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PubMed1980

Acculturation and mental disorder in the Inuit.

The phenomenon of acculturation stress is described with particular reference to the subsequent development of the transitional role conflict. The adolescent and young adult male Eskimo is especially susceptible to the anxiety generated by the process of acculturation and it is the interaction of this external stress with the bio-psychosocial characteristics of the individual within his ecological group, that may lead to an increased incidence of mental disorder. The clinical picture that develops will depend on the complex interaction of this psychosocial stressor and the level of ego development and its accompanying defence and coping strategies. We see how the development of manifest psychopathology in two young Inuit males was intimately associated with the stresses of acculturation acting upon personalities characterized by a low self-esteem and negative self-image, feelings of emasculation and a state of anomie. Coping and defensive strategies exhibited both similarities (drugs, alcohol, withdrawal, actin out) and differences (psychosis versus dissociation). The value of modified supportive therapy with continuity of care aimed at increasing self-esteem through sublimation, identification, reduction of dependency and encouragement of growth and autonomy is described, as are measures aimed at primary prevention.

Acculturation↗
PubMed1982

Psychosomatic disorders in the elderly.

There is no agreement on the incidence or prevalence of psychosomatic disorders in the elderly. This is due in large part to the methodological difficulties of the epidemiological studies which have not employed the same diagnostic criteria and classification. Drawing on the literature and on clinical experience, a classification is offered, and using the diagnostic criteria explicit in this classification, probable trends are identified. Pseudodementia may well be the only stress-related disorder that is peculiar to the elderly.

Aged↗
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↗
PubMed1988

Psychiatric consultation in a general hospital.

The psychiatrist's role in the therapeutic management of a wide range of hospitalized persons is now recognized. This study investigated the extent and the pattern of consultations among the medical specialties (medicine, surgery, obstetrics/gynecology, family practice, pediatrics and psychiatry) in a large teaching hospital over a one year period. Among the specialties consultations were requested most often from within the same specialty; for example, medicine sought 64.4% consults from medicine. The proportion of patients with an associated psychiatric diagnosis in each of the specialties ranged from 2 to 21%. Psychiatric consultations on these patients ranged from 5 to 13 per hundred (medicine = 12, surgery = 8.9, family practice = 13.2 and pediatrics = 5). Consultations rates reported in previous studies were also reviewed. Factors that may contribute to the generally low rate of psychiatric consultation and the implications for providing better care are then discussed.

Alberta↗
PubMed1977

Medical ethics and child abuse.

The practice of good medical ethics is of particular importance in cases of juvenile maltreatment. In a number of court cases concerning battered children doctors' statements have been presented to the effect that maltreatment has not taken place. In twelve cases reported during the period 1971-75 the doctors' statement was misleading. In each of twelve cases it should have been the doctor's duty to record in his statement that this was a case of child abuse and/or neglect. It appears that as far as the individual doctor was concerned, he often state "these things should be dealt with by the child welfare authorities", who in their turn mereley referred to the doctor's statement. It is unlikely that this is maltreatment", the child welfare officer will reiterate. In six cases this statement was used in court before any evaluation had been made on the basis of the sequence of events. In all twelve cases the doctor had failed to make an adequate examination of the symptoms. It seems as if the doctor was not sufficiently interested in providing evidence of assault. In some cases, even, pathognomonic findings must have been kept secret. Psychological or emotional maltreatment need to be evaluated by a child psychologist who is a practical diagnostician. Injuries arising from physical abuse are most successfully diagnosed on surgical and casualty wards. Pediatricians must be cautious about dismissing diagnoses of maltreatment that have been established by other specialists, especially child psychologists.

Battered Child Syndrome↗
PubMed1976

The nature of bodily symptoms.

Psychiatric descriptions of bodily symptoms have usually been derived from narrowly restricted clinical experience. It is argued that it is more useful to review evidence from all medical settings and occurrence, nature, disability and presentation are here discussed. Syndromes of hypochondriacal reactions appear to be extreme and uncommon manifestations of a universal potential.

Attitude to Health↗
PubMed1987

The impact of recent undesirable life events on psychiatric disorders in childhood and adolescence.

The timing and number of recent stressful life events occurring in the year before onset of emotional or behavioural disorder was examined in a consecutive sample of children. Overall, events increase the relative risk of psychiatric disorder by 3-6 times. Events occur throughout the 12 months, but tend to cluster in the 16 weeks nearest onset of symptoms. The number of events influences the onset of disorder: cases with multiple events are more likely to have an event within 16 weeks of onset; cases with single events are more likely to have the event 36-52 weeks before onset. Cases whose onset occurs within 4 weeks of an event may have experienced single or multiple events. The results support the concept of additivity of recent stressful events in some cases of emotional and behavioural disorders in childhood.

Adolescent↗
PubMed1995

Psychogenic basilar migraine: report of four cases.

We discuss four patients with the clinical diagnosis of basilar migraine and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribution of the basilar artery, followed by pulsating headache with nausea. Verbal unresponsiveness and sensory symptoms occurred in all four patients; two also had focal paresis or jerking movements. Diagnostic studies excluded other disorders with similar symptoms. None of the patients improved with antimigraine or antiepileptic drugs. Provocation tests with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities during spontaneous or provoked episodes. Two patients improved with psychiatric treatment. Conversion disorder or malingering should be considered in patients whose symptoms of basilar migraine are atypical or refractory to treatment.

Adult↗