585 patients, 91 (15.5 %) were screened positive for depression and/or anxiety. Eighteen patients were excluded from the study due to pre-existing psychiatric disorders. Of the remaining 73 patients, 23 (31.5 %) agreed to be referred to a psychiatrist. Only 17 (23.3 %) attended the psychiatrist appointment. A total of 11 (15.1 %) and one (1.4 %) patients were subsequently diagnosed with major depressive disorder and generalized anxiety disorder, respectively. Another 50 (68.5 %) patients were not referred to a psychiatrist, predominantly (n = 43, 58.9 %) due to reluctance to be referred to a psychiatrist. The reasons included avoidance of referral likely related to stigma (n = 22, 51.2 %), self-reliance, family and caregivers' disapproval of referral, and logistic difficulty. The mean scores in NDDI-E and GAD-7 in the referred group were higher than the not-referred group but not statistically significant (NDDI-E: 17.8 ± 3.6 vs. 16.5 ± 2.5, p = 0.072; GAD-7: 12.4 ± 5.70 vs. 9.8 ± 5.4, p = 0.061)., Conclusion: A significant number of PWE were reluctant to receive psychiatric referrals predominantly due to self-avoidance or family and caregiver disapproval of referral likely related to stigma. An integrated epilepsy care management model is recommended., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: It remains unclear whether general hospitals without psychiatric wards can provide sufficient services for both physical and mental health needs, as they often lack adequate psychiatrists, primarily due to cost constraints. This article explores the relationship between the number of full-time psychiatrists and functionality for integrating physical and mental health services in these settings., Methods: The Medical Policy Committee of the Japanese Society of General Hospital Psychiatry conducted a nationwide survey in 2022 to evaluate the detailed scope and volume of service of psychiatric departments in general hospitals without a psychiatric ward. The survey collected data related to scope and volume of service, including the availability of on-call services, the number of patients seen in outpatient settings, and the number of consultation-liaison services provided. The results were analyzed based on the number of full-time psychiatrists, with and without data from university hospitals, and categorized by hospital type. To account for confounding factors, multivariable regression analyses were also performed., Results: Broader scope and higher vollume in essential services was observed depending on the number of full-time psychiatrists, including on-call services, outpatient services, and consultation-liaison services, especially pediatric, anorexia, and perinatal psychiatric issues. Hospitals with multiple full-time psychiatrists offered broader services, a scope beyond the capacity of a single full-time psychiatrist, as confirmed by multivariable analyses. University hospitals offered the widest range of psychiatric services., Conclusions: Despite often being underestimated due to cost constraints, having multiple full-time psychiatrists in a general hospital without a psychiatric ward is essential for supporting the broader scope needed to integrate physical and mental health services., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Industry payments to psychiatrists remain poorly characterized. Using data from the Centers for Medicare and Medicaid Services, the authors of this repeated cross-sectional study detail the extent and concentration of nonresearch industry payments to psychiatrists from 2015 to 2021. The proportion of psychiatrists receiving industry payments, payment distribution, and payment concentration among psychiatrists was assessed. Among 56,955 psychiatrists, 75.0% received any industry payments from 2015 to 2021. These payments, totaling $357,971,774, were highly concentrated: 1% of psychiatrists received 74.7% of industry payments, with notable state-level variations in concentration of top industry-paid psychiatrists. The median psychiatrist received $0 from industry each year., Competing Interests: Dr. Havlik receives consulting fees from Ieso Digital Health and Frontier Psychiatry. Dr. Ross receives research support through Yale University from Johnson & Johnson and from Arnold Ventures. Dr. Ross formerly received research support from the Medical Device Innovation Consortium. In addition, Dr. Ross was an expert witness at the request of the Greene Law Firm, the relator’s attorneys, in a qui tam lawsuit. Dr. Rhee has served as a stakeholder and consultant for the Patient-Centered Outcomes Research Institute (PCORI) and received consulting fees from PCORI. Dr. Rhee serves as an advisory committee member for International Alliance of Mental Health Research Funders. Dr. Rhee is currently a co-editor-in-chief of Mental Health Science and receives honorarium payments annually from its publisher, John Wiley & Sons. The other authors report no financial relationships with commercial interests.

Objective: To examine trends and predictors of administrative actions against psychiatric clinicians' licenses between 2002 and 2022., Methods: Data from the National Practitioner Data Bank (NPDB) identified 6400 disciplinary actions against psychiatric clinicians' licenses. Linear trend models assessed the trends of disciplinary actions across mental/physical health, licensing/legal issues, and unprofessional conduct. A first-order autoregressive model with a time indicator interaction term evaluated structural breaks (ie, a sudden or gradual change in the characteristics of data in a time series). Predictors of claims were assessed using logistic regression., Results: Since 2002, disciplinary actions related to clinicians' mental/physical health (P=0.004) and licensure/legal issues (P=0.018) have decreased, while actions related to unprofessional conduct remained unchanged (P=0.358). Declines emerged in 2012 for mental/physical health (break coefficient -0.367; P=0.026) and in 2009 for unprofessional conduct (break coefficient -0.199; P=0.013). Clinicians facing disciplinary actions related to physical/mental health were significantly younger than those with legal/licensure issues (P<0.001). While the average age remained stable for mental/physical health-related actions, the average age increased for actions related to licensure/legal claims and unprofessional conduct., Conclusions: The decrease in disciplinary actions related to physical/mental health may reflect better access and acceptance of treatment of clinicians, while the reduction in licensure/legal actions may indicate policy shifts. Findings regarding age underscore the need for enhanced support for mid and late-career clinicians to promote lifelong learning and practice., Competing Interests: Dr J.R.S. has received research support from the National Institutes of Health (NIMH/NIEHS/NCATS/NICHD). He has received material support from Myriad Genetics and royalties from Springer and Cambridge University Press, honoraria from the Neuroscience Education Institute and Medscape and serves as an author for UpToDate. He has provided consultation to Alkermes, Otsuka, Cerevel and Genomind. Drs J.R.S. and J.A.M. receive research support from the Yung Family Foundation. The remaining author has no conflicts of interest., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The World Psychiatric Association (WPA) Working Group on Digital Psychiatry aims to digitally supplement, support and improve mental health and care literacy, acceptance and accessibility across WPA member countries and National Psychiatric Associations (NPAs). To help with this goal, the present study was set to explore first the global status of digital mental health and care across NPAs METHODS: An international expert survey on the digitalization level across all 145 WPA NPAs was electronically distributed through Qualtrics. Descriptive statistics were carried out on the global dataset., Results: Across all 145 responses, 57 were included for analysis (39.3 % response rate). Most NPAs reported lacking an official section on digital mental health (73.7 %), missing national (59.6 %) or regional policies (82.5 %), clinical guidelines (>60 % depending on the digital tool/program), and education/training in both medicine (77.2 %) either and psychiatry training programs (71.9 %). Telemedicine seemed to be the most regulated digital tool in more than half of all included NPAs. Telemedicine (45.6 %) and telemental healthcare (38.6 %) were generally reimbursed. The reported highest priority areas for future actions across WPA Regions were education and training, and the development of guidelines., Conclusion: This study represents a benchmark in the work of the WG on Digital Psychiatry. It presents clear priority areas that will guide the delivery of targeted actions aimed to promote digital mental health and care, and ultimately, equitable mental health outcomes around the world. Overall, the highest priorities to be globally implemented are represented by education/training and evidence-based clinical practice guidelines., Competing Interests: Declaration of Competing Interest All the authors report no relevant conflicts of interest for this article., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Catatonia, characterized by motor, affective, and speech disturbances, is a prevalent yet frequently misdiagnosed syndrome in the psychiatric domain, with reported prevalence ranging from 5% to 18%. This study aimed to ascertain the incidence of catatonia diagnoses and the quality of care provided within the psychiatric emergency room (ER), while also evaluating psychiatrists' general awareness of the syndrome through a survey., Methods: A retrospective analysis of psychiatric ER records spanning June 18th to August 20th, 2022, was conducted to assess catatonia diagnosis frequency and treatment approaches. A Google Survey was distributed to full-time psychiatrists in the ER, querying their knowledge about catatonia prevalence, diagnostic modalities, and treatment strategies., Results: Analysis of 1118 patient records revealed a catatonia diagnosis rate of 0.36% (four cases) in the psychiatric ER. Remarkably, 75% of diagnosed patients were assessed by a single psychiatrist among nine available. Survey responses from all nine ER psychiatrists highlighted that 44% considered encountering catatonia as infrequent, while 33% regarded it as generally rare. Furthermore, 33% expressed willingness to employ potent antipsychotic interventions., Conclusion: The study revealed a markedly low catatonia detection rate in the psychiatric ER, coupled with inconsistent treatment approaches. Survey findings reflected a considerable proportion of psychiatrists holding outdated perceptions of catatonia., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Mentoring plays an integral role in the success of faculty. This study explores faculty access to formal and informal mentorship and how mentorship impacts faculty engagement. Data are from 2020 to 2023 administrations of the StandPoint Faculty Engagement Survey. We compare clinically active faculty with a PhD or other health doctorate (OHD) in departments of psychiatry and neurology (Doctoral-PN) with both faculty with an MD or equivalent degree in those departments (Physician-PN), and with faculty with a PhD or OHD in other clinical departments (Doctoral-Other). Psychologists who are active in clinical care are represented in these departments although their representation likely varies by institution. Forty-four percent of Doctoral-PN faculty received formal mentoring and 65% received informal mentoring. Those receiving formal mentoring were more satisfied with professional development opportunities and reported increased understanding of promotion than those who were not. They were also more satisfied with their department and would recommend their medical school to others. The literature to date acknowledges the challenges to professional growth and advancement faced by Doctoral-PN faculty, including psychologists, practicing in academic health centers. This paper adds to previous research by presenting data on organizational outcomes associated with mentoring for these faculty., Competing Interests: Declarations Conflict of interest Susan M. Pollart, Elza Mylona, Troy Buer, Jennifer Apps, and Valerie Dandar have no relevant financial or nonfinancial interests to disclose. Ethics Approval AAMC research using StandPoint Surveys data was approved by the American Institutes for Research. Consent to Participate The StandPoint Faculty Engagement Survey is a voluntary survey, and informed consent was obtained from all participants. Consent for Publication The StandPoint Survey disclosure describes that data may be used for research when deidentified and reported in the aggregate. Informed consent was obtained from all participants. Human and Animal Rights Statement All procedures involving human sbujects were in accordance with the ethical standards of the U.S. Office for Human Research Protections and the Belmont Report of 1979. The study was approved by the institutional review board of the American Institutes for Research., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To explore the opinions of French psychiatrists toward the legalization of medical or recreational use of cannabis in France., Methods: Psycan was an anonymous Internet survey conducted between September 28, 2021 and March 29, 2022, among subscribers of the Encéphale Online community, i.e., approximately 4000 French psychiatrists. Participants were asked to complete a structured questionnaire, collecting their socio-demographic features, clinical experience, opinions toward cannabis legalization, and perceived impact of cannabis derivatives for psychiatric disorders. Logistic regression models were used to identify factors associated with being for or against cannabis legalization., Results: In total, 413 psychiatrists answered the survey, of whom 253 (61.3%) declared being in favour of recreational cannabis, and 349 (84.4%) of medical cannabis. Being in favour of legalization of recreational cannabis was negatively associated with being female (odd ratio [OR]=0.61; 95% confidence interval [CI]=0.41-0.93), and with the frequency of meeting patients with cannabis use disorder (OR=0.60; 95%CI=0.43-0.83). Most respondents were concerned about the development of psychotic disorders. The most frequent pro-legalization arguments were improved prevention, better control of product content, and better protection of youth, respectively. Arguments against legalization were increased societal damages, increased impact on health, including mental health., Conclusions: A majority of French psychiatrists were in favour of the marketing of medical cannabis, and, to a lesser extent, the legalization of recreational cannabis. For recreational cannabis, the proportion of pro-legalization psychiatrists was slightly more elevated than that found in the French general population., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Premenstrual dysphoric disorder (PMDD) and severe premenstrual syndrome (PMS) exert profoundly adverse effects on quality of life. We surveyed psychiatrists and clinical psychologists in Japan to determine their understanding and practice of diagnosing PMDD/PMS., Methods: We targeted psychiatrists and clinical psychologists working at health administration facilities of universities in Japan who treat female patients with depressive symptoms in their late teens and 20 s-when PMDD/PMS is likely to develop. We presented a fictitious clinical case of a 23-year-old female and investigated whether the participants considered PMDD/PMS as a potential diagnosis. We also investigated the practitioners' basic understanding of PMDD/PMS., Results: We analyzed survey responses from 26 psychiatrists and 140 clinical psychologists. Comparatively few respondents considered PMDD/PMS a possible diagnosis or routinely inquired about a patient's menstruation. When practitioners were provided with information linking observed symptoms to the menstrual cycle, most considered PMDD and PMS possible diagnoses. Recognizing and considering PMDD/PMS was related to the respondents' attributes., Conclusions: Clinicians should consider PMDD/PMS when treating women with depressive symptoms., Competing Interests: Declaration of Competing Interest The authors have no competing interest to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation., Methods: Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots., Results: Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services., Conclusions: MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The RANZCP conducted an anonymous survey of 7200 members (trainees and psychiatrists) in December 2023, receiving 1269 responses, representing the views of roughly 1 in 6 members, and of the respondents, three quarters reported experiencing burnout in the last 3 years. We provide a commentary, citing evidence from relevant previous research, discussing the implications and proposing potential interventions., Conclusions: Members of the RANZCP reported worsening workforce shortages, with 9 in 10 respondents stating that these negatively impacted patient care, and 7 in 10 experiencing symptoms of burnout. Eighty per cent identified workforce shortages as the top contributing factor to such burnout. The aetiology of workforce shortages and burnout is likely due to operational and structural shortfalls in psychiatric services. However, public and private sector employment information was not included in the report. There are a range of strategic, evidence-based interventions to address the psychiatrist and trainee workforce challenges, comprising general healthcare service as well as specific initiatives. Based on the findings of the report, such interventions are needed, now.

Introduction: There is growing evidence supporting dietary interventions in major depressive disorders and other mental disorders. The WPA Action Plan 2023-2026 prioritises several actions including the improvement and the preservation of mental health through the adoption of healthy lifestyle choices illustrated in the Healthy Lifestyles Hub and research. Greater emphasis on physical activity, nutrition and sleep hygiene between patients and psychiatric staff is an objective of WPA Action Plan 2023-2026., Methods: The survey was conducted from May to June 2024 using Google Forms. A questionnaire was administered to a sample of mental health professionals and consisted of statements investigating specific knowledge in nutritional Psychiatry and adoption of strategies to improve nutritional interventions in mental health. With this study, we aimed to investigate insight and attitudes on nutrition in mental health among a sample of psychiatrists and psychologists resident in Italy., Results: 110 participants (61 psychologists, 46 adult psychiatrists and 3 child psychiatrists) agreed to participate in our survey. 89.2% (n=91) of them worked in southern Italy. The majority of participants were female (77.98%) and reported working in a Mental Health Centre (n=41, 37,27%), followed by psychiatric residential facilities (n=22, 20%), private practice (n=19, 17.27%), hospital (n=14, 12.73%), university research centre (n=4. 3.64%), other non specified institute (n=10; 9.09%). When asked the importance of a nutritional approach in the context of mental disorders no difference was found between the professional groups (p-value 0.653). Female gender is most represented, although not significantly (p-value 0.161). The need for further research in the field of nutritional psychiatry is widely considered by all mental health professionals, but without professional (p-value=0.416) and gender differences (p-value=0.426). Psychologists statistically significantly reported the need for specific training in nutritional psychiatry (p-value 0.004). We found a significant coefficient between number of years of working experience and nutritional training needs among all health professionals (tau -0.169; p-value = 0.022)., Conclusions: Specific nutrition training courses both for adult and child psychiatrists and psychologists are needed in order to increase awareness on nutrition as a well-being contributing factor in the biopsychosocial model.

Background and Objectives: Addiction consultation services provide access to specialty addiction care during general hospital admission. This study assessed opioid use disorder (OUD) outcomes associated with addiction consultation., Methods: Retrospective cohort study of individuals with OUD admitted to an academic medical center between 2018 and 2023. The exposure was addiction consultation. Outcomes included initiating medication for OUD (MOUD), hospital length of stay, before-medically-advised (BMA) discharge, and 30- and 90-day postdischarge acute care utilization., Results: Of 26,766 admissions (10,501 patients) with OUD, 2826 addiction consultations were completed. Consultation cohort was more likely to be young, male, and White than controls. Consultation was associated with greater MOUD initiation (adjusted odds ratio [aOR], 5.07; 95% confidence interval [CI], 4.41-5.82), fewer emergency department visits at 30 (aOR, 0.78; 95% CI, 0.67-0.92) and 90 (aOR, 0.79; 95% CI, 0.69-0.89) days, and fewer hospitalizations at 30 (aOR, 0.65; 95% CI, 0.56 to 0.76) and 90 (aOR, 0.67; 95% CI, 0.59-0.76) days. Additionally, consultation patients were more likely to have a longer hospital stay and leave BMA., Conclusions and Scientific Significance: Addiction consultation was associated with increased MOUD initiation and reduced postdischarge acute care utilization. This is the largest study to date showing a significant association between addiction psychiatry consultation and improved OUD outcomes when compared to controls. The observed reduction in postdischarge acute care utilization remains even after adjusting for MOUD initiation. Disparities in access to addiction consultation warrant further study., (© 2024 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry (AAAP).)

Objective: To investigate whether information about the gender, ethnicity, and socioeconomic status of the patient affects psychiatric assessments in a sample of practicing clinicians in Swedish adult psychiatry., Method: The study used an experimental design in which vignettes describing patients were identical except for information regarding their gender, ethnicity, and socioeconomic status. The outcome variables included assessments of the severity of the patient's clinical condition, how dangerous the patient was to themselves and others, the likelihood of reporting to social services (due to concern for the welfare of children), and whether the patient was recommended psychotherapy or psychopharmaceutical treatment., Results: A series of ANOVAs were performed to investigate main and interaction effects of the studied variables. The performed analyses identified several instances in which the clinicians' assessments varied as a function of the social categories under investigation. For example, male patients and "Arab Swedish" patients were perceived as more dangerous, "Arab Swedish" patients, male patients, and patients with low socioeconomic status were less likely to be recommended psychotherapy, and "Arab Swedish" patients were more likely to be reported to social services. The effect sizes were generally small., Conclusions: The study provides support for the suggestion that information regarding patient gender, ethnicity, and socioeconomic status affects central aspects of psychiatric assessments. The results are interpreted and discussed in relation to other studies on the influence of social stereotypes on psychiatric assessments and the practice of clinical psychiatric assessments., (© 2024 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Objective: Harmonized tools are essential for reliable data sharing and accurate identification of relevant factors in mental health research. The primary objective of this study was to create a harmonized questionnaire to collect demographic, clinical and behavioral data in diverse clinical trials in adult psychiatry., Methods: We conducted a literature review and examined 24 questionnaires used in previously published randomized controlled trials in psychiatry, identifying a total of 27 domains previously explored. Using a Delphi-method process, a task force team comprising experts in psychiatry, epidemiology and statistics selected 15 essential domains for inclusion in the final questionnaire., Results: The final selection resulted in a concise set of 22 questions. These questions cover factors such as age, sex, gender, ancestry, education, living arrangement, employment status, home location, relationship status, and history of medical and mental illness. Behavioral factors like physical activity, diet, smoking, alcohol and illicit drug use were also included, along with one question addressing family history of mental illness. Income was excluded due to high confounding and redundancy, while language was included as a measure of migration status., Conclusion: The recommendation and adoption of this harmonized tool for the assessment of demographic, clinical and behavioral data in mental health research can enhance data consistency and enable comparability across clinical trials., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: M.B. is supported by a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship and Leadership 3 Investigator grant (1156072 and 2017131). M.B.: Grant/Research Support: MRFF, NHMRC, Congressionally Directed Medical Research Programs (CDMRP) USA, AEDRTC Australian Eating Disorders Research and Translation Centre, Patient-Centered Outcomes Research Institute (PCORI), Baszucki Brain Research Fund, Danmarks Frie Forskningsfond, Psykiatrisk Center Kobenhavn, Stanley Medical Research Institute, Victorian Government Department of Jobs, Precincts and Regions, Wellcome Trust, Victorian Medical Research Acceleration Fund, Controversias Psiquiatria Barcelona, CRE, Victorian COVID-19 Research Fund; Consultancies: Lundbeck, Sandoz, Servier, Medisquire, HealthEd, ANZJP, EPA, Janssen, Medplan, RANZCP, Abbott India, ASCP, International Society of Bipolar Disorder, Precision Psychiatry, Penn State College of Medicine, Shanghai Mental Health Centre (last 3 years)—all unrelated to this work. O.M.D. is Associate Professor (Research) Deakin University and has received grant support from the Brain and Behaviour Foundation, Simons Autism Foundation, Stanley Medical Research Institute, Deakin University, Lilly, NHMRC and ASBDD/Servier. She has also received in-kind support from BioMedica Nutraceuticals, NutritionCare and Bioceuticals. L.J.W. is supported by a NHMRC Emerging Leader Fellowship (1174060). A.J.W. is supported by a Trisno Family Fellowship, funded in part by an NHMRC CRE (1153607). He has previously received grant/fellowship support from the Trisno Family Gift and Deakin University. M.B., S.L.R., A.T., O.M.D. and A.J.W. are named investigators on the Medical Research Futures Fund 2020 Million Minds Mission—MAGNET: Mental Health Australia General Clinical Trial Network (2006296).

Introduction: Telemedicine has become a fundamental pillar of the evolution of healthcare worldwide. In Tunisia, the challenges of the health system, amplified by the COVID-19 pandemic, have highlighted the urgency to adopt innovative solutions. In this regard, the publication of Presidential Decree No. 318/2022 on April 8 in the Official Journal of the Tunisian Republic represents a significant advance in the regulation of telemedicine., Aim: To assess the knowledge of Tunisian psychiatrists and child psychiatrists regarding telemedicine, its legal framework, and their perceptions of this new medical practice., Methods: A descriptive cross-sectional study was conducted 8 months after the issuance of the presidential decree. The survey was conducted online through an electronic questionnaire on Google Forms., Results: A total of 68 participants were included in this survey. The median number of professional years was 5±7 years. Among the participants, 82% worked in psychiatry and 18% worked in child psychiatry. The sector of practice was public in 69% and private in 31% of cases. Most of them (62%) did not know about the different telemedicine acts, and 57% of doctors were unaware of the existence of the presidential decree. The majority of doctors (84%) expressed a favorable opinion regarding the adoption of telepsychiatry, regardless of sex (p=0.69), professional status (p=0.512), specialty (p=1), years of experience (p=0.83), and practice sector (p=1)., Conclusion: Despite a low level of knowledge regarding telemedicine, the study highlights the interest of the participants in integrating telepsychiatry into their clinical practices.

Background: At the beginning of the COVID-19 pandemic, it was foreseen that the number of face-to-face psychiatry consultations would suffer a reduction. In order to compensate, the Australian Government introduced new Medicare-subsidized telephone and video-linked consultations. This study investigates how these developments affected the pre-existing inequity of psychiatry service delivery in Australia., Methods: The study analyses five and a half years of national Medicare data listing all subsidized psychiatry consultation consumption aggregated to areas defined as Statistical Area level 3 (SA3s; which have population sizes of 30 k-300 k). Face-to-face, video-linked and telephone consultations are considered separately. The analysis consists of presenting rates of consumption, concentration graphs, and concentration indices to quantify inequity, using Socio Economic Indexes for Areas (SEIFA) scores to rank the SA3 areas according to socio-economic disadvantage., Results: There is a 22% drop in the rate of face-to-face psychiatry consultation consumption across Australia in the final study period compared with the last study period predating the COVID-19 pandemic. However, the loss is made up by the introduction of the new subsidized telephone and video-linked consultations. Referring to the same time periods, there is a reduction in the inequity of the distribution of face-to-face consultations, where the concentration index reduces from 0.166 to 0.129. The new subsidized video-linked consultations are distributed with severe inequity in the great majority of subpopulations studied. Australia-wide, video-linked consultations are also distributed with gross inequity, with a concentration index of 0.356 in the final study period. The effect of this upon overall inequity was to cancel out the reduction of inequity resulting from the reduction of face-to face appointments., Conclusion: Australian subsidized video-linked psychiatry consultations have been distributed with gross inequity and have been a significant exacerbator of the overall inequity of psychiatric service provision. Future policy decisions wishing to reduce this inequity should take care to reduce the risk posed by expanding telepsychiatry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yeatman, Enticott, Lakra and Meadows.)

Objective: Sex disparity is a major societal issue. The aim of this paper was to describe changes in the representation of women among speakers of the American Psychiatric Association (APA) annual meeting over 10 years, between 2009 and 2019 and to compare them to changes in the proportion of women among American psychiatrists., Methods: Data were collected from the programs of the APA annual meetings of 2009 and 2019, and from the Association of American Medical Colleges. Descriptive and comparative statistical analyses were performed., Results: There were 1,138 distinct speakers at the 2009 conference and 1,784 at the 2019 conference. The number of distinct female speakers increased from 413 (36.3%) to 813 (45.6%). The proportion of female speakers at the meetings was almost equivalent to the proportion of women in the American psychiatrists' workforce. The number of female chairs increased from 158 (39.6%) to 322 (46.4%). There were 38 female speakers in child and adolescent psychiatry in 2009 (51.4% of 74 speakers) and 74 in 2019 (51.0% of 155 speakers)., Conclusions: The representation of women at the APA annual meetings increased between 2009 and 2019. At the same time, the growth in the percentage of women in the American psychiatrists' workforce was slower. The APA appears to promote female representation during its annual meetings., Competing Interests: CH reports personal fees from EISAI, Janssen, Lundbeck, Otsuka and UCB. WEH reports personal fees from Air Liquide, EISAI, Janssen, Lundbeck, Otsuka, UCB, Roche and Chugai. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Importance: The American Medical Association has acknowledged the public health threat posed by racism in medicine. While clinicians in psychiatry have echoed the sentiment, the research community has largely been silent. Current understanding of the biological domains that underlie psychiatric disorders was historically established by studying White populations, often leaving widely used treatments ineffective for Asian, Black, Hispanic, Indigenous, and other racial and ethnic minority individuals. This article addresses how undersampling of racial and ethnic minority individuals has led to overgeneralized physiological findings, the implications for development of psychiatric treatments, and steps to improve service to racially diverse communities., Observations: Three primary observations regarding differences associated with race and ethnicity have been addressed in the existing psychiatric research: misdiagnosis, medication nonadherence, and treatment efficacy and expression of adverse effects. While cultural factors have been discussed as potential factors associated with these differences, a lack of understanding of physiologic systems may be foundational to each of these issues. Recent evidence points to race differences in psychophysiological measures, likely attributed to factors including the lived experience of racism as opposed to inherent biological differences. This mounting evidence supports a reassessment of existing work to examine potential divergent patterns within racial and ethnic groups. The following strategies may improve understanding of the influence of racism on physiology, allowing clinicians to better address psychiatric symptoms and improve existing treatment approaches. Thus, psychiatric researchers need to (1) understand the historic and current terminology for race and ethnicity and use appropriate terms and categories as defined by sociologists, population health experts, and databases while respecting individuals' right to self-identify, (2) refine research questions, and (3) reexamine research data to determine whether patterns observed in largely White populations can extend to other groups. To appropriately implement these steps, researchers must accept the discomfort that accompanies growth, invite scientists from diverse backgrounds to participate, and use resources to increase diversity in recruitment of study participants. This will require a commitment from funding agencies to provide adequate support to recruit and investigate large, diverse samples., Conclusions and Relevance: To create more suitable medical treatments and improve the quality of care received by those with psychiatric conditions, further discussion is needed surrounding the physiologic toll that racism has had on multiple generations of racial and ethnic minority groups and how that may alter responsivity to biobehavioral interventions. To better inform psychiatric research, the resources provided must be expanded, basic physiologic studies should be replicated with more diverse samples and adequate analyses, and psychiatry scientists must reconsider approaches to clinical research.

Few studies address publication and outcome reporting biases of randomized controlled trials (RCTs) in psychiatry. The objective of this study was to determine publication and outcome reporting bias in RCTs funded by the Stanley Medical Research Institute (SMRI), a U.S. based, non-profit organization funding RCTs in schizophrenia and bipolar disorder. We identified all RCTs (n = 280) funded by SMRI between 2000 and 2011, and using non-public, final study reports and published manuscripts, we classified the results as positive or negative in terms of the drug compared to placebo. Design, outcome measures and statistical methods specified in the original protocol were compared to the published manuscript. Of 280 RCTs funded by SMRI between 2000 and 2011, at the time of this writing, three RCTs were ongoing and 39 were not performed. Among the 238 completed RCTs, 86 (36.1%) reported positive and 152 (63.9%) reported negative results: 86% (74/86) of those with positive findings were published in contrast to 53% (80/152) of those with negative findings (P < .001). In 70% of the manuscripts published, there were major discrepancies between the published manuscript and the original RCT protocol (change in the primary outcome measure or statistics, change in a number of patient groups, 25% or more reduction in sample size). We conclude that publication bias and outcome reporting bias is common in papers reporting RCTs in schizophrenia and bipolar disorder. These data have major implications regarding the validity of the reports of clinical trials published in the literature., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Catatonia is often overlooked, and a key factor for underdiagnosis may be an inadequate understanding of catatonia's heterogeneous phenotypes. The aim of this study was to identify the current state of theoretical and applied knowledge of catatonic features among psychiatry trainees and practitioners using the Bush-Francis Catatonia Rating Scale (BFCRS), the most commonly used instrument to identify and score catatonia., Methods: We created an online 50-item multiple-choice test and 3-minute standardized patient video to be scored using the BFCRS. Email invitations were sent to medical students and psychiatry residents and fellows through listservs of psychiatry clerkship and residency directors and to consultation-liaison psychiatrists through the Academy of Consultation-Liaison Psychiatry. Participants could access the exam from October 1 to December 31, 2020., Results: In our sample (n = 482), participants correctly answered an average of 55% of test questions and identified 69% of BFCRS items on the standardized patient exam. Multivariable regression adjusting for demographics revealed that, compared to medical students, psychiatrists scored 7 points higher on the multiple-choice test and identified only 2 more items correctly on the BFCRS. Older participants performed worse than younger participants. No meaningful performance differences were identified by region or gender. Several items were consistently misidentified., Conclusions: We found significant inaccuracies in clinicians' understanding of catatonic features irrespective of their stage of training and years of experience. These data suggest prevalent gaps in catatonia recognition among psychiatrists, psychiatry trainees, and medical students utilizing the BFCRS. This has important implications for clinical research and patient care., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument-the Description and Evaluation of Services and Directories-DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making., Competing Interests: The authors have declared that no competing interests exist.

Background: The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations., Methods: The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19., Results: While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations., Conclusions: Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

Objective: This study aimed to examine differences in completion rates between telepsychiatry and in-person visits during the COVID-19 pandemic and a prior reference period., Methods: The authors used electronic medical record data along with chi-squared or t tests to compare patients' demographic characteristics. Generalized estimating equations for estimating the odds of primary and secondary outcomes were used, controlling for demographic characteristics., Results: During COVID-19, the odds of completing a telepsychiatry visit (N=26,715) were 6.68 times the odds of completing an in-person visit (N=11,094). The odds of completing a telepsychiatry visit during COVID-19 were 3.00 times the odds of completing an in-person visit during the pre-COVID-19 reference period (N=40,318)., Conclusions: In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.

Objective: It has been widely predicted that the COVID-19 pandemic will have a detrimental impact on the mental health (MH) of individuals. This has been dubbed as the MH 'second wave'. In Australia, these impacts have been partly mitigated by institutional responses such as increased access to psychotherapy. Consultation Liaison (CL) psychiatry services provide MH care to acutely unwell patients in general hospitals. It was hypothesised that the number of referrals to the studied service had increased since the start of the pandemic., Methods: From the Electronic medical records (eMRs), the authors collected daily referral numbers, over 3 consecutive years, to a large CL service in metropolitan Sydney., Results: Referrals were significantly increased by 25%, 95% CI [1.14, 1.36], p < .001 since the start of the pandemic. This increase was delayed, and remained elevated despite a reduction in COVID-19 infections., Conclusion: This study adds evidence to the existence of the MH 'second wave', highlights a key impact on healthcare workers' well-being and will assist in guiding resource allocation decisions in the near future.

Introduction: Psychiatry's postgraduate training curriculum in Iran has been revised and one of the core revisions has been the incorporation of full-time 9-months of psychotherapy training. However, little is known about psychotherapy training in Iran., Methods: An online anonymous survey was developed by the Early Career Psychiatrists (ECP) Section of the World Psychiatric Association (WPA). The survey included 16 questions about the: (a) quality of psychotherapy training (supervision, type of psychotherapy training available, barriers in accessing training); (b) organizational aspects of psychotherapy training (compulsoriness, payment, and assessment); (c) satisfaction with training in psychotherapy; (d) self-confidence in the use of psychotherapy. This survey was circulated to Iranian early career psychiatrists and psychiatric trainees., Results: 112 early career psychiatrists and psychiatric trainees from across Iran responded to the survey; 98.2% of which stated that psychotherapy training is included in their psychiatry training, and cognitive behavioral therapy and psychodynamic psychotherapy were the most reported modalities integrated into their psychiatric training. Moreover, 43.3% of the participants reported that they were satisfied or very satisfied with their psychotherapy training during the training years., Discussion: Psychotherapy is integrated into psychiatric training programs in most educational centers in Iran. The modalities and satisfaction of trainees are similar to that of high-income countries in other continents. Supervision and training in modalities like family therapy could be further implemented and adapted to the Iranian culture., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Objective of the present manuscript is to investigate, among Italian early career psychiatrists (ECPs), prescriber and patient-related factors associated with lithium or valproate preference to treat patients affected by Bipolar Disorder (BD)., Methods: An on-line survey was carried out among 252 ECPs, investigating their prescription patterns in relation to lithium and the differences with prescription of valproate. Collected data were compared according to lithium or valproate prescription preference in the long-term treatment of BD by χ 2 tests for qualitative variables., Results: Over two thirds of ECPs preferred lithium over valproate for the maintenance treatment of BD. Less than half of the sample used lithium as first-line agent for mania or major depression, and less than one third for mixed episodes. Factors associated with lithium preference as first-line maintenance treatment include perception of having a good knowledge of lithium ( p  < 0.001) and complete satisfaction with education on lithium ( p  < 0.001). One of the main factors to prefer valproate was the concern about long-term side effects of lithium ( p  < 0.001)., Conclusions: Type of education, source of information, clinical experience and safety concerns influence the choice of lithium versus valproate in the long-term treatment of BD. Present findings may guide educational training of ECPs.KEY POINTSLithium has been less prescribed in the last years for long-term treatment of Bipolar Disorder.Educational and clinical factors seem to influence the attitude to prescribe lithium.Only half of the Italian early career psychiatrists declare to have at least an adequate knowledge of lithium.Residency program in psychiatry should consider the implementation of education on lithium.

On March 11th, 2020, the outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic. Governments took drastic measures in an effort to reduce transmission rates and virus-associated morbidity. This study aims to present the immediate effects of the pandemic on patients presenting in the psychiatric emergency department (PED) of Hannover Medical School. Patients presenting during the same timeframe in 2019 served as a control group. A decrease in PED visits was observed during the COVID-19 pandemic with an increase in repeat visits within 1 month (30.2 vs. 20.4%, p BA  = 0.001). Fewer patients with affective disorders utilized the PED (15.2 vs. 22.2%, p BA  = 0.010). Suicidal ideation was stated more frequently among patients suffering from substance use disorders (47.4 vs. 26.8%, p BA  = 0.004), while patients with schizophrenia more commonly had persecutory delusions (68.7 vs. 43.5%, p BA  = 0.023) and visual hallucinations (18.6 vs. 3.3%, p BA  = 0.011). Presentation rate of patients with neurotic, stress-related, and somatoform disorders increased. These patients were more likely to be male (48.6 vs. 28.9%, p BA  = 0.060) and without previous psychiatric treatment (55.7 vs. 36.8%, p BA  = 0.089). Patients with personality/behavioral disorders were more often inhabitants of psychiatric residencies (43.5 vs. 10.8%, p BA  = 0.008). 20.1% of patients stated an association between psychological well-being and COVID-19. Most often patients suffered from the consequences pertaining to social measures or changes within the medical care system. By understanding how patients react to such a crisis situation, we can consider how to improve care for patients in the future and which measures need to be taken to protect these particularly vulnerable patients.

This study aimed to examine attitudes towards people with mental illness and psychiatry and interest in career choice in psychiatry among medical students from three medical schools in Czechia and Slovakia. A total of 495 medical students participated in a cross-sectional study. Participants completed (1) the Medical students' version of mental illness: clinicians' attitudes (MICA-2) scale, (2) the Reported and intended behaviour scale (RIBS), (3) the Attractiveness of working on a psychiatry-related position scale (P-ATTRACT), and (4) the Status of psychiatry scale (P-STATUS). Descriptive statistics, group comparisons and regression models were calculated. From 23 to 30% of students considered a specialization in psychiatry. However, only about 1% of them had a strong interest in psychiatry as a future career, moreover, students of higher years of study found psychiatry less attractive compared to those who are in the beginning of the study. The consideration of specialization in psychiatry was found to be statistically significantly associated with less stigmatizing attitudes and lower social distance towards people with mental illness. There were statistically significant differences in stigmatizing attitudes among medical schools, with a medical school emphasizing the education in psychiatry the most showing more positive attitudes. It is necessary to increase the interest in psychiatry and minimize stigma among medical students. Psychiatry curriculum in Central and Eastern European region should include more psychiatry-related courses, training in community and out-patient facilities, peer-lectors, and offer counselling after exposure to emotionally challenging clinical situations.

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine., Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole., Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care., Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high., Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery., (Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.)

Abstract: Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC).We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate.Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team.Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians' knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions., Competing Interests: The author reports no conflicts of interest in this work., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The rapid integration of Artificial Intelligence (AI) into the healthcare field has occurred with little communication between computer scientists and doctors. The impact of AI on health outcomes and inequalities calls for health professionals and data scientists to make a collaborative effort to ensure historic health disparities are not encoded into the future. We present a study that evaluates bias in existing Natural Language Processing (NLP) models used in psychiatry and discuss how these biases may widen health inequalities. Our approach systematically evaluates each stage of model development to explore how biases arise from a clinical, data science and linguistic perspective., Design/methods: A literature review of the uses of NLP in mental health was carried out across multiple disciplinary databases with defined Mesh terms and keywords. Our primary analysis evaluated biases within 'GloVe' and 'Word2Vec' word embeddings. Euclidean distances were measured to assess relationships between psychiatric terms and demographic labels, and vector similarity functions were used to solve analogy questions relating to mental health., Results: Our primary analysis of mental health terminology in GloVe and Word2Vec embeddings demonstrated significant biases with respect to religion, race, gender, nationality, sexuality and age. Our literature review returned 52 papers, of which none addressed all the areas of possible bias that we identify in model development. In addition, only one article existed on more than one research database, demonstrating the isolation of research within disciplinary silos and inhibiting cross-disciplinary collaboration or communication., Conclusion: Our findings are relevant to professionals who wish to minimize the health inequalities that may arise as a result of AI and data-driven algorithms. We offer primary research identifying biases within these technologies and provide recommendations for avoiding these harms in the future., Competing Interests: Chris Callison-Burch declares no competing interests. Isabel Straw has been an unpaid intern with the e-Health company "Neuroflow" as part of her Masters in Public Health (MPH) Program. While this has been entirely separate from this research project, the timing of the internship overlaps with the period of time taken to write this article. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Telemedicine has traditionally been used in rural areas, but the recent development of mHealth solutions has led to a growth in urban telemedicine services. The aim of this study was to determine whether urban and rural patients in a large academic medical center use telemedicine to access different healthcare specialties at different rates. This retrospective cohort study examined all telemedicine visits dated 2008-2017 at a large academic medical center. Visits were classified by clinical specialty. Teledermatology, child telepsychiatry, and adult telepsychiatry made up 97 percent of telemedicine visits. Rural patients were more likely to have multiple telehealth visits. A significant difference was observed between rural and urban use of telemedicine, both in terms of specialties and demographics. This suggests that health systems should consider adjusting resources and training to meet the different needs of these two populations. In particular, telemedicine may offer help for the nationwide maldistribution of adolescent psychiatry providers., (Copyright © 2021 by the American Health Information Management Association.)

Objective: The main objective of the present study is to examine a number of suicides among Italian doctors. We further compared data from our sample with those of suicide in the general population and in the literature, in order to detect any differences that can provide preventive recommendations., Methods: This is a retrospective study of 60 suicides committed by doctors from 2009 to 2019, in Italy., Results: The sample was constituted mainly by men (77%, 46 cases) aged between 50 and 69 years (70%, n=42). Most of the suicides took place in Northern Italy (50%, n=30). Among known medical specialization, 26% (n=14) concerned general practitioners, the remaining 74% (n=39) were specialized doctors, with a prevalence of anesthetists (9%, n=5), haematologists (8 %, n=4), pediatricians (6%, n=3), psychiatrists (6%, n=3) and oncologists (6%, n=3). Regarding the suicide method, the most used was precipitation (30%, n=16), followed by poisoning/overdose (24%, n=13), firearm (19%, n=10), suffocation/hanging (19%, n=10) and self-induced injuries (8%, n=4)). The most frequent place of suicide is in 35 cases was at home (59%), followed by the hospital (18%; n=11), or others (23%; n=14). When possible, any reported risk factors and predisposing conditions for suicide were studied, and divided into five categories: depression/psychiatric pathology (28%, n=16); other organic disease (8%, n=5); work-related problems (stress, burn-out, mobbing, work-related judicial problems) (20%, n=12); judicial problems unrelated to the medical profession (8%, n=5); family and relationship problems (12%, n=7)., Conclusions: The risk factors for suicide in our sample of doctors overlap with data from literature for doctors in western countries. Clinical recommendations and prevention strategies for suicide risk are therefore similar.

Objective: In response to the COVID-19 pandemic, many psychiatrists have rapidly transitioned to telemedicine. This qualitative study sought to understand how this dramatic change in delivery has affected mental health care, including modes of telemedicine psychiatrists used, barriers encountered, and future plans. The aim was to inform the ongoing COVID-19 response and pass on lessons learned to psychiatrists who are starting to offer telemedicine., Methods: From March 31 to April 9, 2020, semistructured interviews were conducted with 20 outpatient psychiatrists practicing in five U.S. states with significant early COVID-19 activity. Inductive and deductive approaches were used to develop interview summaries, and a matrix analysis was conducted to identify and refine themes., Results: At the time of the interviews, all 20 psychiatrists had been using telemedicine for 2-4 weeks. Telemedicine encompassed video visits, phone visits, or both. Although many continued to prefer in-person care and planned to return to it after the pandemic, psychiatrists largely perceived the transition positively. However, several noted challenges affecting the quality of provider-patient interactions, such as decreased clinical data for assessment, diminished patient privacy, and increased distractions in the patient's home setting. Several psychiatrists noted that their disadvantaged patients lacked reliable access to a smartphone, computer, or the Internet. Participants identified several strategies that helped them improve telemedicine visit quality., Conclusions: The COVID-19 pandemic has driven a dramatic shift in how psychiatrists deliver care. Findings highlight that although psychiatrists expressed some concerns about the quality of these encounters, the transition has been largely positive for both patients and physicians.

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000-2019 ( N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities., Competing Interests: The authors declare no conflict of interest.

Objective: The authors examined the prevalence of burnout and depressive symptoms among North American psychiatrists, determined demographic and practice characteristics that increase the risk for these symptoms, and assessed the correlation between burnout and depression., Methods: A total of 2,084 North American psychiatrists participated in an online survey, completed the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire-9 (PHQ-9), and provided demographic data and practice information. Linear regression analysis was used to determine factors associated with higher burnout and depression scores., Results: Participants' mean OLBI score was 40.4 (SD=7.9) and mean PHQ-9 score was 5.1 (SD=4.9). A total of 78% (N=1,625) of participants had an OLBI score ≥35, suggestive of high levels of burnout, and 16.1% (N=336) of participants had PHQ-9 scores ≥10, suggesting a diagnosis of major depression. Presence of depressive symptoms, female gender, inability to control one's schedule, and work setting were significantly associated with higher OLBI scores. Burnout, female gender, resident or early-career stage, and nonacademic setting practice were significantly associated with higher PHQ-9 scores. A total of 98% of psychiatrists who had PHQ-9 scores ≥10 also had OLBI scores >35. Suicidal ideation was not significantly associated with burnout in a partially adjusted linear regression model., Conclusions: Psychiatrists experience burnout and depression at a substantial rate. This study advances the understanding of factors that increase the risk for burnout and depression among psychiatrists and has implications for the development of targeted interventions to reduce the high rates of burnout and depression among psychiatrists. These findings have significance for future work aimed at workforce retention and improving quality of care for psychiatric patients.

Psychiatric disorders are prevalent in dermatology patients. Psychodermatology is the body of knowledge at the intersection of psychiatry and dermatology practice. The purpose of this literature review was to assess the knowledge, attitudes, and practices of health care professionals regarding psychodermatology. A search of relevant articles was conducted in PubMed, CINAHL, ERIC, and PsychInfo databases using a comprehensive set of search terms. Studies were included if (1) study participants were health care professionals, (2) studies contained data that could be extracted, and (3) studies were published in peer-reviewed journals. A review of study findings was conducted. A total of nine studies were included in the review. Studies were conducted in several countries. Findings from the review confirmed that providers frequently reported psychocutaneous disorders in their practice. There were, however, gaps and variations in providers' knowledge base and level of comfort treating these patients. Further, providers acknowledged a lack of training in the practice of psychodermatology. The findings from this review suggest that health care professionals from multiple areas of the world may lack a full understanding, level of comfort, and proper training in psychodermatology. Improving the knowledge base and increasing level of comfort in treating psychodermatological disorders can improve the practice of psychodermatology amongst providers. Further, addressing knowledge and comfort level among providers through training and continuing education may improve outcomes for patients with psychocutaneous disorders.