The Hillside journal of clinical psychiatry最新文献

The author describes a young woman with both Capgras syndrome and Huntington's Disease. The possible pathophysiology of Capgras syndrome is briefly reviewed in the context of the neuropathology of Huntington's Disease.

Despite the opportunity of helpful intervention, palliation, and prevention in the form of psychosocial counselling, specialized services for AIDS patients and individuals-at-risk have met with resistance within psychiatry. Resistance can be understood as a reaction to the nature of the illness and its demographics. It can also be understood as an outgrowth of current psychiatric practice and theory, especially as it pertains to homosexuality.

Very limited information exists on possible effects of lithium on male spermatogenesis. The formation and transit of the male gamete occurs in a highly sensitive ionic environment. We prospectively analyzed ten male euthymic bipolar outpatients who had been on extended maintenance lithium. Samples were collected at entrance, days 35, and 70, in order to assess gametes in different stages of spermatogenesis. No significant differences emerged either within, between subjects, or in contrast to a matched control relative to a series of analytic criteria.

We pay tribute to Lew Robbins and Hillside Hospital for the opportunity given me to develop work in the psychopharmacological treatment of mental disorders. A historical review is given of early experience with antipsychotics and antidepressants and the failed attempts to relate therapeutic effect of psychoanalytic formulations. Work done at Hillside demonstrated the importance of developmental history for schizophrenic prognosis and drug responsivity. Surprising findings such as the positive antidepressant benefits of chlorpromazine are detailed and discussed. The resemblances between bipolar affective disorder and schizophrenia are detailed and related to the peculiar finding that all anti-schizophrenic drugs are also anti-manic. The converse of this is also discussed. The psychopharmacological resemblances between bipolar disorder and schizophrenia, as well as the relationship to genetic findings, lead to a two factor theory of schizophrenia and hypotheses concerning the nature of delusional and deteriorative processes.

How do Orthodox Jewish clients feel about the religious identity of their therapists? Do they have any preferences; and if so, why? The research reported here was designed to answer these questions. Semi-structured in-person interviews were conducted with a sample of Orthodox Jewish clients of out-patient mental health clinics and private practitioners. The findings of this study revealed a wide range of diverse meanings attached to the therapist's religious identity by Orthodox Jewish clients. The implications of the findings for clinical practice with Orthodox Jewish clients as well as other religious minority group clients are discussed. The overall findings suggest that religious differences in the therapeutic relationship can and do play a critical role in the treatment process.

The authors conducted a systematic investigation of nightmares in consecutive admissions to an inpatient unit at a Veteran Administration hospital for a six-month period. Fifteen of the 41 nightmare sufferers identified their nightmares as post-traumatic. Examination of the nightmares in the light of family histories revealed that familial dysfunction from many points in the nightmare sufferers' life histories found clear-cut representation in the nightmare scenario. In this sample, post-traumatic nightmares dealt not only with the identified trauma, but also with a lifelong continuum of family stresses for which the traumatic scene served as a screen.

Four cases of resistant Schizophrenia treated with valproate association with different neuroleptic drugs (thioridazine in three cases and loxapine in one) are presented. After a mean period of three months with this treatment, clinical improvement, consisting in a reduction of positive symptoms, as measured by the BPRS, and a normalization of hostile/disruptive behavior, was observed, and hospital discharge was possible. Reduction of symptoms was still present after a follow-up of 4 to 24 months. As valproate is a drug with gabaergic properties, a GABA involvement in the pathogenesis of schizophrenia is discussed. The association of valproate to neuroleptic drugs should be considered in the treatment of resistant Schizophrenia.

A family approach to suicidal crises in hospitalized borderline patients is described. The approach is aimed not only at the acute crises, but at the likelihood that repetitive, panic-inducing suicidal episodes provoke shame-producing over-regulation in the short run or exhaustion of support systems (family and treatment team) in the long run. An emergency family session with a hospitalized patient in acute suicidal crisis is presented. Subacute hospital treatment must respond to these crises mindful of long-term as well as acute risks. Subacute hospitalization allows for family intervention to buttress support systems for the long term task of caring for the suicidal borderline patient.

Naturally occurring panic attacks and various interventions which trigger anxiety in panic patients are accompanied by disturbances in the acid-base balance. Carbon dioxide appears to play an important role in many experimental panic provoking conditions. The influence of respiratory and metabolic pH disturbances on cerebral physiology is discussed and speculations are made about the possible mechanisms underlying CO2-induced anxiety in panic disorder.