摘要:

The social changes incident to industralization, detribalization, and urbanization, along with increasing acceptance of western medicine in Kenya, appear to be related to a progressively increasing rate of mental hospital admissions since 1950. There are no systematic changes, however, in the ratio of urban originated or of male to female admissions.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Several cases are presented to demonstrate persisting belief in witchcraft and the continuing appeal of native healing practices among the educated as well as other strata of the population. These beliefs provide a source of security and stand-by ways of dealing with illness and offering support for the patient and family; at the same time, they often interfere with the willingness of the patient or his family to permit or comply with prescribed psychiatric treatment by a physician. The psychiatrist, in order to be successful, must simultaneously cope with and understand the utility of these beliefs as he attemps to treat his patient's illness.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Mental health service development in “emerging nations” is determined in part by political ideologies. These require congruent diagnostic and treatment philosophies, and influence decisions about allocating resources and attitudes toward consultants from industrialized nations viewed as exploiters. The dominance of wealthy elites with relatively powerless masses may result in few public resources for health education or services. A historically accepted gulf between the disadvantaged and the affluent who provide the nation's physicians may also increase authoritarianism in the latter and reduce the possibility of collaborative or psychotherapeutic treatment relationships aimed at increased self-determination. Industrialization provides both new opportunities for upward social mobility and increased possibilities of achievement-aspiration discrepancy. Specific issues influencing the nature both of prevailing mental health problems and of service delivery include: migration, literacy, local folk medicine, and the status of the family.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Despite the fact that malaria is an extraordinarily common condition and cerebral manifestations of malaria occur in about 2% of cases, little scientific attention has been focused on the psychic effects of malarial infestation. One important reason for the dearth of data on the psychopathological concomitants of malaria is the failure to obtain routinely thick blood smears on patients admitted to psychiatric units in areas in which malaria is endemic and on the steadily increasing numbers of patients recently returned from such areas. In this paper the author reviews published data on the incidence of cerebral malaria, its neurological and psychiatric manifestations, and the pathophysiology of the condition. With these data as background, the author reports the comparatively high incidence of acute psychotic episodes associated with malaria among patients admitted during a 2-year period to the only psychiatric facility in Liberia, West Africa. The clinical characteristics of these patients are described and illustrated by 4 case examples. Drawing on these clinical observations, the three following questions are considered: 1) Can environmental stress precipitate an attack of malaria? 2) Can environmental stress plus malaria precipitate a psychotic episode? and 3) Can malaria alone precipitate an acute exacerbation of chronic mental illness?

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Magical thinking is by no means limited to “preliterate societies.” Supernatural explanations are no less common in developed nations than in developing ones when people are confronted by unexpected personal disasters such as flood, fire, death of a spouse or child, or sudden illness. This paper is concerned not withhowillness affects individuals, but their attempts to explainwhy: Why them? Why then? The focus of concern is the very widespread system of beliefs that attributes behavior disturbance to malign magic—a hex or spell perpetrated by one individual on another whose success he envies and resents. The characteristics of beliefs shared by many people within two cultural groups are considered, Liberians and black Americans. The two systems of beliefs, strikingly similar in many ways, are usually called “witchcraft” in Liberia and “rootwork” in America. Data are presented from the author's 2 years experience as director of the only psychiatric facility in Liberia, and from a study of patients treated during the past 2 years at the University of Connecticut-McCook Hospital in Hartford. Case history material of 4 patients is included to illustrate the principal features of the belief systems as well as the range of behavior disturbances associated with witchcraft and rootwork beliefs. The report concludes with a discussion of how professionals can utilize a knowledge of these belief systems to diagnose and treat patients more effectively who are convinced of their importance.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The authors emphasize the importance of the admission process in the overall course of hospitalization. Reviewing the literature, demographic, social, symptom, interpersonal, organizational, and attitudinal factors all seem to influence both who becomes hospitalized and where. In spite of this there have been few systematic attempts to establish rational admission criteria. As a result, this lack has oftentimes led to inappropriate admissions on the one hand and to underutilization of hospitalization on the other. To help offset this difficulty a list of valid reasons for hospitalization is proposed. It is pointed out, however, that although such criteria are useful in determining who should be admitted, it is of limited value in deciding where the patient should be hospitalized. In matching individual patients with particular types of hospitals it is useful to consider certain parameters. More specifically, the hospital variables are: a) the average length of stay; b) individualvs.milieu orientations; and c) active treatmentvs.custodial care. The patient variables are: a) the duration of the presenting problem; b) degree of psychosocial problems; and c) the patient's failure to respond to a hospital's treatment program. Utilizing these six variables, the authors present explicit guidelines for matching particular patients with particular hospitals.Finally, certain general theoretical principles and practical techniques are suggested to improve the admission process. A two-stage admission process is suggested, which includes: a) preadmission screening; and b) the admission work-up. The goals of the former stage are to determine if the patient belongs in that particular hospital, to obtain information, to instill a sense of hope, to collect data, and to set a proper tone. The goals of the latter stage are to acquire a complete history and to acclimate the patient to the treatment facility. It is pointed out that the way in which the total admission procedure is executed can have a profound effect on the subsequent course of hospitalization.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The longitudinal sleep electroencephalogram and 24-hour telemetric activity measurements are reported on a patient with a psychotic depression. During the patient's spontaneous partial remission, the sleep patterns showed a marked rapid eye movement recovery, along with other changes in the various sleep parameters. Telemetric activity measurements appeared to mirror certain of the sleep changes so that periods of “hypersomnia” were associated with reduction of activity levels while the periods of insomnia were associated with a marked increase.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

While the problem-oriented approach to record-keeping is gaining wide usage and enthusiastic acceptance in the general medical community, it has made to this time little impact in psychiatry. This paper describes how the basic components of the problem-oriented system can be effectively adapted for use in psychiatric practice. This uniquely “psychiatric” adaptation of the problem-oriented record was employed successfully on a 28-patient adult unit and consists of eight clearly denned elements. The system was found to meet or exceed the major criteria for excellence in medical record-keeping. In addition it was found to have the following advantages: It is adaptable for use in any type of psychiatric treatment setting. It allows for more precise determination of treatment goals and patient response; it offers more precise guidance to staff workers, while at the same time increasing both their learning and their sense of participation in the therapeutic task; it is readily adaptable for research use; and it provides the psychiatrist with a practical and workable instrument than can enhance both his patient's care and his own continued professional growth.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Reviews of 22 studies between 1949 and 1969 of women who received tubal ligations primarily for contraceptive reasons are presented, as well as six studies of male reaction to vasectomy, including one study of female reaction to vasectomy. Previously suggested contraindications are thoroughly summarized. Tubal ligation studies in terms of patient characteristics are analyzed. Results show a greater per cent of regret over sterilization in studies in which: 1) attrition was under 30 per cent; 2) women reported less than four children; and 3) therapeutic abortion was performed concomitantly with sterilization. The identification of a response bias in favor of more satisfied patients in high attrition studies than in low attrition studies led to the conclusion that the prevalence of regret over sterilization has been underestimated. Actual prevalence may be as high as 25 per cent, which presents a clinical and social problem requiring extensive research. Findings are discussed in terms of previous research and clinical applications.The paper concludes that low parity and concomitant abortion are tentative risk factors for sterilization, although unsatisfied maternal desire may be more important than low parityper se.Other contraindications may include psychopathology, high religiosity, marital instability, misconceptions about the operation or about alternative methods of birth control, inability to accept loss, and recent severe loss. Psychological consultation is suggested to evaluate patient personality, attitudes toward reproductive function and body image, and possible effects on sexual role or self-image.The research reviewed suffered from methodological problems of design and measurement. Future research should attempt to eliminate the inclusion of patients with concomitant abortions, psychopathology, hysterectomy, or who are over age 45. Objective psychological measurement and ratings of adjustment by spouse or physician should supplement patient report of regret as outcome criteria. Reliability and validity of such outcome measures should be determined. Samples should be large enough to provide ample statistical power. Pre- and postoperative measures of adjustment are desirable once the epidemiology of adverse reaction is clear. Control groups of patients using other methods of birth control should be included to provide rational bases for choosing among relevant clinical alternatives. In addition to improving methodology, future research should try to determine the true prevalence of adverse reaction to sterilization, should compare couples switching from one method of birth control to another, and should investigate the processes involved in deciding to seek sterilization and in adjusting to it afterwards.

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1973

数据来源: OVID