{"title":"Conversion Disorder in a Depressed Patient: The Analysis of Paralysis","authors":"Michael A. Chen, David S Im","doi":"10.29046/jjp.016.1.002","DOIUrl":"https://doi.org/10.29046/jjp.016.1.002","url":null,"abstract":"Pat ients present ing with neurologic and pseudoneurologic symptoms present both a diagnostic and treatment challenge. This case report describes the ER course ofa man who presented wi th aphonia and paralysis, his medical clearance, transfer to the psychiat ric ER and subsequent recovery. Th e history qf conversion disorder and its characteristics are briefiy reviewed, and the etiology qf thi s patient 's symptoms and a discussion qf effectioe treatment pla ns are discussed. Although the conce pt of conve rsion symptoms dates at least to th e ancient Greeks and was discussed by Freud and Breu er in Studies on Hy steria ( I) in the la te 1890's, it has been an in cr easingly infrequent (although not rare) diagnosis. In cont rast to most other DSM diagnoses , unconscious processes or conflicts a re implicated in the development of conve rsion disorder. Conversion di sorder generally involves a symbolic relationship between an underlying psychological conflict and disturbed physical functioning. \"Classic\" symptoms include paralysis, aphonia , seizures, malcoordination, dyskinesia, blindness , anesthesia, a nd parasthesias. The disorder has been most com monly described in rural women of lower socio -economic status. The following case des cribes a welleducated man wh o was brou gh t to the Emergency Department after becoming acutely unresponsive (with paralysis and aphonia), and highlights his subse q ue n t course in th e emerge ncy se t t ing .","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"22 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":"131358298","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 Ideal Psychiatry Residency Training Program","authors":"A. Tasman","doi":"10.29046/jjp.006.2.012","DOIUrl":"https://doi.org/10.29046/jjp.006.2.012","url":null,"abstract":"There is little to be added in th e way of specifics to J ames Deming's review of the necessary ingredients for an ideal Resid ency T rain ing Program (I ). He not only reviews the specific issues wh ich must be add ressed regard ing the \" nuts and bolts\" of training, but also emphas izes th e need for ph ase specificity of bo th clinical and didactic ex periences and th e need to view residency training fr om a developmental perspective. Rather than comment specifica lly on th e points Deming raises, I would like to address other ingred ients in residency training which are to be value d in th e ideal program. With th e exp losio n of kn owledge in the field over the last several decades, tra ining directors and facul ty, as well as t ra inees, are faced with enormous co nce r ns about how this infor ma tio n can be most usefull y present ed and integrated. My own bias places this task under th e rubric of needing to learn an appreciat ion for process. T his phenomenon is often discu ssed primari ly from th e perspective of psych otherapy practice , but I mean something di ffe rent here . T he biopsychosocial model encompasses a view th at in understand ing th e individual, we must be prepared to understand th e processes with in that person from biologic, intrapsychic, interpersonal, familial , and environmental points of view. The ideal training program shou ld not on ly provide a set of cli nica l and didactic experiences which cover this knowledge, but a lso provide a means within which these varying levels of observation and understanding of a patient can be integrated. I find that this integration occurs most effec t ive ly in th e supervisors office, when a resident presents case material and is helped to put together what is seen clinically, what is experienced by th e physician , and wha t is known about psychopathology from a variety of points of view. It is th erefore essential, in order for this process to occur optimally, that th e supervisors ha ve the requisite appreciation for process and capac ity to integrate different levels of understanding. Departments of Psychiatry rarely feature a monolithic approach to understanding psychopathology, although th ere are excep tions . It is important in the choice of those individuals who are selected for supervision, that attention be paid to the particular interests and teaching skills of faculty members. It is essential to have super visors who not o nly have a specific area of expertise in psychiatric knowledge and practice , bu t also the capacity to","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"164 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":"124605006","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":"HIV-Positivity, AIDS, and The Military Psychiatry Residency Experience","authors":"R. Koshes","doi":"10.29046/jjp.009.2.003","DOIUrl":"https://doi.org/10.29046/jjp.009.2.003","url":null,"abstract":"Psychiatry residents in the military work with a diverse population qf HIV-positive and AIDS patients who are in various stages in their illnesses, military careers, and acceptance ofthe disease process. In this circumstance, the military psychiatry residen t must be a clinician, administrator, andpatient advocate. Additionally, the militaryresident must uphold Department qf Defense regulations which mandate that soldiers be both physically and emotionallyfit to peiform their duties. This paper describes the unique role of the military psychiatrist in working with HIV-positive and AIDS patients in the militarysetting.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"10 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":"122126354","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":"Psychodynamics: The State of the Art","authors":"R. Hall","doi":"10.29046/jjp.011.2.013","DOIUrl":"https://doi.org/10.29046/jjp.011.2.013","url":null,"abstract":"Whither psych odynamic psychotherapy in th e era of managed ca re? This is th e ce nt ral qu estion raised (and a nswere d) in a new text ed ited a nd, in part , au t ho red by H a rveyJ. Schwartz, MD . In his introduction, Schwar tz says, \"T his book is int ended as an inv itation. An invit at ion to ge t to know how a number of psych oa nalyt ic psychi atri s ts think abou t th eir patien ts, th eir work, a nd in th e process, th em selves.\" His book , however, ends up being a grea t deal more t ha n th a t. The ea rly cha pters ent itled \" Bas ic Conce p ts \" serve as a n in troducti on to th e hist ory and th eory of psychod ynamics. The heart of th e tex t deals with th e a pp lication of psych odyn a mic principl es to va rious current ly recogni zed diagn osti c en t it ies. In taking this approach , Schwartz makes th e case ove r a nd over th at psychodynamic psychotherapy has a br oad er ap plica tion th rou gh ou t th e who le ran ge of psych iatric illnesses th an most resi dent s wou ld have im agined. He see ms to be saying \" . .. yes , mos t of us agree th a t psychodynamic psycho th erapy is im porta n t a nd th e tran smi ssion of it s core concepts shou ld be preserved , but how ca n we apply th e techniq ues to spec ific t rea t ment se tt ings and clin ical synd romes?\" By havin g th e variou s cont ributors res po nd within very specific d iagnost ic areas , Schwartz has chose n to mee t th e qu estion head-on . In th ese central chapters, th e biases of th e ind ivid ual a ut ho rs cer tain ly show through but overa ll we a re presen ted wit h a wealth of informative and, more importantly, useful mat erial. The latter chap te rs deal wit h a few spec ia lty a reas including int errupt ion s in treatment , resea rch a nd psychodyna mics, a nd th e psych ology of prescribing a nd taking me d ica t ion. In th e book 's final chapte r, \"A Recommended C urriculum for Psychodyna mic Training,\" Allen T asm an sums up th e importance of th e issu e at hand when he says, \"At sta ke is our vision of th e futu re psychi atrist. \" From a resid ent 's poin t ofview, this last cha p te r should pr obably be read first. The qu estions he ra ises are, \" Do we think th e fu ture psychi atrist should / will be a n applied neu robi ologist who sho uld know onl y th e indications for explora to ry psych otherapy, so as to mak e a ppropriate referrals to psych ologists and socia l workers as many neurologist s and fa mily practition ers now do? Do we think that th e re marka ble new knowled ge of neurobiology . .. , will render","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"23 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":"127433706","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 Resident Initiated Prite Review Course: Trials and Tribulations","authors":"D. Metzler, D. L. Kinsey, L. R. Dickson, M. Hyatt","doi":"10.29046/jjp.011.1.015","DOIUrl":"https://doi.org/10.29046/jjp.011.1.015","url":null,"abstract":"The expe rie nce of developing a review course to study for th e Psychia t ry Residen t 's In-T ra ining Exam (PRITE) is d iscussed. Resid ents in our program felt that th e review course was usefu l with re sp ect to th e following: studying for the PRIT E; future study for National Boa rds; and learning of new mat eri al. The Psychi atry Resident 's In-T ra ining Exam (p RITE) was developed in 1979 as a mechanism to assess the knowledge ba se of psychiatric resid ents in a sta ndardized format (1,2,3). The exa m was origina lly designed to simulat e th e Am erican Board of Psychiat ry and Ne urology (ABPN) examina t ion, PART I, a nd has ga ine d widespread acce ptance despite questions ab out it s ability to accurat ely tes t or reflect the know ledge of th e exa minee (1,4,5) . Principles derived from a syst em for se lf-educa t ion of resid ents publ ish ed by Taylor and Torrey (6) were a pplied to a review course developed at thi s inst it u t ion to improve th e knowledge base of each resid en t with th e goal of incr easing pe rforma nce on th e PRITE a nd, ultimately, ABPN exa m Part I. This pap er discusses the review course from its conception to fina l eva lua t ion with views offered from th e organize rs, th e resid en cy direct or, a nd th e resid ents tau ght by thi s method . It was hypoth esized th at most participants would feel th at th e review course was useful in stu dying for th e PRITE exa m and th at those who had ac t ive ly particip ated (i.e., mad e a handout or gave a lect ure) wou ld feel th e review course was more useful th an th ose who were pa ssive participants.","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":"129967742","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":"Rome to Cologne","authors":"J. Sarnoff","doi":"10.29046/jjp.004.2.010","DOIUrl":"https://doi.org/10.29046/jjp.004.2.010","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"44 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":"133362573","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":"First-Known Hypnopompic Hallucination Occurring In-Hospital: Case Report","authors":"Paul Ballas D.O.","doi":"10.29046/JJP.020.1.005","DOIUrl":"https://doi.org/10.29046/JJP.020.1.005","url":null,"abstract":"Despite the high prevalence of hypnopompic hallucinations in the community, to our knowledge there are no reports that have been published in the English literature of these phenomenon observed by staff in the hospital setting. Psychiatric or neurological evaluation often ensues if a patient reports hallucinations in other circumstances, but when they are reported in connection with sleep, further evaluation is rarely performed because such events are common in the general populace. Our report emphasizes the distinction between hypnopompic and hypnagogic hallucination as an ongoing feature of life that someone is aware of, which we believe to be the case for normal persons who have them, and a similar hallucination occurring for the first time in someone who is unaware of it, at least unable to remember it. In the latter instance, we suggest careful interview for symptoms of a sleep disorder. Hypnagogic (prior to sleep onset) and hypnopompic (upon arousal from sleep) hallucinations are both phenomena that occur in normal people and symptoms that are characteristic of narcolepsy (1, 2). They are a common occurrence, experienced by almost everyone at least once and have also been shown to be associated with the use or withdrawal from certain medications, specifically, tricyclic antidepressants, opiates, and donepezil (3-5). Although hypnopompic and hypnagogic hallucinations are generally considered to be normal phenomenon, they have increased incidence in several psychiatric and neurologic disorders (6). One study of over 14,000 subjects revealed that people with anxiety, depression, or bipolar affective disorder have a two-fold increase in experiencing hypnopompic or hypnagogic hallucinations at least once weekly. The same study showed that people with adjustment disorders have a 1.5fold increase in experiencing these phenomenon at least once weekly (6-8). The notion that such phenomena are normal may be part of the reason behind the wide variation in the literature with regard to their lifetime incidence (hypnopompic 6-13%, hypnagogic 25–38%) (4, 9-11). Over 50 percent of people who experience them have no","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"91 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":"130578019","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 Case of Conversion Catatonia Misdiagnosed for 24 Years","authors":"P. Wiener","doi":"10.29046/JJP.008.1.005","DOIUrl":"https://doi.org/10.29046/JJP.008.1.005","url":null,"abstract":"Catatonia is a synd rome whose etiology may be both diverse and di fficul t to subs tantiate . Ms. H. is a 45-year-old black female wit h 18 previous psychiatr ic hospital izations beginning at age 21 . A common characteristi c to all hosp ital izations was a catatonic presentation (i.e ., the patient was mute with marked muscul ar rigidity; sh e would refuse to eat or fo llow orders) . In ea ch of her previous 18 hospitali zations, the patient was thought to be psycho tic. It was found that each ca ta to nic episode co u ld be related to a severe psychological stressor. The patient 's illness never involv ed delusio ns, hallucinations o r disturbances in thought form. Upon d etailed evaluation of thi s pat ien t 's hi sto r y she was found to have symp toms co nsistent wit h conversion di sorder. I report here the identification of a conversion d isorder presenting as recurrent episodes of catatonia. Intramuscular lorazepam was fou nd to be repea tedly success fu l in resolving the ca ta tonic sta te .","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"55 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":"131768530","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":"Implementation of a Computer-Based Communication System for Psychiatry Residents","authors":"Lieberman, Z. Daniel","doi":"10.29046/jjp.014.2.001","DOIUrl":"https://doi.org/10.29046/jjp.014.2.001","url":null,"abstract":"In order to encourage different kinds ofcommunication among residents who werelocated at a number qfgeographically separate sites, a computerized communication system was implemented. Priority was placed on both ric/messqf'features and easecfuse. Residents wereable to send private email.j oin public conferences, and access databases ofinformation. The system was initially usedtry a large number ofresidents, and usage patterns are described. The introduction to information technology that residents gainedfrom thesystem led to othercomputerprojects, and an interest in the resources ofthe Internet.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"1165 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":"134521082","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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