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Biomedical subjects

Z J Lipowski

Publications and source records attributed to Z J Lipowski.

At least 37 records · Page 2Linked to original sources
PubMed1988

An inpatient programme for persistent somatizers.

Somatization, defined as a transient or persistent tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them, represents a common problem in clinical practice. A comprehensive inpatient rehabilitation program for somatizing patients has been developed at the Clarke Institute in Toronto and is described in detail. It involves concurrent application of psychiatric, psychological, social, and medical therapies.

Hospitals, Psychiatric↗
PubMed1987

Delirium (acute confusional states).

Delirium (acute confusional states), a common and often overlooked psychiatric disorder, can occur at any age, but elderly persons are especially prone to develop it. In later life, it is often a conspicuous feature of systemic or cerebral disease and drug (notably anticholinergic) toxicity, and it may constitute a grave prognostic sign. Its development in a hospitalized patient may interfere with his or her management, disrupt ward routine, and cause medicolegal complications as a result of patient injury. Acute onset of a fluctuating level of awareness, accompanied by sleep-wake cycle disruption, lethargy or agitation, and nocturnal worsening of symptoms, are diagnostic. Early recognition of delirium and treatment of its underlying cause are essential.

Attention↗
PubMed1987

Somatization: the experience and communication of psychological distress as somatic symptoms.

Somatization implies a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them. So defined, it is neither a disorder nor a diagnostic category but a generic term for a set of experimental, cognitive, and behavioral characteristics of patients who complain of physical symptoms in the absence of relevant medical findings. Such patients are ubiquitous in all medical care settings, pose difficult diagnostic and management problems, and overutilize health care thus contributing to its cost. Somatization may be transient or persistent, and may or may not be associated with a diagnosable medical or psychiatric disorder. The most common concurrence of somatization is with affective and anxiety disorders, and, to a lesser degree, the somatoform disorders. Persistent somatization poses a serious clinical, social, and economic problem and hence early identification of potential chronic somatizers should be attempted to avoid its development. Pain, fatigue, dizziness, and dyspnea are the commonest symptoms. Etiology of somatization is multifactorial and so should be its management.

Adaptation, Psychological↗
PubMed1987

Comprehensive management of persistent somatization: an innovative inpatient program.

Psychiatry has been largely unsuccessful in developing effective treatment strategies for patients with chronic somatization. They continue to utilize a disproportionate share of health care resources and experience personal distress and significant social and occupational dysfunction. The Psychosomatic Medicine Unit at the Clarke Institute of Psychiatry is attempting to treat these patients with a comprehensive treatment program that takes into account the multifactorial etiology of the disturbance. The unit is in a tertiary care facility and the patient population is heterogeneous with respect to the underlying psychiatric diagnosis and the duration of symptoms. All patients are significantly dysfunctional and have typically failed other treatment approaches. The treatment process begins with an assessment phase in which the patient is comprehensively evaluated from the physical and psychiatric perspectives. The rehabilitation phase consists of a variety of treatment modalities including group programs in goal-setting, life skills and interpersonal relations, group therapy, individual psychotherapy, family therapy, occupational therapy and vocational rehabilitation, biofeedback and physiotherapy. Psychotropic medications play an important role in some patients. This paper will describe the unit and its program in detail.

Combined Modality Therapy↗
PubMed1987

The interface of psychiatry and medicine: towards integrated health care.

Establishment of closer links with medicine in clinical work, research and teaching represents a major achievement of psychiatry in this century. Development of general hospital psychiatry has played a key role in this regard. Numerous studies quoted in this article have documented a large overlap between psychiatric and physical morbidity in the community and in all health care settings. These findings argue most strongly in favour of continued efforts to expand all activities at the interface of psychiatry and medicine, with truly integrated health care as the ultimate goal.

Delivery of Health Care↗
PubMed1986

Somatization: a borderland between medicine and psychiatry.

Somatization is the tendency to experience and communicate psychologic distress in the form of somatic symptoms that the patient misinterprets as signifying serious physical illness. Patients with persistent somatization relentlessly seek medical diagnosis and treatment despite repeated reassurance that physical illness is either absent or insufficient to account for their symptoms and disability. Such abnormal illness behaviour leads to overuse of health care facilities and contributes to the high cost of health care. Somatization may occur transiently in response to stressful life events or it may be persistent and result in chronic partial or total disability. Diagnostic and therapeutic guidelines that may help physicians identify and manage such patients more effectively are discussed.

Cross-Sectional Studies↗
PubMed1986

Consultation-liaison psychiatry: the first half century.

Consultation-liaison psychiatry is over 50 years old. Its main goal has been to bring medicine and psychiatry closer together so as to improve patient care in its psychosocial and psychiatric aspects. The history of this field may be divided into four overlapping phases: the beginnings, the organizational phase, the phase of conceptual development, and the phase of rapid growth. The highlights of each phase are outlined. The author concludes that C-L psychiatry has achieved the status of a full-fledged subspecialty of psychiatry, one whose main contribution has been to draw attention of clinicians and researchers to psychosocial aspects of physical illness, and to the psychiatric complications of such illness and of the medical and surgical therapies.

History, 20th Century↗
PubMed1986

Psychosomatic medicine: past and present. Part I. Historical background.

Psychosomatic Medicine as an organized field of scientific inquiry and a mode of approach to patient care has existed for 50 years. It has focused on the study of the interaction of psychosocial and biological factors in health and disease. Despite its relatively recent origin, this field continues a long tradition in Western thought and medicine, one concerned with the reciprocal relationship of mind and body as two integral aspects of the human organism. That tradition goes back to ancient Greece and represents a counterpoint to the dualistic and reductionistic conceptions. Psychosomatic medicine merged as a reaction against them and as an organized attempt to subject various aspects of mind-body relationship in health and disease to scientific inquiry. Three major methodological approaches to such inquiry have been employed: the psychoanalytic, the psychophysiological, and the psychobiological. The author discusses the relative contributions of these approaches in the first phase in the development of psychosomatic medicine, i.e. between circa 1930 and 1960.

Europe↗
PubMed1986

Psychosomatic medicine: past and present. Part II. Current state.

The first historical phase of psychosomatic medicine was largely dominated by the psychoanalytic approach to research and theory. The current phase has shown a radical shift away from that approach. It has focused on the study of the physiological mechanisms mediating between psychological states and body functions in health and disease, and on the role of personally meaningful life events and psychophysiological responses to them in the etiology, course, and outcome of a wide range of physical illnesses. The concepts of psychosocial stress, psychophysiological response specificity, coping, adaptation, and social supports predominate in psychosomatic theory. Research has grown in scope, diversity, and methodological sophistication. Concurrently, clinical application and the psychosomatic approach to patient care has expanded in the form of consultation-liaison psychiatry and behavioural medicine. The author reviews the current state of the field in its scientific and clinical aspects, and offers definitions delineating its scope.

Behavioral Medicine↗
PubMed1986

Psychosomatic medicine: past and present. Part III. Current research.

A comprehensive classification of contemporary psychosomatic studies by their subject and methodology, respectively, is presented. Representative examples of the current research in this field are provided. Special emphasis is given to the most prominent areas of investigation, i.e. psychophysiology, psychoendocrinology, psychoimmunology, and studies of the impact of stressful life events on health. The widening scope and diversity of psychosomatic research are underscored by its illustrative examples.

Allergy and Immunology↗
PubMed1986

To reduce or to integrate: psychiatry's dilemma.

Three conceptual approaches to psychiatry may be distinguished: the somatic (biological); the psychological (psychodynamic, psychosocial); and the integrative (holistic, biopsychosocial). The first two emerged in the early nineteenth century, the third - in this century. All three continue to vie for influence today. The author traces their historical precursors and discusses their current state. He argues that psychiatrists need to apply methodological reductionism but adopt an integrative orientation in theory and clinical practice.

Brain Diseases↗
PubMed1985

Delirium and other organic mental disorders in a general hospital.

The authors analyze 133 cases of organic mental disorders (OMDs) from a total of 771 patients who were referred for psychiatric consultation from a general hospital. The cases represent a 2-year referral period which began July 1, 1980, when DSM-III criteria were instituted. Delirium and dementia are most commonly diagnosed and features of these, particularly in the geriatric population, are described. Delirium was more frequent in patients with multiple medical problems, was an indicator of poor prognosis having the highest mortality rate, and was usually undiagnosed by the referring physician.

Age Factors↗
PubMed1984

Organic brain syndromes: new classification, concepts and prospects.

The concept, definitions and classification of organic mental disorders have been radically revised in DSM-III, the new American classification. Seven organic brain syndromes have been included and their diagnostic criteria explicitly formulated. The boundary between so-called functional and organic mental disorders has been blurred. The author discusses these changes in the light of growing importance of organic psychiatry due to aging of the population and the high incidence and prevalence of organic mental disorders in the elderly.

Aged↗
PubMed1984

Organic mental disorders--an American perspective.

The new American psychiatric classification (DSM-III) features a radically new approach to organic mental disorders. The concept of organicity has been liberalised to allow inclusion of psychiatric correlates of cerebral disorders which not only fail to involve cognitive impairment but in some cases also resemble affective, paranoid, and schizophrenic disorders. The highlights, and implications of the new approach are discussed.

Delirium↗
PubMed1983

Psychosocial reactions to physical illness.

Recently medical educators have emphasized the need for physicians to acquire the skills to deal with psychologic aspects of patient care. To facilitate this task a descriptive schema is presented for use in evaluating patients' psychosocial reactions to physical illness. Three core components of such reactions are: the personal meaning of illness, emotional responses to illness and modes of coping with illness. Clinical application of this schema may help with patient management and prevent psychiatric complications of physical illness.

Adaptation, Psychological↗