The effects of long-term psychotherapy on patients' self-perception.

A review of the literature regarding the effects of long-term psychotherapy indicates that it has rarely been examined purely from the standpoint of the patient. This study attempts to determine how the patients perceive attitudinal change in themselves and their therapists during the treatment process. Twenty patients who received dynamically oriented psychotherapy in excess of one year in a typical outpatient clinic participated. These patients were randomly assigned a therapist who was either a Clinic staff member or senior resident in psychiatry. Slightly more than half the patients included in the study had a diagnosis of psychoneurosis, while the remainder were viewed as possessing characterological or psychotic disturbances. Evaluation of patient attitudes was achieved through the use of a modified version of Osgood's Semantic Differential Scale. It was determined that patients perceived themselves as becoming significantly more like their therapists after one year of psychotherapy. They saw themselves as more active, independent, dominant, outgoing, realistic and happy. This "psychic shift" is discussed in terms of identification, transference and counter-transference phenomena.     

Potential analytes for the diagnosis of thrombosis. An overview.

The coagulation response is a complex interaction involving the vascular surface, blood platelets, and the plasma coagulation factors. These reactions are integrated to give rise to a locally efficient generation of both platelet aggregates and the enzymatic process associated with fibrin formation. Following mechanical, chemical, or biological "damage" to the vascular endothelial surface, coagulation is initiated by a composite of cellular adhesive reactions certainly involving the platelet and potentially also involving other inflammatory cells. The blood coagulation mechanism can be presented as a collection of zymogen-to-enzyme transformations, with each proteases participating with a cofactor protein on a "surface" that gives rise to the competent blood clotting complex. These complexes catalyze the generation of additional enzymes required for succeeding reaction complexes. It is likely that the coagulation reaction system is continuously "on," producing products at some low "idling" rate, with the products of the various reactions being neutralized by the collection of protease inhibitors and cofactor-neutralizing reactions that regulate the blood clotting process. These latter systems include, as principal components, the antithrombin III-heparin anticoagulant and the activated protein C pathway that disables cofactor proteins. Small changes in the concentrations of modulators can cause large effects in response to relatively small inputs. The coagulation process may be regarded as being at an incipient stage, separated from visually observable coagulation by a narrow threshold, which, once crossed, gives rise to the generation of fibrin and other products associated with alpha-thrombin generation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Modelling the dynamic ventilatory response to hypoxia in humans

A two-component dynamic model was used to describe the ventilatory response to sustained hypoxia in humans. One component (X_s) represents the stimulating effects of hypoxia and the other component (X_d), the hypoxic ventilatory decline. The total ventilatory response to hypoxia is represented by the sum of the two components. A nonlinearity is included to account for the nonlinear steady-state ventilatory response to hypoxia. A sensitivity analysis of the model indicates that, with a step change in as the input, all the parameters can be estimated from the data except for the nonlinearity. The relative sensitivity of the parameters from the model analysis was confirmed in an experimental study. However, comparing steps into hypoxia versus steps out of hypoxia we found a decrease in the gains of both components. The most likely explanation for the decrease in the gains is that the combination of X_s and X_d is not entirely additive. Other models may be required to completely describe the ventilatory response to inputs more complex than steps.     

Expert performance in low-back disorder recognition using patient pain drawings.

Eight low-back-pain experts who regularly include pain drawings in their clinical workup were asked to classify 25 drawings. The experts used only the drawings to place cases into one of five broadly defined diagnostic categories: benign disorder, herniated disc, spinal stenosis, underlying disorder, or psychogenic disturbance. The physicians demonstrated adequate accuracy--51% correct--when compared with change (20% correct). Classification accuracy was greatest for psychogenic disorders (85%), followed by spinal stenosis (58%), herniated discs (52%), and benign disorders (50%). Predictions were comparatively poor for the underlying disorder category (10%). The individual physician accuracies varied from 44 to 60%. "Classic" pain patterns for each disorder group were identified by determining which drawings were correctly classified by most physicians. Physicians may wish to impart greater significance to pain drawings close to one of our "classic" patterns than to others.     

Assessment of electric differential treatment (EDiT) and Endosan treatment for ovarian cysts and concomitant symptoms

The mechanisms of action and clinical applications of electric differential treatment (EDiT) and Endosan in the treatment of ovarian cysts and concomitant symptoms are reviewed. Possible mechanisms of action include an increased level of cyclic AMP, stimulation of endorphin release, anti-inflammatory action, and steroidogenesis resulting from normalization of intercellular communication. Favorable results in the clinical setting were achieved in the treatment of ovarian cysts. Treatment success was reflected in a significant reduction in overall cyst size as well as amelioration of various concomitant symptoms, including fever, chills, inflammation, and abdominal pain. EDiT and Endosan were shown to have potent analgesic and anti-inflammatory effects. No adverse effects have been reported.     

Dopaminergic neuronal responses to a non-amphetamine CNS stimulant

Summary The present study compares the effects of d-amphetamine (d-AMP) and the potent non-amphetamine CNS stimulant, amfonelic acid (AFA), on the firing rate of single midbrain dopaminergic (DA) neurons and on neostriatal DA metabolism (dihydroxyphenylacetic acid—DOPAC). The results indicate that AFA, like d-AMP, reduces the firing rate of DA neurons, although unlike d-AMP, AFA does not cause a decrease in neostriatal DOPAC content and, in fact, enhances that produced by haloperidol (HALO). The AFA-induced decrease in firing rate, like d-AMP, is reversed by the DA receptor blocker HALO, but again unlike d-AMP, the decrease in firing rate is not prevented by catecholamine synthesis inhibition with-methyl-para-tyrosine. Thus, both amphetamine and amfonelic acid have identical electrophysiological effects on DA neurons but act by different mechanisms.     

A replication study on P300 single trial analysis in schizophrenia: confirmation of a reduced number of 'true positive' P300 waves

A single trial analysis of event-related potentials (auditory odd-ball paradigm) of 20 schizophrenics was performed in comparison to matched healthy controls. The purpose of the study was to test the hypothesis that in schizophrenia the well-known P300 amplitude reduction of averaged event-related potentials is due to fewer elicited single trial P300 waves. The results of the present study support this finding of our previous exploratory investigation and point to the view that schizophrenics reveal basal disturbances in information processing due to inadequately elicited electrophysiological responses to target stimuli.     

Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study

OBJECTIVE: Suicidal behavior is highly prevalent in borderline personality disorder and major depressive episode, although the characteristics of suicide attempts in the two disorders are believed to differ. Comorbidity of borderline personality disorder and major depressive episode may obscure characteristics of suicide attempts that are uniquely related to the psychopathology of each disorder. We compared suicidal behavior in patients with borderline personality disorder, major depressive episode, and borderline personality disorder plus major depressive episode to determine whether characteristics of suicide attempts differed between groups and if aspects of core psychopathology predicted specific attempt characteristics. METHOD: Eighty-one inpatients with borderline personality disorder, including 49 patients with borderline personality disorder plus major depressive episode, were compared to 77 inpatients with major depressive episode alone on measures of depressed mood, hopelessness, impulsive aggression, and suicidal behavior, including lifetime number of attempts, degree of lethal intent, objective planning, medical damage, and degree of violence of suicide methods. RESULTS: No significant differences were found in the characteristics of suicide attempts between patients with borderline personality disorder and those with major depressive episode. However, patients with both disorders had the greatest number of suicide attempts and the highest level of objective planning. An increase in either impulsive aggression or hopelessness or a diagnosis of borderline personality disorder predicted a greater number of attempts. Hopelessness predicted lethal intent in all three groups and predicted objective planning in the group with both disorders. Medical damage resulting from the most serious lifetime suicide attempt was predicted by number of attempts. CONCLUSIONS: Comorbidity of borderline personality disorder with major depressive episode increases the number and seriousness of suicide attempts. Hopelessness and impulsive aggression independently increase the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depressive episode.     

Association of aggressive behavior with altered serotonergic function in patients who are not suicidal

OBJECTIVE: The purpose of this study was to determine whether aggression and serotonergic dysfunction are related in the absence of a history of suicidal behavior. Although serotonergic dysfunction has been implicated in aggressive and impulsive behavior, most studies of such behavior have included individuals with a history of suicide attempts. Low concentrations of CSF 5-hydroxyindoleacetic acid (5-HIAA) have been consistently associated with suicidal behavior, presenting a potential confound in the link between aggression and serotonergic dysfunction. METHOD: The authors examined the association between aggression and CSF 5-HIAA concentrations in a group of 64 patients who had different DSM-III-R axis I diagnoses and no past suicidal behavior. Aggressive (N=35) and nonaggressive (N=29) groups were defined by a median split on a six-item history of adulthood aggressive behavior. RESULTS: The aggressive group had significantly lower CSF 5-HIAA concentrations than the nonaggressive group. Aggressive individuals also scored significantly higher on self-report measures of hostility, impulsiveness, and sensation seeking. CSF 5-HIAA concentrations, however, did not correlate with self-reported hostility and impulsivity. CONCLUSIONS: There is an association between aggressive behavior and serotonergic dysfunction independent of suicidal behavior in patients with axis I disorders who exhibit relatively milder forms of aggressive behavior. Analogous to findings with suicidal behavior, a low concentration of CSF 5-HIAA is related to aggressive behavior but does not show the same relationship to the continuum of aggressive feelings and thoughts.