Psychiatry Commons^™

Case Report Of Dramatic Resolution Of Psychotic Symptoms During Cross-Over To Clozapine, Leo Sher M.D., Alan Mendelowitz M.D.

Jefferson Journal of Psychiatry

Clozapine is the first antipsychotic drug with proven superiority over conventional antipsychotics in the management of treatment-resistant patients. We describe a case of tratment-resistant schizoaffective disorder in a young woman who improved rapidly on clozapine. The patient was started on a low dose of clozapine while fluphenazine was decreased. She improved significantly during the first several days of treatment. This improvement took place well before the expected effect of clozapine. Possible explanations for this unusual response include: 1) the placebo effect; 2) fluphenazine dose-response curve; 3) acute clozapine neurochemical mechanisms; 4) inaccurate original diagnosis. Better understanding of the mechanisms of …

Case Report: Failure Of Group Therapy With Elderly Russian-Jewish Immigrants (An Exploratory Analysis), Gennady Berezkin M.D.

Jefferson Journal of Psychiatry

This paper is a description of an unsuccessful attempt to carry out group therapy with elderly Russian-Jewish immigrants.

An attempt was made to conduct group therapy following general principals of traditional psychotherapy with geriatric populations.

In the final analysis, we conclude that culturally based preconceptions toward psychotherapy, culturally based stereotypes of interpersonal relationships and culturally-based transference to the therapist were the primary reasons for the development of negative transference and resistance which culminated in the ultimate failure of group psychotherapy with this group of elderly immigrants.

Saint Simeon The Stylite: A Psychiatric Examination Of The Life Of A Fifth Century Monk, Iracema Leroi M.D., Joseph B. A. Meagher M.D., M.R.C. (Psych) Frcpc

Jefferson Journal of Psychiatry

Religion is now the focus of more attention in psychiatry. This paper examines the life of the fifth century monk, Simeon the Stylite, from a contemporary psychiatric perspective. Such a retrospective examination presents difficulties with regard to the diagnosis of possible psychotic phenomena. A further examination presents difficulties with regard to the diagnosis of possible psychotic phenomena. A further problem is trying to distinguish between a religious and a psychiatric interpretation of particular experiences.

The authors outline the life of Simeon and some contemporary opinions. They agree with Kroll and deGanck that great caution is needed in the psychiatric interpretation …

The Psychiatry Access Center: A New Opportunity For Innovative Residency Training, M. Bates Redwine M.D., Ryan Finkelbine M.D., William Carson M.D., Susan Hardesty M.D., Linda Lewis M.N., R.N., C.S.

Jefferson Journal of Psychiatry

A recently introduced PGY-1 rotation in an innovative, managed care oriented program offers many training advantages for residents. The rotation offers first-year residents intensive interviewing-skills training, experience with obtaining and documenting the psychiatric history and physical examination, and in the process, offers early exposure to a managed care environment. The Psychiatry Access Center employs non-resident clinicians to perform urgent evaluations and all admissions to the main psychiatric hospital. The service has been tested successfully without requiring resident work, and therefore allows the integration of residents into the system via a new rotation designed to focus exclusively on educational needs.

Implementation Of A Computer-Based Communication System For Psychiatry Residents, Daniel Z. Lieberman M.D.

Jefferson Journal of Psychiatry

In order to encourage different kinds of communication among residents who were located at a number of geographically separate sites, a computerized communication system was implemented. Priority was placed on both richness of features and ease of use. Residents were able to send private email, join public conferences, and access databases of information. The system was initially used by a large number of residents, and usage patterns are described. The introduction to information technology that residents gained from the system led to other computer projects, and an interest in the resources of the Internet.

Call For Papers On Aspects Of Violence And Psychiatric Training, Derek Puddester M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Difficulties Associated With A Clinical Psychiatric Study Of A Transient Population, Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Editor's Column, Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Defiant Children: A Clinician's Manual For Assessment And Parent Training By Russell A. Barkley, M.D., Stephen Zerby M.D.

Jefferson Journal of Psychiatry

No abstract provided.

[In Response To "The Neuroleptic Treatment Of Schizophrenia: Dosing Strategies, Depot Preparations And Novel Medications" By Alexander S. Young, M.D. (Volume 13, 18-26)], James Longhurst M.D., Joseph Cassar M.D.

Jefferson Journal of Psychiatry

No abstract provided.

The Relevance Of Transference During Medication Management: A Case Of Erotized Transference, Helen C. Kales M.D., James Abelson M.D., Ph.D., Michelle B. Riba M.D.

Jefferson Journal of Psychiatry

Forces existing in psychiatry may diminish the importance of psychotherapy training as psychiatrists are increasingly given the task of medication management. Psychotherapeutic relationships can be created in medication management settings, however, and the neglect of concepts such as transference could have deleterious consequences. The authors describe the case of a man with a traumatic brain injury referred for medication management who developed an erotized transference toward his female resident-physician. This case illustrates the concept that an understanding of transference is relevant to the setting of medication management

Gabapentin In The Treatment Of Bipolar Disorder, Wendy M. Waits, Donald P. Hall Jr., M.D.

Jefferson Journal of Psychiatry

Gabapentin, a relatively new anti-epileptic drug (AED), is emerging as a therapeutic option for treatment refractory and rapid-cycling bipolar illnesses. Pharmacotherapy for bipolar disorders traditionally involves valproate, carbamazapine, or lithium, drugs which are associated with numerous adverse effects. Conversely, gabapentin has an attractive pharmacokinetics profile and relatively few side effects. There are no large randomized controlled clinical trials to date examining gabapentin’s role in mood stabilization. However, informal reports have cited encouraging results in up to 80% of patients and general tolerance to side effects. These findings make the new drug a possible choice for patients who have failed to …

The Somatization Of Depression In Native Pakistani Women, Rubeena H. Mian M.D., Linda S. Grossman Ph.D.

Jefferson Journal of Psychiatry

Previous studies have pointed out the comorbidity of somatization and depression among non-Western psychiatric patients. We studied the somatization of depression in Pakistani women. Two groups were studies: inpatients with DSM-III-R diagnoses of major depression and a comparison sample of women living in the community without psychiatric diagnoses. Both groups were administered a rating scale for somatization. Results indicated that patients reported significantly more somatic symptoms than nonpatients. These findings support the concept that somatization may be a cultural mode of mental distress among Pakistani women, as has been observed for other non-Western populations.

Folie Á Deux: Two Case Reports, Mohammad Y. Abu-Salha M.D.

Jefferson Journal of Psychiatry

Two cases of “Shared Psychotic Disorder” were diagnosed over a period of less than a year in a children’s psychiatric center. Shared Psychotic Disorder is one of the differential diagnoses that need to be entertained when evaluating a delusional patient. Including the patient’s family and/or significant others in the assessment increases the possibility of diagnosing Shared Psychotic Disorder. An eight-year-old girl was admitted after exhibiting psychotic behavior with paranoid delusions she shared with her mother. Specifically, she reported that “neighbors next door were repeatedly breaking into her house, pinning her down, raping her, and injecting her with I.V. drugs.” An …

Early Detection Of Autism In The Population, John D. Mclennan M.D., Ph.D.

Jefferson Journal of Psychiatry

Frequently there is a delay in the diagnosis of autism in children which may result in a lost opportunity to provide early intervention. Signal detection studies have suggested that single items have good predictability for autism which suggests simple screening procedures may be helpful in the early detection of an autistic disorder. Studies of autism in the very young have found that specific social deficits appear to characterize this group. A three stage procedure is presented as a possible approach to detect autism at an early age in the population thereby allowing for early intervention.

Editor's Column, Tanis Gaitens M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Children And Adolexcents Of Distinction - Culturally Diverse Children And Adolescents: Assessment, Diagnosis, And Treatment By Ian A. Canino, M.D. And Jeanne Spurlock, M.D., Lloyda R. Broomes M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Stevens-Johnson Syndrome Following Treatment With Carbamazepine For A Mood Disorder, Albert Coleman M.D., M.P.H., B. Trappler M.D.

Jefferson Journal of Psychiatry

A case of Stevens-Johnson Syndrome (SJS) induced by carbamazepine in a psychiatric patient with schizo-affective disorder is reported. The patient also had diabetes mellitus and was on glyburide which posed an initial dilemma at the onset of SJS as to the causative drug. In view of the expanding use of carbamazepine in psychiatric patients and the potentially lethal consequences of SJS, the authors suggest a risk management approach when initiating Carbamazepine therapy to reduce the incidence and morbidity of the syndrome.

Steroid-Induced Psychosis Presenting As "Alice In Wonderland" Syndrome, Vinobha Gorriah M.D., Frank W. Favazza M.D., Migdalia Fort-Ramirez M.D.

Jefferson Journal of Psychiatry

A 40 year old overweight male with a history of bronchial asthma, hypertension, and “schizophrenia” was admitted for intractable bronchial asthma. He did not have a history of drug or alcohol use.

Upon admission, he was treated with high doses of IV methyl prednisone, oral prednisone, and triamcinolone inhaler. He developed complex visual hallucinations which decreased following tapering of prednisone and discontinuation of the triamcinolone. EEG showed diffuse slowing suggesting a toxic metabolic state.

Managed Mental Health Care: An Oxymoron Of Ethics?, Jonathan M. Metzl M.D.

Jefferson Journal of Psychiatry

No abstract provided.

The Role Of Group Psychotherapy In Psychiatric Residency Training, Shahbaz R. Khan M.D., Katherine A. Cowan M.D., Pedro Ruiz M.D.

Jefferson Journal of Psychiatry

Group psychotherapy has become a well-recognized treatment modality in the mental health field. Educationally, however, group psychotherapy has not reached the priority level it deserves. We described our experiences in using group psychotherapy as a training tool at the University of Texas at Houston. In describing our program, we used case illustrations to better demonstrate the richness of our training experiences. Group psychotherapy should be more extensively used in the training of tomorrow’s mental health professionals.

The Neuroleptic Treatment Of Schizophrenia: Dosing Strategies, Depot Preparations And Novel Medications, Alexander S. Young M.D.

Jefferson Journal of Psychiatry

Significant progress has been made over the past decade in the use of antipsychotic medication. An improved understanding of neuroleptic side effects has led to the development of new clinical strategies for dosing traditional medications. Traditional medications have become widely used in depot preparations. Risperidone, a new medication with an improved side effect profile, has recently become available. Clozapine, a novel medication, has entered widespread use. The use of these new clinical technologies is briefly discussed, along with the implications they have for the role of the psychiatrist in community mental health settings.

Ultradian Cycles Of Mood In Normal And Depressed Subjects, Donald P. Hall Jr., M.D., David Benedek M.D., Audrey Chang

Jefferson Journal of Psychiatry

Objective: To study ultradian cycles of mood in four inpatient groups.

Method: We assessed the mood of depressed and nondepressed subjects, on an hourly basis, between 7:00 a.m. and 10:00 p.m. for two consecutive days using a visual analog scale of mood. Hourly mood scores for each group were plotted against time.

Results: We found ultradian cycles with mean lengths of 3-4 hours in all groups. The major depressive episode and adjustment disorder depression groups, however, had ultradian cycles of significantly greater amplitude than ward staff.

Conclusions: Depressed patients demonstrate greater amplitude in ultradian cycles of mood than nondepressed subjects.

Smoking Rates After Cessation Of Alcohol And/Or Cocaine: A Pilot Study, Timothy R. Jennings M.D.

Jefferson Journal of Psychiatry

Objective: To assess the change in smoking rates in alcohol and/or cocaine dependent patients after the cessation of the primary drug of use.

Design: A self-report questionnaire was administered upon admission to a Residential Treatment Facility, in the fourth week, and in the final (sixth) week of the program. The control group was administered a self-report questionnaire at the time of intake as controls and again four and six weeks later.

Setting: Residential Treatment Facility (RTF) a 30 bed inpatient alcohol and drug treatment unit, at Eisenhower Army Medical Center, Fort Gordon, Georgia.

Patients: A Total of 42 patients; 37 …

Editor's Column, Carmen Z. Harlan M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Manipulating Fate: Medical Innovations, Ethical Implications, Theatrical Illuminations, Karen H. Rothenberg, Lynn W. Bush

Faculty Scholarship

Transformative innovations in medicine and their ethical complexities create frequent confusion and misinterpretation that color the imagination. Placed in historical context, theatre provides a framework to reflect upon how the ethical, legal, and social implications of emerging technologies evolve over time and how attempts to control fate through medical science have shaped -- and been shaped by -- personal and professional relationships. The drama of these human interactions is powerful and has the potential to generate fear, create hope, transform identity, and inspire empathy -- a vivid source to observe the complex implications of translating research into clinical practice through …

Reintegration Of Child Soldiers In Burundi: A Tracer Study, Mark J.D. Jordans, Ivan H. Komproe, Wietse A. Tol, Aline Ndayisaba, Theodora Nisabwe, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.

Evaluating Psychiatric Patients’ Attitudes Of A Shared Electronic Medical Record, Edward R. Norris Md, Fapa, Fapm, Julia R. Correll Ba, Jamie Bongiovi Lcsw, David Dylewski Ms, Gail Stern Msn, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.

Neurotechnology And Psychiatric Biomarkers, William Bosl

Nursing and Health Professions Faculty Research and Publications

No abstract provided.

Hemicrania Continua Headache In A Veteran With Post Traumatic Stress Disorder And Major Depressive Disorder Without Traumatic Brain Injury, Brandon A. Kohrt, Erica Duncan

Psychiatry and Behavioral Sciences Faculty Publications

Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.