Medicine and Health Sciences Commons^™

Uses Of Carbamazepine For Psychiatric Disorders: A Review, Edward Kim, Md

Jefferson Journal of Psychiatry

Carbamazepine, first synthesized in 1953, was initially marketed in Europe as an anticonvulsant. In 1971 Dalby reported the drug's psychotropic effects, most notably mood stabilization, in patients with temporal lobe epilepsy (TLE) (1). Other psychiatric applications such as the treatment of affectively and behaviorally labile patients are being explored. These studies are yielding data relevant to the treatment and understanding of the neurobiology of mental illness. For this reason, familiarity with carbamazepine is becoming increasingly important to psychiatrists.

Dysmorphophobia In A Diastrophic Dwarf: A Psychiatry-Dermatology Liaison Approach, Donald J. Kushon, Md

Jefferson Journal of Psychiatry

This is a case study of a 30-year-old male diastrophic dwarf who complained of hypertrichosis on his back and nose of 3 years duration. He had no previous psychiatric history, and although the distortion he described on his back was not apparent to others, there was a minimal amount of dark hair growth on his nose. He had unresolved conflicts concerning his disproportionate arms and legs and had sought surgical correction for many years from many orthopedic surgeons to no avail. After a diagnosis of dysmorphophobia was made by a psychiatric consultant, weekly visits with the dermatologist were arranged for …

Transparency And Termination In Group Psychotherapy: A Resident's Perspective, Althea Donovan, Md

Jefferson Journal of Psychiatry

Termination has been seen as a difficult and complex process in group psychotherapy. Although termination of group members has be en explored, little is written on the subject of the therapist's termination; i.e., in the case of a group which continues after the therapist departs. This circumstance must occur frequently, however, especially since 91% of psychiatric programs, (Yalom (1985) citing Pinney) have at least one year of group psychotherapy training. This implies that group therapist termination must occur on a regular basis at some training programs. Even so, there are no specific guidelines or more general exploration of an inexperienced …

Psychotherapy And Mental Retardation: What's The Use?, Jolyn Welsh Wagner, Md

Jefferson Journal of Psychiatry

The lack of adequate treatment opportunities for mentally retarded people with emotional disturbances has been well documented (11,14,9,16,8,2 1,10,19). A high prevalence of psychopathology, estimated at 4- 5 times that of the non-retarded population (8,10) identifies a population extremely vulnerable to emotional problems. Although advocates from many disciplines, including psychiatry, (15) have worked diligently since the early 20th Century to eliminate massive institutionalization, sterilization, and isolation of the retarded from society's defensive arsenal, the mental healthfield, especially psychiatry, has failed to meet current needs with appropriate clinical services.

The Missed Appointment: A Resident's Journal Through Activity To Introspection, Marcia J. Kaplan, Md

Jefferson Journal of Psychiatry

There was one experience during my medical school psychiatry rotation that I could not forget. In a classroom on the cardiology ward, I listened, transfixed like a child at a magic show, as a psychiatrist interviewed a man who was recovering from a heart attack. Initially the man denied any stresses in his life that might have affected his health, but as he went on, a different story unfolded. He spoke of his recent retirement, his wife's dissatisfactions and hostility, his disappointment with his children, his growing sense of failure and futility, and the recurring tightness in his chest that …

The Potential Role Of Psychiatry Residents' Councils, J. Thomas Pichot, Md

Jefferson Journal of Psychiatry

There are numerous books and articles within the scientific literature that deal with issues of training psychiatry residents and the characteristics of that milieu. Those authors that deal primarily with stress usually discuss the sources of the stress and the resultant behavioral changes that are manifested by the trainees. Typically, are relatively small portion of the discussion is devoted to how these problems are, or might be, addressed. This paper, while not itself intended to be an overview of stress in residency; will concentrate on a literature review of some specific aspects of the residency training process, primarily role definition …

The Physical Examination In Psychiatry, Scott Patten, Md

Jefferson Journal of Psychiatry

The physical examination is a neglected aspect of the psychiatric assessment. For example, a survey of ninety-eight practicing psychiatrists, conducted by Patterson (1) in 1978, found that none of them routinely performed physical examinations on their patients. More than one-half of these psychiatrists reported that they no longer felt competent to do so. One situation in which psychiatrists do often perform physicals is while admitting patients to hospital. However, the quality of these examinations is often poor (2 ,3).

An indifferent attitude toward the physical examination has persisted in psychiatry despite numerous publications emphasizing the importance of medical assessment (2-8). …

Some Comments On The Concept Of The Ego-Ideal, Gurmeet Kanwal, Md

Jefferson Journal of Psychiatry

In a review of the literature on the ego-ideal my impression has been that this concept has been placed in the position of a stepchild of the structural model of the mind, falling somewhere between the ego and the super-ego, and yet remaining loosely linked to both. Authors such as Jacobson (1954), Hartmann and Lowenstein (1962), Sandler (1963), and Schafer (196 7), have regarded the ego-ideal as a substructure of the super-ego. Others like Annie Reich (1953, 1954), Lampl de-Groot (1947), Peter Bios (1972), and Chasseguet-Smirgel (1975), have tended to view the two as being separate structures.

The purpose of …

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

In selecting, or as now in introducing the table of contents of each new issue of the Jefferson Journal, or in response to some occasional question as to the orientation of the Journal, the ghostly concept of eclecticism reappears. In choosing a residency training program in psychiatry, the nascent resident of the 1980's was usually met with a chorus of "eclectic" brochures and training directors, each describing their own version of this ideal. Having comfortably accepted this pleasingly vague and democratic ideal, it was disconcerting to hear my own training director, Dr. Harvey Schwartz, challenge this descriptive term. He …

Resident Editorial Board

Jefferson Journal of Psychiatry

List of Resident Editorial Board for Volume 6, Number 2, 1988 issue of Jefferson Journal of Psychiatry.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor, Volume 6, Number 1, 1987.

A Personal Journey, Shimon Waldfogel, Md

Jefferson Journal of Psychiatry

MAUS A SURVIVOR'S TALE

Art Spiegelman

New York Pantheon Books 1986.

Obsessive-Compulsive Disorder Reconsidered, Christopher J. Mcdougle, Md

Jefferson Journal of Psychiatry

OBSESSIVE-COMPULSIVE DISORDERS: THEORY & MANAGEMENT

Edited by Michael A. Jenike, Lee Baer, William E. Minichiello

Littleton, Mass, PSG Publishing Company, In c.1986. 196 pages, $24.50

In Response: The Usefulness Of Neutrality, Paul A. Dewald, Md

Jefferson Journal of Psychiatry

The term "neutrality" as used in psychoanalysis has multiple meanings, each carrying major emotional significance. In that sense "neutrality" is a term which evokes the metaphor of the "Six Blind Men and the Elephant."

In her paper, "The Usefulness of Neutrality," Julia Jones Zawatsky uses the term to express a variety of issues related to a complex and difficult clinical situation. Neutrality includes the therapist taking an equidistant position from the various forces involved in the compromise formation used to solve psychic conflict. She also uses the term to acknowledge the multiple facets of the therapist's conscious and unconscious …

Brief Communication: A Resident Elective Abroad, P. Conlon, M.B.

Jefferson Journal of Psychiatry

Elective study abroad during a residency is unusual, although this is not uncommon for medical students and fellows. There may be several reasons for this. Resident training programs are structured to last three or four years in North America and traditionally are under the auspices of specific university departments. This is a relatively short period of training compared to European countries, and consequently there tends to be less flexibility, and therefore less mobility, in training. Residencies also tend to be a combination of education, training and service requirements, and as programs have a specific allocation of positions for each year …

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.

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. …