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Psychiatric residents are increasingly called upon to work cross-culturally, serving diverse populations including refugees. This study aims to (1) understand the training experience of psychiatry residents working with refugees and (2) assess the level of satisfaction of refugees, most of whom are Iraqi, who seek psychological treatment at the University of Colorado Hospital (UCH)’s Refugee Mental Health Program of Colorado (RMHPC). Using qualitative methodology, over a 1-year period, independent evaluators interviewed a group of nine residents who chose to participate in an RMHPC elective and also interviewed ten Iraqi refugee patients who sought services at the clinic. Recordings of the interviews were transcribed and analyzed using thematic analysis. Emerging themes were identified for both resident and refugee patient interviews. Five major themes emerged summarizing residents’ experiences: (1) adapting practices to meet refugee needs, (2) value of supervision, (3) cultural barriers, (4) need for extra resources, and (5) effect on future practice. Four major themes emerged summarizing Iraqi refugees’ experiences: (1) reasons for seeking treatment, (2) barriers to treatment, (3) residents’ knowledge of culture and needs, and (4) quality of treatment. This study’s findings highlight the complexities of effectively treating refugee patients and suggest ideas for training residents. Additionally, they offer important frameworks for developing, implementing, and evaluating culturally responsive practices in the context of training psychiatry residents and other mental health professionals. An essential key to this process was giving voice to refugees who accessed and engaged our services.

Clinical observations regarding apathy and motivation derived from many psychiatric and neurological conditions have generated divergent descriptions of apathy-related syndromes. Stimulated by complex cases presenting with prominent apathy, uses of the term “apathy” and “related phenomena” in the Diagnostic and Statistical Manual of Mental Disorders, diagnostic proposals for apathy as a syndrome and disorder of motivation, Research Domain Criteria (RDoC) systems governing motivational processes, and their clinical intersections are reviewed. Clinical apathy and associated dysfunctions can be addressed using constructs suggested by the RDoC domain of Positive Valence Systems, including approach motivation and component processes of reward valuation, effort valuation/willingness to work, expectancy/reward prediction error, and responses to reward and reward learning. Although apathy syndromes have been validated, defining potentially distinct disorders of motivation (not simply subordinated to mood, psychotic, cognitive, or substance use disorders) will require additional research to better delineate etiology and pathogenesis, predictive validators, reliable diagnostic methods, treatments, and demonstrations of use for these diagnostic proposals.

Psychiatry’s evolution has entailed clinical, educational, research, and administrative missions. Faculty development efforts concern ways in which professional identity, attitudes and skills are transmitted and enhanced from generation to generation. Top-down efforts by national and international organizations and bottom-up movements by individuals in numerous local settings have helped faculty and guided the profession forward. Organizations have provided new faculty with access to mentors and peers across the country, training opportunities, and up-to-date information on emerging scientific, pedagogical, and regulatory trends. Additional innovations and evaluation regarding best practices for faculty development initiatives in psychiatry are needed.

The issues centering on the involuntary treatment of severe and enduring anorexia nervosa are daunting. There is a general consensus that people with this illness are likely to have high levels of disability, be underemployed/unemployed, and receive welfare. Anorexia nervosa shows a similar degree of impairment to those with depression or schizophrenia on quality-of-life measures. It is possible to mount a cogent argument as to why a rehabilitation model of care needs to be considered for those with persistent eating disorders. In such cases, harm minimization and improved quality of life should be prioritized and involuntary treatment used judiciously.

Loneliness impacts both physical and psychological health and is associated with increases of all-cause mortality and suicidal behavior. Because loneliness may result from a variety of developmental, interpersonal, and intrapersonal factors, distinguishing its components, origins, and sustaining factors as it manifests in various psychopathological states are important steps in formulating interventions to alleviate these conditions. To date, loneliness has not been widely studied in relation to complex posttraumatic stress disorder (PTSD), which is newly delineated in the International Classification of Diseases, characterized by PTSD symptoms in the context of significant early trauma, as well as “disturbances in self-organization” marked by affective dysregulation, negative self-concept, and disturbances in relationships. In this article, illustrating with case material, we suggest that loneliness plays a major role in the development of complex PTSD and in the preservation of its symptoms. Consequently, therapies for complex PTSD should include interventions that address loneliness.