Online ISSN: 2451-4950

Author : Heun, Reinhard

High variability of the current mental health practices around the globe: Twenty days in the lives of psychiatrists and other mental health care professionals from all over the world

Reinhard Heun; Jibril Ibrahim Moussa Handuleh; Juan Evangelista Tercero Gaitán Buitrago; Melvin S. Marsh; Vitalii Klymchuk; Viktoriia Gorbunova; Gillian Friedmann; Ali Munsif; Rishab Gupta MD; Emil Barna; Demilade S Agbeleye; Vani Kulhalli, MD; Wissam H Mahasneh; Dragana Ignjatovic Ristic; Saumya Singh, MBBS, MRCPsych; Seshni Moodliar-Rensburg; Jack Wellington; Naomi Shorthouse; Robyn-Jenia Wilcha; Udayan Bhaumik; Prerna Sharma

GLOBAL PSYCHIATRY, 2020, Volume 3, Issue 2, Pages 119-140
DOI: 10.2478/gp-2020-0019

Introduction: The present is the future of the past, and the past of the future. This journal as well as this paper endeavour to document
the lives and practices of psychiatrists and other mental health care professionals for the future mental health community and to help
the clinicians of the future to understand the history and practice of psychiatry and mental health care in 2019/20. We, therefore, report
the current days in the lives of psychiatrists and other mental health care professionals.
Material and Methods: To obtain reports of days in the lives of psychiatrists and other mental health professionals, we published the
request on eight occasions from May 2019 to May 2020. We invited the prospective respondents/participants to send a relevant report
of their psychiatric practice in a day with a maximum word count of 750 words.
Results: We received 20 reports of variable lengths from 10 countries from six continents, including from psychiatrists, psychiatrists
in training, clinical psychologists and from medical students about their psychiatric training. The reports revealed a wide and highly
variable range of psychiatric and mental health practices, experiences and expectations. Last but not least, the reports we received were
informative and provided much information to reflect on.

Conclusions: There is a common strong commitment to support patients with mental health problems, but the ways this is achieved
are so diverse that generalisations about a typical common practice seem impossible. Future studies should focus more systematically
on the procedures and practices applied in helping patients with mental health problems in different countries and communities. This
knowledge might eventually help identify the procedures and services that are most efficient and helpful in various clinical contexts.

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Reinhard Heun

GLOBAL PSYCHIATRY, 2018, Volume 1, Issue 2, Pages 61-70
DOI: 10.2478/gp-2018-0009

Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.
We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.
404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.
Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.