Timothy Lacy - Academia.edu (original) (raw)

Papers by Timothy Lacy

Springer eBooks, Dec 24, 2010

Journal of Neuropsychiatry and Clinical Neurosciences, May 1, 2003

During the next year, she developed a number of concerning symptoms. Most prominent was the compl... more During the next year, she developed a number of concerning symptoms. Most prominent was the complaint of "lost and slowed time." She also described poor concentration, low motivation for self-care, anorexia, and apathy. As her condition worsened, she was briefly ...

General Hospital Psychiatry, May 1, 1994

In the past 20 years, several cases have been reported describing an upper airway obstruction rep... more In the past 20 years, several cases have been reported describing an upper airway obstruction reportedly caused by psychological factors. This paper reviews 48 reported cases of "psychogenic stridor." Patients with psychogenic stridor usually present to primary care physicians with symptoms of asthma or stridor unresponsive to conventional treatments. Of the 48 cases reviewed, 52% received a diagnosis of conversion disorder. The obstruction was severe enough to cause intubation and tracheostomies in some patients. In addition, many suffered from the unnecessary side effects of corticosteroids. The literature is reviewed and medical and psychiatric differential diagnosis and treatment are discussed.

Journal of Affective Disorders, Jun 1, 2004

behavioral therapy, light therapy, and their combination in treating seasonal affective disorder"... more behavioral therapy, light therapy, and their combination in treating seasonal affective disorder" (2004).

The journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, Dec 1, 2005

Combined training in family practice and psychiatry is relatively new and consists of equal propo... more Combined training in family practice and psychiatry is relatively new and consists of equal proportions of each specialty intermixed throughout a 5-year period. This blending of two distinct skill sets and patient populations creates opportunities to provide unique patient care. An understanding of psychodynamic principles is vital to treating patients with comorbid medical and psychiatric illnesses in a primary care setting. The patient presented in this article had several medical and psychiatric problems and was treated by a combined family practice-psychiatry resident who cared for her medically and psychiatrically until the time of her death from cancer. Complex patients such as this defy the use of purely applied school-specific psychotherapies. Rather, they require the creative application of integrated psychotherapeutic strategies. Integrated approaches to psychotherapy have been increasingly advocated in recent years. In keeping with terminology used by Carl Jung, this approach may be thought of simply as practical psychotherapy.

Humana Press eBooks, Nov 14, 2003

The psychological effect of terrorism is fear, chaos, and social disruption. Tenorist attacks may... more The psychological effect of terrorism is fear, chaos, and social disruption. Tenorist attacks may take the form of conventional assaults with firearms and explosives or more unconventional weapons such as biological or chemical agents, nuclear weapons, bombs contaminated with radioactive materials, “truck” bombs, and even hijacked airplanes. Significant psychological and behavioral reactions to such an attack are predictable. After an attack, primary care and emergency physicians will see many patients who have acute stress-related emotional and physical symptoms or exacerbations of pre-existing health concerns. The large number of behavioral or psychological casualties will have a significant impact on health care delivery.

Psychiatric Services, Oct 1, 1999

... Toxic Exposure Alice Armstrong Rahill and Ante Lundberg 43 Chapter 5 Psychiatric Aspects of T... more ... Toxic Exposure Alice Armstrong Rahill and Ante Lundberg 43 Chapter 5 Psychiatric Aspects of Technological Disasters Ante Lundberg and ... Heerwagen 175 Chapter 12 Animal-Assisted Therapy in the Treatment of Disruptive Behavior Disorders in Children Aaron Katcher and ...

Southern Medical Journal, Apr 1, 2003

Academic Psychiatry, Aug 1, 2007

The authors evaluate the current practices and perceptions of graduates of combined family medici... more The authors evaluate the current practices and perceptions of graduates of combined family medicine-psychiatry residency programs in the following areas: preparation for practice, boundary formation, and integration of skills sets. The authors conducted an electronic cross-sectional survey of all nationwide combined family medicine-psychiatry training graduates in the spring of 2005. Twenty-seven (62.8%) graduates participated. Nearly 30% worked in positions designed specifically for combined trained physicians, though only 11.1% participated in fully integrated practice. The mean time spent practicing psychiatry and family medicine is 70% and 16%, respectively. Combined trained graduates felt well prepared for practice in both specialties but somewhat less comfortable providing integrated care. Most are in positions that underutilize their ability to integrate family medicine and psychiatry in one practice. Contributing factors may include limited preparation for integration during residency training and lack of integrated job opportunities. Enhancing combined residents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; training in the provision of integrated services may optimize their utilization.

Academic Psychiatry, Dec 1, 2005

To evaluate how family practice-psychiatry residency programs meet the challenges of rigorous acc... more To evaluate how family practice-psychiatry residency programs meet the challenges of rigorous accreditation demands, clinical supervision, and boundaries of practice. A 54-question survey of program directors of family practice-psychiatry residency programs outlining program demographic data, curricula, coordination, resident characteristics, integration, and overall satisfaction was mailed to 11 combined family practice psychiatry-residency programs. Programs surveyed were meeting residency review committee (RRC) requirements, and a majority of the program directors believe that the training is as good as or better than categorical programs, and categorical residents benefited from training alongside combined residents. Training programs are growing in size and producing quality physicians.

Psychodynamic psychiatry, Jun 1, 2022

In the practice of medicine, an understanding of the biological functioning of organs and organ s... more In the practice of medicine, an understanding of the biological functioning of organs and organ systems is the basis for theories of pathology and clinical practice. If psychoanalysis is to be accepted by the medical and psychiatric community, it must be based on a sophisticated understanding of the organ from which mental and emotional experiences emanate and use scientifically acceptable language. Each approach to psychotherapy has its own vocabulary for describing neuropsychological processes. Neurobiological vocabulary provides the various factions "neutral ground" upon which to carry on a multidisciplinary integrative dialogue. An understanding of behavioral neuroscience allows the therapist to look beyond the labels that spawn division and identify unifying biological principles that are described in a variety of ways in a multitude of theories. We contend that the neural network/representational approach to neurobiology views human mental experience as the result of multiple complex integrated systems, and is therefore holistic and antireductionistic in its perspective. Such a biologically informed psychotherapy facilitates integration of skill sets and flexibility in technique. With these principles in mind, the therapist can base his or her approach to the patient based on these principles rather than on devotion to one particular "school" or another. Because behavioral neuroscience supports many of the basic tenets of psychoanalytic theory, such an integrative psychotherapy would be psychodynamically informed. In this paper, we outline some of the ideas we present in our neuroscience course and how we relate biological concepts with some core principles of psychodynamics and psychotherapy. Before he ventured into the world of human mentation, Sigmund Freud was already a gifted neurologist and biologist. His psychoanalysis was initially an attempt to understand the workings of the human mind in biological terms. Unfortunately, the neuroscience of his day

Academic Medicine, 2004

Changes in psychiatric health care delivery driven by such major shifts as deinstitutionalization... more Changes in psychiatric health care delivery driven by such major shifts as deinstitutionalization, community-based care, and managed care have greatly altered the educational milieu for third-year psychiatry clerkships. Students may be assigned exclusively to alcohol and substance abuse treatment units, consultation-liaison services, or outpatient clinics, and may not have as broad an exposure as is desirable to patients with a variety of psychiatric illnesses. The authors describe a pilot course they developed in 2001, Clinical Psychiatric Assessment and Diagnosis, for third-year medical students at the Uniformed Services University of the Health Sciences medical school. The course uses standardized patients (SPs) to help students gain broader clinical experience. In psychiatry, a growing body of literature supports the acceptability, reliability, and validity of objective structured clinical examination assessment using SPs for medical students. Only a few articles report the use of SPs to primarily teach psychiatry instead of evaluating student proficiency in clinical psychiatry. Since this course was developed, the National Board of Medical Examiners announced that all medical students will be required to pass a clinical skills test in order to practice medicine, beginning with the class of 2005. The examination will use SPs modeling different clinical scenarios. In light of this change, many medical schools may have to reevaluate and possibly revamp their curriculums to insure sufficient acquisition of clinical skills in different specialties. The use of SPs in psychiatry could provide an effective, primary clinical teaching experience to address this new requirement as well.

Physician's Guide to Terrorist Attack

American family physician, 2003

Increasingly, atypical antipsychotic drugs are prescribed for elderly patients with symptoms of p... more Increasingly, atypical antipsychotic drugs are prescribed for elderly patients with symptoms of psychosis and behavioral disturbances. These symptoms often occur in patients with Alzheimer's disease, other dementias, or Parkinson's disease. As the average age of Americans increases, the prevalence of Alzheimer's disease and Parkinson's disease will rise accordingly. Although nonpharmacologic treatments for behavioral disturbances should be tried first, medications often are needed to enable the patient to be adequately cared for. Current guidelines recommend using risperidone and olanzapine to treat psychosis in patients with Alzheimer's dementia. Quetiapine and clozapine are recommended for treatment of psychosis in patients with Parkinson's disease. Additional research is needed for a recently approved agent, ziprasidone. To minimize side effects, these medications should be started at low dosages that are increased incrementally. Drug interactions, especia...

General Hospital Psychiatry, 1994

Academic Psychiatry, 2005

Southern Medical Journal, 2003

Studies in health technology and informatics, 2011

Airway management is an essential skill in providing care in trauma situations. The video laryngo... more Airway management is an essential skill in providing care in trauma situations. The video laryngoscope is a tool which offers improvement in teaching airway management skills and in managing airways of trauma patients on the far forward battlefield. An Operational Assessment (OA) of videolaryngoscope technology for medical training and airway management was conducted by the Center for Advanced Technology and Telemedicine (at the University of Nebraska Medical Center, Omaha, NE) for the US Air Force Modernization Command to validate this technology in the provision of Out of OR airway management and airway management training in military simulation centers. The value for both the training and performance of intubations was highly rated and the majority of respondents indicated interest in having a video laryngoscope in their facility.

Military Medicine, 2006

The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfort... more The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and datadriven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.

Communications in Medical and Care Compunetics, 2010

Commercially available “behavior imaging” technology is effectively assisting the diagnosis and m... more Commercially available “behavior imaging” technology is effectively assisting the diagnosis and management of children with neurodevelopmental disorders, including autism. This technology offers a unique way of capturing behavior data in natural environments on video clips, and is complemented by a comprehensive information storage and retrieval platform. Uses to date include providing families living in remote areas with improved access to