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Biomedical subjects

T B Karasu

Publications and source records attributed to T B Karasu.

At least 19 recordsLinked to original sources
PubMed1992

Developmentalist metatheory of depression and psychotherapy.

Examination of the theoretical and clinical literature reveals that the psychological understanding of depression is complex and varied, often differing among major schools or theorists. These variations in conceptual perspective (e.g., drive, ego, object relations, self, interpersonal, cognitive) also naturally impact, directly or indirectly, upon the nature of treatment. This paper has attempted to integrate diverse points of view by offering a developmentalist metatheory based on the psychosexual maturation of the patient. More specifically, four basic prototypes of depression have been depicted: Dyadic deficit depression (DDD), dyadic conflict depression (DCD), triadic deficit depression (TDD), and triadic conflict depression (TCD). Each etiologically relates to early childhood experiences of the individual and is traced to different developmental periods with their own unresolved conflicts or deficient parent(s)/child scenarios. Clinical signs and symptoms as well as therapist/patient interactions have been described and respective technical measures recommended. This schema has therapeutic implications both for the reapproachement of multiple frameworks and for individualized practice in the treatment of depression.

Adolescent↗
PubMed1992

A review of treatment studies of minor depression: 1980-1991.

This article provides a brief overview of the changing nature of the concept of minor depression. It then discusses treatment studies conducted from 1980 to 1991 of patients diagnosed as neurotic depression, depressive neurosis or dysthymia, characterologic depression, "double depression" and minor depression or dysthymia, if there has been a full remission of a major depressive episode lasting at least six months prior to the development of dysthymia. Long-term treatment of chronic depression is also reviewed. Cognitive-behavioral intervention and marital therapy have been reported beneficial for patients diagnosed as having neurotic depression, characterological depression, or dysthymia. All studies of antidepressant drug treatment showed drugs to be efficacious and superior to placebo, with few differences found between drugs. In addition, they all showed the importance of analyzing the interactions between treatment and severity or diagnosis. Patients diagnosed as "double depression" also appear responsive to both psychosocial intervention and drug treatment; in general, however, these patients tend to have a poor long-term outcome and continued treatment is indicated. The most obvious finding to emerge from this review is that the diagnosis of minor depression is ambiguous, in large part because of the lack of defining criteria related to severity and course. The review also revealed that in addition to poorly defined subgroups, many studies lacked controls, had small sample sizes, inadequate and/or inconsistent measures of outcome, and limited follow-up. For these reasons, their findings cannot be considered conclusive. Finally, the literature revealed a dearth of controlled studies of psychosocial treatment for well defined subgroups of neurotic depression.

Antidepressive Agents, Tricyclic↗
PubMed1991

Interrelations between ego functions and personality traits: their relation to psychotherapy outcome.

Ninety consecutive admissions to a large outpatient clinic of a municipal hospital completed two self-report questionnaires: the Self-Evaluation Questionnaire (SEQ) which consists of four 10-item scales that assessed four areas of ego functioning; and the 89-item Personality Profile Index (PPI) that provided measures of eight dimensions of personality traits and also a measure of conflict. Results indicated that the four measures of ego functioning had good internal consistency, and three of the four ego functions had a highly similar pattern of relations to the personality trait dimensions and to the conflict measure. It thus appears that each set of constructs amplifies and sheds light on the other. Two of the ego function measures were significant predictors of psychotherapy outcome. They correlated highly with one another and also with a third measure of ego functioning. This fact, together with the similarity of their correlations with the personality traits, suggests that these ego functions represent different aspects of an underlying construct that could be called Ego Strength. Therefore, combining the three ego functions into a 30-item Ego Strength measure could provide an even more sensitive predictor of therapy outcome and a useful new instrument for psychotherapy research.

Adult↗
PubMed1990

Toward a clinical model of psychotherapy for depression, I: Systematic comparison of three psychotherapies.

In a two-part series, the author explores the current status of psychotherapy for depression. In part I, three predominant approaches to the psychological treatment of depressive disorders today--psychodynamic, cognitive, and interpersonal--are described and contrasted schematically. They are depicted as conceptually different but potentially complementary with regard to 1) basic characteristics, including theoretical orientation, major strategies, goals, and mechanisms of change, and 2) respective advantages and limitations. This clinical comparison forms the foundation of an integrative and selective model for the treatment of depression.

Cognitive Behavioral Therapy↗
PubMed1990

Toward a clinical model of psychotherapy for depression, II: An integrative and selective treatment approach.

This is the second in a two-part series on psychotherapy for depression. Considering depression as a spectrum phenomenon, the author goes beyond manual-based diagnosis to suggest criteria for the use of psychodynamic, cognitive, or interpersonal psychotherapy, with or without pharmacotherapy. He proposes a clinical model that is both integrative and selective and recommends shifting and sharing different therapeutic perspectives in tailoring treatment to the depressed individual.

Cognitive Behavioral Therapy↗
PubMed1990

Malpractice in psychotherapy: an overview.

This paper gives a capsule review of the major issues on the subject of malpractice for individual practitioners of psychotherapy. It examines the elements necessary to support a malpractice claim and presents examples of cases in specific areas of liability. Historically, the field of psychotherapeutic malpractice was largely inactive. However, recent court rulings reveal that psychotherapists are no longer immune to malpractice suits. In decreasing order of the likelihood of the plantiffs being successful in their suits are cases involving the misuse of the therapeutic relationship, breach of confidentiality, and cases that involve prevention of harm to third parties and to patients themselves. Malpractice suits based on negligence in providing appropriate treatment are beginning to emerge and will probably increase in frequency as the efficacy of biological treatment is demonstrated. Available solutions to the problems of malpractice are discussed. It is suggested that in addition to the existing external sanctions, there is a need for consultation plus educational programs to enhance our ability to practice within the boundaries that the courts have set for us.

Confidentiality↗
PubMed1989

New frontiers in psychotherapy.

The author examines new frontiers in psychotherapy from the perspective of four major movements in clinical psychiatry today: (1) the science of psychotherapy, (2) time-limited and tailored treatment, (3) governmental guidelines and public policy-making, and (4) conceptual and clinical rapprochement. Attempts to standardize psychotherapy are evidenced by more refined diagnostic and statistical instruments, operationalized training and treatment manuals, and use of the computer in human simulation. The second movement is manifested by innovative short-term therapies, particularly tailored to depressed populations. The third direction is more extrinsic as cost-effectiveness increasingly becomes the guiding criterion of mental health care. The final frontier reflects attempts to weld various polarities in the field, not only by drawing on a vast psychological armamentarium but by providing new neurobiologic models for complex "psychological" phenomena, from dreams to dependency.

Forecasting↗
PubMed1979

Age factors in patient-therapist relationship.

This paper reports on the effects of therapist and patient age as factors in the evaluation and treatment of adult psychiatric outpatients. Therapist ratings and patient self-ratings are contrasted in three age groups. Rating scales include symptomatology, motivation, insight, and prognosis. In addition, a chart review follow-up of 68 patients includes disposition and drop-out. The data suggest that older patients are perceived as sicker, but less treatable than younger patients or patients of the same age group as the therapist. Residents express a strong preference for treating younger patients, but more readily develop a treatment relationship with same age patients. Both older and younger patients were significantly less likely to remain in treatment. Age of therapist and patient as a significant, frequent unrecognized factor in psychotherapeutic intervention is discussed and modifications in psychiatric training programs are suggested.

Adjustment Disorders↗
PubMed1979

Measurement of thinking dysfunction. An empirical study.

This investigation is concerned with the development of a practical method for assessment of thought disorders. A review of eight major textbooks and four review articles revealed 37 different terms used to describe the components of thought disorders. Because of overlap of meanings or ambiguous usage, these terms were reduced to 17 discrete terms that could be operationally defined. Twenty-five psychiatrist were surveyed on the appropriateness of the definitions and their relevance to the concept of thought disorder. An average of 83 per cent agreement was obtained, and some of the definitions were modified as a result of the survey. Eight psychiatrists then applied this scale, titled the Thinking Dysfunction Rating Scale, to the evaluation of five videotaped patient interviews. Based on observation of all five patients, interjudge agreement was over 90 per cent for all items of the scale. Analysis of variance showed that the scale significantly discriminated among schizophrenics, patients with organic brain syndromes, psychotic depressives, geriatric depressives, and outpatients. The patterns of scores were found to vary among these five groups. The scale should be helpful for teaching purposes and as a checklist for routine clinical diagnosis.

Adult↗
PubMed1979

Psychotherapy of the medically ill.

The author assesses the current status of psychotherapy with medically ill patients. He reviews the special problems of psychological treatment for this population; the respective rationales for the utilization of various psychotherapeutic approaches including psychoanalysis, dynamic psychotherapy, and family and group therapy; and the results of case reports and research studies. The author identifies specific areas of future investigation and research, elucidates some specific implications for clinical practice, and recommends more critical exploration of the role of psychotherapy in the treatment of the medically ill.

Adult↗
PubMed1979

Common mistakes in psychotherapy.

To better monitor the psychotherapy training of psychiatric residents and to understand therapist factors involved in a negative outcome to psychotherapy, the authors surveyed 20 supervisors on the frequency of mistakes made by resident therapists. Among the mistakes most commonly made were wanting to be liked by patients, premature interpretations, overuse of intellectualization, inability to tolerate patients' aggression, and avoidance of fee setting. The authors conclude that the mitigation of the most common errors requires open discussion of countertransference issues.

Clinical Competence↗
PubMed1979

Psychotherapy of the psychosomatic patient.

The role of psychotherapy for psychosomatic patients is reviewed. Barriers to treatment, including special characteristics of these patients that make them poor candidates for traditional psychodynamic interventions, are discussed with implications for practice. Clinical recommendations encompass two broad preparatory phases: I, the health alliance, and II, the life alliance.

Attitude to Health↗
PubMed1979

Toward unification of psychotherapies: a complementary model.

The emergence of different models of psychological healing from Freud to the present, and specific features which characterize "new" psychotherapies in contrast to psychoanalysis are examined. The author maintains that these represent a chronological evolution of therapeutic forms which are complementary and which portend the unification of the psychotherapies.

Freudian Theory↗
PubMed1979

Appearance of new symptoms in hospitalized patients: an instance of institutional iatrogenesis?

Data from the admission and termination forms of 100 consecutively discharged psychiatric inpatients were analyzed to determine the changes that occurred in the symptom profile of each patient during hospitalization. In general, patients entered the hospitalization. In general, patients entered the hospital with severe, chronic symptoms some of which were relieved and some of which remained unchanged. A number of symptoms, however, were reported present on the termination forms that had not been noted at admission. The results of this study offer evidence that a possible effect of the therapeutic process is the occasional appearance of new symptoms in some patients.

Acute Disease↗