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T Shapiro

Publications and source records attributed to T Shapiro.

At least 37 records · Page 2Linked to original sources
PubMed1993

A psychodynamic model of panic disorder.

Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder. They base their psychodynamic formulation on pilot interviews with nine patients with panic disorder, published reports of psychological characteristics of patients with panic disorder, and data from infant and animal research on temperament. Interview results included the following: 1) all of the patients described themselves as fearful, nervous, or shy as children, 2) they remembered their parents as angry, frightening, critical, or controlling, 3) they frequently indicated discomfort with aggression, 4) most described chronic feelings of low self-esteem, 5) their spouses were characterized as passive, kind, and nonaggressive, and 6) stressors associated with frustration and resentment preceded the onset of panic. The authors propose a model in which inborn neurophysiological irritability predisposes to early fearfulness. Exposure to parental behaviors that augment fearfulness results in disturbances in object relations and persistence of conflicts between dependence and independence, which predispose to fears of feeling trapped, suffocated, and unable to escape and/or feeling alone and unable to get help. Catastrophic fears of helplessness in the face of suffocation or abandonment are easily accessible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

On reminiscences.

Recently, psychoanalysts have focused on narrative truth and hermeneutics with diminished attention to the role of remembering in symptom formation and treatment. This shift has tended to remove us from prior status as a motivational and cognitive science with potential for causal inferences. At the same time, psychiatry and cognitive science have moved toward a vigorous study of reminiscences and their role in pathology. Arguments for a revival of Freud's position on the central role of memory are cited. A case example is offered to show that Freud and his psychoanalytic progeny have never taken a simplistic view of archeological truth, but were among the original group to bring to light the distorting effect of mind on remembering, and actually led the way for other scientific approaches.

Fantasy↗
PubMed1993

On psychoanalytic listening: language and unconscious communication.

The authors review past and recent perspectives on psychoanalytic listening, then present a synthetic model founded on psycholinguistics and semiotics. They argue that the analytic listening process can be broken down into nonlinguistic communications and--most important--linguistic categories pertaining to narrativity, symbolic reference, form, and interactive conventions. In each of these areas of signification, the authors present the ways in which the technique of psychoanalytic listening attends to unconscious meanings, thereby differing from ordinary listening which "hears," at best, only denotative and connotative meanings.

Attention↗
PubMed1993

Epidural anesthesia for labor in an ambulatory patient.

The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.

Adolescent↗
PubMed1992

Postpartum paravaginal hematoma and lower-extremity infection.

We report a case of infection of the lower extremity after a normal vaginal delivery. The infection originated in an occult obturator internus muscle hematoma, and diagnosis was based on a clinical suspicion and characteristic findings on computerized tomography scan. These findings permitted prompt surgical drainage, debridement, and antibiotic therapy and resulted in a successful outcome.

Adult↗
PubMed1992

May-Hegglin anomaly: a rare case of maternal thrombocytopenia in pregnancy.

The May-Hegglin anomaly, a rare cause of thrombocytopenia, is an autosomal dominant disorder that may have adverse maternal and fetal consequences. We present herein a case of May-Hegglin anomaly in pregnancy. The characteristic features of this anomaly, clinical presentation, and management options are discussed.

Adult↗
PubMed1992

Psychoanalysis and child and adolescent psychiatry.

This report describes psychoanalytic advances in theory and practice as well as changes in knowledge about determinants of behavior from infancy through adolescence. These changes influence how dynamic psychotherapy is conducted. Mother-infant research, affect development, object relations separation-individuation theory, and newer concepts of regulation of self-esteem are explored as they affect treatment strategies. The authors also review countertransference transference and psychoanalytic reconstruing of adolescence as a stage and their influence on how therapy is conducted. Finally, the authors propose using a dynamic formulation as a means of determining where or when the therapist intervenes.

Adolescent↗
PubMed1992

Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES): use in children with developmental disorders.

The Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES) was used to overcome the limitations of microanalytic facial observations and subjective assessments in the diagnosis of childhood developmental disorders. The KIDIES quantifies eight behavioral and eight affective dimensions by evaluating facial, vocal, gestural, and postural displays. In a sample of 42 subjects, KIDIES ratings distinguished between children with pervasive developmental disorder and a comparison group with mixed developmental diagnoses, and demonstrated sensitivity to emotional changes as a result of environmental shift. The results suggest that the KIDIES has potential as a reliable instrument for evaluating emotional and behavioral patterns in young developmentally disordered children.

Affective Symptoms↗
PubMed1991

Current status of research activity in American child and adolescent psychiatry: Part I.

A survey of research activity of American academic child psychiatrists was completed in February, 1989. The survey demonstrated an increase in research activity since the 1983 report in the Current Status of Child Psychiatry. A definition of a researcher was derived from a study of internists and general psychiatrists and applied to the 488 respondents (78.5% of sample), and it was found that males outnumber females and that researchers contribute significantly more to the literature and education than nonresearchers. Early research exposure and mentoring are important influences on a research career. Recommendations by researchers for future training of researchers are presented. Periodic surveys are encouraged.

Academic Medical Centers↗
PubMed1991

Current status of research activity in American child and adolescent psychiatry: II. A developmental analysis by age cohorts.

A survey designed to assess research activity was sent to 622 full-time child and adolescent psychiatric faculty at 127 academic programs. A 78.5% response rate was achieved. An examination of the responses of three age cohorts was conducted. Only about 10% of the respondents met the empirical definition of a researcher based on percentage of effort, publication, and funding. No increase in research activity was found for the youngest cohort, although significantly more younger women were holding academic appointments. Younger researchers identified psychobiological studies as a particular interest. Researchers at all ages identified a mentor program as a critical aspect of their training.

Adolescent↗
PubMed1991

Social deviance in autism: a central integrative failure as a model for social nonengagement.

Clinically, adult autistic and PDD individuals appear to have an uneasy relationship with their social environment no matter how much developmental progress they make. Many can work at modest jobs, many more do not, and even fewer are interested enough in the human environment to cohabitate and/or marry. A conversation with a young autistic man of 20 about a trip to visit a relative focuses more on the time the train left and how late it was in hypermnestic detail, including all details except the affective environment or the relationships to human beings. This is the human significance of the term autism. Autistics can speak and reference, but they seem not to understand the social requirements of a human interchange. If they do know it, they know it in a fragmentary or rudimentary way devoid of subtlety or nuance. Whatever we mean by social intercourse and whatever functions subsume it, they seem to emerge in interaction with cognition and language. They develop apace as human traverse those first 3 years of life and as they reach social maturity in adolescence. Autistic children appear not to integrate their knowledge of things in a representation that includes emotional and cognitive elements. They do not seem to understand that words necessarily refer to things of this world that others are also referencing in their words and sentences--shared reference is not natural to them. Intersubjectivity as a feature of common code use is not tacit or explicit in their behavior. They similarly do not use social referencing in the way in which normals do, and although they show some attachment to people, they seem to do so without benefit of affective display leading to reciprocity. There is little notion of the external that makes another human being distinguishable from a thing. Their treasured objects in early childhood are hard and lack comforting proximal receptor attractiveness as in normals. Hobson's extensive studies have elaborated a notion about the autistic child's knowledge of person. He comments on the lack of integration of the verbal and visual situational ties in which affective expression emerges and functions. He also comments on the deictic inabilities, inferring that the "I," "you," and "he" references do not have any significance for such children. We would like to note that while Vygotsky and others have observed that speech comes from the world of people, language comes from the maturing organism as an innate propensity.(ABSTRACT TRUNCATED AT 400 WORDS)

Affect↗
PubMed1990

DSM-III and DSM-III-R diagnosis of autism and pervasive developmental disorder in nursery school children.

DSM-III and DSM-III-R diagnoses of 112 developmentally disordered preschool children were compared. There was no significant difference between the DSM-III and DSM-III-R diagnosis of the inclusive category of pervasive developmental disorder, but nearly twice as many cases (58) were diagnosed as autistic disorder by DSM-III-R criteria as were diagnosed as infantile autism (31) by DSM-III. Thirty children met both DSM-III and DSM-III-R criteria for autism (IA/AD) and 23 received a DSM-III diagnosis of atypical PDD (A-PDD) and a DSM-III-R diagnosis of AD (A-PDD/AD). All of the IA/AD children and none of the A-PDD/AD group displayed a marked lack of awareness of others. DSM-III-R criteria have specifically broadened the concept of autism to include children who, although socially impaired, are not pervasively unresponsive to others.

Autistic Disorder↗
PubMed1990

Unconscious fantasy: introduction.

Freudian psychoanalysis has long been a depth psychology with devotion to the idea that unconscious fantasies dictate behavior. That concept is traced from its origins to the present to expose its various forms as ego psychology has emerged.

Defense Mechanisms↗
PubMed1989

Psychoanalytic classification and empiricism with borderline personality disorder as a model.

Psychoanalytic interest in diagnosis has traditionally addressed issues of structure of personality, defense, and repetitive maladaptive patterns of interaction with other human beings based on inferred unconscious fantasies and compromise formations. Empirical studies based on the psychoanalytic model have concentrated on study of the therapeutic process and also on study of diagnostic groups such as borderline personality disorder (BPD). The work in BPD provides a paradigm for future approaches in the study of second-order inferences removed from the immediate observational field, which is tapped by descriptive taxonomies. The concept of structure may be clarified by empirical studies using a psychoanalytic frame of reference.

Borderline Personality Disorder↗
PubMed1989

The psychodynamic formulation in child and adolescent psychiatry.

DSM-III and DSM-III-R aid diagnostic clarity but do not help clinicians plan for common therapies available. A psychodynamic formulation has been described for adults to complement diagnosis and guide management. Child and adolescent psychiatrists would benefit if such a scheme were available for their use. Psychodynamic formulations based on current models are offered and their elements are described. Case vignettes and therapeutic plans are presented to show the practical value of a formal psychodynamic formulation, regardless of the treatment employed.

Adolescent↗