Mentalization within Intensive Analysis with a Borderline Patient

The author discusses whether the concepts of mentalization are helpful within intensive, individual analytic work with a personality disordered patient. Child and adult technique within the widening scope of psychopathology can be thought of as building on developmental help, studied at the Anna Freud Centre from the sixties to reach ‘atypical’ children who could not use classical analysis. The first two years of work with Jenny, a young borderline woman, were anchored by developmental research on attachment and early parent–infant relating. Later, when her capacity to symbolize, tolerate and communicate affect had greatly improved, she could accept and use interpretations, and working in the transference was gradually able to be accepted as thinking and not only as action. The infantile modes of experiencing psychic reality hypothesized in mentalization theory are illustrated from the material, and the status of attachment within psychoanalytic theory is reconsidered. In the last section, how each psychotherapist specifically shapes the process of change will be discussed, building on the concept of ‘marked mirroring’.     

Infectious diseases of the cardiovascular system

Infection and inflammation of the cardiovascular system are a frequent cause of cardiac and/or vascular disease. Major advances have now occurred in understanding cellular and molecular bases of a wide variety of inflammatory cardiovascular diseases. Some of these (myocarditis) have been recognized as inflammatory disease for a long time. In others such as atherosclerosis, the inflammatory nature of the disease has emerged only recently. Myocarditis and pericarditis are inflammation of specific layers of the heart. Myocarditis can lead to heart failure or arrhythmia, and myocytes or the conductive system can be affected. Pericarditis often presents with pain, ever and friction rub, sometimes with malaise or weight loss. Infective endocarditis affects usually the cardiac valves and can be fatal if not treated. Acute or chronic, mostly bacterial in origin, though fungal infections are becoming more common. While diseased valves as a cause is decreasing, medical interventions and immunosuppression as well as prosthetic valves are resulting in an increase in endocarditis. Organisms can enter from oral cavity, especially if there is poor dental hygiene or when dental work has taken place. Vasculitis can also be caused by infections but is very rare.     

Irritable bowel syndrome in Asia: Pathogenesis,natural history,epidemiology, and management

Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom‐based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross‐cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.