Psychiatry Commons^™

On The Outskirts Of Babel, John Matt Dorn, Md

Jefferson Journal of Psychiatry

INTRODUCTION

I admit to a fondness for book lists that began on Wednesdays in the eighth grade, when feet perched imperiously on the table in the corner I would review with inordinate glee the list of recommended reading. What seemed to others an onerous and pedantic exercise was to me a treasure map that dissolved the walls of the school around me.

Munchausen’S Syndrome: Towards A Psychodynamic Understanding, Sharon Riser, Md

Jefferson Journal of Psychiatry

INTRODUCTION

The third edition of the Diagnostic and Statistical Manual of Mental Disorders cites two essential criteria for the diagnosis of chronic factitious disorder with physical symptoms, more poetically known as Munchauseri's Syndrome:

a) Plausible presentation of physical symptoms that are apparently under the individual's voluntary control to such a degree that there are multiple hospitalizations;

b) The individual's goal is apparently to assume the "patient " role and is not otherwise understandable in light of the individual's environmental circumstances(I).

Additionally noted is the frequent occurrence of a true physical illness entailing extensive hospital treatment during the childhood or adolescence …

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

Jefferson Journal of Psychiatry

The season during which this issue of the Journal is being assembled is Autumn. It is a time of change, of growth, of new development.

For a small group of psychiatrists around the country, this period has an additional special meaning-it is recruitment season. For program directors and faculty it is this time every year that the mating ceremony known as the 'match' is prepared for . The mutual cueing and seductiveness, and indeed the ceremonies of courtship itself, are set in motion as faculty and soon-to-be medic al school graduates begin their unique dance.

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

Jefferson Journal of Psychiatry

Recently, an editor of The Jefferson Journal of Psychiatry remarked to me his regret that we don' t publish more original material. By this, I think he meant that the articles we publish do not break new ground, but tend to be compilations of existing ideas and beliefs. I think that he is right about this, and for a while I was disillusioned. On reflection, however, I think there may be some value in our project.

List Of Editors

Jefferson Journal of Psychiatry

List of Editors for Volume 3, Number 1 of the Jefferson Journal of Psychiatry, Jan 1985.

Letters To The Editor

Jefferson Journal of Psychiatry

We welcome all letters to the editor and encourage authors to reply. Input from residents and faculty on ideas presented in the Journal create an arena for discussion and dialogue that is the ultimate purpose of this undertaking.

Post Psychotic Depression In A Patient Who Castrated Himself, Harvey Stabinsky, Md, Jd, Susan Stabinsky, Md, Alfred Wiener, Md

Jefferson Journal of Psychiatry

With this article we inaugurate our efforts to expand the scope of the Journal beyond the walls of Jefferson. We thus open the Journal to residents of all programsand invite them to share their clinical experience and research. Circulation will include contributing programs.

Introduction

The differential diagnosis of psychosis associated with depression includes schizophrenia, schizoaffective and major affective disorders. Depression associated with schizophrenia may be a prominent feature of the patient's early presentation (I), or manifest itself only as the psychotic symptoms resolve (2, 3). Neuroleptics may play a causal role in the development of post-psychotic depression . This drug …

A Forty-Year-Old Woman With A History Of Psychosis And A Seizure Disorder, Jeffrey R. Sarnoff, Md, Robert E. Morrow, Md, Sharon Riser, Md, Ann E. Steel, Md, Jacob Berman, Md

Jefferson Journal of Psychiatry

In this issue of the Journal, we are introducing a new section. the Interdisciplinary Case Conference. Our goal will be to present psychiatric patients in whom pathology is demonstrable not only by interview, but also by physical examination,laboratory studies. and radiographic imaging techniques.

Book Review, John Matt Dorn, Md

Jefferson Journal of Psychiatry

INDIVIDUAL PSYCHOTHERAPY AND THE SCIENCE OF PSYCHODYNAMICS

David H. Malan, D.M., FRC Psych London: Butterworth , 1979 275 pp., $24.95

Psychosis In A Patient With Autoimmune Deficiency Syndrome, Vivian Charneco, Md

Jefferson Journal of Psychiatry

Introduction

Autoimmune deficiency syndrome (AIDS) is a disease whose incidence has grownprecipitously in recent years. Its victims face social and psychological isolation (I) .Contributing to this isolation is the fear of contact with AIDS patients that exists among health care workers and the public (2).

Increasingly more is being under stood about this mysterious disease. Recent reports have supported a viral etiology. The chief criterion for diagnosis is an inverted helper to suppressor T-cell ratio. Other supportive findings include lymphopenia,leukopenia, elevated IgA levels, and anergia. The following case report highlights the neurological and psychiatric symptoms that may be seen in …

Chronic Pain, Roberta Ball, Do

Jefferson Journal of Psychiatry

A complex problem of vast dimensions, chronic pain is receiving increasing attention due to the expansion of knowledge of the neurophysiology, neurochemistry and psychology of pain. Chronic pain presents a challenge to many disciplines in the health professions, and one that is more recently being presented to the psychiatrist.This paper will attempt to define the problem of chronic pain, to explore the concept of organic versus psychogenic pain, to describe the psychodynamics and other characteristics seen in the chronic pain patient and to discuss the importance of the psychiatristin evaluation and treatment of chronic pain .

The Evaluation And Treatment Of A Patient With Anorexia Nervosa, Gail S. Greenspan, Md

Jefferson Journal of Psychiatry

Introduction

Anorexia nervosa is a serious illness that has generated enormous public interest during recent times. Within the psychiatric field, numerous articles and books have been written about this syndrome. This literature reflects varied theoretical frameworks, from primarily biological approaches to family systems to psychodynamic theory. In this paper I will attempt to integrate family systems and psychodynamic theory in an understanding of a young woman with anorexia nervosa who was treated in a hospital setting.

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

Jefferson Journal of Psychiatry

This issue of our Journal marks a new stage in our development. We have started accepting papers from residency programs other than our own. Encouraged by the enthusiastic response our prior issues have elicited from psychiatric educators around the country, we are embarking on a program of expansion. In doing so we hope to provide a unique arena for psychiatric resident thinking. Residents nationwide are invited to share with each other and their faculties, their discoveries, their uncertaintiesand the newness with which they view their work.

Letters To The Editor

Jefferson Journal of Psychiatry

We welcome all letters to the editor, and encourage authors to reply. Input from residents and faculty on ideas presented in the Journal create the arena for discussion and dialogue which is the ultimate purpose of this undertaking.

Therapeutic Guitar-An Alternative Approach To The Treatment Of A Difficult Patient, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

The case described in this article is one where an experimental technique was introduced largely because of the therapist's dissatisfaction with the patient's progress. Despite the likelihood of being criticized, I feel compelled to write about this patient. The progress he has made is beyond my expectations, which were admittedly minimal at the outset.

Misuses Of Computers By Adolescents, Henry A. Doenlen, M.D.

Jefferson Journal of Psychiatry

One subject that has been a topic of much recent publicity and concern has been that of computer misuse. Teenage computer programmers gaining entry into the systems of universities, hospitals and businesses have caused the most concern . The duplication of copyrighted programs and information has also been reported to cause loss of considerable money. There seems to be a subpopulation of people who spend considerable time working with computers. These individuals may do so to the exclusion of other aspects of life such as human interaction . This paper will present both my observations of this behavior and my …

The Treatment Of A Borderline Patient Complicated By Involvement With A Charismatic Religious Cult: A Case Report, Mark Miller, Md

Jefferson Journal of Psychiatry

Introduction

Although much has been written about cults in recent years, many questions remain. Do cults recruit subjects by brainw ashing them or do individuals gravitate to cults to fulfill unmet needs? This paper will review some essential points of cult phenomena and discuss the treatment of one patient who was involved in a charismatic religious cult .

Possible Synergistic Action Between Carbamazepine And Lithium Carbonate In The Treatment Of A Manic Patient., John Matt Dorn, M.D.

Jefferson Journal of Psychiatry

Introduction

Carbamazepine has been proven to be efficacious in some patients with affective disorders, notably those who have not responded well to lithium carbonate or neuroleptics (1,2,3) . For those who have responded poorly to either regimen, however, there have been no effective pharmacotherapies until recently, when case reports have suggested a possible synergistic action between lithium carbonate and carbamazepine (4,5,6). The following case report supports this hypothesis.

The Use Of Carbamazepine (Tegretol) In Psychiatry And Its Association To Kindling, Temporal Lobe Epilepsy And Psychopathology, James Stanch, M.D.

Jefferson Journal of Psychiatry

The recent theory of kindling may help to link neurophysiologic, neurotransmitter and neuroanatomic mechanisms important in understanding the neurology of behavior. Limbic kindling is of interest in developing models of epilepsy, psychosis, learning and memory (l -5). Kindling might explain the late development of psychopathology.

This paper will first define kindling and demonstrate how kindling offers a model within which to view more prolonged behavioral deviations as neurophysiological processes. The use of carbamazepine and its association to kindling, temporal lobe dysfunction and psychopathology will be discussed .

Discussion Of The Paper By David A. Scola, M.D. On “The Hemispheric Specialization Of The Human Brain And Its Application To Psychoanalytic Principles”, Howard Field, M.D., Paul J. Fink, M.D., Thomas Swirsky-Sacchetti, Ph.D.

Jefferson Journal of Psychiatry

Dr. Scola proposes a bold and far-reaching synthesis of psychoanalytic theory, developmental neurobiology and neurophysiology of behavior. Freud found this task so frustrating in 1895 that he renounced neurology in favor of a purely psychologic approach (or so Freud claimed; Frank Sulloway sees it differently). Hypotheses that unconscious mental life is situated in the right cerebrum and that defense mechanisms are related to neuroanatomic connections are intriguing. The presentation does not include evidence which contravenes these theories. Sperry presented some evidence that the right hemisphere is self-aware and self-evaluative (I). One great problem in all cross disciplinary studies is the …