Targeting 3 Tiers of Psychiatric Problems in Patient-focused Psychiatric Practice: Diagnostic Signs, Symptoms, and Impairments; Specific Complex Subjective Complaints; and Contributing Meta-problems

Objective To apply the evidence-based medicine paradigm to the domain of psychiatric practice and to bring out the consequences for psychiatry of this approach in order to foster the emergence of an evidence-based psychiatry. Method The basic assumptions of traditional and evidence-based paradigms, as delineated by the Evidence-Based Working Group, are used to structure an exploration of the evidence-based approach to psychiatry. Theoretical and practical issues are considered and an example of evidence-based decision making is given. Results An evidence-based approach to psychiatry is described as one that emphasizes the importance of systematic observation and the use of rules of evidence in hypothesis testing. It is suggested that psychiatrists using this approach will be in a position to provide superior patient care. Discussion The application of scientific method to psychiatric problems is discussed as the essence of an evidence-based approach. The common error of “scientism” is described. The authors identify advantages and limitations of an evidence-based approach to psychiatric practice and advocate a decision-making process that balances individualized clinical acumen (phronesis) and information derived from empirical study of groups of patients (techne).

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Treatment of victims of trauma

Advances in Psychiatric Treatment ◽

10.1192/apt.1.6.161 ◽

1995 ◽

Vol 1 (6) ◽

pp. 161-169 ◽

Cited By ~ 5

Author(s):

Gwen Adshead

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Mental Illnesses ◽

Psychiatric Practice ◽

Military Conflict ◽

Psychiatric Sequelae ◽

Psychiatric Problems

The psychiatric sequelae of trauma have been most often discussed in relation to disasters, both natural and man-made, and military conflict. This may sometimes lead psychiatrists to think of posttraumatic stress disorder (PTSD) and other posttraumatic mental illnesses as being somewhat exotic and unusual in general psychiatric practice. In this paper, I propose that PTSD and related disorders are actually common psychiatric problems which require treatment.

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Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.marapr02 ◽

2007 ◽

Vol 12 (2) ◽

pp. 4-8

Author(s):

Frederick Fung

Keyword(s):

Concentration Level ◽

Treatment Plan ◽

Toxic Exposure ◽

Dose Response Relationship ◽

Specialty Board ◽

History Of ◽

Subjective Complaints ◽

Based Medicine ◽

Illness Causation ◽

Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

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Childhood Epilepsy Tied to Psychiatric Problems

Pediatric News ◽

10.1016/s0031-398x(10)70068-0 ◽

2010 ◽

Vol 44 (2) ◽

pp. 32

Author(s):

DIANA MAHONEY

Keyword(s):

Childhood Epilepsy ◽

Psychiatric Problems

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Critical Review on Suicide Among Nurses

Crisis ◽

10.1027/0227-5910/a000305 ◽

2015 ◽

Vol 36 (2) ◽

pp. 91-101 ◽

Cited By ~ 17

Author(s):

Marie Alderson ◽

Xavier Parent-Rocheleau ◽

Brian Mishara

Keyword(s):

Risk Factors ◽

Literature Review ◽

High Stress ◽

Related Factors ◽

Work Settings ◽

Work Related ◽

High Prevalence ◽

Full Text Review ◽

The Subject ◽

Psychiatric Problems

Background: Research shows that there is a high prevalence of suicide among nurses. Despite this, it has been 15 years since the last literature review on the subject was published. Aim: The aim of this article is to review the knowledge currently available on the risk of suicide among nurses and on contributory risk factors. Method: A search was conducted in electronic databases using keywords related to prevalence and risk factors of suicide among nurses. The abstracts were analyzed by reviewers according to selection criteria. Selected articles were submitted to a full-text review and their key elements were summarized. Results: Only nine articles were eligible for inclusion in this review. The results of this literature review highlight both the troubling high prevalence of suicide among nurses as well as the persistent lack of studies that examine this issue. Conclusion: Considering that the effects of several factors related to nurses' work and work settings are associated with high stress, distress, or psychiatric problems, we highlight the relevance of investigating work-related factors associated with nurses' risk of suicide. Several avenues for future studies are discussed as well as possible research methods.

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Types of Stressors on Nonprofessional Against-Suicide and Pro-Suicide Message Boards

Crisis ◽

10.1027/0227-5910/a000562 ◽

2019 ◽

Vol 40 (4) ◽

pp. 257-264 ◽

Cited By ~ 1

Author(s):

Thomas Niederkrotenthaler ◽

Benedikt Till

Keyword(s):

Content Analysis ◽

Interpersonal Problems ◽

Suicide Method ◽

Presenting Problems ◽

Message Boards ◽

Safe Method ◽

Different Types ◽

Psychiatric Problems

Abstract. Background: Little is known about presenting problems of primary posters (i.e., posters opening the thread) and their responders in nonprofessional against-suicide and pro-suicide message boards. Aims: We aimed to compare problems described in suicide message boards between different types of users (primary posters and respondents) and between against-suicide, neutral, and pro-suicide message boards. Method: In all, 1,182 archival threads with 20,499 individual postings from seven nonprofessional suicide message boards supporting an against-suicide, neutral, or pro-suicide attitude were randomly selected. Problems mentioned by primary posters and their respondents were coded with content analysis. Differences between pro-suicide, neutral, and against suicide boards, as well as correlations between primary posters and respondents, were calculated. Results: Interpersonal problems were most frequently mentioned by primary posters in against-suicide threads (40.9%) and less frequently in pro-suicide threads (11.8%; p < .001). In pro-suicide boards, the most frequent stressors were suicide method-related (e.g., how to identify a safe method: 26.2% vs. 2.5% in against-suicide boards, p < .001). Primary posters resembled respondents in terms of presenting problems in pro-suicide boards, but not in against-suicide boards. Limitations: Only self-reported problems were assessed. Conclusion: The results confirm a stronger focus on death than on life among users in pro-suicide message boards, and posters with similar problems meet in pro-suicide boards. The posters appear to clearly emphasize social strains over psychiatric problems compared with some professional settings.

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