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Current Psychiatry Reports Mar 2023To present a clinically oriented review of selective serotonin reuptake inhibitor (SSRI)-related bleeding issues commonly addressed by consult-liaison psychiatrists. (Review)
Review
PURPOSE OF REVIEW
To present a clinically oriented review of selective serotonin reuptake inhibitor (SSRI)-related bleeding issues commonly addressed by consult-liaison psychiatrists.
RECENT FINDINGS
Concomitant medical, surgical, or hospital-based conditions exacerbate the risk of SSRI-related bleeding even though a review of the literature suggests it is only marginally elevated. Psychiatrists and other clinicians need to consider these conditions along with antidepressant benefits when answering the question: to start, hold, continue, or change the antidepressant? Where an evidence base is limited, mechanistic understanding may help consult-liaison psychiatrists navigate this terrain and collaborate with other medical specialties on responsible antidepressant management. Most often, the risk is cumulative; data are not directly applicable to complex clinical situations. This review incorporates a hematologic perspective and approach to bleeding risk assessment along with extant data on SSRI-induced bleeding risk ad specific medical conditions.
Topics: Humans; Selective Serotonin Reuptake Inhibitors; Hemorrhage; Antidepressive Agents; Referral and Consultation; Psychiatry
PubMed: 36708455
DOI: 10.1007/s11920-023-01411-1 -
Tijdschrift Voor Psychiatrie 2023Clear and unambiguous description of psychiatric symptoms is a prerequisite for a personalized and reliable mental state examination.
BACKGROUND
Clear and unambiguous description of psychiatric symptoms is a prerequisite for a personalized and reliable mental state examination.
AIM
To draw attention to the correct use of psychiatric language.
METHOD
Description of persistent linguistic errors and relevant but too little used terms, and a new Dutch translation for some psychopathological terms.
RESULTS
The following linguistic errors are presented: ‘concentration’ as if it means the sustaining of attention; ‘compulsive behaviour’ that is not really compulsive; ‘no diagnosis’ while no disorder is diagnosed; ‘no psychopathology’ as if the patient has no science of psychopathology; ‘to impress as’ for characteristic that are not impressive; ‘mild’ while psychiatric disorders are never mild; ‘inhibition’ as if we can observe that subjective phenomenon; ‘signs’ for symptoms that do not appear to us at all; ‘weather and climate’ for affect and mood, while the mood generally changes somewhat faster than he climate. Attention is drawn for the terms chronognosia, overvalued idea, sensory hyporeactivity and disorders of self-awareness. New Dutch translations for dysmorphic disorder, délire de négation, and paranoic are explained.
CONCLUSION
Psychiatrists, watch your language!
Topics: Male; Humans; Mental Disorders; Language; Psychiatry
PubMed: 36951767
DOI: No ID Found -
Psychological Medicine Jan 2023Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some... (Review)
Review
BACKGROUND
Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis.
METHODS
We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust.
RESULTS
While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded.
CONCLUSIONS
The concept of epistemic injustice does not add significantly to existing standards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism.
Topics: Humans; Psychiatry; Mental Disorders; Philosophy, Medical; Morals
PubMed: 36601817
DOI: 10.1017/S0033291722003804 -
Geriatrie Et Psychologie... Mar 2022Résumé Contexte. En Suisse, dans les situations de demandes de suicide assisté, le psychiatre est mis dans une position de « gatekeeper » lorsqu'on lui demande de...
UNLABELLED
Résumé Contexte. En Suisse, dans les situations de demandes de suicide assisté, le psychiatre est mis dans une position de « gatekeeper » lorsqu'on lui demande de se prononcer sur la capacité de discernement et sur l'existence d'un éventuel trouble psychiatrique interférant avec cette capacité et qui empêcherait les patients d'accéder à cet acte.
OBJECTIF
L'étude explore les motifs des demandes de suicide assisté formulées par des patients hospitalisés dans un service somatique du Centre hospitalier universitaire Vaudois ainsi que les enjeux auxquels le psychiatre fait face. Méthode. L'étude se base sur une analyse rétrospective des rapports psychiatriques, concernant 18 patients de 65 ans ou plus qui ont fait une demande de suicide assisté. Nous avons identifié dans le matériel des motifs manifestes mais aussi des éléments latents, en prenant pour cadre la théorie de l'attachement et une lecture psychodynamique orientée autour des concepts de Moi idéal, Idéal du moi et Surmoi. Résultats. Différentes catégories de motifs de recours au suicide assisté ont été identifiées dans les demandes des patients. Au niveau latent, des indices d'attachement sécure et insécure, de sentiments sous-jacents de honte et d'abandon et plus rarement de culpabilité ont été relevés. Outre des limites liées à l'état du patient, le rôle de gatekeeper a un impact sur les possibilités d'aborder ou d'utiliser ces éléments de manière thérapeutique avec le patient.
CONCLUSION
Le psychiatre mis dans un rôle de gatekeeper face au suicide assisté est dans une position peu confortable. Il est amené à penser comment tenir ce rôle tout en demeurant psychiatre de liaison. Abstract Background. In Switzerland, psychiatrists sometimes assume the role of gatekeepers when patients request assisted suicide, evaluating the patient's discernment and the existence of a possible psychiatric disorder interfering with the capacity to discern.
OBJECTIVES
Our study explores the motifs of requests for assisted suicide made by patients hospitalized in a somatic service of Lausanne University Hospital and the challenges faced by the psychiatrist as gatekeeper.
METHOD
We conducted a retrospective analysis of psychiatric reports concerning 18 patients aged 65 years or older who had requested assisted suicide. We aimed to identify both manifest and latent motifs in the patients' accounts, referring to the attachment theory and a psychodynamic analysis based on the concepts of the Ideal ego, the Ego ideal and the Superego.
RESULTS
Different categories of motifs for assisted suicide requests were expressed by the patients. We also found indications of insecure and secure attachment, and underlying feelings of shame and abandonment, more rarely of guilt. In addition to limitations related to the patient's condition, the gatekeeper position limits the possibilities of addressing these issues or using them therapeutically with the patient.
CONCLUSION
The psychiatrist' role as a gatekeeper in assisted suicide is uncomfortable. He or she must think about how to assume this role while remaining being a liaison psychiatrist.
Topics: Female; Humans; Psychiatry; Retrospective Studies
PubMed: 35652851
DOI: 10.1684/pnv.2022.1013 -
Psychotherapy and Psychosomatics 2024
Topics: Humans; Psychiatry; Checklist; Psychiatrists
PubMed: 38663360
DOI: 10.1159/000538544 -
BJPsych Bulletin Oct 2019Research into patient suicide indicates that it has an impact on the psychiatrists involved, but leaves a number of unanswered questions about which elements of the...
Research into patient suicide indicates that it has an impact on the psychiatrists involved, but leaves a number of unanswered questions about which elements of the experience are most likely to cause problems, who is most at risk, what is the clinical or professional significance of any effect on the psychiatrist and how other professionals are affected. Despite these uncertainties, it is clear that a response is needed, with three bodies responsible in different ways for coordinating one: the relevant mental health trust, as employer; the Royal College of Psychiatrists, as the professional representative body; and the National Confidential Inquiry into Suicide and Safety in Mental Health, as mediator of social and professional impact.
PubMed: 31663495
DOI: 10.1192/bjb.2019.53 -
BJPsych Bulletin Oct 2021
PubMed: 34556199
DOI: 10.1192/bjb.2021.79 -
Asia-Pacific Psychiatry : Official... Sep 2022A language disorder is a significant symptom of schizophrenia. A psychiatrist can find this disorder when interviews with a patient. Screening and diagnosis in patients... (Review)
Review
A language disorder is a significant symptom of schizophrenia. A psychiatrist can find this disorder when interviews with a patient. Screening and diagnosis in patients with schizophrenia alone rely heavily on interviews conducted on patients and any instructions captured from patients both verbally and nonverbally. A psychiatrist can also analyze the language aspects in schizophrenia from a language level perspective ranging from phonetic to pragmatic. This analysis paves the way for the process of interference detection since the prodromal phase. Language disorder in schizophrenia is often associated with impaired thinking processes. However, with the development of science and technology today, there is an objective and quantitative method of computational analysis of language through the Natural Language Processing process with a semantic space model that allows a psychiatrist to learn aspects of the human language process, especially in semantic and pragmatic aspects. The review provides a groundbreaking proposal for biomarkers for schizophrenia that have not been available so far through the assessment of language disorders in patients with schizophrenia. Objective and accurate detection of language disorders in schizophrenia can be a modality for psychiatrists to screen, make diagnoses, determine prognosis, evaluate therapies, and monitor recurrence using existing technology media.
Topics: Biomarkers; Humans; Language Disorders; Schizophrenia; Semantics; Thinking
PubMed: 34328267
DOI: 10.1111/appy.12485 -
Psychopathology 2022In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may... (Review)
Review
In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may represent the joints of a phenomenologically oriented diagnosis. The "tightrope walking" attitude refers to the psychiatrist's ability to swing between 2 different and sometimes contrasting tendencies (e.g., engagement and disengagement). The "holistic experience" includes all those intuitive, nonverbal, and pre-thematic elements that emerge in the early stages of the clinical encounter as an emanation of the atmospheric quality of the intersubjective space. The "co-construction of symptoms" regards the hermeneutic process behind psychiatric symptoms, involving both the patient as a self-interpreting agent and the clinician as a translator of his/her experience. Finally, by the "evolving typification" we mean that the closer the relationship becomes with the patient, the more specific and nuanced becomes the typification behind psychiatric diagnosis. Each of these concepts will be accompanied by an extract from a clinical case deriving from one of the authors' most recent clinical experiences.
Topics: Female; Humans; Male; Mental Disorders
PubMed: 34965532
DOI: 10.1159/000520334