Adolescents in psychodynamic psychotherapy: Changes in internal representations of relationships with parents

Abstract

Obwohl Untersuchungen zur Effektivität der Behandlung traditionellerweise auf Vergleichen der Zeitpunkte vor der Behandlung und nach der Behandlung beruhen, scheint es auch nützlich, die Beziehungen zwischen den Zeitpunkten vor der Sitzung und nach der Sitzung einzuschätzen, um ein besseres Verständnis der Mechanismen der Veränderungen zu erlangen. Diese Untersuchung zielte darauf ab, herauszufinden, ob a) die Symptome von Patienten, die an paranoider Schizophrenie litten, sich unmittelbar nach einer Sitzung im Vergleich zu vorher reduzierten und b) es eine systematische Beziehung zwischen dem Angstniveau der Patienten nach der Sitzung und den psychotischen Symptomen gab. Die Datenerhebung umfasste Einschätzungen vor und nach der Sitzung von acht Patienten in 50 integrativen Psychotherapiesitzungen. Die Einschätzungen der Therapeuten wurden als Kontrolle der Selbsteinschätzungen benutzt. Die Ergebnisse weisen auf wichtige Veränderungen bezüglich der Psychopathologie zwischen den Zeitpunkten vor und nach der Sitzung hin und auf eine systematische Beziehung zwischen dem Angstniveau nach der Sitzung und den psychotischen Symptomen. Dies wird hinsichtlich des Beitrags der Angstreduktion als einem wesentlichen therapeutischen Faktor des benutzten Modells diskutiert.

Bien que les études sur l'effectivité des traitements se basent traditionnellement sur la comparaison entre mesures avant et après traitement, il semble bénéfique d’évaluer la relation entre mesures avant et après une séance au cours de la psychothérapie pour mieux comprendre les mécanismes du changement. Cette recherche vise à investiguer (a) si les symptômes de patients souffrant de schizophrénie de type paranoïde diminuent directement après la fin d'une séance par rapport aux symptômes avant la séance, et (b) si il y a une relation systématique après la séance entre le niveau d'anxiété et les symptômes psychotiques par individu. Les données collectées impliquent des auto-évaluations pré- et post-séance par 8 individus dans 50 séances de psychothérapie intégrative. Les évaluations des thérapeutes ont été utilisées comme contrôle des auto-évaluations. Les résultats montrent des changements importants entre les évaluations pré- et post-séances en psychopathologie et une relation systématique entre le niveau d'anxiété post-séance et les symptômes psychotiques. Les résultats sont discutés en relation avec la contribution au soulagement de l'anxiété comme facteur thérapeutique crucial du modèle appliqué.

Si bien los estudios sobre efectividad del tratamiento se han basado tradicionalmente en comparaciones de mediciones tomadas antes y después del tratamiento, parece conveniente evaluar la relación entre las mediciones pre y postsesión durante la psicoterapia a fin de lograr una mejor comprensión de los mecanismos de cambio. Esta investigación tendió a investigar (a) si los síntomas de individuos que sufren de esquizofrenia paranoide se redujeron inmediatamente después de una sola sesión en comparación con los síntomas de su presesión y (b) si hubo alguna relación sistemática entre los niveles postsesión de la ansiedad del individuo y sus síntomas psicóticos. Los datos incluyeron autoevaluaciones pre y postsesión de ocho individuos en 50 sesiones de psicoterapia integradora. Los puntajes de los terapeutas se usaron como control de las autoevaluaciones. Los resultados indican importantes cambios entre los puntajes de la pre y la postsesión de la psicopatología y una relación sistemática entre los niveles postsesión de la ansiedad y los síntomas psicóticos. Se debaten los hallazgos sobre la contribución del alivio de la ansiedad como un factor terapéutico crucial del modelo aplicado.

Tradicionalmente, os estudos da eficiência dos tratamentos têm-se baseado nas comparaç[otilde]es de avaliaç[otilde]es realizadas antes e após o tratamento, porém parece ser benéfico avaliar a relação entre as avaliaç[otilde]es pré e pós-sess[otilde]es de psicoterapia para adquirir uma melhor compreensão dos mecanismos de mudança. A presente investigação procura investigar: (a) se os sintomas dos sujeitos com esquizofrenia do tipo paranóide diminuiam imediatamente após a conclusão de uma única sessão comparando com os sintomas da pré-sessão e, (b) se existia alguma relação sistemática entre os níveis sintomáticos de ansiedade e psicóticos dos pacientes após a sessão. A recolha de dados envolveu auto-avaliaç[otilde]es pré e pós-sess[otilde]es por parte de oito pacientes em 50 sess[otilde]es de psicoterapia integrativa. Foram usadas as avaliaç[otilde]es dos terapeutas como controlo das auto-avaliaç[otilde]es. Os resultados evidenciaram mudanças entre os registos pré e pós-sessão em termos de psicopatologia e uma relação sistemática entre os níveis sintomáticos de ansiedade e os de psicotismo. Os resultados são discutidos em termos das suas contribuiç[otilde]es que o alívio da ansiedade tem como um factor terapêutico crucial do modelo aplicado.

Sebbene gli studi sull'efficacia dei trattamenti sono tradizionalmente legati alla comparazione delle misure prese prima e dopo il trattamento, sembra favorevole valutare la relazione tra le misure pre- e post- seduta durante la psicoterapia, per ottenere una comprensione migliore dei meccanismi di cambiamento.

Questa ricerca ha mirato ad investigare:

–?se i sintomi dei soggetti che soffrono di schizofrenia paranoide erano ridotti immediatamente dopo la conclusione di una singola seduta, comparati con i sintomi della rispettiva pre-seduta e

–?se c'era qualche relazione sistematica tra i livelli post-seduta dell'ansia e dei sintomi psicotici del soggetto.

La raccolta di dati include auto-valutazioni pre- e post- seduta di 8 soggetti in 50 sedute di psicoterapia integrata. Le valutazioni dei terapeuti sono state usate come controllo delle auto-valutazioni.

I risultati indicano cambiamenti importanti tra le valutazioni psicopatologiche pre- e post- seduta e una relazione sistematica tra i livelli post-seduta di ansia e sintomi psicotici.

I risultati sono discussi in relazione al contributo di rilievo dell'ansia come fattore terapeutico cruciale del modello applicato.

     

The Role of 18 F-FDG PET/CT in Assessing Therapy Response in Cervix Cancer after Concurrent Chemoradiation Therapy

Purpose

To determine whether persisting cervical fluorodeoxyglucose (FDG) uptake after concurrent chemoradiotherapy (CCRT) for cervical cancer can reflect residual malignancy.

Methods

F-FDG PET/CT was performed before and after CCRT in 136 patients with cervical cancer. The maximum and mean standardized uptake values (SUVmax and SUVmean) were recorded from PET/CT scans performed pre- and post-treatment. SUVs were correlated with treatment response after CCRT. Final treatment response was determined by MRI and further follow-up PET/CT. One hundred four of 136 patients underwent pelvic MRI, and 32 of 136 patients underwent further follow-up PET/CT. Patients were classified into two categories: patients with residual tumor or patients without residual tumor (complete responder). Pre- and post-treatment serum squamous cell carcinoma antigen (SCC) levels were also recorded for comparison. The optimal cutoff value of SUVmax for predicting residual cervical tumor was determined using receiver-operating characteristic (ROC) analysis.

Results

Of 136 patients, 124 showed complete response on further follow-up studies and 12 were confirmed to have residual tumor. The post-treatment SUVmax and pre-/post-treatment SUVmean of complete responders were significantly lower than those of patients with residual tumor: 2.5 ± 0.8 and 7.2 ± 4.2/1.9 ± 0.7 for complete responders and 5.7 ± 2.6 and 12.8 ± 6.9/3.7 ± 0.7 for patients with residual tumor (p < 0.05). The pre-treatment SUVmax and pre-/post-treatment serum SCC levels of the complete responders tended to be lower than those of patients with residual tumor, but this did not have statistical significance. Using ROC analysis, an optimal cutoff SUVmax of 4.0 on the post-treatment PET/CT yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 92 %, 94 %, 61 %, and 99 %, respectively (p < 0.001).

Conclusions

Persistent cervical FDG uptake in¹⁸F-FDG PET/CT after CCRT for cervical cancer may be caused by residual tumor or post-therapy inflammation. A higher cutoff SUVmax than conventional criteria for cervical cancer in post-CCRT PET/CT might help to detect residual tumor.     

Inhibiting glucosylceramide synthase facilitates the radiosensitizing effects of vinorelbine in lung adenocarcinoma cells

The standard treatment regimen for patients diagnosed with non-small cell lung cancer (NSCLC) with locally advanced stage III disease is concurrent chemoradiotherapy (CCRT). This study investigated the molecular effects of vinca alkaloid vinorelbine (VNR)-based CCRT. We reviewed the records of 68 patients with stage III NSCLC: 42 patients received VNR-based CCRT, and 26 were treated with radiation alone. Human lung adenocarcinoma cells were used in this study to investigate the molecular effects of glucosylceramide synthase inhibition on VNR-based CCRT. There was response rate of 66.7% with CCRT, which was better than the response rate observed with radiation alone (30.8%; P < 0.001). CCRT caused an increase in cell cycle arrest at G₂/M phase accompanied by apoptosis. Oxidative c-Jun N-terminal kinase (JNK) activation was involved in the increased apoptosis levels but not the cell cycle arrest. CCRT also induced an increase in ceramide accompanied by a decrease in glucosylceramide that was positively correlated with the cytotoxic effects. Pharmacologically inhibiting glucosylceramide synthase facilitated VNR- and CCRT-induced apoptosis by promoting the JNK pathway. Inhibiting glucosylceramide synthase facilitates the radiosensitizing effects of VNR by promoting JNK-mediated apoptosis in lung adenocarcinoma cells.     

诱导型一氧化氮合酶在指导晚期鼻咽癌治疗方案选择中的价值

背景与目的:同期放化疗被认为是目前治疗晚期鼻咽癌(nasopharyngeal carcinoma,NPC)的最佳方案,但对于同期放化疗对哪一类患者最有效,哪种化疗药物与放疗联合疗效最佳等问题尚没有一致的结论。有学者推荐将顺铂(cisplatin,DDP)同期放化疗方案作为治疗晚期NPC的标准方案。由于顺铂能增加诱导型一氧化氮合成酶(inducible nitric oxide synthase,iNOS)的表达,使杀肿瘤的一氧化氮(NO)合成增加而抗瘤,因此我们考虑是否可以通过检测治疗前NPC组织中的iNOS的表达来对这种同期放化疗的疗效进行预测,并根据预测结果选择相应的治疗方案。本研究旨在探讨NPC肿瘤组织中诱导型iNOS的表达与DDP同期放化疗后鼻咽局部肿瘤全消与残留的关系,以便选择最合适的治疗方案,最大限度地提高鼻咽局部肿块全消率。方法:应用免疫组化法检测DDP同期放化疗后30例鼻咽局部肿块全消和30例鼻咽局部肿块残留的鼻咽部低分化鳞状细胞癌患者在接受治疗前的肿瘤组织中iNOS的蛋白表达情况。结果:iNOS阳性表达定位于NPC细胞的胞质和胞核内,且胞核染色比胞质更强。iNOS在NPC中总的阳性表达率为71.67%(43/60)。在30例肿块全消和30例肿块残留的NPC组织中,iNOS阳性表达率为分别为86.67%、53.33%,差异具有显著性(χ2=6.748,P=0.034)。两组间iNOS弱阳性及中等阳性表达差异无显著性,而强阳性表达全消组低于残留组,差异有显著性(χ2=4.246,P=0.039)。结论:治疗前检测iNOS在NPC组织中的表达,对预测DDP同期放化疗疗效有一定的价值,可根据其表达情况,选择相对合理的同期放化疗方案。     

The efficacy of concurrent cisplatin and 5-flurouracil chemotherapy and radiation therapy for locally advanced cancer of the uterine cervix

Objective

To evaluate the efficacy of concurrent chemoradiation (CCRT) using 5-flurouracil (5-FU) and cisplatin for locally advanced cervical cancer.

Methods

We reviewed the medical records of 57 patients with locally advanced cervical cancer (stage IIB-IVA and bulky IB2-IIA tumor) who underwent the CCRT at Dong-A University Hospital from January 1997 to June 2007. The CCRT consisted of 5-FU, cisplatin and pelvic radiation. Every three weeks, 75 mg/m² cisplatin was administered on the first day of each cycle and 5-FU was infused at the dose of 1,000 mg/m²/d from the second day to the fifth day of each cycle. Radiation was administered to the pelvis at a daily dose of 1.8 Gy for five days per week until a medium accumulated dose reached to 50.4 Gy. If necessary, the radiation field was extended to include paraaortic lymph nodes. Consolidation chemotherapy was performed using 5-FU and cisplatin.

Results

Fifty-seven patients were enrolled and the median follow-up duration was 53 months (range 7-120 months). The overall response rate was 91.5% (74% complete response and 17.5% partial response). The 5-year overall survival and 3-year progression free survival rates were 69.4% and 74.9%, respectively. During the follow-up period (median 23 months, range 7-60 months), fourteen patients were diagnosed as recurrent disease.

Conclusion

CCRT with 5-FU and cisplatin which is the primary treatment for patients with locally advanced cervical cancer was effective and well tolerated.     

调强放疗同步化疗治疗宫颈癌血液学毒性相关因素分析

目的 探讨调强放疗同步化疗治疗宫颈癌的过程中出现严重血液学毒性的相关因素。方法 回顾性分析126例调强放疗同步化疗的宫颈癌患者资料,对同步放化疗期间可能与严重血液学毒性相关的因素进行单因素和多因素分析。结果 单因素分析显示严重血液学毒性的发生与治疗前肌酐水平、放疗前是否接受化疗及是否有骨髓抑制、骨盆骨髓平均剂量、V20、V40及V50有关（P<0.05）。多因素分析显示骨盆骨髓平均剂量（OR: 1.004, 95%CI: 1.002~1.007）、V40（<41% vs. ≥41%, OR: 0.040, 95%CI: 0.007~0.235）、V50 （<9% vs. ≥ 9%, OR: 0.040, 95%CI: 0.011~0.152）和治疗前肌酐水平（<65 μmol/L vs.≥65 μmol/L, OR: 0.116, 95%CI: 0.030~0.441）与3~4级血液学毒性相关。结论 治疗前肌酐<65 μmol/L、V40<41%和V50<9%是宫颈癌患者同步放化疗期间3~4级血液学毒性发生率降低的相关因素。骨盆骨髓平均剂量越高,血液学毒性发生率增高。治疗前评估肾功能水平,严格控制骨盆骨髓的放疗照射体积及剂量,能减少宫颈癌患者血液学毒性发生,是顺利完成调强放疗同步化疗的保障。     

A comparison of three measures of estimating premorbid intellectual level in dementia of the Alzheimer type

Estimation of premorbid intellectual function is becoming increasingly recognized as a crucial component of neuropsychological assessment in both research and clinical practice. Estimation based on accuracy of pronunciation of irregular words via the National Adult Reading Test (NART) has become popular. However, alternative methods have recently been developed, including the Cambridge Contextual Reading Test (CCRT) and the Spot-the-Word Test (STW). In the present study, the three methods were compared in 21 elderly patients with dementia of the Alzheimer type (DAT), relative to a large sample of healthy controls. Performance on all three measures was relatively unaffected by DAT, and in the controls, both the NART and the CCRT correlated relatively well with current verbal intelligence. However, the correlation between the STW and current verbal intelligence was disappointingly low. The DAT subjects showed a significantly greater improvement in performance (relative to controls) when the irregular words were placed in context (meaningful sentences). The results suggest that the CCRT may provide the fairest estimate of premorbid verbal intelligence in DAT.Copyright © 1998 John Wiley & Sons, Ltd.     

次级淋巴组织趋化因子及其受体CCR7在肿瘤侵袭和淋巴转移中的研究进展

次级淋巴组织趋化因子（SLC）是近年发现的一种新的趋化因子,高表达于次级淋巴组织,能趋化并活化T淋巴细胞、树突状细胞和自然杀伤细胞等免疫效应细胞,在机体淋巴细胞的迁移归巢、抗肿瘤、抗感染过程中具有重要作用。CCR7是SLC的高亲和力受体,近年来研究发现,CCR7和SLC的表达与肿瘤的淋巴转移密切相关。现综述SLC及其受体CCR7的生物学特性和主要功能,并重点阐述SLC和CCR7在肿瘤侵袭和淋巴转移中的研究现状。