Psychiatry Commons^™

A Practical Approach To The Assessment And Management Of Psychiatric Emergencies, J. Gregory Kyser, M.D., Bradley C. Diner, M.D., Gilbert W. Raulston, M.D.

Jefferson Journal of Psychiatry

Patients present to the psychiatric emergency room manifesting a wide variety of symptoms ranging from mild anxiety to violent, uncontrollable behavior. The emergency room psychiatrist must recognize these various presentations and provide appropriate interventions for such patients. It may not be of the utmost importance to distinguish between the subtypes of schizophrenia or endogenous vs. exogenous depression, just as it is not crucial to decide immediately the cause of an acute abdomen, primarily to recognize its presence. However, it is critical to recognize the presence of a psychosis, suicidal intent or the presence of an organically caused alteration in mental …

Confrontations With Death: Psychological Responses During Internship, Michael Miller, M.D.

Jefferson Journal of Psychiatry

During internship, the daily confrontation with the consequences of disease contributes much to the distress which young physicians experience (I). Not only are interns responsible for first line medical care, they must also provide emotional support for their patients struggling with pain, disability and impending death. This paper seeks to examine some of the factors responsible for the turmoil involved in caring for these dying patients.

Our conceptions of death and dying are determined to a large extent by the cultural context in which we live. Compared with other times in which death was not so ego alien, we presently …

Identity Formation And Reformation In First And Second Career Psychiatric Residents, Steven J. Kingsbury, M.D., Ph.D.

Jefferson Journal of Psychiatry

Although all residents seek to acquire competence, those entering psychiatry as a first career appear to use different strategies for the early protection of self esteem than do those entering psychiatry as a second career. These differences and their ramifications for the resident and the residency are discussed.

Differences appear in the formation of a professional identity as a psychiatrist when that career is the second career as opposed to the formation of that identity when the career is the first. For most older psychiatric residents, a first career typically precedes the entrance into psychiatry. In my case, I was …

On Becoming A Psychiatrist: A Resident's Perspective, Phebe M. Tucker, M.D.

Jefferson Journal of Psychiatry

Developing an identity as a psychiatrist is a process which has been seen by many to span an individual's career; from the first decision of choice of a career, through residency training and beyond, into the years of practice. As part of a "Residents' Day Paper," psychiatrists in the Oklahoma City area were surveyed in order to look at their perceptions of the growth of their professional identities. Despite the limitations of a small sample population, limited to one metropolitan area, some interesting common patterns emerged: the psychiatrists surveyed had diverse educational and cultural back grounds, similar practical and unconscious …

Telephone Associated Pathology: Clinical Case Studies And Discussion, Mark Servis, M.D.

Jefferson Journal of Psychiatry

The advancement of modern technology shapes and develops new expressions of psychopathology and accompanying treatments. This is most apparent with the telephone, an instrument of contact and communication for the patient, and assessment and intervention for the therapist. The telephone both constrains and creates unique constellations of patient symptomatology. This paper will examine one such telephone symptom complex-the habitual over use of the telephone by non-bipolar patients. The frequent monopolization of the phone seen in some bipolar patients will not be considered, though the elements of intrusion and aggression discussed in this paper are probably shared by manic patients.

A …

A Pilot Study Of Brief Group Therapies For Preschool Children: Parent Training Vs Group Play Therapy Vs Project Group, William S. Evans, Jr., M.D., Susan A. Black, M.D.

Jefferson Journal of Psychiatry

The optimum modality for treating preschool age children with behavioral and emotional problems is uncertain. One study showed that children with good ego strength respond to psychotherapy independent of whether it is group or individual psychotherapy, provided that a minimum period of psychotherapy occurs (ovick, 1965). The literature has demonstrated that parent training, individual play therapy, and group therapy are all effective modes of treatment with children (Axline, 1969; Moreland, et ai, 1983; Pesco solido & Petrella, 1986). Due to the limited psychiatric resources in the military setting and increasing demand for service, the option for individual therapy may be …

The In-Hospital Suicide: A Psychological Autopsy Of A System Involving Borderline Dynamics, Kathleen A. Hughes, Md, Al Santos, Md

Jefferson Journal of Psychiatry

This manuscript reviews principles of hospital management in the care of severe borderline patients with concomitant affective syndromes. The case presented highlights a process of experiential learning in a novice clinician (a beginning psychiatric resident) and illustrates several critical areas of concern with these patients. The following four facets of clinical management are discussed: 1) Failed attempts to understand borderline dynamics and subsequent countertransference reactions; 2) Staff resistance to consistent, honest and open acknowledgement of suicide potential; 3) Special risks when borderline dynamics are combined with affective syndromes; and 4) Possible suicide preventive measures and their relative effectiveness.

Conversion Hallucinations In A Patient With Pseudohypoparathyroidism, John Kasckow, Md, Ph.D., Allan Maltbie, Md

Jefferson Journal of Psychiatry

There are few case reports in the literature which discuss psychiatric disturbances in patients with pseudohypoparathyroidism (PH P) (1,2). PHP is a disease characterized by an inadequate response to parathyroid hormone . Often these patients are obese with a short, stocky build and moon-shaped face. Mental retardation is present in as many as 10% of these patients; a reversible dementialike syndrome can also occur (2,3). In addition, Capgras' syndrome has been observed in pseudohypoparathyroid patients (1,2). In these last two reports the authors concluded that the psychosis was probably organically-based. Hay et al (I) noted in their case report that …

What Supports Supportive Therapy?, Peter N. Novalis, M.D., Ph.D.

Jefferson Journal of Psychiatry

Think of 1896, the year Jacob Freud died, kindling a depression in his son Sigmund which led to The Interpretation of Dreams. To a raucous convention in Chicago, William Jennings Bryan declaimed against the gold monetary standard: "You shall not press down upon the brow of labor this crown of thorns, you shall not crucify mankind upon a cross of gold" (I). Years later the monetary gold standard was abandoned during the New Deal, but Freud's newly mined "pure gold of analysis" continued to be an object of adulation and emulation, despite Freud's prediction that its …

Pharmacologic Treatments Of Cocaine Dependence, Michael B. Knable, D.O.

Jefferson Journal of Psychiatry

The rapid escalation of cocaine abuse in the United States in the 1980's has generated a host of interesting hypotheses on various aspects of this problem. After a succinct discussion of epidemiologic, clinical, and neuro-pharmacologic aspects of cocaine abuse, a survey of the current literature on psychopharmacologic management of dependence is offered. While several agents have emerged as useful adjunctive treatments for abstinence syndromes it is important for the clinician to remember that there is not official approval for such treatments. Additionally, psychotherapeutic maneuvers, which remain the major tools in treatment of addicts, should not be overlooked when an experimental …

About The Authors

Jefferson Journal of Psychiatry

Biographical information for authors for Volume 7, Number 1, 1989 issue of the Jefferson Journal of Psychiatry.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor Volume 7, Number 1, 1989 for Jefferson Journal of Psychiatry

Book Review: Making All The Difference. Psychotherapy: The Art Of Wooing Nature, Nora M. Kramer, Md

Jefferson Journal of Psychiatry

Book Review:

PSYCHOTHERAPY: THE ART OF WOOlNG NATURE

Sheldon Roth, M.D.

Jason Aronson Inc. Northvale, N.J. (1987), 294 pages.

Book Review: Assessing The Risk, Suicide Risk: The Formulation Of Clinical Judgement, Michael Gray, Md

Jefferson Journal of Psychiatry

Book review of:

SUICIDE RISK: THE FORMULATION OF CLINICAL JUDGEMENT

John T. Maltsberger

New York University Press, New York, 1986

174 pp . $26 .95

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 …

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.

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 …

Letters To The Editor

Jefferson Journal of Psychiatry

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

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

In selecting, or as now in introducing the table of contents of each new issue of the Jefferson Journal, or in response to some occasional question as to the orientation of the Journal, the ghostly concept of eclecticism reappears. In choosing a residency training program in psychiatry, the nascent resident of the 1980's was usually met with a chorus of "eclectic" brochures and training directors, each describing their own version of this ideal. Having comfortably accepted this pleasingly vague and democratic ideal, it was disconcerting to hear my own training director, Dr. Harvey Schwartz, challenge this descriptive term. He …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor, Volume 6, Number 1, 1987.

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

An exhibition of paintings of the American Old West caught my attention one afternoon, after I had wandered across the street from our affiliate V.A. outpatient clinic to the Pennsylvania Academy of the Fine Arts. A popular theme among these romanticized views of the American frontier was the image of the trapper; alone, silent figure working at the nation's interface with the unknown. Several paintings depicted a custom known as the rendez-vous, a semi-annual occurrence wherein the trappers gathered eastward to river outposts in order to socialize, trade information and hand-made maps, restock supplies, and display for sale the …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

Editor's Column, Gregory B. Sullivan, Md

Jefferson Journal of Psychiatry

As the Jefferson Journal of Psychiatry continues in its early growth phase, having accomplished a successful synthesis to become a national publication, we note its own apparent power of accommodation equal to the strain of fusing and adjusting internal and external changes.

Psychiatric residency in itself demands such accommodation. A group of finishing second year residents were taking stock of the fir st half of this process: They noted the difficulty in reconciling their initial conceptions and intentions with the subsequent realization of the limits to knowledge or intervention; they called this disillusionment. Others spoke of a converse strengthening …