Group Training for Psychiatric Residents: Support Group Facilitation and Supervision with Didactics

OBJECTIVE

Group psychotherapy merits dedicated training during psychiatry residency yet is challenging to implement given competing educational requirements. The authors implemented a voluntary support group training intervention for psychiatry residents consisting of a 6-h didactic series followed by at least 6 months of in vivo group facilitation and supervision. We hypothesized participation would improve residents' self-reported skill and knowledge in group facilitation.

METHODS

Psychiatry residents (PGY I-IV) voluntarily participated in this novel intervention that included a didactic series followed by experiential group facilitation and supervision. To assess confidence and self-reported skill level in group facilitation, residents completed two brief self-report surveys: before the didactic series (pre-intervention) and after group facilitation for at least 6 months (post-intervention). Surveys included Likert scales and open-ended questions. Quantitative data were analyzed with descriptive statistics and open-ended qualitative data were analyzed using thematic analysis.

RESULTS

Twenty-three residents attended 4 to 6 h of didactics between 2016 and 2018. Of these 23 residents, 12 facilitated groups and attended supervision for at least 6 months. Twenty residents responded to pre-intervention surveys and 14 responded to post-intervention surveys. After the intervention, respondents reported a significant increase in knowledge and skills in group facilitation of 88% (15/17) on Likert scale questions.

CONCLUSIONS

This study implemented a novel educational intervention to train psychiatric residents in group dynamics and group facilitation. Participation increased residents' self-reported knowledge and skills in group facilitation. Future directions include incorporating feedback about group curriculum, evaluating resident knowledge and skills using assessment measures, recruiting more group participants, and focusing on peer-to-peer mentoring.

The Use of Physostigmine in the Diagnosis and Treatment of Anticholinergic Toxicity After Olanzapine Overdose: Literature Review and Case Report

BACKGROUND

Second-generation antipsychotic agents are commonly used by clinicians for the treatment of various psychiatric and medical conditions. Despite their presumed safety, an overdose with olanzapine may lead to the development of anticholinergic toxicity. The anticholinergic toxidrome is characterized by both central and peripheral physical findings. Central anticholinergic syndrome, a term used to describe the symptoms that arise from reduced cholinergic activity in the central nervous system, is characterized primarily by signs and symptoms consistent with hyperactive delirium. Signs of peripheral anticholinergia include mydriasis and blurred vision, tremors, ataxia, fever/hyperthermia, flushed and dry skin, dry oral mucosa, decreased bowel sounds, constipation, and urinary retention, among other symptoms. In extreme cases, central anticholinergic syndrome can be associated with seizures, coma, respiratory failure, and cardiovascular collapse.

OBJECTIVE

To provide scientific evidence regarding the efficacy and safety of physostigmine use in cases of anticholinergic toxicity.

METHODS

We conducted a comprehensive review of the published literature on the symptoms, diagnosis, and treatment of anticholinergic toxicity.

RESULTS

Currently the recommended treatment for olanzapine overdose, as is the case of most severe anticholinergic toxicity cases, involves supportive care, along with cardiac, neurological, and respiratory status monitoring. In addition, we detail the symptoms characteristic of anticholinergic toxicity, using the case of a patient experiencing central anticholinergic syndrome after an overdose with olanzapine.

CONCLUSION

Physostigmine, a tertiary acetylcholinesterase inhibitor, can be used to assist in the both the diagnosis and management of severe anticholinergic toxicity associated with an olanzapine overdose, which might be applicable to the antimuscarinic toxidrome associated with the ingestion of agents with significant anticholinergic activity.

All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis

BACKGROUND

There are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality.

OBJECTIVE

To synthesize the available information on all-cause mortality after a diagnosis of BCC or SCC in the general population.

METHODS

We searched PubMed (1966-present), Web of Science (1898-present), and Embase (1947-present) and hand-searched to identify additional records. All English articles that reported all-cause mortality in patients with BCC or SCC were eligible. We excluded case reports, case series, and studies in subpopulations of patients. Random effects model meta-analyses were performed separately for BCC and SCC.

RESULTS

The searches yielded 6538 articles, and 156 were assessed in a full-text review. Twelve studies met the inclusion criteria, and 4 were included in the meta-analysis (encompassing 464,230 patients with BCC and with 175,849 SCC), yielding summary relative mortalities of 0.92 (95% confidence interval, 0.83-1.02) in BCC and 1.25 (95% confidence interval, 1.17-1.32) in SCC.

LIMITATIONS

Only a minority of studies controlled for comorbidities. There was significant heterogeneity in meta-analysis (χ2P < .001, I2 > 98%), but studies of SCC were qualitatively concordant: all showed statistically significant increased relative mortality.

CONCLUSIONS

We found that patients with SCC are at higher risk for death from any cause compared with the general population.