Medicine and Health Sciences Commons^™

A Psychiatric Perspective On Erectile Dysfunction, Syed Ahmed, Md

Jefferson Journal of Psychiatry

Erectile impotence is a common family health problem, with exact incidence unknown, that adversely affects both men and their female partners. It is classified as "inhibited sexual excitement" in DSM-III and is defined as the inability to attain or maintain a penile erection until completion of the sexual act. It had been stated formerly, without supporting evidence, that 90% of erectile disorders were "psychogenic. " Today, however, only about one-third are so classified (1). In Kinsey's (2) series, the prevalence of impotence was less than 2% until the age of 40 years; it increased to 6-7% at age 55 …

The Use Of Maintenance Electroconvulsive Therapy For Relapsing Depression, Ted A. Matzen, Md, Ronald L. Martin, Md, Tim J. Watt, Md, Douglas K. Reilly, Md

Jefferson Journal of Psychiatry

It is generally accepted that electroconvulsive therapy (ECT) is an effective treatment of major depressive episodes in patients with both unipolar and bipolar affective disorders (1). Yet, repeated relapse of depression occurs in some patients, even with vigorous maintenance therapy on antidepressant drugs (2-4). This often necessitates rehospitalization for ECT. In past decades, several authors suggested that periodic outpatient ECT was efficacious as a maintenance therapy (5-7). Recently, maintenance ECT was recommended by Fink (8), and Maletzky (9), but barely mentioned in two reviews (10,11), and discouraged in another (12) . However, a recent nationwide survey has disclosed that such …

The Effect Of Acute And Chronic Ethanol On Dopamine Turnover In The Caudate Nucleus Of The Rat, Rif S. El-Mallakh, Md

Jefferson Journal of Psychiatry

It is generally believed that acute and chronic ethanol (EtOH) administration alters the activity of catecholamines in the brain, however, the specific effects of EtOH on the dopaminergic system are disputed (I). Acute EtOH administration has been variously reported to decrease (2,3), increase (4,5), and cause no change (6 ,7) in dopamine (DA) synthesis and turnover. Likewise, chronic EtOH treatments have been reported to decrease (2,8) and increase (9, 10) DA synthesis and turnover. Many of these apparently conflicting results are explained by the use of different animal models (rat (2, 3,6,7,10), rabbit (6), and mouse (4,5,9)), different methods of …

Bioethical Issues In The Management Of Gender Dysphoria, George R. Brown, Md

Jefferson Journal of Psychiatry

The term "gender dysphoria" ( I) describes a heterogeneous group of individuals who express varying degrees of dissatisfaction with their anatomic gender (hence "gender dysphoria"), and the desire to possess the secondary sexual characteristics of the opposite sex. Only a minority o f these patients can be considered on the extreme end of a spectrum of subjective dissatisfaction with assigned anatomy and societally sanctioned gender role (i.e., "transsexual"). The number of such patients presenting to psychiatric clinics has greatly increased subsequent to the 1966 publication of Harry Benjamin's seminal work, The Transsexual Phenomenon (2), and extensive media coverage of individual …

Presentation And Differential Diagnosis Of Hyponatremia In A Schizophrenic Adult Male, Michael J. Sedlacek, Md

Jefferson Journal of Psychiatry

The diagnosis o f hyponatremia can prove to be a challenging task since initial symptomatology may mimic psychiatric illness. Accurate diagnosis and subsequent treatment is essential as this disorder can progress to seizures, coma and death if not recognized. Neither the true incidence nor the etiology of hyponatremia in the schizophrenic population has been established, but a definite association has been shown to exist. A recent retrospective study involving over 20,000 hospital admissions found a 5.8% incidence of hyponatremia in the schizophrenic population as compared with a 0.36% incidence for all admissions (1). The following case illustrates the features of …

Accepting Dependence, Julia Zawatsky, Md

Jefferson Journal of Psychiatry

There is an increasing emphasis on short term treatment in Psychiatry. Short term treatment may not provide the time necessary to permit the regression and foster the dependence necessary for successful treatment.

Supervising Residents Treating Multiproblem Patients: Transformations Of Therapeutic Narcissism, Susan J. Olson, Md, Valerie A. Westhead, Md, Jean M. Goodwin, Md, Mph

Jefferson Journal of Psychiatry

While much of the literature on psychotherapy supervision focuses on teaching psychotherapeutic techniques, most residents and supervisors realize that there is another agenda: making the often drained and narcissistically injured therapist feel better. The beginning therapist's self-esteem is especially vulnerable to injury because most psychiatric residents have "heavily committed themselves to a field of endeavor for which ... they are relatively untested" (I). Coupled with this, they are often assigned the most difficult and demanding patients, those with narcissistic disorders who are unable to soothe themselves. Both Searles (2) and Balint (3) describe the barrage of counter transferences usually experienced …

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

An exhibition of paintings of the American Old West caught my attention one afternoon, after I had wandered across the street from our affiliate V.A. outpatient clinic to the Pennsylvania Academy of the Fine Arts. A popular theme among these romanticized views of the American frontier was the image of the trapper; alone, silent figure working at the nation's interface with the unknown. Several paintings depicted a custom known as the rendez-vous, a semi-annual occurrence wherein the trappers gathered eastward to river outposts in order to socialize, trade information and hand-made maps, restock supplies, and display for sale the …

Resident Editorial Board

Jefferson Journal of Psychiatry

List of Resident Editorial Board for Volume 6, Number 1, 1998 of Jefferson Journal of Psychiatry.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

In Response: Should Psychotherapy Be Taught To Psychiatric Residents?, Robert Michels, Md

Jefferson Journal of Psychiatry

The debate discussing whether psychotherapy should be taught to psychiatric residents (1) reflects the change, growth, and maturation of the profession. A theme that virtually defined psychiatric practice only a few decades ago is viewed by some as ready for discard while others still see it as essential. Of course, this isn't the first time. Eighty years ago some argued that the intellectual excitement and therapeutic promise of psychoanalysis was more than ample reason to discard the sterile and clinically nihilistic concern with constitutional neuropathic diatheses that marked 19th century psychiatry. Fortunately, wiser heads prevailed.

Book Review: The Soft Voice Of Reason, Emanuel E. Garcia, Md

Jefferson Journal of Psychiatry

FREUD AS AN EXPERT WITNESS

K. R. Eissler

Madison, Connecticut, International Universities Press 1986, 449 pages.

Book Review: Towards A Practical Guide To The Therapy Of The Borderline Patient, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

EFFECTIVE PSYCHOTHERAPY WITH BORDERLINE PATIENTS:CASE STUDIES

Robert J. Waldinger, M.D .John G. Gunderson, M.D.

New York, Macmillan 1987, 232 pages

Book Review: Adapting Psychotherapy For An Underserved Population, Lorna Clark-Rubin, Md

Jefferson Journal of Psychiatry

PSYCHOTHERAPY IN THE COMMUNITY:A PSYCHOANALYTICALLY BASED GUIDE TO THE TREATMENT OF THE ADULT

Eric Lager, M.D., Israel Zwerling, M.D.with Joseph Slap, M.D., Samuel Bullock, M.D. Warren Smith, M.D.Warren H. Green, Inc., St. Louis

1983. pp. 190.

The Witness, Paul D. Zislis, Md

Jefferson Journal of Psychiatry

I want to tell you a story. Why? I don't know. Perhaps so that you will understand. Perhaps so that I will understand. It is a story of the present. It is a story that allows a little comprehension of the past. And it is a story that reveals glimpses of the future.

First this preface:

For years I have been drawn as if by a magnet to the subject of the Holocaust. I have read much about it, spoken to some who survived it, seen films on it, visited museums concerned with it. I have seen the faces …

Developmental Stages Of Learning Psychotherapy, Duncan B. Clark, Phd, Md

Jefferson Journal of Psychiatry

The contradictory philosophies of the major schools of psychotherapy present a dizzying array of alternative approaches for the psychiatry resident. The academic efforts that have been made to synthesize differing approaches to psychotherapy have not met with widespread acceptance. Part of the reason why such a synthesis has been slow in coming may be found in the stages of development the practitioner goes through in learning psychotherapy. The concepts of developmental psychology discussed by Chandler (7) in describing the adolescent's confrontation with relativism and "epistemological loneliness" can help us understand some of the cognitive problems faced by the psychiatry resident. …

A Brief Note On A Psychotherapeutic Technique Described By Glover And Its Application During Psychiatric Residency, Emanuel E. Garcia, Md

Jefferson Journal of Psychiatry

Few would dispute the existence of a general tendency to blame psychological ailments on physical problems. For example, we often attribute changes in mood to the somatic effects of the weather, irritability to diet, apathy to physical exhaustion, etc. How many of us can deny at some time having attempted to explain to our spouses that an outburst of temper was really the fault of our indigestion, let us say? Of course, our spouses are rather skeptical. And as psychiatrists we too preserve a skepticism towards the explanations of this kind which our patients so often provide. This is not …

The Ideal Psychiatry Training Program: A Resident's Viewpoint, James E. Deming, Jr., Md

Jefferson Journal of Psychiatry

The journey between medical school graduation and specialty board certification in one's chosen field of medicine may comprise the most challenging, exciting and important times of a young professional's life. This journey is called residency education. While the most obvious objectives are cognitive education and practice in the field, trainees also face fundamental life challenges such as developing identity, intimacy and a direction for their own generative goals in the world.

Psychiatry residency should be viewed as a personal as well as professional developmental process (1). It contains all of the turbulence of adolescence revisited (2), where "normative crises" (3) …

War Of The Worlds Revisited: The Effect Of Watching "The Day After" On Mood State, David G. Daniel, Md, Frances Wolff, M.Ed., Maribeth Smith, Ma

Jefferson Journal of Psychiatry

In the fall of 1983, "The Day After," a fictional account of a nuclear attack on a civilian population, was broadcast on television in the United States and viewed by I00 million Americans . "The Day After" was said to differ from previous movie treatments of nuclear war by the vividness with which it forced its audience to experience the ground zero effects of a nuclear blast on human beings (I) . In what was described as "the most horrifically searing footage ever to pass a network censor,"the audience was shown "group immolation, a carnage of mass vaporization" and "graphic …

Beastly Beatitudes (1): The Case Of A Patient With Severe Borderline Personality Disorder, Paul D. Zislis, Md

Jefferson Journal of Psychiatry

The newspapers, tabloids, and novels are filled with it. So are the television shows and movies. Sensationalism. The public can' t get enough of it. A crazed killer stalks an innocent victim who is alone, isolated and helpless, and he brutally tortures her to death. Sound familiar? The case at hand is a fascinating one which, though perhaps surrounded by the trappings of such sensationalism, provides us with some insight into the inner workings of one patient 's tortured mind.

L-Deprenyl, A Selective Mao-B Inhibitor, Raymond W. Lam, Md

Jefferson Journal of Psychiatry

Monoamine oxidase inhibitors (MAOIs) are now recognized as effective medications in the treatment of major depression (1). However, their clinical use has been limited by the risk of severe hypertensive reactions to oral tyramine challenge. Prevention of this so-called "cheese effect " requires adherence to diet restrictions that can lead to problems with patient compliance to MAOIs.

L-deprenyl is a selective MAO-B inhibitor that is reportedly free of the "cheese effect" (2). This review will discuss the clinical and theoretical importance of this interesting drug.

The Usefulness Of Neutrality, Julia Jones Zawatsky, Md

Jefferson Journal of Psychiatry

Recently, the idea of therapeutic neutrality has been attacked. Many observers have suggested that the neutral therapist is inhuman and unempathic. Actually, being a neutral therapist means being especially human and empathic. The neutral therapist's empathic contact with the patient is the most extensive in that it includes not only contact with feelings and thoughts of which the patient is aware, but also contact with all those intolerable thoughts and feelings of which the patient prefers to be unaware. Such awareness in the therapist is possible only when the therapist remains, as Anna Freud (I) recommends, equidistant from the patient's …

Trauma And Its Ramifications In Vietnamese Victims Of Piracy, Stuart Kleinman, Md

Jefferson Journal of Psychiatry

Approximately 400,000 Vietnamese fled by boat from their homeland to the United States during the years 1975 to 1985. Many of these people were brutally attacked by pirates during their sojourn. This paper is a preliminary investigation of various ramifications of this trauma in seven Vietnamese "boat people."

We found significant psychopathology which is temporally related to the pirate attacks in two of those interviewed and a prominent absence of survivor guilt in all of those interviewed. Factors such as mastery of previous trauma, advanced knowledge of potential traumata, empowerment fantasies, religious beliefs, and altruistic actions may have helped people …

Mead Johnson Award-1987

Jefferson Journal of Psychiatry

The editorial board of The Jefferson Journal of Psychiatry-A Resident Publication is pleased to announce the winner of the first annual Mead Johnson Award for excellence in writing as submitted to the Journal. Paul V. Trad, M.D. has received the one thousand dollar award for his work, "Infant Depression: Nature Seeking Nurture " (JP 5( 1) 15-33, 1987 ). His ambitious synthesis exemplifies the creative potential with in residency and fellowship programs. We hope that this further acknowledgement of Dr. Trad 's work will help to inspire other trainees to undertake such …

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

As the Jefferson Journal of Psychiatry continues in its early growth phase, having accomplished a successful synthesis to become a national publication, we note its own apparent power of accommodation equal to the strain of fusing and adjusting internal and external changes.

Psychiatric residency in itself demands such accommodation. A group of finishing second year residents were taking stock of the fir st half of this process: They noted the difficulty in reconciling their initial conceptions and intentions with the subsequent realization of the limits to knowledge or intervention; they called this disillusionment. Others spoke of a converse strengthening …

Resident Editorial Board

Jefferson Journal of Psychiatry

List of Resident Editorial Board for Volume 5, Issue 2, 1987.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

In Response: New Controversial Diagnoses: Self-Defeating And Sadistic Personality Disorders, Frederic Kass, Md

Jefferson Journal of Psychiatry

Until several years ago the entire literature on Masochistic Personality was theoretical or anecdotal. Dr. Fuller's recent paper, "Masochistic Personality Disorder: A Diagnosis Under Consideration," is a timely contribution in that it is one of a growing number of empirical studies on this topic (1). His major finding, that Masochistic Personality describes a disorder which is not adequately described by the existing Axis II disorders, is consistent with data we recently reported (2). We have found, in addition, that the diagnosis is common, and that the criteria have good internal consistency, specificity, and sensitivity (3,4). At this point the data …

Commentary

Jefferson Journal of Psychiatry

DR. KRAMER COMMENTS ON PSYCHOACTIVITY OF CALCIUM CHANNEL BLOCKERS, CASE REPORTS, AND RESEARCH.

Worthwhile Supplemental Reading For Psychiatrists-In-Training, A. Kenneth Fuller, Md

Jefferson Journal of Psychiatry

Book Reviews of:

MODERN SYNOPSIS OF COMPREHENSIVE TEXTBOOK OF PSYCHIATRY/IV

Harold I. Kaplan and Benjamin J. Sadock,

4th ed.Baltimore, Williams & Wilkins, 1985, 937 pages, $38.50

STUDY GUIDE AND SELF-EXAMINATION REVIEW FOR MODERN SYNOPSIS OF COMPREHENSIVE TEXTBOOK OF PSYCHIATRY/IV

Harold I. Kaplan and Benjamin J. Sadock, 2nd ed.Baltimore, Williams & Wilkins,1985, 551 pages, $22.95