Although pain is not only a physical but also an emotional and cognitive distress, psychiatric management of pain has commonly been overlooked. In this article the author will review the psychiatric assessment and treatment of patients with chronic pain. Pain is not a simple sensory process but a complex perception involving higher levels of the central nervous system, emotional states, and highorder mental processes. Thus the psychosocial aspect should be underscored in patients with chronic pain, and a multidisciplinary approach is necessary in the treatment of chronic pain. Tricyclic antidepressants are most widely used and have proven effective in patients with chronic pain. Anticonvulsants/mood stabilizers, anxiolytics, antipsychotics, and opioid analgesics are beneficial in some cases. Non-Pharmacological and psychological therapy of chronic pain includes cognitive-behavioral therapy, relaxation techniques, biofeedback, hypnosis, psychotherapy, and family therapy. New psychotropic agents and various psychological therapies need to be developed and be proven to be effective and tolerable in patients with chronic pain through well-controlled and long-term follow-up studies. Psychiatric treatments, both pharmacological and non-pharmacological, are helpful in patents with chronic pain.
Analgesics, Opioid ; Anti-Anxiety Agents ; Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Biofeedback, Psychology ; Central Nervous System ; Chronic Pain* ; Family Therapy ; Humans ; Hypnosis ; Mental Processes ; Psychotherapy ; Relaxation Therapy

The mechanism of psychotherapy is explained by the recent developments in neuroscience and neuroimaging. The purpose of this study is to understand the nature of psychotherapy and to discuss the future of psychotherapy improvement with the help of advances of the neurobiological findings in psychotherapy. For this study, we investigated a wide range of materials. We searched for various researches on psychotherapy, brain, and neurobiology. In addition to the conventional psychodynamic psychotherapy, we investigated research findings on cognitive behavioral therapy, interpersonal psychotherapy and eye movement desensitization and reprocessing (EMDR). Moreover, based on the actual experiences of treating patients, we speculated the neurobiological mechanisms of the process and results of psychotherapy. With the development of neuroscience, we are now able to understand the personal consciousness, unconsciousness and developmental process. Also subdividing the disease is made possible. Personalized treatment has become available, and we are able to predict the prognosis of patients. Our memories are composed by implicit memory and explicit memory. By psychotherapy, we can consciously remember explicit memory, and it becomes easier to explore implicit memory through free association. Through psychotherapy, we will also be able to learn the effect of acquired environment and experience. Psychotherapy is able to correct human behaviors by modifying the memories. Through the regulation of emotions, it becomes possible to modify the memories and correct the behaviors. In this process, doctor-patient relationship is the main factor which cause positive treatment effects. Furthermore imagination therapy or unconscious, non-verbal stimuli could bring about positive treatment effects. Now psychotherapy could be explained and studied by neuroscientific researches. In this sense, we could provide the direction of future advances in neuroscience by the neurobiological understanding of psychotherapy.
Brain ; Cognitive Therapy ; Consciousness ; Eye Movements ; Free Association ; Humans ; Imagination ; Memory ; Neurobiology ; Neuroimaging ; Neurosciences ; Prognosis ; Psychotherapy ; Unconscious (Psychology) ; Unconsciousness

The authors reviewed the meanings of a psychoanalytic setting, which is composed of a patient's free association and an analyst's analytic neutrality. In particular, this was done by discussing the definitions of a psychoanalytic setting, the functions of free association, and the development of the meanings of analytic neutrality over time. The purpose this wasto provide an understanding of a psychoanalytic setting for psychoanalytic therapists. To fully understanda psychoanalytic setting, the several points must be considered. Firstly, a patient's introspection about his/her inner world in the presence of an analyst in a psychoanalytic setting facilitates the development of the psychoanalytic process. Secondly, both a patient's reflective functioning of his/her mental process and a patient's relational experiences of transference feelings toward their analyst is important for analytic treatment. Thirdly, a patient's progress withfree association during treatment sessions indicates spontaneity, a motivation to be cured from a patient's standpoint. Fourthly, a patient and an analyst become aware of the meaning of a patient's materials from free association through the process of Ed-highlight: Unclear. I'm not sure what you mean by this word. Are you referring to the patient's thoughts or feelings? free association itself. Fifth, the main aim of analytic neutrality is to understand the patient's psychic reality, and it is important to understand this reality through interaction between a patient and an analyst
Free Association ; Humans ; Motivation ; Psychoanalysis

Mind-body medicine (MBM) is a field of medicine concerned with the ways that the mind and emotions influence the body and physical health. It may be more accurate to think of mind/body as a single entity, with the health of one part necessarily influencing that of the other. The National Institutes of Health (NIH) defines MBM techniques (MBT) as interventions that use a variety of techniques designed to facilitate the mind's capacity to affect bodily functions and symptoms. MBT offers patients with greater control in their treatment, cheaper alternatives, effective options for managing chronic conditions, and methods for maintaining wellness. Mind-body approaches include guided imagery, meditation, hypnosis, and movement therapies such as dance, tai chi, chi gong, and yoga as well as music and chanting. Such approaches are as old as traditional oriental healing systems and as widespread as seen in Chinese, Indian, and East Asians. Modern Western medicine is now beginning to give MBTs recognition in its importance as well as efficacy. This article reviews the medical literatures on the techniques that have been studied the most: relaxation therapy, meditation, hypnosis, cognitive-behavioral therapy guided imagery, and biofeedback.
Asian Continental Ancestry Group ; Biofeedback, Psychology ; Humans ; Hypnosis ; Imagery (Psychotherapy) ; Integrative Medicine ; Meditation ; Mind-Body Therapies ; Music ; National Institutes of Health (U.S.) ; Relaxation Therapy ; Singing ; Tai Ji ; Yoga

PURPOSE: The purpose of this study was to explore the levels of depression and predictors of depression in middle-school girls. METHOD: A self-report survey was conducted with 2nd and 3rd grade students in a girls' middle school (N=401) in Pusan. Data were analyzed with descriptive statistics, Pearson correlation, and simultaneous multiple regression using the SPSS program. RESULTS: The mean score for the Center for Epidemiologic Studies-Depression Scale (CES-D) was 20.63. The level of depression was negatively related to problem-solving ability, self-esteem, total household income, school achievement, self-perception of body-image, and satisfaction in relationships with siblings, parents, and friends. A multivariate approach showed that predictors explained 61% of variance in depression. Significant predictors of depression were self-esteem (beta=-.38), problem-solving ability (beta=-.34), and satisfaction in relationships with friends (beta=-.14) and parents (beta=-.08). CONCLUSION: The findings suggest that it is important to develop educational programs to increase self-esteem and problem-solving abilities in middle school girls. Considering the high levels of depression in middle school girls, school nurses play an important role in detecting and reducing emotional tension among these students. Nursing interventions, including art therapy, problem-solving counseling, and bibliotherapy could be useful in enhancing self-esteem, problem-solving abilities, and satisfaction in relationship with friends, siblings and parents.
Achievement ; Art Therapy ; Bibliotherapy ; Body Image ; Counseling ; Depression ; Family Characteristics ; Friends ; Humans ; Parents ; Problem Solving ; Self Concept ; Siblings

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.
Acupuncture ; Agaricales ; Biofeedback, Psychology ; Chiropractic ; Complementary Therapies* ; Diet ; Erectile Dysfunction* ; Health Food ; Herbal Medicine ; Homeopathy ; Humans ; Hypnosis ; Lycopersicon esculentum ; Male ; Massage ; Medicine, Traditional ; Moxibustion ; Panax ; Psychotherapy ; Surveys and Questionnaires ; Relaxation ; Spiritual Therapies ; Food, Organic

OBJECTIVES: The purpost of this study was to present general system,operation,and program of a day care model managed by a psychiatrist,to evaluate the results of performing this model,and thus to developa day care model applied to Korean situation appropriately for promoting maintenance and rehabilitation of chronic psychotic patients. METHODS: We performed this day care model(hereinafter called as this model) from March 1997 to February 1998. The subjects were composed of 23 psychotic patients. PANSS, Quality of Life Scale,Life Satisfaction Self-Rating Scale were used before beginning this model-and after three months of performing this model. Program Helpfulness Scale,13 Therapeutic Factors Scale were used at one month of day care and after three months of day care. RESULTS: 1) This model helped maintenance and rehabilitation of chronic psychotic patients through reducing their symptoms and increasing quality of life. 2) This model used the various group therapy, especially creative art therapy and activeity therapy, played an important fole,for recovering Physical,psychological,and social functions. 3) Important therapeutic factors at early and late period of this model were identification with therapists,guidance of therapists,and the corrective recatitulation of the primary family group. Important therapeutic factors at early period were group cohesiveness and altruism, and at late period instillation of hope. 4) This model was useful for integration the multidisciplinary therapeutic team and the various therapeutic methods. CONCLUSION: This model would be applied to day care in this country effectively and efficiently for maintenance and rehabilitation of chronic psychotic patients.
Altruism ; Art Therapy ; Day Care, Medical* ; Hope ; Humans ; Psychotherapy, Group ; Quality of Life ; Rehabilitation*

The purpose of this study was to determine the kinds and characteristics of nursing interventions performed by adult nursing units nurses. For this study, 433 taxonomy of nursing intervention classification(NIC) of Iowa University research project were used, which were translated into Korean. The data were collected from 110 nurses of 4 General Hospitals from Jan. 20, 1998 to Feb. 18, 1998 and analyzed with SPSS program. The result are as follows : 1. 31 nursing interventions were performed at least once a day. Most of which were physiological complex domain. The nursing interventions receiving the highest mean-use score were intravenous therapy, documentation, medication, vital sign monitoring. analgesics administration, teaching : prescribed medication, hypoglycemia / hyperglycemia management, nutrition therapy and active listening. 2. 20 nursing interventions were performed several times a day by 50% or more of the nurses. The most frequently used nursing interventions were intravenous therapy, medication, documentation and vital sign monitoring. Most of the nursing interventions used sevral times a day are in the physiological complex domain. 3. 256 nursing interventions performed at least monthly by 50% or more of the nurses. Those nursing interventions were all of the domains and the classes in the NIC taxonomy except the child bearing class. 4. 59 nursing interventions were rarely performed by 90% or more of the nurses. Most of them were in the family domain. The rarely used interventions were contactlense care, animal therapy, art therapy, hypnosis and child bearing care. 5. Adult nursing units performed all kinds of indirect nursing interventions and the most frequently performed nursing interventions were documentation, shift report, order transcription, examination assistance and emergency cart checking. In conclusion the kinds and characteristics of nursing interventions performed by adult nursing units nurses were determined to apply to practice for providing standarized nursing leading to a professional nursing and development. Base on this study, the development of nursing intervention classification suitable for current situation and classified studys concerning are recommanded.
Adult* ; Analgesics ; Animals ; Art Therapy ; Child ; Classification ; Emergencies ; Hospitals, General ; Humans ; Hyperglycemia ; Hypnosis ; Hypoglycemia ; Iowa ; Nursing* ; Nutrition Therapy ; Vital Signs

OBJECTIVES

This study described the demographic and clinical profile, mental health problems, prevalence of psychiatric conditions, psychosocial interventions used, and outcomes of the management of mental health problems among in-patients admitted to non-psychiatry units of tertiary hospitals referred to mental health care providers; and described gender-disaggregated data related to mental health care providers and patients receiving psychosocial interventions in tertiary hospitals.

This study employed a mixed-method design, using both qualitative and quantitative methodologies following the convergence model of triangulation. The following were the data sources: (1) cross-sectional review of charts of patients referred for psychosocial problems using the ICD-10 classification; (2) a survey of mental health service providers; (3) key informant interviews of mental health service providers; and (4) focus group discussions of mental health providers. All data were collated, compared, and contrasted, then analyzed using the convergence model of triangulation design.

Among the 3,502 patients in the chart review, 1,870 (53.40%) were males. The median age was 46.08 years and 92.06% were adults. The most common diagnosis among the patients were mood disorder (744, 21.25%) and organic mental disorder (710, 20.27%). Combination treatment of psychosocial intervention and pharmacology was the most common strategy received by patients. There was a higher proportion of patients admitted to public hospitals (996, 45.27%) who received psychosocial interventions only compared to those admitted to private hospitals (235, 18.05%). There were 3,453 out of 3,502 in-patients referred for psychiatric intervention. Of these 2,420 (70%) received psychoeducation, 2,365 (68.5%), received supportive psychotherapy/counseling, 535 (15.5%) family therapy, and 286 (8.3%) behavior modification. There were more patients given psychosocial interventions 2,541 (72.56%) who were discharged with instruction to follow-up, while around one in 10 (456, 13.02%) was not instructed to do a follow-up consultation. The types of interventions across all data sources were similar.

The most common type of management for psychosocial problems of in-patients in tertiary hospitals was a combination of psychosocial intervention and pharmacotherapy. Psychoeducation, supportive psychotherapy/ counseling, and family therapy were the most often given psychosocial interventions. The patient-related reasons for the choice of interventions were patient’s medical status (diagnosis and severity of symptoms) and psychological status (psychological mindedness), while the provider-related factors influencing the choice of intervention were provider’s skills and personal preference. Moreover, resources (human and material) and service provision policies (treatment guidelines and aftercare interventions) were the most common hospital-related factors. Further prospective research to determine the associated patients, providers, and hospital factors in larger geographic and cultural settings will provide evidence for the effectiveness and outcomes of psychosocial interventions.

This is a report to share the experience of managing a patient planned for surgical wound procedure under anaesthesia with medical hypnosis as a tool for sedation and pain relief with a wrist block to supplement the analgesic effect. This was a patient who presented with severe preoperative anxiety and pain concerning her surgical procedure. She developed an allergy to some analgesia from her first surgical procedure. Adequate motivational interviewing techniques with the patient enabled issues about her anxiety to be explored and helped to ease the patient's anxiety. The surgical procedure was successfully done with hypnosis and regional anaesthesia. The patient's response towards pain and anxiety was documented based on Numerical Reporting Scale. The patient's wound care in the ward and clinic proved to be less painful and more comfortable for the patient with her self-hypnosis skill. Empowering the patient with medical hypnosis during the procedure is an option that should be explored.
Hypnosis