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Biomedical subjects

T B Karasu

Publications and source records attributed to T B Karasu.

At least 55 records · Page 3Linked to original sources
PubMed1980

The ethics of psychotherapy.

The author addresses the ethics of psychotherapy in terms of the interface between science and ethics, the goals of treatment, the therapeutic relationship, and special issues of confidentiality and therapist-patient sex. He considers the problems of multiple therapeutic modalities, dual allegiance of the therapist, the therapeutic use (and abuse) of power, and issues of dependency and suggests ways to maximize the clinician's exercise of ethical choices. Ethical dilemmas in psychotherapy are not entirely soluble; ultimately, the therapist, guided by his or her profession as a group, will be able to find answers to the complex problems that inevitably arise.

Confidentiality↗
PubMed1980

VIth axis for DSM-III: psychodynamic evaluation.

DSM-III has raised questions among mental health professionals about the relationship of diagnosis to treatment. Practicing psychotherapists have been reluctant to endorse the revised classification, arguing that diagnostic discriminations needed to plan psychotherapy treatment are absent from DSM-III's multiaxial system. The clinical usefulness of a diagnostic classification is a major measure of its validity. The authors illustrate with three patients from psychotherapy practice, all with long-standing problems of depressed mood, the limits of DSM-III in planning psychotherapy treatment, and they make suggestions for the development of a treatment-oriented "axis" to complement the current multiaxial evaluation system.

Adjustment Disorders↗
PubMed1980

The medical care of patients with psychiatric illness.

A survey of psychiatric inpatient, outpatients, and consultation services of a large general hospital showed a high incidence of undiagnosed physical illnesses in psychiatric patients. The finding is consistent with that of other researchers and highlights the need for a comprehensive medical examination of all psychiatric patients. The authors discuss the clinical diagnostic interface between physical and psychiatric disorders, as well as medical complications of psychiatric treatment and the reaction of psychiatric patients to physical illness. One recommendation for improving the delivery of medical care to this population is to equip psychiatric services to give complete medical work-ups as part of the standard psychiatric evaluation of entering patients.

Adaptation, Psychological↗
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↗
PubMed1979

Thought disorder in alcoholics.

Research on cognitive impairment in chronic alcoholics has generally focused on pathology associated with organic brain damage. On the other hand, deficits more typical of the functional psychoses have been less explored, due to the absence of appropriate tests. By using the Thought Disorder Rating Scale (TDRS) recently developed at our Center, however, we have tested chronic alcoholics for the presence of classical symptoms of thought disorder. This test is based on the assessment of the patient's verbal behavior by an experienced clinician. Twenty subjects free of psychosis, severe withdrawal symptoms, and medical illness were, after detoxification, administered a test battery which included the TDRS, the Bender-Gestalt Test, and the Zung Self-rating Depression Scale (SDS). Five scored pathologically for thought disorder and of them four had abnormal Benders; whereas only two of 15 of those without thought disorder had abnormal Benders (t = 2.84, p < .01). Although SDS scores for both groups were in the depressed range, there was no significant difference between SDS means for the two groups. TDRS scores for these alcoholics are compared with those for other diagnosed groups, and implications for future investigation are discussed.

Adult↗
PubMed1978

A three-year follow-up study of the elimination of the internship. A comparative study of internship- and noninternship-trained residents in a psychiatric outpatient setting.

The American Board of Psychiatry and Neurology eliminated the internship as a requirement for certification in psychiatry in 1970. Preliminary study on a psychiatric inpatient service of internship-trained first-year residents with that of a matched group of residents who entered the same program without the internship disclosed differences in patient care practices. The same group of residents in their subsequent years of training in a psychiatric outpatient service were compared. A chart review comparison disclosed differences in areas of management in psychiatric outpatient treatment, referral patterns, and use of medication. Supervisory ratings of the residents were found to differ substantially in nine of the 15 measured categories.

Attitude of Health Personnel↗