China Science » Neuroscience

Napoleon Dynamite:Asperger’s disorder or Geek NOS?

admin — Sun, 13 Apr 2008 03:49:43 +0000

Napoleon Dynamite, the quirky hit film from 2004, is a fascinating portrayal of a teenager with social difficulties. The character Napoleon provokes intriguing diagnostic questions in distinguishing between mental illness and the spectrum of normal behavior. He demonstrates several symptoms of Asperger’s disorder, yet he also challenges the notion that children and adolescents with Asperger’s spectrum disorders will not be accepted or understood. He forms genuine, connected friendships, and fans of the movie appear to celebrate his quirkiness rather than ridicule his oddities. The authors explore the extent to which cultural issues have an impact on psychiatric phenomenology, as well as the potential treatment issues for someone with his apparent social challenges. Finally, the authors offer possible explanations for Napoleon’s immense popularity, especially among adolescents. With the rise of computer technology, our culture has fully embraced the idea of what has come to be called “geekdom,” and the authors consider the idea that Napoleon’s popularity may be a more rural equivalent for this phenomenon. The success of the movie appears to be related to a genuine celebration of Napoleon himself.

Levin HW　Schlozman S

***Issue 5

Consultation-liaison psychiatrists on bioethics committees:opportunities for academic leadership.

admin — Sun, 13 Apr 2008 03:47:38 +0000

OBJECTIVE: This article briefly reviews the history of the relationship between psychiatry and the leadership of ethics committees as a background for examining appropriate educational initiatives to adequately prepare residents and early career psychiatrists to serve as leaders of ethics committees. METHOD: A Medline review of literature on psychiatry and ethics committees and consultation as well as recent survey data from the Academy of Psychosomatic Medicine indicate that psychosomatic medicine psychiatrists are particularly qualified and interested in serving as chairs of ethics committees. The authors compare knowledge and skills obtained in psychiatric training with the Society for Heath and Human Values and the Society for Bioethics Consultation Task Force on standards for ethics consultation proposed as core competencies for ethics committee leadership.RESULTS: Psychiatric residency and fellowship training in psychosomatic medicine can provide the knowledge and skill sets to meet the standards for ethics consultation. Further professional development through pursuit of formal ethics training, advance degrees in bioethics, mentoring, and residency and felloships focus on ethics and enhance competency, confidence, and the skills required for ethics committee leadership. CONCLUSIONS: Academic psychiatrists, particularly those in psychosomatic medicine, have historically made a significant contribution as chairs of ethics committees. Continuation and expansion of this leadership may require interested psychiatrists to obtain additional training in bioethics.

Geppert CM　Cohen MA

A neural systems-based neurobiology and neuropsychiatry course: integrating biology, psychodynamics, and psychology in the psychiatric curriculum.

admin — Sun, 13 Apr 2008 03:43:04 +0000

OBJECTIVE: Psychotherapy and biological psychiatry remain divided in psychiatry residency curricula. Behavioral neurobiology and neuropsychiatry provide a systems-level framework that allows teachers to integrate biology, psychodynamics, and psychology. METHOD: The authors detail the underlying assumptions and outline of a neural systems-based neuroscience course they teach at the National Capital Consortium Psychiatry Residency Program. They review course assessment reports and classroom observations. RESULTS: Self-report measures and teacher observations are encouraging. By the end of the course, residents are able to discuss both neurobiological and psychodynamic/psychological concepts of distributed biological neural networks. They verbalize an understanding that psychology is biology, that any distinction is artificial, and that both are valuable. CONCLUSIONS: A neuroscience curriculum founded on the underlying principles of behavioral neurobiology and neuropsychiatry is inherently anti-reductionistic and facilitates the acquisition of detailed information as well as critical thinking and cross-disciplinary correlations with psychological theories and psychotherapy.

Lacy T　Hughes JD

Formal training in women’s issues in psychiatry:a survey of psychiatry residency training directors.

admin — Sun, 13 Apr 2008 03:41:12 +0000

OBJECTIVE: The authors describe the availability of formal residency training opportunities in women’s issues in psychiatry and explore the potential relationships between the availability of training and characteristics of residency programs. METHOD: The authors surveyed psychiatry residency training directors to identify program characteristics and training opportunities. RESULTS: Certain didactic subjects were available in greater than 80% of residencies. Clinical training opportunities were less available and often not required. CONCLUSIONS: Selected didactic training in gender issues is commonly available in a majority of residencies. Nevertheless, general clinical instruction and didactic instruction in several important topics are less available.

Gold LH　Epstein SA

Determining, monitoring, and verifying patient-student involvement (ED-2) in a psychiatry clerkship:preliminary findings.

admin — Sun, 13 Apr 2008 03:40:22 +0000

OBJECTIVE: This article describes the process and preliminary findings that a department of psychiatry developed to meet a new Liaison Committee on Medical Education (LCME) educational standard known as ED-2. METHOD: At an educational retreat, 92% of faculty and 56% of residents who attended developed the types of patient symptoms all students should see and document during a 6-week psychiatry rotation. Data from the first three rotations were collected, including the opinions of faculty and students. RESULTS: Both faculty and students found the system easy to use. Almost half (46%) of the encounters were met through observation with a range of 12% to 81%. There was a significant inverse correlation between students who met encounters through observation and Shelf examination scores. DISCUSSION: The Required Patient Encounter card tracks the patients whom students are seeing, thus enabling the clerkship to meet new LCME educational standards. Future directions will include evaluating whether the categories of symptoms need revision and whether there should be a maximum number of encounters that can be met through observation.

Pary RJ　Becker SL

Gender bias in the diagnosis of a geriatric standardized patient:a potential confounding variable

admin — Sun, 13 Apr 2008 03:39:08 +0000

BACKGROUND: Gender bias has been reported in the diagnosis and treatment of patients with a variety of illnesses. In the context of our 10-station fourth year Objective Structured Clinical Evaluation, we queried whether this could influence diagnosis in a geriatric case. Case writers hypothesized that, due to this bias, the female standardized patient may be diagnosed with depression more often than the male. METHOD: A male or female geriatric standardized patient protrayed a dysphoric widow with mild cognitive impairment. Students examined the patient and documented the clinical encounter and their differential diagnosis. RESULTS: Major depression was diagnosed in 93/107 female standardized patient encounters compared with 58/78 male exams, with the female students contributing most to this difference. DISCUSSION: The potential for gender bias in medical care and in education remains a concern. We need to be mindful of this when designing clinical skills assessments.

Lewis R　Lamdan RM　Wald D　Curtis M

Implementing interpersonal psychotherapy in a psychiatry residency training program.

admin — Sun, 13 Apr 2008 03:38:15 +0000

OBJECTIVE: Interpersonal psychotherapy (IPT) for depression is a brief, well researched treatment for acute major depression. This article describes the implementation of IPT as an evidence-based treatment for depression in a psychiatry residency program. METHOD: The authors tracked the implementation process over 5 years as interpersonal psychotherapy was systematically incorporated into residency training. RESULTS: The authors outline key ingredients for and challenges to effecting change. CONCLUSIONS: Implementation of interpersonal psychotherapy in psychiatry residency training was a cornerstone for learning evidence-based treatment approaches as well as for conveying core psychotherapy concepts.

Lichtmacher J　Eisendrath SJ　Haller E

Overcoming barriers in working with families.

admin — Sun, 13 Apr 2008 03:36:55 +0000

OBJECTIVE: The Accreditation Council for Graduate Medical Education and the Residency Review Committee for psychiatry outline the expected competencies for residents. These competencies include working with families. This article describes barriers that residents face when working with families, and offers ways to overcome these barriers. METHOD: In 23 years of combined experience teaching family therapy to psychiatry residents, the authors have identified typical barriers that residents face when beginning to work with families. RESULTS: Six clinical vignettes, with the resident’s concerns, the supervisor’s intervention and the resident’s response, illustrate these barriers. CONCLUSIONS: In order for residents to become skilled in working with families, barriers should be made explicit and ways of overcoming these barriers should be discussed clearly with residents.

Heru AM　Drury L

Training in tobacco treatments in psychiatry: a national survey of psychiatry residency training directors.

admin — Sun, 13 Apr 2008 03:36:00 +0000

OBJECTIVE: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. METHOD: The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. RESULTS: Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. CONCLUSIONS: The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.

Prochaska JJ　Fromont SC　Louie AK　Jacobs MH　Hall SM

Clinical habits and the psychiatrist: an adult developmental model focusing on the academic psychiatrist.

admin — Sun, 13 Apr 2008 03:32:44 +0000

OBJECTIVE: The authors examine the development of the psychiatrist from an adult developmental perspective, focusing on the early development and consolidation of highly adaptive clinical and other professional habits. They place special emphasis on the professional development of the academic psychiatrist. METHOD: The authors review and use literature on adult psychological development as a formative template upon which a prototypical psychiatrist proceeds through a telescoping series of adult developmental stages. At each stage of clinical development, specific tasks are identified and outlined, and articles from the academic psychiatry literature are cited to provide content-specific examples of the development of academic and clinical habits of importance to those psychiatrists who then develop an academic career. RESULTS: The clinical development of the psychiatrist follows either a continuous or episodic process that parallels the broader themes of adult development, allowing for optimal integration of the interests and skills of the individual in a niche within the increasingly diverse field of psychiatry. For the academic psychiatrist, a continuation of this model applies to development as a clinical instructor and researcher. CONCLUSIONS: Optimum developmental attention to clinical habits and skills begins in medical school and proceeds sequentially throughout subsequent career stages, correlating with subsequent stages of adult development. The authors describe in functional terms strategies for successful navigation of these challenges in clinical habits development. At all stages, mentorship and supervision are highly encouraged, as is attention to macrolevel changes in the clinical and administrative milieu.

Bourgeois JA　Servis M