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Biomedical subjects

N G Hamilton

Publications and source records attributed to N G Hamilton.

At least 19 recordsLinked to original sources
PubMed2000

Suicide prevention in primary care. Careful questioning, prompt treatment can save lives.

Suicide is a major public health problem in the United States. Psychiatric disorders that feature or lead to suicidal ideation may be overlooked in the primary care setting because patients are reluctant to broach the subject. In this article, Dr Hamilton describes how physicians can open a dialogue with patients so that those who need treatment receive it before they resort to suicide.

Adolescent↗
PubMed2000

Therapeutic response to assisted suicide request.

The authors review the first publicly reported case of legal assisted suicide in the United States and discuss possible clinical responses other than assistance in suicide. Psychiatric observers have noted that acceptance of assisted suicide or euthanasia as a medical option has resulted in loss of knowledge about how to respond to suicidal ideation in the seriously ill. The authors discuss specific therapeutic interventions that may be appropriate for seriously ill patients requesting suicide.

Aged↗
PubMed1995

Object relations units and the ego.

The author selectively reviews the literature on object relations units and suggests that a fourth element, ego functioning, should be added to self, object, and affect-sensation for a more clinically comprehensive theory. He suggests that ego functioning may always shift with self, object, and affect-perception in an organically integrated fashion. Such a conceptualization can apply to both healthier and less well-integrated individuals. This expanded concept may or may not be sufficiently comprehensive to replace the traditional structural theory of id, ego, and superego.

Adult↗
PubMed1994

Object relations theory and pharmacopsychotherapy of anxiety disorders.

This paper provides an overview of object relations concepts, applying them specifically to combined psychoterapy-pharmacotherapy of anxiety disorders. Anxiety in this clinical theory is conceptualized as arising from threatened loss of the self- and object-relationship. At a rudimentary level, individuals can attempt to manage potential loss through splitting and projective identification. As benign and loving experiences accumulate and ego functions neurophysiologically develop, whole object relations provide alternate and more modulated ways of coping with anxiety. In anxiety disorders, these more mature coping styles break down. Treatment combining object relations approaches to psychotherapy with pharmacotherapy pay particular attention to the relationship aspects and meanings of medication and prescribing. These approaches use the concepts of empathy, containment, countertransference, splitting, projective identification, and transitional object formation to help patients come to terms with their anxiety and with the treatment relationship.

Adult↗
PubMed1992

Improving quality assurance through psychiatric mortality and morbidity conferences in a university hospital.

To make quality assurance more outcome oriented, the department of psychiatry in a university hospital developed a program of psychiatric mortality and morbidity conferences for reviewing cases with undesirable outcomes. The conference combines aspects of a traditional medical mortality and morbidity conference with features of utilization review and risk management. Case review is focused on mortality, morbidity, or specific indicators developed by the departmental services involved and on a determination of whether an adverse outcome was avoidable, possibly avoidable, or unavoidable. The authors summarize the 100 cases reviewed in the first seven months. They believe the focus on outcome gives the method a useful role in quality assurance; advantages include its recognizable contributions to continuing education and training.

Aged↗
PubMed1990

Splitting and projective identification among healthier individuals.

This paper illustrates splitting and projective identification among people with normal and neurotic personality organizations. Adding these concepts to the repertoire of analytically oriented psychotherapists does not replace previous theories but adds to them. This approach can be integrated with drive theory and ego psychology in practice, or can be used to supplement the approaches of cognitive or interpersonal therapists. Not only borderline patients, but all of us, continually need to define and re-define ourselves in relation to others as we grow and change. The concepts of splitting and projective identification can help when that growth process becomes stymied.

Adult↗
PubMed1990

The containing function and the analyst's projective identification.

The concept of the container and the contained in psychoanalysis describes a process whereby the patient's projective identifications are internalized by the analyst, transformed, given meaning, and returned to the patient in a useful fashion. In this paper, it is suggested that what the analyst gives back, and what the patient receives, is the analyst's projective identification. The containing function itself can be transmitted to the patient via this mechanism. All interpretation, from whatever theoretical viewpoint, has an element of containing and therefore projective identification on the part of the analyst. Paradoxically, neutrality itself can be considered a vehicle for projective identification. Previously, the role of the therapist's projective identification in the containing process has been implied, but not discussed.

Adult↗
PubMed1989

Social networks and negative versus positive symptoms of schizophrenia.

The social networks of people with schizophrenia are less functional than those of nonpsychiatric populations. In this study, positive versus negative symptoms were examined in relation to social networks. Thirty-nine patients with chronic schizophrenia were assessed for positive and negative symptoms and for size and quality of social network. Patients with more negative symptoms had significantly smaller social networks. Their networks were similarly more dysfunctional on a variety of measures. Positive symptoms did not correlate significantly with any network variable.

Adult↗
PubMed1989

A critical review of object relations theory.

Over the past 20 years, object relations theory has broadly influenced general psychiatry. Along with its insights, the theory has brought its own conundrums. This paper provides an overview of the theory, indicating its contributions--such as a basis for individual psychotherapy of severe disorders and a more effective understanding of countertransference--and its shortcomings--such as lack of an explanation for the effects of physical and cognitive factors on object relatedness. Object relations theory fills a niche in the biopsychosocial model but is not a complete psychology for general psychiatry. Rather, it is an addition to drive theory and ego psychology within psychoanalysis.

Adult↗
PubMed1988

Managing violent patient incidents: the role of a behavioral emergency committee.

The Portland (Oregon) Veterans Administration Medical Center acknowledged the problem of dealing with aggressive and disruptive patients by establishing a behavioral emergency committee (BEC). The BEC first introduced a system for tracking disruptive patient incidents and then initiated an electronic flagging system for violence-prone patients that alerts medical center clinical and security personnel when a potentially dangerous patient is present. The committee also coordinates violence control training for medical center personnel. Since the BEC was formed, disruptive behavior among this high-risk patient group has been significantly reduced.

Data Collection↗
PubMed1986

Positive projective identification.

This paper suggests that literature concerning projective identification has excessively focused on the projection of unwanted aspects of the self without giving adequate consideration to projective identification involving good qualities. It is proposed that clinical advantages may derive from dividing projective identification into positive and negative components. This division allows a more ready emphasis on the capacity for beneficial object relations which even psychotic individuals retain despite their obvious hostility. Case vignettes are provided to demonstrate positive projective identification and to emphasize the clinical usefulness of this concept.

Adult↗
PubMed1983

Psychiatric symptoms and cerebellar pathology.

The authors describe three patients hospitalized for psychiatric disorders, all of whom had cerebellar lesions. Referring to recent research on nonmotor cerebellar functions, the authors suggest that patients with cerebellar lesions may develop an organic brain syndrome that closely resembles the organic brain syndrome associated with cerebral cortical lesions.

Adult↗