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Psychiatric rehabilitation is the process of enablement and enhancement of personal autonomy of individuals with chronic psychiatric disabilities. Its governing principles are those of common sense and sound psychiatric practice. These principles are outlined and some specific aspects of the process described. This article provides a brief guide and overview rather than a comprehensive account.
Longstanding concern about possible misuse of the physician's unique prerogative to prescribe sedative drugs that control behavior has been accentuated by the increasing use of benzodiazepines since 1960. The appropriateness of their use in solving psychosocial predicaments is increasingly questioned because their availability has coincided with social movements toward personal autonomy and scientific doubts about the adequacy of a biomedical model in health care. Recent information about patients, physicians' prescribing habits, and drugs leads to an exploration of the existing alternatives. Adoption of a biopsychosocial model could result in lowered drug use with increased levels of public and professional satisfaction.
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The authors analyse the case of a 58-year-old male suffering from substantially "atypical" multiple sclerosis (MS), both in terms of the late onset and because of some characteristics of the course of disease. The patient was treated with a subcutaneous immunomodulator (thymopentin) at a dose of 50 mg/day in 3-monthly cycles with intervals of 2 months between cycles, for a total of 3 cycles. Instrumental (CAT-NMR) and laboratory (immunological) tests were not significant, whereas others provided complex responses that allowed the presence of a demyelinating syndrome to be ascertained, above all due to the positivity of isoelectrofocusing. Treatment with thymopentin, commenced 12 years after the clinical onset of disease and after numerous cycles of cortisone and ACTH therapy, led to a major improvement in clinical conditions, especially of "sthenia" and movement, with consequent recovery of personal autonomy and working capacity which had previously been totally lost. Immunological tests performed at the end of each treatment cycle showed some slight but interesting modifications in parameters relating to DNA and the percentage of HLA antigens bound to lymphocytes. These findings suggest that the patient's immune system was sensitive to treatment with the thymic hormone responsible for the objective clinical improvement. These results appear to open the way to the possible treatment with immunomodulators.
Presented are the findings of a 5-year prospective study concerning residential rehabilitation of 53 subjects with chronic mental illness living in a differentiated system of complementary facilities and services. The focus had been the chronically ill patients' development and disease course, as reflected in their psychological wellbeing, work status, therapeutic requirements, social contacts, as well as periods of rehospitalization. At the end of the 5-year period, 50% of the subjects were living in sheltered communal groups, and some 25% fully on their own. Only 10 percent had returned to psychiatric hospitals as long-term patients. Vocational integration in the general labour market is only rarely achieved, but the work available in sheltered employment is suitable for 40%. All of the patients were in medical care after 5 years. Given a differentiated system of complementary support and services in the residential and vocational spheres, for medical care and leisure activities, persons with chronic mental illness, too, are able to live outside the psychiatric hospital, above all enjoying greater normality in their lifestyles as well as a higher degree of personal autonomy.
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The Nuremberg Code includes 10 principles to guide physician-investigators in experiments involving human subjects. These principles, particularly the first principle on "voluntary consent," primarily were based on legal concepts because medical codes of ethics existent at the time of the Nazi atrocities did not address consent and other safeguards for human subjects. The US judges who presided over the proceedings did not intend the Code to apply only to the case before them, to be a response to the atrocities committed by the Nazi physicians, or to be inapplicable to research as it is customarily carried on in medical institutions. Instead, a careful reading of the judgment suggests that they wrote the Code for the practice of human experimentation whenever it is being conducted.
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South and South-East Asia are at the centre of the most aggressive advances of the AIDS epidemic today. The challenge this presents to the region is clear. While reported absolute numbers still lag behind the African region (11,160,900 in Africa; 3,081,235 in Asia) knowledgeable observers agree that the place of infection and potential devastation in this region exceed what we have seen in Africa. Those concerned with the welfare of the people of Asia, therefore, must make serious efforts to break the chain of HIV transmission as quickly and effectively as possible and identify and care for the infected. Women are entitled to protection by rights the same as men. However, for anatomical reasons, women are more vulnerable than men to infection by HIV. In addition, throughout the Asian region, women's "natural" vulnerability is vastly magnified by poverty and generally low levels of education and personal autonomy which make it difficult for them to gain access to information and appropriate services. Because of women's multiple roles in the epidemic-potential "infectee", care-giver, transmitter of infection-if we are to be successful in halting the spread of HIV/AIDS we must give particular attention to reaching, working with, and serving women. Meeting this challenge requires involvement of men as well as women, individuals and institutions, governments and NGOs, in four broad areas of activity: (i) HIV/AIDS education and information; (ii) basic education and economic activity to reduce gender inequities; (iii) improvements in policy and social environments; and (iv) provision of health and other services. Lack of commitment, skill, or persistence in meeting the challenge will cost lives across Asia.
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Detailed research on the family planning needs of Asian women is extremely important in informing public policy in the new purchaser-provider environment of the National Health Service (NHS), which was introduced in 1991. In depth interviews were conducted with Asian women of Indian, Pakistani and Bangladeshi backgrounds in the South and West Regional Health Authority area, to investigate their family planning behaviour and use of family planning services. This research shows significant diversity in the knowledge and use of contraception between married professional women, married non-professional women and unmarried women. This paper examines the different family planning service implications for each group of women. The results show that professional married women and unmarried women are able to meet their family planning needs by utilising existing family planning services. However, married non-professional women experience significant difficulties in using family planning services largely due to communication problems with health professionals and their low levels of personal autonomy. Most Asian women in this study showed a strong preference for a female GP and a non-Asian GP for sexual health and contraceptive services.
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