Some themes from the philosophy of psychiatry: a short review.

Some major themes in the philosophy of science are briefly reviewed, considering epistemological, ontological and ethical problems in modern psychiatry. A conception of realism at the ontological, empiricism at the methodological level and humanistic ethics is proposed. Meta-psychiatry is suggested as a theoretical discipline integrating clinical research methodology and philosophy of science.     

Italian psychiatry and reform law: a review of the international literature

Through the reform law, and the experiences of change realized prior to the reform, Italian psychiatry expanded its size and influences significantly. The aim of this review is to describe some issues relevant to Italian psychiatry and to try and evaluate the experience of reform as shown in international literature. In this literature, three large groups of contributions can be identified: the so called 'impressionistic' group; the group dealing with the analysis of local and regional situations; and finally the group represented by epidemiological researches and by analysis of national data. The main contributions of each of the three groups are reviewed, and finally the main problems which Italian psychiatry has to face, are outlined.     

Consultation-liaison psychiatry: an international perspective.

Consultation-liaison (C-L) psychiatry is the specialty of physical/psychiatric comorbidity and somatization. As such, it addresses the commonest forms of psychiatric presentation in the community; it is mainstream psychiatry. Its name reflects the fact that most of the patients seen by C-L psychiatrists have to be managed jointly with a non-psychiatrist doctor and other professionals. Because of this, the degree of development of the specialty and its mode of operation differ from country to country, depending on the organization of health services and the varying attitudes towards the disorders in which C-L psychiatry specializes. These differences permit a refreshing opportunity to re-examine the ways in which patients with physical/psychiatric comorbidity and somatization can be helped. The International Organization for Consultation-Liaison Psychiatry was formed to facilitate this process. It has identified challenges that are universal, and which if not met rapidly and efficiently will damage our ability to provide appropriate care for the patients whom we serve.     

Use of the ICD-10 classification in psychiatry: an international survey

On the background of some years of experience with ICD-10 psychiatric diagnoses in many countries of the world, an international comparison was performed to evaluate the frequency and use of the ICD-10 psychiatric diagnoses. For future revision of the ICD-10, it is important to know which diagnostic categories are either not used or are used possibly in an unspecific manner. Nineteen departments of psychiatry in 10 different countries took part in the study, presenting data on 33,857 treatment cases leading to a total of 25,470 ICD-10 main diagnoses. The analysis of data reveals that on a four-character level (Fxx.x), the 10 most often used diagnostic categories represent 40% of all main diagnoses, and 70% on a three-character level (Fxx.-). There are 32 specific diagnostic categories on a four-character level which are not used at all and 121 which are used less frequently than 0.1% in inpatient and outpatient treatment. The study shows that the ICD-10 classification is in use in a variety of treatment settings worldwide. Further results and limitations of this study are discussed against the background of transcultural differences.     

Carbamazepine in psychiatry: a review

Carbamazepine is a tricyclic compound structurally related to imipramine that has been used since the 1960's for the treatment of trigeminal neuralgias and then approved as an anticonvulsant in the U.S. in 1974. In the last decade the use of carbamazepine has been expanded to include the treatment of certain disorders of mood and behaviour. In this paper possible clinical applications of carbamazepine in psychiatry are reviewed along with its pharmacokinetic and pharmacodynamic profile. Also discussed are adverse reactions and drug interactions which are relevant to its use.     

Anhedonia in psychiatry: a review

Anhedonia, the loss of the capacity of feeling pleasure, was first introduced at the end of the last century by a French psychologist, Ribot, and has been the object of much research, essentially in English, for the last decades, in schizophrenia, in depression, in schizoid disorders. After considering the problems of quantitative evaluation, we review the literature and conclude that anhedonia appears to be a multi-morphological symptom and the are probably several types of anhedonia, which shows the necessity of developing more specific reliable evaluation instruments and of diversifying the approaches. We show the utility, in particular, of a psychophysiological approach using endogenous Evoked Potentials. Then several research directions in psychiatry are discussed: what place has anhedonia in the negative form of schizophrenia? Does anhedonia constitute a specific marker of certain endogenous depressions? Does it constitute a personality trait that predisposes to morbidity?     

The future of cultural psychiatry: an international perspective.

Cultural psychiatry has evolved along 3 lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) efforts to respond to the mental health needs of culturally diverse populations that include indigenous peoples, immigrants, and refugees; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. These studies make it clear that culture is fundamental both to the causes and course of psychopathology and also to the effectiveness of systems of healing. The provision of mental health services in multicultural societies has followed different models that reflect their specific histories of migration and ideologies of citizenship. Globalization has influenced psychiatry through socioeconomic effects on the prevalence and course of mental disorders, changing notions of ethnocultural identity, and the production of psychiatric knowledge. A cultural perspective can help clinicians and researchers become aware of the hidden assumptions and limitations of current psychiatric theory and practice and can identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.     

Monitoring the educational achievement of primary school children: an international collaboration

Recent development in measuring educational outcomes has led to increased collaboration between international organisations and better understanding of education systems. From SACMEQ (Southern and Eastern Africa Consortium for Monitoring Educational Quality) a full data archive of the achievement of Grade 6 pupils in fourteen developing countries (including Seychelles) has been prepared. At the same time, from the Seychelles Child Development Study (SCDS) a longitudinal information system has been built on a cohort of Seychellois children from early childhood through their primary education. In this paper, the two sets of data are used to increase understanding of the achievement of pupils in primary schools in Seychelles. The cross-national comparisons of the achievement of pupils in two key learning areas, reading and mathematics, have been discussed to highlight the relative performance of Grade 6 (P6) in the SACMEQ school systems. In addition, the literacy and numeracy levels of Grade 6 pupils have been analysed to bring into sharper focus the Seychelles primary school system. By linking educational outcome at the end of primary schooling and child development outcomes during the primary education cycle, it has been possible to confirm some of the findings from the SACMEQ study. Moreover factors with potential to influence the performance of pupils and affect the learning process in the primary education system in Seychelles have been tentatively explored.     

Hope in psychiatry: a review of the literature

Objective: Hope has long been considered an important therapeutic factor in medicine, nursing and mental health and recently received attention as a central component of recovery. However, conceptual clarity, applicability and the predictive value of hope remain unclear. This review aims to define hope, review current approaches to assessment, and outline research evidence linking hope with effectiveness. Method: We conducted a comprehensive review of publications on the conceptualisation and measurement of hope, and on its use as a predictive variable specifically in mental health patients. Results: Forty‐nine definitions of hope were identified, which were grouped into seven emergent dimensions. Thirty‐two measurement tools were identified, although few have been used in research involving mental health patients. Eleven studies investigated hope as a predictive variable for differing outcomes, with inconclusive results. Conclusion: Many conceptual frameworks for hope have been proposed, but empirical evidence on its predictive power in mental health is lacking.     

Women in psychiatry: a review.

Throughout the world, psychiatry is in a period of accelerated transition. In each nation the role of women in psychiatry, and the role of psychiatry in the lives of women, reflect one aspect of the development of egalitarianism. Women psychiatrists have perennially been confronted with conflicts between their professional and private life responsibilities. Internationally, the external and internal factors that prohibit or limit women's personal development and vocational participation are being scrutinized. American psychiatry is proving to be a pioneer among medical specialities in this area.     

State-university collaboration in Nebraska: public psychiatry residency training in a rural area

The shortage of well-trained psychiatrists in the public sector is particularly severe in rural states, where state hospitals are often isolated from the professional resources available in cities. The combined department of psychiatry at the University of Nebraska Medical Center and Creighton University in Omaha has developed a residency training program at a rural state hospital 150 miles away. To bridge the distance, residents attend classes in Omaha once a week and faculty supervisors fly to the hospital once a week. Residents at the remote facility are subject to the same evaluation procedures used for residents at other facilities. The author describes the role of charismatic individuals in initiating the state-university collaboration, addresses the need for a structure to support the relationship in the absence of its founders, and discusses accreditation of residency training programs based in facilities that are remote from the medical school campus.