The effect of peripheral beta-blockade on psychophysiologic responses in obsessional neurotics

Ithas been postulated that anxiety symptoms are mediated through peripheral mechanisms and that subjective feelings of anxiety are learned associations to bodily symptoms.¹ This hypothesis has been supported by findings indicating the beneficial effects of beta-adrenergic receptor blocking agents in psychiatric patients.^2,3 In anxiety states, particularly, mood changes have been reported even with beta-blockers that penetrate very slowly into the brain.^4–6 Therefore, the improvement in subjective anxiety would appear to be related to peripheral beta-blockade rather than central action.There is also evidence that obsessive-compulsive patients experience increased subjective discomfort, associated with increased autonomic reactivity, while they hold in fantasy ruminative thoughts, or when they touch “contaminating” objects, compared to neutral thoughts or objects.^7,8 The present work is an attempt to measure the psychophysiologic arousal during internal stimulation of such patients before and after beta-blockade with practolol¹ an agent lacking central effects. A decrease in autonomic reactivity accompanied by similar amelioration in subjective anxiety would support Breggin's hypothsis.¹ On the other hand, failure of the latter to accompany the physiologic modifications brought about by practolol would support the theoretical position that assigns fundamental importance to cognitive and situational factors in the genesis and maintenance of anxiety.⁹ This would be of interest with patients in which a specific type of cognitive activity and avoidance behavior dominate the clinical symptomatology.     

不同性别精神障碍患者尿路感染病原菌差异分析

目的 分析广州市某医院不同性别的精神障碍住院患者尿路感染病原菌分布及药敏试验结果的差异，为临床诊疗过程中合理用药提供参考。方法 回顾分析2019年-2020年广州市某医院住院精神障碍患者尿路感染的临床病例资料，共326例，其中男性126例，女性200例。收集患者性别、年龄、尿液培养的细菌鉴定及药敏试验结果等数据。分析不同性别的患者尿路感染病原菌的细菌分布及耐药率的差异。结果 共分离出尿路感染细菌326株，其中多重耐药菌103株（31.60%）。男性和女性患者尿路感染多重耐药菌分别为52株（41.27%）和51株（25.50%），男性患者尿路感染的多重耐药菌分离率高于女性患者，差异有统计学意义（χ²=8.895，P<0.01）。细菌分布方面，女性患者大肠埃希菌构成比高于男性患者（χ²=14.794），而鲍曼不动杆菌和铜绿假单胞菌的构成比低于男性患者（χ²=13.665、4.054），差异均有统计学意义（P<0.05或0.01）。药敏试验结果显示，女性患者组中分离出的大肠埃希菌对氨苄西林/舒巴坦、氨曲南、头孢吡肟、头孢他啶、左旋氧氟沙星、亚胺培南和美罗培南等多种抗生素的耐药率均低于男性患者组，差异均有统计学意义（χ²=5.028~17.680，P<0.05或0.01）。结论 不同性别的住院精神障碍患者尿路感染的发病率和细菌分布存在差异，女性患者大肠埃希菌的耐药率低于男性患者。     

Le MCR : de la musicothérapie pour soutenir l’hospitalisation de la dépression

IntroductionThe Receptive Composite Montage (RCM) is a musical induction technique designed to cause a positive state to in-patients diagnosed with depression in a psychiatric institution. This research aims at proving that the RCM brings patients into a relaxation state and a positive mood within 20 min.MethodThirty-seven in-patients with depression took part in this study. The average age of the sample was slightly under 49 years old (48.73 ± 12.41). The relaxing aspect of the RCM was monitored thanks to data given by an oximeter, which measures the heartbeats and the oxygen saturation level in the in-patient's bloodstream. In order to complete these data, a focal-sampling observation was carried out. Positive mood induction was estimated based on interviews. The data have been processed through analytical statistics.ResultsHeartbeats and oxygen saturation in the bloodstream during the relaxing phase of the montage (P < .001 and z = .018 respectively) tended to increase during the wake-up phase (P < .001) as was anticipated. In-patients who had felt a negative mood before listening to the RCM reported feeling a significant positive mood once they had listened to the RCM (z = .017).ConclusionThe results obtained show that the RCM does induce a relaxation state by decreasing heartbeats and breathing cycles. Moreover, the qualitative data show that when in-patients listen to the RCM, their mood becomes positive through an emotional exercise causing their mood to shift from negative to positive.     

Foisonnement imaginaire et délire paraphrénique dans La Tempête de Shakespeare

ObjectivesTo show, through the figure of Prospero (the “magician” of the Shakespeare's Tempest) the clinical specificity of fantastic paraphrenia: overflowing imaginary, luxuriance of delusion with fantastic and cosmic themes, “diplopia” between the imaginary world and the real world (H. Ey), megalomaniac dimension, etc.MethodA review of the literature will give us the essential elements to understand the singularity and personality of Prospero. These elements will logically lead us to say a few words about paraphrenia–and especially in its fantastic form–by taking our references both in the field of psychiatry (H. Ey) at the same time in the field of psychoanalysis (J. Lacan). Finally, we will conclude by emphasizing two fundamental aspects of paraphrenia that appear quite clearly in Prospero: the “exceptional” identity, and the imaginary proliferation.ResultsIf the character of Prospero, of course, cannot be considered a “clinical” case, the complexity of the character, the intelligence of Shakespeare, his sense of “clinical” observation, invite us to read The Tempest as the paraphrenic delusion of a dethroned Duke, driven by vengeance, persuaded to command Spirits and Nature. In addition, the “power” of paraphrenic delusion will also be grasped, in that it allows do distance, and to control an Other persecutor.DiscussionThe discussion concerns what is signing the stucture of “fantastic paraphrenia” from the psychiatric's and psychoanalytic's point of view, among other things the formation of an “exceptional” identity with megalomaniac colors, omnipotence, “diplopia” between the real world and the imaginary world, the imaginary proliferation, the luxuriance of the delusion, the “consent to the enjoyment of the Other” (Maleval).ConclusionShakespeare has given us, in his immense work, an important view of “psychopatic characters on stage” – to use a Freud's title – with an almost unmatched “clinical” fineness. This is the case for King Lear, for Othello, Macbeth, Hamlet, Richard III, Timon of Athens, Titus Andronicus, and many others. Prospero, in our opinion, can be part of this lineage. The “hypertrophy of the Self”, the imaginary proliferation, the grandiose themes unfolded, the demiurge and theurge incarnated give the feeling – with our current landmarks – to assist in a certain sense to the development of a fantastic paraphrenia.     

冰毒依赖者的行为决策

目的探讨冰毒依赖者的行为决策特点。方法采用爱荷华赌博任务(IGT)对47例男性冰毒吸食者的决策行为进行评估,并根据性别、年龄(3)匹配的原则在当地社区、医院选取27例做正常对照。结果组间主效应(0.000,0.985)、区组内主效应(1.921,0.123)、交互效应(1.713,0.162)不显著,但正常对照组有回避不利选项的倾向,单独统计结果区组效应边缘显著,而吸毒者则无。结论冰毒吸食者的决策能力相对保存完好。     

Rebel Psychoanalyst Adrian Stephen: Brother of Virginia Woolf

Inspired in part by a paper in the British Journal of Psychotherapy by the psychoanalyst Malcolm Pines, describing the Cambridge and Bloomsbury background of the psychoanalyst, Adrian Stephen, in this paper I draw on the writings of his older sister, Virginia Woolf, and on other data as means of highlighting and explaining aspects of his life and work. In particular, I discuss his rebellion against their father, Leslie Stephen; his subsequent rebellion against authority before and during the First World War; and his involvement in psychoanalysis and politics during his medical and psychoanalytic training in the 1920s. I go on to explain how his opposition to tyranny informed his approach to psychoanalysis as means of freeing patients from the control exerted over them by their phantasies. And I show how, during the Second World War, he resisted dominance by Ernest Jones and Edward Glover of the British Psycho‐Analytical Society, and how in his post‐war clinical work he extended Freud's moral version of the super‐ego into an account of it as a wish‐fulfilling agency of the mind.     

Emergence of bariatric psychiatry as a new subspecialty

Bariatric surgery is the branch of surgery aimed at helping a person with obesity lose weight. The implementation of surgical treatment of obesity is growing at an impressive rate. As expected, the expanding implementation of bariatric procedures has progressively revealed critical issues that were not evident when the number of obese patients treated with surgery was relatively small. One critical issue is the importance of mental health assessment and care of bariatric patients. The aim of this review is to provide readers with an up-to-date summary of the goals, methods, and clinical strategies of bariatric psychiatry. The aims can be grouped into three distinct categories. First, to ascertain that there are no psychiatric contraindications to safe bariatric surgery. Second, to diagnose and treat pre-surgery mental conditions that could predict poor weight loss. Third, to diagnose and treat post-surgery mental conditions associated with poor quality of life. Although bariatric psychiatry has gained the status of a new subspecialty within the field of mental health and psychopathology, many clinical questions remain unsolved. We need more long-term data on outcome measures such as quality of life, adherence to behavioral guidelines, risk of suicide, and post-surgery prevalence of psychological disturbances and mental disorders.