Hendry Ton

Discussing Depression with Vietnamese American Patients

Background Asian patients preferentially seek mental health care from their primary care providers but are unlikely to receive it. Primary care providers need culturally-informed strategies for addressing stigmatizing illnesses. Methods 11 Vietnamese American community members participated in semi-structured interviews. Interviews were audio-taped and transcribed. The grounded theory approach was used for qualitative coding and thematic analysis. Results Vietnamese community members describe experiences with depression under four themes: (1) Stigma and face; (2) Social functioning and the role of the family; (3) Traditional healing and beliefs about medications; and (4) Language and culture. Based on this data, we offer suggestions for improving culturally-informed care for Vietnamese Americans. Disucssion Our study adds to the research aimed at improving communication and health care relationships between physicians and Vietnamese American patients. Physicians should learn to tailor their interviewing style to the increasingly diverse patient population.

A qualitative needs assessment for development of a cultural consultation service.

Cross-cultural mental health services were assessed using qualitative interviews and focus groups of 43 mental health clinicians and program directors in one of the most ethnically integrated cities in the US. The commonly used strategy of ethnic matching between clinician and patient was found to be difficult to effectively apply to an ethnically diverse and highly integrated patient population. Information from cultural-competency training was also found to be difficult to apply, particularly due to time limitations and language barriers. Implementation of a cultural consultation service, which uses in-depth cultural evaluations and case-based learning, may help bridge these service gaps.

The Doctoring Curriculum at the University of California, Davis School of Medicine: Leadership and Participant Roles for Psychiatry Faculty.

ObjectiveThe authors describe in detail the 3-year model of the Doctoring curriculum plus an elective fourth-year Doctoring course at University of California, Davis School of Medicine (UCDSOM) and University of California Los Angeles (UCLA) School of Medicine and the critical role for psychiatry faculty leadership and participation.MethodsThe authors present a review of curricular materials and course operations for the different Doctoring courses for first-, second-, third-, and fourth-year curriculum. The authors describe the role of psychiatry faculty in both leadership and in group facilitation.ResultsThe Doctoring curriculum offers case-based, small-group learning that relies heavily on standardized patients to teach core content around doctor-patient communication, ethics behavioral medicine and counseling approaches. There are frequent psychosocial issues woven in to these encounters. Psychiatry faculty members and other mental health professionals are well-prepared by virtue of their training to lead small group discussions and facilitate the supportive elements of the small groups in medical education.ConclusionThe Doctoring curriculum is both a biopsychosocial educational endeavor and a high-visibility leadership opportunity for the Department of Psychiatry. Other medical schools and departments of psychiatry may wish to pursue similar roles in their didactic programs.

Improving Medical Education About Gender-Variant Youth and Transgender Adolescents

Gender minority children and adolescents present to a wide variety of health professionals for gender-related care and other care. However,few professionals may be prepared to meet their needs. Unprepared clinicians risk developing insufficient therapeutic rapport, missing salient information, and inadvertently contributing to risk. In this article the authors outline ways to address these gaps at all training levels to meet the needs of gender minority children and adolescents. They provide practical resources for colleagues interested in expanding education opportunities in their own community. In the end, competency in gender minority health should improve access to care for these youths.

Student assessment of psychiatry clinical simulation teaching modules

Recognizing a need for computer-based instruction in psychiatry education, a clinical simulation initiative (CSI) by the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) developed a free database of psychiatry teaching modules, intended to enhance the learning that takes place during a clinical interaction, or provide a meaningful learning experience if the ideal of direct exposure to the desired clinical condition is not possible. The modules contain illness-specific information, including etiology, epidemiology, differential diagnosis, clinical manifestations and treatment, and are illustrated with video-clips of evolving patient cases played by actors. Interactive quizzes are included in each module to consolidate knowledge, promote critical thinking, and stimulate further learning. Of fourteen areas of psychopathology delineated by ADMSEP’s clinical learning objectives, to date modules that address the psychiatric interview, dementia, bipolar disorder, personality disorders, post-traumatic stress and anxiety disorders have been published on MedEdPORTAL for free access by educators, and additional modules are under development. We obtained data on student satisfaction and the modules’ impact on students’ confidence in disorder-specific knowledge, using surveys that evaluated the modules’ quality and effectiveness. Survey items include educational value, general feedback, and confidence in disorder-specific knowledge, diagnosis, and treatment. Items are rated on a 5-point Likert-type scale, where 11⁄4 Strongly Disagree and 51⁄4 Strongly Agree. Comparisons between preand post-module student confidence ratings were assessed using non-parametric Wilcoxon signed rank tests. Complete survey data from 215 students at seven universities in USA yielded mean ratings of 3.9–4.6 on items measuring module quality and effectiveness. All but one of the student confidence ratings were significantly higher post-module as compared to pre-module (p50.05). Data from our study demonstrate student satisfaction with the modules and positive impact on students’ confidence in disorder-specific knowledge. CSI modules help fulfill educational requirements in psychiatry clinical clerkships and the open access model fosters educational collaboration between institutions.

Utilizing the Electronic Health Record as a Tool for Reducing LGBT Health Disparities: An Institutional Approach

Efforts to eliminate health disparities among lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) populations face historic challenges. Historic extensive mistreatment in medicine helped create a culture in which many deny or hide their sexual orientation and gender identity (SO/GI) when seeking care. In turn, many care providers are not aware which of their patients are LGBTQI. Until recently, there was virtually no education on LGBTQI health provided in medical schools. Without that education, many providers never consider SO/GI in the care of their patients. To improve quality of care for LGBTQI patients, providers must be able to discuss SO/GI with their patients and understand that person’s health risks. The electronic health record (EHR) is a tool which can be used to identify LGBTQI patients and to prompt providers about potentially valuable prevention and treatment efforts. At the University of California, Davis we have begun to gather patient SO/GI data in the EHR, incorporating information communicated from patient to provider directly or through a questionnaire on the patient portal into the EHR. A 4 year competency based curriculum around sexual orientation and gender identity has been developed along with grand rounds and workshops teaching how to discuss SO/GI. Improving atmosphere and educating providers and staff about LGBTQI health disparities has become core to our commitment to improve the experience of LGBT learners, faculty and staff and the quality of care for LGBT patients.

Associations between DSM-IV mental disorders and subsequent onset of arthritis

OBJECTIVE We investigated the associations between DSM-IV mental disorders and subsequent arthritis onset, with and without mental disorder comorbidity adjustment. We aimed to determine whether specific types of mental disorders and increasing numbers of mental disorders were associated with the onset of arthritis later in life. METHOD Data were collected using face-to-face household surveys, conducted in 19 countries from different regions of the world (n=52,095). Lifetime prevalence and age at onset of 16 DSM-IV mental disorders were assessed retrospectively with the World Health Organization (WHO) Composite International Diagnostic Interview (WHO-CIDI). Arthritis was assessed by self-report of lifetime history of arthritis and age at onset. Survival analyses estimated the association of initial onset of mental disorders with subsequent onset of arthritis. RESULTS After adjusting for comorbidity, the number of mood, anxiety, impulse-control, and substance disorders remained significantly associated with arthritis onset showing odds ratios (ORs) ranging from 1.2 to 1.4. Additionally, the risk of developing arthritis increased as the number of mental disorders increased from one to five or more disorders. CONCLUSION This study suggests links between mental disorders and subsequent arthritis onset using a large, multi-country dataset. These associations lend support to the idea that it may be possible to reduce the severity of mental disorder-arthritis comorbidity through early identification and effective treatment of mental disorders.

How to Teach Creatively

Creative teaching involves imaginative approaches that make learning more interesting, exciting, and effective. Creative teachers share a number of characteristics. Although they are content experts, they are also highly motivated, have high expectations, and have strong communication skills. Creative teachers also use techniques to stimulate curiosity and raise confidence. This chapter highlights strategies to help stimulate the academic physician’s creative teaching process.

Book Review: Gwen Yeo and Dolores Gallagher-Thompson (Eds.), Ethnicity and the Dementias (2nd ed.). New York: Routledge, 2006. 390 pp. Cloth:

One in 10 of the world’s population is over 60 years old. In 2050, this proportion will double to one in five. Currently, it is estimated that 24.3 million people worldwide are living with dementia, a number that is expected to increase to 81.1 million by 2040 (Ferri et al., 2005). Over half of those with Alzheimer’s disease reside in developing countries (Vas et al., 2001). Ethnicity and the Dementias addresses the challenges these demographic and epidemiological changes pose for clinicians. While this book focuses primarily on culturally diverse communities within the US, the information presented is relevant to a broader readership. The book draws upon experienced researchers and clinicians from the fields of cultural and geriatric psychiatry to effectively integrate general issues of dementia assessment and treatment in a culturally diverse context. Overall, the material is highly readable and has practical application for the clinician. The book is divided into five major sections: Risk of Dementia, Assessment of Dementia in Diverse Populations, Treatment and Management of Dementia, Working with Families, and Community Partnerships for Support of Ethnic Elders and Families. The first section attempts to characterize the prevalence of dementia in various ethnic groups. Due to the inconsistency and poor availability of data, this section may leave readers with an inadequate sense of prevalence. Interestingly, the authors suggest that ethnic differences in dementia are reduced or disappear altogether when level of education is controlled. The editors have omitted an overview of demographics of older ethnic communities, reasoning that most readers would be aware of this information. However, inclusion of that information would have made the book’s central rationale more compelling. Section II reviews assessment strategies for African American, Asian American, Hispanic, and American Indian elders. The authors discuss general approaches to utilizing neuropsychiatric testing in diverse communities, including use of interpreters and testing bias as a result of ethnicity, education, and literacy. The authors also describe common assessment tools such as the Mini-Mental State Exam and Neuropsychiatric Inventory, while pointing out potential biases that Transcultural Psychiatry 47(2)