Narcissism in the Rorschach revisited: Some reflections on empirical data.

This study investigates the extent to which the Rorschach was able to identify accurately pathological expressions of narcissism according to the methodological recommendations offered by T. Nezworski and J. Wood (1995) . Ninety-one patients who were found to meet DSM-IV criteria for an Axis II disorder (Cluster A personality disorders/&=/&10; antisocial/&=/&20, borderline/&=/&25, histrionic/&=/&5, narcissistic [NPD]/&=/&15; Cluster C personality disorders/&=/&16) and 50 nonclinical participants were compared on 5 Rorschach variables: reflection, pair, personalization, idealization, and the egocentricity index. The results of this study indicate that selected Rorschach variables can be used effectively to differentiate NPD patients from a nonclinical sample and from Cluster A, Cluster C, and other Cluster B personality disorders. Also, the reflection and idealization variables were found to be empirically related to DSM-IV diagnostic criteria for NPD and a self-report measure of NPD. Finally, these 2 variables could be used for classification purposes in ways that were clinically meaningful in the diagnosis of NPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Carotid restenosis: clinical significance and indications for reintervention

Carotid restenosis is defined as a new > 50% diameter-reducing lesion present in sites of previous surgery. The clinical aspects of this complication are strongly connected with their anatomopathologic evolution: fibromuscular hyperplasia in early recurrent disease, atherosclerotic degeneration in the later lesions. Routine postendarterectomy duplex surveillance is able to detect this pathologic evolution. On 570 surgically treated carotid artery a postoperative duplex surveillance was made at 3, 6, 12 months and then yearly. Totally 42 cases of recurrent stenosis (7.3%) were present: in seven cases (16.6%) with a complicated restenosis the patients were symptomatic. In 27 cases (64.2%) restenosis was < 75%, in 8 cases (19.2%) > 75%. Indication to surgery was given for all the complicated restenosis and for high grade stenosis (> 75%). In the 27 cases of restenosis < 75% a conservative therapy together with duplex surveillance was applied: in none of these cases the restenosis increased in an average follow-up of 13.7 months. In the reoperated cases we didn't observe any mortality nor postoperative stroke. With regard to their mainly hyperplastic origin, carotid restenosis are low symptomatic and with a quite benign evolution. Surgical reintervention is to be limited to the symptomatic cases and to the asymptomatic high grade stenosis cases. A particular attention should be reserved to the morphologic characteristics of the lesion in order to detect the atherosclerotic degeneration that might cause cerebral symptoms.     

Review of Affect in psychoanalysis: A clinical synthesis.

Reviews the book, Affect in psychoanalysis: A clinical synthesis by Charles Spezzano (see record 1993-97622-000). Charles Spezzano's Affect in psychoanalysis: A clinical synthesis is difficult to treat adequately in a short review. It's not that the book's main themes cannot be stated: Affects are at the heart of the human experience, reflecting the information that basically motivates us. Language affords us ways of approximating truth, but the closest we come to truth is through communication of affects. Freud's functional theory of affects is central to the practice of psychoanalysis even today. Interest excitement (as Spezzano calls it) is the organizing affect that underlies behavior. Charles Spezzano read a paper to Division 39 in 1991 that was entitled "The Enlightenment: One More Time, With Feeling." As Tabin listened, it seemed that Spezzano was leading to a new way of appreciating the shape of an analysis, by tracking what happens in terms of the patient's affects. The announcement of Affect in psychoanalysis was therefore most welcome. However, this book proves to be yet a preamble to where Spezzano's thinking might lead. In the meantime and above all, although practically everyone knows that psychoanalysis is about affects, once having read Affect in psychoanalysis, this knowledge becomes a keen awareness. Spezzano should feel very pleased with that. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New theoretical vistas in psychoanalysis: Louis Sander's theory of early development.

Discusses the development of L. Sander's theory of early development based on his research over the past 30 yrs. The theory considers the infant, its caretaking environment, and the exchange between them to be a living system. Coherence within the system is maintained through an endless ongoing exchange between the infant and its context of life support (caretaking environment). Sanders proposed an epigenetic sequence of 7 adaptive tasks describing a process whereby interactions originate in the management of basic physiologic states. The stages are as follows: initial regulation (1–3 mo), reciprocal exchange (4–6 mo), initiative (7–9 mo), focalization (10–23 mo), self-assertion (14–28 mo), recognition (18–36 mo), and reversal (18–36 mo). From this sequence, Sanders formulated 5 propositions relating recurrent infant states to the continuity of inner experience and to the achievement of a sense of agony in self regulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immediate implants: indications and clinical decision making

This paper is intended to describe the current concepts in timing of implant placement, and to address some of the controversies surrounding implants and bone grafting.     

Dreams and psychoanalysis: A love-hate story.

This article explores the early and contemporary relationship between dreams and psychoanalysis. Dreams, once at the center of psychoanalytic theory and practice, have lost their singular importance, having been replaced by other concerns (e.g., the therapeutic relationship). The causes of this decline are many and complex, but include, in this hypothesis, a long-standing underlying ambivalence (both love and hate) toward dreams and their interpretation in psychoanalysis. Aspects of this unacknowledged ambivalence include significant cultural, personal, and systemic factors, which are elaborated. Both appreciation, pleasure, and interest, on the one hand, and fear, suspicion, and domination, on the other, are described. The classical method and the interpersonal and relational approaches are examined in relation to dreams, and both are found to reflect difficulties in approaching dreams. Finally, the love–hate story is extended into the relation between dreams, psychoanalysis, and the new electronic era. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chimeric brain: theoretical and clinical aspects

Using xeno-transplantation, interactions of neural tissues of vertebrates and insects were studied. Ventral neurogenic primordium of Notch Drosophila melanogaster embryos was transplanted into neural tube of amphibian and mammalian embryos with the aid of microhydrofeeding. Embryos of four different amphibian species, random bred mice and rats were used as graft recipients. It was concluded that there is a possibility to incorporate nerve cells of insects into the brain of vertebrates. Morphological and functional contacts can be established between the transplanted cells and host brain tissues. Transplanted Drosophila cells preserve their viability for a long time, so that a prolonged influence of the transplant upon the recipient can be predicted, which may be used in medical practice. A mixture of human fetal brain and Notch Drosophila melanogaster neural embryonic tissues were transplanted into the ventro-lateral nucleus of the thalamus of the patients of Parkinson' disease. As a result, tremor and constrained movements disappeared. Post-operation patients have been observed within 13-38 months. No side effects were noted during this time.     

Destructiveness, atrocities and healing: epistemological and clinical reflections

In this paper, destructiveness is approached as a multi-dimensional phenomenon where the mental health perspective addresses only one of these dimensions. An attempt is made to locate this phenomenon in the context of epistemological and societal considerations. Critical of mono-dimensional explanations based on causal-reductive epistemology, the paper instead proposes the idea of an 'ecology of destructiveness', according to which mental health professionals cannot possibly continue to assume the role of detached observers. The ordinariness and archetypal fascination of destructiveness are discussed as preventing the psychologizing and pathologizing of it. In addition, it is suggested that 'destructiveness may be a tragic facet of the human condition', without this implying any justification of it. Based on my work with a group of Bosnian ex-camp prisoners, some basic principles of how one can work with survivors of atrocities are derived and discussed. A central feature of this work is the attempt to create an appropriate therapeutic context within which a 'therapeutic presence' and 'therapeutic witnessing' can be developed. Finally, the relevance of Jungian insights to this kind of work is reviewed and the emergence of new types of defences of the self is identified.     

MR cholangiopancreatography: technique, indications and clinical results

INTRODUCTION: MR cholangiopancreatography (MRCP) is a new noninvasive imaging technique for the study of biliopancreatic disorders, providing projectional images of the biliary tree and pancreatic duct without any contrast agent. MATERIAL AND METHODS: We used different sequences, with both breath-hold and nonbreath-hold techniques, to acquire MRCP images, first based on GE and then on FSE sequences. FSE images provide higher SNR and are less susceptible to artifacts (metal objects, motion and blood flow artifacts). At the Department of Radiology of the University of Rome La Sapienza, we acquired MRCP images with non breath-hold, 3D fat-suppressed TSE sequences (TR = 3000-2000, TE 700, turbo factor 128) optimized on a .5T magnet with 15 mT/m gradients. No patient preparation or sedation was required, although antiperistaltic drugs and oral administration of tap water were preferred. Four hundred and thirty patients were examined, all of them with an indication to conventional cholangiography. RESULTS: MRCP depicted the whole common bile duct and the first-order intrahepatic branches in all the normal cases. Its accuracy in identifying biliary obstruction level and site was 100%, versus 94.6% in characterizing its cause. MRCP had 96.3% diagnostic accuracy in choledocholithiasis, with some false positives and false negatives caused by: 1) small stones missed on MIP reconstructions; 2) signal loss due to complete CBD obstruction by stones; 3) pneumobilia; 4) differential diagnosis between small stones and air bubbles. The main role of MRCP in benign strictures is to provide a detailed map of the biliary tract for better treatment planning. In particular, MRCP is extremely useful in hepaticojejunostomy patients, where ERC is not indicated because of postoperative anatomical changes. Both conventional MRI and MRCP are important in malignant strictures to identify the lesion and to characterize and stage it. Finally, MR pancreatography is very useful to follow up chronic pancreatitis patients because it shows Wirsung duct strictures and dilatations, intraductal filling defects and, in some cases, the communication between the pseudocyst and the pancreatic duct. CONCLUSIONS: MRCP combined with conventional MRI can completely replace CT and ERCP in bilio-pancreatic disorders.     

Homophobia and psychoanalysis: A reply to Roughton.

Replies to R. E. Roughton's (see record 1994-27310-001) response to D. K. Flaks's (see record 1993-23357-001) article on homophobia and the psychologists's role in psychoanalytic training institutes. Flaks commends attempts by the American Psychoanalytic Association to combat homophobia within the organization but notes potential problems that might limit its success. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary American psychoanalysis: A profession? Increasing the role of research in psychoanalysis.

The simmering crisis confronting American psychoanalysis today is, in part, a function of fundamental theoretical and clinical disagreements within psychoanalysis itself. Psychoanalytic training, which conveys the special knowledge of our profession, and its application to techniques of treatment have become fragmented and frayed; boundaries have lost definition and our qualification as a profession is vitiated. Our diminished status is reflected in reduced public support and our smaller share of the patient population. Debate seems unable to resolve these disagreements. Acknowledgment of this reduced status creates the need and the opportunity for an increased role for research in psychoanalysis and the development of an analytic research enterprise capable of exploring for empirical resolutions of basic questions and disputes. Such a concerted effort to define the psychoanalytic enterprise through empirically supported basic tenets is necessary to avoid further dissipation of the markers of our psychoanalytic identity, both as individuals and as a profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The supervisory encounter: A guide for teachers of psychodynamic psychotherapy and psychoanalysis.

Review of book: The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis by Daniel Jacobs, Paul David and Donald J. Meyer, New Haven, CT: Yale University Press, 1985, 285 pp. Reviewed by Alan Z. Skolnikoff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life: Expanding the scope of clinical significance.

Clinical researchers have turned their attention to quality of life assessment as a means of broadening the evaluation of treatment outcomes. This article examines conceptual and methodological issues related to the use of quality of life measures in mental health. These include the lack of a good operational definition of the construct, the use of subjective vs objective quality of life indicators, and the nature of the relationship between symptoms and quality of life judgments. Of special concern is the ability of quality of life measures to detect treatment-related changes. The authors review the application of quality of life assessment across diverse patient groups and therapies and provide recommendations for developing comprehensive, psychometrically sophisticated quality of life measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expanding the scope of clinical practice: The physical examination.

Five clinical health psychologists at a major medical center successfully completed a 36-hr, graduate-level nurse practitioner course in advanced health assessment. The psychologists were trained to conduct thorough physical examinations and evaluate medical histories. All psychologists successfully completed the course and reported high levels of comfort with their ability to (a) conduct physical examinations, (b) describe physical examination findings, (c) provisionally identify medical problems and generally abnormal conditions, and (d) make appropriate referrals to medical specialists, when necessary. The nurse practitioner instructors reported high levels of satisfaction with student mastery of course content. The psychologists and nurses both reported high levels of satisfaction with the student–faculty relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experiencing language: some thoughts on poetry and psychoanalysis

The author uses her experiences as a poet and as a psychoanalyst to compare the two. She discusses poems by James Merrill, Philip Larkin, and Theodore Roethke in order to consider how the analyst listens, how the poet writes, how each listens to what is unsaid in the music of language. Rhythm, meter, and the sounds of words constitute this music. Sound and image are means by which language bypasses logic and touches us. Considering how a poem has an impact can teach us something about how words affect us in psychoanalysis.     

The cocktail party phenomenon revisited: Attention and memory in the classic selective listening procedure of Cherry (1953).

Though E. C. Cherry (1953) examined the recall of information from an irrelevant spoken channel in selective listening, the relationship between attention and subsequent recall still has not been examined adequately. It was examined here in 4 experiments, 3 of which were designed to identify conditions under which some participants, but not others, would notice a change from forward to backward speech. Only participants who shifted attention toward the irrelevant channel during the backward speech later recalled hearing it. In those whose attention shifted, shadowing errors peaked dramatically about 15 s after the change. There was no evidence of direct or indirect memory for phrases presented in the irrelevant channel. The results contradict models of attention stating that listeners process task-irrelevant information extensively without diverting resources used in shadowing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information theoretical concepts in clinical chemistry: the use of spreadsheet programs for convenient calculation of information theoretical quantities

The substrate binding sites of endo-(1-->5)-alpha-L-arabinanases (EC 3.2.1.99) from Aspergillus niger and Aspergillus aculeatus were investigated using reduced and regular (1-->5)-alpha-L-arabino-oligosaccharides and high performance anion exchange chromatographic analysis. Calculation of bond cleavage frequencies and kcat/K(m) parameters for these substrates enabled the determination of the number of arabinofuranosyl binding subsites and the estimation of the binding affinities of each subsite. The A. aculeatus endo-arabinanase has six subsites arranged symmetrically around the catalytic site, while the A. niger endo-arabinanase has five subsites; two from the catalytic site towards the non-reducing end of the bound substrate and three toward the reducing end. The two subsites directly adjacent to the catalytic sites in both the A. niger and A. aculeatus endo-arabinanase have near-zero net free energy of binding. These results are unlike most glycopyranosyl endo-hydrolases studied which have net negative (unfavourable) energies of interaction at these two subsites, and may be related to the greater conformational flexibility of arabinofuranosyl residues than glycopyranosyl residues. The complete subsite maps are also rationalized with regard to the observed action patterns of these enzymes on linear (1-->5)-alpha-L-arabinan.     

Noninterpretive interventions in psychoanalysis and psychotherapy: A developmental perspective.

One of the more important issues confronting psychoanalysis and psychotherapy seems to involve the clinical and theoretical aspects of so-called noninterpretive interventions. Advances in infant research, developmental psychology, and clinical theory may aid in shedding new light on the role and mechanisms of action of a variety of noninterpretive interventions and clinical concepts, including validation and confirmation, mirroring, clarification, "holding environment," negative therapeutic reactions, and others. In addition, these advances may enhance the understanding of the nature of change in psychoanalysis and psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)