The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.
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This chapter explores recent insights from preclinical and clinical studies of cancer induced bone pain (CIBP). There are various neuropathic, nociceptive, and inflammatory pain mechanisms that contribute to CIBP. Neuropathic pain can be induced as tumor cell growth injures distal nerve fibers that innervate bone and pathological sprouting of both sensory and sympathetic nerve fibers. These changes in the peripheral sensory neurons result in the generation and maintenance of tumor induced pain. CIBP is usually described as dull in character, constant in presentation, and gradually increasing in intensity with time. A component of bone cancer pain appears to be neuropathic in origin as tumor cells induce injury or remodeling of the primary afferent nerve fibers that normally innervate the tumor bearing bone. The treatment of pain from bone metastases involves the use of multiple complementary approaches including radiotherapy, chemotherapy, surgery, bisphosphonates, and analgesics.
The vast majority of cervical cancer cases are human papillomavirus -mediated. Incidence and mortality significantly declined with introduction of screening with Pap smears. Adenocarcinoma often presents with larger tumors (“barrel cervix”) with higher risk of local failure. Cervical cancers are often asymptomatic and detected on screening, or can present with abnormal vaginal discharge, post-coital bleeding, dyspareunia, or pelvic pain. Three Food and Drug Administration approved vaccines are available that prevent the development of cervical cancer. Imaging includes positron emission tomography/computed tomography (nodal staging), pelvic magnetic resonance imaging (to delineate local disease extent and guide decisions on fertility vs. non-fertility sparing approaches). Treatment at early stages is often surgical, while Radiation therapy (
RT)+/− Chemotherapy ( CHT) is employed in later stages. When treating definitively, External beam radiation therapy is followed by an intracavitary or interstitial brachytherapy boost. Post-operative RT+/− CHTis occasionally indicated for adverse pathologic features.
World Health Organization grade III gliomas are referred to as anaplastic gliomas. The general treatment paradigm includes maximal safe surgical resection followed by adjuvant radiation therapy and chemotherapy (
CHT). The randomized trials that established a survival benefit from chemotherapy used Procarbazine, Lomustine, and Vincristine ( PCV). Concurrent and adjuvant temozolomide ( TMZ) is given more often and is still subject to ongoing study. An improved understanding of genomics is rapidly informing the clinical behavior and treatment. Histologic subtypes of anaplastic gliomas include anaplastic astrocytoma and anaplastic oligodendroglioma ( AO). Headache and seizures are the most common symptoms of anaplastic gliomas. Adjuvant radiation improves overall survival after surgery compared to observation or CHTalone and is indicated for all high-grade gliomas. Despite the survival advantage demonstrated with PCVin patients with AOsand AOs, many substitute TMZas it is easier to administer and generally better tolerated.
Primary progressive aphasia (PPA) is the term applied to a clinical syndrome characterized by insidious progressive language impairment that is initially unaccompanied by other cognitive deficits. This chapter describes several variants of PPA and more than one etiology. It explains three main variants of PPA, namely, semantic Variant of PPA (svPPA), nonfluent/agrammatic variant of PPA (nfvPPA) and logopenic variant of PPA (lvPPA), and also describes criteria for their diagnoses. The defining symptom of PPA is the presence of a language impairment for at least 2 years in the absence of any other significant cognitive problem. Assessment of other cognitive domains is challenging because many tests of memory, attention, executive functioning, and visual-spatial skills rely on language processes in some manner. There are no drug therapies proven to arrest progression of signs and symptoms of PPA due to frontotemporal lobar dementia (FTLD) or Alzheimer’s disease (AD) pathologies.
In the therapeutic community (TC) perspective, the substance abuse disorder is not distinct from the substance abuser. A picture of dysfunction and disturbance of individuals entering treatment reflects a more fundamental disorder of the whole person. This chapter presents the TC view of the disorder in the context of current biomedical, social, and psychological understanding of chemical dependency. Overall, the picture that individuals present when entering the TC is one of health risk and social crises. In the TC perspective, drug abuse is a disorder of the whole person, affecting some or all areas of functioning. In the TC view, social and psychological factors are recognized as the primary sources of the addiction disorder. Substance abusers themselves cite a variety of reasons and circumstances as causes of their drug use. TC policy on the use of pharmacotherapy is currently undergoing modifications.
The therapeutic community (TC) for addictions descends from historical prototypes found in all forms of communal healing. A hybrid, spawned from the union of self-help and public support, the TC is an experiment in progress, reconfiguring the vital healing and teaching ingredients of self-help communities into a systematic methodology for transforming lives. Part I of this book outlines the current issues in the evolution of the TC that compel the need for a comprehensive formulation of its perspective and approach. It traces the essential elements of the TC and organizes these into the social and psychological framework, detailed throughout the volume as theory, model, and method. Part II discusses the TC treatment approach, which is grounded in an explicit perspective that consists of four interrelated views: the drug use disorder, the person, recovery, and right living. The view of right living emphasizes explicit beliefs and values essential to recovery. Part III details how the physical, social organizational, and work components foster a culture of therapeutic change. It also outlines how the program stages convey the process of change in terms of individual movement within the organizational structure and planned activities of the model. Part IV talks about community enhancement activities, therapeutic-educational activities, privileges and sanctions, and surveillance. The groups that are TC-oriented, such as encounters, probes, and marathons, retain distinctive self-help elements of the TC approach. Part V depicts how individuals change through their interaction with the community, provides an integrative social and psychological framework of the TC treatment process, and outlines how the basic theory, method, and model can be adapted to retain the unique identity of contemporary TCs.
The chapter discusses strategies for radiation therapy treatment planning for lymphoma. It explains clinical application, patient setup and immobilization. Treatment planning describes dose specification, extended field radiation therapy, involved/regional field radiation therapy, and involved site radiation therapy. Radiation therapy is used as monotherapy, or as an adjunct to chemotherapy to treat Hodgkin’s and Non-Hodgkin’s lymphoma. The chapter provides clinical application, patient setup, and treatment planning with dose specification, and treatment techniques for total skin electron irradiation. The clinical application for total skin electron irradiation is definitive treatment of cutaneous T-cell lymphoma, also called mycosis fungoides. The chapter also presents clinical application, patient setup, and treatment planning for total body irradiation. Total body irradiation is used on its own, or as an adjunct to chemotherapy as part of a myeloablative regimen, to condition the host prior to receiving a hematopoietic transplantation.
This chapter presents sets of questionnaires are helpful in working with fertility treatment. Infertility clients often carry within them a strong sense of blame and misplaced personal responsibility. The two primary negative cognitions that appear most often are: “There’s something wrong with me”, and “I must have done something wrong”. The chapter also presents a construction of a Time Line. Each Time Line corresponds to only one theme: responsibility, trust or control. It is important that the client have general information about the Adaptive Information Processing (AIP) Model in order to ensure optimum participation in treatment. The client is informed about what to expect relative to the process and effects of Eye Movement Desensitization and Reprocessing (EMDR). Based on client needs, risk considerations may include: poor self-care and nutrition, side effects of hormone or drug therapy consistent with fertility treatment, marital strain, or weakness in support system.
This chapter discusses dermatological toxicities of anticancer therapies and mainly focuses on two adverse events: hand–foot syndrome (HFS) and paronychia. HFS is a well-documented reversible adverse effect of many chemotherapeutic therapies, causing a wide variety of cutaneous symptoms ranging from erythema, dysesthesia, pain, and desquamation of the palms and soles to impairing daily activities of living. The standard approach used in the management of HFS is treatment interruption or dose modification, with symptom improvement reported within 1 to 2 weeks. Paronychia is the inflammation of the nail folds, jeopardizing the nail fold barrier and potentially exposing the nail matrix to damage. Paronychia is also an adverse effect of chemotherapeutic agents. The known causes of acute paronychia prior to the introduction of epidermal growth factor receptor (EGFR) inhibitors included staphylococci, streptococci, and pseudomonas, whereas, Candida albicans was frequently associated with chronic paronychia, with diabetes mellitus being a predisposing factor.