The therapeutic alliance--a proteus in disguise.

The therapeutic alliance is a vital component of not only the psychoanalytic relation but of all therapeutic encounters between psychotherapist and patient. Despite the universal application and realization of the alliance concept in therapeutic endeavors, it is often ignored as an operative concept in the therapeutic theoretical armamentarium or is formulated in alternative terms. It also comes into play implicitly, even when the concept is formally dismissed as irrelevant. This discussion addresses the meaning and variations of expression of the alliance in the clinical setting and focuses particularly on ways in which the alliance is actually formulated in alternate terms that usually address some partial aspect of the alliance without acknowledging its relevance or importance in the therapeutic relationship and interaction between therapist and patient. I conclude that even when its role in therapy is ignored, minimized, or denied, the alliance continues to play a vital role that requires therapeutic attention and processing in its own right. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic alliance: Theme and variations.

The therapeutic alliance is often misconceived, misunderstood, or ignored in conceptualizing the therapeutic process and the therapeutic relation in analysis and other forms of therapy. Conversely, I will argue that the alliance is indispensable in all forms of therapy. After briefly outlining the nature of the alliance, I discuss some of the empirical findings regarding its utility in various therapeutic contexts. I then consider its role and function in various therapeutic settings other than adult analysis and psychotherapy, including child analysis, treating various forms of psychopathology, and related contexts like supervision, forensic psychiatry, and hospital and medical treatment. The alliance plays a definite but analogous role in all of these, with differences according to context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metabolism and regulation of nitric oxide: a hard-to-control mediator

Although nitric oxide (NO) is implicated in numerous regulatory mechanisms, its therapeutic use remains problematic. Synthesis of this mediator of low specificity with multiple effects involves two types of enzymes (constitutive and inducible). The complexity of the corresponding regulatory mechanisms precludes control for therapeutic use. As NO interacts with numerous metabolic pathways and can also be stored, interpretation of experimental results is difficult, which hinders development of therapeutic trials. In addition, NO is a free radical and thus participates in the free radical cascade. Another difficulty in use of NO is its role in equilibrium implicating still poorly understood mediators (such as endothelin at a vascular level). The complexity of NO pathways explains why therapeutic trials of NO to date have proven unsatisfactory except for treatment of arterial pulmonary hypertension.     

Therapeutic alliance: Its place as a process and outcome variable in dynamic psychotherapy research.

Argues that conceptual unclarity has surrounded psychotherapy research efforts to define and measure the therapeutic alliance. A precisely defined conception of the therapeutic alliance is offered that focuses on the patient's active collaboration in the tasks appropriate to the treatment process. The therapeutic alliance is thus distinguished from patient characteristics and attitudes as well as from therapist contributions to the formation of the alliance. The importance of the therapeutic alliance as a change measure in process research is underscored, and its place as a primary indicator of outcome is described. Empirical studies are reviewed, with particular reference to the Menninger Treatment Interventions Project, and the use of single-case methodology is considered. The special relevance of the therapeutic alliance to the investigation of the therapeutic change process with borderline patients is outlined. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of helium-oxygen gas mixtures in acute obstructive respiratory insufficiencies

Therapeutic use of helium has been described since 1930. Its main action is to reduce bronchial resistances and consequently overall respiratory work. Helium is substituted for nitrogen. The effects of inhaling a helium-oxygen mixture result exclusively from the physicochemical properties of helium: very low density, high kinetic viscosity. With the advent of selective bronchodilators, use of helium was rapidly abandoned until recently with new interest for the treatment of severe acute asthma. We review the literature on the physical properties of helium-oxygen mixtures and propose an analysis of their therapeutic use in severe acute asthma as well as other indications such as acute episodes of obstructive bronchopneumonia and obstruction of the upper airways. Due to the non-invasive nature of this technique, its easy use with spontaneous ventilation and the large body of theoretical data emphasizing its adaptation for therapeutic use, helium-oxygen gas mixtures offer an important therapeutic option for treating severe diseases with poor prognosis. A multicentric national study is under way to validate its use early by emergency ambulatory units for the treatment of severe acute asthma.     

Therapeutic jurisprudence: Five dilemmas to ponder.

This article identifies and examines 5 conundrums confronting therapeutic jurisprudence. Is therapeutic jurisprudence distinguishable from other jurisprudences that share its goal of using the law to improve the well-being of others (the identity dilemma)? Can the term therapeutic be defined in a meaningful way (the definitional dilemma)? Will the vagaries of empirical research, on which therapeutic jurisprudence heavily relies, doom its proposals (the dilemma of empirical indeterminacy)? How will a therapeutic jurisprudence proposal that benefits only a subgroup of those it affects be implemented (the rule of law dilemma)? When and how should a therapeutic jurisprudence proposal be balanced against countervailing constitutional and social policies (the balancing dilemma)? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generalization and maintenance in therapeutic systems: Analysis and proposal for change.

The position presented is that generalization and maintenance of therapeutic gains are not adequately accounted for in many therapeutic systems. A discussion of the importance of these issues is followed by an analysis of the barriers to programming durable therapeutic change. Preliminary suggestions for enhancing accountability for long-term clinical outcome are provided. I conclude that the profession's internal monitoring of long-term outcome be considered a priority in the optimal delivery of clinical services and in ultimately controlling its own practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

John Rickman, Wilfred Ruprecht Bion, and the origins of the therapeutic community.

The history of psychiatric therapeutic communities is complex and obscure. Nevertheless, one can make a reasonable case for saying that the first true therapeutic community was created at Northfield Military Hospital, Birmingham, England, in 1945. That community had its origins in the thought and practice of two British psychoanalysts, John Rickman and Wilfred Ruprecht Bion. Accordingly, in the present article their careers and the social and intellectual influences bearing on them are discussed. The article then continues by describing Rickman's work as a military psychiatrist, Bion's prototype of a therapeutic community, and the therapeutic community that was eventually created at Northfield. It is hoped that the article will provide some of the groundwork for an adequate history of the therapeutic community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement of tacrolimus (FK506) and its metabolites: a review of assay development and application in therapeutic drug monitoring and pharmacokinetic studies

Tacrolimus (FK506, Prograf) is a macrolide immunosuppressant used for the prevention of organ rejection after transplantation. Tacrolimus demonstrates considerable interindividual variation in its pharmacokinetic profile. This has caused difficulty in defining the optimum regimen and has highlighted the need for therapeutic drug monitoring. Several assay methods for the measurements of tacrolimus in biological specimens have been developed. These assay methods were used for therapeutic drug monitoring and/or pharmacokinetic studies. Two commercially available immunoassays, based on the same monoclonal antibody to tacrolimus, have been used for therapeutic drug monitoring of tacrolimus in whole blood. For pharmacokinetic studies, the assay methods were used to measure tacrolimus and its metabolites in very low concentrations in selected biological matrixes to determine the metabolic and pharmacokinetic profiles of this drug.     

Current aspects in the diagnosis and therapy of hypothyroidism]

Also at present hypothyroidism is frequently not recognised, especially its discrete forms of the course should be more included in differential-diagnostic considerations. Decisive is the clinical anamnestic suspicion which, after exhaustion of the laboratory-diagnostic possibilities, will justify the application of probatory therapy, even on a relatively large scale. This disease deserves secial regard, taking into consideration its beneficial and well practicable therapeutic influencibility and, on the other hand, its sever prognostic consequences to the subject in case of therapeutic neglect. The problems of therapy are not so much consisting in the occurrence of side-effects or in a non-optimal choice of drugs, but the more in a delayed onset, low dosage or interruption of the therapy.     

Buerger's disease

Diagnostic criteria and therapeutic strategies for Buerger's disease have been established recently. However, there are many unknown factors concerning its etiology and exacerbation. Further studies are necessary for the better understanding of these factors and it is important to establish therapeutic modalities matching the pathology. Although drug therapy is the basic approach to treatment of the disease, aggressive surgical treatment also can prove to be effective in many cases.     

Endoscopic polypectomy in the large bowel--the pathologist's view

Colonoscopy remains the main diagnostic tool in colorectal diseases. Endoscopic polypectomy is a routine therapeutic method for colorectal adenomas, but its yield must be verified histologically. Complete endoscopic and histologic resection of an adenoma is regarded as a sufficient method of its treatment. Some early colon cancers can also be managed endoscopically, providing that strict histologic criteria are fulfilled. It is the duty of clinicians to supply pathologists with all the clinical data on the patient and to properly mark the resected specimen. Pathologists must understand the therapeutic technique, its limits, and provide physicians with a detailed histopathological report that includes not only a proper histological assessment of the resected tissue, but also a comment on completeness of the neoplasm resection. This article should help both clinicians and pathologists to benefit from the potential of histological examination.     

An appraisal of rational-emotive therapy.

Albert Ellis's rational-emotive therapy (RET) is scrutinized on several conceptual and empirical grounds, including its reliance on constructive assessment and its ethical stance. Its professional impact thus far exceeds its scientific status. Opinion varies on how even to define irrational beliefs; 1 consequence is problems in assessing them. Meta-analytic reviews provide support for the general utility of RET, but more qualitative reviews question both the internal and external validity of much of the published research. Lacking are process studies that can shed light on the mechanisms of therapeutic change, a situation likely due to the complexity of RET and to a lack of consensus as well about its very definition. Perhaps more progress can be achieved by forsaking studies of RET as a package and shifting instead to an examination of specific therapeutic tactics in particular circumstances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moral knowledge and the problems of psychotherapy.

The distinction between objective and subjective knowledge has a long philosophical history, but the modem version has ties to Hume's separation of reason and belief. The extraction of reason from mere habits of the mind raises its own problems concerning the possibility of knowledge (via the problem of induction). These problems are especially acute within the therapeutic context. Indeed, the inclusion of morals in psychotherapy is considered unethical. This arises from the assumption that morality is idiosyncratic and subjective whereas scientific knowledge is objective and thus closer to truth. The argument developed here is that the therapeutic endeavor is implicitly philosophical and civic in its assumptions. As such it requires the resources of moral and political philosophy as well as a standard by which to assess its achievements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The jurisprudence of therapeutic jurisprudence.

In less than a decade, therapeutic jurisprudence, which began as a scholarly approach to mental health law, has emerged as a mental health approach to law generally. In this essay, one of the founders of this new field offers a further elaboration of the theory of therapeutic jurisprudence and a response to the key issues raised by commentators and critics. This essay discusses the relationship between therapeutic jurisprudence and other schools of jurisprudence and analyzes the approach's normative focus and its limits. It also addresses how "therapeutic" should be defined, whether the approach is paternalistic, whether the limits of social science methodology doom the enterprise, how therapeutic and other potentially conflicting values can be reconciled, and how the law should respond when such conflicts persist. Finally, the essay charts the path of therapeutic jurisprudence and analyzes new developments in the field. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cervical lymph nodes metastases from a pituitary carcinoma

Ipratropium bromide is a synthetic derivative of atropine with little absorption when used in inhalation, and therefore little secondary effects. The authors review its pharmacological properties and therapeutic efficacy in the treatment of asthma in children. Combined nebulized inhalation of ipratropium bromide and beta 2 sympathomimetic results in a more efficient and more sustained bronchodilatation than beta 2 sympathicomimetic alone in the treatment of acute asthma in children. Ipratropium bromide should be usefully introduced in the therapeutic scheme of acute asthma in children. Further studies will be necessary in order to determine its efficacy and tolerance in infants.     

Videotherapy in the context of group therapy for late-latency children of divorce.

Although videotape has been used for a variety of clinical and research purposes, it is now being used in a unique fashion as a therapeutic tool in group treatment of late-latency children of divorce. The videotherapy takes the form of videotaped dramas staged by children, with the intent of making a "movie." The timing of its use is crucial, the child's stage of development is relevant, and its effectiveness is dependent on other therapeutic activities. Several differences appear to exist between videotherapy and usual role playing in therapy, chief of which is that the children invest their activity with more enthusiasm than is usually observed in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing closeness in psychotherapy.

Suggests that closeness is an elusive concept that nevertheless is central to the thinking of many psychotherapists about the process and goals of their work. Closeness is actually a metaphor that names something otherwise lacking a name. The author proposes that the behavioral correlate of an experience of closeness is an act of sharing. Managing closeness in psychotherapy therefore amounts to a series of decisions about what will be shared. An important characteristic of sharing is that it tends to be progressive, a source of its therapeutic power and its dangerousness. Implications of these ideas are examined, with particular attention to the problem of sexual abuse and those isolated individuals (both patients and therapists) who are more in need of therapeutic closeness and more vulnerable to its overextensions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative mold and yeast recovery analysis (the effect of differing incubation temperature ranges and growth media)

The Authors underline the most important pathological, clinical and therapeutic aspects of appendiceal adenocarcinoid. Appendiceal adenocarcinoid is quite a rare tumor, presently considered as a single entity; it differs from typical carcinoid of the appendix because of its well definite histology, its aggressive behaviour and its poorer prognosis. There are no precise prognostic and therapeutic criteria to direct the operative choice between appendectomy and hemicolectomy. In particular the tumor diameter is of no use since the tumor often present diffuse rather than nodular growth. According to most Authors appendectomy is not sufficient in the following cases: liver lymph-node or retroperitoneal metastases; cecal meso-appendiceal or peritoneal spreading; histological poorly differentiated tumors, with nuclear atypia and high mitotic count. Some Authors performed hemicolectomy and bilateral oophorectomy in all case with peritoneal involvement since the ovaries are a frequent site of metastases.     

A study of the pharmacokinetics of phenytoin (diphenylhydantoin) in epileptic patients, and the development of a nomogram for making dose increments

Phenytoin is metabolized to its parahydroxylated derivative by hepatic microsomal enzymes. This hydroxylation is a saturable process, that is, the rate of metabolism fails to increase in proportion to the serum concentration. This leads to a nonlinear relationship between the maintenance dose of the drug and the resulting steady-state serum level. As the therapeutic range of serum levels is reached, the increase in level produced by a given increment in dose becomes progressively greater. An increment of only 50-100 mg will carry the serum level from the lower to the upper limit of the therapeutic range in most patients. Thus, problems in bioavailability, noncompliance, and drug interactions are an important practical problem with this drug. Monitoring serum phenytoin levels during chronic therapy is an invaluable therapeutic aid, enabling dosage adjustments to be made in order to achieve a level within the therapeutic range. A nomogram is presented in this paper in order to assist the physician in making dosage increments.