History of psychiatry and the psychiatric profession

Beer, M. Dominic

doi:10.1097/yco.0b013e328330c3c2

Cited by 6 publications

(8 citation statements)

References 32 publications

(22 reference statements)

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“…During the past 20 years, deinstitutionalization activity has changed the primary location of care from mental hospitals to community-based outpatient clinics (1). Nonethe-less, the financial resources for community-based interventions have been limited, and families of the patients with severe mental disorders have been requested to increase their responsibility to support the patients (2).…”

Section: Introductionmentioning

confidence: 99%

Burden experienced by caregivers of schizophrenia patients and its related factors

Hajebi

Naserbakht

Minoletti

2019

Med. J. Islam. Republ. Iran

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Background: Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family. Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers, selected from the outpatient department of a psychiatric hospital in Tehran, Iran, using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Spearman correlation coefficient and linear regression method. Data were analyzed using SPSS software (Version 21) and significance level was set at p< 0.05. Results: The level of burden experienced by most of primary caregivers was higher than moderate. The scores obtained in the subscales of emotional over involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers, respectively, and the scores had a significant direct correlation with the burden experienced by the caregivers. The findings of multiple linear regression showed that lower family income (β=-0.33, p< 0.001), higher duration of disorder (β= 0.19, p= 0.006), and younger age at onset of the disorder (β=-0.26, p= 0.001) were predictive of higher burden of disease on caregivers. Conclusion: Based on the results, some demographic factors of the primary caregivers, patients, and their family significantly affected the burden experienced by the primary caregivers. Most of the caregivers had high expressed emotions and a significant direct association existed between the expressed emotions and the burden experienced.

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Section: Introductionmentioning

confidence: 99%

Burden experienced by caregivers of schizophrenia patients and its related factors

Hajebi

Naserbakht

Minoletti

2019

Med. J. Islam. Republ. Iran

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“…During the last decades, in many countries, the so-called "deinstitutionalization" has changed the primary location of health care from hospital to community-based outpatient services [35]. Nonetheless, the nancial resources for community-based interventions are limited [6,36,37], although most severe mental disorders compromise many areas of an individual's life, such as interpersonal relationship, work and/or self-care [38,39].…”

Section: Introductionmentioning

confidence: 99%

Empathy and burden in caregivers of patients with schizophrenia spectrum disorders

Lorenzo¹,

Girone²,

Panzera

et al. 2020

Preprint

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Background The caregiver of patients loads different kind of burdens, including emotional distress. Aims of this study were to evaluate the burden and empathy of caregivers of patients with schizophrenic spectrum disorders and to evaluate if these dimensions are correlate between them and/or with selected variables of caregivers and assisted patients. Methods We selected a sample of 60 caregivers (34 women and 26 men), who assisted patients with schizophrenia spectrum disorders treated in our local Community Mental Health Center for a 1-year minimum period. We administered to our sample two scales, Zarit Burden Interview (ZBI) and Balanced Emotional Empathy Scale (BEES) and collected data of caregivers and their assisted patients in a 3-month period. Results We reported a mean ZBI score of 49.68 (± 15.03 SD) and a mean BEES score of 14.35 (± 9.05 SD), indicating the perception of moderate-severe burden and a low level of empathy, respectively. The analysis of internal consistency confirmed the good reliability of both ZBI (Cronbach's alpha = 0.90) and BEES (Cronbach's alpha = 0.77). The correlation between the two scales was not statistically significantly at Spearman test. Only a few variables, the living environment ("do not live with the patient") indirectly, and the Clinical Global Impression-Severity (CGI-S) score of assisted patients, in a direct way, were statistically significantly correlated with ZBI score. We highlighted only a positive statistically significant correlation between the fifth dimension score of BEES ("Tendency to avoid emotional involvement with fragile people") and CGI-S and GAF (Global Assessment of Functioning) scores of assisted patients. Conclusions Our study highlights that the burden of caregivers of patients with severe psychiatric disorders is similarly high to that of organic or neurologic disorders and is associated with low emotional empathy experienced by caregivers, probably due to a defensive psychological mechanism.

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“…Tais elementos históricos são fundamentais para se compreender o contexto sócio-histórico em que se insere o trabalho do psiquiatra atualmente (Shorter, 2008;Porter, 2002;Beer, 2009), especialmente diante das rupturas e permanências históricas de seus referenciais teóricos e de suas práticas (Bertolli, 2017). A tensão entre as dimensões natural-biológica e histórico-social, presentes na história da constituição da Psiquiatria enquanto campo de atuação médica, permanence nos dias de hoje tanto nas abordagens diagnósticas quanto na conduta assistencial (Singh e Singh, 2004).…”

Section: A Psiquiatria Como Especialidade Médica: a Questão Históricaunclassified

“…A descoberta e difusão dessas modalidades de tratamento foram determinantes nas mudanças das classificações dos transtornos mentais, o que também não exclui a importância que teve nesse sentido o envolvimento de grandes empresas do ramo farmacêutico (Cosgrove, 2009). Influenciada por Kraepelin e pelos degenarionistas Morel e Magnan, ainda no século XIX (Caponi, 2011;Pereira, 2008), essa perspectiva organicista buscava constituir cientificamente a Psiquiatria ao propor "uma abordagem estritamente médica da psiquiatria moderna" (p. 30) e esse esforço promoveu as transformações no DSM-3 (1980) que estabeleciam critérios considerados objetivos e ateóricos para o diagnóstico dos transtornos mentais, os quais foram perpetuados no DSM-4 (1994) e DSM-5 (2013).…”

Section: Matrizes Teóricas Do Diagnóstico: a Questão Nosológicaunclassified

“…Gowans et al (2011) acrescentou a esses atributos dos futuros psiquiatras a falta de interesse por esportes, a disposição maior em lidar com problemas sociais e atividades extra-hospitalares. Para Lampe (2013), seria justamente a postura "não científica" atribuída à Psiquiatria que constituiria um diferencial efetivo na sua abordagem dos transtornos mentais e na empatia para com os pacientes.…”

Section: O Modo De Ser Do Psiquiatraunclassified

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O psiquiatra em conflito: fatos, valores e virtudes no dilema das internações involuntárias

Castellana¹

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Castellana GB. The conflicted psychiatrist: facts, values and virtues in the dilemma of involuntary commitment [thesis]. Faculdade de Medicina, Universidade de São Paulo; 2019. INTRODUCTION: Some of the most complex situations faced by Psychiatry are clinical judgment and decision-making, constantly placing psychiatrists at odds about the best course of action. This is especially true in cases involving involuntary commitment, in which the patient's absence of consent with the treatment may constitute a moral dilemma for the physician. That is why these are considered "difficult cases", which must be weighed against the patient's autonomy and risk presented. The aim of this paper is to assess to what extent the psychiatrist's subjective dimension influences his/her decision-making in these cases, examining the relationship between facts, values and virtues in psychiatric clinic. METHODOLOGY: Grounded on qualitative methodology, based on content analysis, 17 third-year residents in Psychiatry of the same program were interviewed. These interviews had two parts: case studies and professional experience. For the first part, interviewees were presented with two hypothetical cases, both inspired by ordinary clinical practice, in which he/she was asked to either opt for involuntary commitment or discharge of patient, in each case with the relevant justifications. For the second part, the focus was on the interviewee's experience, going from Medical School to residency in Psychiatry. RESULTS: The interview results revealed that in both cases, clinical judgment and treatment proposed, each psychiatrist's subjective values influenced their assessment. These values were coupled with different epistemological perspectives of psychopathological knowledge adopted by the psychiatrists and revealed in their professional experience. Based on the use of such knowledge, it was possible to identify three types of psychiatric rationale: organicist, theoretically based on Neurosciences; psychodynamic, theoretically grounded on Psychoanalysis; and phenomenological, theoretically supported by Phenomenology. Analysis of the results also revealed that this judgment by psychiatrists requires some virtues, including empathy, self-knowledge, availability to interpersonal relationships and practical wisdom (phronesis). Accordingly, each final clinical decision revealed to depend on the psychiatrist's ethical and epistemological positions. CONCLUSIONS: clinical judgment and the corresponding decision-making are based not only on technical-scientific knowledge, but also on the psychiatrist's system of values and virtues. This whole, which combines scientific facts, values and virtues in psychiatric practice, places the habitus of psychiatrists at the border between natural and human sciences, which is responsible for the constant questioning of whether this speciality belongs to the hegemonic, organicist scientific realm of Medicine.

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History of psychiatry and the psychiatric profession

Abstract: Much varied and important research on the history of psychiatry is being performed around the world. This scholarship provides insight into the cultural context and ways in which psychiatry was practised in the past and can help shed light on the way in which psychiatry is conducted today.

Cited by 6 publications

References 32 publications

Burden experienced by caregivers of schizophrenia patients and its related factors

Burden experienced by caregivers of schizophrenia patients and its related factors

Empathy and burden in caregivers of patients with schizophrenia spectrum disorders

O psiquiatra em conflito: fatos, valores e virtudes no dilema das internações involuntárias

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