Narrative psychiatry

OBJECTIVE: In the modern training environment, some question whether trainees have the opportunity to develop ownership of patient care, which includes concepts such as advocacy, autonomy, commitment, communication, follow-through, knowledge about the patient, responsibility, and teamwork. Despite descriptions of what ownership is, there is little discussion of how to foster ownership during residency. The objective of this study was to solicit psychiatry resident and faculty perspectives on ways to enhance resident ownership in training...

For centuries, medicine and psychiatry mirrored society's equivocations regarding childhood trauma. Those conflicts have mostly resolved, with widespread agreement that children are commonly exposed to traumatic events that may lead to PTSD and other mental conditions. The psychiatric and legal arguments should no longer be about the reality of childhood trauma in general; instead, experts should focus on the methodology of translating a particular child's narrative truth of maltreatment into a historical account, so that the expert can be qualified to offer criminal or civil court testimony after examining the child...

This paper presents a novel method for automatically recognizing symptom severity by using natural language processing of psychiatric evaluation records to extract features that are processed by machine learning techniques to assign a severity score to each record evaluated in the 2016 RDoC for Psychiatry Challenge from CEGS/N-GRID. The natural language processing techniques focused on (a) discerning the discourse information expressed in questions and answers; (b) identifying medical concepts that relate to mental disorders; and (c) accounting for the role of negation...

The widespread adoption of electronic health record (EHRs) in healthcare systems has created a vast and continuously growing resource of clinical data and provides new opportunities for population-based research. In particular, the linking of EHRs to biospecimens and genomic data in biobanks may help address what has become a rate-limiting study for genetic research: the need for large sample sizes. The principal roadblock to capitalizing on these resources is the need to establish the validity of phenotypes extracted from the EHR...

We consider how conceptions of the self and identity from the philosophical literature can help us to understand identity disturbance in borderline personality disorder (BPD). We present 3 philosophical approaches: connectedness, narrative, and agency. We show how these map on to 3 different ways in which the self can be temporally extended. The connectedness approach is dominant in philosophy, and the narrative approach has been used by psychiatry, but we argue that the lesser-known agency approach provides a promising way to theorize some aspects of identity disturbance in BPD...

OBJECTIVES: The aim of this work was to examine, via narrative review, the evidence supporting the drive for more peer workers to gauge the likely impact on patient outcomes. CONCLUSIONS: Despite considerable research into the effectiveness of peer workers in clinical psychiatry, there is insufficient evidence to support the proposition that a substantial peer workforce would improve the outcomes of people living with mental illness.

Metacognitive Therapy and Pharmacotherapy - Adapted to Unaccompanied Refugee Minors Unaccompanied refugee minors (URM) present a relatively new challenge for adolescent psychotherapy and psychiatry. The evidence of possible treatment approaches is scarce. This paper presents a pragmatic adaptation of Wells' Metacognitive Therapy (MCT) for this population for the first time. Unlike the established trauma-focused treatment approaches MCT does not aim at prolonged exposure to the trauma narrative. Instead, patients shall learn to leave the distressing thoughts alone and to reduce the perseverating thinking processes (rumination and worrying)...

BACKGROUND: The ketogenic diet (KD) has been used in treatment-resistant epilepsy since the 1920s. It has been researched in a variety of neurological conditions in both animal models and human trials. The aim of this review is to clarify the potential role of KD in psychiatry. METHODS: Narrative review of electronic databases PubMED, PsychINFO, and Scopus. RESULTS: The search yielded 15 studies that related the use of KD in mental disorders including anxiety, depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD)...

BACKGROUND: Year-end clinic handoffs in resident continuity clinics are an important patient safety issue. METHODS: Intervention articles addressing the year-end resident clinic handoff were identified in a targeted literature search. These articles were reviewed and abstracted to summarize the current literature. On the basis of these reviews and consensus expert opinion, recommendations to improve year-end clinic handoffs were developed. RESULTS: Of 23 identified articles, 10 intervention articles in the fields of internal medicine, internal medicine-pediatrics, psychiatry, and family medicine were ultimately included...

In this presentation we will develop some ideas about possible relationships between literary narratives and psychiatry. To carry out this task we will analyze the work of some authors (Vila Matas, Guerriero, Kleinman, Franzen and others) in order to share a reflection on the current situation of psychiatry and medicine.

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This exploratory study looks at the training and postgraduate experience of the 2008-2014 graduates of the Chicago Institute for Psychoanalysis. It follows our former study of all living graduates through the year 2007 (Schneider et al., 2014). The survey developed and used in the first study, with a few additional questions added to increase our understanding of the training experience, was sent to 38 graduates with a return rate of 58%. As with the first survey, graduates were invited to assess, among other training experiences, their training analysis, classroom work, and supervision, and to tell of their post-graduation involvement in teaching, supervising, study groups and other professional endeavors...

This article recounts the case of a patient with schizophrenia engaged in time-limited psychodynamic psychotherapy with a psychiatry resident-the first case history of its type to the author's knowledge. This patient suffered from chronically debilitating schizophrenia with persistent positive and negative symptoms at the time of treatment, despite usual psychiatric management. He benefited significantly from 18 weekly sessions of weekly dynamic therapy, achieving symptom reduction, increased social involvement, and improved functioning-gains that were sustained at 9-month follow-up...

An inventory on the two critical dimensions that structure the Randomized Controlled Trial in Psychiatry, namely the definition of inclusion criteria for eligible patients for testing and the choice of psychometric methods of pathology assessment and its evolution during the experiment, considers the importance of increasingly numerous and precise international recommendations. Taking into account the formal constraints of industrial, questioning the cultural differences of the methodological approach of the tests, meeting the requirements of feasibility and ever increasing security, frequent cumbersome procedure often contrasts with the modest nature of the results...

BACKGROUND: There is a major gap between the US and most European countries regarding the implementation of early intensive behavioural intervention (EIBI) for children with autism. The present paper reports on the current status of EIBI in Switzerland and on the effectiveness of EIBI under clinical conditions in a Swiss pilot project. METHODS: The paper combines a narrative report of the care system for children with autism in Switzerland and an initial evaluation of EIBI as implemented in the Department of Child and Adolescent Psychiatry, University of Zurich...

OBJECTIVE: Confirmatory randomised controlled trials require solid justifications, especially with regard to whether the experimental intervention is promising. Such evidence is generated in exploratory trials. However, empirical evidence shows that the quality of such trials is still suboptimal. More generally, the development process of healthcare interventions and especially of drugs, remains inefficient. Over the past 10-20 years, a vast amount of methodological work has been published about exploratory trials...

O. Hobart Mowrer had one of the most productive and curious careers of any psychologist in the 20th century, despite struggling with severe mental illness and anxiety about his sexuality. Early in his career, he was one of the country's leading experimental psychologists. During the mid-1940s, he became interested in religion and argued that anxiety was caused by repressed guilt that came from real wrongdoing. By the late 1950s, he had abandoned mainstream psychology, arguing that religion had been corrupted by its embrace of psychology and psychiatry...

Introduction Nurses' notes are used primarily as a communication tool between nurses, doctors and member of the professional team to ensure continuity of patient care. They contain life-history of individuals with mental health disorders. This nurses' communication tool describes the patient care during hospitalization in acute psychiatric ward. In fact, these observations contained in the progress notes represent more than a simple picture of mental illness. They always tell a story constructed by socio-cultural norms...

This narrative review describes recent developments in the use of technology for utilizing the self-monitoring of mood, provides some relevant background, and suggests some promising directions. Subjective experience of mood is one of the valuable sources of information about the state of an integrated mind/brain system. During the past century, psychiatry and psychology moved away from subjectivity, emphasizing external observation, precise measurement, and laboratory techniques. This shift, however, provided only a limited improvement in the understanding of mood disorders, and it appears that self-monitoring of mood has the potential to enrich our knowledge, particularly when combined with the advances in technology...

There is increasing attention to the costs and efficacy of health care and in particular to psychiatry. To weigh the costs and benefits appropriately, it is important to be able to compare effects.<br/> AIM: To describe the efficacy of psychiatric treatment compared to treatment in general medicine.<br/> METHOD: Narrative review.<br/> RESULTS: The average effect size of psychiatric treatment was 0.49 and that of general medicine treatment 0.45. The effect size of psychotherapy varied from 0...