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Management and Social Aspects
of mental disorderRonny T Wirasto
Program Studi Pendidikan Dokter
FMIPAUniversitas Tadulako
2011
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Topik
Definisi
Gangguan
Diagnosis Terapi
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Social Background
Cultural and Racial disparities
Ethnicity
Gender differential
Social Class
Spirituality
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Cultural and Racial Disparities
Potential sources of healthcare disparities
Patient preference
Site of care
Provider contribution
Patient preferences (e.g., Non-whites more likely to refuse
treatment)
Site of care (minorities treated in settings w/ lower quality
care
Some evidence that providers diagnostic & treatment
decisions are influenced by patients race & ethnicity
Evidence of poorer quality of communication for non-white vs
non-white patients
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What is Culture?
Definition: the sum total of the way of living;
includes values, beliefs, standards, language,
thinking patterns, behavioral norms,communications styles, etc. Guides decisions and
actions of a group through time.
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The Culture of Western Medicine Meliorismmake it better
Dominance over naturetake control
Activismdo something Timelinesssooner than later
Therapeutic aggressivenessstronger=better
Future orientationplan, newer=better
Standardizationtreat similar the same
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Others
Accept With Grace
Balance/Harmony withNature
Wait and See
Cautious Deliberation
Gentle Approach
Take Life As It ComesTime Honored
Individualize
Recognize Differences
West Make it Better
Control Over Nature
Do Something
Intervene Now
Strong Measures
Plan AheadRecent isBest
StandardizeTreatEveryone the Same
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Gender differential
female patients with trapezius myalgia, increased levelsof glutamate and serotonin exist in muscle tissue(Rosendal et al., 2004).
Studies have also shown that females are more
sensitive than males to experimental pain (Berkley,1997;Dao and LeResche, 2000; Riley et al., 1998)
gender dependent differences in experimental paincompared with clinical pain remains speculative and
further research is required (Fillingim, 2000) gender is only one factor that may influence the
experience of pain
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Social Class
Social classa status hierarchy by which
groups and individuals are classified on the
basis of esteem (regard, respect) and prestige
(reputation, influence derived from
achievements).American Marketing
Association
The different lifestyles of social classes lead todifferent benefits being sought
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Common factors used to place people into
different social classes: occupation, source ofincome, possessions, associations with others,
and level of influence.
Related to health care usage and treatment
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Spirituality
Role in treatment of pain
Common Coping Tools Prayer Spiritual Meditation Hope Reading faith-based literature Finding spiritual role models for coping Seeking spiritual support/connection
Prayer place attendance Seeking instrumental support Religious reappraisal
( f
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Altered Perceptions
Changed Mood
Changed Social Interactions
Changed Behaviors
Physiological/Neurological Changes
Altered neurotransmitter levels
Altered sleep
Altered HPA activity levelsAltered threshold for recognizing distress signals
Psycho-Social Changes
Meaning Making Attributions
Self-Efficacy
Distraction
Social Support
Instrumental Support
Relaxation
Possible Unique R/S Factor
Spiritual Support
Spiritual Growth
Spiritual Meaning Making AttributionsAdditional Efficacy Beliefs
Spiritual Beliefs and Practices
Positive vs. Negative
Public vs. Private
Intrinsic vs. Extrinsic
Existential vs. Religious
(Adapted from:
Wachholtz, Pearce
& Koenig, 2007)
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CULTURE or GENETIC?
Poor metabolizers: dose adjustment
Polymorphisms:
Codeine poor choice if lacking
debrisoquisparteine; a drug metabolizing
enzyme.
Pharmacogenetics Pharmacogenomics
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