Psychiatry Commons^™

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

This issue of our Journal marks a new stage in our development. We have started accepting papers from residency programs other than our own. Encouraged by the enthusiastic response our prior issues have elicited from psychiatric educators around the country, we are embarking on a program of expansion. In doing so we hope to provide a unique arena for psychiatric resident thinking. Residents nationwide are invited to share with each other and their faculties, their discoveries, their uncertaintiesand the newness with which they view their work.

Letters To The Editor

Jefferson Journal of Psychiatry

We welcome all letters to the editor, and encourage authors to reply. Input from residents and faculty on ideas presented in the Journal create the arena for discussion and dialogue which is the ultimate purpose of this undertaking.

Therapeutic Guitar-An Alternative Approach To The Treatment Of A Difficult Patient, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

The case described in this article is one where an experimental technique was introduced largely because of the therapist's dissatisfaction with the patient's progress. Despite the likelihood of being criticized, I feel compelled to write about this patient. The progress he has made is beyond my expectations, which were admittedly minimal at the outset.

Misuses Of Computers By Adolescents, Henry A. Doenlen, M.D.

Jefferson Journal of Psychiatry

One subject that has been a topic of much recent publicity and concern has been that of computer misuse. Teenage computer programmers gaining entry into the systems of universities, hospitals and businesses have caused the most concern . The duplication of copyrighted programs and information has also been reported to cause loss of considerable money. There seems to be a subpopulation of people who spend considerable time working with computers. These individuals may do so to the exclusion of other aspects of life such as human interaction . This paper will present both my observations of this behavior and my …

The Treatment Of A Borderline Patient Complicated By Involvement With A Charismatic Religious Cult: A Case Report, Mark Miller, Md

Jefferson Journal of Psychiatry

Introduction

Although much has been written about cults in recent years, many questions remain. Do cults recruit subjects by brainw ashing them or do individuals gravitate to cults to fulfill unmet needs? This paper will review some essential points of cult phenomena and discuss the treatment of one patient who was involved in a charismatic religious cult .

Possible Synergistic Action Between Carbamazepine And Lithium Carbonate In The Treatment Of A Manic Patient., John Matt Dorn, M.D.

Jefferson Journal of Psychiatry

Introduction

Carbamazepine has been proven to be efficacious in some patients with affective disorders, notably those who have not responded well to lithium carbonate or neuroleptics (1,2,3) . For those who have responded poorly to either regimen, however, there have been no effective pharmacotherapies until recently, when case reports have suggested a possible synergistic action between lithium carbonate and carbamazepine (4,5,6). The following case report supports this hypothesis.

The Use Of Carbamazepine (Tegretol) In Psychiatry And Its Association To Kindling, Temporal Lobe Epilepsy And Psychopathology, James Stanch, M.D.

Jefferson Journal of Psychiatry

The recent theory of kindling may help to link neurophysiologic, neurotransmitter and neuroanatomic mechanisms important in understanding the neurology of behavior. Limbic kindling is of interest in developing models of epilepsy, psychosis, learning and memory (l -5). Kindling might explain the late development of psychopathology.

This paper will first define kindling and demonstrate how kindling offers a model within which to view more prolonged behavioral deviations as neurophysiological processes. The use of carbamazepine and its association to kindling, temporal lobe dysfunction and psychopathology will be discussed .

Discussion Of The Paper By David A. Scola, M.D. On “The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles”, Howard Field, M.D., Paul J. Fink, M.D., Thomas Swirsky-Sacchetti, Ph.D.

Jefferson Journal of Psychiatry

Dr. Scola proposes a bold and far-reaching synthesis of psychoanalytic theory, developmental neurobiology and neurophysiology of behavior. Freud found this task so frustrating in 1895 that he renounced neurology in favor of a purely psychologic approach (or so Freud claimed; Frank Sulloway sees it differently). Hypotheses that unconscious mental life is situated in the right cerebrum and that defense mechanisms are related to neuroanatomic connections are intriguing. The presentation does not include evidence which contravenes these theories. Sperry presented some evidence that the right hemisphere is self-aware and self-evaluative (I). One great problem in all cross disciplinary studies is the …

The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles, David A. Scola, M.D.

Jefferson Journal of Psychiatry

Volumes of research have been accumulated over the past decade concerning hemispheric specialization of the human brain. Likewise, over the past century, psychoanalysts have painstakingly unraveled through their clinical observation many of the mysteries of intrapsychic functions. Yet little has been written concerning attempts to integrate these seemingly divergent viewpoints.

It was Freud's hope that a neural basis for his clinical observations and psychological explanations of the human mind would eventually be established . This was not possible in his day, however, so this idea was gradually abandoned. With the advent of computers and high technology, perhaps it is time …

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

This second issue of our resident journal enlarges our educational effort s in two important ways. The first is obvious . As you can see, we have published this forum in an attractive new form at. This is highlighted by the new cover designed by Dr. Jeffrey Sarnoff. The second piece of progress is our enlarged audience. In addition to our own Jefferson faculty and residents, the Journal is now being distributed to psychiatrists throughout Pennsylvania. For both of these improvements in form we are indebted to the Mead Johnson Pharmaceutical Division for their generous sponsorship.

Table Of Contents: The Jefferson Journal Of Psychiatry, Volume 2, Number 1, January 1984

Jefferson Journal of Psychiatry

Table of Contents: The Jefferson Journal of Psychiatry, Volume 2, Number 1, January 1984.

Dedication

Jefferson Journal of Psychiatry

Dedication to Paul J. Fink, MD.

Editors: The Jefferson Journal Of Psychiatry

Jefferson Journal of Psychiatry

Chief Editor, Associate Editors, Former Editors, Cover Design and Faculty Advisor.

Meningitis Presenting As Depression: A Case Report, Karl Doghramji, Md

Jefferson Journal of Psychiatry

The relationship between psychiatric and medical illness has long been recognized by clinicians. Of special importance to psychiatrists are the diagnostic dilemmas posed by medical illnesses presenting as psychiatric disorders. In a review of recent studies, LaBruzza found that "at least one out of every twenty patients receiving an initial psychiatric evaluation may have an underlying medical illness which accounts for the psychiatric symptoms." This was especially true with inpatients, where between 5% and 30% of patients, with a weighted average of 12%, had medical illnesses accounting for their psychiatric complaints 11). One medical illness which can resemble psychiatric illness …

Attention Deficit Disorder, Residual Type- A Case Study, James Stanch, Md

Jefferson Journal of Psychiatry

The syndrome of Minimal Brain Dysfunction (MBD) in children has been well described by a number of authors. Such children were first described in 1941 by Werner and Strauss(1) who made a distinction between brain injury and -simple- mental retardation. In the past such terms as Hyperactive Child Syndrome, Minimal Brain Damage, and Hyperkinetic Behavior Syndrome have been used to describe this syndrome.

A Case Of Recurrent Dissociative Episodes In A Patient With Congenital Defects, Mark Miller, Md

Jefferson Journal of Psychiatry

Case Report

Marie, a 30 year old American-born Hispanic female, was first seen in the emergency room with suicidal ideation (the impulse to jump in front of an oncoming car), depression, anxiety, and distress about "always getting attacked so much."

Interpersonal Relationships As Sources Of Medical Student Stress, Beverly Jones, Md

Jefferson Journal of Psychiatry

Introduction

The issue of physician impairment, that is , decreased ability or quality of functioning due to intemperate use of drugs or alcohol, emotional or psychiatric dysfunction, has recently received attention (1,5) . Studies have indicated the risks physicians face of substance abuse problems(6,7), marital discord(8,9), suicide (lO,ll), and psychiatric problems (l2-14). studies have also addressed the difficulties faced by medical students (15-20).

A group of medical students at the University of North Carolina came together to investigate the subject of medical student impairment . A survey was constructed in order to ascertain the sources of stress in medical school. …

Olfaction And Sexuality, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

A patient who describes himself as "sanitary" told me of his concern with odors. Whenever he thinks about establishing a sexual relationship , he develops a fear that his partner may smell offensive, especially around her genital area. He describes signs and symptoms of sympathetic overactivity when he engages in foreplay, and is afraid that he might be impotent if he smells anything offensive. In fact, he has to insert a finger into his partner's vagina during foreplay, to test the nature of the odor. He feels relieved when the smell is neutral or perfumed, and demonstrates enhanced sexual performance. …

Editors' Column

Jefferson Journal of Psychiatry

With this issue, The Jefferson Journal of Psychiatry , a Resident Publication, comes into being.

The purpose of this journal is to provide a forum for the presentation of ideas, data, and discussion. We are trying to give residents a setting in which to communicate in a way more formal than the seminars of residency training, but less forbidding than national journals.

Introduction, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

It is with great pride that we introduce our new resident JOURNAL. This unique forum was created to allow our resident s the opportunity to explore the challenges and pleasures to writing and publishing. Putting one's thoughts and experiences on paper demands a clarity of thinking and a willingness to share what is otherwise private.

For the resident this becomes a valuable educational enterprise. For the faculty this is an opportunity to view first hand the work of our trainees . Not limited to reading course descriptions of clinical service schedules, our staff can now get to know t he …

Psychological And Cognitive Determinants Of Vision Function In Age-Related Macular Degeneration., Barry W. Rovner, Robin J Casten, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Neurology Faculty Papers

OBJECTIVE: To investigate the effect of coping strategies, depression, physical health, and cognition on National Eye Institute Visual Function Questionnaire scores obtained at baseline in a sample of older patients with age-related macular degeneration (AMD) enrolled in the Improving Function in AMD Trial, a randomized controlled clinical trial that compares the efficacy of problem-solving therapy with that of supportive therapy to improve vision function in patients with AMD.

METHODS: Baseline evaluation of 241 older outpatients with advanced AMD who were enrolled in a clinical trial testing the efficacy of a behavioral intervention to improve vision function. Vision function was characterized …

Psychostimulants As Cognitive Enhancers: The Prefrontal Cortex, Catecholamines And Attention Deficit Hyperactivity Disorder, Craig Berridge, David M. Devilbiss

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Psychostimulants exert behavioral-calming and cognition-enhancing actions in the treatment of attention deficit hyperactivity disorder (ADHD). Contrary to early views, extensive research demonstrates that these actions are not unique to ADHD. Specifically, when administered at low and clinically-relevant doses, psychostimulants improve a variety of behavioral and cognitive processes dependent on the prefrontal cortex (PFC) in subjects with and without ADHD. Despite the longstanding clinical use of these drugs, the neural mechanisms underlying their cognition-enhancing/therapeutic actions have only recently begun to be examined. At behaviorally-activating doses, psychostimulants produce large and widespread increases in extracellular levels of brain catecholamines. In contrast, cognition-enhancing doses …

Evidence Based Treatment Of Schizophrenia: Do We Know Enough, Faheem Khan, Haider A Naqvi

Department of Psychiatry

No abstract provided.

The Constant Threat Of Terrorism: Stress Levels And Coping Strategies Amongst University Students Of Karachi, Ayesha Ejaz Ahmed, Komal Masood, Sohni Vicky Dean, Tanzila Shakir, Ahmed Abdul Hafeez Kardar, Usman Barlass, Syed Haider Imam, Mohammad Ghawar Khan Mohmand, Hussain Ibrahim, Imad Saeed Khan, Usman Akram, Farid Hasnain

Department of Psychiatry

OBJECTIVES: To assess the levels of stress in the face of terrorism and the adopted coping strategies, amongst the student population of universities in Karachi

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METHODS: A descriptive, cross sectional study was conducted on undergraduate students from four universities of Karachi. Self-administered questionnaires were filled out by 291 students. Pearson Chi-Square test was used to assess associations between stress levels and different variables at a level of significance of 0.05%

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RESULTS: A total of 65.8% of the students had mild stress levels, 91.5% of university students were exposed to terrorism through television, while only 26.5% students reported personal …

Pregnant Women As Research Participants: Why Is Additional Protection Required?, Kyoko Wada

Research Day (Arts & Humanities, FIMS, and Education)

Today, blanket exclusion of pregnant women from research participation is not endorsed; however, a tendency still remains to exclude pregnant women from participating in research. This exclusion results in insufficient data to guide clinical practice for pregnant women, and hence adds risks to pregnant women and fetuses (Lyerly et al. 2007, 2008, 2009; Baylis 2010; Goldkind et al. 2010).

Improving Function In Age-Related Macular Degeneration: Design And Methods Of A Randomized Clinical Trial., Barry W Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in older adults and impairs the ability to read, drive, and live independently and increases the risk for depression, falls, and earlier mortality. Although new medical treatments have improved AMD's prognosis, vision-related disability remains a major public health problem. Improving Function in AMD (IF-AMD) is a two-group randomized, parallel design, controlled clinical trial that compares the efficacy of Problem-Solving Therapy (PST) with Supportive Therapy (ST) (an attention control treatment) to improve vision function in 240 patients with AMD. PST and ST therapists deliver 6 one-hour respective treatment sessions …

Fuzzy Logic: A “Simple” Solution For Complexities In Neurosciences?, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai

Medical College Documents

Background: Fuzzy logic is a multi-valued logic which is similar to human thinking and interpretation. It has the potential of combining human heuristics into computer-assisted decision making, which is applicable to individual patients as it takes into account all the factors and complexities of individuals. Fuzzy logic has been applied in all disciplines of medicine in some form and recently its applicability in neurosciences has also gained momentum.
Methods: This review focuses on the use of this concept in various branches of neurosciences including basic neuroscience, neurology, neurosurgery, psychiatry and psychology.
Results: The applicability of fuzzy logic is not limited …

Universal Or Indicated Screening In Primary Care?, Matthew Wintersteen, Md

Department of Psychiatry and Human Behavior Faculty Papers

To the Editor: In the November 2010 issue, Schmitt and colleagues (1) reported that the duration of visits increased when depression screening was conducted in primary care. This report is timely given recent recommendations for both adult and pediatric screening for depression in primary care. Schmitt and colleagues examined data representative of more than 641 million primary care visits in2005–2007 and found that when depression screening was documented in patients’ records, physicians’ time with patients increased significantly.

Safety And Efficacy Of Abt-089 In Pediatric Attention-Deficit/Hyperactivity Disorder: Results From Two Randomized Placebo-Controlled Clinical Trials., Timothy E. Wilens, Laura M. Gault, Ann Childress, Christopher J. Kratochvil, Lindsey Bensman, Coleen M. Hall, Evelyn Olson, Weining Z. Robieson, Tushar S. Garimella, Walid M. Abi-Saab, George Apostol, Mario D. Saltarelli

Journal Articles: Psychiatry

OBJECTIVE: To assess the safety and efficacy of ABT-089, a novel α(4)β(2) neuronal nicotinic receptor partial agonist, vs. placebo in children with attention-deficit/hyperactivity disorder (ADHD).

METHOD: Two multicenter, randomized, double-blind, placebo-controlled, parallel-group studies of children 6 through 12 years of age were conducted. Study 1 (n = 274) assessed six treatment groups over 8 weeks: 4 once-daily (QD) ABT-089 doses (0.085-0.700 mg/kg), QD atomoxetine, and placebo. Study 2 (n = 119) assessed three treatment groups over 6 weeks: 2 QD ABT-089 doses (0.7 mg/kg, 1.4 mg/kg) and placebo. The primary efficacy variable was the investigator-administered Attention-Deficit/Hyperactivity Disorder Rating Scale-IV: Home …

Suicide Bombing: A Geopolitical Perspective, Haider Naqvi, Syed Faraz Kazim, Shafqat Huma

Department of Psychiatry

Suicide bombing is a very complex phenomenon. It has been a focus of research in recent times. However inherent biases of researchers muddle the picture: researchers from western countries focus the issue around political liberty and notion of democracy, while those from Islamic countries tend to take the afterlife-reward notion as an incentive for suicide bombing. However in order to understand this complex phenomenon it is important to consider the contextual factors. In this review we have attempted to highlight various geopolitical factors which contribute to increased incidence of suicide bombing in South East Asia.