Cases reported "Recurrence"

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1/13. Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers.

    Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.
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ranking = 1
keywords = psychotherapy
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2/13. High-impact therapy for smoking cessation.

    Cigarette smoking is the leading cause of preventable death and disability-and thus an issue of considerable importance to psychotherapists. The majority of smoking-cessation programs available to the public uses an effective group format, but it remains underused. Many smokers who seek treatment request individual counseling; however, empirically based individual treatments are still in the early stages of development. High-impact therapy is a form of short-term dynamic psychotherapy adapted by the authors for the treatment of the hard-core smoker. It recognizes that the relationship among smoking, life stressors, personality factors, and psychological disorders is complex, and it intervenes using motivational and defense-challenging techniques. One of the main and distinctive features of this model is the emphasis on emotional arousal to facilitate the mastery of emotional conflict, making this a high-impact form of psychotherapy.
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ranking = 0.4
keywords = psychotherapy
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3/13. Recurrent attacks of fear and visual hallucinations in a child.

    The case of a 7-year-old boy suffering from recurrent nocturnal and occasional daytime attacks with intense fear and complex visual hallucinations is presented. His state was otherwise normal, as were routine electroencephalographic (EEG) and magnetic resonance imaging (MRI) investigations in the past. Several differential diagnoses such as panic disorder, pavor nocturnus, and nightmares were considered but could not be definitely established or excluded. Since the attacks appeared after the divorce of his parents, an adjustment disorder was suspected, and the patient received psychotherapy for more than 2 years without an effect on the attacks. Only when long-term video-EEG recorded two typical attacks with left temporal ictal seizure patterns was focal epilepsy diagnosed and successfully treated with antiepileptic medication. A suspected origin of seizures in the amygdala was supported by a high-resolution MRI showing a cortical dysplasia extending from the left anteromedial temporal lobe to the amygdala. The case exemplifies difficulties in the differential diagnosis of panic-like attacks and underlines the value of long-term video-EEG, which may be necessary to establish the correct diagnosis and to prevent ineffective therapeutical approaches.
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ranking = 0.2
keywords = psychotherapy
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4/13. Recurrent symptomatic bradycardia due to secret ingestion of beta-blockers--a rare manifestation of cardiac Munchhausen syndrome.

    The term Munchhausen syndrome was established in 1951 by Asher to describe a severe psychiatric illness in which patients simulate false symptoms and signs. We report on a female general practitioner who repeatedly ingested high doses of beta-blockers in order to simulate symptomatic sick-sinus syndrome. She had been admitted to intermediate care units in several hospitals before the correct diagnosis was made by finding the tablets in her toilet bag. Following psychiatric exploration and psychotherapy, she has been working in her community again for about a year. This is the first report on the clinical presentation and course of disease in a patient with cardiac Munchhausen syndrome who secretly ingested beta-blockers to provoke a menacing bradycardia. The follow-up indicates that frequent and intense symptomatic episodes of this remarkable psychiatric disease can be interrupted by long normal intervals.
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ranking = 0.2
keywords = psychotherapy
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5/13. The psychosocial treatment of recurrent diabetic ketoacidosis: an interdisciplinary team approach.

    The professional expertise of the diabetes mental health professional is integral to the interdisciplinary team approach to recurrent diabetic ketoacidosis (DKA). A case report provides the context to illustrate the interconnection of concurrent strategies of diabetes management, teaching, and counseling. Specific methods include a practical approach to manipulative behavior in blood glucose monitoring, supervision of insulin administration, education, and intensive psychotherapy. In this case study, the adolescent's removal from her home environment, along with medical supervision and extensive psychosocial support, was instrumental in reversing the pattern of self-destructiveness. Recurrent DKA is a very specific problem for which the mental health professional can play an effective treatment role.
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ranking = 0.2
keywords = psychotherapy
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6/13. Group psychotherapy in the treatment of adolescent and preadolescent military dependents with recurrent diabetic ketoacidosis.

    The adolescent military dependent with recurrent diabetic ketoacidosis (DKA) is a difficult management problem. Career relocations and an absentee sponsor frequently preclude family-oriented interventions. We recently treated four patients with recurrent DKA who had failed to improve following intensive medical and educational programs. They were enrolled into weekly outpatient group psychotherapy in addition to routine medical management. Three out of the four patients improved in compliance and had a decrease in the frequency or severity of DKA. This approach may be effective when individual psychotherapy or lengthy hospitalization are either too far removed or too costly.
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ranking = 1.2
keywords = psychotherapy
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7/13. Psychogenic relapses in childhood epilepsy in puberty and adolescence.

    Epileptic patients who, after years of being free from symptoms, have relapses during puberty or adolescence (some-times coinciding with a reduction in therapy) pose special therapeutic and diagnostic problems. Because of pubertal lability, the cause of a relapse might seem to be "organic", especially if the EEG also shows a "deterioration", yet psychogenic factors must not be disregarded. On the basis of typical case studies, a characteristic constellation is presented. The achievement of a "well-behaved" child at first dramatically improves and this correlates with the success of antiepileptic therapy. Then individuation and further development cannot adequately take place because the family unit is not functioning properly. At a critical stage of development, the excessive expectations of the parents lead to too much stress on the child, thus destroying the balance within the family system, which has hitherto been maintained only with difficulty. Attempts to improve the situation by changing the medication (increasing the dose or switching to another drug) fail. If, however, it is realized that the symptoms are of psychogenic origin, adequate therapeutic interventions (e.g. adequate schooling or professional training as well as psychotherapy) promise good results.
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ranking = 0.2
keywords = psychotherapy
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8/13. Interpersonal psychotherapy adapted for ambulatory cocaine abusers.

    The authors describe the strategies and goals of Klerman et al.'s Interpersonal psychotherapy (IPT) as revised for application to cocaine abusers. IPT is a brief, individual psychological treatment suitable for use by experienced psychotherapists. The goals are reduction or cessation of cocaine use and development of more productive strategies for dealing with social and interpersonal problems associated with the onset and perpetuation of cocaine use. The treatment has four definitive characteristics: (a) adherence to a medical model of psychiatric disorders; (b) focus on patient's difficulties in current interpersonal functioning; (c) brevity and emphasis on consistency of focus; and (d) use of an exploratory stance by the psychotherapist which is similar to that of supportive and exploratory psychotherapies. It is currently being used in combination with medications in a clinical trial evaluating the efficacy of desipramine, lithium carbonate, methylphenidate, and placebo as treatment for ambulatory cocaine abusers.
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ranking = 0.8
keywords = psychotherapy
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9/13. Non-neurogenic bladder and chronic renal insufficiency in childhood.

    Functional voiding disorders and urinary tract infections are common in childhood, but are usually not accompanied by upper urinary tract deterioration. Nevertheless a small group of children remain at risk of developing chronic renal insufficiency (CRI). Clinically these children present day and night wetting. The most important parameter, however, is urinary retention which is reflected by an abnormal voiding pattern in the uroflow curve. After ruling out patients with neurogenic or anatomical disorders, nine girls with psychogenic urine retention were observed for 5 years. Terminal renal insufficiency was seen in one, CRI in five patients and in three patients the kidney function could be maintained, but they all had severe scarring of at least one kidney. Furthermore, all revealed a dilation of the bladder and the upper urinary tract. Vesicoureteral reflux occurred in six and obstruction of the ureterovesical junction in three patients. Two girls underwent repeated reflux surgery resulting in a rapid deterioration of renal function. Three patients developed hypertension and one had a hypertensive crisis with microangiopathic anaemia and acute renal failure. Psychogenic disorders and problematic family settings were observed in all cases. Bladder training, transitory suprapubic catheters, intermittent catheterisation, medication and psychotherapy can avoid severe kidney damage and achieve a stabilisation of renal function. It is important to bear this syndrome in mind when evaluating girls with asymptomatic bacteriuria and urinary retention.
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ranking = 0.2
keywords = psychotherapy
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10/13. Futility of muscle flaps for self-inflicted wounds.

    Unacceptable forms of self-mutilation usually are resistant to surgical intervention and have a basis in psychopathology. Establishing this diagnosis may be as difficult as is the treatment, frequently involving a prolonged process of exclusion of other known disease entities. Management of these chronic self-inflicted wounds demands flexibility by the surgeon who must be aware of this possibility and willing to deviate from the normal approach to wound healing. Simplicity is of paramount importance. The use of vascularized tissues and, in particular, the sacrifice of scarce muscle flaps probably is unwarranted except as a last resort because these wounds nevertheless remain recalcitrant to permanent healing. Instead, a nonconfrontational approach with long-term psychotherapy should be a major part of the initial therapy with surgery considered only important in an adjunctive role.
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ranking = 0.2
keywords = psychotherapy
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