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[Ambivalence].

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Emotions↗

The psychodynamics of terrorism.

The authors propose a dynamic and social explanation for the 'malignant aggression' of the terrorist. No specific terrorist character is to be looked for. Rather, terrorism can occur whenever political conditions provide social legitimation for the acting out of deeply repressed hatred. The origins of this hatred lie in parental abuse, leading to murderous rage in the child, which must be deflected onto safer targets than the terrifying parent, such as the parent's enemies, or the authorities of one's country. Political terrorism therefore involves the exploitation of mental illness, connived at in turn by the international public through the media.

Authoritarianism↗

Controlled trial of calcitriol in the prevention of bone disease in haemodialysed patients.

Seventy-six patients receiving regular haemodialysis, without biochemical or radiological evidence of renal osteodystrophy, entered a five-year double-blind placebo-controlled trial of calcitriol (1,25-dihydroxycholecalciferol) in the prevention of bone disease. Significantly more patients on placebo developed bone disease as judged by a sustained elevation of plasma alkaline phosphatase or the development of sub-periosteal erosions on hand radiographs. Serum parathyroid hormone fell significantly in the patients receiving calcitriol and was significantly lower than in patients receiving placebo. It is concluded that calcitriol delays and may prevent the development of metabolic bone disease in patients receiving regular haemodialysis therapy.

Adolescent↗

Reflections.

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Adolescent↗

Definitive treatment of the borderline personality.

A discussion of "Notes on the Potential Differentiation of Borderline Conditions," by W.W. Meissner, M.D. Through psychotherapy, borderline personalities can develop a mature level of emotional autonomy. Their fundamental psychopathology involves annihilation anxiety consequent on inadequacy and instability of holding-soothing introjects. Psychological corollaries of this deficit render them unable to effect the internalization of real caring relationships that is necessary for development of effective holding introjects. Ideally, psychotherapy proceeds in three phases. Phase I is devoted to amelioration of the pathological impediments to using relationships with the therapist and others as resources for a holding-soothing form of emotional security. The outcome is development of a relatively stable idealized self-object transference in terms of holding-soothing, along with formation of relatively stable idealized holding-soothing introjects. Phase II of treatment involves optimal disillusionment in relation to idealization of the therapist as holding-soother; this results in gradual acceptance of the realistic use of external objects along with modification of holding-soothing introjects to correspond more nearly with reality. Stable autonomy in the area of self-security is fully attained in Phase III, in which the relationship with the therapist provides the context for the patient's developing capacities by means of identification to care for, esteem, love, and trust himself or herself. Psychotherapy of narcissistic issues is also important, but special precautions must be observed.

Adult↗

Long-term experience of alfacalcidol in renal osteodystrophy.

Thirteen patients receiving regular haemodialysis, with biochemical or radiological evidence of renal osteodystrophy, were treated with alfacalcidol (1 alpha hydroxy vitamin D3) for four years. During the first eighteen months of treatment plasma alkaline phosphatase and serum parathyroid hormone concentrations fell and subperiosteal phalangeal erosions improved. Thereafter plasma alkaline phosphatase and serum parathyroid hormone concentrations rose and after four years' treatment only four patients had a normal plasma alkaline phosphatase, only five a normal serum parathyroid hormone level and in only six had the erosions healed completely. Hypercalcaemia occurred in twelve patients, plasma calcium exceeding 3.0 mmol/l in ten. Plasma calcium rose abruptly close to the time when plasma alkaline phosphatase became normal and often remained raised despite reduction in dosage of alfacalcidol. We have reservations about the ultimate value of long-term treatment with alfacalcidol in haemodialysed patients with renal osteodystrophy and urge caution in its use.

Adult↗

Psychiatric symptoms in disliked medical patients.

Twenty-two patients seen in a clinic for systemic lupus erythematosus were tested for organicity, depression, anxiety, and hostility. Four of the clinic's physicians ranked these patients from most liked to least liked. In three of the four physicians, dislike was significantly correlated with the patient's degree of organicity. Ten of the patients were ranked among the three most disliked patients by one or more of the ranking physicians. This group of most disliked patients contained all patients with signs of organic brain damage and all suicidal patients. Dislike of a patient by the physician may be a clue to serious psychiatric impairment.

Adolescent↗

Aggression, trauma, and hatred in the treatment of borderline patients.

This article focuses on the etiology of aggressive affect, behavior, and fantasy in the treatment of patients with severe personality disorders in an effort to further our understanding of the psychopathology and treatment of these patients. In the process, the relationship between inborn disposition to aggressive behavior and the effect of severe trauma and psychosocial pathology in early childhood are examined. Various types of transferences marked by aggression and specific approaches to each of these are outlined. Particular reference is given to the management of intense hatred--as a derivative of aggression--in the transference, and of the unconscious identification with both victim and victimizer in patients who have experienced sexual or physical abuse.

Adult↗

[Hatred and change of love into hatred from the psychiatric nosological aspect (author's transl)].

Pathological hatred affects belong to the paranoic reactions, paranoic developments and paranoid psychoses. The normal hatred affect helps as a means to the end of removing the object of hatred. The passion of hatred is an affect swinging between a feeling of triumph and a feeling of impotence and the cardinal symptom of a paranoic neurotic development. Hatred becomes monomania when the affect degenerates maniacally (e. g. queruousness) or perversely (e. g. misogyny). In catathymic mania, hatred is projected on to the "pursuer". The metamorphosis of love into hatred is historically and dynamically behind all normal and pathological manifestations of hatred.

Adult↗

Fear, loathing, dermatology, and telemedicine.

Change is not necessarily progress. Few physicians- and still fewer specialists-would characterize the wrenching changes occurring in health care over the past decade as progress. When is the last time you heard about a change in the provision of health care that gave providers more time, made practice more profitable, reduced paperwork, or made your life generally easier? Still thinking? So am I. Bad news of one sort or another has come in an unbroken stream for years now, or at least it seems that way. Payments to providers are continually reduced. Managed care has steadily reduced specialists' access to patients. The paperwork associated with referrals, billing, and laboratories continues to mount for most of us.

Dermatology↗