Philadelphia, Pa. (March 11, 2013) – Members of the Deaf community who suffer from mental health problems need culturally sensitive treatment to avoid misdiagnosis and inappropriate treatment, according to a report in the March Journal of Psychiatric Practice.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“Deaf individuals comprise a cultural and linguistic minority group within the United States, and culturally and linguistically appropriate psychiatric treatment must reflect these differences,” according to Sarah A. Landsberger, PhD, and coauthors of the Indiana University School of Medicine, Indianapolis.  With the goal of providing guidance for hearing psychiatrists, the authors review the limited research literature on mental health care for deaf patients.

Providing Mental Health Care for Deaf Patients—Interpreters Needed!

Approximately 1.2 million American are functionally deaf―that is, they are unable to understand vocal communication even with hearing aids. Many deaf individuals identify culturally with the Deaf community and culture, in which deafness is not viewed as an impairment but rather as a locus of pride and identity.

When deaf patients require mental health services, the first major challenge is finding a means to communicate with the patient in order to elicit symptoms. Many deaf individuals use American Sign Language (ASL)—a manual language with its own grammar, syntax, and vocabulary.

“Ideally, clinicians most suited to working with the Deaf population are those who are fluent in ASL, have had significant exposure to the Deaf community, and understand Deaf cultural values,” Dr Landsberger and coauthors write.

Unfortunately, few providers meet these criteria.

For patients who are fluent in ASL, nonsigning clinicians will need to employ a certified interpreter with specialized training in mental health interpretation.  Finding such interpreters can be difficult, however.  Dr Landsberger and colleagues call for specialized mental health training for ASL interpreters who work in psychiatric settings.

Challenges in Communication, Diagnosis and Treatment

Unfortunately, some deaf individuals have never had adequate exposure to or training in ASL or other communication systems used by the Deaf population.  They may have serious language deficits, communicating mainly by gestures and mime. For these patients, the doctor may need to employ both a certified deaf interpreter—who is trained to help gather the intended message and put it into grammatically correct ASL—as well as an ASL interpreter.

Correct diagnosis is another challenge.  Evaluating for psychotic disorders, such as schizophrenia, in deaf patients can be especially difficult. A key question is whether the person has experienced hallucinations—especially auditory hallucinations (hearing voices). But how does one explain the concept of hearing voices to someone who has been deaf from birth?

Another common symptom of psychosis is disorganized thoughts, which are usually diagnosed based on disorganized speech.  Psychiatrists evaluating deaf patients need to be cautious to avoid misinterpreting language deficits as a symptom of psychosis.

Effectively providing “talk” therapy—that is, different types of psychotherapy—to deaf patients poses obvious challenges. The authors discuss ways of adapting psychotherapy to be more effective for deaf patients and how the presence of an interpreter may affect the doctor-patient therapeutic relationship.

“As with any cultural minority, providers should seek specific training and education to become culturally competent providers to deaf people,” Dr Landsberger and coauthors write.  “At a minimum, clinicians who have large numbers of deaf patients in their caseloads should be knowledgeable about Deaf culture and become fluent in sign language.”  They conclude by calling for more research concerning mental health care for the deaf.

About Journal of Psychiatric Practice

Journal of Psychiatric Practice®, a peer reviewed journal, publishes reports on new research, clinically applicable reviews, articles on treatment advances, and case studies, with the goal of providing practical and informative guidance for clinicians. Mental health professionals will want access to this journal­—for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. John M. Oldham, MD, is the editor in chief and past president of the American Psychiatric Association.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (August 29, 2012) – Most patients who seek repeated (secondary) cosmetic nose surgeries do so because of new or uncorrected deformities—similar to the reasons for patients undergoing primary rhinoplasty, suggests a report in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Based on his experience of 150 secondary procedures, Dr. Mark Constantian of St. Joseph Hospital and Southern NH Medical Center, Nashua, NH, concludes, “[T]he motivations of secondary rhinoplasty patients resemble those of most other aesthetic and reconstructive patients.”  His experience questions the perception that patients seeking repeated rhinoplasty are “demanding” or “difficult.”

In Most Cases, Secondary Rhinoplasty Is Appropriate

Dr. Constantian performed the secondary procedures over a 16-month period in 2007-08.  He analyzed the patients’ reasons for surgery, any management issues, the surgeon’s and patient’s satisfaction with the results, and other issues.  The patients were 121 women and 29 men, median age 42 years.  They had undergone one to eight previous surgeries, with an average of 3.6 per patient.

For 41 percent of patients, the reason for repeat rhinoplasty was the development of a new deformity—for example, a previously straight nose that had become crooked.  In 33 percent, the first rhinoplasty failed to correct the original deformity.

Another 15 percent of patients perceived the loss of desired “personal, familial, or ethnic characteristics.”  One percent had new or continued problems with airflow obstruction.  “Thus the majority (90 percent) sought surgery to correct residual or new deformities, to restore personal characteristics than had been lost, or to correct functional complaints,” writes Dr. Constantian.

Only 10 percent of patients were seeking further improvement in an “already acceptable result,” as judged by Dr. Constantian.  He rated this group of patients as having an average score of about 1 on a 5-point deformity scale, compared to 3 or higher in the other groups.

Dr. Constantian had previously operated on 16 of the patients; in 12 cases, he agreed that the repeat surgery was appropriate.  Overall, 14 percent of patients were considered “demanding” by the surgeon and staff, while 27 percent had possible depression.  Overall, 97 percent of patients were happy with their outcomes.

Few Patients Have Body Dysmorphic Disorder

Just three patients met criteria for body dysmorphic disorder (BDD)—a psychiatric disorder in which patients have excessive concerns about their physical appearance that interferes with daily life.  Previous reports have suggested high rates of BDD among patients undergoing multiple plastic surgery procedures.

Patients seeking second (or more) rhinoplasties are often considered problematic by plastic surgeons.  Such patients may be seen as “excessively demanding, often depressed, and impossible to please.”

But Dr. Constantian questions those perceptions—his experience suggests that 90 percent of patients have appropriate cosmetic or functional reasons for repeat rhinoplasty.  He points out that nearly three-fourths of patients in his study had deformities that either developed after or weren’t corrected by the original surgery.  “To these patients, the first operation had either been wasted or had done harm.”

Dr. Constantian believes that a careful selection process—including evaluation of the patient’s expectations and ability to handle possible complications—may have led to a lower rate of “severely unhappy patients” in his practice.  Noting the spectrum of body dysmorphic symptoms, he plans a more in-depth analysis of patients who undergo multiple plastic surgeries but fall short of meeting criteria for BDD.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com