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Ethics in Psychiatry

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129 papers 100 to 500 followers Articles highlighting ethical issues (and other interesting stuff). Worth reflecting on, discussing...
https://www.readbyqxmd.com/read/27620683/the-mass-production-of-redundant-misleading-and-conflicted-systematic-reviews-and-meta-analyses
#1
John P A Ioannidis
POLICY POINTS: Currently, there is massive production of unnecessary, misleading, and conflicted systematic reviews and meta-analyses. Instead of promoting evidence-based medicine and health care, these instruments often serve mostly as easily produced publishable units or marketing tools. Suboptimal systematic reviews and meta-analyses can be harmful given the major prestige and influence these types of studies have acquired. The publication of systematic reviews and meta-analyses should be realigned to remove biases and vested interests and to integrate them better with the primary production of evidence...
September 2016: Milbank Quarterly
https://www.readbyqxmd.com/read/27777274/involuntary-outpatient-commitment-and-the-elusive-pursuit-of-violence-prevention-a-view-from-the-united-states
#2
Marvin S Swartz, Sayanti Bhattacharya, Allison G Robertson, Jeffrey W Swanson
OBJECTIVE: Involuntary outpatient commitment (OPC)-also referred to as 'assisted outpatient treatment' or 'community treatment orders'-are civil court orders whereby persons with serious mental illness and repeated hospitalisations are ordered to adhere to community-based treatment. Increasingly, in the United States, OPC is promoted to policy makers as a means to prevent violence committed by persons with mental illness. This article reviews the background and context for promotion of OPC for violence prevention and the empirical evidence for the use of OPC for this goal...
October 24, 2016: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
https://www.readbyqxmd.com/read/24507917/structural-competency-theorizing-a-new-medical-engagement-with-stigma-and-inequality
#3
REVIEW
Jonathan M Metzl, Helena Hansen
This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed "structural competency," consists of training in five core competencies: 1) recognizing the structures that shape clinical interactions; 2) developing an extra-clinical language of structure; 3) rearticulating "cultural" formulations in structural terms; 4) observing and imagining structural interventions; and 5) developing structural humility...
February 2014: Social Science & Medicine
https://www.readbyqxmd.com/read/27844179/-it-s-making-contacts-notions-of-social-capital-and-implications-for-widening-access-to-medical-education
#4
S Nicholson, J A Cleland
In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a discourse that portrays WA applicants and students as lacking the essential skills or attributes to be successful in medical education. Much of the research in this area to date has been weak and it is critical to better understand how WA applicants and students negotiate medical admissions and education to inform change...
November 14, 2016: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/27584000/ensuring-competent-care-by-senior-physicians
#5
Richard E Hawkins, Catherine M Welcher, Victoria Stagg Elliott, Richard S Pieters, Liana Puscas, Paul H Wick
The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable...
2016: Journal of Continuing Education in the Health Professions
https://www.readbyqxmd.com/read/27825398/neighborhood-deprivation-and-depression-in-adult-twins-genetics-and-gene%C3%A3-environment-interaction
#6
E Strachan, G Duncan, E Horn, E Turkheimer
BACKGROUND: Depression is a significant problem and it is vital to understand its underlying causes and related policy implications. Neighborhood characteristics are implicated in depression but the nature of this association is unclear. Unobserved or unmeasured factors may confound the relationship. This study addresses confounding in a twin study investigating neighborhood-level effects on depression controlling for genetics, common environment, and gene×environment (G × E) interactions...
November 9, 2016: Psychological Medicine
https://www.readbyqxmd.com/read/27802977/should-psychiatrists-be-more-cautious-about-the-long-term-prophylactic-use-of-antipsychotics
#7
Robin M Murray, Diego Quattrone, Sridhar Natesan, Jim van Os, Merete Nordentoft, Oliver Howes, Marta Di Forti, David Taylor
Patients who recover from an acute episode of psychosis are frequently prescribed prophylactic antipsychotics for many years, especially if they are diagnosed as having schizophrenia. However, there is a dearth of evidence concerning the long-term effectiveness of this practice, and growing concern over the cumulative effects of antipsychotics on physical health and brain structure. Although controversy remains concerning some of the data, the wise psychiatrist should regularly review the benefit to each patient of continuing prophylactic antipsychotics against the risk of side-effects and loss of effectiveness through the development of supersensitivity of the dopamine D2 receptor...
November 2016: British Journal of Psychiatry: the Journal of Mental Science
https://www.readbyqxmd.com/read/27779512/the-discriminatory-patient-and-family-strategies-to-address-discrimination-towards-trainees
#8
Emily E Whitgob, Rebecca L Blankenburg, Alyssa L Bogetz
PURPOSE: Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families. METHOD: A purposeful sample of pediatric faculty educational leaders was recruited from April-June 2014 at Stanford University...
November 2016: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/27798486/medical-assistance-in-dying-special-issues-for-patients-with-mental-illness
#9
Kathleen Sheehan, K Sonu Gaind, James Downar
PURPOSE OF REVIEW: Medical Assistance in Dying (MAID) is now legal in many jurisdictions for competent adults who have intolerable suffering and/or have a terminal illness with a short prognosis. Mental illness can be a source of suffering for these individuals, but it can also affect their capacity to make medical decisions. Clinicians, and psychiatrists in particular, need to understand how to assess patients with mental illness who are requesting MAID, to determine the impact of their mental illness on the MAID request...
January 2017: Current Opinion in Psychiatry
https://www.readbyqxmd.com/read/27620684/mass-production-of-systematic-reviews-and-meta-analyses-an-exercise-in-mega-silliness
#10
Matthew J Page, David Moher
No abstract text is available yet for this article.
September 2016: Milbank Quarterly
https://www.readbyqxmd.com/read/27706136/evidence-for-a-limit-to-human-lifespan
#11
Xiao Dong, Brandon Milholland, Jan Vijg
Driven by technological progress, human life expectancy has increased greatly since the nineteenth century. Demographic evidence has revealed an ongoing reduction in old-age mortality and a rise of the maximum age at death, which may gradually extend human longevity. Together with observations that lifespan in various animal species is flexible and can be increased by genetic or pharmaceutical intervention, these results have led to suggestions that longevity may not be subject to strict, species-specific genetic constraints...
October 5, 2016: Nature
https://www.readbyqxmd.com/read/27810891/sponsorship-bias-in-the-comparative-efficacy-of-psychotherapy-and-pharmacotherapy-for-adult-depression-meta-analysis
#12
REVIEW
Ioana A Cristea, Claudio Gentili, Pietro Pietrini, Pim Cuijpers
BACKGROUND: Sponsorship bias has never been investigated for non-pharmacological treatments like psychotherapy. AIMS: We examined industry funding and author financial conflict of interest (COI) in randomised controlled trials directly comparing psychotherapy and pharmacotherapy in depression. METHOD: We conducted a meta-analysis with subgroup comparisons for industry v. non-industry-funded trials, and respectively for trial reports with author financial COI v...
November 3, 2016: British Journal of Psychiatry: the Journal of Mental Science
https://www.readbyqxmd.com/read/27765774/extremism-religion-and-psychiatric-morbidity-in-a-population-based-sample-of-young-men
#13
Jeremy W Coid, Kamaldeep Bhui, Deirdre MacManus, Constantinos Kallis, Paul Bebbington, Simone Ullrich
BACKGROUND: There is growing risk from terrorism following radicalisation of young men. It is unclear whether psychopathology is associated. AIMS: To investigate the population distribution of extremist views among UK men. METHOD: Cross-sectional study of 3679 men, 18-34 years, in Great Britain. Multivariate analyses of attitudes, psychiatric morbidity, ethnicity and religion. RESULTS: Pro-British men were more likely to be White, UK born, not religious; anti-British were Muslim, religious, of Pakistani origin, from deprived areas...
December 2016: British Journal of Psychiatry: the Journal of Mental Science
https://www.readbyqxmd.com/read/27732715/neurodevelopmental-implications-of-fetal-exposure-to-selective-serotonin-reuptake-inhibitors-and-untreated-maternal-depression-weighing-relative-risks
#14
Lee S Cohen, Ruta Nonacs
No abstract text is available yet for this article.
October 12, 2016: JAMA Psychiatry
https://www.readbyqxmd.com/read/27705252/vaccine-refusal-revisited-the-limits-of-public-health-persuasion-and-coercion
#15
James Colgrove
In recent years, vaccine refusal and associated declines in herd immunity have contributed to numerous outbreaks of infectious diseases, consumed public health resources, and provoked increasingly polarized debates between supporters and opponents of vaccines. Although the prominence of the..
October 6, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27705256/data-monitoring-committees-expect-the-unexpected
#16
David L DeMets, Susan S Ellenberg
No abstract text is available yet for this article.
October 6, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27732126/structural-racism-and-supporting-black-lives-the-role-of-health-professionals
#17
Rachel R Hardeman, Eduardo M Medina, Katy B Kozhimannil
On July 7, 2016, in our Minneapolis community, Philando Castile was shot and killed by a police officer in the presence of his girlfriend and her 4-year-old daughter. Acknowledging the role of racism in Castile’s death, Minnesota Governor Mark Dayton asked rhetorically, "Would this have happened if..
October 12, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27732817/liberty-versus-need-our-struggle-to-care-for-people-with-serious-mental-illness
#18
Lisa Rosenbaum
In 1985, when internist Jim O’Connell, cofounder of the Boston Health Care for the Homeless Program, began doing outreach to homeless people, one of the toughest questions he faced was whether to commit someone to the hospital for involuntary psychiatric treatment. States vary in their criteria for..
October 13, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27410527/palliative-care-the-other-opioid-issue
#19
Lucas Laursen
No abstract text is available yet for this article.
July 13, 2016: Nature
https://www.readbyqxmd.com/read/27698212/the-futility-of-risk-prediction-in-psychiatry
#20
Roger Mulder, Giles Newton-Howes, Jeremy W Coid
Significant efforts have been made to identify risk factors associated with suicide. However, the evidence suggests that risk categorisation may be of limited value, or worse, potentially harmful, confusing clinical thinking. We argue instead for a shift in focus towards real engagement with the individual patient, their specific problems and circumstances.
October 2016: British Journal of Psychiatry: the Journal of Mental Science
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