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[New perspective in liaison psychiatry. Experience at the Pediatric Hospital of the National Medical Center Siglo XXI].

In hospitalized and chronically ill children, the prevalence of psychopathology is very high. It is necessary that in its prevention, diagnosis and treatment not only professionals of the mental health disciplines intervene but also that the pediatricians, nurses and the family of the patient himself participate actively. Consultation Liaison Child Psychiatry activities at the Pediatric Hospital of the National Medical Center "Siglo XXI" are described. Its goal is to incorporate the mental health professional to the team of hospital care and promote that pediatricians gain a greater conscience of psychological and social factors that are crucial for the sick child.

Child↗
PubMed1976

A medical paradox: curative versus preventive medicine.

A familiar medical contrast is presented as part of a modern medical problem. The problem it reflects is the relative importance of preventive and curative services for medical practitioners, which is already, or will shortly resolve itself into, a dilemma of whether medical men should stress preventive medicine to the possible detriment of curative medicine. It is submitted that the solution to both problem and dilemma should be sought against the background of history and philosophy, where they are seen to be expressions of an eternal paradox--that of the relative value of the individual in relation to the family, group, or community. If the submission is valid, then the answer to the problem is not a purely medical exercise, nor is the dilemma purely a 'doctor's dilemma'. The paradox, being eternal, is not soluble in our time, but the community must, on the urging of the medical profession, find a general solution to the problem--'a public consensus for out time'. This must be followed by public demand for a parliamentary solution--'decision-making ex consensus'. It is argued that although the latter programme does not come easily to democracy, it can be achieved through public consensus if action is taken by the leaders of thought in appropriate categories. Initiative must be exercised by the medical profession, but public consensus can only be achieved in consultation with the leaders of all learned professions, civil servants and legislators. It must then be presented fairly and without bias to the public. In the meantime, the medical profession must formulate its own 'medical consensus' and the doctor must resolve his personal dilemma according to formulated law, public or medical consensus or, in the last resort, according to his conviction and conscience. This method of solving a problem will almost certainly be applicable to other and more recent medical problems such as the population explosion, selective abortion and euthanasia.

Ethics, Medical↗
PubMed1994

Freud's treatment of a narcissistic patient.

The newly-published correspondence between Freud and Ernest Jones reveals Freud's views on the treatment of a severely narcissistic patient in 1922, just prior to his writing 'The Ego and the Id'. His formulation centres on 'a deep sense of guilt ... a conflict between Ego and Ideal ... whenever it is revived she projects her self-criticism to other people, turns her pangs of conscience into sadistic behaviour'. He aims toward 'reconciliation of her Ideal to her Ego', and emphasises her need for his friendly support in order to tolerate the analytic process. Freud's views, expressed in his formulation, coincide with ideas that the author has put forward over the past two decades in regard to the vicious cycle of punitive unconscious self-criticism, self-deprivation, and excessive demand (narcissistic entitlement) and the need to maintain functional neutrality by providing support. The discussion addresses the contrast between Freud's therapeutic activity and his published recommendations, emphasising Freud's mistaken belief in the analyst's 'objectivity' in the analytic situation and his passionate commitment to maintaining the scientific respectability of psychoanalysis, with its consequences in the minimalist austerity of 'classical technique'.

Countertransference↗
PubMed1994

[The last melancholia of Alonso Quijano, the Righteous].

In Cervantes' immortal novel, "Don Quixote" is the nom de guerre that Alonso Quijano--a honest Spanish yeoman nicknamed "The Upright One"--adopts under the spell of insanity that has lured him into being a knight rider. A psycho-spiritual analysis of Don Quixote's return to mental health is presented, covering the time-span between Don Quixote's coming back to this native village and his last days. By way of a "historical diagnosis", the author proposes some clinical explanations: Goodman Quijano's last illness might have been a plasmodium falciparum-caused malaria; malaria, however did not contribute to reinstate soundmindedness (as per Wagner von Jauregg's therapeutic criteria, for example). Goodman Quijano's last fit of melancholy disclosed contempu mundi in him, a renunciation giving way to a joyful lucidity--in other words, a psychological awakening to a sublime conscience level of genuine spiritual characteristics.

Depressive Disorder↗
PubMed1994

The ethical dilemmas of general practice.

It is not possible, and perhaps not even desirable to construct a code of ethics that covers all eventualities, and yet we are swamped with ethical problems and decisions every day in general practice. In my experience, most doctors are predominantly ethical people, and hold the interests of their patients as the prime reason for their existence. In the final instance, it is our own conscience that will dictate our behaviour, and it is the opinion of our peers that will guide us in difficulty. This poses more questions than it does answers, but we must continue in our tradition of service, practising only to the highest standards of ethical behaviour.

Australia↗
PubMed1993

Alternatives in human reproduction. Methods, indications, prognosis, bioethical problems.

The alternative methods in human reproduction do nothing else than try to help an individual or a couple to achieve the primordial goal of life: perpetuation of the species. These methods try to reconstruct the biologic premises necessary for perpetuation by various means such as: a. in vitro fecundation correlated or not with artificial fecundation with donor, ovocyte donation, embryo donation, borrowed mother; b. intratubular transfer of gametes; c. unnatural circumstances, i.e., the possibility that men be a host for the embryo up to term, a hypothesis which for the time being is possible only in science-fiction. The birth of Louisa Brown in 1978 was the border between hope and certainty, between dream and pragmatism. Thus, the alternative methods of reproduction have become routine in the medical life and penetrated into the conscience of an ever greater number of people but at the same time have raised an immense number of questions regarding the status of the embryo and the foetus, but more important, of the child born under these circumstances. These questions await answers both from medicine and the law and have to be within the limits of the common sense. Those who participate in the in vitro fecundation programs should not lose their quality of being human, should pay respect to the nature and the natural, encourage hope and be moral.

Beginning of Human Life↗
PubMed1993

Juror stress.

That jurors may be harmed as a result of their carrying out their civic duties is receiving increased attention from the courts and the media (Sevilla & Beyers, 1990; Craver, 1993). The pilot tests reported here represent initial efforts to undertake a proactive project for identifying and mitigating the possible adverse effects of stress on jurors and to contribute to the understanding and treatment of secondary trauma for at-risk groups. In many ways juries are the black box of the legal system. Their decision-making process is typically shrouded in mystery. So that they may fully explore the issues and examine their consciences, jurors meet privately when reaching their decision and, beyond entering a verdict, are typically not required to provide the rationale for their verdict. Furthermore, jurors are often reluctant to discuss the bases for their verdicts after the trial is over and an unspoken code of honor may limit their willingness to critique their fellow jurors. Perhaps in part because we know so little about their decision-making process, as well as because of their intrinsic and symbolic importance to the legal system, there may be a tendency to take jurors for granted and to assume that they are relatively unaffected by their jury duties. Although jurors are expected to appear impassive and emotionally detached in court, for some trials it is only the rare individual who will not be emotionally moved by what he or she has seen and heard or by the gravity of the decision that is required. Several recent cases have provided a glimpse of what goes on within this black box and suggest that greater attention may need to be given to the needs of these jurors.

Adult↗
PubMed1993

Listening to what the patient does not tell us.

In the intimacy of outpatient psychotherapy, the psychiatrist's ethical responsibility (burdensome at times) is always to place the emotional priorities of the patient ahead of the therapist's external and internal agendas. For example, the therapist's schedule (anticipated vacation), the therapist's interest in the patient for the sake of a publication, presentation, teaching, have to be subordinated to the emotional and somatic vulnerabilities and needs of the patient. The only sensor for this interaction is the professional conscience of the therapist. Excerpts from psychotherapy with six patients will highlight the dilemmas which each patient had which forced them to camouflage their hurts from themselves. An attempt will also be made to highlight ethical and professional dilemmas of the therapist.

Adult↗
PubMed1993

[Flumazenil, a benzodiazepine antagonist, in endoscopic premedication].

Midazolam is the benzodiazepine recommended for anaesthesia induction when an early recovering is desirable. Flumazenil, which is also a hydrosoluble imidazobenzodiazepine, improves the safety of the forhere one because it immediately reduces the degree of sedation. With this purpose, this last drug has been studied in 25 patients who had been previously treated with Midazolam in order to carry out different endoscopic studies. The Flumazenil average dose used was 0.276 mg and the conscience recovering after its intravenous injection, evaluated by a simple oral numeric regression test, oscillated between 60 and 300 seconds with an X of 96 seconds. Once the study was finished, all patients were discharged from hospital after two-hour observation, except for one patient (4%) who suffered a complication and so was discharged after a twenty-four-hour control. No doubt the advent of a drug opposed to benzodiazepine receptors used in anaesthetic induction shows the possibility of a quick recovering and moreover. Quicker discharge from hospital.

Adult↗
PubMed1993

Superego pathology in conduct disorders.

This paper describes a form of superego pathology which arises from very traumatic childhood experience. The youngster takes into him or herself the negative qualities of the cruel, neglectful, and unloving caretakers. This internal abuser becomes the conscience and gives rise to an inner image of the self as evil and meriting only punishment and reproof. This joins the ego ideal as one of the regulating elements in the superego. Milder cases result in a success neurosis; more severe pathology expresses itself as "a criminal from a sense of guilt." Such youngsters tend to find ways of blaming themselves for the misfortunes of their friends and kin, they find patterns of adaptation which allow for chronic self abasement, and they are very likely to drift into substance abuse. There are many varieties of this form of disturbance, but characteristically, in the face of therapeutic efforts, they respond with a negative therapeutic reaction. Some suggestions are offered for therapeutic approaches.

Adaptation, Psychological↗
PubMed1993

[Removal of melanocytic nevi as a prophylaxis and early recognition of cutaneous and mucous malignant melanoma].

In article 1240 melanocytic nevi were described in which 26 melanomas were found. The authors present necessity of early removal (excision) of dysplastic melanocytic nevi, pigmented lesions with high risk of malignant transformation, giant congenital melanocytic nevi before adolescence and nevi which are irritated constantly. Particularly dysplastic nevi and pigmented lesions with high risk often contain melanoma "in situ" or invasive melanoma. Such a procedure early done, prevents developing of tumor and makes possible early recognition of melanoma but the procedure depends on a conscience of patients, members of their families, nurses and doctors.

Adult↗
PubMed1993

[The driving force in the thinking of Norbert Elias. An attempt at psychoanalytic interpretation].

The theory of civilization proposed by the eminent sociologist Norbert Elias, who died in 1990, has its roots in Freud's theory of culture. Elias always denied the importance of personal factors in connection with his work, but as has been demonstrated in connection with artists such as Leonardo da Vinci and indeed Freud himself, this does not make it any the less legitimate to go in search of those infantile/unconscious motifs and affective sources powering Elias' prodigious scholarly creativity and informing his work, in however sublimated a form. Proceeding from the observation that successful scholarly or artistic production represents a synthesis of the forces of id, ego and super-ego, i.e. of affect, knowledge and conscience, the author demonstrates that concerns of central moment to Elias' thinking--commitment and non-involvement, establishment and outsider, the restraining of aggression in the civilizational process, interdependence of individuals--are partly the product of early experiences which Elias was able to turn to fruitful account in his work.

Cultural Characteristics↗
PubMed1993

[Kekulé's dream. Additional observations on the "benzol ring"].

20 years ago, Alexander Mitscherlich published in this journal a brief psychological study of the famous dream the chemist Friedrich August Kekulé had immediately before putting forward his representation of the benzene molecule in the "Kekulé formula". Mitscherlich (among whose forebears a number of prominent chemists figured) interpreted the dream as an expression of a frustrated and repressed sexual desire. The present author, by contrast, favours an interpretation which shifts the focus away from the suggestive power of the dream image-a snake biting its own tail-and sees Kekulé's dream production as a reflection of the psychic effort it cost him to ward off latent feelings of guilt associated with the early death of his wife and to alleviate scruples of conscience about his own achievement.

Benzene↗
PubMed1993

The first American medical school.

John Archer, a physician from Harford County, was one of the graduates of the first medical school on American soil-Philadelphia College-in 1768. The names of the initial instructors, including John Morgan, William Shippen, and Thomas Bond, and of the first graduates, including John Archer and Jonathon Potts, are well known to most medical historians. Many of these early American physicians had a deep sense of political commitment, and placed conscience and love of country above their medical practices.

History, 18th Century↗
PubMed1995

[Moral action in nursing].

What ought I to do? is the classic question of moral dilemmas. It is concerned with the field of action in which human beings meet and where moral decisions have to be made in the course of everyday nursing care. Only when nurses discuss their own actual experiences, can they learn to arrive at a competent appropriate rationale and justification for action. With growing self-confidence, the willingness to act increases. Ethics is one of the relevant fields of knowledge. The attempt to create a link between moral action in nursing and ethics, comes to grief when the "myth of life and death" and the "Hypocratic myth" move centre stage. These myths really belong to the medical, not nursing perspective. Several other medical tendencies for generalisation and some in nursing, create barriers to the development of appropriate models for nursing action. It would be bad advice for nursing to present itself as a reservoir of humanitarianism. An appeal to professional conscience is no guarantee that morally defensible decisions will be arrived at. Only continuous examination of their own actions against a framework of sound moral argument can make it more likely that action appropriate to the desired goal can take place.

Conflict, Psychological↗
PubMed1996

[The efficacy of protirelin in subjects with stabilized outcomes of stroke].

Protirelin is a valid means in the therapy of patients with stabilized outcomes by stroke. It has proved efficacious in the improving of the neurologic and cognitive deficits, of conscience, alertness, mood and behaviour alterations. Furthermore in conjunction with the kinesitherapeutic treatment, protirelin has granted a general recovery of not only mental but also sphincteral conditions, of outer and inner mobility and social activities. This drug has proved efficacious in the control of the hypermyotony.

Aged↗
PubMed1996

[Orodental hygiene habits in preadolescents and adolescents from 2 urban and 2 rural secondary schools].

OBJECTIVE: Buccodental health is a problem of high prevalence, including mainly caries, malocclusion and malposition. Dental caries is the principal oral problem of childhood and adolescence. The objective of our study was to know the information, customs and attitudes in relationship to buccodental hygiene of preadolescent and adolescent students. MATERIAL AND METHODS: The design is a cross-sectional epidemiological study of two urban (n = 330 students) and two rural (n = 270 students) schools. We performed an individual interview with the students that included 27 items concerning knowledge, customs and attitudes about buccodental hygiene. RESULTS: The prevalence of caries is 24.5% in our population. We found the best buccodental hygiene in rural students and girls. The adolescents are more problematic than preadolescents. CONCLUSION: It is important to make health examinations and to have health education in school, especially concerning some pathologies with a higher prevalence such as dental caries and other buccodental diseases. The first step towards good health education is to know the reality of the problem. A higher level of sanitary education in rural schools is most likely the cause for better results in this population. The girls have more conscience of this disease. It is necessary to increase the health education about buccodental hygiene, mainly in adolescence.

Adolescent↗
PubMed1996

The ethics of managed care: Part 3--Toward a common vision.

A common set of values is one of the primary unifying elements of any systematized group. The moral crisis in health care today has more to do with value dis-integration than economic dis-array. The use of resource allocation mechanisms like managed care expand the needs of conscience with those of man-willed choice. If health professionals are to meet the ethical challenges of "managed care," they must start by reminding themselves of what the scientific and ethical commitments both promise and imply.

Ethics, Professional↗