For most of the history of psychology and psychiatry, there has been a focus on the negative aspects of mental health, involving the diagnosing and treating of diseases and disorders. In recent years, however, there has been a move toward “Positive Psychology,” in which (as the name implies) the focus is on the positive aspects of mental health. Psychological changes and symptoms throughout the life span are seen as having the potential for positive growth that can be incorporated into the treatment process rather than a pathologic process that needs to be eliminated or suppressed. Additionally, over the past few decades, practitioners are seeing more and more people who may not have a clinical diagnosis yet feel there is something “missing” in their lives.
{"title":"The Psychospiritual Clinician's Handbook: Alternative Methods for Understanding and Treating Mental Disorders","authors":"S. Kilpatrick","doi":"10.4088/PCC.V08N0212A","DOIUrl":"https://doi.org/10.4088/PCC.V08N0212A","url":null,"abstract":"For most of the history of psychology and psychiatry, there has been a focus on the negative aspects of mental health, involving the diagnosing and treating of diseases and disorders. In recent years, however, there has been a move toward “Positive Psychology,” in which (as the name implies) the focus is on the positive aspects of mental health. Psychological changes and symptoms throughout the life span are seen as having the potential for positive growth that can be incorporated into the treatment process rather than a pathologic process that needs to be eliminated or suppressed. Additionally, over the past few decades, practitioners are seeing more and more people who may not have a clinical diagnosis yet feel there is something “missing” in their lives.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"8 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":"129288850","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}
Sleep and Dreaming is a compilation of papers, critical reviews, and commentaries published from 2000 to 2002 in the journal Behavioral and Brain Sciences that assess the “relationship of dreaming to brain physiology and neuro-chemistry and the possible functions, or lack of functions, of REM [rapid eye movement] sleep and of dreaming”(ix). As a summary of this fascinating field, this book is becoming significantly outdated; as an entree for the primary care clinician, it is likely to be more soporific than scintillating. The book comprises an introduction and 5 chapters (reviewing the cognitive neuroscience of conscious states, the discordance of dreaming and REM sleep, mentation in REM and non-REM sleep, the case against memory consolidation in REM sleep, and an evolutionary hypothesis of the function of dreaming). Peer commentary and author responses follow, and there is a comprehensive list of references and a useful index. The book is quite exhaustive in treatment, and the main articles and invited commentary demonstrate the give and take of science in action. There are plenty of controversies, and the text provides a detailed overview of sleep and dreaming. If you really are an aficionado of sleep disorders and want to better understand the latest models of dreaming as well as the theoretical connections among such disorders as narcolepsy, REM-behavioral disorder, and posttrau-matic stress disorder, you might find this compilation worth a read. For my money, the introduction or an overview from one of the standard texts is more than enough. To be fair, this book appears to target the sleep physiologist. Unfortunately, for most psychiatrists, let alone primary care clinicians, this book may be just a bad nightmare.
{"title":"Sleep and Dreaming: Scientific Advances and Reconsiderations.","authors":"J. Susman","doi":"10.4088/PCC.V08N0110B","DOIUrl":"https://doi.org/10.4088/PCC.V08N0110B","url":null,"abstract":"Sleep and Dreaming is a compilation of papers, critical reviews, and commentaries published from 2000 to 2002 in the journal Behavioral and Brain Sciences that assess the “relationship of dreaming to brain physiology and neuro-chemistry and the possible functions, or lack of functions, of REM [rapid eye movement] sleep and of dreaming”(ix). As a summary of this fascinating field, this book is becoming significantly outdated; as an entree for the primary care clinician, it is likely to be more soporific than scintillating. \u0000 \u0000The book comprises an introduction and 5 chapters (reviewing the cognitive neuroscience of conscious states, the discordance of dreaming and REM sleep, mentation in REM and non-REM sleep, the case against memory consolidation in REM sleep, and an evolutionary hypothesis of the function of dreaming). Peer commentary and author responses follow, and there is a comprehensive list of references and a useful index. The book is quite exhaustive in treatment, and the main articles and invited commentary demonstrate the give and take of science in action. There are plenty of controversies, and the text provides a detailed overview of sleep and dreaming. \u0000 \u0000If you really are an aficionado of sleep disorders and want to better understand the latest models of dreaming as well as the theoretical connections among such disorders as narcolepsy, REM-behavioral disorder, and posttrau-matic stress disorder, you might find this compilation worth a read. For my money, the introduction or an overview from one of the standard texts is more than enough. To be fair, this book appears to target the sleep physiologist. Unfortunately, for most psychiatrists, let alone primary care clinicians, this book may be just a bad nightmare.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133401845","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}
The following book review was printed in our sister publication, The Journal of Clinical Psychiatry. We at the Companion believe that the review will be of great interest to our readers as well. —L.C.
{"title":"Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940-2004","authors":"D. Dunner","doi":"10.4088/PCC.v08n0110a","DOIUrl":"https://doi.org/10.4088/PCC.v08n0110a","url":null,"abstract":"The following book review was printed in our sister publication, The Journal of Clinical Psychiatry. We at the Companion believe that the review will be of great interest to our readers as well. —L.C.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122457223","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}
Chronic fatigue syndrome (CFS) has been recognized as an entity since the 1800s, when it was known as “neurasthenia.” A panel of experts who convened in 1994 to establish a set of diagnostic criteria for CFS described it as a syndrome that includes disabling fatigue, cognitive difficulties, nonrefreshing sleep, and myalgias. Autonomic instability, mental illness, immunologic abnormalities, and swollen lymph nodes are sometimes present in patients with CFS. It frequently coexists with fibromyalgia. The Handbook of Chronic Fatigue Syndrome summarizes the current research and clinical knowledge about this disorder. Chronic fatigue syndrome is largely a “diagnostically homeless” entity. No one medical specialty takes ownership of CFS, and it is not routinely included in medical school and residency curricula. There is much controversy surrounding its diagnosis and even its legitimacy as a medical illness. The differential diagnosis of CFS is large, making its diagnosis difficult. Endocrine, rheumatologic, neurologic, infectious, hematologic, nutritional, metabolic, and psychiatric disorders can mimic or contribute to the disorder. Profound occupational, social, and family problems can also result from the illness. A multisystem approach using the biopsychosocial model is best used in the diagnosis and management of CFS. Part I of the Handbook discusses epidemiology, differential diagnosis, sociocultural issues, immunology, and genetics; the major criteria as well as additional symptoms that constitute the diagnosis of CFS, as established by the panel of experts, are listed. Part II is about the social, individual, and family systems effects of CFS. Part III goes into specifics about the symptomatology of CFS, including sections on pain and fatigue, orthostatic intolerance, and sleep, cardiac, and neuroendo-crine dysfunction. Part IV discusses pain rating scales and other diagnostic instruments. Part V is a large section on treatments and interventions. Comprehensive treatment regimens including medical treatment, exercise, nutrition, and psychotherapy are described. Part VI discusses diagnosis and treatment of CFS in children and adolescents. The editors have succeeded in producing a comprehensive and interesting text. Although this volume, at 794 pages, stretches the definition of “handbook,” readers are rewarded with an exhaustively researched and evidence-based work that should prove to be clinically useful.
{"title":"Handbook of Chronic Fatigue Syndrome","authors":"L. Cantor","doi":"10.4088/PCC.v07n0611","DOIUrl":"https://doi.org/10.4088/PCC.v07n0611","url":null,"abstract":"Chronic fatigue syndrome (CFS) has been recognized as an entity since the 1800s, when it was known as “neurasthenia.” A panel of experts who convened in 1994 to establish a set of diagnostic criteria for CFS described it as a syndrome that includes disabling fatigue, cognitive difficulties, nonrefreshing sleep, and myalgias. Autonomic instability, mental illness, immunologic abnormalities, and swollen lymph nodes are sometimes present in patients with CFS. It frequently coexists with fibromyalgia. \u0000 \u0000The Handbook of Chronic Fatigue Syndrome summarizes the current research and clinical knowledge about this disorder. Chronic fatigue syndrome is largely a “diagnostically homeless” entity. No one medical specialty takes ownership of CFS, and it is not routinely included in medical school and residency curricula. There is much controversy surrounding its diagnosis and even its legitimacy as a medical illness. The differential diagnosis of CFS is large, making its diagnosis difficult. Endocrine, rheumatologic, neurologic, infectious, hematologic, nutritional, metabolic, and psychiatric disorders can mimic or contribute to the disorder. Profound occupational, social, and family problems can also result from the illness. A multisystem approach using the biopsychosocial model is best used in the diagnosis and management of CFS. \u0000 \u0000Part I of the Handbook discusses epidemiology, differential diagnosis, sociocultural issues, immunology, and genetics; the major criteria as well as additional symptoms that constitute the diagnosis of CFS, as established by the panel of experts, are listed. Part II is about the social, individual, and family systems effects of CFS. Part III goes into specifics about the symptomatology of CFS, including sections on pain and fatigue, orthostatic intolerance, and sleep, cardiac, and neuroendo-crine dysfunction. Part IV discusses pain rating scales and other diagnostic instruments. Part V is a large section on treatments and interventions. Comprehensive treatment regimens including medical treatment, exercise, nutrition, and psychotherapy are described. Part VI discusses diagnosis and treatment of CFS in children and adolescents. \u0000 \u0000The editors have succeeded in producing a comprehensive and interesting text. Although this volume, at 794 pages, stretches the definition of “handbook,” readers are rewarded with an exhaustively researched and evidence-based work that should prove to be clinically useful.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129242341","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}
Remember the mid-1980s? Many psychiatric researchers were very surprised to find a large burden of depression in primary care patients. Of course, with the advent of the SSRIs (selective serotonin reuptake inhibitors) and other safe and effective antidepressants, we in primary care were reassured that we could, indeed, adequately treat these patients, reducing morbidity (and mortality!) with expedition and ease. Twenty years on, and the plot has thickened. In our offices and for our patients, the high prevalence of treatment-resistant depression, the confusion involving differential diagnoses (including bipolar depression and substance abuse disorder), and the interplay of Axis II disorders with Axis I pathology have laid bare some of the halcyon assumptions regarding easy efficacy that marked primary care affective medicine 2 decades ago. If the past informs the present, and is truly prologue to the future, then we could use a history lesson. Callahan and Berrios provide the very best kind—well-written, informative, clearly referenced, and lucidly conceptualized—to tell a story of how we came to approach mental illness in primary care as we do. Their central thesis states that the current model of depression is deterministic and too narrowly defined, overemphasizing the biomedical and failing to take fully into account the contributions of psychosocio-spiritual factors to the patient's experience of emotional suffering. They contend that this narrow model, developed by specialty psychiatry and later endorsed by primary care physicians, prevents many patients from receiving adequate diagnoses and treatment. In addition, it neglects many of the multidisciplinary strengths of the generalist physician and thus lowers the quality of care. To begin, the authors explode 2 favorite myths of modern medicine: that of the old-time doctor (who saw fewer patients, had more time, and was happier with the practice) and that of the old-time patient (who complained less, appreciated the doctor more, and was reluctant to accept medical treatment for emotional suffering). Next, they portray the realities of midcentury primary care and subsequent changes in generalist practices. They then trace the emergence of specialty psychiatry, the development of effective medications for psychiatric disorders, and the rise of criteria-based psychiatric diagnoses. Following the development of fluoxetine as penicillin for the blues, the authors describe the consequences of marketing in a vacuum—the interaction of pharmaceutical companies with physicians or patients in the absence of robust regulatory and academic relationships. The book closes by arguing that only a broader model of mental health and illness will bring to bear the particular strengths of primary care in reducing the overall burden of morbidity and mortality (in a manner similar to the mass strategy associated with such multifactorial illnesses as coronary artery disease and diabetes mellitus). In other
{"title":"Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940–2004","authors":"W. Jackson","doi":"10.4088/PCC.v07n0511","DOIUrl":"https://doi.org/10.4088/PCC.v07n0511","url":null,"abstract":"Remember the mid-1980s? Many psychiatric researchers were very surprised to find a large burden of depression in primary care patients. Of course, with the advent of the SSRIs (selective serotonin reuptake inhibitors) and other safe and effective antidepressants, we in primary care were reassured that we could, indeed, adequately treat these patients, reducing morbidity (and mortality!) with expedition and ease. Twenty years on, and the plot has thickened. In our offices and for our patients, the high prevalence of treatment-resistant depression, the confusion involving differential diagnoses (including bipolar depression and substance abuse disorder), and the interplay of Axis II disorders with Axis I pathology have laid bare some of the halcyon assumptions regarding easy efficacy that marked primary care affective medicine 2 decades ago. \u0000 \u0000If the past informs the present, and is truly prologue to the future, then we could use a history lesson. Callahan and Berrios provide the very best kind—well-written, informative, clearly referenced, and lucidly conceptualized—to tell a story of how we came to approach mental illness in primary care as we do. Their central thesis states that the current model of depression is deterministic and too narrowly defined, overemphasizing the biomedical and failing to take fully into account the contributions of psychosocio-spiritual factors to the patient's experience of emotional suffering. They contend that this narrow model, developed by specialty psychiatry and later endorsed by primary care physicians, prevents many patients from receiving adequate diagnoses and treatment. In addition, it neglects many of the multidisciplinary strengths of the generalist physician and thus lowers the quality of care. \u0000 \u0000To begin, the authors explode 2 favorite myths of modern medicine: that of the old-time doctor (who saw fewer patients, had more time, and was happier with the practice) and that of the old-time patient (who complained less, appreciated the doctor more, and was reluctant to accept medical treatment for emotional suffering). Next, they portray the realities of midcentury primary care and subsequent changes in generalist practices. They then trace the emergence of specialty psychiatry, the development of effective medications for psychiatric disorders, and the rise of criteria-based psychiatric diagnoses. Following the development of fluoxetine as penicillin for the blues, the authors describe the consequences of marketing in a vacuum—the interaction of pharmaceutical companies with physicians or patients in the absence of robust regulatory and academic relationships. \u0000 \u0000The book closes by arguing that only a broader model of mental health and illness will bring to bear the particular strengths of primary care in reducing the overall burden of morbidity and mortality (in a manner similar to the mass strategy associated with such multifactorial illnesses as coronary artery disease and diabetes mellitus). In other","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127707074","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 grant that it is uncommon for reviewers to share their thoughts on books that have been in print for 4 years. However, I also confess that it is not uncommon for this reviewer to sometimes attend to the tyranny of the urgent, while the seductive book slides further and further beneath a pile of unread journals, personal correspondence, scattered bills and professional letters, and yes, the occasional parking violation. Thus it was that, a full 2 years from the intended season, I read this anthology—and fell so hopelessly for its variety and subtlety of expression of the untellable, the incomprehensible experience of mental illness, that I bring you this summation. Unholy Ghost is a collection of 23 essays by persons who are writers by trade and depressives (or family members of depressives) by fate. In the manner of (and containing an excerpt from) Styron's classic memoir Darkness Visible, the book comprises pieces that are unrelated, but not disjointed, as each offers a unique perspective on what the inner life of depression truly is. I have pored over research articles, labored over textbooks, and memorized sections (yes) of the DSM-IV, but never have I encountered documents that framed the stories of my own patients so well as some found here. Consider the title phrase, borrowed from Jane Kenyon's “Credo”: “Pharmaceutical wonders are at work/but I believe only in this moment/of well-being. Unholy ghost,/you are certain to come again.”1 For the clinician, this book is a mine containing rich ore, and much of the work has been done in helping him or her to grasp the patient's inner life. The interplay between medical illness (heart surgery) and depression, the struggle of a pregnant mother with the risk of teratogenicity of pharmaceutical therapy, the relation between pain and depression, the special characteristics of unipolar versus bipolar depression, ethnic and cultural contextualization of mental illness, the experience of hospitalization and electroconvulsive therapy, the influence of childhood events on adult psychiatric health and illness—they're all here and faithfully rendered. To hear Darcey Steinke say, “I felt like I'd been found incompetent and fired from my own life” (p. 64) or listen to David Karp report that “my mind made a choice each day about how to torment my body” (p. 143) is to be granted a special window into the soul of depression by those unfortunate enough to have lived it, gifted enough to report it, and courageous enough to undertake such an enterprise. The sections are modular, and thus, each demands little of the busy practitioner's time. Woe to the reader, however, who starts this book without adequate time. He or she will soon be drawn inexorably to it, and it will be the journals, the letters, and yes, the traffic violation, which end at the bottom of the heap.
{"title":"Unholy Ghost: Writers on Depression","authors":"W. Jackson","doi":"10.4088/PCC.v07n0313","DOIUrl":"https://doi.org/10.4088/PCC.v07n0313","url":null,"abstract":"I grant that it is uncommon for reviewers to share their thoughts on books that have been in print for 4 years. However, I also confess that it is not uncommon for this reviewer to sometimes attend to the tyranny of the urgent, while the seductive book slides further and further beneath a pile of unread journals, personal correspondence, scattered bills and professional letters, and yes, the occasional parking violation. Thus it was that, a full 2 years from the intended season, I read this anthology—and fell so hopelessly for its variety and subtlety of expression of the untellable, the incomprehensible experience of mental illness, that I bring you this summation. \u0000 \u0000Unholy Ghost is a collection of 23 essays by persons who are writers by trade and depressives (or family members of depressives) by fate. In the manner of (and containing an excerpt from) Styron's classic memoir Darkness Visible, the book comprises pieces that are unrelated, but not disjointed, as each offers a unique perspective on what the inner life of depression truly is. I have pored over research articles, labored over textbooks, and memorized sections (yes) of the DSM-IV, but never have I encountered documents that framed the stories of my own patients so well as some found here. Consider the title phrase, borrowed from Jane Kenyon's “Credo”: “Pharmaceutical wonders are at work/but I believe only in this moment/of well-being. Unholy ghost,/you are certain to come again.”1 \u0000 \u0000For the clinician, this book is a mine containing rich ore, and much of the work has been done in helping him or her to grasp the patient's inner life. The interplay between medical illness (heart surgery) and depression, the struggle of a pregnant mother with the risk of teratogenicity of pharmaceutical therapy, the relation between pain and depression, the special characteristics of unipolar versus bipolar depression, ethnic and cultural contextualization of mental illness, the experience of hospitalization and electroconvulsive therapy, the influence of childhood events on adult psychiatric health and illness—they're all here and faithfully rendered. To hear Darcey Steinke say, “I felt like I'd been found incompetent and fired from my own life” (p. 64) or listen to David Karp report that “my mind made a choice each day about how to torment my body” (p. 143) is to be granted a special window into the soul of depression by those unfortunate enough to have lived it, gifted enough to report it, and courageous enough to undertake such an enterprise. \u0000 \u0000The sections are modular, and thus, each demands little of the busy practitioner's time. Woe to the reader, however, who starts this book without adequate time. He or she will soon be drawn inexorably to it, and it will be the journals, the letters, and yes, the traffic violation, which end at the bottom of the heap.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115465222","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}
There is certainly no shortage of self-help books targeted at improving society's mental health, one coffee table at a time. Many of these titles profess to provide readers with key insight into their problems, thereby saving them time and money over more traditional psychiatric care. Although many titles are written to augment current treatment, some books are antipsychiatry. This is certainly one of them, despite having been penned by a board-certified psychiatrist. Dr. William Glasser graduated from Case Western Reserve University with his M.D. in 1953 and became board certified in 1961. From 1956 to 1986, Dr. Glasser was a private practice psychiatrist. He created what he termed reality therapy and subsequently founded the Institute for Reality Therapy in 1967, which he later renamed the William Glasser Institute. The institute became his full-time occupation, where he teaches his own psychological theories. Reality therapy is a counseling method that focuses on the future by helping individuals take ownership of and responsibility for their actions. The fundamental precept is that the future is ours and success is based on the behaviors we choose now. The technique of focusing on one's choices is referred to as choice theory. This theory states that all human beings are driven to satisfy 5 genetically programmed needs: survival, love and belonging, power, freedom, and fun. According to Dr. Glasser, the behavior of most individuals is explained by external control psychology, which postulates that people, situations, and things outside of us cause our behavior. This external behavior control is destructive to relationships, so people become disconnected from those for whom they care. This disconnectedness causes psychic stress such as mental illness (including depression, anxiety, and schizophrenia), drug addiction, violence, and countless somatic complaints. Choice theory focuses on controlling one's own behavior. By realizing that all behavior is a choice, the issue becomes making choices that bring happiness. Dr. Glasser postulates that everything contained in the DSM-IV-TR is a result of an individual's brain creatively expressing its unhappiness. He suggests that by making all choices based on what will connect one to those individuals for whom one cares, one creates internal happiness by satisfying one's genetic needs. When one meets these needs, the brain should feel less psychic stress and stop manifesting what we refer to as mental illness. Although the extent to which psychiatric training programs should have a biological emphasis is controversial, none would go so far as to say there is no such thing as mental illness. Dr. Glasser demonizes the entire profession as charlatans who have been brainwashed by their predecessors or who simply misrepresent many of the psychiatric illnesses to patients as having a biological basis. He refers to all medications as “brain drugs,” and the book is full of statements comparing these me
{"title":"Warning: Psychiatry Can Be Hazardous to Your Mental Health","authors":"C. White","doi":"10.4088/PCC.V07N0208","DOIUrl":"https://doi.org/10.4088/PCC.V07N0208","url":null,"abstract":"There is certainly no shortage of self-help books targeted at improving society's mental health, one coffee table at a time. Many of these titles profess to provide readers with key insight into their problems, thereby saving them time and money over more traditional psychiatric care. Although many titles are written to augment current treatment, some books are antipsychiatry. This is certainly one of them, despite having been penned by a board-certified psychiatrist. \u0000 \u0000Dr. William Glasser graduated from Case Western Reserve University with his M.D. in 1953 and became board certified in 1961. From 1956 to 1986, Dr. Glasser was a private practice psychiatrist. He created what he termed reality therapy and subsequently founded the Institute for Reality Therapy in 1967, which he later renamed the William Glasser Institute. The institute became his full-time occupation, where he teaches his own psychological theories. \u0000 \u0000Reality therapy is a counseling method that focuses on the future by helping individuals take ownership of and responsibility for their actions. The fundamental precept is that the future is ours and success is based on the behaviors we choose now. The technique of focusing on one's choices is referred to as choice theory. This theory states that all human beings are driven to satisfy 5 genetically programmed needs: survival, love and belonging, power, freedom, and fun. According to Dr. Glasser, the behavior of most individuals is explained by external control psychology, which postulates that people, situations, and things outside of us cause our behavior. This external behavior control is destructive to relationships, so people become disconnected from those for whom they care. This disconnectedness causes psychic stress such as mental illness (including depression, anxiety, and schizophrenia), drug addiction, violence, and countless somatic complaints. Choice theory focuses on controlling one's own behavior. By realizing that all behavior is a choice, the issue becomes making choices that bring happiness. Dr. Glasser postulates that everything contained in the DSM-IV-TR is a result of an individual's brain creatively expressing its unhappiness. He suggests that by making all choices based on what will connect one to those individuals for whom one cares, one creates internal happiness by satisfying one's genetic needs. When one meets these needs, the brain should feel less psychic stress and stop manifesting what we refer to as mental illness. \u0000 \u0000Although the extent to which psychiatric training programs should have a biological emphasis is controversial, none would go so far as to say there is no such thing as mental illness. Dr. Glasser demonizes the entire profession as charlatans who have been brainwashed by their predecessors or who simply misrepresent many of the psychiatric illnesses to patients as having a biological basis. He refers to all medications as “brain drugs,” and the book is full of statements comparing these me","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116733109","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}
Sleep disorders are a significant cause of distress in patients of all ages. These patients may seek treatment for such problems from a psychiatrist or family physician. Unfortunately, sleep medicine is not usually included in the curriculum of most medical schools or residencies, so physicians may find themselves at a loss as to how these conditions should be managed. This text presents the fundamentals of sleep architecture and provides descriptions of sleep disorders, their treatments, and effective behavioral interventions. The first chapter is introductory. The physiology of sleep is discussed in Chapter 2, with an emphasis on modalities that measure sleep architecture, duration, and quality. Sleep logging, actigraphy, and polysomnography are described in detail, along with examples of specific sleep disorders and their polysomnographic evaluation. In Chapter 3, the clinical evaluation, polysomnographic analysis, and medical treatment of obstructive sleep apnea (OSA) are discussed. This includes the significant role of obesity and other medical problems that are involved in the disorder. Weight loss, exercise, nasal continuous positive airway pressure (CPAP), and surgery are presented as possible treatments. It is interesting to note that depression and chronic fatigue are major sequelae of OSA. Unfortunately, these symptoms may interfere with treatment. Chapter 4 includes the physiology, clinical symptomatology, and polysomnographic evaluation of periodic limb movements of sleep disorder (PLMS). Its differential diagnosis and medical workup are presented together with pharmacologic interventions. Interestingly, this disorder is also linked to depressionlike symptoms, expanding the medical differential diagnosis of depression. There may be insomnia associated with cognitive-behavioral problems such as catastrophizing and fear of sleep. Chapter 5 provides a thorough description of the clinical diagnostic criteria for narcolepsy. Pharmacologic interventions such as stimulants are discussed, but the behavioral management of the disorder is emphasized. Behavioral treatment is presented as an important adjunct to medication. These interventions include frequent naps, sleep hygiene, dietary measures, and strategies to increase daytime alertness. Chapter 6 is concerned with behavioral interventions for sleep disorders such as narcolepsy, PLMS, and OSA. Although there is some new information in this chapter, there is much repetition of information from previous chapters. Chapter 7 provides an introduction to the chapters that follow. It presents the basics of cognitive science, operant and classical conditioning, self-regulation, and social cognitive theory. This information will be familiar to mental health practitioners but may not be of interest to other readers. The purpose of this chapter is to lay the foundation for the subsequent description of behavioral interventions in sleep disorders. It is pertinent for an understanding
{"title":"Treating Sleep Disorders","authors":"L. Cantor","doi":"10.4088/PCC.V07N0108","DOIUrl":"https://doi.org/10.4088/PCC.V07N0108","url":null,"abstract":"Sleep disorders are a significant cause of distress in patients of all ages. These patients may seek treatment for such problems from a psychiatrist or family physician. Unfortunately, sleep medicine is not usually included in the curriculum of most medical schools or residencies, so physicians may find themselves at a loss as to how these conditions should be managed. This text presents the fundamentals of sleep architecture and provides descriptions of sleep disorders, their treatments, and effective behavioral interventions. \u0000 \u0000The first chapter is introductory. The physiology of sleep is discussed in Chapter 2, with an emphasis on modalities that measure sleep architecture, duration, and quality. Sleep logging, actigraphy, and polysomnography are described in detail, along with examples of specific sleep disorders and their polysomnographic evaluation. \u0000 \u0000In Chapter 3, the clinical evaluation, polysomnographic analysis, and medical treatment of obstructive sleep apnea (OSA) are discussed. This includes the significant role of obesity and other medical problems that are involved in the disorder. Weight loss, exercise, nasal continuous positive airway pressure (CPAP), and surgery are presented as possible treatments. It is interesting to note that depression and chronic fatigue are major sequelae of OSA. Unfortunately, these symptoms may interfere with treatment. \u0000 \u0000Chapter 4 includes the physiology, clinical symptomatology, and polysomnographic evaluation of periodic limb movements of sleep disorder (PLMS). Its differential diagnosis and medical workup are presented together with pharmacologic interventions. Interestingly, this disorder is also linked to depressionlike symptoms, expanding the medical differential diagnosis of depression. There may be insomnia associated with cognitive-behavioral problems such as catastrophizing and fear of sleep. \u0000 \u0000Chapter 5 provides a thorough description of the clinical diagnostic criteria for narcolepsy. Pharmacologic interventions such as stimulants are discussed, but the behavioral management of the disorder is emphasized. Behavioral treatment is presented as an important adjunct to medication. These interventions include frequent naps, sleep hygiene, dietary measures, and strategies to increase daytime alertness. \u0000 \u0000Chapter 6 is concerned with behavioral interventions for sleep disorders such as narcolepsy, PLMS, and OSA. Although there is some new information in this chapter, there is much repetition of information from previous chapters. \u0000 \u0000Chapter 7 provides an introduction to the chapters that follow. It presents the basics of cognitive science, operant and classical conditioning, self-regulation, and social cognitive theory. This information will be familiar to mental health practitioners but may not be of interest to other readers. The purpose of this chapter is to lay the foundation for the subsequent description of behavioral interventions in sleep disorders. It is pertinent for an understanding","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130045169","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}
J. Rosenbaum, C. O'brien, M. Otto, M. Pollack, P. Roy-Byrne, Samantha A. Stewart
This AcademicHighlights section of The Primary Care Companion to The Journal of Clinical Psychiatry presents the highlights of the meeting "Utilizing Benzodiazepines in Clinical Practice: An Evidence-Based Discussion" held August 16, 2004, in Boston, Mass., and supported by an unrestricted educational grant from Pfizer Inc. This report was prepared by the CME Institute of Physicians Postgraduate Press, Inc.Chair Jerrold F. Rosenbaum, M.D., began the meeting by explaining that he had been asked to be a discussant at a case conference at Massachusetts General Hospital where Samantha A. Stewart, M.D., presented the case of a woman (described herein by Dr. Stewart) who was admitted with cognitive deficits potentially caused by benzodiazepine abuse and dependence--issues that were heavily debated during the 1980s. Dr. Rosenbaum stated that the purpose of the meeting was to address concerns related to benzodiazepine use in clinical practice today.
{"title":"Academic Highlights: Benzodiazepines: Revisiting Clinical Issues in Treating Anxiety Disorders","authors":"J. Rosenbaum, C. O'brien, M. Otto, M. Pollack, P. Roy-Byrne, Samantha A. Stewart","doi":"10.4088/PCC.V07N0104","DOIUrl":"https://doi.org/10.4088/PCC.V07N0104","url":null,"abstract":"This AcademicHighlights section of The Primary Care Companion to The Journal of Clinical Psychiatry presents the highlights of the meeting \"Utilizing Benzodiazepines in Clinical Practice: An Evidence-Based Discussion\" held August 16, 2004, in Boston, Mass., and supported by an unrestricted educational grant from Pfizer Inc. This report was prepared by the CME Institute of Physicians Postgraduate Press, Inc.Chair Jerrold F. Rosenbaum, M.D., began the meeting by explaining that he had been asked to be a discussant at a case conference at Massachusetts General Hospital where Samantha A. Stewart, M.D., presented the case of a woman (described herein by Dr. Stewart) who was admitted with cognitive deficits potentially caused by benzodiazepine abuse and dependence--issues that were heavily debated during the 1980s. Dr. Rosenbaum stated that the purpose of the meeting was to address concerns related to benzodiazepine use in clinical practice today.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124269511","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}
Considering how important sleep is in general, and insomnia is as a chief complaint in the primary care setting, good texts on the subject are sorely needed. Medical school curricula mostly ignore sleep, and insomnia is unmentioned even in many residency settings. Insomnia: Principles and Management fills a need for the practicing physician covering a broad range of topics within the umbrella of insomnia. In 5 sections, 14 chapters, 8 appendices, and 285 pages, this book covers many topics. Some are a bit obscure, such as “Amygdalar Modulation of Sleep Regulation,” whereas others are more clinical, e.g., “Long-Term Use of Hypnotic Medications.” Overall, 21 authors provide a broad look at insomnia and information for the beginner looking for basic information as well as the scholar looking for research topics. If you are looking for an easy cover-to-cover read, this book might not be the best selection; however, if you desire a single book to act as both primer and reference, this should do the trick. Part I, Characterization of Insomnia, reviews the diagnosis of insomnia, certain clinical aspects, and psychiatric comorbidities. Depending on which group of experts you ask, there are anywhere from 18 to 84 different sleep disorders of which insomnia is a subset. The complexities of accurate diagnosis are detailed and organized into groups. Some conclusions are implied, such as the importance of mood disorders associated with insomnia—which will surprise nobody. Other conclusions are less obvious, such as “ … the majority of insomniacs do not appear to have significantly disrupted sleep” (p. 31) and “improvement of nighttime sleep does not directly result in improved daytime functioning” (p. 31). While a bit dense in parts, this section succeeds in its goal of description and characterization. Part II, Treatment of Insomnia, disappointed me by its lack of cases and a relatively abstract approach. As a family physician, I need some straightforward concepts illustrated by examples. Fortunately, Dr. Peter Hauri does include several case studies in chapter 14, but other authors did not. The treatment part of the book is more directed toward a sleep clinic or comprehensive program and is less useful for a single practitioner alone with a tired patient looking for a 15-minute solution. Chapter 6 is about melatonin—fact and fiction—but does provide some useful conclusions such as “Melatonin is more likely to promote sleep when given during the day in the context of accumulated homeostatic sleep drive. It is less likely to promote sleep directly when given at night” (p. 108). Chapter 7, “Long-Term Use of Hypnotic Medications,” is only 6 pages long and is not a comprehensive discussion on pharmacotherapy. This section is the one I found most lacking. I would have liked an additional chapter devoted to general treatment focused on medications and including other modalities. Part III, Special Topics in Insomnia, is more helpful than the title suggests
{"title":"Insomnia: Principles and Management","authors":"Roy H. Jacobson","doi":"10.4088/PCC.V06N0510","DOIUrl":"https://doi.org/10.4088/PCC.V06N0510","url":null,"abstract":"Considering how important sleep is in general, and insomnia is as a chief complaint in the primary care setting, good texts on the subject are sorely needed. Medical school curricula mostly ignore sleep, and insomnia is unmentioned even in many residency settings. Insomnia: Principles and Management fills a need for the practicing physician covering a broad range of topics within the umbrella of insomnia. In 5 sections, 14 chapters, 8 appendices, and 285 pages, this book covers many topics. Some are a bit obscure, such as “Amygdalar Modulation of Sleep Regulation,” whereas others are more clinical, e.g., “Long-Term Use of Hypnotic Medications.” Overall, 21 authors provide a broad look at insomnia and information for the beginner looking for basic information as well as the scholar looking for research topics. If you are looking for an easy cover-to-cover read, this book might not be the best selection; however, if you desire a single book to act as both primer and reference, this should do the trick. \u0000 \u0000Part I, Characterization of Insomnia, reviews the diagnosis of insomnia, certain clinical aspects, and psychiatric comorbidities. Depending on which group of experts you ask, there are anywhere from 18 to 84 different sleep disorders of which insomnia is a subset. The complexities of accurate diagnosis are detailed and organized into groups. Some conclusions are implied, such as the importance of mood disorders associated with insomnia—which will surprise nobody. Other conclusions are less obvious, such as “ … the majority of insomniacs do not appear to have significantly disrupted sleep” (p. 31) and “improvement of nighttime sleep does not directly result in improved daytime functioning” (p. 31). While a bit dense in parts, this section succeeds in its goal of description and characterization. \u0000 \u0000Part II, Treatment of Insomnia, disappointed me by its lack of cases and a relatively abstract approach. As a family physician, I need some straightforward concepts illustrated by examples. Fortunately, Dr. Peter Hauri does include several case studies in chapter 14, but other authors did not. The treatment part of the book is more directed toward a sleep clinic or comprehensive program and is less useful for a single practitioner alone with a tired patient looking for a 15-minute solution. Chapter 6 is about melatonin—fact and fiction—but does provide some useful conclusions such as “Melatonin is more likely to promote sleep when given during the day in the context of accumulated homeostatic sleep drive. It is less likely to promote sleep directly when given at night” (p. 108). Chapter 7, “Long-Term Use of Hypnotic Medications,” is only 6 pages long and is not a comprehensive discussion on pharmacotherapy. This section is the one I found most lacking. I would have liked an additional chapter devoted to general treatment focused on medications and including other modalities. \u0000 \u0000Part III, Special Topics in Insomnia, is more helpful than the title suggests","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129260471","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：