Biomedical subjects
M S Rapp
Publications and source records attributed to M S Rapp.
Chemical restraint.
There are clinical and medico-legal implications to the forced administration of neuroleptic medication to actively resisting, aggressive psychiatric patients. However, there is little information on how frequently this occurs. This survey of its incidence on an acute admission ward demonstrates that "chemical restraint" as defined, is uncommon, considering the characteristics of this patient population. It is nearly always a response to threatened or actual violence towards others. The survey discovered, unexpectedly, that there were considerable differences in the actual measures used and in drug doses used during the event, between two wards of the same treatment unit. A prospective study might correlate the different patterns with degree of success, as well as address other questions, the resolution of which would lead to better quality of care.
Informed consent and phobias.
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A fatality possibly due to legal process.
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Monosymptomatic hypochondriasis.
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The suitability for admission of geriatric patients to an acute admissions ward.
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Polypharmacy in psychiatry: update and future trends.
Psychoactive drug combinations continue to be controversial. The concept of "polypharmacy", a pejorative and meaningless term, nevertheless gave rise to useful surveys on combined drug use, to methods of monitoring and controlling multiple drug use, and to a small number of studies which imply that a few psychoactive drug-drug combinations are rational. This paper updates the contributions to these areas since two major reviews of the subject were published in the early 1980's. It highlights common pitfalls in the survey-taking process. Finally, it suggests future useful avenues of study and research, wherein it is hoped that the studies will be more rational than the term "polypharmacy".
Neuroleptic potentiation of serum TCA levels is uncommon.
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Differential diagnosis and treatment of the "housebound syndrome".
Not all people who become housebound suffer from agoraphobia. Other emotional illnesses can underlie this behaviour. Early diagnosis is important. Some conditions can be treated by family physicians without special training, and some are appropriately treated only in special settings. This paper describes psychiatric disorders that may present as a "housebound syndrome" and outlines the principles of treatment for each.
Muscle relaxation techniques: a therapeutic tool for family physicians.
Muscle relaxation techniques are important adjunctive therapy for anxiety-related conditions. Family physicians can learn to teach the techniques so as to try helping anxious patients themselves rather than automatically referring them to a psychiatrist. The exercises are generally acceptable to patients, are easy to learn and do not require expensive equipment. They are beneficial in insomnia and tension headache, of some value in chronic anxiety states and a useful adjunct in hypertension. In this paper the evidence supporting the value of muscle relaxation therapy is briefly reviewed, methods of teaching and of practising the techniques are described in detail, and answers to some of the questions and problems that may arise are presented.
Differential efficacy of biofeedback in headache.
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Ethics in behaviour therapy: historical aspects and current status.
Ethical problems in clinical practice arise when clinicians confront competing value systems. Historically, behaviour therapy has been criticized because of alleged special ethical, moral and legal problems. These problems are no greater or smaller than in other forms of psychotherapeutic practice. But they can differ in emphasis. This article describes partial responses to selected ethical dilemmas facing general psychotherapy, and outlines relatively novel issues raised by certain features of behavior therapy practice.
Mega-doses of behaviour therapy for treatment-resistant agoraphobics.
This was a pilot project set up to test the feasibility of effectively and inexpensively treating agoraphobic patients who had not responded to adequate trials of behaviour therapy (and other therapy) in the past. We employed a quantitatively intensive program of exposure therapy, calisthenics and muscular relaxation, and have explained the rationales for the choice of each treatment. The results were gratifying in four of the five patients, with follow-up to three years. This pilot project enabled us to set up a cost-effective treatment for all forms of agoraphobia which is as efficient as other programs described. It has also highlighted the fact that some patients exist who may do poorly on schedules of behaviour therapy which are adequate for some patients, and yet may do well if the amount of treatment is drastically increased.
Medical certification of the mentally ill.
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