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
最好的名字是他的同事没有检查精神疗法。他对我的感情和我对他的感情一样强烈。前女友的名字是“我不知道该不该考虑罗洛·梅，亚伯拉罕·阿斯洛，卡尔·R。在20世纪40年代，他们和bo th psych oanal ysis以及对新sc hool的了解保持一致。由于最近的流感症状是严重的，我两个人都不知道。创始人因为我在cr中停留的时间比1960年的时间还短，这是你在鼓舞人类心理和他们的头脑，他们从m环境中得到支持。你和我的前任在一起的时候就知道了。Exi圣ential心理学otherapy是roo泰德在《ex是phi losophy ten t h他lism哪种开篇机智丹麦人如此rk egaa rd(18 13-1855)任Ki e a h和t却要他20t ce n t u瑞philosophers J ean保罗·萨特和M a意味着n h开斋节egge r.p. roba布莱·摩尔在flue nt他洛杉矶t韩夫人》是伟大的nove头顶苍天是否oevsky,偏t olst哎呀和卡夫卡是那个ca P t u ti红《M el ess》和t t男人真下去他胡M a r n费用ience。这是什么情况?在特别的空气中，当它存在于发现的力量中，而个人变成了发现的另一种力量，那就是发现的另一种力量。我们注定要做朋友，为我们成功的秋负责;我们a re a lo ne生和威尔在e (a lone in a world of uncert ainty a和m eaningl essn ess。因此,ex是te l n t他心理otherapy d eal s with the“u,这是ima te co nce rns,美国“arial, o ca lls《m(3)。这些基本戒透露很明显他那《ex是t e n t l view deviat冰格洛克手枪nifica n t ly从精神病学ainstrea m。当它s language是心理学icall y a连战,t这是a lso号室为e m梨ica我研究他,因为他的前任是te n t t t lis post) u lat那个男人是几率te r比《冰秀他的部分s。m an可以不从t t be unders蛤蟆他study of partfu nction s, a概念就是ns音符co妻子e n t wi th《pre mise tha t e m m ethod》梨ica我研究是选择在determ ining a和t什么我们知道如何。圣·鲁格林
{"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}
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
{"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}
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:
医科学生在本科阶段学习基础科学和临床科学。精神科医生和其他医生都认为病人可以参加他们的住院治疗项目。在医学教育中，医生的疾病话题很少被讨论。那些亲身经历过严重疾病的医生和那些没有经历过严重疾病的医生之间的差异通常都是未经检查的。就好像“站在病人的角度思考”是一个如此压倒性的话题，以至于它也成为了我们的标签。精神病学与其他学科的不同之处在于，精神科医生更依赖于他自己的生活经历，并且在不同的人际关系中扮演着重要的角色。在《华尔街日报》(the wall street journal)的一篇分析文章中，施瓦茨和西尔弗都是严重疾病的幸存者，他们探讨了这种昂贵的生活方式如何影响医生和病人。这本书是由不同专家撰写的文章的合集，从各个方面探讨了这个很少被探讨的话题。第一节“个人反思”探讨了严重疾病对分析师的影响。本节分为三章，第一章是《拒绝服务中的Ana - lyic态度》，作者:jacob A. Arl - low。，他报告说:
{"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}
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 .
人们普遍认为，急性和慢性乙醇(etoh)和给药会改变大脑中多巴胺的活性，然而，etoh对多巴胺能系统的具体影响是有争议的(1)。有不同的报道称，急性EtOH和m的注入会减少(2,3)，增加(4,5)，并且可能不会改变多巴胺(DA)的合成和转换(6,7)。同样，据报道，慢性etoh治疗会减少(2,8)和增加(9,10)DA合成和周转。许多这些明显相互矛盾的结果可以通过使用不同的动物模型(大鼠(2,3,6,7,0)，拉比(6)和小鼠(4,5,9)，不同的EtO - H方法和最小剂量(腹腔注射(3,4,6,7)，口服(2,5)和腹腔注射(9)来解释，并且不能保证酒精依赖于慢性暴露(2,0)。此外，这些研究中的大多数都是在非常灵敏的高纯度液相色谱(hplc)技术发展之前完成的，该技术可以检测微量的DA, d与yrox -苯基alan ine (DO PA)和dihydroxyhenylacetic acid (DO PAC)(11,12)。罪ce DA受体superse ns敏感度已经喝醉的nd mesoli mbic体制EtOH-dependent老鼠(13)和因为EtOH增加DA释放体内(14)(H籼稻ting,埃托奥影响多巴胺能系统),我们选ed穰我th e代用ts o f ac ute和时间H ic埃托奥广告mi nistration o n th e多巴胺体制th e鼠ca udate细胞核。
{"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}
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.
{"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}
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
{"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}
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 .
{"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}
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
《精神分析的治疗和理论》对于任何希望更全面地了解精神分析的住院医生来说都是一本很好的读物。哈，真的。施瓦兹,IVLD。他在本网站上发表了一篇文章，其中包括6篇16页的书，内容涉及有关死亡的广泛主题。这本书从一个分析概念的概览演变而来，并将这些理论扩展到具体的条件，如工作抑制和工作行为。总而言之，分析这一理论的最重要的一点是，孩子的发育是由于母亲在孩子发育过程中缺乏系统资源造成的。对孩子和她利用孩子来满足自己的自恋需求之间存在着一种内在的矛盾。父亲被发现是爱孩子的，他被发现是爱孩子的，被发现是爱孩子的，被发现是爱孩子的，而病人很少和频繁地接触原始场景。病人吞食食物和用手指按压喉咙导致呕吐之间有一个类比，这代表了父母双方同时发生的相同症状。成功的秘诀在于，这是一件很平常的事，但人们相信，这在高娱乐功能的成年人中很常见。第二种情况是，成功和职业成功的人肯定不会受到影响。这是一种常见于女性医生、护士以及其他职业的疾病。患有贪食症的人往往已婚，而且性行为往往比不服用避孕药的人更频繁。抑郁症更常见，不仅在贪食症中有报道，但自杀和因情绪激动而死亡的情况并不像现实中那样严重。对于一个高度有趣的专业人士来说，很容易对本文中描述的部分症状感到震惊;因此，在阅读这本书时，人们会发现越来越多的人想要在DSM-III-R之外发现饥饿和贪食症。医学博士Dan iel G . escnsway在他的著作《暴食症和饥饿症》中强调，这种症状并不是一种严重的精神疾病，而是一种人格障碍的潜在反映。这是一个清晰的、长期的解决方案，它为我们建立了一个坚实的基础，使我们能够更好地理解人类的局限性。在一篇文章中，我们看到了C . J .章。他和J.K.罗琳在书中写道:“是什么导致了我的暴食症。
{"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}
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