T he initia l clinical tria l of electroco nvu lsive th erapy (ECT) was performed by Ugo Cerletti and Lucino Bin i at th e U niversity of Rome in 1938. T he following paper will exam ine both the developments wh ich led to the first trial of ECT, and th e use of ECT over th e subseque nt fifty years. Hopefull y, by inv est igating the historical aspect s of the development and progression of ECT , a bette r understa nding of this treatment modali ty ca n be attained. T he therapeutic use of electricity was not unique to ECT. T here is evidence th at Ancient Romans used th e cu r rent generated by electric eels for the treatment of headach es, gout, and to assist in obstetr ica l procedures. The recent his tory o f th e th erapeutic use of electricity dates to 1744 when th e journal entitle d " Electr icity and Medicine" was firs t publish ed. It was claimed here that elec tric stimu li co u ld be curative for " neurologic and mental cases of paralysis and ep ilepsy (1)." J.B. LeRoy in th e 175 5 ed ition of " Electr icity and Medicine" detailed a case of hyste rical blindness whic h was cured with three applicat ions of e lectric shock (1). In 1752 , Benjami n Franklin recorded th e use of an "elec tro static mach ine to cu re a woman of hys terical fits (2). " By th e mid 19th century the use of electrothera py had so progressed that G.B.C. Duchenne (often refer red to as th e Fath er of Electrotherapy) would say, "No sin ce re neurologist could p ract ice wit hout the use of electrotherapy (1)." Bu t , despite th e documented use of electrotherapy through th e 19th century, there is little ev idence that th is was of any influence in th e development of ECT. The historical emphasis in the medicina l use of electricit y was on the electric st im ulus in and of itsel f, whereas the e lectricity in ECT was used solely for its co nv u lsan t proper t ies. A more important co ntribution to the development of ECT was th e work of Jul ius Wagner-Jauregg . It was a co mmon observation in th e lat e nineteenth ce ntury tha t a wide variety of d isorders often improved clinically following febrile ep isodes. Wagner-Jau regg, in 1917 , attempted to a lleviate the symptoms of dementia paralyti ca (neuro-syphilis) by ind uc ing fever with th e intram uscular injection of blood from patients with ma laria. Of th e fir st nine patient s he investigated, three had a complete recovery, three had a temporary symptom-
1938年，罗马大学的乌戈·切莱蒂(Ugo Cerletti)和卢西诺·宾尼(Lucino Bin i)进行了首次临床试验。下面的文章将检查导致电痉挛疗法第一次试验的发展，以及电痉挛疗法在随后的五十年中的使用。希望通过对电痉挛疗法发展和进步的历史方面的研究，能够更好地理解这种治疗方式。电的治疗用途并不是电痉挛疗法所独有的。有证据表明，古罗马人利用电鳗产生的电流来治疗头痛、痛风和辅助产科手术。关于电的治疗性使用的最近的历史可以追溯到1744年，当时题为“电与医学”的杂志首次出版。在这里，有人声称电刺激可以治疗“神经和精神上的麻痹和癫痫(1)”。J.B. LeRoy在1755年出版的《电与医学》中详细介绍了一个用三次电击治愈了癔病性失明的病例。1752年，本杰明·富兰克林记录了他使用“静电机器来治疗一个患有癔病的女人”。到19世纪中期，电疗的应用已经取得了如此大的进步，以至于G.B.C.杜兴(通常被称为电疗之父)会说:“没有哪个神经学家能在不使用电疗的情况下治疗冰。”但是，尽管电疗法在19世纪有文献记载，但几乎没有证据表明它对电痉挛疗法的发展有任何影响。医学上使用电的历史重点是电刺激本身，而电痉挛疗法的电仅仅是为了治疗而使用，而不是为了治疗。对电痉挛疗法发展更重要的贡献是Jul ius Wagner-Jauregg的工作。这是一个共同的观察在19世纪后期，各种各样的疾病往往改善临床发热发作后。1917年，Wagner-Jau regg试图通过向疟疾患者的肌肉内注射血液来治疗发烧，以减轻痴呆症麻痹(神经梅毒)的症状。在他调查的前9例患者中，3例完全康复，3例有暂时症状
{"title":"An Historical Review of Electroconvulsive Therapy","authors":"B. Wright","doi":"10.29046/JJP.008.2.007","DOIUrl":"https://doi.org/10.29046/JJP.008.2.007","url":null,"abstract":"T he initia l clinical tria l of electroco nvu lsive th erapy (ECT) was performed by Ugo Cerletti and Lucino Bin i at th e U niversity of Rome in 1938. T he following paper will exam ine both the developments wh ich led to the first trial of ECT, and th e use of ECT over th e subseque nt fifty years. Hopefull y, by inv est igating the historical aspect s of the development and progression of ECT , a bette r understa nding of this treatment modali ty ca n be attained. T he therapeutic use of electricity was not unique to ECT. T here is evidence th at Ancient Romans used th e cu r rent generated by electric eels for the treatment of headach es, gout, and to assist in obstetr ica l procedures. The recent his tory o f th e th erapeutic use of electricity dates to 1744 when th e journal entitle d \" Electr icity and Medicine\" was firs t publish ed. It was claimed here that elec tric stimu li co u ld be curative for \" neurologic and mental cases of paralysis and ep ilepsy (1).\" J.B. LeRoy in th e 175 5 ed ition of \" Electr icity and Medicine\" detailed a case of hyste rical blindness whic h was cured with three applicat ions of e lectric shock (1). In 1752 , Benjami n Franklin recorded th e use of an \"elec tro static mach ine to cu re a woman of hys terical fits (2). \" By th e mid 19th century the use of electrothera py had so progressed that G.B.C. Duchenne (often refer red to as th e Fath er of Electrotherapy) would say, \"No sin ce re neurologist could p ract ice wit hout the use of electrotherapy (1).\" Bu t , despite th e documented use of electrotherapy through th e 19th century, there is little ev idence that th is was of any influence in th e development of ECT. The historical emphasis in the medicina l use of electricit y was on the electric st im ulus in and of itsel f, whereas the e lectricity in ECT was used solely for its co nv u lsan t proper t ies. A more important co ntribution to the development of ECT was th e work of Jul ius Wagner-Jauregg . It was a co mmon observation in th e lat e nineteenth ce ntury tha t a wide variety of d isorders often improved clinically following febrile ep isodes. Wagner-Jau regg, in 1917 , attempted to a lleviate the symptoms of dementia paralyti ca (neuro-syphilis) by ind uc ing fever with th e intram uscular injection of blood from patients with ma laria. Of th e fir st nine patient s he investigated, three had a complete recovery, three had a temporary symptom-","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"82 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":"128612331","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":"Psychiatric Training: The Culture and Its Contradictions by T.M. Luhrmann","authors":"C. Myers","doi":"10.29046/jjp.016.1.009","DOIUrl":"https://doi.org/10.29046/jjp.016.1.009","url":null,"abstract":"","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":"126819017","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}
Psychiatrists arefrequenlly challenged to differentiateprimarypsychiatricsymptomsfrom those that arise secondary to medical illness. Errors in clinical assessment can lead to significant morbidity and even mortality. Wernicke's encephalopathy is a medical condition that presents, in part, as psychiatric symptomatology. Despite an estimated incidence of2%, 80% qf the cases are undiagnosed. Of its classic triad, ophthalmoplegia and ataxia call be quite subtle, oreven absent, whereas mental status changes are present in all but 10%ofcases. This disorder, although widely recognized as a complication ofalcoholism, has many lessftequently considered etiologies, including iatrogenic causes, which may constitute a largefraction ofthe unrecognized cases. The authorlooks at a caseofWemicke's encephalopathy that was iatrogenically induced andpresentedaspsychiatric symptomatology. Wernicke's ence phalopa thy is a medi ca l condition which results from impaired intestinal absorpt ion of thiamine. It s pr imary manifest ations a re neurological and psych iatric, however its neurologica l seque lae (ophtha lmo pleg ia a nd a taxia) are ofte n subt le and a high ind ex of suspicion is essen tia l to conside r th e diagnosis (I). Dist urbances of consciousness an d mentation are typica l and pr esen t in all but 10 pe rce nt of pat ients (2) . The following ca se illust rates a primarily psych iatric presentat ion of the illn ess, followin g int ravenou s fluid administ ration, in a 3 1-yea r-old man with hypere mesis and protract ed hiccups.
{"title":"A Psychiatric Presentation of Wernicke's Encephalopathy Following Intravenous Fluid Administration","authors":"D. O. D. Geenans","doi":"10.29046/JJP.010.2.003","DOIUrl":"https://doi.org/10.29046/JJP.010.2.003","url":null,"abstract":"Psychiatrists arefrequenlly challenged to differentiateprimarypsychiatricsymptomsfrom those that arise secondary to medical illness. Errors in clinical assessment can lead to significant morbidity and even mortality. Wernicke's encephalopathy is a medical condition that presents, in part, as psychiatric symptomatology. Despite an estimated incidence of2%, 80% qf the cases are undiagnosed. Of its classic triad, ophthalmoplegia and ataxia call be quite subtle, oreven absent, whereas mental status changes are present in all but 10%ofcases. This disorder, although widely recognized as a complication ofalcoholism, has many lessftequently considered etiologies, including iatrogenic causes, which may constitute a largefraction ofthe unrecognized cases. The authorlooks at a caseofWemicke's encephalopathy that was iatrogenically induced andpresentedaspsychiatric symptomatology. Wernicke's ence phalopa thy is a medi ca l condition which results from impaired intestinal absorpt ion of thiamine. It s pr imary manifest ations a re neurological and psych iatric, however its neurologica l seque lae (ophtha lmo pleg ia a nd a taxia) are ofte n subt le and a high ind ex of suspicion is essen tia l to conside r th e diagnosis (I). Dist urbances of consciousness an d mentation are typica l and pr esen t in all but 10 pe rce nt of pat ients (2) . The following ca se illust rates a primarily psych iatric presentat ion of the illn ess, followin g int ravenou s fluid administ ration, in a 3 1-yea r-old man with hypere mesis and protract ed hiccups.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"74 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":"133879263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Usefulness of Neutrality","authors":"Julia Jones Zawatsky","doi":"10.29046/JJP.005.2.002","DOIUrl":"https://doi.org/10.29046/JJP.005.2.002","url":null,"abstract":"","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"1 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":"128406411","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}
Few aspects of psychiatric trammg are more troubling to beginning resid ents than the emerging awareness of their own co untertransferences. This is often viewed with a mixture of disgust and em barassment as a sign of incompetence and lack of professionalism. Conflicting views on th e or igi ns of, and appropriate responses to countertransference furth er add to the di fficul ty and anxiety of psyc hiatric training. The frustration a nd se nse of helplessness which often accompany these feelings can lead to disillusionment a nd various degrees of acting out which ul timately compromise patient ca re and resid e nt education. Ironicall y, th e feeling of being overwhelmed by co untertra nsference can often occur several months into a psychiatric resid ency. Once beginni ng residents have acquired th e basic clinical skills needed for acute diagnosis and treatment, subtler issues in patient management arise . The greate r degree of psychiatric patient contact and greater difficulty in maintaining professiona l distance through procedures and lab stud ies makes this inevitable. It is often no t until th e outpatient yea rs when residents begin to treat " h igher func tion ing" patients that psychodynamic ed ucatio n is deemed clinically useful. Co untertransference, like other psychodynamic topics, ma y be view ed as " ir re leva nt" to inpatient psychiatry, which emphasizes biological and behavioral inter ventio ns. At all levels of training, howe ver, acquiring a systematic understanding of cou ntertransfere nce ma y be one of the most anxiolytic and educat iona lly use ful advances a resident can make.
{"title":"Countertransference and Inpatient Psychiatry: Theoretical and Clinical Aspects","authors":"Edward Kim","doi":"10.29046/JJP.006.2.010","DOIUrl":"https://doi.org/10.29046/JJP.006.2.010","url":null,"abstract":"Few aspects of psychiatric trammg are more troubling to beginning resid ents than the emerging awareness of their own co untertransferences. This is often viewed with a mixture of disgust and em barassment as a sign of incompetence and lack of professionalism. Conflicting views on th e or igi ns of, and appropriate responses to countertransference furth er add to the di fficul ty and anxiety of psyc hiatric training. The frustration a nd se nse of helplessness which often accompany these feelings can lead to disillusionment a nd various degrees of acting out which ul timately compromise patient ca re and resid e nt education. Ironicall y, th e feeling of being overwhelmed by co untertra nsference can often occur several months into a psychiatric resid ency. Once beginni ng residents have acquired th e basic clinical skills needed for acute diagnosis and treatment, subtler issues in patient management arise . The greate r degree of psychiatric patient contact and greater difficulty in maintaining professiona l distance through procedures and lab stud ies makes this inevitable. It is often no t until th e outpatient yea rs when residents begin to treat \" h igher func tion ing\" patients that psychodynamic ed ucatio n is deemed clinically useful. Co untertransference, like other psychodynamic topics, ma y be view ed as \" ir re leva nt\" to inpatient psychiatry, which emphasizes biological and behavioral inter ventio ns. At all levels of training, howe ver, acquiring a systematic understanding of cou ntertransfere nce ma y be one of the most anxiolytic and educat iona lly use ful advances a resident can make.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"3 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":"128537739","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. Blumenthal, H. Field, E. Gottheil, M. Guerra, W. Maddrey, R. Serota, E. Shaw
Ellen S haw. M. D., Fellow in Hepatology: Mr. J is a fort y-six-year-old white male who was initially seen on th e medical service in July 1982. At that time he presented with hepatic encepha lopathy, jaundice, and ascites . A liver biopsy was per formed, confirming the clinica l diagnosis of a lcoholic hepati t is superimposed on cirrhosis. Following dischar ge it was difficult to mainta in Mr. J as an out patient. He did not follow dieta ry rest rictions or ta ke diur et ics as presc ribed . Addit iona lly he was unable to control his drinking. Fina lly about a yea r ago a Levine shunt was imp lanted in an effort to control his asci tes . Subsequently he did well for a period of several months. He was ab le to abstai n from alcohol with a resu lt ing decrease in his ascites and jaundice. Recent ly he has resu med drinking, with a retu rn of his sym ptoms. He has missed his last several appointments in the clinic. Co nt rol of his medical pro blem s rem ains problemat ic unless his alcohol abuse ca n be bett er controlled. Willis C. Maddrey , M.D., Maggey Prof essor and Chairman of the Department of Medicine: I a m grateful for th e opportunity to discuss thi s te rrible problem . I know this pat ient, as ma ny of you do. He is prototypical of a group of patients in whom cirrhosi s a nd a ll of its complicati ons induced by a lcohol has led to a complex situation that is a downw ard spira l. As Dr . Shaw relat ed , th is man developed cirrhosis, the major mani fest ati on of which was ascites. If he would trea t himself appropri at ely, that is to say, be a bsti nent and ta ke diuretics, in addit ion to his Levine shunt, then his life expecta ncy would be reasona ble, about ten yea rs. Once you get cirrhosis your life expecta ncy dr ops remarkabl y. But if Mr. J were to take care of himself he would probabl y be a ll right for about ten years . Our pro blem , therefore, is th is pa tient' s persist ent addiction to alcohol. As you know, when this patient dried out, he took a look a t his life and decid ed it was bett er to be an a lcoholic . T hat's our probl em . Wh at I would like to talk about is the pa rt I work with the most: the physica l consequences of a lcohol abuse . You are a ll aware of the stat ist ics, but they are wor th reviewing. A bout one in ten chronic a lcoholics will develop cir rhosis . A chronic alcoholic to a hepat ologist is someo ne who dr inks more than sixteen ounces of eighty-six proof whiskey or its equivalent a day. I'm not using a socia l definition . T here a re people who are imp aired a t less tha n that and ot her s who are not a t much more than tha t. In fact, I have a number of pa tients with minimal liver abnorm alit ies in whom I'm relat ively ce rtain tha t they're telling me the truth when the y tell me the y
艾伦·肖。医学博士，肝病学研究员:J先生是一名64岁的白人男性，1982年7月首次就诊。当时他表现为肝性脑病、黄疸和腹水。肝活组织检查证实临床诊断为酒精性肝，合并肝硬化。出院后，J先生作为门诊病人很难维持。他没有遵循饮食习惯，也没有按照规定服用膳食补充剂。此外，他还无法控制自己的饮酒习惯。最后，大约一年前，为了控制他的脑炎，他植入了莱文分流器。随后的几个月里，他表现得很好。他戒了酒，结果腹水和黄疸减少了。最近他又喝酒了，症状又发作了。他错过了在诊所的最后几次预约。除非他的酗酒问题能得到更好的控制，否则控制他的健康问题仍然是个问题。Willis C. Maddrey，医学博士，医学教授和医学部主席:我很感谢有机会讨论这个可怕的问题。我和你们许多人一样了解这个病人。他是一组肝硬化患者的典型，酒精引起的所有并发症导致了一种复杂的情况，即螺旋式下降。肖说，这名男子发展为肝硬化，主要症状是腹水。如果他能适当地治疗自己，也就是说，做一个手术，服用利尿剂，除了他的莱文分流器，那么他的预期寿命将是合理的，大约10年，一旦你得了肝硬化，你的预期寿命会大幅下降，但如果J先生照顾好自己，他可能会好大约10年。因此，我们的问题是，这个病人对酒精有持续的依赖。如你所知，当这个病人戒酒后，他审视了自己的生活，决定最好还是做一个酒鬼。这是我们的问题。我想说的是我工作中接触最多的部分:酒精滥用的身体后果。你对统计数据很了解，但它们值得回顾。大约十分之一的慢性酗酒者会发展成肝硬化。对肝病专家来说，慢性酗酒者是每天喝超过16盎司的86度威士忌或与其相当的酒的人。我没有使用社会定义。这里有一些人的肝脏比这少很多，而另一些人的肝脏比这多不了多少，事实上，我有一些病人的肝脏有轻微的异常，我相对确信当他们告诉我y的时候他们说的是真话
{"title":"Intractable Alcoholism in a Patient with a Levine Shunt","authors":"B. Blumenthal, H. Field, E. Gottheil, M. Guerra, W. Maddrey, R. Serota, E. Shaw","doi":"10.29046/jjp.003.1.012","DOIUrl":"https://doi.org/10.29046/jjp.003.1.012","url":null,"abstract":"Ellen S haw. M. D., Fellow in Hepatology: Mr. J is a fort y-six-year-old white male who was initially seen on th e medical service in July 1982. At that time he presented with hepatic encepha lopathy, jaundice, and ascites . A liver biopsy was per formed, confirming the clinica l diagnosis of a lcoholic hepati t is superimposed on cirrhosis. Following dischar ge it was difficult to mainta in Mr. J as an out patient. He did not follow dieta ry rest rictions or ta ke diur et ics as presc ribed . Addit iona lly he was unable to control his drinking. Fina lly about a yea r ago a Levine shunt was imp lanted in an effort to control his asci tes . Subsequently he did well for a period of several months. He was ab le to abstai n from alcohol with a resu lt ing decrease in his ascites and jaundice. Recent ly he has resu med drinking, with a retu rn of his sym ptoms. He has missed his last several appointments in the clinic. Co nt rol of his medical pro blem s rem ains problemat ic unless his alcohol abuse ca n be bett er controlled. Willis C. Maddrey , M.D., Maggey Prof essor and Chairman of the Department of Medicine: I a m grateful for th e opportunity to discuss thi s te rrible problem . I know this pat ient, as ma ny of you do. He is prototypical of a group of patients in whom cirrhosi s a nd a ll of its complicati ons induced by a lcohol has led to a complex situation that is a downw ard spira l. As Dr . Shaw relat ed , th is man developed cirrhosis, the major mani fest ati on of which was ascites. If he would trea t himself appropri at ely, that is to say, be a bsti nent and ta ke diuretics, in addit ion to his Levine shunt, then his life expecta ncy would be reasona ble, about ten yea rs. Once you get cirrhosis your life expecta ncy dr ops remarkabl y. But if Mr. J were to take care of himself he would probabl y be a ll right for about ten years . Our pro blem , therefore, is th is pa tient' s persist ent addiction to alcohol. As you know, when this patient dried out, he took a look a t his life and decid ed it was bett er to be an a lcoholic . T hat's our probl em . Wh at I would like to talk about is the pa rt I work with the most: the physica l consequences of a lcohol abuse . You are a ll aware of the stat ist ics, but they are wor th reviewing. A bout one in ten chronic a lcoholics will develop cir rhosis . A chronic alcoholic to a hepat ologist is someo ne who dr inks more than sixteen ounces of eighty-six proof whiskey or its equivalent a day. I'm not using a socia l definition . T here a re people who are imp aired a t less tha n that and ot her s who are not a t much more than tha t. In fact, I have a number of pa tients with minimal liver abnorm alit ies in whom I'm relat ively ce rtain tha t they're telling me the truth when the y tell me the y","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"1 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":"115787894","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}
Background: Research on treatment of depression has raised concerns regarding adequacy of medication trials and rationality of drug choice. Little data exists regarding pharmacotherapy by psychiatric residents. As practice habits begun in training will likely persist after graduation, examination of residents' antidepressant use may ultimately improve treatment by psychiatrists. Methods: Charts of new patients presenting to the Wake Forest University Psychiatry Resident Clinic were reviewed. Survey was made of medications prescribed to 112 patients diagnosed with major depression, dysthymia, depressive disorder NOS, adjustment disorder with depressed mood, or bipolar disorder with a documented depression during the studied period. Drug choice and maximum dose were noted. Results: Most-prescribed antidepressants included sertraline, trazodone, citalopram, mirtazapine, venlafaxine, and bupropion. The most used tricyclic antidepressant was amitriptyline (n=7), with an average highest dose of 110.7 mg per day. No MAOIs were prescribed. Augmentation treatment with lithium was prescribed twice and thyroid hormone once. No patients received ECT. Conclusions: Depressed patients in this resident clinic were treated primarily with SSRIs and other newer antidepressants. Little use was made of TCAs, MAOIs, ECT or traditional augmentation strategies. Further research should aim to determine whether more education in older antidepressant treatment modalities should be emphasized.
{"title":"Antidepressant Pharmacotherapy: Prescription Practices in Psychiatric Resident Care","authors":"R. Dew, Vaughn McCall","doi":"10.29046/JJP.019.1.003","DOIUrl":"https://doi.org/10.29046/JJP.019.1.003","url":null,"abstract":"Background: Research on treatment of depression has raised concerns regarding adequacy of medication trials and rationality of drug choice. Little data exists regarding pharmacotherapy by psychiatric residents. As practice habits begun in training will likely persist after graduation, examination of residents' antidepressant use may ultimately improve treatment by psychiatrists. Methods: Charts of new patients presenting to the Wake Forest University Psychiatry Resident Clinic were reviewed. Survey was made of medications prescribed to 112 patients diagnosed with major depression, dysthymia, depressive disorder NOS, adjustment disorder with depressed mood, or bipolar disorder with a documented depression during the studied period. Drug choice and maximum dose were noted. Results: Most-prescribed antidepressants included sertraline, trazodone, citalopram, mirtazapine, venlafaxine, and bupropion. The most used tricyclic antidepressant was amitriptyline (n=7), with an average highest dose of 110.7 mg per day. No MAOIs were prescribed. Augmentation treatment with lithium was prescribed twice and thyroid hormone once. No patients received ECT. Conclusions: Depressed patients in this resident clinic were treated primarily with SSRIs and other newer antidepressants. Little use was made of TCAs, MAOIs, ECT or traditional augmentation strategies. Further research should aim to determine whether more education in older antidepressant treatment modalities should be emphasized.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"36 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":"127761543","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}
Civil commitment has become a practically unavoidable process .for today's practicing psychiatrist. It creates a complicated triangular relationship involving the legal system, the medical system, and the pat ient. This article is a first person narrative qf a case which helps describe the Wisconsin civil commitment process as it operates in Miltoaukee County. It illustrates the frus trations that a psychiatrist (and in this case a fi rst year psychiatry resident) can experience in such a system. Finally, it addresses these problems associated with civil commitment and discusses possible solutions. I first becam e initia ted into th e Mi lwaukee County (W isconsin) civil commitment process duri ng my firs t year of psychia try train ing. During my first test imony, I had been qu es t ion ed sa tisfactorily by th e patient 's attorney, and th en the Cou nty a tt orney ask ed me confide n t ly, " Doc to r, how lon g have you been a psych ia t ry resid ent?" I a nswe red, "abo ut two weeks." Wh en th e j udge a nd everyone else in th e court room finall y st opped lau ghing and my emba rrassme nt had fad ed , we were ab le to put th e focu s back on th e issu e at hand. Wi th tha t being my introduction to th e fru stration of th e Mil waukee County civil com mit ment sys te m, I now use it as a prologue for a case report whi ch illust rat es ma ny of the shortcomings of that syst em, as well as the com plexity of th e Wiscon sin laws of com mit me nt, as th ey are practi ced in Milwaukee Co unty. Work ing with this patient showed me th e importan ce of th e in terface bet ween th e legal syst em and psychiatry. This is th e case ofj.S. (ce rtain identifyin g features have been changed for th e sa ke of confide n tia lity). j.S. is a 4 1 year old woma n diagnosed wit h chronic schizophre nia . She had bee n hospi talized many times over the last 20 yea rs sec ondary to psychot ic st a tes which usually occurred aft er Miss S. had stopped ta kin g her pr escribed neu rol epti c medication. Sh e becam e quit e dangerous at th ese times developing delu sions focus ed on a need for excessive weight loss. In May of 1990 , Miss. S. was hosp itali zed under simila r circumsta nce s. Two mont hs previous to this admission, becau se of a simi lar episode of dangerous weigh t loss, her fat her had been appointed her tempora ry gua rd ian. J on A. Lehrmann, M. D. is a PGY-III res iden t in th e Dep artment of Psychi a try a t the Medical Co lleg e of Wiscons in in Milwaukee.
对于今天的执业精神科医生来说，民事承诺实际上已经成为一个不可避免的过程。它创造了一个复杂的三角关系，涉及法律系统、医疗系统和病人。这篇文章是一个案例的第一人称叙述，它有助于描述威斯康星州民事承诺过程，因为它在密尔沃基县运作。它说明了精神科医生(在这种情况下是第一年精神科住院医生)在这种系统中可能经历的挫折。最后，本文讨论了与民事承诺相关的这些问题，并讨论了可能的解决方案。我第一次进入密尔沃基县(威斯康星州)民事承诺程序是在我第一年的精神病学培训期间。在我的第一次测试中，我被病人的律师说得很满意，然后县里的一位律师问我，“医生，你在这里做心理医生多久了?”我回答道:“大约两个星期。”当法官和法庭上的其他所有人终于停止了诉讼，我的emba课程也结束了，我们才能够把注意力重新放在手头的问题上。这是我对密尔沃基县民事诉讼制度的挫折的介绍，现在我用它作为一个案例报告的开场白，这个案例报告将指出该制度的许多缺点，以及威斯康星州民事诉讼法律的复杂性，因为它们在密尔沃基县实施。和这个病人一起工作让我看到了法律系统和精神病学之间的接口的重要性。这是j。s。的情况。(为了保证可信度，某些识别特征已被更改)。j.S.是一名41岁的女性，被诊断患有慢性精神分裂症。在过去的20年里，她曾多次因精神疾病住院，通常发生在s小姐停止服用医生所开的新药物后。在那些时候，她变得非常危险，产生了专注于需要过度减肥的妄想。1990年5月，s女士在类似的情况下住进了医院。在此入院前两个月，由于类似的危险的体重下降，她的医生被任命为她的临时监护人。J . a . Lehrmann博士是位于密尔沃基的威斯康星州医疗公司精神科的pgp - iii级医生。
{"title":"Climbing through the Milwaukee County Civil Commitment Process","authors":"Jon A. Lehrmann","doi":"10.29046/jjp.011.2.007","DOIUrl":"https://doi.org/10.29046/jjp.011.2.007","url":null,"abstract":"Civil commitment has become a practically unavoidable process .for today's practicing psychiatrist. It creates a complicated triangular relationship involving the legal system, the medical system, and the pat ient. This article is a first person narrative qf a case which helps describe the Wisconsin civil commitment process as it operates in Miltoaukee County. It illustrates the frus trations that a psychiatrist (and in this case a fi rst year psychiatry resident) can experience in such a system. Finally, it addresses these problems associated with civil commitment and discusses possible solutions. I first becam e initia ted into th e Mi lwaukee County (W isconsin) civil commitment process duri ng my firs t year of psychia try train ing. During my first test imony, I had been qu es t ion ed sa tisfactorily by th e patient 's attorney, and th en the Cou nty a tt orney ask ed me confide n t ly, \" Doc to r, how lon g have you been a psych ia t ry resid ent?\" I a nswe red, \"abo ut two weeks.\" Wh en th e j udge a nd everyone else in th e court room finall y st opped lau ghing and my emba rrassme nt had fad ed , we were ab le to put th e focu s back on th e issu e at hand. Wi th tha t being my introduction to th e fru stration of th e Mil waukee County civil com mit ment sys te m, I now use it as a prologue for a case report whi ch illust rat es ma ny of the shortcomings of that syst em, as well as the com plexity of th e Wiscon sin laws of com mit me nt, as th ey are practi ced in Milwaukee Co unty. Work ing with this patient showed me th e importan ce of th e in terface bet ween th e legal syst em and psychiatry. This is th e case ofj.S. (ce rtain identifyin g features have been changed for th e sa ke of confide n tia lity). j.S. is a 4 1 year old woma n diagnosed wit h chronic schizophre nia . She had bee n hospi talized many times over the last 20 yea rs sec ondary to psychot ic st a tes which usually occurred aft er Miss S. had stopped ta kin g her pr escribed neu rol epti c medication. Sh e becam e quit e dangerous at th ese times developing delu sions focus ed on a need for excessive weight loss. In May of 1990 , Miss. S. was hosp itali zed under simila r circumsta nce s. Two mont hs previous to this admission, becau se of a simi lar episode of dangerous weigh t loss, her fat her had been appointed her tempora ry gua rd ian. J on A. Lehrmann, M. D. is a PGY-III res iden t in th e Dep artment of Psychi a try a t the Medical Co lleg e of Wiscons in in Milwaukee.","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"59 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":"127029890","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 biography was published in 1989 as a tribute to C harles Schultz's fortiet h anniversary of publishing Peanuts. The longevity of his ca r too n and th e fact th at he has drawn eac h strip by himself is unique. His characte rs a re known in eve ry contine nt and their trials and tribulations a re translated into ove r twe nty la nguages every day. So why would I recommend this book to th e ge neral pu blic, and to psychiatrist s and m ental health professionals in pa rt icul ar? Becau se in this authoriz ed biography, Rheta Grimsley J ohnson, a nation ally ren owned syndicated columnist , shows how a man do es not hav e to be crippled by his mental illness and how thi s man in particul ar could not have becom e what he is today without coming to terms with agorophobia a nd depression . The ea rly chapte rs describe how Schultz grew up in Minnea polis as an only child who was close to his mother and fa the r. Significa n t mil eston es from his life are ment ioned , in pa rticul ar th ose whi ch see m to be reflect ed in Peanuts. For example, th e whole family moved to Nee dles, California during the Grea t Depression whil e his fa t he r looked for work , eve ntually moving back to Minneapolis whe re he graduated from high school. In sch ool he was a C stude n t with very few friends, spe ndi ng most of his lun ch hours by himself a nd feeling intimidated by th e others. A whole chapter is devot ed to th e woman on whom The Little Red H aired Girl is based. We see th at his popular charac te r Charlie Brown re flec ts som e of Schultz's own ex periences and feelings. The crit ica l point in his life, according to Johnson , was his draft in to World Wa r II th e same week that his mother died fr om ca nce r . H e never had th e opportunity to say goo d-bye to his mother and according to J ohnson, thi s was a n issu e he never succes sfully re solved. H e returned from th e war a nd soug ht work as a n a rt illust ra tor and as a fr ee lan ce ca r toonist for newspapers whil e waiting for his big chance to be publish ed in a major newspap er. The middle chapte rs furn ish more detail on how Schultz was ab le to get Peanuts publish ed and eventually known in every corner of th e globe. The remaining chapte rs show what day to day ope ra tio ns a re curre n t ly like with Schultz working in his stud io in Sa nta Clara, Califo rn ia . J ohnson mak es clear referen ces through out thi s boo k to th e fact that Schult z
{"title":"So Much Success, So Little Joy","authors":"D. Gerstman","doi":"10.29046/jjp.011.1.007","DOIUrl":"https://doi.org/10.29046/jjp.011.1.007","url":null,"abstract":"This biography was published in 1989 as a tribute to C harles Schultz's fortiet h anniversary of publishing Peanuts. The longevity of his ca r too n and th e fact th at he has drawn eac h strip by himself is unique. His characte rs a re known in eve ry contine nt and their trials and tribulations a re translated into ove r twe nty la nguages every day. So why would I recommend this book to th e ge neral pu blic, and to psychiatrist s and m ental health professionals in pa rt icul ar? Becau se in this authoriz ed biography, Rheta Grimsley J ohnson, a nation ally ren owned syndicated columnist , shows how a man do es not hav e to be crippled by his mental illness and how thi s man in particul ar could not have becom e what he is today without coming to terms with agorophobia a nd depression . The ea rly chapte rs describe how Schultz grew up in Minnea polis as an only child who was close to his mother and fa the r. Significa n t mil eston es from his life are ment ioned , in pa rticul ar th ose whi ch see m to be reflect ed in Peanuts. For example, th e whole family moved to Nee dles, California during the Grea t Depression whil e his fa t he r looked for work , eve ntually moving back to Minneapolis whe re he graduated from high school. In sch ool he was a C stude n t with very few friends, spe ndi ng most of his lun ch hours by himself a nd feeling intimidated by th e others. A whole chapter is devot ed to th e woman on whom The Little Red H aired Girl is based. We see th at his popular charac te r Charlie Brown re flec ts som e of Schultz's own ex periences and feelings. The crit ica l point in his life, according to Johnson , was his draft in to World Wa r II th e same week that his mother died fr om ca nce r . H e never had th e opportunity to say goo d-bye to his mother and according to J ohnson, thi s was a n issu e he never succes sfully re solved. H e returned from th e war a nd soug ht work as a n a rt illust ra tor and as a fr ee lan ce ca r toonist for newspapers whil e waiting for his big chance to be publish ed in a major newspap er. The middle chapte rs furn ish more detail on how Schultz was ab le to get Peanuts publish ed and eventually known in every corner of th e globe. The remaining chapte rs show what day to day ope ra tio ns a re curre n t ly like with Schultz working in his stud io in Sa nta Clara, Califo rn ia . J ohnson mak es clear referen ces through out thi s boo k to th e fact that Schult z","PeriodicalId":142486,"journal":{"name":"Jefferson Journal of Psychiatry","volume":"126 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":"122885732","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}
I would like to respond to the article e n t itled " A Practi ca l Approach to the Assessment and Management of Psychiatric Emergencie s" (Jefferson J ournal of Psychiatry, Vol. 7:8 I -9 1, 1989). The au thors are to be co ngratulated for their concise distillation of the major clinical problems encountered in emergency psychiatry. However, there are several aspects of this r eview which require further amplifica t ion and clarification . The authors tend to emphasize drug therapy. While d rug treat ment is an integral part of emergency psych iatry, an understandin g of th e psychodynamic issues related to violence, su icide, an d adjustment disorders ca n frequently facilita te a psychologica l rein tegration fo r the patient and reduce or obvia te the need for med ica t ion . Furthermore, in the treatment of personal ity d isorders, substance abuse patients and depressed and/or suicida l patients, and ge riatric emergencies, timely family intervention by enlisting the help o f th e pat ien t 's support network ca n frequently atten uate the emergency, minimize med ication and avert hospital izat ion. T he irony of emergency psychiatry is th at like a ll emergency med icine, the em phasis is generally placed on rapid intervention and disposi tion. Paradoxica lly in emergency psych iatry, "tincture of time" is o ften a power ful tr ea tment intervention. Obviously, the abi lit y to em ploy psych o therapeutic interventions is dependent on space and staff availability. Specifica lly addressing severa l issues raised by the authors, I was curiously struck by the sta te ment that " the psych iatrist should never tak e part in any pat ient restrain t, but rather g ive orders an d d irect the action ." It is no t quite clear to me why psychiatrists shou ld never take part in any patient restraint. T here is no ev idence to ind icate that such interventions would di srupt a therape ut ic rela tionsh ip. Assuming that a psyc hiatrist is knowledgeabl e in restrain t procedures and adept at th is techniq ue , I bel ieve that th e psychi at r ist should active ly invol ve him/hersel f since part of his /her task is to rol e-m odel approp riate treatment interventions fo r o ther staff. At o ther times, th e psychiatrist may in fact be th e most ill-equipped member of a team to give orders and di rect ac tio n and frequently psych ia tr ic tech nicians or nursing staff are more experienced and skillfu l in restra int procedures. I think that the invol vement of
我想回应一篇名为“精神紧急情况评估和管理的实践方法”的文章(《杰弗逊精神病学杂志》，卷7:8 I - 9,1989)。作者对急诊精神病学遇到的主要临床问题进行了简明扼要的总结，值得祝贺。然而，这一审查有几个方面需要进一步扩大和澄清。作者倾向于强调药物治疗。虽然药物治疗是紧急精神病学的一个组成部分，但了解与暴力、自杀和适应障碍有关的心理动力学问题，往往可以促进患者的心理控制融合，减少或消除对医学治疗的需求。此外，在治疗人格障碍、药物滥用患者、抑郁症和/或自杀患者以及儿科紧急情况时，通过寻求患者支持网络的帮助进行及时的家庭干预，可以经常减轻紧急情况，减少药物治疗并避免住院。急诊精神病学的讽刺之处在于，就像所有急诊医学一样，重点通常放在快速干预和处置上。矛盾的是，在急诊精神病学中，“时间的酊剂”往往不是一种有效的治疗干预措施。显然，采用心理治疗干预的可能性取决于空间和工作人员的可用性。在具体处理作者提出的几个问题时，我对“精神科医生不应该参与任何病人的约束，而应该发出命令并指导行动”的说法感到奇怪。我不太清楚为什么精神科医生不应该参与任何病人的约束。没有证据表明这种干预会破坏治疗关系。假设一名精神科医生对治疗程序和技术都很熟悉，我认为他/她应该积极参与，因为他/她的部分任务是为其他工作人员提供适当的治疗干预措施。在其他时候，精神科医生实际上可能是一个团队中最不擅长发号施令和指导行动的成员，而通常精神科技术人员或护理人员在控制程序方面更有经验和技巧。我认为参与
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