{"title":"Psychiatry and Psychoanalysis in The Nineties","authors":"D.E. Custer","doi":"10.29046/jjp.009.2.010","DOIUrl":"https://doi.org/10.29046/jjp.009.2.010","url":null,"abstract":"Th e Ph iladelphia Associa tion.for Psychoanalysis hosted a panel designed.for medical students, psychiat ric residents, psychiat rists and other professionals interested in applying psychoanalysic thought and listening skills to areas in general psychiat ry. Th e educational objecti ves included increasing fa mi liarity with the various components qfpsychoanalyt ic listening, (greater skill in mak ing use ofpsychoanalytic listening in work wi th patients) and height ened awareness ofthe varied applicat ions qf'psychoanalytic listening as a tool in general psychiatri c practice. T he Philad elphia Association for Psychoa na lysis host ed a pan el designed for medi ca l stude n ts, psychia t r ic residen ts, psychi atrist s a nd other profession als in terested in applying psychoan a lyt ic th ou ght a nd listening skills to areas in gene ral psych iat ry. Moderat or Bru ce J. Levin , M. D. ope ne d th e pa nel by describing two ge ne ra l approaches to patient ca re in psych ia t ry in th e 1990 's. U tiliz ing advances in neuroscien ce, one approac h searches for th e physica l and descriptive means to understand pat ients. Throu gh ca re ful listening, t he ot her a pproac h searc hes for th e emotional con t r ibu t ions to illn ess. The latter approach of ca re ful psychoa nal yt ic liste ning has expande d knowled ge in psych on eu rosis, personality di sorders, psych osoma tic medicine, gro up psych ology, a nd child a nd adolescent psych iatry. T hr ou gh a personal an a lysis, psycho an a lyt ic coursewor k, clinical expe rie nce and supervision, psychoa nalysts lea rn to eva lua te th e manifest con te nt of speech in searc h of its deeper meaning. Through th is meth od , th e analyst un covers un con sciou s conflict whi ch gives a grea te r understanding of th e pat ient to promot e furthe r a llevia t ion of suffe ring. Dr Levin developed the pan el d iscu ssion to demonstrate th at psychoanalyti c principl es applied","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123417219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychodynamic Contours of Post-Traumatic Stress Disorder","authors":"N. Freedman","doi":"10.29046/jjp.011.2.014","DOIUrl":"https://doi.org/10.29046/jjp.011.2.014","url":null,"abstract":"In Psychotherapy ofthe Combat Veteran, Harvey]. Schwartz, M.D . offers th e reader a n intellectually challe nging but rewarding journey throu gh a psychodynamic ex ploration of the \" wa r neuroses.\" Though th e conce pt of a post-t rauma tic stress di sorder (PTSD) was noted by Dr. Schwa rtz to have occurred in th e lit era tu re by 1978, and it was ens hrine d in the DSM III in 1980, th e work in this volum e lift s th e veil of the purely descriptive approach to explore th e psych odynamic con tours of the top ic. Dr. Schwartz has assembled many aspect s of th e lit erature includi ng th e hist ory of traumatic neu roses, sleep research , psych o-pharmacology, gro up therapy, bri ef th erapy, psychoanalytic psychotherapy, prevention, a nd a n investiga tion of th e effects of th e broader social environme nt. Schwartz frames th e book with a n exce lle n t int roduct ory cha pte r th at se ts ou t th e volume's main tasks: (I) an investigation of th e psych ological effec ts of massive trauma, including th e interaction of overwhelming ex ternal eve n ts wit h underlying infantile conflicts or fantasies; and (2) a n explora tion of wha t an effective \" holdi ng enviro nmen t\" may be for th e suffere rs of PT SD. Thes e tasks are accom plish ed with a fin e coll ec tion of ar ticl es which re vie w past lit erature and present original formulation s. Transferen ce and count ert ransference in work with severe ly traumatized patients are add ressed by Sha piro and in two articles by Schwartz. Blitz and Greenberg postulate a n a pproach to d rea m mat eri al related to conce pts of se lf psychology. Most helpful to m e were t he ab undant case exa m ples in this volume, whi ch provided vivid glim pses of th e psych ot he rapeut ic work . Those who have had some ex pe rience wi th t ra uma survivors a nd ca n a pprec ia te th e abstract nature of psychodynamic lit era ture will be able to ex t ra ct useful pointers for the direction and pitfalls in psych odynamic psychoth erap y with sufferers ofPTSD. Dr. Schwartz presents several cases including a/p a rt icula rly moving study of a severe ly di ssociated patient ca ugh t up in relivin g a n overwhelming trau ma tic experi-","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126935521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Potential Drug Interactions with Coumadin (Warfarin) and Prozac (Fluoxetine): A Brief Report and Review of the Literature","authors":"R. J. Claire, M. Servis, J. Cram","doi":"10.29046/jjp.009.2.006","DOIUrl":"https://doi.org/10.29046/jjp.009.2.006","url":null,"abstract":"We were askedto see a woman with recurrent depression and a history ifdeep vein thrombosis. (Consultation and L iaison Service). She had been started initially on Prorac (fluoxetine) and was secondarily started on Coumadin (uiaifarin). The patient presented with severe bruising if both lower extremities. We were asked to investigate the case to determine if a drug interaction with Prozac had produced the problem. A review if the world's literaturefai led to produce a report ifa drug interaction between Prozac and Coumadin producing a bleeding disorder. Scrutiny ifthis case could not produce evidence that this occurred. A retrospective analysis if 4 additional cases was performed. None ifthesepatients requiredadjustment iftheir Coumadin while on Prozac. It would be reasonable to assume that as th e mean age of th e U nited States population rises , th e inciden ce of como rbid medi cal a nd psychi a tric d isease is incr easing. Patients a re oft en pr escribed medi cations whi ch may int eract with psychotropic drugs . Second-generation ant idepressants a re ge ne ra lly cons idered safe drugs in th e medi call y ill popu lation because of their minimal a n t icho linerg ic properties and fewer adverse sid e effec ts. Fo r th e ph ysician , a kn owled ge of drug interactions with th e most com monly prescribed psychotropic medi cations is not only helpful , but should be th e standard of ca re. Recen tly, we were asked to see a woman with recurrent depression a nd a history of deep vein thrombosis . Sh e had been initially s tar te d on Prozac (fluoxe t ine ) an d was secondarily started on Co umad in (warfarin) . The pat ient pr esent ed with seve re bru ising of both lower ex t re mi t ies and a seco ndary cellu litis . An added com plica ting fact was that she had a Di ptheria , Pertussis, T et anus vaccination 3 weeks prior to ad mission. Bot h ce llulitis and th e D.P.T. vaccin at ion pot entially int e rfere with coag ula t ion. On admission her Proth rom bin Tim e (PT) was 50 a nd Part ial Thromb oplastin Time (PTT) was 100, a sce nario more cons iste nt with a coagulopa thy rather than Coumadin toxicity. When as ked to consult on this case , we had to investigat e th e possibil ity of Prozac interact ing wit h Coumadin. The Ph ysicia ns Desk Reference ca u tions agains t coa d ministe r ing th e two drugs . (I)","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129785367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Book Review: Biologic Psychiatry for the Biologist","authors":"J. Seibyl","doi":"10.29046/jjp.008.1.013","DOIUrl":"https://doi.org/10.29046/jjp.008.1.013","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"6 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120900417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary: The HIV-Positive Resident: Questions and More Questions","authors":"M. Blythe","doi":"10.29046/jjp.007.1.009","DOIUrl":"https://doi.org/10.29046/jjp.007.1.009","url":null,"abstract":"The resident physician who is infected with the human immunodeficiency virus (HIV) faces unique problem s. In addition to the diffi culties caused by a chronic and lethal disease, HIV-infected physicians-in-training face e thica l, educational and practical problems that are unique to th e interplay between residency training and the infectio n . To date, physicians who have been found to be infect ed with HI V have faced public discrimination, many with devastating results. Dr. Hacib Ao un, a Venezulean-born cardiologist who contracted AIDS from a boy with leukemia while he was a resident at Johns Hopkins, overcame rumors about how he had contracted the disease only to be faced with possible deportat ion. Despite being married to a U.S. citizen , Dr. Aoun was confronted with an immigration law th at stated that foreign citizens who have AIDS cannot become U.S. residents (1). Dr. Robert J. Huse was forced to close his Texas pediatrics practice wh en irate parents learned he had tes ted positive for HIV (2). Newspaper headlines from the November 16th issue of Today, an English newspaper, proclaimed \"A I DS Doctor Who Died\"; the pape r provided a photograph of th e doctor and a one-page report, noting that his wife and children were \" in hiding\" (3). While the issue of patient safety has been raised with aweso me regularity in these and other reports on physicians with AIDS, public h ysteria usually centers around patients contracting AIDS from ph ysicians. Despite numerous reports that casual contact does not spread AIDS (4), even health ca re professionals are often ignorant about AIDS and how it is transmitted (5). Few people would disagree with the American Medical Association position that a physician who knows th at he or she is seropositive should not engage in any activity that creates a risk of transmitting the disease to others (6). However, fear of this disease is so intense, that what constitutes \"safety\" has sometimes been differently defined for A IDS than for other diseases, even more prevalent diseases such as Hepatitis B which can also have letha l consequences (7). More recently, however, the safety issue has shifted to AIDS dementia . Infected physicians might fail to treat patients safely, according to this reasoning, not because of the possibility of infecting th e patient but because th e dementia could prevent the physician from practicing good medicine (3). As","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132584404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Book Review: Assessing the Risk, Suicide Risk: The Formulation of Clinical Judgement","authors":"Michael Gray","doi":"10.29046/JJP.007.1.011","DOIUrl":"https://doi.org/10.29046/JJP.007.1.011","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131066812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"No More Cuts: The Curious Fate of Self-Mutilation in Its Development","authors":"Zhabiz Kazeminezhad, S. Akhtar","doi":"10.29046/JJP.020.1.004","DOIUrl":"https://doi.org/10.29046/JJP.020.1.004","url":null,"abstract":"In this article, we present descriptions of four young women with relatively severe personality disorders. All four were in psychodynamic psychotherapy and all had the symptom of self-cutting. During their treatment, it became evident that their self-cutting had undergone a transformation and a new symptom had appeared in its place. In three, self-cutting was substituted by behaviors that we might call “cutting equivalents” and, in the fourth, by an enhanced self-reflective attitude and by journal-writing. We suggest that symptom-replacement for self-cutting may be common in its developmental course or in its course as it becomes influenced by psychotherapy, and that the replacement is sometimes, perhaps often, salutary. Approaching severe personality disorders psychodynamically has its pros and cons (1-3). On the one hand, it provides a deeper and more specific understanding of the patient, one in which his or her symptoms are seen as intricately bound with constitutional givens, early childhood experiences, and unconscious fantasies. On the other hand, if symptoms are end-products of a ‘trauma-fantasy-wish-defense’ sequence, any effort aimed simply at symptom-reduction is conceptually suspect and has practical risk. Psychodynamic models of etiology compel the prediction that removing a manifest disturbance might be undesirable, if the underlying issues responsible for it remain unresolved. This consideration acquires greater significance in cases of severe personality disorders (e.g., borderline, schizoid, antisocial, paranoid), which in some instances appear nearly intractable. The best outcome could be that a new, less toxic symptom replaces the older, more toxic one. Of course, if the former takes sublimatory or even “pseudo-sublimatory” form (1), the outcome can be regarded as not bad after all.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132386598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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