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Month: November 2017

Saboteurs, Scapegoats And Secrets: Diagnosis In Family Therapy

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IN CLINICAL PRACTICE one becomes more and more impressed with the importance of interviewing and understanding the whole family in certain situations. Family attitudes can make or break a successful treatment program, so a diagnostic interview should be held to determine how a family functions.

The Diagnostic Interview

The diagnostic interview is different from a therapeutic interview, especially concerning the referring agent and the family. No commitment for ongoing work is made prior to the diagnostic interview. The possibilities for further counselling are assessed with the family, and ideally with the referring agent,'at or shortly after the diagnostic interview. The referring agent may be a public health nurse, teacher, child care worker, or social worker from a community agency. We hope to have all the important members of the family present at the diagnostic interview. In practice this usually means everyone living in the same house as...

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Family Interventions in Health Care

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In this article the author discusses the background and present status of family interventions in health care. He notes the convergence of interest occurring in this area among several health care disciplines during the 1970s and 1980s. He also summarizes his and colleague Macaran Baird's model for primary care family interventions in health care, which distinguishes between primary care interventions and specialized family therapy interventions. The author then describes new work on delineating levels of professional involvement with families in health care, and discusses curriculum implications of these levels. Finally, he offers advice and warnings about collaboration among different professional groups in this emerging area.

Family interventions in health care can be defined as efforts by health care professionals to work systematically with the patient's family for the purposes of prevention, treatment, management, or rehabilitation of biopsychosocial problems. The focus of such interventions may be: (a) on the individual patient, with the family playing a supportive...

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Brief Screening for Family Psychiatric History The Family History Screen

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Abstract

BACKGROUND:

Brief screens to collect lifetime family psychiatric history are useful in clinical practice and for identifying potential families for genetic studies.

METHODS: The Family History Screen (FHS) collects information on 15 psychiatric disorders and suicidal behavior in informants and their first-degree relatives. Since each question is posed only once about all family members as a group, the administrative time is 5 to 20 minutes, depending on family size and illness. Data on the validity against best-estimate (BE) diagnosis based on independent and blind direct interviews on 289 probands and 305 relatives and test-retest reliability across 15 months in 417 subjects are presented.

RESULTS: Agreement between FHS and BE diagnosis for proband and relative self-report had median sensitivity (SEN) of 67.6 and 71.1 respectively; median specificity (SPC) was 87.6 and 89.4, respectively. Marked decrease in SEN occurred when a single informant....

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Therapeutic Communication

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Abstract

This article focuses on the concept of "Therapeutic communication". it also tries to highlight the importance of this concept, which through verbal or nonverbal communication makes the nurse consciously influence a client or help the client. it involves the use of specific strategies that encourage the patient to express feelings and ideas. There are different reactions to "therapeutic communication" as all patients differ in their characters, background, social status, culture, etc.

This article will also compare the role of the nurse as compared to that of the doctor. They must both master efficient therapeutic techniques of communication in order to establish empathy towards the experience that the patient reveals. it is of great importance for them to have communicative therapeutic skills in order to successfully apply the communicative process as well as to fulfill the standards of healthcare for the patients. Through therapeutic communication they should establish a relationship,...

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When Munchausen Becomes Malingering: Factitious Disorders That Penetrate the Legal System

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Factitious disorders are those conditions in which individuals actively create signs or symptoms of physical or psychological disease states.' Although there are numerous reports of factitious psychological disorders, there is controversy about the legitimacy of the diagnosis This paper will limit its focus to factitious physical disorders and how they may enter the legal system in civil litigation. Although most psychiatrists are familiar with factitious disorders from their medical training, many attorneys and judges have had not any exposure to such cases. As these cases appear to be developing more frequently in legal and other non-medical settings,' it is important for these non-psychiatrists to become aware of the factitious disorders in order to deal with cases appropriately. Considerable education may be necessary to inform legal staff about factitious disorders because the entity is so counter intuitive-no one expects an apparently reasonable person to actively create a...

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Factitious Disorder Imposed on Another (Munchausen by proxy)

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Practice Essentials

Factitious disorder imposed on another (formerly factitious disorder by proxy) has as its cardinal characteristic the production or feigning of physical or psychological symptoms in another person, usually a child or adult under the care of the person with the disorder. It is currently understood as including the condition commonly known as Munchausen syndrome by proxy (MSBP). Signs and symptoms

Common presentations of factitious disorder imposed on another (including MSBP) include the following:

•Bleeding •Seizures •Recurrent apparent life-threatening events •Poisoning •Apnea •Central nervous system (CNS) depression •Diarrhea and vomiting •Fever, either feigned (via falsification of chart records) or actual •Rash •Hypoglycemia •Hyperglycemia •Hematuria or guaiac-positive stools •Multiple infections with varied and often unusual organisms

Warning signs that raise the possibility of this disorder include the following:

Unexplainable, persistent, or recurrent illnesses Discrepancies among the history, clinical findings, and child’s general health

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What Is the Difference Between Malingering and Factitious Disorder?

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Factitious disorder is the term used to describe a pattern of behavior centered on the exaggeration or outright falsifications of one’s own health problems or the health problems of others. Some people with this disorder fake or exaggerate physical problems; others fake or exaggerate psychological problems or a combination of physical and psychological problems. Factitious disorder differs from a pattern of falsified or exaggerated behavior called malingering. While malingerers make their claims out of a motivation for personal gain, people with factitious disorder have no such motivation.

Factitious Disorder Basics

People with factitious disorder do several things that are unexpected for patients who present themselves for medical treatment, or for individuals seeking treatment for others in their care. First, they commonly exaggerate or lie about problems in their medical histories or the histories of others. They also present their doctors with symptoms that don’t legitimately ....

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Munchausen’s Syndrome and Other Factitious Disorders in Children

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Abstract

There has been increasing recognition in the pediatric literature for the past 20 years that illness falsification by caregivers must be included in the differential diagnosis of children presenting with persistent, unexplained symptoms or laboratory findings. However, there is considerably less awareness that pediatric symptoms can also be intentionally falsified by child and adolescent patients, and this unique group has remained virtually invisible. There have been reports that many children with factitious disorders also suffer from other mental disorders, particularly personality disorders. We report an unusual case of Munchausen's syndrome in a 15-year-old patient with sickle cell disease. We also review other reported pediatric factitious disorders in literature. Our purpose is to make clinicians aware of this less known disorder in children and to discuss the similarities and differences these disorders have in children compared to adults with the same disorders.

Introduction

Adult patients who present with symptoms of factitious disease are...

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Are Psychiatric Diagnoses Defamatory Statements?

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Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To evaluate evidence from randomised controlled trials (RCTs) for the efficacy of different communication strategies used by clinicians to inform patients about the diagnosis and outcome of schizophrenia, compared with treatment as usual

To compare efficacy between different communication strategies.

Background

Description of the condition

Schizophrenia, a serious mental illness, is a group of heterogeneous disorders typically characterised by the presence of delusions, hallucinations, disorganised speech, disorganised behaviour, and negative symptoms (avolition, apathy, anhedonia, alogia, affective blunting). The two major classification systems, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), have different requirements of symptoms duration for the diagnosis of schizophrenia. While the DSM requires a total duration of a minimum of six months, the ICD-10 warrants a minimum duration of one month.

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Different Communication Strategies For Disclosing A Diagnosis Of Schizophrenia And Related Disorders

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Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To evaluate evidence from randomised controlled trials (RCTs) for the efficacy of different communication strategies used by clinicians to inform patients about the diagnosis and outcome of schizophrenia, compared with treatment as usual

To compare efficacy between different communication strategies.

Background

Description of the condition

Schizophrenia, a serious mental illness, is a group of heterogeneous disorders typically characterised by the presence of delusions, hallucinations, disorganised speech, disorganised behaviour, and negative symptoms (avolition, apathy, anhedonia, alogia, affective blunting). The two major classification systems, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), have different requirements of symptoms duration for the diagnosis of schizophrenia. While the DSM requires a total duration of a minimum of six months, the ICD-10 warrants a minimum duration of one month. The DSM-IV has a requirement for...

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Lies in the Doctor-Patient Relationship

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Have you ever lied to your patients or been surprised to learn that one of your patients lied to you? Have you considered it important to learn why lies emerge in the treatment relationship? Have you wondered whether (or how) you should confront such untruths? If you have, then the following discussion should provide the forum for answers to these and other questions related to the exploration, detection, and management of lies in the medical arena.

Clinicians realize that making an accurate diagnosis relies on the provision of reliable information by patients and their family members and that timely, astute, and compassionate care depends on effective bidirectional communications (between the patient and the physician). Unfortunately, both patients and physicians are often challenged by complicated communications; each group withholds, distorts, obfuscates, fabricates, or lies about information that is crucial to the doctor-patient relationship and to effective treatment....

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Niacin Skin Flush Test: A Research Tool for Studying Schizophrenia.

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Abstract

BACKGROUND:

A body of biochemical evidence suggests that abnormal phospholipid metabolism may play a role in the etiology of schizophrenia, and possibly, other psychiatric and neurological diseases. Niacin, a B-complex vitamin, induces prostaglandin synthesis, vasodilatation, and skin flushing when applied as a solution on the skin or taken orally. In schizophrenia, diminished or absent skin response to niacin represents a robust finding.

RESULTS:

Attenuated niacin skin-flush response has been analysed as a potential biochemical marker of impaired prostaglandin signaling in schizophrenia. Diminished skin redness after topical application of niacin might be caused by a reduced level of the precursor arachidonic acid in the peripheral membranes, increased activity of the enzyme phospholipase A2, abnormal expression of niacin or prostaglandin receptors, or poor vasomotor activity of cutaneous capillary walls. Heritability estimates established in several studies support niacin skin flush response as a vulnerability...

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About Schizophrenia and Psychosis

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About one in a hundred people have schizophrenia and can have a variety of ‘positive’ symptoms, such as hallucinations, delusions or disordered speech/behaviour, and ‘negative’ symptoms such as problems with fluency of language and thoughts or with expression of emotions.

As is the case with most mental illness, the cause of schizophrenia is not known. The conventional treatment for schizophrenia is usually long-term treatment with antipsychotic medication. A nutritional approach works alongside conventional treatment and may improve both positive and negative symptoms, and also reduce the side-effects of medication.

Below is an outline of nutrition approaches that may be relevant:

• Correcting blood sugar problems made worse by excess stimulant and drug use • Addressing essential fat imbalances • Increasing antioxidants; niacin (Vitamin B3) therapy • Addressing methylation problems helped by B12 and folic acid • Investigating pyroluria and the need for zinc and identifying any food allergies

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What-If Analysis

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Definition

In order to be able to evaluate beforehand the impact of a strategic or tactical move so as to plan optimal strategies to reach their goals, decision makers need reliable predictive systems. What-if analysis is a data-intensive simulation whose goal is to inspect the behavior of a complex system, such as the corporate business or a part of it, under some given hypotheses called scenarios. In particular, what-if analysis measures how changes in a set of independent variables impact a set of dependent variables with reference to a given simulation model such a model is a simplified representation of the business, tuned according to the historical corporate data. In practice, formulating a scenario enables the building of a hypothetical world that the analyst can then query and navigate.

Historical Background

Though what-if analysis can be considered as a relatively recent discipline, its background is rooted at the confluence... ..

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Czech Factors Related to Reproductive Coercion and Pregnancy Avoidance Among Women Experiencing Intimate Partner Violence

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Approximately 5% of US women have experienced reproductive coercion – an intimate partner trying to get them pregnant when they did not want to be (Black et al., 2011). Reported prevalence is higher (14-74%) in smaller community samples of women receiving services (Miller et al., 2010; Moore, Frohwirth, & Miller, 2010; Raphael, 2005). Associations with physical/sexual violence have been mixed (Messing & Thaller, 2012; Miller et al., 2010), though reproductive coercion was related to unintended pregnancy when physical violence was present (Miller et al., 2010). Reproductive coercion has also been associated with compromised sexual health decision-making (fear of refusing sex or asking a partner to use a condom; Messing & Thaller, 2012). There is need to investigate other factors associated with reproductive coercion and pregnancy avoidance among women experiencing intimate partner violence (IPV) to inform development of screening tools and targeted interventions....

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