Showing papers in "International Journal of Psychiatry in Medicine in 2022"

Mental health comorbidity and youth onset type 2 diabetes: A systematic review of the literature

Abstract: Background Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity, makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. Methods A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. Results 13 publications from 8 studies (N=2244, age 6–17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. Conclusions While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D.

Psychological consequences and daily life adjustment for victims of intimate partner violence

Abstract: Introduction Intimate partner violence (IPV) is a distressing reality worldwide. Victims of IPV usually experience long-term mental health disorders and maladjustments in their daily lives. Aims To examine the prevalence of depression, anxiety, and post-traumatic stress disorder in female victims of IPV that participated in a public mental health care program, and to analyze the relationships between the type of IPV exposure, its psychological consequences, and daily life adjustment. Method Up to 164 female victims of IPV referred by their primary care doctors to the Adult Mental Health Casntre of Sant Cugat del Vallès (Barcelona) between 2010 and 2016 were evaluated using several tests (Index of Spouse Abuse - ISA, Beck Depression Inventory - BDI-II, Sate-Trait Anxiety Inventory - STAI, the Maladjustment Scale - MS, and the Severity Symptom Scale for Post-traumatic Stress Disorder - EGS). Results Of the 164 referred women, 102 (62.2%) agreed to participate (mean age 44.98 years, range 19–71) and 73% scored above the cut-off point in the physical IPV dimension (ISA). Moreover, 73% had depression symptoms, 77% trait anxiety, and 87% state anxiety altered scores. Prevalence of post-traumatic stress disorder was also high (87%). IPV interfered significantly in all the aspects of the daily lives of 92% of the sample. Conclusions The participants of the study experienced many psychological symptoms and a high level of interference with all aspects of their daily lives. These consequences were of similar magnitude amongst victims of emotional abuse compared to those who suffered physical violence.

This is My Learner, Not My Patient: Addressing Concerns in Learners With Attention Deficit Hyperactivity Disorder

Abstract: With the increasing number of medical students diagnosed with adult ADHD, residency programs face an imperative task to handle accommodations effectively. As medical residents occupy unique roles as learners and employees, defining a clear process to protect residents and programs can be challenging. This article will review legal requirements, disclosure processes, and sample accommodations that can help family medicine programs make sense of their responsibilities and support residents. Collaboration, clear boundaries, and effective documentation increase the likelihood of a predictable process to facilitate inclusion of learners with ADHD into graduate medical education and residency.

Prevalence of attention deficit hyperactivity disorder in an adult mental health service in the Republic of Ireland.

Abstract: Objective Attention Deficit Hyperactivity Disorder (ADHD) is well recognised in childhood. However, recognition that it commonly persists into adulthood is relatively recent. This study is the 2nd phase of a two-phase epidemiological investigation of the prevalence of adult ADHD in outpatients in Ireland. Method In phase-1, 634 participants were screened with Adult ADHD Self-Report Scale (ASRS) and Wender Utah Rating Scale (WURS). Those scoring positive in both scales have been invited to participate in the 2nd phase where the scales Conners’ Adult ADHD Diagnostic Interview (CAADID), Mini International Neuropsychiatric Interview (MINI), and Global Assessment of Functioning (GAF) were administered, plus clinical evaluation based in DSM-5. Results 131 were eligible, 110 participated (84.0%). Using the CAADID (DSM-IV criteria) 71 were diagnosed with ADHD. Projecting to the total sample (N = 634) the prevalence was 13.25%, CI:95%:10.71-16.14. Converting the DSM-IV criteria to DSM-5, 89 had ADHD (prevalence:16.72%, CI: 13.9-19.86). Using clinical evaluation, 86 were diagnosed with ADHD (prevalence:16.09%, CI:13.31-19.18). Only 3 cases were diagnosed before with ADHD. Comorbidity was higher in those with ADHD, with the median number of additional diagnoses 2 (min 0 max 8, IQR 3) Also, they had significantly higher rates of depression and recurred depression. Agreement between DSM-IV and DSM-5 was high (rho = 0.90, p < .0001). Conclusions High rates of undiagnosed ADHD were found to be present among AMHS attendees. Clinicians in AMHS need to be knowledgeable and alert to possible ADHD among their caseloads, and offer appropriate intervention. Interventions are urgently required to increase the detection and treatment of adult ADHD.

Somatic and psychological distress among Russian university students during the COVID-19 pandemic

Abstract: Objective Previous studies highlighted a high prevalence of mental health issues among students during the COVID-19 pandemic, but there is no evidence from Russia. This study was aimed to examine the prevalence of somatic and psychological distress among Russian university students. Method The cross-sectional study was conducted in March-April 2021. The participants were university students from several regions of Russia (N = 1236). The Patient Health Questionnaire-15 and Depression, Anxiety, and Stress Scales-21 were used to measure the somatic and psychological distress. Results The prevalence of somatic burden, depression, anxiety, and stress was 72.2%, 54.7%, 63.4%, and 55.4%, respectively. Somatic burden, anxiety, and stress were more frequently observed in females and students with experience of COVID-19 disease compared to males and students without experience of COVID-19 disease. Conclusions These data illuminate the high prevalence and potential risk factors for somatic and psychological distress among Russian university students and determine the importance of psychoeducation and preventive measures in the Russian university environment.

Burnout among university students during distance learning period due to the COVID-19 pandemic: A cross sectional study at the University of Jordan

Abstract: Objective The COVID-19 pandemic led to a deviation from classical face-to-face learning to distance learning. Few studies examined burnout among university students during the distance learning period due to the COVID-19 pandemic. This study that aims to investigate the prevalence of burnout among university students during distance learning and the factors associated with it. Method A cross-sectional study was conducted among undergraduate students at the University of Jordan. The modified version of the Maslach Burnout Inventory for students (MBI-SS) was used to assess burnout. Results The total number of participants was 587 and the mean total of MBI-SS score was 63.34 ± 8.85. Based on the MBI-SS definition, 6.6% of the study participants were found to have symptoms of burnout. Practicing hobbies, level of satisfaction with distance learning, and thoughts about quitting courses were significant predictors of burnout. Conclusion This study showed a relatively low prevalence of burnout among students during the distance learning period with several factors associated with it. As a result, identifying these factors will help both students and educational institutions to implement strategies that are needed for the primary and secondary prevention of burnout.

Balint in the time of COVID-19: Participant and facilitator experience of virtual Balint groups compared with in-person

Abstract: Background Current literature highlights peer and psychological support as important for staff well-being, to cope in pandemic conditions. Aims Our organisation increased Balint group provision during unfamiliar challenges of COVID-19. This unique context allowed comparison of multiple new virtual and face-to-face (F2F) Balint experiences. Method Following March 2020 lockdown, four existing Balint groups for doctors in psychiatry moved to online, with two new groups established virtually in specific response to the pandemic. All participants and facilitators of these virtual Balint groups were sent a questionnaire to anonymously rate their experience and provide qualitative feedback. Results The response rate was 89% for participants (51 respondents) and 100% for facilitators (5 respondents). Participants found both formats supportive; providing a space to talk, feel heard and validated, helping work feel less stressful. Participant ratings slightly favoured F2F, but some prefer to continue virtually. Facilitators felt virtual attendance was easier, but adherence to conventional Balint group structure and format more difficult. Conclusions Participant and facilitator responses demonstrate Balint groups, when both F2F and virtual, were experienced as a source of support and connectivity, being valued across different psychiatry grades. Notable virtual benefits seem to be limited to more practical aspects, that is, time, flexibility, logistics and accessibility. There are expressed challenges of virtual Balint; however, some participants still favour this format going forward. Our findings endorse virtual Balint as a welcomed means of emotional well-being, peer support and developing psychotherapeutic competencies during pandemic-related restrictions, with potential to extend beyond COVID-19.

Editorial: Balint and burnout: A remedy for our time?

Abstract: When psychiatrist Herbert Freudenberger popularized the concept of “burnout” in the 1970s, in no way could he have anticipated the overwhelming impact of the COVID-19 pandemic on the medical profession and the population at large. In his work with addicts, he described burnout as “becoming exhausted by making excessive demands on energy, strength, or resources” in the workplace. Frontline workers today acknowledge that the definition applies as well to coping with the ravages of the pandemic...only more so! In Freudenberger’s day, remedies for personal burnout included “fixing the healthcare system,” “clarifying costs of procedures,” “simplifying coding,” “promoting legislation,” “facilitating decision-making without outside intrusion,” and perhaps...while awaiting these time-delayed changes... “taking a vacation.” The idea of sharing one’s grief and complaints with others in Balint-like groups was not offered. The idea of Balint Groups began with Michael and Enid Balint in England in the 1950s in a kind of quasi-crisis. After the war, exhausted physicians were seeking ways to become re-acclimated to general medical practice, and the newly founded British National Health Service was looking for ways to care for a weary population. Groups of general practitioners organized by the Balints seemed a reasonable, if small, way to address these challenges. Opportunity was presented to a number of these overburdened post-war practitioners to come together in experimental groups to enhance sharing of clinical case experiences and to bolster mutual resilience. The experiment proved effective; Balint groups began to spring up around the world for tired, stressed, even exhausted

Epidemiology and prevalence of somatic symptom disorder at the primary care level in Muscat, Oman: A cross-sectional study

Abstract: Objectives Somatic symptom disorder (SSD) is a diagnostic classification to describe the occurrence of physical symptoms without organic cause. This study aimed to identify prevalence rates and associated characteristics of SSD among adults in primary care settings. Methods This cross-sectional study took place between July 2020 and March 2021 and included a random selection of 3383 Omani adults attending 12 primary healthcare centres in Muscat Governorate. Screening was conducted using an Arabic version of the Somatic Symptom Scale-8 (SSS-8). Results A total of 2000 adults participated in the study (response rate: 67.3%), of which most were female (71.7%) and under 50 years old (86.2%). Based on their SSS-8 scores, 602 participants (17.8%) had SSD, resulting in an overall prevalence estimate of 30.1% (95% confidence interval: 28.13–32.15). Significant associations were observed between SSD and age (p = 0.002), gender (p < 0.001), marital status (p = 0.030) and chronic comorbidities (p = 0.001). In addition, adjusted odds ratio estimates revealed SSD to be significantly associated with gender (p < 0.001), education level (p < 0.001) and chronic comorbidities (p = 0.001). Conclusion The estimated prevalence of SSD in primary care settings is high compared to reports from elsewhere in the Gulf region. There is an urgent need to enhance the diagnosis of SSD at the primary care level in order to reduce healthcare service overutilisation and patient dissatisfaction. Moreover, healthcare practitioners should be aware of the effect of age, gender, educational status and chronic comorbidities on somatic symptoms.

First experiences of the dying patient: student essays from Australia

Abstract: Two articles in this issue of the Journal are from the Balint Society of Australia and New Zealand (BSANZ), which has been supporting an essay competition for medical students since 2015. These essays are two of 45 student entries in 2021, based on reflections about a significant patient. This biannual competition uses similar criteria to the International Ascona Prize. Students are encouraged to describe a student-patient relationship from their medical studies and to include critical reflection on the implications of their learning in relation to becoming a doctor. Since its inception, there have been 60 to 75 entries in each competition from Australian and New Zealand medical students. Despite the distractions and uncertainty of Covid-19 over the last two years, it was particularly rewarding in 2021 to receive 45 essays of a high standard. Many of the students’more poignant essays focussed on their first experiences of end-of-life care. Australasian medical schools are largely postgraduate entry. These essays are from junior students as they first enter the clinical phase of training. At this stage, it can be profoundly shocking for students to get to know a patient, who then dies from a terminal illness. These essays may represent opportunities to work through their affective responses to those patients, as while there are some reflective groups in these

Cognitive-behavioral therapy for insomnia for primary care: Review of components and application for residents in primary care

Abstract: Healthy sleep patterns are a significant component of good physical and mental health. Quality sleep can be affected by such things as stress, age, pregnancy, physical health problems, and shift work. Behaviors related to sleep problems can be one of three types: predisposing, precipitating, and perpetuating. Additionally, cognitive processes related to sleep quality tend to be predominated by sleep thinking or insomnia thinking. Multiple medical organizations promote Cognitive Behavioral Therapy for Insomnia as a best practice for clinical management of sleep problems and disorders. Cognitive Behavioral Therapy for Insomnia consists of five components aimed at addressing both the behavioral and cognitive impediments to high quality sleep. These components are sleep hygiene, relaxation, sleep restriction, stimulus control, and cognitive therapy. This paper will address each component, as well as provide a patient education pattern well suited for primary care settings.

Prevalence of depressive disorders in a primary care setting in Ho Chi Minh City, Vietnam: A cross-sectional epidemiological study

Abstract: Objective This research was conducted to identify the prevalence and associated factors of depressive disorders, as well as evaluate the recognition rate of general practitioners in detecting these mental health issues in primary care. Method Five hundred and twelve participants (55.3% female, mean age = 46.35 years) were assessed by psychiatrists based on the DSM-5 clinical procedures over a two-month survey in a primary care facility in Ho Chi Minh City, Vietnam. Results There were 15.8% (95% confidence interval [CI] 12.9-19.2) of the population having depressive disorders, with major depressive disorder being the most prevalent subtype at 8% (95% CI 5.9-10.6). General practitioners could detect depressive disorders in 2.5% of all cases (95% CI .5-7.7). Significantly linked with depressive disorders in multivariable analysis were Chinese ethnic or other minority races (adjusted odds ratios [aOR] = 4.10, 95% CI 1.04-16.12), and low economic status (aOR = 5.41, 95% CI 1.29-22.59). Conclusions The high prevalence of depressive disorders in outpatients of primary care clinics may raise the awareness of the practitioners about screening and other appropriate actions to tackle the issue.

Dispensing patterns of mental health medications before and during the COVID-19 pandemic in Alberta, Canada: An interrupted time series analysis

Abstract: Background The COVID-19 pandemic has negatively impacted the general population in all aspects of life. Estimates of mental health medication dispensing in Alberta were investigated to elucidate areas of need within mental health and pharmacy practice during the pandemic. Methods We employed an interrupted time series analysis using linear regression models to estimate community and outpatient medication dispensing trends of 46 medications used to treat mental health disorders. Three parameters were examined. The first was the medication dispensing slope before COVID-19. The second was the immediate effect of COVID-19 on dispensing (i.e., the difference in dispensing rate between the month before and after the first case of COVID-19) and the third was the medication dispensing slope during COVID-19. Results Dispensing rates of 61% (n = 34) of the examined medications remained similar before and during the COVID-19 pandemic. However, eight medications (i.e., amitriptyline, escitalopram, fluoxetine, paroxetine, bupropion, desvenlafaxine, venlafaxine, and oxazepam) showed an immediate and significant increase in dispensing rate following the onset of the pandemic that was sustained over the first 13-months of the pandemic. Conclusion Initial increases in dispensing patterns of antidepressants may be attributed to a “stockpiling phenomenon” but the sustained higher levels of dispensing suggest an unfavorable shift in the population’s mental health. Monitoring of medication dispensing patterns during COVID-19 may serve as a useful indicator of the population’s mental health during the current pandemic and better prepare community pharmacists in future pandemic planning, medication dispensing strategies, and care of chronic medical conditions.

Sleep-deprived electroencephalography, a forgotten investigation in psychiatry; a case series

Abstract: Objectives Many patients with psychiatric disorders may have epileptic disorders; however, clinical diagnosis without imaging investigation may result in misdiagnosis and thus resistance to treatment. We investigated electroencephalography (EEG) abnormalities in the patients with psychiatric disorders referred to us with treatment resistance. Methods In this case series study, nine patients with mood and psychotic symptoms who were referred to us at Belmont Private Hospital, Australia, from August 2018 to July 2020, were evaluated. Results Complete examination showed the presence of undiagnosed temporal lobe epilepsy. Notably, the seizure symptoms had been assumed as part of other psychiatric co-morbidities. Conclusions This study suggests the necessity of paying attention to the biological etiologies of mental illnesses in the initial assessments in psychiatric and neurological practice. Performing electroencephalogram and treating such patients with mood stabilizers, which have antiepileptic properties, can change the course of the mental illness decisively.

Mija

Abstract: “Buenos dı́as, doctora.” Her smile was warm like a handmade tortilla fresh from the tortillero, her eyes sparkling like obsidian in the sun. Sitting in her hospital recliner chair in silk pajamas, adorned with a golden hair wrap like a crown, the seventy-twoyear-old Señora Castillo didn’t look sick. She certainly didn’t look like she had myelodysplastic syndrome, a disease eating away at her bone marrow, impairing her body’s ability to create healthy blood cells and platelets. “Buenos dı́as, mi reina,” I said, curtseying in my scrubs. She laughed, her voice thick and gravely like thunder rumbling in the distance. As a bilingual Indigenous Chicana, I take pride in providing high quality medical care to my Spanish speaking patients. Caring for Latinx patients in their native tongue, with all the beauty and the nuances Spanish has to offer, is one of the most rewarding parts of my day. To hear rich stories of my patients’motherlands is a privilege, a treasure, like biting into a plain pastelito only to find it filled with deliciously sweet and tangy guayaba. Señora Castillo’s stories were a tray piled high with guayaba-filled pastelitos. From the countryside of Guatemala, Señora Castillo grew up in rural poverty, relying on the land for sustenance. Her skin, forged under the iron of an unforgiving sun, was weathered with age spots, her muscles sinewy from years of backbreaking labor. Each morning as I rounded, she regaled me with another snippet of her life; how she used to chase the chickens in the yard and how, as a little girl, she learned to snap their stringy necks and pluck their spiny feathers; how she used to wake up before the break of dawn to pound, mash, and cajole into existence the savory papusas that would feed her family; how she fell in love with the man of her dreams and built her own house, her own family. She had been blessed with 13 children, she said, all of them

Balint in the Animal World: Balint Groups for Veterinary Professionals

Abstract: Objective Veterinary medical providers face many of the same stressors related to the therapeutic relationship that human medical providers face, and have reported high rates of emotional distress as an aspect of Veterinary practice. Balint Group work is relatively novel in Veterinary Medicine, and the Balint method has yet to be evaluated in the veterinary community. We hypothesized that applying the Balint method in veterinary medicine would be feasible and offer similar benefits to veterinary providers. Method The authors offered monthly in-person Balint groups, co-led by two American Balint Society trained leaders and evaluated feedback from Balint group attendees to determine the value and feasibility of adapting Balint groups from Human Medicine to veterinary professionals. Balint groups were offered to the veterinary community at a non-profit urban specialty and emergency hospital. During the pandemic, the group transitioned to an online format. All participants were sent an anonymous email survey to collect feedback about their experience. Results Monthly Balint Groups were offered to veterinary professionals, with traditional Balint structure and parameters and co-led by ABS trained leaders. Feedback was obtained, indicating that Balint Group discussions were helpful to Veterinarians. Conclusions Balint Groups are a useful tool for veterinary professionals and are likely to provide similar benefits to those enjoyed by human healthcare providers.

Electroencephalogram utilization and psychiatric comorbidities among children and adolescents with epilepsy in rural Southwestern Uganda

Abstract: Objective This study aimed at describing routine electroencephalogram (EEG) findings among children and adolescents with a clinical diagnosis of epilepsy and determines how interictal EEG abnormalities vary with the psychiatric comorbidities. Methods We conducted a cross-sectional study among children and adolescents with epilepsy aged 5–18 years receiving care from a regional referral hospital in Southwestern Uganda. Psychiatric comorbidities were assessed using an adapted parent version of Child and Adolescent Symptom Inventory-5. Thirty-minute EEG samples were taken from routine EEG recordings that were locally performed and remotely interpreted for all participants. Results Of the 140 participants, 71 (50.7%) had normal EEG findings and 51 (36.4%) had epileptiform abnormalities while 18 (12.9%) had non-epileptiform. Of those who had epileptiform abnormalities on EEG, 23 (45.1%) were focal, 26 (51.0%) were generalized, and 2 (3.9%) were focal with bilateral spread. There was no significant association between the different psychiatric comorbidities and the interictal EEG abnormalities. Conclusions Among children and adolescents with a clinical diagnosis of epilepsy in Southwestern Uganda, only 36% showed epileptiform abnormalities on their EEG recordings. There was no association between the interictal EEG abnormalities and psychiatric comorbidities.

When worlds collide: Socio-political conflict in patient care

Abstract: The country as a whole has been on high alert since early 2020. That year began with the SARS-CoV-2 pandemic, then moved through the largest single day drop of the Dow Jones industrial average, the murders of Breonna Taylor and George Floyd and subsequent Black Lives Matter protests, murder hornets, the election of Joe Biden, alleged voter fraud, and then culminated on January 6, 2021, with the assault on the United States Capital Building. Societal issues including racism, discrimination, and distrust of leaders have been themes in the news and social media. It should come as no surprise that we may be called upon to provide treatment to patients with whom we have significantly different belief systems, which could result in conflict. The emotional rawness that pervades much of society lays emotions bare for many. Our ethical responsibilities as healthcare providers compel us to think about these complex relationships intentionally, and with compassion. In an interactive workshop conducted at the 42nd Forum for Behavioral Science in Family Medicine, participants were led through scenarios in which conflict could enter the exam room, discussion of the potential consequences, and consideration of ways to respond ethically in those situations. The discussions were couched in the codes of ethics of the American Psychological Association, the National Association of Social Workers, and the American Medical Association. The interactive session was designed to encourage participants to (1) consider potentialities of patient-provider conflict, (2) consider ethical, compassionate responses, and (3) be mindful of social media.

The Juice is Worth the Squeeze: Psychiatry Residents’ Experience of Balint Group

Abstract: Introduction Balint Groups provide physicians with a forum to develop their capacity to empathically engage with patients, through exploring patient-provider relationships. The Dalhousie University Department of Psychiatry implemented a mandatory Balint Group as part of the junior resident curriculum. The purpose of this study is to explore how residents describe their experience of participating in this Balint Group. Methods Psychiatry residents in their first year of training participated in a focus group to discuss their experiences of the Balint Group. Data was analyzed using content analysis. Results Three main categories were identified: the purpose of, the process of, and participation in the Balint Group. Process was subdivided into Balint Frame and Institutional Factors. Participation was further subdivided into vulnerability, reflection, fellowship, and validation. Conclusion Residents attributed fellowship with their peers, self-efficacy and hope in their work to their participation in the Balint Group. While there was an adjustment period, residents grew to accept, and even appreciate the group. Lack of problem-solving became accepted as part of the purpose of the group and this acceptance was attributed to having other avenues within the program to address problems raised in the discussion. Feeling disconnected when the session ended was described and was related to the abrupt termination of the virtual session or having to exit the group early to return to clinical duties. While the virtual nature of the group was not explicitly identified as a challenge, having to leave early was. While these institutional factors can be mitigated through programmatic implementation, they are not a deal breaker to implementing a Balint Group in a residency training program. Even in a lunch hour or virtual environment our data suggests that the juice is worth the squeeze.

COVID-19 vaccine compliance in adolescents with attention-deficit/hyperactivity disorder

Abstract: Objective To compare the rate of the administration of the Pfizer–BioNTech COVID-19 vaccinations between adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD subjects. Method A retrospective chart review was performed on all adolescents aged 12–17 years registered at a central district in Israel from January 1st 2021 to October 31st 2021. Results Of the 46,544 subjects included in the study, 8241 (17.7%) were diagnosed with ADHD. Of them, 3% were PCR-COVID-19 positive. Among the patients with ADHD, the older adolescents were more likely to be vaccinated: 48.8% of those aged 12-15 years were vaccinated versus 59.6% of patients aged 16-17 years. The ultra-orthodox Jewish and Arab adolescents in the ADHD group were far less likely to be vaccinated (22.9% and 34.6%, respectively), compared to the adolescents with ADHD in the general population (60.5%). Girls were also somewhat more likely to be vaccinated. Conclusions Adolescents diagnosed with ADHD had a higher COVID-19 vaccination rate compared to their non-ADHD counterparts. The vaccine uptake was lower amongst Arab and ultra-orthodox Jewish populations.

Experiences from a Balint group intervention with urban public school teachers

Abstract: Background: U.S. teacher shortages have more than tripled since the 2012-2013 school year, to over 110 000 teachers needed in 2016. At the conclusion of the 2011-12 school year, 13.8% of public-school teachers left their position. Approximately 50% of the public-school teachers cited the inability to manage their roles as the primary factor for leaving. Purpose: The purpose of this study was to examine the influence of participation in a 6-month Balint group experience on a novice teacher’s self-efficacy, experience with burnout, and intentions to persist in the classroom. Research Design: A converged mixed-methods approach was used. Each question was explored with a corresponding qualitative and a quantitative dataset. Data Collection: Qualitative data included (a) a semi-structured focus group; (b) field notes shared from the co-facilitator and Balint group leader; (c) semi-structured debriefs with the Balint group leaders; (d) open-ended questions on the pre and post-test reflection forms, and (e) semi-structured interviews with 3 participants that served as a form of member checking. Quantitative data included pre and post-test and monthly reflection forms that were collected at the conclusion of each meeting. Teacher’s self-efficacy, experience with burnout, and intentions to persist in the classroom. Study Sample: Eight teachers volunteered for the group after an email solicitation to all the teacher development program’s members. Results: This article examines sources of stress for new teachers, themes that came up in the Balint group that reflect the stress and its impact, and changes in felt burnout, self-efficacy, an intent to persist in teaching. Teachers faced similar stressors to professionals in the medical field. Conclusion: Balint offers an opportunity to addres the social and emotional needs teachers face.

The balint method online: Past, pandemic and future

Abstract: The Balint Method has been used worldwide since Michael and Enid Balint developed it in the 1950s. Even with the proliferation of Balint groups there were still doctors and other clinicians who did not have local access. The online format was developed to provide Balint groups to those individuals. With the pandemic the majority of clinicians were unable to get together in person. The online format provided a lifeline for Balint work. This article provides a short history of the development of Balint online, how the pandemic affected further development, and a summary of what was learned from that experience.

Now showing: The presentation. Using video recording to enhance Balint leadership training

Abstract: Review of video recorded sessions is a powerful teaching tool in medical education, helping students appreciate both spoken and unspoken communications not fully appreciated in the moment. For many years, the American Balint Society has used video review in its Leadership Training Intensive courses, however technical challenges around setting up and operating the equipment have led some faculty to question whether the benefits are worth the effort and anxiety. We describe here an approach to video review in Intensives with a focus on the case presentation. Close attention to the case presentation can uncover important clues about a presenter’s feelings and conflicts in a case, clues that may easily be missed on first pass. The Balint group leader listens for clues and cues to the patient’s state of mind, and how the clinician is being distracted or deflected from their authentic role. Focusing the video review at an Intensive on the case presentation highlights for novice leaders the importance of maintaining keen focus on this initial section of the Balint group process for information on “what this case is about.” Finally, we predict that Balint group leaders who emerge from an Intensive with this new appreciation for close listening to the presentation will not only be more effective Balint group leaders but will also be in a better position to serve as clinical role models, teaching by example to their Balint group members the importance of attending closely to the patient’s communications in the patient – clinician encounter.

Research Cum Training: Assumptions, Balint’s Method, and Future Directions

Abstract: Michael Balint conducted several multi-year training programs for general practitioners designed to teach lessons from a psychoanalytic perspective on the relationships doctors have with their patients and contribute to their healing skills. This group process evolved, and it was described along with an elaboration of significant researched observations of interferences in those relationships. There were several other similar multi-year experiential group endeavors conducted and/or inspired by Michael and Enid Balint which were designed to further investigate the subtleties in relationships between doctors and patients. However, none have been done since the late 1990’s. Instead, research about the impact of Balint group impact has been dominated by the evidence-based approach to all medical research, and it has been typified by variations on randomized controlled, double blind research methodologies. A recent literature review has highlighted the limited results of such studies along with questions about methodological approach. However, the authors continue to support the search for appropriate dependent variables to validate the value of Balint groups for physicians. This paper identifies and examines the implicit assumptions that underly current research efforts. In addition, there is an exploration of Michael Balint’s approach to “research cum training” along with describing his assumptions and the results of his research approach. In addition, recommendations are made to extend the work of the work of uncovering healing dynamics in doctor patient relationships.

Mind-Body dualism and medical student attitudes toward mental illness in Saudi Arabia

Abstract: Background Philosophical beliefs regarding the origin of mental illness may underlie resistance to psychiatric treatment and affect attitudes toward the mentally ill. Aim The present study sought to: (1) identify characteristics of medical students who hold mind-brain dualism (MBD) beliefs and (2) determine relationships between MBD beliefs and perceptions of mental illnesses. Methods This was a cross-sectional study that asked medical students questions about mind-brain beliefs and religiosity. Three fictitious vignettes (schizophrenia, antisocial personality disorder [APD], and depression) were presented and then students asked about how much participants felt the patients in these scenarios bore responsibility for their illness. A MBD score was calculated to measure MBD beliefs, and a total responsibility score (RS) was used to measure patient blameworthiness. Mediation analysis was used to examine whether MBD beliefs explained the relationship between religiosity and perceived patient responsibility for their illness, and whether this was moderated by gender. Results The questionnaire was completed by 106 Saudi medical students. The average RS was highest for the APD scenario and lowest for schizophrenia, whereas depression fell intermediate between those two (ANOVA F (1.82, 219.83) = 27.21, P < .001). Religiosity was positively correlated with RS, a relationship that was mediated by MBD in all three vignettes. Conclusion Mind-brain dualism beliefs among medical students in Saudi Arabia were associated with greater perceptions of self-infliction, preventability, controllability, and blameworthiness for patients with mental illness, moderated by gender. Greater emphasis on the neurobiological aspects of psychiatric disorders might help to change this attitude.

Bridging diverse experiences in clinical relationships

Abstract: As Mark Twain once said, “Prediction is difficult—particularly when it involves the future.” This statement was borne out by our own attempts to predict the course of the Covid 19 pandemic to hold the 2022 National Meeting of the American Balint Society. Originally scheduled for May of 2020, cancelled due to the Covid pandemic, rescheduled for January 2022, and changed at the last minute from an in-person to a virtual meeting with all the complications entailed in such a change, the result was a successful and gratifying meeting for all who attended. Because we pivoted to a virtual meeting to avoid becoming a super-spreader event, many more participants than usual could attend. The current volume of the International Journal of Psychiatry in Medicine (IJPM) continues its publishing partnership with the American Balint Society (ABS). The papers published in this issue were presented at the 2022 Annual Meeting of the ABS. They are representative of the richness and scholarship that emerges when a suitable frame is established, and a protected space is provided. The reader is invited to enter this space and at the same time be prepared for the many ways one’s understanding of the impact of a Balint group experience may be challenged and the ways one’s perspective of the power of relationships may be stirred up. Two groups of ABS members deserve acknowledgment for helping bring this issue to press: John Freedy organized reviewers of the many papers submitted to the Enid Balint student paper contest, selecting three winning essays and three honorable mention submissions, all of which highlight the emotionally gut-wrenching experience