Objective:To determine prevalence and predictors of depression among emergency department (ED) patients.Method: For 1 week in November 2003, consecutive adult patients presenting to an urban ED from 8:00 a.m. to midnight were screened for a DSM-IV major depressive episode using the Harvard Department of Psychiatry National Depression Screening Day Scale. Patients who were severely ill or who had altered mental status were excluded. Demographic factors, psychiatric history, and brief medical history also were assessed.Results: Of 182 patients enrolled, 57 (32%, 95% CI = 25 to 39) screened positive for depression, which was much greater than general community estimates (6.6%, p < .0001). Depression was more likely (p < .001) in patients with a psychiatric history (61% vs. 22%), substance abuse history (65% vs. 30%), or a suicide attempt (67% vs. 30%). Eleven percent (95% CI = 7 to 17) of subjects endorsed suicidal ideation at least "some of the time."Limitations: This sample underrepresented severely ill, acutely distressed, or cognitively disabled patients. The most likely effect of these exclusion criteria was to yield an underestimate of depression. Also, the ED was located in a northeastern, urban city, which may not represent the rest of the country. Finally, we used a screening instrument without established operating characteristics within the ED setting.Conclusion: Although findings suggest that depression is common, it is often ignored in the ED setting. Recent efforts to increase awareness of depression in outpatient medical settings may be warranted in EDs as well.(Prim Care Companion J Clin Psychiatry 2006;8:66-70)

In May 2020, the Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released its final report and recommendations. These recommendations pertain to away rotations, virtual interviews, Electronic Residency Application Service opening for programs and the overall residency timeline, and general communications and attempt to provide clarity and level the playing field during the 2020–2021 residency application cycle. The WG’s aims include promoting professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The authors argue the first 3 WG recommendations may disproportionately impact candidates from historically excluded and underrepresented groups in medicine (HEURGMs) and may affect an institution’s ability to ensure equity in the selection of residency applicants and, thus, warrant further consideration. The authors examine these recommendations from a diversity, equity, and inclusion (DEI) perspective. For each of the first 3 WG recommendations, the authors highlight new opportunities created by the recommendations and detail challenges that programs must carefully navigate to ensure equity for all candidates. The authors also recommend solutions to guide programs as they address these challenges, meet new common program requirements, and attempt to promote equity for HEURGMs. Finally, the authors recommend that after the 2020–2021 recruitment cycle, the medical education community evaluate DEI-related outcomes of both the WG’s and the authors’ recommendations and incorporate the findings into future application cycles.

There is a renewed interest in teaching and cultivating compassionate patient-centered care among trainees and faculty. Much of the erosion in medical professionalism can be attributed to what has been labeled the "Hidden Curriculum." We have identified eight archetypal areas where the Hidden Curriculum exerts influence on trainees and faculty. These include: Lack of Accountability to Patients, The Influence of Legal Phobia, Physician and Nursing Overload (how documentation and busy work detracts from patient-centered care), Negative Attitudes and Apathy from Teachers, The Influence of the Electronic Health Record (EHR) in Patient Depersonalization, The Negative Effect of "Work-Life" Balance, The Concept of the "Difficult Patient," and the Negative impact of Evidence-Based Medicine on a Patient-Centered Approach. We believe that we need to focus and assess the residents and faculty's knowledge and attitudes towards the Hidden Curriculum. We believe that reflective learning can enhance professionalism, humanism and compassionate patient-centered care. Reflective learning with specific focus on hidden curriculum can also contribute to the continuous improvement of care in our complex health care environment. In addition interprofessional seminars debating impact of Hidden Curriculum can increase awareness among health professionals on the hidden curriculum in daily practice and education.

For the first time in US history, first-year female medical school matriculants (50.7%) outnumbered men (49.3%) in 2017 [1]. Moreover, in 2019, women accounted for 50.5% of all medical students for the first time [1]. Yet, female faculty continue to be underrepresented at the highest rankings in academic medicine as a whole and in psychiatry [2, 3]. Women represent only 26% and 32% of full professors among all medical faculty and psychiatry faculty, respectively, with a majority identified as White [3]. Structural racism, gender bias, and discrimination, along with the lack of systematic strategies that aim to achieve gender and racial equity, result in persistent achievement and promotion disparities among students, residents, and faculty, especially among those who are underrepresented in medicine [4,5].We will review the barriers women face advancing their careers in academic medicine in general, and academic psychiatry in particular, with specific attention paid to inequities for Black, Indigenous, and People of Color (BIPOC) women and especially underrepresented in medicine (URM) women compared to White women based on race/ethnicity. We will also consider the intersecting impact of sexual orientation and gender identities on women. Although there is a substantial body of research on academic medical career progression for

Obsessive compulsive disorder (OCD) is a highly heterogeneous disorder, presenting with a wide array of symptoms. Sometimes, OCD can appear to be psychotic in nature, with periods of loss of insight or the emergence of paranoid ideas. Likewise, individuals with schizophrenia spectrum disorders (SSDs), including schizophrenia or schizo-affective disorder, can have obsessive-compulsive or "obsessive-compulsive like" symptoms. The complexities of differentiating obsessive-compulsive symptoms from true psychotic symptoms have been recognized in adults. However, in the child and adolescent OCD literature, this has just begun to be explored. In children, limited insight regarding their obsessions and compulsions often makes it more difficult to differentiate OCD from psychotic disorders, including schizophrenia. This report describes 2 adolescents who were initially diagnosed with "difficult-to-treat" SSDs, leading to the use of third-line antipsychotic treatments such as clozapine. Once the core symptoms were recognized as obsessions and compulsions, and appropriately treated, the apparent "psychosis" resolved and did not return over extended follow up. Awareness of the possibility of OCD presenting as if it were a schizophrenia spectrum disorder can facilitate proper diagnosis and treatment.

Despite increasing faculty development efforts in psychiatry departments and institutions, real and significant unmet faculty development needs remain. Protected time remains a significant unmet need of teaching faculty which requires careful attention by departmental leadership.

Objective: We sought to derive preliminary estimates of the prevalence of bipolar disorder among a sample of emergency department (ED) patients.Method: For 1 week in November 2003, consecutive patients aged ≥ 18 years presenting to an urban ED between 8:00 a.m. and midnight were screened for bipolar disorder. We used the National Depression Screening Day protocol, which includes the Mood Disorder Questionnaire. Patients who were severely ill or who had altered mental status were excluded. Demographic factors, past mental health history, and medical history also were assessed.Results: Of the 212 patients that were approached and eligible, 182 (86%) were enrolled. Our sample's point prevalence for positive screen for bipolar disorder was 6.6% (95% CI = 3.5% to 11.2%).Conclusion: Nearly 7% of ED patients screened positive for bipolar disorder, which is considerably higher than community estimates of 1.3%. Further prospective research on bipolar disorders among ED patients is needed to further define the scope of the problem and to inform the development of appropriate screening, assessment, and intervention programs.

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