Psychiatric education in aerospace medicine.

In order to facilitate curriculum design for psychiatric education in aerospace medicine, three groups of physicians were surveyed: experienced flight surgeons, student flight surgeons, and psychiatrists trained in aerospace medicine. Two measures were obtained: 1) an assessment of the usefulness of particular psychiatric skills and knowledge in the practice of aerospace medicine, and 2) a rating of the clinician's abilities in these areas. Results support the primary importance of interviewing and diagnostic skills. Student flight surgeons show deficiencies in the areas of administrative knowledge and in knowledge of the impact of the flyer's environment upon his mental status. These findings link psychiatry in aerospace medicine with the emphasis on understanding the man/environment interface and on the flight surgeon's organizational function of boundary control through decisions on fitness to fly.     

精神科与其他临床科室护理人员心理状况对照调查分析

 目的 了解精神科护理人员的心理状况.方法 采用焦虑自评量表(SAS)、症状自评量表(SCL-90)、抑郁自评量表(SDS)和社会支持评定量表(SSRS)对工作在精神科的护理人员及其他临床科室的护理人员进行对照调查.结果 两组人员的SAS、SCL-90、SDS及SSRS总分无统计学意义(P＞0.05),但是精神科护理组在SCL-90中抑郁因子、焦虑因子分高于对照组(P＜0.05),说明长期工作在精神科对她们的心理有一定的影响,表现为焦虑抑郁情绪.对精神科护理组人员进行心理疏导,两周后复测SCL-90抑郁因子、焦虑因子分与对照组无统计学意义(P＞0.05),精神科护理组得分与国人常模青年组比较无统计学意义(P＞0.05),说明对有一定焦虑抑郁情绪的人员及时进行心理疏导后可恢复至正常.结论 精神科护理人员与其他临床科室护理人员的心理健康状况无统计学意义,但精神科护理人员的抑郁、焦虑水平高于对照组,经心理疏导后,心理状况可恢复到正常水平.     

Shoplifting in the mentally ill: the role of bipolar affective disorder and mental retardation

This study explores shoplifting behaviour in mentally ill patients, and evaluates the association between shoplifting and different mental illnesses in a local Chinese population. A comparison is made between shoplifting offenders and a matched control group of non-offenders among the psychiatric patients registered at a university department of psychiatry. Major depression, bipolar affective disorder (BAD) and mental retardation (MR) are the most common diagnoses among mentally ill shoplifters, while patients with a diagnosis of BAD or MR are at higher risk of committing an offence than patients with other diagnoses. Bipolar affective disorder has not been described as a risk factor for shoplifting behaviour in the psychiatric literature. Such a possibility should be seriously considered in the psychiatric assessment of shoplifting cases.     

Psychiatric evidence in criminal courts: the need for better understanding

The rules of admissibility of expert evidence from mental health professionals are not clear. The task of a psychiatrist providing expert opinion to criminal courts is far from clear. Psychiatric experts are trained in a particular set of ethical and philosophical frameworks. They have expertise in the diagnosis and management of behaviours arising from mental disorders. The concept of mental disorder itself is a dimensional one. Such a dimensional view of human behaviour and mental disorders is hard to fit into the categorical view of human behaviour that the law follows. The task of the psychiatric expert is to marry these two philosophically different branches. Such a task would be facilitated by clear rules of admissibility of expert psychiatric evidence, clear definition of the roles and limitations of psychiatric evidence in criminal cases, a better understanding and training of mental health professionals in legal principles and a better understanding by the legal professionals of the mental health concepts. This article aims to analyse the legal basis of the admissibility of expert mental health evidence, the differences in the philosophies of the two disciplines and the challenges in addressing legal criteria while staying faithful to the ethos of psychiatry and psychology.     

British military forensic psychiatry

Military psychiatry has recently generated a lot of interest. In contrast there is virtually no literature on military forensic psychiatry. The first section of the paper is a brief review of British military psychiatric services and recent data on the prevalence of mental illness in British armed forces personnel. The second section summarizes the relevant aspects of the British military judicial and penal systems including the practice of summary justice, the court martial system, and sentencing and corrective training. The third section of the paper addresses issues which are particular to forensic psychiatry, including mental defences in relation to the military, the military offences of malingering and impersonation, risk assessment in military contexts and the notion of 'temperamental unsuitability' to military service.     

Concurrent psychiatric illness in inpatients with post-traumatic stress disorder

The discharge diagnoses of 374 inpatients on a VA Medical Center general psychiatry ward were reviewed. Sixty-three (16.8%) were diagnosed as having posttraumatic stress disorder (PTSD). The mean number of diagnoses was 2.9 for the PTSD group, compared with 1.4 for the non-PTSD patients. The most common comorbid conditions in the PTSD patients were alcohol abuse, unipolar major depression, substance abuse, atypical psychosis, and intermittent explosive disorder. All of these disorders except substance abuse occurred significantly more frequently in the PTSD patients than in those free of PTSD. Schizophrenia and organic mental disorders occurred significantly more frequently in the non-PTSD group. These results suggest a need for thorough psychiatric evaluation in patients with PTSD and the need to evaluate for PTSD when combat veterans present with one of several psychiatric syndromes mentioned above.     

Psychiatric care of the homeless mentally ill: an opportunity for military psychiatry training

This paper reviews the phenomenon of homelessness in the United States and locally in Washington, D.C. Prevalence data of psychiatric illness in the homeless is presented, as is the formation of a psychiatric service network to treat the homeless mentally ill. Additionally, the author describes the development of an innovative training program in community psychiatry, focusing specifically on issues inherent in understanding the work of the psychiatric resident in community-based training and service delivery. The relevance of this experience to military medicine involves training psychiatric residents to develop service-delivery schemes in times of rapidly expanding mental health needs, such as combat.     

The role of psychiatry in U.S. Air Force primary care: research-based models for clinical consultation and education

The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and data-driven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.     

Informed consent: myth or reality

The rapidly growing awareness and respect of the social needs and legal rights of the patient in many countries is a sign of cultural maturity of society at large. However, the implementation of these achievements is especially arduous in the field of psychiatry because often mental patients have cognitive restrictions and/or emotional distress both of which may interfere with the exercise of their civil rights. One focus of this paper is the challenging process of obtaining legally valid consent from a severely ill psychiatric patient for diagnostic procedures and for treatment and also for participation in research projects. This paper also analyzes and discusses the new developments in the health legislation in Israel and focuses on the questions that arise in its application to the field of psychiatry. A recommendation for practical assessment of competence is presented. Systematic studies ofthe application of legal regulation and appropriate modifications are needed.     

Psychiatric referrals during peace and wartimes: a Nigerian experience

Using a questionnaire administered by us, we sought to investigate the differences between patients referred to the psychiatric department of a Nigerian military general hospital during peacetime and those referred during the civil war in Liberia in which Nigerian soldiers were involved as peacekeepers. Referrals to psychiatry in peacetime were quite few but increased considerably during the period of combat in direct relation to the increase in the number of surgical wounded in action cases. Organic mental disorders and anxiety disorders were more frequently referred in peacetime than in war, whereas substance abuse disorders were more frequent during the combat period. Non-psychotic psychiatric conditions were less referred in the wartime group, partly because of nonrecognition at the mission areas and also because of recovery in front-line areas or consideration of their evacuation as a nonpriority. Mental health workers engaged at the mission areas require more training in the identification of such cases.     

Attitudes of psychiatrists towards forensic psychiatry: a survey

Forensic psychiatry has been rapidly expanding in recent years and more NHS forensic beds are planned. This study aimed to examine the attitudes of psychiatrists towards forensic psychiatry. A questionnaire was given to psychiatrists attending a regional Royal College of Psychiatrists conference. In addition forensic psychiatrists were surveyed in the two local regional secure units. Ninety-eight psychiatrists, including twenty-four forensic psychiatrists, completed the questionnaire. Forensic and non-forensic psychiatrists tended to agree with the expansion in forensic beds. Non-forensic psychiatrists wanted a lower threshold for admission to secure units. Forensic psychiatrists disagreed. Non-forensic psychiatrists tended to feel that forensic psychiatry has been over-funded compared with other psychiatric services. They also commented that forensic services should integrate more closely with other non-secure psychiatric services and should offer more community forensic services rather than concentrating care on in-patients. Forensic services should consider what services they provide and try to meet the desires of secondary services, such as more community forensic services and greater integration with other psychiatric services.     

Psychiatric testimony in Britain

In the criminal-justice system psychiatric evidence may be relevant both before and after conviction. The scope of psychiatric testimony in the criminal courts has been more restricted in Britain than it has been elsewhere. It is generally confined to questions of fitness to plead, responsibility and disposal after conviction. A distinction must be made between matters of clinical psychiatry and those of moral culpability or legal competence. When psychiatric evidence strays from purely clinical questions there is an increased likelihood of misuse and abuse. Even when considering clinical issues there are factors of a non-clinical nature which may distort the type of evidence given. The implications of these matters for psychiatric witnesses are discussed. It is suggested that forensic psychiatrists are refining their role as expert witnesses.     

Treatment for offender patients: how should success be measured?

The criteria used to judge the success of treatment for mentally ill (psychotic) patients are the same for offenders and non-offenders. For those offender patients detained as psychopaths, the incremental validity of the medical concept is dubious and recourse is often made to the use of the criminal criterion of reconviction in order to measure therapeutic effectiveness. One such study is reported here and others are reviewed. It is argued that reconviction is not a valid measure of psychiatric treatment and that the criteria used to judge therapeutic effectiveness in forensic psychiatry should not differ from those used in all other forms of psychiatric care.     

Psychiatric support to magistrates' courts

There are many problems associated with magistrates' courts obtaining psychiatric advice when faced with defendants with mental health problems. Often the disposal of such individuals is less than ideal because of the unavailability of expert advice. In order to overcome these difficulties in Hampshire, a protocol has been developed to guide the court towards other sources of expert psychiatric advice as an alternative to the traditional route of using a consultant psychiatrist. By using existing court diversion schemes, prison mental health teams and care co-ordinators in community mental health teams, it is hoped that this will result in a more timely and reliable flow of psychiatric information. Not only will this provide an improved service to the courts but the mentally disordered defendant should benefit from a better informed bench when they are considering his/her disposal.     

The combat soldier

The Gulf War illness problem is seen as a post-war syndrome related to veteran discontent rather than as a new phenomenon. It is here proposed that application of social psychiatric thinking and workmen's compensation experience can help in understanding the problem. Social psychiatry has been neglected in the training of so many psychiatrists that many of them fail to understand the Army as a community and to recognize that a community's parts may develop symptom neuroses. Most psychiatrists, however, do know that a symptom neurosis will not disappear until it no longer serves its purpose. The young soldier may know that he is being trained for combat duty but manages to distance himself from the terrible realities of military combat by creating a psychic reality that protects him. Social psychiatric emphasis is used to describe his response when brought face to face with himself as a combatant with overwhelming responsibilities and genuine lethal danger. The brilliance and relevance of social thinking is demonstrated by examples from the works of Gustave LeBon and Georg Simmel so that its application to present--and future--military problems may be brought into focus.     

The flight surgeon and psychiatry: interest and skills

Much of the flight surgeon's day-to-day clinical practice involves the use of psychiatric skills in the assessment and management of the problems of flyers and their families. Folklore holds that among nonpsychiatrists, the older, more experienced, nontrainee clinician is more interested in and knowledgeable about the psychiatric aspects of his practice. We studied this assumption in 170 flight surgeons who varied in age, experience, and whether or not they were presently in training or had already completed training in flight medicine. Measures of interest in psychiatry and self-assessed ability in seven areas of psychiatric skills and knowledge were obtained. Results indicate that age and experience are unrelated to interest in psychiatry, while being in training has a significant negative impact. Self-assessed ability is significantly related to training status, age, and experience. The flight surgeon's subjective assessment of needing further education was increased by being in a training status, but unaffected by age or experience.     

Images of the brain: past as prologue

The invention of the Anger scintillation camera and the development of 99mTc tracers brought about a tenfold increase in nuclear brain scanning between 1963 and 1973, an increase that plateaued with the introduction of x-ray computed tomography. A second growth curve began in 1976 at which time there were four PET centers in the United States, a number that grew to 60 worldwide over the next decade. PET, SPECT, MRI, and MRS are leading us into a new era of in vivo brain chemistry, based on regional bioenergetics and neurotransmission. The immediate impact is in epilepsy, stroke, brain tumors and the dementias, with psychiatric diseases becoming a major focus of research. Receptivity has become a biochemical as well as a psychological approach to mental functions. The finding of elevated D2 dopamine receptors in schizophrenia in living patients may be the forerunner of a new biochemical approach to psychiatry.     

Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes

Sport psychiatry focuses on diagnosis and treatment of psychiatric illness in athletes in addition to utilization of psychological approaches to enhance performance. As this field and its research base are relatively new, clinicians often deliver psychiatric care to athletes without a full understanding of the diagnostic and therapeutic issues unique to this population. In this systematic review, we discuss published findings relating to psychiatric diagnosis and medical treatment of mental illness in athletes. There have been several studies looking at the prevalence of some psychiatric disorders in various athlete populations. Eating disorders and substance abuse are the most studied of these disorders and appear to be common problems in athletes. However, to provide informed understanding and treatment, we especially need more research on overtraining syndrome, bipolar disorder, suicidality, anxiety disorders, attention-deficit hyperactivity disorder (ADHD) and psychosis in athletes. Research is needed in the areas of prevalence, risk factors, prognosis and the unique experiences facing athletes with any of these disorders. Additionally, there have not been any large, systematic studies on the use of psychotropic medications in athletes. Small studies suggest that some medications may either be performance enhancing or detrimental to performance, but we need larger studies with rigorous methodology. Higher level athletes suffering from psychiatric symptoms often have reservations about taking medications with unknown performance and safety effects, and methodological issues with the current literature database preclude any definitive conclusions on performance effects of psychiatric medications. We need many more, higher quality studies on the use by athletes of antidepressants, mood stabilizers, anxiolytics, stimulants and other ADHD medications, sedative-hypnotics and antipsychotics. Such studies should utilize sensitive performance measures and involve longer term use of psychotropic medications. Furthermore, study subjects should include athletes who actually have the psychiatric disorder for which the medication is proposed, and should include more women.     

HIV/AIDS, psychiatric disorder and sexual assault in Transkei: a case report

HIV infection and psychiatric disorders have a complex relationship. HIV infection could lead to psychiatric disorders, and psychiatric patients are more vulnerable to HIV infection. HIV is not only an illness which is associated with stigmatization and discrimination, but also has several risks attached including physical and sexual abuse. There is a scarcity of literature on HIV, mental illness and sexual assault although they are a common trio. The author describes an HIV-positive woman with a psychiatric disorder. She suffered from AIDS and periodic psychotic epidsodes. On a day when she had such an episode she became a rape victim. The history, and physical and genital examination has been described. The need for further research in the area of HIV/AIDS and mental health has been discussed. Preventive strategies have been recommended for HIV-infected individuals in poor health resource settings.     

Assessing mental disability in minors

Forensic psychiatry devotes a great deal of attention to the "imprecise" and "insufficiently scientific" nature of psychiatric disability assessment, and, for this reason, it is vitally important to establish a reliable method of assessing different levels of disability. The assessment of mental disability in minors is unique in that it involves developmental aspects, which affect the formation and outcome of the disability. The relationship between disability and development is reciprocal: disability can affect development, thereby intensifying the degree of disability, while development affects integration of the disability into the personality and self-image, thereby preventing or reducing the transformation of disability into handicap. Only an understanding of both the psychopathological structure and its interaction with developmental elements can lead to an accurate assessment of the degree of disability. Such an understanding is vital to the proper practice of forensic psychiatry. We hereby propose a new formula for disability quantification which provides an arithmetical means for the calculation of disability percentages in minors, and we recommend its use in the assessment of demands for National Insurance benefits and compensation claims. The relationship between this new formula and the existing Children's Global Assessment Scale (CGAS) functional scale, when tested retrospectively on 50 clinical reports composed by the writers of this article, showed a good correlation in the results obtained independently by each writer. Two case studies are presented here. A further evaluation by objective evaluators is necessary in order to construct a model for a final objective evaluation of disability in children and adolescents.