RESUMO
The introduction of "dual diagnosis" had the merit of drawing attention on substance use among patients with mental illness. In due course, as what often happens with innovations, the concept of dual diagnosis displayed considerable limitations and was progressively replaced by comorbidity. This paper critically reviews the limitations of dual diagnosis and comorbidity and formulates an alternative proposal based on clinimetric methods. In many instances of diagnostic reasoning in psychiatry and in clinical psychology, the process ends with the identification of the disorders and their diagnoses. However, diagnostic end-points, the customary guidance of diagnostic reasoning, should be replaced by the conceptualization of disorders as "transfer stations," which are amenable to longitudinal verification and modification. Indeed, diagnoses might encompass a wide range of manifestations, seriousness, prognosis, and response to treatment that need to be evaluated. A new clinimetric approach which takes advantage of clinimetric methods (including macro-analysis, micro-analysis, staging, and evaluation of subclinical symptoms) is proposed. This approach may allow an accurate analysis of the different problem areas of each patient and their hierarchical organization and may yield important implications for mental health and substance abuse clinics.
Assuntos
Transtornos Mentais/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Escalas de Graduação Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
BACKGROUND: Epidemic asthma outbreaks are potentially a very high-risk medical situation in seaport towns where large volumes of soybean are loaded and unloaded Airborne allergen assessment plays a pivotal role in evaluating the resulting environmental pollution. OBJECTIVE: The aim of this study was to measure the airborne Gly m 1 allergen level in the seaport of Ancona in order assess the soybean-specific allergenic risk for the city. METHODS: Allergen and PM10 were evaluated at progressive distances from the port area. Allergen analysis was performed by monoclonal antibody-based immunoassay on the sampled filters. Daily meteorological data were obtained from the local meteorological station. For estimating the assimilative capacity of the atmosphere, an approach based on dispersive ventilation coefficient was tried. RESULTS: The allergen concentrations detected were low (range = 0.4-171 ng/m3). A decreasing gradient of the airborne allergen from the unloading area (22.1 +/- 41.2 ng/m3) to the control area (0.6 +/- 0.7 ng/m3) was detected. The concentration of the airborne Gly m 1 was not coupled with the presence of the soy-carrying ships in the port. A statistically significant relationship between airborne allergen, PM10 and local meteorological parameters quantifies the association with the atmospheric condition. CONCLUSION: Airborne Gly m 1 is part of the atmospheric dust of Ancona. The low level of this allergen seems consistent with the absence of asthma epidemic outbreak.
Assuntos
Ar/análise , Alérgenos/química , Antígenos de Plantas/química , Asma/epidemiologia , Monitoramento Ambiental , Proteínas de Plantas/química , Alérgenos/imunologia , Antígenos de Plantas/efeitos adversos , Antígenos de Plantas/imunologia , Asma/etiologia , Asma/imunologia , Cidades , Exposição Ambiental/efeitos adversos , Epidemias , Monitoramento Epidemiológico , Humanos , Itália , Exposição Ocupacional/efeitos adversos , Material Particulado/efeitos adversos , Proteínas de Plantas/efeitos adversos , Proteínas de Plantas/imunologia , Grupos Populacionais , Medição de Risco , Glycine max/imunologiaRESUMO
The biopsychosocial model of disease has recently been depicted as the basis for a renewed emphasis on the multiaxial diagnostic system of the DSM-IV. The authors challenge this stance, underscoring the clinical inadequacies of the DSM-IV in the setting of medical disease, particularly the chapters concerned with somatoform disorders and psychological factors affecting medical conditions. Diagnostic criteria which are based on the clinical insights derived from psychosomatic research in the past decades may offer new opportunities to psychosomatic medicine and consultation-liaison psychiatry. The development of the Diagnostic Criteria for Psychosomatic Research (DCPR), encompassing alexithymia, type A behavior, irritable mood, demoralization, disease phobia, thanatophobia, health anxiety, illness denial, functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction, is described. Preliminary results obtained with the combination of DSM and DCPR criteria appear to be promising.
Assuntos
Transtornos Psicofisiológicos/diagnóstico , Papel do Doente , Transtornos Somatoformes/diagnóstico , Estresse Psicológico/complicações , Negação em Psicologia , Transtorno Depressivo/classificação , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Humanos , Humor Irritável , Moral , Escalas de Graduação Psiquiátrica , Transtornos Psicofisiológicos/classificação , Transtornos Psicofisiológicos/psicologia , Transtornos Somatoformes/classificação , Transtornos Somatoformes/psicologia , Estresse Psicológico/psicologiaRESUMO
A substantial body of research suggests that subclinical symptoms characterize the longitudinal course of major depression and have important pathophysiological and treatment implications. Specific treatment of residual symptoms may in fact improve longterm outcome, by acting on those residual symptoms that progress to become prodromes of relapse. The assessment of psychological well-being is also important, since its absence may create conditions of vulnerability to possible adversities. The route of recovery, thus, lies not exclusively in alleviating the negative, but in engendering the positive.
Assuntos
Adaptação Psicológica , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Ajustamento Social , Humanos , Relações Interpessoais , Indução de Remissão , Índice de Gravidade de DoençaRESUMO
Psychiatric illness, psychological distress and illness behavior were investigated in 30 hirsute women and 30 nonhirsute healthy control subjects matched for sociodemographic variables. The majority of patients showed a good psychological adaptation to illness: they did not report significantly more anxiety, depression, and abnormal illness behavior than controls. One-sixth of the patients, however, suffered from a clinically meaningful affective disorder. Further, hirsute patients displayed significantly more hostility and irritable mood than controls (p less than 0.01).