Hospital & community psychiatry
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Hosp Community Psychiatry · Jan 1986
Review Case ReportsPosttraumatic stress disorder among black Vietnam veterans.
Because of racism in the military and racial and social upheaval in the United States during the Vietnam War years, as well as limited opportunities for blacks in the postwar period, black veterans of the Vietnam War often harbor conflicting feelings about their wartime experiences and have difficulty rationalizing brutality against the Vietnamese. As a result, black veterans suffer from posttraumatic stress disorder (PTSD) at a higher rate than white veterans. Diagnosis and treatment of PTSD in black veterans is complicated by the tendency to misdiagnose black patients, by the varied manifestations of PTSD, and by patients' frequent alcohol and drug abuse and medical, legal, personality, and vocational problems. The author presents his and others' recommendations about ways to treat black veterans with PTSD.
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The 1982 Supreme Court decision in Youngberg v. Romeo gave mental health professionals flexibility to exercise professional judgment in using seclusion to control violent patients, and also suggested that seclusion and restraint might be used when patients exhibit disruptive behavior that may lead to violence. ⋯ They found that seclusion and restraint practices varied widely depending on the population served and the philosophical orientation of the hospital staff, and were more often used to contain behavior that might lead to violence rather than to control violent behavior itself. They conclude that there is overwhelming empirical support for using seclusion and restraint to limit the progression of disruptive behavior to actual violence, but that the decision to do so should be based on sound clinical judgment.
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The increasing number of deinstitutionalized patients in crisis are placing new demands on general hospital emergency rooms. The authors discuss the approaches used in staffing and operating a psychiatric emergency service at a large general hospital in western Massachusetts. ⋯ Subsequently a proposal was developed for a seven-bed emergency psychiatric treatment unit to provide brief, intensive psychiatric care for both voluntary and involuntary inpatients. The authors describe the staffing and layout of the unit, and the population to be served.
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In the past ten years developments in social psychology, neurochemistry, learning theory, and psychophysiology have expanded the concept of chronic pain into a biopsychosocial model, in which pain is viewed as a form of abnormal illness behavior influenced by a wide range of biological, social, and psychological factors. Using the literature on chronic pain, the authors discuss the evolution of the chronic pain concept into the multidisciplinary multimodal approach used by pain clinics today, and the factors identified in the literature that influence a patient's perception of pain. Finally, based on their experiences in setting up a pain clinic and on the literature on leading pain management programs, they discuss in detail the evaluation, treatment, and management strategies of a comprehensive chronic pain management program.