Medical Specialties Commons^™

Methylphenidate, Bupropion, And Ssri Triple Therapy, William Bobo M.D.

Jefferson Journal of Psychiatry

Methylphenidate and bupropion have been demonstrated as being effective adjuncts to serotonin reuptake inhibitors in the treatment of depression (1,2). The use of these medications in case of a depressed patient whose condition was resistant to several forms of monotherapy, monotherapy with "standard" augmentation and ECT. After only a partial response to fluoxetine and methylphenidate, bupropion was added, resulting in full, sustained remission.

Severe Generalized Edema Associated With Phenelzine, William Bobo M.D., Cheryl A. Hemme M.D.

Jefferson Journal of Psychiatry

Rabkin, et al. describes a 4% incidence of phenelzine-induced edema, which appears to be due to increased capillary permeability (1,2). This adverse effect is not further characterized in the literature and is not readily mentioned as one of the many drug effects that could result in severe physical morbidity. We present the case of a depressed patient who developed a generalized edema severe enough to deserve an extensive medical workup. Once the drug was tapered, the edema and its associated symptoms rapidly resolved.

Personality Traits In Juvenile Delinquents: Associations With Peer And Family Relations, Jeffrey J. Wilson M.D., Sharon E. Willams Ph.D., Evan Garner M.D., Elaine Duxbury B.A., Hans Steiner Dr. Med. Univ.

Jefferson Journal of Psychiatry

Objective: To establish family and peer correlates of personality traits shown to be predictive of future criminal recidivism.

Method: 137 incarcerated boys aged 13-18 (x = 16 ± 1.2), 35% black, 21% Hispanic, 43% white, and 1% other completed the Weinberger Adjustment Inventory (WAI) and a psychosocial history obtained by a social worker. Records were summarized using two raters who assigned numerical ratings to dimensions of family and peer relations.

Results: As expected, observer ratings of family and peer relationships were correlated with the personality characteristics of distress, denial and restraint as measured by the WAI.

Conclusion: Family and peer …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Papers

The purpose of this review is to summarize studies on various topics in adult knee reconstruction that were published during the year 2010. The keywords “knee” and “arthroplasty” and “prospective” and “randomized” were used to perform a search of the National Library of Medicine's PubMed database; the search was limited to studies that were published in The Journal of Bone and Joint Surgery (American Volume) or The Journal of Arthroplasty in 2010. The resulting seventeen studies are included in this review of adult reconstruction of the knee and are included in the complete bibliography at the end of the manuscript. …

Folie A Famille Associated With Amphetamine Use, Kevin P. Hill B.A., Ashwin A. Patkar M.D., Stephen P. Weinstein Ph.D.

Jefferson Journal of Psychiatry

Shared Psychotic Disorder involving an entire family (folie a famille) is extremely rare. Only two cases of Shared Psychotic Disorder linked to stimulant abuse have been documented in the literature. We report a case of folie a famille that involved 5 members of a family, and was associated with amphetamine use in the primary individual. Our case shares many clinical and etilogical factors with previously reported cases of shared psychotic disorders. A wide variety of psychotic manifestations are associated with amphetamine use and clinicians should be aware of this uncommon syndrome among stimulant-using population, particularly due to the recent increase …

Countertransference In Two Settings: A Case Report, Randi L. Plotkin M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Conversion Disorder In A Depressed Patient: The Analysis Of Paralysis, Michael A. Chen Ph.D., David S. Im M.D.

Jefferson Journal of Psychiatry

Patients presenting with neurologic and pseudoneurologic symptoms present both a diagnostic and treatment challenge. This case report describes the ER course of a man who presented with aphonia and paralysis, his medical clearance, transfer to the psychiatric ER and subsequent recovery. The history of conversion disorder and its characteristics are briefly reviewed, and the etiology of this patient's symptoms and a discussion of effective treatment plans are discussed.

Patient Violence In Psychiatric Residency: A Nationwide Survey, Tricia L. Park Ph.D., Thomas L. Schwartz M.D.

Jefferson Journal of Psychiatry

Twenty percent of current psychiatric residents (N = 517) responded to a nationwide survey about patient violence. Thirty six percent of responders reported 630 assaults, with 74% of residents receiving 1,853 threats. While age and training level were correlated to each other (r = .35, p < .001), no correlations were found between gender, age, height, weight number of hours of violence management training and the occurrence of assault and threat. A smaller proportion of first year residents reported assaults and threats, and more males (79%) had been threatened (females = 69%). Sources of study bias are identified and future research directions are outlined.

Editor's Column, Scot R. Maclean M.D.

Jefferson Journal of Psychiatry

No abstract provided.

About The Authors

Jefferson Journal of Psychiatry

No abstract provided.

On The Technical Error Of The Psychotherapist, Satoshi Tamiya M.D., Tetsuro Takahashi M.D.

Jefferson Journal of Psychiatry

The authors present a psychotherapy case where the therapist's countertransference-based technical error and his way of dealing with it remarkably influenced the course of treatment. The authors emphasize that appropriate training, including supervision and personal psychotherapy or psychoanalysis, is imperative, especially so that the beginning therapist can learn to manage countertranference appropriately. Since technical errors cannot always be avoided, it is important for the therapist to deal with them therapeutically, without feeling ashamed or guilty.

Late Onset Tay-Sachs Disease Presenting As A Brief Psychotic Disorder With Catatonia: A Case Report And Review Of The Literature, Osama Saleh M.D.

Jefferson Journal of Psychiatry

This is a case report of late onset Tay-Sachs Disease diagnosed in a 14-year-old male non-Jewish adolescent who presented in a psychotic and catatonic state. The objective is to emphasize that Tay-Sachs disease can present with psychiatric symptoms, with a variety of phenotypes from infancy to adulthood, and can affect individuals other than Ashkenazi Jews. Amphiphilic drugs, including phenothiazine and tricyclic antidepressants, may worsen the course of the illness. Resistant catatonia can respond to an extended trial of high dose lorazepam.

Phase I Evaluation Of Intravenous Ascorbic Acid In Combination With Gemcitabine And Erlotinib In Patients With Metastatic Pancreatic Cancer., Daniel A. Monti, Md, Edith Mitchell, Anthony J Bazzan, Susan Littman, George Zabrecky, Charles J Yeo, Madhaven V Pillai, Andrew B Newberg, Sandeep Deshmukh, Mark Levine

Department of Medical Oncology Faculty Papers

BACKGROUND: Preclinical data support further investigation of ascorbic acid in pancreatic cancer. There are currently insufficient safety data in human subjects, particularly when ascorbic acid is combined with chemotherapy.

METHODS AND FINDINGS: 14 subjects with metastatic stage IV pancreatic cancer were recruited to receive an eight week cycle of intravenous ascorbic acid (three infusions per week), using a dose escalation design, along with standard treatment of gemcitabine and erlotinib. Of 14 recruited subjects enrolled, nine completed the study (three in each dosage tier). There were fifteen non-serious adverse events and eight serious adverse events, all likely related to progression of …

Review Of The Pharmacological Treatment Of Delirium In The Pediatric Population With Accompanying Protocol, Nathan Lavid M.D., Lawrence J. Budner M.D., F.A.A.C.A.P.

Jefferson Journal of Psychiatry

Objective: To review the current state of pharmacological treatment of delirium in the pediatric population and to derive a treatment protocol from our review.

Method: Medline-assisted search of the literature. Articles pertaining to the pharmacological treatment of delirium in children and adolescents were reviewed. Due to the paucity of articles, studies of treatment guidelines for delirium in the adult population were reviewed. Also presented for reference, are studies of optimal dosing regimens of psychotropic agents potentially useful in treating pediatric delirium. Our protocol is extrapolated from previously established guidelines for adult treatment meshed with the current knowledge presented in …

Seasonal Affective Disorder And Seasonality: A Review, Leo Sher M.D.

Jefferson Journal of Psychiatry

Seasonal affective disorder is a condition where depressions in fall and winter alternate with nondepressed periods in the spring and summer. The Degree to which seasonal changes affect mood, energy, sleep, appetite, food preference, or the wish to socialize with other people has been called "seasonality." The author reviews historical aspects, clinical features, epidemiology, genetics, pathophysiology, and treatment of seasonal affective disorder and seasonality. Better understanding of the contemporary concept of seasonal affective disorder, seasonality, and light treatment will improve patient care and promote scientific advances in behavioral sciences.

Editor's Column, Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

About The Authors

Jefferson Journal of Psychiatry

No abstract provided.

About The Authors

Jefferson Journal of Psychiatry

No abstract provided.

Case Report Of Dramatic Resolution Of Psychotic Symptoms During Cross-Over To Clozapine, Leo Sher M.D., Alan Mendelowitz M.D.

Jefferson Journal of Psychiatry

Clozapine is the first antipsychotic drug with proven superiority over conventional antipsychotics in the management of treatment-resistant patients. We describe a case of tratment-resistant schizoaffective disorder in a young woman who improved rapidly on clozapine. The patient was started on a low dose of clozapine while fluphenazine was decreased. She improved significantly during the first several days of treatment. This improvement took place well before the expected effect of clozapine. Possible explanations for this unusual response include: 1) the placebo effect; 2) fluphenazine dose-response curve; 3) acute clozapine neurochemical mechanisms; 4) inaccurate original diagnosis. Better understanding of the mechanisms of …

Case Report: Failure Of Group Therapy With Elderly Russian-Jewish Immigrants (An Exploratory Analysis), Gennady Berezkin M.D.

Jefferson Journal of Psychiatry

This paper is a description of an unsuccessful attempt to carry out group therapy with elderly Russian-Jewish immigrants.

An attempt was made to conduct group therapy following general principals of traditional psychotherapy with geriatric populations.

In the final analysis, we conclude that culturally based preconceptions toward psychotherapy, culturally based stereotypes of interpersonal relationships and culturally-based transference to the therapist were the primary reasons for the development of negative transference and resistance which culminated in the ultimate failure of group psychotherapy with this group of elderly immigrants.

Saint Simeon The Stylite: A Psychiatric Examination Of The Life Of A Fifth Century Monk, Iracema Leroi M.D., Joseph B. A. Meagher M.D., M.R.C. (Psych) Frcpc

Jefferson Journal of Psychiatry

Religion is now the focus of more attention in psychiatry. This paper examines the life of the fifth century monk, Simeon the Stylite, from a contemporary psychiatric perspective. Such a retrospective examination presents difficulties with regard to the diagnosis of possible psychotic phenomena. A further examination presents difficulties with regard to the diagnosis of possible psychotic phenomena. A further problem is trying to distinguish between a religious and a psychiatric interpretation of particular experiences.

The authors outline the life of Simeon and some contemporary opinions. They agree with Kroll and deGanck that great caution is needed in the psychiatric interpretation …

The Psychiatry Access Center: A New Opportunity For Innovative Residency Training, M. Bates Redwine M.D., Ryan Finkelbine M.D., William Carson M.D., Susan Hardesty M.D., Linda Lewis M.N., R.N., C.S.

Jefferson Journal of Psychiatry

A recently introduced PGY-1 rotation in an innovative, managed care oriented program offers many training advantages for residents. The rotation offers first-year residents intensive interviewing-skills training, experience with obtaining and documenting the psychiatric history and physical examination, and in the process, offers early exposure to a managed care environment. The Psychiatry Access Center employs non-resident clinicians to perform urgent evaluations and all admissions to the main psychiatric hospital. The service has been tested successfully without requiring resident work, and therefore allows the integration of residents into the system via a new rotation designed to focus exclusively on educational needs.

Implementation Of A Computer-Based Communication System For Psychiatry Residents, Daniel Z. Lieberman M.D.

Jefferson Journal of Psychiatry

In order to encourage different kinds of communication among residents who were located at a number of geographically separate sites, a computerized communication system was implemented. Priority was placed on both richness of features and ease of use. Residents were able to send private email, join public conferences, and access databases of information. The system was initially used by a large number of residents, and usage patterns are described. The introduction to information technology that residents gained from the system led to other computer projects, and an interest in the resources of the Internet.

Call For Papers On Aspects Of Violence And Psychiatric Training, Derek Puddester M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Difficulties Associated With A Clinical Psychiatric Study Of A Transient Population, Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Editor's Column, Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Inflammatory Signaling Compromises Cell Responses To Interferon Alpha., W-C Huangfu, J Qian, C Liu, J Liu, A E Lokshin, D P Baker, H Rui, S Y Fuchs

Department of Cancer Biology Faculty Papers

Interferon alpha (IFNα) is widely used for treatment of melanoma and certain other malignancies. This cytokine as well as the related IFNβ exerts potent anti-tumorigenic effects; however, their efficacy in patients is often suboptimal. Here, we report that inflammatory signaling impedes the effects of IFNα/β. Melanoma cells can secrete pro-inflammatory cytokines that inhibit cellular responses to IFNα/β via activating the ligand-independent pathway for the phosphorylation and subsequent ubiquitination and accelerated degradation of the IFNAR1 chain of type I IFN receptor. Catalytic activity of the p38 protein kinase was required for IFNAR1 downregulation and inhibition of IFNα/β signaling induced by proinflammatory …

Defiant Children: A Clinician's Manual For Assessment And Parent Training By Russell A. Barkley, M.D., Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

[In Response To "The Neuroleptic Treatment Of Schizophrenia: Dosing Strategies, Depot Preparations And Novel Medications" By Alexander S. Young, M.D. (Volume 13, 18-26)], James Longhurst M.D., Joseph Cassar M.D.

Jefferson Journal of Psychiatry

No abstract provided.

The Relevance Of Transference During Medication Management: A Case Of Erotized Transference, Helen C. Kales M.D., James Abelson M.D., Ph.D., Michelle B. Riba M.D.

Jefferson Journal of Psychiatry

Forces existing in psychiatry may diminish the importance of psychotherapy training as psychiatrists are increasingly given the task of medication management. Psychotherapeutic relationships can be created in medication management settings, however, and the neglect of concepts such as transference could have deleterious consequences. The authors describe the case of a man with a traumatic brain injury referred for medication management who developed an erotized transference toward his female resident-physician. This case illustrates the concept that an understanding of transference is relevant to the setting of medication management