Biomedical subjects
Publications and source records attributed to H Klar.
Administration of amantadine was associated with psychotic decompensations in two schizophrenic patients being maintained on concomitant neuroleptic medication. Despite a postulated dopaminergic mechanism, there seems to have been only one previous report of amantadine's precipitating psychosis in a schizophrenic patient.
The authors discuss the role and development of countertransference in brief psychotherapy. Factors inherent to the goals, setting and techniques of brief therapy appear to undercut the development of a regressive countertransference. The countertransference phenomena that seem to be more prevalent in brief treatment are those stemming from the reality-based response of the therapist to the patient. The impact of these factors on patient selection and treatment outcome in brief therapy are discussed.
We have reviewed both the rationale for and approaches to the use of psychotropic medications in the treatment of personality disorders. Despite some studies that may provide the seeding crystals around which significant data bases regarding the drug treatment of personality disorders will develop, the pharmacologic treatment of personality disorder remains a clouded area governed more by opinion than fact. Clinicians must still be guided by basic clinical sense regarding the use of medications with these patients. Some questions to ask are the following: Has the patient responded to medications in the past? What are the risks for abuse or self-destructive acting out? What is the risk-to-benefit ratio for the introduction of a drug into a psychotherapeutic situation at a given time? Is hospitalization necessary to assess the potential benefits of medication to the patient while minimizing the potential to act out? Although these guidelines may seem inadequate, clinicians can take some solace in the fact that ongoing studies will lead to better informed psychopharmacologic choices for patients with personality disorders.
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The authors discuss the indications, contraindications, and enabling factors for four types of psychodynamically informed psychotherapy: supportive, focal, exploratory, and psychoanalysis. They outline the inherent and practical difficulties impeding psychotherapy outcome studies and summarize the limited research regarding psychodynamic treatments. The overall efficacy of psychotherapy has been documented, but to date studies have not demonstrated specific differential effectiveness and indications. The authors present the rationale for each of the four approaches and suggest ways of selecting among them.
During the early 1960s partial hospitalization emerged as an important component of community-based psychiatric treatment. Initially partial hospitals offered all types of treatment to all types of patients. To help mental health professionals make informed decisions when matching specific treatments to specific patient characteristics, the authors define three kinds of partial hospitals--intensive care, chronic care, and rehabilitation partial hospitals--and propose selection criteria for referral to each model. Factors to be considered in making differential therapeutic decisions between a specific type of partial hospital program and alternative methods of treatment, such as inpatient treatment, are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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This paper is intended as a contribution to understanding why, up until recently, there have been so few case reports of actual abuse and its sequelae in the psychoanalytic literature. We suggest that psychoanalytic insights into the nature of psychic reality, while indispensable to the evolution of psychoanalytic thinking, have nonetheless had the adverse effect of collapsing any distinction between unconscious fantasies and repressed memories. Moreover, the idea that knowledge of external reality is itself mentally constructed also has diminished interest in uncovering trauma and "real" history. We present a report of an adult analysis that illustrates the recovery of a dissociated memory of sexual abuse that occurred during adolescence, as a springboard to discuss problems analysts have had in dealing with trauma theoretically. We hypothesize that repressed memories and unconscious fantasies can often be distinguished insofar as they may "be stored" or encoded differently, and that consequently the sequelae of trauma and fantasy often, but not always, can be disentangled. We describe some different modes of encoding trauma and some different ways of remembering, re-experiencing, and re-enacting it. And, finally, we suggest why traumatic memories are increasingly accessible to patients today.