PSYCHIATRY&CLINICAL PSYCHOLOGY Romanian Free Psychiatrists Association(APLR)-FEBRUARY 2024: April 2011

* mesaj lunar

Stimati colegi,

Suntem virtual peste 500,noi facem APLR ,viitorul psihiatriei si psihologiei poate chiar al filozofiei acestor doua discipline. Multi fac pe amnezicii si inccarca un alt week end destul de banal .Timpul trece si noi trebuie sa-i adugam idei memorabile,sa ne opunem depresiei generale si sa supravetuim la un nivel superior profesional si uman.frar o constiinta colectiva eroica nu putem ajunge la nimic.Asa ca va asteptam ! Pregatim si conferinta dela Predeal dela 21 mai.

Prof.ROMILA

La Multi Ani! de FLORII-Invitatie la Expo Bonsai

Editorial Aprilie 2011 - Profesor Dr. Aurel ROMILA

                                                           D I A G N O S T I C

     Pentru meseria noastra valoreaza 50 %, terapeutica fiind cealalta jumatate.Teoretic pare usor. Inveti semiologia, sindromologia si nozologia si apoi incadrezi in DSM. Operatiunea cere ani de ucenicie, cu indrumare critica a unui maestru. Greselile sunt frecvente. Prima greseala este intuitia abuziva care duce la identificari pripite fara excluderea lucida a optiunilor diferentiale. Pe linga o invatare serioasa este obligatoriu exercitiul aplicarii la caz. Diagnosticul ramine deschis. El cere si o evaluare de etapa. Pina la urma evaluarea cere o comparare cu normalitatea care justifica cunoasterea psihologiei si a celorlalte stiinte umaniste. Din diverse motive multi dezechilibrati ramin in societate fara diagnostic si numai in cazul unor fapte ajung la o expertiza. Confuziile cele mai frecvente sunt ale nevrozelor cu psihopatia, sau ale psihozelor cu psihopatia borderline. Deasemenea dementa cu deteriorarea. Chiar intelectul limita daca nu cunosti media, mai departe polimorfismul sindromatic al psihopatiilor, nevrozelor, psihozelor,dementelor. Comorbiditatea neurologica si somatica. Patologia acuta este mai cunoscuta decit cea cronica. Si daca ne mai amintim ca nu exista boli ci bolnavi?
     Esentiala mi se pare inzestrarea intelectuala a psihiatrului din perioada premedicala. Vocatia cere inteligenta, vointa, cultura si rabdare bineboitoare cit si invatarea din propriile greseli. Nimeni nu e perfect.
      Cei care inavata acum nu stiu ca s-a putut abuza pentru interese nemedicale. Sa speram ca etica diagnosticului e sfinta. Diagnosticul este un instrument codificat, nu trebuie sa-i spui cuiva: ai schizofrenie!
    Argumentarea dignosticului se face pe intocmirea unei foi de observatie. Nu e o sclavie sa fii rezident. E bine sa faci cit mai multe foi. Apoi sa discuti cu cei care stiu. Sa citesti si sa compari cu observatii din literatura. Sa inveti sa rezumi. Sa ajungi sa stii discernamintul faptelor in expertiza psihiatrica.
     Laicii cred ca stiu sigur ca altcineva e bolnav! Toata lumea stie futbol dar si psihiatrie si agenda medicala si chiar si psihanaliza! Dreptul la opinie in democratie, dar ultimul cuvint il are psihiatrul format rational o viata intreaga. Si grupul psihiatric isi are uscaturile lui si culmea este ca unii malformati isi diagnosticheaza abuziv colegii.
     Omul ramine in istorie cit isi aplica rationalul in actiunile sale sociale. Asa se mentine societatea si scade antisocialitatea.
                                                                              prof.Romila.

Catalogul Pictorilor Celebri

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5000 de pictori celebri si 100000 tablouri valoroase din tezaurul picturii universale.

Panoramic 3D Lacasuri de Cult - Romania

Panoramic 3D Manastiri si Biserici ROMANIA

1. Manastiri Bucovina

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*Click pe Imagine si apoi cu Mouse vizualizati liber (dreapta-stanga, sus-jos) directia dorita.

Welcome Tour

Calatorii pe Glob

1. Andaluz

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2. Bora Bora

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3. Camera de Chihlimbar

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4. Giethoon

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5. Istanbul

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6. Japonia - 11 Martie 2011

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7. Jardines

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8. Jerusalem - Mount Of Olives

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9. Lotus Lake - Taiwan

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10. Mormantul Maicii Domnului

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11. Pestera Patriarhilor

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12. Photos National Geographic 2010

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13. Russian Churces

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14. Sanctuarul Ascuns

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15. Thailand - The Queen Garden

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16. Trenuletul

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17. Wonderful Images

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18. Viajando por Ecuador

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19. Pasarea Paradisului

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20. Cocori

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Medscape - New Articles

Performance Improvement: Do You Assess Suicidality?
Medscape Education Psychiatry & Mental Health, 2011-02-28


Most Emailed Articles on Medscape
1.	2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB" Medscape Education
2.	IDSA Issues First Guidelines for Treatment of MRSA Medscape Education
3.	The Last Hours of Living: Practical Advice for Clinicians MedscapeCME Nurses
4.	Updated USDA Dietary Guidelines Released Medscape Education
5.	New Guidelines for Exercise in Type 2 Diabetes Medscape Education

How Are Second-Generation Antipsychotics Advancing the Treatment of Depression?
2010-10-04


Most Emailed Articles on Medscape
1.	2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB" Medscape Education
2.	IDSA Issues First Guidelines for Treatment of MRSA Medscape Education
3.	The Last Hours of Living: Practical Advice for Clinicians MedscapeCME Nurses
4.	Updated USDA Dietary Guidelines Released Medscape Education
5.	New Guidelines for Exercise in Type 2 Diabetes Medscape Education

The Prevention of Schizophrenia
Schizophrenia Bulletin, 2011-03-01


Most Emailed Articles on Medscape
1.	A Matter of Respect and Dignity: Bullying in the Nursing Profession Medscape Nurses
2.	Propoxyphene Withdrawn From US Market Medscape Medical News
3.	Overhauling Nursing Education Medscape Nurses
4.	The 2010 AHA Guidelines: The 4 Cs of Cardiac Arrest Care Medscape Emergency Medicine
5.	Vitamin D Supplementation: An Update US Pharmacist

Bipolar Disorder Often Mistaken for Depression in Primary Care
Medscape Education Clinical Briefs, 2011-03-08


Most Emailed Articles on Medscape
1.	2010 AHA Guidelines: The ABCs of CPR Rearranged to "CAB" Medscape Education
2.	IDSA Issues First Guidelines for Treatment of MRSA Medscape Education
3.	The Last Hours of Living: Practical Advice for Clinicians MedscapeCME Nurses
4.	Updated USDA Dietary Guidelines Released Medscape Education
5.	New Guidelines for Exercise in Type 2 Diabetes Medscape Education

MDLinx - New Articles

Vitamin D and Subsequent Systolic Hypertension Among Women
American Journal of Hypertension, 02/22/11

Griffin FC et al. – Consistent with previous animal and human studies, the authors found a single–time measure of vitamin D among young adult women was associated with systolic hypertension 14 years later. These prospective results suggest the need for further study of the role vitamin D insufficiency in early adulthood as a risk factor in subsequent hypertension among women.

Vitamin D and the Prevention of Hypertension and Cardiovascular Diseases: A Review of the Current Evidence
American Journal of Hypertension, 03/07/11

Geleijnse JM – Epidemiological data suggest that optimal vitamin D status is important for cardiovascular disease (CVD) prevention, but results from different studies are conflicting and confounding cannot be ruled out. Randomized?controlled trials of vitamin D supplementation and BP have yielded inconsistent results, and trials that addressed the effect of vitamin D on CVDs are lacking.

Osteoporosis in men
Best Practice & Research Clinical Endocrinology & Metabolism, 03/21/11

Gielen E et al. – Male osteoporosis is an increasingly important public health problem: from age 50 onward, one in three osteoporotic fractures occurs in men and fracture–related morbidity and mortality are even higher than in women. In 50% of osteoporotic men, an underlying cause can be identified (secondary osteoporosis).

Use of Fibrates in the United States and Canada
JAMA, 03/23/11

Jackevicius CA et al. - During the past decade, prescriptions for fibrates (particularly fenofibrate) increased in the United States, while prescriptions for fibrates in Canada remained stable. Methods

This is a population-level, observational cohort study.
IMS Health data from the United States and Canada was used.
Patients who were prescribed fibrates between January 2002 and December 2009 were enrolled.

Results

In the United States, fibrate prescriptions dispensed increased from 336 prescriptions/100 000 population in January 2002 to 730 prescriptions/100 000 population in December 2009, an increase of 117.1% (95% confidence interval [CI], 116.0%-117.9%).
In Canada, fibrate prescriptions increased from 402 prescriptions/100 000 population in January 2002 to 474 prescriptions/100 000 population in December 2009, an increase of 18.1% (95% CI, 17.9%-18.3%) (P <.001).
In the United States, fenofibrate prescriptions dispensed increased from 150 prescriptions/100 000 population in January 2002 to 440 prescriptions/100 000 population in December 2009, an increase of 159.3% (95% CI, 157.7%-161.0%), comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009.
In Canada, fenofibrate prescriptions increased from 321 prescriptions/100 000 population in January 2002 to 429 prescriptions/100 000 population in December 2009.
The annual ratio of generic to brand-name fenofibrate use in the United States ranged from 0:1 to 0.09:1 between 2002 and 2008.
The annual ratio of generic to brand-name fenofibrate use in Canada steadily increased from 0.51:1 to 1.89:1 between 2005 and 2008.
In the United States, crude fenofibrate expenditures increased from $11 535/100 000 population/month in 2002 to $44 975/100 000 population/month in 2009.
The rates in Canada declined from $17 695/100 000 population/month in 2002 to $16 112/100 000 population/month in 2009.
Fibrate expenditures per 100 000 population were 3-fold higher in 2009 in the United States compared with Canad

Your Article Summary

Initial hypertension treatment: one combination fits most
Journal of the American Society of Hypertension, 03/22/11

Brook RD et al. - Authors outline a novel algorithm of starting initial therapy with a single tablet containing amlodipine + benazepril in most patients with hypertension regardless of stage or comorbidities. This streamlined approach is likely to yield an overall positive risk/benefit ratio. Methods

Authors reviewed published studies related to the efficacy and efficiency of starting combination antihypertensive treatment versus mono-therapy.

Results

The evidence supports that initial combination therapy is more effective for many outcomes (ie, reaching blood pressure targets, rapidity of control, patient adherence, and cardiovascular protection assessed by surrogate markers).
The few available published clinical trials and observational studies support that the amlodipine + an angiotensin-converting enzyme inhibitor combination may be the most effective for reducing cardiovascular events.

Daily ZEN

Questions from the Wan Ling Record

Huang po (d.850)

Question: At the moment of Enlightenment, where is the Buddha?

Answer: Whence does your question come? Whence does your consciousness arise? When speech is silenced, all movement stilled, every sight and sound vanished—then is the Buddha’s work of deliverance truly going forward! Then, where will you seek the Buddha? You cannot place a head upon your head, or lips upon your lips; rather, you should just refrain from every kind of dualistic distinction. Hills are hills. Water is water. Monks are monks. Laypeople are laypeople. But these mountains, these rivers, the whole world itself, together with sun, moon, and stars—not one of them exists outside your minds!

Outside Mind, there is nothing. The green hills which everywhere meet your gaze and that void sky that you see glistening above the earth—not a hairsbreadth of any of them exists outside the concepts you have formed for yourself! So it is that every single sight and sound is but the Buddha’s Eye of Wisdom.

Phenomena do not arise independently but rely upon environment. And it is their appearing as objects which necessitates all sorts of individualized knowledge. You may talk the whole day through, yet what has been said? You may listen from dawn till dusk, yet what will you have heard? Thus, though Gautama Buddha preached for forty-nine years, in truth no word was spoken.

Question: Assuming all this is so, what particular state is connoted by the word Bodhi?

Answer: Bodhi is no state. The Buddha did not attain to it. Sentient beings do not lack it. It cannot be reached with the body nor sought with the mind. All sentient beings are already of one form with Bodhi.

Question: But how does one “Attain to the Bodhi-Mind?”

Answer: Bodhi is not something to be attained. If, at this very moment, you could convince yourselves of its unattainability, being certain indeed that nothing at all can ever be attained, you would already be Bodhi-minded. Since Bodhi is not a state, it is nothing for you to attain. And therefore, it is written of Gautama Buddha: “While I was yet in the realm of Dipamkara Buddha, there was not a grain of anything to be attained by me. It was then that Dipamkara Buddha made his prophecy that I, too, should become a Buddha.”

If you know positively that all sentient beings are already one with Bodhi, you will cease thinking of Bodhi as something to be attained. You may recently have heard others talking about this “attaining the Bodhi-Mind,” but this may be called an intellectual way of driving the Buddha away! By following this method, you only appear to achieve Buddhahood; if you were to spend eon upon eon in that way, you would only achieve Sambogakaya and Nirmanankaya. (ie you would achieve the physical and spiritual aspects of a Buddha, which an Enlightened One bears within various realms of transitory existence, but you would lack the Dharmakaya, the aspect of a Buddha as identical with the Absolute.) What connection would all that have with your original and real Buddha-Nature? Therefore is it written: “Seeking outside for a Buddha possessed of form has nothing to do with you.”

Question: If we have always been one with the Buddha Absolute, why are there nevertheless beings who come into existence through the four kinds of birth and enter the six states of existence, each with the characteristic form and appearance of its kind?

Answer: The essential Buddha-Substance is a perfect whole, without superfluity or lack. It permeates the six states of existence and yet is everywhere perfectly whole. Thus, every single one of the myriads of phenomena in the universe is the Buddha. This substance may be likened to a quantity of quicksilver which, being scattered in all directions, everywhere re-forms into perfect wholes. When undispersed, it is of one piece, the one comprising the whole and the whole comprising the one. The various forms and appearances, on the other hand, may be likened to dwellings. Just as one abandons a stable in favor of a house, so one exchanges a physical body for a heavenly body, and so on up the planes of Prateyaka-Buddhas, Bodhisattvas, and Buddhas. But all alike are things sought by you or abandoned by you; hence the differences between them. How is it possible that the original and essential nature of the universe should be subject to this differentiation?

Question: How do the Buddhas, out of their vast mercy and compassion, preach the Dharma to sentient beings?

Answer: We speak of their mercy and compassion as vast just because it is beyond causality and therefore infinite. By mercy is really meant not conceiving of a Buddha to be enlightened, while compassion really means not conceiving of sentient beings to be delivered.

In reality, their Dharma is neither preached in words nor otherwise signified; and those who listen neither hear nor attain. It is as though an imaginary teacher had preached to imaginary people. As regards all these dharmas (teachings), if, for the sake of the Way, I speak to you from my deeper knowledge and lead you forward, you will certainly be able to understand what I say; and as to mercy and compassion, if for your sakes I take to thinking things out and studying other people’s concepts—in neither case will you have reached a true perception of the real nature of your own Mind from within yourselves. So, in the end, these things will be of no help at all.

Huang-Po

Excerpted from The Zen Teaching of Huang Po-On the Transmission of Mind

Translated by John Blofeld 1958