首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 312 毫秒
1.
A crisis in the behavioral health care workforce has drawn considerable attention from consumers, families, advocates, clinical professionals, and system administrators at local, state, and federal levels in the past decade. Its effects have been felt in the recruitment, retention, and performance of psychiatrists in the public sector, where a focus on biological aspects of illness and efforts to cut costs have made it difficult for public psychiatrists to engage meaningfully in leadership, consultation, prevention, and psychosocial interventions. An array of training opportunities has recently been created to meet the needs of community psychiatrists at various stages of their careers, from psychiatrists just beginning their careers to those who have been working as medical directors for several years. This article describes the development of these initiatives and their impact on public psychiatry in four key areas--training of experienced psychiatrists, ensuring retention of psychiatrists in community programs, providing fellowship training, and creating professional identity and pride. Although these programs constitute only initial steps, opportunities for psychiatrists to obtain advanced training in community psychiatry are much greater now than they were ten years ago. These initiatives will enhance the professional identity of community psychiatrists and provide a solid foundation for future development of public service psychiatry in the behavioral health workforce.  相似文献   

2.
There are three different domains of Freud's heritage that help to understand the relationships between psychiatry and psychoanalysis in the past and today, even after the development of international classifications, biological psychiatry and cognitivism.The first is the concept of man being defined by the unconscious. This idea was considered revolutionary at the time and still is today. However it was not accepted by all psychiatrists depending on their cultural background and their theoretical options. It is a very profound concept but cannot apply to everybody.Psychotherapy is the second technique. Many psychiatrists may reject it but, nevertheless, although they do not practice it themselves, they are willing to propose it to their patients.The third technique deals with Freud's writings on preconsciousness. It can be a significant help in identifying illnesses and in an understanding of psychic functioning. It can be used by all psychiatrists, even those lacking a psychoanalytical background. Psychiatric practice would be impoverished if this technique was not used.  相似文献   

3.
Lack of appropriate training in both public mental health service and rural mental health service is a major factor in the critical shortage of child psychiatrists in rural settings. The authors describe a residency training program in rural public mental health designed to help alleviate that shortage. The program familiarizes fourth-year residents in child psychiatry with the clinical, political, and social aspects of rural public mental health services through didactic and supervisory sessions as well as an eight-month practicum experience involving provision of inservice training and administrative and case-related consultation to staff of mental health agencies. An assessment of the program indicated that participants felt it was beneficial, but the program was only partly successful in increasing the number of child psychiatrists entering practice in rural areas. The authors urge that residency programs in child psychiatry give priority to training child psychiatrists for work in rural settings.  相似文献   

4.
The authors describe the nature of current social and economic forces impacting on the education and future practice of general psychiatry residents in child and adolescent psychiatry. They review theoretical and practical reasons for training in child and adolescent psychiatry, analyze the form and content of what is currently taught based on a national survey of general training programs, and suggest guidelines for the training and postgraduate practice of general psychiatrists in evaluating and treating children and adolescents. The authors conclude that while social and economic changes necessitate general psychiatrists' clinical involvement with children and adolescents, insufficient general training may necessitate postgraduate education and supervision. They pose ethical and professional dilemmas for the field in meeting the national shortage of child and adolescent psychiatrists and propose strategies to enhance recruitment into child and adolescent residency training.  相似文献   

5.
Social psychiatry started over a century ago under the auspices of mental and racial hygiene, but after World War II it embraced concepts of community-based care and de-institutionalization. The major psychiatric reforms in the second half of the last century were mainly based on such concepts, including the reforms of Swiss and especially Zurich psychiatry. The present needs for psychiatric care, and the specific political and economic conditions for a continuation along this line are explored and found to be favourable. Also, the profile of future psychiatrists, as formulated by professional associations and expert groups, corresponds to concepts of social psychiatry. The World Health Organization stimulates service improvements in the same direction. The consequences concern the education and training, and the professional role of future psychiatrists. Finally, the future of social psychiatry will be shaped by public expectations and acceptance of community-based services.  相似文献   

6.
Face to the situation of child and psychiatry in Cote d’Ivoire – 1 psychiatrist for 1,446,204 children and adolescents, the existence of a only one state structure of care (Child Guidance Center [CGI]) and no possibility of hospitalization, a study whose aim was to review child psychiatry in Cote d’Ivoire from 2000 to 2009 and to propose future, was conducted. The analysis of 72 documentary sources allowed to classify the data according to four parameters: activity of care, training, research and recommendations and perspectives of the different authors. The main results on clinical activity were: 2953 consultations per year with s an average of 477 new patients, a change in the age curve (10 years ago, the center received mostly teenagers against children 0 to 4 years now), a majority of young male patients, reasons for consultation dominated by psychomotor and behavioral troubles. Six Ivorians psychiatrists, all trained in France, were in charge of training in child psychiatry to a various target. In terms of research, there were 24 works among which only four specifically dealt with child and adolescent psychiatry. All the recommendations previously made revolved around the need to develop child psychiatry in Cote d’Ivoire with a better promotion of CGI. This report calls for a revaluation of child and adolescent psychiatry in Cote d’Ivoire.  相似文献   

7.
In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.  相似文献   

8.
There is widespread concern among psychiatrists that the profession is in crisis and that it faces an array of external and internal challenges. Indeed, some observers have questioned whether the psychiatrist is an endangered species. This paper argues that medical specialties can become extinct as the case of the apothecaries exemplifies. The training template for psychiatry in the UK was put in place 40 years ago and there is a need to carefully examine whether it is still fit for purpose. Advances in theoretical knowledge and in basic understanding of psychiatric disorders have not significantly influenced the structure of clinical placements; rather it is service developments and administrative demands that have been the determinants of changes in training. Urgent action is required to address the need for reform of training that will ensure the future of psychiatry as a profession.  相似文献   

9.
Clinical guidelines for attention deficit/hyperactivity disorder (ADHD) recommend a multimodal treatment encompassing pharmacological medication with methylphenidate, cognitive-behavioral therapy (CBT) and family treatments. Methylphenidate is the most effective treatment, though the relatively high rate of partial responders, and the possible parental reluctance against the pharmacological treatment. Thus, it is interesting to consider new non-pharmacological therapies based, such as CBT, on the learning capacity of children to self-regulate their behavior. Neurofeedback is interesting insofar as it would allow children to acquire self-control over certain brain activity patterns to improve the regulation of their behavior in daily-life situation. Early studies on neurofeedback in ADHD are nearly 30 years old. Two training protocols were created, based on EEG abnormalities in ADHD. First training allows the modulation of EEG frequency bands: increased activity in the beta band, or decreased activity in the theta rhythm. The second allows an increase in a slow cortical potential. In both protocols, feedback of the brain activity patterns is given to children in real time as a kind of computer game, and changes that are made in the desired direction are rewarded, i.e., positively reinforced. The evidence-based level of the neurofeedback is still unclear. But, unlike other mental disorders, many studies have investigated the effect of this treatment on symptoms of ADHD. Thus, we propose to analyze the data of literature and especially recent studies. A meta-analysis and randomized controlled studies seem to confirm the efficacy and the possible place of neurofeedback in the multimodal treatment strategies of ADHD. But, if this treatment supposes to allow self-regulation of children behavior by learning the control of EEG activity, the specific mechanisms of action on brain activity remains problematic. Thus, we propose to identify methodological and neurophysiological areas for future research on this therapy involving the subject and electrophysiology in psychiatry.  相似文献   

10.
In the 1970s and early 1980s, neuroendocrinology was viewed by many neuroscientists as a "window to the brain" to an understanding of brain function." In psychiatry, many have viewed sleep physiology as a window in biological psychiatry. This is, in part, because sleep is one of the few easily quantifiable functions of interest to psychiatrists. Melatonin is a hormone with powerful effects on behavior particularly circadian and sleep behavior. In contrast with other hormones, the pathophysiology and pathology of abnormal melatonin secretion is poorly understood. In this article, we document the well-established phase-shifting and sleep-promoting effects of melatonin and discuss some implications for neuropsychiatrists when the neurophysiology of melatonin goes array. It is both striking and in some ways not surprising that the majority of patients with phase delay syndrome described in our research studies have been misdiagnosed as having depression. The reason for this is elucidated in this article and the information concerning this condition may be helpful to many who are relatively unfamiliar with this particular sleep disorder. We can anticipate that patients with specific neurological disorders may have changes in their melatonin secretion and future research, for example in patients with head injury and conditions such as retinitis pigmentosa may be the basis for reviews a few years hence.  相似文献   

11.
Missions of psychiatrists in charge of expertises relating to pre-release of persons are regulated within a juridical framework elaborated by the penal policy of the current society. These missions are undertaken within the strict limits not only of medical ethics and deontology but also of those of the corpus of the current criminology and psychiatry. Taking into account the possible gaps between policy and corpus the legitimate desire of satisfying social orders; of executing judicial rulings and of helping magistrate's decisions should not lead the psychiatric expert to the illusion of omnipotence and of knowing everything and most of all to ignorance of major difficulties of prognosis of acting out, i.e. of uncertainties inherent to the concept of dangerousness contrasting with the gravity and the increasing number of decisions that the psychiatrist inspires and pretends justifying. Only a truly conscientious, attentive expert work that conforms to acquired scientific data can serve the cause of justice and contribute to the development of forensic psychiatry, and of psychiatry itself, notably in that which concerns illnesses that may favour transgressions.  相似文献   

12.
Summary: The paper is intended to answer the question whether and to what extent the psychopathology in the direction of Karl Jaspers and Kurt Schneider is still meaningful for contemporary psychiatry. K. Schneider developed gradually his “Clinical Psychopathology”, proceeding from Jaspers' 4th edition of the “General Psychopathology” (1946). The Jaspersian-Schneiderian approach, aiming more at the elucidation of the patient's own inner experiences than at the observation of behaviour, has overcome the overly objectifying psychiatry of Kraepelin. The history and bearing of Jaspersian-Schneiderian psychopathology on psychiatry, its tenets, positions and concepts, as well as findings and results obtained with the approach are outlined. Recent developments in psychiatry, underestimating or even neglecting the psychopathological approach, are in danger of resulting in a loss of psychopathological competence in research and practice. The essay shows that this psychopathology is far from over, but remains relevant for clinical and biological psychiatry and should lead now, as ever, all other special and basic sciences in psychiatry. The critical methodological reflection and the fundamental psychopathological framework, created by Jaspers and modified and adapted to the requirements of clinical psychiatry by K. Schneider, are also today practically useful and heuristically fruitful. That we need psychopathology for diagnostics, therapy and primary and secondary prevention of schizophrenic psychoses, and also for biological psychiatric research, has been demonstrated by means of a long string of contributions of the last decades. The Jaspersian-Schneiderian approach does not mean definite conclusion and codification, but leaves enough room for new developments, completing, correcting and changing many aspects of classical and present psychiatric views. It ensues that the view of European psychiatrists that we need psychopathology, according to the axiom: “First things first” (Gross and Huber 1993a, 2000a), and the call of Andreasen (Andreasen 1998) for a serious investment in training a new generation of psychiatrists in psychopathology, seem to be well founded and entirely justified.  相似文献   

13.
The paper is intended to answer the question whether and to what extent the psychopathology in the direction of Karl Jaspers and Kurt Schneider is still meaningful for contemporary psychiatry. K. Schneider developed gradually his "Clinical Psychopathology", proceeding from Jaspers' 4th edition of the "General Psychopathology" (1946). The Jaspersian-Schneiderian approach, aiming more at the elucidation of the patient's own inner experiences than at the observation of behaviour, has overcome the overly objectifying psychiatry of Kraepelin. The history and bearing of Jaspersian-Schneiderian psychopathology on psychiatry, its tenets, positions and concepts, as well as findings and results obtained with the approach are outlined. Recent developments in psychiatry, underestimating or even neglecting the psychopathological approach, are in danger of resulting in a loss of psychopathological competence in research and practice. The essay shows that this psychopathology is far from over, but remains relevant for clinical and biological psychiatry and should lead now, as ever, all other special and basic sciences in psychiatry. The critical methodological reflection and the fundamental psychopathological framework, created by Jaspers and modified and adapted to the requirements of clinical psychiatry by K. Schneider, are also today practically useful and heuristically fruitful. That we need psychopathology for diagnostics, therapy and primary and secondary prevention of schizophrenic psychoses, and also for biological psychiatric research, has been demonstrated by means of a long string of contributions of the last decades. The Jaspersian-Schneiderian approach does not mean definite conclusion and codification, but leaves enough room for new developments, completing, correcting and changing many aspects of classical and present psychiatric views. In ensues that the view of European psychiatrists that we need psychopathology, according to the axiom: "First things first" (Gross and Huber 1993a, 2000a), and the call of Andreasen (Andreasen 1998) for a serious investment in training a new generation of psychiatrists in psychopathology, seem to be well founded and entirely justified.  相似文献   

14.
Ethology is relevant to clinical psychiatry for two different reasons. First, ethology may contribute significantly to the development of more accurate and valid methods for measuring the behavior of persons with mental disorders. Second, ethology, as the evolutionary study of behavior, may provide psychiatry with a theoretical framework for integrating a functional perspective into the definition and clinical assessment of mental disorders. This article describes an ethological method for studying the nonverbal behavior of persons with mental disorders during clinical interviews and reviews the results derived from the application of this method in studies of patients who had a diagnosis of schizophrenia or depression. These findings and others that are emerging from current ethological research in psychiatry indicate that the ethological approach is not limited simply to a mere translation into quantitative and objective data of what clinicians already know on the basis of their judgment or the use of rating scales. Rather, it produces new insights on controversial aspects of psychiatric disorders. Although the impact of ethology on clinical psychiatry is still limited, recent developments in the fields of ethological and Darwinian psychiatry can revitalize the interest of clinical psychiatrists for ethology.  相似文献   

15.
The two primary audiences for this article are psychiatrists interested in a cultural psychiatry career and academic as well as healthcare leaders who are in a position to support cultural psychiatry training. In addition to describing my own personal journey through cultural psychiatry, this report includes strategic recommendations for becoming a cultural psychiatrist as well as rationales for supporting a cadre of cultural psychiatrists in the coming decades. A World Health Organization (WHO) sponsored program for training clinicians in addictions is described. Finally, the account summarizes those clinical, research, educational, consultative, and leadership roles that cultural training influenced during my career.  相似文献   

16.
The reintroduction of the internship requirement has caused a number of changes in psychiatric education in the past decade. Many psychiatric educators and departments of psychiatry have been faced with the challenges of organizing internships and establishing an internship curriculum. This has been especially challenging because the psychiatrists involved have seldom had full postgraduate training in the fields being organized and have not previously administrated clinical services in those areas. The authors discuss the goals of the internship for future psychiatrists and the pros and cons of university versus community general hospital based internships for future psychiatrists, and find several potential advantages to the latter. Also discussed are their consistent observations of internship programs for future psychiatrists over the past decade in three geographically separate regions and in state and private institutions. They and most other faculty members in their respective departments believe that the reinstitution of the internship has had largely beneficial effects on future psychiatrists.  相似文献   

17.
The relationship between the field of genetics and the social sciences has been fraught with difficulties. The philosophers were the first to predict that it would not be an easy matter, and genetics was used in psychiatry not as an aid to persons recognized as being vulnerable, but with the aim of putting a term to degeneration within the population (the theory of Morel). The hesitancy shown by psychiatrists toward this area of research can thus be well understood. However, genetics is first of all a powerful and original means of investigating psychic suffering. A certain number of misunderstandings explain why psychiatrists (French psychiatrists in particular, and to a greater degree than the patients themselves) show some reserve regarding genetic research into mental illnesses. Three concepts that are often poorly understood have been detailed in this article (genetic determinism, heritability, familial aggregation), then illustrated for schizophrenia through a review of familial studies and several candidate genes. The implications and limits of genetics as applied to schizophrenia should thus be better defined.  相似文献   

18.
19.
20.
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.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号