Biomedical subjects

R Pary

Publications and source records attributed to R Pary.

30 records · Page 2Linked to original sources

PubMed1988

The violent patient: what to do?

Violence is a common clinical problem that must be quickly assessed to be properly managed. The examiner should keep at a safe distance from the patient and conduct the interview in a firm but nonthreatening manner. Verbal intervention, pharmacotherapy, and occasionally, physical restraints are indicated as a first-line approach while treatment of the underlying medical or psychiatric abnormality is initiated. Once the violent patient is under control, management includes thorough diagnostic assessment, pharmacotherapy, careful psychotherapy, and mobilization of community resources.

Humans↗

PubMed1988

Evaluation and management of self-mutilation.

Instances of deliberate self-injury are observed in both psychotic and nonpsychotic individuals. Patients with command hallucinations, religious preoccupations, substance abuse, and social isolation are the most vulnerable. Persons who request unnecessary surgical procedures for bizarre reasons also are at high risk. Such behavior constitutes a medical, surgical, and psychiatric emergency. A thorough psychiatric evaluation is mandated in every case. Vigorous psychiatric treatment and follow-up care involving the full range of pharmacologic, somatic, and psychologic interventions are indicated.

Adult↗

PubMed1988

Depression and alcoholism: clinical considerations in management.

When alcohol abuse occurs with depression, both the substance abuse and the mood disorder necessitate treatment. These conditions may have some similar manifestations, making differential diagnosis difficult. Depressed alcoholics report more previous treatment for substance abuse, withdrawal symptoms, and marital problems than those without depression. They also incur greater loneliness, unemployment, and social ineptness. Depressive symptoms found commonly in this group include work inhibition, guilt, self-disgust, dissatisfaction, and social disinterest. A history of depression among relatives favors a dual diagnosis of alcoholism and depression. Distinguishing those alcoholics with specific depressive illness enhances the therapeutic efficacy. Alcohol abusers need treatment, but those with concomitant depression persisting well beyond detoxification often require antidepressant medications. In long-term care, lithium may reduce alcohol-related rehospitalizations. A strong doctor-patient relationship with or without pharmacotherapy promotes continuation in a therapeutic regimen. Involvement in Alcoholics Anonymous and disulfiram maintenance therapy are other deterrents to drinking relapse.

Alcoholism↗

PubMed1988

A preventive approach to the suicidal patient.

Physicians may have the opportunity to prevent suicide. An awareness of suicide risk factors, such as depression, alcoholism, drug abuse, schizophrenia, and chronic pain or disease, may facilitate suicide prevention. Recognition of acute and chronic suicidal vulnerability occurs through direct questioning. Psychiatric consultation is indicated for patients exhibiting clear self-injury risk, as exemplified by expressed suicide intent, an overt plan for death, or a "gesture." Hospitalization is usually recommended for socially isolated patients presenting with overt suicidal ideation, complicated by injurious self-harm, encephalopathy, or substance abuse. Family involvement and a "no-suicide" contract with the patient, coupled with close outpatient follow-up appointments, should suffice for those exhibiting milder or transient thoughts of suicide without manifest intent to die.

Adult↗

PubMed1988

Post-traumatic stress disorder in Vietnam veterans.

Post-traumatic stress disorder evolved from the concepts of shell shock and traumatic war neurosis. In Vietnam veterans, the disorder is associated with unemployment, marital discord, alcoholism and increased autonomic system response to perceived symbols of war trauma. A combination of psychotherapy and pharmacotherapy is the recommended treatment.

Humans↗

PubMed1987