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Results for “Reality Therapy”

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At least 289 records · Page 16Linked to original sources
PubMed1994

Endocrine therapies for BPH: scientific rationale, clinical results, and patient selection.

In 1993, medical therapy for BPH is a reality. Androgen deprivation therapy (LHRH agonists, antiandrogens, and 5 alpha-reductase inhibitors) has been shown to be effective by reducing the static component of BPH. Of these agents, the 5 alpha-reductase inhibitors have the greatest promise because of their low toxicity profile. Aromatase inhibitors, which function via a different mechanism, however, have not been demonstrated, as monotherapy, to be effective in the treatment of symptomatic BPH. It is still theoretically possible that aromatase inhibitors could have a role in the management of prostatism if they are utilized in conjunction with an antiandrogen or 5 alpha-reductase inhibitor. Although the early results for this endocrine therapies are encouraging, several issues relating to medical treatment remain unanswered. Not everyone with significant prostatism will respond to androgen deprivation therapy. How does the physician identify pre-treatment the patient most likely to achieve a significant improvement in voiding function with 5 alpha-reductase inhibitor therapy? At the present time, there is no method--based on symptoms, DRE findings, serum hormone and PSA levels, or histopathologic criteria--for recognizing the ideal patient for androgen deprivation therapy. Without question, it is a subjective decision. As a result, the benefits and risks of these medical approaches as well as those of the minimally invasive and surgical therapies must be discussed with the patient so that he can participate in the management decision. In this manner, the expectations and needs of the patient will be best served.

5-alpha Reductase Inhibitors↗
PubMed1995

Gene therapy in acute critical illness.

The development of techniques for manipulating nucleic acids and strategies for delivering DNA to humans has made gene therapy a reality. Although mostly focused on genetically based diseases so far, there is every reason to expand the concept to include acquired diseases. Critical illness may be a good target for gene therapy because of the high mortality and need for only transient treatment. Genes can be delivered in vivo using viral vectors (replication-deficient adenovirus and adeno-associated virus most often). Viral vectors have some negatives, mainly the triggering of an inflammatory and an immune response. Nonviral DNA delivery systems include liposomes (cationic or anionic), direct DNA injection, and polycation-DNA-glycoconjugates. Combining liposomes with viral components to deliver plasmids with a transgene may improve efficiency of delivery without causing toxicity. In a model of acute lung injury, in vivo delivery of a vector hyperexpressing the prostaglandin synthase gene using cationic liposomes resulted in increased production of prostaglandin E2 and prostacyclin in the lungs, and protected the lungs from the effects of endotoxin. This end-result demonstrates the feasibility of this approach. A similar rationale for the treatment of sepsis could be used. Other promising therapeutic genes would include those encoding antioxidant enzymes or antiproteases. The logistics for moving to initial studies of gene therapy in critically ill humans have been worked out for other diseases; such steps should expedite the exploration of this new category of therapies.

Acute Disease↗
PubMed1988

Time, reconstruction and psychic reality.

This paper illustrates certain relationships between the concepts of time, reconstruction and psychic reality as they appear in the clinical situation. A case example introduces the literature concerning the difficulty of knowing over time "what actually happened." Arlow's model of the two projectors, which has been used to describe psychic reality, is extended from a developmental point of view. Two further case examples then illustrate how attention to the patient's unique psychic reality can lead to different reconstructive problems and interventions. The two case examples raise certain questions about the nature of early experience and the role of external reality. The conclusion takes a broader view of the relationships between time, reconstruction and psychic reality utilizing two examples from contemporary Western literature.

Adult↗
PubMed1995

Individual psychotherapy and persons with serious mental illness: the clients' perspective.

The perspectives of persons with serious mental illness about their experiences with individual psychotherapy were obtained from a stratified random sample of 12 psychosocial rehabilitation centers from all centers in Maryland. Response and completion rates, test-retest reliability, and generalization data were positive. Eight areas were explored: (1) Utilization and duration: of the 212 respondents, 90 percent had been in therapy for a median of 12 months (mean = 3 years); only a third expected to end their therapy within 5 years. (2) Therapeutic effectiveness: most of the respondents (72%) reported that individual psychotherapy had brought positive changes to their lives, 14 percent reported negative changes, and 14 percent reported that therapy had had no effect. (3) Preferred interventions and parameters: sixteen percent felt that medication was most useful, 25 percent felt that talking therapy was most useful, and 60 percent endorsed a combination of the two. With respect to diagnosis and psychotherapy, 84 percent of respondents with schizophrenia preferred brief, less frequent sessions of reality-oriented therapy over longer, more frequent sessions of insight therapy. Respondents with bipolar and major depression were equally split between the two. (4) Therapeutic issues: human concerns were more frequently rated as important and were rated higher in importance than illness-specific symptoms. (5) Clients' view of illness: Only 8 percent thought their illness was a brain disease, a third thought it was a psychological problem, and a quarter thought it was a combination of both; a third answered, open quote I don't know closed quote. Almost half did not know what their therapists thought. (6) Therapeutic relationship: Friendliness was the quality most desired in a therapist. (7) Confidentiality: Most felt that therapists generally kept the clients' confidences. (8) Empowerment: Persons who felt empowered in therapy spent less time in hospitals, expected a shorter stay in therapy, and knew more about their problems. Suggestions are made about a more client-responsive model of individual psychotherapy for persons with serious mental illness.

Adolescent↗
PubMed1990

The Tao, psychoanalysis and existential thought.

The purpose of this paper is to clarify some existing misunderstandings in the area of psychotherapy, existential approach and the Eastern Tao (Zen Buddhism, Confucianism, Lao-tzu, Chuang-tzu) by showing the common elements between Eastern Tao and psychoanalysis, and existential thought. The author compared the goal of Tao practice, namely, Zen Buddhism, Confucianism etc. with that of Western psychoanalysis, humanistic psychology and transpersonal psychotherapy. He concludes that these goals are the same and that the names are different. He also compared the procedures and processes of psychoanalysis and Zen practice. Sudden enlightenment and gradual training in Zen practice were compared with insight and 'working through' in psychoanalysis. Zen emphasis on relationship, ego strength and interpretation was linked with similar topics in psychoanalysis. The results of Zen practice and the central features of every psychoanalytic treatment were examined and found the same, that is, the resolution of, or transcending of, love (dependence) and hate (hostility). The description of a mature analyst and that of a Boddhisattva were compared and found the same. A trace of neurotic motivation remains but they are not influenced by it in helping others. The problem of theory and reality was discussed and strong emphasis on reality was described; in other words, the goal is directed at reality and theory is only a means pointing at reality. If you see the reality, you should forget the theory.

Buddhism↗
PubMed1999

Angiogenesis and gene therapy in man: dream or reality?

Preclinical studies indicate that angiogenic growth factors can stimulate the development of collateral arteries in animal models of peripheral or myocardial ischaemia, a concept termed 'therapeutic angiogenesis'. The goal of this review is to provide a brief overview of the advantages and disadvantages of gene versus recombinant protein therapy for therapeutic angiogenesis. We also discuss different options for delivering genes to patients, including plasmids and modified viral vectors. Recently, the safety and potential utility of gene therapy for ischaemic disease were demonstrated in 3 clinical trials involving the delivery of plasmid DNA encoding the 165 amino acid isoform of human vascular endothelial growth factor (phVEGF165), a factor that specifically promotes the proliferation and migration of vascular endothelial cells. Two trials involved the administration of phVEGF165 for peripheral arterial disease. In one trial, the plasmid was administered to the arterial wall from a hydrogel-coated angioplasty balloon, while a second trial examined the direct injection of phVEGF165 into the skeletal muscle of the affected limb. More recently, phVEGF165 was directly injected into ischaemic myocardium. In all these trials, it appears that administration of phVEGF165 led to improvements in tissue perfusion.

Angiogenesis Inducing Agents↗
PubMed1999

Angiogenesis and gene therapy in man: dream or reality?

Preclinical studies indicate that angiogenic growth factors can stimulate the development of collateral arteries in animal models of peripheral or myocardial ischaemia, a concept termed 'therapeutic angiogenesis'. The goal of this review is to provide a brief overview of the advantages and disadvantages of gene versus recombinant protein therapy for therapeutic angiogenesis. We also discuss different options for delivering genes to patients, including plasmids and modified viral vectors. Recently, the safety and potential utility of gene therapy for ischaemic disease were demonstrated in 3 clinical trials involving the delivery of plasmid DNA encoding the 165 amino acid isoform of human vascular endothelial growth factor (phVEGF165), a factor that specifically promotes the proliferation and migration of vascular endothelial cells. Two trials involved the administration of phVEGF165 for peripheral arterial disease. In one trial, the plasmid was administered to the arterial wall from a hydrogel-coated angioplasty balloon, while a second trial examined the direct injection of phVEGF165 into the skeletal muscle of the affected limb. More recently, phVEGF165 was directly injected into ischaemic myocardium. In all these trials, it appears that administration of phVEGF165 led to improvements in tissue perfusion.

Angiogenesis Inducing Agents↗
PubMed2003

Three-year follow-up for virtual reality exposure for fear of flying.

Thirty participants who had been treated for aviophobia with virtual reality graded exposure therapy with physiological monitoring and visual feedback (VRGETpm), virtual reality graded exposure therapy with physiological monitoring only (VRGETno), or imaginal exposure therapy (visualization) with physiological monitoring only (IET) between January 1998 and January 1999 were contacted in January 2002 for a 3-year posttreatment follow-up assessment. Of the participants in the VRGETpm group who had flown successfully by the end of treatment, all had maintained their ability to fly at follow-up. Of the participants in the VRGETno group who had flown successfully by the end of treatment, two were no longer able to fly. Of the participants in the IET group who had flown successfully, all were still able to fly. It appears that the addition of teaching self-control via visual feedback of physiological signals may serve to maintain treatment gains in long-term follow-up.

Adult↗
PubMed1989

Understanding negative hallucination: toward a developmental classification of disturbances in reality awareness.

Negative hallucinations are explored from a psychodynamic viewpoint in four cases of neurosis. Next, shifting to the level of clinical theory, negative hallucinations are contrasted with five better-studied disturbances in reality awareness. It is noted that all six function as screen phenomena, and all occur in everyday contexts. These and other phenomenological issues lead to an assertion that negative hallucinations are regressive perceptual phenomena, similar in form to both preconscious perceptions and infantile amnesia. Finally, developmental considerations are used to derive a coherent hierarchy of disturbances in reality awareness.

Adult↗
PubMed1996

'Psychic reality' and reality testing in the analysis of perverse defences.

The author considers that a large group of clinical phenomena, of which perversion is the most dramatic example, is characterised by the effort to disavow troubling perceptions of reality. In these cases, patients are sometimes characterised--erroneously, in his view-as living in a different 'psychic reality'. He suggests that patients who use perverse defences are able to distinguish fantasy from reality, but they are motivated to refrain from testing cherished fantasies against their own view of reality. Such patients are difficult to work with, because they dismiss painful realities in treatment as readily as any other unwanted perceptions. The author suggests that treatment must focus on the various disavowals of the patient's own perceptions of reality, to the extent that the analyst must be prepared to be a spokesperson for reality. Treatment in which the patient's 'psychic reality' is viewed as a 'kind' of reality rather than addressed as a fantasy can thus collude with perverse defences.

Adult↗