Differential effects of cognitive therapy and pharmacotherapy on depressive symptoms

Patterns of symptom change were examined in 35 unipolar depressed outpatients treated with either cognitive therapy or pharmacotherapy (imipramine HCI). Cross-lagged panel analyses were used to evaluate the temporal relationships among changes in views of the self, hopelessness, mood, motivation and vegetative symptoms during treatment weeks 1–4.During cognitive therapy improvements in hopelessness, views of the self and mood generally preceded changes in vegetative and motivational symptoms. On the other hand, no consistent pattern of change was associated with pharmacotherapy. While these results are compatible with the notion that cognitive therapy initially alters negative thinking and mood, which secondarily leads to improvements in vegetative and motivational symptoms, further studies with a placebo or wait-list group are needed to determine if this is a unique effect of cognitive therapy.     

Competing role demands of therapists' professional and marital lives

This review evaluates current knowledge regarding the multilevel and reciprocal relations between psychotherapists' professional and marital lives. Because few articles pertain specifically to psychotherapists, the review incorporates pertinent literature concerned with other health service professionals. A model of reciprocal influence is proposed which conceptualizes interactive effects among the professional's personal history, vocational life, and marital life. Conflicted nurturing in the professional's family of origin may cultivate a need for control over interpersonal relations, which is fulfilled by professional training and practice. Empirical research supports the notion that professional intimacy serves a defensive function against conflict over marital intimacy. However, residual conflicts over intimacy surface in the marriage, and both the therapist and spouse may develop psychological symptoms.     

An oral examination of the psychiatric knowledge of medical housestaff: Assessment of needs and evaluation baseline

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and “psychogenic” pain. The stan-dardized simulations were punctuated by standardized “open” questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized as “good,” “adequate,” “inadequate,” or “poor,” in terms of “what an internist needs to know,” Blind raters of the exam achieved an interrater reliability of 0.88. The results indicated major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were “good,” whereas 42% were “inadequate” or “poor.” For example, 88% of the doctors could not name three factors that help distinguish organic from “functional” psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.     

Correlates of lithium response in psychotic-affective syndromes

We examined clinical and biochemical predictors of lithium response in 17 schizoaffective patients as well as the effect of lithium treatment upon several aminergic systems in this group. Ten patients were rated improved by the addition of lithium to the treatment regimen. No clinical predictors reached significance although DSM-III diagnosis and family history showed trends. Pretreatment plasma GABA was higher in the responders to lithium as compared to the nonresponders. Lithium tended to increase CSF HVA, CSF GABA, and plasma cAMP and to decrease plasma GABA. Lithium had little effect upon CSF 5HIAA, CSF cAMP, or plasma HVA.     

Conservation-withdrawal versus depression

Conservation-withdrawal should be included in the differential diagnosis of the withdrawn, apathetic medical patient. The clinician's awareness of the conservation-withdrawal phenomenon can avert the unnecessary use of psychotropic medications and avoid the alienation that arises between the patient and his primary physician when an unwarranted psychiatric diagnosis is applied. Recognizing the distinction between conservation-withdrawal and clinical depression permits the primary physician to utilize his own skills in supporting his patient.     

Cognitive behaviour therapy for anorexia nervosa: Some preliminary findings

Five patients with anorexia nervosa were treated using a cognitive behavioural approach which was an adaptation of an established treatment for the related eating disorder, bulimia nervosa. The results were mixed. For patients with episodes of bulimia the outcome was sufficiently promising to merit more systematic research.     

Psychopharmacologic management of the psychiatric emergency patient

The general hospital emergency room has become the locus of care for many psychiatric patients. It has become essential for emergency department personnel to be able to manage the behavioral emergency. Critical to this management is the rational use of psychotropic drugs. The author offers guidelines for the use of antipsychotic drugs and minor tranquilizers. The importance of differential diagnosis and the correlation of drug use with patient variables are stressed. The section on anti-depressants addresses the issues of when, and under what conditions the treatment of a depressive disorder can be initiated in an emergency setting. An approach to the toxic-behavioral-confusional state is offered. The final section reviews the approach to the patient who is a diagnostic dilemma and/or mute.     

Liaison psychiatry in an Indian general hospital

Patterns and the “dynamics” of the psychiatric referral process in a postgraduate teaching general hospital in India have been studied and compared with the trends in the West. The overall referral rate was 1.48%. On the whole, it is not simply the problem of “organic” versus “functional” diagnosis or abnormal behavior that are referred for psychiatric opinion. A large variety of other clinical problems are referred as well. Most of these problems could be tackled by simple measures like advice to the treating team, use of drugs, and supportive psychotherapy in the respective wards.     

Behavioral treatment of chronic pain: variables affecting treatment efficacy

Behavioral approaches to pain management have been shown to be efficacious in many instances but many of the variables indicating or contra-indicating such treatment remain unspecified. The data reported here demonstrated that while patients referred by both Disability and Medical Subspecialties showed improvement in pain report, affect, and feelings of control, those patients referred by Disability improved reliably less, remain hospitalized longer and were reliably less compliant. These data can be understood within an operant conditioning conceptualization of illness behavior.