The Western journal of medicine最新文献_第6页

Irresistible joys and discouraging pitfalls in diagnosing personality disorders. 诊断人格障碍的不可抗拒的快乐和令人沮丧的陷阱。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.215

M. Gitlin

{"title":"Irresistible joys and discouraging pitfalls in diagnosing personality disorders.","authors":"M. Gitlin","doi":"10.1136/EWJM.176.3.215","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.215","url":null,"abstract":"We humans seem to have an inherent urge to describe and label personalitiesin individuals we meet in everyday life, both professionally and personally.Unfortunately, neither lay descriptors nor psychiatric diagnoses easilycapture the sense we often have of others. In fact, describing andcategorizing personality and personality disorders have been among the weakestlinks in psychiatric nosology since the introduction of the Diagnostic andStatistical Manuals of Mental Disorders (DSMs). Even with the atheoretic,primarily descriptive approaches of DSM-III (published in 1980),DSM-III-R, andDSM-IV,1the section on personality disorders is the most problematic. Still, theinherent attraction of personality labeling is often too great to resist. \u0000 \u0000In his essay, Walling uses the descriptions of Achilles' behaviors andpersonality traits in The Iliad to diagnose him according toDSM-IV criteria. Although the author selects passages from the textthat are consistent with his conclusion that Achilles had antisocialpersonality disorder, we should view this conclusion with great cautionbecause it illustrates some of the pitfalls of personality diagnoses. \u0000 \u0000A personality disorder is an enduring and stable pattern of innerexperience and behavior that deviates markedly from cultural expectations, ispervasive and inflexible, begins in early adolescence or early adulthood, andleads to distress andimpairment.1 Becausepersonality disorders are longitudinal and stable, diagnoses based oncross-sectional examinations are fraught with difficulties. Thus, Achilles mayhave thought and acted as described in The Iliad and noted byWalling, but what do we know about his patterns of behavior throughout hislife? The DSM-IV criteria for antisocial personality disorder requiresymptoms of conduct disorder (similar to adult antisocial behaviors) beforeage 15. Was Achilles a destructive, aggressive, deceitful child or adolescent?Without this information, it is impossible to make an accurate diagnosis. \u0000 \u0000In addition, diagnoses of personality disorders can be made only byexamining the individual's behavior in the context of his culture. AlthoughWalling describes some examples of Achilles' behavior that seem at variancewith his cultural norm, without a fuller knowledge of the culture, suchinterpretations are suspect. \u0000 \u0000An explicit rule for diagnosing personality disorders requires that thetraits and behaviors used to make the diagnosis be due not simply to theeffect of transient stressors or another psychiatric disorder such asdepression, mania, or anxiety disorders. Achilles' behaviors during wartimemay not reflect his typical behaviors at other times. Again, the hallmark ofpersonality and its disorders is the predictable, consistent, enduring patternof traits and behavior, not a series of behaviors during a time of crisis.Similarly, a fixation on honor and revenge and excessive mourning could hardlyqualify as obsessive-compulsive personality traits without further informationabout the c","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"134 1","pages":"215"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77380329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using e-mail to investigate outbreaks. 使用电子邮件调查病毒爆发。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.181

L. Castrodale, M. Beller, S. A. Jenkerson, Bruce Chandler

引用次数: 4

Emergency contraception: a vital component of reproductive health programs. 紧急避孕:生殖健康项目的重要组成部分。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.152

J. Beitz, J. Hutchings

{"title":"Emergency contraception: a vital component of reproductive health programs.","authors":"J. Beitz, J. Hutchings","doi":"10.1136/EWJM.176.3.152","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.152","url":null,"abstract":"see also p 188 \u0000 \u0000Emergency contraception (EC) refers to contraceptive methods that may beused in the first few days after unprotected intercourse to prevent pregnancy.Although EC is an essential reproductive health option, it remains vastlyunderused. \u0000 \u0000The use of analogs of the female hormones, estrogen and progesterone, aspostcoital contraception was first described in the scientific literature morethan 30 years ago. However, only within about the past 7 years has EC begun tomove from being the “best-kept secret” into the contraceptivemainstream. \u0000 \u0000The most common method of EC involves taking an increased dose of oralcontraceptive pills as soon as possible—optimally, within 72 hours (3days)—after unprotected sex. A second dose is taken 12 hours later.Insertion of an intrauterine device within 5 days of unprotected sex isanother, less frequently used, method of EC. Although intrauterine devices areeffective, and their use is an appropriate method for many women, pills areeasier to administer and may be taken by a wider user group. \u0000 \u0000In many countries, dedicated products are available for use as EC, althoughstandard oral contraceptives can also be used in the absence of a specificallylabeled EC product. In the United States, the Food and Drug Administration hasendorsed off-label ECprescribing.1 \u0000 \u0000Unlike many other health priorities, the need for EC education for bothclients and providers of health services and increasing EC access are notlimited to one particular country or region of the world. In both developingand developed countries, EC remains not only an underused but alsomisunderstood and often completely unknown method of contraception. However,the morbidity and mortality associated with unintended pregnancy in thedeveloping world are particularly striking. \u0000 \u0000About 75 million unintended pregnancies occur in the developing worldannually, and each year 8 to 30 million women experience contraceptivefailure.2,3Women who have an unintended pregnancy often seek abortion; of the estimated45 million pregnancies that are terminated by abortion each year, about halfare performed under unsafeconditions.4 \u0000 \u0000In most of the developing world, such as in sub-Saharan Africa and LatinAmerica, where access to safe abortion services is severely restricted,maternal deaths due to septic abortion can exceed those from all other causes.Women who survive unsafe abortion often suffer debilitating and chronicmorbidity, including infertility; increased risk of ectopic pregnancy;abdominal adhesions that cause chronic pain; structural damage to vagina,cervix, uterus, bladder, or rectum; and exacerbation of chronic anemia. Inaddition to this burden of unnecessary human suffering, the cost of providingremedial health services to these acutely ill women robs countries of fundsneeded for more cost-effective preventive care. \u0000 \u0000Adolescent girls, in particular, suffer disproportionately from unintendedpregnancies and unsafe abortion. Worldwide, pregnancy-related deaths","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"353 1","pages":"152-4"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74126095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Physicians, shamans, and personal trainers. 医生，巫师和私人教练。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.200

S. Chandrasoma

引用次数: 0

Achilles' heel and painting by numbers. 阿喀琉斯之踵和数字绘画。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.214

R. Ratzan

{"title":"Achilles' heel and painting by numbers.","authors":"R. Ratzan","doi":"10.1136/EWJM.176.3.214","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.214","url":null,"abstract":"In his article, Walling purports that the behavior and traits of Achilles, Homer’s magnificent poetic creation, represent diagnostic criteria for antisocial personality disorder. Instead of formulaic verse, we now read about Achilles in formulaic diagnosis. When I told a classicist friend about this theory, he said, “Of course Achilles was antisocial—but he was also in the middle of a war!” Walling makes the mistake of conducting a cross-cultural comparison between our culture and one that is far removed in time, geography, and cultural values and was based on war, warriors, male domination, shame, and honor. The author also tries in a few pages to squeeze a young Greek warrior living some 3,000 years ago, a man told he is fated to die soon, into the cookie cuttermold of “antisocial personality,” a template arbitrarily defined, and periodically redefined, by predominantly 20th century Western European white men. Walling gives us a snapshot of a man who, as almost all students of Homer would agree (when they agree on little else), changes radically over the course of the 24 books. This psychological analysis of Achilles is not the first. Three other analyses—those of Graham Zanker, Jonathan Shay, and W Thomas MacCary—shed different lights on the intricately composed psyche of Homer’s hero. Zanker posits a “complexity of motive in Achilles.” He uses this allegedly antisocial hero as the paradigm of magnanimity, exemplified in the famous meeting (in book XXIV) of Achilles and Priam. Achilles has just killed, intentionally mutilated, and disgraced Priam’s son Hector to avenge the killing of Achilles’ dearest friend, Patroclus. Hermes escorts Priam deep behind Greek battle lines to Achilles’ tent in an effort to convince him to release Hector’s body for proper burial. In the scene, Priam invokes the memory of Peleus, Achilles’ own dead father, and the fiercest warrior in the war proves capable of compassion and tears and a change of mind that we previously thought inconceivable. Achilles’ generosity at this point in the poem is astounding given his recent display of wonton bloodshed and wrath (commentators of the Iliad point to this word in the first line of the epic as indicating where our proper attention belongs) against all things and persons Trojan. Using philosophical vocabulary more familiar to other critics of morality in Homer than it is to us, Zanker concludes that this generosity is a result of Achilles’ proximate motive of loyalty, his ultimate guilt-based motive for cooperative behavior, and his inner motives of affection and fair play. p137 For Shay, a psychiatrist with vast experience interviewing and treating veterans of the war in Vietnam, Achilles is a soldier suffering from post-traumatic stress disorder. He acts like one “already dead,” p52 suffers survivor guilt p70 and suicidal thoughts, p72 and eventually evolves into a rage-filled warrior of the type Shay terms a “berserker,” p77 a transition that forever changes a person. p98 ","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"37 1","pages":"214-5"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81581322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What is a minimally conscious state? 什么是最低意识状态?

The Western journal of medicine Pub Date : 2002-03-01 DOI: 10.1007/springerreference_183075

R. Cranford

引用次数: 68

Investigation of children with "developmental delay". “发育迟缓”儿童的调查。

The Western journal of medicine Pub Date : 2002-01-01 DOI: 10.1136/EWJM.176.1.29

L. Hartley, A. Salt, J. Dorling, P. Gringras

引用次数: 6

The airway: emergent management for nonanesthesiologists. 气道:非麻醉医师的紧急管理。

The Western journal of medicine Pub Date : 2002-01-01 DOI: 10.1136/EWJM.176.1.45

R. Fowler, R. Pearl

引用次数: 9

No: it is dangerous to ask psychiatrists to enforce social policy. 不:要求精神科医生执行社会政策是危险的。

The Western journal of medicine Pub Date : 2002-01-01 DOI: 10.1136/ewjm.176.1.5

G. Yamey, Philip E. Shaw

{"title":"No: it is dangerous to ask psychiatrists to enforce social policy.","authors":"G. Yamey, Philip E. Shaw","doi":"10.1136/ewjm.176.1.5","DOIUrl":"https://doi.org/10.1136/ewjm.176.1.5","url":null,"abstract":"Whom the Gods would destroy they first make mad. Henry Wadsworth Longfellow Most of us want a society that is free of racism. But it is folly to think that this freedom will come by calling racism an illness and mandating its “treatment” by physicians. A just society must have a social and legal framework to detect and prosecute racist crimes. Psychiatrists, though, are not the makers or enforcers of social policy: this is why we have politicians and police. The history of psychiatry is full of examples of people being labeled as ill for social or political reasons. To paraphrase Longfellow, those whom society and psychiatrists wish to destroy, they first label mentally ill. For example, Chinese police subject political nonconformists to psychiatric appraisal before committing them to psychiatric hospitals against their will.1 Members of the Falun Gong, a spiritual movement vilified by the Chinese government, have been incarcerated in mental hospitals, where they undergo forced administration of psychotropic drugs, electroshock therapy, and brutal beatings.2 Members are told, “No transformation, no release.” Some have died from this psychiatric “treatment.”1 Such abuses are not restricted to Asian psychiatry. American psychiatry, which leads the call to label racism as a mental illness,3 should remember its own mistreatment of gay men and lesbians. The first Diagnostic and Statistical Manual of Mental Disorders, published in 1952, included homosexuality as an illness—legitimizing the forced “treatment” of healthy people.4 In considering homosexuality a sickness, psychiatry was acting out the wishes of a society that could not accept same-sex relationships. It is, therefore, horrifying that we now hear calls to label homophobia as an illness.5 Deja vu, anyone? Society is right to condemn homophobes, but should we really be asking psychiatrists to force them to undergo treatment of their homophobia? Racist beliefs may, of course, be part of an underlying mental illness, but they are not in themselves pathologic. For example, a patient who thinks that all Irish people are evil because they are exposed to uniquely high levels of radiation from the sun is clearly delusional. But what about an Englishman who hates the Irish because “they all support terrorist organizations”? Although he is wrong, he is not ill but holds a view that is common—and to a degree understandable, given recent history. It is the form—and not the content—of people's beliefs that determines whether they have a mental illness. What if we try to classify all racist beliefs as representing some other form of psychological illness? For example, let's try to call racist beliefs “overvalued ideas,” the psychiatric term for logically understandable but not acceptable ideas pursued by a person beyond the bounds of reason. We run into trouble when we think of extreme racists who do little more than vote for a quasi-fascist party once every 5 years. This is scarcely a","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"48 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88595061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Curtailing antibiotic use in agriculture: it is time for action: this use contributes to bacterial resistance in humans. 减少农业中抗生素的使用:现在是采取行动的时候了:这种使用助长了人类细菌的耐药性。

The Western journal of medicine Pub Date : 2002-01-01 DOI: 10.1136/EWJM.176.1.9

S. Heilig, Philip R. Lee, L. Breslow

{"title":"Curtailing antibiotic use in agriculture: it is time for action: this use contributes to bacterial resistance in humans.","authors":"S. Heilig, Philip R. Lee, L. Breslow","doi":"10.1136/EWJM.176.1.9","DOIUrl":"https://doi.org/10.1136/EWJM.176.1.9","url":null,"abstract":"Antibiotics are arguably the single most important and widely used medical intervention of our era. Almost every medical specialty uses antibiotic therapy at some point. These drugs have prevented incalculable suffering and death and are perhaps still the closest medications we have to a “magic bullet.” Of course, bad bugs can bite back, and bacterial adaptation and resistance were reported soon after antibiotics were first used. The struggle to stay one step ahead of pathogens has been widely described and debated. Correcting the overuse of antibiotics in human medicine has gradually become a priority, with slow but heartening progress being gained in this darwinian race. Still, the rise of multidrug resistance and the ready transfer of resistant traits among pathogens require heightened action if we are to prevent increasing outbreaks of infections that become more difficult, or even impossible, to treat. One essential course of action is to minimize any and all causes and reservoirs of antibiotic resistance. Besides medical use in humans, there is the troubling issue of use in agriculture, specifically in livestock production. Antibiotics have long been routinely used not only for the treatment of infections, but also as a means of getting animals to market faster by growth promotion. Controversies about these practices have resulted in numerous reports, dating back decades, urging more caution or outright bans on the practice. The World Health Organization and other leading medical and public health bodies have advised that animals not be dosed with antibiotics used in humans—to little avail here in the United States to date, even though our own Food and Drug Administration (FDA) took this position as far back as 1972.1 Still, many longtime observers of the issue were surprised—or even shocked—to learn the true extent of antibiotic use on farms. A recent report estimates that upward of 70% of all antibiotics manufactured are used in agricultural settings.2 Although the exact percentages are uncertain, agricultural antibiotic use is apparently more substantial than previously thought. And the type of use is worrisome because it involves continual, subtherapeutic doses that would seem to provide ideal environments for the selection of resistant pathogens. The introduction of new molecular epidemiologic tools has heightened the worry because these tools have been used to show that resistant bacteria originating on farms are finding their way into humans.3,4,5,6,7,8,9,10 The extent of this epidemiologic “spillover” to date is uncertain— assertions of the extent of bacterial resistance arising from farms vary widely—and this needs to be a higher research priority. But there is no question that the phenomenon does exist. Recognizing this risk, the American Medical Association's house of delegates recently adopted a policy stating that the association “urges that nontherapeutic use of antimicrobials in animals that are also used in hu","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"11 1","pages":"9-11"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82293982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17