Psycho-analysis in the National Health Service General Hospital

SUMMARY

The paper describes the author's experience of practising psychotherapy based on psycho-analytic principles in three National Health Service Hospitals. Each is associated with a Post-Graduate institute. The Royal Marsden Hospital associated with the Institute of Oncology specialises in the treatment and study of cancer in all its forms in all ages. The Hammersmith Hospital is the site of the Royal Post-Graduate Medical School and it has an Obstetric and Gynaecology Unit which is part of the Institute of Obstetrics and Gynaecology. The Royal National Throat, Nose and Ear Hospital is a more compact specialist hospital associated with and containing the Institute of Laryngology and Otology.

In this paper instances are described where psychotherapy of Kleinian orientation has been helpful and has often been the only means of assisting patients by increasing their understanding and diminishing mental pain. The effects of introducing a psychotherapeutic rather than a psychiatric approach into the work of these departments is also described. The application of basic and fundamental analytic principles had a considerable advantage over the non-analytic psychological approach and was, in these circumstances, complementary to the one based on the medical/scientific model. This was particularly true of painful ‘terminal’ conditions. Liaison difficulties arise initially from the fact that medical and non-medical colleagues are commonly without experience of psychodynamic thinking and practice, and instead have many misconceptions about its nature and value. When the usefulness of the approach becomes evident to such colleagues prejudice gives way to understanding and co-operation. This has proved to be the most effective way of introducing analytically orientated psychotherapists and psycho-analytic thinking into the National Health Service, at the same time restoring to patients their dignity and supplying their needs as individuals for sensitive consideration and care.     

综合医院开展临床预防服务的可行性

临床预防服务是预防医学的重要组成部分,也是临床医学的重要内容.鉴于慢性非传染性疾病对社会、家庭及个人的负担越来越重,在各级医院尤其综合医院开展临床预防服务,对预防慢性病的发生、发展,降低死亡率、减轻社会、家庭负担,将起到事半功倍的作用,产生深远影响.     

综合医院开展临床预防服务的可行性

临床预防服务是预防医学的重要组成部分,也是临床医学的重要内容。鉴于慢性非传染性疾病对社会、家庭及个人的负担越来越重,在各级医院尤其综合医院开展临床预防服务,对预防慢性病的发生、发展,降低死亡率、减轻社会、家庭负担,将起到事半功倍的作用,产生深远影响。     

Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

人性化药学服务与我院药物咨询

为了解我院药物咨询工作情况,提高药学服务质量,随机抽取562例药物咨询记录,按患者咨询内容进行分析和总结.结果显示咨询对象以患者为主;咨询内容主要是药理作用与用途(占16.7％)、用法用量(占16.0％)、不良反应及注意事项(占12.5％)等.从而得知药物咨询是人性化药学服务的重要组成部分,对提高药学服务水平,保证药物疗效、保障患者用药安全及促进合理用药等有积极的推动作用.     

Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.     

关于综合医院中医科发展的若干思考

综合医院中医科的发展面临很多难题,其根源既有中医自身存在的问题,也有综合医院大环境的影响。只有认清自身的优势与不足,加上好的政策扶持,中医科才有发展的希望。     

关于综合医院中医科发展的若干思考

综合医院中医科的发展面临很多难题,其根源既有中医自身存在的问题,也有综合医院大环境的影响.只有认清自身的优势与不足,加上好的政策扶持,中医科才有发展的希望.     

心身疾病新的评估策略:心身医学研究诊断标准

心身研究的诊断标准(DCPR)是由国际调研组提出的心身医学研究临床诊断概念和结构框架.人们对影响躯体疾病的易损性,病程,预后,康复的心理因素的评估受到日益关注.DCPR的研发理论基础是将来源于心身研究的心理变量转变成用以鉴别诊断的可操作性诊断标准.ICPR是一个简单、有效和可靠的定式访谈工具,可用于筛查、诊断心身疾病和心理生理障碍.补充ICD- 10、DSM、CCMD的临床诊断应用的不足.包含了十二组心身综合征,其目的是将影响躯体状况预后和治疗价值中的心理变量转化为客观的心身医学研究用诊断标准用工具.这十二组症状包括健康焦虑,死亡恐惧症,疾病恐惧症,疾病否认,持续的躯体化症状,转换性障碍,继发于精神障碍的功能性躯体症状,周年反应,精神消沉,易激惹心境,A型行为和述情障碍.提出心身疾病临床多轴诊断系统.     

The Utility of the Megargee-Bohn Typology in a Forensic Psychiatric Hospital

The utility of the Megargee-Bohn MMPI typology (Megargee & Bohn, 1979) was examined in 1007 male forensic psychiatric inpatients. The 10 profile types were identified although the proportions differed as expected fiom the original sample. Comparison of demographic, clinical, and forensic characteristics revealed significant differences between 9 of the profile types. Our fmdings indicate that the typology can reliably and usefully describe different categories of patients in our setting. The typology can also be used to make inferences about treatment needs. Our findings support the continued development of an MMPI-based actuarial system for criminal populations as has been done for psychiatric populations.