Danish Psychiatry During the Nazi Occupation

The Nazi occupation of Denmark between April 1940 and May 1945 did not have the same grave consequences for Danish psychiatry as in countries such as Poland, Russia, and France. Only one of the Danish mental hospitals, Oringe, outside the city of Vordingborg in southern Zealand, was evacuated by the Germans, and deportation of "antisocial individuals" to concentration camps was rare. Danish mental hospitals were not marked by starvation, infections, or high mortality during the occupation. To a great extent, the Wehrmacht left the Danes to run their own affairs, Jewish psychiatrists continued their work in the hospitals until the end of 1943, and only rarely did Danish psychiatrists report problems with the occupying power. Paradoxically, the presence of German troops was considered to have unexpected positive effects on psychiatric morbidity among civilians in wartime.     

The impact of contact with psychiatry on senior medical students' attitudes toward psychiatry

OBJECTIVE: To investigate the attitudes of Danish medical students as to the attractiveness of psychiatry as a career possibility and to asses the impact on such attitudes of actual contact with psychiatry. METHOD: A base-line survey included 222 senior medical students, of whom 160 were also surveyed subsequent to a 4-week psychiatric affiliation. RESULTS: The base-line survey shows that psychiatry is rated as less attractive than other specialization groups, and that working as health assistants in psychiatric wards contributes to the problematic image. However, a 4-week psychiatric affiliation resolves a number of image issues, and following such an affiliation more medical students were considering specializing in psychiatry. CONCLUSION: The findings of this study suggest that psychiatric affiliations can influence students' attitudes to psychiatry. The observed changes in attitudes lead to the presumption that some aspects of the image problem of psychiatry stem from inadequate knowledge of psychiatry as a specialty and the actual work psychiatrists perform.     

Editorial

Nordic Journal of Psychiatry is now entering a new year, and the first issue of the 48th volume is published. Thus, the journal has served the Nordic psychiatric associations for almost half a century. During the autumn of 1993, the Editorial Board of the journal was gathered in Uppsala. We felt confident that the journal today reaches all adult psychiatrists in the five Nordic countries and all child and adolescent psychiatrists in Iceland, Denmark, and Norway, as well as many subscribers in the Baltic countries and all over the world. However, we do not reach all the child and adolescent psychiatrists in Sweden and Finland. We regard this as a problem because we believe that a fruitful exchange of ideas between adult psychiatry and child and adolescent psychiatry is extremely important today.     

Consortium-based consultation/liaison research: commentary and perspective

Although a consortium approach for clinical trials is a common research strategy which has made important contributions in other disciplines in medicine, to date it has not been employed for research efforts in the consultation/liaison setting. There are several reasons for this: the relative newness of the field, lack of administrative control over patient care, and the unavailability of a standard methodology that could be adapted to multiple sites. Four basic research strategies can be employed within the framework of a research consortium to advance scientific knowledge in consultation/liaison psychiatry: 1) prevalence studies of psychiatric morbidity in medical settings; 2) interrelationship among psychiatric and medical conditions; 3) the outcome of psychiatric interventions within medical milieu; and, 4) cost-benefit evaluation. A field-tested computerized database protocol and a software system usable on an office-based microcomputer were employed to obtain standardized data across multiple training sites. The advantages and disadvantages of consortium studies are described.     

The Senior Psychiatrist Survey I: age and psychiatric practice.

OBJECTIVE: The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP). METHOD: A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection. RESULTS: Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between case selection and age. Psychiatrists reporting increased credibility and respect as a benefit of their current age upon their psychiatric practice were older, as were those identifying fatigue and an inability to keep up to date as a drawback of age. Psychiatrists reporting a lack of credibility and respect were younger, as were those who reported increased enthusiasm and optimism. CONCLUSIONS: Age is associated with benefits and drawbacks to the practice of psychiatry and this may be reflected in the different practice profiles of older and younger psychiatrists.     

Trends in psychiatric practice, 1965-1980

The authors compare the results of a study of the practice activities of psychiatrists conducted in 1979-1980 with one conducted in 1965. Although office-based practice has remained the core activity of the profession, psychiatrists in 1979 had a greater tendency to divide their time among multiple practice sites and activities during the work week. As a consequence, the percentage of practitioners working part-time in a variety of organized care settings has increased substantially. These findings support a view of psychiatry as a profession that is far more diversified than it was 15 years ago. The authors discuss major factors affecting trends in psychiatric practice.     

The crisis in psychiatry: A public health perspective

Abstract

The role and responsibilities of psychiatry and psychiatrists have changed significantly in recent decades as a consequence of changes in society. The target of psychiatrists has moved from the treatment of specific mental disorders to the management of a wide range of psychological conditions. Following these changes, a public health approach has been claimed as necessary for psychiatric practice and research, given the current ongoing crisis in mental health. If we want to promote a public health approach, the following actions should be responsibly taken by modern mental health professionals: (1) the identification of causes of mental disorders, (2) the refinement of diagnoses, (3) the social inclusion of patients, (4) the involvement of users and carers in mental health research and practice, and (5) the improvement of psychiatric treatments and services. This crisis should represent a stimulus for all psychiatrists and a reconceptualization of psychiatry as public health is not in question.     

Psychiatry of somatic diseases: Epidemiology,pathogenesis, classification

Physical illness is a major cause of psychiatric morbidity. This statement is supported both by epidemiological surveys and by countless clinical studies documenting the causal role of somatic diseases and their treatment in concurrent psychiatric disorders. Despite the high frequency and practical importance of this association, however, the whole area of psychopathology related to physical illness has been relatively neglected by American psychiatrists. We know little about the incidence and prevalence of psychiatric disorders caused by organic disease in general and by the various classes of somatic disorders in particular. The official classification of mental disorders is inadequate and muddled in its treatment of psychiatric syndromes causally related to cerebral and systemic diseases.¹ The mechanisms, processes and significant variables intervening between a given physical disorder or injury on the one hand, and the development of psychological dysfunction on the other, that are the domain of psychopathogenesis, are still inadequately worked out. The various explanatory concepts and hypotheses in this area are not integrated, and the relevant terminology is ambiguous and overlapping. As a result, teaching of this aspect of psychiatry is generally poor, research lags, and patient care suffers.The writer reviews epidemiological data on the association of psychiatric and physical illness, formulates psychopathogenesis, surveys the determinants and modes of psychological responses to disease and injury, and presents a classification of the related psychiatric syndromes. It is an attempt at integration of a large body of data.     

Geriatric psychiatry versus general psychiatry inpatient treatment of the elderly

OBJECTIVE: The authors compared the clinical treatment given older psychiatric inpatients on a geriatric psychiatry unit and a general psychiatry unit. METHOD: The charts of 50 randomly selected general psychiatry inpatients over the age of 65 years and 50 inpatients from the geriatric psychiatry unit who were matched for age, gender, and primary diagnosis were reviewed. RESULTS: Significantly greater percentages of older inpatients treated on the geriatric psychiatry unit received complete organic medical workups, structured cognitive assessment, aging-sensitive aftercare referral, and monitoring of psychopharmacological side effects and blood levels than comparable patients on a general psychiatry unit. CONCLUSIONS: Geriatric psychiatry subspecialty inpatient care appears to be associated with distinct clinically relevant assessment and treatment advantages. Continuing geropsychiatric education of general psychiatrists is indicated.     

The theory and practice of psychiatry in the Soviet Union

In this paper I shall present some of the salient features of Soviet psychiatry. I shall first explore the main currents in the history of Russian and Soviet psychiatry, which provide the foundation for the contemporary theory and practice of psychiatry in the Soviet Union. This will be followed by a discussion of the training and research interests of the Soviet psychiatric profession. Much of this analysis is based on both the published Soviet psychiatric literature and interviews with psychiatrists from the Soviet Union, which I have been conducting over the last several years.     

Community psychiatry and the education of psychiatrists

Opinions vary as to the place in psychiatric education of training for community psychiatry. The confusion is partly due to the assumption that community psychiatry represents a new subspecialty and that therefore training for community psychiatry should follow basic clinical education. With the exception of certain administrative and research aspects, the practices and the knowledge employed by community psychiatrists are becoming part of all effective contemporary psychiatric practice and should be part of the basic education of every psychiatrist. A three-year residency program which coordinates clinical and community psychiatric knowledge and experience is presented. The needs of participants in mental health programs, of teachers and of researchers in community psychiatry, can best be met by specific postgraduate instruction combined with simultaneous job experience.An earlier version of this paper was presented to the staff of the Department of Psychiatry, University of Colorado Medical Center, December 4, 1967.     

Réformer la nosographie psychiatrique par la mathématisation. Progrès scientifique et nécessité sociale du DSM-III

The DSM-III introduced a new approach of the psychiatric diagnosis by statistics, relying on the quantification of the diagnostic reliability. It thus proceeded to significant changes in the diagnostic categories. These changes were also defined by another principle called “atheorism”. This reform was undertaken by North-American psychiatry as it was crossing a form of crisis, during which the knowledge, the know-how, the autonomy and the ethic of the psychiatrists were questioned. This article intends to emphasize the social and scientific issues at stake in this use of statistics to define mental disorders. We therefore put the DSM-III in the perspective of the empiricism in psychiatry and present the way it was received and the effects it had. We venture in conclusion the hypothesis that DSM-III was a response to the question of the existence of North-American psychiatry as a profession and we try to apply this hypothesis to current French psychiatry.     

The child and adolescent track in the forensic fellowship

Exposure to child and adolescent forensic issues is limited in general psychiatry residency and child and adolescent psychiatry residency programs. There is no Graduate Medical Education Program for child and adolescent forensic psychiatry that is approved by the American Council on Graduate Medical Education (ACGME). Forensic psychiatry residency directors can create a child-focused forensic training opportunity that meets the needs of the ACGME program in forensic psychiatry. By creating didactic, clinical, and research experiences relevant to child and adolescent forensic psychiatric issues, this much-needed training can be provided to qualified psychiatrists.     

Healing psychiatry: a pragmatic approach to bridging the science/humanism divide

Competing urges to think of human mental suffering as comprehensible and susceptible to scientific formulation, or as deeply complex and beyond the reach of scientific analysis, have torn at the fabric of psychiatry for many years and have left the field conceptually divided between science and humanism. Conceptual reparation of psychiatry is now a core mission of a field that is trying to heal itself so that it is equipped to heal the patients it serves. To formulate their cases comprehensively and provide patients with cutting-edge care, psychiatrists must heal the conceptual wounds that have resulted from dividing the human individual into an object of scientific scrutiny and a subject of personal experience. They must synthesize science and humanism in order to generate new understanding of mental disorders and to train future clinicians and researchers. Principles of classical American pragmatism, I argue in this article, can help to transcend the science/humanism divide in psychiatry. Clinical pragmatism focuses on favorable treatment outcomes by respecting the practical, pluralistic, participatory, and provisional aspects of psychiatric care. It demands that psychiatrists have the skill and flexibility to use multiple explanatory concepts in a collaborative, open-ended process with their patients. These themes are explored from the perspectives of contemporary psychiatric treatment, training, and research.     

Spectrum and frequency of use of statistical techniques in psychiatric journals

Educators in psychiatry face an important challenge in deciding what quantitative skills to teach and where in the educational agenda to teach them. One strategy is to focus the quantitative training of psychiatrists on techniques they need to be effective consumers of their literature. The authors catalogued the statistical methods described in 15 major psychiatric journals during 1983 and 1984. A dozen procedures, typically encountered in intermediate-level statistics courses, accounted for approximately 95% of all the statistical methods reported. Readers of psychiatric journals also routinely encounter multivariate, nonparametric, and categorization techniques. Educators might apply these results in designing exposure to statistical skills for future psychiatrists.     

The private practice study group as phase-IV research tool

Research in the routine field of psychiatry must include psychiatrists in private practice. A majority of psychiatric patients is treated as outpatients and many of these are only seen by private psychiatrists. Setting or patient variables pose restrictions on the therapy which leads to the development of specific treatment strategies. Because these are empirically based, it can be expected that the knowledge of practitioners can make a major contribution to the development of optimal treatment recommendations. Research in private practice requires special organisational efforts. One way to get access to this field are collaborative study groups which bring together scientists and their research facilities with practitioners and their surgeries. Such an instrument may allow: access to patients, which may never show up in any other research institution; monitoring of patient characteristics and treatment modalities under routine conditions; elaboration of special skills, insights and treatment strategies developed by the practitioner. These study groups can vary with regard to type of practice, type of collaboration and type of research. Studies can rely on information from patient self-reports, observations by the practitioners themselves or their office assistants and on data gathered by scientific staff working occasionally or continuously in the practice.     

Attitude of the medical profession to psychiatry.

The attitude of the medical profession to psychiatry carries important implications for the quality of personnel attracted into the specialty and for the treatment, in a general medical setting, of patients with mental disorders. This article examines the components of doctors' attitudes and reviews the literature with regard to their attitudes to psychiatrists themselves, psychiatric patients and psychiatry as a vocation. The implications of these findings for psychiatrists are discussed.     

Training psychiatrists to diagnose and treat substance abuse disorders

Addiction training in psychiatric residency programs needs expansion. Epidemiology research has shown that patients with substance use disorders and co-occurring mental health disorders are the norm in nearly all clinical settings. Unfortunately, traditional training approaches built around brief rotations on detoxification or intensive substance abuse rehabilitation units do not adequately train psychiatrists in long-term management skills, and may reinforce misperceptions that these patients do not respond to treatment. An enhanced addiction curriculum coupled with an extended outpatient clinic rotation is an ideal model for teaching the skills needed to successfully care for these patients. Training must include an adequate knowledge base, an opportunity to cultivate positive attitudes toward these patients, and recognition that psychiatrists must take responsibility for treating the addiction problem and any co-occurring psychiatric disorders. The program developed at Boston University Medical Center successfully integrates expanded addiction psychiatry training into the general psychiatry residency.