Harvard review of psychiatry
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Harv Rev Psychiatry · Jan 2008
ReviewThe use of palliative sedation for existential distress: a psychiatric perspective.
This article introduces a structure for standardization in the ongoing debate about the application of palliative sedation for psychological and existential suffering at the end of life. We differentiate the phenomenon of existential distress from the more general one of existential suffering, defining existential distress as a special case of existential suffering that applies to persons with terminal illness. We introduce both a clinical classification system of existential distress based on proximity to expected death and a decision-making process for considering palliative sedation (represented by the mnemonic, TIRED). Neuropsychiatric clinical cases will be used to demonstrate some of the concepts and ethical arguments.
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Harv Rev Psychiatry · Jan 2008
Prescription opioid abuse and dependence among physicians: hypotheses and treatment.
Physician impairment is a serious public health issue affecting physicians as well as their families, colleagues, and patients. Though physicians generally display healthier habits than members of the general population, overall rates of impairment are similar among both groups, and prescription drug abuse (including prescription opioids) is particularly problematic among physicians. The current review focuses mainly on prescription opioid abuse and dependence among physicians. ⋯ Medical and psychosocial interventions, 12-step involvement, and extensive use of evaluations are highlighted. Attention is paid to typical follow-up contracting and monitoring strategies, as well as strategies for prevention. Given the extremely positive outcomes demonstrated by specialized programs for treating impaired professionals, it is recommended that their methods be disseminated and utilized in treatment centers for the general public.
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Medical errors in the general medical sector result in significant patient deaths and injuries, as well as high costs to the health care system. Despite the growing literature on errors in medical and surgical specialties, few studies have examined the incidence, nature, predictors, and prevention of errors that may occur in mental health treatment settings. The purpose of the current review is to examine the lessons learned from patient-safety research in the general medical sector, provide examples of types of errors in psychiatry, review the errors identified in the literature, offer a discussion of error-reduction strategies for improving patient safety, and provide recommendations for future research. Increased attention to medical errors in psychiatry is necessary in order to build safer health systems and promote a culture of safety among providers, thereby producing better care for patients with mental disorders.