Psychiatry MMC

Psychiatry MMC - ISSN: 1550-5952 - Volume 4 - Issue 4 - April 2007

Brief Report:
Increased Suicidality in Mania Complicated by Alcoholism by Alexander H. Fan, MD; Mark A. Frye, MD; Susan J. Hassell, MS, MPH; Sun Hwang, MS; Lindsay Kiriakos, MD; Jim Mintz, PhD; Michael J. Gitlin, MD; Lori L. Altshuler, MD

Abstract Objective. This retrospective study was done to assess the impact of concurrent alcohol use on the illness presentation of patients hospitalized for mania. Design. Retrospective demographic and clinical data were systematically collected from the hospital records of 122 patients hospitalized for an index episode of mania between 1988 and 1995. Comorbid alcoholism was defined as alcohol abuse/dependence, based on DSM-IV criteria. Blind to alcohol use and treatment intervention, a retrospective clinical assessment of illness severity was made by the Clinical Global Impression (CGI) at the end point of hospital discharge. Demographic and clinical differences between the alcoholic and nonalcoholic manic subjects were analyzed by chi-square and independent t-tests. Survival analyses with hospital length of stay as the dependent variable were conducted on the two groups. Setting. Tertiary care university hospital. Participants. Patients with bip

Forensic Files:
Psychiatric Evaluations of Asylum Seekers: Is it Ethical Practice or Advocacy? by CA Morgan III, MD, MA

Letters to the Editor:
April 2007

Psychotherapy Rounds:
Recognizing and Managing Erotic and Eroticized Transferences by Darnell Ladson, DO; and Randon Welton, MD, LtCol, USAF

Abstract: Transference has been proposed as a critical concept in psychotherapy. The transference may be positive, negative, or sexualized. When the transference becomes sexualized, there are potentially damaging outcomes depending on the management of the transference. This paper addresses the significance of early experiences in residency training with sexualized transference and focuses on the therapeutic relationship in which the transference has become eroticized. The author will explore the potential benefits and challenges of properly managing such transference.Key Words: psychotherapy, countertransference, transference, sexualized transference, erotic transference, eroticized transference

Review:
Borderline Personality and the Pain Paradox by Randy A. Sansone, MD; and Lori A. Sansone, MD

Abstract: Clinical observations and empirical studies indicate that patients with borderline personality are both sensitive and insensitive to pain. This dichotomy may be explained by the context of the pain. For acute self-induced pain, borderline patients seem to experience attenuated pain responses. For chronic endogenous pain, borderline patients appear pain intolerant. In this paper, we explain this unusual paradox. We then discuss the psychiatric assessment of chronic pain, emphasizing the importance of initially determining the patient�s status with regard to borderline personality disorder. For those chronic pain patients who have comorbid borderline personality disorder, we recommend a specific pain-management strategy that addresses the self-regulation difficulties of these patients and minimizes the risks of treatment. Key Words: borderline personality disorder, pain, management, psychotherapy

Neuroscience and Psychoanalysis: Approaches to Consciousness and Thinking by Lawrence Greenman, MD

Abstract: There exists an enormous amount of biological and scientific data in the field of neuroscience, which are daunting and laborious to those who are not directly engaged in these specialized areas. The intricacies and complexities of the role of the central nervous system (CNS) in psychiatric disorders and human behavior are, of course, acknowledged. In this article, observations and speculations of some prominent workers in the field of neuroscience are described with focus on their conclusions, rather than specific findings as they pertain to the mind-body relationship. The mind-brain/body issue has not been resolved insofar as clarifying the connections between CNS activity and thinking is concerned. Currently, it is useful to accept the concept of parallelism between CNS activity and thought. An argument will be made for the inclusion of the psychoanalytic method as an essential component of the scientific effort to elucidate consciousness and thinking.Key Wor

Trend Watch:
Strattera: Ups, Downs, and Emerging Uses by Elisa F. Cascade; Amir H. Kalali, MD; and David Feifel, MD, PhD

Abstract: Although overall prescribing of atomoxetine hydrochloride (HCI) (Strattera) continues to decline, recent anecdotal reports suggest emerging uses of the product in combination therapy. In this article we examine trends in atomoxetine (HCI) prescribing as well as use in combination with other psychotropic classes. An expert commentary is provided on the data.key words: ADHD, attention deficit hyperactivity disorder, pharmacology, atomoxetine hydrochloride, Strattera, augmentation

Update on Cognition:
Will Improving Cognition Change Functional Outcomes in Schizophrenia? by Philip D. Harvey, PhD

This regular column is written to provide readers with the latest updates on the measurement and treatment of cognitive and functional deficits in psychiatric disorders.