The Psychiatric Clinics of North America 
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This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.Emerging Knowledge of the Neurobiology of COVID-19
Many patients with COVID-19 will experience acute or longer-term neuropsychiatric complications. The neurobiological mechanisms behind these are beginning to emerge, however the neurotropic hypothesis is not strongly supported by clinical data. The inflammatory response to SARS-CoV-2 is likely to be responsible for delirium and other common acute neuropsychiatric manifestations. Vascular abnormalities such as endotheliopathies contribute to stroke and cerebral microbleeds, with their attendant neuropsychiatric sequelae. Longer-term neuropsychiatric syndromes fall into two broad categories: neuropsychiatric deficits occurri...
Source: The Psychiatric Clinics of North America - November 10, 2021 Category: Psychiatry Authors: Matthew Butler, Benjamin Cross, Danish Hafeez, Mao Fong Lim, Hamilton Morrin, Emma Rachel Rengasamy, Tom Pollak, Timothy R. Nicholson Source Type: research
Inpatient Psychiatry During COVID-19: A Systems Perspective
Numerous reports describe how individual hospitals responded to the COVID-19 pandemic, but few describe how these changes occurred across a large public health system of care. As the early epicenter of the pandemic, New York State ’s response, particularly the New York City metropolitan area, included a range of coordinated planning and regulatory efforts to preserve and create medical and intensive care unit capacity where needed; maintain access to acute psychiatric services; and redefine inpatient psychiatric care throug h strict infection control, easing of regulatory requirements, and use of telehealth. These strate...
Source: The Psychiatric Clinics of North America - November 10, 2021 Category: Psychiatry Authors: Joshua Berezin, Flavio Casoy, Matthew D. Erlich, Yamilette Hernandez, Thomas E. Smith Source Type: research
The Impact of COVID-19 on United States Emergency Departments
Behavioral emergencies in the U.S. have been on the rise over the past decade, with some studies even reporting a doubling in the number of people experiencing symptoms related to mental health conditions, although overall visits to U.S. EDs decreased during the COVID-19 pandemic. The uncertainty surrounding the COVID-19 pandemic caused many people to avoid healthcare facilities, including emergency departments, even if they may have otherwise sought emergency care, and was associated with increases in new behavioral health diagnoses. Measures to limit the spread of COVID-19 also led to people limiting their in-person cont...
Source: The Psychiatric Clinics of North America - November 10, 2021 Category: Psychiatry Authors: Manuel G. Alvarez Romero, Chandra Penthala, Scott L. Zeller, Michael P. Wilson Source Type: research
Ethical Considerations in Trauma-Informed Care
Exposure to trauma is common in the general population, with increased rates of exposure in persons with mental health conditions. Health care service provision may be traumatizing or retraumatizing, especially in settings of involuntary treatment, physical and chemical restraints, and/or seclusion, which may also contribute to vicarious trauma in health care workers. Trauma-Informed Care (TIC) approaches are evidence-based practices consistent with existing ethical frameworks, aimed to promote safe, transparent, empowering, and collaborative care environments to mitigate the pervasive impact of trauma on health, care enga...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Kaila Rudolph Source Type: research
The Evolution of Forensic Psychiatry Ethics
Developments in forensic psychiatry demonstrate evolving thinking about a profession negotiating legal and medical realms. Various approaches have attempted to balance the traditional ethics of medical practice with those of a legal system rooted in vigorous advocacy for one side or the other. Forensic psychiatry provides numerous models for navigating the complex social narratives that intersect Law and Psychiatry. Obligations to vulnerable persons and values underscore the proper ethical balance between forensic practitioners and institutions that are demonstrably unjust. It is the unifying ideas of culture, professional...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Philip J. Candilis, Richard Martinez Source Type: research
Reconsidering Gold Standards for Surrogate Decision Making for People with Dementia
As dementia progresses and cognitive function declines, surrogate decision making becomes increasingly prevalent. By convention, there is a hierarchical approach to proxy decision making beginning with known wishes, followed by a substituted judgment standard, and then a best-interests standard. For people with dementia, discrepancy in proxy assessments is common and associated with negative behavioral outcomes. Therefore, optimal approaches to proxy decision making for people with dementia should instead prioritize and implement options that encourage direct participation of persons with dementia and standards that explic...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: James M. Wilkins Source Type: research
Severe and Enduring Anorexia Nervosa and Futility
The concept of futility in the treatment of individuals with severe and enduring anorexia nervosa remains controversial and has significant legal and ethical considerations. For those who have been unremittingly ill for 8 to 12 years, full recovery, although possible, is unlikely, and alternatives to traditional, active treatment must be explored. The harm reduction model, palliative care, and end-of-life care are explored as meaningful and reasonable treatments for this population. Landmark cases demonstrating the legal and ethical controversy of such treatment are explored. (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Patricia Westmoreland, Libby Parks, Kristen Lohse, Philip Mehler Source Type: research
Ethics Oversight in Psychiatry
Hallmarks of professions include self-regulation. The American Psychiatric Association fulfills this responsibility by delegating the handling of ethics complaints against members to each of 72 District Branches (DBs). The authors sought to explore the number and typology of ethics complaints received by member DBs, the handling of complaints, the relationship between the DB and state licensing authorities, the challenges and resources needed for conducting complaints, and the overall attitude of DBs regarding ethics review. This analysis presents the results of the survey and outlines how the process may be useful for pro...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Michelle Hume, Kelsey Hobart, Laura Briz, Safiah Amara, Sean D. Cleary, Philip J. Candilis Source Type: research
Practical Research Ethics in Psychiatric Clinical Trials
This article emerges from the authors ’ experience, providing practical guidance to colleagues seeking input on how to design and implement clinical research protocols in accordance with key ethical considerations. Thus, the intent of this article is to provide (1) an overview of common ethical considerations when conducting psychiatr ic clinical research along with (2) practical advice for preparing Institutional Review Board applications and associated materials in the ethical conduct of psychiatric clinical research. (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Michelle Hume, Melissa Abraham Source Type: research
Autonomy and Multiculturalism
Individual patient autonomy is a core ethical consideration in Western bioethics, which has traditionally referred to respecting the ability of capable patients to formulate their own medical decisions. Increasing cultural diversity within the US warrants transition to medical models aligned with moral pluralism and a relational approach to autonomy, focused on the patient as embedded within a social network, with family as a central component of decision making. Standardized cultural assessments and increased provider training in cultural competence and humility can assist in addressing cultural gaps in mental health care...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Kaila Rudolph Source Type: research
Respect for Persons in the Psychiatric Treatment of Children and Adolescents
Child and adolescent psychiatry involves simultaneously balancing duties to various vulnerable parties. Balancing autonomy and protection for adolescents is complex; state laws governing these situations often add confusion. Common prescribing patterns in child psychiatry lack robust evidence, and utilization of stimulants, atypical antipsychotics, and polypharmacy has skyrocketed. Significant concerns about distributive justice arise from alarming patterns in psychiatric treatment of vulnerable populations, like those affected by poverty, racism, adverse childhood experiences, and certain legal statuses. Principles of jus...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Rachel Conrad, Bethany Brumbaugh Source Type: research
Ethical Issues in Consultation-Liaison Psychiatry
This article contextualizes several key ethical issues in consultation-liaison (C-L) psychiatry within historical and principlist frameworks. After summarizing the history of the field, it focuses on 3 main areas of ethical import in C-L psychiatry: decisional capacity assessment, psychosocial evaluations for transplant, and treating mental illness in pregnant patients. (Source: The Psychiatric Clinics of North America)
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Marta D. Herschkopf Source Type: research
Ethical Considerations in Substance Use Disorders Treatment
Substance use disorders (SUDs) treatment and perceptions of addiction are changing. Advances have been made in both the understanding of disease pathology and the development of effective treatments. More needs to be done to change societal misperceptions of individuals with SUDs. Unsuccessful health care approaches that overly focus on single discipline treatment paradigms need to be replaced with multidisciplinary and interdisciplinary models of treatment. The acceptance of SUDs as chronic diseases is essential to expand effective treatments and sustain remission. Creating a culture willing to provide treatment and helpi...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Venkata R. Jonnalagadda Source Type: research
Ethics in Systems of Care
Many psychiatrists work within systems of care, including hospitals, private practice settings, government institutions, accountable care organizations, and others, and often face a multitude of responsibilities to different entities and interests within these roles. Specifically, the sacred fiduciary relationship between a psychiatrist and a patient in treatment itself may engender complicated reactions that often require careful attention of the psychiatrist. When such treatment is provided within the complexity of a system, the psychiatrist's obligations to patients may become even more nuanced and also come into tensio...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Charles C. Dike, Merrill Mathew, Amanda Calhoun Source Type: research
Ethical Practice in Emergency Psychiatry
Emergency psychiatric practice requires management of both high psychiatric acuity and high ethical complexity. Ethical dilemmas are embedded in the context and practice of agitation management, medical evaluation of uncooperative patients, and involuntary psychiatric hospitalization. Tensions between patient confidentiality and societal interests arise when obtaining collateral information, reporting abuse and neglect, and managing patients who pose a risk of harm toward others. Ultimately, attention to virtue ethics can guide emergency psychiatrists on how to carry out humane and therapeutic care while navigating the eth...
Source: The Psychiatric Clinics of North America - November 9, 2021 Category: Psychiatry Authors: Brandon Hamm Source Type: research
