Severe personality disorders are at the top of the list for many clinicians when asked which group of patients are the most challenging to treat. These challenges often result in clinicians' questioning their skills or feeling resentful toward the patients. Although personality disorders as a group are fairly prevalent in the general population, little attention is paid to them and how they affect the delivery of medical care. In a somewhat cynical view, this is because there are no novel therapeutic agents approved for the treatment of personality disorders, which would then provide the army of pharmaceutical company representatives and hosted lectures. These heterogeneous groups of patients are high utilizers of services, have longstanding illness, are entrenched in the mental health care system, and at first blush offer little hope for a “cure.” Of the list of personality disorders, borderline personality disorder meets many of these criteria, and insurance companies have often seized on this in an attempt to limit expenditures. Although this portends a challenging therapeutic encounter, it also offers a potential for therapist growth and mastery. The motivation behind Integrative Treatment for Borderline Personality Disorder is to provide the therapist with the necessary toolbox to survive and even thrive when treating patients with borderline personality disorder. Although this volume is primarily aimed at therapists treating patients with borderline personality disorder, in the course of the book the author identifies diagnostic concepts and treatment strategies that make the text a valuable read for all therapists. Acknowledging up front some of the difficulties encountered in treating this population, the text seeks to develop in the reader an awareness of where the common pitfalls are and how to successfully navigate them in a typical treatment course. The target audience is mental health care workers at all levels of experience and does not require significant prior experience with psychodynamic or cognitive-behavioral therapy (CBT). However, those clinicians who have struggled in treating this population will undoubtedly see some of their interactions in the clinical scenarios detailed. In focusing on borderline personality clients, the author meets 2 difficult challenges: first. clarifying diagnostic issues for this population and providing etiological evidence; and second, integrating diverse treatment modalities, ranging from traditional psychodynamic theories to the more modern CBT/dialectical behavioral therapy, with a sprinkling of psychopharmacology on top. Dr. Preston is a practicing psychologist and has served on the faculty of the University of California, Davis, medical school. Moreover, he has earned his writing chops by authoring over 17 books on the subject of mental illness. His personal experience treating patients with borderline personality disorder shows in his clinically focused text. His prior authorship has
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Psychiatric treatment is a private experience cloaked in confidentiality and, often for the outsider, mystery. Too rarely, the insiders—psychiatrist or patient—reveal the essentials of how the psychiatric treatment process works. Solving Psychiatric Puzzles by V. Sagar Sethi reveals through the stories of his patients over the last 15 years of practice the process by which he has assessed and treated them. It's a self-portrait of his psychiatric practice. Beginning with an introduction that examines Dr. Sethi's personal history, the way physicians listen, psychiatric decision-making, and a “Very Brief History of Psychiatry,” the book is organized into 3 sections: “Voices of Patients,” “Assorted Stories,” and “Appendices.” The first section presents 10 cases, first through the voice of the patient, describing the symptoms and why psychiatric care was sought, then through Dr. Sethi's summary of the history, the treatment plan, and follow-up visits—often including his thoughts on the difficulties involved in dosing medications, prescribing to children, hearing threats of suicide, involuntary commitment to hospitals, and other challenging areas of psychiatry. The second section presents 17 vignettes illustrating the range of problems faced by a general psychiatrist. The “Appendices” include information for the lay reader on psychiatric disorders, schools of psychotherapy, medication names, and the private practice of psychiatry. Dr. Sethi has written a book that will interest the general reader as well as physicians, medical students, and anyone curious about the practice of psychiatry. He writes of his frustrations with managed care and the changes in medicine that have occurred while he has practiced. Numerous editing errors are distracting, but minor specks on this revealing window into Dr. Sethi's practice.
{"title":"Solving Psychiatric Puzzles.","authors":"Joseph M. Cerimele, L. Wulsin","doi":"10.4088/PCC.V09N0312B","DOIUrl":"https://doi.org/10.4088/PCC.V09N0312B","url":null,"abstract":"Psychiatric treatment is a private experience cloaked in confidentiality and, often for the outsider, mystery. Too rarely, the insiders—psychiatrist or patient—reveal the essentials of how the psychiatric treatment process works. Solving Psychiatric Puzzles by V. Sagar Sethi reveals through the stories of his patients over the last 15 years of practice the process by which he has assessed and treated them. It's a self-portrait of his psychiatric practice. \u0000 \u0000Beginning with an introduction that examines Dr. Sethi's personal history, the way physicians listen, psychiatric decision-making, and a “Very Brief History of Psychiatry,” the book is organized into 3 sections: “Voices of Patients,” “Assorted Stories,” and “Appendices.” The first section presents 10 cases, first through the voice of the patient, describing the symptoms and why psychiatric care was sought, then through Dr. Sethi's summary of the history, the treatment plan, and follow-up visits—often including his thoughts on the difficulties involved in dosing medications, prescribing to children, hearing threats of suicide, involuntary commitment to hospitals, and other challenging areas of psychiatry. \u0000 \u0000The second section presents 17 vignettes illustrating the range of problems faced by a general psychiatrist. The “Appendices” include information for the lay reader on psychiatric disorders, schools of psychotherapy, medication names, and the private practice of psychiatry. \u0000 \u0000Dr. Sethi has written a book that will interest the general reader as well as physicians, medical students, and anyone curious about the practice of psychiatry. He writes of his frustrations with managed care and the changes in medicine that have occurred while he has practiced. Numerous editing errors are distracting, but minor specks on this revealing window into Dr. Sethi's practice.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134463914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This book was compiled to aid the interpretation of previously done dementia trials and provide assistance in creating meaningful future ones. The volume starts with a brief history of work done to date and proceeds through various clinical trial designs. A considerable amount of time is spent on different potential outcome variables, including a discussion of the representation of these outcomes via scale. Ethical considerations in treatment of dementia as well as in conducting dementia research are also discussed. Trial Designs and Outcomes in Dementia Therapeutic Research, which was edited by 2 Canadian experts on Alzheimer's disease and geriatric medicine, is well organized and indexed. Topics of interest can be easily located. It has useful discussions of different study designs that can be employed in dementia research and the types of bias that can be introduced. Chapters concerning the currently available treatments for dementia, both pharmacologic and psychosocial, are useful reviews now but will very likely rapidly become out of date and contribute little to the overall purpose of the book. The book concludes with the recognition that, while progress has been made in the treatment of dementia, the outcomes wanted by patients—a return to former functioning—are, for the most part, unavailable. Included is an impassioned discussion of what the goals of dementia research should be and how to measure them and consideration of the different aims of different stakeholders. The complexity of dementia and its impact on the elements of personhood, family, caregivers, and the health care system are stressed.
{"title":"Trial Designs and Outcomes in Dementia Therapeutic Research.","authors":"T. Holsinger","doi":"10.4088/PCC.v09n0212b","DOIUrl":"https://doi.org/10.4088/PCC.v09n0212b","url":null,"abstract":"This book was compiled to aid the interpretation of previously done dementia trials and provide assistance in creating meaningful future ones. The volume starts with a brief history of work done to date and proceeds through various clinical trial designs. A considerable amount of time is spent on different potential outcome variables, including a discussion of the representation of these outcomes via scale. Ethical considerations in treatment of dementia as well as in conducting dementia research are also discussed. \u0000 \u0000Trial Designs and Outcomes in Dementia Therapeutic Research, which was edited by 2 Canadian experts on Alzheimer's disease and geriatric medicine, is well organized and indexed. Topics of interest can be easily located. It has useful discussions of different study designs that can be employed in dementia research and the types of bias that can be introduced. \u0000 \u0000Chapters concerning the currently available treatments for dementia, both pharmacologic and psychosocial, are useful reviews now but will very likely rapidly become out of date and contribute little to the overall purpose of the book. \u0000 \u0000The book concludes with the recognition that, while progress has been made in the treatment of dementia, the outcomes wanted by patients—a return to former functioning—are, for the most part, unavailable. Included is an impassioned discussion of what the goals of dementia research should be and how to measure them and consideration of the different aims of different stakeholders. The complexity of dementia and its impact on the elements of personhood, family, caregivers, and the health care system are stressed.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125232521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Psychotherapy as Religion, author William M. Epstein seeks to demonstrate that the entire field of psychotherapy is based upon unscientific concepts and has never been shown to effectively treat any mental disorder. Dr. Epstein, a professor of social work at the University of Nevada, reports that the basis of his premises are derived from reviewing randomized controlled trials that addressed effectiveness and were published within the past decade in either the American Journal of Psychiatry, Archives of General Psychiatry, or the Journal of Consulting and Clinical Psychology. The introduction presents the author's conclusion that psychotherapy, while lacking in efficacy, is widely accepted in America because it is in concordance with the nation's “heroic individualism” and belief in personal responsibility for social ills. He argues that psychotherapy has taken on the role of social religion, and finds similarities with Christian Science. The major portion of the book is devoted to criticism of individual studies and meta-analyses. Specific topics include depression, anxiety, eating disorders, addictions, testing methodology, psychodynamic psychotherapy, and cognitive-behavioral therapy. In each chapter, the author identifies apparent limitations in every study he encounters. Many of his arguments appear articulate and well crafted, such as rejecting studies with high attrition rates or lack of an adequate comparison arm. In other instances, he discounts studies on the basis of the argument that psychologists have an inherent conflict of interest when evaluating the validity of their own field, and therefore might not be able to objectively report upon the patients they evaluate. The author's use of complicated sentence structure and obscure vocabulary impairs the readability of the text. Likewise, redundant editorializing detracts from what would otherwise be a straightforward and logical presentation. The book may appeal most to those with an interest in evidence-based medicine and to those true believers in psychotherapy who enjoy having their faith challenged.
在《作为宗教的心理治疗》一书中，作者威廉·m·爱泼斯坦试图证明，整个心理治疗领域都是建立在不科学的概念基础上的，而且从未被证明能有效治疗任何精神障碍。爱泼斯坦博士是内华达大学(University of Nevada)的社会工作教授，他报告说，他的假设的基础来自于回顾了过去十年里发表在《美国精神病学杂志》(American Journal of Psychiatry)、《普通精神病学档案》(Archives of General Psychiatry)或《咨询与临床心理学杂志》(Journal of Consulting and Clinical Psychology)上的关于有效性的随机对照试验。引言部分提出了作者的结论，即心理治疗虽然缺乏疗效，但在美国被广泛接受，因为它符合美国的“英雄个人主义”和个人对社会弊病负责的信念。他认为心理治疗已经扮演了社会宗教的角色，并发现了与基督教科学的相似之处。这本书的主要部分是对个人研究和元分析的批评。具体的主题包括抑郁、焦虑、饮食失调、成瘾、测试方法、心理动力学心理治疗和认知行为治疗。在每一章中，作者都指出了他所遇到的每一项研究的明显局限性。他的许多论点似乎清晰而精心设计，例如拒绝高流失率或缺乏适当比较的研究。在另一些情况下，他认为心理学家在评估自己领域的有效性时存在固有的利益冲突，因此可能无法客观地报告他们评估的病人，因此他对这些研究不以为然。作者使用复杂的句子结构和晦涩的词汇，损害了文章的可读性。同样，多余的编辑也会减损原本应该是直接和合乎逻辑的陈述。这本书可能最吸引那些对循证医学感兴趣的人，以及那些喜欢自己的信仰受到挑战的心理治疗的真正信徒。
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Depression is the leading cause of disability in the United States, and worldwide it accounts for more of the disease burden than any other illness but heart disease. However, in contrast to many other common chronic illnesses, this disease has yet to be characterized thoroughly by the elucidation of evidence-based mechanisms for its existence and treatment. Depression and Brain Dysfunction includes 20 authors who contribute to 12 chapters associated with about a dozen color plates. The chapters are well-written, with a congruence of style, and they are replete with over a thousand references, many quite recent. This text is divided into 2 sections that are well-integrated. The first addresses fundamentals of depression, including classification schemes and recent research on neurotransmitter dysregulation, hypothalamus-pituitary-adrenal axis abnormalities, and cellular resistance. Highlighted are recent advances in structural and functional neuroimaging. The second, and more powerful, section focuses on the manifestation of depression in many common illnesses that may serve as useful models to help study clinical and biochemical facets of this disease. Chapter 1 acquaints the reader with the phenomenology or psychopathology of depression, covering its history and including Biblical references, descriptions of the actual experience contrasted with moods and emotions, the Beck cognitive model, categories, and dimensions, as well as current classification schemes. A short discussion of transcultural psychiatry, including problems in diagnosis, ends the chapter. The next 3 chapters develop the concepts of the basic neurobiology of depression and structural changes of brain function. These chapters include a review of neural anatomy, neurotransmitter pathways, and current biochemical models of depression. Results from functional positron emission tomography and single photon emission computed tomography imaging in secondary depressions are linked to these underlying models. The first section concludes with a detailed description of the clinical implications of a genetically epilepsy-prone rat model and affective disorders. The latter half of the text provides a detailed analysis of the epidemiology and impact of depression when it occurs in conjunction with an underlying chronic neurologic condition such as stroke, Parkinson's disease, or Alzheimer's disease, to name a few. Practicing clinicians will find these chapters particularly useful for patient care. Salient clinical questions, such as whether depression increases the risk of cardiac arrhythmias or the risk and severity of diabetes mellitus, are addressed. In addition, each chapter analyzes relevant diagnostic dilemmas and reviews evidence for specific treatment recommendations. Electroconvulsive therapy is not mentioned, due to a paucity of studies in these subgroups. However, more about this robust treatment might have been included in the first part of the book. Depr
{"title":"Depression and Brain Dyfunction","authors":"S. Ober","doi":"10.4088/PCC.V09N0115","DOIUrl":"https://doi.org/10.4088/PCC.V09N0115","url":null,"abstract":"Depression is the leading cause of disability in the United States, and worldwide it accounts for more of the disease burden than any other illness but heart disease. However, in contrast to many other common chronic illnesses, this disease has yet to be characterized thoroughly by the elucidation of evidence-based mechanisms for its existence and treatment. \u0000 \u0000Depression and Brain Dysfunction includes 20 authors who contribute to 12 chapters associated with about a dozen color plates. The chapters are well-written, with a congruence of style, and they are replete with over a thousand references, many quite recent. \u0000 \u0000This text is divided into 2 sections that are well-integrated. The first addresses fundamentals of depression, including classification schemes and recent research on neurotransmitter dysregulation, hypothalamus-pituitary-adrenal axis abnormalities, and cellular resistance. Highlighted are recent advances in structural and functional neuroimaging. The second, and more powerful, section focuses on the manifestation of depression in many common illnesses that may serve as useful models to help study clinical and biochemical facets of this disease. \u0000 \u0000Chapter 1 acquaints the reader with the phenomenology or psychopathology of depression, covering its history and including Biblical references, descriptions of the actual experience contrasted with moods and emotions, the Beck cognitive model, categories, and dimensions, as well as current classification schemes. A short discussion of transcultural psychiatry, including problems in diagnosis, ends the chapter. \u0000 \u0000The next 3 chapters develop the concepts of the basic neurobiology of depression and structural changes of brain function. These chapters include a review of neural anatomy, neurotransmitter pathways, and current biochemical models of depression. Results from functional positron emission tomography and single photon emission computed tomography imaging in secondary depressions are linked to these underlying models. \u0000 \u0000The first section concludes with a detailed description of the clinical implications of a genetically epilepsy-prone rat model and affective disorders. \u0000 \u0000The latter half of the text provides a detailed analysis of the epidemiology and impact of depression when it occurs in conjunction with an underlying chronic neurologic condition such as stroke, Parkinson's disease, or Alzheimer's disease, to name a few. Practicing clinicians will find these chapters particularly useful for patient care. \u0000 \u0000Salient clinical questions, such as whether depression increases the risk of cardiac arrhythmias or the risk and severity of diabetes mellitus, are addressed. In addition, each chapter analyzes relevant diagnostic dilemmas and reviews evidence for specific treatment recommendations. Electroconvulsive therapy is not mentioned, due to a paucity of studies in these subgroups. However, more about this robust treatment might have been included in the first part of the book. \u0000 \u0000Depr","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125399008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This book ended up being more than I expected. I was anticipating a handy reference source for commonly used psychotropic medications, which it is, but that is only part of what makes this a useful and valuable resource tool. The Handbook of Clinical Psychopharmacology for Therapists is logically organized into 3 major sections. The first, “Understanding Psychopharmacology: The Basics,” is easily the most academic of the three. Liberal use of case histories and sidebars with interesting anecdotal information, however, make it surprisingly readable and user-friendly. The second section, “Clinical Syndromes: Etiology, Diagnosis, and Treatment Implications,” is the largest and most clinical segment. In it the reader will find a comprehensive list and description of the most common psychiatric disorders. Included in these descriptions are helpful suggestions regarding possible drugs and medical conditions that cause similar behavioral patterns as well as guidelines for when nonmedical practitioners should consider referral for medication treatment. The third section, “Medications and Pharmacologic Treatment,” contains the information that I was initially looking for. Again the authors organize their material in a logical and clinically useful manner on the basis of major drug categories. They also provide handy thumb-tabs along with numerous charts and tables relating to issues such as dose guidelines, common side effects, special considerations, and treatment algorithms. I particularly appreciate their inclusion of a review on over-the-counter and herbal products, an area of increasing interest in recent years. This third section is what will make this text a frequent reference source for me and is the reason I plan to keep it on my desk rather than in my bookcase. The book ends with 8 appendices intended for readers looking for a more in-depth discussion of topics mentioned earlier in the book. Included here are an expanded review of pharmacokinetics, numerous tables listing psychotropic drug interactions, an outline for performing a neurocognitive mental status exam, and a reference list of books to recommend to patients. All in all, the Handbook of Clinical Psychopharmacology for Therapists is a well-written text that is capable of providing the reader with comprehensive review information as well as quick reference assistance.
{"title":"Handbook of Clinical Psychopharmacology for Therapists, 4th ed.","authors":"R. Zylstra","doi":"10.4088/PCC.V08N0612","DOIUrl":"https://doi.org/10.4088/PCC.V08N0612","url":null,"abstract":"This book ended up being more than I expected. I was anticipating a handy reference source for commonly used psychotropic medications, which it is, but that is only part of what makes this a useful and valuable resource tool. \u0000 \u0000The Handbook of Clinical Psychopharmacology for Therapists is logically organized into 3 major sections. The first, “Understanding Psychopharmacology: The Basics,” is easily the most academic of the three. Liberal use of case histories and sidebars with interesting anecdotal information, however, make it surprisingly readable and user-friendly. \u0000 \u0000The second section, “Clinical Syndromes: Etiology, Diagnosis, and Treatment Implications,” is the largest and most clinical segment. In it the reader will find a comprehensive list and description of the most common psychiatric disorders. Included in these descriptions are helpful suggestions regarding possible drugs and medical conditions that cause similar behavioral patterns as well as guidelines for when nonmedical practitioners should consider referral for medication treatment. \u0000 \u0000The third section, “Medications and Pharmacologic Treatment,” contains the information that I was initially looking for. Again the authors organize their material in a logical and clinically useful manner on the basis of major drug categories. They also provide handy thumb-tabs along with numerous charts and tables relating to issues such as dose guidelines, common side effects, special considerations, and treatment algorithms. I particularly appreciate their inclusion of a review on over-the-counter and herbal products, an area of increasing interest in recent years. This third section is what will make this text a frequent reference source for me and is the reason I plan to keep it on my desk rather than in my bookcase. \u0000 \u0000The book ends with 8 appendices intended for readers looking for a more in-depth discussion of topics mentioned earlier in the book. Included here are an expanded review of pharmacokinetics, numerous tables listing psychotropic drug interactions, an outline for performing a neurocognitive mental status exam, and a reference list of books to recommend to patients. \u0000 \u0000All in all, the Handbook of Clinical Psychopharmacology for Therapists is a well-written text that is capable of providing the reader with comprehensive review information as well as quick reference assistance.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131300167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I've a confession (well, two). I've a weakness for dictionaries, and I love to read history. So any claim to objectivity in this review is henceforth renounced, and I shall be perfectly happy to share with you why I keep turning back to Dr. Shorter's little book and why it has spent 6 months circulating on my desktop, bedside, and computer table rather than finding a place among its peers in the office library. Edward Shorter, a professor of the history of medicine at the University of Toronto, has a particular interest in the development of psychiatry. In the brief introduction to the dictionary, he outlines 3 broad phases of modern psychiatric practice: the asylum period (1770–1870), the psychoanalytic period (1870–1970), and the pharmacologic period (1970–present). Shorter sees our current era as the renaissance of the biological view of psychiatric illness, in which the biomedical models of illness that typified the asylum period have gained a new footing via molecular and genetic studies that have led to effective pharmacologic treatments. The dictionary is arranged in customary alphabetical fashion, with a variety of entries, including persons, diseases, medications, schools of thought, and schools proper (including hospitals used as such). The descriptions given to each entry range from a half page to several pages and are generally in succinct prose. For instance, the term melancholia is explained to have originated with classical Greek physicians. Next, early quotations from Timothy Bright, John Haslam, Phillippe Pinel, and William Cullen are cited, showing how the term changed in later usage. Robert Burton's The Anatomy of Melancholy (1621) is quoted extensively. The term's decline in usage is noted, as well as its rehabilitation by Karl Leonhard and its subsequent inclusion in the DSM system. The entries give just enough to titillate the interested learner, who can go for lengths of playing “connect-the-dots” with trains of thought, word origins, and conceptual nosology. But who reads dictionaries? Well—me. And medical students, psychiatry residents, generalists who want to know more about psychiatry, and students of the panorama that is the history of medicine. Desktop, bedside, computer table—find a place for Shorter's historical dictionary, and it will stay there for some time to come.
{"title":"A Historical Dictionary of Psychiatry","authors":"W. Jackson","doi":"10.4088/PCC.V08N0511","DOIUrl":"https://doi.org/10.4088/PCC.V08N0511","url":null,"abstract":"I've a confession (well, two). I've a weakness for dictionaries, and I love to read history. So any claim to objectivity in this review is henceforth renounced, and I shall be perfectly happy to share with you why I keep turning back to Dr. Shorter's little book and why it has spent 6 months circulating on my desktop, bedside, and computer table rather than finding a place among its peers in the office library. \u0000 \u0000Edward Shorter, a professor of the history of medicine at the University of Toronto, has a particular interest in the development of psychiatry. In the brief introduction to the dictionary, he outlines 3 broad phases of modern psychiatric practice: the asylum period (1770–1870), the psychoanalytic period (1870–1970), and the pharmacologic period (1970–present). Shorter sees our current era as the renaissance of the biological view of psychiatric illness, in which the biomedical models of illness that typified the asylum period have gained a new footing via molecular and genetic studies that have led to effective pharmacologic treatments. \u0000 \u0000The dictionary is arranged in customary alphabetical fashion, with a variety of entries, including persons, diseases, medications, schools of thought, and schools proper (including hospitals used as such). The descriptions given to each entry range from a half page to several pages and are generally in succinct prose. For instance, the term melancholia is explained to have originated with classical Greek physicians. Next, early quotations from Timothy Bright, John Haslam, Phillippe Pinel, and William Cullen are cited, showing how the term changed in later usage. Robert Burton's The Anatomy of Melancholy (1621) is quoted extensively. The term's decline in usage is noted, as well as its rehabilitation by Karl Leonhard and its subsequent inclusion in the DSM system. The entries give just enough to titillate the interested learner, who can go for lengths of playing “connect-the-dots” with trains of thought, word origins, and conceptual nosology. \u0000 \u0000But who reads dictionaries? Well—me. And medical students, psychiatry residents, generalists who want to know more about psychiatry, and students of the panorama that is the history of medicine. Desktop, bedside, computer table—find a place for Shorter's historical dictionary, and it will stay there for some time to come.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131844373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An office visit for even a simple condition like hypertension may be routine to a physician, but patients, in the back of their mind, may fear the implications of the doctor's assessment for the length of their life or changes in their lifestyle. Existential concerns are never far from a physician's daily business, yet we receive little formal instruction in how to use the doctor-patient relationship to talk with patients about issues like death and life meaning in a helpful way. While Yalom's intended audience is the young psychotherapist, physicians of any specialty will find both the existential theme and his reflections on the healing relationship quite relevant to their own practices. The Gift of Therapy is a brief work written as a series of 2- to 3-page tips of the trade, with a tone somewhere between that of an informal memoir and off-the-cuff teaching on morning rounds with a seasoned psychiatrist. It is peppered with brief clinical examples invariably on point, as well as well-distilled literary references. The first 40 mini-essays address the therapeutic relationship, stressing how Yalom works by keeping the content in the moment rather than analyzing past conflicts. The next 10 sections describe how he discusses the issues of death, freedom, and life meaning with patients. Seven sections are devoted to working with dreams, and the remainder of the book is composed of miscellaneous observations and advice on the conduct of therapy with its joys and hazards. A work of this nature is brief by necessity, but it would have been helpful to include a discussion on isolation, since he lists it among the 4 existential life concerns and since it is an integral part of the experience of physical or mental illness. The Gift of Therapy is not an exposition of theory or philosophy—it is meant as a high-yield, practical guide to building healing relationships with patients. Yalom has done a service by demystifying the act of engaging with patients about their ultimate concerns in the moments of great life transition that we physicians are privileged to share with them.
对于医生来说，即使是像高血压这样简单的疾病，也可能是例行公事，但患者在内心深处，可能会担心医生对他们生命长度或生活方式改变的评估的影响。存在的问题从来都不是医生的日常工作，但我们很少得到正式的指导，如何利用医患关系，以有益的方式与病人谈论死亡和生命意义等问题。虽然Yalom的目标受众是年轻的心理治疗师，但任何专业的医生都会发现存在主义主题和他对治疗关系的反思都与他们自己的实践非常相关。《治疗的礼物》(The Gift of Therapy)是一部简短的作品，由一系列2到3页的小贴士组成，其语气介于非正式回忆录和经验丰富的精神科医生上午查班时的即兴教学之间。书中穿插着简明扼要的临床案例，无一例外地切中要点，也不乏精雕细琢的文学参考。前40篇小文章讲述了治疗关系，强调了Yalom如何将内容保持在当下，而不是分析过去的冲突。接下来的10节描述了他如何与病人讨论死亡、自由和生命意义的问题。书中有七个部分是关于梦的研究，剩下的部分是关于治疗的各种观察和建议，包括治疗的乐趣和危险。这种性质的作品必然是简短的，但如果包括对孤立的讨论，将会有所帮助，因为他将其列为存在主义生活的4个问题之一，而且它是身体或精神疾病经历的一个组成部分。《治疗的礼物》不是对理论或哲学的阐述，而是一本关于如何与病人建立治愈关系的实用指南。Yalom做了一项服务，通过消除与患者接触的行为的神秘感，了解他们在重大生命转变时刻的终极关切，我们医生有幸与他们分享。
{"title":"The Gift of Therapy","authors":"J. C. Fetter","doi":"10.4088/PCC.v08n0311a","DOIUrl":"https://doi.org/10.4088/PCC.v08n0311a","url":null,"abstract":"An office visit for even a simple condition like hypertension may be routine to a physician, but patients, in the back of their mind, may fear the implications of the doctor's assessment for the length of their life or changes in their lifestyle. Existential concerns are never far from a physician's daily business, yet we receive little formal instruction in how to use the doctor-patient relationship to talk with patients about issues like death and life meaning in a helpful way. \u0000 \u0000While Yalom's intended audience is the young psychotherapist, physicians of any specialty will find both the existential theme and his reflections on the healing relationship quite relevant to their own practices. The Gift of Therapy is a brief work written as a series of 2- to 3-page tips of the trade, with a tone somewhere between that of an informal memoir and off-the-cuff teaching on morning rounds with a seasoned psychiatrist. It is peppered with brief clinical examples invariably on point, as well as well-distilled literary references. \u0000 \u0000The first 40 mini-essays address the therapeutic relationship, stressing how Yalom works by keeping the content in the moment rather than analyzing past conflicts. The next 10 sections describe how he discusses the issues of death, freedom, and life meaning with patients. Seven sections are devoted to working with dreams, and the remainder of the book is composed of miscellaneous observations and advice on the conduct of therapy with its joys and hazards. \u0000 \u0000A work of this nature is brief by necessity, but it would have been helpful to include a discussion on isolation, since he lists it among the 4 existential life concerns and since it is an integral part of the experience of physical or mental illness. \u0000 \u0000The Gift of Therapy is not an exposition of theory or philosophy—it is meant as a high-yield, practical guide to building healing relationships with patients. Yalom has done a service by demystifying the act of engaging with patients about their ultimate concerns in the moments of great life transition that we physicians are privileged to share with them.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127916769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In our society, movies hold a prodigious power to reflect and sometimes shape our culture. In the last 10 years, we've gained easy and inexpensive access to large numbers of movies through libraries, rental stores, cable TV, and the Internet. This should be good news for teachers of all kinds, but how often do we use movies in our teaching? For most of us health educators, the leap from viewing movies as easy entertainment to using them as effective teaching tools requires guidance by experts who know both the movies and the health topic of interest. For teachers of topics relating to mental illness, the first hurdle is the question, “What do we do with so many good movies and so many bad movies about mental illness?” The number of movies about mental illness overwhelms most of us. Then the process of finding the right movie for a class session, selecting the key sections, and preparing the relevant questions can seem like more work than it's worth. In their second revised and expanded edition of Movies & Mental Illness, Wedding, Boyd, and Niemiec have provided us an informative guide that draws on nearly 1000 films. This encyclopedic but friendly paperback volume is written for teachers and students of psychopathology courses and is intended for use as a supplement to core psychopathology texts. Medical educators such as teachers of behavioral science curricula in family medicine, other primary care disciplines, and psychiatry will find it a valuable time-saver for those who want to add drama to the classroom. The authors, 2 psychologists and a social worker, organize this second edition of Movies & Mental Illness around 13 diagnostic or assessment categories. Each chapter begins with questions to consider while watching the specific movie the authors selected to illustrate the category. The authors then demonstrate their clinical approach in the form of a “fabricated case history” of the key character. A Beautiful Mind and John Nash provide the focus for the chapter on schizophrenia, and Psycho and Norman Bates provide the focus for the chapter on dissociative disorders. Elaboration on the disorders, including theoretical background, and on other movies, including “additional questions for discussion,” gives breadth to the chapters. The authors are not timid about pointing out the misrepresentations of mental illness that contribute to stigma, as listed in Appendix E. However, the book might have been stronger if the authors had acknowledged the potential influence of the disproportionate number of female villains (32%) to female heroes (12%) in Appendix B on perpetuating gender stereotypes. The authors have accumulated a wealth of knowledge, most compactly collected in “Appendix G,” their annotated list of nearly 1000 movies, organized by psychopathologic topics, each movie receiving the authors' 5-point rating for the movie's value as a teaching film as well as a work of art. They also maintain a Web site with this information plus p
{"title":"Movies & Mental Illness: Using Films to Understand Psychotherapy, 2nd ed.","authors":"L. Wulsin","doi":"10.4088/PCC.V08N0311B","DOIUrl":"https://doi.org/10.4088/PCC.V08N0311B","url":null,"abstract":"In our society, movies hold a prodigious power to reflect and sometimes shape our culture. In the last 10 years, we've gained easy and inexpensive access to large numbers of movies through libraries, rental stores, cable TV, and the Internet. This should be good news for teachers of all kinds, but how often do we use movies in our teaching? For most of us health educators, the leap from viewing movies as easy entertainment to using them as effective teaching tools requires guidance by experts who know both the movies and the health topic of interest. For teachers of topics relating to mental illness, the first hurdle is the question, “What do we do with so many good movies and so many bad movies about mental illness?” The number of movies about mental illness overwhelms most of us. Then the process of finding the right movie for a class session, selecting the key sections, and preparing the relevant questions can seem like more work than it's worth. \u0000 \u0000In their second revised and expanded edition of Movies & Mental Illness, Wedding, Boyd, and Niemiec have provided us an informative guide that draws on nearly 1000 films. This encyclopedic but friendly paperback volume is written for teachers and students of psychopathology courses and is intended for use as a supplement to core psychopathology texts. Medical educators such as teachers of behavioral science curricula in family medicine, other primary care disciplines, and psychiatry will find it a valuable time-saver for those who want to add drama to the classroom. \u0000 \u0000The authors, 2 psychologists and a social worker, organize this second edition of Movies & Mental Illness around 13 diagnostic or assessment categories. Each chapter begins with questions to consider while watching the specific movie the authors selected to illustrate the category. The authors then demonstrate their clinical approach in the form of a “fabricated case history” of the key character. A Beautiful Mind and John Nash provide the focus for the chapter on schizophrenia, and Psycho and Norman Bates provide the focus for the chapter on dissociative disorders. Elaboration on the disorders, including theoretical background, and on other movies, including “additional questions for discussion,” gives breadth to the chapters. The authors are not timid about pointing out the misrepresentations of mental illness that contribute to stigma, as listed in Appendix E. However, the book might have been stronger if the authors had acknowledged the potential influence of the disproportionate number of female villains (32%) to female heroes (12%) in Appendix B on perpetuating gender stereotypes. \u0000 \u0000The authors have accumulated a wealth of knowledge, most compactly collected in “Appendix G,” their annotated list of nearly 1000 movies, organized by psychopathologic topics, each movie receiving the authors' 5-point rating for the movie's value as a teaching film as well as a work of art. They also maintain a Web site with this information plus p","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115970063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
edited by Alistair Burns on behalf of the European Dementia Consensus Network (EDCON) Group. Taylor & Francis Group, New York, N.Y., 2005, 224 pages, $99.95. In a world with a gradually aging population, dementia is a global problem that is becoming increasingly common. According to Alzheimer Disease International, there are 18 million people worldwide with dementia, of whom almost 25% live in Europe.1 The current state of dementia care in Europe is, therefore, of great interest. Controversies in the evaluation and treatment of dementia in the United States have lead to an abundance of guidelines from geriatric, family medicine, neurology, and psychiatry organizations. Standards in Dementia Care is an ambitious effort from the European Dementia Consensus Network, or EDCON, to summarize and synthesize current practices and guidelines for the treatment of Alzheimer's disease across Europe. EDCON's members are drawn from the United Kingdom, the Netherlands, Switzerland, Spain, and Denmark. This book is divided into 6 sections: an introduction, a European perspective on the practice of dementia care, multidisciplinary working, carer stress, services, and ethical/legal issues. In most chapters, perspectives from different European countries are presented. In the introduction, titled “Standards of Care in Dementia in Europe—A Consensus,” EDCON gives 6 general recommendations for the care of patients with dementia: standardization in care; standards that are evidence-based and applicable to the different sites of care (home as opposed to a long-term care facility, for example); a partnership between patients, their care-givers, and their health care and social workers; carefully planned services; preservation of the dignity of the patient; and support of the caregiver. The second section consists of a general review of dementia care in the 18 European countries. This is perhaps the most interesting section, as an incredible variability in services between countries is displayed. Nations that are wealthier and have socialistic health care offer more detailed and comprehensive services that are government funded. Some countries have government-sponsored research related to dementia care and a national health policy in which geriatric and dementia services are provided. Some countries have guidelines about the diagnosis of dementia, including the role of investigations such as magnetic resonance imaging. The coverage of medications for dementia is also quite variable. Coverage of expensive cholinesterase inhibitors is not universal, and in some countries such as Denmark, only a neurologist can prescribe them. Services such as day care, nursing home care, hospitalization, and respite care are often available, but inadequate funding is common. Subspecialty services are frequently limited, or even nonexistent (for example, only the United Kingdom has a well-developed “Old Age Psychiatry” service). In Germany, there is an acute shortage of geria
{"title":"Standards in Dementia Care","authors":"Manoj Kumar Singh","doi":"10.4088/PCC.v08n0212b","DOIUrl":"https://doi.org/10.4088/PCC.v08n0212b","url":null,"abstract":"edited by Alistair Burns on behalf of the European Dementia Consensus Network (EDCON) Group. Taylor & Francis Group, New York, N.Y., 2005, 224 pages, $99.95. \u0000 \u0000In a world with a gradually aging population, dementia is a global problem that is becoming increasingly common. According to Alzheimer Disease International, there are 18 million people worldwide with dementia, of whom almost 25% live in Europe.1 The current state of dementia care in Europe is, therefore, of great interest. \u0000 \u0000Controversies in the evaluation and treatment of dementia in the United States have lead to an abundance of guidelines from geriatric, family medicine, neurology, and psychiatry organizations. Standards in Dementia Care is an ambitious effort from the European Dementia Consensus Network, or EDCON, to summarize and synthesize current practices and guidelines for the treatment of Alzheimer's disease across Europe. EDCON's members are drawn from the United Kingdom, the Netherlands, Switzerland, Spain, and Denmark. \u0000 \u0000This book is divided into 6 sections: an introduction, a European perspective on the practice of dementia care, multidisciplinary working, carer stress, services, and ethical/legal issues. In most chapters, perspectives from different European countries are presented. \u0000 \u0000In the introduction, titled “Standards of Care in Dementia in Europe—A Consensus,” EDCON gives 6 general recommendations for the care of patients with dementia: standardization in care; standards that are evidence-based and applicable to the different sites of care (home as opposed to a long-term care facility, for example); a partnership between patients, their care-givers, and their health care and social workers; carefully planned services; preservation of the dignity of the patient; and support of the caregiver. \u0000 \u0000The second section consists of a general review of dementia care in the 18 European countries. This is perhaps the most interesting section, as an incredible variability in services between countries is displayed. Nations that are wealthier and have socialistic health care offer more detailed and comprehensive services that are government funded. Some countries have government-sponsored research related to dementia care and a national health policy in which geriatric and dementia services are provided. Some countries have guidelines about the diagnosis of dementia, including the role of investigations such as magnetic resonance imaging. The coverage of medications for dementia is also quite variable. Coverage of expensive cholinesterase inhibitors is not universal, and in some countries such as Denmark, only a neurologist can prescribe them. Services such as day care, nursing home care, hospitalization, and respite care are often available, but inadequate funding is common. Subspecialty services are frequently limited, or even nonexistent (for example, only the United Kingdom has a well-developed “Old Age Psychiatry” service). In Germany, there is an acute shortage of geria","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128811528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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