The Impact of the Sibling in Clinical Practice: Transference and Countertransference Dynamics.

For many years, the impact of sibling relationships on psychological development has been neglected in the literature, overshadowed by the role of the parent-child relationship. As a result, attention to sibling dynamics and sibling transference as valuable information for case formulation and treatment interventions has not been used to its maximum potential. The authors demonstrate how deliberate consideration of sibling dynamics as well as the transferences and countertransferences associated with those dynamics can facilitate treatment. Several important sibling dynamics are discussed, including siblings' influences on identity development; sibling rivalry, jealousy, envy, guilt, and resentment; and sibling attachment. The impact of sibling dynamics on adult love relationships is discussed, as are potential effects of sibling abuse and sibling bereavement. Examples of how these dynamics can manifest themselves in transference and countertransference reactions and suggestions for working with those dynamics are illustrated with clinical examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender specific differences in left ventricular adaptation to obesity and hypertension

We studied the correlation between retinal nerve fiber layer thickness and visual field loss in 117 eyes of 62 patients with open angle glaucoma using the Aulhorn Classification as modified by Greve. We divided the peripapillary area into four quadrants [superior (S), inferior (I), temporal (T), nasal (N)] and the total (T0), and measured the peripapillary retinal nerve fiber layer thickness (NFLT) with a confocal scanning laser polarimeter (Nerve Fiber Analyzer). We also obtained the relative ratios (mean ratios) of the total circumference to the nasal quadrant (T0/N), the superior to the nasal quadrant (S/N), the temporal to the nasal quadrant (T/N), the inferior to the nasal quadrant (I/N), the total to the temporal quadrant (T0/T), the superior to the temporal quadrant (S/T), the nasal to the temporal quadrant (N/T), and the inferior to the temporal quadrant (I/T). Significant decreases were observed in the mean ratios to the temporal quadrant, i.e., T0/T, S/T, and I/T, in stages I to VI when compared with stage 0. However, no significant differences were observed among stages I to VI. These results suggest that these parameters may not precisely reflect the progression of the disease, but may aid differential diagnosis of the early stage (stage 0) from the middle and late stages (stages I to VI).     

Augmentation of the cardiac natriuretic peptides by beta-receptor antagonism: evidence from a population-based study

OBJECTIVES: The present retrospective analysis of data derived from a population-based study examined the relationship between intake of beta-receptor antagonists and plasma concentrations of the cardiac natriuretic peptides and their second messenger. BACKGROUND: Beta-receptor antagonists are widely used for treatment of cardiovascular disease. In addition to direct effects on heart rate and cardiac contractility, recent evidence suggests that beta-receptor antagonists may also modulate the cross talk between the sympathetic nervous system and the cardiac natriuretic peptide system. METHODS: Plasma concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and their second messenger cyclic guanosine monophosphate (cGMP) were assessed in addition to anthropometric, hemodynamic and echocardiographic parameters in a population-based sample (n = 672), of which 80 subjects used beta-receptor antagonists. RESULTS: Compared to subjects without medication, subjects receiving beta-receptor antagonists were characterized by substantially elevated ANP, BNP and cGMP plasma concentrations (plus 32%, 89% and 18%, respectively, p < 0.01 each). Analysis of subgroups revealed that this effect was highly consistent and present even in the absence of hypertension, left atrial enlargement, left ventricular hypertrophy or left ventricular dysfunction. The most prominent increase was observed in a subgroup with increased left ventricular mass index. By multivariate analysis, a statistically significant and independent association between beta-receptor antagonism and ANP, BNP and cGMP concentrations was confirmed. Such an association could not be demonstrated for other antihypertensive agents such as angiotensin-converting enzyme inhibitors or diuretics. CONCLUSIONS: Beta-receptor antagonists appear to augment plasma ANP, BNP and cGMP concentrations. The current observation suggests an important contribution of the cardiac natriuretic peptide system to the therapeutic mechanism of beta-receptor antagonists.     

Leukotriene receptor blockade in experimental heart failure

The pathophysiological role of endogenous leukotrienes in cardiovascular control and the regulation of renal function in congestive heart failure is not known. Therefore, in six conscious dogs with or without heart failure induced by right ventricular pacing (270/min, 10 days) we studied the effects of the leukotriene receptor antagonist FPL55712 on hemodynamics, plasma hormones and renal function. In healthy dogs, FPL55712 (1 mg kg-1 + 0.01 mg kg-1 min-1 i.v.) had little effect on hemodynamics, only reducing heart rate by 11% and insignificantly increasing systemic vascular resistance. Plasma levels of norepinephrine (-57%), renin (-30%) and aldosterone (-24%) were significantly decreased. Renal function parameters were not changed. In dogs with heart failure, FPL55712 significantly increased systemic vascular resistance (+16%) and decreased cardiac output (-15%). Plasma hormone levels were not changed, but renal plasma flow was decreased (-13%) and glomerular filtration rate (+12%), renal vascular resistance (+13%) and filtration fraction (+23%) were increased. It is concluded that there is no evidence for a contribution of endogenous leukotrienes to the systemic vasoconstriction in experimental heart failure. Whether the increase in systemic and renal vascular resistance induced by the leukotriene antagonist in dogs with heart failure reflects a role for endogenous leukotrienes with vasodilator action is still unclear and deserves further investigation.     

Maintaining boundaries in psychotherapy: Covert narcissistic personality characteristics and psychotherapists.

The psychological literature to date has identified more than one form of narcissism: the more well-known grandiose form, and the less familiar and recognized covert form. Although the distinction between these two narcissistic types has been identified with regard to better conceptualizing client dynamics, there has been much less written about how covert narcissistic tendencies and traits may affect psychotherapists and psychotherapy. This paper uses psychodynamic theory to highlight the role that covert narcissistic characteristics may have on the psychotherapists' ability to maintain boundaries, potentially leading to boundary transgressions (existing along a continuum from therapeutically useful to maladaptive and anti-therapeutic). Specific therapeutic situations have been delineated to increase therapists' recognition and awareness of themes that may emerge and compromise the boundaries between themselves and their clients. Areas of focus include narcissism and its forms, the possible connection between covert narcissism in psychotherapists and the impact on managing boundaries, the potential therapeutic implications of covert narcissistic tendencies in psychotherapists, and the implications of covert narcissistic personality characteristics on treatment, supervision, and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)