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At least 235 records · Page 13Linked to original sources
PubMed1993

Symposium: Normal and abnormal REM sleep regulation: REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature.

REM sleep behaviour disorder (RBD) is an injurious clinical disorder of attempted dream-enactment ('oneirism') in humans which has a corresponding experimental animal model involving dorsolateral pontine tegmental lesions in cats. To date, our sleep disorders centre has collected data on 96 chronic RBD cases which can be compared with pooled data on 70 chronic RBD cases from other centres contained in 26 reports published in the world literature since 1985, when our initial cases were first reported. The data from our centre and from other centres demonstrate a male predominance in RBD (87.5% vs 63.5%); indicate a similar mean age of RBD onset (52.4 y vs 55.9 y); contain substantial numbers of diverse central nervous system disorders causally associated with RBD (47.9% vs 60.0%); and identify clonazepam treatment as being very effective in controlling both the (violent) dream and sleep behavioural disturbances of RBD. Our centre's data additionally reveal an 80% prevalence of elevated stage 3/4 (slow-wave) sleep% for age in RBD, and reveal a frequent presence of periodic and aperiodic limb movements during NREM sleep. Thus, RBD in humans is a complex syndrome in which there is generalized REM and NREM sleep motor dyscontrol, as was originally observed in the animal RBD model by Jouvet and Delorme in 1965.

Journal Article↗
PubMed2003

The cumulative advance of human know-how.

Modern humans possess an enormous amount of 'know-how' that enables them to do things that early humans could not dream of doing. This paper explores some promising connections between two bodies of empirical research and theorizing that bear on technological know-how and its advance. Cognitive science is concerned with the nature and mechanisms of human knowing. The focus traditionally has not been on the knowledge involved in complex technologies, nor on the processes through which human know-how has advanced over time. However, certain recent developments in this field provide a nice linkage with the implicit cognitive theorizing used by scholars who study the advance of technology. And a number of the debates in the two fields are similar.

Biological Evolution↗
PubMed1999

[Prolonged electroencephalographic and video monitoring an experience from a military Chilean hospital].

BACKGROUND: Cerebral activity must be registered for prolonged periods in certain clinical situations that are not resolved with conventional electroencephalography. AIM: To report the experience with prolonged electroencephalographic and video monitoring at a Neurology Department, of a Military hospital in Santiago. PATIENTS AND METHODS: A retrospective analysis of patients referred for continuous electroencephalographic and video monitoring between 1991 and 1996. Three hundred thirty six patients, aged 3 months to 60 years old, were studied in the period and in 244, there was information about the diagnosis, treatment and evolution. RESULTS: Monitoring was performed in an outpatient basis in 84% of subjects and lasted between 2 and 7 hours. One hundred ten patients were epileptics, 77 patients had a suspicion of epilepsy, 13 patients had possible pseudoseizures and 33 patients had miscellaneous diagnoses. In 154 patients, electroencephalographs recorded during wakefulness, somnolence and spontaneous dream, were normal. Intercritical recordings with epileptic activity were obtained in 76 patients and in 30 of these, critical epileptic activity was also recorded, not always associated to clinical manifestations. Unspecific electroencephalographic alterations were recorded in 14 patients. CONCLUSIONS: Prolonged electroencephalographic and video monitoring can be useful for patients with complex neurological problems.

Adolescent↗
PubMed1997

The future of biostatistics: expecting the unexpected.

The paper explores the future of (clinical) biostatistics. In the first part of the paper important trends in biostatistics are reviewed: new applications and more complex data; causal models for observational data; cross-validation-based model building; graphical chain and random effect models; faster computing and new algorithms as Markov chain Monte Carlo; generalized estimating equations and pseudo-likelihood; pooled data sets for meta-analysis and prognostic modelling. In the second part some dreams and nightmares of the author are sketched. Dreams are: implementation of prognostic and diagnostic models in the clinic; an instantaneous numeric integrator; much more and better organized follow-up data; disease mapping in space and time. 'Nightmares', that is, issues which it is hoped will go out of use in the future, are: P-value; rank tests; exact methods; meta-analysis; matched case-control studies.

Biometry↗
PubMed2001

The teaching facility at the Eric Williams Medical Sciences Complex. An additional rising star from the west.

The teaching facility at the Eric Williams Medical Sciences Complex was designed to provide a comprehensive structural environment for a multidisciplinary Faculty whose teaching methodology utilized an integrated Problem-based Learning approach. Though the Faculty is over 11 years old, the full realization of the vision has not become a reality and the next 10 years will be devoted to fulfilling the dream.

Curriculum↗
PubMed1984

Denial in fantasy and hypomania: an exploration.

There is a spectrum of normality and psychopathology in which we see the presence of denial in fantasy, action, and word. The underlying ego distortions, such as the overuse of a denying fantasy in reality testing, will determine the clinical appearance of this mechanism. Traumatic experiences in the first 18 months are a determining factor in the development of these ego distortions. Clinical material is presented that supports a theory of elation put forward by Lewin (1950) who suggests that denying elations are repetitions of childhood dreams with their adult elaborations. In Mrs. A., the denying elations occurred particularly when experiences of castration anxiety or object loss became intolerable.

Adult↗
PubMed2002

Acute delirium induced by metoprolol.

OBJECTIVE: To describe a case of delirium associated with use of metoprolol and to analyse 24 such cases including 22 cases reported to Australian Adverse Drug Reaction Advisory Committee and one case previously published (S. Ahmad, Am Fam Physician, 1991;44:1142, 1144). CASE SUMMARY: An 89 year old caucasian man with an acute coronary syndrome who had no psychiatric history and no infections, brain injury, stroke, metabolic nor neoplastic disease developed delirium after two small doses of metoprolol (25 mg). The delirium disappeared within 20 hours after metoprolol was ceased, despite continuing all other medications. THE COMBINED SERIES: Of 24 patients (12 women, mean age 71.8 years), 83% were older than 60 years. The duration of therapy before onset of delirium in 14 (58%) subjects was within one week; 23 of 24 patients were receiving therapeutic amounts of the drug (25-200 mg/day). Clinical features included confusion/disorientation in all subjects, agitation in 13, aggression in 6, visual hallucinations in 7, auditory hallucinations in 1, paranoid delusions in 3, vivid dreams in 2 and language disturbances in 3 persons. Bradycardia was reported in 4 cases, hypotension in 2, fatigue/tiredness in 3, Raynaud's phenomenon in 1 and skin rash in 1 patient. DISCUSSION: The mechanism of metoprolol-induced delirium is unclear. It could be due to impairment of hepatic metabolism (especially in the ageing liver) and complex neurotransmitter-related effects on brain beta-adrenoceptors and serotonin (5-HT) receptors. CONCLUSIONS: Physicians should be aware that metoprolol, a widely used beta-blocker, may rarely cause delirium, especially in the elderly population.

Acute Disease↗
PubMed1997

Synchronized activities of coupled oscillators in the cerebral cortex and thalamus at different levels of vigilance.

The cerebral cortex and thalamus constitute a unified oscillatory machine displaying different spontaneous rhythms that are dependent on the behavioral state of vigilance. In vivo multi-site recordings from a variety of neocortical areas and related thalamic nuclei in cat, including dual simultaneous intracellular recordings, demonstrate that corticofugal volleys are effective in synchronizing fast (20-50 Hz) and low-frequency (< 15 Hz) oscillations in thalamocortical networks, characterizing activated and de-afferented states. (i) Fast spontaneous oscillations depend on the depolarization of thalamic and cortical cells and appear in a sustained manner during waking and REM sleep. Corticothalamic neurons, discharging high-frequency (400 Hz) spike-bursts at 30-40 Hz, are good candidates to synchronize fast oscillations in reentrant thalamocortical loops. Weakly synchronized, fast spontaneous oscillations may be reset and become robustly coherent after relevant sensory stimuli in waking or internal signals during the dreaming state. (ii) During quiescent sleep, the long-range synchronization of brain electrical activity results from synchronous hyperpolarizations in forebrain neurons. The corticothalamic inputs during the depolarizing component of the slow oscillation (< 1 Hz) are effective in grouping the thalamic-generated sleep rhythms (spindles at 7-14 Hz and delta at 1-4 Hz) into complex wave-sequences. These inputs also control the shape of spindles, and favor the long-range synchronization and nearly simultaneous appearance of spindles. (iii) The cortical control of thalamic activity is also demonstrated in spike-wave-seizures developing from sleep patterns. More than half of thalamocortical neurons are silent during spike-wave seizures, being tonically hyperpolarized, and display IPSPs (closely related to the paroxysmal depolarizing shifts of cortical cells) that are determined by the pattern of activities in thalamic reticular cells. All these data congruently show the power of cortical control upon thalamic oscillators.

Animals↗
PubMed2000

Interdisciplinary team for the treatment of eating disorders.

Eating disorders are pathologies with a complex, multifactorial etiopathogenesis. Their treatment requires an interdisciplinary team. This paper discusses some characteristics and the most common difficulties encountered by such a team (multiple transfers, concealed alliances, role inversion, dissociation). Since their task that is carried out with patients in a critical situation and conflicting families, the team members are exposed to stressing conditions (illustrated by their dreams), and faced with possibilities of withdrawal and/or burn-out.

Adolescent↗
PubMed1998

Telephone analysis: out of sight, but not out of mind.

Past traditions and prejudices may have precluded many analysts from openly considering the use of telephone analysis as a viable treatment option. However, at times psychoanalysis by telephone may represent the best treatment available for a particular patient. Use of the telephone in clinical practice evokes complex feelings and raises a number of important issues for both patient and analyst. A case of telephone analysis is presented to illustrate the poignancy of initial telephone contact, issues associated with the decision to do psychoanalysis by telephone, some of the paradoxes and complexities of telephone work itself, and the termination process. Initial resistances by both patient and analyst are discussed, and modification of technique and its applicability to psychoanalysis in general are examined. Indicators for telephone analysis are considered.

Adult↗
PubMed1984

[The ambitio-impulse different from narcissism].

We should not let our dynamic drive bog down in the ambiguous concept of "libido". A concept which disturbed Freud himself as is clearly demonstrated in his latest works and which has been considerably misused afterwards. In order to achieve this aim we have in the light of psychopathology, of the symbolic nature of dreams and of our own personal experience set to describe three fundamental drives-the real roots of Man unseparable from his constitution-namely 1. ambitio: (which prompts Man to assert himself, to develop and dominate); 2. agressio: (the urge to defend our internal territory or to overcome obstacles according to our will); 3. attractio: (the disposition to be moved or attracted by this or that object). The present paper shall deal with ambitio which is not to be mixed up with conscious ambition. This unconscious drive, axial and archaic which nourishes the evolution of all living matter (even a tree trunk) should not be interspersed with guilt but is indispensable to our emergence from the Cosmos. Ambitio can be subject to hypertrophy by a compensatory process in cases of megalomania and on the contrary it can be atrophied in the case of a failure syndrome or inferiority complex for example. The most delicate stage of the process is that of its taming and of its conscious acceptance. All things which if properly dealt with and if we want to avoid the traps of authoritarianism or of the narcissistic delusion will lead us in the interest of others, to the most realistic modesty.

Acute Disease↗
PubMed2000

Further support for the concept of a G-LOC syndrome: a survey of military high-performance aviators.

METHODS: Some 329 military high-performance pilots were anonymously surveyed to determine the occurrence rates for a symptom complex of acceleration-induced neurologic manifestations. The premise for this symptom complex is the theory that acceleration-induced neurologic effects are not always an all-or-none phenomenon with G-LOC as the operational endpoint. RESULTS: A significant number of aircrew in selected types of aircraft reported symptoms such as euphoria, apathy, displacement, depersonalization, poor response to auditory stimuli, immediate memory difficulties, sensory abnormalities, motor abnormalities, confusion, and dream-like state without loss of consciousness. CONCLUSION: These findings may signal a need for alterations in G-awareness training.

Adult↗
PubMed2006

The occurrence of obstructive vs absorptive hydrocephalus in newborns and infants: relevance to treatment choices.

BACKGROUND AND OBJECTIVE: The classification of hydrocephalus in newborns and in infants is different from the classification in adulthood. This difference exists due to disparity in the source pathologies that produce the hydrocephalus, and the practical distinctions in prognosis and treatment choices. The objective of this paper is to present the spectrum of obstructive-communicating hydrocephalus, which is more complex in the pediatric group, and to propose the relevance of this particular classification to treatment options. MATERIALS AND METHODS: The authors categorized infants with active hydrocephalus at time of presentation into the following four groups along the spectrum of communicating vs obstructive HCP. Group 1: patients with a purely absorptive (communicating) HCP. In these patients, tetraventricular dilatation is usually observed with occasional extraaxial fluid accumulation. An extracranial CSF diversion (shunt) is the treatment of choice. Group 2: patients with an obstructive component together with a persistent absorptive component. In these patients, a technically successful endoscopic procedure will not prevent progression of clinical symptoms of HCP. An extracranial CSF diversion (shunt) should be the treatment of choice even though some of these patients are currently treated by endoscopy. Group 3: patients with an obstructive component together with a temporary absorptive component. In these patients, a technically successful ETV should be followed by temporary CSF drainage [via LP, continuous spinal drainage (CLD), or ventriculostomy] with or without supplemental medical treatment (i.e., Diamox) for several days. Such temporary drainage may decrease failure rate in this subgroup. Group 4: patients with a purely obstructive HCP. In these patients, an endoscopic procedure (ETV) is the treatment of choice. According to this spectrum classification, the authors classify different entities with representative cases and discuss relevancy to treatment options and prognosis. RESULTS: The data suggest that obstructive hydrocephalus in the very young population may be rather a combination of obstructive and absorptive problem. The outcome of the patient depends mainly not only on the basic pathology causing the hydrocephalus but also on the treatment that is chosen and its complications. While bleeding and infection represent the major causes for communicating hydrocephalus, patients with complex pathologies of congenital type and intra- or interventricular obstructions may reflect obstructive hydrocephalus. Treatment of these patients may be successful by shuntless procedures if the absorptive problem is not the major component. In transient absorptive hydrocephalus, temporary measures were effective in many cases leading to successful procedures of ETV and/or posterior-fossa decompression in selected cases. CONCLUSIONS: Shuntless procedures are the dream of a pediatric neurosurgeon provided it solves the problem and does not imply unacceptable risk. However, the benefit has to be evaluated years after the procedure is performed, as only prospective multicenter studies will truly show which procedure may have the best overall results in the developing child. Until such studies are available, understanding the basic pathology or the combination of pathologies leading to hydrocephalus in a given child may open the window of opportunities for other than shunt surgery in many hydrocephalic children with major obstructive component.

Cerebrospinal Fluid Shunts↗
PubMed2004

[Hallucinations and dementia. Prevalence, clinical presentation and pathophysiology].

Hallucinations are a common feature of certain degenerative diseases with a risk of dementia such as Alzheimer's disease, Lewy body dementia, and Parkinson's disease. Obtaining valid epidemiological data is nevertheless quite difficult because of methodological problems. As a rule, hallucinations are more prevalent in Lewy body disease than Parkinson's disease or Alzheimer's disease. The prevalence in parkinsonian dementia is about the same as in Lewy body disease. Complex visual hallucinations predominate, auditory or tactile hallucinations are more exceptional. Minor forms (illusions, sensation of presence) are also observed. Recurrence is common, mainly in the evening or at night. Patients with advanced mental impairment generally take the hallucinations for reality. The hallucinations can be associated with psychological and behavioral disorders such as delusionnal idea or identification disorders. It is important to search for other causes of hallucinations such as drugs, ocular disorders, or depression, but many of these disorders are common comorbidities in elderly patients with degenerative disease. There is no unique model fitting all the hypothesized pathogenic mechanisms. Complex visual hallucinations most likely arise from abnormal activation of the extra-striat temporal associative regions, but only hypothetical mechanisms have been proposed. Genetic studies and functional imaging have not provided convincing evidence. Current focus is placed on an imbalance between deficient cholinergic transmission and preserved or augmented monoaminergic transmission at the cortical level, but other neurotransmission systems could be involved. The dream dysregulation mechanism proposed in Parkinson's disease cannot be generalized. The link between cognitive disorders and hallucination is also poorly understood: hallucinations are associated with more severe cognitive impairments or more rapid cognitive deline in Parkinson's disease and Alzheimer's disease, but the association with specific cognitive disorders remains to be fully explored.

Cognition Disorders↗
PubMedDate not supplied

Bumsters, big black organs and old white gold: Embodied racial myths in sexual relationships of Gambian beach boys.

Sexuality is a platform upon which ideologies are enacted. Based on ethnographic fieldwork in The Gambia, this paper discusses the embodiment of racial myths about male Black bodies and Western affluence. Methods utilized included participant observation, focus group discussions and in-depth interviews. Beach-boys, locally called bumsters, are a common feature of the country's tourism. Societal attitudes to bumsters are ambivalent. Bumsters variously indulge in a complex web of sexual activity ranging from commercial to non-commercial, voluntary to socially-imposed, individual to peer-driven, heterosexual to homosexual, casual to regular, particularly with foreign tourists. Narratives about their sexuality reveal an enactment of myths about the male Black body and superior sexual performance on one hand, and images of plundered wealth sitting in 'the West'--a dream destination flowing with milk and honey, and physically represented by the toubab--a local label for White foreigners-on the other. This highly fantasized wealth forms the core of youth aspirations to travel abroad. Sexual activity with a toubab is the ticket out of Africa's inherent scarcity. Metaphors and idioms of unlimited virility and dynamic manhood are reinforced through sex tourism and form part of the identity of Gambian bumsters. These self-images reinstate and reinforce racial stereotypes.

Attitude to Health↗
PubMed2006

Engineering cells for cell culture bioprocessing--physiological fundamentals.

In the past decade, we have witnessed a tremendous increase in the number of mammalian cell-derived therapeutic proteins with clinical applications. The success of making these life-saving biologics available to the public is partly due to engineering efforts to enhance process efficiency. To further improve productivity, much effort has been devoted to developing metabolically engineered producing cells, which possess characteristics favorable for large-scale bioprocessing. In this article we discuss the fundamental physiological basis for cell engineering. Different facets of cellular mechanisms, including metabolism, protein processing, and the balancing pathways of cell growth and apoptosis, contribute to the complex traits of favorable growth and production characteristics. We present our assessment of the current state of the art by surveying efforts that have already been undertaken in engineering cells for a more robust process. The concept of physiological homeostasis as a key determinant and its implications on cell engineering is emphasized. Integrating the physiological perspective with cell culture engineering will facilitate attainment of dream cells with superlative characteristics.

Animals↗
PubMed1992

The function of humor in a four-year-old.

A child's attempt at humor in the midst of a psychoanalytic session is examined. A joke is told that began as a dream which the 4-year-old analysand attempted to modify. The joke is not entirely successful from a formal standpoint. This "failure" is examined from the point of view of the anxiety that may have derailed the joke and the developmental immaturity that may have compromised it. A developmental line of the symbolic process is suggested, double meanings and multiple meanings becoming more complex as development proceeds.

Child, Preschool↗
PubMed2003

Developmental aspects of trauma and traumatic aspects of development.

In this paper I try to show that inherent in healthy development are emotional experiences that are the stuff of trauma. Failure to reintegrate these experiences means that they can serve as a resonating board for difficulties in later life, adding to their traumatic impact. Focusing on global changes that occur at the end of the first year, I exemplify these developments with an infant observation and show how a six-year-old boy's failure to integrate them contributed to his experiencing a normal life event as a trauma. I then offer clinical material from the analysis of a man to demonstrate how later life events resonated with early experience associated with this period. All are linked to a complex pattern of object relations I have come across clinically, whereby feelings of grief associated with an idealized object are split off from feelings of grievance against an object experienced as persecutory because of its perceived superior status.

Adult↗