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
费城协会。为精神分析学组织了一个小组面向医科学生、精神科住院医师、精神科医生和其他对将精神分析思想和倾听技巧应用于普通精神病学领域感兴趣的专业人士。教育目标包括提高学生对精神分析倾听的各个组成部分的熟悉程度;(在与病人一起工作时更熟练地使用精神分析倾听)，并高度认识到精神分析倾听作为一种工具在一般精神病学实践中的各种应用。T他Philad elphia协会Psychoa na裂解宿主l ed锅el用于读出ca stude n ts, psychia T r ic residen ts, psychi atrist年代和其他职业als在应用psychoan terested lyt ic th欧碧和听力地区基因、心理iat铁路Moderat或Bru ce j·莱文,m . d .开放ne d th e pa nel通过描述两个通用电气ne ra患者l方法ca再保险心理1990 th e ia T变化的年代。U tiliz ing neuroscien ce的进步,一种方法是寻找物理和描述性的方法来了解病人。通过认真的倾听，他们找到了一种方法来寻找与疾病有关的情感联系。后一种方法是仔细的心理健康清单，它扩展了我在心理方面的知识，包括精神疾病、人格障碍、心理医学、成人心理学、儿童和青少年心理病学。通过个人分析、心理分析课程、临床经验分析和监督，精神分析学家学会了分析言语的显性内容，以寻求其更深层次的含义。通过该方法，分析人员发现了意识冲突，从而对患者有了更深入的了解，从而通过对患者的痛苦循环的分析进一步促进患者的健康。莱文博士开发了一种名为“精神分析”的会话，以演示精神分析原理的应用
{"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}
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-
《退伍军人的心理治疗》，哈维。施瓦茨博士。通过对“神经病”的心理动力学探索，为读者提供了一段智力挑战但有益的旅程。虽然的让步pt post-t劳马抽搐压力di sorder (PTSD)是由元音rtz博士指出,发生在th e你重新点燃时代到1978年,这是实体hrine d 1980年在DSM III, th e在这个volum e工作提升s的面纱的纯描述性的方法探索的心理odynamic con旅游ic。施瓦茨博士已经组建了许多方面的th e点燃过后includi ng th e创伤的neu玫瑰,睡眠研究、心理o-pharmacology, gro疗法,bri ef erapy,精神分析心理治疗、预防、一个nd n室内外的th e的影响广泛的社会城市。施瓦茨帧th e书与n过量米歇尔n t int roduct ory cha pte r, se ts ou t th e体积的主要任务:(I)的调查的心理地质代用ts巨大的创伤,包括压倒性的交互前ternal前夕n ts智慧h基本幼儿冲突或幻想;(2)探讨对ptsd患者而言，一个有效的“持有环境”是什么。这些任务是通过一系列的文章来完成的，这些文章回顾了过去的文献和现在的原始公式。Sha piro和Schwartz在两篇文章中强调了严重创伤患者工作中的转移和计算转移。Blitz和Greenberg提出了一种与自我心理学概念相关的研究方法。对我最有帮助的是本卷中丰富的案例，这些案例生动地揭示了强奸者工作的心理。那些有过创伤幸存者的经历，并且能够理解心理动力心理学的抽象本质的人，将能够为ptsd患者的心理动力心理学的方向和陷阱提供有用的指导。施瓦茨博士介绍了几个案例，其中包括一项非常感人的研究，研究的是一名严重分离的患者，他们在经历了一次压倒性的创伤经历后，可能会感到痛苦
{"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}
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)
我们被要求去看一位有复发性抑郁症和深静脉血栓病史的女性。(谘询及联络服务)她最初开始使用proorac(氟西汀)，随后开始使用香豆素(uiaifarin)。患者表现为双下肢严重瘀伤。我们被要求调查这个病例，以确定是否药物与百忧解的相互作用导致了这个问题。一项对世界文献的回顾未能产生百忧解和香豆丁之间药物相互作用产生出血性疾病的报告。仔细审查，如果这个案件不能提供证据，这发生了。对另外4例病例进行回顾性分析。如果这些患者在服用百忧解时需要调整他们的香豆素，则没有一例。我们可以合理地假设，随着美国人口平均年龄的增长，医疗和精神疾病的发病率也在增加。患者经常服用处方药物，这些药物可能与精神药物相互作用。第二代蚂蚁idepressants再保险ge ne ra增加缺点被安全药物的读出叫y生病不爱你副调制因为他们最小的n t icho linerg ic性能和更少的不良sid e代用ts。佛r th e ph ysician, kn猫头鹰通用电气的药物相互作用与th e最com mon规定精神读出阳离子不仅是有用的,但应该ca再保险的标准。Recen t,我们被要求看到一个女人与复发性抑郁症和深静脉血栓形成的历史。她最初服用百忧解(氟替宁)，随后开始服用华法林(华法林)。患者表现为严重的下动脉粥样硬化和继发性细胞炎。另一个复杂的事实是，她在旅行前3周接种了白喉、百日咳和破伤风疫苗。麻疹和百白破疫苗接种都可能与凝血有关。入院时，她的凝血酶(PT)为50 a，部分凝血酶活时间(PTT)为100 a，这是一个更符合凝血酶毒性而不是香豆素毒性的病例。当我们被要求对这个病例进行咨询时，我们不得不调查百忧解与香豆素相互作用的可能性。参考文献中的博士们对这两种药物的使用提出了反对意见。(我)
{"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}
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
感染人类免疫缺陷病毒(HIV)的住院医师面临着独特的问题。除了慢性和致命疾病造成的困难外，感染艾滋病毒的实习医师还面临着住院医师培训与感染之间相互作用所特有的理论、教育和实际问题。迄今为止，被发现感染了艾滋病毒的医生都面临着公众的歧视，其中许多都带来了毁灭性的后果。出生在委内瑞拉的心脏病专家哈奇布·奥恩(Hacib Ao un)医生在约翰·霍普金斯医院(Johns Hopkins)住院时，从一名患有白血病的男孩那里感染了艾滋病。他克服了有关他是如何感染上这种疾病的谣言，但却面临着可能被驱逐出境的危险。尽管奥恩与美国公民结婚，但移民法规定患有艾滋病的外国公民不能成为美国居民(1)。罗伯特·j·豪斯(Robert J. house)医生被迫关闭了他在德克萨斯州的儿科诊所，因为愤怒的父母得知他的艾滋病毒检测呈阳性(2)。11月16日的英文报纸《今日》(Today)的头条新闻宣称“一位去世的艾滋病医生”;报纸提供了这名医生的照片和一份一页的报告，指出他的妻子和孩子“躲起来了”(3)。虽然在这些和其他关于医生感染艾滋病的报道中，病人的安全问题经常被提到，但公众的歇斯底里通常集中在从医生那里感染艾滋病的病人身上。尽管有大量的报道称偶然的接触不会传播艾滋病(4)，但即使是卫生保健专业人员也常常对艾滋病及其传播方式一无所知(5)。很少有人会不同意美国医学协会的立场，即一个知道自己血清呈阳性的医生不应该从事任何有可能将疾病传播给他人的活动(6)。对艾滋病的“安全性”的定义有时与其他疾病不同，甚至比乙肝等更普遍的疾病也有致命的后果(7)。然而，最近，安全性问题已经转移到艾滋病性痴呆。根据这一推理，受感染的医生可能无法安全地治疗患者，不是因为可能感染患者，而是因为痴呆症可能阻止医生进行良好的治疗(3)
{"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}
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.
{"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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