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Rabu, 24 Oktober 2012

Guest Blogger Dr. Meg Chisolm on Systematic Psychiatric Evaluation



Over on our Clinical Psychiatric News blog, I've written a review of a new book, just published by Johns Hopkins University Press, Systematic Psychiatric Evaluation,  A Step-by-Step Guide in Applying The Perspectives of Psychiatry, by Margaret S. Chisolm, M.D. and Constantine G. Lyketsos, M.D., M.H.S.  Do check out my review over on CPN (it should be up later today), along with ClinkShrink's article on "Debunking The Mad Artistic Genius Myth" and Roy's piece on World Mental Health Day which lists some great resources. 

Dr. Chisolm was kind enough to write a Shrink guest post for us on her inspiration for writing the book, with just a little about French cooking.  Sorry no recipes here.  Meg writes:


I did my psychiatry residency training at Johns Hopkins University in the late 1980s, under department chair Paul McHugh and residency director Phillip Slavney.  These leaders also are the authors of the textbook The Perspectives of Psychiatry, whose principles informed the way I and a generation of Hopkins healthys since have been trained.  The basic idea of The Perspectives is that by conducting an evaluation that considers a patient’s psychiatric presentation from each of four perspectives, the clinician can better understand the nature(s) and origin(s) of the patient’s problems, and develop a more comprehensive and personalized formulation and treatment.  (The four perspectives are: disease, dimensional, behavior, and life-story.) 

The most frequent question raised about the Perspectives model by trainees and clinicians unfamiliar with the approach is “How are the Perspectives any different from Engel’s biopsychosocial model?”  In response, McHugh and Slavney are fond of saying that the biopsychosocial model provides the ingredients (atoms to biosphere) for understanding patients with psychiatric illness, but the Perspectives provides the recipe.  I like this analogy (or is it a metaphor?) because, in addition to enjoying my work as a healthy, I like to cook.  But, more about that later. 

As a Hopkins-trained healthy, I had probably read The Perspectives of Psychiatry about five times, beginning with my stint as a medical student during my sub-internship at Hopkins.  Let me tell you, The Perspectives is a good, but hard read.  As a student, I don’t think I understood much of it.  Reading it again as a psychiatry intern, having seen many more patients with psychiatric conditions, it started to make some sense.  As a junior resident, I began to understand it a little better, which was a good thing since – by then – I was expected to be teaching the book to medical students.  By the time I was a chief resident teaching junior psychiatry residents how to apply the Perspectives approach to patients, I thought I had it down.  Well, I was wrong.  It wasn’t until I began writing a casebook companion to The Perspectives of Psychiatry that I finally figured it out.  So, if the biopsychosocial method provides the ingredients and The Perspectives of Psychiatry the recipe, that’s one highfalutin’ cookbook!  And that’s where our new book Systematic Psychiatric Evaluation: A Step-by-Guide to Applying ‘The Perspectives of Psychiatry’ (Chisolm & Lyketsos) comes in.

So, back to French cooking.  If any of you are into cooking, reading cookbooks, or just watching the Food Network, you may have heard of Auguste Escoffier’s 1903 Guide Culinaire.  Escoffier wrote his book for professionally trained and experienced European chefs (working in restaurants, hotels, ocean liners, private estates, etc).  Escoffier’s book outlined recipes and discussed methods of professional food preparation and kitchen management.  Escoffier did not offer his reader detailed recipes with instruction on basic cooking techniques, as he assumed the reader would already have this set of knowledge and skills.  His book’s target reader was not the average home cook looking for advice on how to keep a soufflé from falling.  Enter Julia Child and friends.  In Mastering the Art of French Cooking Julia Child et al translated a selection of Guide Culinaire recipes into simple steps and added detailed instruction on the basic techniques (How do you keep a soufflé from falling?  Ask Julia).  Julia Child’s goal was to start someone off in French cooking with the hope that someday they would be ready to go deeper and perhaps read the master himself. 

And so it is with Systematic Psychiatric Evaluation.  If you’re a clinician who already conducts a systematic psychiatric evaluation and are adept with applying the Perspectives approach to patients, there’s no need to read our book.  But, if you are new to the Perspectives and/or want to familiarize yourself with the model, we’ve got you covered.  Systematic Psychiatric Evaluation walks the reader through the basic concepts of The Perspective of Psychiatry and shows, step-by-step, how to apply these concepts to evaluate, formulate and develop individualized treatment plans for patients with psychiatric conditions.

Bon appétit!


Senin, 18 Juli 2011

Book Review: Crazy by Rob Dobrenski (ShrinkTalk.net)

Rob Dobrenski, PhD. is a psychologist who blogs over on ShrinkTalk.net.  He's written a book about what it's like to be a psychology graduate student, a psychotherapy patient, and a psychologist.  Oh, we like the folks who go from Shrink blog to Shrink book -- it somehow feels familiar -- and so I agreed to read his book: Crazy: Tales on and Off the Couch.

So bear with me while I tell you that the book rubbed me wrong at the outset.  Dr. Dobrenski begins by saying something to the effect that he describes things that all shrinks feel, and if they say they don't, they aren't being honest.  I really hate it when people tell me what I feel.  It's like saying that Prozac made your depression better and if it didn't, then you just didn't recognize it.  And then the book gets off on a provocative start -- Rob discovers that many people in his life, from a patient, to a colleague, to himself -- are "f***ing crazy." The asterisks are mine. Dr. Dobrenski had no trouble using the word -- I counted 19 times in the 39 pages, including in direct quotes of discussions he has with both a patient and one of his supervisors.  Not in a million years.  I wasn't sure what the point was.  To let people know he knows obscene words?  To be provocative, obviously.

Somewhere around page 50, the author begins to talk about his work with a teenage boy.  He loses some of his bravado, chills on the cool, dirty words, and when he talks about this socially awkward teen who keeps him jumping with his incessant questions, I turned a corner.  It suddenly felt genuine, and I could feel Rob's anxiety as he was in the room with this boy who would have made any therapist uncomfortable.  Oh, plus Rob's back goes in to spasm and he has to deal with this as he finesses conducting the session.  Somehow Rob has either willingly taken on, or been thrust into, the role of being the patient's sex educator.  A little unusual, but I do think many therapists can identify with being cornered into an uncomfortable role in therapy -- if not for many sessions, then at least for a few minutes.  
    "....but seeing a 14-year-old in a blue blazer with a crest on it, speaking like Dr. Ruth, made me feel beads of perspiration form on my forehead.    

   "Why are some people gay and some straight?"     

   I sensed that Jack's questions might be getting progressively more difficult.     

   "That's actually a question that no one truly knows the answer to...."     

   "And you, Robert? What do you think?"     

   Did I murder someone?  Am I on trial here?  Again, the rule: Do. Not. Lie. 

I ended up enjoying the rest of the book and I thought he did a nice job describing his work with sex offenders and their partners.  Worth the read for someone who wants a peek into therapy without actually going, but probably not for the practicing shrink.

Just a few minor details: There's no medication called Xypreza, it's Zyprexa, and Zoloft does not come in 10 mg doses. And finally, the peek is a peek, it's not an in-depth examination, and it is from a single perspective. 

And finally, to the guy who starts his book by saying, "Any shrink who tells you he can't relate to what is written here is incredibly private and guarded..."  I'd like to assert that eating photographs of your ex-girlfriend is really weird and is not a universal phenomena. There are some things you may be better off not announcing to the world.