Medicine and Health Sciences Commons^™

Brief Reports: Depressive Phenomena In Infants, Vanshdeep Sharma, Md

Jefferson Journal of Psychiatry

Interest in childhood depression is demonstrated by an increasing amount of research in the area. A review of literature suggests that depression as a clinical entity is observable in children ( I ).

Body-Snatching: Medicine And The Cartesian Threat, Mark D. Sullivan, Md, Phd

Jefferson Journal of Psychiatry

Twentieth century physicians are proud to be biological scientists. It is this feature above all others that distinguishes us from our predecessors. Because it is the badge of our progress in medicine, biology is often considered the essential core of medical care. Indeed, we can become so focused upon the biology inmedicine that all other aspects of caring for patients fade into a murky background of ill-defined sentimentality.

Different Perspectives Of Psychiatry Within Two Neighboring Residency Training Programs, Bruce Rosenblum, Md

Jefferson Journal of Psychiatry

This paper arises out of my fortunate opportunity to observe two very different psychiatric residency training programs. While a fourth-year resident at a large, psycho dynamically-oriented private psychiatric hospital, I was able to do a consultation liaison rotation at a neighboring academic institution at the vanguard of biological psychiatry. I left the familiar, we ll-manicured suburban grounds for the inner city of Baltimore to be one of the first experiments in "cross-fertilization" between these residency training programs. Although the two institutions are located in the same city and stem from the early history of American psychiatry, they have been worlds …

Dynamic Considerations In Psychiatric Crisis Intervention, Keith Cheng, Md

Jefferson Journal of Psychiatry

One of the most challenging tasks for psychiatrists and psychiatric residents is emergency room triage. This task becomes more frequent as more patients depend on the emergency room for psychiatric treatment. Various social and economic pressures account for an increased utilization of psychiatric triage. The government funds that were to provide community care for the ex-patients of state hospitals have never materialized in adequate amounts (1). Many of these patients become dependent transients who in a crisis must use the emergency room as a psychiatric clinic. To keep premiums down, some insurance companies have eliminated their outpatient psychiatric coverage, often …

Treatment Of Mental Disorders In Pregnancy: A Review Of Neuroleptics, Antidepressants, And Lithium Carbonate, Lawrence L. Kerns, Md

Jefferson Journal of Psychiatry

Pregnancy is frequently complicated by the development or recurrence of a serious mental disorder; neurotic, major affective, and psychotic illnesses have all been observed (1-4). When a major mental disorder arises in a pregnant woman and threatens the health or life of the patient and/or fetus, it should be treated early and aggressively to minimize complications and forestall the advance of the disease. Nonbiologic methods like individual psychotherapy, couples or family therapy, social casework, and hospitalization in a supportive, structured milieu should form the first line of treatment. Electroconvulsive therapy (ECT) may be the treatment of choice for some patients, …

Masochistic Personality Disorder: A Diagnosis Under Consideration, A. Kenneth Fuller, Md

Jefferson Journal of Psychiatry

In the past three decades, few diagnoses in psychiatry have had a more turbulent history than the personality disorders (1). Labels such as inadequate, emotionally unstable, and asthenic personalities entered the official nomenclature and were later withdrawn. Borderline, antisocial and compulsive personality disorders are additions that have become entrenched in the classification of mental disorders. The turmoil maintains its course with a diagnosis of Masochistic Personality Disorder under consideration to join the existing categories of personality disorders in the revised edition of DSM-III (DSM-III-R) (2).

The category of Masochistic Personality Disorder does not exist in the three earlier versions of …

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

The challenge of understanding and treating the increasing number of patients who suffer from some form of eating disorder has been addressed at length in the past issues of the JeJferson Journal. Beginning in the July 1985 issue, Dr. Eric Levin presented a clinical and theoretical report entitled "Bulimia as a Masturbatory Equivalent." The last issue contained an "In Response" column by Dr. C. Philip Wilson, a foremost authority on the psychoanalytic approach to this problem. This issue brings forth further commentary by Dr. Jeffrey Jonas, a recognized leader in the pharmacologic concept of treatment. The differences in approach are …

Editor's Column: Remarkable Conversations, Jeffrey R. Sarnoff, Md

Jefferson Journal of Psychiatry

Over the past year or so, several of us who are intimately involved in the editing and production of this journal have been personally challenged by the emergence of serious illness in either ourselves or our immediate fami lies. In each instance, the psyc hiatrist so affected has maintained the degree of equilibrium necessary to permit continuing, effective participation in this enterprise.Given this, the question emerges: Why do we do the work that has led us from a journal with a press run of four hundred copies in 1983, to a journal with a national circulation of seven thousand copies …

Editorial Staff

Jefferson Journal of Psychiatry

List of Editorial Staff for Volume 4, Issue 2, Spring 1986 issue of the Jefferson Journal of Psychiatry.

In Response: A Discussion Of "Bulimia As A Masturbatory Equivalent", C. Philip Wilson, Md

Jefferson Journal of Psychiatry

My research and that of my colleagues in the psychodynamic cause, structure and treatment of patients with bulimic anorexia nervosa correlates with and confirms the hypotheses presented by Levin ( 1) that bulimic symptoms may represent a masturbatory equivalent.

In our recently published book, Fear of Being Fat: The Treatment of Anorexia Nervosa and Bulimia (2) we confirmed Sperling's findings (3) that unresolved preoedipal fixations to the mother contribute to difficulties in psychosexual development and that anorexic girls and boys displace sexual and masturbatory conflicts from the genitals to the mouth.

In Search Of The "Fundamental Rule" Of Supportive Psychotherapy, Jeffrey R. Sarnoff, Md

Jefferson Journal of Psychiatry

Early in my first year of residency training in psychiatry, while working between acute-care inpatient units and a busy crisis service, it appeared that virtually every patient was said to have been treated with supportive psychotherapy, in conjunction with psychotropic medication. This appearance was deceiving, and if not for thorough supervision, reading, discussion with faculty and peers, and autocritical review, I might still believe that my earliest, and perhaps sickest, patients were indeed treated with supportive psychotherapy. In retrospect, some were and some were not; the explanation for this discrepancy came with the realization that I did not have very …

Learning And Teaching Psychoanalytic Psychotherapy, Ann E. Steel, Md

Jefferson Journal of Psychiatry

Book review of:

AN INTRODUCTION T O PSYCHOTHERAPY

Sidney Tarachow, M.D.

New York: International University Press, Inc.,1963. 332 pp., $32 .50

Canoe Trip, David Mitchell, Md

Jefferson Journal of Psychiatry

"Perfect," he said as he carved his knife into the surgical wound, exposing another layer of fascia. We were standing in the operating theatre: he, the surgical chief resident, and I, a third-year medical student. It was the first of many appendectomies I would scrub in for during my surgical rotation. The patient was a I2-year-old boy who had come to the Grand Valley Hospital emergency room that day. He had a low-grade fever, sweats, and periumbilical pain that had migrated to the right lower quadrant of his abdomen. After quizzing me on various anatomical structures, removing the inflamed appendix, …

Folie Á Deux, Ulhas Mayekar, Md

Jefferson Journal of Psychiatry

Folie a deux, also called dual psychosis, involves the transfer of delusional ideas from a psychotic individual to a nonpsychotic individual within the framework of a close relationship, with the eventual in corporation of the delusional system into the psyche of the previously non psychotic individual.

Diagnosis In The Neuroleptic Malignant Syndrome, James H. Dallman, Md, Cpt, Mc

Jefferson Journal of Psychiatry

Neuroleptic malignant syndrome (NMS) is an uncommon, potentially lethal complication of treatment with antipsychotic medication. First described in American journals by Delay and Deniker in 1968 (1), this syndrome has been reported for many years in the European and Japanese literature.

Decision Trees For Use In Childhood Mental Disorders, Henry A. Doenlen, Md

Jefferson Journal of Psychiatry

The third edition of The Diagnostic and Statistical Manual ofMental Disorders (DSM-III) (1) provides specific diagnostic categories for use in childhood mental disorders, even though these diagnoses are not limited to children. In addition, many of the diagnostic categories used for adults are considered appropriate for use in children. DSM-I II instructs the clinician to diagnose children by first considering the section "Disorders First Evident in Infancy, Childhood, or Adolescence" before considering the disorders described elsewhere. However, this may lead to problems because some major diagnostic categories such as affective disorders and schizophrenia are not included …

The Neuropsychiatric Syndrome Of A Psychomotor Seizure Disorder In Shakespeare's Othello, The Moor Of Venice, Alan J. Cohen, Md

Jefferson Journal of Psychiatry

Many of Shakespeare's characters suffer from the myriad of medical and surgical ailments that afflict mankind. Although many of these diseases serve merely to enhance the subtle shading of character in Shakespearean drama, certain disorders seem to provide a vital focus for the basic theme and plot development of the plays. No group of disorders is more implicated by the behavior and thought patterns of Shakespeare's characters than neuropsychiatric disease. Othello, the Moor of Venice stands out as a striking example of a tragedy

in which the main character suffers grievous consequences from a disease that affects …

Carbamazepine In Treatment Of The Violent Psychotic Patient, Lauren A. Pate, Md

Jefferson Journal of Psychiatry

Violence in the psychiatric setting may be perpetrated by patients with a variety of diagnoses including character disorders, episodic dyscontrol syndromes, and drug or alcohol intoxication. The violent behavior of aggressive psychotic patients is typically the most bizarre, unpredictable, and the least responsive to intervention with neuroleptics or lithium carbonate. Carbamazepine, an established anticonvulsant, has achieved growing prominence as an adjunctive measure in treatment of the violent psychotic. This paper will review the literature and summarize the posited pharmacological mechanisms, reported side effects, and clinical experience with carbamazepine in controlling the symptoms of violence and aggression in psychosis.

The Stress Factor: Exploring The Possibility Of A Psychological Component To Cancer, Bernard M. Edelstein, Md

Jefferson Journal of Psychiatry

As dwellers in the same house, it seems only logical that psyche and soma would be interdependent , that well-being in one would promote health in the other, and that illness in one would soon become manifest in its partner. Yet quantifying this intuitive relationship has long been a difficult task. Establishing a mechanism for disease-heart disease, infectious disease, neoplastic disease which can withstand the scrutiny of experimental rigor, is difficult enough. To introduce a seemingly not quantifiable entity such as psychology in the form of stress or anxiety presents such great complexity that for a long time it seemed …

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

The teaching of the concepts and techniques of dynamic psychotherapy to residents is a formidable task facing most all residency directors and faculty. The challenge of 'new' therapies and the revolution in neurobiology has led to a significant deemphasis in dynamic training in many programs in recent years. Where once there was relative uniformity of philosophy, a variety of approaches now abound. Medical school graduates can choose from programs that offer intensive training in psychoanalytic psychiatry as well as those that mention Freud only in passing. Most call themselves 'eclectic' and teach a potpourri of therapies that vary with faculty …

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

The season during which this issue of the Journal is being assembled is Autumn. It is a time of change, of growth, of new development.

For a small group of psychiatrists around the country, this period has an additional special meaning-it is recruitment season. For program directors and faculty it is this time every year that the mating ceremony known as the 'match' is prepared for . The mutual cueing and seductiveness, and indeed the ceremonies of courtship itself, are set in motion as faculty and soon-to-be medic al school graduates begin their unique dance.

Letters To The Editor

Jefferson Journal of Psychiatry

We welcome all letters to the editor and encourage authors to reply. Input from residents and faculty on ideas presented in the Journal create an arena for discussion and dialogue that is the ultimate purpose of this undertaking.

Post Psychotic Depression In A Patient Who Castrated Himself, Harvey Stabinsky, Md, Jd, Susan Stabinsky, Md, Alfred Wiener, Md

Jefferson Journal of Psychiatry

With this article we inaugurate our efforts to expand the scope of the Journal beyond the walls of Jefferson. We thus open the Journal to residents of all programsand invite them to share their clinical experience and research. Circulation will include contributing programs.

Introduction

The differential diagnosis of psychosis associated with depression includes schizophrenia, schizoaffective and major affective disorders. Depression associated with schizophrenia may be a prominent feature of the patient's early presentation (I), or manifest itself only as the psychotic symptoms resolve (2, 3). Neuroleptics may play a causal role in the development of post-psychotic depression . This drug …

A Forty-Year-Old Woman With A History Of Psychosis And A Seizure Disorder, Jeffrey R. Sarnoff, Md, Robert E. Morrow, Md, Sharon Riser, Md, Ann E. Steel, Md, Jacob Berman, Md

Jefferson Journal of Psychiatry

In this issue of the Journal, we are introducing a new section. the Interdisciplinary Case Conference. Our goal will be to present psychiatric patients in whom pathology is demonstrable not only by interview, but also by physical examination,laboratory studies. and radiographic imaging techniques.

Book Review, John Matt Dorn, Md

Jefferson Journal of Psychiatry

INDIVIDUAL PSYCHOTHERAPY AND THE SCIENCE OF PSYCHODYNAMICS

David H. Malan, D.M., FRC Psych London: Butterworth , 1979 275 pp., $24.95

Psychosis In A Patient With Autoimmune Deficiency Syndrome, Vivian Charneco, Md

Jefferson Journal of Psychiatry

Introduction

Autoimmune deficiency syndrome (AIDS) is a disease whose incidence has grownprecipitously in recent years. Its victims face social and psychological isolation (I) .Contributing to this isolation is the fear of contact with AIDS patients that exists among health care workers and the public (2).

Increasingly more is being under stood about this mysterious disease. Recent reports have supported a viral etiology. The chief criterion for diagnosis is an inverted helper to suppressor T-cell ratio. Other supportive findings include lymphopenia,leukopenia, elevated IgA levels, and anergia. The following case report highlights the neurological and psychiatric symptoms that may be seen in …

Chronic Pain, Roberta Ball, Do

Jefferson Journal of Psychiatry

A complex problem of vast dimensions, chronic pain is receiving increasing attention due to the expansion of knowledge of the neurophysiology, neurochemistry and psychology of pain. Chronic pain presents a challenge to many disciplines in the health professions, and one that is more recently being presented to the psychiatrist.This paper will attempt to define the problem of chronic pain, to explore the concept of organic versus psychogenic pain, to describe the psychodynamics and other characteristics seen in the chronic pain patient and to discuss the importance of the psychiatristin evaluation and treatment of chronic pain .

The Evaluation And Treatment Of A Patient With Anorexia Nervosa, Gail S. Greenspan, Md

Jefferson Journal of Psychiatry

Introduction

Anorexia nervosa is a serious illness that has generated enormous public interest during recent times. Within the psychiatric field, numerous articles and books have been written about this syndrome. This literature reflects varied theoretical frameworks, from primarily biological approaches to family systems to psychodynamic theory. In this paper I will attempt to integrate family systems and psychodynamic theory in an understanding of a young woman with anorexia nervosa who was treated in a hospital setting.

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

This issue of our Journal marks a new stage in our development. We have started accepting papers from residency programs other than our own. Encouraged by the enthusiastic response our prior issues have elicited from psychiatric educators around the country, we are embarking on a program of expansion. In doing so we hope to provide a unique arena for psychiatric resident thinking. Residents nationwide are invited to share with each other and their faculties, their discoveries, their uncertaintiesand the newness with which they view their work.