The American journal of psychiatry
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Of 15 patients with psychiatric reactions to lidocaine, 12 (80%) had mood changes, 11 (73%) had "doom anxiety," eight (53%) had overt confusional states, and six (40%) had hallucinations and delusions. The authors contend that morbid fears of impending doom or the belief that death has occurred are specific manifestations of lidocaine toxicity and may be mistakenly attributed to "understandable" fears about death during the course of recovery from a myocardial infarction on the coronary care unit.
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The authors describe changes in DSM-III substance use disorders to be included in the revised version, DSM-III-R. Major revisions include removal of the distinction between "abuse" and "dependence" and broadening the definition of "dependence" to a syndrome of clinically significant behaviors that indicate a serious degree of involvement with psychoactive drugs; creation of a new category of "psychoactive substance neuroadaptation syndrome" for individuals whose physiological adaptations to high doses of psychoactive substances did not arise from their own behavior; use of an identical set of symptoms and behaviors to determine dependence on all different classes of psychoactive substances; and provision of a system for rating severity of dependence.
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To some degree, all psychiatric encounters, by constraining behavioral variation and autonomous decision making, threaten a personhood already impaired by illness. The challenge presented by this and other factors in Western psychiatry is how to resolve the ethical dilemmas of justice, autonomy, and beneficence inherent in contemporary hospitalization and treatment practices for severely mentally ill persons. The author discusses this challenge in terms of the physician-patient contract, clinical standards for limiting autonomy, and the Kantian concept of equality of mutual respect. The legal code in relation to psychiatry has evolved into a contemporary interpreting mechanism for Kantian cultural tradition.