2017 - Page 15 of 100 - searchfortruth.info

Family Interventions For Mental Disorders: Efficacy And Effectiveness

November 20, 2018October 16, 2017 by admin

The physician Henry Richardson described the role of family care in the recovery from physical and mental health problems in 1948 (1). His landmark book entitled "Patients have families" was read by a group of psychiatrists and social anthropologists at the Palo Alto Research Institute in California and became the basis of the systemic approach to family interventions (see 2 for details of this historical perspective). Unlike Richardson, these psychoanalytically trained professionals postulated that family influence was an etiological factor in serious mental disorders, rather than a key factor on the road to recovery. For many years the family system was thought to be the root of all evil and families were accused of inadvertently abusing their offspring through a variety of subtle communication strategies, such as the double-bind or communication deviance. However, these pioneers of family treatment spent considerable time with families and attempted to help them correct...

The Police and Mental Health

November 20, 2018October 16, 2017 by admin

Abstract

With deinstitutionalization and the influx into the community of persons with severe mental illness, the police have become frontline professionals who manage these persons when they are in crisis. This article examines and comments on the issues raised by this phenomenon as it affects both the law enforcement and mental health systems. Two common-law principles provide the rationale for the police to take responsibility for persons with mental illness: their power and authority to protect the safety and welfare of the community, and their parens patriae obligations to protect individuals with disabilities. The police often fulfill the role of gatekeeper in deciding whether a person with mental illness who has come to their attention should enter the mental health system or the criminal justice system. Criminalization may result if this role is not performed appropriately. The authors describe a variety of mobile crisis teams composed of police, mental health professionals, or both...

The “Center Mass” Myth and Ending a Gunfight -Triggernometry

November 20, 2018October 16, 2017 by admin

Surviving a gunfight isn’t what you think it is. Don’t let conventional wisdom get you killed. A well place round to “center mass” in your attacker may not take him out of the fight. Lots of people stay in the fight after “center mass” hits, and some even win it. If you expect to win your gunfight, you have to make sure that you have effectively ended the threat of your attacker. One, two or even several well placed “center mass” shots may not do what you think it will, and learning to recognize this before you gunfight may save your life.

There is a self styled self defense “expert” under every rock, and perhaps two behind every bush, these days. If you have a pet theory on what might work on the street then you can probably find a champion for that idea who actually charges people to teach...

Psychiatric Drugs And Mass Murder: Exploring The Connection

November 20, 2018October 14, 2017 by admin

As the country reels from news of yet another senseless mass killing in suburban Milwaukee, coming on the heels of the even more deadly massacre in Aurora, Colorado, Americans are left to wonder what could possibly be responsible for this outbreak of bloody insanity and murder. But as terrible as these two incidents were, they have an undeniable ring of familiarity about them – since the year 2000, there have been twenty-six cases of mass murder (four or more victims) in the United States, as opposed to twenty combined during the 1980s and 1990s. And before the 1980s, mass killing sprees were actually quite rare in this country, usually averaging no more than one or two per decade. So it appears we are looking at a trend of madness that began approximately thirty years ago and has been picking up steam every since.

While the anti-gun forces came out in legion following the killingsy...

Prevalence And Experience Of Harassment Of People With Mental Health Problems Living In The Community

November 20, 2018October 14, 2017 by admin

Abstract

Background The levels and experiences of harassment of people with mental health problems in the community compared with those of the general population have not been explored.

Aims To measure the levels and experience of harassment experienced by people with mental health problems in the community in Scotland and compare them with the general population.

Method Experiences of harassment were collected by interviewing 165 individuals with mental health problems and a control group of 165 people from the general population.

Results Harassment in the community was found to be twice as common for individuals with mental health problems (41%) than for those in the general population (15%). The harassment commonly involved verbal abuse referring to the individual's mental health problems and was committed primarily by teenagers and neighbours.

Conclusions Harassment has a significantly higher prevalence among individuals with mental health problems living in the community and is believed to have...

Fatal Toxicity Of Drugs Used In Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

Certified deaths from fatal poisoning (accidents, suicides and open verdicts) in England and Wales have declined steadily (from 3952 in 1979 to 2565 in 2004). There was also a small annual reduction in suicides in males and in females over this period. In 2004, self-poisoning accounted for 25% of suicides and open verdicts in males (n = 862) and 45% in females (n = 540). Poisoning death rates per million prescriptions were about 10 times higher for tricyclic antidepressants (TCAs) than for selective serotonin reuptake inhibitors (SSRIs), England and Wales, 1993-2004. However, despite the increased prescription of SSRIs and related compounds in recent years, there has been only a slight decrease (some 10%) in the annual number of antidepressant-related poisoning deaths, in line with the reduction in suicides (all methods) over this period. Citalopram appears to have higher overdose toxicity than other SSRIs. Of newer non-SSRI antidepressants, the overdose...

Industry Sponsorship And Financial Conflict Of Interest In The Reporting Of Clinical Trials In Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

OBJECTIVE: Financial conflict of interest has been reported to be prevalent in clinical trials in general medicine and associated with a greater likelihood of reporting results favorable to the intervention being studied. The extent and implications of industry sponsorship and financial conflict of interest in psychiatric clinical trials have not been investigated, to the authors' knowledge.

METHOD: The authors examined funding source and author financial conflict of interest in all clinical trials published in the American Journal of Psychiatry, the Archives of General Psychiatry, the Journal of Clinical Psychopharmacology, and the Journal of Clinical Psychiatry between 2001 and 2003.

RESULTS: Among 397 clinical trials identified, 239 (60%) reported receiving funding from a pharmaceutical company or other interested party, and 187 studies (47%) included at least one author with a reported financial conflict of interest. Among the 162 randomized, double-blind, placebo-controlled studies examined, those that reported conflict of interest were 4.9...

The Role of Stimulants in Late-Life Depression

November 20, 2018October 14, 2017 by admin

In this issue, Lavretsky and colleagues report the results of a controlled study to determine whether the addition of methylphenidate to citalopram would accelerate and enhance antidepressant response in older adults (1). This was a 16-week, double-blind, three-arm, parallel-design study comparing the combination of methylphenidate and citalopram and either drug plus placebo. The study builds on previous work by the authors. The study participants had a mean age of 69 years, and all had a diagnosis of major depressive disorder. The authors found that the combination treatment accelerated response and increased the remission rate, and the differences were statistically significant and clinically meaningful. The authors also examined whether adjunctive methylphenidate improved cognition. Although cognition improved with treatment, there were no significant differences between treatments. This is a high-quality study, both in design and in the careful reporting of results.

Figure 1, from the online data supplement of the Lavretsky et al...

The Noncompliant Patient in Psychiatry: The Case For and Against Covert/Surreptitious Medication

November 20, 2018October 14, 2017 by admin

Abstract

Nonadherence to treatment continues to be one of psychiatry’s greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients’ family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal and ethical issues of a patient’s competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious...

Disgust And Psychiatric Illness: Have We Remembered?

November 20, 2018October 14, 2017 by admin

Abstract

It has been argued that disgust has been forgotten by psychiatry. An overview of recent research on disgust is provided. Findings suggest that disgust is a predictor of the development of specific psychiatric conditions.

Research suggesting that disgust has a role in psychiatric illness has emerged (Phillips et al, 1998). Although a well-developed theory of disgust exists in the literature (Rozin & Fallon, 1987), it does not indicate how extreme disgust reactions relate to psychopathology. Briefly, disgust is readily distinguished from other emotions, has robust behavioural correlates such as avoidance and distinct facial expressions, and has specific physical effects such as nausea. Disgust follows a developmental pattern whereby the aforementioned reactions are taught by caregivers, generally as a defence against oral ingestion of items considered contaminated.

At its core, disgust means ‘bad taste’. The notion that disgust might have evolved from the food rejection system is evidenced by the gagging...

Law & Psychiatry: Mental Illness, Police Interrogations, and the Potential for False Confession

November 20, 2018October 14, 2017 by admin

Recently, an alarmingly high incidence of wrongful convictions has been documented in the United States, in large part because of "Innocence Projects" that use DNA analyses from crime scenes to exonerate innocent persons. The best-known Innocence Project, administered through the Benjamin N. Cardozo School of Law in New York, has helped to free 138 people who had been wrongfully incarcerated. Approximately 25 percent of these cases involved false confessions arising from inappropriate police interrogations. Among these false confession cases, persons with mental impairment appear to be disproportionately represented. The Innocence Project's Web site notes, "Truly startling is the number of false confession cases involving the mentally impaired and the mentally ill. Police interrogation in the [false confession] cases reveals a lack of training and a disregard for mental disabilities" (1).

An example of where this situation can lead is the case of Eddie Joe Lloyd, who spent 17 years

Psychological Debriefing: Theory, Practice and Evidence

November 20, 2018October 14, 2017 by admin

The history of psychological trauma is littered with episodes of knowledge and forgetting, just as post-trauma memory is scattered with episodes of remembering and amnesia. This authoritative text goes some way towards the prevention of the threatened but premature death-knell for psychological debriefing. Few issues in mental health are as controversial as psychological debriefing, with polarised views common. The term ‘psychological debriefing’ has been used for different types of intervention, and this book highlights the range of conceptualisations, methodologies and interventions that constitute the area of debriefing, with single sessions superseded by critical-incident stress management (the Cochrane Collaboration review examined only randomised controlled trials incorporating one-off sessions (Rose et al, 2001)).

The editors, Raphael & Wilson, have an impressive track record in their International Handbook of Traumatic Stress Syndromes (1993), a seminal text on psychological trauma. Here, they precede each chapter with an editorial commentary, which provides a helpful overview.

Debt and Deliberate Self-Poisoning.

November 20, 2018October 14, 2017 by admin

Abstract

This study is a descriptive survey of financial difficulties in a consecutive series of patients who deliberately poisoned themselves. Over three months 160 such patients presented to the liaison psychiatry service at Leeds General Infirmary. Information was available on 147 of these patients, of whom 54 (37%) had problem debts. Patients in debt were more likely to harm themselves with greater suicidal intent and, after the episode, to report more symptoms of depression and hopelessness. Psychiatrists were more likely to diagnose mental illness in those in debt...

Psychostimulants in Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

The use of the psychostimulants in psychiatry is reviewed. A brief historical perspective on dextroamphetamine is presented, and a brief review of the psychopharmacology of dextroamphetamine, methylphenidate and magnesium pemoline is given. The literature on the use of stimulants in the treatment of resistant depression, apathetic geriatric patients and patients medically ill with a secondary depression is summarized and two case histories given to illustrate the clinical usefulness of the stimulants. The literature on the use of stimulants as an adjunct to antidepressant therapy and as a diagnostic test is also discussed. Finally the use of stimulants in obsessional illness and adult attention deficit disorder is summarized. The writer concludes by commenting that the stimulants have a very useful role in the treatment of certain categories of depression...

The Case of the Confidential Confession: Psychiatry

February 21, 2019October 14, 2017 by admin

The law, medicine, and theology trilogy uniting these Essays, addressing the ethical response to information a professional gains in confidence about a wrongful conviction and an impending execution, raises an overarching question: How does the role of a professional affect our ethical duties as members of society? Likely, few would seriously argue that if the same disclosure about an impending wrongful execution were made to a friend wearing no professional garb that we would find an ethical duty to prevent the friend from disclosing a confidence, rather than an ethical duty compelling the friend to come forward to avoid the wrongful execution. Does the role of a professional displace personal moral standards? Implicit in the problem is the assumption that professionals should act differently. Attempts to articulate a profession's sense of its unique ethical responsibilities are contained, in part, in its ethical code. Psychiatric ethics draw from the field of medical ethics...

Deception And Self-deception In Shamanism And Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

The author argues that both shaman and psychiatrist are obliged to use a degree of self-deception in assuming their roles. The shaman must rationalize his use of trickery to impress his patients, and the psychiatrist deceives himself that his psychotherapeutic techniques have specific healing properties in the face of evidence which suggests that he often merely mobilizes the general effects of placebo and suggestion. Shaman and psychiatrist appear to use the same mental mechanisms in deceiving themselves. Inadequate method and theory may be supported by reference to personal experience and unrelated data or defended by circular reasoning or comparison with an even more inadequate system. The practitioner may also allow his perception of his abilities to be moulded by social consensus...