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Sigmund Freud claimed to hate being photographed, yet he carefully fashioned his public image. Always immaculately dressed, he sported an old-fashioned beard that helped to establish his status as the founding father of psychoanalysis. An avid collector, Freud chose objects for their symbolic as well as their aesthetic interest.
The experience of hypoglycemia is probably the most feared and hated consequence of life with type 1 diabetes among pediatric patients and their parents. Although transient detrimental effects are clearly disturbing and may have severe results, there is surprisingly little evidence of long-term CNS damage, even after multiple hypoglycemic episodes, except in rare instances. Despite the latter evidence, we advocate that every treatment regimen be designed to prevent hypoglycemia without inducing unacceptable hyperglycemia and increasing the risk of micro- and macrovascular complications.
The relation between young surgeons and transplantation has always been a "love and hate" one. Until a few years ago this branch of surgery was seen as pioneering, with extreme and and extensive training, and was reserved to few elected members. Nowadays things are different. In this article we try to understand the true reasons that young Italian surgeons avoid transplantation surgery.
INTRODUCTION: Chromosomal aberrations, with or without congenital physical abnormalities, have been frequently found associated with neuropsychiatric disorders, including mental retardation, psychosis, autism, and criminal behaviour. The meaning of the association frequently remains unclear. However, consistent findings of association between specific chromosomal abnormalities and clinical phenotype may provide evidence of a causal relationship and shed light on the pathogenesis of obscure disorders. CASE-REPORT: Here, we present the case of a 28 year-old, Caucasian male affected by pervasive developmental disorder, associated with chromosomal translocation 46, XY, t (X; 4) (p11; q13), and abnormal facial features. A few days after birth, the patient was taken away from his parents and adopted for unknown reasons. No information is available about his biological relatives. Mild delay in the development of spoken language was reported. Since early childhood, the patient's behaviour was characterized by troublesome relationship with his parents and his fellows, and persistent violation of norms and rules at home and at school. Consequently, social and school functioning was poor. When he was eight, verbal and motor stereotypy appeared for the first time. As an adolescent, he was more and more aggressive. He exhibited countless episodes of rage and verbal and physical aggressiveness. After he had completed secondary school, his way of life was chaotic. He got into the habit of staying away from home, sleeping in the day and vagabonding at night. He began to abuse alcohol. Grandiosity and persecutory delusions became evident. He claimed to hate the Vatican, the Pope, and the Polish people and to be the Devil, the Antichrist. He feared that his food was poisoned by his mother and refused to eat at home any more. He loved to remain in a cage with two wild dogs, accumulating and keeping bottles full of his urine. He often engaged in violent fights in the street with tramps and foreigners. Finally, he was involuntary admitted to a psychiatric intensive care unit. He was hostile, uncooperative, and violent. Magnetic resonance imaging of brain was normal, Wechsler Adult Intelligence Scale IQ score was 96 (total), 108 (verbal), 80 (non verbal), and Standard Progressive Matrices score was 44/60, chromosomal examination [banding R (RBG)] revealed an apparently balanced translocation 46, XY, t (X; 4) (p11; q13). The patient was treated with risperidone (8 mg/day) and valproate (1500-2000 mg/day) with improvement. Psychotic symptoms, hostility and violence vanished. Amazingly, his behaviour and attitude became normal. Very early onset of symptoms, absence of negative signs, and dysmorphic features suggesting an underlying medical disease do not support the diagnosis of schizophrenia. DISCUSSION: The diagnosis of pervasive developmental disorder, not otherwise specified, could be made, considering the delay in the development of spoken language, the large discordance between verbal and non verbal WAIS IQ score, the presence of stereotypy, abnormal facial features, and motor clumsiness. The late onset of symptoms precludes the diagnosis of autism, while the delay in language does not permit the diagnosis of Asperger's disorder. The lack of information on his biological relatives did not permit us to assess the presence of genetic, physical or mental abnormalities in his family. Therefore, the causal relationship between the chromosomal translocation and the psychiatric disorder is uncertain in this patient. Similar genetic abnormalities found in patients affected by neuropsychiatric disorders could confirm an etiological link.
Stalking is an old behavior, but a new crime. The author has reviewed what is currently known about the epidemiology, demography, psychiatry, psychology, pursuits and outcomes, threatening communications, violence, and clinical risk management of stalking cases. But this "dark heart of romantic pursuit" (p 7) extends beyond the paradigm of science and is often an aggressive and aberrant expression of unrequited love. In 1579, John Lyly wrote "As the best wine doth make the sharpest vinegar, so the deepest love turneth to the deadliest hate" (Euphues: The Anatomy of Wit).
This article is intended to familiarize the general practitioner with the important concepts in the practice of psychoanalysis. It provides an overview of the development of the field of psychoanalysis, considering it as theory of personality, as an explanation of psychopathology, and as a research procedure. It also explores psychoanalysis as a method of treatment and presents an outline of the knowledge and training necessary to become a psychoanalyst. A consideration of the analytic process includes a review of the postulates that govern its application--the analytic process, the therapeutic dyad, and psychodynamic interventions. Historical and political issues are examined, including the spread of psychoanalytic theory, the various contributions of important psychoanalytic thinkers, a review of the struggle of nonmedical psychoanalysts to break the one-time monopoly held by medical psychoanalysts, and the ongoing love-hate relationship between clinical practitioners and academic psychologists. In addition to providing this background material, this article explores the issues currently facing the field of psychoanalytic thought--the need for integration of the structural and relational perspectives and the outlook for the future of the discipline.
A factor analysis of 1309 Fagerstrom Tolerance Questionnaires (FTQ) was performed with LISCOMP software, which utilizes tetrachoric correlations to account for the dichotomous responses of the FTQ. Three factors with eigenvalues greater than 1.0 were obtained, accounting for 56.6% of the variance. Factor 1 was loaded by questions "How soon on waking do you smoke your first cigarette?," "Do you find it difficult to refrain from smoking in places it is forbidden?," "How many cigarettes a day do you smoke?," and "Do you smoke if you are so ill that you are in bed most of the day?" Factor 2 was loaded by questions "Which cigarette would you hate to give up?" and "Do you smoke more during the morning than during the rest of the day?" Factor 3 was loaded exclusively by question "What brand do you smoke?" The question "Do you inhale always, sometimes, or never?" loaded exclusively on a fourth factor, however its eigenvalue did not reach significance. Support is provided for the modification of the eight-item FTQ to the six-item Fagerstrom Test for Nicotine Dependence (FTND). Based on the wording of the questions that loaded on each factor, we propose that Factor 2 assesses the degree of urgency to initiate smoking after overnight abstinence and that Factor 1 reflects the persistence of smoking during waking hours.
2D gel electrophoresis is the technology that everyone loves to hate-it requires manual dexterity and precision to reproduce precisely and is thus not well-suited as a high-throughput technology. Although almost everyone would like to replace it, the resolution and sensitivity it offers are exquisite and unsurpassed if one wants a global view of cellular activity. There have been several recent developments, for example, the detection of low abundance proteins, and the resolution possible with narrow-range IPG gels.
Phosphoinositolglycan (PIG) molecules have been implicated to stimulate glucose and lipid metabolism in insulin-sensitive cells and tissues in vitro and in vivo. The structural requirements for this partial insulin-mimetic activity remained unclear so far. For establishment of a first structure-activity relationship, a number of PIG compounds were synthesized consisting of the complete or shortened/mutated glycan moiety derived from the structure of the glycosylphosphatidylinositol (GPI) anchor of the GPI-anchored protein, Gce1p, from yeast. The PIG compounds were divided into four classes according to their insulin-mimetic activity in vitro with the typical representatives: compound 41, HO-SO2-O-6Manalpha1(Manalpha1-2)-2Manalpha1 (6-HSO3)- -6Manalpha1-4GluNb eta1-6(D)inositol-1,2-(cyclic)-phosphate; compound 37, HO-PO(H)O-6Manalpha1(Manalpha1-2)-2Manalpha1-6Manal pha1-4GluNbeta1-6( D)inositol-1,2-(cyclic)-phosphate; compound 7, HO-PO(H)O-6Manalpha1-4GluN(1-6(L)inositol-1,2-(cyclic)-ph osp hate; and compound 1, HO-PO(H)O-6Manalpha1-4GluN(1-6(L)inositol. Compounds 41 and 37 stimulated lipogenesis up to 90% (at 20 microM) of the maximal insulin response but with differing concentrations required for 50% activation (EC50 values 2.5 +/- 0.9 vs 4.9 +/- 1.7 microM) as well as glycogen synthase (4.7 +/- 1 vs 9.5 +/- 1.5 microM) and glycerol-3-phosphate acyltransferase (3.5 +/- 0.8 vs 8.0 +/- 1.1 microM). Compound 7 was clearly less potent (20% of the maximal insulin response at 100 microM), whereas compound 1 was almost inactive. This relative ranking in the insulin-mimetic potency between members of the PIG classes (e.g., 41 > 37 >> 7 > 1) was also observed for the (i) activation of glucose transport and glucose transporter isoform 4 translocation in isolated normal and insulin-resistant adipocytes, (ii) inhibition of lipolysis in adipocytes, (iii) stimulation of glucose transport and glycogen synthesis in isolated normal and insulin-resistant diaphragms, and (iv) induction of tyrosine phosphorylation of insulin receptor substrate-1 (IRS-1) in diaphragms. The complete glycan core structure (Man3-GluN) of typical GPI anchors including a mannose side chain and the inositolphosphate moiety was required for maximal insulin-mimetic activity of the PIG compounds with some variations possible with respect to the type of residues coupled to the terminal mannose/inositol as well as the type of linkages involved. These data argue for the potency and specificity of the interaction of PIG molecules with putative signaling component(s) (presumably at the level of the IRS proteins) in adipose and muscle cells which finally lead to insulin-mimetic metabolic activity even in insulin-resistant states.
The love-hate relationship between iron and living matter has generated mechanisms to maintain iron concentration in a narrow range, above and below which deleterious effects occur. At the cellular level, iron homeostasis is accomplished by the activity of the IRP proteins, which, under conditions of iron depletion, up-regulate the expression of the iron acquisition proteins TfR and DMT1. It has been shown that hydrogen peroxide activates IRP1 and that this activation mediates a potentially harmful increase in cell iron uptake. Here we show that IRP1 activity is also induced by iron-mediated oxidative stress. When cells were incubated with up to 20 microM of iron, a typical decrease in IRP1 and IRP2 activity was observed. Interestingly, when iron was further increased to 40 or 80 microM. IRP1 was reactivated in three of the four different cell lines tested, i.e., Caco-2 cells, N2A cells and HepG2 cells. In the fourth cell line (K562) IRP1 activity did not increase, but neither did it decrease. This response to iron was largely abrogated when the antioxidant N-acetyl cysteine was added along with iron to the culture medium. Thus, the effect of iron was mediated by oxidative stress. Increases in IRP1 activity were accompanied by increases in cell iron uptake, an indication that the activated IRP1 was functional in the activation of iron uptake. Hence, this iron-induced iron uptake feedback loop results in the increase of intracellular iron and increased oxidative stress.
Biographical references to Winnicott's analysis of Masud Khan provide the background for this exploration of Winnicott's and Khan's conflicts about disillusionment. On the basis of historical data, speculative hypotheses are presented about possible sources of Winnicott's difficulty engaging Khan's hate and destructiveness. Winnicott's feelings about Khan may have been influenced not only by his denied disillusionment with his own father and his analysts, James Strachey and Joan Riviere, but also by the impact of Strachey's covert anti-Semitism.
Due to the extreme states of masochism, dependency, and narcissistic rage that these patients experience, the treatment must be attuned to the inevitable periods of regression and primitive defense. The patient feels compelled to be a servant to the object, yet is furious at this less than equal status. The alternating states of idealizing the object in a masochistic fashion, the anger at the lack of self importance, and the desperate hope for soothing from that object create an externally focused character structure, which generally leads to a pattern of acting out, the lack of internal linking processes, and a scarcity of interpersonal skills that foster mutuality. A fundamental lack of self soothing leads to a perpetual search and craving for the soothing talents of the object. It is often unconsciously believed that compliance and servitude will bring about this gift of soothing from the object. Hans Loewald (1962) had described internalization as a process whereby the child reaches out to take back from the environment what has been removed from him in an ever-increasing manner since his birth. For the forgotten hero, this theory is definitely true. Not only is the treatment of this type of patient one of gradual internalization of new internal object relationships and the working through of the older more pathological ones, but it is a true understanding between patient and analyst of the original nontolerable removal of the uniqueness of the self via reality and/or fantasy states. When this situation is focused upon and worked with, the taking back from the environment can occur in a spirit devoid of former states of envy, hate, resentment, and wild craving that were formally protected and disguised in a facade of dependent masochism. The patient has essentially experienced or perceived his parents, usually the mother, as not providing a soothing function or a proper fit for his developing ego. The patient has then gone about constructing various methods to compensate for this lack. The analyst is often experienced as not providing an adequate soothing function, but this emptiness is warded off from conscious expression with a compromise formation of dependent, masochistic, or narcissistic methods of relating. This style of compromise hides any envy, hunger, or rage and keeps alive the hopes of being rewarded with soothing. The patients expects to be used as a waste disposal unit and believes that this dumping by the object into him is the longed-for love. Ideally, interpretations focus upon the hunger for the soothing function of the object and the drive to obtain it at any cost. The patient will fiercely resist because he believes that in giving up his masochism and dependency, he would expose his envy and narcissistic injury. This patient believes he would then lose any hope of ever receiving the soothing function due to the fantasized destruction of the source of that soothing, his beloved object.
The structural analysis of social behavior (SASB) model dissects interpersonal and intrapsychic events into 3 underlying dimensions: (a) focus (on other, on self with other, and on self with self): (b) affiliation (love vs. hate); and (c), interdependence (enmeshment or dominance-submission vs. differentiation or emancipate-separate). Accompanied by predictive principles (similarity, opposition, complementarity, introjection, antithesis), the model can operationalize important aspects of a wide range of psychological events. Questionnaires, coding systems, and software permit the SASB model to be applied in a wide array of clinical and research contexts. It has been used by people of divergent theoretical persuasions including the interpersonal, cognitive-behavioral, client-centered, psychoanalytic, expressive, family, and group approaches. In this article, the model and its predictive principles are reviewed, along with examples of research, clinical, and theoretical applications. The articles in this section provided examples of especially creative and appropriate uses.
In a large, national sample of 2,431 lesbians and bisexual women, those who had children before coming out, those who had children after coming out, and those who did not have children were compared on demographic factors and milestones in the coming-out process. Differences were found in race/ethnicity, age, prior marriage, income, religion, use of mental health counseling, and reported hate crimes. Results are also presented for lesbians and bisexual women of each ethnic/racial and age group. Controlling for age and income, lesbians and bisexual women who had children before coming out had reached developmental milestones in the coming-out process about 7-12 years later than women who had children after coming out and about 6-8 years later than nonmothers.
AIMS: To assess the validity of the Fagerström test for nicotine dependence (FTND, six items) and of a short-form of this questionnaire, the Heaviness of Smoking Index (HSI, two items), in a population of relatively light smokers. DESIGN: Comparison of item content with published definitions of addiction. Test-retest reliability and multiple tests of construct validity, based on a secondary analysis of a cohort study conducted between November 1995 and June 1996. SETTING: University of Geneva, Switzerland. PARTICIPANTS: Students (82%), academic (12%) and administrative staff (6%): 643 smokers at baseline and 482 smokers at follow-up. MEASUREMENTS: French-language versions of the FTND and HSI, smoking status, saliva cotinine level, self-efficacy for quitting smoking and other variables related to addiction with cigarettes. FINDINGS: A literature review showed that both composite scales fail to assess several recognised aspects of tobacco dependence. In this population of relatively light smokers (average: 12 cigarettes per day), both tests had important floor effects with, respectively, 55% and 63% of participants with scores equal to 0 or 1 on these scales. In addition, two of the FTND items (Difficult-to-refrain and Hate-most-to-give-up) had poor psychometric properties. Even though FTND and HSI correlated about as expected with criterion variables, the number of cigarettes smoked per day performed better than either composite scale on most validation criteria. CONCLUSION: In a population of relatively light smokers, FTND and HSI seem to measure little more than the number of cigarettes per day. Designing a new and more broadly applicable test of addiction to cigarettes is a research priority.
AIM OF THE STUDY: To examine the lived experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression. BACKGROUND: Postnatal depression affects approximately 1 in 10 childbearing women in Hong Kong. However, most studies of postnatal depression have been carried out in Western societies and no qualitative research was found describing the experience of Hong Kong Chinese mothers with postnatal depression. DESIGN: A phenomenological study was conducted. Data were collected by semi-structured interviews. A purposive sample of 35 women diagnosed with postnatal depression was interviewed. Interview data were analysed following Colaizzi's phenomenological methodology. RESULTS: Themes that emerged describing participants' experiences included trapped in the situation, ambivalent towards the baby, uncaring husband, and controlling and powerful in-laws. Women felt hopelessness, helplessness and loss of control. They were trapped in a situation that had no way of escape except by violent means, such as homicide or suicide. Feelings towards the baby were ambivalent, both hate and love. Several women had injured, or had thought of injuring or killing, their babies and/or themselves. Women's unhappiness was attributed to a noncaring husband, and controlling and powerful in-laws. Generally, women did not seek help until their depression was diagnosed by screening tests. CONCLUSION: This study has revealed insights into how women experienced postnatal depression in Hong Kong, and what they perceived as contributing to their depression. These insights may be used to guide interventions for women and their families to raise awareness regarding the support childbearing women need.
Although a seborrheic keratosis is not rare on the skin of the trunk, extremities, head and neck of an elderly person, it is uncommon to originate in the external ear canal. Even rarer, an irritated subtype may arise in this location. We report the case of a 63-year-old man with an irritated seborrheic keratosis arising in the right external ear canal, who first presented with a bloody discharge from his right ear canal 3 years and 10 months before the subsequent operation. Macroscopically, a dome-like, black elevation was found at the anterior wall of the right external ear canal. A biopsy showed an exophytic papillomatous, hyperkeratotic growth of basaloid cells which revealed some nuclear atypism and mitosis. Squamous eddies and moderate inflammatory infiltrate were noted. Some cellular atypism made us suspect an irritated seborrheic keratosis. Because the patient hated the extirpation, he remained untreated for 3 years and 3 months following his first presentation. The biopsy and a surgical resection of his second presentation confirmed the diagnosis of irritated seborrheic keratosis. Immunohistochemical analysis of Ki-67, p53 and papillomavirus was performed to elucidate its character. We emphasize that irritated seborrheic keratosis does occur in the external ear canal and may cause some diagnostic difficulty. Pathologists should be aware of this fact and avoid overdiagnosis.
Coping with the stress induced by ESRD patient noncompliance is a time consuming, nonproductive, demoralizing undertaking that is unavoidable. An orderly, non-confrontational approach encompassing measures to protect mentally incompetent and unaware patients as well as those too sick to comprehend and consent to therapy (dialysis) is provided. Individual practitioners should utilize all available resources including patient relatives and friends, collaborating psychiatrists, and institutional risk-management officers to assist in devising the best resolution to what may escalate into an onslaught against the renal care team. No single solution is applicable to the myriad variables that may impinge on a specific patient's seemingly apathetic or hateful behavior underlying noncompliance.