Advance Care Planning (ACP) is increasingly recognised as part of holistic patient-centred care. The goal of ACP is to help the patient explore and express his preferences regarding options and goal of care before the event of a catastrophic illness. Family physicians are well sited to conduct ACP in the community with their patients. It should be offered, with discernment and empathy, to individuals, ranging from the well healthy patient to those with organ complications from chronic diseases, who are ready to participate in such dialogue. It should always be paced at the patient’s pace.

The elderly have complex bio-psycho-social needs which are best met by a multidisciplinary team approach. In a multidisciplinary team, diverse perspectives are gathered to make a unified decision to solve a complex problem. Having a clear vision with common goals and ensuring an organised framework with good collaboration among team members are some of many factors needed to build a strong team. Benefits include the ability to provide comprehensive and personalised care to the patient during care transition, henceforth reducing overall hospitalisation and healthcare costs.

Dysphagia is a common problem among the elderly either as a result of age-related loss of musculature and function involved in the act of swallowing, and/or because of neurological, degenerative, respiratory and musculoskeletal diseases that cause decreased swallowing function. Assessment for dysphagia is important to prevent serious complications such as aspiration pneumonia. Referral to the speech-language therapist for comprehensive assessment paves the way for proper management. The management may include diet modification, compensatory swallowing techniques, swallowing exercises or use of feeding tubes and facilitative devices.

To highlight the diagnostic challenges in diagnosing a patient with schizoaffective disorder under DSM-IV-TR and to evaluate the effectiveness of changes in DSM-V in addressing these issues. Methods: We present the evolution of the diagnosis from its inception, outline its complex nosology, review the diagnostic difficulties under DSM-IV-TR and critique the proposed changes made in DSM-V. Results: A complex nosology, varied thresholds of diagnosis under DSM-IV-TR, and the inherent difficulty in obtaining a detailed longitudinal history from a patient contribute to the challenge of diagnosing a patient with schizoaffective disorder. Changes in DSM-V attempt to increase the reliability of the diagnosis by specifying and raising temporal thresholds, moving the time of disease observation away from a single episode but towards the lifetime of illness. Conclusion: Changes made in DSM-V only address a small part of the difficulties raised and clinicians will continue to face challenges in diagnosing schizoaffective disorder under DSM-V. However, there might still be value in the proposed changes under DSM-V

Adult ; Antisocial Personality Disorder ; Homicide ; psychology ; Humans ; Korea ; ethnology ; Male ; Mass Casualty Incidents ; psychology ; Suicide ; psychology ; United States ; Universities ; Virginia

Hypnosis can be defined as a procedure during which changes in sensations, perceptions, thoughts, feelings or behaviour are suggested. Hypnosis can be used to amplify whatever it is about therapy that makes it therapeutic. It permits a wide range of choices regarding where and how to intervene in the patient's problems. In this paper, we set out to examine the rationale of using hypnotherapy to manage various types of sleep disorders, and to explore the techniques, strategies and hypnotic scripts employed by various hypnotherapists. We also examine the research data available on the efficacy of hypnosis in the treatment of sleep disorders. Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions. Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias, specifically for head and body rocking, bedwetting and sleepwalking. Hypnosis is a specialised technique, not a therapy itself, and should be used as an adjunctive intervention within a complete psychological and medical treatment package. Most of the literature is limited to case reports or studies with such a small sample that at times it is very difficult to interpret the results. There is a major placebo effect, so uncontrolled trials are of limited value. It is hard to perform a randomised, double-blind, controlled trial to evaluate hypnotherapy given that cooperation and rapport between patient and therapist is needed to achieve a receptive trance state.
Humans ; Hypnosis ; Nocturnal Enuresis ; therapy ; Parasomnias ; therapy ; Sleep Initiation and Maintenance Disorders ; physiopathology ; therapy ; Sleep Wake Disorders ; therapy

Health Knowledge, Attitudes, Practice ; Humans ; Mental Disorders ; diagnosis ; rehabilitation ; therapy ; Psychiatry

INTRODUCTIONSome studies have demonstrated an increased risk of death for patients admitted at nights or during weekends. This study was undertaken to investigate the demographic profile, medical interventions and outcome of severe head injury patients stratified according to day and time of admission to a specialised neurosciences intensive care unit (NICU).

MATERIALS AND METHODSA retrospective study using a prospectively maintained severe head injury database in a tertiary hospital. Admissions to the NICU were grouped into weekdays, weeknights and weekends. A comparison of patients admitted during the day and night hours were also made.

RESULTSA total of 838 severe head injury patients admitted to NICU were included in the study, of which 263 were admitted on weekdays, 327 on weeknights and 248 on weekends. More patients were admitted during the night (496) compared to during the day (342). There were no significant differences in the demographic profile, mechanism of injury, severity of injury, need for neurosurgical intervention, and duration of mechanical ventilation, intensive care unit (ICU) stay and mortality associated with day and time of admission. In multivariate analyses controlling for confounding factors, no statistically significant difference in ICU mortality was found with the day and time of admission.

CONCLUSIONSThere were more severe head injury patients admitted to ICU at night and on weekends, with no significant difference in demographic profile, types of injuries, need for neurosurgical interventions and duration of ICU stay and mortality in a specialised NICU with adequate staffing and requisite diagnostic and therapeutic modalities available.

Adult ; Aged ; Craniocerebral Trauma ; mortality ; Female ; Glasgow Coma Scale ; Hospital Mortality ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Retrospective Studies ; Singapore ; epidemiology ; Time Factors ; Trauma Centers ; standards

Neuropsychiatry is an emerging field at the intersection of neurology and psychiatry, driven by the unprecedented advances in neuroscience. The arbitrary demarcation between neurology and psychiatry, which largely existed only in the last century and a half, has become less tenable. We discuss the definition and scope of this emerging field. We also review the development of clinical neuropsychiatry in Singapore in the context of historical developments and recent changes in the field from other countries. At a more practical level, we discuss a few of the clinical settings in which neuropsychiatry operates, in particular, the stigma associated with psychiatric disorders locally, and the significant number of patients with psychiatric or psychosomatic symptoms presenting to neurology and general practice clinics. The stigma may be ameliorated by better understanding of the neurobiological basis of psychiatry. We see the future of neuropsychiatry in Singapore, as in other developed countries, as one approach to understand and manage complex brain disorders. We advocate training for both psychiatry and neurology residents in their counterpart fields, which will lead to greater understanding of both fields, and enhance collaboration in clinical care and research.
Brain Diseases ; diagnosis ; history ; physiopathology ; psychology ; History, 19th Century ; History, 20th Century ; Humans ; Neurology ; history ; Neuropsychology ; history ; Neurosciences ; history ; Psychiatry ; history ; Singapore