The Psychiatric clinics of North America
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Concern about the different forms of domestic violence continues to escalate. Beginning with identification of child abuse in the 1960s; spouse abuse, primarily of women, in the 1970s; and, most recently, identification of the rising incidence of elder abuse and neglect, the medical community, state, local, and federal governmental agencies and the public continue to promote joint programs to identify, guide to treatment, and simultaneously develop prevention and early intervention programs. Emphasis initially on the use of legal systems to stop, the abuse must almost be mandatory, because numerous studies show that treatment is most successful when abusers are forced to admit to themselves and others that they have, in fact, committed crimes. ⋯ Psychiatric treatment modalities must occur within a framework of acknowledging that domestic violence victims suffer from post-traumatic stress disorder. Psychiatrists can serve as leaders in coordinating multi-pronged treatment options for the victims: advocacy groups; alcohol and drug detoxification; and individual, couple, and family therapy. Psychiatrists can also serve as consultants, leaders, and educators in prevention and early intervention programs to educate the public and all levels of professionals who work with victims: police and legal systems, social service workers, teachers, religious leaders, essentially all who touch the lives of people of all ages who are supposed to live together in domestic mutual respect and caring but do not.
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Psychiatr. Clin. North Am. · Mar 1987
Case ReportsMajor mental illness and childbearing. A role for the consultation-liaison psychiatrist in obstetrics.
Considerable attention has been paid to psychiatric disorders arising in the postpartum period. However, there has been very little systematic study of mental illness during pregnancy. ⋯ This article reviews the existing literature and along with illustrative cases discusses the management of mental illness related to pregnancy. The relationship between the consultation-liaison psychiatrist and the obstetrician-gynecologist in caring for such problems is emphasized.
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Pathologic aggression can be evaluated in terms of its psychosocial provocations, but it also must be recognized as a physiologically generated behavior and that disruptions of those controlling physiologic mechanisms can lead to pathologic states of aggression. Laboratory and clinical evidence indicates that the phylogenetically older limbic system is the anatomic core and that serotonin is the major neurotransmitter linked to that behavior. Hormonal factors influence aggression but are, to a large extent, altered by the aggressive acts themselves. There are a number of recognizable clinical syndromes which, by producing abnormal activity in limbic structures, by interfering with higher cortical control, or by causing neuroendocrine dysfunction, lead to states of pathologic aggression.
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Psychiatr. Clin. North Am. · Jun 1986
Case ReportsA neuropsychiatric approach to impulse disorders.
Disordered impulse control (or pathologic impulsivity) is a common feature of many neurologic and psychiatric illnesses. Diagnosis is founded on comprehensive neuropsychiatric evaluation. ⋯ Evaluation and diagnostic classification are discussed. Several clinical synopses are presented to illustrate the common complexity of evaluation and treatment in presentations of pathologic impulsivity.
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The genetic contribution to schizophrenia is the most clearly established etiologic factor. This article briefly reviews the evidence for a genetic influence as well as recent challenges to that evidence. It discusses the possible modes of transmission and outlines current efforts to identify more precisely the genetic and environmental factors contributing to schizophrenia and the nature of the gene-environment interaction.