David Lukoff, PhD. The importance of spirituality in mental health. Interview by Bonnie Horrigan.
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Humans↗
Biomedical subjects
D Lukoff
Publications and source records attributed to D Lukoff.
Religious and spiritual case reports on MEDLINE: a systematic analysis of records from 1980 to 1996.
OBJECTIVE: To undertake a systematic analysis of case reports involving religious or spiritual issues published between 1980 and 1996. DATA SOURCES: MEDLINE, the National Library of Medicine's bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, and the preclinical sciences. STUDY SELECTION: A search of 4,306,906 records indexed on MEDLINE from 1980 to 1996. DATA EXTRACTION: A total of 364 abstracts were found, then subjected to coding analysis. DATA SYNTHESIS: Categories were developed for (1) types of healthcare situations involving religious/spiritual issues, (2) religious and spiritual interventions, (3) collaboration between healthcare and religious professionals, (4) psychopathology and sensitivity themes, and (5) religious faith/spiritual path. Although all of these case reports involved religious and spiritual issues, only 45 (12%) explicitly mentioned a religious professional. Of these, only 8 (2%) indicated any collaboration between healthcare and religious professionals. CONCLUSIONS: A paucity of published case report literature exists on religious and spiritual issues (.008% of the MEDLINE records), indicating that the increasing acceptance of these factors by patients and healthcare professionals is not yet reflected in scientific and clinical journals. A need exists for more documented examples of collaboration between healthcare and religious professionals.
Humans↗
The case study as a scientific method for researching alternative therapies.
This article argues that the case study design is a research method capable of providing valuable data and insight into alternative therapies. The background and roots of the case study in medicine and clinical practice are covered, and the status of the case study as a scientific method is examined. The highly regarded randomized controlled clinical trial--though often powerful and useful--is neither feasible nor ideal for understanding the effects of many unconventional treatment approaches. Given the complexity of the factors involved in unconventional therapeutic applications--health beliefs, changing health paradigms, patient/practitioner interactions, multiple treatment modalities, multiple symptom profiles--the case study approach offers an alternative methodological route for investigating and generating findings in this arena. Reliability and validity of data collection, data reduction, and interpretation can be enhanced through steps discussed in this article. As it continues to work with evidence that is currently unorganized, the field of alternative medicine can benefit both in clinical prowess and scientific stature from additional, carefully conducted case studies.
Complementary Therapies↗
Religious or spiritual problem. A culturally sensitive diagnostic category in the DSM-IV.
A new diagnostic category entitled religious or spiritual problem has been included in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) under Other Conditions That May Be a Focus of Clinical Attention. Along with several other changes, this category contributes significantly to the greater cultural sensitivity incorporated into DSM-IV. The authors review the approval process, including the changes that were made in both the proposed new category and the former V Code section of DSM-III-R. In addition, the definition, assessment methods, types, and clinical significance of religious and spiritual problems are clarified, along with the differential diagnostic issues raised by the definitional changes in the former V Code section. Finally, clinical issues involving cultural sensitivity and the implications for future research are addressed. The new category could help to promote a new relationship between psychiatry and the fields of religion and spirituality that will benefit both mental health professionals and those who seek their assistance.
Culture↗
Cultural considerations in the assessment and treatment of religious and spiritual problems.
Scott Peck, a psychiatrist who has written several books on the spiritual dimensions of life, including the best-selling The Road Less Traveled, gave an invited address which drew a standing-room only audience at the 1992 Annual Meeting of the American Psychiatric Association. He pronounced that psychiatrists are "ill-equipped" to deal with either religious/spiritual pathology or health. Continuing to neglect religious/spiritual issues, he claimed, would perpetuate the predicaments that are related to psychiatry's traditional neglect of these issues: "occasional, devastating misdiagnosis; not infrequent mistreatment; an increasingly poor reputation; inadequate research and theory; and a limitation of psychiatrists' own personal development." In recent years, there have been a number of developments that have begun to redress psychiatry's cultural insensitivity to the religious and spiritual dimensions of life. In 1990, the APA Committee on Religion and Psychiatry initiated an APA Position Statement entitled "Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitments and Psychiatric Practice." These guidelines emphasized that "psychiatrists should maintain respect for their patient's beliefs ... and not impose their own religious, antireligious, or ideologic systems of beliefs on their patients, nor should they substitute such beliefs or ritual for accepted diagnostic concepts or therapeutic practice." These guidelines reinforce the importance of acknowledging and respecting differences in religious/spiritual beliefs between clinicians and their patients. More recently, the Accreditation Council for Graduate Medical Education published the new "Special Requirements for Residency Training in Psychiatry," which incorporated several changes mandating instruction about gender, ethnicity, sexual orientation, and religious/spiritual beliefs. Finally, the inclusion of "religious or spiritual problem" as a diagnostic category for the first time in the DSM-IV acknowledges that religious and spiritual issues can be the focus of psychiatric consultation and treatment. John McIntyre, MD, former APA President, and Harold Pincus, Director of the APA's Office of Research, observed that this new entry in DSM-IV was "a sign of the profession's growing sensitivity not only to religion but to cultural diversity generally." It is hoped that these developments will increase the accuracy of diagnostic assessments, reduce iatrogenic harm from misdiagnosis, and increase the mental health professional's respect for individual beliefs and values.
Culture↗
Toward a more culturally sensitive DSM-IV. Psychoreligious and psychospiritual problems.
In theory, research, and practice, mental health professionals have tended to ignore or pathologize the religious and spiritual dimensions of life. This represents a type of cultural insensitivity toward individuals who have religious and spiritual experiences in both Western and non-Western cultures. After documenting the "religiosity gap" between clinicians and patients, the authors review the role of theory, inadequate training, and biological primacy in fostering psychiatry's insensitivity. A new Z Code (formerly V Code) diagnostic category is proposed for DSM-IV: psychoreligious or psychospiritual problem. Examples of psychoreligious problems include loss or questioning of a firmly held faith, and conversion to a new faith. Examples of psychospiritual problems include near-death experiences and mystical experiences. Both types of problems are defined, and differential diagnostic issues are discussed. This new diagnostic category would: a) improve diagnostic assessments when religious and spiritual issues are involved; b) reduce iatrogenic harm from misdiagnosis of psychoreligious and psychospiritual problems; c) improve treatment of such problems by stimulating clinical research; and d) encourage clinical training centers to address the religious and spiritual dimensions of human existence.
Culture↗
Sexual side effects of antipsychotic medication: evaluation and interventions.
Sexual side effects of antipsychotic medications, which include disturbances of erection and ejaculation, changes in libido, and priapism in men and decreased libido, orgasmic dysfunction, and menstrual irregularities in women, are estimated to occur in 30 to 60 percent of persons taking the drugs. The authors review side effects associated with specific drugs and present guidelines for assessing whether sexual dysfunction is related to medication. Pharmacological interventions that may reduce antipsychotic-induced sexual dysfunction include gradually reducing the dose or changing the type of medication and administering other medications such as bethanechol, neostigmine, cyproheptadine, and bromocriptine that are known to improve sexual dysfunction.
Adult↗
A prospective study of stressful life events and schizophrenic relapse.
In this prospective, longitudinal study, 11 recent-onset schizophrenic outpatients who met criteria for psychotic relapse or significant psychotic exacerbation during a 1-year period of standardized maintenance medication, and 19 patients who did not relapse during this follow-up period, were interviewed monthly regarding life events. As hypothesized, for relapsing patients, a significantly higher number of independent life events (those not the result of symptomatology or personal influence) occurred in the month preceding relapse. This increase was apparent relative to either the analogous month of a "nonrelapse" period in the same patient or the average number of independent events per month during a 1-year standardized medication period for nonrelapsing patients. The methodological advances of this design as well as the consistency of these findings with those of previous retrospective studies supports the hypothesis that life events may sometimes "trigger" schizophrenic episodes.
Adult↗
A holistic program for chronic schizophrenic patients.
A 10-week, inhospital holistic health program for male schizophrenic patients was compared with an equally intense social skills training program. The holistic program included training in the stress reduction techniques of exercise and meditation as well as education in stress management. Patients were also encouraged to explore the growth potential of their psychotic experiences and to develop positive beliefs about the outcome of their illness. Both groups showed similar significant decreases in psychopathology from admission to discharge, but the use of medication and a token economy milieu by all patients confounds the interpretability of this finding. After the holistic patients were discharged into the community, there was no maintenance of any of the holistic techniques. The 2-year relapse rate did not differ significantly between the two treatments. Findings from various studies associating schizophrenic relapse with stressful life events and familial tension make further experimentation with stress reduction techniques for the treatment of schizophrenia worthwhile.
Attitude↗
Symptom monitoring in the rehabilitation of schizophrenic patients.
Although precise laboratory methods for measuring psychopathology are not available, interviewer-rated instruments developed to assess symptomatology can be used to monitor schizophrenic patients undergoing rehabilitation. By regularly assessing patients, rehabilitation staff can improve the effectiveness of their interventions. Patients can be screened for high levels of symptomatology which might preclude assignment to rehabilitation programs with high levels of social stimulation. Monitoring the prodromal symptoms of relapse can sometimes prevent florid relapses and sustain a rehabilitative trajectory. Standardized instruments for measuring positive symptoms (e.g., hallucinations, delusions, and conceptual disorganization) and negative symptoms (e.g., affective blunting, amotivation, and asociality) are available. Monitoring target symptoms may be particularly cost effective in the rehabilitation milieu. Use of suggested operational criteria for defining clinical states such as relapse would improve outcome studies on rehabilitation interventions.
Adult↗
Sex education and rehabilitation with schizophrenic male outpatients.
Research indicates that schizophrenic patients lack intimate relationships and show a high rate of sexual dysfunction. Despite increasing awareness of the rights of handicapped persons to sexual expression, the treatment of schizophrenic patients rarely addresses their sexuality. A sex education program for recent-onset male schizophrenic patients attending an outpatient clinic was developed in response to several incidents involving patients' inappropriate sexual behaviors. To enhance our understanding of the current sexual functioning and needs of these patients, sex histories were taken. Almost all of the 16 patients interviewed were sexually active, with autoerotic activity predominating. Sixty-three percent of the patients reported orgasmic and/or erectile dysfunctions. Other studies have linked sexual dysfunction to the side effects of antipsychotic medications. The objectives of the sex education program were: to provide information; to clarify values; to overcome sexual dysfunction; and to enhance intimacy skills. The authors used role playing, modeling, group exercises, and explicit sex therapy audiovisual material to improve patients' intimacy skills. Patients participated actively and used the group to explore sexual issues. No exacerbations of symptoms were observed among patients participating in the program.
Aftercare↗
Life events, familial stress, and coping in the developmental course of schizophrenia.
Recent studies have isolated some socioenvironmental factors that seem to predict the onset of schizophrenic episodes in vulnerable persons. In particular, stressful life events have been found to cluster in the 3- to 4- week period preceding a schizophrenic episode in some patients. Many persons with a schizophrenic disorder also seem to contribute to additional stressful life change events--for example, by high geographic mobility--thereby playing an active role in precipitating the onset of illness episodes. Within the family environment, hostile, critical, and emotionally overinvolved attitudes toward the patient by relatives have been found to be related to relapses. Irregularities in the communication style of parents also predict the subsequent development of schizophrenia spectrum disorders among disturbed adolescents. Many schizophrenic patients also seem to be deficient in the coping skills required to remediate the losses brought on by life events or to deal effectively with stressful relatives. Thus, they may experience greater and more prolonged stress than most others due partially to inadequate social and problem-solving skills and less supportive social networks. These findings have important implications for the design of clinical interventions as well as the development of a comprehensive vulnerability/stress model for the course of schizophrenic disorders.
Adaptation, Psychological↗
A review and critique of social skills training with schizophrenic patients.
The literature dealing with social skills training of schizophrenic patients indicates that topographical features and self-reports of anxiety and discomfort can be changed for the better by social skills training. Unfortunately, these changes do not occur for every patient and, when they do occur, often do not generalize to new situations. Research must be directed to determining the interaction between patient characteristics and training procedures as they affect outcome. The scope of the procedures must also be expanded if meaningful changes in patients' quality of life are to be effected.
Antipsychotic Agents↗