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  1. Article ; Online: "And Then He Died".

    Yager, Joel

    JAMA

    2023  Volume 329, Issue 14, Page(s) 1151–1152

    MeSH term(s) Humans ; Death
    Language English
    Publishing date 2023-03-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2023.2678
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Psychosocial Exoskeletons: Normal Development, Psychopathological and Sociopathological Phenomena, and Therapeutic Applications.

    Yager, Joel

    The Journal of nervous and mental disease

    2022  Volume 211, Issue 2, Page(s) 83–87

    Abstract: Abstract: In medical therapeutics, exoskeleton refers to external protections, supports, and appliances. By analogy, psychosocial exoskeletons can be envisioned as assistive psychological and social structures that brace and extend individuals' coping ... ...

    Abstract Abstract: In medical therapeutics, exoskeleton refers to external protections, supports, and appliances. By analogy, psychosocial exoskeletons can be envisioned as assistive psychological and social structures that brace and extend individuals' coping abilities. This article considers the utility of defining "psychosocial exoskeletons" as a framework to encompass psychological and social devices that enhance coping, and "therapeutic psychosocial exoskeletons" as devices assisting psychiatric treatment. Clinical observations were augmented via selective narrative review using PubMed and PsychInfo.A range of psychological and social devices were identified that constitute psychosocial exoskeletons. In extremes, psychosocial exoskeletons may prescribe comprehensive lifestyles including dress, rites, taboos, and acceptable relationships. These devices may enhance normal or psychopathological development.Therapeutic psychosocial exoskeletons consist of intentionally prescribed psychotherapeutic and sociotherapeutic interventions assembled to address patient-centered problems. Elements may include counseling and psychotherapies, peer-based recovery programs, institutional programs, and social interventions involving financial assistance, supported employment, pets, and other practical resources.
    MeSH term(s) Humans ; Exoskeleton Device ; Psychotherapy ; Mental Disorders/therapy
    Language English
    Publishing date 2022-08-01
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 3020-x
    ISSN 1539-736X ; 0022-3018
    ISSN (online) 1539-736X
    ISSN 0022-3018
    DOI 10.1097/NMD.0000000000001565
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Sleepy Psychotherapists: How Clinicians' Biological Factors May Affect the Conduct of Psychotherapy.

    Yager, Joel

    American journal of psychotherapy

    2021  Volume 74, Issue 1, Page(s) 30–35

    Abstract: Objective: Numerous therapist variables and cognitive biases can affect the quality of the therapeutic alliance and the conduct and outcomes of psychotherapy. This article aims to examine factors that potentially affect clinician performance, including ... ...

    Abstract Objective: Numerous therapist variables and cognitive biases can affect the quality of the therapeutic alliance and the conduct and outcomes of psychotherapy. This article aims to examine factors that potentially affect clinician performance, including chronobiological variables of clinicians and patients.
    Methods: The author reviewed literature pertaining to biological influences on human cognitive performance and considered how these factors may apply to the practice of psychotherapy.
    Results: Biological factors potentially affecting the conduct and quality of psychotherapy were identified. These factors include decision fatigue, hunger, sleep deficit, shift work, and several chronobiological issues related to circadian rhythms and episodic ultradian rhythms. In addition, misaligned scheduling of psychotherapy sessions in relation to therapist and patient evening-morning chronotypes may impede the effectiveness of psychotherapy.
    Conclusions: The practice of psychotherapy is cognitively demanding, requiring that clinicians remain constantly alert and in command of their executive functions. Decreases in clinician alertness resulting from homeostatic depletion, chronobiologically misaligned schedules, and illness-associated factors may reduce the quality and benefit of psychotherapy sessions. Mitigation strategies are available. Investigations of these factors are needed.
    MeSH term(s) Biological Factors ; Circadian Rhythm ; Humans ; Psychotherapists ; Psychotherapy ; Sleepiness ; Therapeutic Alliance
    Chemical Substances Biological Factors
    Language English
    Publishing date 2021-03-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2950-6
    ISSN 0002-9564
    ISSN 0002-9564
    DOI 10.1176/appi.psychotherapy.20200030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: A Clinician's Guide to Polycultural Psychiatry.

    Yager, Joel

    Harvard review of psychiatry

    2021  Volume 29, Issue 2, Page(s) 159–168

    Abstract: Abstract: Patients and families each present unique microcultures, mixing and blending numerous broadly conceptualized cultural identity groups. Within individuals and families, cultural identities are experienced and enacted as complex matrices of ... ...

    Abstract Abstract: Patients and families each present unique microcultures, mixing and blending numerous broadly conceptualized cultural identity groups. Within individuals and families, cultural identities are experienced and enacted as complex matrices of intersecting identities that, to varying degrees, complement, assimilate, accommodate, or clash. In these patterns, individuals' relationships to cultures are not necessarily categorically distinct ("multicultural"). Instead, they are often "polycultural," defined as partial and plural; rather than interpreting different cultural traditions as separate and independent, they are, within the lives of individuals and families, better understood as systems that interact with and influence one another.Cultural identity groups extend beyond those traditionally considered by transcultural psychiatry-that is, beyond ethnic, racial, and language groups. They encompass (in alphabetical order) educational, ethnic, extended family, gender-oriented, generational, geographic, language and dialect, organizational, physical or psychiatric disability, political, professional, racial, religious, sect, social class, and vocational identity groups, among others. Simplistic assumptions and generalities about identity groups risk cultural stereotyping that may negatively bias clinical assessments. Therefore, practitioners striving for cultural sensitivity need to adopt nuanced strategies for approaching broad polycultural identity questions in clinical practice. Accordingly, this article suggests frameworks and strategies for (1) assessing and confronting one's own cultural preconceptions and prejudices, and (2) developing etic (objective quantitative data) and emic (insiders' experiential worldviews) perspectives pertinent to clinical anthropathology. Both etic and emic perspectives are necessary for polyculturally nuanced, respectful, comprehensive inquiries pertinent to patients' and family's health beliefs, psychiatric difficulties, and health practices. Supplementary material from the DSM-5 section on cultural formulation is adapted and discussed, along with the implications of polycultural psychiatry for education and training in psychiatry.
    MeSH term(s) Diagnostic and Statistical Manual of Mental Disorders ; Ethnic Groups ; Humans ; Psychiatry
    Language English
    Publishing date 2021-02-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1174775-4
    ISSN 1465-7309 ; 1067-3229
    ISSN (online) 1465-7309
    ISSN 1067-3229
    DOI 10.1097/HRP.0000000000000284
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Targeting 3 Tiers of Psychiatric Problems in Patient-focused Psychiatric Practice: Diagnostic Signs, Symptoms, and Impairments; Specific Complex Subjective Complaints; and Contributing Meta-problems.

    Yager, Joel

    Journal of psychiatric practice

    2021  Volume 27, Issue 6, Page(s) 472–477

    Abstract: Background: While contemporary psychiatric assessments ordinarily focus on signs, symptoms, and impairments comprising formal diagnoses, these assessments sometimes minimize or ignore specific complaints and other contributing problems that are the ... ...

    Abstract Background: While contemporary psychiatric assessments ordinarily focus on signs, symptoms, and impairments comprising formal diagnoses, these assessments sometimes minimize or ignore specific complaints and other contributing problems that are the sources of patients' and families' greatest distress. Neglect of these problems may decrease patient satisfaction and reduce the quality of care.
    Methods: The author reviewed limitations of previous problem-oriented efforts in psychiatry and limitations of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. This review provided the basis for reconceptualizing how problems might be identified and framed in clinical assessments.
    Results: A clinically practical 3-tier framework for psychiatric problems is suggested. The first tier encompasses diagnostic contents, including subjective symptoms, observable signs, and impairments. The second tier consists of additional specific complex subjective complaints in the patient's and family's own words, comprised of highly individualized distressing intrapsychic, interpersonal, and environmental situations and conflicts. The third tier consists of contributing meta-problems, comprised of significant additional patient-related or systems-related difficulties noted by clinicians that contribute substantially to complicated clinical problem sets.
    Conclusions: Diagnostic or not, specific problems expressed by patients and families and contributing meta-problems should be integrated into initial formulations and tracked during treatment. Whereas only some of these problems may fall within a clinician's scope of responsibilities, all should fall within the scope of concern, some to be referred to others, and some exceeding caregivers' capacities. Periodic review of problem lists for patients' and families' most distressing concerns can contribute to the therapeutic alliance, increase patient satisfaction, and perhaps improve outcomes.
    MeSH term(s) Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Patient Satisfaction ; Psychiatry
    Language English
    Publishing date 2021-11-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2022726-7
    ISSN 1538-1145 ; 1527-4160
    ISSN (online) 1538-1145
    ISSN 1527-4160
    DOI 10.1097/PRA.0000000000000583
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Addressing Suffering in Patients With Psychiatric Disorders.

    Yager, Joel

    The Journal of nervous and mental disease

    2021  Volume 209, Issue 9, Page(s) 615–621

    Abstract: Background: Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians' concerns, it is not even indexed in the Diagnostic ... ...

    Abstract Background: Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians' concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care.
    Methods: Sources for this article were obtained via a selective literature search in PubMed using the terms "suffering" in the title and the terms "psychiatric disorder," "mental illness," "assessment," "measurement," "scale," "existential suffering," and "unbearable suffering." Articles of interest were followed up using a snowball technique to examine "similar articles" and "cited by" titles to find additional pertinent articles.
    Results: Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders.
    Conclusions and implications: Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians' attention is limited to conventional psychiatric signs and symptoms.
    MeSH term(s) Grief ; Humans ; Mental Disorders/diagnosis ; Mental Disorders/physiopathology ; Mental Disorders/psychology ; Mental Disorders/therapy ; Psychological Distress
    Language English
    Publishing date 2021-04-12
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 3020-x
    ISSN 1539-736X ; 0022-3018
    ISSN (online) 1539-736X
    ISSN 0022-3018
    DOI 10.1097/NMD.0000000000001348
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Infective Messages: Definitions, Processes, and Implications for Trauma, Identities, Internal Conflicts, Psychotherapy, and Research.

    Yager, Joel

    The Journal of nervous and mental disease

    2021  Volume 209, Issue 7, Page(s) 474–480

    Abstract: Background: Throughout life, individuals are bombarded by countless emotion-generating messages. Certain of these messages, for example, some insults, admonitions, rejections, challenges, or insightful declarations, can be viewed as "infective." ... ...

    Abstract Background: Throughout life, individuals are bombarded by countless emotion-generating messages. Certain of these messages, for example, some insults, admonitions, rejections, challenges, or insightful declarations, can be viewed as "infective." Infective messages shock, puncture, adhere, disturb, and generate discernable host responses that assimilate, accommodate, or repel the intruding messages. Messages originating in one's own mind can stimulate psychological equivalents of autoimmune responses. Sometimes, these messages produce enduring psychological changes. Infective messages may traumatize, organize, or therapize. The aims of this article are to consider how infective messages a) relate to their messengers (vectors), structural characteristics, and recipient (host) factors; b) might contribute to trauma, personal identity formation, psychological conflicts, and emotional self-regulatory and cognitive heuristics; c) might inform the conduct of psychotherapy; and d) suggest future research.
    Methods: Clinical observations were augmented with selective literature reviews. These sources contributed to perspectives regarding how certain messages might become infective; contribute to trauma, complex aspects of identity formation, and inner conflict; and inform the conduct of psychotherapy.
    Results: Infective messages are commonly characterized by short, cogent communications emanating from credible sources that fall on vulnerable recipients' receptive, dispositional feeling states. These infective stimuli trigger reactive and defensive emotions and associated behaviors reflecting responses to significant threats or benefits relative to the individual's deepest needs, motivations, and values. Defensive overreactions may occur in response to messages to which individuals have been previously sensitized. Infective message contents appear to assimilate into constantly evolving, dynamic autobiographical brain maps consisting of highly specific neuronal networks that range from the brainstem through limbic structures to multiple cortical areas. Autobiographical maps built from message-injected contents may transform, akin to the incorporation of retroviruses or prions, to encode personal identities as aspects of the self. Contrasting maps may exist semi-independently of one another, continuously evolving, interacting, combining, dividing, conflicting, and contending with one another for attention. Achieving attentional awareness, such maps help structure how individuals conceptualize and communicate about their encoded traumas, diverse identities, and the conflicts among them.
    Conclusions and implications: During psychotherapy, aftereffects of traumatizing infective messages might be detoxified by deconstructing, desensitizing, and processing messages' precise words and emotional envelopes in relation to contexts in which they were delivered, and the individual's inner dispositions at moments of impact. Carefully crafted, timely interpretations can be therapeutically infective, generating enduring positive impacts. Future studies using an assortment of approaches can test these perspectives.
    MeSH term(s) Adolescent ; Adult ; Biomedical Research ; Child, Preschool ; Communication ; Conflict, Psychological ; Emotions/physiology ; Female ; Humans ; Male ; Personality/physiology ; Psychological Trauma/physiopathology ; Psychological Trauma/psychology ; Psychological Trauma/therapy ; Psychotherapy ; Self Concept ; Social Interaction
    Language English
    Publishing date 2021-03-26
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 3020-x
    ISSN 1539-736X ; 0022-3018
    ISSN (online) 1539-736X
    ISSN 0022-3018
    DOI 10.1097/NMD.0000000000001321
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Why Defend Harm Reduction for Severe and Enduring Eating Disorders? Who Wouldn't Want to Reduce Harms?

    Yager, Joel

    The American journal of bioethics : AJOB

    2021  Volume 21, Issue 7, Page(s) 57–59

    MeSH term(s) Feeding and Eating Disorders ; Harm Reduction ; Humans
    Language English
    Publishing date 2021-07-14
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2060433-6
    ISSN 1536-0075 ; 1526-5161
    ISSN (online) 1536-0075
    ISSN 1526-5161
    DOI 10.1080/15265161.2021.1926160
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Trends in Psychiatric Residency Education and Practice From 1944 to 2019: A Loving, Informal, and Highly Personal Review Served With Gently Roasted Sacred Cow.

    Yager, Joel

    Journal of psychiatric practice

    2020  Volume 26, Issue 6, Page(s) 493–502

    Abstract: In celebration of the American Psychiatric Association's 175th anniversary, the author presents an overview of major trends in psychiatric residency education over the past 75 years, from 1944 to 2019, using narrative review and personal perspectives ... ...

    Abstract In celebration of the American Psychiatric Association's 175th anniversary, the author presents an overview of major trends in psychiatric residency education over the past 75 years, from 1944 to 2019, using narrative review and personal perspectives infused with occasional irreverence. In both 1944 and today in 2020, psychiatric educators have been challenged by having too many patients, too few clinicians, too few teachers, and too little knowledge. Over the course of these years, psychiatric residency training has adapted and evolved in response to major ongoing shifts in psychiatric practice patterns shaped by economic, social, and cultural forces, academic regulations and processes, roles for psychiatry vis-à-vis other health and mental health professions, diagnostic and scientific models, psychotherapeutic, psychosocial, and biological treatment paradigms, methods of education, and methods of educational evaluation. Trends in psychiatric education have moved from loosely and irregularly structured clinical and didactic curricula to much more highly regulated and bureaucratized program requirements and processes, from faith-based beliefs and practices to increasing reliance on evidence-based faith, from the availability of Federal funds directly supporting stipends and teachers to the disappearance of those funds, from few to increasing numbers of women entering psychiatry (and all of medicine), and persistent concerns about recruiting excellent and diverse US medical school graduates into residency. Psychiatric educators will continue to help generate, synthesize, sustain, and disseminate meaningful narratives and to prepare future generations of psychiatric residents armed with iteratively better myths and conceptualizations about human nature, purpose, and our place in the universe-and about how to better confront and reduce psychiatric suffering through psychotherapeutic, psychosocial, and biological treatment strategies. Trends are onward and upward.
    MeSH term(s) Curriculum/trends ; Humans ; Internship and Residency/trends ; Psychiatry/education ; Psychiatry/trends ; United States
    Language English
    Publishing date 2020-12-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2022726-7
    ISSN 1538-1145 ; 1527-4160
    ISSN (online) 1538-1145
    ISSN 1527-4160
    DOI 10.1097/PRA.0000000000000503
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Can Trans-Syndromal Prototypes ("Types") Improve Depiction of Complex Psychiatric Cases?: An Alternative Way to Consider Concordant Comorbid Psychiatric Disorders and Their Contexts as Coherent Units for Research, Assessment, and Treatment Planning.

    Yager, Joel

    The Journal of nervous and mental disease

    2020  Volume 209, Issue 1, Page(s) 1–8

    Abstract: Background and aims: In many psychiatric settings, patients with complex cases are the rule rather than the exception. These cases are characterized by multidiagnostic conditions, often complicated with distressed social contexts, for which few if any ... ...

    Abstract Background and aims: In many psychiatric settings, patients with complex cases are the rule rather than the exception. These cases are characterized by multidiagnostic conditions, often complicated with distressed social contexts, for which few if any evidence-based practice guidelines exist. The aim of this hypothesis-generating article is to consider whether and how these cases might comprise trans-syndromal prototypes ("types"), coherent units that could serve as the basis for further study, assessment, and treatment planning.
    Methods: For context, psychiatric and medical visit diagnoses and problem lists noted among principle visit diagnoses and "snapshot" portions of electronic medical records were tabulated for 293 psychiatric outpatients seen consecutively during a 1-week period at a university psychiatric clinic. By considering resulting comorbidity patterns in these records from the perspectives of clinicians caring for these patients, several commonly encountered diagnostic-problem sets emerged as candidate types.
    Results: Of 293 patients, only 18% had a single diagnosis, 43% had two, 29% had three, and 7% had four or more noted. Occurring in assorted combinations, specific diagnostic areas noted included depressive disorders (68%, the large majority major depressive disorder recurrent), anxiety disorders (60%, the large majority generalized anxiety disorder, with or without panic disorder and/or social anxiety disorder), posttraumatic stress disorder (22%), attention deficit hyperactivity disorder (ADHD) (17%), alcohol and substance abuse disorders (16%), personality disorders (11%), and bipolar disorders (18%). Several illustrative candidate types emerging from this population are described including major anxious depressive disorder, anxiety disorder secondary to ADHD, complex emotional instability disorder, multi-impulsive eating disorder, substance-dependent impoverished personality disorder, painful mood disorder, and complex personal and cultural trauma disorder. Other potential types are identified as well.
    Conclusions and implications: The types described here are but a small selection, because other settings including community mental health centers, private practices, public and private hospitals, and forensic facilities see a variety of other types as well. The study of types might provide important findings about pathogenesis, course, outcome, and treatment to augment information obtained from examination of individual diagnostic components.
    MeSH term(s) Adolescent ; Adult ; Anxiety Disorders/psychology ; Attention Deficit Disorder with Hyperactivity/psychology ; Biomedical Research ; Bipolar Disorder/psychology ; Comorbidity ; Depressive Disorder/psychology ; Diagnosis, Dual (Psychiatry) ; Female ; Humans ; Male ; Mental Disorders/classification ; Mental Disorders/diagnosis ; Mental Disorders/psychology ; Mental Disorders/therapy ; Middle Aged ; Patient Care Planning ; Personality Disorders/psychology ; Stress Disorders, Post-Traumatic/psychology ; Substance-Related Disorders/psychology ; Young Adult
    Language English
    Publishing date 2020-11-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3020-x
    ISSN 1539-736X ; 0022-3018
    ISSN (online) 1539-736X
    ISSN 0022-3018
    DOI 10.1097/NMD.0000000000001261
    Database MEDical Literature Analysis and Retrieval System OnLINE

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