All of these variables impede access to care, which is critical to individual health, and the attainment of social equity. These are essential to the pursuit of happiness, described in this country’s founding document as an “inalienable right.” It is from this that our profession derives its duty to address the social determinants of health.
As the importance and centrality of mental health becomes apparent within and beyond the health care sector, so will opportunities for psychiatrists to apply their knowledge and skills to meet the growing needs. Through careful attention to the moral imperatives and explanatory models among cultures that differ from their own, psychiatrists have been very successful in engaging local entities and establishing partnerships that incorporate trust, credibility, transparency, and accountability to achieve mutual benefits with communities. The following is a guide to assist psychiatry residency programs interested in developing and implementing a global mental health (GMH) curriculum, but unfamiliar with the nuances of GMH education and training. It may also be useful to medical students and psychiatric residents with interest in GMH education and training opportunities. This guide takes into consideration both an international and a domestic scope of GMH with a key focus on curriculum development addressing inequalities among people from various cultures. This guide is developed by the American Psychiatric Association (APA) Council on International Psychiatry, with support by the APA Caucus on Global Mental Health and Psychiatry.
The American Psychiatric Association (APA) Ethics Committee occasionally receives inquiries from members who are troubled by negative reviews about them or their practice posted online by patients or other individuals. This often creates a difficult dilemma for the psychiatrist who must respect the patient’s voice but also desires to preserve the integrity of the psychiatrist’s public image. This resource document is offered to provide guidance to psychiatrists regarding receipt of negative online reviews.
The doctor-patient relationship should ideally be a collaborative and mutually respectful one. In some instances, however, patients may engage in behaviors that can engender concern and even fear in the psychiatrist involved. When these behaviors are repeated, unwanted, and distressing, we might colloquially refer to them as “stalking.” In the midst of a stalking episode, it may be difficult for the psychiatrist to know how to proceed, what steps to consider to protect oneself and what choices to consider to manage the patient-physician relationship. In this document we provide practical guidance for psychiatrists who may face these situations in the course of their work with patients. It was drafted via the consensus of individuals whose practices intersect at the interface of law and psychiatry and represents a range of voices and recommendations. It provides general guidance and is not considered dispositive for any particular response to specific situations. Individual circumstances may require courses of action that differ from those noted in this document.
In 2013, an APA Resource Document on “Risk Management and Liability Issues in Integrated Care Models” was developed.1 This document outlined liability issues in a new and emerging area of collaborative /integrated care. In this model psychiatrists’ expertise is leveraged through curbside consultations and caseload reviews to provide more effective care for mild to moderate behavioral health conditions in the primary care setting. With the advent of CPT codes for the Collaborative Care Model, there has been a noticeable increase in the number of requests psychiatrists are receiving to do indirect consultations, caseload reviews, and education in states where they are not licensed. Further, the use of telecommunication solutions to enhance and expand existing services in one state can lead to increases in requests for psychiatric consultation to address patient choice, peer consultation, and workforce shortages in another state. States are actively developing policies to address the issue of licensure requirements for these consultation services, including physician to physician (P2P) consultation
Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist
Consultation-Liaison Psychiatrists are experienced in responding to requests from medical services for the determination of decisional capacity (DC). General psychiatrists are occasionally called upon to perform decisional capacity determinations, especially when functioning in a consultation-liaison role. Some may not have extensive prior or current experience in decisional capacity determinations. In recent years, there has been a significant amount of clinical research literature on DC, particularly in a consultation-liaison clinical context. As such, having a review of the recent literature leading to an evidence-based, standardized approach to DC determinations is of pragmatic value to the general psychiatrist.
On December 26, 2018, the Food and Drug Administration (FDA) issued a final order regarding the reclassification of devices for administration of electroconvulsive therapy (ECT).i On the basis of device risk and the steps needed to give reasonable assurance of safety and effectiveness, the FDA categorizes medical devices into one of three classes (Class I, II, or III), with Class I devices generally posing the lowest risk to the patient.ii As part of a broader statutory requirement to re-categorize class III devices that were marketed prior to May 28, 1976,iii the FDA evaluated evidence related to the effectiveness and safety of ECT, convened a meeting of its Neurological Devices Advisory Panel to evaluate the effectiveness and safety of ECT devices, published a draft order on the reclassification of ECT devices and reviewed over 3,400 public comments related to the draft order. The American Psychiatric Association (APA) participated in this process by providing testimony at the Neurological Devices panel hearing and by submitting detailed comments on the draft order.i
The psychological impact of being unable to conceive despite trying is a profound loss and a significant life crisis (Kohan et al. 2015). Many individuals suffer in isolation, unaware that infertility is highly prevalent afflicting approximately one in eight couples worldwide. The feelings and reactions to infertility are complex, ranging from anger with self for the failure of one’s body to procreate (Kohan et al. 2015), an associated decrease in sexual desire, an impaired orgasmic function and a loss of sexual satisfaction when ‘sex by the clock for procreation’ is required (Kohan et al. 2015; Marci et al. 2012). Couples may feel socially excluded, negatively stigmatized (Ergin et al. 2018) and find it particularly painful to be around other couples with children or with unaware extended family members who make insensitive comments. Women trying to conceive face profound sadness and grief with each returning menstrual cycle. Seeking treatment with an infertility healthcare provider requires significant sacrifice of time, privacy and money with no guarantee of conception or successful birth. This can be disempowering, stressful, frustrating, and at times profoundly sad.
The use of cannabis for medical indications has received considerable attention as several states have moved to legalize cannabis for various purposes. A growing number of patients cite post-traumatic stress disorder (PTSD) as the reason for seeking cannabis for medical purposes in states where it is legal.1 Furthermore, approximately 15% of Veterans who are treated in Department of Veterans Affairs (VA) outpatient PTSD clinics report recent (past 6 months) cannabis use.2 This position statement was developed through review of the evidence to date and to establish the APA's consensus on the matter.
Regardless of their area of specialization, adult psychiatrists are likely to encounter patients who are transgender; however, medical school curricula and psychiatric residency training devote little attention to caring for these patients. The primary aim of the present article is to assist adult psychiatrists who do not specialize in transgender clinical care in the delivery of respectful, clinically competent and culturally attuned care to gender variant patients including those who identify as transgender or transsexual or meet DSM-5 criteria for the diagnosis of Gender Dysphoria. The following are reviewed: The history and evolution of conceptualizations of gender variance, its classification and related terminology including differences between DSM-IV and DSM-5; the prevalence of transgender identity and Gender Dysphoria; the influences of biological and psychosocial factors on gender development; the clinical assessment and treatment of Gender Dysphoria in adults; and current societal trends, including increased societal acceptance of gender variance, legal protections for gender variant individuals and increased access to gender transition services.
The medical use of cannabis has received considerable attention as several states have voted to remove civil and criminal penalties for patients with qualifying conditions. Yet, on a national level, cannabis remains a schedule I substance under the Controlled Substances Act (CSA), the most restrictive schedule enforced by the Drug Enforcement Administration (DEA) (1). The Food and Drug Administration (FDA), responsible for approving treatments after appropriate and rigorous study, has not approved cannabis as a safe and effective drug for any indication (2). This juxtaposition of practice and policy has prompted many professional medical organizations to issue official positions on the topic. This statement reflects the position of the American Psychiatric Association (APA) on the use of cannabis for medical and psychiatric indications, taking into account the current evidence base and statements from other medical organizations. It does not cover the use of synthetic cannabis-derived medications such as Marinol and Syndros (dronabinol), Cesamet (nabilone) or Epidiolex (contains a purified drug substance cannabidiol, one of more than 80 active chemicals in cannabis) which have been studied and approved by the FDA for specific indications.
In May 2009, an Action paper was passed by the APA Assembly (and approved by the Board of Trustees in July 2012) calling for the developed of an APA Position Paper on the Clinical Application of Brain Imaging in Psychiatry. This action paper was developed in response to questions raised by claims being made that brain imaging technology had already reached the point that it was useful for making a clinical diagnosis and for helping in treatment selection.