Jefferson Journal of Psychiatry最新文献

{"title":"Death, Freedom, Isolation and Uncertainty","authors":"C. Holzer","doi":"10.29046/JJP.009.1.012","DOIUrl":"https://doi.org/10.29046/JJP.009.1.012","url":null,"abstract":"The a u t hor is p ro ba bly best known for hi s co nt ri bu tions to g ro up psych otherapy. H owever, in hi s m ost recent book he atte m p ts to d e m o nst ra t e the a pplica tio n of ex is te n t ia l philosophical ideas to ind ividual psycho t herapy wit h ten patients. Nam es of ex is te n t ia l psych ot hera pist s that come to mind include Rollo May, Abraham M aslow, Carl R . Rod ge rs a nd Gordon Allpo rt. In the 1940s they g rew di ssatisfied with bo th psych oanal ysis a nd posit ivis tic behavorism a nd in the 1950s fou nded a new sc hool they ca lled Hu m anistic Psych ology (1 ,2) . For a sho r t period thei r nati onal influ ence was co ns iderable, leadi ng to the es ta blish me nt of both a j ournal a nd a national co nve n t ion. The founders beca m e in cr easingly a lienat ed by a 1960's cou n te rc u lt u re that e m braced humanist psych ology a nd they wit hd rew th e ir suppor t from the m ovement. Lo osely co nnecte d with the ex is te n t ia l school a nd spo rad ica lly co ncerned wit h their issu es we re a nalys ts lik e Ka re n H orn ey, Ott o Rank a nd E r ich Fromm. Exi st ential psych otherapy is roo ted in the phi losophy of ex is ten t ia lism which begins wit h the Dane So ren Ki e rk egaa rd ( 18 13-1855) a nd leads to t he 20t h ce n t u ry philosophers J ean Paul Sartre and M a rti n H eid egge r. P roba bly more in flue nt ia l t han a ny of the above are the great nove ls by Dost oevsky, T olst oy and Kafka that ca p t u red the ti m el ess and hones t tru ths of t he hu m a n expe r ience. What is the ex is t e n t ia l paradigm? Out of d esp air, whe n fa cing the finit eness of the se lf, the individual becomes awa re of se lf, is se lf, a nd u nd e rst a nd s se lf. W e are doomed to be fr ee, to be responsible for the cho ices we m ake; we a re born a lo ne a nd we will di e a lone in a world of uncert ainty a nd m eaningl essn ess. Thus, ex is te n t ia l psych otherapy d eal s with the \" u lt ima te co nce rns,\" as Yal o m ca lls the m (3) . These basic precepts reveal clearly that the ex is t e n t ia l view deviat es sig nifica n t ly from m ainstrea m psychiatry. While it s language is psycholog icall y a lien , t here is a lso no room for e m pir ica l research because t he ex is te n t ia lis t post u lat es that man is grea te r than the su m of his part s. M an can no t be unders tood from t he study of partfu nction s, a notion that is not co ns ist e n t wi th the pre mise tha t e m pir ica l research is the m ethod of choice in determ ining how a nd wha t we know. The st ruggling","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"11 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":"115198128","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":"In Response: The Place of Psychotherapy Training in Residency Programs","authors":"H. Curtis","doi":"10.29046/jjp.007.2.013","DOIUrl":"https://doi.org/10.29046/jjp.007.2.013","url":null,"abstract":"As a belated response to th e deba te about the value of teaching psych othe rapy in psychi atric residency traini ng, (j efferson J ournal of Psychiatry, Vol. 5( I ):54-66, 1987) 1 wo uld like to add my vo ice to th e affirmative side. That there is suc h a debat e seems sym pto mat ic of a n unfo r tunate and unnecessary misuse of impor tan t ad vances in neurobiol ogy to justi fy the sidelining of psych odynamic psych o therapy. A sea rc h of the psych iat r ic literature of recent years re veals an em phasis on biol og ical psych iatry and a re lative neglect of psych otherap y. A similar trend has been no ted in some residency programs a nd in th e an nua l meet in gs of the American Psychiatr ic Association . However, th e pendulum appears to be swinging back , as was demonstrated at a recent meeting of the A PA, where pan els and lectures on psych otherapy attracted overflow audiences. A symposium on psych otherapy sponsored by the Am erican Psych oanalytic Associat ion could not be contained in th e 200 seat room and several hundred other people had to be sh unte d into adj ace nt rooms where the dis cus sion cou ld be hea rd over loudspeak ers. T he a ud ience, co mposed mainly of young people , was obv ious ly hungr y fo r more infor mation on the psychologi cal aspect of psychiatry, a fact no ted by officers of the A PA who recognized th e relat ive im balance of the recen t p rograms. As a n examp le of th e kin d of interest that brough t so man y you ng psych iatrists to that symposium, quest ions were raised by severa l in th e audience about deali ng with unruly emotions a nd irrat ionality in thei r patients, whil e others extended th a t to include simi lar reactions in themselves . T hey were clearly not satisfied with a medication-only approach th at wo u ld assume th at such reac tions we re sim p ly epip henomena of a biological di sorder , fo r which drugs could be give n to erad icate undesirable emotions. A prefer ence for this way of avoid ing or co ntro lling unreason and d ist r essing affects ma y often ste m from a need to control fee lings aroused in resonance with the patient's storm y emot ions . It is a lso frequently co up led with claims that th e efficacy of psych otherapy is un p roven , or that it is not co st-effective, or that other health professionals can supply it. T he other way is to recogn ize that bo th we and our patients are ca pa ble of a wide ra nge of fee lings and th ou gh ts, sometimes reasonable and som etimes","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"154 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":"123273544","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":"Walking in One's Own Shoes","authors":"D. Gerstman","doi":"10.29046/jjp.011.2.012","DOIUrl":"https://doi.org/10.29046/jjp.011.2.012","url":null,"abstract":"Medi cal stude nts are taught ba sic scien ces and clini cal scie nces during th eir undergraduate training. Psychia t r ists and other ph ysicians a re tau ght pa t ient ca re in th eir resid en cy programs. In medical ed ucat ion, th e topi c of illness in th e physician is rarely di scussed . The differences between doct ors who have personally expe rience d a serious medical illn ess a nd those who have not usu all y go un exam ined. It is as if wa lking in our patient 's shoes is a topic so overwhelming that it has becom e tab oo. Psychiatry differs from other di sciplines becau se th e psychi atrist is more dep en dent upon his own life expe rie nce a nd it s rol e in th e t ran sferen t ial re lat ionship. In Illn ess in the A nalyst, Drs. Schwartz and Silver, both survivors of se r ious illnesses, explore how th is expe rie nce ca n affect both ph ysician a nd patient. The book is a collec t ion of articles writt en by different au t hors exa mining a va rie ty of aspect s of this rarely explore d topi c. The first sec t ion, Personal Reflections, explores how serious illness affect s th e analyst. This sect ion is divided in to three chap te rs, t he first bein g \"T he Ana lyt ic Attitude in th e Servi ce of Denial \" byJacob A. Arl ow, l-LD., wh ere he rep ort ed:","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"16 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":"126478201","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":"The Effect of Acute and Chronic Ethanol on Dopamine Turnover in the Caudate Nucleus of the Rat","authors":"R. El-Mallakh","doi":"10.29046/JJP.006.1.005","DOIUrl":"https://doi.org/10.29046/JJP.006.1.005","url":null,"abstract":"It is ge nerally bel ieved that acute and chro nic e thanol (EtO H) ad ministra tion alters th e ac t ivity of ca techolam ines in the brain , however, th e specific effects of EtO H on th e dopam inergic system are disputed ( I) . Acute EtOH ad m inis tration has been vari ously reported to decrease (2 ,3), increase (4,5) , and ca use no change (6 ,7) in dopamine (DA) synthesis and turnover. Lik ewise , chronic EtO H treatmen ts have been reported to decrease (2 ,8) and increase (9, I0) DA synthesis and turnover. Many of these apparently co nflicting results are ex plained by the use of d ifferent anima l models (rat (2, 3 ,6,7, I0) , rabbi t (6), and mouse (4,5,9», different meth ods of EtO H ad min ist ration (intraperitoneal (3 ,4,6,7), oral (2,5) , and inh ala tio n (9», and no assurance of a lcoho lic dependence with ch ron ic ex posure (2, I0). Furth er , the majority of th ese stu d ies were ca rr ied out prior to th e development of a very se nsitive h igh per for mance liquid ch romatography (H PLC) tech nique which ca n detect minute amounts of DA, d ih yrox yphenylalan ine (DO PA) , and di hydroxyp henylacetic acid (DO PAC) (11 ,12). Sin ce DA receptor superse ns itivity has been fou nd in the mesoli mbic syste m of EtOH-dependent rats (1, 13) and because EtOH increases DA release in vivo (14) (indica ting th at EtO H does affect the dopaminergic syste m), we elect ed to exa mine th e effec ts o f ac ute and chron ic EtO H ad mi nistration o n th e dopaminergic syste m in th e rat ca udate nucleus .","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"15 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":"128293832","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":"Life under Scrutiny","authors":"Andrés Martin","doi":"10.29046/JJP.012.1.011","DOIUrl":"https://doi.org/10.29046/JJP.012.1.011","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"30 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":"114860853","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":"Treating Dual Diagnosis Patients: Challenges and Opportunities","authors":"R. Howland","doi":"10.29046/JJP.008.1.002","DOIUrl":"https://doi.org/10.29046/JJP.008.1.002","url":null,"abstract":"T he use and abuse of drugs and alc ohol ha ve recently gained grea ter attention both from the public and the medical profession . Desp ite increasing cognizance of its un fo r tunate consequences, substance use has become a more pervasive element of conte mporary society. As substance abuse ha s come to affect more segments of the population, it is not surprising that this problem a lso has affected the mentally ill. Awareness of the mentally ill subs ta nce ab user ha s grown , a lthough this population has not been well studied or well served by th e mental health system . These dually diagnosed patients often a re depict ed as the square pegs of psychiatry, not quite fitting into the round hol e of menta l health treatment. The reason for this is clear. Because of the curren t structure of th e mental health service delivery syste m , psychiatric and subs tance abuse services are provided almost exclusivel y by independent syste ms (1 ,2). As a result , those patients who are perhaps most in need of treatment are most likel y to fall through the cracks of the system. Providing services for this group of patients represents a clinical and administrative challenge, wh ich has no t bee n adequately addressed by the psychiatric profession . In this paper, I suggest that psychiatrists can accept greater responsibility for working with th e d ually di agnosed , and that this responsibility could begin with th e psych iatrist-i n-tra in ing. Although the prob lem may be difficult to overcome, psychiatry is in a unique position to accept this responsibility, effect changes in th e syste m , and have a positive impact on the lives of patients with dual diagnoses.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"8 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":"128329716","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":"Evaluation and Treatment of Demented Elderly","authors":"Barry Rovner","doi":"10.29046/jjp.010.1.008","DOIUrl":"https://doi.org/10.29046/jjp.010.1.008","url":null,"abstract":"There are curre nt ly 27 mill ion people over 65 in the United States and this number will double in th e next 50 years . This will confro n t psychiatrists and ot her physician s with th e ca re of m any elderly pat ients with dementia. T hese pa tien ts will ofte n require hospi tali za tion whe n ill becau se the ir mental, physica l, a nd social func t ioning tends to break down a t once, overwhe lming fami lies and outpatient ph ysician s. Once hospitali zed, th ey require acc ura te di agnoses, multidisciplinary ca re, and planning for rehabi litation from th e on set of th e hospi tali zat ion . However, dementia is ofte n undiagn osed a nd untreated in universi ty hospi tal s as well as in prima ry ca re clinics a nd nursin g homes. The conse q ue nces of th is are limi ted pr osp ect s for clinica l improvement a nd th e likelihood of fur ther decline. Dr. Ros enberg's con t r ibu t ion to th e Jdftrson J ournal ofPsychiatry, \" Psychi atric Cons ulta t ion for th e Demented Eld erly\" eloq ue n t ly describ es t he d ilemmas of ca ring for elde rly dement ed patients in ge ne ral hospital se tt ings. It is notable th at the psychi atric consultants' initial advice to prescri be a high -poten cy neu rol eptic along with an antich olin ergic agen t is pot entially problematic becau se of demented pa ti ents propen sit y to develop ext rapyramidal side effec ts a nd deli riu m from th ese agents , respectively. Usin g a benzodiazipine is equally pr obl ematic because it may incr ease cog nitive impai rment a nd th e risk of fall s. These com plica t ions con t r ibu te to th e se nse th at gene ra l hospi tal wards are inappropriate places to ca re for demented patients. In stead , such patient s may fare bett er on dedicated ge ria t r ic psychi at ry/medi cal units wh ere the mi lieu and approach es to ca re are design ed to suppo r t impaired pat ients, com pe nsa te for th eir deficit s, a nd st im ula te th eir remaining ca pa bilit ies to ac h ieve th eir high est level of fun ct ion. Care on th e unit sho uld be ca r r ied ou t by a multidisciplina ry tea m under th e direct ion of a ge ria tric psychi atrist. The team sho uld cons ist of geriat ricians, and ge ro n to logica lly-t ra ine d nurses, social workers, a nd occupa tio na l a nd recr eational th erapists. Dr. Rosenberg's case report illu strates th e variet y of dan gers of a n inappropriate placement. Ph ysicians a re angry, nurses a re frus t ra ted , the ward is","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"12 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":"134281333","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":"A Sexually and Physically Abused Child: His Inner World","authors":"Carmen Mayugba-Sugai","doi":"10.29046/JJP.008.2.003","DOIUrl":"https://doi.org/10.29046/JJP.008.2.003","url":null,"abstract":"This paper describes how a sexually abused 8 yea r old boy's internal dynamics correlated with and influ enced his behavior whil e he was on an inpatient unit. T hrough play therapy and unit staff's observation , th e psych opathological seq uelae to the ab use unfolded in a very interesting way. T his process of correlating play materia l with observations of behavior on th e uni t , helped the treatment team in understanding the chi ld's inner world .","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"16 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":"124166631","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":"Therapeutic Guitar-An Alternative Approach To the Treatment of a Difficult Patient","authors":"M. Buxbaum","doi":"10.29046/jjp.002.1.007","DOIUrl":"https://doi.org/10.29046/jjp.002.1.007","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"142 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":"132660170","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":"The Psychoanalytic Approach to Bulimia","authors":"Doris Mirowski","doi":"10.29046/jjp.011.2.011","DOIUrl":"https://doi.org/10.29046/jjp.011.2.011","url":null,"abstract":"B ulim ia: Psychoanalytic Treatment and Theory is good reading for any resident who wish es for a more com ple te underst anding of th e cond it ion. Ha rveyJ . Schwartz, IVLD. edi te d a nd con t r ibuted to this com pre he ns ive six teen cha pter boo k cove ring a wide ra nge of topics regarding bu limia. The book evolves fr om a n overvi ew of an alyti c conce pts a nd ge ne ral th eories to specific conditions such as pr egn an cy, wor k inhibition a nd add ict ive beh avior. In quick sum mary, th e a na lytic th eory is th a t th e buli mic's development results from a mother's sym bo lic un availability during th e patien t 's development. There is mat ernal a mbivalence towards th e child a nd her use of th e child for he r own narciss istic need s. The father is found to be ove rst im ula t ing a nd sed uc t ive, a nd th e patient has ea rly a nd frequent expos ure to primal scen es . An analogy is drawn between t he devouring of food by th e patient a nd forcing the finger int o her throat with resulting regurgit ation as representing a sim ultaneous iden ti ficat ion with both parents. The secre t ivene ss tha t is inh erent to bu limia belies it s hea vy pr esen ce in high fun ctioning adult s. The cond ition is ce r tainly not incon gruou s with ac hieveme nt a nd profession al success. It is a co mmo n disorder a mo ng female doct or s and nurses as well as a mong other profess iona ls. Peopl e with bulimia a re oft en married a nd a re frequently more sexually ac t ive th an a no re xics. Depression is mo re com mo nly rep ort ed in bulimia but su icide a nd death from com plica t ions are not cha rac te rist ic. For a high fun cti oning professional it is su rprising ly easy to em pa thize with th e pat ien ts described in thi s text; thus one finds while reading it an incr easin g desire to und erst and bulimia beyond th e DSM-III-R. Dan iel G escnsway, M.D. em phasizes in his cha pter \" Bulimia a nd Pr egna ncy\" th at th e syndrome is not on e of a n ea t ing di sorder but reflect s underl yin g persona lity disturban ces. This cha p te r was clear a nd, a long with addressing pr egnancy, es ta blish ed a strong foundation for a n a na lyt ic und erstanding of bu limia. In a n ea rl ie r chap ter C J . T abin an d J.K. T abi n wr ite that \" wha t d ist ingu ished th e bulimic or","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"50 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":"125437340","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}