Psychodynamic aspects of psychopharmacology

This paper presents a framework for understanding the psychodynamic issues pertaining to psychopharmacology. It examines the treatment situation from three perspectives: the self-in-relation-to-others, the patient-prescriber relationship, and cultural attitudes. It discusses psychodynamic factors involved in clinical improvement and deterioration. The relevance of these issues is discussed and contrasted with the biomedical model of mental illness. It concludes by advocating the mindfulness of psychodynamic factors and the maintenance of dialectics in clinical practice.     

Psychodynamic aspects of occupational stress

Freud described work as that which attaches the individual most firmly to reality. Many patients present to psychiatrists with disturbances in the capacity to work. This paper reviews common psychodynamic constellations in such patients in the belief that depth psychological approaches should complement recent person-environment fit considerations. Work inhibitions may arise from repressed aggression and/or sexuality displaced onto occupational tasks. Fear of success may be rooted in both oedipal and pre-oedipal conflicts. Work compulsion may evince attempts to appease a harsh super-ego. Chronic job dissatisfaction often arises from maladaptive attempts to regulate self-esteem. More importantly however, these disturbances frequently arise from interacting dynamic factors which must be carefully attended to by clinicians.     

Pharmacologic inhibition of the libido: therapy or repression? II. Clinical aspects

Some neuroleptic medicine or hormonal by-products may--partly or fully-as to the dose--inhibit the libido of the patients who ask for it themselves causing in this way a pharmacological castration, a temporary or permanent one, but which is always reversible when the therapy is stopped. These inhibiting treatments, which essentially apply to males, are particularly useful in the case of the hypersexual patients or in the case of second offenders.     

The Karolinska Psychodynamic Profile. II. Interdisciplinary and cross-cultural reliability

The Karolinska Psychodynamic Profile (KAPP) is a rating instrument based on psychoanalytical theory, that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail and kept close to clinically observable phenomena. The information needed for assessment is obtained through a structural interview procedure. The interrater reliability was tested with different Swedish raters with varying psychodynamic training and experience. It was also tested with a non-Swedish rater with psychoanalytic training. The interrater correlations were generally high, suggesting that the KAPP has interdisciplinary and cross-cultural reliability.     

Psychodynamic aspects of personality of patients with Parkinsonism]

After reviewing the literature on personality and Parkinsonism and recalling the two concepts which conflict on the etiology of their personality, the author has examined Rorschach charts of 20 Parkinsonians. This was done through formal analysis and content analysis in order to show the various dynamic aspects of personality, the psychic mechanisms preferentially used and the possible relations between psyche and soma. The results reveal a modification of personality in the direction of global narrowing, on ideas and affect, a reduction of relational investments, a narcissitic and hypochondriac retrieval and an important reduction of affects. Two different types of personality appear out of this common branch. The first is characterized by rigidity and stereotipy, the second characterized by some smoothness and a wider opening toward the external world. The psychodynamic study reveals that personality reorganization takes place through libidinal retrieval, through defensive and narcissisic move. After the completion of the study, the somatopsychic hypothesis remains most produce; however the premorbid personality and in particular the aggressive problem can integrate with the behavioral modifications due to Parkinson's disease in order to finally bring a original psycho-affective picture.