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Feminist epistemology
Published in Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills, The Routledge Handbook of Feminist Bioethics, 2022
Increasingly, the lens of epistemic injustice is applied to vulnerable or marginalized patient groups as a means of understanding some of the features of their vulnerability. One such group is people whose symptoms do not fit neatly with known illnesses, or whose illnesses are stigmatized, such as chronic fatigue syndrome (CFS) and chronic pain (e.g. Blease, Carel and Geraghty 2017; Buchman, Ho and Goldberg 2017). Psychiatric care is another context in which patients are regarded as doubly vulnerable – both due to their status as patients in clinical hierarchies, and due to the nature of their illness. Several recent articles explore the impact of epistemic injustices on patients in mental health and psychiatric contexts (e.g. Sanati and Kyratsous 2015; Crichton, Carel and Kidd 2017; Kurs and Grinshpoon 2018; Bueter 2019).
Assessment of Co-occurring Disorders, Levels of Care, and ASAM Requirements
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Elizabeth Reyes-Fournier, Tara G. Matthews, Tom Alexander
The most restrictive level of care would be for those living with both severe mental health and substance use diagnoses. For many individuals, the severity of their co-occurring symptoms may have caused them to lose their primary housing, and they may be arrested as their symptoms manifest in the streets or other community areas (Ding et al., 2018). As many of these individuals most likely have not adhered to medication management for mental health symptoms while simultaneously engaging in illicit substance use, their presentations upon arrest would require that they be seen and treated at a local emergency room. Usually, after the initial assessment, the individual is referred to inpatient psychiatric care, where they would be treated for immediate substance use concerns such as withdrawal while also being treated for primary mental health diagnoses. The time needed for symptom amelioration is a predictor of length of stay; this can usually range between 10 to 28 days (SAMHSA, 2005). After discharge, the client is usually linked with outpatient substance use treatment and outpatient mental health treatment. Counselors should consider more enhanced levels of care such as residential treatment for those who have met criteria for several episodes of such a high level of care, especially if their home environments (or lack thereof) are related to resuming substance use or lack of follow through with mental health treatment.
Using Psychotherapy and Medications to Treat a Teenager with Prodromal Symptoms
Published in Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman, Understanding and Caring for People with Schizophrenia, 2020
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman
Prodromal individuals also often experience a decline in academic and social functioning (2). However, this impairment in functioning is generally not as severe as that experienced by individuals with schizophrenia and may not be apparent until very close to when they actually develop syndromal schizophrenia. Furthermore, prodromal individuals very often experience other nonspecific symptoms such as depression and anxiety. Many of these people will have already received psychiatric care for comorbid conditions, such as major depressive disorder, obsessive compulsive disorder, or other anxiety disorders, before their diagnosis of prodromal psychosis. This period can last between days and years, though very uncommonly lasts more than two to two-and-a-half years (2, 3).
Poor Sleep Quality Predicts Decline in Physical Health Functioning in Patients with Coronary Heart Disease and Moderating Role of Social Support
Published in Behavioral Medicine, 2022
Biing-Jiun Shen, Jonathan Jun Liang Tan, Yue Xu, Hung Yong Tay
Participants were 255 patients with CHD, among whom 185 completed the follow-up assessments at 6 months, from the Heart Wellness Center at the Singapore Heart Foundation. The Heart Wellness Center offers community-based outpatient cardiac rehabilitation for cardiac patients to achieve and maintain optimal physical activity and healthy lifestyle changes. Eligible participants were individuals over 21 years of age and diagnosed with CHD verified by a cardiologist. Individuals were excluded if they were diagnosed with other severe illnesses under active treatment (e.g., cancer, renal failure, etc.), presented with psychiatric disorders requiring ongoing intensive care, or demonstrated cognitive deficits that interfered with their understanding of interview questions or questionnaires. Individuals receiving ongoing intensive psychiatric care were those who attended day hospital for outpatient services or who had two or more psychiatric hospitalizations in the previous year. Given that these psychiatric conditions were likely to confound the assessment of sleep and health functioning, individuals who met these criteria were excluded. The eligibility of participants was ensured by screening by the clinical staff at recruitment site, reviews of medical charts and medication records, and health interviews supervised by a clinical psychologist.
Single, Fixed-Dose Intranasal Ketamine for Alleviation of Acute Suicidal Ideation. An Emergency Department, Trans-Diagnostic Approach: A Randomized, Double-Blind, Placebo-Controlled, Proof-of-Concept Trial
Published in Archives of Suicide Research, 2022
Yoav Domany, Cheryl B. McCullumsmith
An intranasal mucosal atomization device was used to provide one intranasal application of solution (volume 0.1 ml) in each nostril and an additional squirt in each nostril separated by 10 minutes, (altogether 4 squirts). Each of the 4 ketamine squirts provided 10 mg of study drug, totaling 40 mg. Drug was applied by the study physician- a psychiatrist. Subjects’ vital signs were monitored for 4 hours post administration. At the completion of the post-treatment observation period, the participant was admitted to the psychiatry units at the UCMC. The time of discharge was determined by a blinded, non-study physician who was not aware of the patient’s status (randomization) in the study. All patients received standard psychiatric care by the treating (non-study) psychiatrist. The treating physicians could make any changes in treatment they deemed warranted by the patient’s condition.
Differences in triage and medical confidentiality between prisons of Belgium and the Netherlands
Published in Acta Clinica Belgica, 2021
Jan Matthys, Mathieu Hallyn, Anneleen Miclotte, Georges Van Maele, Dirk Avonts
In the Netherlands, prison doctors are satisfied with the psychiatric services in prison, the opportunities for referral and the facilities of psychological support. (Dr 13, the Netherlands): There is a good access to psychiatric care by a psychiatrist in full time employment. When the detainee needs very intensive psychiatric care a transfer is arranged to a special psychiatric penitentiary facility. In urgent situations, an appeal can be made to the mental health service of the GGD (GemeentelijkeGezondheidszorgDienst). Once a week a multidisciplinary consultation takes place between the different disciplines, including a psychiatrist, physiotherapist, GP, nurse and psychologist