ABSTRACT
This paper focuses on the treatment of patients with schizophrenic disorders employing the Team Group model. The advantages and disadvantages of the Team Group are presented. Systems theory and principles of group development are applied as a basis for understanding the dynamics of the group in the context at the acute psychiatric unit. Particular problems encountered in treating patients with schizophrenic disorders in this setting are presented. These include: (1) issues of therapist style and technique, (2) basic psychopathology of the schizophrenic disorders, and (3) phase-specific problems associated with the dynamics of the group. Recommendations for therapist interventions are made that may better integrate these patients into the Team Group.
Subject(s)
Psychotherapy, Group/methods , Schizophrenia/therapy , Schizophrenic Psychology , Group Processes , Hospitalization , Humans , Physician-Patient Relations , Systems TheoryABSTRACT
Because of rapid patient turnover and periodic therapist rotations, inpatient psychotherapy groups with open membership can sometimes appear to be forever beginning or forever ending. Described here is a model of group process that identifies four distinct stages of group development experienced by open-ended groups. Each of the four stages--called rebeginning, subgrouping, work phase, and termination--is characterized by attention to a particular boundary issue. In stages 1 to 3, the group members gradually move from establishing the group's separateness from other hospital systems to establishing alliances with the therapist and with each other to developing mutually supportive relationships. When several members are discharged, the group enters stage 4, during which it renews its efforts to fortify its external boundary. Therapeutic interventions appropriate to each stage of group development are discussed.
Subject(s)
Psychotherapy, Group/methods , Adult , Female , Group Processes , Humans , Male , Models, Psychological , Psychiatric Department, Hospital , Psychotherapy, Brief/methods , Scapegoating , Self DisclosureABSTRACT
There is considerable disagreement about the relationship between borderline personality disorder and the affective disorders. The authors report the results of a study of the relationship between dexamethasone suppression and depressive subtype in hospitalized depressed borderline patients. Twenty-three patients met research criteria for unipolar major depressive episode without psychosis of at least moderate severity. Thirteen patients also met criteria for borderline personality disorder. Dexamethasone suppression test (DST) results showed no significant correlation with either melancholia or borderline personality disorder alone. However, of the 13 borderlines, eight failed to suppress and six of those eight were not melancholic. The authors conclude that abnormal response to dexamethasone in nonmelancholic borderlines casts some doubt on the specificity of the DST for melancholia.
Subject(s)
Borderline Personality Disorder/diagnosis , Depressive Disorder/diagnosis , Dexamethasone , Hospitalization , Personality Disorders/diagnosis , Adolescent , Adult , Aged , Borderline Personality Disorder/blood , Borderline Personality Disorder/complications , Depressive Disorder/blood , Depressive Disorder/complications , Evaluation Studies as Topic , Humans , Hydrocortisone/blood , Middle AgedABSTRACT
Hysteroid dysphoria has been described in outpatient populations and is thought to be a subtype of atypical depression involving rejection sensitivity and therapeutic response to monoamine oxidase inhibitors. The presence of hysteroid dysphoria was assessed, using a semistructured interview, in 18 depressed inpatients. The 6 patients who met the criteria for hysteroid dysphoria did not differ from other depressed patients in severity, premorbid adjustment, number of atypical features, or presence of melancholia. Implications for treatment are discussed.
