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Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor for the Jefferson Journal of Psychiatry, Volume 3, Number 2, July 1985.

E = Mc², John Matt Dorn, Md

Jefferson Journal of Psychiatry

Book Review: WHY PSYCHOTHERAPISTS FAILRichard D. Chessick, M.D.New York: Jason Aronson, 1971203 pp., $20.00

The Impact Of Hysterectomy During Adolescence In A Woman Of Reproductive Age, Susan K. Ball, Md

Jefferson Journal of Psychiatry

There is extensive psychiatric literature on the psychological effects of hysterectomy on both pre-menopausal and post-menopausal women, but a careful search covering the last ten years and beyond reveals no references to the impact of hysterectomy during adolescence. There is also nothing on this subject in the gynecological literature of the last ten years. Obviously, the incidence of severe pathology necessitating hysterectomy is extremely rare. However, there can be little doubt that a procedure of such symbolic magnitude at an age when a young woman is trying to integrate her personality, emerge as an autonomous sexual being, and experiencing a …

Psychotherapy Or Pseudotherapy?, Lawson R. Wulsin, Md

Jefferson Journal of Psychiatry

What is psychotherapy? I wish I knew . Thick books and long talks still leave me wondering. Hours of patients and almost as many hours of supervision leave the question hanging. I know what ECT is and how to give a good trial of arnitryptiline, but I am never quite sure if what I am offering is true psychotherapy. Admittedly I am young and have only been wet for five years. But I have had one experience in my short time that put the question in perspective by putting it backwards, that is, what is notpsychotherapy, or what is pseudotherapy?

The Webs We Weave: A Patient With Depression, Mary Ann Venezia, Md

Jefferson Journal of Psychiatry

Looking back over C.'s records, I was struck by a phrase I had used to describe her, "She really seems at a loss as to what she should do with herself. " A more accurate appraisal might have reflected my own uncertainty as to how I could help C. Hospitalized eight times in eight years after serious suicide attempts, she had been treated with neuroleptics, antidepressants, psychotherapy, and been involved with a day program. Once again she was in the hospital, severely depressed following a suicide attempt. There was little the psychiatric establishment had not tried . So I taught …

The Neuroleptic Malignant Syndrome: Do We Know Enough?, Ali Hassan M. Ali, Md

Jefferson Journal of Psychiatry

The Neuroleptic Malignant Syndrome (NMS) is a potentially grave adverse reaction to oral or parenteral neuroleptic therapy that may be an underdiagnosed and easily overlooked clinical problem. NMS is characterized by hyperthermia, hypertension, diaphoresis, muscular rigidity, and altered mentation. There is currently no way of predicting which patients will develop NMS, although its incidence may be higher in patients who are unresponsive to usually effective dosages of neuroleptics ( I) .

NMS was first described in the French literature by Delay and Deniker in 1960 (2). They reported five cases among several hundred patients who were treated with haloperidol (Haldol"), …

A Patient With Aids, Susan Ball, Md, Stephen Hauptman, Do, Jean Helz, Md, Sheila Murphey, Md, Beth Shindell, Mss

Jefferson Journal of Psychiatry

Susan Ball , M.D.. Chief Resident: Mr. B, a thirty-five-year-old white male, was admitted to the medical service with chief complaints of fever, chills, and increasing shortness of breath. This was Mr. B's second admission. His first was six month s ago for pneumonia, leukopenia, and lymphadenopathy of unknown etiology. At that time he was treated with antibiotics; he improved and was discharged. Since that time Mr. B reported continuing to feel weak and lethargic. Two weeks before this admission he noted the onset of fever, chills, sore throat, and a nonproductive cough. He initially saw …

Bulimia As A Masturbatory Equivalent, Eric Levin, Md

Jefferson Journal of Psychiatry

Introduction

In the last few years much has been written about those who binge-eat and then purge. These people, most of whom are women, resort to extreme measures to avoid gaining weight while not foregoing the gratification of eating.

Most recent papers on this disorder have focused upon description, classification, and the search for neurobiological causality . Little has been presented on the psychodynamics of bulimia that would help us understand the symbolic significance of this disorder. The following case presentation illustrates how bulimia may present as a neurotic symptom, and as such may be overdetermined, yet representative of a …

Some Reflections On Termination: Transference And Countertransference, Frederick L. Becker, Jr, Md

Jefferson Journal of Psychiatry

INTRODUCTION

Nearing the completion of my psychiatric residency, I ingenuously told my supervisor that I needed to know the steps of termination in therapy with patients. On the surface, this request reflected an awareness of the issues at hand and their importance. Beneath lay ambivalence and countertransference anxiety . For the graduating resident, time ordinarily invested in thought and study fills with practical considerations of job hunting and starting a practice. The resident' s own unresolved and unsettling separation issues can further push aside therapeutic considerations for his patients. Termination, the art of the veteran therapist, becomes an unwelcome …

The Use Of Light In The Treatment Of Depression, Mark D. Miller, Md

Jefferson Journal of Psychiatry

INTRODUCTION

Light has recently been reported to be a useful treatment in affective illness (1,2, 3, 4, 5, 6). What type of patients respond to this type of treatment ? What is the theoretical mechanism of action of light therapy and what are the implications of this research for the existing theories of affective illness? This review will seek answers to these questions by summarizing the recently reported studies of the effects of light on depression , by reviewing the pertinent contributions from neuroanatomy, endocrinology and circadian rhythm physiology, and, finally, by suggesting some points of integration of these recent …

Editor's Column, John Matt Dorn, Md, Chief Editor

Jefferson Journal of Psychiatry

The last few months of my residency have been a strange time for me. Half-way out the door and half-way in, I find myself simultaneously saying hello and good-bye. This in itself is not unusual. There are many situations in life that arouse varying degrees of separation and stranger anxiety. Perhaps this time is unique because it marks, at least superficially, the end of a prolonged adolescence. Or, as a friend of mine who is also finishing his professional training wrote to me recently: "Good students that we have been, we face a sudden decline in the steady flow of …

List Of Editors

Jefferson Journal of Psychiatry

List of Editors for Jefferson Journal of Psychiatry Volume 3, Number 2, July 1985.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to the Jefferson Journal of Psychiatry.

The Double Blind Gordian Knot, John Matt Dorn, Md

Jefferson Journal of Psychiatry

Book Review of: DIFFERENTIAL THERAPEUTICS IN PSYCHIATRY: THE ARTAND SCIENCE OF TREATMENT SELECTIONA. Frances, M.D., J. Clarkin, Ph.D., & S. Perry, M.D.New York: Brunner/Mazel, 1984395 pp., $30.00

Problems With Separation In An Identical Twin, Henry A. Doenlen, Md

Jefferson Journal of Psychiatry

Introduction

During residency we learn to apply the theories of development to understand and help our patients. These theories are based upon the relationship between a single childand his parents as he struggles to separate and individuate. Identical twins have special problems in that not only do they have to separate from their parents, but also from each other.

The Importance Of Comprehensive Assessment Of The Sexually Abused Child, Luz N. Colon-De Marti, Md

Jefferson Journal of Psychiatry

In the past few years public awareness of sexual abuse of children has increased, together with the recognition of its social, physical, and psychological effects (I). We must emphasize our role as diagnosticians in doing a comprehensive assessment of the sexually abused child. It is our professional responsibility to assess the general psychological status of the child before and after sexual abuse.

The Use Of Art Therapy In A Patient With Chronic Schizophrenia, Robert Morrow, Md

Jefferson Journal of Psychiatry

The artistic drawings of psychiatric patients have been of increasing interest to mental health professionals over the last hundred years. In the 1870's Simon speculated on the relationship between the art of psychotics and their illnesses (1) . Freud and Jung made observations about the symbolism of art work. By the 1940's Naumberg developed a system of art therapy relying heavily on psychoanalytic theory that is now a therapeutic discipline in its own right (2).

In the inpatient milieu art therapy is commonly offered in conjunction with other therapies that make up the inpatient experience. The art therapist often shares …

Interaction Of The Opiate And Neuroendocrine Systems, Peter Demaria, Jr, Md

Jefferson Journal of Psychiatry

Opiates are known to produce various physiological effects. Our understanding of these effects has been greatly increased by the discovery of the opiate receptor and the endogenous opioid peptides. Recent investigation has demonstrated that three distinct receptor subtypes exist; their function is currently being actively investigated.

Intractable Alcoholism In A Patient With A Levine Shunt, Bruce Blumenthal, Ms, Howard Field, Md, Ed Gottheil, Md, Linda Guerra, Ma, Willis Maddrey, Md, Ron Serota, Md, Ellen Shaw, Md

Jefferson Journal of Psychiatry

Ellen Shaw. M.D., Fellow in Hepatology: Mr. J is a forty-six-year-old white male who was initially seen on the medical service in July 1982. At that time he presented with hepatic encephalopathy, jaundice, and ascites. A liver biopsy was performed, confirming the clinical diagnosis of alcoholic hepatitis superimposed on cirrhosis. Following discharge it was difficult to maintain Mr. J as an outpatient. He did not follow dietary restrictions or take diuretics as prescribed. Additionally he was unable to control his drinking. Finally about a year ago a Levine shunt was implanted in an effort to control his ascites. Subsequently he …

Caring For Survivors Of Sudden Death In The Emergency Ward, Jeffrey Sarnoff, Md

Jefferson Journal of Psychiatry

Frequently, emergency physicians have to interact with family and friends of persons who have died suddenly, often unexpectedly. These interactions are in complex ways difficult for both emergency ward (EW) staff and for survivors of sudden death. It may be that the way in which this crisis is managed will be a major determinant in how these survivors will remember the incident of sudden death, and how they will cope with it psychologically and physiologically.

Parental Bereavement Following The Death Of An Adult Child, Allan E. Crandell, Md

Jefferson Journal of Psychiatry

Introduction

To coin a title with the words "death" and "children" in it appears to me like the height of incongruity. Children are like definitions of life itself. They seem to bubble over and to foam with vitality. Life seems to be theirs, even the sickly and skinny ones, and death is the property of the old. Children have sparkling eyes and uncomplicated ways and innocence and a simplicity I envy. I am temporarily tempted to keep the little ones that way. I think of joining parents and educators who struggle to spare them from any ugliness in their world, …

On The Outskirts Of Babel, John Matt Dorn, Md

Jefferson Journal of Psychiatry

INTRODUCTION

I admit to a fondness for book lists that began on Wednesdays in the eighth grade, when feet perched imperiously on the table in the corner I would review with inordinate glee the list of recommended reading. What seemed to others an onerous and pedantic exercise was to me a treasure map that dissolved the walls of the school around me.

Munchausen’S Syndrome: Towards A Psychodynamic Understanding, Sharon Riser, Md

Jefferson Journal of Psychiatry

INTRODUCTION

The third edition of the Diagnostic and Statistical Manual of Mental Disorders cites two essential criteria for the diagnosis of chronic factitious disorder with physical symptoms, more poetically known as Munchauseri's Syndrome:

a) Plausible presentation of physical symptoms that are apparently under the individual's voluntary control to such a degree that there are multiple hospitalizations;

b) The individual's goal is apparently to assume the "patient " role and is not otherwise understandable in light of the individual's environmental circumstances(I).

Additionally noted is the frequent occurrence of a true physical illness entailing extensive hospital treatment during the childhood or adolescence …

Editor's Column, John Matt Dorn, Md, Chief Editor

Jefferson Journal of Psychiatry

Recently, an editor of The Jefferson Journal of Psychiatry remarked to me his regret that we don' t publish more original material. By this, I think he meant that the articles we publish do not break new ground, but tend to be compilations of existing ideas and beliefs. I think that he is right about this, and for a while I was disillusioned. On reflection, however, I think there may be some value in our project.

List Of Editors

Jefferson Journal of Psychiatry

List of Editors for Volume 3, Number 1 of the Jefferson Journal of Psychiatry, Jan 1985.

Clinical Guidelines Written By Residents, David W. Andrews Md

JHN Journal

“Variation” is an innocent word that that can represent many levels of frustration to the clinician. Variation among patients is the least of these; the physician expects patients and their individual problems to be as diverse as the human race itself. Variation within a practice should be due to matching the specific needs of the specific patient. Other variations can mean trouble if they represent differences in understanding of the problem among clinicians and other allied health practitioners. These differences could be between institutions or even between shifts within one institution.