ABSTRACT
Phenomenological psychopathology has been defined as a human science that is concerned with the object on which clinical psychology and psychiatry act. How psychopathological experiences are understood is an important factor determining decision-making in clinical care. An accurate understanding of psychopathology is fundamental to the effectiveness of mental health treatments. This is even more important in a field such as substance use disorders in which social and cultural values influence both diagnosis and decision-making. In this article, we offer a contribution to clinical decision-making in substance use disorders by suggesting the association of Phenomenological Psychopathology and Values-Based Practice, constituting a Values-based Phenomenology We present a fictitious clinical case (to preserve confidentiality), illustrating a three-step practical application of Values-based Phenomenology. We conclude that although still a nascent discipline, Values-based Phenomenology offers a promising approach to reducing the gap between services and patients' needs in clinical decision-making, and thus to improving clinical care in substance use disorders.
A psicopatologia fenomenológica é uma ciência humana que define o objeto sobre o qual atuam a psicologia clínica e a psiquiatria. O modo como são compreendidas as experiências psicopatológicas é um fator importante nas tomadas de decisão clínica. Uma compreensão acurada de psicopatologia é fundamental para a efetividade dos tratamentos em saúde mental. Isso é mais importante ainda em um campo como o dos transtornos por uso de substâncias, no qual há um importante imbricamento entre valores sociais e culturais. Neste artigo, se oferece uma contribuição para as tomadas de decisão clínica nos transtornos por uso de substâncias por meio da associação entre a psicopatologia fenomenológica e a Prática Baseada em Valores, constituindo uma fenomenologia baseada em valores. Apresenta-se um caso clínico fictício (visando à preservação de confidencialidade) ilustrativo dos três passos da aplicação prática da fenomenologia baseada em valores. Conclui-se que a fenomenologia baseada em valores constitui uma abordagem promissora para o aprimoramento das tomadas de decisão clínica nos transtornos por uso de substâncias.
Subject(s)
Psychopathology , Mental Health , Alcohol-Related Disorders , AlcoholismABSTRACT
BACKGROUND: Recognizing dying patients is crucial to produce outcomes that are satisfactory to patients, their families, and clinicians. AIM: Earlier discussion of and shared decision-making around dying to improve these outcomes. DESIGN: In this study, we interviewed 16 senior clinicians to develop summaries of palliative care in 4 key specialties: Cardiology, Vascular Surgery, Emergency General Surgery, and Intensive Care. SETTING: Oxford University Hospitals. RESULTS: Based on themes common to our 4 clinical areas, we developed a novel diagnostic framework to support shared palliative decision-making that can be summarized as follows: 1) Is the acute pathology reversible? 2) What is the patient's physiological reserve? 3) What is important to the patient? Will they be fit enough for discharge for a reasonable length of time? CONCLUSIONS: We believe that education using this framework in the medical school and postgraduate curricula would significantly improve recognition of dying patients. This would serve to stimulate earlier conversations, more shared decision-making, and ultimately better outcomes in palliative care and patient experience.
ABSTRACT
Shared decision-making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed-upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. The specialties we consider are Primary Care, Mental Health, Paediatrics, Palliative Care, Medicine, and Surgery. SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high-quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient-centred care but must be implemented with continued people centricity in order to realize its full potential.
Subject(s)
Communication Barriers , Decision Making, Shared , Medicine , Patient Care Planning/ethics , Patient-Centered Care , Physician-Patient Relations/ethics , Benchmarking/methods , Cultural Competency , Humans , Medicine/classification , Medicine/methods , Needs Assessment , Patient Participation , Patient Satisfaction , Patient-Centered Care/methods , Patient-Centered Care/trendsSubject(s)
Aortic Aneurysm, Abdominal/surgery , Clinical Decision-Making , Decision Support Techniques , Healthcare Disparities/standards , Patient Selection , Practice Guidelines as Topic/standards , Professional Practice Gaps/standards , Vascular Surgical Procedures/standards , Aortic Aneurysm, Abdominal/diagnosis , Humans , Predictive Value of Tests , Risk FactorsABSTRACT
Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers' General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of brain. From the second time slice, 1959 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons - a pluralistic approach, reliability and validity, and closer collaboration among relevant stakeholders - provide an emerging framework for more effective translation of research into practice in 21st century psychiatry.
ABSTRACT
IN THIS ARTICLE WE ARGUE THE CASE FOR A PROPOSAL: that psychiatry should recognise, embrace and take seriously the role of values, alongside facts, in diagnosis. We present a three-step argument in support of our proposal; we raise a number of key questions from the perspectives of different stakeholders in mental health; and we conclude with a note on the significance of our proposal for building a more equal relationship between patients and professionals.
ABSTRACT
This article illustrates the practical impact of recent developments in the philosophy of psychiatry in five key areas: patient-centred practice, new models of service delivery, neuroscience research, psychiatric education, and the organisation of psychiatry as an international science-led discipline focused on patient care. We conclude with a note on the role of philosophy in countering the stigmatisation of mental disorder.