The therapeutic frame revisited: A contemporary perspective.

Argues that since it was first proposed, the therapeutic "frame" has been widely adopted in a relatively unquestioned manner despite major modifications in clinical theory and practice. A reexamination of the frame from a contemporary perspective is presented. While traditional conceptions of the frame emphasize its function for the client, it is argued that this structure also serves a crucial purpose for the therapist. By minimizing the opportunity for self-indulgence (e.g., by fostering abstinence, anonymity, and neutrality), the frame enables the clinician to maintain a therapeutic stance and to create an environment that fosters comprehension of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intrapsychic and interactive dimensions of resistance: A contemporary perspective.

An integration of contemporary perspectives on resistance analysis is presented that emphasizes the salience of both intrapsychic and interactive dimensions of this phenomenon. Viewed as embodying desperate psychological imperatives imbued with unconscious infantile misconceptions, resistance is presented as serving multiple functions and encompassing aspects of all mental action within the psychoanalytic situation. Finding the analytic resources to exploit its relevant meanings is described as a central and indispensable aspect of working in depth. Several basic strategies for working with these phenomena are delineated in this article and the continued usefulness of understanding the role of resistance as guardian of psychic equilibrium is highlighted. Emphasis is given to safeguarding an analytic relationship that both sustains the patient and provides a vehicle for the exploration and modification of resistant activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Valvular disease associated with systemic illness

The connective tissue diseases are immune-mediated inflammatory diseases that manifest predominantly with symptoms and signs of musculoskeletal and mucocutaneous inflammation. They frequently affect the heart valves, pericardium, and myocardium. In patients with AKS, the aortic root and conduction system are also frequently involved. Echocardiographic series in these patients have demonstrated that valvular disease is highly prevalent and associated with substantial morbidity and mortality (Table 1). The prevalence rates of clinically detected valvular disease, however, are either unknown or low. This discrepancy is related to lack of awareness, overshadowing of the cardiovascular manifestations by the inflammatory symptoms and signs of the musculoskeletal system, lack of systematic application of the history and cardiovascular physical examination, and high sensitivity of echocardiography for detecting subclinical abnormalities. Several valvular abnormalities have been identified as unique to a specific disease. Libman-Sacks vegetations, valve nodules, and subaortic bump are characteristic of SLE, RA, and AKS (see Table 1). The valvular complications and respective therapy are similar to those of other causes of valvular disease; however, the associated morbidity and mortality of these complications in these patients are high. The worse prognosis of valvular disease in these patients is related to the chronicity and debilitating nature of their illness, their high prevalence of multisystem disease, and immunosuppression. These factors underscore the importance of early recognition, prevention of complications, and proper clinical or echocardiographic follow-up. The distinctive echocardiographic characteristics of the valve abnormalities associated with the connective tissue diseases may allow their differentiation from other common valvulopathies, such as infective endocarditis, rheumatic valvular disease, and degenerative valvular disease (Table 2). Despite the clinical and prognostic implications of valvular disease associated with the connective tissue diseases, incomplete data are available about pathogenesis, relation to clinical features of the primary disease, evolution, and effect of steroid or cytotoxic therapy. Echocardiography, especially TEE, has the potential to redefine the prevalence rates and to characterize better the valve abnormalities associated with these conditions. Finally, future large cross-sectional and longitudinal studies using clinical and echocardiographic data may help to define better the presence, evolution, and therapy of the valvular disease associated with the connective tissue diseases.     

Predicting risk for pregnancy by late adolescence: A social contextual perspective.

To evaluate a model of social contextual influences on risk for adolescent pregnancy, 368 target adolescents (52% female, 48% male) and their mothers, fathers, and closest age siblings were assessed 6 times over a 7-year period beginning when the target adolescents were in 7th grade. Two pathways were found to increase risk for involvement in a pregnancy by late adolescence. Middle adolescent risk-taking behavior mediated the influence of early adolescent parental warmth–involvement and deviant-peer affiliations on involvement in a pregnancy by 12th grade. Also, early adolescent academic competence mediated the relationship between parental warmth–involvement and involvement in a pregnancy by 12th grade. Theoretical and practical implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

对妊娠合并心脏病患者心理干预的临床分析

目的:探讨心理干预对妊娠合并心脏病的作用.方法:对妊娠合并心脏病的住院病人有针对性地进行心理干预,探索心理干预对妊娠合并心脏病的作用以及对疾病康复效果.笔者对2007.6年至2010.6年的83个妊娠合并心脏病的住院病人,对各自不同的心理状况,有针对性地进行心理干预和疏导.结果:通过入院前后的量表调查,了解到病人的心理状况基本恢复正常.结论:心理干预是预防和控制妊娠合并心脏病的基础和前提,能消除病人的不良心理因素,减轻心理负担,避免心衰的发生,主动配合治疗护理,有利于妊娠合并心脏病的康复.     

Prevalence of heart disease diagnosed de novo in pregnancy in a West London population

OBJECTIVES: To determine the prevalence of heart disease diagnosed de novo in pregnancy in a West London population and to re-examine the current role of routine cardiovascular examination in antenatal care in the UK. DESIGN: Retrospective study. SETTING: Obstetric medical clinics at Queen Charlotte's and Chelsea Hospital, University College Hospital and Northwick Park Hospital. POPULATION: Three hundred and twenty women referred for cardiac evaluation during pregnancy. RESULTS: The majority of the 139 women referred specifically for evaluation of murmurs during pregnancy were found to have physiological murmurs (97%). Only four women (3%) were found to have significant cardiac lesions de novo in their pregnancy. Three of these four women were immigrants who had no previous history of heart disease. The only woman from the UK was already known to have a murmur from childhood. CONCLUSIONS: Our study shows that heart disease diagnosed de novo in pregnancy in a West London population is an uncommon problem with low prevalence. It also appears to be a problem seen mainly in the immigrant population. The results emphasise the importance of taking a thorough medical history in all pregnant women. However, our results if they are confirmed, would suggest that only immigrants and those with significant symptoms or a known history of heart murmur or heart disease need undergo cardiovascular examination during pregnancy. These findings need to be confirmed in a larger group in other parts of the UK before further recommendations on selective cardiovascular examination can be made. This will have significant implications for midwifery-led care.     

The care of patients with ischaemic heart disease from a gender perspective

In summary, there are gender and age differences in prevalence, prognosis and manifestation of cardiovascular disease, a phenomenon which has been known for a long time. Nevertheless, it is only since the end of the 1980s that this has been generally discussed and that research has been commenced with specific reference to female coronary artery disease, not only in Sweden but internationally as well. The reason for this gender difference is not known, but it has been suggested that women are cared for and treated differently. In recent years, reports have been received from different centres which indicate that there are gender differences in the use of diagnostic and therapeutic measures in cardiovascular disease. Because of this gender difference in prognosis, investigation and treatment, special measures need to be applied in the care of female cardiovascular patients. It is also very important that randomized studies include a sufficient number of women in order to be able to answer gender-specific questions. The good prognosis for women with angina shown in the Framingham study most likely reflected a high prevalence of women with chest pain originating from disease other than that affecting the coronary arteries. This created the impression that women tolerated angina better; thus, angina in women has been given less attention. It is likely that this has led to incorrect decisions concerning investigation and treatment alternatives, resulting in an inability to identify the high-risk woman in time. When she is finally admitted to proper care, she is older, has concomitant diseases and revascularization often has to be performed at an acute, unstable stage, which leads to higher mortality and morbidity in connection with the intervention. This phenomenon has been described as the so-called 'Yentl syndrome' i.e. a woman has to masquerade as a man in order to receive the same treatment. More medical research needs to be done on women's health to come to terms with this problem. Hitherto, major efforts have been made to obtain homogeneous groups in research studies, which is why there are lots of results containing data on middle-aged white men. Even in tests on rats the females are excluded. The results of studies performed exclusively on men cannot be generalized to apply to women without evidence that the results can be used safely and effectively on both sexes. Research on health problems that are common to both sexes must include both men and women, preferably of all ages. It is also important to point out that unnecessarily restrictive inclusion criteria diminish the ability to generalize the results. Moreover, the chance increases of being able to detect a difference in the effects of treatment in a population with an increased risk, such as the elderly and women with a high frequency of recurring coronary artery disease. There are sill many questions to be answered before we can treat women with coronary artery disease properly.     

Rendu-Osler-Weber disease and intracranial hemorrhage during pregnancy. A case report

A 24-year-old woman with Rendu-Osler-Weber disease presented an intracranial hematoma during pregnancy. The main localizations of the Rendu-Osler-Weber disease, an inborn disease, are discussed. Neurological complications are rare. Vascular malformations are more fragile during pregnancy. The obstetrical attitude depends on the organ involved and the severity of the complications.     

Health promotion and coronary heart disease: A rejoinder.

Replies to the contention of R. C. Lefebvre (see record 1986-20193-001) that the review by the present author (see record 1985-12441-001) of the diet/heart controversy is one-sided and will induce uncertainty. Although there is no disagreement that preventive efforts should be supported, concern is expressed about Lefebvre's suggestion that a discussion of inconsistent scientific data should be avoided. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological predictors of heart disease: A quantitative review.

A meta-analysis, or quantitative review, was performed to integrate and organize the results of studies that investigated certain personality variables in relation to coronary heart disease (CHD). The personality variables included were anger, hostility, aggression, depression, extroversion, anxiety, Type A, and the major components of Type A. The meta-analytic framework helps focus attention on issues needing clarification. The results indicate that modest but reliable associations exist between some of the personality variables and CHD. The strongest associations were found for Type A and, surprisingly, for depression, but anger/hostility/aggression and anxiety also related reliably to CHD. The Structured Interview diagnosis of Type A was shown to be clearly superior to the Jenkins Activity Survey as a predictor of CHD. The Type A–CHD relation was smaller in prospective than in cross-sectional studies and smaller in recent than in less recent studies. This review also revealed that information about the interrelations of personality predictors of CHD is sorely needed. The picture of coronary-proneness revealed by this review is not one of a hurried, impatient workaholic but instead is one of a person with one or more negative emotions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of contemporary ideomotor theory.

[Correction Notice: An erratum for this article was reported in Vol 136(6) of Psychological Bulletin (see record 2010-20845-001). In the Online First Publication of the article “A Review of Contemporary Ideomotor Theory” by Yun Kyoung Shin, Robert W. Proctor, and E. J. Capaldi (Psychological Bulletin, posted September 6, 2010, doi: 10.1037/a0020541), the title of the article was incorrectly listed as “A Review of Contemporary Idiomatic Theory.” All versions of this article have been corrected.] A framework for action planning, called ideomotor theory, suggests that actions are represented by their perceivable effects. Thus, any activation of the effect image, either endogenously or exogenously, will trigger the corresponding action. We review contemporary studies relating to ideomotor theory in which researchers have investigated various manipulations of action effects and how those effects acquire discriminative control over the actions. Evidence indicates that the knowledge about the relation between response and effect is still a critical component even when other factors, such as stimulus–response or response–response relations, are controlled. When consistent tone effects are provided after responses are made, performance in serial-reaction tasks is better than when the effects are random. Methodology in which acquisition and test stages are used with choice–reaction tasks shows that an action is automatically associated with its effect bilaterally and that anticipation of the effect facilitates action. Ideomotor phenomena include stimulus–response compatibility, in which the perceptual feature of the stimulus activates its corresponding action code when the stimulus itself resembles the effect codes. For this reason, other stimulus-driven action facilitation such as ideomotor action and imitation are treated as ideomotor phenomena and are reviewed. Ideomotor theory also implies that ongoing action affects perception of concurrent events, a topic which we review briefly. Issues concerning ideomotor theory are identified and evaluated. We categorize the range of ideomotor explanations into several groups by whether intermediate steps are assumed to complete sensorimotor transformation or not and by whether a general theoretical framework or a more restricted one is provided by the account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A realist perspective.

Discusses whether changes in theoretical positions in psychology represent genuine progress or merely current opinion and proposes that psychology's problems are epistemological rather than ethical. A realist position is espoused that is not in line with the dominant view in psychology of the relation between theorizing and data and of the proper way to settle scientific disputes. An instrumentalist position like that of constructionism is suggested to lead to lower levels of evidential sensitivity. Some unsound doctrines that are implicitly or explicitly adopted are explored. First, because certain truth is unattainable, truth should be abandoned as the primary criterion of theories. Secondly, there is no difference between theories and models. The third doctrine is that of dualism, which has recently emerged in arguments about the logic of treatment evaluation in psychology. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)