1,721,395 research outputs found
The puzzle of psychiatric interview
No full textThe psychiatric interview plays a critical role in clinical assessment and therapy. Problems with assessment reliability and validity that were apparent in nosological and diagnostic discrepancies plagued the field of psychiatry historically. Technical approaches including structured interviews were developed to address these problems. Although these approaches decreased diagnostic variance, they focused narrowly on eliciting signs and symptoms conforming to previously agreed diagnostic categories, necessarily restricting the range and richness of experiences and narratives that are elicited. This restriction inhibits the utility of assessment in furthering the interpersonal rapport and exploration that is essential to the task of therapy The author reviews critiques of technical approaches to psychiatric assessment and highlights critical, often unexamined, epistemological assumptions and questions. In light of these critiques, he proposes a phenomenological approach to psychiatric assessment focused on narratives that situate particular experiences in the broader life context. In this approach the assessor functions as a participant observer, relying on the same empathic skills that inform effective therapy. It is argued that without overturning the advances in assessment reliability gained through technical approaches to the psychiatric interview, a phenomenological approach can illuminate, enrich, and broaden psychiatric assessment, increasing its effectiveness in psychopathological understanding and in therapy
A case study in semantic deconstruction
No full textI discuss a case study of 'semantic deconstruction' - a semantic deviance that occurred in a patient affected by schizophrenia. This consisted in fragmentation of sentences into single words, and of words into letters. Image-driven felt meanings were the outcome of this process of semantic deconstruction whereby sentences and words are broken down in smaller units so that their true meaning may come to light. This process deviates from ordinary semantics and paves the way to an idiosyncratic understanding of the world. I argue that the origin of this phenomenon can be traced back to a disorder of temporality, namely the failure of the constitutive temporal synthesis that may create micro-gaps of experience. This synthesis 'functions' implicitly, and therefore I refer to it with the term 'transcendental time' (TT). TT underlies and constitutes any given phenomenal experience as a unified flow. The disintegration of time-flow induces a sensitisation to details. One may become absorbed by finer and finer details, to the point that one may feel separately the physiognomies of each and every word. This implies that persons who undergo the disintegration of TT may start to notice islands of unrelated and self-referential language experience. The disintegration of TT thus implies a fragmentation of language and thought experience that is accompanied by a pictorialisation/materialisation of these fragments. These splinters of language, no longer embedded in the flowing continuity of experience, appear as images or (quasi)- physical objects floating in an objective space
The Portrait Of The Psychiatrist As A Globally Minded Citizen
No full textPURPOSE OF REVIEW: To discuss the importance of psychopathology in psychiatric curricula.
RECENT FINDINGS: 2013 is the centennial of the first edition of Karl Jaspers' General Psychopathology. Several books and articles published during this year discuss the role of psychopathology for psychiatrists.
SUMMARY: Psychiatrists need personal formation or cultivation alongside a thorough scientific education - restrictively understood as acquisition of technical knowledge and skill training. Psychopathology provides both educational resources (e.g., valid and reliable concepts and methods for establishing accurate diagnosis) and that kind of sensitivity, namely the sensitivity to what is appropriate in dealing with others, for which knowledge from general principles does not suffice. Tact, as the ability to feel an atmosphere and to attune with it in those situations that are not yet plainly and unambiguously defined, is an example of this. When evidence-based guidelines are still scarce (as is the case, for instance, with early psychoses), tact seems to be an indispensable resource for the psychiatrist
Il Questionario dei Sintomi-base e la sua applicazione nella clinica della schizofrenia
No full textL'introduzione nel nostro paese dei principi teorici, prima, e in seguito delle scale valutative relative alla teoria dei sintomi-base mettono a disposizione del clinico strumenti effica sotto il profilo diagnostico, terapeutico e riabilitativo nel campo delle sindromi schizofreniche. Il presente contributo si propone, in primo luogo, di fornire una guida all'applicazione ed alla interpretazione del questionario dei sintomi-base aggiornate con la letteratura recente ed inserite nell'ambito del paradigma della "vulnerabilibta'". Si propone, infine, di precisare in qual modo la teoria dei sintomi-base puo' fornire un valido punto di riferimento nella formulazione di un modello della vulnerabilita' schizofrenica funzionale alla autocomprensione da parte dei pazienti della propria malattia
- …
