1/11. causality in medicine: towards a theory and terminology.One of the cornerstones of modern medicine is the search for what causes diseases to develop. A conception of multifactorial disease causes has emerged over the years. Theories of disease causation, however, have not quite been developed in accordance with this view. It is the purpose of this paper to provide a fundamental explication of aspects of causation relevant for discussing causes of disease. The first part of the analysis will discuss discrimination between singular and general causality. Singular causality, as in the specific patient, is a relation between a concrete sequence of causally linked events. General causation, e.g. as in disease etiology, means various categories of causal relations between event types. The paper introduces the concept of a reference case serving as a source for causal inference, reaching beyond the concept of general causality. The second part of the analysis provides exemplification of a theory of causation suitable for discussing singular causation. The chain of events that induce a disease state can be identified as effective causal complexes, each complex composed of non-redundant components, which separately contribute to the effect of the complex, without the individual component being necessary or sufficient in itself to produce the effect. In the third part of the analysis the theory is elaborated further. Causes, defined as non-redundant components, can furthermore be differentiated according to their avoidability, according to theories about human error or by the potential of eradication. Multifactorial models of disease creates a need for systematic approaches to causal factors. The paper proposes a taxonomical terminology that serves this purpose.- - - - - - - - - - ranking = 1keywords = individual (Clic here for more details about this article) |
2/11. Prematurity and adult minor illness.The long term impact of being born premature has received limited scientific investigation. Studies that have been carried out, focus on outcomes in childhood, with very few considering the impact on adult physical health. Three case studies are presented here, investigating differences in adult minor illness and psychological variables between adult participants born preterm, fullterm but small and fullterm with normal birthweight. This is a retrospective design using questionnaires and checklist to gather relevant information. Minor illness symptoms, daily hassles, anxiety, depression and general self-efficacy were measured. The participant born preterm scored higher on all measures. Data were applied to the Equilibrium Model for Minor Illness. Being born early appears to have a greater impact on later adult outcomes measured than being born fullterm but small or fullterm but of normal weight. In this article the authors reflect upon possible explanations for the different outcomes of each of the participants within the foetal origins of disease theory.- - - - - - - - - - ranking = 5.3281017064571keywords = health (Clic here for more details about this article) |
3/11. A Canadian medical-psychiatric inpatient service.Patients with both psychiatric and medical illnesses present complex and, at times, difficult diagnostic and management problems. Medical-psychiatric units designed to provide integrated medical and psychiatric care have been established in the united states. This paper describes the development and structure of such a unit established at a Canadian general hospital, using psychiatric facilities and resources already in place. A one year review of the characteristics of patients discharged from the service found that their mean length of stay was similar to that of inpatients discharged from the general adult inpatient services, but shorter than that of patients discharged from the psychogeriatric service. Many of these patients had neurological conditions; coexisting affective disorders, substance abuse, organic mental syndromes and somatoform disorders were diagnosed frequently. We believe that a medical-psychiatric inpatient unit can provide integrated care to patients who might otherwise receive less than adequate care.- - - - - - - - - - ranking = 252.97269592292keywords = service (Clic here for more details about this article) |
4/11. Maladaptive denial of physical illness: a proposal for DSM-IV.Denial of physical illness is a commonly encountered problem in consultation-liaison psychiatry. Although there is an extensive literature on denial, it has virtually ignored the diagnostic issues raised by the individual whose denial of physical illness is clearly maladaptive. The authors propose that DSM-IV include a subtype of adjustment disorder called "with maladaptive denial of physical disorder." They discuss this new category, its differential diagnosis, and the benefits to clinical practice of this proposed addition to diagnostic classification.- - - - - - - - - - ranking = 1keywords = individual (Clic here for more details about this article) |
5/11. Adaptive responses to illness and disability. Healthy denial.The authors attempt to understand the nature and sources of "resilience" by a comparison of three individuals who showed unusual courage in the face of death, illness, and congenital disability. Various adaptive traits that enabled them to function effectively and remain optimistic are discussed. The authors specifically consider the role of "healthy" denial and argue that it does not fully explain or account for their singular optimism confronting adversity. The term "resilience" is proposed to describe both the particular cognitive style of "hardiness" and the "ego strength" that characterize such patients. Possible sources and origins of resilience are suggested. Finally, implications for the treatment of such patients are considered.- - - - - - - - - - ranking = 6.3281017064571keywords = health, individual (Clic here for more details about this article) |
6/11. Silence as resistance to medical intervention.A group of 47 individuals initially silent about their physical symptoms and/or dysfunction were studied after they finally had come to medical attention. They were then interviewed, using the associative anamnesis technique, to evaluate the psychologic aspects of their silence. It was found to be a key element in the defensive complex directed against intense neurotic feelings activated by the patient's current physical condition. The tendency toward silence appeared to have been reinforced by emotionally traumatic experiences involving physical illness or injuries in early life. Also found associated with silence were such different factors as a series of ostrich-like denying rationalizations, a fanatic commitment to cultist beliefs, a conviction that emotional conflict is the primary cause of organic illness, and motivations linked to retention of power in reality situations. Clinical examples drawn from these categories are given. Means of increasing the awareness that such silence exists and methods of dealing with it are discussed.- - - - - - - - - - ranking = 1keywords = individual (Clic here for more details about this article) |
7/11. The Pena-Shokeir syndrome: report of nine Dutch cases.We report on nine individuals with the Pena-Shokeir syndrome. Clinical findings are compared with data on patients from the literature. Emphasis is made on genetic background, neuropathological findings, and (in two cases) on prenatal data. Possible pathogenetic mechanisms are discussed.- - - - - - - - - - ranking = 1keywords = individual (Clic here for more details about this article) |
8/11. The role of family therapy in treating physical illness.Family relationships, behavior patterns, and the manner of responding to stress are important causal factors in physical illness and in health. Using case examples from his own practice as well as a review of the literature, he demonstrates ways that families help create and complicate physical illness. elements of his family therapy program that he feels contribute to its success include helping the family focus on the past in relation to present concerns, investigating ways the family reacts to the illness, asking the patient why he is ill, conducting classes in stress release, and helping the family change patterns of interaction.- - - - - - - - - - ranking = 5.3281017064571keywords = health (Clic here for more details about this article) |
9/11. culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described as illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.- - - - - - - - - - ranking = 5.3281017064571keywords = health (Clic here for more details about this article) |
10/11. A combined treatment approach to anxiety in the medically ill.Anxiety occurs frequently in patients who are medically ill. A proper search for the underlying cause of the anxiety is essential if the clinician is to make a correct diagnosis and initiate appropriate treatment. Two aspects of the patient's history are particularly important during assessment: the duration and severity of medical illness (and treatments) and the duration and severity of anxiety symptoms. When acute anxiety is encountered, the clinician must rule out a rapidly worsening medical condition, substance-induced anxiety (toxicity or withdrawal), and a psychological reaction to stressors associated with the medical illness. During evaluation of medically ill individuals with chronic anxiety, the clinician must rule out medical disorders that can mimic anxiety disorders, psychiatric disorders associated with anxiety symptoms, and poor adjustment to the medical illness. It is also worth remembering that anxiety disorders occur at an increased frequency in individuals who have chronic medical illness.- - - - - - - - - - ranking = 2keywords = individual (Clic here for more details about this article) |
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