ABSTRACT
This paper explores what is known about adherence to antipsychotic medications in general and the possible reasons for non-adherence in Samoan New Zealanders. Samoan New Zealanders are either Samoan-born immigrants or their descendents born in New Zealand. Clinicians recognize a high prevalence of non-adherence among Samoan New Zealanders. The authors hypothesize that traditional Samoan beliefs play a prominent role in problems with adherence. To investigate this hypothesis, a review of the literature on adherence in Samoan New Zealanders was undertaken. Documents from the Ministry of Health support the hypothesis. To investigate this issue, the Ministry of Health initiated a qualitative research project to examine the nature of Samoan traditional beliefs. The results of this study are summarized. No research had previously been undertaken on adherence in Samoan New Zealanders. In general, there is a lack of research on all aspects of the mental health of Pacific peoples in New Zealand. Literature reviews of adherence research consistently show that interventions that improve adherence address the beliefs, behaviours, and relationships surrounding adherence. This finding supports the author's hypothesis that traditional beliefs play an important role in the problem of adherence. Further definitive study with Samoan New Zealanders is required.
Subject(s)
Antipsychotic Agents/therapeutic use , Medication Adherence/ethnology , Culture , Humans , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Mental Health Services , Native Hawaiian or Other Pacific Islander/psychology , New Zealand , Samoa/ethnologyABSTRACT
INTRODUCTION: Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism. METHODS: We reviewed the literature on Malignant Narcissism which was sparse. It was first described in psychiatry by Otto Kernberg in 1984. There have been few contributions to the literature since that time. We discovered that the syndrome of Malignant Narcissism was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry. We searched for prominent malignant narcissists in recent history. We reviewed the literature on treatment and developed categories for family assessment. RESULTS: Malignant Narcissism is described as a core Narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation. There is no structured interview or self-report measure that identifies Malignant Narcissism and this interferes with research, clinical diagnosis and treatment. This paper presents a synthesis of current knowledge about Malignant Narcissism and proposes a foundation for treatment. CONCLUSIONS: Malignant Narcissism is a severe personality disorder that has devastating consequences for the family and society. It requires attention within the discipline of psychiatry and the social science community. We recommend treatment in a therapeutic community and a program of prevention that is focused on psychoeducation, not only in mental health professionals, but in the wider social community.
Subject(s)
Fantasy , Folklore , Literature, Modern , Medicine in Literature , Personality Disorders/diagnosis , Adult , Aggression/psychology , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/psychology , Antisocial Personality Disorder/therapy , Child , Child Abuse/psychology , Child of Impaired Parents/psychology , Family Conflict/psychology , Family Relations , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Mental Disorders/therapy , Paranoid Disorders/diagnosis , Paranoid Disorders/psychology , Paranoid Disorders/therapy , Parenting/psychology , Personality Disorders/psychology , Personality Disorders/therapy , Sadism/diagnosis , Sadism/psychology , Sadism/therapy , Suicide/psychology , Syndrome , Therapeutic Community , Unconscious, PsychologyABSTRACT
This paper explores the essential features of recovery and the need for an existential approach in psychiatry. The biopsychosocial model often fails to sufficiently validate the existential suffering of patients. We review the major principles of recovery and the philosophical and psychiatric principles of existentialism. The ontological or intrinsic existential issues of death, isolation, freedom and meaninglessness are described and their manifestations are explored in clinical syndromes. When ultimate existential concerns are recognised, patients have an opportunity to understand their life on a deeper level that is not defined as a medical disorder but as a part of human existence. Understanding that existential concerns underlie a great deal of human behaviour helps to free patients from the stigma of psychiatric labels. An existential approach is a humanistic way toward recovery.
Subject(s)
Existentialism , Mental Disorders/therapy , Philosophy, Medical , Adaptation, Psychological , Anxiety/psychology , Anxiety/therapy , Attitude to Death , Awareness , Defense Mechanisms , Freedom , Humans , Individuality , Mental Disorders/psychology , Motivation , Problem Solving , Psychoanalytic Theory , Psychotherapy , Quality of Life/psychology , Social Identification , Social Isolation , Social ResponsibilityABSTRACT
OBJECTIVE: The aim of this study was to assess the importance of addressing psychoeducational and existential issues in group therapy for patients with bipolar disorder. METHOD: The group consisted of 10 bipolar patients. Group sessions were held for 2 hours weekly for 3 months and then monthly up to 2 years. Group topics focused on psychoeducation, cognition and existential issues. RESULTS: Over 2 years, two members had a minor relapse that did not require hospitalization. Adherence with pharmacotherapy and follow up was 100%. All members reported significant improvements in family and social function and nine members remained employed in full-time jobs. There was a high level of satisfaction with the group process. CONCLUSION: Addressing existential and psychosocial issues in bipolar disorder group therapy may improve outcome. This approach deserves further thorough investigation.
Subject(s)
Bipolar Disorder/therapy , Cognitive Behavioral Therapy/methods , Existentialism , Mental Health , Patient Education as Topic , Psychotherapy, Group/methods , Adult , Community Mental Health Services/organization & administration , Female , Humans , Male , Surveys and Questionnaires , Treatment OutcomeABSTRACT
In the last two decades the clinical and research focus in psychotic disorders has shifted to first episode psychosis, early detection of the prodromal phase of psychosis and an effective integrated treatment model known as "Early Intervention". The first five years of psychosis that is described as a "critical period" is the most important time for recognition and treatment. Services for Early Intervention should be easily accessible, non-threatening and non-stigmatising. Effective treatment is based on successful engagement and the development of trust between patients, their families and the mental health professionals assisting them. Psychosocial interventions have a fundamental place in early treatment. They provide a humane basis for acute and continuing care, prevention or resolution of the secondary consequences of psychosis and the promotion of recovery. Antipsychotic medication is considered effective and is recommended by evidence based research in the treatment of first episode psychosis. A program of extensive public education and specific education forteachers, general health and mental health professionals about the prodrome and nature of first episode psychosis can reduce the duration of untreated psychosis and improve treatment outcome. Countries that do not have services for Early Intervention should seriously consider implementing this model.
