The Hillside journal of clinical psychiatry最新文献

Twelve DSM-IIIR diagnosed schizophrenics, with neuroleptic-induced akathisia (NIA), were treated with either propranolol or matched placebo for two days, followed by a treatment crossover phase for five more days. Raters and patients were "blind" to treatment. This study shows that 120 mg of propranolol a day is more effective than placebo in reducing akathisia, and that propranolol's antiakathisic effect may require several days of treatment.

Two culturally diverse groups of male youths, ages 16-18, were compared with respect to self-image correlates of alcohol and drug use. Self-image was measured through use of the Offer Self-Image Questionnaire (OSIQ), a reliable, well-validated measure of adolescent self-image covering eleven separate areas of functioning. Alcohol and drug use were measured by means of the Delinquency Checklist (DCL), a self-report measure of delinquent behavior first developed by Short and Nye. The adolescents studied were culturally diverse: one group consisted of the entire junior class of an all-male, all-black Roman Catholic Parochial School located in an economically deprived urban neighborhood; the other group comprised a random sample of all the junior and senior boys in an almost all-white, upper-middle-class, suburban public high school. Results showed that in both groups drug use is associated with poor family relationships and impaired self-image. Selling drugs was more prevalent by self-report among the black, inner-city youths than it was among the white, suburban youths. Selling drugs was associated with poor impulse control, relatively low vocational and educational goals and poor coping skills. The research data is discussed in regards to its relevance to therapy of two culturally diverse groups of adolescents.

A situation is described of suddenly erupting conflict in an interdisciplinary meeting of psychiatric hospital staff. The conflict is related to the systemic impact of recent changes in psychiatric hospital practice. The observed affect and interpersonal dynamics are reviewed in the context of different conceptual frameworks. These include Maslow's hierarchy of needs model, the group focal conflict paradigm and the concept of scapegoating. The use and integration of these three approaches toward understanding affectively laden administrative conflict are discussed. Specific reference is made to the utilization of such understanding in developing leadership skills in a multi-disciplinary mental health setting.

At one institute 48 percent of physician candidates doing class-work are over 40. This percentage has increased over the past decade, perhaps reflecting new economic constraints and the increased proportion of women candidates. A review of the first training analysis, Freud's, and conversations with some present day candidates indicate that choosing training at mid-career can address specific adult developmental issues, including the "race against time," needs for increased structuring of family life and of creative work and shifts from physical to intellectual play and from being a mentee to mentorship.

Some patients manifest intense transferences or transference-like reactions in the earliest hours of psychotherapy. Although these reactions may actually represent transference, they may also arise from other sources, such as aspects of a patient's character, displacements from former therapists, impaired reality testing, information about the therapist, and therapist's behavior. Clinical examples are presented, and their management is discussed.

This report reviews the phenomenology related to the rescue and later development of the newborn babies buried in the rubble of several collapsed maternity hospitals in Mexico City during the earthquake of September 1985. We describe the rescue process as well as the impact of this process on the community. The rescued babies' development has been followed through the first 15 months of their lives and we describe our observations. We also review the implications of the emotional burdens that these babies may bear and the possible repercussions later in their development.

Ninety-five inpatient, RDC-diagnosed major depressives, 68 unipolar and 27 bipolar, underwent 72-hour urine collection for the measurement of 3-methoxy-4-hydroxyphenylglycol (MHPG). The average 24-hour urinary MHPG was compared by multivariate analysis of variance with the postdexamethasone cortisol (DST), the delta thyroid stimulating hormone (TRHST), six quantitative EEG (QEEG) measures of regional interhemispheric symmetry and six QEEG measures of focal frequency abnormalities. MHPG failed to discriminate between unipolar and bipolar II depression. It showed no significant correlations with postdexamethasone cortisol or delta TSH. It failed to correlate with QEEG regional coherence or with focal frequency abnormalities. MHPG covaries independently of other markers of depression.

Sixty-five schizophrenic subjects (46 men and 19 women) were tested for motor preference and compared to age and sex-matched controls. There were significantly more nondextrals among the schizophrenic women. Both male and female nondextral schizophrenics were hospitalized more frequently and for longer periods than dextral schizophrenics.

This paper suggests that separation and loss in early childhood may be less critical to later life than some people believe. Rather, internalization--after as well as before, age five--may be a developmental process to which psychotherapists need to pay particular attention. By attending to our patient's experiences of separation and loss, we allow them a metaphor, a language, with which they can describe the vicissitudes of lasting attachments. Similarly, the separation/individuation process of infancy, popularized by Klein and Mahler, is important, not just because it describes the biosocial fact of preverbal infancy but because it draws our attention to a metaphor that describes the struggle for identity that characterizes young adulthood.

Vascular dementia results from ischemic injury to the brain. Depression is a frequent complication of cerebrovascular dementia (CVD) occurring in 25 to 80% of patients during the course of their illness. Depression is unrelated to the severity of intellectual compromise or to the co-existence of delusions. The symptom profile of depression in CVD is indistinguishable from that of late-onset idiopathic major depressive episodes. The frequency of depression differs with the subtype of CVD and is most common in disorders with lesions of the frontal lobes, either cortical or subcortical. In addition to lesion site, other contributors to depression in CVD include vascular disease of other organs, drug therapy of co-existing medical conditions, and psychological reactions to disability. The depression of CVD responds to treatment with antidepressant agents.