Physical illness in children of Holocaust survivors.

During medical or psychiatric hospitalization, Nazi Holocaust survivors may display emotional symptoms that reflect the psychological sequelae incurred by their traumatization. What is often less recognized is the idiosyncratic responses that may be seen in the children of these survivors in response to physical illness and hospitalization. Psychiatrists should be alert to the possible effects of Holocaust-related experiences. Awareness of emotional conflicts, defenses, and strengths in these individuals may enhance the therapeutic alliance as well as treatment planning. The author describes two cases illustrating adaptive and maladaptive manifestations of the Holocaust theme in response to medical illness.

Religious issues in the capacity evaluation.

The authors explore the difficulties present in the capacity evaluation of patients with strong religious beliefs. The article reviews the legal protection for treatment refusal on religious grounds as well as psychiatry's approach to religion. Clinical cases encountered in an urban hospital are presented to highlight how the conflicts among psychiatric, religious, and legal issues can be resolved. Suggestions are made for incorporating an exploration of religious values into the capacity assessment.

Severe ocular self-injury.

To further delineate the clinical characteristics of patients who deliberately, severely mutilate their eyes, we reviewed the medical records of a specialty eye hospital and found nine cases of intentional, severe, self-inflicted eye injuries. We identified two groups of patients. Most were young psychotic individuals with severe psychopathology often involving sexual and religious delusions, command hallucinations, and the propensity to act on delusions. The second group was comprised of patients with organic disabilities, either dementia or severe mental retardation, where a lack of impulse control and preexisting eye irritation or surgical operation may have contributed to the act. One patient was a recidivist. Two-thirds of the patients were confined at the time of the act. That self-mutilation may occur frequently in confined patients calls for active vigilance from caretakers; that it may recur calls for caution by the psychiatrist.

Spirituality in medicine.

Attending to the spiritual dimension of the patient can provide the physician with a more in-depth understanding of the patient and his or her needs. The physician may use a variety of spiritually informed therapeutic tools that can greatly facilitate the patient's coping ability, thus enhancing well being. Physicians' own religious or spiritual practices may impact upon their ability to function effectively in clinical practice. Specific suggestions are offered for attending to the spiritual aspects of the patient.

Using awareness of religious factors to enhance interventions in consultation-liaison psychiatry.

Religion plays an important role in the lives of most Americans and often influences the ways patients react to medical illness. However, the religious aspects of patients' lives are often ignored or only superficially explored by consultation-liaison psychiatrists. Building on an existing typology, the authors use six dimensions of religious experience to discuss approaches to incorporating religious factors in the psychiatric evaluation and treatment of the hospitalized medical patient; the dimensions include religious beliefs, participation in religious rituals, and affiliation with a religious community. Case examples illustrate how these approaches can enhance the work of the consultation-liaison psychiatrist and improve the patient's coping ability.

Oedipism in a patient with frontal lobe encephalomalacia.

There is a growing recognition of the role of the frontal lobes in the aetiology of severe behavioural aberrations. The authors describe a case of Oedipism in a patient who had MRI evidence of frontal lobe encephalomalacia. After discussing the function of the frontal lobes in modulating behaviour the authors suggest that the structural lesion seen on the MRI was in part responsible for the patient's self-destructive act. Treatment issues and the importance of recognizing underlying structural lesions in instances of extreme self-mutilation are discussed.

Religious training and religiosity in psychiatry residency programs.

The authors present the results of a survey that inquired into the religious life of 121 residents from 5 psychiatric residency programs. In addition, the study sought to explore the didactic and supervision experience of the residents regarding religious issues. The authors' results show that this group of residents appears to be more religious than what has been reported before in prior studies of psychiatrists' religious beliefs. While didactic exposure was limited, those who received didactic exposure were more likely than those who did not to believe that religion is important in the clinical setting, and the former also felt more competent to recognize and attend to a patient's religious and spiritual issues. Still, most residents felt competent to address religious issues in their clinical encounter. The implications of the results are discussed as they relate to training.