Arnold Winston

BRIEF PSYCHOTHERAPY OF PERSONALITY DISORDERS

Thirty-two patients with personality disorder diagnoses were randomly assigned to two treatment conditions that vary on several techniques of brief dynamic psychotherapy. Seventeen patients constituted a waiting list control group. The two brief psychotherapies showed significant improvement on target complaints, SCL-90, and Social Adjustment Scale-SR compared with the control subjects. The two therapy groups were similar in overall outcome but showed interesting differences on several subscale measures. Process measurements of videotaped sessions revealed significant variations in frequencies of therapist interventions across the two treatment conditions, which validated planned differences in the treatment techniques.

Fluoxetine-Induced Psoriasis

BACKGROUND: A number of medications have been reported to induce psoriasis. We report two cases of fluoxetine-related psoriasis and discuss similarities between lithium-, trazodone hydrochloride-, and fluoxetine-induced psoriasis. OBSERVATIONS: Two women being treated for depression with fluoxetine developed psoriasis after 6 and 12 months exposure. This time frame is clinically similar to that observed with lithium-induced psoriasis. CONCLUSIONS: The occurrence of lithium- and fluoxetine-induced psoriasis may not be random. Both drugs modulate serotonergic function, a factor that may contribute to the pathophysiology of psoriasis. If a patient on acute or long-term fluoxetine therapy develops psoriasis, the drug should be considered as a possible etiologic agent.

The Effects of Confrontation and Clarification on Patient Affective and Defensive Responding

This study examined the effects of therapist confrontations and clarifications on patient defensive and affective responding in short-term dynamic psychotherapy. Four videotaped therapy sessions from each of 16 patients were coded on a per-minute basis for the occurrence of selected patient and therapist variables. Contrary to prediction, no significant differences were found regarding the effects of confrontation and clarification of defense on immediate patient affective responding. In addition, therapist confrontation of patient defensive behavior elicited significantly more defensive responding than did clarification. Results also indicated that, within a 3-minute frame, patients affective and defensive responding in minute 3 is most closely related to their own behavior in minute 1 regardless of the intervening therapist activity. Future research, it is suggested, needs to focus on a longer time frame as well as on the cumulative effects of persistent confrontations on patient affective responding.

NMR water‐proton spin‐lattice relaxation time of human red blood cells and red blood cell suspensions

NMR water‐proton spin‐lattice relaxation times were studied as probes of water structure in human red blood cells and red blood cell suspensions. Normal saline had a relaxation time of about 3000 ms while packed red blood cells had a relaxation time of about 500 ms. The relaxation time of a red cell suspension at 50% hematocrit was about 750 ms showing that surface charges and polar groups of the red cell membrane effectively structure extracellular water. Incubation of red cells in hypotonic saline increases relaxation time whereas hypertonic saline decreases relaxation time. Relaxation times varied independently of mean corpuscular volume and mean corpuscular hemoglobin concentration in a sample population. Studies with lysates and resealed membrane ghosts show that hemoglobin is very effective in lowering water‐proton relaxation time whereas resealed membrane ghosts in the absence of hemoglobin are less effective than intact red cells.

Toward an integrated brief psychotherapy.

The authors argue for an integrated model of brief psychotherapy that includes psychoanalytic and cognitive-behavioral approaches, as well as pharmacotherapy when necessary. The use of such a model gives the clinician the opportunity to tailor the treatment to the individual patient using differential therapeutics. In implementing a differential therapeutic approach, dynamic psychotherapy can be conceptualized using a health-sickness or psychopathology continuum, which is then superimposed upon a psychotherapy continuum ranging from expressive to supportive interventions. The use of such a psychotherapy continuum helps clinicians tailor the treatment approach to the specific patient. The authors first review psychotherapy outcome studies from the last two decades that suggest that an integrated approach may be advantageous. They then present findings from process studies that highlight the importance of the patient/therapist relationship. In the final sections of the article, the authors discuss how to use an integrated approach to brief psychotherapy, including the use of medication when appropriate. The authors also discuss the use of trial therapy during the initial session to help the therapist determine whether a supportive or expressive approach will be most appropriate for the individual patient and present two case vignettes illustrating the expressive and supportive approaches to trial therapy.