卒中病房医患互动中的心理分析与应对

本文分别从主客体关系、人格、防御机制、移情和反移情以及马斯洛的需要理论方面对 医患关系的现状进行论述,并提出了积极的建议,如：在患者中可以进行小组集体心理治疗解决类 似的心理问题,并将叙事医学的理念渗透其中;在医护人员中进行巴特林小组的训练,提升医师的医 患沟通技巧,了解自身能力和责任的局限性,明确自身的职业定位,提高职业认同感,更好地服务患 者,有益于建立良好的医患关系。     

Cultural, psychological, and demographic correlates of willingness to use psychological services among East Asian immigrants

To assess East Asian immigrants' willingness to use psychological services if depressed and willingness to recommend psychological services to distressed friends, and to examine their cultural (acculturation status, self-construal, ethnic identity), psychological, and demographic correlates, 170 East Asian immigrants (88 male, 82 female) were administered a battery of psychometrically established measures. Approximately 50% of participants expressed strong unwillingness to seek psychological treatments, and approximately 30% expressed strong unwillingness to recommend such treatments to distressed friends. Personal willingness to use psychological services was positively associated with assimilation, being female, age, and English fluency, but was negatively associated with interpersonal distance and number of years in the United States. In contrast, willingness to recommend psychological services to friends was positively associated with independent self-construal, overall ethnic identity, interpersonal sensitivity, being female, and number of years in the United States but was negatively associated with interpersonal distance and reported obsessive-compulsive symptoms. A minority of East Asian immigrants report being willing to seek or to recommend psychological services. Psychological distress, and cultural and demographic features were differentially associated with willingness to seek versus willingness to recommend psychological services.     

Communicating with an autistic boy by gestures

Following unsuccessful attempts to teach a 6-year-old, mute autistic-retarded boy to follow simple verbal instructions, an effort, described in the case study, was made to train the child to comply with gestural commands. It is reported that the latter part of the program worked well, resulting in the boy's ability to follow instructions to stand up, sit down, turn around, turn an object over, go to another person, and give an object to someone else. Also, other activities began to come under gestural control, and the child learned to instruct a person to stand up. It is further suggested that the acquired behavior did not require much time or effort to establish (24 one-hour sessions, none of which totally devoted to gestural training). The results and potentialities of the described training procedure are discussed in light of recent findings by other researchers.We wish to thank the mothers and teachers of the children for their interest and participation. We are also indebted to Cecelia and Gerald Smith for information and assistance, to Stephen Springer for sharing with us his knowledge of sign language, and to Mark Sherman for providing data on gestural vs. auditory control.     

Depressions secondary to other psychiatric disorders and medical illnesses

The authors studied 401 patients with depressions secondary to psychiatric illnesses (substance abuse disorders or somatoform, anxiety, or personality disorders) or depressions secondary to medical illnesses. They found that the patients with depressions secondary to psychiatric illnesses had an earlier age at onset, were more likely to have suicidal thoughts or to have made suicide attempts, were less likely to have memory problems, were less improved with treatment and more likely to relapse on follow-up, and had more alcoholism in their families than patients with depressions secondary to medical illnesses. Depressions secondary to medical illnesses seem to fit the category of reactive depression, and depressions secondary to psychiatric illnesses fit the definition of neurotic depression.     

AIDS: challenge to liaison psychiatry. Various expectations by clinicians concerning liaison psychiatry]

Interdisciplinary group work could be conceived as shared common abilities in order to provide a global management of diseases. In this regard, psychologists should assumed several tasks: to advise on patient's psychological resources to keep them less anxious or more cooperative, to humanize hospital and death, to prevent burn-out. This does not mean a management of the illness, but a careful listening to help patients to find a meaning to what they are living. The aim should not to harmonize different skills but to define each other place (physician, social worker, nurse, psychologist...) concerning queries that involve us and that wonder us about life, health, sexuality, love, the way we take risks.     

Patient rights, professional ethics, and situational dilemmas in mental health services.

Patient rights, professional ethics and situational dilemmas in mental health services are discussed in terms of their interrelationships, with a major focus on voluntary clients and community-based services. Vignettes are provided under the headings of: I. The rights to respect, dignity, and non-discrimination; II. The rights to appropriate treatment, to consent and to refuse; III. The rights to least restrictive, least intrusive intervention; IV. The rights to confidentiality of personal information, to consent to or refuse release of records, and the right to peruse personal records. The author stresses that the rights and responsibilities of various parties must be balanced to arrive at the best decisions.     

Clinicians imagine a patient's view: Rating disclosures of confidential information

Consent to disclosure of confidential information is a cornerstone of the clinician-patient relationship; however, changes in the legal, regulatory, and technological landscape affecting patient confidentiality have brought increasing conflict between ethics-based commitments and the realities of practice. In this pilot study, 119 mental-health clinicians completed a questionnaire that measured levels of disapproval of disclosures of confidential information to various third parties. Clinicians were asked to respond as though they were patients whose information was to be disclosed. Clinicians, taking a patient's perspective, most disapproved of disclosures to anyone who wanted the information and to entities that marketed pharmaceutical, medical, or other products. They were progressively less uncomfortable with disclosures to family members, for educational use without consent but with de-identification, to insurance companies, to pharmacists, to journals, for educational purposes in training other clinicians, and for research. They were least disapproving of disclosures to other clinicians. Based on this initial study of clinicians taking a patient's perspective, clinicians will do well to inform patients about disclosure practices at least as fully as they themselves would want to be informed.     

Metaphorical Stories for Education About Mental Health Challenges and Stigma

In 1989, my psychiatrist convinced me to present to a small group of parents of people with mental health challenges. I had terrible stage fright, but I coped well. It was such a success that I was invited to present to other groups. Thus, I started presenting to groups and other audiences. In this article, I want to share my experience using metaphorical stories when presenting. The more I presented to different audiences, the more I found I was trying to explain complicated matters. It is not enough to want to communicate with someone, and it is not enough that he or she wants to communicate with oneself. Suitable conditions are required for communication. Because I was captivated in my childhood by the fables of Aesop, La-Fontaine, and Krilov, I used in my presentations various fables and other types of metaphorical stories to bridge the gap of knowledge and to enable communication. When I could not find metaphorical stories to suit my presentations, I made them up.     

Le futur en questions et questionnements du futur

Time is a close friend to the human being, though unnoticeable, mostly when it comes to its component related to the future. Nevertheless, time is still a mystery to him. What will be the well being, the power, of the one who can know and manage all the components: past, present and forthcoming of time? A handful of beings, more godlike, attains the knowledge of the future that is forbidden to the mere human who keeps on running after it, therefore looking to reach God so much as to forget the past, and the worst to live the present time. Focusing on the present, we will try to envision the different views of the complex of time through human-scale events, in relation to health and well being, nevertheless discussing man's relationship with the universe. This way, we are not intended to prove any cause or effect, but to raise questions which answers depend on each person, according to him, however, could be part of systems that may be more and more complex and far away. We conclude that at the level of a single human being, considered as such, without any further complexification, to live means one or another form of forecast, prediction, foresight and for a stronger reason when it is about more or less enlarged social groups.     

Ethanol-induced swelling in neonatal rat primary astrocyte cultures

We tested the hypothesis that astrocytes swell in response to ethanol (EtOH) exposure. The experimental approach consisted of an electrical impedance method designed to measure cell volume. In chronic experiments, EtOH (100 mM) was added to the culture media for 1, 3, or 7 days. The cells were subsequently exposed for 15 min to isotonic buffer (122 mM NaCl) also containing 100 mM EtOH. Subsequently, the cells were washed and exposed to hypotonic buffer (112 mM NaCl) containing 100 mM mannitol. Chronic exposure to EtOH led to a marked increase in cell volume compared with control cells. Specific anion cotransport blockers, such as SITS, DIDS, furosemide, or bumetanide, when simultaneously added with EtOH to hyponatremic buffer, failed to reverse the EtOH-induced effect on swelling. In acute experiments, confluent neonatal rat primary astrocyte cultures were exposed to isotonic media (122 mM NaCl) for 15 min, followed by 45-min exposure to hypotonic media (112 mM NaCl, mimicking in vivo hyponatremic conditions associated with EtOH withdrawal) in the presence of 0–100 mM EtOH. This exposure led to a concentration-dependent increase in cell volume. Combined, these studies suggest that astrocytes exposed to EtOH accumulate compensatory organic solutes to maintain cell volume, and that in response to hyponatremia and EtOH withdrawal their volume increases to a greater extent than in cells exposed to hyponatremia alone. Furthermore, the changes associated with EtOH are osmotic in nature, and they are not reversed by anion cotransport blockers.     

Réflexions éthiques sur les interventions médicopsychologiques auprès des victimes

Recognition of the psychic injury potentially inferred by a traumatic event's reality led to cares reproduction for the persons concerned by the event (victims, families, rescuers). These “urgence medicopsychlogiues” interventions are conceived for potentially traumatic events, meaning sudden, violent, unpredictable events leading to life threatening experiences. Being confronted to death's reality leads to the annihilation of the usual defence mechanisms and to an incapacity to be able to elaborate what is being experienced. Confrontation with the trauma can have multiple and unpredictable consequences. Premature psychic cares for the persons implied are therefore implemented, as are somatic cares. If these processes allow coverages (care) adapted to the clinical demonstrations (appearances) of the psychic injured (wounded) persons, they can lead (drive) to multiple drift of which their use for not traumatic facts. If these processes allow care to be adapted to the clinical demonstrations of the psychic injured persons, they can lead to multiple drift, among them, being treated for non traumatic events. This, in particular, may lead to “psychiatrisation” of reactions nevertheless adapted to critical events, to standardized cares and to the illusion that a one and only intervention could be enough to dike all risks linked to post-traumatic disorders. Cares as close as possible to the traumatic event are only one of the many answers to be brought to the persons involved and can not be organized without frame, limit and an ethical position of the professionals who participate in it. Our comment, which is based on our experience in coordinating more than 300 medical psychological emergency interventions, aims at announcing our thinking about what ethic is at stake when taking care of these psychic victims. The current situation is paradoxical: on one side there is a bigger recognition of the reality of the psychic wounds and the potential consequences caused by a traumatic event and of other, this systematic consideration leads to a collective identical demand of the traumatic fact transforming it into a political stake. The social and political recognition of the psychic traumatism is parallel to its instrumentalisation and exploitation. That leads inevitably to maintaining the subjects involved in a state of dependence, vulnerability and psychic incompetence, that of the victim. In the absence of ethical reflection on early psychological care, the medical psychological emergency diversion of care is inevitable with its main consequence: the stake in the show of the psychic suffering is leading to the fact that every implied person is dispossessed of its own history. The traumatic fact having become a social and political stake, the medias do participate in the overbid with, for some, drift which lead to the systematic call to the psychiatrics and psychologist in order to comment on the slightest event, to a psychiatrisation of demonstrations of distress, to a stigmatization of people involved into the reducing category of the traumatized “victims”, to a focus on a one and only type of suffering, to a generalization of traumatic events and to an attempt of instrumentalisation of the medical psychological emergency devices. The traumatism has to remain a clinical event, which requires specific care joining a medical logic and must not become an object of demand joining a social and political logic.     

Hyperresponsiveness of the rat neuroendocrine system due to repeated exposure to stress

Sequential exposure to stressors may elicit a period of endocrine hyperresponsiveness during which plasma hormone concentrations reach higher levels after repeated exposure to a stressor compared to levels after initial exposure. The present study was designed to further characterize hyperresponsiveness to repeated stress and determine if hyperresponsiveness is dependent upon repeated exposure to the same stressful stimuli. In Experiment 1, rats were stressed by inescapable tailshock, immobilization or exposure to shock chamber without shock for one, two, three, four or five consecutive days (15 min/day). In rats exposed to tailshock, corticosterone (CS) levels in plasma collected on days 2, 3, 4 and 5 were higher than CS levels following acute tailshock on day 1, demonstrating hyperresponsiveness to repeated tailshock. Hyperresponsiveness of CS secretion also occurred in groups of rats restrained for four or five days. No changes occurred in the CS response of animals repeatedly exposed to immobilization. Prolactin (PRL) levels were not affected by repeated exposure to the stressors. However, PRL values were different between the stress conditions and indicated that the order of stressor severity was tailshock > immobilization > exposure to shock chamber without shock.

In Experiment 2, rats were exposed to either one or two consecutive days of tailshock or immobilization. Other rats were exposed to either tailshock or immobilization on the first day, then switched to the other stressor on the next day. Hyperresponsiveness to repeated tailshock, but not immobilization, was reflected in plasma levels of CS and adrenocorticotropic hormone (ACTH), but not PRL. Hyperresponsiveness of CS and ACTH secretion also was found in rats first stressed by immobilization then switched to tailshock, demonstrating that hyperresponsiveness is not dependent upon reexposure to familiar stressful stimuli. However, hyperresponsiveness did not occur in rats first exposed to tailshock then switched to immobilization. The data suggest that both immobilization and tailshock primed the organism to hyperrespond, but only the more severe stressor (tailshock) elicited hyperresponsiveness of the neuroendocrine system.     

Training police trainees about ways to manage trauma and loss

For the second year we were invited to be trainers at a training seminar for senior police educators, held in the German Federal Police University and sponsored by the European Police College, hence, having the opportunity to build on their previous applications. We applied exercises (psychoeducation, mindfulness/awareness, journaling, processing in dyads) that introduced in this training and designed to teach officers how to handle exposure to adversities and minimize potential negative consequences. Police officers expect exposure to potentially traumatic incidents, yet, often suffer deeply because of unresolved trauma related to handling horrific events. Our work aimed to open discussion in order to formulate a standard component in training curricula related to teaching police trainees ways to effectively handle and process trauma.     

Existential despair and bipolar disorder: the therapeutic alliance as a mood stabilizer

Talking with a manic patient is not easy, but it is also not hopeless. Manic patients are hopeful, ever hopeful, and indeed often too hopeful. But their hopes and dreams, however big, are usually brief and soon damaged by the realities of life. Ultimately, most patients with bipolar disorder become chronically depressed, denied of their hopes by others. Appropriate medication treatment is necessary, but not sufficient, for many such persons. The job of the clinician is twofold initially: first, to seek to existentially be with manic patients and then, to counterprojectively give perspective to those patients about their manic worldview, without completely denying it. This twofold approach then can lead to a healthy therapeutic alliance, which itself has a mood-stabilizing effect. Along with mood-stabilizing medications, this alliance can then lead patients toward full recovery. Put more simply, clinicians need to talk to manic patients about their hopes, to explore the limits of their grandiosity without judging it, to seek out their strengths and to validate them. They also need to go where the patients are, to encounter patients and find the person beneath the illness, to provide a strong relationship, an alliance that cannot be shaken, to conflict with the patient sometimes and not at other times. It is a tall order, and one not infrequently avoided. Yet the times seem to call for a return to actually talking with manic patients, and maybe curing them with such talk. Or perhaps that is grandiose.     

The use of nanoparticles for gene therapy in the nervous system

Nanoparticles represent an alternative to viral vectors for genetic material transfer to the nervous system. However, to increase transfection efficiency in the central nervous system and to decrease toxicity, the design of nanoparticles needs to be improved to enhance blood-brain barrier crossing and endosomal escape. This paper reviews the strategies used to solve these difficulties and covers the use of various nanoparticles including natural inorganic particles, natural polymers, cationic lipids, polyethylenimine derivatives, dendrimers, and carbon-based nanoparticles. The effectiveness, both in vivo and in vitro, of each method to deliver genetic material to neural tissue is discussed.     

Establishing metaphorical reasoning in children with autism

Researchers have shown that children with autism have difficulty with non-literal language, such as irony, sarcasm, deception, humor, and metaphors. To date, few studies have attempted to remediate these deficits, and no studies of which we are aware have attempted to teach children with autism to understand metaphors. Metaphorical reasoning consists of complex verbal behavior, involving relations of coordination, hierarchy, and distinction, at a minimum. The purpose of the current study was to evaluate multiple exemplar training for teaching children with autism to attend to relevant features of the context in which a metaphor is used and to engage in the required relational responding in order to respond correctly to metaphorical questions. Participants included three children, ages 5-7. Results suggest that multiple exemplar training is effective for teaching children with autism to understand metaphors. Furthermore, generalization to untrained metaphors was found for all participants.     

Afferent projections to the interpeduncular nucleus in the rat, as studied by retrograde and anterograde transport of wheat germ agglutinin conjugated to horseradish peroxidase

We examined the afferent projections to the subnuclei of the interpeduncular nucleus (IPN) in the rat by means of retrograde and anterograde transport of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP). We observed locations of retrogradely labeled cells following injections of WGA-HRP into the IPN, and distributions of anterogradely labeled fibers and terminals within the IPN following injections into the areas that contain cells of origin of afferents. Results of the retrograde and anterograde experiments have clarified the detailed organization of the IPN afferents. A part of the nucleus incertus, located dorsomedial to the dorsal tegmental nucleus, projects to the contralateral half of the rostral subnucleus of the IPN; the pars caudalis of the dorsal tegmental nucleus projects sparsely to the rostral lateral, dorsal lateral, lateral, caudal, and apical subnuclei predominantly contralaterally; the laterodorsal tegmental nucleus, to most of the subnuclei predominantly contralaterally; the ventromedial central gray rostral to the dorsal tegmental nucleus and lateral to the dorsal raphe nucleus projects to the rostral lateral and dorsal lateral subnuclei predominantly contralaterally; the median raphe nucleus, substantially to all subnuclei; the medial habenular nucleus, in a topographic manner, to the rostral, central, and intermediate subnuclei, to the rostral lateral and lateral subnuclei predominantly ipsilaterally, and to the dorsal lateral subnucleus predominantly contralaterally; the supramammillary nucleus and areas around the origin of the mammillothalamic tract and near the third ventricle project sparsely to the ventral part of the rostral subnucleus and to the central, lateral, caudal and apical subnuclei; the nucleus of the diagonal band, sparsely to the rostral, central, dorsal lateral, caudal, and apical subnuclei. These differential projections of the afferents to the subnuclei of the IPN may reflect its complex functions within the limbic midbrain circuit.     

Effects of repetitive daily acute stress on pituitary LH and prolactin release during exposure to the same stressor or a second novel stress

The present study was carried out to examine the effect of repetitive acute stress on pituitary secretion of prolactin (PRL) and luteinizing hormone (LH) during subsequent exposure to the same stimulus or to a second, novel stress. Intact adult male rats were subjected to either a single or 10 daily acute episodes of a psychological stress, transfer to a novel environment, or a physical stressor, restraint. A single acute exposure to either stress caused a temporary but significant increase in circulating concentrations of LH and PRL, and repetitive daily exposure to these stressors resulted in the habituation of stress-stimulated release of both hormones by the 10th consecutive day. When rats previously exposed to daily novel environment stress were subjected to a single episode of restraint stress, they showed an attenuation of both the LH and PRL secretory responses to this type of stress, compared to rats exposed to only one episode of restraint. These results indicate that repeated daily exposure to specific acute stress stimuli can result in the eventual habituation of both the LH and PRL hormonal responses to stress. At least with regard to the paired stressors examined in this study, adaptation to one type of acute stress stimulation may result in altered hormonal responsiveness to a second, unfamiliar stressor.