ABSTRACTS - World Psychiatric Association

RS19.
CURRENT CLINICAL PERSPECTIVES
IN PSYCHOSOMATIC MEDICINE
RS19.1.
CURRENT ISSUES ON COMORBID CONDITIONS
P. Ruiz
Department of Psychiatry and Behavioral Science, Houston,
TX, USA
Comorbidity conditions have become a major clinical area of interest
in recent years. While we have become very much aware of all the
current diagnostic categories included in the DSM-IV, the presence of
more than one psychiatric illness or condition in day to day psychiatric
practice is the rule rather than the exception. Comorbidity factors
nowadays need to be taken into consideration not only among
psychiatric and medical conditions, but also among psychiatric conditions
as well; for instance, it is common to see major depression or
anxiety disorders manifested together with addictive disorders such
as cocaine dependence. Depressive disorders are among the most
common conditions observed in the field of psychiatry, and, therefore,
it is imperative that we pay attention to the psychiatric conditions
that are concomitantly manifested with depressive disorders in
our daily practice. This paper aims to review the extensive role of
comorbidities related to depression as a major financial burden in the
field of psychiatry, and the evidence about how to appropriately diagnose
and treat these comorbidities.
RS19.2.
CURRENT TREATMENT OF POSTPARTUM
DEPRESSION
N.L. Stotland
Rush Medical College, Chicago, IL, USA
Postpartum depression is finally receiving appropriate public and
professional interest. A book by an American movie star, and her
public statements, have helped to decrease stigma. Psychotherapies
are as effective for postpartum depression as for depression at other
times in life, and can be first-line treatment for mild to moderate cases
of postpartum depression. Patients who are more severely depressed
will probably require pharmacologic treatment. There is some concern
about the possible dangers of some or all psychotropic medications,
particularly the selective serotonin uptake inhibitors (SSRIs)
most commonly used to treat depression, to the breastfeeding infant.
There is an increasing body of knowledge about the appearance of the
various SSRIs in breast milk. However, it may be unwise to change
medication in cases where several agents had to be tried before therapeutic
benefit was achieved. If a woman has taken an SSRI during
pregnancy, and up to the time of delivery, the small amount in breast
milk may even diminish the risk of withdrawal symptoms in the baby.
It is crucial to understand and to explain to the patient the documented
and persistent ill effects that having a mother who is
depressed has on a baby, so that the best possible risk/benefit ratio
can be determined. It is often useful to involve those closest to the
patient in the treatment decision. Since postpartum depression
undermines a new mother’s confidence in her mothering ability, it is
also crucial to encourage and support her in that function.
RS19.3.
CURRENT EDUCATIONAL ISSUES PERTAINING
TO CERTIFICATION IN PSYCHOSOMATIC MEDICINE
D.K. Winstead
Department of Psychiatry and Neurology, Tulane University
School of Medicine, New Orleans, LA, USA
Psychosomatic medicine (formerly known as consultation-liaison psychiatry)
has advanced rapidly in the United States in the past two
decades. Similar advances are also taking place in other industrialized
nations such as Canada, Japan, European countries and others. In
2003, the American Board of Psychiatry and Neurology officially recognized
this field and set about to create a written examination for certification
purposes and a second examination to be taken 10 years later
for maintenance of certification (recertification). At the same time, the
Accreditation Council of Graduate Medical Education approved a one
year fellowship and set forth requirements for official accreditation. To
date approximately 36 programs have been accredited and 853 individuals
have been certified. Criteria for program accreditation are
reviewed, as well as the major topics covered in the content outline of
material that is ultimately tested by the written Board examination. The
examination is administered by computer at a specialized testing center.
Two hundred questions are administered over a 4 hour period.
Although viewed as a subspecialty that would train psychiatrists for an
academic or tertiary care practice, the numbers are not yet robust
enough to sustain the field. Possible remedies for this dilemma would
involve both increased funding for fellowship training as well as
increased reimbursement for patient care services delivered.
RS19.4.
ILLNESS, SPIRITUAL BELIEFS AND CULTURE
IN PSYCHIATRIC CONSULTATIONS
E.F. Foulks
Jefferson Parish Human Services Authority, Metaire, LA, USA
Gallup opinion surveys in the US have found that the number of people
who indicate that they believe in God has remained consistently
around 95%. About a third of these view religious commitment as “the
most” significant component of their lives. Two thirds say religion is
“important or very important” in their lives and indicate a preference
for “a professional counselor who is religious”. Scott Peck has pointed
out that, while patients often invoke religious beliefs to explain their
symptoms of mental disorder, they are seldom elicited by or communicated
to the mental health professional, often resulting in misdiagnosis
and mistreatment. Treating the “whole person”, body and soul, has
been the aim of physicians since antiquity. During the past century,
advances in biomedical science and technology have often shifted
focus of the clinician on biological tests and treatments, sometimes
neglecting the inner-psychological experiences of suffering of the
patient. Returning the clinical gaze once again on the bio-psychosocial-spiritual
needs of the patient seems to be an inevitable emerging
process, one that promises to enrich the experience of healing for the
patient and clinician as well, offering both hope and meaning.
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