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American Psychiatric Association, May 16-20

The 168th American Psychiatric Association Annual Meeting

The annual meeting of the American Psychiatric Association was held from May 16 to 20 in Toronto and attracted approximately 10,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in psychiatry. The conference highlighted recent advances in the prevention, detection, and treatment of psychiatric conditions.

In one study, David Brown, of the Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, Ill., and colleagues conducted a literary review investigating the recruitment strategies of religious extremists, including their targets for recruitment and how to counter their recruitment strategies.

“In their narrative, extremists portray themselves as freedom fighters or champions rising against this threat. Their message is targeted towards vulnerable youth who have a weakened sense of identity due to cultural isolation,” Brown said. “To counter the recruitment by religious extremists, it is necessary to dismantle this narrative by highlighting its contradictions and assumptions, and promote more diverse viewpoints. This study’s relevance clinically is to educate providers and the public about the narrative told by religious extremists. Practicing psychiatrists can use this information to gain a better understanding of and provide better care for patients with anxiety and/or posttraumatic stress disorder.”

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In another study, Jhilam Biswas, M.D., of the University of Massachusetts in Boston, and colleagues observed that Indian psychiatrists found somatic symptoms like pain, sleep, and appetite to be significantly more common in depression, and violent and aggressive behavior to be significantly more common in mania, than did American psychiatrists. In addition, the investigators observed that American psychiatrists found pessimism about the future to be more commonly seen in depression, and pressured speech and marked distractibility to be more commonly seen in mania, than did Indian psychiatrists.

“Both psychiatric groups felt the top four symptoms of psychosis were paranoia, lack of insight, delusions, and auditory hallucinations, and both groups agreed that visual hallucinations and motor peculiarities to be least commonly seen in psychosis,” Biswas said. “Despite a different set of resources in the two communities, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care, but Indian psychiatrists did not. Indian psychiatrists reported ’embarrassing the family’ was a significant barrier to accessing care; however, American psychiatrists did not.”

Overall, the investigators found that certain symptomatic presentations of universal diagnoses in mental illness will vary across cultures.

“Because psychiatrists see a large volume of individuals in their communities, their collective perception of the most common symptoms in psychiatric illness is a tool to be used in finding cultural patterns arising in mentally ill populations around the world,” Biswas concluded. “Understanding cultural patterns makes all of us better international psychiatrists and better teachers.”

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Nazanin Alavi, M.D., of Queen’s University in Kingston, Canada, and colleagues found that suicidal behaviors, including attempts and harm to self, remain the most common reasons for presentation to emergency departments or psychiatric clinics.

“Although many predictors of suicide have been identified, many important risk factors are missed in the suicide assessment by physicians,” Alavi said. “We suggest that educational interventions presenting the suicide risk factors to emergency medicine physicians and psychiatrists could improve the assessments. In addition, we suggest a three-category checklist (past and current psychiatric history, patient’s environment, and characteristics of the suicidal behavior), with each category including different suicide risk factors. We are hoping to implement our checklist in the emergency department.”

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