Psychoanalytic psychotherapy with brain-injured adult psychiatric patients

Scant attention has been paid to psychotherapy with patients who have acquired neurological conditions. In this paper the authors describe the common psychological problems and repetitive themes that emerge in the therapeutic process with these patients, as well as the salient attitudes toward therapy and the therapist that these patients manifest. Case vignettes illustrate the theoretical and technical considerations.     

The changing role of dynamic psychotherapy in psychiatric practice

The author reviews the range of accepted indications for dynamic psychotherapy when he first began practice after World War II and describes factors that have played a role in the current undervaluing of this treatment approach. He attributes much of the change to research that has produced a different understanding of many of the conditions treated by psychiatrists and has placed greater emphasis on their medical and biological aspects than on their psychological aspects. He also attributes many alterations in current practice to the change from a two-party to a three-party reimbursement system for psychiatric services. On the basis of his practice, the author illustrates his belief that dynamic therapy continues to have a role in today's psychiatric practice. He describes one category of patients in particular-those who seek treatment for "problems of living"-who can be helped by dynamic psychotherapy. The author makes a case for freeing dynamic therapy from the need to rely exclusively on the criteria of the medical model for its legitimacy.     

Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice

OBJECTIVES: This study provided generalizable national data on the treatment of adult patients with schizophrenia in the United States and assessed conformance with the practice guideline treatment recommendations of the Schizophrenia Patient Outcomes Research Team and the American Psychiatric Association. METHODS: National data from the American Psychiatric Institute for Research and Education's 1999 Practice Research Network study of psychiatric patients and treatments were used to examine treatment patterns for 151 adult patients with schizophrenia. Analyses were performed and adjusted for the weights and sample design to generate nationally representative estimates. RESULTS: Findings indicated that patients with schizophrenia who were treated by psychiatrists had complex clinical problems and were markedly disabled. Forty-one percent of patients had a comorbid axis I disorder, and 75 percent were currently unemployed. Thirty-five percent were currently experiencing medication side effects, and 37 percent were currently experiencing problems with treatment adherence. Although most patients received guideline-consistent psychopharmacologic treatment, treatment was characterized by significant polypharmacy. Rates of conformance with the guideline recommendations were significantly lower for psychosocial recommendations than for psychopharmacologic recommendations. Although 69 percent of patients received at least some psychosocial treatment, none of the unemployed patients received vocational rehabilitation services in the past 30 days. CONCLUSIONS: These data suggest unmet need for psychosocial treatment services among individuals with schizophrenia. These findings raise questions about whether currently available antipsychotic medications are being used optimally or whether they offer limited effectiveness for patients with complex clinical problems who are treated in routine psychiatric practice.     

Teaching psychotherapy to psychiatric residents in Israel

This work examines the rationale for, and the feasibility of teaching psychotherapy to psychiatric residents, and the "what if" of dropping it from the curriculum. Psychotherapy is one of the pillars of psychiatry. However, current economic constraints and the increasing weight of phenomenological and biological psychiatry make it more difficult to prioritize and allocate resources to its teaching. The term psychotherapy encompasses several techniques, some of which are extremely effective. It often confounds skills, attitudes, theory, body of knowledge and specific practices. Looking at each component separately, a stepped curriculum for teaching is outlined; alternatives to traditional theories are offered; and the need to allocate time and resources for teaching and learning are shown as the rate-limiting factor for the survival of psychotherapy within psychiatry. Not limited to residents, the debate about psychotherapy in psychiatry concerns the profession's core identity and its traditional person-centered nature.     

Patterns of self-disclosure in psychotherapy and marriage

This study compared patterns of self-disclosure in psychotherapy and marriage. Participants (48 married, current psychotherapy patients, mean age = 42) completed a 101-item Disclosure to Therapist Inventory and a companion measure, a 101-item Disclosure to Spouse Inventory. Results indicated a pattern of greater disclosure to one's therapist in regard to issues involving despair (e.g., feelings of depression), and to one's spouse in regard to procreation and body concerns (e.g., birth control) and values (e.g., feelings about religion, race, or politics). Issues involving sex were infrequently discussed in either context. Discrepancy scores (differences between extent of disclosure and perceived importance) were greater in the spouse condition. Outcome predictors varied by situation, with overall disclosure predicting therapeutic outcome and both overall disclosure and discrepancy scores predicting marital satisfaction. Findings suggest that although there is substantial overlap in issues discussed in these two contexts, certain intimate disclosures are perceived as situation-specific. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

基于心理治疗理论探讨精神科心理治疗中的医患沟通技巧

<正>1引言对精神疾患的诊治不同于诊治其他一般躯体疾病,它缺乏足够的测量仪器为医生的诊治提供依据,更多地是依靠医生掌握的专业技能和实践经验。然而治疗精神疾患的优势在于心身疾病的特殊性决定了对其进行药物治疗的同时辅助以心理治疗,疗效更好。据美国宾夕法尼亚大学相关研究报道,使用认知疗法的心理治疗对单相抑郁症患者通过12周的积极治疗,80%的患者症状得到显著改善,疗效优于丙咪嗪治疗的对照组,随访一年,疗效稳定[1]。     

Boredom in psychiatric practice

This paper discusses some of the causes of boredom in psychiatric practice. It also describes how many psychiatric conditions can have boring facets to them, which can lead to difficulties in treatment and "burn-out" in the therapist. Finally, some practical suggestions are given to help avoid and deal with boredom.     

Nutraceuticals in psychiatric practice

Nutraceuticals can be defined as food components or active principles present in aliments which have positive effects for health and quality of life, including preventing or treating disorders. Herbal and "natural" food supplements are increasingly used to treat different psychiatric disorders, often as "self-prescribed" therapies. With factors such as chronic illness, poor health, emotional distress, and quality of life influencing the desire for complementary medicine, patients with comorbid medical and psychiatric problems seem likely to turn to this approach. We reviewed the most commonly used herbal and dietary supplements for which a certain efficacy on psychiatric symptoms or disorders has been claimed, checking current Pubmed-indexed literature (the most important being St. John's wort, Omega-3 fatty acids, valerian, Kava, Ginkgo, folate, B vitamins, S-Adenosylmethionine, inositol, alfa-lactoalbumin and passionflower). There is evidence of efficacy for some of these herbs an supplements, proved also by Cochrane's meta-analysis. However many different areas (including efficacy, tolerability, optimal dosing, adequate shelf life, drug and non-pharmacological interactions) need to be thoroughly studied; moreover political decisions need to be scientifically guided in order to best serve psychiatric patients' interests and to prevent using of expensive and sometimes un-useful therapies. This implies that a scientific strategy is needed to rule out any third-part economical interest which could in any way influence therapeutic choices. The article presents some promising patents on nutraceuticals in psychiatric practice.     

Sulpiride in psychiatric practice

Sulpiride is a substituted benzamide which blocks selectively D-2 receptors. The authors tested its clinical effectiveness in schizophrenia, anorexia nervosa and bulimia nervosa. In schizophrenia its action was compared with that of haloperidol. It was revealed that sulpiride is an effective drug, in particular in schizophrenia with abulic and depressive symptoms without productive symptoms and in psychoaffective psychoses. In the treatment of anorexia nervosa and bulimia nervosa its therapeutic action was not superior to that of other preparations used in these diseases.