Occupational therapy in acute inpatient psychiatry: an activities health approach

This article discusses some of the challenges that occupational therapists working in acute psychiatric inpatient settings commonly face. There is often a lack of sufficient time available for treatment as well as limitations inherent in addressing functional problems in the artificiality of a hospital environment. A theoretical framework is introduced from which the role of occupational therapy and realistic objectives for acute short-term care can be identified. This framework for inpatient occupational therapy practice is based on the concept of activities health, which provides a definition of health in functional rather than medical terms. The importance of emphasizing the patient's competence in roles assumed in community living is emphasized. A step-by-step approach to program development with specific examples is also provided.     

Rheumatoid arthritis: more aggressive approach improves outlook

As recently as 10 years ago, many patients with rheumatoid arthritis would receive only a nonsteroidal anti-inflammatory drug and low-dose corticosteroids until damage to their joints was documented. Now, despite risks of toxicity and adverse effects, a disease-modifying antirheumatic drug such as methotrexate is given as early as possible to retard disease progression and help prevent new erosions. Other agents can be added to or used in place of methotrexate, such as a biologic response modifier that regulates the proinflammatory cytokine tumor necrosis factor-alpha.     

An aggressive approach to promoting health responsibility

1. A self-care framework is appropriate for nursing assessment of health-promoting lifestyle practices among older adults. 2. Older adults do accept responsibility for their own health and practice preventative and health-promoting behaviors. 3. This group of adults does plan changes in health habits. A significant number are able to sustain change in habits over time. 4. Nurses are not perceived as sources of health-promoting information or support for health activities by this age group. Nurses need to be more aggressive promoters of health for all adults to retain this very important component of nursing practice.     

Preventive treatment of migraine: an overview

The pharmacologic treatment of migraine may be acute (abortive, symptomatic) or preventive (prophylactic). Most migraine preventive medications were designed to treat other disorders (e.g., propranolol for hypertension, valproate for epilepsy, etc.). Preventive medication is usually given daily for months or years; however, treatment can be episodic, subacute, or chronic. The medications can be divided into two major categories: (i) Alternatives of high efficacy, which include β- blockers , tricyclic antidepressants , and divalproex , and of lower efficacy, which include selective serotonin reuptake inhibitors, calcium channel antagonists, and non-steroidal antiinflammatory drugs and (ii) second-line choices of high efficacy, which include methysergide and monoamine oxidase inhibitors. The choice of preventive treatment depends on the individual drug's efficacy and side effects, the patient's wants, needs, and response to prior treatment, and the presence of any comorbid or coexistent disease.     

A solution-focused approach to engagement in acute psychiatry

Mental health nurses working in acute wards need to be able to engage with patients, yet this is becoming increasingly difficult to do. With discharge plans often made as soon as patients arrive, and discharges precipitated by demand for beds, how do nurses engage patients and what do they engage them in? Solution-focused communication skills can help in this respect. The techniques are simple and not time-consuming and give nurses a clear sense of a therapeutic role. This article discusses how solution-focused approaches benefit patients and nurses.     

Anal melanoma: an aggressive malignancy masquerading as hemorrhoids

Anal melanoma is a devastating malignancy easily confused with benign hemorrhoids. Physician unfamiliarity with this bleeding rectal lesion can lead to delays in diagnosis and therapy. Four cases of anal melanoma, all initially mistaken for hemorrhoids, have been documented in the past 4 years at our institution. Despite surgical intervention and chemoimmunotherapy, each patient succumbed to widely metastatic disease. Average survival was 15.2 months. The clinical, pathologic, surgical, and oncologic features of anal melanoma are reviewed to enhance physician recognition of this unusual anorectal disorder.     

Teaching psychiatry in a new medical school: a multimedia approach.

As a developing department in a new medical school, we were able to improve our curriculum by using a multimedia approach to teaching psychiatry. We relied heavily on a programmed self-instructional text with videotaped clinical examples (PLS), learning objectives, formal classroom presentations, small group discussions, self-assessment exercises, an affective approach to the patient-doctor relationship using role-playing and videotaped patient vignettes, and finally live patient interviews. We believe we have been able to present the widely agreed upon content in the basic science years, using a wide variety of teaching materials and technics which maintain the interest of most students.     

Preventive psychiatric-mental health nursing using a group approach

With psychiatric-mental health professionals in constant search of mechanisms to promote mental health more effectively and efficiently and maintain people in the community, increasing attention is being given to the utilization of group skills. Group work within hospitals and mental health centers has become generally well established, but it has yet to be fully utilized in the community.     

Whole systems working and acute inpatient psychiatry: an exploratory study

The concept of 'whole system' working is fundamental to contemporary policy and consequently to practice and service development within UK mental health services. This paper reports on an exploratory study of the meaning of the 'whole system' to staff working within adult mental health services in North Wales, conducted within a broader practice development project. A focus group was used to collect data from a multiprofessional group drawn from two acute inpatient wards, Community Mental Health Teams (CMHTs) and an assertive outreach team. Thematic analysis generated three themes central to effective whole system working in adult mental health services. Discussion on the efficacy of the whole system gave rise to an understanding that this whole system varies in its effectiveness in responding to people with differing clinical presentations. Furthermore, it appears that under certain circumstances, the whole system may work to shift responsibility in order to manage worker's anxiety more adroitly than, for example, working creatively to respond to people's needs. The paper concludes that whilst by no means exhaustive or complete, these three themes enable critical reflection, discussion and identification of practice development challenges that may facilitate more effective whole system working and better services in North Wales and possibly in other settings.     

Coping with the aggressive patient: an alternative to punishment.

Extremely aggressive patients in mental institutions constitute a threat to staff and other patients that usually necessitates the use of physical restraints. With chronically aggressive patients this cycle of behaviors is defeating for both the staff and the patient. In this case history the authors describe how positive and negative reinforcement and shaping were used to alter the previously unmanageable aggression of a 36-year-old male psychiatric patient.     

Castleman disease mimicking an aggressive retroperitoneal neoplasm

A case of Castleman disease of the retroperitoneum in a 26-year-old woman is presented. Sonography, computed tomography, and magnetic resonance imaging demonstrated a large retroperitoneal mass with somewhat heterogeneous imaging characteristics. Although a definitive preoperative diagnosis was not possible, magnetic resonance imaging was useful in delineating the extent of the tumor and defining the characteristics of surrounding soft tissues.     

Management of common stress fractures. When to apply conservative therapy, when to take an aggressive approach

Stress fractures are an increasingly common injury in primary care patient populations. Early diagnosis and prompt conservative therapy are effective for most of these injuries. Special attention to clues from history taking and physical examination in an at-risk patient population can lead physicians to the correct diagnosis. Most stress fractures resolve with rest and progressive reintroduction of stressors, but certain injuries, such as stress fractures of the femoral neck and fifth metatarsal, have a high risk of complications and require aggressive therapy.     

A positive approach to the treatment of aggressive brain injured clients

A broad spectrum behavior therapy approach was used to treat physical aggression in five brain injured clients. The approach employed high density reinforcement, reinforcer sampling, environmental control, selection of appropriate responses, inconvenience review, self-control training and self-monitoring. All five clients showed significant decreases in aggression immediately after the implementation of the program.