Pulsion et clinique de la déambulation dans un syndrome de type Alzheimer : une lecture lacanienne

AimsThis article addresses the issue of wandering in Alzheimer's disease from a psychoanalytic point of view, taking into account the importance of the spatial dimension in psychic dynamics.MethodAfter having presented wandering from a behavioral point of view, it is discussed from a metapsychological perspective, making use of A. & G. Haddad's concept of the “viatoric drive” and as well as J. Lacan's reflections on “the wandering of the journey” and “the wandering of desire.” The clinical vignette of Mr. M. in a workshop of therapeutic mediation through art helps us illustrate the unconscious psychic movements at play in walking.ResultsThree subjective markers emerge: wandering reveals the subject's difficult in orienting himself in both physical and psychological space, demonstrating a form of excitation that is not supported by the viatoric drive; “the wandering of the journey” makes it possible to relocate the place of the Other in the Imaginary; “the wandering of desire” incites the subject to repetition through the play of the drives.DiscussionNeurodegenerative disease is an obstacle to wandering. Art-therapy workshops can help Alzheimer's patients with the reorganization of wandering, where unconscious knowledge would prevail over the excitation of ambulation, thus suggesting, for the subject, the possibility of a structuring “elsewhere.”ConclusionThinking of mediated workshops as places of creation for the subject opens up the possibility of inhabiting one's wandering, considered as expressions of a journey and of desire.     

反刍思维对老年结肠造口患者自我表露与孤独感的中介效应

目的探讨老年结肠造口患者自我表露、反刍思维与孤独感的相互关系。方法对210例老年结肠造口患者,采用一般资料调查表、痛苦表露指数问卷、孤独感中文简版量表、反刍思维量表进行问卷调查。结果老年结肠造口患者反刍思维评分为(2.64±0.59)分,处于中等偏高水平;自我表露为(30.58±8.11)分,处于低水平;孤独感为(14.76±3.79)分,处于高等水平。患者的自我表露与反刍思维呈负相关(P0.01),反刍思维与孤独感呈正相关(P0.01),自我表露与孤独感呈负相关(P0.01);中介效应检验结果显示,反刍思维对自我表露与孤独感起部分中介作用(68.97%)。结论造口对老年患者的自我表露、反刍思维和孤独感存在着不同程度的影响。护理人员应关注老年结肠造口患者的思维变化,制定相应的护理策略提高其自我表露水平,降低反刍思维水平,进而减轻老年肠造口患者的孤独感,以提高患者心理健康水平。     

Causal mediation analysis with multiple mediators in the presence of treatment noncompliance

Randomized experiments are often complicated because of treatment noncompliance. This challenge prevents researchers from identifying the mediated portion of the intention‐to‐treated (ITT) effect, which is the effect of the assigned treatment that is attributed to a mediator. One solution suggests identifying the mediated ITT effect on the basis of the average causal mediation effect among compliers when there is a single mediator. However, considering the complex nature of the mediating mechanisms, it is natural to assume that there are multiple variables that mediate through the causal path. Motivated by an empirical analysis of a data set collected in a randomized interventional study, we develop a method to estimate the mediated portion of the ITT effect when both multiple dependent mediators and treatment noncompliance exist. This enables researchers to make an informed decision on how to strengthen the intervention effect by identifying relevant mediators despite treatment noncompliance. We propose a nonparametric estimation procedure and provide a sensitivity analysis for key assumptions. We conduct a Monte Carlo simulation study to assess the finite sample performance of the proposed approach. The proposed method is illustrated by an empirical analysis of JOBS II data, in which a job training intervention was used to prevent mental health deterioration among unemployed individuals.     

Multilevel moderated mediation model with ordinal outcome

Although increasingly complex models have been proposed in mediation literature, there is no model nor software that incorporates the multiple possible generalizations of the simple mediation model jointly. We propose a flexible moderated mediation model allowing for (1) a hierarchical structure of clustered data, (2) more and possibly correlated mediators, and (3) an ordinal outcome. The motivating data set is obtained from a European study in nursing research. Patients' willingness to recommend their treating hospital was recorded in an ordinal way. The research question is whether such recommendation directly depends on system‐level features in the organization of nursing care, or whether these associations are mediated by 2 measurements of nursing care left undone and possibly moderated by nurse education. We have developed a Bayesian approach and accompanying program that takes all the above generalizations into account.     

观点采择干预对青少年学生艾滋病污名的影响

目的了解青少年学生艾滋病污名的现状并探讨观点采择干预对其的影响。方法采用整群抽样法抽取某中学初中一年级5个班的学生,按学号单双分为对照组和干预组。被试对象均采用艾滋病污名问卷进行前测,观点采择干预后,均进行艾滋病污名后测,同时采用基本共情量表测共情水平。比较两组艾滋病污名差异,分析共情在观点采择对艾滋病污名影响中的中介作用。结果完成本研究被试对象为146名,其中对照组72名,干预组74名,艾滋病污名前测对照组及干预组艾滋病污名总分分别为(43. 75±8. 95)分和(44. 40±10. 41)分,两组间差异无统计学意义(P>0. 05)。艾滋病污名后测对照组及干预组艾滋病污名总分分别为(42. 65±11. 40)分和(37. 82±9. 94)分,两组差异有统计学意义(P<0. 05),共情中介效应的系数c(c=-0. 210)、系数a(a=0. 181)、系数b(b=-0. 163)和系数c’(c’=-0. 181)差异均有统计学意义(P<0. 05),中介效应占总效应的比值为14. 05%,共情在观点采择与艾滋病污名关系间存在部分中介作用。结论青少年学生普遍存在艾滋病污名,观点采择干预能有效降低其艾滋病污名,共情在观点采择对艾滋病污名的影响中发挥部分中介作用。     

The role of psychological and social factors in the relationship between attachment and suicide: A systematic review

Insecure attachment is widely accepted to be a risk factor for suicidal thoughts and behaviour. To increase our understanding of this distal association, the current systematic review aimed to evaluate empirical evidence that has investigated the role of psychosocial mechanisms within this relationship. Sixteen original research articles were identified, with the majority carrying out mediational analyses to test their hypotheses. Substantial heterogeneity was found across studies with regards to their theoretical approach to assessing attachment, suicide‐related outcomes, sample population, statistical analyses, and the psychological factors under investigation. Nevertheless, this emergent evidence base indicates that a range of predisposing, precipitating, and crisis‐state factors may mediate the association between attachment security and suicidality. Studies that investigated moderating factors did not report significant findings, and the mediating role for psychiatric diagnoses remains unclear. Furthermore, this emerging research base is limited by an over‐reliance on cross‐sectional designs and self‐reported data. Longitudinal and experimental designs are required to verify causal pathways and to investigate whether trait vulnerabilities interact with acute stressors to increase suicide risk. Finally, disorganized attachment has been overlooked so far and should be given greater consideration going forward.     

Peptide encapsulation regulated by the geometry of carbon nanotubes

In this work the encapsulation of an α-helical peptide in single carbon nanotubes (CNTs) with similar diameter and length but different geometry (armchair and zigzag) was investigated through molecular dynamics simulations and free energy calculations. Our simulation results showed that in vacuo it makes no evident difference whether the investigated peptide is encapsulated in armchair or zigzag CNTs; however, in aqueous solution the armchair CNT encapsulates the peptide remarkably easier than the zigzag CNT does. A detailed analysis revealed that the equilibrium conformation of the water molecules inside the CNTs with varying geometry mediates the peptide encapsulation. It suggests that the water molecules play an important role in regulating behaviors of biomolecules in bio-systems. Then the impact of the CNT geometry on the conformational changes of the confined peptide was studied. Analyses of secondary structures showed the α-helix of the peptide could be better maintained in the zigzag CNT.     

心理一致感在慢性心力衰竭患者家庭功能和自我护理行为间的中介作用

目的了解慢性心力衰竭患者自我护理行为的现况,验证并分析心理一致感在慢性心力衰竭患者家庭功能和自我护理行为间的中介作用。方法采用便利抽样的方法,选取台州市某三级甲等医院349例门诊慢性心力衰竭患者进行问卷调查,以患者一般资料、家庭关怀度指数量表、心理一致感量表、心力衰竭自护指数量表为研究工具进行横断面调查。结果 349例患者,心力衰竭自护指数量表标准化总分为(113.48±45.96)分,家庭关怀度指数量表总分(7.44±2.71)分,心理一致感量表总分为(65.11±12.18)分;心理一致感在慢性心力衰竭患者家庭功能和自我护理行为间的中介效应显著,中介效应大小为0.251,中介效应占总效应的27.18%。结论慢性心力衰竭患者自我护理整体处于较低水平,心理一致感既可以直接影响慢性心力衰竭患者的自我护理行为,也可以作为家庭功能影响自我护理行为的中介变量。