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The Witness, Paul D. Zislis, Md

Jefferson Journal of Psychiatry

I want to tell you a story. Why? I don't know. Perhaps so that you will understand. Perhaps so that I will understand. It is a story of the present. It is a story that allows a little comprehension of the past. And it is a story that reveals glimpses of the future.

First this preface:

For years I have been drawn as if by a magnet to the subject of the Holocaust. I have read much about it, spoken to some who survived it, seen films on it, visited museums concerned with it. I have seen the faces …

Developmental Stages Of Learning Psychotherapy, Duncan B. Clark, Phd, Md

Jefferson Journal of Psychiatry

The contradictory philosophies of the major schools of psychotherapy present a dizzying array of alternative approaches for the psychiatry resident. The academic efforts that have been made to synthesize differing approaches to psychotherapy have not met with widespread acceptance. Part of the reason why such a synthesis has been slow in coming may be found in the stages of development the practitioner goes through in learning psychotherapy. The concepts of developmental psychology discussed by Chandler (7) in describing the adolescent's confrontation with relativism and "epistemological loneliness" can help us understand some of the cognitive problems faced by the psychiatry resident. …

A Brief Note On A Psychotherapeutic Technique Described By Glover And Its Application During Psychiatric Residency, Emanuel E. Garcia, Md

Jefferson Journal of Psychiatry

Few would dispute the existence of a general tendency to blame psychological ailments on physical problems. For example, we often attribute changes in mood to the somatic effects of the weather, irritability to diet, apathy to physical exhaustion, etc. How many of us can deny at some time having attempted to explain to our spouses that an outburst of temper was really the fault of our indigestion, let us say? Of course, our spouses are rather skeptical. And as psychiatrists we too preserve a skepticism towards the explanations of this kind which our patients so often provide. This is not …

The Ideal Psychiatry Training Program: A Resident's Viewpoint, James E. Deming, Jr., Md

Jefferson Journal of Psychiatry

The journey between medical school graduation and specialty board certification in one's chosen field of medicine may comprise the most challenging, exciting and important times of a young professional's life. This journey is called residency education. While the most obvious objectives are cognitive education and practice in the field, trainees also face fundamental life challenges such as developing identity, intimacy and a direction for their own generative goals in the world.

Psychiatry residency should be viewed as a personal as well as professional developmental process (1). It contains all of the turbulence of adolescence revisited (2), where "normative crises" (3) …

War Of The Worlds Revisited: The Effect Of Watching "The Day After" On Mood State, David G. Daniel, Md, Frances Wolff, M.Ed., Maribeth Smith, Ma

Jefferson Journal of Psychiatry

In the fall of 1983, "The Day After," a fictional account of a nuclear attack on a civilian population, was broadcast on television in the United States and viewed by I00 million Americans . "The Day After" was said to differ from previous movie treatments of nuclear war by the vividness with which it forced its audience to experience the ground zero effects of a nuclear blast on human beings (I) . In what was described as "the most horrifically searing footage ever to pass a network censor,"the audience was shown "group immolation, a carnage of mass vaporization" and "graphic …

Beastly Beatitudes (1): The Case Of A Patient With Severe Borderline Personality Disorder, Paul D. Zislis, Md

Jefferson Journal of Psychiatry

The newspapers, tabloids, and novels are filled with it. So are the television shows and movies. Sensationalism. The public can' t get enough of it. A crazed killer stalks an innocent victim who is alone, isolated and helpless, and he brutally tortures her to death. Sound familiar? The case at hand is a fascinating one which, though perhaps surrounded by the trappings of such sensationalism, provides us with some insight into the inner workings of one patient 's tortured mind.

L-Deprenyl, A Selective Mao-B Inhibitor, Raymond W. Lam, Md

Jefferson Journal of Psychiatry

Monoamine oxidase inhibitors (MAOIs) are now recognized as effective medications in the treatment of major depression (1). However, their clinical use has been limited by the risk of severe hypertensive reactions to oral tyramine challenge. Prevention of this so-called "cheese effect " requires adherence to diet restrictions that can lead to problems with patient compliance to MAOIs.

L-deprenyl is a selective MAO-B inhibitor that is reportedly free of the "cheese effect" (2). This review will discuss the clinical and theoretical importance of this interesting drug.

The Usefulness Of Neutrality, Julia Jones Zawatsky, Md

Jefferson Journal of Psychiatry

Recently, the idea of therapeutic neutrality has been attacked. Many observers have suggested that the neutral therapist is inhuman and unempathic. Actually, being a neutral therapist means being especially human and empathic. The neutral therapist's empathic contact with the patient is the most extensive in that it includes not only contact with feelings and thoughts of which the patient is aware, but also contact with all those intolerable thoughts and feelings of which the patient prefers to be unaware. Such awareness in the therapist is possible only when the therapist remains, as Anna Freud (I) recommends, equidistant from the patient's …

Trauma And Its Ramifications In Vietnamese Victims Of Piracy, Stuart Kleinman, Md

Jefferson Journal of Psychiatry

Approximately 400,000 Vietnamese fled by boat from their homeland to the United States during the years 1975 to 1985. Many of these people were brutally attacked by pirates during their sojourn. This paper is a preliminary investigation of various ramifications of this trauma in seven Vietnamese "boat people."

We found significant psychopathology which is temporally related to the pirate attacks in two of those interviewed and a prominent absence of survivor guilt in all of those interviewed. Factors such as mastery of previous trauma, advanced knowledge of potential traumata, empowerment fantasies, religious beliefs, and altruistic actions may have helped people …

Mead Johnson Award-1987

Jefferson Journal of Psychiatry

The editorial board of The Jefferson Journal of Psychiatry-A Resident Publication is pleased to announce the winner of the first annual Mead Johnson Award for excellence in writing as submitted to the Journal. Paul V. Trad, M.D. has received the one thousand dollar award for his work, "Infant Depression: Nature Seeking Nurture " (JP 5( 1) 15-33, 1987 ). His ambitious synthesis exemplifies the creative potential with in residency and fellowship programs. We hope that this further acknowledgement of Dr. Trad 's work will help to inspire other trainees to undertake such …

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

As the Jefferson Journal of Psychiatry continues in its early growth phase, having accomplished a successful synthesis to become a national publication, we note its own apparent power of accommodation equal to the strain of fusing and adjusting internal and external changes.

Psychiatric residency in itself demands such accommodation. A group of finishing second year residents were taking stock of the fir st half of this process: They noted the difficulty in reconciling their initial conceptions and intentions with the subsequent realization of the limits to knowledge or intervention; they called this disillusionment. Others spoke of a converse strengthening …

Resident Editorial Board

Jefferson Journal of Psychiatry

List of Resident Editorial Board for Volume 5, Issue 2, 1987.

Reciprocal Effects Of Oxidative Stress On Heme Oxygenase Expression And Activity Contributes To Reno-Vascular Abnormalities In Ec-Sod Knockout Mice, Tomoko Kawakami, Nitin Puri, Komal Sodhi, Lars Bellner, Toru Takahashi, Kiyoshi Morita, Rita Rezzani, Tim D. Oury, Nader G. Abraham

Biochemistry and Microbiology

Heme oxygenase (HO) system is one of the key regulators of cellular redox homeostasis which responds to oxidative stress (ROS) via HO-1 induction. However, recent reports have suggested an inhibitory effect of ROS on HO activity. In light of these conflicting reports, this study was designed to evaluate effects of chronic oxidative stress on HO system and its role in contributing towards patho-physiological abnormalities observed in extracellular superoxide dismutase (EC-SOD, SOD3) KO animals. Experiments were performed in WT and EC-SOD^(−/−) mice treated with and without HO inducer, cobalt protoporphyrin (CoPP). EC-SOD^(−/−) mice exhibited oxidative stress, renal histopathological abnormalities, …

Severe Propylthiouracil-Induced Hepatotoxicity In Pregnancy Managed Successfully By Liver Transplantation: A Case Report, Evan Sequeira, Sikolia Wanyonyi, Raj Dodia

Obstetrics and Gynaecology, East Africa

Introduction: Propylthiouracil-induced severe hepatotoxicity is a relatively rare occurrence, with very few cases reported in the literature. The management of this complication in pregnancy can be a challenge because of the effects of the various treatment options on the fetus.

Case presentation: We report a rare case of fulminant hepatic failure in a 36-year-old gravida 2 black woman of African descent that occurred at 17 weeks gestation following propylthiouracil treatment for Graves’ disease. Her liver failure was managed by liver transplantation and thyroidectomy. Her pregnancy was continued to term, though with not so favorable early childhood sequelae.

Conclusion: This case …

Cranioplasty After Decompressive Craniectomy: An Institutional Audit And Analysis Of Factors Related To Complications, Zain A. Sobani, Muhammad Shahzad Shamim, Syed Nabeel Zafar, Mohsin Qadeer, Najiha Bilal, Syed Ghulam Murtaza, Ather Enam, Muhammad Ehsan Bari

Section of Neurosurgery

Background:Although a relatively simple procedure, cranioplasties have been associated with high complication rates. Keeping this in perspective, we aimed to determine the factors associated with immediate and long-term complications of cranioplasties at our institution.
Methods: A retrospective review of Patient records was carried out for Patients having undergone reconstructive cranioplasties at our institution during the last 10 years (2001-2010). All case notes, records, and investigations were reviewed and the data were recorded in a predesigned questionnaire. Complications were recorded along with existing comorbids and measures taken for their prevention and management. Univariate and multivariate logistic regression analysis was performed …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

In Response: New Controversial Diagnoses: Self-Defeating And Sadistic Personality Disorders, Frederic Kass, Md

Jefferson Journal of Psychiatry

Until several years ago the entire literature on Masochistic Personality was theoretical or anecdotal. Dr. Fuller's recent paper, "Masochistic Personality Disorder: A Diagnosis Under Consideration," is a timely contribution in that it is one of a growing number of empirical studies on this topic (1). His major finding, that Masochistic Personality describes a disorder which is not adequately described by the existing Axis II disorders, is consistent with data we recently reported (2). We have found, in addition, that the diagnosis is common, and that the criteria have good internal consistency, specificity, and sensitivity (3,4). At this point the data …

Commentary

Jefferson Journal of Psychiatry

DR. KRAMER COMMENTS ON PSYCHOACTIVITY OF CALCIUM CHANNEL BLOCKERS, CASE REPORTS, AND RESEARCH.

Worthwhile Supplemental Reading For Psychiatrists-In-Training, A. Kenneth Fuller, Md

Jefferson Journal of Psychiatry

Book Reviews of:

MODERN SYNOPSIS OF COMPREHENSIVE TEXTBOOK OF PSYCHIATRY/IV

Harold I. Kaplan and Benjamin J. Sadock,

4th ed.Baltimore, Williams & Wilkins, 1985, 937 pages, $38.50

STUDY GUIDE AND SELF-EXAMINATION REVIEW FOR MODERN SYNOPSIS OF COMPREHENSIVE TEXTBOOK OF PSYCHIATRY/IV

Harold I. Kaplan and Benjamin J. Sadock, 2nd ed.Baltimore, Williams & Wilkins,1985, 551 pages, $22.95

Book Review: The Feel Of The Road, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

Book Review:

A PRIMER FOR PSYCHOTHERAPISTS

Kenneth Mark Colby, M.D.

New York, John Wiley and Sons, 195I, 167 pages,

$29 .95

Book Review: A Comprehensive Guide To Cognitive Therapy Techniques, Michael S. Greenberg, Phd

Jefferson Journal of Psychiatry

Book Review of:

HANDBOOK OF COGITIVE THERAPY TECHNIQUES

Rian E. McMullin, Ph .D.

New York, W.W. Norton, 1986, 356 pages, $34.95

Treatment Of The Negative Symptoms Of Schizophrenia With Verapamil, William A. Price, Md, Dawn Heil

Jefferson Journal of Psychiatry

The illness of schizophrenia, as it is understood today, appears to consist of a heterogeneous group of disorders which share several common features, such as partial response to medications, poor long-term prognosis, and the presence of psychotic symptoms. These psychotic symptoms have been arbitrarily divided into two subgroups, positive and negative, in an attempt to better understand this disease process (1,2). The positive symptoms, such as delusions and hallucinations, generally have an acute onset with frequent exacerbations and remissions and a favorable long-term prognosis and response to medications. The negative symptoms, which include affective blunting , social withdrawal, apathy, and …

Masson's Assault On Truth: A Critique, Emmanuel E. Garcia, Md

Jefferson Journal of Psychiatry

In his book, The Assault on Truth, j. M. Masson (I) proposes to challenge the very foundations of psychoanalysis by showing how Freud 's abandonment of the so-called seduction theory of the etiology of neurosis was erroneously predicated.

Masson's argument, in essence, may be summarized as follows. Freud, while studying with the eminent neurologist Charcot in Paris (from October 1885 to February 1886), found himself exposed to the prevalent horrors of ch ild abuse, which were copiously detailed in the French medical literature at the time, and which were very probably demonstrated to him at the …

Should Psychotherapy Be Taught To Psychiatric Residents? A Debate., Donald W. Black, Md, John Ascher, Md, Hal Cash, Md, John Markowitz, Md, Paul Hamburg, Md, Jeffrey Satinover, Md, Alan Mellow, Md

Jefferson Journal of Psychiatry

Much of this discussion was inspired by a debate held at the 1984 APA Annual Meeting, entitled " Does Psychodynamic Theory Have Little Relevance to Contemporary Psychiatric Care?" We saw the need for a debate, resident generated, that would address a corollary issue in residency training.

Our program will include an introduction, a debate involving statements for the affirmative, that is, that psychotherapy should be taught to psychiatric residents, and two statements for the negative, that psychotherapy should not be taught to psychiatric residents. Concluding remarks will follow.

If our title is provocative , if what we have to say …

A Review Of Ethnopsychiatric Studies Of Depression, Nancy E. Wilson, Ab, Daniel R. Wilson, Md

Jefferson Journal of Psychiatry

One of the common goals in medical anthropology is to elucidate the significance of culture in determining health and thus clarify the complex biopsychosocial model to provide better, more appropriate care (I). Prominent among environmental influences is the society in which a person develops: and it is his position in this constellation of people, with their shared ethos and world view, which molds experience, cognition, and affect (2). Cultural meanings, norms, and power arrangements shape illness to a great degree by defining the sick role and consequent illness behaviors. Medical anthropology, as a discipline, has among its concerns the cultural …

Reflections On The Psychotherapy Of A Patient With Multiple Personality Disorder, David Fink, Md

Jefferson Journal of Psychiatry

Historically, the diagnosis of Multiple Personality Disorder (MPD) has generated curiosity, fascination, skepticism, and disbelief. From the first reported cases in the early nineteenth century, controversy has abounded about the plausibility of the many dramatic manifestations of the illness, its pathogenesis, and appropriate approaches to its treatment (I). From the midst of scientific controversy and debate, a more refined conceptualization of the illness is being developed, particularly since the recent inclusion of the diagnosis in DSM-III (2). Noteworthy among these advances are the theories of pathogenesis described by Kluft (3), and Braun and Sachs (4) which …

Infant Depression: Nature Seeking Nurture, Paul V. Trad, Md

Jefferson Journal of Psychiatry

Of the numerous clinical and theoretical problems confronting medicine today, infant depression represents an increasingly compelling and misunderstood concern (1). Early studies notwithstanding, the concept of infant depression remains in the embryonic and evolving stages of clarification. In studying infant depression, the clinical investigator is initially faced with the difficulty of devising a specific operational definition. Several definitional schemes have been proposed. The first advocates that depression is a proliferative idea that retains a concrete, immutable definition; another scheme argues that depressive affect, a key index of the disorder, is merely an illusory signal that masks the underlying process; still …

Hypnosis In The Criminal Case: Facts And Fallacies, Phyllis E. Amabile, Jd, Md, Thomas H. Jobe, Md

Jefferson Journal of Psychiatry

Throughout the past century, criminal cases have been documented in which a party has sought to introduce into evidence information obtained through the process of hypnosis. The usefulness of the technique of hypnosis in various psychological the rapies has already been well established. The courts, however, have differed markedly in their decisions on the admissibility of hypnotic material into evidence. Consequently, no clear rationale or guidelines for admissibility have been established.

Editor's Column, Jeffrey R. Sarnoff, Md

Jefferson Journal of Psychiatry

As this issue of the Journal goes to press, it seems apt to reflect upon several years of editorship. An esteemed colleague, Gregory B. Sullivan , M.D .,is in the process of taking over the responsibilities of Chief Editor; the Journal is in able hands as I move on to other endeavors.

Since its inception nearly five years ago, th e Journal has flourished , riding out occasional rough weather in its course from a local to a national publication. Many residents and faculty members have worked with spirit and diligence to foster its growth ; I am thankful for …

Resident Editorial Board

Jefferson Journal of Psychiatry

Resident Editorial Board for Volume 5, Number 1, Winter 1987 for Jefferson Journal of Psychiatry.