RESUMO
The abuse of psychiatry in Nazi Germany 60 years ago was the abuse of the 'duty to care'. Its scale was enormous; 300,000 people were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe. This episode occurred in a country with a high reputation for its medicine, including psychiatry, and for its interest in the ethics of medical research. The economic conditions which preceded the violent political upheaval had led to increasing concern about 'the burden on the State' of the mentally ill and disabled. These preoccupations are still with us today. There may still be lessons to be learnt from the Nazi episode.
Assuntos
Experimentação Humana/história , Sistemas Políticos/história , Política , Psiquiatria/história , Pessoas com Deficiência/história , Ética Médica/história , Alemanha , História do Século XX , Humanos , Transtornos Mentais/história , Transtornos Mentais/terapiaAssuntos
Felicidade , Transtornos Mentais/classificação , Transtornos do Humor/classificação , Escalas de Graduação Psiquiátrica , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Senso de Humor e Humor como AssuntoRESUMO
DSM-III has largely been based upon essentialist notions of increasingly accurate and 'valid' definitions of diseases. A nominalist approach would facilitate study of aetiological factors and variables in the natural history of diseases.
Assuntos
Transtornos Mentais/classificação , Filosofia Médica , Escalas de Graduação Psiquiátrica , Humanos , Transtornos Mentais/diagnóstico , Encaminhamento e ConsultaRESUMO
A system of ward support for chronic psychiatric patients in an urban community is described, which makes available ward and staff facilities throughout the 24 hours and at weekends. Details are given of a group of 41 patients using this facility over a period of six months. Two types of use of the ward were identified, based on the amount of social interaction with other staff and patients. The 'unengaged', with a high rate of visits, were mainly schizophrenic patients with an early first onset of illness and currently a scanty social network (small primary group and often no confidant). The 'engaged', with a lower rate of visits, were people with a later onset and a larger social network.
Assuntos
Serviços Comunitários de Saúde Mental , Unidades Hospitalares , Meio Social , Apoio Social , Adulto , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Esquizofrenia/terapia , AutocuidadoRESUMO
The excretion of N,N,-dimethyltryptamine (DMT) has been measured in longitudinal studies of five patients with schizophrenic illnesses and in four patients with rapidly or slowly cycling manic-depressive illness. The excretion of DMT was frequently raised in patients when they were psychotic but was usually normal when they had recovered. However, rapid changes in the severity of illness or sudden switches from one mood state to another were not accompanied by changes in the excretion of DMT. These findings contrast with the immediate hallucinogenic effects of an injection of DMT, and suggest that the extracerebral production of DMT (as measured by its urinary excretion) does not provoke the experience of hallucinations in psychotic patients.
Assuntos
Transtorno Bipolar/urina , N,N-Dimetiltriptamina/urina , Esquizofrenia/urina , Triptaminas/urina , Transtorno Bipolar/psicologia , Feminino , Humanos , Masculino , Psicologia do EsquizofrênicoRESUMO
The excretion of the hallucinogen dimethyltryptamine (DMT) and its precursor N-methyltryptamine (NMT) was studied among 74 recently admitted psychiatric patients and 19 normal persons. Both compounds were detected in 24-hour urine samples from all subjects. Dimethyltryptamine excretion was greatest in schizophrenia, mania, and "other psychosis" and tended to decline as clinical state improved. Psychotic depressives excreted smaller amounts of DMT more akin to those excreted by neurotic and normal subjects. Urinary NMT excretion was unrelated to psychiatric diagnosis. Ratings on the Present State Examination (PSE) also indicated that increased excretion of DMT was associated with psychotic rather than neurotic psychopathology. Forty-three percent of the variance in urinary DMT levels could be explained in terms of six of the 38 PSE syndromes. Syndromes suggesting elation, perceptual abnormalities, and difficulty in thinking and communicating were most correlated with raised urinary DMT excretion.
Assuntos
N,N-Dimetiltriptamina/urina , Transtornos Psicóticos/urina , Triptaminas/urina , Adolescente , Adulto , Transtornos Psicóticos Afetivos/urina , Idoso , Transtorno Bipolar/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Neuróticos/urina , Transtornos Paranoides/urina , Transtornos Psicóticos/psicologia , Esquizofrenia/urinaRESUMO
The urinary excretion of N,N-dimethyltryptamine (DMT) was higher in patients with severe liver disease than in normal subjects. This difference remained significant when patients with all grades of hepatic encephalopathy were excluded. Patients with liver disease whose mental states were normal excreted amounts of DMT similar to those of patients with a hospital diagnosis of schizophrenia.
