Part II of the ABPN certification examination.
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Biomedical subjects
Publications and source records attributed to R B Granet.
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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.
Magnetic resonance imaging (MRI) is an effective diagnostic radiologic procedure with a wide margin of safety. The authors describe the phenomenology and etiology of claustrophobia during MRI and provide an integrative management approach for referring physicians, radiologists, and technicians who deal with this difficult problem.
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The authors provide three case examples of anniversary reactions in psychotherapists evoked in the course of treating patients. They note that psychotherapy has always been discussed in terms of time and phases, which lend themselves to periodicities and may provide the potential for anniversary phenomena. The authors recommend that therapists be aware of such phenomena; monitor their own losses, defenses, and dreams; and continue their own supervision. Possible positive aspects of identification of therapists' anniversary reactions are increased empathy with patients and help in completing unresolved therapeutic and personal issues.
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The authors emphasize the importance of a consultation psychiatry experience in the maturation of the young psychiatrist by examining some of the processes operational in both community and hospital consultation work, performed by the senior author during his fourth year of residency. Such experiences can provide opportunities for developing psychiatric skills not emphasized elsewhere, including the adoption of an active therapeutic stance, the application of the psychodynamic theory to the consultation system itself, and teaching without the use of jargon. In addition the experience as consultant facilitates the transition from residency to the outside world, not only through attitudinal changes achieved by exposure to less structured settings, a change in the supervisory model, and a solidification of identity as a physician and psychiatrist, but also by providing the resident the opportunity to begin de-cathecting from the training program.
The authors describe several problems that are unique to the beginning supervisor of psychiatry residents. These difficulties can be divided into four general areas: inexperience, competition, identity, and administration. The authors provide examples to illustrate the types of situations that the new supervisor may encounter and make recommendations for dealing effectively with them.
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A case of a forty-eight year old woman with myxedema and acute psychosis is reported to illustrate the difficulties of diagnosis in psychiatry. A specific focus is placed on the problem of differentiating organic from functional illness. Several guidelines are offered to aid the clinician with the problem of diagnosis.
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There exists very little data on how graduating psychiatry residents make practice choices. By reviewing the psychodynamic and institutional themes that emerged in a Career Planning Seminar taught at The New York Hospital-Cornell Medical Center over the past decade, the authors hope to provide new information about this important developmental task. In addition, the ways in which trainees perceive specific career options will be described.