Medicine and Health Sciences Commons^™

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.

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 the arena for discussion and dialogue which is the ultimate purpose of this undertaking.

Therapeutic Guitar-An Alternative Approach To The Treatment Of A Difficult Patient, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

The case described in this article is one where an experimental technique was introduced largely because of the therapist's dissatisfaction with the patient's progress. Despite the likelihood of being criticized, I feel compelled to write about this patient. The progress he has made is beyond my expectations, which were admittedly minimal at the outset.

Misuses Of Computers By Adolescents, Henry A. Doenlen, M.D.

Jefferson Journal of Psychiatry

One subject that has been a topic of much recent publicity and concern has been that of computer misuse. Teenage computer programmers gaining entry into the systems of universities, hospitals and businesses have caused the most concern . The duplication of copyrighted programs and information has also been reported to cause loss of considerable money. There seems to be a subpopulation of people who spend considerable time working with computers. These individuals may do so to the exclusion of other aspects of life such as human interaction . This paper will present both my observations of this behavior and my …

The Treatment Of A Borderline Patient Complicated By Involvement With A Charismatic Religious Cult: A Case Report, Mark Miller, Md

Jefferson Journal of Psychiatry

Introduction

Although much has been written about cults in recent years, many questions remain. Do cults recruit subjects by brainw ashing them or do individuals gravitate to cults to fulfill unmet needs? This paper will review some essential points of cult phenomena and discuss the treatment of one patient who was involved in a charismatic religious cult .

Possible Synergistic Action Between Carbamazepine And Lithium Carbonate In The Treatment Of A Manic Patient., John Matt Dorn, M.D.

Jefferson Journal of Psychiatry

Introduction

Carbamazepine has been proven to be efficacious in some patients with affective disorders, notably those who have not responded well to lithium carbonate or neuroleptics (1,2,3) . For those who have responded poorly to either regimen, however, there have been no effective pharmacotherapies until recently, when case reports have suggested a possible synergistic action between lithium carbonate and carbamazepine (4,5,6). The following case report supports this hypothesis.

The Use Of Carbamazepine (Tegretol) In Psychiatry And Its Association To Kindling, Temporal Lobe Epilepsy And Psychopathology, James Stanch, M.D.

Jefferson Journal of Psychiatry

The recent theory of kindling may help to link neurophysiologic, neurotransmitter and neuroanatomic mechanisms important in understanding the neurology of behavior. Limbic kindling is of interest in developing models of epilepsy, psychosis, learning and memory (l -5). Kindling might explain the late development of psychopathology.

This paper will first define kindling and demonstrate how kindling offers a model within which to view more prolonged behavioral deviations as neurophysiological processes. The use of carbamazepine and its association to kindling, temporal lobe dysfunction and psychopathology will be discussed .

Discussion Of The Paper By David A. Scola, M.D. On “The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles”, Howard Field, M.D., Paul J. Fink, M.D., Thomas Swirsky-Sacchetti, Ph.D.

Jefferson Journal of Psychiatry

Dr. Scola proposes a bold and far-reaching synthesis of psychoanalytic theory, developmental neurobiology and neurophysiology of behavior. Freud found this task so frustrating in 1895 that he renounced neurology in favor of a purely psychologic approach (or so Freud claimed; Frank Sulloway sees it differently). Hypotheses that unconscious mental life is situated in the right cerebrum and that defense mechanisms are related to neuroanatomic connections are intriguing. The presentation does not include evidence which contravenes these theories. Sperry presented some evidence that the right hemisphere is self-aware and self-evaluative (I). One great problem in all cross disciplinary studies is the …

The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles, David A. Scola, M.D.

Jefferson Journal of Psychiatry

Volumes of research have been accumulated over the past decade concerning hemispheric specialization of the human brain. Likewise, over the past century, psychoanalysts have painstakingly unraveled through their clinical observation many of the mysteries of intrapsychic functions. Yet little has been written concerning attempts to integrate these seemingly divergent viewpoints.

It was Freud's hope that a neural basis for his clinical observations and psychological explanations of the human mind would eventually be established . This was not possible in his day, however, so this idea was gradually abandoned. With the advent of computers and high technology, perhaps it is time …

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

Jefferson Journal of Psychiatry

This second issue of our resident journal enlarges our educational effort s in two important ways. The first is obvious . As you can see, we have published this forum in an attractive new form at. This is highlighted by the new cover designed by Dr. Jeffrey Sarnoff. The second piece of progress is our enlarged audience. In addition to our own Jefferson faculty and residents, the Journal is now being distributed to psychiatrists throughout Pennsylvania. For both of these improvements in form we are indebted to the Mead Johnson Pharmaceutical Division for their generous sponsorship.