1/7. Treating obsessive compulsive disorder: a new role for infectious diseases physicians?BACKGROUND: patients with psychiatric disorders are often seen by infectious disease physicians. Sometimes the psychiatric condition is the primary disorder, and the physician's main task is the early identification of the disorder and referral to specialist psychiatric services. On other occasions, the psychiatric condition will need to be addressed in addition to the infectious disease, and the physician aims to treat in conjunction with a psychiatrist. It is rare for referrals to be made from psychiatry to infectious diseases physicians. METHOD: A single case study is used to describe a modification of Danger Ideation Reduction Therapy (DIRT), a novel intervention for obsessive compulsive disorder (OCD). In our modification the infectious diseases physician plays a key, collaborative role in the psychological treatment of the patient. RESULTS: Although an uncontrolled trial, results from the modified DIRT protocol are encouraging and warrant replication in a randomised controlled trial. CONCLUSIONS: A collaborative approach by the infectious diseases physician, the microbiology laboratory and the psychologist can provide a valuable means of retaining patients with OCD in treatment and in the management of this common, disabling condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Evaluation of the returned traveler.Recognition of clinical syndromes in returned travelers is an important part of providing care to international travelers. The first step is to take a history with attention to pre-travel preventive measures, the patient's itinerary, and potential exposure to infectious agents. The patient should then be examined to document physical signs, such as fever, rash, or hepatosplenomegaly, and to have basic laboratory data obtained. This evaluation will provide most physicians with the necessary information to generate a differential diagnosis. Each diagnosis should be matched against the incubation period of the disease, the geographic location of illness, the frequency of illness in returned travelers, and the pre-travel preventive measures. Careful attention to these aspects of patient care should result in the appropriate diagnosis and therapeutic intervention for the ill returned traveler.- - - - - - - - - - ranking = 0.1keywords = physician (Clic here for more details about this article) |
3/7. Avoiding laboratory pitfalls in infectious diseases.In today's medical care environment, clinicians are challenged to order clinically relevant, cost effective laboratory tests and antibiotic therapy. Together, physicians and laboratories must have guidelines and strategies that can provide quality patient care, while minimising costs and preventing further emergence of antimicrobial drug resistance. Five clinical vignettes that demonstrate these principles are presented.- - - - - - - - - - ranking = 0.1keywords = physician (Clic here for more details about this article) |
4/7. patients with delusional and bizarre thinking.patients with delusional or other types of bizarre thinking are often incorrectly labeled as schizophrenic. This error has significant medical and social implications to the patient. Delusional thinking has been linked with a variety of nonschizophrenic problems including the use of licit and illicit drugs, a wide variety of medical diseases, and nonschizophrenic psychiatric disturbances. A series of case studies in which the diagnosis of schizophrenia was incorrectly made elucidates the problem and helps the physician consider the alternatives.- - - - - - - - - - ranking = 0.1keywords = physician (Clic here for more details about this article) |
5/7. Infectious disease marker testing of the autologous blood donor. A case study in clinical ethics.OBJECTIVE--The food and Drug Administration currently requires written authorization from the patient's physician before autologous units of blood that are positive or reactive for hepatitis b surface antigen or anti-human immunodeficiency virus can be shipped from a site of collection different from the site of transfusion. Additionally, the blood Products Advisory Committee has recommended the universal testing of all autologous units of blood. DESIGN--The case of an autologous blood donor with positive infectious disease markers is presented. The ethics of infectious disease testing of patients who preoperatively donate their own blood is discussed. RESULTS--Many ethical issues are raised by policies requiring infectious disease testing of the autologous blood donor. blood banking and transfusion medicine specialists should examine the ethical issues raised by regulatory mandates to perform infectious disease testing of the patient who desires to make a preoperative autologous blood donation. CONCLUSION--A policy that protects the rights of the patient as well as the rights and concerns of health care professionals should be pursued.- - - - - - - - - - ranking = 0.1keywords = physician (Clic here for more details about this article) |
6/7. Ethical issues in infectious diseases.Ethical behavior is an essential component of professional life. Developments in medical science continually test society's concepts of right and wrong, of virtue and morality. Ethical conflicts will be played out in public with greater frequency and intensity. physicians will be challenged to maintain high standards of ethical conduct despite the pressures that personal preference, society, and government may exert. We do not present neat solutions to ethical conflicts, but we describe a framework for understanding models of physician behavior and outline an approach to the analysis of problems.- - - - - - - - - - ranking = 0.1keywords = physician (Clic here for more details about this article) |
7/7. Psychiatric diseases presenting as infectious diseases.Although many psychiatric diseases have somatic manifestations, some focus on fears or delusions of infection. When a patient with a psychiatric basis for an apparent infection presents to an infectious disease physician, the physician may find the problem confusing, amusing, and ultimately frustrating until the psychiatric basis for disease is recognized. Some of these psychiatric disorders can be treated and controlled with medication and psychotherapy, although patients may resist psychiatric referral. This article reviews examples of psychiatric disorders in patients who present to the infectious disease physician, including factitious infection, malingering, obsessive compulsive disorder, phobias, veneroneuroses, somatization disorders, and delusional infection. The role that physicians play in amplifying these disorders is reviewed. Strategies for referral to psychiatric services are also discussed. patients with a psychiatric disease are seen in infectious disease practices more commonly than physicians realize.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |