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Psychiatrike = Psychiatriki 2020Ιn this study we aim to examine and integrate current literature and research on attachment theory and its expression on the specific field of obstetrics, the perinatal... (Review)
Review
Ιn this study we aim to examine and integrate current literature and research on attachment theory and its expression on the specific field of obstetrics, the perinatal period. In medical settings in general, and in the field of obstetrics in specific, which is the clinical domain of the perinatal period, obstetricians, psychiatrists and psychologists frequently come across antenatal and postnatal concerns, psychological issues as well as psychiatric symptomatology stemming from closer observation of the women's difficulties or reported by women themselves. To our theoretical understanding, in order to better comprehend these psychosocial concerns and deliver timely and more effective personalized interventions to women in need, it is of paramount importance to thoroughly examine the perspective proposed by attachment theory, as it was first developed by child psychiatrist-psychoanalyst John Bowlby and the newest theoretical developments on the field that followed. Subtypes of attachment style are examined regarding their imprint on the benefits, as well as the difficulties and risks they place on women during each perinatal stage. "Insecurity" in attachment and significant relationships appears to render women more vulnerable in relation to psychopathology, according to the literature reviewed. As far as the psychopathological symptoms and disorders related to the perinatal period and their connection to attachment are concerned, the main disorders and symptomatology discussed in the literature appear to be perinatal depression, postpartum depression, perinatal anxiety and posttraumatic stress symptoms related to pregnancy and labor. At the same time, "security" attachment-wise, tangibly observed in couples with strong intramarital support, appears to offer a protective barrier against adversities by enabling securely attached women to remain calmer and make better use of their emotional and social resources throughout the challenging perinatal phase. Consequently, mothers-to-be become more eligible to overcome perinatal difficulties by the use of patterns of behavior that promote their well-being. Through the in-depth review of the current literature on attachment theory available and the tools of knowledge it equips us with, we attempted to assemble the real challenges and needs deriving from the demands that pregnancy, labor and the postpartum place on new mothers, as well as the way close relationships become affected by or, correspondingly, can be positively used in order to protect and shield women and their families from acknowledged stressful perinatal phases.
Topics: Adaptation, Psychological; Female; Humans; Perinatal Care; Postpartum Period; Pregnancy; Pregnant Women; Stress, Psychological
PubMed: 33099466
DOI: 10.22365/jpsych.2020.313.257 -
Psychotherapy and Psychosomatics 2020Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy... (Review)
Review
Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
Topics: Antipsychotic Agents; Asian People; COVID-19; Clozapine; Coronavirus Infections; Drug Labeling; Humans; Pandemics; Pneumonia; Pneumonia, Viral; Psychiatry; Schizophrenia
PubMed: 32289791
DOI: 10.1159/000507638 -
Innovations in Clinical Neuroscience 2019The Very Important Patient poses specific challenges to the treating psychiatrist. Whether it is fame, money, power or position that creates the VIP status, this type of... (Review)
Review
The Very Important Patient poses specific challenges to the treating psychiatrist. Whether it is fame, money, power or position that creates the VIP status, this type of patient can elicit similar feelings within the psychiatrist and create various treatment barriers. Boundary violations, accompanying entourage, presentation of gifts, devaluation, scheduling irregularities and transference/countertransference issues are some of the concerns that may arise within the psychiatric treatment of the VIP patient. This article will review the treatment dynamics created by the VIP patient as well as the approaches that the psychiatrist can utilize in a therapeutic manner.
PubMed: 31832261
DOI: No ID Found -
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 -
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 -
Indian Journal of Psychiatry Mar 2022A psychiatrist, in India, unlike in the western developed world often is required to play dual role of being a treating psychiatrist and that of an expert witness for...
A psychiatrist, in India, unlike in the western developed world often is required to play dual role of being a treating psychiatrist and that of an expert witness for the same patient. In the clinical scenario, the principle of therapeutic alliance comes into play, while in the court of law, he/she needs to play the role of assisting the judicial system to deliver "justice." Psychiatrist role in the court is directed by the court rules and not by the clinical rules. This chapter aims to describe the various roles played by the psychiatrist in the court room and provides a basic outline of the medicolegal expectations from a psychiatrist.
PubMed: 35599660
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_721_21 -
BJPsych International Feb 2022The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution... (Review)
Review
The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.
PubMed: 36622643
DOI: 10.1192/bji.2021.51