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Biomedical subjects

K Laemmel

Publications and source records attributed to K Laemmel.

17 recordsLinked to original sources
PubMed1996

[Psychiatric emergencies].

Psychiatric emergencies must not just be seen as catastrophies. They invariably represent the nadir of a development which has not been given enough attention while it arose. In contrast to a typical medical emergency situation the doctor is usually not particularly welcome by the disturbed psychiatric patient and his family. This may represent some hardship for the good doctor. When arriving at the scene of a psychiatric emergency, an accurate differential diagnosis will be of primary importance. Suicidality, disturbances of consciousness, states of excitement, dyskinesias and affective crises are the most frequent findings. In contrast to a somatic crisis where rapid intervention may be life-saving, it is advisable, to take your time and make sure you took everything into account, before making a decision. Sometimes the use of medication can dramatically change the scene from drama to dialogue. Basically, one has to determine if a hospitalization is necessary or not. Two primary concerns have to be looked into here: suicidal risk and dangerousness to others. It is good to be aware of those situations and diagnoses well known for their high suicidal potential. The question which - if any - compulsive measures have to be taken has to be answered and acted upon. Unpopular as they may be, they can resolve an extremely difficult situation within minutes. Unnecessary hesitation is not asked here for the sake of the patient as well as his family. The best way to deal with psychiatric emergencies is to avoid them. Looking out for signs and symptoms of a beginning psychotic development or suicidal ideation and acting upon it, for instance with medication and/or intensifying contacts with the patient are the primary means to prevent a crisis. Stopping medication, by patient or doctor, is one of the main reasons for psychiatric emergencies. After a psychiatric emergency has evolved, it pays out, to carefully analyse its development, the way it was handled and how it finally ended. Thus a crisis may, like the Chinese symbol for it with its double meaning, evolve to a chance for the patient.

Acute Disease↗
PubMed1996

[Interview in medicine].

The very earliest myths relating to the art of healing give great weight to the vital importance of human dialogue. Today's technology, however, supplies the physician with so many diagnostic and therapeutic tools that the one-on-one encounter with the patient is steadily losing its significance. And yet, even today the dialogue is still one of the most important components of the healing process. The dialogue between physician and patient has three generally acknowledged objectives: gaining information about the illness, getting a clear understanding of the patient as a person, and the therapeutic effect. Taking the patient's history largely serves the first objective. At this stage, the physician--depending on his orientation--already chooses from a wide spectrum of approaches: from conducting a cursory, purpose-oriented interview to engaging in an open compassionate dialogue. The last approach, anchored in a spirit attuned to the patient's psyche and mind-set, will not only yield important clues as to the systemic interrelationships underlying the disease, but it also provides the foundation for the therapeutic dimension of the dialogue. By engaging in a dialogue and by his very readiness to do so, the physician unconsciously reveals a lot about his own person. In order to achieve a true dialogue, it is necessary that he abandon the role-playing so common to physician-patient relationships and that he meet his patient on a person-to-person basis. In the process he will reveal his self-perception, his relationship to fellow human beings and, not least, his idea of what it means to be a healer. This idea depends completely on his perception of human beings in general, on whether he sees people as complex machines controlled by the brain computer or as spiritual beings whose bodies function as the screen onto which their thoughts, ideas and convictions are projected. A true dialogue between physician and patient provides the foundation for healing to take place. The complete trust of the patient, his willingness to cooperate, his compliance, and, in the end, the very healing process itself depend on the physician's ability to engage in dialogue. The art of meaningful communication can be taught. Medical students, the physicians-to-be, can learn a lot from the example set by their mentors. When university professors, chiefs of service and supervising attending physicians are appointed, their ability to demonstrate not only a gift of dialogue, but also the awareness of its vital importance in a doctor-physician relationship should be a decisive factor.

Communication↗
PubMed1993

[Misdiagnosis of psychosomatic disorders].

Considering the frequency with which the diagnosis 'psychosomatic illness' is established, it is puzzling how little attention has been paid to its differential diagnosis. The reason for this may be found not only in the difficulties with which that diagnosis is made but also in the doctor's view of the world and his or her understanding of illness in general. If the doctor only believes in what can be measured and weighed as being real, all symptoms for which no identifiable cause can be found must be considered as imaginary and 'all in the patient's head'. Most contemporary theories about the origin of psychosomatic illness are based on Freud's speculations, established at the beginning of this century. The are deeply rooted in the mechanistic, reductionistic and monocausalitic theories typical for his time. They suggested that the metamorphosis from thought-processes to somatic symptoms begin with a rather mysterious 'jump', taking place in the unconscious of the patient and thus remaining unknown to him. Today we know that all illness has a multifactorial basis and does not develop in a straight line but as a cybernetic loop. Psychosocial factors play as much a role as biological ones. Diagnosis by exclusion (no clear physical findings) or through dualistic thinking (the cause must be either psychological or physical) are, after inadequate knowledge of somatic or psychological medicine, the most common source of the erroneous diagnosis of psychosomatic illnesses. To avoid this, a psychosomatic perspective is needed, an outlook which is based on a holistic understanding of man in health and sickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1991

[Midlife crisis: crisis in the middle of life].

Since ancient times man tried to understand the roots of his obviously often irrational behaviour. According to the prevailing "Zeitgeist", hypotheses for it ranged from demonical possession, psychological schools of thought to the role of transmitter substances at the synaptic level. For ages it has been observed and described, that men goes in his development through typical and predictable phases with their typical crises. Poets knew and wrote about it since the dawn of culture but science got interested in it only in this century. Elliot coined the term "midlife crisis" in 1965, turning attention to an age-group which was before practically ignored by psychology. He pointed out that due to a collision between developmental factors and a static identity a crisis occurred in human beings, characterized by a feeling of despair, goallessness, fatigue and consciousness of significant basic anxiety. In response to such pressures a change of comportment takes place which puzzles the people closest to the stricken. Established patterns of behaviour seem to dissipate in favour of unusual, unexpected, adolescent or even crazy actions. Many examples from history, ranging from Dante to Gauguin seem to prove the point. Realizing the presence of the crisis and its origin and interpreting it as a call for change, reorientation and new definition of priorities present a great chance to adjust one's life at this important turn. It is of great importance to recognize, that changes must take place in one's inner values and that trying to escape into frenzied activities leads nowhere.(ABSTRACT TRUNCATED AT 250 WORDS)

Ego↗
PubMed1991

[Mood and state of mind].

Man's basic mood is of far greater significance than commonly assumed. It is communicated to his fellow man from afar, by his facial expression, and thus can cast a long shadow upon human relations. As this is an unconscious phenomenon, the pre-existing mood is reconfirmed by each encounter--a self fulfilling prophesy. The realization that a pre-existing mood determines our experience more than the reality of the experience itself is nothing new. It is pointed out in both ancient Greek and far Eastern philosophy, in the Bible, and in modern psychology. Every human being has the ability to influence his mood through self-own awareness. If he fails to do this, his features become frozen and unalterable, like the Person, the mask of the classic Greek theatre. While alterations of mood are considered normal phenomena, depression must be seen as a manifestation of pathological affect, usually accompanied by somatic symptoms. Depressions have been known and described since the dawn of mankind. 15 bis 25% of all depressives commit suicide. They are treated preferably by a combination of pharmaco- and psychotherapy. In the realm of the latter, Beck's Cognitive Therapy has proven to be especially efficacious. As this is a common and dangerous illness, it is very important for every physician to be familiar with it. Not only to save lives by instituting adequate treatment, but to open one's heart and to empathize with the patient, to see in him a brother rather than merely an object of scientific exploration.

Affect↗
PubMed1991

[Psychosomatic considerations in dysphagia].

A psychosomatic perspective reintroduces what has always been known but has become seemingly forgotten in contemporary medicine: To understand man in illness and health, social, inter- and intrapersonal considerations are of equal importance to the traditional biological concerns. The act of swallowing is discussed as a paradigm of such complex interactions. The oropharynx is a weather corner of man's non verbalized emotions. Globus sensation, dysphagia and vomiting, commonly described as being of psychosomatic origin, represent but a small part of the frequent functional disturbances of this region. The treating physician must have a special attitude in caring for the many patients with swallowing disorders. Accessibility, flexibility and a nonjudgmental approach are called for. Thus the 'helpless expert' can turn helper, a true therapist (Greek: therapon = servant) and spare the patient a long and futile Odyssey from doctor to doctor.

Deglutition Disorders↗
PubMed1983

[Authority in the psychiatric clinic].

Although considerable progress was made as far as therapy and individual rights of the patients are concerned today the psychiatric hospital is more than ever the butt of open citicism. One of the reasons for that is the odium of involuntarity and authority surrounding it. It is based on the ill-fame and dubious reputation of the nineteenth century "asylum". The problem of authority concerns today's hospitals as much as ever. How the hospital is run depends naturally in the first place on the personality of it's director his views on authority, as much as on his understanding and ability to handle the intensive dynamic processes in the institution. Recognizing the boundaries of his actual knowledge and training, his "authoritative authority", makes him wisely limit his goals and activities. Power or "authoritarian authority" must be employed with restraint and moderation but without hesitancy when necessary. The clinic represents for the patient a total milieu. It's therapeutic effect relies a great deal on the regulatory influence of the daily routine based on the authority of the treatment team. Jones' ideas of the "Therapeutic Community" have only limited value for today's psychiatric hospital. Even less significant contributions have been made by the antipsychiatric movement or the Marxist-inspired reformers of the last decades. Only that is therapeutic which in the final analysis helps the patient to cope successfully with reality. Even today the use of involuntary measures-seclusion and medication etc. remain a necessary tool for the treatment of some patients. As every institution is always part of a public or private structure, it's authority is always bridled by these. Ethical clinical psychiatry requires an ethical political state, if it is not to become it's henchman. Even in democratic countries problems may arise around involuntary hospitalization, the care of psychiatrically ill criminals or the legalities around medicating the uncooperative psychotic patient. Attempts of intrusion into the independence and authority of the psychiatric hospital can also occur from the families of the patients, the admitting physicians or the mass media who developed a last a somewhat unsavory interest into the psychiatric institution. To deal with these challenges authoritative authority is mandatory as much as the understanding of the dynamics of human behavior. Special problems exist for the psychiatric service within a general hospital. As the most recent arrival from the banishment in the outskirts into the fold of medicine, it has to prove itself first.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed1979

[Multiple therapy (complementary therapy)].

The term "Multiple therapy" is used to describe the combined use of more than one therapist for one patient following a preconceived plan (German: "Komplementärtherapie"). Combined with dynamic ward groups this approach intensifies the impact of short term in-hospital treatment. The purpose of this strategy is to fragment the patient's defenses, to shorten the therapeutic process and to prime and prepare the patient for ambulatory treatment after discharge. The employment of Multiple therapy in a hospital minimally necessitates workable interpersonal relationships between the members of the team, intensive supervision to prevent countertransference problems and a compatible point of view regarding the goal of treatment amongst the staff. All therapeutic methods, new or old, are in the final analysis nothing else than what the word connotes: a method, a means to an end. They never represent the way itself. The quality of psychiatric therapy and treatment does not depend upon the method, be it multiple therapy, individual analytic therapy, one of the non-verbal methods used or any other. What really counts is 1) whether the method is used by a team which truly wants to cooperate for the benefit of the patient, transcending their own ego demands, 2) whether it really improves interpersonal communication. Every psychiatric patient is somehow alienated and removed from his fellow men. Therapeutic methods employed at the hospital are valid if they facilitate to bridge this gap. If that is achieved, therapy can be considered successful. If not, such approaches merely represent meaningless occurrences which at best foster an illusion that "something really happened". That is not the same as when we see the beginning of a healing process. The therapeutic atmosphere in the hospital is meant to create a climate wherein a natural innate healingpower of man will be liberated. The Romans knew it already: Medicus curat, natura sanat.

Adolescent↗