Medical Specialties Commons^™

A Sexually And Physically Abused Child: His Inner World, Carmen Mayugba-Sugai, M.D.

Jefferson Journal of Psychiatry

This paper describes how a sexually abused 8 year old boy's internal dynamics correlated with and influenced his behavior while he was on an inpatient unit. Through play therapy and unit staff's observation, the psychopathological sequelae to the abuse unfolded in a very interesting way. This process of correlating play material with observations of behavior on the unit, helped the treatment team in understanding the child's inner world.

Neurodevelopmental Disorders Associated With Chromosome 15, Karl G. Sieg, M.D.

Jefferson Journal of Psychiatry

Chromosome 15 is a focus of increasing interest to both psychiatry and neurology. Several neurodevelopmental disorders are genetically associated with this autosome, including Prader-Willi syndrome, Angelman syndrome, Dyslexia, Autism, Hyperlexia, Ring 15 Chromosome syndrome, and Trisomy 15 syndrome. This report provides a review of the molecular biology of chromosome 15 and these associated disorders.

Therapeutic Alliance And Involuntary Commitment Of A Minor, Karen Dineen Wagner, M.D., Ph.D, Sharon R. Weinstein, M.D., Richard F. Wagner, Jr., M.D.

Jefferson Journal of Psychiatry

Children are legally entitled to be present throughout the commitment hearing for continued hospitalization. The effect of this process on the therapeutic alliance between the child and the psychiatrist warrants examination. A case study of a 14 year-old boy who participated in the court proceedings is presented. The outcome of the hearing resulted in a disruption of the therapeutic alliance. Alter natives to current commitment procedures for minors are discussed.

Mead Johnson Award

Jefferson Journal of Psychiatry

The Mead Johnson Award has been established to honor the best paper submitted to The Jefferson Journal ofPsychiatry: A Resident Publication during each calendar year. An award of one thousand dollars is given to the chosen author, with an additional one thousand dollars to be given to the residency program or fellowship in which the author is enrolled. The winning submission will be selected by the Journal's editorial board from manuscripts submitted on any subject related to psychiatric practice and/or research. We invite authors to review the Information for Contributors section of this issue. The …

Editor's Column, Edward Kim, M.D.

Jefferson Journal of Psychiatry

This issue of the Jefferson Journal of Psychiatry impressively reflects current trends in the American Psychiatric Association. Past President Herb Pardes took as his theme "The Research Alliance: Road to Clinical Excellence." Current President Elissa Benedek has adopted the theme "Our Children, Our Future" for the 1991 annual meeting. Adjusting to the responsibilities of chief editorship (under the watchful eye of my predecessor, Dr. Trefzger), I am impressed by the evolution of the Journal and the manuscripts submitted for review.

Editorial Staff

Jefferson Journal of Psychiatry

List of Editorial Staff for Jefferson Journal of Psychiatry, Volume 8, Number 2, 1990.

Mis Posterior Cervical Spine Surgery: Five-Level Fusion Through A Novel Cervical Tube, Ashwini Sharan Md, Mitchell A. Hardenbrook, Md, John K. Ratliff Md, James Harrop, Md

JHN Journal

Minimally invasive surgical (MIS) techniques to the spine have focused mainly on the lumbar region. Many reports exist on the ability to decompress the neural structures in the lumbar and thoracic spine both via an anterior and posterior approach. Familiarity with these techniques now allows one or two level interbody and pedicle fusions, and treatment of trauma through MIS approaches. Controversy exists as to the efficacy of these techniques because direct studies comparing MIS approaches with open techniques are lacking. However, proponents of these techniques site smaller incision, less muscle retraction, less blood loss, shorter length of stay and better …

The Gross Clinic, The Agnew Clinic, And The Listerian Revolution., Caitlyn M. Johnson, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Thomas Eakins was an American artist whose unique and prolific style set him apart from other artists of the late 19th century.1 He chose to portray his subjects with intense objectivity, never deviating from reality. Even during his era when art was expected to be always beautiful, demonstrating Victorian morals of decency and decorum, Eakins chose to paint the naked truth.1 Walt Whitman was noted to have said, ‘‘I never knew of but one artist, and that’s Tom Eakins, who would resist the temptation to see what they ought to be rather than what it is.’’2 It was Eakins’ rigid …

Robert Milton Zollinger, M.D., Teacher, Surgeon, Soldier, And Farmer., Fiona M. Chory, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

From Humble roots, Dr. Robert Milton Zollinger worked his way to a position in history among the giants of American surgery. He was born on September 4, 1903, in the central Ohio town of Millersport, the son of Elmira and William Zollinger. Neither of his parents had a high school education, but they supported education and always expressed a confidence that young Robert would be successful at anything he attempted.1 He had aspirations of attending West Point, a dream that was never fulfilled when he decided to be a surgeon. On being informed of his son’s intentions, Zollinger’s father bestowed …

Surgical Management Of Fungal Vertebral Osteomyelitis, Benjamin M. Zussman, Bs, David L. Penn, Ms, James S. Harrop, Md

JHN Journal

Fungal vertebral osteomyelitis (FVO) is an uncommon but aggressive disease that may cause spinal instability, neurological insult, and possible death. Little data about treatment strategies and patient outcomes exist. A retrospective review of medical and surgical management with follow-up of this disease was performed.

Bevacizumab: A Controversial Agent Against High-Grade Gliomas, Sussan Salas, Md, Miguel Guzman, Md, Kevin Judy, Md

JHN Journal

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. Despite the current regimen of surgical resection with subsequent external beam radiotherapy and temozolomide, mean survival is 14.6 months and 2-year survival is 26%. GBM is a highly vascular tumor, a result of its increased expression of vascular endothelial growth factor (VEGF) compared to other brain tumors. VEGF promotes endothelial cell proliferation, and is thought to have a pivotal role during tumor progression. Multiple treatment modalities have targeted VEGF and VEGF receptors (VEGFTs) due to their essential roles in the regulation of angiogenic processes. Bevacizumab is a …

The Prevalence Of Cervico-Arterial Dissection In Sub-Arachnoid Hemorrhage In The United States, Ali Seifi, Md, Fred Rincon, Md, Msc, Mitchell Maltenfort, Phd, Pascal Jabbour, Md, Rodney Bell, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Objectives: In this study, we sought to determine the prevalence of cervico-arterial dissection in aubarachnoid hemorrhage (SAH) using a large administrative database.

Postoperative Glycemic Variability In Diabetic And Non Diabetic Patients, Boris Mraovic, Md, Brian Hipszer, Md, Zvi Grunwald, Md, David Gratch, Do, Charles J. Yeo, Md, Jennifer Lessin, Rn, Kathleen O'Malley, Rn, Angela Gulino, Md, Peter Simpson, Meng, Jeffrey Joseph

Department of Anesthesiology Faculty Papers

Objectives: Glycemic variability increases oxidative stress and may trigger the inflammation and coagulation cascades. Variability may be associated with increase morbidity and mortality in ICU patients. We analyzed glycemic variability after major surgery in diabetic (DM) and non-diabetic (NDM) patients using an automated intravenous blood glucose monitor (IVBG).

Predictors Of Appropriate Defibrillator Therapies- A Single Center Analysis, Rina R. Shah, Ratika Gupta, Carrie Stackhouse, Robin Ward, Behzad B. Pavri

Division of Cardiology Faculty Papers

Discussion:

• Although differences in HR and the JT interval were statistically significant in patients who received appropriate shock vs. those who did not, these differences are not clinically meaningful
• We did not identify any clinical predictors of early vs. late ICD shocks
• These data suggest that we may not be able to improve on current guidelines for patient selection for ICD implantation.

Baseline Monitoring Of Standard Health Indicators In A Formerly Homeless Population, Lara Carson Weinstein, Md, Mph, Marianna Lanoue, Phd, Elizabeth Collins, Bs

Department of Family & Community Medicine Presentations and Grand Rounds

Research Question: What are the rates of baseline health status indicators recording at Pathways to Housing (PTH) using select recommended measures from the National Association of State Mental Health Program Directors (NASMHPD) and the Healthcare Effectiveness Data Information Set (HEDIS)?

How do health indicators compare between clients receiving direct clinical care in the integrated care program vs non-integrated care clients?

Individual Agency, Community Capacity Building, And Chronic Illness Care: Using Participatory Methods To Implement The Stanford Chronic Disease Self Management Program In A Housing First Program, Lara Carson Weinstein, Md, Mph, Abbie Santana, Msph, Carolyn Armour, Cornelius Crossan, James Lawson, Karen Webb

Department of Family & Community Medicine Presentations and Grand Rounds

Research questions:

Is a standardized chronic disease self management program (CDSMP) experienced as a valuable intervention by Pathways' consumers?

What is the impact of collaborative inquiry into health program development on participant's critical agency?

About The Authors

Jefferson Journal of Psychiatry

List of authors for Jefferson Journal of Psychiatry, Volume 8, Number 1, 1990.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor for Jefferson Journal of Psychiatry, Volume 8, Number 1, 1990.

Book Review: Biologic Psychiatry For The Biologist, John P. Seibyl, M.D.

Jefferson Journal of Psychiatry

PSYCHOPHARMACOLOGY: THE THIRD GENERATION OF PROGRESS

Edited by Herbert Y. Meltzer, M.D .New York, Raven Press, 1987

1824 pages, $160.00

Book Review: Illness Or Person?, Beth Z. Mark, M.D.

Jefferson Journal of Psychiatry

Book Review of:

PSYCHOTHERAPY OF NEUROTIC CHARACTER

Dana Shapiro

New York, Basic Books, 1989

In Response: A Practical Approach To The Assessment And Management Of Psychiatric Emergencies, William R. Dubin, M.D.

Jefferson Journal of Psychiatry

I would like to respond to the article entitled "A Practical Approach to the Assessment and Management of Psychiatric Emergencies" (Jefferson Journal of Psychiatry, Vol. 7:8 I-9 1, 1989). The authors are to be congratulated for their concise distillation of the major clinical problems encountered in emergency psychiatry. However, there are several aspects of this review which require further amplification and clarification.

Psychiatrists' Knowledge And Attitudes About The Acquired Immune Deficiency Syndrome, Carol L. Alter, M.D., Ellen S. Dickinson, M.D., Greg Miller, M.D.

Jefferson Journal of Psychiatry

Since 1981 the Acquired Immune Deficiency Syndrome (AIDS) has become the primary health care issue in this nation. Psychiatrists have had a central role in caring for AIDS patients: they have been asked to evaluate and treat patients with neuropsychiatric manifestations of AIDS and emotional reactions to the illness itself, as well as to treat those who are fearful of acquiring AIDS. Numerous studies in the literature have explored the physician and lay population's knowledge and attitudes about AIDS. To date no study has addressed these issues in psychiatrists in specific (1- 9).

Most studies suggest that individuals who have …

The Homicide Witness And Victimization; Ptsd In Civilian Populations: A Literature Review, Gerald M. Streets, M.D.

Jefferson Journal of Psychiatry

People who witness the murder of an individual, whether a family member or acquaintance, often experience their loss as a psychic trauma. This described trauma is revealed by the symptom complex defined in the DSM-III-R as post -traumatic stress disorder (PTSD). Children, in particular, frequently suffer from debilitating grief, which hinders their emotional and cognitive development. This grief may masquerade as a learning disability, hyperactivity, or an attention deficit disorder. Witnessing murder and being victimized (i.e, rape, incest, and physical abuse) are equivalent experiences in their potential for generating massive intrapsychic conflict. Being poor is a predisposing factor which puts …

Exploring Frontal Lobe Dysfunction In Schizophrenia With Positron Emission Tomography, Donald P. Hall, Jr., M.D.

Jefferson Journal of Psychiatry

Frontal lobe dysfunction in schizophrenic pa tients has been highly suspected for many years. Many psychiatrists and patients, however, are awaiting solid proof of a biological manifestation of this disease. While positron emission tomography does not uniformly demonstrate such a manifestation, it does demonstrate a prefrontal cortex deficit in most reported studies. Further, a localization of the attention deficit of schizophrenia, in the prefrontal cortex, is strongly suggested by some studies.

INTRODUCTION

Positron emission tomography (PET) has enabled investigators in modern clinical psychiatry to demonstrate that schizophrenia is, at least in part, a frontal lobe disorder. PET studies of many …

A Case Of Conversion Catatonia Misdiagnosed For 24 Years, Pauline K. Wiener, M.D.

Jefferson Journal of Psychiatry

Catatonia is a syndrome whose etiology may be both diverse and difficult to substantiate. Ms. H. is a 45-year-old black female with 18 previous psychiatric hospitalizations beginning at age 21. A common characteristic to all hospitalizations was a catatonic presentation (i.e ., the patient was mute with marked muscular rigidity; she would refuse to eat or follow orders). In each of her previous 18 hospitalizations, the patient was thought to be psychotic.

It was found that each catatonic episode could be related to a severe psychological stressor. The patient's illness never involved delusions, hallucinations or disturbances in thought form. Upon …

Enhancing The Utility Of The Dexamethasone Suppression Test: A Chart Review And Application Of Bayes' Theorem, Scott B. Patten, M.D.

Jefferson Journal of Psychiatry

The dexamethasone suppression test (DST) is the most extensively studied biological test in psychiatry. Despite this, its role in the diagnostic assessment of psychiatric patients remains controversial. Shortcomings of the test include limited sensitivity (45%) and limited specificity (75-80%) (1). The DST has many proposed uses, including the differentiation of endogenous from non-endogenous depressions, helping to decide when maintenance medications may be withdrawn, and as a diagnostic test for major depression. This paper is concerned with the latter use only, that is, the ability of the DST to function as a useful diagnostic test for major depression.

The significance of …

Reliability Of Trainees' Endorsements On Standardized Psychiatric Interviews, Thomas E. Uttley, M.D.

Jefferson Journal of Psychiatry

This study investigated the utilization of standardized psychiatric interviews (SPI's) in psychiatric training programs. As the field of psychiatry, and the training of its' new members moves to conformits' principles to scientific models, the reliable use of SPI's is use ful in reaching that goal, in both research and diagnostic applications. This investigation contains two studies. In Study 1, a random survey of 20 percent of all psychiatric residency training programs was conducted to determine the prevailing level of training devoted to SPI's. The resulting findings are referred to as "training as usual" (TAU). Study 1 shows that residents are …

Imipramine In The Treatment Of Obsessive-Compulsive Symptoms In Schizophrenic Spectrum Illnesses: Three Case Reports, Ileana Zaharovits, M.D., Marvin H. Lipkowitz, M.D.

Jefferson Journal of Psychiatry

It has long been known that obsessions and compulsions occur during the course of a schizophrenic illness (1- 7). It is, therefore, of interest that there has been little systematic research into the treatment of these symptoms in patients suffering from schizophrenia.

It is possible that the meager research in this area is related both to the difficulty at times in differentiating signs of a psychotic decompensation in severe obsessive-compulsive disorder (OeD) from those of schizophrenia; and to the significant amount of controversy regarding the function of obsessive compulsive symptoms in patients suffering from schizophrenia and related diseases. For example, …

Postpartum Depression In A Caretaking Grandmother: Case Report, Valerie D. Raskin, M.D.

Jefferson Journal of Psychiatry

Postpartum depression has only recently been understood to affect individuals other than the biological mother (1). In such cases, postpartum depression has been attributed to the enormous psychological and social stress of the caretaking role, with its demands to nurture in the face of what may be the sense of having been insufficiently nurtured oneself (2). A growing number of grandparents, especially maternal grandmothers, are being asked to serve as primary caretakers for their grandchildren, due to circumstances which include adolescent childbearing, single parent families and substance abuse. A case report of a new grandmother with significant caretaking functions who …

Treating Dual Diagnosis Patients: Challenges And Opportunities, Robert H. Howland, M.D.

Jefferson Journal of Psychiatry

The use and abuse of drugs and alcohol have recently gained greater attention both from the public and the medical profession. Despite increasing cognizance of its unfortunate consequences, substance use has become a more pervasive element of contemporary society. As substance abuse has come to affect more segments of the population, it is not surprising that this problem also has affected the mentally ill. Awareness of the mentally ill substance abuser has grown, although this population has not been well studied or well served by the mental health system. These dually diagnosed patients often are depicted as the square pegs …