A survey of personnel and services offered in 32 outpatient US clozapine clinics.

Background: Clozapine clinics can facilitate greater access to clozapine, but there is a paucity of data on their structure in the US.

Methods: A 23-item survey was administered to participants recruited from the SMI Adviser Clozapine Center of Excellence listserv to understand characteristics of clozapine clinics.

Results: Clozapine clinics (N = 32) had a median caseload of 45 (IQR = 21-88) patients and utilized a median of 5 (IQR = 4-6) interdisciplinary roles.

Supporting the Mental Health Workforce During and After COVID-19.

The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.

The Role of Digital Navigators in Promoting Clinical Care and Technology Integration into Practice.

As the role of technology expands in healthcare, so does the need to support its implementation and integration into the clinic. The concept of a new team member, the digital navigator, able to assume this role is introduced as a solution. With a digital navigator, any clinic today can take advantage of digital health and smartphone tools to augment and expand existing telehealth and face to face care.

New Tools for Implementing Evidence-Based Care for Serious Mental Illness.

More than 11 million adults in the United States have a serious mental illness. Outcomes for these illnesses are good when appropriate treatments are received; however, rates of delivery and utilization of evidence-based care for this population are moderate to low. This article introduces SMI Adviser, a national initiative, supported by the Substance Abuse and Mental Health Services Administration, to advance the use of evidence-based practices and delivery of patient-centered care for the population with serious mental illness.

Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession.

Objective: The authors examined the prevalence of burnout and depressive symptoms among North American psychiatrists, determined demographic and practice characteristics that increase the risk for these symptoms, and assessed the correlation between burnout and depression.

Methods: A total of 2,084 North American psychiatrists participated in an online survey, completed the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire-9 (PHQ-9), and provided demographic data and practice information. Linear regression analysis was used to determine factors associated with higher burnout and depression scores.

Autonomic arousal and learning in Web-based simulation: a feasibility study.

Introduction: Autonomic arousal is an important component of understanding learning as it is related to cognitive effort, attention, and emotional arousal. Currently, however, little is known about its relationship to online education. We conducted a study to determine the feasibility of measuring autonomic arousal and engagement in online continuing medical education (CME).

Interprofessional differences in disposition decisions: results from a standardized web-based patient assessment.

Objective: This study examined differences in disposition decisions among mental health professionals using a standardized Web-based simulation.

Methods: Using a Web-based simulation that described, across users, the same complex psychiatric patient, credentialed clinicians in a psychiatry department conducted a violence risk assessment and selected a level of follow-up care.

Results: Of 410 clinicians who completed the simulation, 60% of psychiatrists were more likely than other types of clinicians to select higher levels of care (inpatient or emergency services) for the standardized virtual patient (odds ratio=2.

Simulation-based ongoing professional practice evaluation in psychiatry: a novel tool for performance assessment.

Background: Ongoing professional practice evaluation (OPPE) activities consist of a quantitative, competency-based evaluation of clinical performance. Hospitals must design assessments that measure clinical competencies, are scalable, and minimize impact on the clinician's daily routines. A psychiatry department at a large academic medical center designed and implemented an interactive Web-based psychiatric simulation focusing on violence risk assessment as a tool for a departmentwide OPPE.

Attendees' perceptions of commercial influence in noncommercially funded CME programs.

Introduction: The controversy surrounding commercial support for continuing medical education (CME) programs has led to policy changes, but data show no significant difference in perceived bias between commercial and noncommercial CME. Indeed, what attendees perceive as commercial influence is not fully understood. We sought to clarify what sources contribute to attendees' perceptions of commercial influence in non-industry-supported CME programs, and how attendees perceive that this influence manifests itself on both speaker and program levels.

The psychodynamics of transference--a virtual reality model.

Objective: Virtual reality is not only being utilized increasingly as an enhancement for diagnosis and treatment of psychiatric illness, but it also can be used to model theories, generate hypotheses, and provide a new context for teaching psychodynamic therapy. Here we describe the use of an online virtual world--Second Life--as a heuristic tool for understanding and teaching a key psychoanalytic concept, transference.

Methods: Using an extended vignette to illustrate the results of the modeling process, we explore teaching the vicissitudes of object relationships by means of analogs in virtual reality.

Enhancing informed consent best practices: gaining patient, family and provider perspectives using reverse simulation.

Background: Obtaining informed consent in the clinical setting is an important yet challenging aspect of providing safe and collaborative care to patients. While the medical profession has defined best practices for obtaining informed consent, it is unclear whether these standards meet the expressed needs of patients, their families as well as healthcare providers. The authors sought to address this gap by comparing the responses of these three groups with a standardised informed consent paradigm.

Attention to body mass index by child psychiatry providers when prescribing second-generation antipsychotic medication to children: a survey study using a clinical vignette.

Aim: We sought to determine whether weight and body mass index measurement were taken into consideration when prescribing second-generation antipsychotic (SGA) medication to a child.

Methods: Two hundred clinicians were surveyed using a hypothetical clinical case vignette at a child psychopharmacology, postgraduate medical education course. The vignette described an overweight 10-year-old boy who was about to be prescribed an SGA medication to control psychotic symptoms.

Medical professionalism: a tale of two doctors.

The AMA's social media guidelines provide physicians with some basic rules for maintaining professional boundaries when engaging in online activities. Left unanswered are questions about how these guidelines are to be implemented by physicians of different generations. By examining the issues of privacy and technological skill through the eyes of digital natives and digital immigrants, the challenges associated with medical e-professionalism become clear.

Web-based simulation in psychiatry residency training: a pilot study.

Background: Medical specialties, including surgery, obstetrics, anesthesia, critical care, and trauma, have adopted simulation technology for measuring clinical competency as a routine part of their residency training programs; yet, simulation technologies have rarely been adapted or used for psychiatry training.

Objective: The authors describe the development of a web-based computer simulation tool intended to assess physician competence in obtaining informed consent before prescribing antipsychotic medication to a simulated patient with symptoms of psychosis.

Method: Eighteen residents participated in a pilot study of the Computer Simulation Assessment Tool (CSAT).

Psychogenic movement disorders and motor conversion: a roadmap for collaboration between neurology and psychiatry.

Background: There are a host of vague terms to describe psychologically-mediated symptoms that mimic neurological disease, such as "functional," "non-organic," "psychogenic," or "medically unexplained." None of these terms has a direct translation in psychiatric classification, and psychiatrists are often faced with patients who do not believe in a psychological origin for their symptoms.

Objective: Within the framework of psychogenic movement disorders, we discuss the roadblocks to effective collaboration and treatment in these patients and the current state of the literature regarding diagnosis and treatment.

Crime and hate in virtual worlds: a new playground for the ID?

Virtual worlds offer the potential for friendship, compassionate listening and support, and even love for 15 million users worldwide. But virtual analogs of crimes such as rape, murder, and pedophilia also exist within these worlds. The writings of Freud and Winnicott provide one model for understanding what may motivate these virtual crimes and how to think about them clinically.

Medical student involvement in website development.

Background: The digital management of educational resources and information is becoming an important part of medical education.

Aims: At Vanderbilt University School of Medicine, two medical students sought to create a website for all medical students to act as each student's individual homepage.

Method: Using widely available software and database technology, a highly customized Web portal, known as the VMS Portal, was created for medical students.