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Design of imidazole-containing endosomolytic biopolymers for gene delivery.

The development of safe and effective gene delivery agents poses a great challenge in the quest to make human gene therapy a reality. Cationic polymers represent one important class of materials for gene delivery, but to date they have shown only moderate efficiency. Improving the efficiency will require the design of new polymers incorporating optimized gene delivery properties. For example, inefficient release of the DNA/polymer complex from endocytic vesicles into the cytoplasm is one of the primary causes of poor gene delivery. Here we report the synthesis of a biocompatible, imidazole-containing polymer designed to overcome this obstacle. DNA/polymer polyplexes incorporating this polymer were shown to have desirable physico-chemical properties for gene delivery and are essentially nontoxic. Using this system, mammalian cells in vitro were transfected in the absence of any exogenous endosomolytic agent such as chloroquine.

Animals↗

The psychoanalyst's mind: from listening to interpretation--a clinical report.

Freud's delineation of 'psychical reality' as our investigative domain poses compelling epistemological and clinical challenges, which must profoundly affect our understanding of what is meant by what is real. Exploring the patient's inner reality as our central database, we are given a remarkable, but elusive opportunity for discovery and recognition, holding a pervading mutative power. It is elusive, for, despite our intentions otherwise, there is a continuing pull towards a belief in the greater 'wisdom' of our own assumptions and predilections, a blurring of the boundaries between our and our patient's vantage points, leading us away from essential, if subtler dimensions of the patient's experience. Utilising a clinical example, the author tries to illustrate some of her efforts to listen to her patient, and the difficulty she encountered. Her struggle was one which, she believes, has more far-ranging, even ubiquitous ramifications. Further consideration is given to some of the theoretical underpinnings in this mode of analytic listening.

Adult↗

[Sociotherapy in the psychogeriatric nursing home. Possibilities for a psychogeriatric sociotherapy].

Terms as sociotherapy, environment therapy and the therapeutical environment have their origin in psychiatry and from there influenced various other treatment settings. The basic philosophy however is still the same: people live and are treated in social organizations which have an influence on their feeling of well-being and chances on recovery. Depending on the specific characteristics, each treatment setting has developed different ways of interpreting and practicing this philosophy. One of the ways of defining the psychogeriatric interpretation of sociotherapy is the analysis of the behavior of the nurse in a psychogeriatric nursing-home, with a sociotherapeutic treatment philosophy, in relation to the patients. Evaluation of behavior in terms of its sociotherapeutic characteristics is not necessarily equivalent to sociotherapeutic behavior. It however gives a clearer view of the way a philosophy is practiced and the conditions under which this is done.

Aged↗

The reality and the image of God in psychotherapy.

I have suggested that the plea for increased respect for the religious patient's perspectives demands a willingness on the psychotherapist's part to acknowledge the unique reality of the patient's relationships with religious objects, a reality which extends beyond the assumptions and predicates of standard interpersonal models of human behavior. At the same time, the psychotherapist can legitimately expect of the religious patient a willingness (notwithstanding the customary resistances) to expose his or her religious feelings and relationships to the type of analysis which attempts to clarify the nature and quality of the interpersonal or psychodynamic bases and implications of religious material. The psychotherapist can not arbitrate moral claims and decisions for the patient, nor rightfully present himself as possessing the single, "true" understanding of religious experience. Yet the therapist can invite the patient to examine the moral implications of his psychological experiences and the psychological impact and consequences of his religious experiences. What knowledge we as psychotherapists possess about human nature can be used to influence changes in the lives of our patients which they find useful and relevant for living in the world they have created for themselves. But we must, I think, humbly anticipate qualities of human nature and relationship whose ultimate meanings may defy every convention and paradigm.

Adult↗

Dual coding: a cognitive model for psychoanalytic research.

Four theories of mental representation derived from current experimental work in cognitive psychology have been discussed in relation to psychoanalytic theory. These are: verbal mediation theory, in which language determines or mediates thought; perceptual dominance theory, in which imagistic structures are dominant; common code or propositional models, in which all information, perceptual or linguistic, is represented in an abstract, amodal code; and dual coding, in which nonverbal and verbal information are each encoded, in symbolic form, in separate systems specialized for such representation, and connected by a complex system of referential relations. The weight of current empirical evidence supports the dual code theory. However, psychoanalysis has implicitly accepted a mixed model-perceptual dominance theory applying to unconscious representation, and verbal mediation characterizing mature conscious waking thought. The characterization of psychoanalysis, by Schafer, Spence, and others, as a domain in which reality is constructed rather than discovered, reflects the application of this incomplete mixed model. The representations of experience in the patient's mind are seen as without structure of their own, needing to be organized by words, thus vulnerable to distortion or dissolution by the language of the analyst or the patient himself. In these terms, hypothesis testing becomes a meaningless pursuit; the propositions of the theory are no longer falsifiable; the analyst is always more or less "right." This paper suggests that the integrated dual code formulation provides a more coherent theoretical framework for psychoanalysis than the mixed model, with important implications for theory and technique. In terms of dual coding, the problem is not that the nonverbal representations are vulnerable to distortion by words, but that the words that pass back and forth between analyst and patient will not affect the nonverbal schemata at all. Using the dual code formulation, and applying an investigative methodology derived from experimental cognitive psychology, a new approach to the verification of interpretations is possible. Some constructions of a patient's story may be seen as more accurate than others, by virtue of their linkage to stored perceptual representations in long-term memory. We can demonstrate that such linking has occurred in functional or operational terms--through evaluating the representation of imagistic content in the patient's speech.

Cognition↗

Computer-supported cognitive behavioral treatment of anxiety disorders.

This article reviews the empirical literature pertaining to the use of computer-supported cognitive-behavioral treatment of anxiety disorders, including palmtop computers, virtual reality exposure therapy, and personal computer software programs. The advantages and disadvantages unique to each type of technology are described. The review concludes with a discussion of ethical issues, barriers to the use of technology by clinicians, and suggestions for a process by which scientists and practitioners can conceptualize how technology can advance our understanding of anxiety and our dissemination of effective treatments.

Anxiety Disorders↗

The phenomenon of regression to the mean and clinical investigation of blood cholesterol lowering drugs.

The phenomenon of regression to the mean is widespread. It may affect any quantitative biological data in which there is "within subject" variability. It is demonstrated, as an example in practice, by a shift from high to lower values with time in a selected subset of patients with an abnormally high blood cholesterol. The phenomenon will influence experiments involving before-after measurements of a continuous variable. An incorrect conclusion may be reached if investigators do not take regression to the mean into account when designing a clinical trial of hypolipidemic therapy. The reality of the phenomenon is illustrated by a prospective study.

Anticholesteremic Agents↗

Brief report: two case studies using virtual reality as a learning tool for autistic children.

The children complied with most requests. Some of our teaching goals were limited by technology or space while others were limited by the difficulty of presenting a task to the children in a way that was understandable within their environment. However, the opportunity to introduce this technology to children was an important first step in exploring the potential VR offers to understanding the perceptual processes involved in autism. Our results indicate that the will accept a VR helmet and wear it, identify familiar objects and qualities of these objects in their environment while using the helmet, and locate and move toward objects in their environment while wearing the helmet. More research is necessary to verify the potential in this area, especially to discover if learning experiences through VR generalize to other environments, but it appears virtual reality may provide a useful tool for furthering our understanding of autism and guiding efforts at treatment and intervention.

Autistic Disorder↗

[Reality of menopausal hormone replacement therapy by French gynaecologists: OCEANIDES, a transversal and longitudinal national epidemiology study].

OBJECTIVE: To describe the initiation of hormone replacement therapy (HRT) in standard gynaecological practice in France, and to assess treatment adherence factors at 1 year follow-up. MATERIALS AND METHODS: Six hundred and nineteen gynaecologists distributed on the French territory and 1428 menopausal women were included in a transversal then longitudinal epidemiology study run over a period of 1 year. They filled out a questionnaire specially made for the purpose. All patients underwent patch HRT. RESULTS: One year after initiation of HRT, 1161 patients completed the study; 959 (82.6%) were still under HRT, and 202 (17.4%) had stopped altogether. Very few differences were found between those patients continuing with and those having stopped HRT. The two groups were comparable for the whole range of their own socio-demographic characteristics and for the demographic characteristics and medical practice of their gynaecologists. It had, however, more often been for renewal of an ongoing treatment that the patients who later ceased HRT had come to the consultation at which HRT was initiated, and these patients had less often enquired about the sexual benefits of HRT. DISCUSSION AND CONCLUSIONS: Adherence to physician-initiated patch HRT was good at 1 year follow-up. This result may be related to the quality of care provided by the gynaecologists, who listened to their patients, explained the treatment, and initiated personalised low-dose regimens, which they adapted to the patients' needs.

Cross-Sectional Studies↗

Reality monitoring and motor memory in checking-prone individuals.

Studies concerning reality monitoring and motor memory abilities in checkers have provided mixed results. The aim of this study was to re-examine this question by asking 75 undergraduate students to perform, watch the experimenter perform, imagine themselves performing, imagine the experimenter performing, or verbally repeat different daily actions. Two groups were created (checking-prone and nonchecking-prone subjects) based on participants' checking subscores on the revised version of the Obsessive-Compulsive Inventory. First, results suggested that checking-prone subjects have a poorer motor memory than nonchecking-prone participants. Second, our data indicated that checking-prone participants confused actions they had performed with actions the experimenter had performed more often than nonchecking-prone participants. In other words, checking-prone participants remembered events from an observer's viewpoint. Finally, our findings suggest that dissociation could be a mediating variable between some of the reality monitoring abilities and checking.

Adult↗

Treatment of acrophobia in virtual reality: the role of immersion and presence.

In this study the effects of virtual reality exposure therapy (VRET) were investigated in patients with acrophobia. Feelings of presence in VRET were systematically varied by using either a head-mounted display (HMD) (low presence) or a computer automatic virtual environment (CAVE) (high presence). VRET in general was found to be more effective than no treatment. No differences were found in effectiveness between VRET using an HMD or CAVE. Results were maintained at 6 months follow-up. Results of VRET were comparable with those of exposure in vivo (Cyberpsychology and Behavior 4 (2001) 335). In treatment completers no relationship was found between presence and anxiety. Early drop-outs experienced less acrophobic complaints and psychopathology in general at pre-test. They also experienced less presence and anxiety in the virtual environment used in session one as compared to patients that completed VRET.

Analysis of Variance↗