Dualism and the ‘difficult patient’: why integrating neuroscience matters

2020 ◽  
Vol 26 (6) ◽  
pp. 327-330
Author(s):  
Andrew M. Novick ◽  
David A. Ross
Keyword(s):  
Psychiatric Illness ◽  
Medical Model ◽  
Disease Process ◽  
Difficult Patient ◽  
Unique Challenge ◽  
Psychiatric Illnesses ◽  
False Dichotomy ◽  
Traditional Medical Model ◽  
Behavioural Aspects

SUMMARYPatients with psychiatric illness present a unique challenge to clinicians: in contrast to the traditional medical model, in which patients are conceptualised as being stricken by a disease, patients with certain psychiatric illnesses may seem complicit in the illness. Questions of free will, choice and the role of the physician can cause clinicians to feel helpless, disinterested or even resentful. These tensions are a lasting legacy of centuries of mind–body dualism. Over the past several decades, modern tools have finally allowed us to break down this false dichotomy. Integrating a modern neuroscience perspective into practice allows clinicians to conceptualise individuals with psychiatric illness in a way that promotes empathy and enhances patient care. Specifically, a strong grasp of neuroscience prevents clinicians from falling into the trap in which behavioural aspects of a patient's presentation are perceived as being separate from the disease process. We demonstrate the value of incorporating neuroscience into a biopsychosocial formulation through the example of a ‘difficult patient’.

scholarly journals Beyond Broca’s area

2019 ◽  
Vol 98 (4) ◽  
pp. 238-240
Author(s):  
David A. Ross ◽  
Andrew M. Novick
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Patient Care ◽  
Psychiatric Illness ◽  
Psychiatric Patients ◽  
Difficult Patient ◽  
Unique Challenge ◽  
Psychiatric Illnesses ◽  
Future Physician

Patients with psychiatric illness often present a unique challenge to medical students: in contrast to some medical conditions, in which patients may seem to be stricken by a disease, patients with certain psychiatric illnesses may seem complicit with the illness. Questions of free will, choice, and the role of the physician can quickly become overwhelming. This may result in students feeling helpless, disinterested, or even resentful. Here we argue that integrating a modern neuroscience perspective into medical education allows students to conceptualize psychiatric patients in a way that promotes empathy and enhances patient care. Specifically, a strong grasp of neuroscience prevents the future physician from falling into dualistic thinking in which the psychosocial aspects of a patient’s presentation are considered beyond the realm of medicine. The value of incorporating neuroscience into a full, biopsychosocial formulation is demonstrated with the case example of a “difficult patient.”

New Zealand Drinking Habits and Treatment of Probationers WHO Abuse Alcohol

1978 ◽  
Vol 11 (3) ◽  
pp. 148-155 ◽  
Author(s):  
Robert A Brown
Keyword(s):  
New Zealand ◽  
Short Circuit ◽  
Medical Model ◽  
Disease Process ◽  
Training Programme ◽  
Alcohol Abusers ◽  
Cultural Attitudes ◽  
Drinking Habits ◽  
Controlled Drinking ◽  
Traditional Medical Model

The importance of drinking in New Zealand and the ambivalent cultural attitudes towards the use of alcohol are outlined. Although the cost to society is most dramatically illustrated by those who suffer the ravages of alcoholism with its poor prognosis, a case is made for identifying and providing treatment at an earlier stage to other groups of suspected alcohol abusers. The second part of the paper describes a controlled drinking training programme being established by the author for probationers whose offending involved drinking. By providing community-based treatment for these inappropriate drinkers it is hoped to short circuit the sequence of institutionalization, labelling, and subsequent social rejection (Blizzard, 1971) which appear to be central in the development of the alcoholic's selffulfilling prophecy of “one drink, then drunk”. By shaping up controlled drinking as a social skill, the avoidance conditioning paradigm outiined here fulfils the “constructional” approach to problem behaviours advocated by Coldiamond (1974). This contrasts with the traditional medical model which entails abstinence, but at the same time removes responsibility for drinking from the alcohol abuser by endowing him with a disease process which is progressive and irreversible.

scholarly journals Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies

2019 ◽  
Vol 17 (1) ◽  
pp. 280 ◽  
Author(s):  
Zhisong Zhang ◽  
Kaising Sun ◽  
Chonnakarn Jatchavala ◽  
John Koh ◽  
Yimian Chia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psychiatric Illness ◽  
Web Of Science ◽  
Psychiatric Patients ◽  
Scientific Evidence ◽  
Mental Illnesses ◽  
Systemic Review ◽  
Official Language ◽  
Psychiatric Illnesses

Background: In psychiatry, stigma is an attitude of disapproval towards people with mental illnesses. Psychiatric disorders are common in Asia but some Asians receive inadequate treatment. Previous review found that Asians with mental illness were perceived to be dangerous and aggressive. There is a need for renewed efforts to understand stigma and strategies which can effectively reduce stigma in specific Asian societies. The objective of this systematic review was to provide an up-to-date overview of existing research and status on stigma experienced by psychiatric patients and anti-stigma campaigns in China, Hong Kong, Japan, Singapore, Korea, and Thailand. Methods: A systematic literature search was conducted in the following databases, including PubMed, PsycINFO, Embase, Web of Science, and local databases. Studies published in English and the official language of included countries/territories were considered for inclusion in the systematic review. Any article on stigma related to any form of psychiatric illness in the six Asian societies was included. Results: One hundred and twenty-three articles were included for this systematic review. This review has six major findings. Firstly, Asians with mental illnesses were considered as dangerous and aggressive, especially patients suffering from schizophrenia and bipolar disorder; second, psychiatric illnesses in Asian societies were less socially-acceptable and were viewed as being personal weaknesses; third, stigma experienced by family members was pervasive and this is known as family stigma; fourth, this systemic review reported more initiatives to handle stigma in Asian societies than a decade ago; fifth, there have been initiatives to treat psychiatric patients in the community; and sixth, the role of supernatural and religious approaches to psychiatric illness was not prevailing. Conclusion: This systematic review provides an overview of the available scientific evidence that points to areas of needed intervention to reduce and ultimately eliminate inequities in mental health in Asia.

Velcro on the Slippery Slope: The Role of Psychiatry in Active Voluntary Euthanasia

1995 ◽  
Vol 29 (4) ◽  
pp. 580-585 ◽  
Author(s):  
Christopher James Ryan
Keyword(s):  
Psychiatric Illness ◽  
Terminally Ill ◽  
Slippery Slope ◽  
Voluntary Euthanasia ◽  
Psychiatric Illnesses ◽  
The Poor ◽  
Slippery Slope Argument ◽  
Affected Person ◽  
The Right

Objective: The aim of the paper is to determine the role that psychiatrists should play in legislation that establishes a right to active voluntary euthanasia (AVE). Method: One version of the “slippery slope” argument, usually invoked against the legalisation of AVE, is recast as an argument for the introduction of strong safeguards in any future AVE legislation. The literature surrounding the prevalence of psychiatric illnesses in the terminally ill, physicians' ability to identify such illnesses and the aetiology of suicide in the terminally ill is examined. Results: The strength of the slippery slope argument, combined with the poor ability of general physicians to diagnose psychiatric illness in the terminally ill, demands that any legislation allowing AVE should require a mandatory psychiatric review of the patient requesting euthanasia. Conclusions: Any legislation adopted that establishes a right to active voluntary euthanasia should include a mandatory psychiatric review of the person requesting euthanasia and a cooling off period before the request is acceded to. In addition, the discovery of a serious mental illness ought to disqualify the affected person from the right to AVE until that illness resolves.

Servicing the Senior Swallow: A Family-Centered Private Practice Model of Service Delivery

2020 ◽  
pp. 1-4 ◽  
Author(s):  
Yvette M. McCoy
Keyword(s):  
Older Adults ◽  
Medical Model ◽  
Recovery Process ◽  
Swallowing Disorders ◽  
Current Evidence ◽  
Care Needs ◽  
Skilled Nursing ◽  
Person Centered Care ◽  
Centered Care ◽  
Traditional Medical Model

Purpose Person-centered care shifts the focus of treatment away from the traditional medical model and moves toward personal choice and autonomy for people receiving health services. Older adults remain a priority for person-centered care because they are more likely to have complex care needs than younger individuals. Even more specifically, the assessment and treatment of swallowing disorders are often thought of in terms of setting-specific (i.e., acute care, skilled nursing, home health, etc.), but the management of dysphagia in older adults should be considered as a continuum of care from the intensive care unit to the outpatient multidisciplinary clinic. In order to establish a framework for the management of swallowing in older adults, clinicians must work collaboratively with a multidisciplinary team using current evidence to guide clinical practice. Private practitioners must think critically not only about the interplay between the components of the evidence-based practice treatment triad but also about the broader impact of dysphagia on caregivers and families. The physical health and quality of life of both the caregiver and the person receiving care are interdependent. Conclusion Effective treatment includes consideration of not only the patient but also others, as caregivers play an important role in the recovery process of the patient with swallowing disorders.

METHODOLOGY OF PLAYING ACTIVITY IN REHABILITATION PRACTICE

2018 ◽  
Vol 28 (7) ◽  
pp. 2543-2548
Author(s):  
Petya Kasnakova
Keyword(s):  
Positive Emotions ◽  
Healing Process ◽  
Disease Process ◽  
Special Role ◽  
Thought Processes ◽  
Active Involvement ◽  
Movement Skills ◽  
Movement Training ◽  
Motor Movement

The games play a special role in rehabilitation practice. The positive emotions they cause in patients cannot be achieved by other methods and means of modern rehabilitation. The role of game playing activity in practice is crucial to the achievement of one of the important tasks in implementing rehabilitation measures, namely to evacuate the patient from the depressed mental state, to distract him from the disease process and to focus on mobilizing his healing powers. The mood, the emotional charge and the dynamics that the games create are particularly suited to awakening the patient's interest in the healing process, their attraction and their active involvement in the rehabilitation activities. The connection between the actions in the game and the movements in the analytical exercises accelerates the formation of motor habits, physical qualities and skills not only in children but also in adult patients with various pathological injuries. Rehabilitation games are suitable for all ages by enhancing the health of the occupants, developing their mental qualities, improving the activity of the vestibular, visual and motor analyzers. The basis of the motor movement training game methodology and the improvement of motor movement skills is the activation of the thought processes and emotional experiences, the development of the functions of the musculoskeletal system, the cardiovascular system and the respiratory system.

Levantine Art in the “Orientalizing” Period

2019 ◽  
pp. 369-383
Author(s):  
Marian H. Feldman
Keyword(s):  
Twentieth Century ◽  
Cultural Relations ◽  
Ancient Greek ◽  
The West ◽  
False Dichotomy ◽  
First Millennium

The “Orientalizing period” represents a scholarly designation used to describe the eighth and seventh centuries bce when regions in Greece, Italy, and farther west witnessed a flourishing of arts and cultures attributed to contact with cultural areas to the east—in particular that of the Phoenicians. This chapter surveys Orientalizing as an intellectual and historiographic concept and reconsiders the role of purportedly Phoenician arts within the existing scholarly narratives. The Orientalizing period should be understood as a construct of nineteenth- and twentieth-century scholarship that was structured around a false dichotomy between the Orient (the East) and the West. The designation “Phoenician” has a similarly complex historiographic past rooted in ancient Greek stereotyping that has profoundly shaped modern scholarly interpretations. This chapter argues that the luxury arts most often credited as agents of Orientalization—most prominent among them being carved ivories, decorated metal bowls, and engraved tridacna shells—cannot be exclusively associated with a Phoenician cultural origin, thus calling into question the primacy of the Phoenicians in Orientalizing processes. Each of these types of objects appears to have a much broader production sphere than is indicated by the attribute as Phoenician. In addition, the notion of unidirectional influences flowing from east to west is challenged, and instead concepts of connectivity and networking are proposed as more useful frameworks for approaching the problem of cultural relations during the early part of the first millennium bce.

Pre-Existing Psychiatric Illness Is Associated With an Increased Risk of Delirium in Patients With Acute Respiratory Distress Syndrome

2021 ◽  
pp. 088506662110190
Author(s):  
Saminder Singh Kalra ◽  
Johnny Jaber ◽  
Bashar N. Alzghoul ◽  
Ryan Hyde ◽  
Sarina Parikh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Psychiatric Illness ◽  
Distress Syndrome ◽  
Multivariable Logistic Regression Analysis ◽  
Psychiatric Illnesses ◽  
Increased Risk ◽  
Icu Delirium ◽  
The Impact

Background: Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. Study Design and Methods: We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. Results: 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). Interpretation: ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.

scholarly journals Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Human Herpesviruses Are Back!

Biomolecules ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 185
Author(s):  
Maria Eugenia Ariza
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Disease Process ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Barr Virus ◽  
Fatigue Syndrome ◽  
Specific Proteins ◽  
Epstein Barr ◽  
Human Herpesviruses

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) or Systemic Exertion Intolerance Disease (SEID) is a chronic multisystem illness of unconfirmed etiology. There are currently no biomarkers and/or signatures available to assist in the diagnosis of the syndrome and while numerous mechanisms have been hypothesized to explain the pathology of ME/CFS, the triggers and/or drivers remain unknown. Initial studies suggested a potential role of the human herpesviruses especially Epstein-Barr virus (EBV) in the disease process but inconsistent and conflicting data led to the erroneous suggestion that these viruses had no role in the syndrome. New studies using more advanced approaches have now demonstrated that specific proteins encoded by EBV could contribute to the immune and neurological abnormalities exhibited by a subgroup of patients with ME/CFS. Elucidating the role of these herpesvirus proteins in ME/CFS may lead to the identification of specific biomarkers and the development of novel therapeutics.

Sign in / Sign up

Export Citation Format

Share Document