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Biomedical subjects

T B Karasu

Publications and source records attributed to T B Karasu.

At least 19 recordsLinked to original sources
PubMed1992

Developmentalist metatheory of depression and psychotherapy.

Examination of the theoretical and clinical literature reveals that the psychological understanding of depression is complex and varied, often differing among major schools or theorists. These variations in conceptual perspective (e.g., drive, ego, object relations, self, interpersonal, cognitive) also naturally impact, directly or indirectly, upon the nature of treatment. This paper has attempted to integrate diverse points of view by offering a developmentalist metatheory based on the psychosexual maturation of the patient. More specifically, four basic prototypes of depression have been depicted: Dyadic deficit depression (DDD), dyadic conflict depression (DCD), triadic deficit depression (TDD), and triadic conflict depression (TCD). Each etiologically relates to early childhood experiences of the individual and is traced to different developmental periods with their own unresolved conflicts or deficient parent(s)/child scenarios. Clinical signs and symptoms as well as therapist/patient interactions have been described and respective technical measures recommended. This schema has therapeutic implications both for the reapproachement of multiple frameworks and for individualized practice in the treatment of depression.

Adolescent↗
PubMed1992

A review of treatment studies of minor depression: 1980-1991.

This article provides a brief overview of the changing nature of the concept of minor depression. It then discusses treatment studies conducted from 1980 to 1991 of patients diagnosed as neurotic depression, depressive neurosis or dysthymia, characterologic depression, "double depression" and minor depression or dysthymia, if there has been a full remission of a major depressive episode lasting at least six months prior to the development of dysthymia. Long-term treatment of chronic depression is also reviewed. Cognitive-behavioral intervention and marital therapy have been reported beneficial for patients diagnosed as having neurotic depression, characterological depression, or dysthymia. All studies of antidepressant drug treatment showed drugs to be efficacious and superior to placebo, with few differences found between drugs. In addition, they all showed the importance of analyzing the interactions between treatment and severity or diagnosis. Patients diagnosed as "double depression" also appear responsive to both psychosocial intervention and drug treatment; in general, however, these patients tend to have a poor long-term outcome and continued treatment is indicated. The most obvious finding to emerge from this review is that the diagnosis of minor depression is ambiguous, in large part because of the lack of defining criteria related to severity and course. The review also revealed that in addition to poorly defined subgroups, many studies lacked controls, had small sample sizes, inadequate and/or inconsistent measures of outcome, and limited follow-up. For these reasons, their findings cannot be considered conclusive. Finally, the literature revealed a dearth of controlled studies of psychosocial treatment for well defined subgroups of neurotic depression.

Antidepressive Agents, Tricyclic↗
PubMed1979

Age factors in patient-therapist relationship.

This paper reports on the effects of therapist and patient age as factors in the evaluation and treatment of adult psychiatric outpatients. Therapist ratings and patient self-ratings are contrasted in three age groups. Rating scales include symptomatology, motivation, insight, and prognosis. In addition, a chart review follow-up of 68 patients includes disposition and drop-out. The data suggest that older patients are perceived as sicker, but less treatable than younger patients or patients of the same age group as the therapist. Residents express a strong preference for treating younger patients, but more readily develop a treatment relationship with same age patients. Both older and younger patients were significantly less likely to remain in treatment. Age of therapist and patient as a significant, frequent unrecognized factor in psychotherapeutic intervention is discussed and modifications in psychiatric training programs are suggested.

Adjustment Disorders↗
PubMed1979

Measurement of thinking dysfunction. An empirical study.

This investigation is concerned with the development of a practical method for assessment of thought disorders. A review of eight major textbooks and four review articles revealed 37 different terms used to describe the components of thought disorders. Because of overlap of meanings or ambiguous usage, these terms were reduced to 17 discrete terms that could be operationally defined. Twenty-five psychiatrist were surveyed on the appropriateness of the definitions and their relevance to the concept of thought disorder. An average of 83 per cent agreement was obtained, and some of the definitions were modified as a result of the survey. Eight psychiatrists then applied this scale, titled the Thinking Dysfunction Rating Scale, to the evaluation of five videotaped patient interviews. Based on observation of all five patients, interjudge agreement was over 90 per cent for all items of the scale. Analysis of variance showed that the scale significantly discriminated among schizophrenics, patients with organic brain syndromes, psychotic depressives, geriatric depressives, and outpatients. The patterns of scores were found to vary among these five groups. The scale should be helpful for teaching purposes and as a checklist for routine clinical diagnosis.

Adult↗
PubMed1979

Psychotherapy of the medically ill.

The author assesses the current status of psychotherapy with medically ill patients. He reviews the special problems of psychological treatment for this population; the respective rationales for the utilization of various psychotherapeutic approaches including psychoanalysis, dynamic psychotherapy, and family and group therapy; and the results of case reports and research studies. The author identifies specific areas of future investigation and research, elucidates some specific implications for clinical practice, and recommends more critical exploration of the role of psychotherapy in the treatment of the medically ill.

Adult↗
PubMed1979

Common mistakes in psychotherapy.

To better monitor the psychotherapy training of psychiatric residents and to understand therapist factors involved in a negative outcome to psychotherapy, the authors surveyed 20 supervisors on the frequency of mistakes made by resident therapists. Among the mistakes most commonly made were wanting to be liked by patients, premature interpretations, overuse of intellectualization, inability to tolerate patients' aggression, and avoidance of fee setting. The authors conclude that the mitigation of the most common errors requires open discussion of countertransference issues.

Clinical Competence↗
PubMed1979

Psychotherapy of the psychosomatic patient.

The role of psychotherapy for psychosomatic patients is reviewed. Barriers to treatment, including special characteristics of these patients that make them poor candidates for traditional psychodynamic interventions, are discussed with implications for practice. Clinical recommendations encompass two broad preparatory phases: I, the health alliance, and II, the life alliance.

Attitude to Health↗
PubMed1979

Toward unification of psychotherapies: a complementary model.

The emergence of different models of psychological healing from Freud to the present, and specific features which characterize "new" psychotherapies in contrast to psychoanalysis are examined. The author maintains that these represent a chronological evolution of therapeutic forms which are complementary and which portend the unification of the psychotherapies.

Freudian Theory↗
PubMed1979

Appearance of new symptoms in hospitalized patients: an instance of institutional iatrogenesis?

Data from the admission and termination forms of 100 consecutively discharged psychiatric inpatients were analyzed to determine the changes that occurred in the symptom profile of each patient during hospitalization. In general, patients entered the hospitalization. In general, patients entered the hospital with severe, chronic symptoms some of which were relieved and some of which remained unchanged. A number of symptoms, however, were reported present on the termination forms that had not been noted at admission. The results of this study offer evidence that a possible effect of the therapeutic process is the occasional appearance of new symptoms in some patients.

Acute Disease↗
PubMed1979

Thought disorder in alcoholics.

Research on cognitive impairment in chronic alcoholics has generally focused on pathology associated with organic brain damage. On the other hand, deficits more typical of the functional psychoses have been less explored, due to the absence of appropriate tests. By using the Thought Disorder Rating Scale (TDRS) recently developed at our Center, however, we have tested chronic alcoholics for the presence of classical symptoms of thought disorder. This test is based on the assessment of the patient's verbal behavior by an experienced clinician. Twenty subjects free of psychosis, severe withdrawal symptoms, and medical illness were, after detoxification, administered a test battery which included the TDRS, the Bender-Gestalt Test, and the Zung Self-rating Depression Scale (SDS). Five scored pathologically for thought disorder and of them four had abnormal Benders; whereas only two of 15 of those without thought disorder had abnormal Benders (t = 2.84, p < .01). Although SDS scores for both groups were in the depressed range, there was no significant difference between SDS means for the two groups. TDRS scores for these alcoholics are compared with those for other diagnosed groups, and implications for future investigation are discussed.

Adult↗
PubMed1978

A three-year follow-up study of the elimination of the internship. A comparative study of internship- and noninternship-trained residents in a psychiatric outpatient setting.

The American Board of Psychiatry and Neurology eliminated the internship as a requirement for certification in psychiatry in 1970. Preliminary study on a psychiatric inpatient service of internship-trained first-year residents with that of a matched group of residents who entered the same program without the internship disclosed differences in patient care practices. The same group of residents in their subsequent years of training in a psychiatric outpatient service were compared. A chart review comparison disclosed differences in areas of management in psychiatric outpatient treatment, referral patterns, and use of medication. Supervisory ratings of the residents were found to differ substantially in nine of the 15 measured categories.

Attitude of Health Personnel↗
PubMed1978

Toward a rationale for the seclusion process.

The present paper summarizes three studies focusing on different aspects of seclusion room practices. The first study involved chart review to collect empirical data on reasons for seclusion, length of seclusion, and characteristics of secluded patients. The second study focused on staff attitudes toward seclusion; the third dealt with the attitudes of both secluded and nonsecluded patients. The average time of seclusion was approximately 4 hours and in most cases aggressive behaviors of various types were cited as the precipitating event. In addition, patient and staff attitudes implied that a major function of the seclusion process was to isolate patients from disturbing interactions and to maintain the smooth functioning of the ward minisociety. Two models of seclusion, an ethological model and a behavioristic "time out" model, were developed in order to integrate the results of these studies. Implications of the findings and models are presented for changes in seclusion room procedures.

Adult↗
PubMed1978

Clinical utility of a rapid diagnostic test series for elderly psychiatric outpatients.

Psychiatric evaluation of the elderly is especially difficult for several reasons, e.g., the presence of organic impairment, the effects of multiple drug therapy, and the tendency to confuse the normal concomitants of aging with neurotic symptoms. The authors have developed and evaluated a brief series of self-report assessment tests (GRDB) designed to assist the psychiatrist in the process of diagnosis. Coefficients of the internal consistency of the seven scales are presented. A comparison was make between 28 psychiatric patients attending a geriatric clinic and 48 well-functioning elderly persons matched for age and sex, and living in the same community. Results showed that the geriatric outpatients functioned at a lower level of adaptation than did the control group, on all seven scales - depression, daily living skills, social interaction, cognitive skills, number of illnesses, number of life problems, and the use of drugs and alcohol. These findings provide a measure of discriminant validity. The advantages of this brief assessment instrument are discussed.

Aged↗