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Artykuły w czasopismach na temat "Psychiatric out-patient care"
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Mattsson, Monica, i Bengt Mattsson. "Physiotherapeutic Treatment in Out-Patient Psychiatric Care". Scandinavian Journal of Caring Sciences 8, nr 2 (czerwiec 1994): 119–26. http://dx.doi.org/10.1111/j.1471-6712.1994.tb00241.x.
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Moutoussis, Michael, Fiona Gilmour, Dave Barker i Martin Orrell. "Quality of care in a psychiatric out-patient department". Journal of Mental Health 9, nr 4 (1.08.2000): 409–20. http://dx.doi.org/10.1080/713680257.
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Moutoussis, Fiona Gilmour, Dave Bar, Michael. "Quality of care in a psychiatric out-patient department". Journal of Mental Health 9, nr 4 (styczeń 2000): 409–20. http://dx.doi.org/10.1080/jmh.9.4.409.420.
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Moreno, A. Chinchilla, L. Mateo Mateos, M. Martín Larrégola i A. Diez Saez. "Socio-Demographic Profile of Out-Patient Clinic First Assessment". European Psychiatry 24, S1 (styczeń 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71176-9.
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Introduction:Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.Objectives:To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.Methods:We include 9 variables from 104 first assessments carried out in our center.Results:48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.Conclusions:As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.
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Killaspy, Helen. "Psychiatric out-patient services: origins and future". Advances in Psychiatric Treatment 12, nr 5 (wrzesień 2006): 309–19. http://dx.doi.org/10.1192/apt.12.5.309.
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Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.
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Hautala-Jylhä, Pirjo-Liisa. "Patient and Personnel Conceptions of the Patient-Nurse Relationship in Psychiatric Post-Ward Out-Patient Services". International Journal of Human Caring 11, nr 4 (czerwiec 2007): 24–32. http://dx.doi.org/10.20467/1091-5710.11.4.24.
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The aim of this study was to analyze and describe the conceptions of patients and personnel concerning the patient-nurse relationship in psychiatric post-ward out-patient services. Aphenomenographic approach was used. The four main categories were patient’s appearance, behavior, and nonverbal expression; empowering of the patient; characteristics of patient-nurse relationship; and setting and maintaining limits. Especially in psychiatric nursing, the significance of the patient-nurse relationship needs to be emphasized. In a successful and collaborative patient-nurse relationship, the patient learns to care for him/herself and to restore interest in taking care of him/herself and surviving in everyday life.
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Sheikh, A. Jawad, i Christopher Meakin. "Consumer satisfaction with a psychiatric out-patient clinic". Psychiatric Bulletin 14, nr 5 (maj 1990): 271–74. http://dx.doi.org/10.1192/pb.14.5.271.
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NHS out-patient clinics remain a major point of contact between psychiatrists and their patients. There are several advantages to this setting for consultation: it is time efficient, there is usually easy access to case records and contact with other disciplines and services is often available. With the current trend towards community care, increasing use of out-patient facilities is likely as home visiting becomes impractical and, moreover, may be undesirable for some patients.
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Johansson, Håkan, i Mona Eklund. "Helping alliance and early dropout from psychiatric out-patient care". Social Psychiatry and Psychiatric Epidemiology 41, nr 2 (1.01.2006): 140–47. http://dx.doi.org/10.1007/s00127-005-0009-z.
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Goss, Claudia, Francesca Moretti, Maria Angela Mazzi, Lidia Del Piccolo, Michela Rimondini i Christa Zimmermann. "Involving patients in decisions during psychiatric consultations". British Journal of Psychiatry 193, nr 5 (listopad 2008): 416–21. http://dx.doi.org/10.1192/bjp.bp.107.048728.
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BackgroundPatient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry.AimsTo assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement.MethodEighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested usingt-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients.ResultsInterrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level.ConclusionsThe OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
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Kessing, Lars Vedel, Hanne Vibe Hansen, Anne Hvenegaard, Ellen Margrethe Christensen, Henrik Dam, Christian Gluud i Jørn Wetterslev. "Treatment in a specialised out-patient mood disorder clinicv.standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial". British Journal of Psychiatry 202, nr 3 (marzec 2013): 212–19. http://dx.doi.org/10.1192/bjp.bp.112.113548.
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BackgroundLittle is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder.AimsTo assess the effect of treatment in a specialised out-patient mood disorder clinicv.standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder.MethodPatients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register.ResultsA total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37–0.97,P=0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care.ConclusionsTreatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.
Rozprawy doktorskie na temat "Psychiatric out-patient care"
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Rognstadbråten, Anna, i Pia Rydström. "Det diffusa ansvaret - gör att vi inte förstår varandra : Sjuksköterskors erfarenhet av samverkan mellan psykiatrisk öppenvård och psykiatrisk slutenvård". Thesis, Högskolan Väst, Avdelningen för omvårdnad - avancerad nivå, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-11276.
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Earlier studies show that when psychiatric out- and in-patient care units work together the risk for hospitalization decreases, leads to increased flexibility and shorter in-patient periods. At a psychiatric clinic in western Sweden there are routines in place regarding the transfer of patients from in-patient to out-patient care. The aim of this study was to describe nurses' experience of how out-and in-patient clinics collaborate during patients in-patient care. This is a qualitative study with an inductive approach. Ten nurses participated through semi structured interviews. The result ended up in two domains and eight subthemes and one theme, the diffuse responsibility – makes us not understand each other. Nurses in both out- and in-patient care experience uncertainty as to who has the responsibility for patients' treatment-plans and also uncertainty in how communication between the two parties works. Nurses in in-patient care experience that the out-patient care are uninterested, and nurses in out-patient care experience that in-patient care does not follow treatment-plans. In Conclusion both nurses in out- and in-patient care describe a need for an improved partnership. Some find that they are unsure of their role and their responsibility in the partnership. Structures for an improved partnership need to be implemented from the staff leadership, to be able to live up to the national guidelines and ensure that patients receive the treatment which serious psychiatric illness needs.
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Maphats'oe, Pulane. "Patient satisfaction survey on the quality of psychiatric care at Mohlomi psychiatric out-patient clinic in Lesotho". Thesis, 2015. http://hdl.handle.net/10539/17328.
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A Research Report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Public Health.
October 2014, Johannesburg.Background: Patient satisfaction with health services has widely been associated with increased health-seeking behaviour, improved clinical outcomes, and overall quality of health care. Research that has emerged from the developed world has steered the development of both satisfaction measures, as well as research into patient satisfaction at public health facilities. Despite the importance of patient satisfaction to positive health outcomes, few studies exist in the developing world that examine patient satisfaction levels with public health services. Even fewer exist in the field of public mental health services. This study aims to determine adult patients’ satisfaction with dimensions of care at a psychiatric out-patient clinic in Maseru, Lesotho. Design: The study employs a quantitative cross–sectional study design, using interviewer administered paper-pencil questionnaires, which was adapted from the Charleston Psychiatric Out-patient Satisfaction Scale (CPOS) (Pellegrin, Stuart, Maree, Freuh, & Ballenger, 2001). The sample size for the present study was 271, with 194 females, who comprised the majority of the sample and 77 males. The adapted questionnaire elicited information on patient satisfaction within four specific dimensions of care namely, the staff-patient relationship, administrative services, responsiveness to patients’ treatment expectations and waiting times. In addition, a qualitative component including two open-ended questions gauged participants’ overall experience of satisfaction and self-reported recommendations on how to improve the clinic services. Statistical analyses: Univariate analyses were conducted on patient socio-demographic variables and patient satisfaction scale. Subscales of patient satisfaction with the quality of services at the psychiatric facility were created. Bivariate analysis was conducted on the socio-demographic variables, treatment history, referral source and subscales of the patient satisfaction scale using crosstabs and chi- square analysis. The two open-ended questions were analysed using thematic content analysis, hence identifying the themes and sub-themes. Results: Univariate analyses showed that across all the 12 items measuring patient satisfaction, patients were mostly highly satisfied with the services. Chi-square analysis showed that age was significantly associated with administrative services (p=.014) and waiting time (p=0.05) and marginally significantly associated with responsiveness to patients’ treatment expectations (p=.063). Results from the open-ended component highlighted that most participants were dissatisfied with aspects pertaining to access to service, waiting times and adequacy of services. Conclusion: Despite the seeming overall satisfaction expressed with the quality of psychiatric care on a scale of patient satisfaction, disaggregation of the results by subscales, as well as exploration of the open-ended responses from patients suggests that our understanding of patient satisfaction with the quality of mental health services may be limited by methodological issues, where patients felt more comfortable with the non-limiting nature of the open-ended section as opposed to the closed-ended nature of the quantitative section of the study tool. Furthermore, patients who are older may be more likely to show higher levels of satisfaction with care in a context where public health care is often challenging to access. This finding highlights a need for management and other stakeholders to pay more attention to the improvement of services for younger patients, who showed lower satisfaction levels with care. Future research employing mixed methods study designs is also suggested.
Książki na temat "Psychiatric out-patient care"
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Thomas, Alan. Psychiatric assessment of older people. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0009.
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The venue for assessment varies but given the choice there are substantial advantages in the first assessment being conducted at home. The aims of the assessment are to do more than achieve a diagnosis, though this is crucial; the aim should also be to produce a holistic assessment of all needs leading to the involvement a range of appropriate professionals in health and social care services to address these needs and carry out their own specialist assessments. Information from informants will supplement that of the patient and enable completion of all the important domains in the psychiatric history. The mental state examination will include a special emphasis on cognitive assessment and a brief physical looking for neurological signs is important.
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Sookman, Debbie. Ethical Practice of Cognitive Behavior Therapy. Redaktorzy John Z. Sadler, K. W. M. Fulford i Werdie (C W. ). van Staden. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780198732372.013.35.
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Contemporary cognitive behavior therapy (CBT) comprises complex interventions that have demonstrated efficacy and/or are currently the evidence-based psychotherapeutic treatment of choice for many psychiatric disorders. This chapter discusses management of ethical issues that may arise during evidence-based CBT: initial assessment, informed consent, exposure-based therapy, out of office sessions, management of boundaries, homework, and risk management. The patient-therapist relationship and conceptualization of resistance during CBT are discussed. A crucial requirement of ethical mental health care is additional dissemination of CBT expertise. In this current era of specialization, interventions that target disorder specific symptoms and related difficulties (American Psychiatric Association,2013) show special promise. It is the ethical responsibility of clinicians regardless of orientation to be guided by current empirical research and their own specific areas of competence when making treatment recommendations. A priority for clinical research is further examination of the specific therapeutic ingredients that impact outcome and optimize recovery.
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A, Lewis Dan, i Lurigio Arthur J, red. The State mental patient and urban life: Moving in and out of the institution. Springfield, Ill., U.S.A: Charles C. Thomas, 1994.
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Brugha, Traolach S. Full assessment: direct observation and the signs of autism. Redaktor Traolach S. Brugha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198796343.003.0009.
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This chapter focuses on direct observation and examination, moving consciously from the traditional interview, question, and answer format, to the observational format. Observing 1:1, with a carer present—for example, does the patient engage, both verbally and non-verbally, or is (s)he aloof, unless directly asked to join in? The Autism Diagnostic Observation Schedule (ADOS) is mentioned with an outline description. The limitations of observation, if comorbidity is present, are pointed out, indicating how comorbidity can be distinguished (and then referring on to Chapter 10). Methods used by psychopathologists in psychiatry to observe signs of autism are also refreshed.
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Schouten, Ronald, i Philip J. Candilis. Civil Commitment. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199387106.003.0002.
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More than any other clinical intervention, civil commitment is subject to strict legal requirements and oversight. Although the rules and processes vary by jurisdiction, the legal proceedings in all jurisdictions are designed to balance the autonomy interests and constitutional rights of the patient against the state’s legitimate exercise of authority. This chapter reviews the legal principles underlying civil commitment and describes how those principles are applied in different ways, using examples from various jurisdictions. Using a case vignette, it explores a common scenario in which an emergency room physician who must make a decision regarding a patient’s need for hospitalization obtains a psychiatric consultation, and it follows the civil commitment process as it would play out in one jurisdiction. By its nature, civil commitment is both a clinical intervention and a legal process, and the chapter addresses some of the clinical challenges encountered in the course of involuntary hospitalization.
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Webb, Allison M. B., Shannon C. Ford i Patcho N. Santiago. Adjustment Disorder. Redaktorzy Frederick J. Stoddard, David M. Benedek, Mohammed R. Milad i Robert J. Ursano. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457136.003.0005.
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Adjustment disorder is a psychiatric diagnosis that has undergone numerous iterations within the Diagnostic and Statistical Manual of Mental Disorders and is characterized by an immediate or almost immediate maladaptive or pathologic psychological response to a stressor. When the stressor is removed, there is the expectation that the patient returns to his or her previous level of functioning. This chapter provides an overview of its historical development, diagnostic criteria, potential controversies, epidemiology, neurobiology, comorbidities, and other differential diagnostic and treatment considerations such as ruling out depression and using assessment instruments. The chapter closes with the presentation of a case illustrating application of the criteria and clinical characteristics of adjustment disorder.The views expressed in this chapter are those of the authors and do not reflect the official policy of the Department of Army/Navy/Force, Department of Defense, or U.S. Government. The identification of specific products or scientific instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency.
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Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.
Części książek na temat "Psychiatric out-patient care"
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Martin, Peggy. "Nursing care of the patient who is out of touch with reality". W Psychiatric Nursing, 296–306. London: Macmillan Education UK, 1987. http://dx.doi.org/10.1007/978-1-349-09408-0_27.
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Costa e Silva, Jorge Alberto. "Aspects of in- and Out-Patient Care in Economically Underprivileged Countries". W Epidemiology and Community Psychiatry, 403–8. Boston, MA: Springer US, 1985. http://dx.doi.org/10.1007/978-1-4684-4700-2_60.
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McKnight, Rebecca, Jonathan Price i John Geddes. "General aspects of care: settings of care". W Psychiatry. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198754008.003.0017.
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Current mental healthcare services in most of the developed world are unrecognizable compared with those of the mid twentieth century. There has been a major shift from long- term institutional to community care. This chapter describes current approaches to providing mental health services, particularly for people between the ages of 18 and 65 (services for children are discussed in Chapter 17, and services for the elderly in Chapter 18). It is important for all doctors to have a basic understanding of the structure of services for three main reasons: … 1 It will help you to get the most out of clinical rotations in psychiatry, either at undergraduate or postgraduate level. 2 All clinicians need to know when and how to refer their patient to appropriate services. 3 Patients being treated by other medical specialties may have psychiatric co- morbidities. Effective management and liaison with mental health services requires a working knowledge of common conditions and their treatment. … Mental health services are organized in different ways from country to country. This chapter describes mainly the provision of services in the UK, but the principles apply generally. To understand the range of psychiatric services that are required for a specific community it is necessary to know: … 1 the frequency of mental disorders in the population; 2 the severity of these conditions and the impact they have upon a person’s ability to function; 3 how patients with these disorders come into contact with the health services; 4 what type of services people engage with and find effective. … The local prevalence of mental disorders will vary, but approximate estimates can be obtained from national surveys (Table 11.1). Approximately 20 per cent of adults and 10 per cent of children experience a mental health problem in any given year. A more detailed discussion of the epidemiology of mental health as a whole can be found in Chapter 2, p. 5, and for specific disorders in their individual chapters. The basic principles of the provision of mental health services are the same as for any other health service. Services should be accessible, comprehensive, appropriate to the needs of the community, offer up- to- date treatments, effective, and economical. Patients should be offered a choice in the treatment they receive, although the caveat to this is when an individual is being treated under the Mental Health Act.
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Huntley, Jonathan, Alan Thomas i Rob Stewart. "Psychiatric assessment of older people". W Oxford Textbook of Old Age Psychiatry, 145–52. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198807292.003.0009.
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The venue for psychiatric assessment varies, but given the choice, there are substantial advantages in the first assessment being conducted at home. The aims of assessment are to do more than achieve a diagnosis, though this is crucial; the aim should also be to produce a holistic assessment of all needs, leading to the involvement of a range of appropriate professionals in health and social care services to address these needs and carry out their own specialist assessments. Information from informants will supplement that of the patient and enable completion of all the important domains in the psychiatric history. The mental state examination will include a special emphasis on cognitive assessment, and a brief physical examination looking for neurological signs is important.
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Corbett, Anne. "Detecting and Managing the Untreated Pain in Dementia". W Overlapping Pain and Psychiatric Syndromes, redaktorzy J. Gregory Hobelmann i Michael R. Clark, 342–56. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190248253.003.0025.
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Dementia affects more than 30 million people worldwide and is a major public health issue because of the complex treatment and care needs of these older patients. Pain is very common in people with dementia and is closely linked to key clinical outcomes, including mobility and falls, behavioral symptoms, mental health, and quality of life. Effective pain management is therefore essential to provide a good quality of care for these individuals. Pain assessment and treatment can be challenging in dementia because of loss of communication and insight as the condition progresses. There are also indications that the dementia syndrome itself affects the experience of pain and response to established treatment approaches. Guiding principles for pain management are therefore focused on a person-centered approach, with careful monitoring to avoid the risk for polypharmacy and treatment sensitivity that is common in people with dementia. This chapter outlines the current evidence pertaining to pain in people with dementia and sets out recommendations for both assessment and treatment of pain in this patient group.
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Doleys, Daniel M., i Nicholas D. Doleys. "There Are Not Enough Sheep". W Psychological and Psychiatric Issues in Patients with Chronic Pain, redaktorzy Daniel M. Doleys i Nicholas D. Doleys, 117–26. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197544631.003.0014.
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It is difficult to overemphasize the potential impact of sleep and sleep disorders on chronic pain. Indeed, there are data indicating that sleep disturbance mat be a significant causal factor in the development and maintenance of chronic pain. One would think that daytime pain would predict degree of sleep. But, in fact, it is the opposite; sleep is better predictor of daytime pain intensity. The factor associated with poor sleep are many and varied. Ruling out sleep apnea should be a priority. The availability of in-home studies simplifies the assessment/screening, and may engender greater cooperation. Sleep apnea contributes to hypogonadism, which, in turn, impact a number of physical factor that influence mood, function, and pain. There is a number of approaches that can be implemented in the primary care and pain clinic setting to address the problem of sleep disorders in the patient with chronic pain.
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M. Perez, Linda, Suzi E. Desmond i Cheryl J. Sundheim. "From the Shadow to the Light: Navigating Life as a Mother with a History of Substance Use and Parenting a Child Healing from Early Childhood Trauma". W Psychoanalysis [Working Title]. IntechOpen, 2020. http://dx.doi.org/10.5772/intechopen.94073.
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We report on an innovative in-patient residential recovery program that serves as a model for those who treat low-income women with substance use and psychiatric problems and their children. The case discussed details the psychotherapeutic treatment of a mother and child that was carried out within the protection of the program’s seeking safety, trauma informed model of care. The treatment demonstrates the sensitive care that is needed when working with a young child with a history of early childhood trauma and the favorable ways that holding the mother in mind freed her to be emotionally available to her son. In this situation, the therapist provided an emotionally-attuned interpersonal therapeutic relationship and created features of safety in the environment that helped the child develop an emerging reorganized protective structure to safely explore his fears. The mother and child can follow a course of recovery from traumatic experiences within the context of favorable conditions, thereby interrupting the intergenerational dynamics of early relational trauma.
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Reuber, Markus, Gregg H. Rawlings i Steven C. Schachter. "Neuropsychologist, 7 years’ experience, UK". W Non-Epileptic Seizures in Our Experience, redaktorzy Markus Reuber, Gregg H. Rawlings i Steven C. Schachter, 236–40. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190927752.003.0080.
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This chapter demonstrates the rise and fall of a Non-Epileptic Attack Disorder (NEAD) service. The first recorded NEAD referral to the Neuropsychology Service arrived in 2004. The patient was referred to Neuropsychology by a Consultant Neurologist, who wrote that having captured some of the attacks on telemetry, it was clear that these were “non-epileptic.” The patient was also under the care of mental health services for depression and other psychiatric difficulties. She was sent a waiting list letter, but the referral was not followed up and she was never seen. Even at this early stage in the provision of NEAD services, it was evident that the remit of mental health and physical health services was unclear and that patients could fall through the gap. In the following three years, referrals remained low at one or two per year. However, in 2012, NEAD made up 7% of all referrals. Recognizing that this group of people needed specialist intervention, a Neuropsychologist undertook an extensive literature review. Some facts stood out: the extreme delay in obtaining a diagnosis, the importance of receiving a clear and compassionately delivered diagnosis in reducing or stopping seizures, the sense of being left in limbo following diagnosis, and the need for clients to have a safe place to process painful emotions.
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González, Loreto Fernández, Jonathan Irish i Gary Rodin. "Head and Neck Cancer". W Psycho-Oncology, redaktor Mark Lazenby, 215–20. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190097653.003.0030.
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The management of head and neck cancer (HNC) poses significant challenges for both patients and clinicians because some of the most complex clinical scenarios in oncology occur with this condition. Better understanding of the disease has produced advances in medical treatments in recent decades, improving survival and health-related quality of life (HRQOL). Nevertheless, virtually all patients with HNC experience some impairment in HRQOL because of the disease and/or its treatment. This impairment may be transient or permanent and may manifest as symptoms, limitations in function, and/or an inability to engage in previous roles and normal routines. A multidisciplinary team delivers optimal psychosocial care in HNC, with interventions adapted to the changing needs of patients across the treatment and survivorship trajectories. Assessments should be carried out before the initiation of treatment and subsequently to identify psychosocial strengths, vulnerabilities, and stressors and to plan psychosocial interventions that may be required during and after treatment and in the survivorship phase. Psychiatric comorbidity is significant in this population and may require specialized management. Research on psychosocial interventions has grown in recent years, with promising initial results. Future directions should include strategies to integrate specialized psychosocial care into the standard of care for this patient population.
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Weinman, John, i Keith J. Petrie. "Health psychology". W New Oxford Textbook of Psychiatry, 1135–43. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0147.
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Health psychology is concerned with understanding human behaviour in the context of health, illness, and health care. It is the study of the psychological factors, which determine how people stay healthy, why they become ill, and how they respond to illness and health care. Health psychology has emerged as a separate discipline in the past 30 years and there are many reasons for its rapid development. An important background factor is the major change in the nature of health problems in industrialized societies during the twentieth century. Chronic illnesses such as heart disease and cancer have become the leading causes of death, and behavioural factors such as smoking, diet, and stress are now recognized as playing a major role in the aetiology and progression of these diseases. The provision of health care has grown enormously and there is an increased awareness of good communication as a central ingredient of medical care and of the importance of such factors as patient satisfaction and quality of life as key outcomes in evaluating the efficacy of medical interventions. Although health psychology has developed over a similar time period to general hospital/liaison psychiatry and shares some common areas of interest, there are some clear differences between these two fields. Liaison psychiatry has a primary focus on hospital patients, particularly those experiencing psychological difficulties in the face of a physical health problem. In contrast, health psychology has a much broader focus on both healthy and ill populations and on the psychological processes that influence their level of health or their degree of adaptation to disease. Whereas health psychology has been mainly concerned with developing explanations based on theory, for health-related and illness-related behaviour, liaison psychiatry has concentrated on the diagnosis and treatment of either unexplained symptoms or psychiatric disorders occurring in people with medical conditions (see the other chapters in Part 5 of this volume). In this chapter we provide an overview of the main themes and areas in health psychology. Four broad areas of behaviour will be reviewed, namely behavioural factors influencing health, symptom and illness behaviour, health care behaviour, and treatment behaviour. Inevitably such an overview is selective and the interested reader should seek out a more comprehensive introductory text or more in-depth accounts of specific areas.