The Patient: Biological, Psychological, and Social Dimensions of Medical Practice

ISBN-13: 9781468449570 / Angielski / Miękka / 2012 / 458 str.

Leigh, Hoyle

Opis

The old-fashioned doctor, whose departure from the modern medical scene is so greatly lamented, was amply aware of each patient's per- sonality, family, work, and way of life. Today, we often blame a doctor's absence of that awareness on moral or ethical deficiency either in medical education or in the character of people who become physicians. An alternative explanation, however, is that doctors are just as moral, ethical, and concerned as ever before, but that a vast amount of additional new information has won the competition for attention. The data available to the old-fashioned doctor were a patient's history, phys- ical examination, and "personal profile," together with a limited number of generally ineffectual therapeutic agents. A doctor today deals with an enormous array of additional new information, which comes from X-rays, biopsies, cytology, electrographic tracings, and the phantas- magoria of contemporary laboratory tests, and the doctor must also be aware of a list of therapeutic possibilities that are both far more effective and far more extensive than ever before.

Spis treści

I. On Becoming a Patient: Psychosocial Considerations.- 1. Illness and Help-Seeking Behavior.- Concepts and Definitions: Help-Seeking Behavior and Illness Behavior.- Factors That Influence Help-Seeking Behavior.- Factors That Influence How Symptoms and Illness May Be Perceived.- Demographic Factors.- Role of Stress.- Role of Previous Experience (“Priming Factors”).- Taxonomy of Medical Help-Seeking Behavior.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 2. The Sick Role.- Sick-Role Expectations.- Sick-Role Performance by Patients.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 3. Expectations in the Consulting Room.- Relief from Distress.- Communication of Information.- Effect of Priming Factors on Expectations.- The Physician’s Covert Expectations.- Society’s Expectations of the Physician—The “Doctor Role”.- Technical Competence.- Universalism.- Functional Specificity.- Affective Neutrality.- Collectivity Orientation.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- II. On Being a Patient: Psychophysiological Considerations.- 4. Anxiety.- Phenomenology of Anxiety.- Theories of Anxiety and Emotions.- Learning-Theory Model.- Psychoanalytic Signal Theory of Anxiety.- Physiology of Anxiety.- Brain Mechanisms of Anxiety.- Central Neurotransmitters in Anxiety.- Function of Anxiety.- Dysregulation of Anxiety.- Fainting.- Hyperventilation Syndrome.- Stress-Related Disorders.- Classification of Anxiety Dysregulation Syndromes.- Evaluation of Anxiety.- Contexts of Anxiety.- Differential Diagnosis of Anxiety States.- Management of Anxiety.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 5. Psychological Defense Mechanisms.- Distress, Anxiety, and Defense Mechanisms.- Classification of Defense Mechanisms.- Defenses Listed According to Their Main Subsystem Effects.- Illustrations of Defense Mechanisms as They May Be Encountered in Medical Practice.- Defense Mechanisms That Manifest Their Main Effects in the Input Subsystem.- Defense Mechanisms That Manifest Their Main Effects in the Internal Processing Subsystem.- Defense Mechanisms That Manifest Their Main Effects in the Output (Action) Subsystem.- Defense Mechanisms the Main Effects of Which Are More Evenly Distributed in All the Subsystems by Affecting the Decider or Executive Subsystem Itself.- Defense Mechanisms, Anxiety, Character, and Coping Styles.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 6. Depression, Mania, and Suicide: Affective Disorders.- Affect, Mood, Depression, and Mania.- Phenomenology of Depression and the Depressive and Manic Syndromes.- Separation, Bereavement, and Grief.- Phenomenology.- Course.- Pathological Grief Reactions.- Separation in Children.- Separation in Infant Monkeys.- Function of Depression.- Significance of Bereavement, Depression, and Affective Disorders.- Epidemiology of Affective Disorders.- Brain Mechanisms of Affective Disorders.- Biogenic Amines.- Receptor Sensitivity.- Acetylcholine.- Other Putative Neurotransmitters and Neuromodulators.- Intracellular Sodium.- Psychological Aspects.- A Hypothetical Integrated Model.- Physiology and Endocrinology of Affective Disorders.- Neuroendocrinology.- Physiological Signs of Depression (Depressive Syndrome).- Evaluation of Depression.- Dexamethasone Suppression Test.- Physical Symptoms in Depressive Syndrome Associated with Major Affective Disorders.- Evaluation of Suicide Potential.- Risk Factors.- Suicide Attempt.- Evaluation of Suicide Attempt.- Management of Depression.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 7. Psychosis.- Psychosis, Madness, and Insanity.- General Phenomenology of Psychosis.- Schizophrenia—A Classic Psychosis.- Brief History.- Definition.- Clinical Features and Diagnostic Criteria.- Course and Prognosis.- Mortality.- Epidemiological Aspects.- Etiological Aspects.- Nature of Psychosis.- Evaluation of Psychosis.- Biological Dimension.- Personal Dimension.- Environmental Dimension.- Differential Diagnosis of Psychosis.- Management of Psychosis.- Biological Dimension.- Personal Dimension.- Environmental Dimension.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 8. Confusion, Delirium, and Dementia: Organic Brain Syndromes and the Elderly Patient.- Definitions and Phenomenology.- Organic Brain Syndrome.- Delirium.- Dementia.- Epidemiology of Organic Brain Syndromes.- Pathophysiology of Organic Brain Syndromes.- Prevalence of Dementia in the Elderly.- Alzheimer’s Disease and Multiinfarct Dementia.- Alzheimer’s Disease.- Multiinfarct Dementia.- Clinical Course of the Dementias in the Elderly.- Memory Dysfunction in the Elderly.- Evaluation of Organic Brain Syndromes.- Biological Dimension.- Personal Dimension.- Environmental Dimension.- Differential Diagnosis of Organic Brain Syndromes.- Management of Organic Brain Syndromes.- Biological Dimension.- Personal Dimension.- Environmental Dimension.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 9. Pain.- Definitions and Functions of Pain.- Qualities of Pain.- Nature of Pain.- Neurophysiology of Pain.- Historical Neurophysiological Theories of Pain Perception.- Role of Endorphins in Pain Mechanisms.- Descending Influences from the Brain.- Central Neuropharmacology of Pain.- Psychosocial Factors That Influence Pain Experience.- Placebo Effect.- Use of Placebos in Medical Practice.- Psychological Meanings of Pain.- “Psychogenic” Pain.- Management of Pain.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 10. Sleep and Dreaming.- Stages of Sleep.- NREM Sleep.- REM Sleep.- Basic Rest—Activity Cycle.- Biological Rhythms.- Brain Mechanisms of Sleep.- Dreams.- Functions of Sleep and Dreaming.- Sleep Needs.- Environmental Factors That Affect Sleep.- Sleep Disorders.- Classification.- Insomnia.- Hypersomnia.- Narcolepsy.- Somnambulism (Sleepwalking).- Enuresis (Bed-Wetting).- Night Terrors.- Nightmares.- Sleep Apnea.- Medical Conditions Affected by REM Sleep.- Hyperthyroidism and Hypothyroidism.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- III. On Assessing a Patient: A Clinical Systems Approach.- 11. Approach to a Patient: The Patient Evaluation Grid.- The Patient, the Patient’s Components, and the Patient’s Environment.- Disease, Illness, and Distress.- Patient Evaluation Grid (PEG).- What Goes into the PEG.- Significance of Contexts.- Significance of Dimensions.- Rational Patient Management.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 12. Current Context.- Current Context in the Biological Dimension.- Current Context in the Personal Dimension.- Outline of the Mental-Status Examination.- Current Context in the Environmental Dimension.- Interaction among the Current-Context Dimensions.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 13. Recent Context.- Recent Context in the Biological Dimension.- Recent Context in the Personal Dimension.- Recent Context in the Environmental Dimension.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 14. Background Context.- Background Context in the Biological Dimension.- Background Context in the Personal Dimension.- Personality as a Factor in the Pathogenesis of Disease.- Background Context in the Environmental Dimension.- Intersystems Interaction in the Background Context—Development.- Freud.- Erikson.- Piaget.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- IV. On Managing a Patient.- 15. The Case of the “Sick Tarzan”: A Challenging Case History.- 16. The Doctor-Patient Relationship.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 17. The Patient’s Personality.- Personality and Character.- Concept of Personality Types in Patients.- Personality Types and the Sick Role.- Dependent, Demanding Patients.- Orderly, Controlling Patients.- Dramatizing, Emotional Patients.- Long-Suffering, Self-Sacrificing Patients.- Guarded, Suspicious Patients.- Superior and Special Patients.- Seclusive, Aloof (Schizoid) Patients.- Impulsive Patients with a Tendency to Act Out.- Patients with Mood Swings.- From Types to Individuals.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 18. The Hospitalized Patient.- The Hospital as a Social System.- Kinds of Hospitals.- The People in a Hospital.- Organization of an Inpatient Unit.- The Hospital and Outside Organizations.- The Hospital Environment.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 19. Therapeutic Dimensions.- Approaches in the Biological Dimension.- Approaches in the Personal Dimension.- Psychotherapy in Medical Settings.- Formal Psychotherapy.- Approaches in the Environmental Dimension.- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 20. Drugs That Affect Behavior.- Drugs Affect All Dimensions of the Patient.- Psychotropic Drugs.- Antianxiety Drugs (Minor Tranquilizers).- Drugs That Affect Mood.- Antipsychotic Drugs (Major Tranquilizers, Neuroleptics).- Summary.- Implications.- For the Patient.- For the Physician.- For the Community and the Health-Care System.- Recommended Reading.- References.- 21. Some Illustrative Patients.- Management of the “Sick Tarzan”.- Biological Dimension.- Personal Dimension.- Environmental—Interpersonal Dimension.- The Case of the Catatonic Patient with Enlarged Ventricles.- History and Course.- Comments.- The Case of the Suicidal Terminal Cancer Patient.- History.- Evaluation.- Course of Management.- Comments.- 22. Summary and Perspectives.- References.