CPNP Announcements

Back to table of contents Previous article Next article Professional NewsFull AccessMilitary Broadens Online MH ScreeningRich DalyRich DalyPublished Online:21 Jul 2006https://doi.org/10.1176/pn.41.14.0009The U.S. military's online mental health screening tool, developed to address rising stress levels in troops at home and abroad, has proven more effective than the Department of Defense's (DoD) traditional screening programs in gathering candid responses on possible mental health problems.The new Web site, which allows anonymous self-screenings for signs of depression, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), and alcohol abuse, had elicited more openness than the four in-person assessments the military uses, according to preliminary findings of ongoing research on the program."People tend to be more candid when using an online or telephone-based screening than in person, and we can speculate that it is because there is more privacy or they are more comfortable," said Air Force Col. Joyce Adkins, a psychologist in the Pentagon's Office of Health Affairs and program manager of the Mental Health Self-Assessment Program.The program, which went online in January and has been widely publicized to members of the military and their families, assesses answers to questions about recent behavior and mood swings. If the responses indicate possible problems, the site refers participants to a central locator office that provides contact information for local clinicians.The initial findings answer the criticisms of some veterans leaders who described the online surveys as inadequate substitutes for face-to-face encounters with psychiatrists or mental health professionals. The findings of higher degrees of candor among online respondents in the DoD program are similar to the findings reported by other researchers of online mental health screening tools.A study titled "Psychology of the Internet" published in 1999 by Cambridge University Press found that people tend to disclose more information about themselves to computers than in face-to-face contact. A 2004 study in the Journal of Clinical Psychology found that computer-based assessment can gather information of greater quantity and higher quality than clinician-administered assessment.In addition, a 2003 study in the Journal of Medical Internet Research found that a Web-based depression and anxiety test was reliable for identifying patients with and without major depressive disorder and several anxiety disorders—panic disorder with and without agoraphobia, social phobia/social anxiety disorder, obsessive-compulsive disorder, and PTSD."I don't know that people are being dishonest otherwise, but they are more candid across the board" with the online approach, Adkins maintained.Michele ybarra, Ph.D., who has researched online mental health tools, said studies of this emerging area of care indicate that those who use online screening tools are then more likely to seek inperson care from mental health clinicians than people who fail to take advantage of them."The concern was that people would use these tools to say, `Oh, I'm not that bad off so I don't need any help,' but we have found they do just the opposite of that," said Ybarra, president of internet Solutions for Kids Inc, a not-for-profit research company.The military's standard screening tools for mental illness among troops are included as part of its mandatory health assessments that occur immediately before and after deployment and then three to six months after return.A recent study found that a third of service members returning from Iraq who completed the postdeployment survey received counseling (Psychiatric News, June 16).A fourth screening tool, the Periodic Health Assessment (PHA), is given to all members of the military and their families annually."The PHA is designed for everybody, every year, to do a global health assessment," Adkins said.The new screening tool and the military's more traditional mental health screening programs ask similar questions, and both require more research to better assess their effectiveness, said capt. Thomas Grieger, M.C., an associate professor of psychiatry at the Uniformed Services University of the Health Sciences. Both a Government Accountability Office study and a DoD National Quality Management Program study questioned whether adequate referrals followed the use of such screening tools."you would know if you might have a problem, but it would not definitively tell you that your problem is significant, nor would it be able to tell you that it isn't," said Grieger, who represents the Society of Uniformed Services Psychiatrists in the APA assembly. "It just says that you have some symptoms."Adkins emphasized that the online program is designed to supplement—not replace—the more formal programs. The online program, Adkins said, helps to fill a void when face-to-face screening and counseling are not immediately available to a service member or relative. it is also described as primarily an educational tool for those under stress and those who know someone under stress.Other measures of the site's success include its level of use. While Adkins declined to specify the overall number of users, she said its use has steadily increased since its launch to the point that "thousands" use it each week.Following the success of the online mental-assessment program, the military now plans to add an anonymous phone-based version for those without Internet access. It is scheduled to be launched by the end of the year.Also planned is an early intervention, cognitive-behavioral psychoeducational program to provide preemptive education in depression, PTSD, and generalized anxiety disorder to those whose screenings did not indicate that they may need treatment.The DoD also is developing a Web-based psychoeducation program on alcohol abuse that is in the pilot stage.Military clinicians knew that a key component of the online program's success would be its ability to be "relevant, convenient, targeted, and trusted." To meet the last goal, the DoD chose the nonprofit company Screening for Mental Health Inc., which created the National Depression Screening Day program, to design the online tool.Paul Davidson, executive director of the nonprofit National Gulf War Resource center, said the reluctance of members of the military to seek mental health assistance is affected by fears that just asking for help will impact their status within their unit and the military careers. He praised the online tool as providing a place where they can feel comfortable to answer honestly and find out if they need professional help."For some this may be their only way to find out if they should seek help," he told Psychiatric News.The online screening tool is posted at<www.militarymentalhealth.org/welcome.asp>.▪ ISSUES NewArchived

Experts Shine Spotlight on Racial Differences in Illness

Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.

Psychiatric genomics is a rapidly growing field that holds much promise for improving risk prediction, prevention, diagnosis, treatment selection, and understanding of the pathogenesis of patients' symptoms. The field of psychiatry (i.e., professional organizations, mental health clinicians, educational institutions), however, needs to address numerous challenges to promote the responsible translation of genomic technologies and knowledge into psychiatric practice. The goal of this article is to review how clinicians currently encounter and use genomics in the clinic, to summarize the existing literature on how clinicians feel about the use of genomics in psychiatry, and to analyze foreseeable ethical and legal challenges for the responsible integration of genomics into psychiatric care at the structural and clinic levels. Structural challenges are defined as aspects of the larger system of psychiatric practice that constitute potential barriers to the responsible integration of genomics for the purposes of psychiatric care and prevention. These structural challenges exist at a level where professional groups can intervene to set standards and regulate the practice of psychiatry and genomics. Clinic-level challenges are day-to-day issues clinicians face when managing genomic tests in the clinic. We discuss the need for action to mitigate these challenges and maximize the clinical and social utility of psychiatric genomics, including the following: expanding genomics training among mental health clinicians; establishing practice guidelines that consider potential clinical, psychological, and social implications of psychiatric genomics; promoting an integrated care model for managing genomics in psychiatry; emphasizing patient engagement and informed consent when managing genomic testing in psychiatric care.

The necessity of engaging qualified interpreters to work in partnership with mental health clinicians when serving patients with a limited English proficiency (LEP) is gaining widespread support. Numerous research studies have documented improved patient health and satisfaction outcomes in this regard. Psychiatric practice often involves complexities of thought, language, and communication that clinicians and interpreters must appreciate. One such topic is engaging LEP patients in the mental status examination (MSE). This chapter describes the nature of the MSE, challenges when interpreting for the MSE, strategies for handling such challenges, and approaches for effective collaboration between interpreters and mental health clinicians regarding the MSE and cross-linguistic mental health care more broadly. The current state of scholarship in the field of mental health interpreting and training opportunities for interpreters who seek to improve their knowledge and skills in the mental health arena also are discussed.

As CPNP's fiscal year and my term as president wind down, it's impossible not to reflect on this past year's events. It has been a distinct honor and privilege to serve as president of our organization. Our engaged membership, the other volunteer leaders, and the CPNP Staff make that task seem almost easy. With the help of all of those people, CPNP has moved forward in a number of arenas during the past year. I want to take this opportunity to highlight some of the significant developments and accomplishments from the last year.This year started with a concerted initiative in the legislative affairs arena. Starting with numerous conversations and dialogue at the 2012 Town Hall Meeting in Tampa, Florida, momentum has been gained in our efforts to achieve provider status and eventual reimbursement for pharmacists' direct patient care services. This began with contracting with Carey Potter as a Government Affairs Consultant and the formation of the Comprehensive Medication Management Reimbursement (CMMR) work group. The efforts of that group led to CPNP's endorsement of Comprehensive Medication Management (CMM) as a practice model for psychiatric pharmacy. Along with that endorsement came an organizational commitment to present ongoing education about this practice model to our membership and to partner with other organizations to promote CMM. Subsequently, ACCP announced their legislative initiative to seek provider recognition for qualified clinical pharmacists who provide direct patient care services. After careful consideration, CPNP decided to partner with ACCP in this effort. Activities to seek legislative support have begun. Our CMMR work group and our legislative committee have now been merged into a Government Affairs Council (GAC) with responsibility for coordinating our efforts in seeking provider recognition as well as other legislative and government affairs activities. These other activities involve a strong CPNP presence on the Pharmacy Stakeholders group and advisory groups related to Long-Term Care among others.CPNP's online, open-access journal, The Mental Health Clinician (MHC) has made impressive progress and achieved notable growth. MHC now has an ISSN, a unique eight-digit number used to identify a print or electronic periodical publication, which allows for worldwide identification of periodicals. The editorial board for MHC has grown. Perhaps most significantly, MHC now contains significant (and growing) peer-reviewed content. Our members and others now have an additional avenue in which to publish scholarly works and research. The readership of MHC, based on website “hits”, is growing; and MHC is clearly drawing attention to the CPNP website.CPNP's membership has grown and there are significant opportunities for members to be involved in our organization. Throughout the year, there are literally hundreds of opportunities for individual members to contribute the success of CPNP. These include committee positions, membership on our three editorial boards, acting as authors or peer reviewers for MHC submissions and recertification products, helping field test and identify cutoff scores for recertification product examinations, and serving in various other ad hoc volunteer positions. Our recent 16th Annual Meeting is an example of the important role member involvement plays. Without the volunteer efforts of the Programming Committee, the Recertification Editorial Board, and our members who were Roundtable Facilitators and award judges, exciting, successful meetings like that would not be possible. CPNP members who served as speakers also played a significant role in the Annual Meeting's success. There is also growth in the student membership of CPNP. The number of student chapters has increased to nine. These members represent the future of our organization.As I described in an earlier presidential letter, CPNP has begun the process of developing a new strategic plan. Significant effort went into the initiation of this process in January at a retreat meeting. We now have workgroups actively developing the objectives that will drive achievement of the strategic goals of this new plan. That process will be ongoing through the summer and fall and will result in a new plan enabling CPNP to be positioned to take advantage of opportunities and leverage its resources including our members who are applying their skills and efforts through CPNP to improve the care of those affected by mental and neurologic illnesses.In closing, I thank all of the membership for the support and enthusiasm you bring to our organization. It has made my year as president rewarding and enjoyable. At the end of June, Dr. Julie Dopheide will assume the presidency of CPNP. I know that she too will benefit from your ongoing support and enthusiasm. I will, of course, continue to be involved as immediate past-president. I know that Dr. Dopheide will lead us through another great and successful year.Thank you all for a great year. Be well.Rex Lott

Psychiatric Pharmacy Residency Training

No abstract available.

Data Raise Concerns About Polypharmacy Trend

A US PSYCHIATRY RESIDENT'S PERSPECTIVE OF TELE-PSYCHIATRY SUPERVISION OF MENTAL HEALTH PROVIDERS IN LIBERIA

This study explored how mental health clinicians assess and respond to physical illness among patients presenting for mental health intake evaluations. A total of 129 adults were seen for a mental health intake visit. The intake visits were videotaped and involved 47 mental health clinicians from eight clinics who provided outpatient mental health and substance abuse treatment. A total of 120 videos of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Twenty-eight intake visits exemplifying in-depth physical illness assessments were selected and transcribed for qualitative analysis. Physical health was discussed in most intake visits (87%). Clinicians elicited information on physical health in 79 visits (66%), and patients volunteered such information in 80 visits (67%). Frequency of assessment differed by clinician discipline (p<.05) and by patient ethnicity (p=.06). Qualitative analysis revealed characteristics of appropriate assessments, such as formulating the contribution of physical conditions in the psychiatric differential diagnosis, noting physical side effects of medications, adjusting treatment plans, encouraging patient contact with primary care providers, and promoting physical health care. Assessment of physical illness is relatively common among mental health clinicians but was lacking in one-third of the cases in this study, until raised by patients. Because frequency of assessment differed by clinician discipline and patient ethnicity, innovations in patient assessment and clinician education are needed to address disparities in management of physical illness among individuals with mental illness.

Back to table of contents Previous article Next article Psychiatry & PsychotherapyFull AccessRetaining Psychodynamic Thought in Contemporary PsychiatryRandon S. Welton, M.D.Randon S. WeltonSearch for more papers by this author, M.D.Published Online:30 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.11.30AbstractPsychodynamic psychotherapy was once a cornerstone of psychiatric training and practice. Historically, most psychiatrists would have felt comfortable exploring patients’ unconscious and interpersonal issues in weekly therapy sessions. In contemporary psychiatry, however, psychodynamic thought has lost its preeminence. Managed care’s preferential reimbursement of psychopharmacology and reliance on lower-cost therapists compounded by the mistaken belief that psychodynamic psychotherapy lacks empirical support led to a steady decline in psychiatrists providing psychodynamic psychotherapy. Ironically this occurred simultaneously with the emergence of a literature demonstrating the efficacy and cost-effectiveness of psychodynamic psychotherapy in managing personality disorders, chronic depression, and anxiety. What can psychiatry do to preserve the benefits engendered by a psychodynamic understanding of patients?In addition to promoting psychodynamic psychotherapy, psychiatric training should focus on the advantages of incorporating psychodynamic thought into a wider range of patient interactions. Psychodynamically informed psychiatrists can emphasize once commonly held beliefs such as these:Everyone has an active unconscious that in part dictates their desires, reactions, and behaviors.Past experiences shape one’s current relationships, emotions, and decisions.People tend to form recurring patterns of relationships often based on early childhood models.The relationship between the psychiatrist and patient contains both diagnostic and therapeutic potential.We must act quickly, however, if we want a psychodynamic orientation to remain a core feature of psychiatry; the last generation of psychiatrists who were steeped in psychodynamic thought are rapidly reaching retirement age. Some psychiatrists, especially those in private practice, are able to offer traditional psychodynamic psychotherapy, but all psychiatrists can still inculcate a psychodynamic understanding into routine clinical care. Consider the following example:A young man was seen in the ICU by the consultation/liaison team. He had cut his wrist and taken an overdose of acetaminophen. When the resident sat down with him, the patient was curt and dismissive. “Let’s get this over with. ... I was suicidal, but I am not anymore. I have seen the error of my ways. I promise.”Despite the aggressiveness of these remarks, the resident sensed the patient was more scared than angry. She asked why he was trying to push her away when she was trying to help him. He became suddenly tearful, “That is what they always say. You pretend to care, but when I need you, no one is there for me.” Recognizing that the intensity of his response came from previous disappointments, she tried to reassure him of her desire to help and said, “It sounds like people have let you down before. I wonder if that had something to do with you trying to kill yourself.” This led to a conversation about his chronic relationship struggles and the argument with a close friend that had precipitated the suicide attempt.A minimal psychiatric response to this situation would be to thoroughly document a risk assessment and make recommendations about psychopharmacology. A psychodynamic psychiatrist would reflect on what these interactions say about the patient’s past experiences and inner life and how those factors should guide her approach to the patient.The consultation/liaison resident encouraged the patient to discuss the relationship with his friend and their distressing conversation. She then asked him to consider a different perspective.“You two sound very close. You have felt rejected by many people in your life, but maybe his spending time with other people is not a rejection of you. I wonder if there are parts of his life that don’t involve you, just like there are parts of your life that don’t involve him.” The patient nodded. “Well, he was going over to play some stupid online game. He knows that I get bored with that stuff. He has asked me before, and I have always said ‘no.’ ” The resident suggested, “So maybe he didn’t invite you because he knew you wouldn’t want to go.”The resident’s understanding of the patient’s interpersonal vulnerabilities allowed her to strengthen their therapeutic alliance and to help the patient re-examine long-standing, unconscious beliefs about his relationships. She continued his current medications without change and arranged for a next-day appointment with his outpatient therapist.Retaining a psychodynamic orientation can deepen our understanding of patients and guide our interactions wherever we work. We should not settle for a reductionistic view of patients’ symptoms, as if their primary problem was a medication deficiency. Today’s psychiatrists can incorporate these practical psychodynamic principles into their everyday work and thereby provide the comprehensive care that patients need and deserve ■Randon S. Welton, M.D., is an associate professor of psychiatry and director of the psychiatry residency program at Wright State University School of Medicine. He is also a member of the Committee on Psychotherapy of the Group for the Advancement of Psychiatry (GAP). ISSUES NewArchived

Free AccessFocus: The Use of Psychotropic Drugs in Autism and Other Pervasive Developmental DisordersLukas Propper and Herbert OrlikLukas Propper1 Assistant Professor of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail: [email protected]1 Assistant Professor of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail: [email protected]2 Associate Professor of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail: [email protected]Search for more papers by this author[email protected] and Herbert Orlik2 Associate Professor of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail: [email protected]1 Assistant Professor of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail: [email protected]2 Associate Professor of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail: [email protected]Search for more papers by this author[email protected]Published Online:November 2009https://doi.org/10.1521/capn.2009.14.2.1PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Next article FiguresReferencesRelatedDetails Cited byCited by1. Treatment in autism spectrum disorderOnline publication date: Go to citation Crossref Google Scholar2. Autism Spectrum DisorderOnline publication date: 17 August 2013. Go to citation Crossref Google Scholar Volume 14Issue 2Apr 2009 Information© 2009 Guilford Publications Inc.PDF download

&lt;p&gt;The modern era of psychopharmacology began in the 1950s with the discovery of the antipsychotic drug chlorpromazine (Thorazine). Since then, many drugs have been developed, investigated, and marketed for the treatment of all forms of mental illness. Although medications are not completely effective for all patients, most individuals will generally derive some satisfactory benefit from an appropriately prescribed medication. However, even the best medications do not work in patients who do not take them. Although not taking medication reliably is well recognized as a common problem, surprisingly, patients and their prescribers can grossly overestimate medication adherence. For this reason, the concept of medication adherence is a more practically important pharmacotherapy issue than is expert knowledge in clinical psychopharmacology. In this article, the importance of medication adherence, the factors associated with poor adherence, and some approaches for improving adherence is discussed. &lt;/p&gt;&lt;h4&gt;ABOUT THE AUTHOR&lt;/h4&gt; &lt;p&gt;Robert H. Howland, MD, is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.&lt;/p&gt; &lt;p&gt;Address correspondence to Robert H. Howland, MD, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: &lt;a href="mailto:HowlandRH@upmc.edu"&gt;HowlandRH@upmc.edu&lt;/a&gt;.&lt;/p&gt; &lt;p&gt;Dr. Howland has disclosed no relevant financial relationships.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt; Review why medication adherence is important.&lt;/li&gt; &lt;li&gt;Describe some of the factors associated with poor medication adherence.&lt;/li&gt; &lt;li&gt;Discuss some approaches to improving medication adherence.&lt;/li&gt; &lt;/ol&gt;

It’s About Time! Three Researchers Win Nobel for Circadian Clock Discoveries