GWU Group Helps Train Refugee Aid Workers

Myanmar’s Mental Health System Undergoes Major Modernization

Surgery and conflict

Back to table of contents Previous article Next article Professional NewsFull AccessSTARRS Findings Shed More Light On Army SuicidesAaron LevinAaron LevinSearch for more papers by this authorPublished Online:14 May 2018https://doi.org/10.1176/appi.pn.2018.5b19AbstractMore time in training and more time at home between deployments may help prevent suicide deaths among U.S. Army soldiers.The latest published findings from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) has found that the odds of a suicide attempt among U.S. Army soldiers were greater for those who deployed within their first year in the service and for those with less than six months between their first and second deployments. The results may have implications for Army training and length of time between deployments, wrote Robert Ursano, M.D., and colleagues in JAMA Psychiatry on April 18. Ursano is a professor of psychiatry and neuroscience and director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md.Army STARRS researchers collected data on 1.6 million active-duty soldiers from 2004 to 2009 in a project designed to investigate risk factors and protective factors for suicide, suicidal behavior, and other mental or behavioral health issues.“There were nearly 10,000 suicide attempts overall during that time,” said Ursano in an interview. “Suicide attempts are indicators of individuals in need of care. For the Army, they also carry a cost in how they affect units.”Ursano and co-author Murray Stein, M.D., M.P.H., a professor of psychiatry and family medicine and public health at the University of California, were co-principal investigators on Army STARRS. The project not only gathered new data as the United States was fighting two wars; it also pulled together material previously recorded but not held in one place.“At first, Army STARRS told us much of what we already knew, but now we are able to quantify that information,” commented retired Army psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H., a professor of psychiatry at USUHS and a clinical professor at Georgetown University and George Washington University, in an interview. Ritchie was not involved with the current study. “The important thing about this study is that it not only gathered data but also made some practical suggestions about what may be done to reduce the risk of suicide attempts.”For the current study, the researchers collected administrative data records on a sample of 593 soldiers who had served between 2004 and 2009, had completed exactly two deployments, and had documented suicide attempts during or after their second deployment. They were matched with a control sample amounting to 19,023 person-months. Most of the soldiers were male (86.5 percent), currently married (67.1 percent), and had joined the Army before age 21 (64.8 percent).No effects were found relating to military occupational specialty, sex, deployment status, duration of first deployment, or previous mental health diagnosis, said the authors. The risks of combat experience itself or of high-risk military specialties, like combat medics, could not be determined in this study. Time-related variables were adjusted for sociodemographic and service-related factors.Soldiers who had served 12 months or less before their first deployment had greater odds of a suicide attempt (odds ratio, 1.7) during or after their second deployment. That risk might be reduced if soldiers “had more time to train and acclimate to the military before their initial deployment,” suggested the researchers.A second variable was “dwell time,” the period between deployments when soldiers recover from their experiences in the war zone and train for future duty. After adjustment, a dwell time of six months or less also was associated with increased risk of a suicide attempt (odds ratio, 1.8). Prior research has found that dwell times for troops of 30 to 36 months are associated with reduced rates of acute stress, anxiety, and depression compared with troops who had not been deployed.Dwell time is not as simple to control as it may seem, said Ritchie. “Military leaders appreciate the need for a longer time between deployments, but if you have a war to fight, you have to balance your options.”The study indicates that suicide attempts might be reduced by 14.2 percent if the initial training period is greater than 12 months and by 4.0 percent if the dwell time is at least six months, said the authors.“We were surprised by the clarity of the findings and the strength of the association of risk with early deployment,” added Ursano. “The lack of findings related to length of deployment highlight the dynamic nature of deployment and the many ‘moving parts’ that must be considered.” ■“Associations of Time-Related Deployment Variables With Risk of Suicide Attempt Among Soldiers” can be accessed here. ISSUES NewArchived

Costas Nikolaos Stefanis

Psychiatrists need to be more involved in the public debate over mental illness and gun violence, argue to ethics experts.

CONCERN for the individual volunteer, even as his number increases, remains one of the outstanding characteristics of the Peace Corps. The extensive participation of the mental health and public health professions in the selection, training, and overseas psychological support of the volunteer reflects this concern and may have helped to keep the rate of permature return as low as it is. To describe the care with which volunteers are finally chosen from the large pool of applicants would require a paper in itself, and we refer the interested reader to Hobbs (1) . Suffice it to say that applicants are carefully screened and matched to the requirements of their proposed project. They are then invited to the training site for an intensive 8to 12-week course in which the trainees are tested, interviewed, and observed in their performance and interactions. A psychiatrist meets with them in a series of five small informal, anticipatory guidance sessions, and more formally whenever indicated. They are evaluated medically to be certain they can meet the physical demands of the project. Those who successfully complete this arduous training phase become the Peace Corps voilunteers. [For a description of the development of the program for preventive psychiatry in the Peace Corps, see Leopold and Duhl (2, 3) and Kramer and Frank (4). A manual for psychiatric consultants including suggestions for the anticipatory guidance sessions was prepared by Caplan (5) and published by the Peace Corps.] During the 17-month period ending January 1963 covered in this report, the Peace Corps placed 3,805 volunteers in 43 countries. Of this number only 116 returned home from 28 countries. This represents 3 percent of the volunteers in the field at the end of that period. However, if we correct for the differences in time abroad, the rate has been nearly constant at 54 returning volunteers per 1,000 man-years of overseas service, or 5.4 percent per annum. Adding all the volunteers overseas during each month gives the total number of man-months, which divided by 12 converts to the number of man-years. Although some volunteers have been abroad for the full 17 months, more than half have been there only 5 months. The total number of man-years of experience was 2,152.3 during this period. The number of volunteers returninig each month for all reasons has varied from none to as many as one a day in January 1963. However, with some lag this number has been roughly proportional to the total number of volunteers sent overseas, with a slight rise during the last 2 months (fig. 1). The following observations may be made on the basis of data accumulated after a careful Dr. Thomson is a lecturer in the department of psychological medicine, University of Edinburgh. He formerly was a clinical and research fellow at the Massachusetts General Hospital on Peace Corps assignment. Dr. English is chief psychiatrist, Medical Programs Division, Peace Corps, Washington, D.C., detailed from National Institute of Mental Health, Public Health Service; and clinical assistant professor in psychiatry, George Washington University, Washington, D.C. Dr. Victor Kovner, Peace Corps physician in Venezuela, and Dr. Mark Beaubien, Peace Corps physician in Malaysia, assisted in the preparation of this paper before going overseas.

<p>A 35-year-old bipolar II female patient presents with depression, comorbid panic attacks, and a history of childhood adversity. Onset began at 13 years with major depression followed by hypomania. The patient also has a history of substance abuse. She became tolerant to benzodiazepines for panic attacks, but she does not do well on antidepressants because of cycle acceleration despite lithium prophylaxis.</p> <h4>ABOUT THE AUTHOR</h4> <p>Robert M. Post, MD, is Head, Bipolar Collaborative Network, Chevy Chase, Maryland, and Professor of Psychiatry, Pennsylvania State University School of Medicine, Hershey, Pennsylvania, and George Washington University, Washington, D.C.</p> <p>Address correspondence to: Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201B, Bethesda, MD 20814; <a href="mailto:robert.post@speakeasy.net">robert.post@speakeasy.net</a>.</p> <p>Dr. Post disclosed the following relevant financial relationships: Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, and Shire Laboratories: Consultant; and Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb; and GlaxoSmithKline: Member of Speakers’ Bureau.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol> <li>Discuss the pharmacologic and psychotherapeutic treatment strategies for a patient with bipolar disorder.</li> <li>Manage the recurrent symptom presentations in a patient with bipolar disorder.</li> <li>Manage comorbidities in a patient with bipolar disorder.</li> </ol>

<p>Disease prevention and health promotion are important elements of public health. Tobacco control, motor vehicle safety, nutrition, and immunizations are widespread public health measures employing science, policy, and interventions. Psychiatrists may ask what constitutes disease prevention and health promotion in the mental health field and how prevention and promotion fit into their clinical work.</p><h4>ABOUT THE AUTHORS</h4><p>Carol Koplan, MD, is Adjunct Assistant Professor, Rollins School of Public Health of Emory University, Department of Health Policy and Management and Department of Behavioral Sciences and Health Education, Atlanta, Georgia. Anthony Charuvastra, MD, is Child and Adolescent Psychiatry Resident, New York University School of Medicine, Department of Psychiatry, New York, New York. Michael T. Compton, MD, MPH, is Assistant Professor, Emory University School of Medicine Department of Psychiatry and Behavioral Sciences and Department of Family and Preventive Medicine, and Rollins School of Public Health of Emory University, Department of Behavioral Sciences and Health Education, Atlanta, Georgia. James C. MacIntyre II, MD, is Staff Psychiatrist, Department of Psychiatry, Carolinas Medical Center—Behavioral Health Center, Charlotte, North Carolina. Rebecca A. Powers, MD, MPH, is Adjunct Clinical Assistant Professor of Psychiatry, Stanford University School of Medicine, Los Gatos, California. David Pruitt, MD, is Professor and Director of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Department of Psychiatry, Baltimore, Maryland. Larry Wissow, MD, MPH, is Professor, Johns Hopkins University, Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland.</p><p>Address correspondence to: Michael T. Compton, MD, MPH, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, SE, Room #333, Atlanta, GA 30303; fax: 404-616-3241; email: <a href="mailto:mcompto@emory.edu">mcompto@emory.edu</a>.</p><p>Acknowledgements: The authors gratefully acknowledge the past collaborations of Daniel Z. Lieberman, MD, GAP Prevention Committee, 2000-2003. Dr. Lieberman is Assistant Professor of Psychiatry and Behavioral Sciences, Director of Clinical Research Center, George Washington University, Washington, D.C.</p><p>The authors disclosed no relevant financial relationships.</p>

Flight from despair

Accuracy of the estimation of dental age in comparison with chronological age in a Spanish sample of 2641 living subjects using the Demirjian and Nolla methods

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Lynn E. DeLisiLynn E. DeLisiLynn E. DeLisi, MD, is currently Attending Psychiatrist at the Cambridge Health Alliance, Cambridge, Massachusetts, USA, and Professor of Psychiatry, Harvard Medical School, Boston, USA. In addition, she is Editor-in-Chief of the journal Psychiatry Research, Co-Founding Editor of Schizophrenia Research, Co-Founder and Past President of the Schizophrenia International Research Society (SIRS), Co-Founder and former secretary of the International Society of Psychiatric Genetics (ISPG), and a fellow of the American College of Neuropsychopharmacology (ACNP) and the American Association for the Advancement of Science (AAAS). In October 2007 and 2013 she chaired or co-chaired the World Congress of Psychiatric Genetics in New York and Boston for over 1000 participants and, for several years, has been an organizer of the Schizophrenia International Research Society Conference taking place in Italy and the USA as well. Her undergraduate degree is in zoology from the University of Wisconsin, USA. She obtained her MD degree from the Medical College of Pennsylvania, USA, and went on from there to do three years of general practice work with the migrant Chile farmers of Northern New Mexico. She completed a residency in psychiatry at Saint Elizabeth's Hospital, Washington DC, USA, and was a post-doctoral fellow and then a full-time staff research psychiatrist in the NIMH intramural research program, St. Elizabeth's Hospital (Washington DC, USA) and the NIH Campus (Bethesda, Maryland, USA). In 1987, she moved to The State University of New York, USA, at Stony Brook, where she set up several research programs on the longitudinal biological outcome of schizophrenia, emphasizing both brain imaging and genetic studies. From 2001 through 2008, she was Professor of Psychiatry at New York University School of Medicine, USA, and Associate Director of The Center for Advanced Brain Imaging at The Nathan S. Kline Institute for Psychiatric Research, until she obtained her current position at Harvard Medical School and its affiliate hospitals. She has dedicated her career to research programs on detection of schizophrenia, while at the same time treating chronic patients with schizophrenia, and those with other acute serious mental illnesses. She also teaches and mentors several residents and trainees, both locally and internationally at congresses. She has edited and authored over 300 books and manuscripts and serves on the editorial board of several other journals. In her off hours, she volunteers as the vice-chair of her local town's planning board and has worked on issues, such as the legalization of marijuana, affecting her local neighbours in many ways. Jair MariJair MariJair Mari is a medical doctor with a residence training in psychiatry. He is the current head of the Department of Psychiatry and Medical Psychology of Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil, being an active member of the WPA urban mental health section. He took his medical degree at ABC medical school in Santo Andre in Brazil, and in 1981 he went to the Institute of Psychiatry, King's College London, UK, for PhD training. He was keen to develop research instruments to be applied in Brazil and introduced ROC analysis to compare psychometric properties of mental health screening instruments. In 1991, as a post doc, he went to the McMaster University, Canada, where he generated the first mental health systematic review on family psychosocial interventions in schizophrenia. He was one of the first collaborators start the Cochrane Library endeavour. In 1996, he became a tenured professor of psychiatry in the Universidade Federal de São Paulo. An important part of his career was dedicated on teaching mental health research methodology for hundreds of mental health professionals in Brazil, having a leading role in developing evidence-based medicine in Brazil. He was a consultant for the Ministry of Education and led a group of academics who developed international level standards to evaluate post-grad level courses, contributing to the change of culture in psychiatric departments, which resulted in an increased Brazilian scientific production in the field. He was one of the editors of the Brazilian Journal of Psychiatry for ten years (1998–2008) and promoted the full indexation of the journal by turning the publication fully English. The Brazilian psychiatric journal has now achieved on of the highest impact factor in Latin America. Dr Mari joined a WPA task force to improve standards of psychiatry journals in developing countries. In 2013 he was awarded a special grant by the State of São Paulo Funding Agency (FAPESP), to create an Advanced Science School for Prevention in Mental Health, bringing to São Paulo more than 30 top level academics and 100 selected global students who were developing post-grad projects in preventive psychiatry. He was the field coordinator for the ICD11 development in Brazil, and he is now a member of the Education and Publishing Committee of the WPA.

Clinical Professor of Psychiatry; and the Behavioral Sciences; George Washington University; Medical Center; Washington, DC

Resilience in Palestinian refugee society: a report of observations

The wave of popular unrest in the Arab world reached Syria in March 2011, and what started as peaceful demonstrations with simple demands of justice and freedom turned into a brutal armed conflict and a full-scale civil war. Over seven years of conflict resulted in the deaths of over half a million Syrians, the forced displacement of millions more, and a huge loss of the country's social and physical structures. What began as another Arab Spring movement against a dictatorial regime has turned into a proxy war that has attracted the interests of the world and regional powers. The paper discusses Syria's political history and investigates the motives for the Syrian uprising and argues that it is related to socio-economic deprivations rather than sectarianism. The work underlines the interests of the countries involved in the Syrian conflict focusing on Russia, USA, Iran, and Turkey, as well as their contribution to the future reconstruction of the country. Over the past few years, the Syrian regime and its allies targeted many cities and destroyed opposition-held neighborhoods. The work considers if this destruction was part of an overall strategy adopted by the al-Assad regime to terrorize those who opposed it and change Syria demographically, examining the new laws issued by the government to transfer public properties into the hands of its loyal businessmen factions, as in the case of the reconstruction project in the city of Homs. Seven years of war exhausted Syria's financial stocks, and the country (and in turn the regime) is suffering the consequences of military spending. But like any other war, destruction is also a great opportunity to generate money through reconstruction and growth. It is a “win-win situation”; the regime will use the fund designated for reviving the country to its own benefit, gaining future profits. Already invested in the conflict, involved countries will be part of the reconstruction process to secure their presence and control in Syria. United Nations agencies like UNDP (United Nations Development Programme) and UNHCR (United Nations High Commissioner for Refugees) are working closely with the Syrian regime and its governmental representatives. This research examines their involvement and how their ‘humanitarian mission' is being exploited to prop up the al-Assad regime.

Infectious diseases in refugees coming from Syria and Iraq to Lebanon