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Biomedical subjects

Z J Lipowski

Publications and source records attributed to Z J Lipowski.

At least 19 recordsLinked to original sources
PubMed1992

Inpatient treatment of persistent somatization.

Patients with disabling, persistent somatization pose significant challenges in clinical management. This study describes 92 patients treated on an inpatient psychosomatic medicine unit for persistent somatization. The most important factor in defining clinically significant subgroups of these patients was mood. Compared with depressed somatizing patients, nondepressed somatizing patients had chronic illnesses of early onset, had symptoms that were not correlated with current life stressors, and were generally unresponsive to treatment. There were few clinical predictors of treatment outcome apart from the duration of symptoms, the presence of mood disturbance, and a history of stable interpersonal relationships.

Adolescent↗
PubMed1992

Consultation-liaison psychiatry at century's end.

Consultation-liaison psychiatry is over 60 years old. It emerged as an offspring of psychobiology, general hospital psychiatry, and psychosomatic medicine. The author discusses its main functions and argues that it meets American Psychiatric Association criteria for subspecialization.

Education↗
PubMed1992

Update on delirium.

Delirium is a common syndrome in hospitalized medical and surgical patients and in those seen in emergency departments. It is particularly common in the demented elderly patients. To prevent it, for example by avoiding polypharmacy in the elderly, is important. It is most important to diagnose delirium early and to search for its cause without delay as this may be life-saving in some patients and may help avoid injury in others. This syndrome, long neglected by investigators, calls for vigorous research to establish its epidemiology, pathogenesis, and long-term outcome.

Delirium↗
PubMed1991

Delirium: how its concept has developed.

The development of the concept of delirium spans nearly 2,500 years. Its core clinical features were recognized at least as early as the 16th century, while its management reflected a humane approach from the beginning of the modern era. In the 19th century delirium became linked with the concepts of disordered consciousness and confusion, but these two terms were also used in regard to certain functional mental disorders. The most important contribution in this century was the work of Engel, Romano, and associates, who postulated that the syndrome was due to reduction in brain metabolic rate, as reflected in slowing of the EEG background activity. These and other developments are discussed in this article. A list of proposed research priorities is included.

Aged↗
PubMed1991

Consultation-liaison psychiatry 1990.

Consultation-liaison (C-L) psychiatry is a subspecialty concerned with clinical service, teaching, and research by psychiatrists in nonpsychiatric health care settings. These activities are focused on the physically ill and on the somatizing patients. The main objective of C-L psychiatry is to maintain a bridge between psychiatry and medicine for the sake of providing biopsychosocial health care. C-L psychiatry's functions include clinical work, teaching, and research at the interface of psychiatry and medicine. This field has grown substantially in the past two decades as is brought out in this article.

Aged↗
PubMed1990

Somatization and depression.

The majority of depressed patients complaining of physical symptoms first present to general practitioners. This article reviews the frequency of association between somatization and depression and the links between them. The need to prevent persistent somatization is emphasized.

Aged↗
PubMed1990

The integrative approach to psychiatry.

From the early days of psychiatry as a distinct field of knowledge and clinical practice two competing approaches to the etiology and treatment of mental disorders have vied for dominance: the somatic and the psychic ("moral"). We are witnessing the same struggle today. To speak metaphorically, we can opt for either brainless or mindless psychiatry, as Szasz proposed. He failed to consider a third option, however, one that may be called an integrative approach. The latter is neither mindless nor brainless but rather encompasses both the mind and the brain in its theoretical and practical consideration. I will formulate the integrative approach in this paper and argue that it has a distinct advantage for both the study and treatment of mental disorders.

Biological Psychiatry↗
PubMed1990

Chronic idiopathic pain syndrome.

Chronic idiopathic pain syndrome is a common, disabling and costly condition. It is believed to be of psychological origin but may involve both cerebral and peripheral physiological mechanisms. It is often associated with depression. Its assessment and management need to be multifactorial, i.e., medical, psychosocial and psychiatric. A thorough initial medical assessment is crucially important in order to identify any organic contributory factors and to gain the patient's trust. It is also essential to carry out a psychosocial and psychiatric assessment so as to evaluate the role of psychological and socioeconomic factors and establish whether a diagnosable psychiatric disorder is present. The latter is most likely to be a depressive, anxiety, or somatoform disorder. If the medical assessment fails to come up with a plausible organic explanation for the patient's pain, he or she should be told so clearly. The patient should be told that the goal of the treatment is not to cure the pain but to help him/her improve his/her functioning and sense of control over pain and life generally. The type of management most likely to succeed in this goal is one that is multifactorial and comprehensive rather than focused on one treatment modality only.

Chronic Disease↗
PubMed1989

Psychiatry: mindless or brainless, both or neither?

After a period marked by one-sided emphasis on psychodynamics and social issues, or what could be called "brainless" psychiatry on account of its relative neglect of cerebral processes, we are witnessing an opposite trend towards extreme biologism or "mindless" psychiatry. The pendulum has swung periodically from one to the other of these reductionistic positions throughout the history of psychiatry. The author argues that neither brainless nor mindless psychiatry can do justice to the complexity of mental illness and to the treatment of patients. Psychiatry's distinguishing feature as a clinical discipline is its equal concern with subjective experience, or the mind, and with the body, including brain function, which together constitute a person, a psychiatrist's proper focus of inquiry and intervention. Moreover, a person, viewed as a mindbody complex, is in constant interaction with the environment. It follows that both study of mental illness and clinical practice need to take into account the psychological, the biological and the social aspects. These three aspects are not mutually reducible and are indispensable for the understanding and treatment of the individual patient. Such a comprehensive, biopsychosocial approach provides an antithesis to the reductionistic viewpoints and, in the writer's opinion, is both practically and theoretically most satisfying.

Attitude of Health Personnel↗
PubMed1988

Somatization: the concept and its clinical application.

Somatization, a tendency to experience and communicate somatic distress in response to psychosocial stress and to seek medical help for it, poses a major medical, social, and economic problem. It is most often associated with depressive and anxiety disorders and constitutes the core of somatoform disorders. Its persistent form is especially costly and difficult to prevent and manage. The author discusses the prevalence, clinical manifestations, etiology, and treatment of somatization and presents a critical review of somatoform disorders.

Anxiety Disorders↗