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Biomedical subjects

T B Karasu

Publications and source records attributed to T B Karasu.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1988

The measurement of psychodynamic variables.

The paper is concerned with the integration of psychodynamic theory with psychometric theory in order to find meaningful ways to measure psychodynamic variables. Four reasons are suggested for the use of self-report tests in psychotherapy research. These include the need for reliable measuring instruments, cost-efficient methods of data collection, and the progressive refinement of "fuzzy" concepts through the process of test construction. A three-stage approach to outpatient assessment is presented which is called sequential psychodiagnostic evaluation. The first stage refers to the evaluation of crisis issues such as suicidality or psychosis; the second to egodystonic symptom assessment; and the third refers to the assessment of egodystonic states such as personality traits, ego strength and defenses. The construction of a number of these scales is illustrated and their use in a research study of predictors of psychotherapy outcome described.

Defense Mechanisms↗
PubMed1986

Combined psychotherapy and pharmacotherapy for depression. A systematic analysis of the evidence.

To determine whether combined psychotherapy and pharmacotherapy is superior to alternative therapies for unipolar depression, we reviewed all controlled studies of outpatients treated for unipolar depression reported between 1974 and 1984. To accomplish this, we developed a new statistical approach that is specific in its method of evaluating the quality of each study and specific about the weights given to each outcome. The combined active treatments (drugs plus psychotherapy) were appreciably more effective than the placebo conditions but only slightly superior to psychotherapy alone, pharmacotherapy alone, or either of these combined with a placebo.

Adolescent↗
PubMed1986

The specificity versus nonspecificity dilemma: toward identifying therapeutic change agents.

The author examines the specificity versus nonspecificity dilemma that characterizes the unresolved question of how psychotherapy works. He explores different meanings and arguments on both sides of the controversy and attempts to identify three therapeutic change agents that all schools of therapy share as the basis of their different techniques: affective experiencing, cognitive mastery, and behavioral regulation. The roles and functions of these agents are discussed with regard to their potential complementarity in clinical practice.

Affect↗
PubMed1986

The psychotherapies: benefits and limitations.

The promises and challenges of the psychotherapies today are explored in the areas of treatment, training, diagnosis, research, and review. Benefits discussed include advances in the science and standardization of psychotherapy assessment and practice; improved research tools for establishing therapeutic efficacy; development of new clinical modalities, especially short-term techniques; cooperative efforts to combine and integrate diverse methods of treatment; establishment of ethical codes of conduct for the therapist; and the application of computerized evaluation and cost-containment procedures. At the same time, limitations reflect the various conceptual confusions, research inadequacies, identity crises, political pressures, and economic constraints of the field. Of particular concern is the current "age of accountability" which has placed cost-effectiveness at the pivot of public policy in mental health care.

Combined Modality Therapy↗
PubMed1984

Psychodynamic variables as predictors of psychotherapy outcome.

Predicting the outcome of psychotherapy is a central concern in psychiatry. Twenty-one medical students seeking psychotherapy were evaluated on a number of psychodynamic and process variables using self-report scales and scales completed by the therapist before, during, and after psychotherapy. There were significant differences between patients and a comparison group on eight variables before therapy. Ten psychodynamic variables (six representing ego defense mechanisms) and four process variables were found to be highly correlated with outcome measures; the process variables were the best predictors of outcome. The data support the use of psychodynamic and process variables as predictors of outcome in psychoanalytically oriented psychotherapy.

Adult↗
PubMed1984

Recent developments in individual psychotherapy.

Individual psychotherapy, the pivotal modality of psychiatry, has undergone a constant revolution since the inception of psychoanalysis; over the years the treatment models have shifted from dynamic to behavioral to experiential. The author discusses forces, such as economic pressures to establish cost-effectiveness, that have precipitated these changes. After reviewing comparative studies of the efficacy of psychotherapy, he examines new developments in individual psychotherapy such as brief treatment and cognitive therapy for depressive disorders. The efficacy of combined techniques, the impact of diagnostic tools and training manuals, and ethical issues, such as sexism, are also explored.

Combined Modality Therapy↗
PubMed1982

Learning dynamic psychotherapy: a longitudinal study.

The authors investigated the evolution of psychotherapeutic skills over time in a group of psychiatric residents in their third year of training. A 29-item Supervisors Evaluation Scale measuring psychotherapy skills was developed. Each resident who began his or her clinical experience in conducting individual analytically oriented psychotherapy was rated by his or her supervisors on this scale toward the beginning of training and again 8 months later. Statistically significant changes were found for 7 of the skills measured. The authors feel that these may reflect those aspects of psychotherapy which the beginning therapist can readily learn with supervision and experience.

Attitude of Health Personnel↗
PubMed1982

Psychotherapy and pharmacotherapy: toward an integrative model.

The author reviews historical trends, hypotheses, and problems in the application of pharmacotherapy and psychotherapy and uses research findings to develop an integrative model. He portrays a chronology of models over three decades; an "additive" relationship represents the decade of 1970 to 1980. He presents factors that must be considered in determining the effects of pharmacotherapy plus psychotherapy and recommends refinement of these variables in future research.

Humans↗
PubMed1982

Psychotherapy with elderly patients.

The purpose of this article is to present a review of the psychotherapy of the elderly, emphasizing traditional methods as well as some newer techniques. It will first review the literature on the process of psychotherapy in the elderly, then the rationale for such therapy will be discussed, and finally important technical points about such therapy will be listed, including information about the cognitive psychotherapies in the treatment of demented elderly.

Aged↗
PubMed1982

A suicide attempt by a seductive patient: what's the treatment plan?

For the past ten columns, we have been exploring questions of differential diagnosis and the ways to apply the Diagnostic and Statistical Manual of Mental Disorders, third edition, to the complexity of the clinical situation. We are now embarking on an even more uncharted and certainly more controversial area: differential therapeutics. In this column, to appear in alternate issues, we will learn how our guest experts would select treatment modalities for various clinical situations. We have the good fortune to lead off this new series with Toksoz B. Karasu, M.D., professor of psychiatry at Albert Einstein College of Medicine in the Bronx and director of psychiatry at the Bronx Municipal Medical Center, Dr. Karasu is the chairman of the American Psychiatric Association's commission on psychiatric therapies and has been deeply involved in studying how best to determine which treatments are most effective for which psychiatric disorders in which patients and circumstances.

Adult↗
PubMed1981

Psychotherapy skill profiles of psychiatric residents.

A survey of experienced clinicians has suggested that negative outcomes of psychotherapy may be related to misapplications or deficiencies of technique. The present study was, therefore, concerned with two questions: a) does the more competent psychiatric resident have a different profile of therapeutic skills from the less competent resident; and b) are the more competent residents more aware of their own behavior with patients than less competent residents? To answer these questions, a Supervisors' Evaluation Scale and a parallel Psychotherapy Self-Evaluation Scale were developed, and their reliability, content, and discriminant validities were established on the basis of their use with a group of psychiatric residents being supervised in an outpatient clinic. Results demonstrated that the more and less competent trainees, selected on the basis of global ratings, differed significantly on almost every item of the Supervisors' Evaluation Scale, but did not differ on most of the items of the Psychotherapy Self-Evaluation Scale. Residents reported it to be particularly difficult to deal with patients' aggression and acting out behavior, fee setting and collecting, and understanding the patients' defensive structures. The rating scales can be used to assist in supervision by assessing the level of acquired skills in psychotherapy, and can also be used to help identify special areas of strengths and weaknesses.

Ambulatory Care↗
PubMed1980

Expectations of hospital treatment. Conflicting views of patients and staff.

A 40-item therapeutic community questionnaire, developed from a survey of experts, was used to assess the treatment needs and expectations of a group of 30 hospitalized psychiatric patients. The patients' attitudes regarding an ideal ward atmosphere were compared to those, as measured previously by the identical instrument, of the treating staff. The results indicated that psychiatric inpatients found the therapeutic community modality consistent with their needs and expectations. However, staff and patients were divided in attitude toward the therapeutic community concept. The staff's definition of therapeutic community was broad and exceeded the principles of the therapeutic community experts. The patients desired a more conservative approach which combined respect and responsibility with a ward structure that was unambiguous and less democratic. Studies of ward atmosphere as well as premature termination in psychotherapy indicate that such conflicts in viewpoint between patients and staff might have detrimental effects on hospital outcome. A negotiated approach to inpatient treatment is suggested as a means to establish greater autonomy, growth in self-esteem, sense of responsibility, and increased trust on the part of hospitalized patients.

Attitude↗