The Hillside journal of clinical psychiatry最新文献

Pseudoseizures have been historically, and continue to be, a challenging diagnostic and therapeutic problem. This paper reviews the literature relevant to these difficulties. The interplay of psychiatry and neurology in this disorder is discussed, with special attention to diagnostic issues. In addition, several matters relating to associated psychopathology and treatment are raised.

The paper examined the relationship between the scales of the Luria Nebraska Neuropsychological Battery and measures of cerebral blood flow in a sample of 51 chronic schizophrenic patients without a history of brain damage. Of 88 correlations between the two sets of data, 22 were significant at the .05 level. The measurement of left anterior gray flow were particularly predictive of LNNB scores, although all correlations were at a moderate level, ranging from -.24 to -.38. The data are consistent with the hypothesis that neuropsychological testing performance in schizophrenics is related to brain function rather than merely reflecting deficits due to anxiety or other psychiatric features which have been hypothesized to invalidate neuropsychological assessment in this population. The data are also consistent with the notion that schizophrenia is more likely associated with left-anterior functioning, and that gray-matter measures in rCBF are effective predictors of neuropsychological performance.

This study explores the contribution of parental qualities to the borderline personality disorder. The Parental Bonding Inventory is used to compare four parental qualities (caring mother, caring father, overprotective father, and overprotective mother) across three groups (borderline personality disorders, assorted psychiatric controls and normal controls). The major finding was that the borderline patients perceived their parents to be significantly less caring and more overprotective than both the psychiatric control or nonclinical control groups. This study was verified previous reports that patients diagnosed with an affective illness (in either the borderline group or psychiatric control group) reported no significant differences on the inventory. Pinpointing parental characteristics which antecede mental disorders may be an important first step in devising primary preventive interventions for adult disorders.

In examining the conditions of depression and masochism, my intention has been to expand our area of study beyond psychodynamics alone. My first aim was to present what I believe are the intimately intertwined dynamics of each condition, a metaphorical double helix of depression and masochism in a matrix of narcissism. It may make clearer how either depression or masochism may present clinically in combination, at times in tandem, or manifestly as either state alone. My second, but major, aim is ecumenical: to interweave contributions from outside psychoanalysis. The neurophysiological bases and genetic determinants for most depressions are by now well-recognized. Masochism, much like depression, with which it is closely allied, may not necessarily arise out of conflict alone. I have presented brief excerpts of material, much of it still speculative, from areas of genetics, biochemistry, and ethology, to support the concept of a biological anlage for masochism. This would help explain the enormous difficulties therapists find in the path of its successful treatment. I believe Lorenz's theories on animal "bonding" suggest precursors to our concepts of masochism. I further believe our field of study has reached the point at which these and probably additional scientific disciplines can be helpful or even necessary for the further understanding of character, and for the solution of the persistent riddle of masochism, whose full understanding has continued to elude us.

In this paper I have reviewed the literature concerning the distressing or painful aspects of the psychotherapeutic role. The literature describes both painful aspects of psychiatric residency as well as difficulties and distress encountered in post-training practice of psychotherapy. After summarizing the major sources of emotional distress for therapists, the view was advanced that a failure to cope adequately with distress generated during the training period may lead an individual to continued distress and distortion of the psychotherapeutic role throughout his career. The major forms this distortion may take were also summarized. Strategies to reduce or correct these painful aspects of training and practice were suggested. Most of these focus on greater attention to these problems during the training period which is regarded as formative. Instructing trainees about the distressing nature of some aspects of the therapeutic work, practical suggestions to reduce the intensity of this distress, and intensive didactic work on patients and clinical situations likely to be especially distressing were recommended. It appears that we work in a profession both troubled and troubling. For those of us who are firmly convinced of the value of our work, the open discussion of the distressing aspects of the psychotherapeutic role is both necessary and welcome. It is only by candid and frequent discussion and exploration that we may arrive at effective remedies for these problems. If the training period is indeed a formative stage of professional development when enduring patterns may be established, then the open discussion of these difficulties with trainees and an increased focus on the problems during the training period may be an important first step in evolving better strategies to alleviate the distress generated by intensive work with disturbed patients.

Two patients, previously labeled lithium "intolerant," tolerated lithium without side effects when it was given on a double-blind basis. Blind medication trials may be clinically useful in some cases for determining the true nature of drug side effects.

The focus of the paper is the female physician patient's conflicts in female identification as central to the recovery of optimum energy and creativity. The conflicts are examined as they become salient in the transference reactions to the female therapist. The role of the environment in the potentiation and reinforcement of conflicts is assessed comparatively in older and younger generations of women physicians.

There are powerful non-rational forces in patients and therapists alike, and in the therapeutic context. These forces often determine whether individual or family therapy is chosen. Historical, cultural, and economic forces, patient and family motivations, and therapist preferences are all powerful determinants of modality choice. This is partly due to the newness of the field of family therapy, and will probably continue until we have a better conceptual grasp of family theory and nosology, the interrelation of individual and family pathology, and a clearer delineation of the criteria for these modalities.