Case Conference Grand Rounds

2002: Psychosomatic Medicine in a Cross-Cultural Perspective Chairs: Francois Lespérance, MD and Shari Waldstein, PhD "Ulcerative Colitis" Presenters: Susan B. Levenstein, MD, Spallanzani Hospital, Rome, Italy Discussant: Robert G. Maunder, MD, Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada Dr. Levenstein will describe the initial medical presentation, the psychosocial history, the disease course and its relation to life stressors, and the impact of disease on the lives of two patients with ulcerative colitis, one Italian and one American. She will include introductions to the biology of ulcerative colitis and to a few concepts of its interrelations with psychosocial factors. "Medical Care for A Patient with A History of Migration and Somatoform Disorder" Presenters: Head ad interim of the Medical Division C.L. Lory-Haus, Inselspital, Berne, Switzerland Discussant: Corina Salis Gross, PhD, Department of Social Anthropology, University of Berne, Switzerland The grand rounds on somatizing patients in general medical care will focus on patients with a history of migration. 20% of the Swiss population are immigrants, most with a marginalized status and employed in unqualified jobs with increased health hazard. Outcome in foreign patients, e.g. with chronic pain or somatoform disorders, is considered to be worse than in Swiss patients. Possible measures to improve outcome were developed in interdisciplinary collaboration with cultural anthropologists and will be presented in this grand round, combining case material and the discussion of concepts applied and refined in our institution to meet the diagnostic and therapeutic issues raised by patients with a history of migration. The focus will be laid on migration-specific history taking as an important tool in the care of these patients. Vascular Depression and Chronic Pain Chairs: Shari Waldstein, PhD and Francois Lesperance, MD Vascular Depression Presenters: David L. Sultzer, MD and Stephen T. Chen, MD, UCLA Department of Psychiatry and Biobehavioral Sciences and VA Greater Los Angeles Healthcare System Clinical Controversies in Vascular Depression: Is it Vascular? Is it Depression? Case presentation History, cerebrovascular risk factors, mood symptoms, cognitive signs, labs and neuroimaging, treatment course Overview: Vascular Depression Cerebrovascular disease as a risk factor for mood symptoms Mood symptom clusters associated with cerebrovascular disease Concurrent cognitive deficits Validity of "vascular depression" Treatment issues Discussion: Audience Chronic Pain Presenters: Francis Keefe, PhD, Duke University Medical Center and Mark Lumley, PhD, Department of Psychology, Wayne State University Psychosocial Interventions in Rheumatoid Arthritis: Coping Skills Training and Emotional Disclosure This case conference will present two patients with rheumatoid arthritis, who received different treatment approaches. One patient, presented by Dr. Keefe, participated in a coping skills training intervention program, and the other patient, presented by Dr. Lumley, participated in an emotional disclosure intervention. Similarities and differences in these two approaches will be discussed. Chairs: Norman B. Levy and Shari R. Waldstein HIV Presenters: Hamp Atkinson and Igor Grant This Grand Rounds case presentation will describe the course, impact, and treatment of HIV-associated neurocognitive disorder. Videotape interviews will illustrate clinical features of this disorder and usual techniques of bedside examination for neurocognitive deficits in HIV. Cardiovascular Disease Presenters: Robert Soufer and Matthew M. Burg The Grand Rounds on Cardiovascular Disease will combine clinical case material with literature review to examine the role that psychological factors can play in ischemic syndromes. Cases will be used to identify aspects of stress related transient events, with clinical data serving to illuminate this relationship. Findings from a range of research will then be used to further expand upon issues of assessment and discuss potential interventions. Chair: Igor Grant Somatization Presenters: Jim Spira and Steve Locke The attendees will learn the differential diagnosis for the various somatoform disorders and learn effective interdisciplinary treatment for patients who are high utilizers of medical care. Gulf War Syndrome Presenter: Benjamin Natelson Participants will get an understanding of an important proportion of Gulf veterans with unexplained illness - those who fulfill case definitions for chronic fatigue syndrome (CFS). They will learn how these veterans differ from civilians with CFS, and they will get an understanding of how a practitioner would deal with such a patient. Childhood Asthma Presenters: Bruce Miller and Beatrice Wood The discussants will present treatment case of child with asthma whose psychological and social context appear to have psychophysiological consequences for the asthma; relate the clinical characteristics of the case to Dr. Miller's Autonomic Nervous System Dysregulation Model of the Influence of Emotions of Asthma; demonstrate how the treatment interventions were guided by the ANS Dysregulation model and present outcome of treatment.