A QUESTION OF ABSENCE

This paper was written in an effort to process rather extreme countertransference reactions to an ‘absent’ patient, i.e. one who attended her twice-weekly psychotherapy only sporadically. At times she did not come for up to several months and consequently a serious debt would accrue. However, it was not so much the amount owing but rather the constant cancellations, with seemingly ‘rational’ excuses about her non-attendance that would provoke an intense frustration accompanied, at times, by furious, almost sadistic countertransference feelings. The patient kept her therapist ‘dangling in uncertainty’ ( Brenman Pick, 2002 ), which the author considered to be a reflection of the patient's inner sado-masochistic object world. The author attempts to make sense of her countertransference in the light of the patient's early relationships and subsequently forms a hypothesis that the absences have been necessary to convey, very powerfully, experiences that may not have been communicated by regular attendance. Finally, the author offers her ‘Afterthoughts’ in the light of developments since the patient has read the paper and given her permission for publication.     

p16 Immunoreactivity in unusual types of cervical adenocarcinoma does not reflect human papillomavirus infection

Houghton O, Jamison J, Wilson R, Carson J & McCluggage W G
(2010) Histopathology 57, 342–350
p16 Immunoreactivity in unusual types of cervical adenocarcinoma does not reflect human papillomavirus infection Aims: The association between human papillomavirus (HPV) and cervical carcinoma is well known, with HPV being identifiable in almost all cervical squamous carcinomas and most adenocarcinomas. However, the prevalence of HPV in unusual morphological types of cervical adenocarcinoma has not been investigated extensively. The aim was to determine HPV status in a series of primary cervical adenocarcinomas, enriched for unusual morphological types. The relationship between HPV and p16 immunoreactivity in these neoplasms was also investigated, as it is generally assumed that in cervical neoplasms diffuse p16 expression is predictive of the presence of high‐risk HPV. Methods and results: Sixty‐three cervical adenocarcinomas, comprising those of usual type (n = 43), minimal deviation type (n = 4), gastric type (n = 3), intestinal type (n = 3), mesonephric type (n = 3), clear cell type (n = 4), serous type (n = 2) and hepatoid type (n = 1) underwent linear array HPV genotyping and immunohistochemistry for p16. Overall, HPV was identified in 32 of 56 cases (57%) in which sufficient DNA was present for analysis. The most common HPV types were 16 and 18, with these being identified in 20 and 18 cases, respectively, either alone or in combination. Seventy‐eight per cent of usual‐type adenocarcinomas were HPV‐positive, as was the single serous carcinoma in which there was sufficient DNA for analysis. In contrast, all minimal deviation adenocarcinomas and those of gastric, intestinal, mesonephric and clear cell types were HPV‐negative, as was the single hepatoid carcinoma. All usual‐type adenocarcinomas exhibited p16 immunoreactivity (diffuse staining in all but one case), as did 11 of 20 of those of unusual morphological type (five focal, six diffuse). Conclusions: Most, but not all, cervical adenocarcinomas of usual type contain HPV, but those of unusual morphological type are almost always HPV‐negative. This has implications for the efficacy of HPV vaccination in the prevention of cervical adenocarcinoma. A significant proportion of cervical adenocarcinomas are p16‐positive in the absence of HPV, illustrating that in these neoplasms diffuse p16 immunoreactivity is not a reliable surrogate marker of the presence of high‐risk HPV.     

Association Between Polymorphisms of the Dopamine Receptor D2 and Catechol-o-Methyl Transferase Genes and Cognitive Function

The dopaminergic neurotransmitter system of the brain is involved in working memory and other cognitive functions. Studies suggest an important role for dopamine synthesis and uptake in modulation of human cognitive processes. We studied the association between polymorphisms in the catechol-o-methyl transferase (COMT) and dopamine receptor D2 (DRD2) genes and general cognitive ability in a secondary analysis of 2091 men and women, aged 55–80 years living in Scotland. General cognitive ability ‘g’ was derived from five cognitive tests of different domains. COMT was not associated with cognitive ability in this population. The DRD2 C:C genotype of rs6277 was associated with decreased general cognitive ability ‘g’ (p = 0.003), and DRD2 rs1800497 heterozygotes had lowest mean general cognitive ability ‘g’ (p = 0.007). There was an indication of a potential interaction between the DRD2 SNPs.     

Polymorphisms in the serotonin reuptake transporter gene modify the consequences of social status on metabolic health in female rhesus monkeys

Individuals vary substantially in their vulnerability to physical and psychosocial stressors. The causes of such variation in susceptibility to stress are poorly understood, but are thought to relate in part to genetic factors. The present study evaluated the extent to which polymorphisms in the gene encoding the serotonin reuptake transporter (5HTTLPR or SERT) modulated physiologic responses to the imposition of psychosocial stress (social reorganization and subordinate social status) in female rhesus monkeys. Forty females, drawn from the middle ranking genealogies of several large social groups, were reorganized into eight groups containing 5 monkeys each; four groups were comprised entirely of animals homogeneous for the long promoter variant in the SERT gene (l/l), while the other four groups had monkeys with at least one allele of the short promoter variant (l/s or s/s). Females were sequentially introduced into these new groups in random order and dominance ranks were established within several days. During the ensuing 6 weeks, dominant monkeys exhibited elevated rates of aggression while subordinates displayed high rates of submission. Notably, females with the s-variant SERT genotype, collapsed across social status positions, exhibited the highest overall rates of both aggression and submission. Although neither social status nor SERT genotype influenced morning cortisol concentrations, glucocorticoid negative feedback was reduced significantly in subordinate compared to dominant females irrespective of genotype. All animals lost weight and abdominal fat across the experiment. However, decreases were greatest in subordinates, regardless of genotype, and least in dominant females with the l/l genotype. Serum concentrations of insulin, glucose, and ghrelin decreased significantly during the group formation process, effects that were independent of genotype or social status. In contrast, social status and genotype interacted to influence changes in serum concentrations of leptin and triiodothyronine (T3), as dominant, l/l females had the highest levels while subordinate s-variant females had the lowest levels. The order in which a female was introduced to her group generally predicted her eventual social rank. However, rank was additionally predicted by pre-experimental T3 and abdominal fat values, but only in the l/l animals. While these findings must be replicated with a larger sample size, the data suggest that the s-variant SERT genotype confers increased vulnerability to the adverse effects of psychosocial stress associated with subordinate status while the l/l genotype benefits the most from the absence of stress conferred by dominant social status. These findings suggest that genetic factors modify the responses of monkeys to social subordination and perhaps other psychosocial stressors.     

Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection

A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, presented with menorrhagia. She had been treated with oral contraceptives for 3 years. Office endometrial biopsy indicated well-differentiated villoglandular adenocarcinoma of the endometrium. The patient refused hysterectomy and would consent only to hysteroscopic resection. She remains alive and well, with no clinical evidence of recurrence 5 years after resection. We propose that skillful resectoscopic surgery, under specific circumstance, may be an appropriate alternative treatment to hysterectomy for some early uterine malignancies.     

Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder

Previous research has demonstrated broad neurobehavioral abnormalities in bipolar affective disorder (cf. G. Cassens, L. Wolfe, & M. Zola, 1990). However, there have been no comparisons of neuropsychological function across patients with manic, depressed, or mixed subtypes. In the present study, 37 manic, 24 mixed-episode, and 25 depressed bipolar I inpatients and 34 control subjects were administered a brief battery of neuropsychological tests. The multivariate and univariate effects of participant group on the neuropsychological measures were uniformly significant (p < .05). Planned contrasts revealed that the bipolar participants performed worse than the controls, and few differences existed between the 3 patient groups. Additionally, the bipolar groups were impaired on 50% of the test battery. These abnormalities were unlikely attributable to differences in psychiatric symptomatology, medical illness, comorbid psychiatric diagnoses, or medication status. Findings imply that acute mood disturbance during bipolar disorder yields significant neurobehavioral dysfunction.