Anesthesia and Mental Illness

Abstract

Although drug interaction probably remains the most potentially serious problem, current evidence suggests that psychiatric medication need not be discontinued prior to anesthesia and surgery, discontinuation of medication may constitute its own hazards. Most interactions can be predicted and appropriate precautions taken, the use of meperidine is now absolutely contraindicated for patients receiving MAOI's.

Sociological issues in the conceptualization of mental illness

“…Many of the critics of traditional psychiatry, which is dominated by the values and assumptions of 'mediane', believe that the controversial issues and conflicting viewpoints can only be understood in terms of broader philosophical and political beliefs underlying them (Bus&eld 1974,1986, Ingleby 1981, 1982, Sedgwidc 1972, 1982 There appears, therefore, to be some general agreement regarding the broader interplay of ideas and assumptions outside of 'mediane's' own belief system, which help shape the existmg mental health services and the role of practitioners and clients within it Concepts of health and illness and the best ways to tackle health problems are, therefore, influenced by the prevailmg and dominant ideas that filter mto our consaousness by those in a position to 'define' such ideas and set health care agendas The prevaihng ideology m Bntain during the 1980s and early 1990s of 'self-care' has, therefore, its generation within the assumptions of those people in a position of power and thus becomes a political and philosophical issue which incorporates social and economic considerations and interests Ingleby (1981) suggests that the deep structure of disagreements v«thin and about psychiatry reflects an opposition of two philosophical systems Like Sedgwick (1972Sedgwick ( , 1982 he believes that the most dominant view m medicme and traditional psychiatry is based upon positivism or factism, which seeks to assimiliate the human sciences as closely as possible to the natural saences Here, mental illnesses exist as social facts and are analysed as pathological 'givens'…”

“…The opposing philosophical viewrpomt, Ingleby (1981) refers to as the 'interpretative' view This view incorporates the concept of 'relativism' and sees the subject matter and the methodology of the hunian sciences as unique Here, mental illness is seen as problematic and to be analysed as a value-laden 'social construction ' Sedgwick (1972) refers to the way these philosophical frameworks affect soaology by refemng to 'external sociology' (positivist) and 'lmmanentist soaology' (interpretative, relativist) Due to the dommance of positivism, both Sedgwick (1972) and Ingleby (1981) reflect how 'immanent/ lnteipretative' theorists have usually had to begin by denying the vahdity of the natural-saentific perspective on questions of human behaviour The central feature, therefore, of questioning the validity of 'psychiatric medicine' has been over its claim to be an objective, value-free, saentific venture It is this doubtful element that Ingleby (1982) argues creates the bebef that psychiatry is so obviously 'socially constructed' The writer intends at this point, therefore, to review the knowledge base underpinnmg concepts of mental illness and outlme the nature of social relativity…”

“…The conceptual problem appears to stem from the task of trying to place physical and mental illnesses on the same medical (positivist) footing, m order to reduce the controversial nature of the distance between the two (Sedgwick 1972) This has led to the task of trying to purge all cultural norms (with their variability from society to soaety) from the concept of mental illness (Wootton 1959) To do tbs, though, requires a microscopic and molecular analysis of the 'objective' nature of human behaviour This is not only highly problematic but has so far been unsuccessful and is, therefore, an idealistic notion and not one that has current practical usage According to Sedgwick (1972) this is only one way of creating such congruity By working in the reverse direction (relativism rather than positivism), the character of both physical illness and mental illness can be revealed as 'soaal constructions' Below the level of mankind all hfe forms m nature exist outside the constructs of illness, disease and, therefore, treatment, until man intervenes with his uiuque definitions based upon his own interests and concerns For example, our interest in the animal world IS based ufK)n food and/or other social economic uses, witnessed by the general lack of concern over the diseases that affect squirrels or foxes Once physical illness is grounded as 'culturally relative' (le ascnbed by individuals or by others according to the dominant theory of the culture regarding causes of illness -invasion by germs or evil spints) the variability of what counts as 'mental illness' does not render the term as problematic as cntics of traditional psychiatry hold As a value-laden concept, 'all sickness is essentially deviancy', according to Sedgwick (1972) whereby no attnbution of sickness to any being can be made without the expectation of some alternative state of dtairs whidi is considered more desirable Thus, m the absence of a normative alternative, the definition of illness has no meaning Intrinsic to this view is the point that there are no 'illnesses or diseases in nature' outside of the sigmficantx that man attaches to them The medical enterprise (both physical and mental) is, therefore, seen as being value-loaded, it is not simply an appbed biology, but a biology applied in accordance with the dictates of soaal interest (Sedgwick 1972) Busfield (1986) agrees with the analysis made by Sedgwick, regarding the role of values m concepts of health and illness, but argues that although many theonsts make a case for widespread concern about the operation of values throughout mediane, there are especial grounds for concern in the mental health held…”

Preoperative assessment and management of patient with psychiatric comorbidity

“…It is important that doctors recognise patients with mental disorder during preoperative assessment, because some symptoms, even somatic disorders could be related to this. 3 To prevent and treat it, some psychotropic medications are used: antidepressants, anxiolytics, antipsychotics (neuroleptics), sedatives, anticonvulsants etc. In the last decade there has been more use of sedatives, neuroleptics and antidepressants in populations of much younger patients, prescribed by psychiatrists and general practitioners.…”

Combination of ECT and clozapine in drug-resistant schizophrenia

“…Combination with ECT is quoted as a safe and clinically beneficial strategy. Other reports, barring initial concerns about the risk of spontaneous or prolonged seizures with this combination,3 also describe the combination of ECT and clozapine to be safe and clinically effective 4–8. Combining ECT and clozapine has also been advocated for achieving rapid control of disturbed behaviour, when time does not allow for dose titration with clozapine as monotherapy 9…”