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PubMed2002

Rabbitfish ("aras"): an unusual source of ciguatera poisoning.

BACKGROUND: Ciguatera poisoning is the commonest fish-borne seafood intoxication. It is endemic to warm water tropical areas and is caused by consumption of bottom-dwelling shore reef fish, mostly during spring and summer. The causative agent, ciguatoxin, is a heat-stable ester complex that becomes concentrated in fish feeding on toxic dinoflagellates. The common clinical manifestations are a combination of gastrointestinal and neurologic symptoms. Severe poisoning may be associated with seizures and respiratory paralysis. OBJECTIVE: To describe a series of patients who sustained ciguatera poisoning in an uncommon region and from an unexpected source. PATIENTS: Two families complained of a sensation of "electrical currents," tremors, muscle cramps, nightmares, hallucinations, agitation, anxiety and nausea of varying severity several hours after consuming rabbitfish ("aras"). These symptoms lasted between 12 and 30 hours and resolved completely. The temporal relationship to a summer fish meal, the typical clinical manifestations along with the known feeding pattern of the rabbitfish suggested ciguatera poisoning. CONCLUSIONS: The Eastern Mediterranean basin is an unusual region and the rabbitfish an unusual source for ciguatera poisoning. There are no readily available and reliable means for detecting ciguatoxin in humans. A high index of suspicion is needed for diagnosis and a thorough differential diagnosis is essential to eliminate other poisonings, decompression sickness and encephalitis. Supportive therapy is the mainstay of treatment.

Adult↗
PubMed1994

The functions of writing: transmission between generations and role assignment within the family, in Henry James and his family.

The Jameses provide abundant material for this study of the function of writing within a family, combining a relationship between generations and between the sexes among siblings. The starting point is Henry's dream of the Galerie d'Apollon, which can be referred to its sources in reality; its autobiographical account; and its transformation into a story. This material gives clues to some central features of his unconscious conflicts with both his father and elder brother. The father's writings deal with his concern with religion, which expresses his relationship with his own father. William transforms his father's theology into philosophy and becomes one of the pioneers of modern psychology. Alice's diary recounts her identification with her father's infirmity through her hysterical paralysis. Henry's work reveals that he is the one who really succeeded in solving his conflicts with the father. His literature is transgressive according to his father's and brother's values, though he shares their ideal of a consciousness common to the Jameses. Through fiction, Henry has indirect access to the drives; but only in his work did he acknowledge these, overcoming his oedipal conflicts. Thus Henry is the closest of the Jameses to psychoanalysis; his work enables us to make some hypotheses regarding the creative process.

Family↗
PubMed1975

Clinical recognition of early schizophrenic decompensation.

The early signs and symptoms of schizophrenic decompensation are subtle and variegated. Today's community patient often presents with vague complaints of brief duration making it imperative that today's diagnostician be able to recognize and appropriately treat early psychopathology. This paper collates a number of observations of developing psychotic phenomena -- self reports, clinical studies and controlled experiments -- and provides a useful format for organizing these complex and changing behaviors. Data are presented and discussed using our clinical schema for detailing the natural progression of developing psychotic phenomena into four distinct stages. Efficacy of early recognition and treatment in aborting or diminishing a major psychotic episode is discussed. The advantages of recognizing the early signs of psychotic decompensation are apparent. First, with adequate intervention and treatment, the overt psychotic state may be attenuated. Although the feasibility of reducing the incidence of schizophrenia through intervention in "high risk" groups, or those experiencing insidious symptoms remain speculative (further investigation in this area is urgently needed), nonetheless, early diagnosis and comprehensive rehabilitative care significantly improves social and occupational adjustment. A second advantage accrues from early diagnosis. It enables patient and family to better cope with the illness. We have previously outlined a schema detailing the natural progression of developing psychotic phenomena into four distinct stages. The phenomena, when identified, can be seen as a continuum. However, many clinicians fail to recognize the earlier phases and typically the diagnosis of psychosis is made relatively late at what we call stage three of the four stages we described.

Affective Symptoms↗
PubMed1992

Life support systems for Mars transit.

The long-held human dream of travel to the stars and planets will probably be realized within the next quarter century. Preliminary analyses by U.S. scientists and engineers suggests that a first trip to Mars could begin as early as 2016. A proposal by U.S.S.R. space planners has suggested that an effort involving the cooperation and collaboration of many nations could begin by 2011. Among the major considerations that must be made in preparation for such an excursion are solidification of the scientific, economic and philosophical rationales for such a trip made by humans, and realistic evaluations of current and projected technical capabilities. Issues in the latter category include launch and propulsion systems, long term system stability and reliability, the psychological and physiological consequences of long term exposure to the space environment, the development and use of countermeasures to deleterious human physiological responses to the space environment, and life support systems that are both capable of the immense journey and reliable enough to assure their continued operation for the duration of the voyage. Many of the issues important in the design of a life support system for a Mars trip are based on reasonably well understood data: the human requirements for food, oxygen and water. However, other issues are less well-defined, such as the demands that will be made on the system for personal cleanliness and hygiene, environmental cleanliness, prevention or reduction of environmental toxins, and psychological responses to the environment and to the diet. It is much too early to make final decisions about the characteristics of the long-duration life support system needed for travel to Mars, or for use on its surface. However, it is clear that life support systems will evolve during the next few decades form the relatively straightforward systems that are used on Shuttle and Soyuz, to increasingly more complex and regenerative systems. The Soviet Union has an operating life support system on Mir that can apparently evolve, and the United States is currently planning the one for Space Station Freedom that will use partial regeneration. It is essential to develop concepts now for life support systems on an advanced Space Station, the lunar outpost (to be launched in about 2004) and the lunar base. Such concepts will build on current technology and capabilities. But because of the variety of different technologies that can be developed, and the potential for coordinating the functions of very diverse sub-systems within the same life support system, the possibility of developing an efficient, reliable mixed process system is high. It is likely that a life support system for Mars transit and base will use a composite of physical, chemical, and biological processes. The purpose of this paper is to explore the potentially useful structural elements of a life support system for use on a Mars trip, and to identify the features that, at this time, appear to be most appropriate for inclusion in the system.

Carbon Dioxide↗
PubMed1985

The erotic transference in women and in men: differences and consequences.

Although the erotic transference is believed to be universal, it is variable in its expression. Drawing on the distinction between transference resistance and resistance to the awareness of the transference, I have proposed that, in general, the erotic transference utilized as resistance is more common among women, while resistance to the awareness of the erotic transference is more common among male patients. Erotic transference as resistance poses different analytic problems from those posed by resistance to its awareness. With women in treatment with men, the erotic transference is more often overt, consciously experienced, intense, long-lived and directed toward the analyst, and focused more on love than sex; with men in treatment with women, the erotic transference is muted, relatively short-lived, appears indirectly in dreams and triangular preoccupations, is seldom consciously experienced as a dominant affective motif, is frequently transposed to a woman outside the analytic situation, and most often appears as sexual rather than as a longing for love. In women, the strength of the erotic transference may obscure other important dynamics and conflicts. In short, the strength of the erotic transference, while it has significant therapeutic potential, often acts as a strong transference resistance to working out underlying conflicts. In contrast, in male patients in treatment with women, there is a resistance to the experience of the transference and, frequently, one witnesses defenses against the erotic transference rather than the transference itself. Yet, the dangers are substantial when the erotic transference fails to develop or is suppressed. This difference in the manifestation of the erotic transference parallels an extratherapeutic difference. In general, women achieve their self-identity as women by virtue of certain defining relationships, whereas men achieve their self-identity as men through achievement and autonomy. The reasons for these differences have been explored in terms of cultural dictates, but more particularly in terms of an asymmetry in psychological development.

Adult↗
PubMed1990

Self-analysis: a fool for a patient?

In this paper I first reviewed the scanty publications on the subject of self-analysis. Although it was recommended by Freud as early as 1910 for every analyst, self-analysis turns out to have many pitfalls and to be quite a complicated and controversial procedure. There is no agreement on the proper technique of self-analysis in the literature, nor is there any discussion of the determinants of the particular choice of technique of self-analysis that is employed, nor even of the reasons why some analysts do not engage in it at all. Using clinical data gathered from written material of many years of self-analysis following the termination of a successful training psychoanalysis, I have attempted to elucidate some of the problems posed by this procedure. These problems are in some ways similar to formal psychoanalysis, but are in some ways contingent on the fact that it is basically a different technique. It is a solitary occupation and therefore suffers from the dangers of disintegration into autism, narcissism, and obsessional rumination. There is no living presence of an analyst to serve either as a transference figure or to make interpretations and stimulate the production of material. The identification with the analyst's analyzing function is far from simple in self-analysis because of the complex nature of the various internalizations of the analyst that take place over years of a formal training analysis. Thus, Ticho (1967) is correct when she claimed that self-analysis is a skill that the analysand has to acquire by himself or herself. An important phase of the beginning of self-analysis involves the working through of the separation from the psychoanalyst and the re-evaluation of the analyst and the analytic process. This results in a heightened sense of independence and autonomy, increased cohesion of the self, and maturation--which is manifested by greater autonomous ego functioning, a more mature sense of identity, and continued transformations of narcissism which highly valuable goals, on the basis of the data I have presented, can be approached through the process of self-analysis. Above all this stands the most important goal of self-analysis, the understanding of one's countertransference reactions. This is especially important in the treatment of seriously disturbed patients who become disruptive, and thus get labeled borderline, often as a response to unconscious countertransference manifestations from the analyst which are then experienced in the self-object transference as failures in empathy.(ABSTRACT TRUNCATED AT 400 WORDS)

Conflict, Psychological↗
PubMed1982

Twin transference as a compromise formation.

This paper explores the meanings and functions of a transference paradigm of a fantasied twin relationship with the analyst. Twin transference in the analysis of nontwins has been reported infrequently in the psychoanalytic literature, except recently by Kohut and his co-workers, who refer to twinship transference as a variant of narcissistic mirror transference. We suggest that such narrow definition tends to reduce the complexity of the wish for a twinlike relationship with the analyst. Analytic data are used to show the advantages of examining twin transference within structural theory, in terms of the multiple functions served by this rather primitive transference paradigm, rather than reducing it only to one variant of the need for certain mirroring functions. We suggest that twin transference, together with all twin fantasies, subserves multiple functions, of which we highlight gratification and defense against the dangers of intense object need. In this formulation, the twinlike representation of the object provides the illusion of influence or control over the object by the pretense of being able to impersonate or transform oneself into the object and the object into the self. Intense object need persists together with a partial narcissistic defense against full acknowledgment of the object by representing the sought-after object as combining aspects of self and other. Further analytic attention needs to be directed to the specific representation of the needed object in certain primitive transference paradigms instead of exclusive emphasis on the functions required of the object. Our analytic data are used to argue that intense early needs of an object are best understood analytically within a conflict model in which they are modified by multiple wishes, drives, fears, dangers, and needs for defense.

Dreams↗
PubMed2005

Grouping of brain rhythms in corticothalamic systems.

Different brain rhythms, with both low-frequency and fast-frequency, are grouped within complex wave-sequences. Instead of dissecting various frequency bands of the major oscillations that characterize the brain electrical activity during states of vigilance, it is conceptually more rewarding to analyze their coalescence, which is due to neuronal interactions in corticothalamic systems. This concept of unified brain rhythms does not only include low-frequency sleep oscillations but also fast (beta and gamma) activities that are not exclusively confined to brain-activated states, since they also occur during slow-wave sleep. The major factor behind this coalescence is the cortically generated slow oscillation that, through corticocortical and corticothalamic drives, is effective in grouping other brain rhythms. The experimental evidence for unified oscillations derived from simultaneous intracellular recordings of cortical and thalamic neurons in vivo, while recent studies in humans using global methods provided congruent results of grouping different types of slow and fast oscillatory activities. Far from being epiphenomena, spontaneous brain rhythms have an important role in synaptic plasticity. The role of slow-wave sleep oscillation in consolidating memory traces acquired during wakefulness is being explored in both experimental animals and human subjects. Highly synchronized sleep oscillations may develop into seizures that are generated intracortically and lead to inhibition of thalamocortical neurons, via activation of thalamic reticular neurons, which may explain the obliteration of signals from the external world and unconsciousness during some paroxysmal states.

Animals↗
PubMed2003

Narcolepsy in the older adult: epidemiology, diagnosis and management.

Narcolepsy is a disorder of impaired expression of wakefulness and rapid-eye-movement (REM) sleep. This manifests as excessive daytime sleepiness and expression of individual physiological correlates of REM sleep that include cataplexy and sleep paralysis (REM sleep atonia intruding into wakefulness), impaired maintenance of REM sleep atonia (e.g. REM sleep behaviour disorder [RBD]), and dream imagery intruding into wakefulness (e.g. hypnagogic and hypnopompic hallucinations). Excessive sleepiness typically begins in the second or third decade followed by expression of auxiliary symptoms. Only cataplexy exhibits a high specificity for diagnosis of narcolepsy. While the natural history is poorly defined, narcolepsy appears to be lifelong but not progressive. Mild disease severity, misdiagnoses or long delays in cataplexy expression often cause long intervals between symptom onset, presentation and diagnosis. Only 15-30% of narcoleptic individuals are ever diagnosed or treated, and nearly half first present for diagnosis after the age of 40 years. Attention to periodic leg movements (PLM), sleep apnoea and RBD is particularly important in the management of the older narcoleptic patient, in whom these conditions are more likely to occur. Diagnosis requires nocturnal polysomnography (NPSG) followed by multiple sleep latency testing (MSLT). The NPSG of a narcoleptic patient may be totally normal, or demonstrate the patient has a short nocturnal REM sleep latency, exhibits unexplained arousals or PLM. The MSLT diagnostic criteria for narcolepsy include short sleep latencies (<8 minutes) and at least two naps with sleep-onset REM sleep. Treatment includes counselling as to the chronic nature of narcolepsy, the potential for developing further symptoms reflective of REM sleep dyscontrol, and the hazards associated with driving and operating machinery. Elderly narcoleptic patients, despite age-related decrements in sleep quality, are generally less sleepy and less likely to evidence REM sleep dyscontrol. Nonpharmacological management also includes maintenance of a strict wake-sleep schedule, good sleep hygiene, the benefits of afternoon naps and a programme of regular exercise. Thereafter, treatment is highly individualised, depending on the severity of daytime sleepiness, cataplexy and sleep disruption. Wake-promoting agents include the traditional psychostimulants. More recently, treatment with the 'activating' antidepressants and the novel wake-promoting agent modafinil has been advocated. Cataplexy is especially responsive to antidepressants which enhance synaptic levels of noradrenaline (norepinephrine) and/or serotonin. Obstructive sleep apnoea and PLMs are more common in narcolepsy and should be suspected when previously well controlled older narcolepsy patients exhibit a worsening of symptoms. The discovery that narcolepsy/cataplexy results from the absence of neuroexcitatory properties of the hypothalamic hypocretin-peptidergic system will significantly advance understanding and treatment of the symptom complex in the future.

Adult↗
PubMed1998

Brain and conscious experience.

There is a deep belief that we can attain not only a neuroscience of consciousness but a neuroscience of human consciousness. It is as if something terribly new and complex happens as the brain enlarges to its human form. Whatever this is, it triggers our capacity for self-reflection, for ennui, and for lingering moments, I would like to propose a simple, three-step suggestion. First, we should focus on what we mean when we talk about conscious experience. It is merely the awareness we have of our capacities as a species, but not the capacities themselves--only the awareness or feelings we have about them. The brain is clearly not a general purpose computing device but is a collection of circuits devoted to quite specific capacities. This is true for all brains, but what is wonderful about the human brain is that we have untold numbers of these capacities. We have more than the chimp, which has more than the monkey, which has more than the cat, which runs circles around the rat. Because we have so many specialized systems and because they can frequently do things they were not designed to do, it appears our brains have a single, general computing device. But we do not. Thus, step 1 requires that we recognize we are a collection of adaptations and, furthermore, we recognize the distinction between a species' capacities and its feelings about those capacities. Now consider step 2. Can there be any doubt that a rat at the moment of copulation is as sensorially fulfilled as a human? Of course it is. Do you think a cat does not enjoy a good piece of cod? Of course it does. Or, a monkey does not enjoy a spectacular swing? Again, it has to be true. Each species is aware of its special capacities. So, what is human consciousness? It is the very same awareness, save for the fact that we can be aware of so much more, so many wonderful things. A circuit--perhaps a single system or one duplicated over and over again--is associated with each brain capacity. The more systems a brain possesses, the greater the awareness of capacities. Think of the variations in capacity within our own species; they are not unlike the vast differences between species. Years of split-brain research have informed us that the left hemisphere has many more mental capacities than the right one. The left is capable of logical feats that the right hemisphere cannot manage. Although the right has capacities such as facial recognition systems, it is a distant second with problem-solving skills. In short, the right hemisphere's level of awareness is limited. It knows precious little about a lot of things, but the limits to human capacity are everywhere in the population. No one need be offended to realize that just as someone with normal intelligence can understand Ohm's law, others, like yours truly, are clueless about Kepler's laws. I am ignorant about them and will remain so. I am unable to be aware about what they mean for the universe. The circuits that enable me to understand these things are not present in my brain. By emphasizing specialized circuits that arise from natural selection, we see that the brain is not a unified neural net that supports a general problem-solving device. With this being understood, we can concentrate on the possibility that smaller, more manageable circuits produce awareness of a species' capacities. Holding fast to the notion of a unified neural net means we can understand human conscious experience only by figuring out the interactions of billions of neurons. That task is hopeless. My scheme is not. Hence step 3. The very same split-brain research that exposed shocking differences between the two hemispheres also showed that the human left hemisphere has the interpreter. The left brain interpreter's job is to interpret our behavior and our responses, whether cognitive or emotional, to environmental challenges. It constantly establishes a running narrative of our actions, emotions, thoughts, and dreams. It is the glue that keeps our

Animals↗