Neuropsychiatry: a management model for academic medicine

Neuropsychiatry has become the subject of a number of editorials and position papers in recent years. Historical, philosophical, clinical, scientific, and educational dimensions of neuropsychiatry have been discussed in these papers. The potential business aspects of this topic, however, have received little, if any, comment. In this paper, the authors describe the business performance characteristics of an integrated neuropsychiatry department, formed through the merger of two traditional departments of psychiatry and neurology. The merger of neurology and psychiatry to create an integrated neuropsychiatry department according to the model described produced significant improvement in financial performance.     

Decline in quality of life for patients with severe dementia following a ward merger

The effect of a ward merger on the quality of life of patients with severe dementia in a mental hospital was investigated by means of the observational method of dementia care mapping (DCM). Nineteen patients in two long-stay wards were included in the study prior to the merger. Fourteen of these were observed in the merged ward, together with five newly admitted patients. Key DCM indicators showed that the quality of life of patients included in both phases of the study had declined significantly. This may be explained, in part at least, in terms of a cycle of demoralization and depersonalization' in the interaction of staff and patients. Further research is required into the dynamics of this cycle.     

脑静脉窦血栓形成早发性痫性发作影响因素研究

目的探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)患者早发性痫性发作的相关因素。方法选取CVST患者为研究对象,按照发病2周内有无痫性发作分为早发性痫性发作组和对照组进行回顾性分析,收集患者急性期临床表现、影像学、脑电图等临床资料,对可能影响CVST早发性痫性发作的因素进行单因素和多因素分析。结果研究纳入CVST患者64例,其中早发性痫性发作组19例(29.7%),对照组45例(70.3%)。单因素分析显示早发性痫性发作组妊娠期或产褥期(52.6%vs 20.5%,P=0.01)、意识障碍(31.6%vs8.89%,P=0.02)、多脑叶病变(52.6%vs 24.4%,P=0.03)、静脉性脑梗死合并出血(52.6%vs11.1%,P=0.01)、脑电图异常(73.7%vs 46.6%,P=0.01)率均显著高于对照组。Logistic回归分析显示多脑叶病变[比值比(odds ratio,OR)12.89,95%可信区间(confidence interval,CI)2.12~78.41)]、静脉性脑梗死合并出血(OR 12.92,95%CI 1.68~99.25)、脑电图异常(OR 2.19,95%CI 1.07~4.49)是CVST早发性痫性发作的独立危险因素。结论多脑叶病变、静脉性脑梗死合并出血、脑电图异常是CVST早发性痫性发作的独立危险因素。     

Fasciculation in the early mouse trigeminal nerve is not ordered in relation to the emerging pattern of whisker follicles

Detailed reconstructions of lengths of the embryonic mouse maxillary nerve were made from serial light and electron microscope sections to determine whether there is any correspondence between the arrangement of fasciculi in the developing nerve and the emerging pattern of whisker follicles on the snout. There was neither correspondence nor obvious pattern in the arrangement of fasciculi at either E11, when trigeminal nerve fibers first contact the presumptive whisker pad, or at E12, when the pattern of developing whisker follicles becomes apparent. Fasciculi merged and branched to form an intricate plexus. Furthermore, the ratio of the number of nerve fibers in one fasciculus to the number in another prior to their merger differed significantly from the ratio of fiber numbers in the two fasciculi after their separation, which indicates that nerve fibers are freely exchanged between fasciculi. Our findings suggest that the somatotopic representation of the whisker follicle pattern in the brainstem does not develop by nerve fiber growth augmenting an initially ordered pattern of fasciculi.     

The Movement Disorder Society and Movement Disorders: A Modern History

The Movement Disorder Society (MDS) developed out of a merger with two short‐lived organizations, the Movement Disorder Society, primarily organized to develop a journal for the subspecialty, and the International Society of Motor Disturbances, primarily organized to develop international congresses. The formal merger of the Movement Disorder Society and the International Society of Motor Disturbances into the Movement Disorder Society took place at the 2nd International Congress of Movement Disorders in Munich, Germany, in June 1992. Whereas the journal, Movement Disorders, and the annual International Congress of Parkinson's Disease and Movement Disorders remain the anchors of the society, the goals now include the development of regional symposia, regional sections, Web‐based educational programs, and outreach efforts to include young investigators, wide international membership, and inclusion of non‐neurologists, including basic scientists, neurosurgeons, and nonphysician health professionals. Movement Disorders has a continuingly growing subscribership and rising impact factor. © 2011 Movement Disorder Society     

Studies in countertransference and gender: female analyst/male patient in two cases of childhood trauma

The paternal transference and the erotic transference have been singled out in the literature as more problematic for women analysts with male patients. Two clinical cases provide evidence for their appearance indicating that the reactions they trigger in women may explain the difficulties in their recognition and interpretation. In these particular cases, the author analyzes her counterresistance to a projected narcissistic, cruel father object and her defense of masochistic submission, following more stereotypical gender lines. And in the case of an eroticized transference, the fears of a symbiotic and incestuous merger made more difficult the elucidation of the complex transference reaction. The hypothesis is forwarded that cultural prohibitions are partly responsible for the lack of recognition of these transferences and for the challenging countertransference that they elicit.     

"Resources for each other." The society of German neurologists and psychiatrists and the Nazi "health leadership"

The history of the German Association for Psychiatry and--after its merger with the Society of German Neurologists in 1935--the Society of German Neurologists and Psychiatrists (Gesellschaft deutscher Neurologen und Psychiater, GDNP) during the period of National Socialism has been subjected to only rudimentary research. The conventionally accepted idea that two independent professional associations were "coordinated" from above and turned into the extended arm of Nazi genetic health policy (Erbgesundheitspolitik) against their will must be reconsidered. This paper asks how the relationship between the GDNP and the Nazi state can be described adequately. Psychiatry and neurology as practice and science, and the biopolicy development dictatorship of National Socialism functioned, so the basic thesis, as "resources for each other" (Mitchell Ash).     

Behavior therapy and its malcontents—I. Denial of its bases and psychodynamic fusionism

Historically, behavior therapy is the label applied to therapeutic practices based on experimentally established principles and paradigms of learning. Since the referent of the label is a synthetic construct, it is inappropriate to dispute its meaning as some are now doing. A good deal of criticism has been leveled against behavior therapy by people who are here called “malcontents” because their criticisms are attributable to inadequacies in their understanding of it. The malcontents are subdivided into five sometimes overlapping, groups: (1) those who deny the foundations of behavior therapy, (2) those who advocate some kind of merger with psychoanalysis, (3) those who advocate the accretion of “multimodal” techniques, (4) those who see behavior therapy as based entirely on cognitive change and (5) those who see it as an “exposure” technology. The untenability of the first of these positions is shown in Part I.     

GUEST EDITORIAL

Some time ago, Epilepsia published a Guest Editorial summarizing some of the merits of the proposed merger of the scientific and social international organizations into one to be called Epilepsy International. Dr. Maurice Parsonage has asked that an opportunity be made available for the presentation of another view. This request has been approved by the International League Against Epilepsy, the owner of Epilepsia. I am happy to present Dr. Parsonage's commentary below.     

A pathway to spirituality

The phenomenology of mystical experiences has been described throughout all the ages and in all religions. All mystical traditions identify some sense of union with the absolute as the ultimate spiritual goal. I assume that the pathway to both theistic and secular spirituality and our readiness to seek a solution in a psychological merger with something beyond the self evolves out of our human experience. Spirituality is one of man's strategies for dealing with the limitations of the life cycle, separation and loss, biological fragility, transience, and non-existence. Spirituality may serve as the affective component to a belief system or myth that is not rooted in scientific evidence but is lived as if it is true. Spirituality may take many forms, but I will suggest that in some instances it may serve as a reparative process in which one creates in the external world, through symbolic form, a nuance or facet of an internalized mental representation which has become lost or is no longer available to the self; or it may represent the continuity of the self-representation after death through a self-object merger. Lastly I will illustrate from the writings of two of our greatest poets, Dante Alighieri and William Wordsworth, how their poetry became interwoven with a profound spirituality. In Dante we will see the elaboration of a religious spirituality, while in the writings of Wordsworth a secular spirituality emerges interwoven with nature and belatedly his identification with "tragic man" as his mythos.     

Spontaneous mineralization of the sciatic nerve of senescent rats

Summary A spontaneous mineralization of the sciatic nerve of senescent specific pathogen-free-bred rats (aged 42 months) is reported. Deposits were found in the endoneurium of different branches of the nerve at mid-thigh level. They appeared as small discrete deposits or as large tubular-shaped concretions, probably formed by the growth and merger of the smaller deposits. Some of the concretions were found in close proximity to blood vessels. Deposits consisted of dense aggregations of randomly entangled spicules spreading within bundles of collagen fibrils. Calcium was detected by histochemistry and X-ray dispersion microanalysis. Phosphorus was also found, possibly associated with calcium to form hydroxyapatite.Supported by grants from the FRFC and carried out within the framework of the Commission of the European Communities Concerted Action on Ageing and Diseases (EURAGE). E.T. was supported by a grant from the IRSIA.     

Behavior therapy and its malcontents—II. Multimodal eclecticism,cognitive exclusivism and “exposure” empiricism

The term “malcontent” is applied to critics of behavior therapy whose criticisms are attributable to inadequacies in their understanding of it. Part I of this article discussed the malcontentedness of those who deny the bases of behavior therapy and of those who advocate a merger with psychoanalysis. Part II rebuts those who advocate the accretion of “multimodal” techniques, those who see behavior therapy as based entirely on cognitive change, and those who see it as an “exposure” technology. An important factor behind the positions taken by most malcontents is their dividing the human personality into a biological realm and a cognitive realm—Ryle's “ghost in the machine”. Awareness of the unity of the organism is an essential requisite for the scientific study of the most complex levels of human behavior.     

The “Army” Incident: The Psychology of Uniforms and Their Abolition on an Adolescent Ward†

Abstract

The phenomenology of mystical experiences has been described throughout all the ages and in all religions. All mystical traditions identify some sense of union with the absolute as the ultimate spiritual goal. I assume that the pathway to both theistic and secular spirituality and our readiness to seek a solution in a psychological merger with something beyond the self evolves out of our human experience. Spirituality is one of man's strategies for dealing with the limitations of the life cycle, separation and loss, biological fragility, transience, and non—existence. Spirituality may serve as the affective component to a belief system or myth that is not rooted in scientific evidence but is lived as if it is true. Spirituality may take many forms, but I will suggest that in some instances it may serve as a reparative process in which one creates in the external world, through symbolic form, a nuance or facet of an internalized mental representation which has become lost or is no longer available to the self; or it may represent the continuity of the self-representation after death through a self—object merger. Lastly I will illustrate from the writings of two of our greatest poets, Dante Alighieri and William Wordsworth, how their poetry became interwoven with a profound spirituality. In Dante we will see the elaboration of a religious spirituality, while in the writings of Wordsworth a secular spirituality emerges interwoven with nature and belatedly his identification with “tragic man” as his mythos.     

Mapping connectivity in the developing brain

Recently, there has been a wealth of research into structural and functional brain connectivity, and how they change over development. While we are far from a complete understanding, these studies have yielded important insights into human brain development. There is an ever growing variety of methods for assessing connectivity, each with its own advantages. Here we review research on the development of structural and/or functional brain connectivity in both typically developing subjects and subjects with neurodevelopmental disorders. Space limitations preclude an exhaustive review of brain connectivity across all developmental disorders, so we review a representative selection of recent findings on brain connectivity in autism, Fragile X, 22q11.2 deletion syndrome, Williams syndrome, Turner syndrome, and ADHD. Major strides have been made in understanding the developmental trajectory of the human connectome, offering insight into characteristic features of brain development and biological processes involved in developmental brain disorders. We also discuss some common themes, including hemispheric specialization – or asymmetry – and sex differences. We conclude by discussing some promising future directions in connectomics, including the merger of imaging and genetics, and a deeper investigation of the relationships between structural and functional connectivity.     

Reprint of: Mapping connectivity in the developing brain

Recently, there has been a wealth of research into structural and functional brain connectivity, and how they change over development. While we are far from a complete understanding, these studies have yielded important insights into human brain development. There is an ever growing variety of methods for assessing connectivity, each with its own advantages. Here we review research on the development of structural and/or functional brain connectivity in both typically developing subjects and subjects with neurodevelopmental disorders. Space limitations preclude an exhaustive review of brain connectivity across all developmental disorders, so we review a representative selection of recent findings on brain connectivity in autism, Fragile X, 22q11.2 deletion syndrome, Williams syndrome, Turner syndrome, and ADHD. Major strides have been made in understanding the developmental trajectory of the human connectome, offering insight into characteristic features of brain development and biological processes involved in developmental brain disorders. We also discuss some common themes, including hemispheric specialization – or asymmetry – and sex differences. We conclude by discussing some promising future directions in connectomics, including the merger of imaging and genetics, and a deeper investigation of the relationships between structural and functional connectivity.     

The development and growth of community mental health in Brooklyn: Current issues and problems

The Brooklyn Psychiatric Centers came into being as a result of the merger of five local community mental health clinics. The coordination of these clinics into a larger agency was planned in order to obtain the advantage of a single administrative structure and at the same time decentralize services on a community basis to meet unique neighborhood needs. The services which were developed, the training program, research, the relationship with other agencies, the education of the community itself through seminars, meetings, etc., are described. The emphasis of the Centers' activities in the evolving philosophy of community mental health is stressed.The authors are all members of the staff of the Brooklyn Psychiatric Centers, 129 Montague St., Brookly, N.Y. 11201. Mr. Tulchin, a psychologist, is Psychology Consultant and Director of Educational Therapy; Miss Crampton, a social worker, is Executive Director; and Dr. New, a psychiatrist, is Clinical and Training Director. The paper was compiled by Mr. Tulchin from reports submitted by himself, Miss Crampton, Dr. Leonard R. Kane, Dr. New, and Mr. Martin M. Schwartz. A version of this paper was read at the American Orthopsychiatric Association meeting in San Francisco, Calif., April 15, 1966.     

2型糖尿病患者合并周围神经病变相关危险因素分析

目的 探讨2型糖尿病周围神经病变的相关危险因素.方法 选取2型糖尿病（DM）患者114例为研究对象,根据有无合并周围神经病变将其分为糖尿病周围神经病变组（DPN组）和非糖尿病周围神经病变组（NDPN组）.分析患者临床资料,探讨2型糖尿病周围神经病变相关因素.结果 （1） DPN组与NDPN组病患年龄、病程、FPG、2hPG、HbA1C、尿 A/C 差异均有统计学意义（P〈0.05）.（2）Logistic分析显示糖尿病病程、年龄、糖化血红蛋白（HbA1C）是糖尿病周围神经病变的独立危险因素.结论 糖尿病病程、年龄、空腹血糖、餐后 2 h血糖、糖化血红蛋白等是 2 型糖尿病并周围神经病变的相关危险因素.其中年龄大、病程长、高HbA1C的糖尿病患者发生 DPN 的风险增加.提示临床医生应在糖尿病早期对DPN和相关危险因素进行预防和干预.     

Preliminary experiments in nerve regeneration through laser-drilled holes in silicon chips

Many of the present limitations of peripheral nerve repair might be overcome by performing nerve repairs at the axon level. One approach to nerve repair at this level would be to implant a neuroprosthesis in the form of a microelectronic switchboard which could route the connections of regenerated axons to their correct destinations. This requires a merger of microsurgery and microelectronics. Three steps are needed to achieve this goal. (1) The achievement of in vivo compatibility and electrical contact between axons and a material compatible with microelectronics. (2) The fabrication of a microelectronic neuroprosthesis with electrodes to establish communication with the axon. (3) The development of signal processing hardware and software to control the mapping of the regenerated axons. This report describes preliminary experiments in regenerating peripheral nerve axons through an electronic-grade silicon chip with laser-drilled holes small enough to capture either one or a few axons per hole. We have observed the viability of such nerves in 4 rats for 6 months to 1 year, and in two primates for more than 3 months. As our experiments show, this technique is not yet as effective as suture repair, but the development of a neuroprosthesis that communicates with peripheral nerve axons could have applications including nerve repair, neuroma, and nerve grafts, as well as interfacing the peripheral nervous system to prostheses of other kinds.