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PubMedDate not supplied

On diagnosing.

Explore the source record for details and available documents.

Adult↗
PubMed1994

Treatment of incest perpetrators: a five-phase model.

The author's experiences with treating fathers who committed incest and were sentenced to undergo therapy are discussed in this paper. The treatment consists of five phases. Following crisis intervention and assessment, an analysis is made of the sequence of events, thoughts, moods, and behaviors that precede sexual contact. In the third phase, the client's sense of guilt is brought out and he actively takes responsibility for the sexual abuse of his daughter. In the fourth phase, the origin of the sexual abuse is clarified as it is put into the context of his own problems and the problems within the family. In the fifth phase, strategies for relapse prevention are practiced. In addition there are partner-relationship sessions with the couple as well as family counseling sessions. Up to now none of the clients have recidivized.

Adolescent↗
PubMed1980

Supervision in liaison and consultation psychiatry.

This paper reports special problems and techniques of teaching liaison and consultation psychiatry to psychiatric residents. It has become apparent that traditional methods of resident training are inadequate, and that specialized techniques of supervision are required to help the resident deal with the unique aspects of the liaison and consultation environment. Specific recommendations are made and discussed.

Countertransference↗
PubMed1990

Ability to avoid premature treatment. A skill of consultation-liaison psychiatrists.

The pressure to diagnose and treat patients rapidly is an enormous stressor for consultation-liaison psychiatrists. The intent of this article is to identify the external and intrapsychic factors that may contribute to such stressors and thus lead to premature interventions. Case vignettes are provided to illustrate those factors, and recommendations are offered to help the consultant recognize the need to acquire an important skill: the ability to avoid premature treatment.

Adult↗
PubMed1992

A profile of the noncompliant patient: a thirty-month review of outpatient psychiatry referrals.

Missed appointments to outpatient psychiatry programs have been identified as a major form of noncompliance in the literature. Over a two-and-a-half year period, 874 referrals to the outpatient psychiatry department of a large teaching hospital were examined for significant differences between compliant and noncompliant patients. Noncompliant patients comprised 17.8% of the total number of cases dispositions and were significantly more likely to be single, diagnosed personality disorder or substance abuse, and referred from the Emergency Department than complaint patients. Further analysis of emergency referrals, the single most significant predictor, indicated that patients from this referral source were more likely to be male, unmarried, unemployed or on welfare, and diagnosed personality disorder or substance abuse than referrals from general practice and internal sources. The results are discussed in light of previous research, and recommendations are made for increasing compliance to outpatient appointments.

Adult↗
PubMed1986

Two cases of misdiagnosis: some essentials of intake.

This article traces the history of two clinical cases. The first case describes a substance abusing patient who enacted the part of a narcotics addict. This enactment was affirmed by both alcohol and narcotic treatment programs, leading to a misdiagnosis. The second case describes a substance using client misdiagnosed as a result of assumptions made by the referral source. Biases inherent in the assessment of drug involved patients are illustrated and the utility of the hypotheses testing approach as a method of diagnostic error reduction and correction is discussed.

Adult↗
PubMed1989

The psychotherapy of dually diagnosed patients.

A model of psychotherapy with dual diagnosis patients is presented. This therapy is divided into 3 phases: achieving sobriety, maintaining abstinence, and advanced recovery. In each of these phases, dual diagnosis patients require many specialized techniques, which are discussed. After sobriety, psychotherapy is behavioral and supportive. When abstinence is stabilized, then psychodynamic principles can be integrated into an approach that recognizes the role played by potential return to substance abuse. Abstinence is even more critical in dual diagnosis patients than in uncomplicated substance abusers. In advanced recovery, more traditional psychotherapy can be done, particularly in nonpsychotic patients.

Alcoholism↗
PubMedDate not supplied

A psychoanalyst in methadonia.

This paper argues that the contemporary psychoanalytic model of addiction is compatible with the biochemical deficit model of Dole and Nyswander, the basis of methadone pharmacotherapy. The author explains the self-object function of methadone in the repair of self-deficits, specifically in the area of affect regulation, and he expands the dynamics of self-repair to the relational and programmatic "context of care" of methadone maintenance. Clinically, the problems of resistance and transference are examined as they arise and are resolved within an intersubjective counseling relationship. The treatment process in methadone maintenance is then reconceptualized as the gradual transformation of the central organizing principles of the addicted person as a result of the experience of psychophysiological stability, complemented by acceptance and empathy within a secure context of care. In closing, the need for an individual, self-focused approach to deciding between maintenance and detoxification is suggested.

Adult↗
PubMedDate not supplied

The development of a partial hospitalization program for mentally ill chemically abusing (MICA) patients.

The article begins with a review of the high prevalence of concurrent mental illness and chemical abuse (MICA) disorders among clinical populations, highlighting the need for development of appropriate services to treat these persons. This is followed by a description of a partial hospitalization program developed at the University of Rochester Medical Center-Strong Memorial Hospital, established to treat MICA patients. The program description includes information pertaining to the mission of the program, treatment setting, staffing, schedule, and diagnostic and sociodemographic data on 50 consecutive patients admitted to the program. It includes a review of the major goals of the program and the manner in which each of these goals is addressed. This is followed by a discussion of several arguments for the inclusion of patients with personality disorders in MICA treatment when there is concurrent substance abuse. It concludes with a case vignette of a patient treated in the MICA program.

Adaptation, Psychological↗
PubMed1994

Systematic clinical supervision in a child psychiatric ward: satisfaction with nursing care, tedium, burnout, and the nurses' own report on the effects of it.

The effects of systematic clinical supervision on all nurses (n = 11) at a ward for child psychiatric care was evaluated by means of open-ended questions, the tedium measure, Maslach's burnout inventory (MBI), and the satisfaction with nursing care at baseline, and after 6 and 12 months of supervision. Two main themes emerged: (1) being understood and understanding others led to improved cooperation and self-confidence and, (2) broadened and better knowledge base led to increased goal-oriented and active nursing actions in their clinical work. The nurses' satisfaction increased significantly regarding responsibility, organization, quality of care, cooperation, and comfort in the work group. The degree of tedium decreased significantly regarding mental exhaustion, whereas there were no significant changes in the degree of burnout as measured by MBI. The data point to the fact that systematic clinical supervision may be a way to show and use the knowledge embedded in practice and to improve the efficiency, the climate, and the cooperation of a work group.

Adolescent↗
PubMed2005

Systemic issues involved in working with professional sports teams.

Sport psychiatrists face a number of systemic and intra-psychic issues when treating professional athletes. Although only a modicum of literature exists to aid sport psychiatrists, there are several steps they may take to become an integral part of an athletic organization and to be successful in the treatment of the athletes themselves. The ability to delineate their role within the sports club is crucial to mental health professionals' organizational success. Equally important, it is incumbent upon sport psychiatrists to recognize and transcend intra-psychic issues that occur between athlete and physician.

Countertransference↗