Subject(s)
Alcoholism , Licensure, Medical , Physician Impairment , Substance-Related Disorders , Adult , Alcoholism/rehabilitation , Humans , Licensure, Medical/legislation & jurisprudence , Licensure, Medical/trends , Male , Middle Aged , North Carolina , Organizational Policy , Private Practice/legislation & jurisprudence , Private Practice/trends , Substance-Related Disorders/rehabilitationSubject(s)
Interviews as Topic , Licensure, Medical , Governing Board , Humans , North Carolina , Social Control, FormalABSTRACT
Chronic neck and shoulder pain is a complex, multifactorial problem. Often many months have passed since its onset. During this time the patient may have seen many physicians and tried many medications, some with abuse potential. Most patients are depressed and have lost their ability to cope with the stresses of daily life. The goals of therapy are to enable patients to deal with the problem and to bring them to the point where pain is no longer the dominant factor in their lives. For patients with chronic neck and shoulder pain of myofascial origin, this is accomplished with a multi-disciplinary approach that incorporates use of psychotherapeutic techniques, nonsteroidal antiinflammatory medications, antidepressant drugs, trigger-point injection, and several physical therapy modalities.
Subject(s)
Myofascial Pain Syndromes/complications , Neck , Pain/etiology , Shoulder , Chronic Disease , Female , Humans , Male , Muscle Spasticity/drug therapy , Muscle Spasticity/physiopathology , Myofascial Pain Syndromes/physiopathology , Myofascial Pain Syndromes/psychology , Pain/physiopathology , Pain/psychology , Palpation , Physical Therapy Modalities , Thoracic Outlet Syndrome/complicationsABSTRACT
In a 6-week double-blind parallel treatment study, dothiepin and amitriptyline were compared to placebo in the treatment of 33 depressed outpatients. Dothiepin and amitriptyline were equally effective in alleviating the symptoms of depressive illness, and both were significantly superior to placebo. The overall incidence of side effects and the frequency and severity of blurred vision, dry mouth, and drowsiness were significantly less with dothiepin than with amitriptyline. Dothiepin also produced fewer CNS and cardiovascular effects. There were no clinically important changes in laboratory parameters. Dothiepin thus was found to be an effective antidepressant drug associated with fewer side effects than amitriptyline in the treatment of depressed outpatients.
Subject(s)
Amitriptyline/therapeutic use , Depressive Disorder/drug therapy , Dibenzothiepins/therapeutic use , Dothiepin/therapeutic use , Ambulatory Care , Amitriptyline/adverse effects , Clinical Trials as Topic , Depressive Disorder/psychology , Dothiepin/adverse effects , Double-Blind Method , Humans , Placebos , Psychiatric Status Rating Scales , Sleep Stages , Vision Disorders/chemically induced , Xerostomia/chemically inducedABSTRACT
The authors emphasize that the future of state mental hospitals should be considered only in the context of a unified system of care and treatment of the mentally ill. They discuss changing perceptions of mental hospitals as resources for mental health care, describe trends that must be considered in developing a unified system of services, and make recommendations about treatment plans, staffing, funding, organization and governance, and legal codes and standards of the components of a unified system.
Subject(s)
Forecasting , Hospitals, Psychiatric , Patient Care Planning , Adult , Aged , Community Mental Health Services , Health Services Needs and Demand , Humans , Legislation as Topic , Mental Disorders/rehabilitation , Middle Aged , United StatesABSTRACT
A psychiatrist meets with physicians, individually or in groups, in their offices, in hospitals, or in any convenient place to provide consultation-education training in basic psychiatric skills, including community psychiatry. The pilot project, reported here, indicates that this program is not only feasible but highly successful. The implications are broad. In addition to providing increased skills for local physicians, the program serves as a training setting in which hospital staff, mental health clinic personnel, and psychiatric residents can learn the skills of consultation.
