Surgery – Miscellaneous
Reexamination Certificate
1999-06-21
2001-02-13
Lacyk, John P. (Department: 3736)
Surgery
Miscellaneous
C128S905000, C600S300000
Reexamination Certificate
active
06186145
ABSTRACT:
BACKGROUND—FIELD OF THE INVENTION
The present invention relates to methods and apparatus for diagnosis and treatment of psychological and/or emotional conditions in human patients with the aid of a microprocessor-based virtual reality simulator.
BACKGROUND—DESCRIPTION OF THE ART
A patient's behavioral response to his/her medical condition is evaluated and treated in conjunction with other, conventional therapy and is conducted by the primary physician, psychologist, psychiatrist, or other health care specialist. Depending on the medical condition, a preliminary picture of the patient's emotional condition may be available to the specialist in the form of answers to questionnaires or results from a battery of tests.
This type of evaluation is currently necessary in psychological conditions such as schizophrenia, depression, hyperactivity, phobias, panic attacks, anxiety, overeating and other emotional disorders or conditions wherein a patient's maladaptive behavioral response to his/her environment is the medical condition to be treated. Currently available tests for classifying such conditions rely on the patient to perform a self-examination and to respond candidly to a series of personal questions. Since most tests differ in their basic scientific assumptions, the results obtained are not standardized and cannot often be used to make meaningful case comparisons.
When applied to pediatric patients, problems existing in the art are amplified as compliance is not guaranteed and when the answering of questionnaires is aided by an adult, the input of the adult usually hampers rather than enhances objective responses. Cohen et al.,
Am. J. Diseases of Children,
143:1229-33 (1989). Self-evaluating questionnaires that allow a child to assess his or her own situation may provide a valuable comparison between the child's view of his or her behavior and that of adults, but the dependability of these questionnaires, especially in pre-adolescent children, has not yet been determined. Braswell et al.,
Cognitive Behavioral Therapy with ADHD Children,
The Guilford Press, New York (1991). Currently available methods of psychological evaluation are painstaking and tedious, involve long hours of diagnostic evaluation and are, consequently, very expensive.
Following diagnosis, the actual therapeutic changes in the patient usually occur outside of the therapy sessions as cognitive and behavioral strategies learned in therapy are applied by the patient to problems encountered in day-to-day situations. Progress is predicated to a large extent on patient cooperation, discipline and the ability to self-manage. Lack of compliance to long-term therapy regimes presents a major obstacle to successful treatment. Children are a particularly difficult group of patients in this respect. Frequently, children lack the understanding, maturity and perseverance required to successfully pursue any kind of a treatment plan.
A patient, whether an adult or a child, may be experiencing any of a number of psychological conditions and/or disorders for which treatment is desired. Illustrative examples of disorders include schizophrenia, obsessive-compulsive disorder, dysthymic disorder, bipolar disorder, anxiety disorders, and impulse control disorders. Alternatively, the patient may be experiencing something that, while not considered to be a full-blown psychological disorder, is nevertheless a stressful, disturbing, and/or undesirable state of mind. For example, a child may experience separation anxiety when he or she starts attending school. A married couple, confronted with monetary or sexual problems, may seek marriage counseling. During divorce proceedings, psychological evaluations could be conducted to assist in determining custody arrangements. Victims of child abuse may require evaluation to determine an appropriate course of treatment.
A standard reference work entitled, “Diagnostic and Statistical Manual, Version IV”, is widely utilized by psychiatrists, psychologists, and other mental health professionals to classify psychological conditions and disorders. This reference work, sometimes referred to as “DSM IV”, is edited by the American Psychiatric Association. Unfortunately, the classification criteria tend to be classical categorizations, very academic in nature, and are often inapplicable or meaningless in the context of children and uneducated adults. Moreover, the DSM-IV is geared more towards the general classification of disorders and is not intended to provide an optimized treatment regime for a particular patient suffering from a specific condition.
By way of illustration, consider one fairly common psychological disorder: Attention Deficit Hyperactivity Disorder (ADHD). ADHD is characterized by the presence of any of the following indicia: inattention, impulsivity, hyperactivity, and boredom. As a practical matter, these indicia may manifest themselves as behavioral problems, social.maladjustment, aggression and/or academic difficulties. It is estimated that ADHD afflicts 3 to 5 percent of American children. Erickson, M.,
Behavior Disorders of Children and Adolescents,
Prentice Hall, Englewood Cliffs, N.J. (1987); Barkley, R.,
Attention Deficit Hyperactivity Disorder,
The Guilford Press, New York (1990). In many cases, ADHD significantly impairs performance at school. If left untreated, ADHD may continue into adulthood, creating problems at home and on the job.
Even with proper and early diagnosis, a reliable and consistently effective treatment for ADHD does not exist. In the United States, as many as 750,000 children take psychostimulant medication such as methylphenidate, dextroamphetamine or Ritalin® (CIBA Pharmaceuticals) every day to treat ADHD. Unfortunately, almost 25 percent of those children experience no behavioral improvement from such drugs, and almost half of the remaining children receive only marginal benefits. Greenhill, L.,
Psychiatric Clin. of N. America,
14:1-25 (1992). Although management techniques other than maintenance with psychostimulants exist, these techniques generally involve behavior therapy in combination with changes in family and school environments. But the implementation of these social changes is often a daunting task. Accordingly, a need exists in the art for techniques to assist in the diagnosis and/or treatment of ADHD by conveying assessment data to health care professionals. In this manner, these health care professionals could be better situated so as to monitor the progress of any ADHD treatment regime, and also to provide healing support. A need also exists in the art for techniques to assist in the diagnosis and treatment of the various sub-categories of ADHD, especially for those children who have ADHD but are not responsive to psychostimulants. These sub-categories of ADHD include (1) the primarily inattentive type; (2) the primarily impulsive-hyperactive type, and (3) the combined type.
Although the foregoing example illustrates the problems associated with diagnosing ADHD, these problems are also applicable in the context of other disorders and conditions, including but not limited to those specifically enumerated above. Thus, there also exists a need in the art for techniques designed to assist in the diagnosis and/or treatment of various psychological disorders and conditions. As in the case of ADHD, these disorders and conditions may also require extensive self-help and self-treatment. A patient may exhibit compulsive behavior, addictive substance abuse, gambling, smoking and/or alcoholism. At the present time, state-of-the-art treatment for these “medical” conditions involves counseling, distraction techniques and chemical replacement therapy. Ultimately, all of these methods depend upon the cooperation of the patient and require a large measure of self-motivation. This is especially important when the patient is in his or her own surroundings where the object(s) of the addiction or compulsion are easily accessible.
Some attempts have been made to use computers to diagnose and educate patients about their medical c
Black Lowe & Graham PLLC
Health Hero Network, Inc.
Lacyk John P.
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