This document discusses the relationship between personality, personality disorders, and responses to illness. It covers how personality is shaped by past experiences and biology, and influences how patients interact with their treatment team and cope with illness. Specific personality types like dependent clingers and entitled demanders are known to stir dislike in physicians due to their demanding behaviors. The document also discusses transference and countertransference between patients and care providers.
Illnesses that were once considered terminal are increasingly being treated as chronic medical conditions that develop over the long term. Advances in medical science have improved treatment options for people suffering from chronic conditions that develop over the long term. These individuals also enjoy higher life expectancy. A primary consequence of this evolution is that, rather than prepare to die, individuals diagnosed with a major chronic illness are faced with the challenge of learning how to adapt over the long term.
Rather than rely on traditional stage-based approaches, which assume that adaptation progresses in linear fashion, we suggest a task-based approach. Task-based models focus on the process of reconstruction of the diagnosed person’s personal, professional and social worlds. These approaches do not prescribe a specific path towards adaptation; rather, they provide a framework through which to understand the process of recovery.
Illnesses that were once considered terminal are increasingly being treated as chronic medical conditions that develop over the long term. Advances in medical science have improved treatment options for people suffering from chronic conditions that develop over the long term. These individuals also enjoy higher life expectancy. A primary consequence of this evolution is that, rather than prepare to die, individuals diagnosed with a major chronic illness are faced with the challenge of learning how to adapt over the long term.
Rather than rely on traditional stage-based approaches, which assume that adaptation progresses in linear fashion, we suggest a task-based approach. Task-based models focus on the process of reconstruction of the diagnosed person’s personal, professional and social worlds. These approaches do not prescribe a specific path towards adaptation; rather, they provide a framework through which to understand the process of recovery.
Module 6, Role and functions of medical social work in various medical settings.
Unit 21 - PATIENT AND FAMILY EDUCATION
(Social Work in the field of health- MSW (S3))
Professionalism is the basis of medicine’s social contract with society
Professionalism demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health
Empathy is the capacity to recognize and experience feelings that are being experienced by another.
“It is the intrapersonal realization of another’s plight that illuminates the potential consequences of one’s own actions on the lives of others.” (Hollingsworth, 2003)
Illness as a stress and coping with illness is the topic of this power point presentation and it includes the descriptions of stress, stress in acute and chronic illnesses and stress in terminal illness.
I think it will be useful to public, medical students and doctors as well.
Stern: Stigma and Mental Illness – A Barrier to Health Seekinghenkpar
Wonca Working Party on Mental Health
World mental Health Day
presentation Dr Anthony Stern (USA)
Stigma and Mental Illness – A Barrier to Health Seeking
Definition of DPR
Why does DPR matter?
Parson's Ideal Doctor & Patient
Types of DPR
Importance of DPR
Elements of DPR
Key components of DPR
Communication between Doctor & Patient
Barriers in communication
Factors influencing DPR
How to improve DPR
Patient Education
The research report Presentation addresses the stigma related to the mental health in our society. This study was intended to increase understanding of peoples’ views of mental illness by developing and administering measures of knowledge and attitudes of people toward mental illnesses.
The research conducted through questionnaires regarding the mental health stigma is reviewed and analyzed that indicates that the majority of the general public holds negative stereotypes towards people with psychological problems.
Hence, a model has been proposed to illustrate what are the peoples’ attitudes towards and knowledge about the mental health, why is it a taboo to talk about this topic, how can this stigma prevent the people from getting help for the psychological difficulties and solutions for reducing and dealing with the mental health stigma are discussed.
FAST-NU
COMPUTER SCIENCE DEPARTMENT
PSYCHOLOGY
COURSE INSTRUCTOR: Miss sumarah rashid
Section: GR-4
Group members:
Taban Shaukat 16K3937
Huzaifah Punjani 16K3924
Anas Bin Faisal 16K4064
Abeer Zehra 16K4068
Maria Ahmed 16K4058
Module 6, Role and functions of medical social work in various medical settings.
Unit 21 - PATIENT AND FAMILY EDUCATION
(Social Work in the field of health- MSW (S3))
Professionalism is the basis of medicine’s social contract with society
Professionalism demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health
Empathy is the capacity to recognize and experience feelings that are being experienced by another.
“It is the intrapersonal realization of another’s plight that illuminates the potential consequences of one’s own actions on the lives of others.” (Hollingsworth, 2003)
Illness as a stress and coping with illness is the topic of this power point presentation and it includes the descriptions of stress, stress in acute and chronic illnesses and stress in terminal illness.
I think it will be useful to public, medical students and doctors as well.
Stern: Stigma and Mental Illness – A Barrier to Health Seekinghenkpar
Wonca Working Party on Mental Health
World mental Health Day
presentation Dr Anthony Stern (USA)
Stigma and Mental Illness – A Barrier to Health Seeking
Definition of DPR
Why does DPR matter?
Parson's Ideal Doctor & Patient
Types of DPR
Importance of DPR
Elements of DPR
Key components of DPR
Communication between Doctor & Patient
Barriers in communication
Factors influencing DPR
How to improve DPR
Patient Education
The research report Presentation addresses the stigma related to the mental health in our society. This study was intended to increase understanding of peoples’ views of mental illness by developing and administering measures of knowledge and attitudes of people toward mental illnesses.
The research conducted through questionnaires regarding the mental health stigma is reviewed and analyzed that indicates that the majority of the general public holds negative stereotypes towards people with psychological problems.
Hence, a model has been proposed to illustrate what are the peoples’ attitudes towards and knowledge about the mental health, why is it a taboo to talk about this topic, how can this stigma prevent the people from getting help for the psychological difficulties and solutions for reducing and dealing with the mental health stigma are discussed.
FAST-NU
COMPUTER SCIENCE DEPARTMENT
PSYCHOLOGY
COURSE INSTRUCTOR: Miss sumarah rashid
Section: GR-4
Group members:
Taban Shaukat 16K3937
Huzaifah Punjani 16K3924
Anas Bin Faisal 16K4064
Abeer Zehra 16K4068
Maria Ahmed 16K4058
Psychological Factors influence on healthAQSA SHAHID
“Psychosocial” factors such as stress, hostility, depression, hopelessness, and job control seem associated with physical health—particularly heart disease.Being in a good mental state can keep you healthy and help prevent serious health conditions. A study found that positive psychological well-being can reduce the risks of heart attacks and strokes. On the other hand, poor mental health can lead to poor physical health or harmful behaviors. Chronic diseases.
Examples of psychosocial factors include social support, loneliness, marriage status, social disruption, bereavement, work environment, social status, and social integration.
Psychosocial factors that may affect pain include things like marital status, social support, bereavement, home and work environment, social status, and social integration. For example, someone who is under great stress due to their family life or work stress might have a lower threshold for pain.
Definition
DEFINITION
An abnormal personality is one in which there are “ deeply ingrained maladaptive pattern’s behavior recognizable by the time of adolescence or earlier and confining through most of adult life because of this ,the patient suffer or others have to suffer and there is an adverse affect on the individual or on society.
Classification or clusters
Cluster A
Cluster B
Cluster C
Causes
Diagnosis
Treatment
Presented by: Dr. Melissa Graham, SAPD Psychologist
Jeanie Paradise, Clinical Director Crisis Care Center
Lt. Teri Neal, Director SAPD Communications Unit
Emile Clede, SAPD Communications Training Coordinator
This presentation mainly explains about the type of patients that are encountered in day to day practice as well as how each of them should be handled to improve the communication between a doctor and the patient.
Lecture on SexEd for Grade 7 female students
Instead of the usually awkward sex ed lecture, I included self-care in all aspects of health: physical, mental, emotional, social, and spiritual.
List of vaccines available in the market
This list includes trade name, manufacturer, common abbreviation, type and route of administration, and primary and booster doses for pediatric population. It also includes link to the vaccines' product information.
This is helpful especially for starting pediatricians
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Personality and Personality Disorders Behavioral response to Illness TMC Psychiatry Rotation By: Cristal Laquindanum, Russell Rivera, Justine Alessandra Uy ASMPH 2012
2. “Behavioral Responses to Illness, Personality and Personality Disorders” Robert J. Ursano, MD Richard S. Epstein, MD Susan G. Lazar, MD Reference
3. Cluster of characteristic behavioral responses that depend on a person’s past experiences, biological propensities, social context, and view of the future. Not static. Changes throughout the life cycle (childhood adulthood old age)
4. Past experiences form the lenses through which the patient looks at the present world directs the pattern of future behaviors Biological propensities underpinning of basic human feelings such as anxiety and excitement; directs individuals’ needs for security, novelty, and avoidance. Social context complex web of interpersonal relationships that make up our world and influence our behavior personality
5. Patient’s personality interacts with and is reactive to the individuals on the treatment team Transference and counter-transference CL psychiatrist’s goals is to understand how the patient’s personality contributes to the patient’s illness, treatment, and adaptation.
6. Identify patient’s behavioral tendencies both during times of acute stress and throughout the life cycle Identified from the present and past history of the patient, MSE, observations of how the patient relates to others Defense Functioning Scale High adaptive level, mental inhibitions level, minor image-distorting level, disavowal level, major image-distorting level, action level, level of defensive dysregulation. Defense mechanisms
8. Common responses to illness High adaptive level: maximize gratification and promote optimum balance between conflicting motives Affiliation Altruism Anticipation Humor Self-assertion Self-observation Sublimation Suppression
9. Common responses to illness Mental inhibitions (compromise formation) level: keep threats out of awareness Displacement Dissociation Intellectualization Isolation of affect Reaction formation Repression Undoing
10. Common responses to illness Minor image-distorting level: distortions used to regulate self-esteem Devaluation Idealization Omnipotence
11. Common responses to illness Disavowal level: removal from awareness or misattribution to external causes Denial Projection Rationalization
12. Common responses to illness Major image-distorting level: gross distortion or misattribution of the image of self or others Autistic fantasy Projective identification Splitting of self-image or image of others
13. Common responses to illness Action Level: action or withdrawal Acting out Apathetic withdrawal Complaining Help-rejecting Passive aggression
14. Common responses to illness Level of defensive dysregulation: pronounced break with objective reality Delusional projection Psychotic denial Psychotic distortion Exaggerated character defense mechanisms
15. Dependent clingers Entitled demanders Manipulative help rejecters Self-destructive deniers Four Types of patients who stir dislike and hate in physicians, Groves (1978)
16. Patients… Demanding and prone to rejection Shows extreme gratitude with flattery “sticky”, unable to be left alone Associated personality traits/disorder: codependent Clinicians… Make time limits clear in advance and schedule appointments so that patients know when their next contacts will be Ensure consistency in staff-patient interactions may decrease the aversion Dependent clinger
17. Patient… Also profoundly needy Overtly hostile and belittling in an unconscious attempt to avoid feelings of helplessness and overwhelming fear of the illness Associated personality traits/ disorders: Narcissistic, borderline personality disorder Clinician… Often wants to counterattack (can easily become vindictive and punitive rather than to help) Encourage to accept the patient’s angry sense of entitlement & redirect the entitlement to an expectation of appropriate medical attention Must not challenge the entitlement; recognize and decrease the terror of abandonment and mistreatment that often fuels this type of patient’s angry demands Entitled demander
18. Patient… Pessimistic, undermine treatment, negative about their care Very dependent and seemingly inexhaustible in their demands Typically defeat all attempts to satisfy their needs Wants to be close to their doctors and nurses while keeping them at a safe distance Clinician… Manipulative help rejecters Might feel anxious, irritated, frustrated and depressed, eventually doubt their own skills Help the patient limit demands and hostility by reassuring him or her that good care will be provided, while encouraging the treatment team to help the patient maintain a sense of separateness and autonomy
19. Patient… Most difficult of the four types of patients Believe that there is no hope Denial helps them survive Uncooperative and dependent Appear to desire self-destruction by continuing to engage in self-injurious behaviors, such as drinking or smoking, after developing repeated serious medical complications caused by these behaviors Clinician… Attitude of diligence and compassion Treat the underlying depression Physician must lower his or her expectations and accept the limits the patient places on the treatment and on the physician Often feels angry and must grapple with his or her ongoing feeling of loss of power and competence Self-destructive denier
20. Patients feel… Physicians should… Help medically ill patients accept inevitable demands of the hospital, their loss of autonomy, and their dependency on the treatment team Sense of control over their illness can greatly enhance the doctor-patient relationship Helplessness and control Frequently experience fear and feelings of helplessness. Not knowing enough facts about their illness and treatment increases sense of helplessness.
21. Correlation between self-regulation and health, independent of physical risk factors. High degrees of self-regulation actively regulate their own lives, without a degree of emotional dependence on others Low degrees of self-regulation have higher blood pressure, are more likely to have diabetes, exercise less, are more overweight, smoke and drink more, have more accidents, have poorer diets, and are more frequently ill and spend more time in the hospital Helplessness and control
22. Altering psychological risk factors with cognitive behavioral treatment reduced mortality Geyer (1997), those with strong sense of coherence see the world as comprehensible, manageable, and meaningful = better health Controllable conditions, monitoring information is adaptive Uncontrollable conditions (terminal illness), avoiding distressing information and blunting may be more adaptive Helplessness and control
23. Physicians… Shame Non-judgmental, emphatic, and supportive stance Encouraging ventilation of self-criticism and guilty ruminations can increase cooperativeness, improve the patient’s mood, and strengthen the doctor-patient relationship Patients… Often react with shame and guilt if their lifestyles have contributed to their illnesses. Smoking, substance abuse, risky sexual behaviors Guilt
24. Countertransference Response to the patient or an identification with the patient’s feelings and beliefs. Physician should perform a thorough evaluation and obtain information from the treatment team. Using one’s reactions to a patient as information to help understand what the treatment team experiences can help the physician recommend effective interventions. Transference and countertransference
25. Task for CL psychiatrist is to forge a therapeutic alliance with the patient and to help the patient form an alliance with the medical and surgical treatment team Address the patient’s transference and/or the countertransference of the staff Empathize with the patient’s specific fears and foster a sense of mastery and control; this may alleviate anxiety and regression and reinforce more mature cooperation. Must help other physicians and staff to avoid defensive postures that are stimulated by countertransference responses such as being too competitive, solicitous, or detached. Modeling and explaining how best to react supportively in the patient’s regressive behavior and defenses. Transference and countertransference
26. Cardiac Disease AIDS Gastrointestinal Disease Somatization and Somatization Disorder Specific illnesses, personality, and behavior
27. Personality Collection of behavioral response probabilities High likelihood of certain affective, cognitive or behavioral responses to life events
41. Somatization and somatization disorder Fogel and Sadavoy (1996) – neuroticism is a stronger predictor of somatic complaints than age Hypochondriacal behavior is not a normal part of aging Factitious Disorder or Munchausen syndrome Patients with somatic symptoms that are dramatic, self-induced, have history of emotional deprivation and severe personality disorder, fragile sense of identity, profound sense of helplessness
43. PERSONALITY TRAITS – characteristic behavioral response patterns – are the typical ways that an individual thinks, feels and relates to others. When FIXED, INFLEXIBLE, UNRESPONSIVE TO CHANGES IN THE ENVIRONMENT and MALADAPTIVE, they can result in psychological and social dysfunction and may constitute a personality disorder. Personality disorders and somatic illness
45. Five-factor System of Personality Traits This model has been used to study the relationship between individual traits and somatic disease
46. Cloniger’s Neurotransmitter-Personality Trait Classification System A classification system that attempts to integrate knowledge of the major neurotransmitter systems (dopaminergic, serotonergic, and noradrenergic) with a tri-dimensional description of personaility traits
47.
48. Classification and Assessment AXIS II DIAGNOSES are defined by symptom “menus” that range from 7-10 items. Depending on the disorder, at least 4 or 5 symptoms are necessary before a specific Axis II diagnosis can be made.
49. Diagnosis OBTAINING THE COMPREHENSIVE HISTORY necessary for diagnosing a personality disorder is time-consuming and difficult. Consultation-liaison psychiatrists initially tend to focus on the most prominent and remediable psychiatric symptomatology and defer Axis II assessment until the patient is discharged to his or her usual environment.
50. Diagnosis Some patient’s chronic physical disorders or Axis I conditions are sometimes misdiagnosed as personality disorders because the clinician incorrectly assesses the onset and chronicity of the symptoms. The high comorbidity of Axis I and Axis II disorders also creates diagnostic difficulties.
51. Epidemiology The epidemiology of personality disorders in medical-surgical patients has been limited by the nosological fuzziness of the personality disorders, the comorbidity of Axis II and Axis I disorders, the difficulty in making cross-sectional assessment at times of great duress, and the fact that epidemiological assessments of Axis II disorders are time-consuming and expensive.
52. Epidemiology Personality disorder diagnoses are almost never included in hospitalization discharge summaries. Mounting evidence suggests that somatization is associated with Axis II disorders.
53. Interaction of Personality Disorders and Somatic Illness The relative fixed behavioral response patterns found in patients with personality disorders can affect illness in many ways. The patient’s personality greatly influences his or her likelihood of seeking out rather than delaying obtaining appropriate treatment or complying with rather than interfering with needed treatment. Personality disorders per se can be major etiological factors in somatic symptomatology.
54. Interaction of Personality Disorders and Somatic Illness Poor health care habits and improper attention to early symptoms of an impending medical condition can lead to exacerbation or early onset of a disease. A somatic presentation is also very common in dissociative identity disorder (DID) and may be more frequent than in other psychiatric conditions. 35% of patients with DID also met criteria for somatization disorder.
55. Interaction of Personality Disorders and Somatic Illness Self-defeating behaviorhas been implicated frequently in treatment compliance problems. It is described as: An unconscious need to suffer and to be punished A way to punish the physician A wish for attention and caring A way to provoke rejection An exhibitionistic attempt to parade suffering to ensure lovability and respect A way to maintain worthiness to be taken care of
56. Interaction of Personality Disorders and Somatic Illness Patients with personality disorders probably constitute the group with the highest likelihood of stimulating countertransference reactions that lead to nontherapeutic staff and physician behavior. Personality disorders also influence the presentation of somatic illness. Consultation-liaison psychiatrists are sometimes consulted for assessment of an unusual presentation of pain by a patient.
60. Personality and Personality Disorders Behavioral response to Illness TMC Psychiatry Rotation By: Cristal Laquindanum, Russell Rivera, Justine Alessandra Uy ASMPH 2012
Editor's Notes
Intimidates, devalues, induces guilt,
Resists treatmentManagement: schedule regular follow up visits, tell them the treatment may not cure the illness, dii
Monitoring – tendency to focus attention on a stressor and one’s responses to it; includes gathering and applying relevant informationBlunting – focus attention away from the stressors and one’s own reactions and thus avoiding, rejecting, and denying the existence of relevant information.