Medicine and Health Sciences Commons^™

Editor's Column, Mary E. Donovan, Md

Jefferson Journal of Psychiatry

With this edition of the Jefferson Journal of Psychiatry I am pleased to welcome Edward Silberman, M.D. as our new Faculty Advisor. Dr. Silberman is the Residency Program Director at Thomas Jefferson University, and he brings a great deal of enthusiasm about resident research, writing and publishing to the Journal. In addition to enthusiasm, he brings his own experience with writing for psychiatric publication with which to advise us, and we welcome his guidance as the Journal begins its twelfth year of publication.

Editorial Staff

Jefferson Journal of Psychiatry

Editorial Staff for Volume 12, Number 1, 1994 for Jefferson Journal of Psychiatry.

Psychodynamic Contours Of Post-Traumatic Stress Disorder, Noah D. Freedman, Md

Jefferson Journal of Psychiatry

PSYCHOTHERAPY OF THE COMBAT VETERAN

Harvey J. Schwartz, M.D., Ed.New York, Spectrum Publications, 1984

Distributed by: Integrated Publishers, 195 McGregor St., Manchester , NH 03102, 603-669-5933

Psychodynamics: The State Of The Art, Robert Hall, M.D.

Jefferson Journal of Psychiatry

PSYCHODYNAMIC CONCEPTS IN GENERAL PSYCHIATRY

Harvey J. Schwartz, MD with Efrain Bleiberg, MD and Sidney Weissman, MD editors

American Psychiatric Press, Inc., in press.

Walking In One's Own Shoes, Robert Neil Gerstman, D.O.

Jefferson Journal of Psychiatry

ILLNESS IN THE ANALYST:IMPLICATIONS FOR THE TREATMENT RELATIONSHIP

Harvey J . Schwartz, M.D. and Ann-Louise S. Silver, M.D.,

Editors International Universities Press, New York 1990, 347 pp., $42.50

The Psychoanalytic Approach To Bulimia, Doris Mirowski, M.D.

Jefferson Journal of Psychiatry

BULIMIA: PSYCHOANALYTIC TREATMENT AND THEORY

Harvey J. Schwartz, M.D., Ed.

International Universities Press, Inc., Madison, CT.

1990 (second edition), 549 pages, $65.00.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

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.

Carbamazepine-Associated Hyponatremia, Mitchell S. Gandelman, Md, Phd, Sandra Dabora, Md, Phd, Rebecca L. Johnson, Md, Michelle B. Riba, Md

Jefferson Journal of Psychiatry

Four cases of CBZ-induced or exacerbated hyponatremia are described in middle-aged to elderly females. Two cases are remarkable in that the pretreatment sodium levels demonstrate hyponatremia. A return to prior sodium levels was observed upon the discontinuation of carbamazepine therapy. No definitive conclusions can be drawn from these case reports; however, similarities in the cases can be examined as follows: (1) all four women have medical problems, in particular two patients had pre-existing hyponatremia; (2) all four patients were using concurrent medications; (3) all four women presented psychotic. A literature review examines risk factors, pharmacological mechanism, and the time course …

Polymyalgia Rheumatica Presenting As Depression: The Role Of The History And Physical Examination In Psychiatric Assessment, J.H. Ennis, Msw, Md, J.K. Leclair, Md, Frcp (C), L. Wadas, Bsw, Csw, C. Patterson, Md, Frcp (C)

Jefferson Journal of Psychiatry

Surveys have indicated that physical examination is a diagnostic tool that is infrequently used by psychiatrists. This is an unfortunate state of affairs in light of the act that the bio-psycho-social formulation of health-care problems is integral to the treatment of psychiatric disorders. The situation becomes all the more complex when faced with the high comorbidity of physical and psychiatric illness in the elderly presenting with depression. The physical examination, guided by a detailed history, must be considered an integral part of the assessment of depression in the elderly. A case study of polymyalgia rheumatica presenting as depression is utilized …

Firesetting In Children, Donna V. Mehregany, Md

Jefferson Journal of Psychiatry

This article reviews the literature regarding the history, etiology, diagnosis, and treatment of firesetting. A critique of the literature reveals the need to generate a clearer definition of firesetting as well as more stringent criteria for diagnosing firesetting. The standard treatments for firesetting are reviewed. Linkage of childhood firesetting to future adolescent and adult crimes is also examined. Finally, avenues for future research are discussed.

Pharmacologic Advances In The Treatment Of Schizophrenia, Scott A. West, Md

Jefferson Journal of Psychiatry

The treatment of schizophrenia was revolutionized with the introduction of chlorpromaeine in 1952. The effectiveness of chlorpromazine in controlling psychotic symptoms lead to the dopamine Hypothesis of schizophrenia, which revolutionized our conceptualization of this illness. Since that time, numerous typical antipsychotic drugs have been developed for the treatment of schizophrenia. However, the introduction of clozapine in 1990 began a new era in the pharmacologic management of schizophrenia. Clozapine, an atypical antipsychotic drug, is effective in controlling the positive Symptoms of schizophrenia in a large number of otherwise treatment-resistant patients, and also improves the negative symptoms of the illness in marry …

Psychogenic Amnesia: A Case Involving Amobarbital Interview And The News Media, Tracey G. Skale, Md, James Randolph Hillard, Md

Jefferson Journal of Psychiatry

A young man was admitted to an urban general hospital psychiatric unit after being brought from a local shopping mall unable to remember his name or any other personal information. He was alert and oriented and demonstrated no cognitive impairment. He agreed to an amobarbital interview and agreed to letting local news media display his picture in hopes that someone would recognize him. The amobarbital interview yielded information allowing identification of the individual, with the help of the news media. News media coverage also led to the discovery that the individual was wanted for a violent crime in another state …

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

Jefferson Journal of Psychiatry

It has been a pleasure and a privilege to have been the Faculty Advisor for the Jefferson Journal of Psychiatry for the past 10 years. We began this resident written and edited journal in 1983 as a small in-house publication designed to encourage our residents to put their thoughts about patient care into written form. Since then we have grown considerably and now serve as the only national resident journal in medicine. Many people over the years have made this effort possible. I would like to pay special thanks to our generous and supportive sponsors and …

Editor's Column, Mary E. Donovan, Md

Jefferson Journal of Psychiatry

In this edition of The Jefferson Journal of Psychiatry we say good-bye to Harvey J. Schwartz, M.D., who founded it as a resident education project ten years ago and who has been our Faculty Advisor ever since. Under Dr. Schwartz's mentorship the Journal has grown from a departmental vehicle for residents' writings to a national publication in which residents can be proud to have their work presented. Having become a nation-wide resident education project, sponsored in part by the APA, the Journal serves to meet a need for all psychiatry residents: to learn about writing, editing and publishing.

Editorial Staff

Jefferson Journal of Psychiatry

Editorial Board for Volume 11, Number 2, 1993 of Jefferson Journal of Psychiatry.

Urolithiasis Location And Size And The Association With Microhematuria And Stone-Related Symptoms., Costas D Lallas, Xiaolong S Liu, Allen N Chiura, Akhil K Das, Demetrius H Bagley

Department of Urology Faculty Papers

PURPOSE: To conduct a study to assess the association between calculus location and size and the incidence of both microhematuria and symptoms of urolithiasis in a urology office environment.

PATIENTS AND METHODS: After Institutional Review Board approval, a prospective study was conducted with data from 100 consecutive patients who presented to our office with documented urolithiasis. The location (caliceal, pelvic, or ureteral) and size (

RESULTS: A total of 111 stones were found in the study population resulting in a 45.9% incidence of microhematuria. In patients with renal pelvic and ureteral stones, 67.6% demonstrated microhematuria vs 36.4% with caliceal stones, …

Hand Problems Among Endourologists., Kelly A Healy, Raymond W Pak, Ryan C Cleary, Arturo Colon-Herdman, Demetrius H Bagley

Department of Urology Faculty Papers

BACKGROUND AND PURPOSE: Endourology has evolved rapidly for the management of both benign and malignant disease of the upper urinary tract. Limited data exist, however, on the occupational hazards posed by complex endourologic procedures. The aim of this study was to determine the prevalence and possible causes of hand problems among endourologists who routinely perform flexible ureteroscopy compared with controls.

MATERIALS AND METHODS: An online computer survey targeted members of the Endourological Society and psychiatrists in academic and community settings. A total of 600 endourologists and 578 psychiatrists were contacted by e-mail. Invited physicians were queried regarding their practice settings …

The Evolution Of Cauterization: From The Hot Iron To The Bovie., Michelle F. Deleon, Ms, Charles J. Yeo, Md, Pinckney Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

The Bovie electrocautery has become a fundamental tool of modern-day surgery, particularly for its integral role in hemostasis, yet despite this landmark invention and its widespread use, there is very little said about the man behind the machine: William T. Bovie. It would be thousands of years from the inception of cautery in medicine until the birth of Dr. Bovie and his device. However, his work in biophysics and collaboration with Dr. Harvey Cushing would revolutionize surgical practice in the early 20th century and forever ingrain his name into the field of surgery.

An Evaluation Of Neuroplasticity And Behavior After Deep Brain Stimulation Of The Nucleus Accumbens In An Animal Model Of Depression., Steven M Falowski, Ashwini Sharan, Beverly A S Reyes, Carl Sikkema, Patricia Szot, Elisabeth J Van Bockstaele

Department of Neurosurgery Faculty Papers

BACKGROUND: Recent interest has demonstrated the nucleus accumbens (NAcc) as a potential target for the treatment of depression with deep brain stimulation (DBS).

OBJECTIVE: To demonstrate that DBS of the NAcc is an effective treatment modality for depression and that chemical and structural changes associated with these behavioral changes are markers of neuroplasticity.

METHODS: A deep brain stimulator was placed in the NAcc of male Wistar-Kyoto rats. Groups were divided into sham (no stimulation), intermittent (3 h/d for 2 weeks), or continuous (constant stimulation for 2 weeks). Exploratory and anxietylike behaviors were evaluated with the open-field test before and after …

Vaccine-Preventable Diseases And Foreign-Born Populations, Marc Altshuler, Md, Giang Nguyen, Md

Department of Family & Community Medicine Faculty Papers

Foreign-born individuals account for over 12% of the U.S. population, according to the most recent census data. Since many vaccine-preventable outbreaks in the U.S. have been correlated with disease importation, Congress has mandated vaccinations for numerous immigrant populations. It is essential for primary care physicians to be knowledgeable on the unique immunization-related needs of foreign-born individuals, to recognize some of the cultural and linguistic challenges that immigrants have accessing healthcare, and remember to use each medical encounter as an opportunity to provide necessary vaccinations.

Switches, Excitable Responses And Oscillations In The Ring1b/Bmi1 Ubiquitination System., Lan K Nguyen, Javier Muñoz-García, Helene Maccario, Aaron Ciechanover, Walter Kolch, Boris N Kholodenko

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

In an active, self-ubiquitinated state, the Ring1B ligase monoubiquitinates histone H2A playing a critical role in Polycomb-mediated gene silencing. Following ubiquitination by external ligases, Ring1B is targeted for proteosomal degradation. Using biochemical data and computational modeling, we show that the Ring1B ligase can exhibit abrupt switches, overshoot transitions and self-perpetuating oscillations between its distinct ubiquitination and activity states. These different Ring1B states display canonical or multiply branched, atypical polyubiquitin chains and involve association with the Polycomb-group protein Bmi1. Bistable switches and oscillations may lead to all-or-none histone H2A monoubiquitination rates and result in discrete periods of gene (in)activity. Switches, overshoots …

Switches, Excitable Responses And Oscillations In The Ring1b/Bmi1 Ubiquitination System., Lan K Nguyen, Javier Muñoz-García, Helene Maccario, Aaron Ciechanover, Walter Kolch, Boris N Kholodenko

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

In an active, self-ubiquitinated state, the Ring1B ligase monoubiquitinates histone H2A playing a critical role in Polycomb-mediated gene silencing. Following ubiquitination by external ligases, Ring1B is targeted for proteosomal degradation. Using biochemical data and computational modeling, we show that the Ring1B ligase can exhibit abrupt switches, overshoot transitions and self-perpetuating oscillations between its distinct ubiquitination and activity states. These different Ring1B states display canonical or multiply branched, atypical polyubiquitin chains and involve association with the Polycomb-group protein Bmi1. Bistable switches and oscillations may lead to all-or-none histone H2A monoubiquitination rates and result in discrete periods of gene (in)activity. Switches, overshoots …

Value-Added Services Of Hospital-Based Radiology Groups, Vijay M. Rao, Md

Department of Radiology Faculty Papers

Presentation at 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

Summary of presentation.

16 slides.

Buffered Memory: A Hypothesis For The Maintenance Of Functional, Virus-Specific Cd8(+) T Cells During Cytomegalovirus Infection., Christopher M Snyder

Department of Microbiology and Immunology Faculty Papers

Chronic infections have been a major topic of investigation in recent years, but the mechanisms that dictate whether or not a pathogen is successfully controlled are incompletely understood. Cytomegalovirus (CMV) is a herpesvirus that establishes a persistent infection in the majority of people in the world. Like other herpesviruses, CMV is well controlled by an effective immune response and induces little, if any, pathology in healthy individuals. However, controlling CMV requires continuous immune surveillance, and thus, CMV is a significant cause of morbidity and death in immune-compromised individuals. T cells in particular play an important role in controlling CMV and …

B1b Lymphocyte-Derived Antibodies Control Borrelia Hermsii Independent Of Fcα/Μ Receptor And In The Absence Of Host Cell Contact., Matthew J. Colombo, David Abraham, Akira Shibuya, Kishore R. Alugupalli

Department of Microbiology and Immunology Faculty Papers

The critical role of IgM in controlling pathogen burden has been demonstrated in a variety of infection models. In the murine model of Borrelia hermsii infection, IgM is necessary and sufficient for the rapid clearance of bacteremia. Convalescent, but not naïve, B1b cells generate a specific IgM response against B. hermsii, but the mechanism of IgM-mediated protection is unknown. Here, we show that neither Fcα/μR, a high-affinity receptor for IgM, nor IgM-dependent complement activation is required for controlling B. hermsii. Bacteria in diffusion chambers with a pore size impermeable to cells were killed when diffusion chambers were implanted into either …

Prevalence And Risk Of Polypharmacy Among The Elderly In An Outpatient Setting: A Retrospective Cohort Study In The Emilia-Romagna Region, Italy, S. Lane Slabaugh, Vittorio Maio, Megan Templin, Safiya Abouzaid

College of Population Health Faculty Papers

Background: Polypharmacy, the simultaneous taking of many medications, has been well documented and is a topic of much concern for those looking to improve the quality of care for the elderly. Elderly patients often develop complicated and multi-factorial health states that require extensive pharmacotherapy, leaving this population at risk for exposure to drug-drug interactions and other adverse events. Previous literature supports an association between an increase in the rate of adverse events as the number of drugs taken by a patient increases.

Objective: We sought to evaluate the prevalence of polypharmacy, and to determine patient characteristics that are predictive of …

Current And Future Directions In Frailty Research., Anita Mohandas, Joanne Reifsnyder, Mimi Jacobs, Tim Fox

College of Population Health Faculty Papers

The concept of frailty has been evolving dramatically for the past 30 years. Through its evolution, a variety of single and multidimensional models have been used to describe frailty. This article reviews the current literature related to the defining dimensions of frailty and identifies the gaps in the literature requiring additional research. A detailed literature review was performed to identify key dimensions and models currently being used to define frailty, classify interventions that have been developed to reverse frailty, and identify potential areas for future research within this field. Despite the large body of research defining the dimensions of frailty, …