Questioning the couch: Historical and clinical perspectives.

Since the beginning of the last century, when Freud introduced the couch in the psychoanalytic room, a number of “objects” have been removed or renovated, yet the couch has almost always remained in place, at least officially. This article has two distinct aims. The first is to offer a reconstruction of the psychoanalytic history of this element of the setting. The second is to rethink the couch, saving it from being reduced to a mere icon. Recent contributions coming from affective neurosciences, infant research, and psychotherapy research seem to question the utility of this element and the nature of the very mechanisms of its therapeutic action. The authors wonder whether the use of the couch is primarily protective for the therapist rather than necessarily helpful for all patients. Taking into account these observations implies bringing the couch out from a silent dimension and reflecting on its role in the conception of therapeutic action and mental functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Historical perspectives on the multicultural guidelines and contemporary applications.

Developing multicultural competencies and guidelines in the field of psychology was a long and challenging process. Therefore, when the "Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists" (American Psychological Association, 2003) were finally approved, it marked a significant event for multicultural advocates and the profession as a whole. This article presents some of the events that led to the approval of the guidelines and describes some of the ways in which psychologists may apply the guidelines in their work as clinicians, educators, and researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The 50th anniversary of the Thayer Conference: Historical perspectives and accomplishments.

Information from several historical sources provides a clearer understanding of the Thayer Conference, including little-known background information. Changes in school psychology since the conference are described through comparisons of the field at the time of the conference and at present. Major recommendations and expectations emanating from the Thayer Conference are reviewed against subsequent developments in the field. Most of the recommendations for the future of the field have been accomplished. Those in favor of two levels of training, credentialing, and service provision continue to divide school psychology and work against its organizational unification and parity with other specialties. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Brain infarction and the clinical expression of Alzheimer disease. The Nun Study

OBJECTIVE: To determine the relationship of brain infarction to the clinical expression of Alzheimer disease (AD). DESIGN: Cognitive function and the prevalence of dementia were determined for participants in the Nun Study who later died. At autopsy, lacunar and larger brain infarcts were identified, and senile plaques and neurofibrillary tangles in the neocortex were quantitated. Participants with abundant senile plaques and some neurofibrillary tangles in the neocortex were classified as having met the neuropathologic criteria for AD. SETTING: Convents in the Midwestern, Eastern, and Southern United States. PARTICIPANTS: A total of 102 college-educated women aged 76 to 100 years. MAIN OUTCOME MEASURES: Cognitive function assessed by standard tests and dementia and AD assessed by clinical and neuropathologic criteria. RESULTS: Among 61 participants who met the neuropathologic criteria for AD, those with brain infarcts had poorer cognitive function and a higher prevalence of dementia than those without infarcts. Participants with lacunar infarcts in the basal ganglia, thalamus, or deep white matter had an especially high prevalence of dementia, compared with those without infarcts (the odds ratio [OR] for dementia was 20.7, 95% confidence interval [95% CI], 1.5-288.0). Fewer neuropathologic lesions of AD appeared to result in dementia in those with lacunar infarcts in the basal ganglia, thalamus, or deep white matter than in those without infarcts. In contrast, among 41 participants who did not meet the neuropathologic criteria for AD, brain infarcts were only weakly associated with poor cognitive function and dementia. Among all 102 participants, atherosclerosis of the circle of Willis was strongly associated with lacunar and large brain infarcts. CONCLUSION: These findings suggest that cerebrovascular disease may play an important role in determining the presence and severity of the clinical symptoms of AD.     

Commentary on "The 50th anniversary of the Thayer Conference: Historical perspectives and accomplishments".

This article comments on Thomas Fagan's historical account (see record 2005-12578-002) of the 1954 Thayer Conference. The Thayer Conference was an important milestone for school psychology and sought to deal with issues such as credentialing, role and function, and training issues for our field. The article provides an excellent framework for understanding this very important conference as well as elucidating how it applies to our current practice. With differences between nondoctoral- and doctoral-level school psychologists continuing, both groups support the field and the manner in which school psychologists are trained and credentialed. The movement to different assessment and treatment strategies is exciting, and the incorporation of research into practice provides not only an important development in our field, but also a reluctance on the part of many to take this type of step away from traditional practice to one that is based on empirically supported practice and intervention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The myth of the nuclear family: Historical background and clinical implications.

Explores the framework from which the nuclear concept of family organization emerged. The studies and evidence reviewed indicate that the nuclear conception of the family is inadequate, misleading, and extremely pernicious when relied on for an understanding of the dynamics of family functioning or as a guide for therapeutic intervention. Clinical practitioners and psychological theorists play a notable role in fostering the nuclear myth. An emerging transactional and extended perspective on the family is presented, and the consequences and clinical implications of the nuclear mythology are examined. (67 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of prosthesis material in emergency surgery. Comments on a clinical case

The authors briefly report the case of a patient in whom a double Mersilene graft was used to repair a strangulated umbilical hernia. This report is interesting for various reasons. Firstly, the fact that surgery was performed under emergency conditions and secondly, the position of the graft, which was certainly not ideal--even if obligatory owing to the circumstances under which the operation was performed--in the abdominal wall. In spite of the successful results obtained, the authors feel that graft should preferably be used in elective surgery in which additional operations are not required which may further contaminate the operating field. In particular, special attention should be paid to graft position in relation to the various layers of the abdominal wall.     

Discrepancies between patient recall and the medical record. Potential impact on diagnosis and clinical assessment of chronic disease

BACKGROUND: During a case-control study, data necessary for fulfilling diagnostic and classification criteria for spondyloarthropathy were collected from 121 patients. OBJECTIVE: To study the potential impact of differences between patient recall and the medical record on diagnosis and clinical characterization of spondyloarthropathy as a model of chronic disease. METHODS: The study was conducted among four Alaskan Eskimo populations served by the Alaska Native Health Service. Two sets of historical data were compiled for each subject, one acquired during the interview and the other derived from the medical record. Paired items from the interview and the medical record were analyzed to determine discrepancies and consequent effects on diagnosis, classification, and disease characterization. RESULTS: Significant differences were observed in the reporting of genitourinary or diarrheal illnesses preceding or associated with arthritis, the occurrence of eye inflammation in association with joint pain, the occurrence of joint pain and back pain together, and the age at onset of back pain all of which are important to the diagnosis and classification of spondyloarthropathy. In contrast, for information needed to establish the probable inflammatory nature of back pain, patient interview was more helpful than the medical records, which did not provide adequate details to differentiate inflammatory from mechanical back pain. CONCLUSIONS: Patient recall bias can substantially affect diagnosis and clinical assessment of chronic disease, as exemplified by spondyloarthropathy. Reliance on records alone, however, may lead to underestimation of features that require subjective appraisal by the patient.     

The effects of movement on perspective taking and the coordination of perspectives.

Two experiments with a total of 112 children in Grades 3 and 5 investigated imagined vs actual movement and visible vs hidden array. Major findings are as follows: Movement to the new location significantly improved perspective-taking scores but did not improve coordination scores, and with respect to coordination scores, movement resulted in the substitution of one type of egocentric error for another. Results are interpreted to mean that the self is an important referent for calculating spatial transformations. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The anatomic basis and clinical applications of flaps based on the posterior tibial vessels

The vascular anatomy of the posterior tibial vessels has been studied in 20 legs of 10 cadavers. The number, size and distribution of the direct cutaneous and direct muscle branches of the posterior tibial vessels were recorded. For analysis, the leg was divided into four equal segments, Zone I being the most distal and Zone IV the most proximal. The direct cutaneous branches were found to cluster mainly around Zone II. The direct muscle branches to the soleus and flexor digitorum longus muscles arose chiefly in Zones II and III. Based on this knowledge, we performed fasciocutaneous, island soleus muscle, musculo-fasciocutaneous and flexor digitorum longus muscle flaps based on the posterior tibial vessels in 12 patients. Four were free fasciocutaneous flaps and eight were pedicled flaps. All flaps survived and there were no major complications. Delayed wound healing was encountered in three patients.     

Obsessive-compulsive disorders in children. A review based on recent research and clinical experiences

This article describes obsessive-compulsive disorder in childhood through a review of some recent research topics and the author's own clinical experiences with the disorder. Among the topics discussed are diagnosis, differential diagnosis, phenomenological characteristics and treatment recommendation. The article concludes that although recent research on obsessive-compulsive disorders in children has lead to important advances in our understanding and treatment of the disorder, much remains to be addressed. Research on childhood obsessive-compulsive disorder in Norway seems to be non-existent, and the author calls attention to the need for empirical studies at Norwegian research institutions. These should include research on treatment preferences in Norwegian child psychiatry clinics.     

The clinical psypsychologist's opportunities and obligations in the community.

A discussion of the role of the clinical psychologist in working within society, in the community, to apply his abilities to the molding of social structure, for "only by going where society is can we maintain ourselves." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current perspectives on using linguistic and cultural factors in counseling the Hispanic client.

This review of the literature examines the role of language and culture in the mental health treatment of Hispanic clients. Several innovative approaches including the use of dichos and cuento therapy are described that incorporate linguistic and cultural traits in treatment. The article proposes that the assessment of such factors as language proficiency, level of acculturation, and the degree to which cultural expressions represent symptomatology should be considered in the development of an effective treatment plan. The process of acculturation is presented as a critical dimension influencing language, cultural beliefs, and mental health. Recommendations are made for future research on issues relating to the use of language switching and language mixing in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of noninsulin dependent diabetes mellitus on the prevalence of clinical osteoarthritis. A population based study

OBJECTIVE: To explore the relation between noninsulin dependent diabetes mellitus (NIDDM) and osteoarthritis (OA) in a population. METHODS: The study population included 632 men and 882 women aged 52-95 years from the Rancho Bernardo community. In 1984-87, participants answered questions about history of diabetes and had a standard oral glucose tolerance (OGTT). In 1988-92, subjects completed a questionnaire about history of arthritis, type of arthritis diagnosed, and presence of joint pain. Nurses examined subjects for presence of Heberden's nodes. Subjects with no history of arthritis were compared to those with a history of OA and other types of arthritis with regard to age, body size, and plasma glucose levels. In addition, subjects were classified by diabetes status to determine differences in the prevalence of arthritis and related characteristics. RESULTS: Neither impaired glucose tolerance nor NIDDM was associated with history of OA, regardless of how inclusive the definition of OA, before or after adjustment for age and maximum lifetime obesity. In age and obesity adjusted analyses, men with a history of OA had lower fasting plasma glucose levels than men with no arthritis (100.2 vs. 103.6 mg/dl, p < 0.05), and men with NIDDM had less hand and hip pain than normoglycemic men (p < 0.05). Heberden's nodes were unrelated to glucose tolerance status. CONCLUSION: This population based study found no positive association between clinical OA and NIDDM defined by OGTT. These results are compatible with community based data examining radiographic OA and history of diabetes.     

The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy

The irritant potential of calcipotriol, 1 alpha,24-dihydroxyvitamin D3 (tacalcitol) and 1 alpha,25-dihydroxy-vitamin D3 (calcitriol) was compared in a hairless guinea pig model, Randomized, occlusive patch testing for 2 days was used. Each group of 8 animals was tested simultaneously with the 3 substances and a placebo vehicle. 3 dose levels i.e. 500 micrograms/ml, 50 micrograms/ml and 5 micrograms/ml were used. Test sites were evaluated at day 2 (2 h after removal of the patches) and again at day 3. Evaluation was blinded and based on a multiple parameter assessment of skin irritancy, comparing clinical scoring, skin perfusion using high resolution laser Doppler image scanning, skin colour (a*, Minolta ChromaMeter) and skin thickening (20 MHz ultrasound) indicating oedema. Skin biopsies were taken for histological preparation and assessment of epidermal hyperplasia. No difference was observed between the irritant potential for calcipotriol, tacalcitol and calcitriol based on clinical scoring as well as objective non-invasive measuring techniques. All 3 substances showed a dose-dependent and equal increase in clinical irritation score, cutaneous blood flow, skin colour and epidermal hyperplasia. The cutaneous inflammatory reaction was dominated by vasodilation and increased cutaneous perfusion. Oedema formation was only seen at the highest dosages tested. Skin barrier damage was not induced as TEWL remained unaffected. The hairless guinea pig appears a valid model to test irritancy of topical D-vitamins since the same profile of irritancy was previously established in humans for 2 of the compounds tested, calcitriol and calcipotriol.     

Etio-pathogenic considerations on the development of multiple bone cysts in the mandible. Report of a clinical case

A case of a mandibular cyst, missing of wall lining and containing some solid material is described. The histologic examination showed that this material consisted of osteofibrous tissue with regressive phenomena, inflammatory cells and hyperplastic nervous tissue. On the basis of clinical and histologic findings it is suggested to be a solitary cyst and the solid material due to a local response to an injury suffered by the patient who is a sport practitioner.     

Contrasting perspectives on the nature of sexual assault provided by a service for sexual assault victims and by the law courts.

Examined data on 1,236 cases responded to during a 5-yr period by a sexual assault service (SSAV) and 116 cases during the same period that appeared before the courts, 58 of them involving abuse of children under 16 yrs old. Large numbers of adult women had been sexually assaulted while persuing normal heterosexual social activities, and children had been abused primarily in their own home by family members. The profiles of victims in the court cases reflected the more traditional views of sexual assault that still appear to hold sway in the legal system. In the courts, adult female victims tended to have been violently assaulted by disturbed men, and child victims tended to be those who were abused outside the family. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)