Papers by Gregg E . Gorton, MD
American Journal of Psychiatry, Jun 1, 1998
Page 1. Letters to the Editor Worsening of Obsessive-Compulsive Symptoms Following Treatment With... more Page 1. Letters to the Editor Worsening of Obsessive-Compulsive Symptoms Following Treatment With Olanzapine TO THE EDITOR: We report a case of olanzepine-induced worsening of obsessive-compulsive symptoms in ...
PubMed, Jul 1, 2018
By definition, the doorknob phenomenon or doorknob statement occurs when patients wait until the ... more By definition, the doorknob phenomenon or doorknob statement occurs when patients wait until the last moment in the clinical encounter—often while the physician is grasping the doorknob to exit the examination room—to utter something that, not uncommonly, provides crucial information. Physicians must then determine whether to pursue this new information immediately or to defer the new issue until the next visit.
Professional Psychology: Research and Practice, Feb 1, 1998
This document is copyrighted by the American Psychological Association or one of its allied publi... more This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychiatric Services, Nov 1, 2000
Psychiatric Services, 1990
This review oftbe recent literature on personality disorders summarizes theoretical and methodolo... more This review oftbe recent literature on personality disorders summarizes theoretical and methodologic issues, DSM-III-R criteria sets, nosological controversies, and current treatment approaches. Work in the personality disorders is burgeoning, with increasing attention to improved reliability and validity of diagnosis. Investigators are looking at such issues as the development of dimensional taxonomies, the effect ofstate vanables, the problem of diagnostic overlap, the effect ofcomorbid conditions on course and treatment, the predictive power of criteria, and external validatons. The DSM-Ill-R criteria sets, despite their polytheticformat, may be no more reliable than their predecessors. Because treatment remains largely unresearched, the dinician must continue to rely on skillful assessment of each patient, with psychoanalytic psychotherapy and symptom-oriented drug trials providing thefoundation of therapy. Since the last review ofrecent developments in the field of personality disorders in this journal, by Widiger and Frances (1) in 1985, the literature in this area has mushroomed.
American Journal of Psychiatry, Jul 1, 2005
Academic Psychiatry, Jun 1, 1996
Residency directors were surveyed about education related to prevention of psychiatrist-patient s... more Residency directors were surveyed about education related to prevention of psychiatrist-patient sexual exploitation. Ninety-nine percent said they provide at least 1 session on this topic, 49% offer a jonrull course on it, and 83% indicated that this instruction should be mandatory. Eight percent of these educational programs had been instituted within the prior 10 years, and 55% of these programs had been instituted within the prior 4 years. Great variability was found in the precise nature of the instruction offered. By contn'buting to increased awareness, better treatment, and possibly to prevention of unethical behavior, such education can benefit patients, trainees, and the profession, and should be required for accreditation. (Academic Psychiatry 1996; 2iJ:92-98) S elf-report survey data reveal that at least 6% to 10% of psychiatrists have had sexual contact with their patients, a figure similar to that for other mental health and medical disciplines (1,2). Despite the fact that 72% of the residents in one study (3) and up to 92% of other therapists surveyed in other studies (4-6) report having sexual feelings toward their patients, only a minority of psychiatrists believe they have received adequate education on the management of those feelings (3,7,8). Such education might enhance not only therapeutic outcome, but also primary and secondary prevention of sexual exploitation (9).
Academic Psychiatry, Mar 1, 1996
Surveys indicate that between 6% and 10% of psychiatrists report sexual contact with patients. Su... more Surveys indicate that between 6% and 10% of psychiatrists report sexual contact with patients. Surveys also indicate that only a small minority of psychiatrists feel that they have received adequate teaching about this unethical behavior. Educational efforts aimed at reducing sexual exploitation of patients would be of value to trainees, patients, academic programs, and the profession. The authors report their experience with a pilot 6-session course for residents, and a longer model course is outlined. Such education should be mandatory in U.S. residencies. Mandated instruction would be consistent with both the high priority training directors have reported placing on the subject of sexual misconduct in ethics teaching, and with the widespread calls for increased education on this important subject.
American Journal of Bioethics, 2004
ABSTRACT The American Journal of Bioethics 4.1 (2004) 48-49 Adil E. Shamoo and Jonathan D. Moreno... more ABSTRACT The American Journal of Bioethics 4.1 (2004) 48-49 Adil E. Shamoo and Jonathan D. Moreno (2004) have certainly hit many of the key reasons why the proposed SATURN (Student Athlete Testing Using Random Notification) study is highly problematic from an ethical perspective. However, a few other issues can usefully be mentioned in the service of an even more complete critique. As a psychiatric clinician who has worked with many substance abusing patients and who has also been involved in training to prevent sexual exploitation of patients, these issues were immediately salient as I read the paper. First, it is not uncommon in both professional and lay writing about intoxicating substances to confuse, or conflate, "use" and "abuse" of same. From a clinical perspective substance use and substance abuse are distinct categories. The mere presence in a body fluid such as urine or blood of an intoxicant or one of its breakdown products does not allow the clinician to distinguish use of that substance from its abuse. Of course, in a situation—such as the transportation industry or possibly even high school sports—where a "zero tolerance" policy is promulgated, this difference is not relevant so long as the individuals gathering this information do not go beyond their specific mandate and draw some unwarranted conclusion regarding the (possible false positive) presence of a specific clinical syndrome (e.g., substance abuse, or even dependence—which is yet another distinct category). Therefore, when in the stated purpose of the SATURN study mention is made of intent both "to assess the use of drugs and alcohol" and "to determine the influence of drug testing on risk of substance abuse," I am left with a lack of clarity as to how "use" and "risk of abuse" will be correlated, and I am concerned about their possible confusion. Similarly, when Shamoo and Moreno comment that "There can be no disagreement that adolescent drug use is a serious problem, both in its magnitude for society and in its consequences for the drug user," I think what they mean to refer to—for this would afford them a more cogent statement—is that "adolescent drug abuse" is a serious problem. This is not a trivial difference, especially when we consider that inevitably with most youth there will occur a "learning phase" with regard to their initial trial states of intoxication with various substances. Some minority of group members will go on to develop true substance abuse and an even smaller portion to develop true substance dependence. Much current research, as both Shamoo and Moreno and the authors of the SATURN study are no doubt well aware, is being conducted in an effort to determine risk factors for progression along this clinical continuum from abstinence to dependence (and even death). An important potential problem with a zero-tolerance approach to substance use (e.g., "Just say No to drugs") by an adolescent population (as opposed to airline pilots) is that it denies the reality of what might well be reasonable degrees of experimentation and learning. This very learning might be precisely what is needed for some—or even many—individuals to develop their own safe usage pattern (including, but not limited to, controlled drinking, occasional use of marijuana, or zero use of any substance). In fact, as we know, reasonable arguments can be made for controlled, socially-more-or-less-safe exposure to substances (e.g., wine with dinner at home with one's parents; smoking a joint at home with a parent) as an effective way to learn safe usage or nonusage practices. If we take this hypothetical a step further, we could argue that high school athletes who have dutifully complied with a mandatory testing program for four years while at home in a safe, secure environment might be placed at higher risk of less safe alcohol/drug experimentation when they leave home and go off to college or to work or to the military, and perhaps then might be even more vulnerable to less safe substance-use-learning behaviors, with heightened risk of worse outcome. Now, with regard to the authors' discussion of the flawed informed consent process in...
American Journal of Psychotherapy, Oct 1, 1988
A depressed woman complained of obsessional worries, insomnia, and lifelong nightmares. A novel c... more A depressed woman complained of obsessional worries, insomnia, and lifelong nightmares. A novel combination of psychodynamic psychotherapy, paradoxical re-experiencing of the nightmares, and posthypnotic suggestion resulted in amelioration of the nightmares and opening of the field for a self-psychological approach to deeper issues. INTRODUCTION Recently, the clinical utility of a flexible, eclectic treatment approach to certain selected patients has been increasingly recognized. This case report, which delineates such an approach, also appears to represent the first specific treatment for lifelong nightmares recorded in the literature. Though the overall framework of the treatment was provided by psychodynamic psychotherapy, a critical early phase involved relaxation training, directed paradoxical re-experiencing of the symptoms-first in the presence of the therapist and then by the patient alone-and indirect and posthypnotic suggestion. These treatment modalities facilitated not only a significant degree of symptom relief but also greater access to the dream material itself, eventually paving the way for the deeper exploratory psychotherapy that constituted the bulk of the treatment. REVIEW OF THE LITERATURE Both hypnosis and psychotherapy have previously been used in the treatment of recurring nightmares. Sometimes these modalities have been deployed separately 1 " 8 and sometimes in concert. 9 " 14 My literature search failed to uncover a single case report on the treatment-by any modality-of recurring lifelong nightmares in an adult. It should be noted that no
American family physician, 2018
By definition, the doorknob phenomenon or doorknob statement occurs when patients wait until the ... more By definition, the doorknob phenomenon or doorknob statement occurs when patients wait until the last moment in the clinical encounter—often while the physician is grasping the doorknob to exit the examination room—to utter something that, not uncommonly, provides crucial information. Physicians must then determine whether to pursue this new information immediately or to defer the new issue until the next visit.
We describe a case of recurrent, life-threatening, catatonic stupor, without evidence of any asso... more We describe a case of recurrent, life-threatening, catatonic stupor, without evidence of any associated medical, toxic or mental disorder. This case provides support for the inclusion of a separate category of “unspecified catatonia ” in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) to be used to classify idiopathic cases, which appears to be consistent with Kahlbaum’s concept of catatonia as a distinct disease state. But beyond the limited, cross-sectional, syndromal approach adopted in DSM-5, this case more importantly illustrates the prognostic and therapeutic significance of the longitudinal course of illness in differentiating cases of catatonia, which is better defined in the Wernicke-Kleist-Leonhard classification system. The importance of differentiating cases of catatonia is further supported by the efficacy of antipsychotics in treatment of this case, contrary to conventional guidelines.
Page 1. Letters to the Editor Worsening of Obsessive-Compulsive Symptoms Following Treatment With... more Page 1. Letters to the Editor Worsening of Obsessive-Compulsive Symptoms Following Treatment With Olanzapine TO THE EDITOR: We report a case of olanzepine-induced worsening of obsessive-compulsive symptoms in ...
Archives of Clinical Neuropsychology, 1998
Http Dx Doi Org 10 1162 152651604773067398, Dec 7, 2010
American Journal of Psychiatry, Oct 8, 2014
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Papers by Gregg E . Gorton, MD