difference betw DSM-IV and DSM-IV TR

DSM-IV-TR incorporated changes from DSM-IV in diagnostic criteria for the following:

Tourette's Disorder
Dementia of the Alzheimer's Type; Dementia Due to Other General Medical Conditions
Personality Change Due to a General Medical Condition
Exhibitionism; Frotteurism; Pedophilia; Sexual Sadism; Voyeurism

http://www.behavenet.com/capsules/disorders/dsm4changeTR.htm

sleep

"knits up the raveled sleave of care"
"the balm of hurt minds, great nature's second course, chief nourisher in life's feast" Macbeth, Shakespeare
"the food that cures all hunger, the water that quenches all thirst, the fire that warms the cold, the cold that cools the heart... the balancing weigh tthat levels the shepherd with the king, and the simple with the wise." Sancho Panza, Cervantes
"If an animal or person survives the injury, it sleeps." (Kreuger 2003)


/on npr
this american life episode 8/8/08
http://www.thislife.org/Radio_Episode.aspx?episode=361
sleep paralysis, "devil sitting on your chest": Mexico; along with hallucinations
[narcolepsy]
[REM behavior disorder]
[night terror, sleep walking]

/blogs
Michael Rack, MD
The number of pure sleep medicine jobs has decreased over the last several years, but there are some 100% sleep medicine jobs out there that are open to all the underlying sleep medicine specialties.
AASM website,
the sleep journals,
recruiting firms like locumtenens.com and MDJobsite.com.
starting your own sleep lab. ads in Sleep Review for companies that you can hire/partner with to assist in this process.
taking a psychiatry job with a hospital that has a sleep lab and make it a condition of your employment that you can read (and get paid for) the patients you refer to the lab.
Sleep forum on the Student Doctor Network for more ideas.

psychiatrists --> sleep medicine

http://pn.psychiatryonline.org/cgi/content/full/41/6/18?etoc
psychiatric news story of more psychiatrists doing sleep medicine

case formulation

Handbook of Psychotherapy Case Formulation
Eells, Tracy D. Guilford Press. 2007.
~$40 on overstock, or amazon.
goes through all the major approaches to formulation. a lot of stuff i haven't heard of, but also psychoanalytical, cognitive therapies, +
i obviously couldn't summarize a 200 page book in an afternoon. may get it later. but these are the notes that i took. lots of ways to look at an encounter. wonder why i haven't heard of some of this stuff before...

/psychoanalytic approach
-what is formulated:
I. structural features of personality. structure refers to those functioning that are fairly stable and euduring. the form
A. autonomous ego functions. disruptions in basic biological, perceptual, motor, or cognitive functions, including language. adequacy of patient's reality testing
B. Affects, Drives, Defenses. way of experiencing impulses and feelings and containing them. is the person able to tolerate a range of feelings without overly suppressing some or feeling overwhelmed by others? is there one predominant affect that colors wide areas of the person's functioning? are closely related affects (anger, hate, irritation, jealousy) sufficiently differentiated or are they all subsumed under rage? how flexibly does the person respond on an emotional level to diverse circumstances? what are the characteristic defenses that they employ? are they successful in allowing them to have a sufficient emotional response without experiencing strong anxiety or depression? are the defenses restricting or interfering with the person's enjoyment of life?
C. Object-related functions. is the person able to be trusting, intimate, and at the same time autonomous? can s/he able to sustain disappointment, disillusionment, loss without becoming incapacitated? in relationships is the person overly controlling? too submissive? self-defeating? demanding?
D. Self-related functions. able to maintain the coherence, stability, and positive evaluation of self. Include issues of individual's identifications, identity, ideals, goals. are the person's values stable? do ambitions match desires an talents? is the person overly susceptible to shame and humiliation, inflation of self or deflation? how susceptible are they to precipitous drops in self esteem?

II. Dynamic Features of Personality. the content
what is the meaning of the symptom understood psychoanalytically?
what motivates the person to act in particular ways?
what are the major areas of conflict, intrapsychic or interpersonal?
conflict and ambivalence are considered to be ubiquitous in human affairs
what is the nature of the conflict among various motives such as wishes, fears, impulses, and needs? usu of a sexual, dependent, or aggressive nature. does the patient effect some compromise among them which actually obscures the nature of the conflict?

III. Developmental antecedents
traumatic events, like physical or abandoment, sexual or physical abuse, surgery, parental psychosis, drug abuse; birth of a sibling, parental discord, school failure
timing- psychosexual and psychosocial stage of development

IV. Adaptive features: assets and strengths
what are their accomplishments? do they have intellectual strengths? mechanical aptitudes? artistic talents? able to get along with others? assert themselves appropriately?
biological determinants of behavior- temperament, genetic endowment, medical illness, perinatal conditions, substance abuse, brain injury, childhood psych/neuro conditions

/time-limited dynamic psychotherapy
CMP= cyclical maladaptive pattern
vicious cycle patient gets into when s/he relates to others
inflexible, self-perpetuating behaviors, self-defeating expectations, negative self-appraisals
four categories
1. acts of self. thoughts, feelings, motives, perceptions, behaviors of patient on an interpersonal nature. sometimes concious, and sometimes outside awareness
2. expectations of others' reactions. how patient imagines others will react to him or her in response to some interpersonal behavior
3. acts of others toward self. actual behaviors of others as observed (or assumed) and intepreted by patient.
4. acts of the self toward the self. behaviors or attitudes towards oneself.
therapist's reaction to patient:

7. watch for dynamics within therapeutic relationship.
8. develop a CMP narrative describint patient's predominant dysfunctional interactive pattern.
9. outline goals of treatment
10. facilitate a new experience; new understanding
13. revise and refine cmp throughout therapy


psychoanalytic case formulation.
nancy mcwilliams. 1999.

research

8/4/08.
a month officially into the rotation. but i feel like i have a fresh start. helps to actually meet with the PI. :P
things to improve on: conceptualization of the outline, learn how to write scientific papers (book), reference primary papers, organization of references.
another deadline in 1.5 weeks aug 14th.

/citing sources
http://www.library.cornell.edu/newhelp/res_strategy/citing/apa.html

rankings

us news and world report 2008 best hospitals

psych:
1. mass general
2. johns hopkins
3. new york presbyterian, columbia and cornell
4. mclean
5. ucla's neuropsych
6. meninger clinic
7. seph
8. mayo clinic
9. univ of pittsburgh
10. stanford
11. emory
12. duke
13. yale
14. barnes-jewish/wash univ
15. austen riggs, stockbridge mass
16. nyu
17. methodist hospital, houston
18. ucsf
19. long island jewish
20. mt sinai
21. ucsd
22. cleveland clinic
23. hartford hospital institute of living
24. hospital of the university of penn