Medical Specialties Commons^™

In Response: Maintenance Ect, Max Fink, Md

Jefferson Journal of Psychiatry

Therapy resistance, relapsing illness, and rapid cycling are aspects of chronic affective illness that continue to frustrate us. ECT was re-introduced to answer the problem of therapy resistant depression. In their recent review, Matzen et al. (I), report their experience in eight cases treated with maintenance ECT. They argue that maintenance ECT should also be considered for relapsing depressive illness.

No systematic study of maintenance ECT has been undertaken since the early I950s, and yet, as reported by Kramer (2) it continues to be used. Kramer directed inquiries to members of the International Association for the Advancement of Electrotherapy. Of …

Commentary: The Hiv-Positive Resident: Questions And More Questions, Marguerite Blythe, Md

Jefferson Journal of Psychiatry

The resident physician who is infected with the human immunodeficiency virus (HIV) faces unique problems. In addition to the difficulties caused by a chronic and lethal disease, HIV-infected physicians-in-training face ethical, educational and practical problems that are unique to the interplay between residency training and the infection.

To date, physicians who have been found to be infected with HIV have faced public discrimination, many with devastating results. Dr. Hacib Aoun, a Venezulean-born cardiologist who contracted AIDS from a boy with leukemia while he was a resident at Johns Hopkins, overcame rumors about how he had contracted the disease only to …

Working With The Homeless: The Psychiatric Resident's Experience, Ronald J. Koshes, Md, Lance D. Clawson, Md

Jefferson Journal of Psychiatry

HOMELESSNESS IN WASHINGTON, D.C.

The latter years of the twentieth century have witnessed a phenomenon unparalleled since the depression of the 1930's. Legions of homeless, disadvantaged, often mentally ill poor have emerged thronging cities, crowding public places and presenting perplexing complex, social, political, economic, and medical/psychiatric service delivery issues ( I ). Counting the homeless, and among them the mentally ill homeless, is a task fraught with difficulty, as some studies have illustrated (2 ,3). Estimates of mental illness among the nation's homeless range from 10% to 70% (4). In the District of Columbia, there are an estimated six to …

Loss And Termination In The Development Of A Resident Group, Teresita A. Mccarty, Md, Kate M. Hendrickson, Md

Jefferson Journal of Psychiatry

Separation and loss experiences are major issues in psychotherapy, but role identity and intimacy are considered the tasks of therapists in training. Experiential groups are advocated during training to enhance coping skills and to teach group process. Focusing on separations in a group setting can highlight that loss is inevitable at any stage of life. The group experience also adds personal meaning to the importance of loss as a training issue. If the group has sufficient time to develop, the members will be able to observe the wide range of responses possible in their peers. We describe the effects of …

Seasonal Affective Disorder: Sad Or Fad?, J. Thomas Pichot, Md, Peter S. Jensen, Md

Jefferson Journal of Psychiatry

Seasonal affective disorder (SAD) and phototherapy have recently been the subject of a great deal of interest in the psychiatric literature. First described in 1984 (I), SAD is now defined as "a cyclic illness characterized by recurrent episodes of fall/winter depression alternating with periods of spring/summer euthymia (normal mood) or hypomania (mild elation and behavioral activation)" (2) . Recent findings indicate that there may be at least two additional patterns of seasonal depressions, one characterized by annual summer depressions with euthyrnic, hypomanic or manic symptoms in the winter, and the other characterized by depressive episodes occurring in both winter and …

Brief Remarks On Some Linguistic Features Of "Empathy" And "Sympathy", Emanuel E. Garcia, Md

Jefferson Journal of Psychiatry

The use of words by an individual or culture is subject to the very same psychological forces that drive man's other activities . Hence, the history of a word's usage becomes a telling record of the mental processes of its creators and users, both conscious and unconscious. Etymology, as Freud has observed in his dreambook (1900), contributes significantly to our understanding of the deeper layers of the psyche . Let us take the word "rival," for example, and see how we may make use of etymological data. It is derived from the Latin "riva lis," I which originally meant "one …

Clonidine In The Treatment Of Tardive Dyskinesia: A Case Review, Vikram Khot, Md, Jean Goodwin, Md, Mph, Geoff Wandry, Md

Jefferson Journal of Psychiatry

Over the past several years, a number of cardiovascular preparations have become widely used in psychiatry. For example, propranolol, introduced for its anti-anginal properties, is now used for stage-fright, lithium tremor and neuroleptic induced akathisia (1,2). Calcium channel blockers are expected to prove useful in the treatment of bipolar affective disorders (3,4). Clonidine exemplifies the rapidity and variety with which a cardiovascular agent has been applied to psychiatric syndromes. Clonidine, a centrally acting anti-hypertensive drug with both alpha-l and alpha-2 adrenergic agonistic properties, has already been used in the treatment of narcotic with drawal, benzodiazepine withdrawal, Tourette's syndrome, akathisia, depression, …

Mechanisms And Therapeutic Implications Of Neuroleptic Atypicality, Daniel C. Javitt, Md

Jefferson Journal of Psychiatry

Neuroleptics have proven effective for the overall treatment of schizophrenia. The neuroleptic therapy of schizophrenia, however, has been limited by tardive dyskinesia and by the relative inability of neuroleptics to ameliorate the negative symptoms of schizophrenia. Intensive research has been conducted to identify atypical neuroleptics which would not cause TD and which would have relatively greater efficacy in treating negative symptoms. Based upon animal models of TD and negative symptoms, four neuroleptics have been identified which may have these properties: clozapine, thioridazine, sulpiride, and molindone. Clinical studies of TD suggest that these four potentially atypical agents may have lower dyskinetic …

Mead Johnson Award-1989

Jefferson Journal of Psychiatry

The editorial board of the Journal is proud to announce the recipient of the 1988 Mead Johnson Award: Althea Donovan, M.D. a graduate of the residency program in psychiatry at Jefferson Medical College, Thomas Jefferson University. Dr. Donovan's article entitled Termination and Transparencyin Group Psychotherapy: A Resident's Perspective, can be found in the most recent issue (Vol.6, No.2) of the journal.

Editor's Column, Elizabeth Trefzger, Md

Jefferson Journal of Psychiatry

At the recent American Psychiatric Association meeting in San Francisco I found myself enjoying the strain of walking the hills. The trolley car lines were too long; I assured myself. .. I didn't have time to wait. This of course served another purpose. It gave me an opportunity to reflect on my thoughts. Enjoying a brisk walk while contemplating various philosophical issues is a luxury which I rarely find time for, my schedule being far too busy.

Resident Editorial Board

Jefferson Journal of Psychiatry

Resident Editorial Board for Number 7, Issue 1, 1989 issue of Jefferson Journal of Psychiatry.

Countertransference And Inpatient Psychiatry: Theoretical And Clinical Aspects, Edward Kim, Md

Jefferson Journal of Psychiatry

Few aspects of psychiatric training are more troubling to beginning residents than the emerging awareness of their own countertransferences. This is often viewed with a mixture of disgust and embarassment as a sign of incompetence and lack of professionalism. Conflicting views on the origins of, and appropriate responses to countertransference further add to the difficulty and anxiety of psychiatric training. The frustration and sense of helplessness which often accompany these feelings can lead to disillusionment and various degrees of acting out which ultimately compromise patient care and resident education. Ironically, the feeling of being overwhelmed by countertransference can often occur …

Reduced Cardioprotective Action Of Adiponectin In High-Fat Diet-Induced Type Ii Diabetic Mice And Its Underlying Mechanisms., Wei Yi, Yang Sun, Erhe Gao, Xufeng Wei, Wayne Bond Lau, Qijun Zheng, Yajing Wang, Yuexing Yuan, Xiaoliang Wang, Ling Tao, Rong Li, Walter Koch, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Diabetes exacerbates ischemic heart disease morbidity and mortality via incompletely understood mechanisms. Although adiponectin (APN) reduces myocardial ischemia/reperfusion (MI/R) injury in nondiabetic animals, whether APN's cardioprotective actions are altered in diabetes, a pathologic condition with endogenously reduced APN, has never been investigated. High-fat diet (HD)-induced diabetic mice and normal diet (ND) controls were subjected to MI via coronary artery ligation, and given vehicle or APN globular domain (gAPN, 2 μg/g) 10 min before reperfusion. Compared to ND mice (where gAPN exerted pronounced cardioprotection), HD mice manifested greater MI/R injury, and a tripled gAPN dose was requisite to achieve cardioprotective extent …

Outcomes And Risk Factors Associated With Endophthalmitis After Intravitreal Injection Of Anti-Vascular Endothelial Growth Factor Agents., Chirag P Shah, Sunir J Garg, James F Vander, Gary C Brown, Richard S Kaiser, Julia A Haller, The Post-Injection Endophthalmitis (Pie) Study Team

Wills Eye Hospital Papers

OBJECTIVE: To describe outcomes of and risk factors for endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection.

DESIGN: Single-center, consecutive, case series and retrospective case-control study.

PARTICIPANTS: Between January 1, 2009, and May 31, 2010, 16 vitreoretinal surgeons administered a total of 27 736 injections. During this period, 23 cases of presumed infectious endophthalmitis occurred. Each surgeon used his own preferred injection technique.

INTERVENTION: Vitreous or aqueous tap, or both, with intravitreal antibiotic injection and subsequent topical antibiotic and steroid drops.

MAIN OUTCOME MEASURES: Visual acuity, bladed lid speculum use, conjunctival displacement, hemisphere of injection, bevacizumab versus ranibizumab, and …

Advanced Glycation End Products Accelerate Ischemia/Reperfusion Injury Through Receptor Of Advanced End Product/Nitrative Thioredoxin Inactivation In Cardiac Microvascular Endothelial Cells., Yi Liu, Yanzhuo Ma, Rutao Wang, Chenhai Xia, Rongqing Zhang, Kun Lian, Ronghua Luan, Lu Sun, Lu Yang, Wayne B Lau, Haichang Wang, Ling Tao

Department of Emergency Medicine Faculty Papers

The advanced glycation end products (AGEs) are associated with increased cardiac endothelial injury. However, no causative link has been established between increased AGEs and enhanced endothelial injury after ischemia/reperfusion. More importantly, the molecular mechanisms by which AGEs may increase endothelial injury remain unknown. Adult rat cardiac microvascular endothelial cells (CMECs) were isolated and incubated with AGE-modified bovine serum albumin (BSA) or BSA. After AGE-BSA or BSA preculture, CMECs were subjected to simulated ischemia (SI)/reperfusion (R). AGE-BSA increased SI/R injury as evidenced by enhanced lactate dehydrogenase release and caspase-3 activity. Moreover, AGE-BSA significantly increased SI/R-induced oxidative/nitrative stress in CMECs (as measured …

Systemic Adiponectin Malfunction As A Risk Factor For Cardiovascular Disease., Wayne Bond Lau, Ling Tao, Yajing Wang, Rong Li, Xin L Ma

Department of Emergency Medicine Faculty Papers

Adiponectin (Ad) is an abundant protein hormone regulatory of numerous metabolic processes. The 30 kDa protein originates from adipose tissue, with full-length and globular domain circulatory forms. A collagenous domain within Ad leads to spontaneous self-assemblage into various oligomeric isoforms, including trimers, hexamers, and high-molecular-weight multimers. Two membrane-spanning receptors for Ad have been identified, with differing concentration distribution in various body tissues. The major intracellular pathway activated by Ad includes phosphorylation of AMP-activated protein kinase, which is responsible for many of Ad's metabolic regulatory, anti-inflammatory, vascular protective, and anti-ischemic properties. Additionally, several AMP-activated protein kinase-independent mechanisms responsible for Ad's anti-inflammatory …

Alcoholic Cardiomyopathy: A Review., Anil George, Vincent M Figueredo

Division of Cardiology Faculty Papers

Alcohol abuse can cause cardiomyopathy indistinguishable from other types of dilated nonischemic cardiomyopathy. Most heavy drinkers remain asymptomatic in the earlier stages of disease progression, and many never develop the familiar clinical manifestations that typify heart failure. We review the current thinking on the pathophysiology, clinical characteristics, and treatments available for alcoholic cardiomyopathy. The relationship of alcohol to heart disease is complicated by the fact that in moderation, alcohol has been shown to afford a certain degree of protection against cardiovascular disease.

Whole-Exome Sequencing Of Dna From Peripheral Blood Mononuclear Cells (Pbmc) And Ebv-Transformed Lymphocytes From The Same Donor., Eric R Londin, Margaret A Keller, Michael R D'Andrea, Kathleen Delgrosso, Adam Ertel, Saul Surrey, Paolo Fortina

Kimmel Cancer Center Faculty Papers

BACKGROUND: The creation of lymphoblastoid cell lines (LCLs) through Epstein-Barr virus (EBV) transformation of B-lymphocytes can result in a valuable biomaterial for cell biology research and a renewable source of DNA. While LCLs have been used extensively in cellular and genetic studies, the process of cell transformation and expansion during culturing may introduce genomic changes that may impact their use and the interpretation of subsequent genetic findings.

RESULTS: We performed whole exome sequencing on a tetrad family using DNA derived from peripheral blood mononuclear cells (PBMCs) and LCLs from each individual. We generated over 4.7 GB of mappable sequence to …

Challenges And Barriers To Improving Care Of The Musculoskeletal Patient Of The Future - A Debate Article And Global Perspective., Hangama C Fayaz, Jesse B Jupiter, Hans Christoph Pape, R Malcolm Smith, Peter V Giannoudis, Christopher G Moran, Christian Krettek, Karl J Prommersberger, Michael J Raschke, Javad Parvizi

Rothman Institute Papers

UNLABELLED: ABSTRACT:

BACKGROUND: With greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor for Volume 6, Number 2, 1988 issue of Jefferson Journal of Psychiatry

In The Beginning...Phylogeny In Freud's Overview Of The Transference Neuroses: A Review-Essay, Emanuel E. Garcia, Md

Jefferson Journal of Psychiatry

A PHYLOGENETIC FANTASY

I. Grubrich-Simitis, editor

A. Hoffer and P. T. Hoffer, translators

Harvard University Press, Cambridge, Mass.

1987

Book Review: A Portrait Of The Analyst, Michael B. Knable, D.O.

Jefferson Journal of Psychiatry

A MIND OF HER OWN: THE LIFE OF KAREN HORNEY

Susan Quinn

New York , Summit Books

Book Review: Lessons Of War, Ronald J. Koshes, Md

Jefferson Journal of Psychiatry

MILITARY PSYCHIATRY: A COMPARATIVE PERSPECTIVE

Richard A. Gabriel, editor

New York, The Greenwood Press 1986, 170 pages

In Response: The Ideal Psychiatry Residency Training Program, Allan Tasman, Md

Jefferson Journal of Psychiatry

There is little to be added in the way of specifics to James Deming's review of the necessary ingredients for an ideal Residency Training Program (1). He not only reviews the specific issues which must be addressed regarding the "nuts and bolts" of training, but also emphasizes the need for phase specificity of both clinical and didactic experiences and the need to view residency training from a developmental perspective. Rather than comment specifically on the points Deming raises, I would like to address other ingredients in residency training which are to be valued in the ideal program.

The Role Of The Resident On The Psychiatric Inpatient Unit: A Systems Perspective, E. Michael Kahn, Md

Jefferson Journal of Psychiatry

A resident in psychiatry is customarily assigned to inpatient duty for the first year of training. The resident's tasks in this setting are complex, and he' is rarely prepared to perform all of them well (1,2,3). The stress on the resident in this situation is great. Most often, these challenges and their mastery are discussed in terms of intrapsychic conflicts; the traditional remedy is the assignment of a supervisor. Little consideration has be en given to the interpersonal and systems matrices in which these events occur, and the coping techniques and conceptual tools which the resident may use to meet …

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 …