What it Means to Bleed: An Exploration of Young Women's Experiences of Menarche and Menstruation

As a topic of psychoanalytic inquiry, menstruation is surprisingly absent from psychoanalytic literature: menstruation as a part of female psychosexual development is in need of further empirical exploration. The research uses semi‐structured interviews with six young women to explore individual experiences of the menarche and menstruation. The data is analysed using narrative and thematic analysis and interpretations, made within a (broadly classical) psychoanalytic frame, drive the results. In this condensed version of the research, three central findings will be discussed: (1) the role of mother in negotiating the menarche; (2) the difficulty of irregular periods and the fear that something internal has ‘gone wrong’; (3) the link to ideas of mess, dirt and shame, potentially reflective of feelings about sexuality. The research concludes that menstruation is an area worthy of careful psychoanalytic consideration in theory and in clinical practice.     

Targeting Lifestyle Behavior Change in Adults with NAFLD During a 20-min Consultation: Summary of the Dietary and Exercise Literature

Non-alcoholic fatty liver disease (NAFLD) is largely linked to poor diet, lack of physical activity/exercise, and being overweight. In the absence of approved pharmaceutical agents, lifestyle modification, encompassing dietary change and increased physical activity/exercise to initiate weight loss, is the recommended therapy for NAFLD. Despite this, the use of lifestyle therapy within clinical settings is lacking with limited guidance available about what it should involve, how it should be delivered, and whether it can be feasibly delivered as part of standard care. This paper highlights the evidence for the use of lifestyle modification in NAFLD. While there is evidence to support use of behavioral strategies to support lifestyle behavior change in other clinical populations, these are yet to be assessed in people with NAFLD. However, there is sufficient evidence to suggest that behavioral intervention targeting diet and physical activity to promote weight loss in general is effective and a number of practical strategies are presented on how this could be achieved.     

Targeting the “Cytokine Storm” for Therapeutic Benefit

Inflammation is the body''s first line of defense against infection or injury, responding to challenges by activating innate and adaptive responses. Microbes have evolved a diverse range of strategies to avoid triggering inflammatory responses. However, some pathogens, such as the influenza virus and the Gram-negative bacterium Francisella tularensis, do trigger life-threatening “cytokine storms” in the host which can result in significant pathology and ultimately death. For these diseases, it has been proposed that downregulating inflammatory immune responses may improve outcome. We review some of the current candidates for treatment of cytokine storms which may prove useful in the clinic in the future and compare them to more traditional therapeutic candidates that target the pathogen rather than the host response.     

Delusions Demand Attention

We used a variant of the Stroop paradigm to investigate attention bias in a young woman (JK) with delusional beliefs that she had died and that members of her family had changed. JK was shown sets of words printed in different colours of ink, and was asked to name the colour of each word. Sets of words were chosen which related to her delusions, and to possible contributory moods. The times taken by JK to colour-name words in these lists were compared with her times to colour-name sets of neutral words. There were three separate testing sessions which took place over a two-year period. In comparison to her times to name the colours of words in the neutral lists, JK was significantly slower to colour-name test lists containing words related to her delusional beliefs. When she was no longer experiencing these delusions, however, she was no slower to colour-name any of the test word lists. The results indicate that the Stroop paradigm can be useful in investigating individual cases of delusions and in monitoring changes in attentional bias over time.     

Integration of a palliative care specialist in an amyotrophic lateral sclerosis clinic: Observations from one center

Palliative care specialists can aid in the care of patients with amyotrophic lateral sclerosis (ALS). In this article, we describe our 1-year experience incorporating a palliative care specialist into the ALS multidisciplinary team. We describe our integration model, patient selection, and visit content. Of 500 total clinic patients, 74 (14.8%) were seen by the palliative care specialist in 1 year. Referral was most often triggered by advance care planning needs (91%). In the initial visit with the palliative care specialist, topics most frequently covered included goals of care (84%), anxiety/depression (35%), and medical decision-making about feeding tubes (27%) or tracheostomy (31%). Symptom management comprised a relatively small number of the visits, and duration of visits was limited by patient fatigue. Patients with complex goals of care may benefit from the input of a palliative care specialist, and unique integration models may help to facilitate care delivery. Muscle Nerve 60 : 137–140, 2019