Currently, ketamine is the only legal psychedelic medicine available to mental health providers for the treatment of emotional suffering. Over the past several years, ketamine has come into psychiatric use as an intervention for treatment resistant depression (TRD), administered intravenously without a psychotherapeutic component. In these settings, ketamine's psychedelic effects are viewed as undesirable "side effects." In contrast, we believe ketamine can benefit patients with a wide variety of diagnoses when administered with psychotherapy and using its psychedelic properties without need for intravenous (IV) access. Its proven safety over decades of use makes it ideal for office and supervised at-home use. The unique experience that ketamine facilitates with its biological, experiential, and psychological impacts has been tailored to optimize office-based treatment evolving into a method that we call Ketamine Assisted Psychotherapy (KAP). This article is the first to explore KAP within an analytical framework examining three distinct practices that use similar methods. Here, we present demographic and outcome data from 235 patients. Our findings suggest that KAP is an effective method for decreasing depression and anxiety in a private practice setting, especially for older patients and those with severe symptom burden.
Volar locking plates for fractures of the distal radius are a common option of care in many centers. Currently, these plates are placed through a standard approach, such as the flexor carpi radialis interval. However, in our opinion, the use of conventional plate application techniques is associated with more soft tissue dissection than is necessary for these new plates. This may contribute to postoperative pain and also to scarring, which may impede the range of motion. To avoid this, dorsal plates have been developed that can be inserted percutaneously. Historically, dorsal plating of the distal radius has been associated with increased morbidity relative to volar plates due to soft tissue depth. This article discusses a single surgeon's technique for insertion of volar locking plates through minimal incisions with sparing of the soft tissues.
In posttherapy interviews with 31 clients who had recently terminated from individual open-ended psychodynamic-interpersonal psychotherapy, 18 reported having had at least 1 corrective relational experience (CRE) during psychotherapy, whereas 13 did not report any CREs. CREs typically occurred in the context of therapeutic relationships that were primarily positive but also had minor difficulties. Therapists typically facilitated CREs by identifying or questioning client behavior patterns and conveying trustworthiness. Corrective shifts for clients typically involved a new understanding of the therapy experience and variantly involved gaining a new understanding of behavior patterns. Consequences generally included improvements in the therapy relationship and intrapersonal well-being. Qualitatively, the 13 non-CRE clients more frequently reported wishing the therapist's theoretical orientation was a better match than did the 18 CRE clients. Quantitatively, the CRE clients rated themselves as having more interpersonal problems at intake on the Inventory of Interpersonal Problems-32 (Barkham, Hardy, & Startup, 1996), had marginally significant improvements in interpersonal functioning over time, rated their therapy alliances higher on the Working Alliance Inventory-Short Revised (Hatcher & Gillaspy, 2006) midtherapy, and rated their therapy alliances higher over time compared with the non-CRE clients. Implications for practice and research are discussed.
Assessing the psychological impact of war is crucial to meet the needs of communities following conflict. To date, mental health in Lebanon's southern civilians has not been assessed in relation to the 2006 War. In 2007, face-to-face interviews were conducted in ten villages in South Lebanon. The sample, consisting of 991 adults, was chosen through random sampling using a crosssectional design. The study evaluated PTSD, traumatic events, depression and general health status. Of the total sample, 17.8% met threshold criteria for PTSD, 14.7% for depression and the average GHQ score was 4.31. Significant differences were observed across villages. This study revealed that war-related life events and exposure are highly associated with psychiatric problems one year following a violent conflict.
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