Psychiatry Commons^™

Masochistic Personality Disorder: A Diagnosis Under Consideration, A. Kenneth Fuller, Md

Jefferson Journal of Psychiatry

In the past three decades, few diagnoses in psychiatry have had a more turbulent history than the personality disorders (1). Labels such as inadequate, emotionally unstable, and asthenic personalities entered the official nomenclature and were later withdrawn. Borderline, antisocial and compulsive personality disorders are additions that have become entrenched in the classification of mental disorders. The turmoil maintains its course with a diagnosis of Masochistic Personality Disorder under consideration to join the existing categories of personality disorders in the revised edition of DSM-III (DSM-III-R) (2).

The category of Masochistic Personality Disorder does not exist in the three earlier versions of …

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

Jefferson Journal of Psychiatry

The challenge of understanding and treating the increasing number of patients who suffer from some form of eating disorder has been addressed at length in the past issues of the JeJferson Journal. Beginning in the July 1985 issue, Dr. Eric Levin presented a clinical and theoretical report entitled "Bulimia as a Masturbatory Equivalent." The last issue contained an "In Response" column by Dr. C. Philip Wilson, a foremost authority on the psychoanalytic approach to this problem. This issue brings forth further commentary by Dr. Jeffrey Jonas, a recognized leader in the pharmacologic concept of treatment. The differences in approach are …

Editor's Column: Remarkable Conversations, Jeffrey R. Sarnoff, Md

Jefferson Journal of Psychiatry

Over the past year or so, several of us who are intimately involved in the editing and production of this journal have been personally challenged by the emergence of serious illness in either ourselves or our immediate fami lies. In each instance, the psyc hiatrist so affected has maintained the degree of equilibrium necessary to permit continuing, effective participation in this enterprise.Given this, the question emerges: Why do we do the work that has led us from a journal with a press run of four hundred copies in 1983, to a journal with a national circulation of seven thousand copies …

Editorial Staff

Jefferson Journal of Psychiatry

List of Editorial Staff for Volume 4, Issue 2, Spring 1986 issue of the Jefferson Journal of Psychiatry.

Letter To The Editor

Jefferson Journal of Psychiatry

Dr. Chessick responds to Dr. Dorn's Review of why Psychotherapists fail.

In Response: A Discussion Of "Bulimia As A Masturbatory Equivalent", C. Philip Wilson, Md

Jefferson Journal of Psychiatry

My research and that of my colleagues in the psychodynamic cause, structure and treatment of patients with bulimic anorexia nervosa correlates with and confirms the hypotheses presented by Levin ( 1) that bulimic symptoms may represent a masturbatory equivalent.

In our recently published book, Fear of Being Fat: The Treatment of Anorexia Nervosa and Bulimia (2) we confirmed Sperling's findings (3) that unresolved preoedipal fixations to the mother contribute to difficulties in psychosexual development and that anorexic girls and boys displace sexual and masturbatory conflicts from the genitals to the mouth.

In Search Of The "Fundamental Rule" Of Supportive Psychotherapy, Jeffrey R. Sarnoff, Md

Jefferson Journal of Psychiatry

Early in my first year of residency training in psychiatry, while working between acute-care inpatient units and a busy crisis service, it appeared that virtually every patient was said to have been treated with supportive psychotherapy, in conjunction with psychotropic medication. This appearance was deceiving, and if not for thorough supervision, reading, discussion with faculty and peers, and autocritical review, I might still believe that my earliest, and perhaps sickest, patients were indeed treated with supportive psychotherapy. In retrospect, some were and some were not; the explanation for this discrepancy came with the realization that I did not have very …

Learning And Teaching Psychoanalytic Psychotherapy, Ann E. Steel, Md

Jefferson Journal of Psychiatry

Book review of:

AN INTRODUCTION T O PSYCHOTHERAPY

Sidney Tarachow, M.D.

New York: International University Press, Inc.,1963. 332 pp., $32 .50

Canoe Trip, David Mitchell, Md

Jefferson Journal of Psychiatry

"Perfect," he said as he carved his knife into the surgical wound, exposing another layer of fascia. We were standing in the operating theatre: he, the surgical chief resident, and I, a third-year medical student. It was the first of many appendectomies I would scrub in for during my surgical rotation. The patient was a I2-year-old boy who had come to the Grand Valley Hospital emergency room that day. He had a low-grade fever, sweats, and periumbilical pain that had migrated to the right lower quadrant of his abdomen. After quizzing me on various anatomical structures, removing the inflamed appendix, …

Folie Á Deux, Ulhas Mayekar, Md

Jefferson Journal of Psychiatry

Folie a deux, also called dual psychosis, involves the transfer of delusional ideas from a psychotic individual to a nonpsychotic individual within the framework of a close relationship, with the eventual in corporation of the delusional system into the psyche of the previously non psychotic individual.

Diagnosis In The Neuroleptic Malignant Syndrome, James H. Dallman, Md, Cpt, Mc

Jefferson Journal of Psychiatry

Neuroleptic malignant syndrome (NMS) is an uncommon, potentially lethal complication of treatment with antipsychotic medication. First described in American journals by Delay and Deniker in 1968 (1), this syndrome has been reported for many years in the European and Japanese literature.

Decision Trees For Use In Childhood Mental Disorders, Henry A. Doenlen, Md

Jefferson Journal of Psychiatry

The third edition of The Diagnostic and Statistical Manual ofMental Disorders (DSM-III) (1) provides specific diagnostic categories for use in childhood mental disorders, even though these diagnoses are not limited to children. In addition, many of the diagnostic categories used for adults are considered appropriate for use in children. DSM-I II instructs the clinician to diagnose children by first considering the section "Disorders First Evident in Infancy, Childhood, or Adolescence" before considering the disorders described elsewhere. However, this may lead to problems because some major diagnostic categories such as affective disorders and schizophrenia are not included …

The Neuropsychiatric Syndrome Of A Psychomotor Seizure Disorder In Shakespeare's Othello, The Moor Of Venice, Alan J. Cohen, Md

Jefferson Journal of Psychiatry

Many of Shakespeare's characters suffer from the myriad of medical and surgical ailments that afflict mankind. Although many of these diseases serve merely to enhance the subtle shading of character in Shakespearean drama, certain disorders seem to provide a vital focus for the basic theme and plot development of the plays. No group of disorders is more implicated by the behavior and thought patterns of Shakespeare's characters than neuropsychiatric disease. Othello, the Moor of Venice stands out as a striking example of a tragedy

in which the main character suffers grievous consequences from a disease that affects …

Carbamazepine In Treatment Of The Violent Psychotic Patient, Lauren A. Pate, Md

Jefferson Journal of Psychiatry

Violence in the psychiatric setting may be perpetrated by patients with a variety of diagnoses including character disorders, episodic dyscontrol syndromes, and drug or alcohol intoxication. The violent behavior of aggressive psychotic patients is typically the most bizarre, unpredictable, and the least responsive to intervention with neuroleptics or lithium carbonate. Carbamazepine, an established anticonvulsant, has achieved growing prominence as an adjunctive measure in treatment of the violent psychotic. This paper will review the literature and summarize the posited pharmacological mechanisms, reported side effects, and clinical experience with carbamazepine in controlling the symptoms of violence and aggression in psychosis.

The Stress Factor: Exploring The Possibility Of A Psychological Component To Cancer, Bernard M. Edelstein, Md

Jefferson Journal of Psychiatry

As dwellers in the same house, it seems only logical that psyche and soma would be interdependent , that well-being in one would promote health in the other, and that illness in one would soon become manifest in its partner. Yet quantifying this intuitive relationship has long been a difficult task. Establishing a mechanism for disease-heart disease, infectious disease, neoplastic disease which can withstand the scrutiny of experimental rigor, is difficult enough. To introduce a seemingly not quantifiable entity such as psychology in the form of stress or anxiety presents such great complexity that for a long time it seemed …

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor for the Jefferson Journal of Psychiatry, Volume 3, Number 2, July 1985.

E = Mc², John Matt Dorn, Md

Jefferson Journal of Psychiatry

Book Review: WHY PSYCHOTHERAPISTS FAILRichard D. Chessick, M.D.New York: Jason Aronson, 1971203 pp., $20.00

The Impact Of Hysterectomy During Adolescence In A Woman Of Reproductive Age, Susan K. Ball, Md

Jefferson Journal of Psychiatry

There is extensive psychiatric literature on the psychological effects of hysterectomy on both pre-menopausal and post-menopausal women, but a careful search covering the last ten years and beyond reveals no references to the impact of hysterectomy during adolescence. There is also nothing on this subject in the gynecological literature of the last ten years. Obviously, the incidence of severe pathology necessitating hysterectomy is extremely rare. However, there can be little doubt that a procedure of such symbolic magnitude at an age when a young woman is trying to integrate her personality, emerge as an autonomous sexual being, and experiencing a …

Psychotherapy Or Pseudotherapy?, Lawson R. Wulsin, Md

Jefferson Journal of Psychiatry

What is psychotherapy? I wish I knew . Thick books and long talks still leave me wondering. Hours of patients and almost as many hours of supervision leave the question hanging. I know what ECT is and how to give a good trial of arnitryptiline, but I am never quite sure if what I am offering is true psychotherapy. Admittedly I am young and have only been wet for five years. But I have had one experience in my short time that put the question in perspective by putting it backwards, that is, what is notpsychotherapy, or what is pseudotherapy?

The Webs We Weave: A Patient With Depression, Mary Ann Venezia, Md

Jefferson Journal of Psychiatry

Looking back over C.'s records, I was struck by a phrase I had used to describe her, "She really seems at a loss as to what she should do with herself. " A more accurate appraisal might have reflected my own uncertainty as to how I could help C. Hospitalized eight times in eight years after serious suicide attempts, she had been treated with neuroleptics, antidepressants, psychotherapy, and been involved with a day program. Once again she was in the hospital, severely depressed following a suicide attempt. There was little the psychiatric establishment had not tried . So I taught …

The Neuroleptic Malignant Syndrome: Do We Know Enough?, Ali Hassan M. Ali, Md

Jefferson Journal of Psychiatry

The Neuroleptic Malignant Syndrome (NMS) is a potentially grave adverse reaction to oral or parenteral neuroleptic therapy that may be an underdiagnosed and easily overlooked clinical problem. NMS is characterized by hyperthermia, hypertension, diaphoresis, muscular rigidity, and altered mentation. There is currently no way of predicting which patients will develop NMS, although its incidence may be higher in patients who are unresponsive to usually effective dosages of neuroleptics ( I) .

NMS was first described in the French literature by Delay and Deniker in 1960 (2). They reported five cases among several hundred patients who were treated with haloperidol (Haldol"), …

A Patient With Aids, Susan Ball, Md, Stephen Hauptman, Do, Jean Helz, Md, Sheila Murphey, Md, Beth Shindell, Mss

Jefferson Journal of Psychiatry

Susan Ball , M.D.. Chief Resident: Mr. B, a thirty-five-year-old white male, was admitted to the medical service with chief complaints of fever, chills, and increasing shortness of breath. This was Mr. B's second admission. His first was six month s ago for pneumonia, leukopenia, and lymphadenopathy of unknown etiology. At that time he was treated with antibiotics; he improved and was discharged. Since that time Mr. B reported continuing to feel weak and lethargic. Two weeks before this admission he noted the onset of fever, chills, sore throat, and a nonproductive cough. He initially saw …

Bulimia As A Masturbatory Equivalent, Eric Levin, Md

Jefferson Journal of Psychiatry

Introduction

In the last few years much has been written about those who binge-eat and then purge. These people, most of whom are women, resort to extreme measures to avoid gaining weight while not foregoing the gratification of eating.

Most recent papers on this disorder have focused upon description, classification, and the search for neurobiological causality . Little has been presented on the psychodynamics of bulimia that would help us understand the symbolic significance of this disorder. The following case presentation illustrates how bulimia may present as a neurotic symptom, and as such may be overdetermined, yet representative of a …

Some Reflections On Termination: Transference And Countertransference, Frederick L. Becker, Jr, Md

Jefferson Journal of Psychiatry

INTRODUCTION

Nearing the completion of my psychiatric residency, I ingenuously told my supervisor that I needed to know the steps of termination in therapy with patients. On the surface, this request reflected an awareness of the issues at hand and their importance. Beneath lay ambivalence and countertransference anxiety . For the graduating resident, time ordinarily invested in thought and study fills with practical considerations of job hunting and starting a practice. The resident' s own unresolved and unsettling separation issues can further push aside therapeutic considerations for his patients. Termination, the art of the veteran therapist, becomes an unwelcome …

The Use Of Light In The Treatment Of Depression, Mark D. Miller, Md

Jefferson Journal of Psychiatry

INTRODUCTION

Light has recently been reported to be a useful treatment in affective illness (1,2, 3, 4, 5, 6). What type of patients respond to this type of treatment ? What is the theoretical mechanism of action of light therapy and what are the implications of this research for the existing theories of affective illness? This review will seek answers to these questions by summarizing the recently reported studies of the effects of light on depression , by reviewing the pertinent contributions from neuroanatomy, endocrinology and circadian rhythm physiology, and, finally, by suggesting some points of integration of these recent …

Editor's Column, John Matt Dorn, Md, Chief Editor

Jefferson Journal of Psychiatry

The last few months of my residency have been a strange time for me. Half-way out the door and half-way in, I find myself simultaneously saying hello and good-bye. This in itself is not unusual. There are many situations in life that arouse varying degrees of separation and stranger anxiety. Perhaps this time is unique because it marks, at least superficially, the end of a prolonged adolescence. Or, as a friend of mine who is also finishing his professional training wrote to me recently: "Good students that we have been, we face a sudden decline in the steady flow of …

List Of Editors

Jefferson Journal of Psychiatry

List of Editors for Jefferson Journal of Psychiatry Volume 3, Number 2, July 1985.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor to the Jefferson Journal of Psychiatry.

The Double Blind Gordian Knot, John Matt Dorn, Md

Jefferson Journal of Psychiatry

Book Review of: DIFFERENTIAL THERAPEUTICS IN PSYCHIATRY: THE ARTAND SCIENCE OF TREATMENT SELECTIONA. Frances, M.D., J. Clarkin, Ph.D., & S. Perry, M.D.New York: Brunner/Mazel, 1984395 pp., $30.00

Problems With Separation In An Identical Twin, Henry A. Doenlen, Md

Jefferson Journal of Psychiatry

Introduction

During residency we learn to apply the theories of development to understand and help our patients. These theories are based upon the relationship between a single childand his parents as he struggles to separate and individuate. Identical twins have special problems in that not only do they have to separate from their parents, but also from each other.