The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Jun 1996
ReviewThe management of treatment-resistant depression in disorders on the interface of psychiatry and medicine. Fibromyalgia, chronic fatigue syndrome, migraine, irritable bowel syndrome, atypical facial pain, and premenstrual dysphoric disorder.
We have reviewed studies examining the efficacy of various psychotropic medications, primarily antidepressant agents, in the treatment of a group of disorders that appear to exhibit some phenomenologic and genetic relationship to major depression. These disorders all appear to benefit (albeit to varying degrees) from antidepressant medications of several different chemical families. This observation has important theoretical and clinical implications. ⋯ From a clinical perspective, too, these results are important. They suggest that trials of antidepressant medications should be strongly considered in patients with these disorders. Furthermore, other types of psychotropic medication appear to have a role in the treatment of individual disorders, as discussed in the corresponding sections.(ABSTRACT TRUNCATED)
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Psychiatr. Clin. North Am. · Mar 1996
ReviewCombined medication and psychotherapy in the treatment of chronic mood disorders.
This article discusses the use of combined treatments for patients with chronic mood disorders. Although very little research concerning the efficacy of combined treatments for patients with chronic depression exists, clinical experience and limited available research suggest that combined treatment may be the most effective treatment option available for this population. The use of combination treatment involving pharmacotherapy, individual psychotherapy, and marital/family therapy is recommended to address the complex biopsychosocial issues involved in chronic mood disorders. Other theoretical and pragmatic issues concerning the delivery of combined treatment also are discussed.
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Psychiatr. Clin. North Am. · Sep 1995
Review Case ReportsThe cultural context of anxiety disorders.
About a century ago, George Crile, a surgeon and experimental physiologist, suggested that the meaning of pain could be discovered in the context of evolution. Pain is a signal of a physical injury that would be otherwise ignored by the individual, a form of ignorance that would ultimately have mortal consequences. Crile believed that pain has a second purpose, that has important implications for how psychiatry now understands the emotions, specifically fear and anxiety. ⋯ Anxiety is not a vector directed toward a threatening object or event in the environment but is situated in the person's own bodily experience, the workings of the mind, the Cartesian theater of self-representation. As an experience and event located entirely within the psyche, to be mastered by asserting a strong ego, reflections on anxiety became one of the self-constituting experiences of the Western concept of the person. In contemporary psychiatry, the constellation of injury, pain, fear, anxiety, memory, and imagination would seem to live on mainly in the context of traumatogenic anxiety and PTSD.(ABSTRACT TRUNCATED AT 400 WORDS)
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Psychiatr. Clin. North Am. · Sep 1995
ReviewCultural aspects of substance abuse and alcoholism. Assessment and management.
Cultures and ethnic groups within cultures prescribe, proscribe, or tolerate use of various psychoactive substances for social or personal purposes. In the United States, these ethnic strictures and practices vary widely. ⋯ In addition, they should be culturally sensitive to those aspects of treatment that can impede or augment successful outcomes. Finally, any and all attempts at primary prevention, early recognition and intervention, and rehabilitation should reflect the complex cultural, political, economic, and religious factors that influence substance use and abuse.
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Psychiatr. Clin. North Am. · Sep 1994
Historical ArticleThe rebirth of forensic psychiatry in light of recent historical trends in criminal responsibility.
The forensic specialist's expertise lies in mapping the interaction of cognitive, affective, and physiologic processes as they affect and are affected by the choices people make, and in connecting this analysis with laws, legal criteria, and other standards. More simply and broadly, it lies in describing both the unique and the universal characteristics of any human being and distinguishing clearly between the two. This is a psychiatrist who conducts in a different arena, and from a more critical perspective, but for the same larger humane purpose, the in-depth journey into the self and its response to stress that is the essence of clinical practice.