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OBJECTIVE: Multifamily group (MFG) psychotherapy is widely used for mental and general medical conditions. MFG therapy engages family members in caring for a loved one experiencing illness and helps clarify the impact of illness on family. Use of MFG therapy for patients with nonepileptic seizures (NES) and their families to explore satisfaction with treatment and family functioning is described. METHODS: MFG therapy for patients with NES and their participating family members was incorporated into an existing interdisciplinary group-based psychotherapy treatment program. The Family Assessment Device and a novel feedback questionnaire were used to understand the effect of MFG therapy on this population. RESULTS: Patients with NES (N=29) and their corresponding family members (N=29) indicated on the feedback questionnaire their satisfaction with having MFG therapy as part of their treatment; satisfaction was also evidenced by a 79% (N=49 of 62) patient participation rate. Patients and family members reported enhanced understanding of the impact of illness on the family and believed MFG therapy would help them communicate about illness and reduce family conflict. Scores on the Family Assessment Device indicated that family members perceived better family functioning than did patients (average scores of 1.84 and 2.99, respectively). CONCLUSIONS: The discrepancy in perceived family functioning supports the idea of integrating family members in treatment for patients experiencing NES. The group treatment modality was satisfactory to participants and may prove useful for other kinds of somatic symptom disorders, which are often external manifestations of internal distress. Family members can become treatment allies in psychotherapy when included in treatment.

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As Vice Chair of Clinical Services of Psychiatry at the University of Colorado, I choose to work where clinical services need most attention. As a woman, I want to show up where we can be seen and show up in the best possible way. Just as COVID began, I found myself doing clinical shifts in the newly created psychiatry emergency room. I became part of a front-line team, where "I" became "We," facing an unknown enemy. Not only was my work life upended, but my personal life was too, as I rushed to help my daughter, a medical student, care for her son when his day-care closed. My commentary highlights the increased burden experienced by women during this time, an example of systemic bias in medicine.

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Expressed emotion (EE) is a highly researched psychosocial construct. Cultural research challenges the assumption that high family criticism is a universal determinant of poor outcome, especially for chronic illness. The concept of warmth, an original component of EE, was dropped owing to the complexity of its measurement. Warmth has now been resurrected as an important predictor of good patient outcome. Cultural scrutiny and appropriate adaptation of any psychosocial construct is necessary before its acceptance into the medical lexicon of healthcare.

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A high percentage of patients presenting to epilepsy centers have a functional neurological disorder with apparent seizures, ultimately diagnosed as nonepileptic seizures (NES). Meta-analyses suggest that psychological treatment is required, but this treatment is not reliably available, resulting in reentry of these patients to neurology clinics and urgent care settings, reducing access for these services to patients with epilepsy and resulting in inadequate psychological care for patients with NES. A sustainable, group therapy-focused treatment clinic for patients with NES was developed as a combined effort between the departments of neurology and psychiatry at the University of Colorado Hospital, consisting of a full psychiatric evaluation, a five-week psychoeducational group, a 12-week psychodynamic therapy group, individual therapy, medication management, and family assessment. One hundred and six patients were treated in this clinic between July 2016 and October 2018. Patient retention after referral for treatment was 89/136 (65.4%), and group therapy adherence was 89/106 (84.0%). Healthcare utilization, used as a proxy to demonstrate worth, decreased during and after treatment. Analysis of the 106 treated patients elucidates other clinical characteristics of this population, including psychiatric comorbidities and specific medication classes at time of NES diagnosis. We conclude that this clinic model is feasible for recruiting, retaining, and engaging patients in appropriate treatment for their NES.

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Donating a kidney to a stranger is known as a Good Samaritan, altruistic, or non-directed donation. Living donation is the only instance in medicine where the "do-no-harm" dictum is intentionally violated. Healthcare professionals 'doing the harm' are ethically responsible to ensure the lowest risk for both the physical and psychological health of the potential donor. To this end, experts in the transplant community published Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States [1]. These Guidelines focus on the identification of risk and protective factors, and basic principles underlying informed consent and outlined a recommended process for donor evaluation. The components of the evaluation include a comprehensive history and current status, capacity to consent, psychological status, relationship to recipient, motivation, donor knowledge and understanding, social support, and financial suitability. The case of a donor, Ms. Angelo, is presented because her responses during evaluation raised questions about how best to understand her motivation. My proposal is that altruism and motivation are best understood by considering the narrative coherence in the donor's story.

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ABSTRACTObjective:Demoralization is a common problem among medical inpatients with such serious health problems as cancer. An awareness of this syndrome, a knowledge of what defines it, and a plan for how to intervene are limited among nursing teams. Nurses are uniquely poised to efficiently provide brief interventions that address demoralization in their patients. To our knowledge, there are no interventions that train nurses to distinguish and treat demoralization in their patients. The objective of the present study was to determine the acceptability, feasibility, and impact of a novel educational intervention for nurses. METHOD: An educational training video was created and delivered to staff nurses (N = 31) at oncology staff meetings to test the feasibility and acceptability of this intervention. Assessments of nurses' knowledge about demoralization and intervention methods were administered immediately before and after the training intervention and through a web-based survey 6 weeks post-intervention. McNemar's test for dependent categorical data was utilized to evaluate change in survey responses at the three timepoints. RESULTS: Nurses' understanding of the concept of demoralization and appropriate interventions significantly improved by 30.3% from pre- to posttest (p ≤ 0.0001). These improvements persisted at 6 weeks post-intervention (p ≤ 0.0001). At 6-week follow-up, 74.2% of participants agreed or strongly agreed that the training had positively changed their nursing practice, 96.8% reported that this training benefited their patients, and 100% felt that this training was important for the professional development of nurses. SIGNIFICANCE OF RESULTS: This pilot intervention appeared feasible and acceptable to nurses and resulted in increased understanding of demoralization, improved confidence to intervene in such cases, and an enhanced sense of professional satisfaction among inpatient oncology floor nurses.

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In the late nineteenth and early twentieth centuries, the unspoken fear of syphilis played a significant role in the development of beliefs about female sexuality. Many women were afraid of sexual relationships with men because they feared contracting syphilis, which was, at that time, untreatable. Women also feared passing this disease on to their children. Women's sexual aversion, or repression, became a focus for Freud and his colleagues, whose theory of psychosexual development was based on their treatment of women. This article examines the case of Dora, the memoirs of Mabel Dodge Luhan and other sources to argue that the fear of syphilis was a significant factor in upper- and middle-class women's avoidance of heterosexual relationships. The fear of syphilis, in turn, became a significant factor in the psychoanalytic construction of female sexuality. The social suppression of the fear of syphilis has had a profound impact on theories of women's development. The implication for psychiatry is that our models of psychological development occur within a sociocultural milieu and cannot escape suppressed aspects of our culture.

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Although family research supports family-centered care for all medical specialties, the benefit of family-centered care has not been fully realized in outpatient practice. Physicians, including psychiatrists, are not routinely taught how to work with families and may not be aware of the evidence-base for family interventions. However, some medical specialties, such as family medicine and palliative care, have a clinical practice that routinely includes the family. Clinicians working in medical clinics, such as diabetes clinics, know that successful management of chronic illness requires family involvement. Psychiatric clinics, such as The Family Center for Bipolar Disorder at Beth Israel Medical Center in New York City, also have a family-centered practice and show improved patient outcomes. This article provides guidelines, including clinical interview questions, to help psychiatrists practice family-centered care, either in a private office or in a general psychiatric outpatient clinic. The guidelines include questions that identify when to seek an in-depth family assessment or consultation. Family-centered care will become more useful when health care reimbursement focuses on patient outcome.

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OBJECTIVE: Problem-based learning (PBL) has been implemented in medical education world-wide. Despite its popularity, it has not been generally considered useful for residency programs. The author presents a model for the implementation of PBL in residency programs. METHOD: The author presents a description of a PBL curriculum for teaching psychosomatic medicine to PGY 2 members in a psychiatry training program. The goals of PBL are to encourage self-directed learning; enhance curiosity, using case-based, contextualized learning; promote collaborative practice; and support patient-centered care. The addition of role-playing exercises helps PGY 2 residents to develop their skills from simply developing a differential diagnosis to being able to construct biopsychosocial formulations, and it provides these residents an opportunity to practice presenting case formulations to the patient and family. RESULTS: Residents and faculty enjoyed the PBL role-playing sessions. Residents wanted the learning objectives given to them rather than generating their own learning objectives, to move through the cases faster, and to receive more information and more cases. CONCLUSION: Teaching psychosomatic medicine, using PBL and role-playing, allows many of the proposed Academy of Psychosomatic Medicine residency core competencies to be met. However, further refinement of the PBL method needs to take place in order to adapt its use to residency programs.

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Good marital quality (MQ) is associated with better outcomes in many medical illnesses, especially for women. However, improved outcome is only apparent when MQ is measured across a range of marital functioning and when it is statistically described as either good or poor functioning. This article describes the biological processes that have been shown to underlie this relationship and reviews the influence of MQ on patient outcomes in cardiovascular disease. Studies of interventions to improve MQ vary in level of sophistication, depending on the skill of the provider. This article describes successful evidence-based interventions and the skill sets associated with those interventions. In daily clinical practice, psychiatrists can assess MQ by using the Global Assessment of Relational Functioning (GARF) scale and by asking questions about several dimensions of functioning. Understanding how to apply findings from family research concerning outcomes of medical illness is especially important for psychiatrists who practice psychosomatic medicine. This article outlines how such findings can be applied in clinical practice.

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OBJECTIVE: The authors assessed medical student attitudes regarding mistreatment and symptoms of posttraumatic stress in those students who reported exposure to mistreatment. METHODS: Third- and fourth-year medical students (N=71) responded to questions from a vignette in which a student is mistreated and then described any mistreatment they had witnessed or experienced. They also discussed related symptoms of posttraumatic stress subsequent to the mistreatment. The revised Impact of Event Scale was the primary outcome measure. RESULTS: Ninety percent of respondents reported sympathy for the student in the vignette and supported her discussing the incident with peers, the resident, and administration. Seventy-three percent reported witnessing or experiencing mistreatment, suggesting symptoms of posttraumatic stress, with no differences in scores across the intended field of study, age, or gender. CONCLUSION: In a supportive environment, medical students will discuss their experiences of mistreatment. Symptoms of posttraumatic stress can occur from mistreatment.

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