Medical Professional World: PSYCHIATRY

Showing posts with label PSYCHIATRY. Show all posts

Monday, January 11, 2016

Doctors, Please Destress Yourself

By Dr Deepu

Off late there are many instances where questions on stress levels of doctors are raised. Recently a survey also revealed that a majority of resident doctors are under stress and also a startling revelation about increased suicide rates among young doctors. Here I want to share a message received on social media.

Dr.Amol Pampatwar 2011 batch Gmch Aurangabad ms Obgy died due to massive ami today at 9.20 am while travelling from miraj to Kolhapur .
He was very soft spoken person n.married a year ago .
Pm showed lad infarct with multiple plaques in coronaries.neglected chest pain for two days....
May his soul rest in peace..... Recently we are hearing news about many young doctors facing morbidity/mortality due to life style diseases like MI etc.
Here are views, though from very short experience:

Doctors are the one who neglect health and healthy lifestyle the most.
Few things that I found helpful are:
1. Practice is a continuous process... You are there in hospital for patients and not vice a versa. So dont get bothered much by fluctuations in practice.

2. Patients need you more than, you need them..
So set your limits. Stop OPD on time. Avoid patients who want to take ur leasure time (few patients feel pride in visiting u on sundays or off ur opd time).

3. 'Put your eggs in different baskets' is a good saying, but dont put them in too many baskets that you are worried about missing few. So dont keep so many attachments to hospitals. Every new attachment demands time plus travel. Stressing us further.

4. Most important, Set your own targets .. not the targets that ur colleague/competator has set. He may be earning much more .. but he might be paying the cost in some other ways (family.. hobbies.. friends etc).

5. When in doubt about health dont be your own doctor.

6. Give time to family and friends, in hour of trouble they are the one who will be with you in hospital and not ur bosses or professional colleagues. ..

7. "Happiness lies in satisfaction". If we are not satisfied, we will not be happy even if we earn highest in world.
8. Best time to be happy is now, best moment to be happy is present moment. Learn to enjoy the whole journey, dont wait to be happy till u reach the destination!!

Monday, December 14, 2015

Nearly One-Third Of Interns, Residents May Experience Depressive Symptoms During Their Training, Analysis Suggests

The Los Angeles Times (12/9, Kaplan) reports in “Science Now” that “nearly one-third of interns and residents experience depressive symptoms or full-blown depression at some point during their training,” an analysis published Dec. 8 in the Journal of the American Medical Association suggests. After analyzing “data from 54 earlier studies involving 17,560 physicians in training,” then pooling results, investigators found that “the prevalence of depression or depressive symptoms was 29%.”

The Washington Post (12/9, Sun) points out in “To Your Health” that “researchers said the prevalence of depression was much higher among medical residents than the general population.” In comparison, “the National Institute of Mental Health has said that in 2013, about 6.7 percent of all US adults had at least one major depressive episode during the previous year.”

TIME (12/9, Oaklander) reports that the reasons for higher rates of depression among new physicians “are complex, ranging from long hours and sleep deprivation to bullying by attending physicians to a stigmatized attitude against mental illness.” Not only are the physicians suffering, but their patients too, as evidenced by the fact that “medical literature links untreated mental health problems in this population of young doctors to more medical errors and worse patient care.”

According to MedPage Today (12/9, Bender), an accompanying editorial observed that even though “the medical profession is obligated to provide the best medical and mental healthcare to its members, ‘best efforts fall short, mostly because of the high levels of stigma attached to seeking mental health care.’” The editorial suggested that “perhaps an overhaul of the graduate medical education training system is in order.”

The summary of the study is given below

The study was done to provide a summary estimate of depression or depressive symptom prevalence among resident physicians.

Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. The estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.

The data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17 560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ² = 0.39, I² = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ² = 0.04, I² = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ² = 0.09, I² = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.

The study revealed the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

Friday, September 4, 2015

Concern over inappropriate use of psychotropic drugs in people with intellectual disability

Over 70% of prescriptions are given to those without a record of mental illness

The proportion of people with intellectual disability in the UK who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness, finds a study published by The BMJ today.

This suggests that, in some cases, these drugs are being used to manage challenging behaviour rather than for mental illness, say the researchers. They call for changes in the prescribing of psychotropic drugs for people with intellectual disability as well as more evidence on their safety in this group.

People with intellectual disability develop severe mental illness at higher rates than do the general population and may show challenging behaviour.

Concern has existed for many years that psychotropic drugs in general - and antipsychotics in particular (mainly used to treat schizophrenia and bipolar disorder) - are overused in people with intellectual disability, but accurate estimates have been difficult to obtain.

So a team of researchers based at University College London set out to describe rates of recorded mental illness, challenging behaviour, and use of psychotropic drugs in people with intellectual disability in UK primary care.

They analysed data from 571 UK general practices using the The Health Improvement Network (THIN), a large database of electronic health records, and identified 33,016 people with a record of intellectual disability. Average age at study entry was 36 years and average follow-up was five and a half years.

Of 9,135 participants treated with antipsychotic drugs by the end of the study period, 6,503 (71%) did not have a record of severe mental illness.

Of the 11,915 with a record of challenging behaviour, 5,562 (47%) had received antipsychotic drugs, whereas only 1,421 (12%) had a record of severe mental illness.

And of those with a record of prescription of antipsychotics, 26% did not have a record of severe mental illness or challenging behaviour.

New prescriptions for antipsychotics were significantly more common in older people and in those with a record of challenging behaviour, severe mental illness, depression, anxiety, autism, dementia, and epilepsy.

People with a record of challenging behaviour were more than twice as likely to receive a prescription for antipsychotics compared with those without a record of challenging behaviour, say the authors.

Prescription of antipsychotic drugs is disproportionate to the level of recorded severe mental illness and is associated with the presence of challenging behaviour, older age, and diagnoses of autism and dementia, they add.

"Inappropriate use of drug treatment has implications for the individual and for healthcare systems," they warn. "These findings highlight the need for an improved evidence base for use of drugs and optimisation of drug treatment in people with intellectual disability."

Link to article