In this paper, the fundamental assumptions of ethics, values and individual moral agency were reviewed so as to arrive at a position that reconciles the tension between universal moral codes and the contextual influences of different psychiatric professional groups. The moral imperatives that merge from the Nuremburg 'Doctor's trial' and the subsequent allegations of abuses of power by psychiatrists under other authoritarian regimes necessitated the development of universal proclamations of ethical conduct. In light of this tension, the argument that a middle ground of negotiated morality according to basic Hippocratic notions and respect for life can become the foundation of binding moral absolutes in psychiatric ethics. It is neither credible nor possible to assert broader ethical maxims within the psychiatric profession, given the different contexts in which professional groups practice their craft. In conclusion, the empirical studies of the value systems of different psychiatric professions should be elaborated and that these be compared to identify the common ground that might form the basis of a global code of ethics for psychiatry.

 

Ethics ; Psychiatry

With increasing realization of the extent and consequences of depressive comorbidity in epilepsy, much human and animal research has focussed on its explanation. Recent studies tackle all three explanatory possibilities: that epilepsy leads to depression; that depression contributes to causation of epilepsy; or that shared causal factors or processes lead to both epilepsy and depression. These are not mutually exclusive; all three probably contribute. Animal models have provided many insights into the interplay between epilepsy and depressive-like behaviours, both associations and mechanisms. Notably, experimental stress potently affects epilepsy endpoints, as well as depressive-like behaviour, having actions at multiple relevant biological levels. Current general (nonepilepsy) depression modelling is biopsychosocial in nature, integrating insights from genetics, epidemiology, psychology and neurobiology; and takes a lifespan developmental perspective, as the causation of depression is a multistage process with origins in early life - as is the case for many epilepsies. These perspectives need to be more fully adopted in the epilepsy/depression fi eld.

A prime diffi culty facing all people with epilepsy is dealing with the stigma which is associated with it in almost all societies. Stigma arises from the perception of difference from the norm, particularly powerful when that difference is not understood. This arises from the uniquely human need for predictability, resulting from the ability to think abstractly, and thus to surmise the future. A failure of expectation, or the uncertainty caused by an inability to predict, causes insecurity, or a “fear of the unknown”, which we try to reduce by rejecting its perceived cause. Stigma can be attached to themselves or their epilepsy by the person with epilepsy, as well as by others about them. Such discomfort is accentuated by perceived inconsistency between the familiar and unfamiliar. Discrimination occurs as a result of stigma, causing people with epilepsy to be preoccupied with epilepsy and expending much psychological energy on disclosure anxiety, vigilance and a consequent uncertainty of identity. This can result in lower self-esteem, self-fulfi lling prophecies, self-blame and self-rejection, and ultimately dehumanisation. The most effective means of overcoming stigma is by contact between people with epilepsy and those holding the stigma against them. Such contact must be on an equal status footing, repeated and consistent, require interdependence, be socially approved and enjoyable, contradict the stereotypes held, and be with individuals seen as representative of the out-group as a whole. Hence familiarity, rather than breeding contempt, produces the predictability and consequent comfort and acceptability of the normal.

Colorectal cancer is becoming increasingly common in Asian countries and still remains the second leading cause of cancer deaths in the United States. Efforts to prevent colon cancer have targeted early detection through screening and chemoprevention. For the last ten years our laboratory has utilized an in vivo screening assay for the testing of potential cancer preventives for colon cancer. We have conducted investigations on over 150 compounds including many with botanical or herbal origins. As part of our program on natural products we have examined a number of herbal and botanical products in the aberrant crypt foci (ACF) assay including Korean red ginseng powder, green tea catechins, curcumin from the Indian culinary spice, tumeric, compounds from garlic and onion, resveratrol from red grapes, among others. In the ginseng experiments groups of 10 F344 rats were fed ginseng powder at a dose of 0.5 g/kg or 2 mg/kg for 5 weeks. During weeks 2 and 3 rats were injected with 10 mg/kg azoxymethane to induce ACF. Controls (n=10) did not receive azoxymethane (AOM). Rats were killed by CO2 overdose and ACF counted in the rat colon. In 8 week post-initiation experiments ginseng powder inhibited the progression of established ACF, indicating a cytostatic effect. This may be due to an anti-inflammatory effect. There is a body of literature that suggests that compounds in wine, tumeric, and tea inhibit cyclooxygenases, thus reducing prostaglandin-mediated effects on the colon. As colon tumors have been shown to highly express COX-2 protein, and given, that many NSAID drugs also suppress COX-1, it is tempting to speculate that herbal products that inhibit one or both forms of the COX enzyme will be effective agents for the prevention of cancer in man.
Animal ; Anticarcinogenic Agents/*pharmacology ; Colonic Neoplasms/pathology/*prevention & control ; Disease Models, Animal ; Human ; Korea ; *Panax ; Precancerous Conditions/pathology/*prevention & control ; Rats ; Rats, Inbred F344

No abstract available.

OBJECTIVE: This study aims to describe the patients' and caregivers' experience with the care provided to them by the residents at the UP-PGH Emergency Room Complex (ERC).
METHODOLOGY: The study was a cross-sectional survey using a self-report questionnaire. Focus Group Discussions (FGDs) were conducted to document experiences of patients. The outputs of these FGDs were formulated into questions that explored whether problems existed in several identified aspects of health care. The questionnaires were administered among patients and caregivers at the PGH-ER. Frequency distribution of the responses was determined and the 95% confidence interval was calculated to test the validity of the results.
RESULTS: Forty one respondents answered the survey questions. The top 5 items perceived to be a problem were the following: 1) alleviation of anxiety; 2) physician accessibility; 3) reassurance by physician; 4) communicating the impression that maximum effort was being exerted; and 5) explanation of possible complications of treatment. Most of these experiences pertained to the domain of communicating empathy. The items pertaining to technical competence of the physician and communication of medical information ranked lower and seemed to be less of a problem. Aside from this there was also a lack of explanation of potential complications of treatments.
CONCLUSION: The study showed that respondents considered communication of empathy to patients and caregivers as the most significant problem. The study also revealed that residents of the UP-PGH ERC gave more importance to the communication of empathy compared to communication of medical information.

Human ; Female ; Anxiety ; Caregivers ; Communication ; Confidence Intervals ; Emergency Service, Hospital ; Empathy ; Focus Groups ; Physicians ; Self Report ; Surveys And Questionnaires

Epilepsy has many non-medical effects on the people with epilepsy, their family and community. To ensure that epilepsy is fully controlled requires a specialist neurologist or paediatrician with up-todate detailed knowledge to diagnose and prescribe treatment, a general practitioner to supervise dayto-day medical management and an epilepsy specialist community worker to provide psychosocial support, information and education to help maintain quality of life. By working together as a team, the specialist, the general practitioner and the epilepsy specialist community worker can ensure that the psychological and social impact of epilepsy is reduced to a minimum.

The Epilepsy New Zealand Field Officer scheme is a model for the provision of community care for people with epilepsy. Epilepsy New Zealand is a voluntary organization. It runs the community care service by employing 27 Field Officers throughout the country. The Officers provide support and information to people with epilepsy, their family and the general public. It is estimated that the service covers about 10% of epilepsy patients in New Zealand. All Field Officers are required to study for nationally recognized Certificate and Diploma in Epilepsy Care qualifications. The funding for this service is by a grant from the Government, charitable trusts and other fund-raising activities.