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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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