High utilizing as a team effort

The following report describes Mr. Z., who was a former long-term hospitalized psychiatric patient and who turned from a permanent inpatient into a high utilizer of a hospital in a process of several years. In addition the report describes the commitment and often unconventional ways of cooperation by different staff and institutions, that made it possible for Mr. Z. to look forward to a future outside the hospital.     

Is a Machine Realization of Truly Human-Like Intelligence Achievable?

Even after more than a half a century of research on machine intelligence, humans remain far better than our strongest computing machines at a wide range of natural cognitive tasks, such as object recognition, language comprehension, and planning and acting in contextually appropriate ways. While progress is being made in many of these areas, computers still lack the fluidity, adaptability, open-endedness, creativity, purposefulness, and insightfulness we associate with the supreme achievements of human cognitive ability. Reasons for this and prospects for overcoming these limitations are discussed.     

Truly Reconciling the Case of Jahi McMath

This article clarifies some issues raised by Dr. Ariane Lewis in her recent “Current Opinion/Arguments” article on the case of Jahi McMath. Review of case materials. Jahi’s case most likely represents an instance of global ischemic penumbra (GIP) mimicking brain death (BD), with intracranial blood flow too low to support neuronal function or to be detected by radionuclide scan but sufficient to prevent widespread necrosis. Her MRI scan 9 months after the ischemic insult showed gross preservation of cortical and internal structures, incompatible with there ever having been a period of completely absent blood flow. Regarding Jahi’s alleged intermittent responsiveness, the set of videos, unsystematic as they are, constitutes convincing evidence that her movements in seeming response to command are not of spinal cord origin and are indeed voluntary responses, placing her in the category of minimally conscious state (MCS). In the absence of serial examinations by experts in MCS, the benefit of the doubt should be given. Unfortunately, her death on June 22, 2018, 4½ years after the diagnosis of BD, precludes such examinations. During those 4½ years, Jahi underwent menarche, with three documented menstrual periods, and ongoing pubertal development. Her case is an important example of false-positive diagnosis of BD, demonstrating the inability of current diagnostic standards to distinguish true BD from potentially reversible brain nonfunction due to GIP. The incidence of such mimicry is impossible to determine, because in most cases a BD diagnosis becomes a self-fulfilling prophecy.     

Building a campus crisis team

Crisis events can produce waves of shock, fear, and disbelief throughout a community. The university campus is a community and no stranger to crisis events. Incidents such as natural disasters, bus accidents, fire, and death on campus have demonstrated this fact. Communities, including the university, are becoming more aware of the need to develop plans to respond to these crisis events. Communities that are prepared to respond to such events may moderate the impact that the crisis has on a community. This article discusses the issues confronted by a small liberal arts university's faculty and staff as they worked together to develop and sustain a crisis response team.     

REFLECTIONS of a community mental handicap team

Eighteen months on from its introduction the members of the Central Frenchay Community Mental Handicap Team reflected on their activities, looking at who had done what to whom, where, why, and with what results. Whilst recognising that service user based data may not be the most effective measure for evaluating team performance, nevertheless the information provides a useful starting point for analysing the achievements of one community mental handicap team during its implementation period.     

Antiepileptic Drug Therapy: When Is Epilepsy Truly Intractable?

Summary: We define intractable in the first 5 years of epilepsy treatment as an average of at least one seizure every 2 months. For the longer term, we define intractable as at least one seizure per year. Population studies from Chicago, IL, U.S.A., Finland, and Nova Scotia, Canada indicate that with long follow-up, many children with intractable epilepsy eventually have remission of their seizure disorder. Epilepsy is no longer intractable when the seizures stop completely. How often does a new antiepileptic drug (AED) render a child seizure-free when one or more AEDs have failed? Literature on adults with epilepsy suggests that few with chronic epilepsy who have not achieved seizure control with several AEDs will achieve complete seizure control with additional AEDs. The Nova Scotia study suggests that if a child's seizure fails to be controlled with a first AED, there is an increased risk of intractable epilepsy. Nonetheless, the chance of eventual, complete remission of epilepsy (seizure-free without AED treatment) is approximately 40%. We conclude that intractability should not be considered until there has been failure of at least three first-line AEDs. Intractable epilepsy is rare. Careful definition of the characteristics of children with intractable epilepsy who do respond completely to new AEDs will likely provide the only rational approach to treatment of children with three drug failures. Collaboration by multiple epilepsy centers will be required to gain this information.     

A multidisciplinary approach to team nursing within a low secure service: the team leader role

PURPOSE: This article critically examines the clinical utility of redesigning a nursing practice model within the Intensive Support and Intervention Service, a new low secure mental health facility in the United Kingdom. Specifically, the “team nursing” approach to care delivery has been adapted to consist of multidisciplinary team leaders as opposed to nursing team leaders. FINDINGS: The authors describe the role, properties, and functions of the multidisciplinary team leader approach. The authors provide examples of the benefits and challenges posed to date and the ways in which potential barriers have been overcome. PRACTICE IMPLICATIONS: Nursing care leadership can be provided by multidisciplinary staff. An adapted model of team nursing can be implemented in a low secure setting.     

Self-immolation as an effort of self-rescue during a psychotic episode

Self-immolation as reported in the literature usually happens in the context of suicide acts or political martyrdom. We report a case in which a patient during a first psychotic episode attempted to immolate herself: she covered her legs with pieces of clothing and set them a fire. Severe burning made amputation of both her legs necessary, one above, one below the knee. The patient had not acted in this way in order to die, but to save herself from the impending end of the world. She was convinced the earth was going to explode, and she would only be able to flee to Venus by self-immolation. She acted under the influence of imperative acoustic hallucinations encouraging her and pressing her to proceed. Antipsychotic treatment with clozapine resulted in complete remission of all psychotic symptoms. Other than during psychosis the patient didn't believe in life on other planets, had no fantasies about the end of the earth, no contact with sects and no religious or cultural motives for self-immolation.     

Experiences of a psychiatric outpatient team in Nicaragua

Summary The paper presents experiences from one of the first psychiatric out-patients teams in Nicaragua which was started in 1982. 198 patients consecutively attending the unit were studied thoroughly as regards clinical diagnosis and areas of conflict presented as reason for attendance. Depressive neurosis and anxiety neurosis were the predominant diagnoses, followed by epilepsy and schizophrenic disorders. Almost half of the patients stated that they had family problems.