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Psychiatric evaluation in the Philippines Essay

1. How would you describe the status of Filipino mental health based on prevalence of psychiatric cases released by DOH and the National Center for Mental Health from 2009-2012? As taken from the report, the WHO identified that stigma, discrimination and neglect have prevented care and management from reaching persons with mental disorders .Psychiatric patients in the Philippines are usually managed in a mental hospital setting. DOH-commissioned Social Weather Stations survey found that 0.7 percent of total Filipino households have a family member who has a psychological disorder such as depression, schizophrenia, epilepsy, and substance abuse. The status of mental health in the Philippines is also greatly affected by psychosocial issues and stress happening in the country such as economic crisis (poverty) and problems in interpersonal relationship (family, friends and workplace).

Although for now the status of Filipino mental health is being balanced by our cultural practices, it is with great importance that we recognize that to further decrease the incidence of psychiatric cases, we need to seek medical assistance to manage them. The Philippines is a country in which psychiatry is taboo. Despite being a very modernized and americanized nation for the most part, plenty of Filipinos still hold onto old traditional and religious beliefs. Psychological disorders are not seen as such, but are thought of as demonic possessions and the like. The social stigma associated with mental illness is a major cause for non-use of health and psychosocial services by Filipinos.

The lack of understanding of mental illness and the importance of mental health among Filipinos is as serious as the lack of a regular and useful database on the prevalence, manifestations, causation and risk factors of mental illness in the country. Thus, in my point of view, although the Philippines has lower number when it comes to psychiatric cases than other countries, our approach in handling such cases are still primitive that it would greatly affect the society and might contribute to the future increase of such cases.

2. Criticize the DSM-IV-TR in terms of reliability and practicality. The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians and psychiatrists to diagnose psychiatric illnesses. It improved diagnostic objectivity by adding prototypes or decision trees outlining defining features of disorders, which lead clinicians through sets of questions regarding the presence or absence of symptoms. Mental health providers use the manual to better understand a client’s potential needs as well as a tool for assessment and diagnosis. The DSM-IV Text Revision is based on five different dimensions.

This multiaxial approach allows clinicians and psychiatrists to make a more comprehensive evaluation of a client’s level of functioning, because mental illnesses often impact many different life areas. I have read several reviews about this system and there has been charges that DSM criteria and categories have little lapse when it comes to reliability and validity of its diagnoses. Some even suggested widespread concerns that DSM diagnostic categories lack clinical, research, and educational utility and that they are misused in a variety of contexts. As I was browsing the net I found two studies that used to describe the reliability and validity of the DSM-IV TR: Hoffmann (2002)

Hoffmann studied prison inmates to look at diagnoses of alcohol abuse, alcohol dependency and cocaine dependency, to see if differences would occur in a computer-prompted structured interview, compared to the DSM-IV-TR criteria. It was found that the DSM-IV-TR diagnosis was valid and that the interview data supported the idea that dependence was more a severe syndrome than abuse. The symptoms from the automated interview matched those of the DSM criteria.

Lee (2006) Lee studied the DSM-IV-TR diagnosis of ADHD to see if it would be suitable for Korean children, and looked at gender differences in the features of ADHD in the DSM. The DSM lists eighteen criteria for ADHD linked to children’s behavior. In total, 48 primary school teachers rated the behavior of 1,663 children (904 of which were boys, the remaining girls) using a questionnaire. Lee looked for concurrent validity by comparing the DSM-IV-TR criteria with criteria arising from the questionnaire, and compared DSM behavioral and psychological characteristics with those found in an ADHD test. Previous studies had showed that ADHD children had oppositional deficit disorder, ODD, as well, having problems with peers and discipline.

Lee decided that finding the same correlation would support the diagnosis and show the DSM to be a valid tool. The same relationship was observed, and so it was said that the DSM-IV-TR had concurrent validity. Also found it to be reliable, as the correlation could check for similar diagnoses. However, the study found that for girls, the DSM-IV-TR symptoms and diagnoses were less compatible than they were for boys, which was a weakness found with the DSM as a diagnostic tool. When it comes to practicality, the DSM-IV TR provides readily available diagnoses that helps clinicians to plan a treatment to patients since the DSM-IV is a categorical classification system.

To be reliable as a diagnostic classification system, there would have to be consistency with the DSM. This means that the DSM is reliable if the clinicians using it consistently arrive at the same diagnoses as each other. Validity is the extent to which a measure of a psychological variable measures what it sets out to measure. Essentially this means the correct variable (in clinical psychology, this variable will be a mental disorder) is measured, by arriving at the correct diagnosis. Needless to say, if the DSM were not reliable, it would not be valid either. This is because if it is unreliable it means inconsistent diagnoses are made, and so it must not be valid either as surely the correct diagnosis is being made.

3. With the patient’s right to privacy, what are the advantages and disadvantages of observing such right in a psychiatric setting?

Privacy is defined in terms of a person having control over the extent, timing, and circumstances of sharing oneself physically, behaviorally or intellectually with others. Psychiatric patients have unique needs and quite often several issues are at stake. Although we handle these patients with a specialized form of care, all of them have all the same rights. One of the most important right is the right to privacy. Advocating a patient’s right is one of the fundamentals of nursing. The nurse must safeguard the patient’s right to privacy. This does not only mean the right to be left alone but more importantly avoiding unwanted intrusion into the patient’s life.

The nurse advocates for an environment that provides for sufficient physical privacy, including auditory privacy for discussions of a personal nature and policies and practices that protect the confidentiality of information. Maintaining the privacy of a psychiatric patient and practicing confidentiality has a lot of advantages. It helps establish trust between a health care provider and the patient, whereas he feels respected thus gathering needed information regarding the patient’s status, including needs and concerns becomes easy. It also helps to reduces worry on the part of the patient and maintains his dignity.

Therefore it could give the patient a sense of control and promotes autonomy. Moreover every freedom should also have its limitation. When we talk about privacy in the psychiatric setting, in times where patients lack the capacity to make decisions for themselves, their best interests should be considered during the treatment. Any treatment should be the least intrusive option for the patient. A patient’s right to privacy may be limited in situations where a person must be continuously observed, such as when restrained or in seclusion when immediate and serious risk to harm self (such as when the patient is under suicide precautions or special observation status) or others exists.

Although this advocates for the safety of the patients in the hospital, some patients may find this experience confusing or upsetting. Furthermore, in practicing their right to access their records, some psychiatric patients might become more worried and pessimistic after reading their records especially if they are not responding well to treatments. And also in case of involuntary hospitalization (which is usually justified by patients’ imminent dangerousness to themselves or others, or their inability to meet basic needs) patients feel their privacy is being violated.

In acknowledgement of the seriousness of depriving a patient of freedom in an involuntary commitment, the involuntary patient could insist his right to privacy and might withhold key information about his status that may contribute to his treatment. The patients’ rights especially regarding his privacy has its advantages and limitations which may result to various effects on his well-being. Health care providers should consider privacy a basic human right and confidentiality a professional obligation.


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