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Clinical Abstracts
---Clinical Abstracts----l Brief psychotherapy Ursano RJ, Hales RE: Areview of brief individual psychotherapies Am JPsychiatry 143:1507-1517. 1986,
• This article concludes that brief psychotherapy has proven cost-effective and will likely come more and more into demand, given projected socioeconomic changes in the near future. The authors compare four methods of brief individual psychotherapy: focal therapy, anxiety-provoking therapy, Mann's time-limited therapy, and the broad-focus therapy of Davanloo. All four modalities show considerable overlap in their goals, tech-
Varied psychological factors in duodenal ulcer patients Magni G, Oi Mario F. Rizzardo R, et al: Personality profiles of patients with duodenal ulcer. Am J Psychiatry 143:1297-1300,1986
• These authors emphasize that psychological factors in peptic ulcer disease appear to be heterogeneous. This disorder has traditionally been considered a psychosomatic one and has been linked in the psychiatric literature to patient characteristics of dependence, neurotic personality features, and anxiety. To study this relationship, the authors obtained personality profiles for 79 patients with active duodenal ulcer. Biological and behavioral variables were also measured. This study gave evidence of
niques, patient selection criteria, and duration of treatment. Two other forms of individual psychotherapy (interpersonal and cognitive) are then described, followed by a comparison of psychodynamic, cognitive, and interpersonal therapies. Again the similarities are emphasized. For example, analysis of defense mechanisms is similar in both cognitive and psychodynamic therapy, while interpersonal therapy is related to the psychodynamic object relations perspective. Differences, such as in the use of directive and behavioral interventions, are also examined. Ursano and Hales
recommend that psychiatric residents be required to develop skills in all psychotherapeutic modalities: brief psychodynamic therapy, crisis intervention, interpersonal therapy, cognitive therapy, supportive therapy, and long-term psychodynamic therapy. As Ursano and Hales aptly remark, "The understanding of which patient for which treatment at which time is as critical for the prescription of psychotherapy as it is for the prescription of psychopharmacologic medications. "
three personality subgroups among the patients studied: "dependent and anxious," "neurotic and anxious," and those" who did not appear to have pathological personality characteristics." No relationship existed between the personality subgroups and the variety of biological variables measured. This heterogeneity of psychological factors encountered may suggest a need for diversified treatment from a psychiatric perspective. It is not correct to consider that all patients with peptic ulcer disease actually have a psychosomatic disorder since some of the patients studied evidenced no pathological personality characteristics.
The present and the future of C·L psychiatry
John L. Black. M.D. MayoC/inic
Ronald K. McCraw. Ph.D. Fort Worth. Tex.
Cohen-Cole SA, Pincus HA. Stoudemire A. et al: Recent research developments in consultation-liaison psychiatry. Gen Hosp Psychiatry 8:316-329, 1986.
• This article presents a selective review of recent advances in consultation-liaison (C-L) psychiatry and discusses directions for future research. Five major areas were selected because of their importance for the future: diagnosis, biological treatments, disease mechanisms, health services research, and psychosocial interventions for medical disorders. In regard to diagnosis, the authors note that DSM-III was developed and field tested on psychiatric patients without serious medical conditions. However,
.Ioamlll Reviewed Inti MItrIcttd Alcohol: Clin Exp Res AmJ Med Am J Psychiatry Am J Psycholller Ann Intern Med Ann Neurol Arch Gen Psychiatry
MAY 1987· VOL 28· NO 5
Arch Intern Med Arch NeUlol 81 J Psychialrf Can J Psychlalry Compr Psychiatry Gen Hasp Psychiatry
Headache
Hasp Community Psychiatry Inl J Psychiatry Med JAMA J BehavMed J Clin Pharmacol J Clin Psychiatry JClin Psychopharrnacol
J MedEduc J Psychosom Res J Stud AlcohOl Lancet Mayo Clln Proc NEnglJ Mea Neurology
Posigrad Med Psychiatr Ann Psychop/1arrnacol Bull Psychosom Med Sleep Stroke and other journals
287
f---------
Clinical Abstracts--------
since many symptoms of psychiatric disorders could be biologically caused or result secondarily from a primary illness, the authors urge a multicenter effort to formulate a diagnostic system for C-L patients. There is a paucity of methodologically rigorous studies of biological treatments relevant to C-L psychiatry. The authors believe that one obstacle to conducting such studies is that often such research must be
conducted on "foreign turf." where necessary control is difficult to achieve. They express the hope that the growth of medical-psychiatric units will diminish this problem. Under disease mechanisms, the authors describe ways in which psychiatric and medical conditions can interact (co-occurrent. linked occurrence, conditions with common symptomatology, and causal links). Additional
funding and research trammg programs are needed. Too often this kind of research" falls through the cracks" of academic departments and of the institutes. Policy issues are increasingly recognized as having major effects on the practice of C-L psychiatry (eg, DRGs). Any research done must be relevant to these issues.
Features of tricyclic nonresponse
sponders. Fifth. many patients who did not respond to full therapeutic tricyclic antidepressant trials did respond to either ECT or monoamine oxidase inhibitors.
and that the physician may want to encourage this process during the postoperative period.
Roose SP, Glassman AH, walsh BT, el al: Tricyclic nonresponders: Phenomenology and treatment. Am J Psychiatry 143345-348. 1986
• This article provides the clinician with practical information about the diagnosis and treatment of the patient whose depression does not respond to the usual treatments. After a brief but careful review of the literature. including studies that have led to some confusion in identifying the characteristics of tricyclic antidepressant nonresponders, the authors report on their experience with 60 nondelusional, unipolar melancholic patients. Several of their findings are particularly notable. First, in their study, as in others. the response rate for tricyclic antidepressants prescribed in therapeutic plasma levels is approximately 80%. Second. "one is not able to predict on the basis of demographic data or clinical phenomenology who will not respond to tricyclic antidepressants." Third, as a group. the nonresponders had higher scores on the anxiety and hyposexuality scales than did responders. Fourth, the tricyclic nonresponders had a history of more previous depressive episodes than the re-
288
AI/an Burstein. M.D. Free/wid. N.J.
John L. Black. M.D. Mayo Clinic
Jarrett W. Richardson 1/1, M.D. Mayo Clinic
INDEX TO ADVERTISERS
Denial in heart transplant recipients Mai FM: Graft and donor denial in heart transplant recipients. Am J Psychiatry 143:1159-1161, 1986.
• Denial was present in 90% (18/20) of survivors of heart transplantation who were interviewed by the author. It was directed toward the graft, the donor. or both. Dr. Mai suggests that denial serves an important adaptive function in transplant patients. Denial directed toward the graft may involve adaptation regarding the individual's personal image and concept of his or her heart and its affective connotations. Denial directed toward the donor involves adaptation about concepts of death. dying, and bereavement. as well as about the complex ambivalent feelings that transplant patients have toward the donor. The article concludes that denial may be seen as a means of coping with feelings until they can be better accommodated,
MAY 1987 Clba Pharmaceuticals Uthobid
273-274
Geigy Pharmaceuticals Tofranil . .. .. . ........
.. 237-238
Mead Johnson Pharmaceutical Division Buspar 257-264 Merrell Dow Pharmaceullcals Norpramln
245-248
Roche Labontorles Valium third cover-Iourlh cover Roerlg Navane SineQuan
second cover-230 . 284-286
Sandoz Pamelor
234, 254-256
The Upjohn Company Halclon Xanax
.. 232 251-252
PSYCHOSOMATICS
• This article concludes that brief psychotherapy has proven cost-effective and will likely come more and more into demand, given projected socioeconomic changes in the near future. The authors compare four methods of brief individual psychotherapy: focal therapy, anxiety-provoking therapy, Mann's time-limited therapy, and the broad-focus therapy of Davanloo. All four modalities show considerable overlap in their goals, tech-
Varied psychological factors in duodenal ulcer patients Magni G, Oi Mario F. Rizzardo R, et al: Personality profiles of patients with duodenal ulcer. Am J Psychiatry 143:1297-1300,1986
• These authors emphasize that psychological factors in peptic ulcer disease appear to be heterogeneous. This disorder has traditionally been considered a psychosomatic one and has been linked in the psychiatric literature to patient characteristics of dependence, neurotic personality features, and anxiety. To study this relationship, the authors obtained personality profiles for 79 patients with active duodenal ulcer. Biological and behavioral variables were also measured. This study gave evidence of
niques, patient selection criteria, and duration of treatment. Two other forms of individual psychotherapy (interpersonal and cognitive) are then described, followed by a comparison of psychodynamic, cognitive, and interpersonal therapies. Again the similarities are emphasized. For example, analysis of defense mechanisms is similar in both cognitive and psychodynamic therapy, while interpersonal therapy is related to the psychodynamic object relations perspective. Differences, such as in the use of directive and behavioral interventions, are also examined. Ursano and Hales
recommend that psychiatric residents be required to develop skills in all psychotherapeutic modalities: brief psychodynamic therapy, crisis intervention, interpersonal therapy, cognitive therapy, supportive therapy, and long-term psychodynamic therapy. As Ursano and Hales aptly remark, "The understanding of which patient for which treatment at which time is as critical for the prescription of psychotherapy as it is for the prescription of psychopharmacologic medications. "
three personality subgroups among the patients studied: "dependent and anxious," "neurotic and anxious," and those" who did not appear to have pathological personality characteristics." No relationship existed between the personality subgroups and the variety of biological variables measured. This heterogeneity of psychological factors encountered may suggest a need for diversified treatment from a psychiatric perspective. It is not correct to consider that all patients with peptic ulcer disease actually have a psychosomatic disorder since some of the patients studied evidenced no pathological personality characteristics.
The present and the future of C·L psychiatry
John L. Black. M.D. MayoC/inic
Ronald K. McCraw. Ph.D. Fort Worth. Tex.
Cohen-Cole SA, Pincus HA. Stoudemire A. et al: Recent research developments in consultation-liaison psychiatry. Gen Hosp Psychiatry 8:316-329, 1986.
• This article presents a selective review of recent advances in consultation-liaison (C-L) psychiatry and discusses directions for future research. Five major areas were selected because of their importance for the future: diagnosis, biological treatments, disease mechanisms, health services research, and psychosocial interventions for medical disorders. In regard to diagnosis, the authors note that DSM-III was developed and field tested on psychiatric patients without serious medical conditions. However,
.Ioamlll Reviewed Inti MItrIcttd Alcohol: Clin Exp Res AmJ Med Am J Psychiatry Am J Psycholller Ann Intern Med Ann Neurol Arch Gen Psychiatry
MAY 1987· VOL 28· NO 5
Arch Intern Med Arch NeUlol 81 J Psychialrf Can J Psychlalry Compr Psychiatry Gen Hasp Psychiatry
Headache
Hasp Community Psychiatry Inl J Psychiatry Med JAMA J BehavMed J Clin Pharmacol J Clin Psychiatry JClin Psychopharrnacol
J MedEduc J Psychosom Res J Stud AlcohOl Lancet Mayo Clln Proc NEnglJ Mea Neurology
Posigrad Med Psychiatr Ann Psychop/1arrnacol Bull Psychosom Med Sleep Stroke and other journals
287
f---------
Clinical Abstracts--------
since many symptoms of psychiatric disorders could be biologically caused or result secondarily from a primary illness, the authors urge a multicenter effort to formulate a diagnostic system for C-L patients. There is a paucity of methodologically rigorous studies of biological treatments relevant to C-L psychiatry. The authors believe that one obstacle to conducting such studies is that often such research must be
conducted on "foreign turf." where necessary control is difficult to achieve. They express the hope that the growth of medical-psychiatric units will diminish this problem. Under disease mechanisms, the authors describe ways in which psychiatric and medical conditions can interact (co-occurrent. linked occurrence, conditions with common symptomatology, and causal links). Additional
funding and research trammg programs are needed. Too often this kind of research" falls through the cracks" of academic departments and of the institutes. Policy issues are increasingly recognized as having major effects on the practice of C-L psychiatry (eg, DRGs). Any research done must be relevant to these issues.
Features of tricyclic nonresponse
sponders. Fifth. many patients who did not respond to full therapeutic tricyclic antidepressant trials did respond to either ECT or monoamine oxidase inhibitors.
and that the physician may want to encourage this process during the postoperative period.
Roose SP, Glassman AH, walsh BT, el al: Tricyclic nonresponders: Phenomenology and treatment. Am J Psychiatry 143345-348. 1986
• This article provides the clinician with practical information about the diagnosis and treatment of the patient whose depression does not respond to the usual treatments. After a brief but careful review of the literature. including studies that have led to some confusion in identifying the characteristics of tricyclic antidepressant nonresponders, the authors report on their experience with 60 nondelusional, unipolar melancholic patients. Several of their findings are particularly notable. First, in their study, as in others. the response rate for tricyclic antidepressants prescribed in therapeutic plasma levels is approximately 80%. Second. "one is not able to predict on the basis of demographic data or clinical phenomenology who will not respond to tricyclic antidepressants." Third, as a group. the nonresponders had higher scores on the anxiety and hyposexuality scales than did responders. Fourth, the tricyclic nonresponders had a history of more previous depressive episodes than the re-
288
AI/an Burstein. M.D. Free/wid. N.J.
John L. Black. M.D. Mayo Clinic
Jarrett W. Richardson 1/1, M.D. Mayo Clinic
INDEX TO ADVERTISERS
Denial in heart transplant recipients Mai FM: Graft and donor denial in heart transplant recipients. Am J Psychiatry 143:1159-1161, 1986.
• Denial was present in 90% (18/20) of survivors of heart transplantation who were interviewed by the author. It was directed toward the graft, the donor. or both. Dr. Mai suggests that denial serves an important adaptive function in transplant patients. Denial directed toward the graft may involve adaptation regarding the individual's personal image and concept of his or her heart and its affective connotations. Denial directed toward the donor involves adaptation about concepts of death. dying, and bereavement. as well as about the complex ambivalent feelings that transplant patients have toward the donor. The article concludes that denial may be seen as a means of coping with feelings until they can be better accommodated,
MAY 1987 Clba Pharmaceuticals Uthobid
273-274
Geigy Pharmaceuticals Tofranil . .. .. . ........
.. 237-238
Mead Johnson Pharmaceutical Division Buspar 257-264 Merrell Dow Pharmaceullcals Norpramln
245-248
Roche Labontorles Valium third cover-Iourlh cover Roerlg Navane SineQuan
second cover-230 . 284-286
Sandoz Pamelor
234, 254-256
The Upjohn Company Halclon Xanax
.. 232 251-252
PSYCHOSOMATICS