Neurotoxische Enzephalopathie unter Neuroleptika und Lithium

Zusammenfassung: Überlappende neuroleptische Medikationen sind in psychiatrischen Behandlungen gelegentlich unumgänglich. Wir berichten über eine unter schizoaffektiver Störung leidende 60-jährige Frau, welche vorübergehend 3 Neuroleptika und Lithium erhielt. Hierunter entwickelte sie eine neurotoxische Enzephalopathie mit Symptomen eines malignen neuroleptischen Syndroms. Gegenwärtig ist unklar, ob irreversible Hirnschäden zurückbleiben werden. Wir empfehlen engmaschige EEG-Kontrollen zur Früherkennung von Neurotoxizitä

"Medikamente sind Bomben" - zum Metapherngebrauch von Lungentransplantations-Patienten mit guter oder ungenügender Compliance

Fragestellung: Nach einer Organtransplantation finden komplexe psychologische Verarbeitungsprozesse statt. In der vorliegenden Studie wurde untersucht, welche Metaphern im Zusammenhang mit Transplantationserfahrungen verwendet werden, und ob Unterschiede zwischen Patienten mit guter bzw. ungenügender Compliance im Gebrauch dieser Metaphern bestehen. Methode: 14 lungentransplantierte Patienten wurden in einem halbstrukturierten Interview zu ihren Transplantationserfahrungen befragt. Ihre Compliance wurde von den behandelnden Ärzten eingeschätzt. Die Auswertung der Interviews erfolgte anhand einer Metaphernanalyse, welche Hinweise auf vor- und unbewusste Vorstellungen der Patienten liefert. Die Interraterreliabilität über die Metapherngruppen war Cohen’s Kappa K = 0.8. Ergebnisse: Die Patienten konzeptualisierten ihren Körper, aber auch ihr Selbst als ein “Gefäß”, dass sowohl materielle (z.B. die Lunge) wie immaterielle Objekte (z.B. Gedanken an den Spender, Affekte) enthält. Der wichtigste Unterschied zwischen den Compliance-Gruppen bestand darin, dass Patienten mit ungenügender Compliance eine grössere Distanz zur transplantierten Lunge erlebten. Auch konzeptualisierten sie ihren Körper bzw. ihr Selbst nicht als ein Gefäß, das die Lunge enthält. Diskussion: Die Ergebnisse zeigen, dass gute Compliance mit einer erfolgreichen Organintegration assoziiert ist, welche die Zugehörigkeit der Lunge in einem als Gefäß konzeptualisierten Körper bzw. Selbst umfasst. Patienten mit ungenügender Compliance nehmen die Lunge eher als Fremdkörper wahr. Diese Verarbeitungsprozesse sind teils bewusster, teils vor- und unbewusster Natur

Mentoring programs for medical students - a review of the PubMed literature 2000 - 2008

Abstract Background Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. Methods A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protégé, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. Results The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Conclusion Mentoring is obviously an important career advancement tool for medical students. In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors. Medical schools could then be monitored with respect to the provision of mentorships as a quality characteristic.</p

Swiss residents' speciality choices – impact of gender, personality traits, career motivation and life goals

BACKGROUND: The medical specialities chosen by doctors for their careers play an important part in the development of health-care services. This study aimed to investigate the influence of gender, personality traits, career motivation and life goal aspirations on the choice of medical speciality. METHODS: As part of a prospective cohort study of Swiss medical school graduates on career development, 522 fourth-year residents were asked in what speciality they wanted to qualify. They also assessed their career motivation and life goal aspirations. Data concerning personality traits such as sense of coherence, self-esteem, and gender role orientation were collected at the first assessment, four years earlier, in their final year of medical school. Data analyses were conducted by univariate and multivariate analyses of variance and covariance. RESULTS: In their fourth year of residency 439 (84.1%) participants had made their speciality choice. Of these, 45 (8.6%) subjects aspired to primary care, 126 (24.1%) to internal medicine, 68 (13.0%) to surgical specialities, 31 (5.9%) to gynaecology & obstetrics (G&O), 40 (7.7%) to anaesthesiology/intensive care, 44 (8.4%) to paediatrics, 25 (4.8%) to psychiatry and 60 (11.5%) to other specialities. Female residents tended to choose G&O, paediatrics, and anaesthesiology, males more often surgical specialities; the other specialities did not show gender-relevant differences of frequency distribution. Gender had the strongest significant influence on speciality choice, followed by career motivation, personality traits, and life goals. Multivariate analyses of covariance indicated that career motivation and life goals mediated the influence of personality on career choice. Personality traits were no longer significant after controlling for career motivation and life goals as covariates. The effect of gender remained significant after controlling for personality traits, career motivation and life goals. CONCLUSION: Gender had the greatest impact on speciality and career choice, but there were also two other relevant influencing factors, namely career motivation and life goals. Senior physicians mentoring junior physicians should pay special attention to these aspects. Motivational guidance throughout medical training should not only focus on the professional career but also consider the personal life goals of those being mentored

Remodeling of Axonal Connections Contributes to Recovery in an Animal Model of Multiple Sclerosis

In multiple sclerosis (MS), inflammation in the central nervous system (CNS) leads to damage of axons and myelin. Early during the clinical course, patients can compensate this damage, but little is known about the changes that underlie this improvement of neurological function. To study axonal changes that may contribute to recovery, we made use of an animal model of MS, which allows us to target inflammatory lesions to the corticospinal tract (CST), a major descending motor pathway. We demonstrate that axons remodel at multiple levels in response to a single neuroinflammatory lesion as follows: (a) surrounding the lesion, local interneurons show regenerative sprouting; (b) above the lesion, descending CST axons extend new collaterals that establish a “detour” circuit to the lumbar target area, whereas below the lesion, spared CST axons increase their terminal branching; and (c) in the motor cortex, the distribution of projection neurons is remodeled, and new neurons are recruited to the cortical motor pool. Behavioral tests directly show the importance of these changes for recovery. This paper provides evidence for a highly plastic response of the motor system to a single neuroinflammatory lesion. This framework will help to understand the endogenous repair capacity of the CNS and to develop therapeutic strategies to support it

The impact of gender and parenthood on physicians' careers - professional and personal situation seven years after graduation

BACKGROUND: The profile of the medical profession is changing in regard to feminization, attitudes towards the profession, and the lifestyle aspirations of young physicians. The issues addressed in this study are the careers of female and male physicians seven years after graduation and the impact of parenthood on career development. METHODS: Data reported originates from the fifth assessment (T5) of the prospective SwissMedCareer Study, beginning in 2001 (T1). At T5 in 2009, 579 residents (81.4% of the initial sample at T1) participated in the questionnaire survey. They were asked about occupational factors, career-related factors including specialty choice and workplace, work-life balance and life satisfaction. The impact of gender and parenthood on the continuous variables was investigated by means of multivariate and univariate analyses of variance; categorical variables were analyzed using Chi-square tests. RESULTS: Female physicians, especially those with children, have lower rates of employment and show lower values in terms of career success and career support experiences than male physicians. In addition, parenthood has a negative impact on these career factors. In terms of work-life balance aspired to, female doctors are less career-oriented and are more inclined to consider part-time work or to continue their professional career following a break to bring up a family. Parenthood means less career-orientation and more part-time orientation. As regards life satisfaction, females show higher levels of satisfaction overall, especially where friends, leisure activities, and income are concerned. Compared to their male colleagues, female physicians are less advanced in their specialty qualification, are less prone to choosing prestigious surgical fields, have a mentor less often, more often work at small hospitals or in private practice, aspire less often to senior hospital or academic positions and consider part-time work more often. Any negative impact on career path and advancement is exacerbated by parenthood, especially as far as women are concerned. CONCLUSION: The results of the present study reflect socially-rooted gender role stereotypes. Taking into account the feminization of medicine, special attention needs to be paid to female physicians, especially those with children. At an early stage of their career, they should be advised to be more proactive in seeking mentoring and career-planning opportunities. If gender equity in terms of career chances is to be achieved, special career-support measures will have to be provided, such as mentoring programs, role models, flexitime and flexible career structures

What do patients think after lung-transplantation about their self, body, and social network? A quantitative analysis of categorical interview data

Objective: Psychosocial aspects have been investigated in transplant medicine mainly by the means of various structured questionnaires. To date only few interview data are available on patients thoughts about their self, the transplanted lung or the medication, and the relationship between these thoughts and compliance or gender. Methods: Twenty patients were interviewed after transplantation about their perceptions on self, body, transplanted lung, medication and social network. Their compliance was rated by the attending physicians. The overall interrater-reliability for the category groups was Kappa=.8. The article presents quantitative results of the content analysis. Results: Statements were made most frequently about the patients' social network and their self, and significantly less frequently about their body, lung and medication. "Closeness", "distance" and "depression" where main issues that these patients were dealing with. "Closeness" and "distance" played major roles in interpersonal relationships as well as in the relationship to the new lung. Depression mainly had to do with health burdens and the psychosocial consequences of the transplantation (e.g. financial worries). Women made significantly more statements about their social network than men; furthermore they formulate more accented emotional evaluations. Patients with low compliance were more frequently preoccupied with their self, their body as well as the experience of "dependence" and "achievement" than patients with high compliance; also low compliant patients made more critical statements. Conclusions: For lung transplant recipients social relationships are the prime topic of their daily experience. With respect to compliance behaviour, special attention should be paid to the patients' self and body perception as well as to their experience of dependence. These results should be confirmed in studies with larger sample sizes