Psychiatric Approach Research Articles

European perspectives on personality disorders: Knowing a complex history for a (hopefully) bright future

ABSTRACTA recent focus in Western European research on personality disorders (PDs) has been an attempt to generate an integrative perspective or at least a common framework that could be used by researchers with different theoretical orientation to exchange and integrate their findings. This article discusses 19th and 20th century Western European perspectives on PDs, which led to their conceptualization as separate entities. In particular, we focus on the contribution of three approaches: the psychiatric approach, the dynamic contribution and the individual difference perspective. European tradition suggests revising current PD classification systems to produce PD diagnoses that are close to clinical reality but also grounded in data from scientific studies and characterized by a high degree of transtheoretical acceptance. Copyright © 2011 John Wiley & Sons, Ltd.

Analysis of psychological distress after management of dizziness in old patients: multicenter study

Dizziness is a common problem in older people, with a reported prevalence of 13-38%. A large percentage of patients with dizziness develop secondary psychiatric disorders over the course of their disease. In particular, clinical depression and anxiety are significant health problems for older adults. We investigated the relationship between dizziness and psychological distress (depression and anxiety) in elderly patients with dizziness, and the relationship with psychological symptoms after managing the dizziness. This study enrolled 126 patients with dizziness, who were 65 years or older. Dizziness and the psychological symptoms of all patients were measured using the Korean Version of the Vestibular Disorders Activities of Daily Living Scale (K-VADL), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI) before and after management. We found a significant decrease in the BDI and STAI state scores after treatment with a reduction in the K-VADL score. For the STAI, the decrease in the score was relatively small after management. Nevertheless, there were significant correlations between the K-VADL score and both the BDI and STAI scores before and after management. Therefore, in the management of elderly patients with dizziness, a psychiatric approach should be considered and psychological support may be needed after managing the dizziness.

Introduction: Experiences of Psychiatric Hospitalization

This issue of Narrative Inquiry in Bioethics focuses on the experience of psychiatric hospitalization. It contains 13 different first hand accounts of the experience of psychiatric hospitalization as well as commentaries from two ethicists who have different but personal experiences with psychiatric hospitalization. Except for abortion, it is hard to think of another part of the health care system that is more controversial. Some accounts would lead to the conclusion that psychiatric hospitalization is like imprisonment of the innocent without trial. Several of the narratives contained in this issue report experiences that involved substantial mistreatment by almost any standard. Another perspective sees psychiatric hospitalization as an opportunity to benefit from the skills, technology, and wisdom of highly trained professionals. Although none of the authors of the narratives in this issue would recommend psychiatric hospitalization as an alternative to a vacation in the Hawaii, several of the narratives in this issue do report on the positive sides of hospitalization. In many ways psychiatric hospitalization reflects the dilemma that the Belmont Report noted in its description of the principle of respect for persons. “Respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy.” On one hand, it is hard to see how one can respect the autonomy of individuals and at the same time pressure them to give up their liberty for a period of time with little guarantee that it will ultimately benefit them. On the other hand, people in crisis are hardly in a situation to make the autonomous responsible decisions that the Belmont Report appears to envision. It is fundamental to the psychiatric approach to the most serious mental illnesses that the individuals so afflicted often have severe impairments to their judgment. Thus there is reason to feel that they have diminished autonomy and they need to be protected from any mistakes in their own judgments. On the other hand, an increasing number of people who have had the experience of mental illness contest that viewpoint. Their perspective is perhaps best captured by the slogan that many would feel is only a slight exaggeration “My diagnosis is your delusion.” How to best respect the autonomy of people with mental illness when they are in crisis is thus a very controversial ethical issue. There are, however, other basic issues that these narratives raise. One fundamental one is the issue of compassion. Over and over the writers talk about the need to feel that someone understands and cares about their situation. They seek someone who will see another human being in their suffering, someone who will appreciate that however strange their behavior may be, their feelings are ones that others might have in a similar situation. They want to be

A Lacanian perspective on psychotic hallucinations

This article gives an overview of the psychiatric approach to psychotic hallucinations and discusses Lacan’s conceptual break from this paradigm. Rejecting the traditional focus on the unreality of hallucinatory perceptions, Lacan examines the effects that psychotic hallucinations have on the person who experiences them. He develops an alternative theoretical framework which indicates that psychosis is characterized by the incapacity to signify one’s own existence as a subject in relation to the Other. Lacan’s different perspectives on hallucinations are discussed in terms of the logic of signification as the constitution of subjectivity and as a manifestation of the object a and jouissance, and also in terms of his theory of the sinthome.

Psychiatric Approach of Fibromyalgia

Fibromyalgia is a disease that occurs frequently. However, people do not know much about this disease and many doctors find it difficult to diagnose such patients. Symptoms of fibromyalgia may not only include pain, but also sleep disorder, fatigue, melancholia, and other mood disorders. Pain is one of the major symptoms of many diseases and may greatly impede the quality and functionof an individual’s life. Yet many clinicians have trouble treating chronic pain in part because they focus on the pain itself, which is merely one of the causes, and not on the evaluation and treatment of problems incidental to pain. It is noted that pain may be accompanied by not only physical suffering, but also emotional problems, such as melancholia and other secondary problems. The causes for fibromyalgia syndrome have not yet been clearly revealed but it is known that mental factors contribute to the occurrence and progress of the symptoms, and that the evaluation of or therapeutic interventions for the mental causes may be due to physical effects. Therefore, based on adequate psychiatric knowledge, clinicians should understand and treat the patients accordingly. It may be that more effective medical services are needed through intensive treatments in multidisciplinary teams for the patients. This article is aimed at investigating the psychological issues that fibromyalgia patients encounter. It also considers the psychiatric drugs and psychosocial treatment that are applied to the disease.

The risk of overlooking risks

In routine clinical practice, the child and adolescent psychiatrist must take diagnostic and therapeutic decisions in a context of relative “uncertainty”. Indeed, reference frameworks based on solid evidence offer more and more often guidelines for our strategies [1]. Protocols and tools are available in order to improve prescription [2], prediction [3] and prevention [4]. In the present issue of European Child and Adolescent Psychiatry, several papers are representative of this process of informed risk management geared to guarantee the effectiveness and safety of our interventions. The European guidelines group for Hyperkinetic disorders [5] have already considerably contributed to the delivery of guidelines for comprehensive and state of the art therapeutic strategies in ADHD [6]. The warnings about the possible adverse effects of ADHD medication led the group to review the literature and consult specialists in paediatrics, cardiology and endocrinology, examining incident causality and potential impact of risk. Evidence and advice are classified according to different domains: cardiac dysfunction, suicide-related events, growth, sleep disturbances, tics, substance abuse, seizures, and psychotic symptoms. The adverse side effects are usually mild or temporary. The very severe adverse effects such as cardiac dysfunction are extremely uncommon. A series of recommendations for monitoring are given, but in the end “the primary responsibility for ensuring the safety of the patient lies with the prescriber” through his careful appreciation of the risk-benefit ratio. The original study presented by Knook et al [7] illustrates the relevance of a joint paediatric and childhood psychiatric approach, previously described in 2006 [8], to detect psychiatric morbidity in children and adolescents initially referred to paediatric departments and outpatient clinics. They assessed psychiatric disorders and their predictors in children and adolescents with unexplained chronic musculoskeletal or abdominal pains or headache (UCP). In this at risk population they found a high prevalence of relevant psychiatric disorders: anxiety, affective and disruptive disorders with an additional risk in children presenting with headache. A careful psychiatric assessment is therefore recommended to detect, in the population with UCP, treatable psychiatric disorders in order to increase the chance that they be incorporated into a tailored treatment plan. Considering psychopathology from a developmental perspective and extending a previous study published in 2007 [9], Perren et al [10] employed a longitudinal and multi-informant approach to assess psychopathology in young children in order to describe the characteristics of psychosocial functioning that could emerge as protective or risk factor for later emotional and conduct problems. The interplay between self-oriented and other-oriented social skills is identified as a multifactorial pivot process in psychological development that could help to predict vulnerability towards later emotional disorders. This work opens new pathways for training and intervention that could promote healthy emotional development and prevent later psychopathological problems. This issue gathers innovative research which highlights the relevance of multidisciplinary and longitudinal studies in assessing the efficacy and safety of early intervention and in detecting high-risk groups. It is a step of major importance towards new preventive strategies in child and adolescent psychopathology.

Als Clinicus over de Grenzen van de Psychiatrie. De verwantschap tussen literatuur en wetenschap in het werk van de psychiater H.C. Rümke (1893-1967)

As a clincian beyond the boundaries of psychiatry. The congeniality of literature and psychiatry in the work of psychiatrist H.C. Rumke (1893-1967) One of the most important Dutch psychiatrists in the interwar period was H.C. Rumke (1893-1967). With his eclectic interest in psychiatric approaches such as both psychoanalysis and phenomenology, Rumke is most well known for his remarkable diagnostic and therapeutic skills. The life and work of Rumke has been studied in detail, most notably by the Dutch historian Jacob Van Belzen. Despite this extensive research, in this paper it is stated that a relevant aspect of Rumke’s work has been largely disregarded – namely his profound interest in and use of poetry and literature. Not only did Rumke write poems himself under the pseudonym of H. Cornelius, in his scholarly work he frequently refers to fictional literature and at the end of his career he wrote a comprehensive analysis of Frederik van Eeden’s novel Van de Koele Meeren des Doods. For the eclectic clinician Rumke literature and poetry are a source of knowledge to gain insight into the human psyche. Furthermore, according to Rumke, often literature succeeds better at expressing the human condition than the science of psychiatry can. In this article it is argued that for a coherent interpretation of the life and work of Rumke this literal and poetic aspect of his work cannot be disregarded. It is precisely Rumke’s profound interest in literature and poetry that reflects his two main theses about the science of psychiatry. These are on the one hand the centrality of clinical practice and on the other hand the boundaries of psychiatry. As a clinical practitioner Rumke’s aim was to be able to understand the suffering of the patient – literature and poetry could help him do that. Rumke’s use of literature and poetry can be understood by taking into account the context of the clinic, but the intertwinement between psychiatry, literature and poetry in Rumke’s work also reflects a broader issue. Namely that the science of psychiatry is not omnipotent and that sometimes the arts are better equipped to grasp the human condition.

University of Central Florida College of Medicine

University of Central Florida College of Medicine

The foundations of 19th-century psychiatric approaches to sexual deviance

Au prix d’un certain schématisme, l’historien du XIXe siècle peut voir se succéder trois modèles scientifiques encadrant les théories et les pratiques médicales mobilisés autour des déviants sexuels. Dans le premier tiers du siècle, les pionniers de l’aliénisme français formulent la monomanie qui se décline en nymphomanie, érotomanie, satyriasis et, plus tardivement, masturbation. La plupart des observations médicales portent sur des femmes ou des fillettes. Ce cadre théorique, mal dégagé de la culture religieuse, n’est pas sans faire penser aux tentations du démon, il est très contesté. La théorie de la dégénérescence, énoncée à la fin des années 1850, triomphe dans le dernier tiers du siècle où se fixe la nomenclature des perversions. Cette fois, la grande majorité des observations de pervers porte sur des hommes et on peut s’interroger sur le changement du genre des malades qui accompagne ce changement de paradigme. Enfin, au tournant du siècle, s’ébauche une psychologie de la vie sexuelle dont Freud donnera une formulation théorique synthétique.

Mental Health Care Policies and Services in Switzerland

This article summarises the recent development of Swiss mental health policies and services. The last three decades have been characterised by a strong emphasis on the socio psychiatric approach Bachmann, 1995; Ciompi, 1997, 1994,1987a, 1987b). The establishment of a decentralised, patient and community focused mental health care network, integrating different therapeutic methods under a uniform administration is the base concept of the emerging movement (Ernst, 1998;Bachmann, 1995,Ciompi, 1994, 1987b). Achievements and problems of mental health care provision are outlined. A more proactive role for mental health care professionals in policy is proposed to contribute to the solution of present injustices. The situation in Switzerland can, however, be considered to correspond to that in a range of other countries. Since the Swiss mental health care system has been strongly influenced by international developments it might be seen to portray Europe on a small scale (Ciompi, 1994; 1987b). Not only in Europe but in all industrialised countries experts presently perceive difficulties in mental health care delivery in an astonishingly similar way (Ernst, 1998). Globally the similarity of mental health needs appears to be much greater than is the case for physical health. The delivery of mental health care might thus be considered as a world-wide issue requiring an international response (Ernst, 1998).

Exploring mediating factors in the association between parental psychological distress and psychosocial maladjustment in adolescence

Parental psychopathology is associated with increased psychosocial maladjustment in adolescents. We examined, from a psychosocial perspective, the association between parental psychological distress and psychosocial maladjustment in adolescents and assessed the mediating role of psychosocial covariates. This is a cross-sectional survey and the setting include representative sample of Quebec adolescents in 1999. The participants of the study include 13- and 16-year-old children (N = 2,346) in the Social and Health Survey of Quebec Children and Adolescents. The main outcome measures are internalizing disorders, externalizing disorders, substance use, and alcohol consumption. For statistical analysis, we used structural equation modeling to test for mediation. Internalizing and externalizing disorders were significantly associated with parental psychological distress, but not substance use or alcohol consumption. The higher the parental distress, the higher the risk of adolescent mental health disorders. The association between parental psychological distress and internalizing disorders was mediated by adolescent self-esteem, parental emotional support and extrafamilial social support. As for externalizing disorders, these variables only had an independent effect. In conclusion, A family’s well being is a necessary condition for psychosocial adjustment in adolescence. Beyond the psychiatric approach, psychosocial considerations need to be taken into consideration to prevent negative mental health outcomes in children living in homes with distressed parents.

Bambini stranieri con bisogni speciali : rappresentazione della disabilità dei figli da parte delle famiglie migranti e degli insegnanti

Qualitative interviews of fathers, mothers and teachers of disabled children (9 children) The children frequent elementary school; with the interviews we have a picture of the story of the development of their disabled children; stories which are influenced by the migration story and the cultural cause. In the narration of the children’s stories we have a few indications about the clinic history and the family’s history before and after the migration. We have children with sensorial disability and with intellectual disability; the parents representation is much more important for the development of each child: this representation come from cultural framework, social origins, motivations for the migration, conditions of the travel, the hopes and the situation that find when arrive in Italy. A few parents hope to take care of their disabled children with the occidental medicine; others have a few difficulties to understand the cultural language of psychiatric approach because have an other diagnostical model. Is not easy to create the possibility of a meeting between the different cultural patterns. There are the much more important affec-tive function of the mothers which have a specific kind of relationship with her sons. It’s important to create the possibility for the valorization of these model of relations mother-disabled son; the pedagogic and social workers must to change approach to favour and to support the development of child and the social and scholastic inclusion.

P02-181 - The Belarusian republican research and practical center of mental health: the main directions of the development

The Republican Scientific and Practical Center of Mental Health (RSPC MH) was founded on 4 February, 2009 in Minsk, the Republic of Belarus.The main directions of the development of the RSPC MH are as following:1.The study of the actual problems of the psychiatry of elderly age as well as Alzheimer disease and other neurodegenerative disorders, epidemiological researches in the Republic of Belarus, working out clinical and psychological tools for the assessment of cognitive functions; implementation of psychiatric approaches peculiar to elderly age into general medicine;2.Developing of innovative methods of diagnostics and treatment of mental and behavioral disorders in extreme situations;3.The study of the problem of the due diagnostics and therapy of affective disorders, working out of the national standards of diagnostics and treatment of depressions and other affective disorders, implementation of the methods of diagnostics of “hidden depression” into general medical practice;4.The study of actual problems of child and adolescent psychiatry: epidemiological researches in the Republic of Belarus, introducing of the tools for psychological assessment of cognitive functions in early childhood; elaborating of the correction and prophylactic programs aimed at prevention of behavioral deviations, alcohol and drug dependence, “non-chemical” addictions such as gambling and “technological addictions” among adolescents;5.Identification of psychological and social-demographic factors influencing the indices of the quality of life of the patients suffered from mental disorders as well as chronic somatic diseases;6.Developing of innovative methods of diagnostics and prevention of suicidal and parasuicidal behavior.

The foundations of 19th-century psychiatric approaches to sexual deviance

The foundations of 19th-century psychiatric approaches to sexual deviance

P02-332 - Dynamic psychiatry - a group-dynamic oriented psychiatry

The group- dynamic view of any human development and change, both of the individual as well as of a group, is one central premise of Günter Ammon's Dynamic Psychiatry. This understanding postulates that any human being- from birth on- experiences consciously and unconsciously innumerable contacts, expectations, desires, conflicts and interactions in many different groups. Those experiences are substantially moulding a person and his/her personality with its intellectual, psychological, and physical dimensions, including the processes of brain development.The earliest, internalized group- dynamic experiences in particular are having a determining influence in shaping significantly a person's later life. Such archaic group- dynamic traumata, which often lead to pathological developments, are then acted out through an obsessive-compulsive disorder.This is the starting point for a variety of different psychotherapeutic interventions with the intention to initiate processes of recovery through emotional correcting inter-human experiences and psycho-dynamic working on internalised conflicts.Against the background of more than forty years of clinical in- and out-patient experience with empirical validation of treatment results, the author's objective is to discuss the importance of such a group-dynamic oriented Dynamic Psychiatry for the treatment of severe mental illnesses.The aim is furthermore, to demonstrate the contribution Dynamic Psychiatry can provide to a spectrum of various and diverse psychiatric approaches.

Manifestation of Cognitive Function in Geriatric Patient with Subjective Memory Complaint

－Abstract－Purpose：The purpose of this study was to find out cognitive function of the patients with subjective memory complaint. Material and Methods：From March 1st 2005 to May 31st 2009, 155 normal individuals without any medical illness who visited Yeungnam University Hospital to undergo medical checkup with neurocognitive test was enrolled, and checked by using Cognitive Assessment & Reference Diagnostic System.Results：107 of the patients had normal cognitive function, 21 patients (about 15%) were diagnosed with dementia, and 10 patients (about 7%) were diagnosed with considerable psychiatric illness, such as depression, anxiety disorder, adjustment disorder. In amnesia, agnosia, aphasia, attention, calculation, dysexecution, Dementia group and Psychiatric illness group has worse score than Normal individuals group. But, in apraxia, Dementia group has worse score than Psychiatric illness group and Normal individual group.Conclusion：Because the patients with subjective memory complaint can be diagnosed as any psychiatric illness as well as dementia, sensitive screening test and early psychiatric approach is needed.

Anxiety, Depression, and Quality of Life in Parkinson's Disease

Anxiety, Depression, and Quality of Life in Parkinson's Disease

Efficacy and Safety Limitations of Attention-Deficit Hyperactivity Disorder Pharmacotherapy in Children and Adults

There have been major advances in the treatment and understanding of attention-deficit hyperactivity disorder (ADHD) in the last decade. Among these are the availability of newer stimulant formulations, an appreciation of the combined effects of medication and behavioural therapies, and a better understanding of the neurobiology of the disorder in children (aged 6-12 years), adolescents and adults. This article focuses on the evaluation of the efficacy and safety profiles of medications used for the management of ADHD. In assessing the various medical treatments for ADHD, certain issues and analyses have become important to address. The diagnosis, characterization and quantification of ADHD symptoms are crucial to assessing treatment effectiveness. A standardized setting for measuring the severity of ADHD symptoms is the laboratory school protocol, which simulates a school environment with tightly controlled timing of measurements. This method has been adapted successfully to the adult workplace environment to help with the evaluation of adult ADHD symptoms. Statistical analyses, such as effect size and number needed to treat, may aid in the comparison and interpretation of ADHD study results. Although an objective approach to evaluating the efficacy and safety profiles of the available medications provides necessary details about the medical options, typical clinical decisions are often based on trial and error and may be individualized based on a patient's daily routine, comorbidities and risk factors. Stimulants remain the US FDA-approved medical treatment of choice for patients with ADHD and are associated with an exceptional response rate. Findings of the Multimodal Treatment of Children With ADHD study suggest that the combination of behavioural and medical therapy may benefit most patients. Nonstimulant agents, such as atomoxetine (FDA-approved), and several non-approved agents, bupropion, guanfacine and clonidine, may offer necessary alternatives to the stimulants. This is especially important for patients who have comorbidities that are contraindicated for stimulant use based on medical issues and/or risk for stimulant abuse. Typical psychiatric comorbidities in patients with ADHD include oppositional defiant disorder, conduct disorder, major depressive disorder, bipolar disorder, anxiety, substance abuse disorder, tic disorder, and Tourette's syndrome. Although relatively safe, both stimulants and atomoxetine have class-related warnings and contraindications and are associated with adverse effects that require consideration when prescribing. Polypharmacy is a common psychiatric approach to address multiple symptoms or emergent adverse effects of necessary treatments. Future research may provide an improved understanding of polypharmacy and better characterization of the factors that influence the diagnosis and successful treatment of patients with ADHD.

Behavioral Neurology and Neuropsychiatry Fellowship Training: The Johns Hopkins Model

Behavioral Neurology and Neuropsychiatry Fellowship Training: The Johns Hopkins Model

Der „schwierige“ Patient in der psychiatrischen Versorgung

A small subgroup of patients who access psychiatric care proves to be "difficult" in many respects. Characteristic features include excessive use of services that entail high costs, enormous problems involved in interacting with the professional staff and fellow patients, and a high complication rate. The central problems comprise noncompliance, aggressiveness, and highly disruptive behavior. Young men predominate and the diagnosis frequently consists of schizophrenic psychoses and cluster B personality disorders. There are often signs of organic brain impairment and substance abuse as well as various comorbid mental disorders. In addition to psychopharmacological and psychotherapeutic treatment options, social psychiatric approaches play a prominent role in satisfactory problem solving. Attitude adjustments and suitable supervision and support of the therapeutic staff are essential.