Psychiatry (Abingdon, England)最新文献_第9页

Fabricated or induced illness: assessment of perpetrators and approaches to management 捏造或诱发的疾病:肇事者的评估和管理方法

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.017

Christopher Bass, David P.H. Jones

{"title":"Fabricated or induced illness: assessment of perpetrators and approaches to management","authors":"Christopher Bass, David P.H. Jones","doi":"10.1016/j.mppsy.2009.03.017","DOIUrl":"10.1016/j.mppsy.2009.03.017","url":null,"abstract":"<div>Fabricated or induced illness (FII) is a rare form of child abuse that is usually, but not exclusively, perpetrated by mothers of children under 5 years of age. Detection and assessment require painstaking and detailed enquiry, and should not be attempted without full information from medical, social care, and other records. Suspected cases of FII often lead to family justice court orders to safeguard the child, appoint a guardian for him or her, and commission assessments. More than half of perpetrators have chronic somatoform and/or factitious disorders, often coexisting with a personality disorder. This article describes case characteristics suggesting that reunification with the child may be possible. These include: (a) acknowledgement of the fabrications; (b) an ability to work collaboratively with health and social services; (c) cessation of somatoform presentations to primary and tertiary care services; (d) reduction in frequency of any self-harming or substance misuse; (e) remaining in a stable relationship with social supports. Treatment phases are described; better outcome has been demonstrated where changes in the family system and a therapeutic alliance with the fabricator’s partner and extended family could be established. The time-frame for intervention must be sensitive to the developmental needs of the child. Successful outcome is dependent upon coordinated efforts by more than one mental health team, working closely with children’s social care, primary health care, and central paediatric involvement, to ensure the child’s safety and future well-being.</div>","PeriodicalId":88653,"journal":{"name":"Psychiatry (Abingdon, England)","volume":"8 5","pages":"Pages 158-163"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mppsy.2009.03.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131936262","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: 6

Medically unexplained symptoms in military personnel 军事人员出现医学上无法解释的症状

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.02.001

Neil Greenberg, Nicola T. Fear, Norman Jones

引用次数: 6

Chronic fatigue syndrome 慢性疲劳综合症

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.003

Tess Browne, Trudie Chalder

引用次数: 12

Occupational psychiatry 职业精神病学

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.011

Samuel B. Harvey, Max Henderson

{"title":"Occupational psychiatry","authors":"Samuel B. Harvey, Max Henderson","doi":"10.1016/j.mppsy.2009.03.011","DOIUrl":"https://doi.org/10.1016/j.mppsy.2009.03.011","url":null,"abstract":"<div>High rates of sickness absence and incapacity benefits constitute an increasing social and economic problem in most developed countries. Psychiatric disorders are now the leading reason for long-term sickness absence and incapacity benefits in the UK. Most of the work-associated costs of psychiatric disorder are due to common mental disorders such as depression and anxiety. Psychiatric disorders can also have a marked effect on workplace performance. Individuals suffering from mental illness are stigmatized in the workplace and often excluded from the various benefits paid employment can provide. There is good evidence that being in employment is associated with better mental health, including improved self-esteem and a lower risk of suicide. There is some evidence that an employee’s perception of their workplace can be associated with an increased risk of psychiatric disorder, particularly if they perceive high job strain. It seems likely that some of this effect may be mediated via factors such as personality and individual perceptions. A good occupational history should be part of any full psychiatric assessment. There is limited evidence regarding work-focused interventions for common mental disorders. The apparent lack of an occupational effect of standard treatments for depression suggests that additional specific interventions addressing return-to-work issues may be needed. There is good evidence that Individual Placement and Support (IPS) programmes are effective in helping individuals with schizophrenia find paid employment. Early detection, prompt focused management, and evidence-based rehabilitation should reduce the occupational impact of any psychiatric disorder.</div>","PeriodicalId":88653,"journal":{"name":"Psychiatry (Abingdon, England)","volume":"8 5","pages":"Pages 174-178"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mppsy.2009.03.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138229488","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

Symptoms: a new approach 症状:新方法

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.016

Michael Sharpe, Jane Walker

引用次数: 16

Conversion disorder 转换障碍

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.001

Timothy R.J. Nicholson, Richard A.A. Kanaan

{"title":"Conversion disorder","authors":"Timothy R.J. Nicholson, Richard A.A. Kanaan","doi":"10.1016/j.mppsy.2009.03.001","DOIUrl":"https://doi.org/10.1016/j.mppsy.2009.03.001","url":null,"abstract":"<div>The condition now known as conversion disorder has been described since the time of Hippocrates. It was of great interest to many pioneers of neurology and psychiatry in the late 19th and early 20th century, such as Charcot and Freud. Since this time, despite being a relatively common condition often leading to severe and persistent disability, it has received relatively little attention from the scientific community. Consequently there has been little progress in understanding its pathogenesis and in finding effective treatments. The focus of this article is the management of motor and sensory conversion disorder, primarily from the perspective of the psychiatrist. The historical context and terminology of the condition are reviewed to minimize confusion and aid communication with both patients and other professionals. Diagnostic issues are explored along with potential psychological and neural mechanisms, revealing evidence for previous emotional trauma as a risk factor and the possible role of stressful life events preceding symptom onset. A guide to assessing suspected conversion disorder is provided, paying particular attention to what it is necessary to check before the assessment begins In order to maximize the chances of therapeutic engagement. The clinical features that help exclude neurological disorder and support conversion disorder are explained. There are no proven treatments specifically for conversion disorder, but current practice is reviewed along with the limited evidence base.</div>","PeriodicalId":88653,"journal":{"name":"Psychiatry (Abingdon, England)","volume":"8 5","pages":"Pages 164-169"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mppsy.2009.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138229489","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

Assessment and immediate management of patients with medically unexplained symptoms in primary care 在初级保健中对有医学上无法解释的症状的患者进行评估和立即处理

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.008

Richard Morriss, Linda Gask

{"title":"Assessment and immediate management of patients with medically unexplained symptoms in primary care","authors":"Richard Morriss, Linda Gask","doi":"10.1016/j.mppsy.2009.03.008","DOIUrl":"10.1016/j.mppsy.2009.03.008","url":null,"abstract":"<div>Medically unexplained symptoms (MUS) are physical symptoms that doctors cannot explain by organic pathology, which distress or impair the functioning of the patient. Patients with MUS account for around 50% more visits to primary care doctors, one-third more secondary care contacts than patients without MUS. MUS are often precipitated or exacerbated by psychosocial stress, depression and anxiety. Primary care consultations can take the form of a contest between the patient with MUS and the doctors: the doctor tries to reassure the patient, the patient provides more evidence of their distress or information that challenges the authority of the doctor, and the consultation often ends in collusion with an investigation, prescription, or referral that neither patient nor doctor is content with. Patients with MUS seek doctors who take their concerns seriously and legitimize their complaints. They do not necessarily expect a cure, but they seek an alliance to help them understand their health problems. Provision of emotional support, modification of symptom beliefs, explanations linking physical problems to psychosocial issues when they are relevant, antidepressants, and graded exercise for some types of MUS seem to be worth trying by doctors for patients with MUS. A four-stage model to help doctors manage MUS is provided. Some patients with chronic MUS and high consultation behaviour will require regular consultations with a single doctor who restricts the use of investigations, prescriptions, and referrals. Cognitive behavioural therapy may be helpful for patients with MUS who are willing to seek further psychological help.</div>","PeriodicalId":88653,"journal":{"name":"Psychiatry (Abingdon, England)","volume":"8 5","pages":"Pages 179-183"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mppsy.2009.03.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134456115","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: 3

Medically unexplained symptoms and the meaning of health – a phenomenological clue 医学上无法解释的症状与健康的意义——现象学线索

Psychiatry (Abingdon, England) Pub Date : 2009-05-01 DOI: 10.1016/j.mppsy.2009.03.012

Andrew Warsop

引用次数: 4

Electroconvulsive therapy 电休克疗法

Psychiatry (Abingdon, England) Pub Date : 2009-04-01 DOI: 10.1016/j.mppsy.2009.01.002

Allan I.F. Scott

引用次数: 0

Pharmacological management of bipolar affective disorder 双相情感障碍的药物管理

Psychiatry (Abingdon, England) Pub Date : 2009-04-01 DOI: 10.1016/j.mppsy.2009.01.006

R. Hamish McAllister-Williams, I. Nicol Ferrier

{"title":"Pharmacological management of bipolar affective disorder","authors":"R. Hamish McAllister-Williams, I. Nicol Ferrier","doi":"10.1016/j.mppsy.2009.01.006","DOIUrl":"10.1016/j.mppsy.2009.01.006","url":null,"abstract":"<div>Lithium is the ‘gold standard’ of the many drug treatments used in bipolar disorder. It has efficacy in the treatment of mania, prophylaxis against manic relapses, and, to a lesser extent, prophylaxis against depressive relapses. It decreases suicidal risk. Blood monitoring of lithium is essential. In addition to side effects, problems include rebound mania on abrupt cessation of lithium and teratogenetic risks. Carbamazepine, valproate, and lamotrigine are anticonvulsants with an evidence base in bipolar disorder. Carbamazepine is anti-manic, but is poorly tolerated and associated with many pharmacokinetic interactions. Valproate is also anti-manic and is prophylactic, especially against mania, but its antidepressant effects in bipolar disorder are unclear. It is associated with many problems when used during pregnancy, and should be avoided in women of childbearing potential. Lamotrigine is not licensed for use in bipolar disorder in the UK, but has some evidence for effectiveness in bipolar depression and, more particularly, prophylaxis against depressive relapse. It must be introduced slowly to avoid dangerous skin reactions. Other anticonvulsants have no evidence supporting their use. Antipsychotics, including the atypicals, are effective in treating mania. Olanzapine and aripiprazole are also licensed for continuation treatment in acute responders. Quetiapine has evidence for effectiveness in both bipolar mania and bipolar depression. The efficacy of antidepressants in bipolar disorder is unclear. Tricyclic antidepressants and mono-amine oxidase inhibitors should probably be avoided, owing to a possible risk of switching to mania. In general, antidepressants should be used in conjunction with a mood stabilizer and for the shortest period necessary.</div>","PeriodicalId":88653,"journal":{"name":"Psychiatry (Abingdon, England)","volume":"8 4","pages":"Pages 120-124"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mppsy.2009.01.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131090018","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: 10