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LGBTQIA+ patients are an important patient population to highlight when discussing urban emergency medicine. There are a multitude of terms regarding gender expression and identity that emergency medicine providers should familiarize themselves with if they plan on taking care of this patient population. Within the LGBTQIA+ population, there are specific medical and psychological issues that are relevant to each subgroup. Providers are not expected to know everything about their patients, but they must remember to remain open-minded and non-judgmental as they take care of everyone with precision and dedication. If a provider feels that the patient needs help in ways they cannot be of service, then the provider should be able to point the patient in the right direction via resources and referrals.
Carter's Psychopathology is an accessible, engaging, and well-organized text covering the study, understanding, diagnosis, treatment, and prevention of psychological disorders. Fully integrating gender and culture in the presentation of mental disorders, and using a sensitive and inclusive language to encourage an empathic approach to psychopathology, this introductory textbook offers students a strong foundation of the socio-cultural factors influencing how we treat mental disorders. Featuring: boxes such as 'the power of words', promoting the use of respectful, empathic language, and 'the power of evidence', demonstrating that scientific evidence can answer questions about psychopathology treatments; real-world case studies and examples; 'concept checks' questions to test the student's mastery of the material covered in each section; chapter summaries listing the 'take-home' points discussed; and key terms and glossary highlighting terms that students will need to understand and become familiar with, this textbook provides a hands-on approach to the study of psychopathology.
Drug-induced movement disorders (DIMDs) form an important subgroup of secondary movement disorders, which despite conferring a significant iatrogenic burden, tend to be under-recognized and inappropriately managed.
Objective
We aimed to look into phenomenology, predictors of reversibility, and its impact on the quality of life of DIMD patients.
Methods
We conducted the study in the Department of Neurology at a tertiary-care centre in India. The institutional ethics-committee approved the study. We assessed 55-consecutive DIMD patients at presentation to our movement disorder clinic. Subsequently, they followed up to evaluate improvement in severity-scales (UPDRS, UDRS, BARS, AIMS) and quality of life (EuroQol-5D-5L). Wilcoxan-signed-rank test compared the scales at presentation and follow-up. Binary-logistic-regrerssion revealed the independent predictors of reversibility.
Results
Fourteen patients (25.45%) had acute-subacute DIMD and 41 (74.55%) had tardive DIMD. Tardive-DIMD occurred more commonly in the elderly (age 50.73±16.92 years, p<0.001). Drug-induced-Parkinsonism (DIP) was the most common MD, followed by tardivedyskinesia. Risperidone and levosulpiride were the commonest culprit drugs. Patients in both the groups showed a statistically significant response to drug-dose reduction /withdrawal based on follow-up assessment on clinical-rating-scales and quality of life scores (EQ-5D-5L). DIMD was reversible in 71.42% of acute-subacute DIMD and 24.40% of patients with chronic DIMD (p=0.001). Binary-logistic-regression analysis showed acute-subacute DIMDs and DIP as independent predictors of reversibility.
Conclusion
DIP is the commonest and often reversible drug-induced movement disorder. Levosulpiride is notorious for causing DIMD in the elderly, requiring strict pharmacovigilance.
Supporting the mental health and well-being of children and young people is a top priority for parents, caregivers and teachers, but it can be tricky to find reliable and evidence-based information. Written by an experienced child and adolescent psychiatrist, in a user-friendly question and answer format, this book outlines the mental health challenges facing our children and young people and offers practical advice on how to best support them. The book covers a wide range of topics, including how biological factors and lifestyle factors affect mental health, parenting strategies, managing school, building networks of support, and connecting with children and young people. It gives a broad overview of the most common mental health difficulties and disorders, and considers how they can be managed. A must read for anyone looking to understand what a child or young person may be experiencing and why, and the practical ways in which to effectively support them.
Shame is a profound negative emotion that can sometimes be cover up by guilt and remain undiagnosed. Shame and guilt have been described as self-conscious and moral emotions as they both involve self-evaluation and lay a role in facilitating moral conduct. They derive from the notion of responsibility, but some authors suggest that while guilt focuses only on the act at hand shame focuses on the one executing it. The self is the object.
Objectives
To review the literature on shame and its role in different disorders both as a causing agent and as a perpetuating agent
Methods
Non-systematic review of the literature with selection of scientific articles published in the past 20 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “shame”, “psychopathology.
Results
Since shame globally decreases self-esteem and is an awareness of personal flaws it can lead to the feelings of helplessness and the development or worsening of mental disorders. As such it is no wonder to find shame being studied in many different forms, more and less structured with important connections being made with social anxiety, eating disorders, dysmorphic disorders, personality disorders and bereavement.
Conclusions
Shame’s role, independently from guilt can have an impact on both the genesis and perpetuation of mental disorders. Its study can uncover missing links between different types of experiences and the pathological reactions that may subsequently follow.
COVID-19 affects nervous system and the mental health of patients.
Objectives
The aim of the study was to determine the prevalence of depression, anxiety, and insomnia among patients hospitalized with COVID-19 in order to understand mediating factors and inform tailored intervention.
Methods
To the study patients with mild and moderate COVID -19 were included. It was no included patients with diagnosed psychiatric disorders. It was conducted an interview, including using telemedicine technologies, assessed HADS, MFI-20, Pittsburgh Sleep Quality Index (PSQI) questionnaire.
Results
It was analyzed the data of 119 patients, 34% patients was female, mean age 58,7±11,1 range 47 to 69 years. Anxiety-depressive symptoms were observed in 33/119 (28%) patients by HADS scale. Clinically significant anxiety and depression were seen in 11% and 4% of the patients, respectively. In 13% patients was observed as anxiety as depression. An increase in the MFI-20 scale (more than 20 points) was found in 87 (73.0%) patients, sleep disorders in accordance with the PSQI questionnaire was recorded in 32 (27.0%) patients. Sleep disorders were manifested by dissatisfaction with sleep quantity or quality that is associated with difficulty falling asleep. All patients have asthenic symptom.
Conclusions
It was noted that in most patients with COVID-19, along with a depressive and anxiety disorders, an asthenic symptom complex, sleep disturbances are recorded. The choice of the medical intervention should be based on the severity of the violations identified taking into account the side effects of the prescribed drugs, drug interactions and somatic status of patients
This chapter examines military attitudes toward “emotional injuries” resulting from the end of romantic relationships. Evaluations of why some men “cracked” evolved substantially from World War I to the present. Often, however, psychiatrists attributed servicemen’s maladies to deficient female love: whether that of mothers or romantic partners. In Vietnam, psychiatrists construed romantic rejection as a “narcissistic injury”: a blow to the ego that led men to decompensate in various ways. Alcoholism, going AWOL, self-harm, and violence directed toward others were all associated with Dear John letters. The chapter considers how the military medical and legal establishments adjudicated unlawful acts perpetrated by servicemen whose intimate relationships had recently been severed by letter. It focuses on two court-martial cases: a Korean War POW who briefly rejected repatriation to the United States in 1953, citing a Dear John as his motive for defection, and a Marine Corps private court-martialled in 1969 for killing four Vietnamese peasants. In the latter case, military lawyers deemed the defendant to have been temporarily insane after his fiancée sent him a Dear John.
The current stage of research on mental disorders is associated with the use of system approaches to the development of the scientific foundations of psychiatric care.
Objectives
Approach to solving problems that arise in the diagnosis of psychopathological conditions, assessing their severity, as well as evaluating the effectiveness of psychosocial treatment and rehabilitation.
Methods
Clinical, psychometric, system analysis methods and algorithms of the Analytical Hierarchy Process (AHP) [1] were used.
Results
When assessing a patient’s condition and behavior, it is necessary to make decisions (diagnosis, development of treatment and rehabilitation plans) based on heterogeneous information (genetic, neuronal and environmental, involving individual characteristics, as well as family and social context). This information is hierarchically organized and includes quantitative and qualitative data. Exposure at each of these different levels can affect the onset and course of the disease, and therefore should be considered in primary prevention and subsequent psychosocial therapy and rehabilitation of patients. Analysis of the problems of assessing psychopathological states and related psychosocial problems shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing the initial information. The main advantages of the AHP include the use of the relationship scale (fundamental scale) for processing heterogeneous data based on expert, clinical information.
Conclusions
The approach provides correct integration of heterogeneous characteristics when considering diagnostic procedures, psychosocial therapy and rehabilitation.1. Mitikhin V.G., Solokhina T.A. S.S. Korsakov Journal of Neurology and Psychiatry, 2019, 2: 49-54. doi:10.17116/jnevro201911902149
This study was examination by Telepsychiatry and E-consalting (telecommunication technologies with the aim of providing psychiatric services from a distance) of war related posttraumatic stress disorder (PTSD).
Methods:
Many patients with PTSD have different symptoms. The authors' objective is to analize component of symptoms in PTSD.
The subjects were 50 male psychiatric patients by Telepsychiatry and e-consalting with war-related PTSD by videoconferencing via broadband ADSL and WADSL by 768 kbps. Posttraumatic stress syndrom-PTSS scale and 20-item Zung selfrating scale was used to assess state measures of symptom severity.
Results:
The symptoms of prolonged PTSS (posttraumatic stress syndrome) with duration between six moths and two years had been founded at 38 (76 %) and 12 (24 %) of patients had no PTSS: symptoms of depression had been found at 34 (68 %) patients. The enduring personality exchange after catastrophic expiriense (with duration more than two years), had been found at 7 (14 %) patients; symptoms of depression had been found at 17 (34 %) patients after two years.
Conclusions:
Evolution of PTSD symptoms and continued examination and follow-up by Telepsychiatry service and e-consalting may be important in predicting the eventual development of depressive symptoms and precipitation of F 62.0 enduring personality exchange after catastrophic expiriense in the war related PTSD. Consequently, Telepsychiatry service and e-consalting it is able to serve not only PTSD but also wide range of other patient population.
John H. Esling, University of Victoria, British Columbia,Scott R. Moisik, Nanyang Technological University, Singapore,Allison Benner, University of Victoria, British Columbia,Lise Crevier-Buchman, Centre National de la Recherche Scientifique (CNRS), Paris
Chapter 7 explores laryngeal speech disorders, voice pathologies that depart from normal function, and the consequences of laryngeal surgery on voice quality from the perspective of the Laryngeal Articulator Model. Clinical cases involve the laryngeal mechanism as a whole, and many voice quality outcomes resemble the registers of linguistic systems. New drawings diagram surgical excisions of laryngeal structures. Post-surgery compensatory behaviours demonstrate innovative adaptation of the aryepiglottic sphincter mechanism to generate ‘substitution voice’. Numerous videos/audio of clinical cases illustrate the effect of pathologies on voice quality. Pre- and post-operative speech production show how altered structures create altered voice quality. Epilaryngeal tube control is shown to be the cornerstone of our ability to adapt. Mongolian long song and human beatboxing illustrate the use of the professional voice. Clinicians as well as linguists will benefit from the detailed new exploration of the laryngeal articulator and its adaptability.
The aim of this article is to draw attention to the clinical importance of disordered sleep in psychiatry and to demonstrate the growing awareness of medical illness as a complication of disordered sleep. As background to these main objectives, some general points are made to illustrate present-day approaches to the common and often serious problem of sleep disturbance.
Methods:
The review is based on a literature search from which key publications were selected to illustrate, in turn, main connections between disordered sleep and psychiatric and medical conditions.
Results:
Many such connections are described. Throughout psychiatry, regarding patients whatever their age, these connections have implications for clinical assessment and management. Emphasis is placed on the risk of misdiagnosis of sleep disorders as psychiatric or medical conditions. Examples of this are provided. The growing evidence that disordered sleep can predispose to medical illness is discussed.
Conclusion:
As the subject of sleep and its disorders is particular relevant in psychiatry, a working knowledge of modern sleep medicine is important in all branches of psychiatric and other medical practice as well as in clinical research.
We report the first case of dysphagia due to engorgement of a congenital vascular ring as a result of the haemodynamic changes of pregnancy. The clinician should be aware of this in the differential diagnosis.Spontaneous recovery may occur six months post partum as the haemodynamic changes resolve, but if further pregnancies are planned surgery is effective.
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