This book shows how contemporary psychoanalytic thinking can be applied in the everyday practice of medicine to enhance the practice of family medicine and all clinical specialties.
Dr. Steinberg analyzes his writings over the past 35 years―on psychiatry and family medicine, liaison psychiatry, and mentoring―based on developments in psychoanalytic thinking. Divided into sections based on different venues of medical practice, including family medicine clinics, inpatient medical and surgical units, and psychiatric inpatient units and outpatient programs, chapters illustrate how various concepts in psychoanalysis can enhance physicians’ understanding and management of their patients. A concluding section contains applications of psychoanalytic thought in non-clinical areas pertinent to medicine, including preventing suicide among physicians, residents, and medical students, sexual abuse of patients by physicians, and oral examination anxiety in physicians.
Readers will learn to apply psychoanalytic concepts with a rational approach that enhances their understanding and management of their patients and practice of medicine generally.
Author(s): Paul Ian Steinberg
Publisher: Routledge
Year: 2020
Language: English
Pages: 244
City: London
Cover
Endorsement
Half Title
Title Page
Copyright Page
Dedication
Table of contents
Foreword
Publication Acknowledgments
Acknowledgments
Introduction Part 1
What is Psychoanalysis?
Which of my Patients Can Benefit from Psychoanalysis or Psychoanalytic Psychotherapy?
Some Historical Observations
My Goal
Psychoanalytic Understanding
The Influence of Psychoanalysis on Medical Practice (And Elsewhere)
Description of Chapters
Myths About Psychoanalysis
Psychoanalysts Treat the Worried Well
Psychoanalysis is Not Evidence-based
Psychoanalysis is Too Expensive and Impractical
Psychoanalysts are Crazy
All Psychoanalysts are Preoccupied with Sex
Some Personal Observations
Appendix: Selection of Patients for Psychoanalysis and Psychoanalytic Psychotherapy
Diagnostic Exclusion Factors
Positive Prognostic Factors
(Relative) Negative Prognostic Factors
References
Part I Learning from Liaison with Family Medicine
Chapter 1 “Problem Patients”: Patients with Significant Personality Disturbance
Patient 1: The Doctor’s Feelings as a Diagnostic Tool
Patient 2: The Patient Who Denies Illness
Who Becomes “Personality-Disordered”?
Patient 3: Definitive Treatment of Personality Disturbance and Disorders
Recognizing Psychiatric Conditions
Choosing a Treatment
Medication
Psychoanalysis or Individual Psychoanalytic Psychotherapy
Other Treatments
Conclusion
References
Chapter 2 Interviewing the Patient
The Value of Listening
Psychiatric Consultation
Giving Patients Advice
Constructive Support
Taking Over Patients’ Responsibilities
Attempting to Understand Patients’ Problems
The Physician’s Feelings as a Diagnostic Tool
Goals of Therapy
Balint Groups
References
Chapter 3 “Are All My Patients Depressed?”: The (Mis-)Diagnosis of Depression
Major Depressive Episode
“Non-Major’’ Depression
“Depressio sine Depressione” (Depression without Depression, or Masked Depression)
Psychoanalytic (Psychodynamic) Psychotherapy
Conclusion: Avoiding “Misdiagnosis”
References
Chapter 4 “My Patient is Psychotic”: Dealing with a Patient with a Paranoid Delusion about Her Disease
Case History
Collaborative Management Approach
Diagnosis and Management
Discussion
Psychiatric Liaison with Family Medicine
Dealing with Suspicious Patients
References
Chapter 5 Holding Patients with Medication: Using Neuroleptics as an Adjunct to Psychotherapy in Patients with Severe ...
Clinical Examples
Discussion
Research Possibilities
References
Chapter 6 What Psychoanalysis and Psychiatry Offer to Medicine
What Psychoanalysts and Psychoanalytically Informed Psychiatrists Offer to Psychiatric and Medical Management
Difficulties in Psychiatry
Assessment and Management
Consultation for Hospitalized Patients
Outpatient Management Consultation
Treatment for Physicians
Conclusions
References
Part II Learning from Consultation/Liaison Psychiatry
Chapter 7 Psychoanalytic Approaches to Psychosomatic Medicine
“Psychosomatic” Conditions and Conversion
Psychosomatic Conditions
References
Chapter 8 Psychiatry for the Masses: Broader Indications for Psychiatric Consultation
Denial of Illness
Culmination of Losses and Anticipating the Need for Referral
Speedy Referral
Non-specific Signs
Conclusions
References
Chapter 9 Where Does My Patient Fit In?: Organizing One’s Diagnostic Thinking in Differentiating Patients According to
Organizing Psychological and Medical Symptoms
Conditions Physicians Feel More Comfortable in Managing
Conditions Physicians Feel Less Comfortable in Managing
Final Comment
References
Chapter 10 “The Most Unkindest Cut of All”2: Psychiatric Complications of Surgery in Men
Literature Review
Approach to the Cases
A Case of Multiple Surgery
A Case of Prostatectomy
A Case of Unilateral Orchidectomy
A Case of Rectal Carcinoma
Discussion
Summary
References
Chapter 11 Psychiatric Diagnosis is Not a Diagnosis of Exclusion: A Patient with Insulinoma Presenting for Psychiatric ...
Case Report
Discussion
Conclusion
References
Chapter 12 Differentiating Psychiatric and Medical Conditions: A Case of Hyperthyroidism Presenting as Delusional Disorder
Case History
Discussion
Conclusions
References
Chapter 13 “My Patient is Hysterical”: Adrenal Carcinoma and Hypertension Presenting with Catatonic Stupor
Case History
Discussion
Conclusions
References
Part III Learning from Inpatient and Day hospital Psychiatry
Chapter 14 The Mother Who Couldn’t Name Her Child:: Problems of Attachment, Identity, and the Capacity to Think
History of Present Illness
Medical History
Developmental History
Back to Our Patient
Mental Status and Physical Examination
Differential Diagnosis
Initial Psychodynamic Formulation
Treatment Plan and Course in Hospital
References
Chapter 15 Freud on the Ward: Integration of Psychoanalytic Concepts into the Formulation and Management of Hospitalized ...
Clinical Example
Discussion
Attachment and Affect Regulation
Self-Image and Internal Object Relations
Transference and Countertransference Implications
Management
Conclusions
References
Chapter 16 Psychoanalytic Approaches Integrated into Day Treatment and Inpatient Settings3
A “Successful” Treatment in an Inpatient Unit and a Partial Hospitalization Program
An “Unsuccessful” Treatment in DTP
Conclusion
References
Part IV Non-clinical Topics
Chapter 17 Attack of Nerves: Oral Examination Anxiety in Physicians
Oral Exams, Transference, and Internal Object Relations
Discussion
Conclusions
References
Chapter 18 Healers Caring for Themselves and Each Other: Preventing Suicide in Medical Students, Residents, and Ourselves
Conclusion
References
Chapter 19 Professional Betrayal: Sexual Abuse of Adult Female Patients by Male Physicians
Introduction
Physician’s Contribution
The Patient’s Contribution
Management of the Abusive Physician
Prevention through Education
Conclusions
References
Envoi
References
Glossary
Index
