Biomedical subjects
Publications and source records attributed to Robert J Gregory.
The authors present 6 cases of factitious disorder seen on a general adult inpatient psychiatry unit of a university hospital. They review the clinical features of this disorder and suggest that factitious disorder is much more prevalent among psychiatric inpatients than is commonly recognized. Strategies to assist in the diagnosis and management this disorder are detailed.
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Logocentrism was conceptualized by Jacques Derrida as connoting the assertion within Western philosophical traditions of certain assumed truths and the exclusion of alternative perspectives. In this paper, the author proposes that the concept of logocentrism may be usefully applied within the clinical situation to enrich understanding of splitting between idealized and devalued perceptions of self and others. He presents a case of a woman with borderline personality disorder to illustrate a logocentric self-structure, as well as how common psychotherapeutic models inadvertently risk reinforcing such structures through the hierarchical nature of the patient-therapist relationship. The process of deconstructing logocentric self-structures is facilitated by the patient experiencing the therapist paradoxically as an extension of the self that sometimes behaves contrary to expectations. Such a deconstructive experience challenges reified perceptions of self and others, serves to broaden the experience of self, and enhances qualities of self-reflection and empathy.
The final moments of a life pose a special and very important time for all participants. Sensitive arrangement of events can provide harmony and a peaceful and memorable transition event. A specific situation, in which a feather is used to symbolize the transition, is reported. Hospice programs can offer ecologically based celebration of life and provide a positive transition for patients, families, friends, and staff.
Recovery from borderline personality disorder involves identification and resolution of two core conflicts. Recovery is a long-term process, however, and entails sequential stages that patients must work through. Each stage has unique challenges and pitfalls that must be overcome in order to avoid traumatic reenactment. It is possible for some patients and their therapists to successfully negotiate the stages, even if pathology is on the severe end of the spectrum.
Guillain Barré Syndrome is a rare disease, affecting primarily, but not solely, the peripheral nervous system. Because it is rare, many physicians, nurses, and health care practitioners see few cases in their careers. A case study, in which the patient/author was not diagnosed for approximately a year, is interesting because of associated depression. Recovery from depression is not simple. The steps achieved by the author took a great deal of effort. However, mental health nurses could play a more active role in raising questions for patients without a diagnosis or with evidence of mental confusion, and in assuring empathetic regard.
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For a long time, public health research has focused on many and diverse types of vulnerable groups in society. Whether drug abusers, prison inmates, smokers, poverty-stricken, mentally ill, HIV positive, or any number of other ailments, the public health system and, in particular, researchers have addressed and reported on people and populations with so-called deficits. Research on these vulnerable groups has been designed, conducted, reported, discussed and analysed, but vulnerable groups continue and, in fact, appear to be increasing in number, size, and range. An alternative approach that begins with entirely different questions is possible and advisable. Public health research could, and in the author's point of view, should, examine the lifestyles and, specifically, decision-making by members of elite groups. Studying up the economic and political ladder calls for examination of how a few reap enormous benefits for themselves, leaving the rest of us to our misfortune. Such decisions as the elite groups make affects resource allocation, use of information, and results in the public health and other social, economic, military, and political sectors in society.
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Guillain-Barré syndrome is a rare neurological disease that causes paralysis and may necessitate hospitalization for some patients in its acute stages. It primarily affects the peripheral nervous system, though recent research has shown that for some patients, the central nervous system is involved. The acute phase often requires intensive care services. Recognition is growing that recovery is not as smooth and free of symptoms as previously thought. Following "recovery" some people endure long-term residual symptoms, such as fatigue and pain. Nursing input can be of value by providing support, information, explanations, and empathy to reassure patients and families. A greater understanding of the nature and course of the disease and its ramifications can lead to more effective nursing management and a faster rehabilitation process.
Patients who are admitted to psychiatric inpatient wards often undergo a medical screening examination in the emergency department to rule out serious or underlying medical conditions that may be better treated elsewhere. Unfortunately, prior research has been conflicting on the relative merits of various screening procedures, making it difficult to implement guidelines. A systematic review of the literature was undertaken to research the current state of knowledge in medical screening procedures. Electronic searches were conducted in PubMed, MEDLINE, and the Cochrane Library for publication years 1966-2003. No restrictions were placed on language or on quality of publications. Twelve studies were found that reported specific yields of various screening procedures. Results indicate that medical history, physical examination, review of systems, and tests for orientation have relatively high yields for detecting active medical problems in patients presenting with psychiatric complaints. Routine laboratory investigations generally have a low yield for clinically significant findings. However, these should be added selectively for four groups at higher risk of serious medical conditions, i.e., the elderly, substance users, patients with no prior psychiatric history, and patients with preexisting medical disorders and/or concurrent medical complaints.
BACKGROUND: Previous research has yielded inconsistent findings on the relationship between personality characteristics and chronic pain. The present study examines measures of alexithymia, somatosensory amplification, attachment, counterdependency, and emotional distress in 140 consecutive general medical outpatients seen in psychiatric consultation. METHODS: Forty-five subjects having no chronic pain (NP) were compared to 49 subjects with chronic pain restricted to their back and/or extremities (BE) and with 46 subjects having pain involving other regions of the body (OP). RESULTS: Findings demonstrated marked counterdependency traits in the BE group relative to the other two groups. By contrast, traits of alexithymia and somatosensory amplification, insecure attachment, and a high level of emotional distress characterized the OP group. A multiple logistic regression model combining counterdependency and secure attachment was 86% accurate in predicting BE (c = 0.86). CONCLUSIONS: The study's findings suggest that personality traits vary according to chronic pain location, although the nature of the relationship still needs to be determined.