Transference and countertransference in medically ill patients

Transference and countertransference feelings/reactions are a valuable source of information about a patient's inner world. A consultation liaison psychiatrist has to help the entire treatment team to understand the patient as well as treat the patient. Studies about transference and countertransference in medical settings are insufficient. An idealized transference often develops, usually at the beginning of the treatment, whereas negative transference occurs rarely. At other times a displaced transference, with anger directed toward the medical team or one of its members may develop. Acute intense transference and countertransference feelings/reactions may be indicators of serious character pathology, such as Cluster B personality disorders. Patients with terminal illness are in need of perceiving the physician as an ideal and omnipotent figure, therefore, encouragement of a regressive relationship is recommended. There is always a risk of either avoidance or over involvement with the patient, especially in cases of catastrophic illness or injury. Not infrequently, interaction with the patient may evoke a traumatic experience in the therapist that has not been worked through sufficiently, and may hinder the therapist's ability to relate to his patient. Therapist countertransference feelings may be informative about the entire medical treatment process of the patient. Collaborative meetings with the medical team may help a therapists to understand their patients' inner worlds and to correct his/her dysfunctional attitudes, which in turn might positively affect treatment compliance and improve prognosis. Herein, the literature regarding transference and. countertronsference in medical patients is reviewed with case examples

Importance of Psychosomatic Approach For Dermatological Diseases

Within psychosomatic approach, patients are evaluated with a multifaceted holistic approach regarding his personality characteristics, his relations with social environment and psychiatric comorbidity in the context of a positive patient-physician relationship. There is a bi-directional relationship between the patients' minds and dermatological diseases; there are a wide variety of factors that cause dermatological disease and dermatological lesions effects persons in many ways. Personality characteristics effect how a person perceives his dermatological illness, adaptation to illness and the course of the illness. In a similar way, psychiatric disorders may be precipitated secondary to the dermatological diseases. Therefore, the management of patients with psychocutaneous diseases necessitates a comprehensive evaluation that moves beyond the visible lesion. Treating these patients with a multidisciplinary team that includes psychiatrist, clinical psychologists and psychotherapists besides dermatologists will increase the quality of health in these patients. (Turkderm 2010; 44 Suppl 1: 7-9

Psychiatric Adverse Effects of Dermatological Drugs

Dermatological drugs, mostly corticosteroids and isotretinoin, cause different psychiatric adverse effects. During steroid therapy, a wide range of psychiatric conditions, from minor clinical symptoms like insomnia and anxiety to serious psychiatric syndromes like psychosis and delirium might be seen. In medical literature, a causal connection is usually suggested between "isotretinoin", which is used for treatment of acne vulgaris and depression and suicide attempts. However, there are no statistically significant double-blind randomized studies that support this connection. Clinicians must know patient's psychiatric history before using any dermatological treatment known as causing psychiatric adverse effects, and psychiatric consultation should be established whenever necessary. (Turkderm 2010; 44 Suppl 1: 52-4

Treatment Modalities for Psychodermatological Diseases

Although psychodermatologic diseases are diagnosed very easily, their treatment often poses a great deal since they are often associated with psychological conflicts and psychiatric disorders such as depression, anxiety disorders and delusional disorders. Therefore dermatological treatment modalities might be insufficient for psychodermatologic diseases. Associations between dermatological and psychiatric diseases and their pathological basis need to be known very well for the treatment success. In case of treatment failure or insufficient treatment, the patient's psychological assessment should be considered and psychopharmacology, psychotherapy, biofeedback and hypnosis may need to be added to treatment plan. Psychopharmacologic, psychotherapeutic and other treatment modalities for treatment of psychodermatological diseases that are associated with psychological conflicts and comorbid major psychiatric diseases are reviewed in this article. (Turkderm 2010; 44 Suppl 1: 46-51

Hypersexuality in a patient with epilepsy during treatment of levetiracetam

Hypersexuality is a rare phenomenon in epilepsy patients. Few cases of hypersexuality are reported as a side effect of an antiepileptic drug. Levetiracetam is reputed as a new and safe antiepileptic, yet its sexual and endocrine side effects are not well known. We report a female patient who developed hypersexuality with the addition of levetiracetam to her ongoing carbamazepine therapy

Psychiatric Evaluation Prior to Epilepsy Surgery

Epilepsy patients who are resistant to medical treatment carry the increased risk of psychiatric comorbidity. There is a bidirectional relationship between epilepsy surgery and psychiatric status. Surgery affects the prognosis of presurgical psychiatric symptoms and psychiatric status affects the postoperative prognosis of epileptic convulsions. Therefore a psychiatrist with experience on patients with epilepsy should be a part of every epilepsy surgery team, to evaluate patients carefully prior to surgery and to follow them accordingly after the operation

Water epilepsy: A report of three cases

Water epilepsy is a rare form of the reflex epilepsies. In this paper, three patients who were followed up in our outpatient clinic is presented. Psychomotor development and neurological examination of patients were normal. The most important factor in the treatment approach is the temperature of the water. In treatment, avoiding bath with hot water or prophylaxis with benzodiazepines should be considered first. (Turk Arch Ped 2011; 46:259-60

Rapidly progressive subacute sclerosing panencephalitis presenting with acute loss of vision

A 10-year-old male presented with vision loss and behavioral changes. He had midpoint pupils with no reaction to light and normal funduscopic examination. Cranial magnetic resonance imaging revealed bilateral cortical lesions at parieto-occipital lobes. Elevated measles antibody titers in the cerebrospinal fluid confirmed the diagnosis of subacute sclerosing panencephalitis. Despite oral inosiplex and supportive care, patient developed generalized seizures with frequent myoclonic jerks and rapidly progressed into coma. Cortical blindness in subacute sclerosing panencephalitis can be an early indicator for fulminant course