Andrew Molodynski

University of Oxford | OX · Department of Psychiatry

Un número significativo de personas en Chile, probablemente millones, viven con un trastorno psiquiátrico diagnosticable de acuerdo con los criterios de la OMS. Es un derecho humano el que dichas personas accedan a tratamientos efectivos, basados en la evidencia, y proporcionados con respeto y compasión, especialmente dado que Chile es considerado...

Medical students are the medical workforce of the future responsible for population and individual health. They are also at a vulnerable age when they are likely to develop psychiatric disorders. The present volume presents research findings on the rates of burnout in medical students from around the world. With rapid advances in medicine pressures...

Previous research has repeatedly shown poor mental health, high rates of substance misuse, and burnout in medical students across many countries. The annual World Happiness Report provides insight into how “happy” countries are and how happiness is measured. Our review aims to identify whether whole population “happiness” across different countries...

Background:Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale. Aims:We aimed to develo...

Social psychiatry is a discipline that focuses on the social dimension of mental health, mental illness, and mental healthcare. It uses concepts and methods of biological and social sciences, including sociology, psychology, and anthropology, to investigate social factors influencing and relevant to occurrence, expression, course, and care of menta...

Social psychiatry is a discipline that focuses on the social dimension of mental health, mental illness, and mental healthcare. It uses concepts and methods of biological and social sciences, including sociology, psychology, and anthropology, to investigate social factors influencing and relevant to occurrence, expression, course, and care of menta...

Background Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale.AimsWe aimed to develop...

Background: Medical students tend to experience high levels of stress during their studies, that can result in mental health disorders and burnout, further affecting academic performance and later ability to practice. Aims: To investigate previous and current mental health issues, significant sources of stress, burnout, and substance use among medi...

Background In recent years there has been significant coverage of mental health in Indian newspapers; the media can play a significant role in perpetuating as well as reducing stigma towards people with mental illness. This paper analyses the content, context and type of newspaper coverage of various mental health disorders in English language news...

Background Medical students are under high pressure to perform academically and also face the impact of the COVID-19 pandemic, putting them at risk of developing burnout. Aims This study aims to evaluate the prevalence and degree of burnout among medical students in Indonesia during 1 month of the COVID-19 pandemic. Methods From April to May 2021...

The use of unmodified electroconvulsive therapy (ECT), i.e., ECT without general anesthesia, vis-a-vis human rights of mental health patients and standards of care, is discussed. An overview of unmodified ECT is provided, followed by an account of recent events in Chile, where the Minister of Health referred the administration of unmodified ECT to...

Background and hypothesis A plausible cause of distress for voice hearers is listening to and believing the threats and criticisms heard. Qualitative research indicates that patients have understandable reasons to listen. This study aimed to develop the understanding of distress using this listening and believing framework. Measures were developed...

Human beings are social animals, and social psychiatry is a key discipline within psychiatry around the world. The impact of social factors on the genesis and perpetuation of mental illnesses and maintenance of well-being of individuals and families is well recognized. Exploring social factors is the key to understanding aetiology and developing th...

Human beings are social animals, and social psychiatry is a key discipline within psychiatry around the world. The impact of social factors on the genesis and perpetuation of mental illnesses and maintenance of well-being of individuals and families is well recognized. Exploring social factors is the key to understanding aetiology and developing th...

Criminal sanctions including court orders, prosecution and imprisonment persist as responses to suicidality in the UK even where there is no public danger. Their prevalence, the level of clinical involvement and outcomes are unclear. There is an urgent need to examine the national picture of harms, benefits and the responsibilities of mental health...

Medicine (like many others) can be an extremely stressful profession. The pressures faced by clinicians are often related to ‘life and death’ situations that can lead to high levels of stress and distress. Students and trainees in a variety of allied health professions face similar pressures related to study or work environments. The practice of me...

Background Medical students are prone to experience high levels of stress during their studies, which can lead to burnout and mental health disorders such as anxiety and depression, that can affect their academic performance and ability to practice. We therefore conducted an online survey to collect data on demographics, sources of stress, mental h...

Background Many with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatme...

Background: Medical students in Denmark undertake a demanding 6-year course which is generally during a critical age for the development of psychiatric disorder and harmful substance or alcohol use behaviours. Previous literature has highlighted significant rates of distress in Danish students. Aims: We surveyed medical students in Denmark to be...

Background: Many with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatm...

Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential m...

Background Medical students in India face multiple challenges and sources of stress during their training. No nationally representative survey has yet been undertaken. We undertook a cross-sectional national survey to assess substance use, psychological well-being, and burnout using CAGE, Oldenburg Burnout Inventory (OLBI), and the short General He...

Background Mental health problems among medical students are highly prevalent internationally. There have been very few studies however in Nepal. This study aimed to assess the frequency of mental health problems and burnout in Nepalese medical students. Results A total of 169 students responded to the questionnaire. Half (50%) of the surveyed stu...

Background Despite the general interest of researchers around the world, there are few studies on the psychological wellbeing and burnout among medical students in Russia. The aim of this study was to perform screening for minor psychiatric disorders, burnout, problematic alcohol use, and quantify the psychological issues and stress among a sample...

Abstract Background: Increasing attention is being paid to medical students’ mental wellbeing globally due in part to their exposure to stressors inherent in medical education and the numerous reports of elevated rates of mental health conditions in this population. Aims: This study aimed to identify stressors and determine prevalence rates of psyc...

Background The COVID-19 pandemic continues to be one of the greatest public health challenges faced by the UK. Reported rates of psychiatric difficulties have increased and the mechanisms by which the pandemic has affected mental health requires investigation. Aims The aim of the study was to understand the psychological impact of the COVID-19 pan...

Background Medical students face high pressures to perform academically, which may lead to poor psychological well-being, burnout, and even mental illness. Aims This study aims to evaluate the mental health, degree of burnout and substance misuse among medical students in Indonesia in order to to build a system that supports the prosperity of futu...

Research There is abundant data revealing that there is significant rate of rates of Psychiatric morbidity, psychological stress, and burnout in the medical student population. A core study group in the UK collaborated with 12 countries around the world to review medical student wellness. In this context we surveyed 101 medical students at the Cumm...

Background Our previous research found very high levels of burnout and mental health problems among medical students across Indonesia, in line with rates in many other countries. This study further analyses the data by comparing six different regions of Indonesia to determine any differences between them on such measures and to look for possible ex...

Aim Surgical trainees deal with long hours and stressful work content. We aimed to assess the burnout levels in London trainees, and trial a mindfulness intervention. Method London core surgical trainees (CST1) were asked to complete an online survey including validated burnout scoring system (Oldenburg Inventory). 54 of a possible 78 trainees res...

The unprecedented SARS-2 COVID-19 pandemic has had a profound impact on individuals, families, and societies worldwide. The impact of the illness does not only directly relate to poor health on infection but also social and political determinants of health. As such, the secondary effects of the pandemic have been profound. Mental health and well-be...

Background The psychological wellbeing and stresses on medical students are currently under a global spotlight. Under a wider initiative supported by the British Medical Association (BMA), international surveys have been conducted to understand and begin to tackle these issues. Method This study aimed at describing the mental wellbeing and levels...

There is no doubt that practice of medicine is an extremely stressful profession. Not surprisingly, training and education in medicine also creates a degree of pressure. In the past 50 years, more attention is being paid to the mental health and well-being of doctors. However, recently focus has shifted to the mental health and well-being of medica...

Background: Studies from around the world have shown higher rates of anxiety, depression, alcohol and other drug use, and burnout in medical students. Aims: The aim of this study was to identify the socio-demographic factors and severity of difficulties Sri Lankan medical students face regarding psychological wellbeing and burnout. Method: This o...

Much attention has been focused on the well-being of health-care staff and more recently medical students. This small-scale study formed a part of a major international initiative and used standardized measures of health, substance misuse, and burnout. We found high levels of stress from several key sources alongside the rates of 80% and 83% for th...

Background Dissociative experiences occur across a range of mental health disorders. However, the term ‘dissociation’ has long been argued to lack conceptual clarity and may describe several distinct phenomena. We therefore aimed to conceptualise and empirically establish a discrete subset of dissociative experiences and develop a corresponding ass...

Background Catastrophic cognitive appraisals, similar to those in anxiety disorders, are implicated in depersonalisation, a form of dissociation. No scales exist to measure appraisals of dissociative experiences. Dissociation is common in psychosis. Misinterpretations of dissociative experiences may maintain psychotic symptoms. Therefore, assessing...

Background A cognitive account identifies six key psychological maintenance factors for persecutory delusions. However, a complex system of causation is likely where these factors interact in their influence on paranoid ideas. We set out to evaluate the causal dynamics of paranoia with theory-driven network approaches. Methods 1809 patients with n...

World Association of Social Psychiatry (WASP) "WASP Position Statement on the Coronavirus Disease (COVID-19) Pandemic" WASP Executive Committee 15 April 2020 WASP Website: https://waspsocialpsychiatry.org/wp-content/uploads/2020/04/WASP-Position-Statement-COVID-19.pdf

High levels of stress, burnout, and symptoms of poor mental health have been well known among practicing doctors for a number of years. Indeed, many health systems have formal and informal mechanisms to offer support and treatment where needed, though this varies tremendously across cultures. There is increasing evidence that current medical studen...

Recent years have seen a surge in interest in mental healthcare and some reduction in stigma. Partly as a result of this, alongside a growing population and higher levels of societal distress, many more people are presenting with mental health needs, often in crisis. Systems that date back to the beginning of the National Health Service still form...

Removing criminal penalties for possession could increase adolescent use, say Bobby P Smyth, Mary Cannon, and Andrew Molodynski. But H Valerie Curran, Niamh Eastwood, and Adam R Winstock find no evidence for this and say that liberalisation of drug laws could reduce harms.

Background The Green et al ., Paranoid Thoughts Scale (GPTS) – comprising two 16-item scales assessing ideas of reference (Part A) and ideas of persecution (Part B) – was developed over a decade ago. Our aim was to conduct the first large-scale psychometric evaluation. Methods In total, 10 551 individuals provided GPTS data. Four hundred and twent...

Medical students in India completed an anonymous online questionnaire regarding mental health and wellbeing, including Oldenburg burnout ratings, CAGE questionnaires, and general health questionnaire (GHQ12). Out of 597 student responses, over 80% were characterised as experiencing burnout. This study highlights the need to further examine this iss...

Medical students are thought to have increased pressures in study life beyond that of their peers. This could impact their psychological wellbeing, burnout and substance use, impeding a smooth transition into the health workforce. A cross-sectional electronic survey of one of New Zealand’s two medical schools was undertaken, and students in all yea...

The wellbeing of doctors in training is currently under the spotlight. The British Medical Association (BMA) has committed to understanding issues of wellbeing amongst medical students. Medical students from England were asked to complete an online survey pertaining to wellbeing. 84 students responded. Results show 29% of respondents were given a m...

Medical students are a known high-risk group for mental health issues. This study aimed to survey the psychological well-being of medical students from Hong Kong, a known stressful city. This study is part of a wider effort to compare the psychological well-being of medical students world-wide. We invited medical students from Hong Kong to complete...

In studies around the world, medical students have been identified as being at high risk for poor mental wellbeing, burnout and mental ill health. This can lead on to poorer physical health, substance misuse and reduced academic performance. We surveyed Portuguese medical students to assess burnout (using the Oldenburg Burnout Inventory, OLBI), min...

Medical students’ wellbeing and mental health requires nurturing in order for them to build success in their careers, help people while doing so, and to be happy. To better characterise the current state of wellbeing in medical schools in Wales, medical students from Cardiff and Swansea Universities were asked to complete an online survey as part o...

Medical students are tomorrow’s healthcare professionals (HCPs), and their role in the design and delivery of healthcare in the future is crucial. Following an invitation to participate in a global call on mental health and wellbeing among medical students, it was decided to include Moroccan medical students based in the Faculty of Medicine and Pha...

In line with studies from around the world, several studies have shown equal or higher rates of anxiety, depression, alcohol and other drug use, and burnout in medical students in Brazil. The aim of the present study was to identify difficulties Brazilian medical students face regarding stressors, psychological distress, and psychiatric morbidity u...

Objectives: The Convention on the Rights of Persons with Disabilities (CRPD) was adopted at the United Nations Assembly in 2006. The main aim of the convention is to ensure equal rights for people with disabilities including the expression of people’s own “will and preferences” concerning health treatment. Article 12 demands the respect of a person...

Across the globe medical students are experiencing high levels of depression, anxiety, and psychological distress. This can ultimately lead to poor academic performance, substance misuse and/or concerns over clinical practice and fitness to practice. We surveyed Jordanian medical students to assess burnout (using the Oldenburg Burnout Inventory, OL...

Medical students (MSs) are an important part of the workforce for delivery of tomorrow’s healthcare. Their ever changing knowledge base and long periods of training may significantly affect their mental health and wellbeing over the years. Following a global call for participation, it was decided to include Italian medical schools based in the Univ...

Doctors and medical students are working in a system which is affecting their mental wellbeing and their ability to provide the best possible care for patients. The British Medical Association conducted an online survey of doctors and medical students in October 2018. In total, 4347 responses were received and analysed. Doctors working the longest...

Background: Treatment approaches for patients with psychosis need major improvement. Our approach to improvement is twofold: target putative causal mechanisms for psychotic experiences that are treatable and also that patients wish treated. This leads to greater treatment engagement and clinical benefit. To inform mental health service provision w...

Objective: The triple bottom line (TBL) of sustainability is an important emerging conceptual framework which considers the combined economic, environmental and social impacts of an activity. Despite its clear relevance to the healthcare context, it has not yet been applied to the evaluation of a healthcare intervention. The aim of this study was...

Inpatient care varies enormously, both between countries and regions and within them. These variations are most stark when based on economic factors, but stigma, prevailing societal attitudes, and the role of the family also play a significant part in the amount and quality of mental health care overall. This chapter begins by outlining global econ...

Aims and method Street triage services are now common but the population they serve is poorly understood. We aimed to evaluate a local service to determine the characteristics of those using it and their outcomes in the 90 day period following contact. Results We found that there were high levels of service use and that the vast majority of contac...

Out‐of‐area placements (OAPs) are heavily relied upon by the NHS to meet growing demand but they are expensive, disruptive for patients, and may reduce quality of care and outcomes for patients. Here, the authors compared 50 patients who used acute OAPs with 50 patients admitted to an acute bed locally as regards length of stay, readmission rates,...

Purpose: Substance use disorders (SUD) are an important health issue internationally. Traditional outpatient programmes often do not adequately address the substantial medical and social needs and in addition many patients have difficulties accessing the care needed. The assertive community treatment (ACT) model was originally developed for patien...

Aims and method Street triage services are increasingly common and part of standard responses to mental health crises in the community, but little is understood about them. We conducted a national survey of mental health trusts to gather detailed information regarding street triage services alongside a survey of Thames Valley police officers to asc...

Background: Police mental health street triage is an increasingly common intervention when dealing with police incidents in which there is a suspected mental health component. We conducted a systematic review of street triage interventions with three aims. First, to identify papers reporting on models of co-response police mental health street tri...

Issues of patient care, freedom and restraint have accompanied the history of psychiatry since its inception. Similarly, its role as an actor in social control has constantly evolved according to place and time. But what about today? Since 2006, the UN and WHO have published three major documents in the field of patients' rights in psychiatry. The...

St Lucia is a small island in the eastern Caribbean with a population of approximately 200 000 people. Although St Lucia is formally ranked as a high middle-income country, there are pockets of deprivation and relatively low living standards. Mental health services in St Lucia have increased considerably and advanced over recent years because of a...

Recent reports have highlighted human rights concerns in Ugandan mental healthcare. This article describes the current situation in terms of healthcare funding and provision, concerns regarding legislation, and health inequalities. Possible reasons for the difficult situation are briefly discussed, including the economy, pervasive stigma and ongoin...

The purpose of this study was to investigate East-West cultural attitudes of mental healthcare professionals (MHPs) towards Involuntary Treatment Orders (ITOs) among Taiwan, England, Wales, and New Zealand. Data on Taiwanese MHPs' views of ITO regime were collected from the National Psychiatric Disease Mandatory Assessment and Community Care Review...

There is established evidence that discrepancy rates in referral thresholds from GPs to secondary care services as high as 10-fold exist between individual GPs. Andrew Molodynski et al looked systematically at the amount and quality of referrals to the secondary care team in order to identify any issues and develop support for referrers to make the...

Coercion remains a dominant theme in mental healthcare and a source of major concern. While the presence of coercion is ubiquitous internationally, it varies significantly in nature and degree in different countries and is influenced by a variety of factors. Recent reports have raised concerns about physical restraint and the increasing use of legi...

Coercion in mental healthcare: different perspectives, similar concerns and a united call for action - Volume 14 Issue 3 - Andrew Molodynski

Background Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, person...

Community Treatment Orders (CTO) have been available for several decades in some countries and are being progressively introduced worldwide, with significant uptake in Asian countries as they move more mental health care into the community. However the evidence for the effectiveness of CTOs is limited. The evidence from local audits and evaluations...

Background: Stigmatizing references to schizophrenia have a negative impact on self-esteem, deter treatment seeking and diminish the effectiveness of treatment. Aims: To analyze the reporting of schizophrenia in Portuguese newspapers. Method: We analyzed five high circulation Portuguese newspapers between 2007 and 2013. We selected all news contain...

The use of coercion is one of the defining issues of mental health care. Since the earliest attempts to contain and treat the mentally ill, power imbalances have been evident and a cause of controversy. There has always been a delicate balance between respecting autonomy and ensuring that those who most need treatment and support are provided with...

Research is critical in advancing health care and improving outcomes for patients. The NHS constitution1 pledges to inform patients of research that they may be eligible to participate in. However, this often does not occur and can be particularly challenging in mental health services, with a number of barriers causing difficulties. Here the author...

Aims and method Community treatment orders (CTOs) are increasingly embedded into UK practice and their use continues to rise. However, they remain highly controversial. We surveyed psychiatrists to establish their experiences and current opinions of using CTOs and to compare findings with our previous survey conducted in 2010. Results The opinions...

The autonomy preference index scale (API) has been designed to measure patient preference for 2 dimensions of autonomy: Their desire to take part in making medical decisions (decision making, [DM]) and their desire to be informed about their illness and the treatment (information seeking; [IS]). The DM dimension is measured by 6 general items toget...