Psychiatry Commons^™

Barriers To Recovery And Recommendations For Change: The Pennsylvania Consensus Conference On Psychiatry's Role., Joseph A. Rogers, Michael J. Vergare, Richard C. Baron, Mark S. Salzer

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: Recovery has emerged over the past decade as a dominant theme in public mental health care.

METHODS: The 2006 Pennsylvania Consensus Conference brought together 24 community psychiatrists to explore the barriers they experienced in promoting recovery and their recommendations for change.

RESULTS: Twelve barriers were identified and classified into one of three categories: psychiatry knowledge, roles, and training; the need to transform public mental health systems and services; and environmental barriers to opportunity. Participants made 22 recommendations to address these barriers through changes in policies, programs, and psychiatric knowledge and practice.

CONCLUSIONS: The recommendations identify areas for change that …

Jefferson Scale Of Patient's Perceptions Of Physician Empathy: Preliminary Psychometric Data., Gregory C. Kane, Joanne L. Gotto, Salvatore Mangione, Susan West, Mohammadreza Hojat

Department of Psychiatry and Human Behavior Faculty Papers

AIM: To develop a brief scale for measuring patient's perceptions of their physician's empathic engagement and to provide preliminary evidence in support of aspects of the scale's psychometrics.

METHOD: Study comprised 225 patients, out of 436 patients (52% response rate) seen by 166 residents in the internal medicine residency program at the Jefferson Hospital Ambulatory Clinic as part of their ambulatory training at Thomas Jefferson University Hospital. A 5-item questionnaire entitled the Jefferson Scale of Patient's Perceptions of Physician Empathy was developed and administered to the study participants. Its factor structure, item-total score correlations, and correlations with several relevant criterion …

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Jefferson Journal of Psychiatry

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Editorial Board

Jefferson Journal of Psychiatry

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Mourning, Salman Akhtar M.D.

Jefferson Journal of Psychiatry

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Neuroleptic Malignant Syndrome, With Attention To Its Occurrence With Atypical Antipsychotic Medication: A Review, Sarah Guzofski M.D. (Pgy2), Ruben Peralta M.D.

Jefferson Journal of Psychiatry

The neuroleptic malignant syndrome (NMS) is an idiopathic, life-threatening reaction to antipsychotic medication. NMS was traditionally attributed to potent dopamine antagonism of typical antipsychotics, but cases of NMS have now been reported for each of the newer antipsychotics. When NMS is caused by a newer, atypical antipsychotic the presentation differs somewhat; fever, rigidity, and, possibly, death may be less frequent. Diagnostic features, predisposing factors, and treatment are discussed, as is the important matter of reinstituting antipsychotic treatment.

A Kind Of Poem For My Friend And Me, Hilary O'Neill M.D. (Pgy4)

Jefferson Journal of Psychiatry

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First-Known Hypnopompic Hallucination Occurring In-Hospital: Case Report, Paul Ballas D.O. (Pgy2)

Jefferson Journal of Psychiatry

Despite the high prevalence of hypnopompic hallucinations in the community, to our knowledge there are no reports that have been published in the English literature of these phenomenon observed by staff in the hospital setting. Psychiatric or neurological evaluation often ensues if a patient reports hallucinations in other circumstances, but when they are reported in connection with sleep, further evaluation is rarely performed because such events are common in the general populace. Our report emphasizes the distinction between hypnopompic and hypnagogic hallucination as an ongoing feature of life that someone is aware of, which we believe to be the case …

No More Cuts: The Curious Fate Of Self-Mutilation In Its Development, Zhabiz Kazeminezhad M.D. (Pgy4), Salman Akhtar M.D.

Jefferson Journal of Psychiatry

In this article, we present descriptions of four young women with relatively severe personality disorders. All four were in psychodynamic psychotherapy and all had the symptom of self-cutting. During their treatment, it became evident that their self-cutting had undergone a transformation and a new symptom had appeared in its place. In three, self-cutting was substituted by behaviors that we might call "cutting equivalents" and, in the fourth, by an enhanced self-reflective attitude and by journal-writing. We suggest that symptom-replacement for self-cutting may be common in its developmental course or in its course as it becomes influenced by psychotherapy, and that …

Psychiatric Diagnoses In Patients With Williams Syndrome And Their Families, Janet C. Kennedy M.D. (Pgy1), David L. Kaye M.D., Laurie S. Sadler M.D.

Jefferson Journal of Psychiatry

Williams Syndrome (WS) is a genetic disorder associated with mental retardation (MR) and a distinct behavioral phenotype including a friendly and outgoing personality. This population, like others with MR, has been reported to have an increased rate of symptoms of mental illness; however, few studies have used DSM-IV criteria to quantify specific psychiatric diagnoses in WS and the prevalence of psychiatric illness in relatives of individuals with WS and the possible relationship between family and patient diagnoses is currently unknown.

Methods: Twenty-one families participated; the patients’ average age was 16 years. DSM-IV diagnoses were applied by using the Anxiety …

Psychogenic Stuttering Following A Gastric Bypass Operation: Case Report, Deborah B. Raphael M.D. (Pgy2), Frank B. Schoenfeld M.D.

Jefferson Journal of Psychiatry

We evaluated a 44-year-old female with bipolar affective disorder who presented with a 4-month history of severe stuttering and vague neurologic complaints. She had lost 200 pounds after gastric bypass surgery two years before. A childhood sexual-abuse victim, she admits that she "hid" in her weight for most of her life. Neurological evaluation of this patient was negative, and speech-pathology evaluation revealed highly atypical stuttering. Gastric bypass patients with a history of psychiatric disorders and childhood sexual abuse may be particularly vulnerable to somatoform disorders.

What Investigations Are Ordered In Patients With First-Episode Psychosis?, Allan Shefrin M.D. (Pgy2), Derek Puddester M.D., Stephanie Greenham Ph.D., Lise Bisnaire Ph.D., Hazen Gandy M.D.

Jefferson Journal of Psychiatry

Psychiatrists are often left with the dilemma of which investigations to order in adolescents presenting with a first episode of psychosis. Blood work, urine studies, and neuroimaging studies were tracked in 13 adolescents admitted with a diagnosis of first-episode psychosis over a 13-month period to the Children’s Hospital of Eastern Ontario. Variation was found in the amount of investigation ordered: 85% of patients received a drug screen; 54% a CT scan; 8% an MRI; 92% a CBC with differential; 92% electrolytes. Abnormalities of CT scans were detected in 2 patients (29%); in neither case did the result lead to a …

Nms, And Why We Should Call It (Malignant) Catatonia, Robert Arnold Johnson M.D. (Pgy4)

Jefferson Journal of Psychiatry

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Medical Symptoms Associated With Tobacco Smoking With And Without Marijuana Abuse Among Crack Cocaine-Dependent Patients., Ashwin A. Patkar, Vikas Batra, Paolo Mannelli, Sarah Evers-Casey, Michael J. Vergare, Frank T. Leone

Department of Psychiatry and Human Behavior Faculty Papers

Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling …

Acgme Research Requirements For Residents In Psychiatry., Kathleen S. Peindl, Stephen Weinstein, Ashwin A. Patkar, Edward Silberman, Michael Vergare

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

Relationship Of Serum Prolactin With Severity Of Drug Use And Treatment Outcome In Cocaine Dependence., Ashwin A. Patkar, Paolo Mannelli, Kenneth M. Certa, Kathleen Peindl, Heather Murray, Michael J. Vergare, Wade H. Berrettini

Department of Psychiatry and Human Behavior Faculty Papers

RATIONALE: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine activity, which modulates the behavioral effects of cocaine. Therefore, serum PRL may have a potential role as a biological marker of drug severity and treatment outcome in cocaine dependence.

OBJECTIVE: We investigated whether serum PRL levels differed between cocaine-dependent (CD) subjects and controls, and whether PRL levels were associated with severity of drug use and treatment outcome in CD subjects.

METHODS: Basal PRL concentrations were assayed in 141 African-American (AA) CD patients attending an outpatient treatment program and 60 AA controls. Severity of drug use was assessed …

Academic Performance Of Psychiatrists Compared To Other Specialists Before, During, And After Medical School., Frederick S. Sierles, Michael Vergare, Mohammadreza Hojat, Joseph S. Gonnella

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: This study was designed to compare psychiatrists with other physicians on measures of academic performance before, during, and after medical school.

METHOD: More than three decades of data for graduates of Jefferson Medical College (N=5,701) were analyzed. Those who pursued psychiatry were compared to physicians in seven other specialties on 18 performance measures. Analysis of covariance was used to control for gender effect.

RESULTS: Compared to other physicians, psychiatrists scored higher on measures of verbal ability and general information before medical school and on evaluations of knowledge and skills in behavioral sciences during medical school, but they scored lower …

Differences In Peripheral Noradrenergic Function Among Actively Drinking And Abstinent Alcohol-Dependent Individuals., Ashwin A. Patkar, Charles A. Marsden, Prakash C. Naik, David A. Kendall, Raman Gopalakrishnan, Michael J. Vergare, Stephen P. Weinstein

Department of Psychiatry and Human Behavior Faculty Papers

We examined whether excessive alcohol consumption was related to changes in plasma levels of noradrenaline (NA) and whether these changes recover following abstinence. We also explored whether there were differences in NA levels between Type I and Type II alcoholics and controls during active drinking and abstinence. Plasma concentrations of NA were determined in (1) 27 Caucasian men with alcohol dependence who were regularly drinking (active drinkers) within 24 hours of hospitalization, (2) 29 Caucasian alcohol-dependent men who were in remission (abstinent for a minimum of three months), and (3) 28 race- and gender-matched healthy controls. NA concentrations were significantly …

Relationship Between Serotonin Transporter Gene Polymorphisms And Platelet Serotonin Transporter Sites Among African-American Cocaine-Dependent Individuals And Healthy Volunteers., Ashwin A. Patkar, Wade H. Berrettini, Paolo Mannelli, Raman Gopalakrishnan, Margret R. Hoehe, Louai Bilal, Stephen Weinstein, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

Alterations in the serotonin transporter (5-HTT) have been implicated in a variety of psychiatric disorders including cocaine dependence. A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) appears to influence the expression of 5-HTT in human cell lines. We investigated whether 5-HTTLPR variants were related to differences in measures of platelet 5-HTT sites in cocaine-dependent patients and healthy volunteers (controls). Polymerase chain reaction-based genotyping of a 44 base pair insertion/deletion polymorphism in 5-HTTLPR was performed in 138 cocaine-dependent African-American subjects and 60 African-American controls. This yielded a short (S) and a long (L) allele. Platelet 5-HTT sites …

Evaluation Of The Ume-21 Initiative At 18 Medical Schools Between 1999 And 2001, J. Jon Veloski, Barbara Barzansky

CRMEHC Faculty Papers

BACKGROUND: This study evaluated the processes of curricular change and the initial outcomes of the Undergraduate Medical Education for the 21st Century (UME-21) project at 18 schools.

METHODS: Site visits were conducted at eight partner schools in 1999 and 2001. Written proposals, progress reports, and final reports of 18 schools were reviewed. Senior medical students' responses to questionnaires, including the annual Association of American Medical Colleges Graduation Questionnaire and a UME-21 supplemental graduation questionnaire, were analyzed.

RESULTS: There was variation among the schools in the curriculum at baseline, in the structure of the UME-21 innovation that was introduced, and in …

Pre-Treatment Measures Of Impulsivity, Aggression And Sensation Seeking Are Associated With Treatment Outcome For African-American Cocaine-Dependent Patients., Ashwin A. Patkar, Heather W. Murray, Paolo Mannelli, Edward Gottheil, Stephen P. Weinstein, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

We investigated whether measures of impulsivity, aggression and sensation seeking differed between cocaine-dependent subjects and controls, and whether these measures were related to treatment-outcome for cocaine patients. Pre-treatment assessments of impulsivity (Barratt Impulsivity Scale [BIS]), aggression (Buss-Durkee Hostility Inventory [BDHI]) and sensation seeking (Zuckerman Sensation Seeking Scale [SSS]) were obtained for 141 African-American cocaine-dependent patients entering a 12-week, intensive outpatient treatment program and 60 controls. The outcome measures were number of negative urine drug screens, days in treatment, dropout rates and number of treatment sessions. Cocaine patients reported significantly higher scores on the SSS, the BIS and the BDHI than …

Comparison Of Pretreatment Characteristics And Treatment Outcomes For Alcohol-, Cocaine-, And Multisubstance-Dependent Patients., Ashwin A. Patkar, Charles C. Thornton, Paolo Mannelli, Kevin P. Hill, Edward Gottheil, Michael J. Vergare, Stephen P. Weinstein

Department of Psychiatry and Human Behavior Faculty Papers

We investigated whether pretreatment characteristics and measures of outcome differed for alcohol-, cocaine-, and multisubstance-dependent patients receiving outpatient substance abuse treatment. One hundred and forty substance dependent individuals (32 alcohol, 76 cocaine, and 32 multisubstance) enrolled in a 12-week outpatient treatment program were compared across measures of addiction severity, personality, and treatment-readiness at admission. In-treatment, end-of-treatment and 9-month follow-up assessments of treatment outcome were then compared across the three groups. Outcome measures included reduction in problem severity, abstinence, retention, number of sessions attended, dropout, and counselor and patient ratings of treatment benefit. At admission, the multisubstance group had a higher …

Comparisons Of American, Israeli, Italian And Mexican Physicians And Nurses On The Total And Factor Scores Of The Jefferson Scale Of Attitudes Toward Physician-Nurse Collaborative Relationships, Mohammadreza Hojat, Joseph S. Gonnella, Thomas J. Nasca, Sylvia K. Fields, Americo Cicchetti, Alessandra Lo Scalzo, Francesco Taroni, Anna Maria Vincenza Amicosante, Manuela Macinati, Massimo Tangucci, Carlo Liva, Gualtiero Ricciardi, Schmuel Eidelman, Hanna Admi, Hana Geva, Tanya Mashiach, Gideon Alroy, Adelina Alcorta-Gonzalez, David Ibarra, Antonio Torres-Ruiz

CRMEHC Faculty Papers

This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician–nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician–Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians’ dominance). Results showed inter- and intra-cultural similarities and differences among the study groups …

Physician Empathy: Definition, Components, Measurement, And Relationship To Gender And Specialty, Mohammadreza Hojat, Joseph S. Gonnella, Thomas J. Nasca, Salvatore Mangione Md, Michael Vergare, Michael Magee

CRMEHC Faculty Papers

OBJECTIVE: There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes. This study was designed to investigate the components of physician empathy, its measurement properties, and group differences in empathy scores.

METHOD: A revised version of the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale, and the differences on mean empathy scores by physicians’ gender and specialty were examined.

RESULTS: Three meaningful factors …

Development And Validation Of A Questionnaire To Evaluate Patient Satisfaction With Diabetes Disease Management, Lisa E. Paddock, J J. Veloski, Mary Lou Chatterton, Felicia O. Gevirtz, David B. Nash

CRMEHC Faculty Papers

OBJECTIVE: To develop a reliable and valid questionnaire to measure patient satisfaction with diabetes disease management programs.

RESEARCH DESIGN AND METHODS: Questions related to structure, process, and outcomes were categorized into 14 domains defining the essential elements of diabetes disease management. Health professionals confirmed the content validity. Face validity was established by a patient focus group. The questionnaire was mailed to 711 patients with diabetes who participated in a disease management program. To reduce the number of questionnaire items, a principal components analysis was performed using a varimax rotation. The Scree test was used to select significant components. To further …