Caring for the psyche: classical origins and modern paradigms.
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Biomedical subjects
Publications and source records attributed to J Bemporad.
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This paper has further developed and argued for a broadened concept of countertransference in psychotherapy with children and adolescents. The model presented here emphasizes that countertransference difficulties may result because of therapist reactions (1) to the child that are acted upon directly in the child's treatment, (2) that are stimulated by the child and displaced onto parents, or (3) that are stimulated by the parents themselves, while still being acted upon in the treatment of the child. In all of these situations, the therapist unconsciously may alter the treatment of the child or the guidance offered the parents about the child. Supervision and consultation in therapy, as well as therapists' examination of their own reactions to all members of the family system (including to those who are not present) are helpful in understanding and managing these complicated countertransference reactions. Finally, it is highly recommended that therapists see parents of a child in treatment regularly to decrease distortions of them and to appreciate them appropriately as ordinary human beings.
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OBJECTIVE: The purpose of this study was to ascertain the current diagnosis in late adolescence or early adulthood of children who had previously been diagnosed as "borderline." METHOD: This was a prospective follow-up study of 19 of a group of 32 children (ages 6-10) who had been diagnosed as "borderline" during their treatment at the Massachusetts Mental Health Center approximately 10-20 years earlier. Life history information was collected, and axis I and axis II diagnoses were assigned by use of the Structured Clinical Interview for DSM-III-R and unstructured clinical interviews. RESULTS: The most significant finding was that, contrary to expectations, there were no axis I diagnoses of affective disorders or schizophrenia. On the other hand, axis II diagnoses were prevalent, and the overall outcome for the subjects was poor. Family stability was the only significant predictor of the relatively good outcome of five of the subjects. CONCLUSIONS: The childhood borderline diagnosis appears to be an antecedent of an array of adult personality disorders, but it is not associated with the adult borderline personality disorder per se, nor with axis I diagnoses.
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We began open trials of beta-blockers, as adjunctive medication, in eight consecutive autistic adults. The immediate result across all patients was a rapid diminution in aggressivity (Ratey et al., 1987). As time on the drug increased, subtler changes in speech and socialization emerged. While results of open trials must be interpreted with caution, these changes were significant and lasting. We speculate that these effects may be the result of a lessening of the autistic individual's state of hyperarousal. As the individual becomes less anxious, defensive and dearousing behaviors are relinquished and more social and adaptive behaviors appear. There is a concomitant improvement in language, though it is unclear whether lost skills are recouped or new ones developed. Further research is indicated.
The authors describe the development of an affective disorders consultation service that implemented a biopsychosocial model of subspecialty consultation within a university-affiliated community mental health center. They retrospectively analyzed the first 2 years of consultations, assessing the process of consultation and examining patterns of consultee inquiries and consultation recommendations. Consultants recommended combined psychopharmacologic and psychodynamic therapies for most patients and found psychodynamic psychotherapy strikingly overlooked by consultees, all of whom were psychiatrists or other mental health professionals. This evaluation documents the psychiatric consultees' deemphasis of the biopsychosocial perspective in clinical practice.
Eight consecutive cases of adults with the diagnosis of early infantile autism and who were treated with a betablocker are presented. Each had been on various and multiple drug, educational, and behavioral regimens to help control aggressive and self-abusive behavior. Most had been institutionalized from an early age, and a broad range of IQs and speech capacities are represented. Results show the betablockers to have a remarkable effect potentiating measurable diminution in previously intractable aggressive behavior and in many cases the decrease or withdrawal of their neuroleptic.
The authors present data from four different institutions from open clinical trials of propranolol in 19 mentally retarded patients with IQs less than 50. When customary forms of treatment had failed, propranolol was initiated. A table showing changes in the patients' behavior is included. Twelve patients demonstrated a pronounced improvement in self-abusive and aggressive behavior, four made moderate gains, and three were considered unchanged. The authors postulate that at least some aspects of the behavioral improvement were due to the peripheral anxiolytic action of the beta-blockers. Contrary to other reports of using higher doses (greater than 520 mg/day range), the authors used a mean dose of 120 mg/day and consider the duration of time spent on the medication as a crucial factor in its effectiveness.
The authors review published studies of the children of parents with major affective disorder and report the rates of diagnosable disorder in the children, their clinical symptoms and other behavioral disturbances, and the differing impact of parental illness at different ages and stages of development. There is significant risk to children in having parents with major affective disorder, and considerable impairment is evident in these children. The authors discuss the methodological issues in the studies and offer suggestions for future investigations.
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