Clinical Interviewing: An Essential but Neglected Method of Medicine

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер 93(2), С. 94 - 99

Опубликована: Янв. 1, 2024

Clinical interviewing is the basic method to understand how a person feels and what are presenting complaints, obtain medical history, evaluate personal attitudes behavior related health disease, give patient information about diagnosis, prognosis, treatment, establish bond between physician that crucial for shared decision making self-management. However, value of this skill threatened by time pressures emphasis on technology. Current care trends privilege expensive tests procedures tag devoted interaction with as lacking cost-effectiveness. Instead, spent inquire problems life setting may actually help avoid further testing, procedures, referrals. Moreover, dialogue an essential instrument increase patient's motivation engage in healthy behavior. The aim paper was provide overview clinical its optimal use relation style, flow hypothesis domains, modifications according settings goals, teaching. This review points primacy process. quality determines data collected and, eventually, assessment treatment. Thus, deserves more attention educational training space encounters than it currently receiving.

Язык: Английский

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Childhood Maltreatment and Somatic Symptoms in Adulthood: Establishing a New Research Pathway

Neuropsychobiology, Год журнала: 2025, Номер unknown, С. 1 - 15

Опубликована: Янв. 14, 2025

Background: Somatic symptoms, such as chronic pain, fatigue, and gastrointestinal disturbances, are commonly reported in individuals with a history of childhood maltreatment (CM), which includes various forms abuse neglect experienced before age 18. Although CM is strongly associated somatic the specific relationships between subtypes these well mechanisms connecting them, remain insufficiently understood. This review examines complex interaction often coexist mental disorders significantly impact quality life healthcare systems. Summary: frequently mix "explained" "unexplained" conditions, personal distress pose diagnostic challenges. has been linked to symptoms through neurobiological mechanisms, HPA axis dysregulation allostatic load, while theoretical models emphasize roles hyperawareness, cultural factors, vulnerability symptom development. However, existing research fails account for subtypes, full range situational leading inconsistencies findings. Key Messages: Bridging gaps literature requires adopting World Health Organization’s subtype definitions ICD-11 codes (MA00-MH2Y) encompass broader spectrum symptoms. Employing rigorous methodologies, systematic reviews meta-analyses, essential advancing understanding. These approaches can enhance accuracy, support tailored interventions, promote biopsychosocial framework research, ultimately improving patient outcomes alleviating societal burdens.

Язык: Английский

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Clinical Use of Staging in Psychiatry

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер 93(3), С. 143 - 150

Опубликована: Янв. 1, 2024

Язык: Английский

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Allostatic Load as a Short‐Term Prognostic and Predictive Marker

Stress and Health, Год журнала: 2025, Номер 41(1)

Опубликована: Янв. 9, 2025

ABSTRACT It would be highly valuable to possess a tool for evaluating disease progression and identifying patients at risk of experiencing more severe clinical course potentially worse outcomes. The concept allostatic load, which represents the overall strain on body from repeated stress responses, has been recognized as precursor development chronic illnesses. functions cumulative measure body's capacity adapt stress. Numerous studies have demonstrated that elevated load levels are associated with various negative health outcomes, both physical mental, predictive mortality than individual biomarkers. Leveraging unique circumstances presented by COVID‐19 pandemic, we evaluated different laboratory parameters in hospitalised assess load. Our results indicated acts strong predictor prolonged hospitalisation, increased ICU days, mortality. This highlights its efficacy precise gauge biological dysregulation linked response during progression. Allostatic is easily obtainable provides an early, cost‐effective indication prognosis. Additionally, it potential forecast necessity admission. As result, this parameter, indicative comprehensive physiological disruption stress, emerges promising prognostic marker patients, extending beyond COVID‐19.

Язык: Английский

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Garcia Adaptive Equilibrium Theory (GAET): A New Nursing Theory for Mental Health Nursing

Issues in Mental Health Nursing, Год журнала: 2025, Номер unknown, С. 1 - 10

Опубликована: Апрель 23, 2025

Mental health nursing demands a dynamic, patient-centered approach that goes beyond crisis intervention and symptom management. Traditional models like the Roy Adaptation Model Tidal emphasize adaptation recovery but fall short in capturing fluid, nonlinear nature of mental health. The Garcia Adaptive Equilibrium Theory (GAET) introduces new framework viewing as continuous balancing process. In this model, nurses serve Facilitators, identifying points instability intervening early to prevent crises.Central GAET is Spectrum, which conceptualizes fluctuating continuum-from stability severe distress. Unlike traditional psychiatric approaches focused on reactive treatment, incorporates Forecasting, proactive assessment strategy integrates subjective tools (scales, narratives) objective data (biomarkers, physiologic signs) anticipate deterioration.By reframing care around real-time stabilization, promotes intervention, sustained well-being, shift toward preventive, holistic care. This theory redefines an active, interdisciplinary practice maintaining equilibrium rather than responding disruption-empowering lead stabilization prevention.

Язык: Английский

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Treating Posttraumatic Stress Disorder: The Complexities of the Clinical Realm

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер 93(4), С. 244 - 248

Опубликована: Янв. 1, 2024

A number of evidence-based psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) are available today [1‒5]. However, many trauma survivors do not have PTSD alone but suffer from various comorbidities. Moreover, patients' priorities frequently differ their therapists' therapeutic strategies. In other words, clinical reality is usually much more complex than research evidence appears to suggest. Thorough training in trauma-focused psychotherapy [4] essential, as knowledge about effective approaches. wisdom may be important. The therapist needs skilled listening patient building up a mutually trusting relationship. They also must able honestly engage shared decision-making while at the same time being straightforward guiding so that they can jointly develop consensus regarding steps take [6‒8].John returns work, tired, bit tense due some minor stressors he had experienced office. On his way home, buys 2 cheeseburgers. His fiancée, Anna, will visit join him dinner. When opening front door apartment, key gets stuck, John has struggle until manages release lock. Anna there already, gives her mouthful, accusing having created problem with key. He drops bag burgers on kitchen table tells going shower before shower, suddenly sees entering bathroom, gagging, looking strange expression, then collapsing. jumps out, naked wet, lying ground motionless, lifeless. shakes her, screams no avail. runs call ambulance. kitchen, obviously taken big bite one calls ambulance second time, asking them angrily why it takes long come. After felt eternity, paramedics arrive, only testify Anna's death.John devastated. cannot sleep. concentrate. senses an unbearable restlessness. consults family doctor who puts sick leave. Yet barely makes through first days immediate aftermath tragic passing away what known "bolus death": burger she gotten stuck throat, causing vagal reflex, which led sudden cardiovascular arrest.Ten after event, I see time. complains insomnia extreme inner tension feels guilty been rescue fiancée. reports frequent flashbacks nightmares reexperiences collapsing, ultimately away. fulfills diagnostic criteria acute (ASD) [9]. provide psychoeducation typical responses potentially traumatic events [10‒12]. try convey confident, optimistic attitude, suggest early intervention, combined "watchful waiting." We agree weekly appointments over next couple weeks (Fig. 1).John's ASD symptomatology fluctuates course days. line current guidelines intervention [1, 13], apply elements cognitive-behavior treatment [14], limited success. me expert, very keen learning my views repercussions how treat trauma-related problems. clearly idealizes extent during these sessions. address John's positive transference this point helps relationship.Six passed since death. somewhat stabilized. acquired set emotion regulation skills such walk when distressed. still nightmares. persistently avoids external reminders death, visiting grave cemetery. keeps blaming himself save life. hypervigilant, difficulties concentrating, suffers insomnia. addition, moderate major depressive disorder. depressed mood most experiences great loss energy, completely worthless.Of note, does feel sad lost Anna. Instead, constantly haunted by guilt feelings. Whenever reminded incident, immediately idea responsible spends hours ruminating: "If was doctor, could applied Heimlich maneuver, thus rescuing her!" (the maneuver medical emergency procedure relieve foreign body airway obstruction if timely properly). feelings additionally fueled little argument upon arrival home: we argued keys, would stressed gagged bite!".John physical health issues: high blood pressure, moderately overweight, glucose levels borderline elevated. While focusing psychiatric aspects crisis, am taking issues into account, considering psychosocial currently exposed elevated preexisting allostatic load overload [15].Now seems right start CBT. core include psychoeducation, training, imaginal exposure cognitive restructuring [4, 12]. scared death treatment. fears "go crazy" were confront dreadful moments As convince probably need sessions, categorically refuses even give try.According international should refuses. What do? intuitively applying "arm-twisting," might lose him. Sequential [16] account patient's views. all, sense (yet) exposure. therefore decide follow preference, change plans accordingly. longer urge undergo therapy. work persistent insomnia, mirtazapine 30 mg bed. accepts 1).I emphasize justified ask whether (and should) done something prevent person present collapsed bathroom! explicitly thanks willingness talk issues. All others symbolically or literally given pat back, trying vain out self-contempt. Over several discuss responsibility using principles Socratic dialog. obsessing Slowly steadily, however, starts getting touch underlying sadness loneliness seem difficult tolerate. 17 years. Their relationship seen ups downs. suffered severe recurring mental went crises; often impatient grumpy Now, deeply regrets raised "front keys" issue her. retrospect, realizes simply brought home work. forward joint dinner, grumpily snapped her.Gradually, realizing generated enormous feelings: offered certain illusion control situation. facing eventually accepting fact nothing done, terrible sequence just happening, cruel twist fate.After 10 sessions dialog restructuring, achieved realistic view role fiancée's less ruminating guilt, instead mourning memories persist, almost vividly event. wakes drenched sweat daily basis.It comes interesting idea: dysfunctional beliefs calling caused unnecessary delay operation. receptionist asked diabetes any cardiac problems, did not. got angry, yelling send immediately, rather "asking silly questions". Now wondering somehow get hold audio recordings two phone made: recordings, obtain objective information inappropriately actually behaved. entirely convinced thought. Not knowing where lead us, encourage anyway.Interestingly, turns easier expected: brings electronic files therapy session. too listen recordings. asks transcribed, agree.The following week, merely transcript distance, trembling sweating. like culprit court trial. live final verdict. this, ambivalent: expecting "death sentence," hopes acquittal least mild negotiations, reading him, kind unconventional hardly sit moans, breathing heavily, heart pounding. keep reading. listens intently. intense pain chest. approach end call, crying. It quite regain composure.The recording shows agitated making call. questions condition. Toward shouted receptionist, turn kept professional composure. By means behavior procedure. fact, already place. According service's files, arrived 8 min merciless judge without evidence.John relieved. self-designed session directly back scene exhausted proud survived exposure! During reads himself, finally, recording. Again, emotionally involved. third "exposure" session, declares "only partially guilty": now recognizes upset place arguing keys. Once all power life, IT specialist. Sadly, enough her.Shortly thereafter, significant intrusions. hyperarousal symptoms decreased significantly, better mood. significantly reduced reexperiencing symptoms. yielded substantial helped understand biographical origins impact schema guarantee success link childhood adolescence, particularly father's unpredictable outbursts anger extremely of.John visits grave, crying, mourning. putting apartment order. joins self-help group people partner. There, finds whom share in-depth conversations cope find new meaning life.When follow-up assessment 1 year depression. stopped psychotropic medication. resumed goes seeing friends. though.John appointment once twice year. 7 years finally dispose rest cheeseburger keeping deep freezer years.Over now, concerned large helping "to emotional responses" [17], So far, good. attitude implicitly conveys problematic message, namely, everything life controlled. matter bad things happen: fall ill, loved one, experience violence. For John, crucial fate. toward regained intrusions, important learn accept virtually unfolding day learned distinguish between hand controllable, beyond control, accepted coped with, along suffering bring about.I myself lesson well: hard initially refused insisting started concerns, later "outlandish" retrieve turned better, recovering. grateful taught lesson. played active design sequential [18]. influenced timing interventions 1). properly poorly timed, value. An mature order unfold its optimal effect. detailed description case study, Online Supplementary Material (for online suppl. material, https://doi.org/10.1159/000538954).Good therapists aware own limitations. tailor individually sequentially [18] each situation, psychopathological status well resources, [15], resilience. And humbly failures.This article based example previously published book chapter [19].The author conflicts interest declare.This study supported sponsor funder.Ulrich Schnyder conceived wrote entire manuscript.

Язык: Английский

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What Is Moral Injury?

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер 93(6), С. 367 - 371

Опубликована: Авг. 29, 2024

Язык: Английский

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Enhancing Conceptual Clarity regarding the Construct of Moral Injury

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер unknown, С. 1 - 10

Опубликована: Окт. 7, 2024

Background: The construct of “moral injury” is used widely in the research literature and media to broadly describe impact events involving perceived violations one’s sense right wrong (herein referred as “potentially morally injurious events” [PMIEs]). Summary: In this theoretical review, we provided a brief overview its limitations including lack consensus-drawn boundaries operational definitions guide hypothesis-driven research. We discussed whether can be reliably distinguished from established psychiatric diagnoses psychological constructs inherent challenges separating or classifying high-magnitude stressful life that likely form majority PMIEs. Assessments purportedly measure are reviewed such shared measurement variance with instruments. Key Messages: identified conceptual strategies for investigating behavioral neurobiological features PMIEs could inform field traumatic stress. concluded may provide an interpretive framework positing why someone beset by guilt, shame, and/or rage whereas existing post-traumatic stress disorder depression comprehensive descriptions regarding what might experience following extremely events. proposed directions better clarify versus categories enhance conceptualization assessment construct.

Язык: Английский

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Innovative Strategies in Evaluation and Treatment of Burnout in Medical Workers

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер unknown, С. 1 - 6

Опубликована: Окт. 11, 2024

Язык: Английский

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Study of Rates and Factors Associated to Psychosomatic Syndromes Assessed Using the Diagnostic Criteria for Psychosomatic Research across Different Clinical Settings

Psychotherapy and Psychosomatics, Год журнала: 2024, Номер unknown, С. 1 - 11

Опубликована: Окт. 17, 2024

Diagnostic Criteria for Psychosomatic Research (DCPR) serve as an instrument identifying and classifying specific psychosomatic syndromes that are not adequately encompassed in standard nosography. The present study aimed at measuring the prevalence of DCPR different clinical settings exploring factors associated to such diagnoses.

Язык: Английский

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