Donald Klein, Dr Klein, Disorder discussed on The Carlat Psychiatry Podcast
He was called the father psychopharmacology. He passed last August at the age of ninety. In this episode we remember Donald Klein Welcome to the car. Let's Qadri podcast brought to you by the Carlyle. Psychiatry Report Keeping Psychiatry honest since two thousand and three. I'm Chris they can the editor in chief of the Carlisle. Psychiatry and I'm Kelly newsom a student psych. MP and a dedicated reader of every issue. Donald Klein died last August of Cardio Pulmonary Arrest. He was there at the beginning and laid the bedrock for the modern practice of psychopharmacology. Here's a few areas where Dr Klein lefties Mark Antidepressant withdrawal. He was the first to describe this phenomena in nineteen sixty one paper on emit Birmingham panic disorder. Dr Klein discovered panic disorder after observing that patients. Who suffered these anxiety? Attacks didn't have they more generalized kind of anxiety and were different from others in that way. They had a phobia of panic attacks and they responded to medications differently that led to one of his greatest contributions which was the concept of pharmacologic dissection. Basically he developed the idea one way to separate different mental illnesses from each other is how they respond to different medications. Sounds like a simple thing. We'd take it for granted granite but Donald plein started it and he. I applied it to panic disorder. This was in the early sixties when chlorpromazine the first antipsychotic Hotak was released and people were using it for everything not sure the limits of what it might do but Dr Klein notice that people with the panic attacks six got worse on chlorpromazine and actually improved with the mid Permian. Dr Klein also used this pharmacologic dissection into to help separate depression into its melancholic. Atypical Forms. He was among the first psychiatrist to discover the Atypical Depression Russian which is characterized by overeating fatigue rejection sensitivity and leaden paralysis. This type of atypical. Depression Russian responded uniquely better to 'em Ao is while the Melancholic type responded. Better to try site clicks sometimes time. Those atypical symptoms were called reverse vegetative symptoms. Meaning they're the opposite of what we normally see in Melancholic Look Depression in melancholic depression. We tend to see low appetite psychomotor agitation instead of tiredness and patients waking king up early in the morning instead of oversleeping and a mood that solid like a rock unchanging instead of a mood that's reactive to every sort out of slight and rejection throughout the day Klein trained as a psychoanalyst and as a physiologist and hope to combine the the two and a research career lift psychoanalysis after realizing that was not possible in a world. Biological Psychiatry was under appreciated. The the mental illness was thought due to poor parenting. He was a bold advocate of the Newfield psychopharmacology in fact he wrote the first ever textbook of sacrifice of college in nineteen sixty nine. Dr Klein had a complex relationship with psychotherapy he certainly valued it as a useful treatment. And but he also testified famously in Congress that psychotherapy was renting a friend but he was deeply compassionate physician. Who got to know his patients well and genuinely cared about them? For example he made an effort to actually try every medication that he gave a patient on on himself to better understand how it was really affecting them. Dr Klein helped draft the DSM. Three with Robert Spitzer in nineteen eighty and famously. He was responsible for getting panic. Disorder in that book but there is another diagnosis that Donald Klein came up with which never made it into the book but might have some utility for the patients. We see even today. It's called his steroid display. His steroid destroyer happens in patients with histrionic personality features. He he said it was often seen in women who were very rejection sensitive and they respond to rejection with these unusual episodes that last about three three days where they'll lay on the sofa tired with heavy feelings of leaden paralysis. Eat Sweets all day and feel intense dis- FAURIA and sadness and anxiety. The episodes resolved he thought either with a few days time or with attention and praise and he saw them as is more of a personality. Trait and fact. Some have speculated that this personality trait he was witnessing is really a variant of borderline personality disorder or or Histrionic personality disorder itself. But as you might have guessed from those physical symptoms. His steroid fauria resembles atypical. Call Depression a lot both have rejection sensitivity eating a lot of carbs and heavy feelings in the arms and legs and that's it's automatically why it was left out of the DSM. Dr Klein argued with Bob Spitzer over this he wanted in the DSM. But Dr Spitzer interns sent want a survey to four thousand psychiatrists asking if they saw any of these features in their patients and in his analysis the features just I didn't cluster together so it got left out the steroid this for you. You will see it to this day in your patience and if you do remember Donald Lines observation that this syndrome responded uniquely well to 'EM AOI antidepressants. They took prescribing. Manny's in July August edition of two thousand and nineteen. And it's there that you'll find few surprises about these drugs it's like did you know that the MA. Oh I diet has gone through a big change in the last twenty years although there is a new. Ma Oi- the skin patch. 'em Sam it's only the older ones that have proven to work in treatment resistant depression. One of those has a side effect profile. That usually makes it the best one to start with channel SIP. Remain find out. WHY THE KARLA REPORT DOT COM? It's there you'll find the full articles that we discussed and especially for all of our listeners. We are offering special discount account where you get thirty dollars off your first year subscription with the Promo Code podcast this subscription includes the print edition delivered to your mouth box and full access to all the articles on the website monthly. Sammy credits to maintain licensure as well as an option for self assessment credits towards board certification..