scholarly journals Psychosis Without Meaning: Creating Modern Clinical Psychiatry, 1950 to 1980

2021 ◽  
Author(s):  
Joel T. Braslow
Keyword(s):  
Clinical Psychiatry ◽  
Life Histories ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Signs And Symptoms ◽  
Primary Treatment ◽  
Social Contexts ◽  
Clinical Practices ◽  
State Hospitals ◽  
1960S And 1970S

AbstractOver the last fifty years, American psychiatrists have embraced psychotropic drugs as their primary treatment intervention. This has especially been the case in their treatment of patients suffering from psychotic disorders such as schizophrenia. This focus has led to an increasing disregard for patients’ subjective lived-experiences, life histories, and social contexts. This transformation of American psychiatry occurred abruptly beginning in the late 1960s and 1970s. My essay looks the ways these major transformations played themselves out in everyday clinical practices of state hospital psychiatrists from 1950 to 1980. Using clinical case records from California state hospitals, I chronicle the ways institutional and ideological forces shaped the clinical care of patients with psychotic disorders. I show there was an abrupt rupture in the late 1960s, where psychiatrists’ concerns about the subjective and social were replaced by a clinical vision focused on a narrow set of drug-responsive signs and symptoms. Major political, economic, and ideological shifts occurred in American life and social policy that provided the context for this increasingly pharmacocentric clinical psychiatry, a clinical perspective that has largely blinded psychiatrists to their patients’ social and psychological suffering.

scholarly journals A questionnaire survey on evaluation for penetration and compliance of the Japanese Guideline on Febrile Neutropenia among hematology-oncology physicians and surgeons

2021 ◽  
Author(s):  
Nobu Akiyama ◽  
Takuho Okamura ◽  
Minoru Yoshida ◽  
Shun-ichi Kimura ◽  
Shingo Yano ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Supportive Care ◽  
Questionnaire Survey ◽  
Primary Treatment ◽  
Beta Lactam ◽  
Clinical Practices ◽  
High Risk Patients ◽  
Mascc Score ◽  
Risk Patients

Abstract Purpose The Japanese Society of Medical Oncology published a guideline (GL) on febrile neutropenia (FN) in 2017. The study’s purpose is to reveal how widely GL penetrated among physicians and surgeons providing chemotherapy. Methods A questionnaire survey was conducted with SurveyMonkey™ for members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed with statistical text-analytics. Result A total of 800 responses were retrieved. Major respondents were experts with more than 10-year experience, physicians 54%, and surgeons 46%. Eighty-seven percent of respondents knew and used GL. Forty-eight percent assessed FN with Multinational Association of Supportive Care in Cancer (MASCC) score “always” or “more than half.” Eighty-one percent chose beta-lactam monotherapy as primary treatment in high-risk patients. Seventy-seven percent did oral antibacterial therapy in low-risk patients ambulatorily. Seventy-eight percent administered primary prophylactic G-CSF (ppG-CSF) in FN frequency ≥ 20% regimen. Fifty-nine percent did ppG-CSF for high-risk patients in FN frequency 10–20% regimen. Ninety-seven percent did not use ppG-CSF in FN frequency < 10% regimen. The medians of complete and complete plus partial compliance rates were 46.4% (range 7.0–92.8) and 77.8% (range 35.4–98.7). The complete compliance rates were less than 30% in seven recommendations, including the MASCC score assessment. Conclusion GL is estimated to be widely utilized, but some recommendations were not followed, presumably due to a mismatch with actual clinical practices in Japan.

General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A131-A136 ◽  
Author(s):  
Ian R. H. Falloon
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Early Detection ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Signs And Symptoms ◽  
Psychotic Episode

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

scholarly journals Voice-Based Screening For SARS-CoV-2 Exposure In Cardiovascular Clinics

2021 ◽  
Author(s):  
Abhinav Sharma ◽  
Emily Oulousian ◽  
Jiayi Ni ◽  
Renato Lopes ◽  
Matthew Pellan Cheng ◽  
...  
Keyword(s):  
Healthcare Provider ◽  
Clinical Care ◽  
Health Centre ◽  
Healthcare Delivery ◽  
Signs And Symptoms ◽  
Kappa Statistic ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Mcgill University ◽  
Strongly Agree

Abstract Aims Artificial intelligence (A.I) driven voice-based assistants may facilitate data capture in clinical care and trials; however, the feasibility and accuracy of using such devices in a healthcare environment are unknown. We explored the feasibility of using the Amazon Alexa (‘Alexa’) A.I. voice-assistant to screen for risk-factors or symptoms relating to SARS-CoV-2 exposure in quaternary care cardiovascular clinics. Methods We enrolled participants to be screened for signs and symptoms of SARS-CoV-2 exposure by a healthcare provider and then subsequently by the Alexa. Our primary outcome was interrater reliability of Alexa to healthcare provider screening using Cohen’s Kappa statistic. Participants rated the Alexa in a post-study survey (scale of 1 to 5 with 5 reflecting strongly agree). This study was approved by the McGill University Health Centre ethics board. Results We prospectively enrolled 215 participants. The mean age was 46 years (17.7 years standard deviation [SD]), 55% were female, and 31% were French speakers (others were English). In total, 645 screening questions were delivered by Alexa. The Alexa mis-identified one response. The simple and weighted Cohen’s kappa statistic between Alexa and healthcare provider screening was 0.989 (95% CI: 0.982, 0.997) and 0.992 (955 CI 0.985, 0.999) respectively. The participants gave an overall mean rating of 4.4 (out of 5, 0.9 SD). Conclusion Our study demonstrates the feasibility of an A.I. driven multilingual voice-based assistant to collect data in the context of SARS-CoV-2 exposure screening. Future studies integrating such devices in cardiovascular healthcare delivery and clinical trials are warranted. Registration https://clinicaltrials.gov/ct2/show/NCT04508972

A glimpse forward regarding psychopathology of psychotic disorders

2020 ◽  
pp. 647-651
Author(s):  
William T. Carpenter
Keyword(s):  
Risk Factors ◽  
Primary Prevention ◽  
Early Detection ◽  
Clinical Features ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Therapeutic Targets ◽  
Partial Solution ◽  
New Knowledge

Issues related to early detection and intervention, primary prevention, and re-conceptualizing therapeutic targets are important current themes in psychosis research. Extensive heterogeneity within each diagnostic class and overlap in clinical features, risk factors and associated features between diagnostic classes, all result in critical limitations in clinical care and research. In this chapter, concrete approaches are suggested to make progress in psychosis research. Each partial solution has a different profile of strengths and weaknesses. New knowledge will be needed to make progress, and that knowledge will be acquired incrementally.

A Factorial Study of Physical Constitution in Women

1950 ◽  
Vol 96 (404) ◽  
pp. 619-632 ◽  
Author(s):  
Linford Rees
Keyword(s):  
Mental Status ◽  
Clinical Psychiatry ◽  
Female Body ◽  
Psychotic Disorders ◽  
Anthropometric Indices ◽  
Body Build ◽  
Objective Procedure ◽  
Total Personality ◽  
Physical Constitution

The assessment of body build as an integral part of the total personality is now accepted as an important procedure in the practice of clinical psychiatry. Body build has been found to influence symptomatology, mental status, course and prognosis in neurotic and psychotic disorders (Betz, 1942; Mauz, 1930; Kisselew, 1931; Freudenberg, 1941; Rees, 1945, 1947). Whereas the delineation of physical types has now become an objective procedure by the use of anthropometric indices (Rees, 1949), it has long been recognized that the differentiation of physical types in women is much more difficult. Kretschmer (1921) pointed out that the types of physique described by him were less easily diagnosed in women, and Sheldon (1940) pays comparatively little attention to the variations of female body build.

Eating Disorders. Review Of Current Treatment Options For Anorexia Nervosa, Focused On Psychotherapy And Pharmacological Treatment

2016 ◽  
Vol 33 (S1) ◽  
pp. S432-S432
Author(s):  
B. Sánchez Sánchez ◽  
P. Muñoz-Calero Franco ◽  
N. Rodriguez Criado ◽  
J.F. Cruz Fourcade ◽  
R. Martín Aragón ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Pharmacological Treatment ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Current Treatment ◽  
Cognitive Behavioral ◽  
Nutritional Rehabilitation ◽  
Clinical Practices ◽  
Major Health Problem ◽  
Competing Interest

IntroductionAnorexia nervosa is a disorder of eating behavior that is a major health problem on our society. It is characterized by three main criteria: self-induced starvation, desire for thinness or fear of obesity, and the presence of medical signs and symptoms due to improper feeding. This work is focused on its treatment. The biopsychosocial approach allows the design and application of effective therapeutic strategies and a multidisciplinary team collaboration is essential.ObjectivesResearch of current pharmacological and psychotherapy treatments options of the disease.Material and methodsLiterature review based on articles and publications on this topic.ResultsIn anorexia nervosa, it is necessary to establish a therapeutic alliance between doctor and patient. Patient usually feels no motivation to improve. The different treatments options to combine, in terms of the patient status, are: nutritional rehabilitation, cognitive-behavioral, family and interpersonal psychotherapies and pharmacological treatment. It can be carried out at the ambulatory, at the day-hospital or by medical stay, even beyond patient will.ConclusionsNowadays, the nutritional rehabilitation is the best treatment established and it is the core treatment. About the psychotherapies, the cognitive-behavioral is the most used because it has exposed better results in all different studies proved and in clinical practices, followed by the family therapy which is the responsible of the patient family's treatment. Pharmacological treatment should not be used systematically and its exclusive use is not enough to resolve anorexia nervosa as there are needed also other treatments combined.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A comprehensive monitoring approach to physical healthcare in people with schizophrenia

2017 ◽  
Author(s):  
David J. Castle ◽  
Peter F. Buckley ◽  
Fiona P. Gaughran
Keyword(s):  
Physical Health ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Health Issues ◽  
Patient Level ◽  
Routine Clinical Care ◽  
Clinical Level ◽  
Physical Health Problems ◽  
Usual Clinical Practice ◽  
Ongoing Monitoring

Monitoring of sentinel physical health issues should be part of the routine clinical care of people with schizophrenia and should include everyone involved, not least the patients’ general practitioners and patients themselves. All too often, however, appropriate ongoing monitoring is not part of usual clinical practice, and patients with psychotic disorders continue to have their physical health problems under-recognized and under-treated. There are numerous barriers to effective monitoring, and these operate at a systems level, clinical level, and patient level. Understanding of these barriers and negotiating them is vital and needs to be responsive to individual circumstances. This chapter provides a number of tools that can assist comprehensive longitudinal monitoring and involve the patient in the process. Clinicians and systems need to ensure such procedures and care pathways are delivered upon and continually audited and updated as required.

Muddying the waters? A false positive case of autoimmune psychosis

2020 ◽  
pp. 103985622096504
Author(s):  
Sarangan Ketheesan ◽  
Georgia Bertram ◽  
Robert Adam ◽  
Anne Stark ◽  
James G Scott
Keyword(s):  
Psychotic Disorders ◽  
Signs And Symptoms ◽  
Psychosocial Problems ◽  
Antibody Testing ◽  
Laboratory Findings ◽  
Antineuronal Antibodies ◽  
Neurological Signs ◽  
Iatrogenic Harm ◽  
Treatment Refractory ◽  
Autoimmune Psychosis

Objective: To discuss challenges with the diagnosis of autoimmune psychosis (AP) in people with chronic psychotic disorders. Method: We present a case of a 23-year-old man with an exacerbation of treatment-refractory psychosis after receiving intravenous immunoglobulin (IVIG) for suspected AP, diagnosed 4 years after the onset of psychosis. We highlight the diagnostic and management challenges in such cases. Results: The diagnosis of AP in people with long-standing illness relies on the interpretation of non-specific clinical and laboratory findings in individuals with psychosocial problems and challenges of acceptance and adherence to complex medical investigations and treatments. Equivocal results from investigations undertaken without logical clinical reasoning can lead to inappropriate interventions that are costly and can cause iatrogenic harm. Conclusion: Psychiatrists should restrict screening for antineuronal antibodies in people with chronic psychosis to those with higher risk features such as persistent treatment refractory symptoms with concurrent neurological signs and symptoms. Further research informing the clinical circumstances for antineuronal antibody testing is needed.

scholarly journals How to Be Savvy About Gender Disparities in Academic Stroke Medicine

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Aleksandra Pikula ◽  
Luciana Catanese ◽  
Cheryl D. Bushnell ◽  
Valeria Caso ◽  
Julie K. Silver
Keyword(s):  
Clinical Care ◽  
Critical Role ◽  
Women's Leadership ◽  
Gender Disparities ◽  
Early Career ◽  
Diagnostic Tools ◽  
Career Stage ◽  
Clinical Practices ◽  
New Treatments

In the past decade, stroke medicine has evolved from discovery of innovative diagnostic tools to implementation of new treatments. These advances are projected to increase the demand for stroke neurologists in academic and clinical practices, but hopefully with equitable opportunities for everyone across the gender spectrum. Academic medicine provides opportunities to participate in clinical care, teaching, research, and administration. The early career stage is short-focused on finding an academic niche and developing new skills that will help you navigate the academic environment. A recent InterSECT article emphasized the critical role of women’s leadership in stroke medicine. In this article, we reflect on workforce gender disparities and provide 5 practical strategies that may help women overcome barriers and advance their work mission.

scholarly journals Collaborative, Multidisciplinary Evaluation of Cancer Variants Through Virtual Molecular Tumor Boards Informs Local Clinical Practices

2020 ◽  
pp. 602-613 ◽  
Author(s):  
Shruti Rao ◽  
Beth Pitel ◽  
Alex H. Wagner ◽  
Simina M. Boca ◽  
Matthew McCoy ◽  
...  
Keyword(s):  
Cancer Genomics ◽  
Clinical Care ◽  
Relevant Literature ◽  
Tumor Biology ◽  
Collaborative Governance ◽  
Disease Classification ◽  
Clinical Practices ◽  
Data Types ◽  
Disease Etiology ◽  
Tumor Boards

PURPOSE The cancer research community is constantly evolving to better understand tumor biology, disease etiology, risk stratification, and pathways to novel treatments. Yet the clinical cancer genomics field has been hindered by redundant efforts to meaningfully collect and interpret disparate data types from multiple high-throughput modalities and integrate into clinical care processes. Bespoke data models, knowledgebases, and one-off customized resources for data analysis often lack adequate governance and quality control needed for these resources to be clinical grade. Many informatics efforts focused on genomic interpretation resources for neoplasms are underway to support data collection, deposition, curation, harmonization, integration, and analytics to support case review and treatment planning. METHODS In this review, we evaluate and summarize the landscape of available tools, resources, and evidence used in the evaluation of somatic and germline tumor variants within the context of molecular tumor boards. RESULTS Molecular tumor boards (MTBs) are collaborative efforts of multidisciplinary cancer experts equipped with genomic interpretation resources to aid in the delivery of accurate and timely clinical interpretations of complex genomic results for each patient, within an institution or hospital network. Virtual MTBs (VMTBs) provide an online forum for collaborative governance, provenance, and information sharing between experts outside a given hospital network with the potential to enhance MTB discussions. Knowledge sharing in VMTBs and communication with guideline-developing organizations can lead to progress evidenced by data harmonization across resources, crowd-sourced and expert-curated genomic assertions, and a more informed and explainable usage of artificial intelligence. CONCLUSION Advances in cancer genomics interpretation aid in better patient and disease classification, more streamlined identification of relevant literature, and a more thorough review of available treatments and predicted patient outcomes.

Sign in / Sign up

Export Citation Format

Share Document