Clare Pain

Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak.

TOC Summary Line: Healthcare workers in hospitals affected by SARS experience increased psychological stress 1–2 years after the outbreak.

Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia : the Toronto Addis Ababa Psychiatry Project (TAAPP)

BackgroundGlobalization in medical education often means a “brain drain” of desperatel needed health professionals from low- to high-income countries. Despite the best intentions, partnerships that simply transport students to Western medical schools for training have shockingly low return rates. Ethiopia, for example, has sent hundreds of physicians abroad for specialty training over the past 30 years, the vast majority of whom have not returned. This represents a highly problematic net transfer of financial and human resources from the Ethiopian people to Western countries that have failed to develop their own adequate health human resource plans.MethodsWith this background in mind, in 2003 Addis Ababa University invited the University of Toronto to collaborate on the first Ethiopian psychiatric residency program to be run entirely in Ethiopia. Called the Toronto Addis Ababa Psychiatry Project (TAAPP), it was established on the principle of supplementing the ability of the small Addis Ababa University Department of Psychiatry to teach, provide clinical supervision, and to help develop educational capacity. Over the last 6 years the model has involved a large number of University of Toronto faculty and residents who have spent blocks of 1 month each in Addis Ababa.ResultsThis article describes the first three phases of TAAPP (I) Development of a model residency program; (II) Enhancing clinical, educational and leadership capacity; and (III) Sustainability, faculty development, and continuing education. Between 2003 and 2009, the number of psychiatrists in Ethiopia increased from 11 to 34; the Addis Ababa University Department of Psychiatry faculty increased members from three to nine. There are new departments of psychiatry established in four other university hospitals in Ethiopia outside the capital city. Mental health services are now being integrated within the national system of primary care.ConclusionAn important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.

Improving Physician-Patient Communication Through Coaching of Simulated Encounters

ObjectiveEffective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees.MethodsTwenty-six family medicine trainees (9 PGY1, 11 PGY2, 6 fellows) from five university-affiliated hospitals conducted four once-weekly, 30-minute videotaped interviews with “difficult” standardized patients. After each interview, trainees received 1 hour of individual coaching that incorporated self-assessment and skills-teaching from experienced psychiatrists. Two follow-up interviews with standardized patients occurred 1 week and an average of 6 months post-intervention. Trainee self-reported physician-patient communication efficacy was measured as a control 1 month before the intervention; during the month of the intervention; and an average of 6 months after the intervention. Coach-rated physician-patient communication competence was measured each week of the intervention.ResultsImprovements in physician-patient communication were demonstrated. Self-efficacy for physician-patient communication improved significantly during the intervention, in contrast to no improvement during the control period (i.e., training-as-usual). This improvement was sustained during the follow-upperiod.ConclusionsThis innovative educational intervention was shown to be highly effective in improving trainee communication competence and self-efficacy. Future applications of this brief model of physician training have potential to improve communication competence and, in turn, can improve patient care.

An Exploration of Young Adults' Progress in Treatment for Dissociative Disorder

Although treatment outcome research on dissociative disorders (DD) is increasing, an examination of treatment progress in young adults with these disorders remains noticeably absent from the literature. Many studies of DD patients report mean ages over 35. The present study examined the response to treatment of a subsample of young adults ages 18–30 with dissociative identity disorder and dissociative disorder not otherwise specified who participated in a naturalistic, longitudinal study of DD treatment outcome. Over 30 months, these patients demonstrated decreases in destructive behaviors and symptomatology as well as improved adaptive capacities. Compared to the older adult participants in the study, the young adults were more impaired initially. However, these younger patients improved at a rapid pace, such that their clinical presentations were similar to or more improved than those of the older adults at the 30-month follow-up. This brief report suggests not only that young adult DD patients can benefit from a trauma-focused, phasic treatment approach but that their treatment may progress at a faster pace than that of older adults with DD.

The Debate About Trauma and Psychosocial Treatment for Refugees

Accepted Western guidelines for the treatment of trauma survivors who are diagnosed with Posttraumatic Stress Disorder (PTSD) demonstrate an emerging consensus with regard to treatment. All of the guidelines cite strong evidence for the inclusion of an exposure component to treatment. However, the accumulated evidence base for the treatment of patients with PTSD is drawn from trials that almost exclusively do not include refugees. The question this chapter explores is the advisability of using an exposure component to the treatment of refugees who have suffered traumatic experiences and who remain symptomatic. Do we have clear evidence that exposure techniques are necessary or even advisable to resolve the psychological difficulties that refugees experience? Based on a number of reasons, the authors suggest that in the first years of resettlement and adaptation, successful treatment should be focused on settlement issues.

Partnering with local scientists should be mandatory

The problem of inequity in international research is perpetuated by policies that enable scientists to conduct research in lower-resourced areas of the world without partnering with local researchers. The World Health Organization (WHO) needs to lead in solving this problem by working with research institutions, journal editors and funding agencies to document the degree of inequity and to impose penalties for failures to collaborate.

Dissociation in Patients with Chronic PTSD: Hyperactivation and Hypoactivation Patterns, Clinical and Neuroimaging Perspectives

Part I: Dissociation: An Overview. van der Hart, Dorahy, History of the Concept of Dissociation. Braude, The Conceptual Unity of Dissociation: A Philosophical Argument. Part II: Developmental Approaches to Dissociation. Carlson, Yates, Sroufe, Dissociation and the Development of the Self. Liotti, Attachment and Dissociation. Silberg, Dallam, Dissociation in Children and Adolescents: At the Crossroads. Dutra, Bianchi, Siegel, Lyons-Ruth, The Relational Context of Dissociative Phenomenon. Barlow, Freyd, Adaptive Dissociation: Information Processing and Response to Betrayal. Schore, Attachment Trauma and the Developing Right Brain: Origins of Pathological Dissociation. Part III: Normal and Exceptional Dissociation. Dalenberg, Paulson, The Case for the Study of Normal Dissociation Processes. Steele, Dorahy, van der Hart, Nijenhuis, Dissociation versus Alterations in Consciousness: Related but Different Concepts. Cardena, van Dujil, Weiner, Terhune, Possession/Trance Phenomenon. Part IV: Acute Dissociation. Bryant, Is Peritraumatic Dissociation Always Pathological? Moskowitz, Evans, Peritraumatic Dissociation and Amnesia in Violent Offenders. Beere, Dissociative Perceptual Reactions: The Perceptual Theory of Dissociation. Part V: Chronic Dissociation. Dell, The Phenomena of Pathological Dissociation. Steele, van der Hart, Nijenhuis, The Theory of Trauma-Related Structural Dissociation of the Personality. Nijenhuis, Somatoform Dissociation and Somatoform Dissociative Disorders. Beere, The Self-System as Mechanism for the Dissociative Disorders: An Extension of the Perceptual Theory of Dissociation. ONeil, Dissociative Multiplicity and Psychoanalysis. Part VI: Neurobiology of Dissociation. Brenner, Neurobiology of Dissociation: A View from the Trauma Field. Nijenhuis, den Boer, Psychobiology of Traumatization and Trauma-Related Structural Dissociation of the Personality. Simeon, Neurobiology of Depersonalization Disorder. Pain, Bluhm, Lanius, Dissociation in Patients with Chronic PTSD: Hyperactivation and Hypoactivation Patterns, Clinical and Neuroimaging Perspectives. Part VII: The DSM-IV Dissociative Disorders. Dell, The Long Struggle to Diagnose Multiple Personality Disorder (MPD): I. MPD. Dell, The Long Struggle to Diagnose Multiple Personality Disorder (MPD): II. Partial MPD. Ross, Dissociative Amnesia and Dissociative Fugue. Simeon, Depersonalization Disorder. Part VIII: Dissociation in Posttraumatic Stress Disorder. Waelde, Silvern, Carlson, Fairbank, Kletter, Dissociation in PTSD. Ginzburg, Butler, Saltzman, Koopman, Dissociative Reactions in PTSD. Ford, Dissociation in Complex Posttraumatic Stress Disorder or Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Part IX: Dissociation in Borderline Personality Disorder and Substance Dependence. Zanarini, Jager-Hyman, Dissociation in Borderline Personality Disorder. Howell, Blizard, Chronic Relational Trauma Disorder: A New Diagnostic Scheme for Borderline Personality and the Spectrum of Dissociative Disorders. Somer, Opiod Use Disorder and Dissociation. Part X: Dissociation and Psychosis. Moskowitz, Read, Farrelly, Rudegeair, Williams, Are Psychotic Symptoms Traumatic in Origin and Dissociative in Kind? Sar, Ozturk, Psychotic Presentations of Dissociative Identity Disorder. Nurcombe, Scott, Jessop, Dissociative Hallucinosis. Ross, The Theory of a Dissociative Subtype of Schizophrenia. Part XI: Assessment and Measurement of Dissociation. Frankel, Dissociation and Dissociative Disorders: Clinical and Forensic Assessment with Adults. Brown, True Drama or True Trauma? Forensic Trauma Assessment and the Challenge of Detecting Malingering. Part XII: Treatment of Dissociation. Kluft, A Clinicians Understanding of Dissociation: Fragments of an Acquaintance. Gold, Seibel, Treating Dissociation: A Contextual Approach. Bromberg, Multiple Self-States, the Relational Mind, and Dissociation: A Psychoanalytic Perspective. Stern, Dissociation and Unformulated Experience: A Psychoanalytic Model of Mind. Part XIII: Toward a Clarified Understanding of Dissociation. Dell, Lawson, An Empirical Delineation of the Domain of Pathological Dissociation. Sar, Ross, A Research Agenda for the Dissociative Disorders Field. Dell, Understanding Dissociation.

The Girl Who Ate Her House—Pica as an Obsessive-Compulsive Disorder A Case Report

This report concerns the interesting clinical phenomenology of a 17-year-old Ethiopian female student with a long-standing history of ingesting nonnutritive materials. She was initially non-selective, but later began more exclusively consuming mud obtained from a wall in front of her house. She suffered from a feeding and eating disorder known as pica. Currently, there is no clearly established etiology for pica. This patients particular psychopathology—recurrent, unwanted, intrusive images and thoughts of the mud wall and of eating the mud; feelings of distress and anxiousness that were not relieved unless she consumed mud; and significant effects on her daily life from her uncontrollable need to return home to eat mud from her wall—suggests an ego-dystonic, obsessive thought-distress-consumption-relief pattern that is consistent with obsessive-compulsive disorder. This case may contribute to the etiological understanding that some forms of pica may be part of the obsessive-compulsive spectrum disorders.

Advancing methods for health priority setting practice through the contribution of systems theory: Lessons from a case study in Ethiopia

Setting priorities for health services is a complex and value laden process. Over the past twenty years, there has been considerable scholarly attention paid to strengthening fairness and legitimacy using the prominent ethical framework, Accountability for Reasonableness (A4R). A variety of case studies applying A4R have advanced our conceptual understanding of procedural fairness, and have highlighted the significance of context through its application. There is a paucity of research, however, that rigorously examines how and to what extent context influences health priority setting processes and the establishment of procedural fairness. We argue here that to study context rigorously requires taking a holistic view of the system by examining the dynamics and interrelationships within it. Using the Transformative Systems Change Framework (TSCF), this investigation sought to examine the influence of system factors on priority setting practice and procedural fairness. A qualitative case study of Ethiopian district health planning was undertaken in 2010 and 2011. Methods included 58 qualitative interviews with decision makers, participant observation, and document analysis. Data analysis followed in three phases: i) an inductive analysis of district health priority setting to highlight experiences across each of the three districts selected, ii) deductive analysis applying A4R and the TSCF independently; and iii) a synthesis of concepts of priority setting practice and procedural fairness within a broader, theoretical understanding of the system. Through the application of the TSCF, a nuanced understanding of priority setting practice is revealed that situates this process within a system of interdependent components that include: norms, operations, regulations, and resources. This paper offers a practical guide attuned to system features influencing the design, implementation, and sustainability of greater fairness in health priority setting practice.

The Impact of Early Life Trauma on Health and Disease: Plate section

Seeking certified reading resources? We have the impact of early life trauma on health and disease to review, not only check out, however additionally download them or perhaps check out online. Locate this terrific book writtern by by now, merely below, yeah only right here. Get the documents in the sorts of txt, zip, kindle, word, ppt, pdf, and rar. Again, never miss out on to review online and also download this publication in our website below. Click the web link.