Lisa Andermann

Psychosis After Resection of Ganglioglioma or DNET : Evidence for an Association

Summary: Purpose: David Taylor and Murray Falconer suggested that some patients may develop a psychotic illness after resection of a ganglioglioma that led to intractable seizures. They implied that the mechanism of this association remained unclear. This concept is currently not universally accepted (M. Trimble, personal communication).

Organizational cultural competence consultation to a mental health institution.

Cultural competence is increasingly recognized as an essential component of effective mental health care delivery to address diversity and equity issues. Drawing from the literature and our experience in providing cultural competence consultation and training, the paper will discuss our perspective on the foundational concepts of cultural competence and how it applies to a health care organization, including its programs and services. Based on a recent consultation project, we present a methodology for assessing cultural competence in health care organizations, involving mixed quantitative and qualitative methods. Key findings and recommendations from the resulting cultural competence plan are discussed, including core principles, change strategies, and an Organizational Cultural Competence Framework, which may be applicable to other health care institutions seeking such changes. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental health care service to the diverse patients, families, and communities.

Culture and the social construction of gender: Mapping the intersection with mental health

The social construction of gender is an important concept for better understanding the determinants of mental health in women and men. Going beyond physical and physiological differences and the traditional biomedical approach, interdisciplinary study of the complex factors related to culture and society, power and politics is necessary to be able to find solutions to situations of disparity in mental health, related to both prevalence of disorders, availability and response to treatment. Gender inequality continues to be a source of suffering for many women around the world, and this can lead to adverse mental health outcomes. This review focuses on developments in the literature on culture, gender and mental health over the past decade, focusing on themes around the social construction of gender, mental health and the media, a look at cultural competence through a gender lens, gender and the body, providing some examples of the intersection between mental health and gender in low-income countries as well as the more developed world, and the impact of migration and resettlement on mental health. At the clinical level, using a bio-psycho-social-spiritual model that can integrate and negotiate between both traditional and biomedical perspectives is necessary, combined with use of a cultural formulation that takes gender identity into account. Research involving both qualitative and quantitative perspectives, and in many cases an ethnographic framework, is essential in tackling these global issues.

Multi-family psycho-education group for assertive community treatment clients and families of culturally diverse background: a pilot study.

This study evaluates the incorporation of Multi-Family Psycho-education Group (MFPG) to an Assertive Community Treatment Team developed to serve culturally diverse clients who suffers from severe mental illness. Participants included Chinese and Tamil clients and their family members. Family members’ well-being, perceived burden, and acceptance of clients were assessed before and after the intervention. Focus group interviews with clinicians were conducted to qualitatively examine MFPG. Family members’ acceptance increased after MFPG. Regular attendance was associated with reduction in perceived family burden. Culturally competent delivery of MFPG enhanced family members’ understanding of mental illness and reduced stress levels and negative feelings towards clients.

Epilepsy in our world: an ethnographic view.

This paper describes how epilepsy is viewed according to biomedicine and the scientific literature and argues that the subjective experience of people dealing with illness is often overlooked by focusing solely on this approach. A review of the pertinent literature from a social science perspective, mainly anthropology and sociology, illustrates the richness of the lived experience of epilepsy that can be uncovered by using ethnographic and other qualitative methods, including narrative studies, in the interest of informing medical practice and leading to a better understanding and treatment of people with this disorder.

The Psychiatry Institute for Medical Students: a decade of success.

Recruiting medical students into psychiatric residency programs has received much attention. In the 1980s and 1990s, North American psychiatric residency programs experienced numerous barriers to recruiting highquality medical students (1–5). This remains a problem around the world. The literature suggests that experiences during medical school, personalities of applicants, and beliefs about the practice of psychiatry are all strongly associated with the decision to enter a psychiatric residency. Recruitment strategies have been widely recommended to bolster positive psychiatry-related experiences and to alter negative perceptions (6–9). In the mid-1990s, only about 4% of U.S. and 6% of Canadian medical school graduates chose psychiatry (10, 11). More recent studies focused on perceptions and attitudes of medical students about psychiatry careers (12– 17). While initial interest is still the most influential factor, positive experiences during psychiatry clerkships and electives have been described as “modifiable programmatic factors that could enhance recruitment to psychiatry” (17). The Psychiatry Institute for Medical Students at the University of Toronto in Ontario was initiated in 1994 as a novel recruitment strategy (18). To our knowledge, similar programs have not been reported. As an indication of how much the recruitment situation has changed in Toronto, the 2008 Canadian Resident Matching Service match was successful in filling all 28 postgraduate year 1 (PGY-1) psychiatric residency positions at the University of Toronto as well as two international medical graduate positions—a total of 30 spots, up from 24 spots 2 years ago (19). As of July 2007, the University of Toronto has 138 psychiatric residents from PGY-1 to PGY-5.

ACT Tailored for Ethnocultural Communities of Metropolitan Toronto

The Frontline Reports column features short descriptions of novel approaches to mental health problems or creative applications of established concepts in different settings. Material submitted for the column should be 350 to 750 words long, with a maximum of three authors (one is preferred) and no references, tables, or figures. Send material to Francine Cournos, M.D., at the New York State Psychiatric Institute (fc15@columbia.edu) or to Stephen M. Goldfinger, M.D., at SUNY Downstate Medical Center (steve007ny@aol.com).

Reflections on Using a Cultural Psychiatry Approach to Assessing and Fortifying Refugee Resilience in Canada

Refugees in Canada, as in many countries around the world, face many difficulties in their journeys towards resettlement and stability. This chapter describes some of the clinical issues around using a cultural competence approach to working with refugees. Use of the cultural formulation is a helpful tool in gaining an appreciation of cultural identity, explanatory models, stressors and supports, as well as cultural factors in the relationship between client and clinician. This approach must also include an understanding of phase-oriented trauma treatment, which begins with safety, symptom reduction and stabilization. Fortifying refugee resilience with an emphasis on current functioning and settlement needs, and avoiding an overly medicalized approach to those who have experienced psychological trauma and torture is recommended. Several vignettes are presented. The importance of post-migration social support is highlighted as one of the most important factors in the promotion of refugee mental health.

Refugees in Host Countries: Psychosocial Aspects and Mental Health

In the last few years, the number of refugees worldwide has increased significantly, reaching the highest levels ever recorded. As described in the literature, the mental health of refugees is affected by their pre-migration, migration, and post-migration experiences. It is well documented that the circumstances that refugees go through can impact both their physical and mental health. While the pre-migration and migration factors cannot be altered, host countries can make the greatest impact on the mental health trajectories for refugees by addressing the post-migration psychosocial factors. This chapter discusses how certain social factors and policies can affect the psychological well-being and mental health of refugees and asylum seekers in Canada and other developed countries.

Understanding health advocacy in family medicine and psychiatry curricula and practice: A qualitative study

Background We explored understanding and experiences of health advocacy among psychiatry and family medicine residents and faculty and the implications for clinical care and teaching through the lens of relationship-centred care. Methods This qualitative study was conducted in the psychiatry and family medicine departments at a large urban university. We interviewed 19 faculty members and conducted two focus groups with 18 residents. Semi-structured questions explored the relational meaning of health advocacy, how residents and faculty learned about the role and ethical considerations involved in incorporating advocacy work into clinical practice within a relationship-centred care framework. Results Four themes emerged from the interviews and focus groups: 1) health advocacy as an extension of the relationship to self; 2) health advocacy and professional boundaries in the physician–patient relationship; 3) health advocacy within a team-based approach; and 4) health advocacy and the physician–community/organization relationship. Participants described implications for practice of the challenges of health advocacy, including perceived institutional risks, professional boundaries and the appropriation of patient voice. Conclusions Our study provides insights into the relational complexities of the health advocate role in residency curriculum and clinical practice. All participants described health advocacy as a broad spectrum of actions that are guided by relationships among patients, health care professionals and communities. Our analysis revealed that some challenges that participants identified with a health advocacy role could be addressed by anchoring the role within a specific theoretical framework. This would better enable us to create a culture of advocacy in the training and development of physicians.