Analytic vs. Dynamic Psychotherapy in the Era of Managed Care
November 1st 1998The dynamically informed psychotherapies can be thought to occur on a continuum, with the most insight-oriented and exploratory types at one end and the most supportive types at the other. Psychoanalysis proper stands at the end of this continuum, followed by analytically oriented psychotherapy, then dynamically oriented psychotherapy. Within this classification, analytical oriented psychotherapy and dynamic oriented psychotherapy are two quite distinct, yet related, forms of therapy.
A New Screening Measure for Detecting 'Hidden' Domestic Violence
November 1st 1998Organ donation from brain-dead patients has become a psychiatric issue in Japanese transplant medicine. Brain death is recognized as human death only in the context of organ transplantation in Japan. Since many Japanese physicians deny that brain death constitutes the death of an individual, there is no solid, general consensus in Japan about what constitutes brain death.
Case Study Writing in Today's Psychiatry
November 1st 1998The poet must remember that it is his poetry which bears the guilt for the vulgar prose of life, whereas the man of everyday life ought to know that the fruitlessness of art is due to his willingness to be unexacting and to the unseriousness of the concerns to his life. The individual must be answerable through and through: all of his constituent moments must not only fit next to each other in the temporal sequence of his life, but must also interpenetrate each other in the unity of guilt and answerability-M.M. Bakhtin, 1919
'Substance P' Antagonist Relieves Depression
November 1st 1998An investigational compound that blocks the neurokinin "substance P" has demonstrated robust antidepressant effect in preliminary clinical testing against paroxetine (Paxil) and placebo. This finding has been described by as "a breakthrough discovery" in mental health care.
A New Screening Measure for Detecting 'Hidden' Domestic Violence
November 1st 1998Only in recent years has the widening scope of domestic violence achieved such national prominence. Highly publicized cases like the Nicole Brown Simpson murder have brought the issue of domestic violence to worldwide attention. Overall rates of violence against women, including both lethal and nonlethal violence, are much higher.
Psychotherapy with Opioid-Dependent Patients
November 1st 1998Psychotherapy as a sole treatment for noncoerced opioid addicts in outpatient settings has been shown to have little patient interest and low chances for success. However, when integrated into a treatment plan that includes methadone maintenance and drug counseling, it can be associated with additional benefits for patients who have moderate to severe levels of psychiatric symptoms.
The Supportive Component of Psychotherapy
November 1st 1998In view of the fact that support is an important aspect of all models of psychotherapy, it is remarkable that beginning practitioners are not taught how to be supportive. Only limited attention has been paid to discussion of the principles underlying supportive interactions. It seems to be taken for granted that good sense, kindness, innate empathy and life experience will enable psychotherapists-and physicians in general-to meet their patients' needs for support by communicating interest, liking and understanding. Just as the literature on psychoanalysis is a source for much of what we know about the expressive component of therapy, the limited literature on supportive psychotherapy is a source for ideas pertinent to the supportive component.
Borderline Personality Disorder: Splitting Countertransference
November 1st 1998A popular slang definition of the verb to split is "to depart," or "to leave." In this context, to split describes the occasional wish of a psychiatrist who may be mired in the chaos created by the behavior of a patient diagnosed with borderline personality disorder. The primary definition of to split is "to divide sharply or cleanly."
10-Point Clock Test Screens for Cognitive Impairment in Clinic and Hospital Settings
October 12th 1998The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.
Medicare Revenue Enhancement and Consultation-Liaison Psychiatry
October 1st 1998Consultation-Liaison (C-L) psychiatric services are generally not profit-making enterprises. Indeed, they are hard-pressed to demonstrate that they break even. Some attention has been paid to this issue in the recent literature, and specific recommendations of a most helpful nature have been made. The C-L service at Lehigh Valley Hospital (LVH) in Allentown, Pa., is an example of recommendations that have been put in place for C-L.
Clashing Forces Pressure Consultation-Liaison Psychiatry
October 1st 1998The future is both bright and dark for consultation-liaison (C-L) psychiatry. It is a paradox created by a still-evolving health care system that affords unique opportunities for innovation, while simultaneously placing seemingly insurmountable obstacles in the way of access to quality care. Striving to navigate these systemic contradictions, C-L psychiatry can be seen as on the verge of either a breakthrough or a breakdown-only time will tell how things will work out for this as yet uncertified subspecialty.
Mutually Beneficial Collaboration Rises Between Psychiatrists and Primary Care Physicians
October 1st 1998As health care continues to shift in the United States from fee-for-service to managed care, and away from specialist-driven care to the primary care gatekeeper, it is necessary to re-examine psychiatric training and the psychiatric services that are being provided.
Making Use of the 'Half We Know Already'
October 1st 1998When Sigmund Freud gave his epochal lectures at Worcester's Clark University in the early 20th century, a young Harvard student named Alan Gregg was in the audience. Upon completion of his medical education and training as an internist, he would become a great visionary of psychiatry's role in the practice of medicine.
NCDEU II: New Research Methodology Leads Issues
October 1st 1998New methods of conducting and evaluating research were as intriguing as their results at the National Institute of Mental Health (NIMH)-sponsored New Clinical Drug Evaluation Unit Program's (NCDEU) 38th annual meeting in Boca Raton, Fla., June 10-13. The meeting has grown from a forum of NIMH-funded researchers reporting on their progress into a convention of approximately 1,000 clinicians, industry and regulatory personnel, and investigators marking the progress in psychopharmacology.
From Mars to Venus-Couples Sex Therapy
September 1st 1998Before Masters and Johnson came on the scene in the late 1950s, any sexual problem was thought to be the result of a deep-seated neurosis that needed to be unearthed. It is now recognized that an understanding of physiology and couples dynamics-along with a practical approach-are required interventions
Caring for the Physician in Couples Therapy
September 1st 1998Day in and day out, psychiatrists-especially those involved with couples therapy-counsel and treat patients experiencing relationship problems with their spouses or partners. But what about the psychiatrist having a similar problem in his or her own life? Who does a doctor turn to for guidance and insight regarding such intimate matters?
From Poster Child to Wanted Poster
September 1st 1998Explaining the Realities of Mental Illnesses. The ongoing campaign against stigma and discrimination attempts to promote an attitudinal shift from misunderstanding and fear to knowledge and compassion. Unfortunately, mental illnesses only grab the public's attention when high-profile tragedies become front-page news.
Controversial Study Investigates Therapeutic Benefit of Placebo
September 1st 1998How much of the beneficial effects of anti-depressant medications can be ascribed to the placebo effect? Irving Kirsch, Ph.D., and Guy Sapirstein, Ph.D., addressed this important question in a recent study that appeared in the first volume of the American Psychological Association's online journal, Prevention and Treatment (June 26,1998). Although their methodology and conclusions have met with some controversy, it would be imprudent to invalidate the study and its hypothesis.
Dramatic Alcohol Treatment Results Seen with Naltrexone
September 1st 1998Results of a multicenter, open-label observational trial of DuPont Merck's REVIA (naltrexone) demonstrated that patients were able to decrease their alcohol consumption from 57 to four drinks per week when the medication was part of an overall treatment program.
The Impact of Psychotherapy on the Brain
September 1st 1998With advances in the neurosciences, and especially in imaging techniques, we stand at the threshold of demonstrating that psychotherapy is a powerful intervention that affects the brain. While it has been intuitively obvious to most clinicians that psychotherapy must work by affecting the brain (how else could it work?), recent breakthroughs in technology demonstrate what kinds of changes occur with psychotherapy.