Medicine and Health Sciences Commons^™

Prediction Of Treatment Response And Diagnosis In Psychiatry, Eduardo Dunayevich, Md

Jefferson Journal of Psychiatry

The lack of diagnostic gold standards and the multiplicity of vantage points used to conceptualize mental illness renders psychiatric diagnostic and therapeutic approaches susceptible to individual and cultural biases. Developments in therapeutic approaches have often provided vantage points from which to conceptualize psychopathology. The identification of predictors of treatment response may be a useful element for clinicians to select between multiple treatment tools in an expanding therapeutic armamentarium while fostering refinements in current diagnostic systems.

The Forgotten Evaluation: Taking Competence Seriously, Seth E. Tabb, Md, Scott A. West, Md

Jefferson Journal of Psychiatry

The medical literature devotes little attention to the application of competency to the general medical patient. Commonly, the only cases recognized as necessitating a competency evaluation are overtly psychotic patients, patients requiring written informed consent, and those patients who refuse treatments strongly recommended by their physician. Clarifying terminology and redefining competency provides a practical screening method for assessing competency in all patients. When physicians neglect the evaluation of competency, patient autonomy is compromised. Not only are all physicians capable of performing a competency evaluation, they are ethically and professionally required to do so.

Transition To Psychiatric Residency: Unique Stresses; Unique Rewards, Catherine A. Belitsky, Md, Frcp(C), Sidney H. Kennedy, Md, Frcp(C)

Jefferson Journal of Psychiatry

An individual's decision to pursue a psychiatric residency following medical school training is shaped by many factors. Beginning residents are often ill prepared for the relative impact that the shift from medical doctor to psychiatric resident entails. This paper reviews the literature regarding demographic and psychological factors relating to recruitment, dynamic and practical issues confronting the beginning resident, and various coping styles adopted. These factors are considered in the context of an inpatient setting where the majority of residents begin their training. Much of the resident response is seen as adaptive and a number of strategies for coping are suggested.

Patients Who Request A Female Psychotherapist, Timothy C. Smith, Md, Melinda Fudge, Md, Salman Akhtar, Md, Steven Samuel, Phd

Jefferson Journal of Psychiatry

Upon arriving at an outpatient clinic, many patients request to see a female psychotherapist. Yet little has been written on this topic. The aim of this study was to explore the demographic and clinical characteristics of such patients. We compared patients who voiced a preference for a female therapist with controls on the demographic variables of age, sex, race, marital and financial status and the clinical characteristics of diagnosis, history of sexual abuse, sexual preference, overt presence of sexual or social difficulties, history of prior treatment, gender of the previous therapist, and treatment drop out rate. A chi square analysis …

Non-Neuroleptic Pharmacotherapy Of Schizophrenia, Sajiv John, Md, Atul Mahableshwarkar, Md

Jefferson Journal of Psychiatry

Patients with schizophrenia are typically treated with a neuroleptic and some form of psychosocial intervention. In spite of optimum treatment, up to one-third of patients continue to remain severely disabled due to persistent positive or negative symptoms. A variety of drugs have been tried as alternatives or additions to traditional neuroleptics in these patients. This paper is a review of these nonneuroleptic treatment alternatives and an attempt to establish some guidelines for their use.

Concepts And Models Of Empathy: Past, Present, And Future, Elizabeth Ann Baxter, Md

Jefferson Journal of Psychiatry

The subject of empathy has been increasing in popularity and importance; correspondingly, the theoretical aspects of empathy are in need of further development. This paper outlines key concepts and processes related to empathy, particularly the mechanisms of identification and regression as they are discussed in the models of empathy articulated by Fleiss, Greenson, and Jordan. Similarities and differences of the models are examined, in addition to each model's description of the roles of identification and regression. Although each model has made significant contributions towards a theoretical perspective of empathy, none of them have distinguished pathological from non-pathological uses of identification. …

Sexual Side Effects Of Psychiatric Medications In Women: A Clinical Review, Laura L. Post, Md, Faacs

Jefferson Journal of Psychiatry

Sexual side effects of psychiatric medications have been estimated to occur in 60% of male clients (1) and 30% of female clients (2). Despite a body of literature relating individual medications to specific sexual side effects, few studies have satisfactorily addressed the psychotropic-induced sexual dysfunctions in women. The spectrum of known sexual sided effects resulting from psychopharmacologic interventionswill be reviewed. Guidelines for appropriately addressing the possibility of sexual side effects within a therapeutic relationship for maximizing reporting of sexual side effects, and for possible treatment approaches to sexual side effects will be described.

Positron Emission Tomography In Psychiatry: New Sights, New Insights, Shitij Kapur, Md, Sylvain Houle, Md, Phd, Frcp (C), Gregory M. Brown, Md, Phd, Frcp (C)

Jefferson Journal of Psychiatry

Positron Emission Tomography (PET) is a new tool with which to explore the neurobiological basis of psychiatric illness. PET permits in-vivo measurement of regional cerebral blood flow, regional glucose metabolism, as well as information about neurochemicals and their receptors. Since regional cerebral bloodflow and glucose metabolism reflect ongoing neuronal activity, the neural bases of different cognitive processes and emotional states can be discerned using PET. Findings from recent studies in schizophrenia, affective disorders, obsessive-compulsive disorders, anxiety disorders, and dementia are reviewed with a special emphasis on how these findings may' be useful in developing a more comprehensive framework for understanding …

Literature Review: Stress Reactance In Psoriatic Patients, W. Michael Hooten, Md

Jefferson Journal of Psychiatry

The association between stress and psoriasis is well documented. A subgroup of psoriatic patients appear to be high stress reactors who can identify specific psychosocial stresses which exacerbate their psoriasis. In contrast, low stress reactors report no association between stress and the exacerbation of psoriasis. In differentiating high versus low stress reactors, a review of the literature suggests: 1) a neurogenic mediated disease process; 2) high stress reactors' disease course is not confounded by underlying psychopathology and, 3) high stress psoriatics experience more disease related stress than low stress reactors.

Being Stalked: A Psychiatrist's Perspective, Kalpana I. Nathan, Md, Tina T. Lee, Md, James Missett, Md, Phd

Jefferson Journal of Psychiatry

It is only recently that stalking has been criminalized after some highly publicized forensic cases. Psychiatric focus has been on erotomania, and in this article we primarily highlight stalking as a separate entity with psychiatric and legal implications. The case reports reveal our vulnerability as therapists, and we hope will raise our awareness of stalking as a potentially dangerous situation. The legal statutes vary in different states, but our recommendations may provide guidelines towards formulating policies and procedures for the safety of healthcare providers.

The Diagnosis Of Multiple Personality Disorder, Joshua D. Mcdavid, Md, Mph

Jefferson Journal of Psychiatry

This paper represents an attempt to facilitate the clinician or psychiatrist in making a diagnosis of Multiple Personality Disorder, the most severe of the dissociative disorders. Emphasis will be placed on detecting signs, symptoms, and information that occur within the constituent parts of a typical psychiatric interview, and that are highly suggestive of MPD even in the absence of alter presentation.

Theme And Content Of Delusions In Asian Indian Psychotic Patients: Correlation With Diagnosis, Christopher Linskey, Md

Jefferson Journal of Psychiatry

The aim of this study was to investigate the types of delusions present in Asian Indian psychotic patients and evaluate correlation with patient diagnosis. Delusional narratives were collected from 50 Indian patients with schizophrenia or an affective disorder. These narratives were judged for delusional theme and content and were correlated with DSM-III-R diagnoses. Using simple categorical analysis, delusional themes of grandiosity and guilt correlated with affective diagnoses. Delusional themes of reference and Schneiderian types were more often associated with schizophrenia. These findings support the concept that delusional themes can be used as valid diagnostic clues in the assessment of psychotic …

Integration Of Assertive Community Treatment Into A Residency Curriculum: The Resident's Perspective, D. Walter Hiott, Md, Alberto B. Santos, Md

Jefferson Journal of Psychiatry

Assertive Community Treatment (ACT) is a service delivery system designed to provide long-term quality care to patients with chronic mental illnesses. A brief description of these programs is presented. These programs can provide valuable training experiences for psychiatric residents. The authors report the results of their survey of residents whose training included a rotation through these services.

The Serotonin Theory Of Depression, Christopher W. Kerr

Jefferson Journal of Psychiatry

In its simplest form, the serotonin deficiency theory of depression postulates that there is a net reduction in serotonin transmission in depressive illness. The pathophysiological change may result from two different mechanisms. The first involves a decrease in serotonin (5-HT) availability which has the consequential effect of compensatory receptor up-regulation or super sensitivity. The second mechanism implies a primary defect in receptor activity and/or signal transduction. The objective of this review is to analyze the serotonin system in depression as it relates to the above two postulates.

What Place Does The Real-Relationship Have In The Process Of Therapeutic Character Change?, Patrice Duquette, Md

Jefferson Journal of Psychiatry

The relationship between therapist and patient is an important tool in the process of helping a patient change. There are various elements that make up the total relationship between patient and therapist, each with its own power to exert for and against change. Transference can be one of the most relentless of these elements in maintaining the status quo for ourpatients. To help our patients make significant gains against this relentless pressure is most of our task in psychotherapy. The real-relationship has been considered in the literature since the early 1940's and is described by Greenson as "the realistic and …

Climbing Through The Milwaukee County Civil Commitment Process, Jon A. Lehrmann, Md

Jefferson Journal of Psychiatry

Civil commitment has become a practically unavoidable process for today's practicing psychiatrist. It creates a complicated triangular relationship involving the legal system, the medical system, and the patient.

This article is a first person narrative of a case which helps describe the Wisconsin civil commitment process as it operates in Milwaukee County. It illustrates the frustrations that a psychiatrist (and in this case a first year psychiatry resident) can experience in such a system. Finally, it addresses these problems associated with civil commitment and discusses possible solutions.

Involuntary Psychiatric Hospitalization And Risk Management: The Ethical Considerations, Richard C. Christensen, Md, Ma

Jefferson Journal of Psychiatry

During an era where physicians go to great lengths to limit personal risk and ensure self-protection from lawsuits, psychiatrists may be inclined to err on the side of involuntarily hospitalizing patients who have been briefly evaluated in the emergency room or clinic setting. However, conscientious treatment decisions, particularly those pertaining to involuntary psychiatric hospitalization, need to address at least two fundamental ethical concerns: the patient's best interests and the clinician's motives. This article discusses the moral components involved in clinical decision making and presents a case example which highlights the ethical implications of involuntary psychiatric hospitalizations.

A Resident Initiated Prite Review Course: Trials And Tribulations, David W. Metzler, M.S., M.D., Daniel L. Kinsey, M.D., Lesley R. Dickson, M.D., Mark Hyatt, M.D.

Jefferson Journal of Psychiatry

The experience of developing a review course to study for the Psychiatry Resident's In-Training Exam (PRITE) is discussed. Residents in our program felt that the review course was useful with respect to the following: studying for the PRITE; future study for National Boards; and learning of new material.

The Psychiatry Resident's In-Training Exam (PRITE) was developed in 1979 as a mechanism to assess the knowledge base of psychiatric residents in a standardized format (1,2,3). The exam was originally designed to simulate the American Board of Psychiatry and Neurology (ABPN) examination, PART I, and has gained widespread acceptance despite questions about …

Thalamic Tumor Presenting As Major Depression And Headache, Robert Jay Claire, M.D.

Jefferson Journal of Psychiatry

We report the case of a 39 year old male who presented with Major Depression, headache, and apathy. Within six weeks of his initial presentation the patient died from a "Central Herniation Syndrome" after biopsy of a left thalamic lesion. The statistics of medical problems presenting as psychiatric disorders as well as recent literature on personality changes associated with thalamic infiltration are reviewed.

It is recognized that from 33-80% of inpatient psychiatric patients have concurrent medical disease. A large proportion of these are unrecognized prior to psychiatric hospitalization (1). In 1983, Martin clearly stated that "psychiatric symptoms are often the …

Five Hours With Frank: A Case Study, Mark E. Kunik, M.D.

Jefferson Journal of Psychiatry

This manuscript explores a resident's dilemma when performing a psychiatric evaluation within the context of releasing a convicted rapist.

A Case Report Of Folie'a Deux: Husband-And-Wife, Ryan M. Nishihara, Craig T. Nakamura

Jefferson Journal of Psychiatry

Shared paranoid disorder is a relatively rare psychiatric disorder in which paranoid delusions are transferred from one individual to one or more other susceptible person(s) in close association. Folie a deux describes a shared paranoid disorder involving two people and is characterized by a complex dependant relationship between the involved individuals. Provided there is no additional underlying psychopathology, there is a good prognosis for the submissive partner. Here we present a case report and discussion off folie a deux involving a husband and wife. Although folie a deux is a relatively uncommon disorder, it is important to recognize such cases …

Clozapine-Induced Seizures And Eeg Changes: A Case Report And Discussion Of Clinical Management, Jeffrey Daly, M.D., Stephen Salloway, M.D., M.S.

Jefferson Journal of Psychiatry

Clorapine is an atypical antipsychotic agent associated with a higher frequency of seizures than standard neuroleptics. In addition, clozapine causes epileptiform abnormalities in the EEG in up to 72% of patients. A patient who developed a generalized seizure shortly after beginning clozapine treatment and the patient's EEG findings are presented. The neuropharmacology of dozapine and the management of clozapine-induced seizures and EEG abnormalities are discussed.

Cultural Aspects Of A Patient's Symptomatology: A Case Report, Theresa M. Miskimen, M.D.

Jefferson Journal of Psychiatry

Culture influences numerous aspects of human experience including behavior, beliefs, values and attitudes. A case report is presented emphasizing how cultural manifestations of a psychiatric illness may materially affect presentation of symptoms, illness perception, and explanatory model of illness of a patient. Cultural background is explored to offer improved rapport and patient care.

Entering Academic Psychiatry: A Resident's Perspective, Julio Licinio, M.D.

Jefferson Journal of Psychiatry

University-based psychiatry residency programs encourage the pursuit of academic careers, both on admission, by favoring applicants with evidence of a commitment to investigation, and after residency training, by selecting as faculty residents who have demonstrated academic and research productivity. While attempting to achieve multiple goals, some residents may be discouraged to pursue an academic career as a result of marked conflict between the clinical and academic components of training. The substantial differences in priorities among psychiatry residents ought to be explored early in residency training by devoting seminars to career planning and by facilitating the pursuit of academic activities under …

The Other Drug War: Societal Attitudes And The Pharmacologic Treatment Of Anxiety Disorders, Bruce Wenokur, D.O., M.P.H.

Jefferson Journal of Psychiatry

Societal attitudes with respect to mood altering agents have undergone cyclical changes through American history. Cycles of relative tolerance and intolerance affect the perception of psychotropic drugs for illicit use, as well as legitimate medical therapy, often creating confusion between these two realms. This article examines the relationship between the prevailing social climate and the subsequent restrictions placed on the use of opiates. Historical attitudes toward opiate use serve as a model to explore the current social climate as it pertains to the pharmacologic treatment of anxiety. The under treatment of anxiety disorders is hypothesized to result largely from social …

A Comparative Content Analysis Of Emily Dickinson's Letters, Patricia Harrison, M.D., Carol Mcleod, M.A.

Jefferson Journal of Psychiatry

To investigate the relationship between creativity and mental illness, a computer content analysis of a random sampling of Emily Dickinson's (ED) letters and a selected sample of ED's "anxiety" letters were compared with speech samples from female subjects with panic disorder (n = 4) and speech samples from a female control group (n = 8). Although this can only be considered a pilot study, the findings suggest that ED's word profiles are more similar to the panic disorder group than to the control group. Limitations of this study (i.e., small sample sizes) and suggestions for future research are discussed.

The Risk Of Hospitalizing Suicidal Patients: A Personal Retrospective, Leora Bar-Levav, M.D.

Jefferson Journal of Psychiatry

Many statistically significant risk factors for suicide have been identified. Unfortunately, no study can identify the patient who will, in fact, kill himself. Maintaining a low threshold for hospitalization of potentially suicidal patients generally lowers their short-term risk. Hospitalization, however, like every medical intervention, carries attendant side effects. The dynamic implications of hospitalization for suicidal patients are considered in this paper along with recommendations to lessen the deleterious effects of such an intervention.

An Overview Of The Separation Phenomenon And The Experience Of Hospitalization For Children, Tara Pressley, M.D.

Jefferson Journal of Psychiatry

When children are psychologically bonded to a caretaking adult they experience a characteristic spectrum of emotions and behaviors upon being separated from that attachment figure. This paper reviews the literature pertaining to the separation phenomenon and the emotional experience of hospitalisation for children in an attempt to integrate this knowledge into the diagnosis and treatment of children hospitalized medically and psychiatrically.

Panic Disorder And Non-Cardiac Chest Pain: A Brief Review, Ruth Infante, M.D.

Jefferson Journal of Psychiatry

The relationship between chest pain and panic disorder is explored; after coronary artery disease and other medical diseases have been ruled out, panic disorder remains a significant contributor to morbidity. Panic disorder is treatable; hence it is important that psychiatrists educate the non-psychiatric medical community so that appropriate referrals and treatment can be made. This would lead to a decrease in health care costs.

Neuroleptic Malignant Syndrome: Diagnostic Dilemma In The Medically Ill, Mahmoud A. Parsa, M.D., Andrew J. Picken,, Robert Keating, M.D.

Jefferson Journal of Psychiatry

Neuroleptic malignant syndrome is a potentially fatal complication of neuroleptic treatment. It is characterized by a variery of signs and symptoms associated with autonomic instability, and hypothalamic and extrapyramidal dysfunction. Since other medical disorders may mimic its clinical presentation, the accurate recognition of this syndrome in the medical setting is often a diagnostic dilemma. Three medically ill patients with a clinical presentation suggestive of neuroleptic malignant syndrome are presented here. The authors discuss the complexity of making the diagnosis, and offer a brief review of the literature.