1
|
Mosqueiro BP, Costa MDA, Caribé AC, Oliveira e Oliveira FH, Pizutti L, Zimpel RR, Baldaçara L, da Silva AG, Moreira-Almeida A. Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:506-517. [PMID: 37718460 PMCID: PMC10897776 DOI: 10.47626/1516-4446-2023-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/25/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. METHODS A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. RESULTS The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. CONCLUSION Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.
Collapse
Affiliation(s)
- Bruno Paz Mosqueiro
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
| | - Marianna de Abreu Costa
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - André C. Caribé
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
- Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Fabrício H.A. Oliveira e Oliveira
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Leandro Pizutti
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Rogério R. Zimpel
- Departamento de Psiquiatria e Espiritualidade, Associação de Psiquiatria do Rio Grande do Sul (APRS), Porto Alegre, RS, Brazil
| | - Leonardo Baldaçara
- Universidade Federal do Tocantins, Palmas, TO, Brazil
- ABP, Rio de Janeiro, RJ, Brazil
| | - Antônio Geraldo da Silva
- ABP, Rio de Janeiro, RJ, Brazil
- Asociación Psiquiátrica de América Latina, Santo Domingo, Dominican Republic
| | - Alexander Moreira-Almeida
- Comissão de Estudos e Pesquisas em Espiritualidade e Saúde Mental, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil
- Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| |
Collapse
|
2
|
Roth B, Grabovac A. Spirituality and Religion in Canadian Psychiatric Residency Training: Follow-up Survey of Canadian Psychiatry Residency Programs. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01785-7. [PMID: 37081373 DOI: 10.1007/s40596-023-01785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE This study assesses the availability and nature of psychiatry resident training in religion and spirituality across Canada. Evidence shows that religious and spiritual topics are important to psychiatric patients and that psychiatrist competence in approaching these topics is correlated to whether they have had previous training in them. Prior studies have shown a lack of training in religion and spirituality in Canadian psychiatry programs and recommended incorporation into psychiatry residency curricula. METHOD A survey was conducted, asking questions about the amount and type of training in religion and spirituality that was accessible to psychiatry residents in the 17 psychiatry residency programs in Canada. One response was sought from each institution by reaching out to the institutions' program directors and requesting that a knowledgeable faculty member complete the survey. RESULTS Out of 14 responding psychiatric residency programs, 2 reported no training opportunities in religion or spirituality, 4 reported only voluntary training opportunities that were largely resident directed, and 8 reported mandatory training. CONCLUSIONS The number of Canadian psychiatry residency programs providing mandatory training in religion and spirituality has increased since the prior published survey in 2003 and there are fewer programs reporting no training at all. However, overall, Canadian psychiatry institutions still place less emphasis on religious/spiritual education than recommended by the international psychiatric community. Several Canadian institutions report well-received implementation of curricula on religion and spirituality that could inform other Canadian institutions.
Collapse
Affiliation(s)
- Benjamin Roth
- University of British Columbia, Vancouver, BC, Canada.
| | | |
Collapse
|
3
|
Dike CC, Briz L, Fadus M, Martinez R, May C, Milone R, Nesbit-Bartsch A, Powell T, Witmer A, Brendel RW. Religion, Spirituality, and Ethics in Psychiatric Practice. J Nerv Ment Dis 2022; 210:557-563. [PMID: 35344979 DOI: 10.1097/nmd.0000000000001505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The interface of religion, spirituality, and psychiatric practice has long been of interest to the ethical psychiatrist. Some prominent early psychotherapists had a strained relationship with religion and spirituality. They posited that religion and spirituality were forms of mental illness, which discouraged the discussion of these values during treatment despite the fact that many patients subscribed to a religious or spiritual viewpoint. Contrarily, others supported a harmonious relationship with religion and spirituality and served as trailblazers for the incorporation of religion and spirituality into psychiatric treatment.As the field of psychiatry continues to evolve, additional dimensions of the relationship between religion, spirituality, and psychiatric practice must be explored. Today, many modern psychiatrists appreciate the importance of incorporating religion and spirituality into treatment, but questions such as whether it is ethical to practice psychiatry from a particular religious or spiritual viewpoint or for psychiatrists to advertise that they subscribe to a particular religion or spirituality and to engage in religious or spiritual practices with their patients remain nuanced and complex. In this resource document, the authors put forth and examine the ramifications of a bio-psycho-social-religious/spiritual model for psychological development and functioning, with this fourth dimension shifting the focus from symptom reduction alone to include other aspects of human flourishing such as resilience, meaning-making, and hope.
Collapse
Affiliation(s)
- Charles C Dike
- Yale University School of Medicine, New Haven, Connecticut
| | - Laura Briz
- Eating Recovery Center Pathlight, Chicago, Illinois
| | - Matthew Fadus
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Martinez
- Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado
| | - Catherine May
- Department of Psychiatry, George Washington University School of Medicine, Washington, DC
| | | | | | - Tia Powell
- Center for Bioethics and Masters' in Bioethics at Montefiore Health Systems and Albert Einstein College of Medicine, New York, New York
| | | | | |
Collapse
|
4
|
Hathaway DB, de Oliveira E Oliveira FHA, Mirhom M, Moreira-Almeida A, Fung WLA, Peteet JR. Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:300-310. [PMID: 34010864 DOI: 10.1097/acm.0000000000004167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients' spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives. METHOD The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees' competencies and/or in patient outcomes following exposure to these educational interventions. RESULTS Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies-representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients-were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients' S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients. CONCLUSIONS S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.
Collapse
Affiliation(s)
- David B Hathaway
- D.B. Hathaway is attending physician, Department of Psychiatry, Brigham and Women's Hospital, and an instructor of psychiatry, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-7271-0018
| | - Fabrício H A de Oliveira E Oliveira
- F.H.A. de Oliveira e Oliveira is psychiatrist and a PhD student, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0001-5304-2835
| | - Mena Mirhom
- M. Mirhom is co-director and a post-doctoral clinical fellow, Public Psychiatry Fellowship, Columbia University Department of Psychiatry, New York, New York; ORCID: https://orcid.org/0000-0003-0408-4056
| | - Alexander Moreira-Almeida
- A. Moreira-Almeida is associate professor of psychiatry and director, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0002-9135-2532
| | - Wai Lun Alan Fung
- W.L.A. Fung is research professor, Tyndale University, faculty member, University of Toronto Faculty of Medicine, medical director, Mount Sinai Hospital Wellness Centre, and attending physician, Department of Psychiatry, Mount Sinai Hospital and North York General Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7260-9163
| | - John R Peteet
- J.R. Peteet is associate professor of psychiatry, Harvard Medical School, site director, Fellowship in Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, and attending physician, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5362-1765
| |
Collapse
|