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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 …

Special Article: One Resident's Perspective On A Different Style Of Psychopharmacological Practice, Michael Amiel, M.D., Docteur J.P. Blayac

Jefferson Journal of Psychiatry

This article provides a comparison of psychopharmacological practices in the U.S. and France. The prescription as well as proscription of various classes of psychotropic drugs are considered. Even though the general guidelines of psychopharmacological practice remain the same, the details vary considerably and are determined especially by commercial factors.

INTRODUCTION

Though a comparison of current clinical psychopharmacological practices in France and the U.S. is an unaddressed topic, these contrasts may be quite striking to an American-trained psychiatrist. The following observations are based on my two month inpatient experience as a fourth-year psychiatric resident at a public psychiatric institution located in …

Mead Johnson Award

Jefferson Journal of Psychiatry

The Mead Johnson Award has been established to honor the best paper submitted to The Jefferson Journal of Psychiatry: 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 board will announce …

Editor's Column, Elizabeth Trefzger, Md

Jefferson Journal of Psychiatry

In selecting articles for, and preparing this latest issue of the Jefferson Journal, I am impressed by the ongoing trend towards refinement that is present in the submissions which we receive. This has been both encouraging and exciting for everyone concerned with the production of the Journal. Much as any other piece of scientific literature, the value of criticism in the production of the work cannot be forgotten . While reflecting on the need for refined and worthwhile criticism I have been reminded of the value of criticism in education. It is through criticism, our own self evaluation, and that …

Resident Editorial Board

Jefferson Journal of Psychiatry

List of Resident Editorial Board for Jefferson Journal of Psychiatry, Volume 8, Number 1, 1990.

About The Authors

Jefferson Journal of Psychiatry

About the authors in the Jefferson Journal of Psychiatry, Volume 7, Number 2, 1989.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to Jefferson Journal of Psychiatry, Volume 7, Number 2, 1989.

Book Review: Humanizing Freud, Edward Kim, M.D.

Jefferson Journal of Psychiatry

FREUD: A LIFE FOR OUR TIME

Peter Gay, Ph.D.

W.W. Norton & Company

New York, 1988 651 pages

$25.00

Book Reviews: Clinical Experiences, Indoctrination And Education In Alcoholism, Marguerite M. Blythe, M.D.

Jefferson Journal of Psychiatry

HEAVY DRINKING: THE MYTH OF ALCOHOLISM AS A DISEASE

Herbert Fingarette

Berkeley, University of California Press 1988, 166 pages

In Response: The Place Of Psychotherapy Training In Residency Programs, Homer C. Curtis, M.D.

Jefferson Journal of Psychiatry

As a belated response to the debate about the value of teaching psychotherapy in psychiatric residency training, (Jefferson Journal of Psychiatry, Vol. 5(I):54-66, 1987) I would like to add my voice to the affirmative side. That there is such a debate seems symptomatic of an unfortunate and unnecessary misuse of important advances in neurobiology to justify the sidelining of psychodynamic psychotherapy. A search of the psychiatric literature of recent years reveals an emphasis on biological psychiatry and a relative neglect of psychotherapy. A similar trend has been noted in some residency programs and in the annual meetings of the American …

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.