ABSTRACT
The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).
Subject(s)
Developing Countries , Epilepsy/epidemiology , Patient Acceptance of Health Care/statistics & numerical data , Psychotic Disorders/epidemiology , Schizophrenia/epidemiology , Adolescent , Adult , Complementary Therapies/statistics & numerical data , Cross-Sectional Studies , Epilepsy/diagnosis , Epilepsy/therapy , Family Practice/statistics & numerical data , Female , Health Services Accessibility/statistics & numerical data , Health Services, Indigenous/statistics & numerical data , Homeopathy/statistics & numerical data , Humans , Malaysia , Male , Middle Aged , Primary Health Care/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Referral and Consultation/statistics & numerical data , Schizophrenia/diagnosis , Socioeconomic FactorsABSTRACT
Se presenta a consideración las dificultades habituales para la toma del caso de enfermos mentales debido principalmente a la proliferación de síntomas psíquicos causados por su enfermedad y por los cambios provocados en la personalidad por las psicodrogas, entre otras. Se expone el pensamiento de Hahnemann al respecto expresado en el Organón entre los parágrafos 216 al 230 y se presenta un caso clínico profundamente estudiado y seguido a través de muchos años. Finalmente se propone un esquema para la toma del caso con el siguiente orden jerárquico: 1) Causalidad: a) Enfermedad somática precedente. b) Desencadenantes afectivo-emotivos. 2) Personalidad premórbida. 3) Síntomas generales. 4) Síntomas mentales de la insanía. 5) Tipos de insanía