Psychiatry Commons^™

Editor's Column, Mary E. Donovan, Md

Jefferson Journal of Psychiatry

With this edition of the Jefferson Journal of Psychiatry I am pleased to welcome Edward Silberman, M.D. as our new Faculty Advisor. Dr. Silberman is the Residency Program Director at Thomas Jefferson University, and he brings a great deal of enthusiasm about resident research, writing and publishing to the Journal. In addition to enthusiasm, he brings his own experience with writing for psychiatric publication with which to advise us, and we welcome his guidance as the Journal begins its twelfth year of publication.

Editorial Staff

Jefferson Journal of Psychiatry

Editorial Staff for Volume 12, Number 1, 1994 for Jefferson Journal of Psychiatry.

Psychodynamic Contours Of Post-Traumatic Stress Disorder, Noah D. Freedman, Md

Jefferson Journal of Psychiatry

PSYCHOTHERAPY OF THE COMBAT VETERAN

Harvey J. Schwartz, M.D., Ed.New York, Spectrum Publications, 1984

Distributed by: Integrated Publishers, 195 McGregor St., Manchester , NH 03102, 603-669-5933

Psychodynamics: The State Of The Art, Robert Hall, M.D.

Jefferson Journal of Psychiatry

PSYCHODYNAMIC CONCEPTS IN GENERAL PSYCHIATRY

Harvey J. Schwartz, MD with Efrain Bleiberg, MD and Sidney Weissman, MD editors

American Psychiatric Press, Inc., in press.

Walking In One's Own Shoes, Robert Neil Gerstman, D.O.

Jefferson Journal of Psychiatry

ILLNESS IN THE ANALYST:IMPLICATIONS FOR THE TREATMENT RELATIONSHIP

Harvey J . Schwartz, M.D. and Ann-Louise S. Silver, M.D.,

Editors International Universities Press, New York 1990, 347 pp., $42.50

The Psychoanalytic Approach To Bulimia, Doris Mirowski, M.D.

Jefferson Journal of Psychiatry

BULIMIA: PSYCHOANALYTIC TREATMENT AND THEORY

Harvey J. Schwartz, M.D., Ed.

International Universities Press, Inc., Madison, CT.

1990 (second edition), 549 pages, $65.00.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

What Place Does The Real-Relationship Have In The Process Of Therapeutic Character Change?, Patrice Duquette, Md

Jefferson Journal of Psychiatry

The relationship between therapist and patient is an important tool in the process of helping a patient change. There are various elements that make up the total relationship between patient and therapist, each with its own power to exert for and against change. Transference can be one of the most relentless of these elements in maintaining the status quo for ourpatients. To help our patients make significant gains against this relentless pressure is most of our task in psychotherapy. The real-relationship has been considered in the literature since the early 1940's and is described by Greenson as "the realistic and …

Climbing Through The Milwaukee County Civil Commitment Process, Jon A. Lehrmann, Md

Jefferson Journal of Psychiatry

Civil commitment has become a practically unavoidable process for today's practicing psychiatrist. It creates a complicated triangular relationship involving the legal system, the medical system, and the patient.

This article is a first person narrative of a case which helps describe the Wisconsin civil commitment process as it operates in Milwaukee County. It illustrates the frustrations that a psychiatrist (and in this case a first year psychiatry resident) can experience in such a system. Finally, it addresses these problems associated with civil commitment and discusses possible solutions.

Involuntary Psychiatric Hospitalization And Risk Management: The Ethical Considerations, Richard C. Christensen, Md, Ma

Jefferson Journal of Psychiatry

During an era where physicians go to great lengths to limit personal risk and ensure self-protection from lawsuits, psychiatrists may be inclined to err on the side of involuntarily hospitalizing patients who have been briefly evaluated in the emergency room or clinic setting. However, conscientious treatment decisions, particularly those pertaining to involuntary psychiatric hospitalization, need to address at least two fundamental ethical concerns: the patient's best interests and the clinician's motives. This article discusses the moral components involved in clinical decision making and presents a case example which highlights the ethical implications of involuntary psychiatric hospitalizations.

Carbamazepine-Associated Hyponatremia, Mitchell S. Gandelman, Md, Phd, Sandra Dabora, Md, Phd, Rebecca L. Johnson, Md, Michelle B. Riba, Md

Jefferson Journal of Psychiatry

Four cases of CBZ-induced or exacerbated hyponatremia are described in middle-aged to elderly females. Two cases are remarkable in that the pretreatment sodium levels demonstrate hyponatremia. A return to prior sodium levels was observed upon the discontinuation of carbamazepine therapy. No definitive conclusions can be drawn from these case reports; however, similarities in the cases can be examined as follows: (1) all four women have medical problems, in particular two patients had pre-existing hyponatremia; (2) all four patients were using concurrent medications; (3) all four women presented psychotic. A literature review examines risk factors, pharmacological mechanism, and the time course …

Polymyalgia Rheumatica Presenting As Depression: The Role Of The History And Physical Examination In Psychiatric Assessment, J.H. Ennis, Msw, Md, J.K. Leclair, Md, Frcp (C), L. Wadas, Bsw, Csw, C. Patterson, Md, Frcp (C)

Jefferson Journal of Psychiatry

Surveys have indicated that physical examination is a diagnostic tool that is infrequently used by psychiatrists. This is an unfortunate state of affairs in light of the act that the bio-psycho-social formulation of health-care problems is integral to the treatment of psychiatric disorders. The situation becomes all the more complex when faced with the high comorbidity of physical and psychiatric illness in the elderly presenting with depression. The physical examination, guided by a detailed history, must be considered an integral part of the assessment of depression in the elderly. A case study of polymyalgia rheumatica presenting as depression is utilized …

Firesetting In Children, Donna V. Mehregany, Md

Jefferson Journal of Psychiatry

This article reviews the literature regarding the history, etiology, diagnosis, and treatment of firesetting. A critique of the literature reveals the need to generate a clearer definition of firesetting as well as more stringent criteria for diagnosing firesetting. The standard treatments for firesetting are reviewed. Linkage of childhood firesetting to future adolescent and adult crimes is also examined. Finally, avenues for future research are discussed.

Pharmacologic Advances In The Treatment Of Schizophrenia, Scott A. West, Md

Jefferson Journal of Psychiatry

The treatment of schizophrenia was revolutionized with the introduction of chlorpromaeine in 1952. The effectiveness of chlorpromazine in controlling psychotic symptoms lead to the dopamine Hypothesis of schizophrenia, which revolutionized our conceptualization of this illness. Since that time, numerous typical antipsychotic drugs have been developed for the treatment of schizophrenia. However, the introduction of clozapine in 1990 began a new era in the pharmacologic management of schizophrenia. Clozapine, an atypical antipsychotic drug, is effective in controlling the positive Symptoms of schizophrenia in a large number of otherwise treatment-resistant patients, and also improves the negative symptoms of the illness in marry …

Psychogenic Amnesia: A Case Involving Amobarbital Interview And The News Media, Tracey G. Skale, Md, James Randolph Hillard, Md

Jefferson Journal of Psychiatry

A young man was admitted to an urban general hospital psychiatric unit after being brought from a local shopping mall unable to remember his name or any other personal information. He was alert and oriented and demonstrated no cognitive impairment. He agreed to an amobarbital interview and agreed to letting local news media display his picture in hopes that someone would recognize him. The amobarbital interview yielded information allowing identification of the individual, with the help of the news media. News media coverage also led to the discovery that the individual was wanted for a violent crime in another state …

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

Jefferson Journal of Psychiatry

It has been a pleasure and a privilege to have been the Faculty Advisor for the Jefferson Journal of Psychiatry for the past 10 years. We began this resident written and edited journal in 1983 as a small in-house publication designed to encourage our residents to put their thoughts about patient care into written form. Since then we have grown considerably and now serve as the only national resident journal in medicine. Many people over the years have made this effort possible. I would like to pay special thanks to our generous and supportive sponsors and …

Editor's Column, Mary E. Donovan, Md

Jefferson Journal of Psychiatry

In this edition of The Jefferson Journal of Psychiatry we say good-bye to Harvey J. Schwartz, M.D., who founded it as a resident education project ten years ago and who has been our Faculty Advisor ever since. Under Dr. Schwartz's mentorship the Journal has grown from a departmental vehicle for residents' writings to a national publication in which residents can be proud to have their work presented. Having become a nation-wide resident education project, sponsored in part by the APA, the Journal serves to meet a need for all psychiatry residents: to learn about writing, editing and publishing.

Editorial Staff

Jefferson Journal of Psychiatry

Editorial Board for Volume 11, Number 2, 1993 of Jefferson Journal of Psychiatry.

About The Authors

Jefferson Journal of Psychiatry

About the Authors, Jefferson Journal of Psychiatry, Volume 11, Number 1, 1993.

The Abc's Of Schizophrenia, Mary Donovan, Md

Jefferson Journal of Psychiatry

SCHIZOPHRENIA GENESIS, THE ORIGINS OF MADNESS

Irving I. Gottesman

W.H. Freeman and Company, New York, 1991

296 pages, $14.95, paperback

A New Voice On Personality Disorders, Dan Block, M.D.

Jefferson Journal of Psychiatry

BROKEN STRUCTURES: SEVERE PERSONALITY DISORDERS AND THEIR TREATMENT

Salman Akhtar, M.D.

Jason Aronson, Inc., 1991

So Much Success, So Little Joy, Robert Neil Gerstman, D.O.

Jefferson Journal of Psychiatry

GOOD GRIEF: THE STORY OF CHARLES M. SCHULTZ

Rheta Grimsley Johnson

Pharos Books, New York 1989

$17.95, 256 pgs.

Perspectives On Psychotherapy: In Our Evolving Profession, Susan M. Hall, M.D.

Jefferson Journal of Psychiatry

MOMENTS OF ENGAGEMENT: INTIMATE PSYCHOTHERAPY IN A TECHNOLOGICAL AGE

Peter D. Kramer , M.D.

W.W. Norton & Co.1989

Hardcover, 260 pp., $24.95

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor. Jefferson Journal of Psychiatry, Volume 11, Number 1, 1993.

A Resident Initiated Prite Review Course: Trials And Tribulations, David W. Metzler, M.S., M.D., Daniel L. Kinsey, M.D., Lesley R. Dickson, M.D., Mark Hyatt, M.D.

Jefferson Journal of Psychiatry

The experience of developing a review course to study for the Psychiatry Resident's In-Training Exam (PRITE) is discussed. Residents in our program felt that the review course was useful with respect to the following: studying for the PRITE; future study for National Boards; and learning of new material.

The Psychiatry Resident's In-Training Exam (PRITE) was developed in 1979 as a mechanism to assess the knowledge base of psychiatric residents in a standardized format (1,2,3). The exam was originally designed to simulate the American Board of Psychiatry and Neurology (ABPN) examination, PART I, and has gained widespread acceptance despite questions about …

Thalamic Tumor Presenting As Major Depression And Headache, Robert Jay Claire, M.D.

Jefferson Journal of Psychiatry

We report the case of a 39 year old male who presented with Major Depression, headache, and apathy. Within six weeks of his initial presentation the patient died from a "Central Herniation Syndrome" after biopsy of a left thalamic lesion. The statistics of medical problems presenting as psychiatric disorders as well as recent literature on personality changes associated with thalamic infiltration are reviewed.

It is recognized that from 33-80% of inpatient psychiatric patients have concurrent medical disease. A large proportion of these are unrecognized prior to psychiatric hospitalization (1). In 1983, Martin clearly stated that "psychiatric symptoms are often the …

Five Hours With Frank: A Case Study, Mark E. Kunik, M.D.

Jefferson Journal of Psychiatry

This manuscript explores a resident's dilemma when performing a psychiatric evaluation within the context of releasing a convicted rapist.

A Case Report Of Folie'a Deux: Husband-And-Wife, Ryan M. Nishihara, Craig T. Nakamura

Jefferson Journal of Psychiatry

Shared paranoid disorder is a relatively rare psychiatric disorder in which paranoid delusions are transferred from one individual to one or more other susceptible person(s) in close association. Folie a deux describes a shared paranoid disorder involving two people and is characterized by a complex dependant relationship between the involved individuals. Provided there is no additional underlying psychopathology, there is a good prognosis for the submissive partner. Here we present a case report and discussion off folie a deux involving a husband and wife. Although folie a deux is a relatively uncommon disorder, it is important to recognize such cases …

Clozapine-Induced Seizures And Eeg Changes: A Case Report And Discussion Of Clinical Management, Jeffrey Daly, M.D., Stephen Salloway, M.D., M.S.

Jefferson Journal of Psychiatry

Clorapine is an atypical antipsychotic agent associated with a higher frequency of seizures than standard neuroleptics. In addition, clozapine causes epileptiform abnormalities in the EEG in up to 72% of patients. A patient who developed a generalized seizure shortly after beginning clozapine treatment and the patient's EEG findings are presented. The neuropharmacology of dozapine and the management of clozapine-induced seizures and EEG abnormalities are discussed.

Cultural Aspects Of A Patient's Symptomatology: A Case Report, Theresa M. Miskimen, M.D.

Jefferson Journal of Psychiatry

Culture influences numerous aspects of human experience including behavior, beliefs, values and attitudes. A case report is presented emphasizing how cultural manifestations of a psychiatric illness may materially affect presentation of symptoms, illness perception, and explanatory model of illness of a patient. Cultural background is explored to offer improved rapport and patient care.