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PubMedDate not supplied

High CD44 expression on human mesotheliomas mediates association with hyaluronan.

PURPOSE: Malignant pleural mesothelioma is a rare malignancy with major environmental implications regarding passive asbestos exposure. We have conducted an immunohistochemical and functional study to address three questions: (1) What is the representation of CD44 on tumor cells as detected by immunohistochemistry? (2) Do cultured cell lines derived from malignant pleural mesothelioma tissue express the same CD44 phenotypes as the original tumors, and can they serve as a model for the study of CD44 in mesotheliomas? (3) What is the functional status of the CD44 expressed on mesotheliomas, with regard to hyaluronan anchorage? MATERIALS AND METHODS: Thirty-seven samples of pleural mesothelioma were obtained from patients entered on phase I/II protocols conducted in the Surgery Branch of the National Cancer Institute since 1991. The diagnosis was confirmed in all 37 patients by means of a battery of immunohistochemical tests for markers differentiating malignant pleural mesothelioma from adenocarcinoma. Tumor-positive lymph nodes and distant metastases were also examined in six of the patients. Cell lines, established from tumor tissue of six of the patients described above, were used in these experiments. Four (H2596, H2461, H2373, H2452) were derived from primary solid tumors and two (HP-1 and HP-3) were derived from effusions. RESULTS: Immunohistochemical staining with a monoclonal antibody (H4C4) that recognizes a constant region of human CD44 demonstrated that 34 (92%) of the malignant pleural mesotheliomas examined expressed CD44 on 50% to 100% of their cells. The extent of CD44 expression was apparently related to histologic subtype with the highest expression seen in epithelioid mesotheliomas and the least in sarcomatoid tumors. Tumor cell lines established from the primary tumors or effusions of six of the malignant pleural mesothelioma patients showed high expression of the hematopoietic form of CD44. Four of these cell lines exhibited strong attachment to hyaluronan in an in vitro attachment assay, indicating that their CD44 was functional with respect to hyaluronan anchorage. Hyaluronan attachment was specific in that it could be abolished by preincubation with epitope-specific anti-CD44 antibodies or soluble substrate or by hyaluronidase treatment of attachment surfaces. CONCLUSIONS: We conclude that CD44 is highly expressed on human mesotheliomas, that cell lines adequately represent tumor expression, and that CD44 mediates association with hyaluronan, a major component of pleural fluid.

Antibodies, Monoclonal↗
PubMed1999

Parental representations associated with adult separation anxiety and panic disorder--agoraphobia.

OBJECTIVE: Early bonding abnormalities have been associated with a range of anxiety and depressive disorders in adulthood, but no specific parental patterns have emerged for particular disorders. The present study investigated the possibility that parental overprotectiveness may be linked to a risk of separation anxiety (SA) in adulthood. METHOD: Two samples were recruited: volunteers (n = 34) whose major anxieties focused on separation concerns, and adult anxiety clinic patients (n = 37) who were diagnosed with panic disorder. Parental characteristics and early SA were assessed by dichotomising the combined sample first according to adult SA categorisation and then by panic disorder status. RESULTS: Subjects assigned to the adult SA category reported high levels of juvenile SA and exposure to maternal overprotectiveness, whereas patients diagnosed with panic disorder reported few differences in their bonding histories compared to residual anxious patients. CONCLUSIONS: The findings of this study suggest that early SA and parental overprotectiveness may not be associated with panic disorder per se, but rather with persisting SA symptoms in adulthood. The overlapping samples and retrospectivity of some measures are important limitations of the study.

Adult↗
PubMed2000

Parental style and vulnerability to depression: the role of core beliefs.

This study considers the potential role of core beliefs (unconditional schema-level representations) in the relationship between recalled parenting in childhood and major depression in adulthood, comparing a group of depressed outpatients (N = 60) with a healthy community sample (N = 67). The depressed group were differentiated by poorer perceived parenting (low care and high overprotection) and by three unhealthy core beliefs (defectiveness/shame, self-sacrifice, and insufficient self-control). Among nonclinical participants, it appears that vulnerability to harm beliefs act as a partial mediator of the relationship between poor paternal care and the development of depressive features. In contrast, a broader set of core beliefs appears to mediate the relationship of maternal bonding and paternal overprotection with depressive symptoms among the depressed group. The findings suggest that clinical work with adults with major depression might need to take account of parental style. Where parents are reported to be uncaring or overprotective, cognitive-behavioral therapy might need to include a schema-focused component.

Adolescent↗
PubMed1998

An empirical study of the psychodynamics of suicide.

This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.

Adolescent↗
PubMedDate not supplied

Four questions. A discussion of "Introjection and the Idealizing Transference".

A discussion of "introjection and the Idealizing Transference" by Theodore L. Dorpat, M.D. The analysis of a patient with a narcissistic disorder is the basis for Dr. Dorpat's thesis that introjections (i.e., object representations) of the analyst as a real person are the basis for subsequent identifications resulting in changes in the self. I disagree with his characterization of the material as representing an idealizing transference. I believe it is better understood as an example of an alter ego or twinship transference. His material demonstrates the crucial role of the analyst as a self-object in the transference, rather than as a real person. The hypothesis that a patient changes as a result of identification with the analyst suggests possible countertransference pitfalls: a rationalized expression of the analyst's unconscious archaic fantasies or the enhancement of the analyst's self-esteem. The perception of such identifications could reflect the personal experience of the analysand who seeks to acquire the characteristics of the training analyst, or they could be apparent rather than real, the result of other therapeutic factors. Dr. Dorpat's paper provides an excellent opportunity for consideration of these issues, but, at present, such introjection-internalization sequences cannot be accepted as scientific formulations.

Countertransference↗
PubMed1984

[Aspects of the preliminary psychotherapeutic phase before analytic treatment of psychosomatically ill patients].

Practical aspects of the treatment of badly affected psychosomatic patients with deficient ego functions are to be presented and discussed here: The presence of the therapist with the patient must be measured in terms of time, space and emotion (not more than 30 minutes; the distance of eye-contact of 1-1,5 m must be kept; kind, dependable devotion). The growth of self-representation and a separate object-representation should be encouraged. This happens a) by enticing the patient to turn his attention from his inner body to the surface of his body and finally to the therapist; b) through the willingness of the therapist to let himself be scrutinized in peace; c) through dialogue between the patient and the therapist. It is of value to attain libidinal cathexis of the body ego of the patient with the help of the therapist and by the patient himself; thereby the old significance can retreat into the background. Overcoming the primary disassociation should be encouraged, namely a) by accepting the limited possibilities of the therapist. b) by showing opposite feelings in the therapist. The present social as well as the previous social situations with the various accompanying inter-personal feelings should make up the content of the discussions between the therapist and the patient in the latter part of the preliminary phase of the treatment. Only after the depicted phase in psychotherapy with badly affected psychosomatic patients attention can be focused on analytical treatment.

Body Image↗
PubMed1991

Correlation of periodontal probe penetration and degree of inflammation.

This histological study correlated the depth of probe penetration to periodontal health in mongrel dogs. Various probing forces were also applied with an electronic pressure-sensitive probe and compared to manual probing. Three adult mongrel dogs with naturally occurring periodontitis in at least one quadrant were selected and gross scaling was only performed in these diseased areas. Mild gingivitis was diagnosed in other areas. One half was scaled and placed on a plaque control regimen to restore clinical health, while the other half remained untreated to maintain the existing gingivitis. The Gingival Index (GI) was recorded on 24 teeth achieving equal representation of different GI values. Probe tips were inserted utilizing manual pressure as well pressures of 15 and 25 gm directed with an electronic pressure-sensitive probe. The probes were bonded to the teeth, and the specimens were sacrificed. Blocks with the probes in place were fixed and decalcified. The probes were removed prior to processing. Sections from each probing site were microscopically analyzed, and the distance was recorded from the tip of the probe to the apical termination of the junctional epithelium (ATJE). The number of inflammatory cells was documented for two fields at x200, one coronal (X) and one apical (Y) to the penetration of the probe's tip. The data were analyzed by two-sample t-test and Pearson product-moment correlation coefficient. A strong correlation was established between probe penetration and degree of inflammation, X (r = 0.6936) and Y (r = 0.7075). The difference in mean inflammation scores between probes coronal or apical to the epithelium was highly significant (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Discriminating among subgroups of borderline personality disorder: an assessment of object representations.

The purpose of this study was to identify subgroups of borderline personality disorder (BPD) by examining internalized object relations. It was predicted: (a) that the internalized object relations of borderline patients as a group can be differentiated from psychiatric patients (comparison group N = 15), and (b) that BPD subgroups significantly differ in their object-relational profiles. Fifty-seven adult borderline subjects (28 male and 29 female) were separated into three groups based on Horney's description of interpersonal styles (moving away, against, and toward). Object relations were assessed using the Bell Object Relations Inventory and from early memories. Four written early memories were scored using the Social Cognition and Object Relations Scale (SCORS). The results suggest that the malevolent inner object world of borderline patients is fundamentally different from nonborderline psychiatric patients; and that the defined BPD subgroups of moving toward, against, and away differed significantly on specific structural and thematic object-relational dimensions. Aspects from Fairbairn's object relations theory and contributions from the self/representational, ego deficit, and Kernberg's models of borderline psychopathology are used to help interpret the findings. Identifying subtypes of BPD may allow for more precise discriminations in separating BPD from other disorders and may provide meaningful therapeutic and prognostic information for the different subgroups of borderline patients.

Adult↗
PubMed2006

Inhibition and object relations in borderline personality traits after traumatic brain injury.

This study aims to assess the nature and severity of borderline traits after traumatic brain injury (TBI). Thirty subjects with moderate or severe TBI were compared to 30 normal controls on the Revised Diagnostic Interview for Borderlines (DIB-R), a dimensional measure of borderline traits, the Go-no go inhibition task, the Complexity of Representations of People and Affect-Tone Relationships Paradigms, two scales from the Social Cognition and Object Relations Scale (SCORS) evaluating the quality of object relations, an estimation of pre-morbid borderline severity, the Beck Depression Inventory (BDI) and various neuropsychological measures. Results indicate that TBIs present more borderline symptoms and traits than controls. However, the severity of borderline symptomatology remains comparatively low for the vast majority. As expected, the TBI group showed a poorer performance on the Go-no go task, a characteristic neuropsychological inhibition deficit. Yet, both samples present similar profiles on the SCORS. Finally, the DIB-R was correlated with the Affect-Tone scale, the BDI and with the pre-morbid severity estimation. Results suggest that post-TBI borderline traits remain rare and relate more to the affective quality of object relations, negative affects and pre-morbid borderline pathology than inhibition deficits.

Adult↗
PubMed1994

What is a clinical fact? Clinical psychoanalysis as inductive method.

This paper is an inquiry into the nature of clinical facts in psychoanalysis. The attainment of representability of psychic reality being requisite for insight, the author examines inductive processes on the part of both analyst and analysand, which are to be considered proper aspects of the study of clinical facts. It is argued that the analyst chooses his interpretations guided in good measure by nonverbal material, based on how he intuits that he is 'used' by the analysand and the ways the analysand feels 'used' by him; such nonverbal clues on the nature of the unconscious relational 'frames' operating in sessions guide him to select relevant associations from the universe of the analysand's verbal utterances. He thus comes to voice his interpretations, purveying a 'mapping' of psychic reality that typically makes use of a new viewpoint for description. Insight is achieved when the analysand attains ostensive refutation or redefinition of his unconscious 'theories' about the relationship, and this happens only in concrete individual situations, when the effects of his relational unconscious 'theories' come to be contrasted observationally in diverse 'screens', perceptual and mnemic, against the background of the analyst's neutrality: in such a way unconscious 'theories' attain the Pcs.-Cs. domain of the 'no'.

Adolescent↗
PubMed2006

Self-object differentiation in suicidal adolescents.

BACKGROUND: Although problems in the differentiation between self and object are commonly encountered in clinical work with suicidal adolescents, empirical validation of this phenomenon is limited in the literature. The aim of this study was to use empirical methods to examine the differentiation between self and parental representations in suicidal inpatient adolescents. METHODS: Ninety-six adolescents participated in the study: 32 suicidal inpatients, 32 nonsuicidal inpatients, and 32 healthy controls. The 3 groups were matched for sex, age, and education. All participants completed scales on self-object differentiation and suicidal tendencies. RESULTS: Suicidal adolescents were found to be significantly different from both nonsuicidal psychiatric and healthy controls in negative self and parental descriptions (P < .001) but did not differ from the other groups when describing positive traits. Moreover, suicidal adolescents described themselves as being significantly less differentiated from both their father (P < .001) and mother (P < .01) in negative traits but not in positive traits, when compared to the 2 other groups. CONCLUSIONS: Suicidal adolescents have difficulties differentiating the negative aspects of the self from the negative aspects of their parents. These results emphasize the importance of object relations theory in understanding suicidal tendencies in adolescents. A model combining negative symbiosis and suicidal tendencies offers several therapeutic intervention strategies.

Adolescent↗
PubMed1995

Self-with-other representations and a taxonomy of motives: two approaches to studying persons.

This article discusses two approaches to studying persons. Part 1 describes data gathering procedures that lead to an integrated visual display of particular self-representations of an individual in various spheres of life. "Self-with-other representation" is introduced as a central unit of analysis in this research. This concept is integrated into a method that is exemplified in this article by a description of how life can be injected into static trait characterization of a person. In the context of a case study, it is shown that the method provides information about how traits are organized in terms of self-with-other working models and the conditions under which a particular working model is likely to prevail. Part 2 presents a new taxonomy of motives. This taxonomy is a product of having dipped into the area of operant conditioning and reformulating behavioral consequences into motivational causes. This intrusion into reinforcement theory has resulted in a two-dimensional classification system (referred to as PACK) that accounts for motives to keep or acquire positive experiences, and to cure or prevent negative experiences. After the taxonomy is described, it is used to organize motivational concepts in the area of goal-directed behaviors, and it is applied to purpose statements of individuals in different age groups.

Adult↗
PubMed1993

The social matrix of aggression. Enactments and representations of loving and hating in the first years of life.

In this paper, we build on a developing body of work that addresses the various contributions to the child's emerging definition of self in the first five years of life. Described is the role of aggression in the shaping of the child's predominant modes of viewing and experiencing the world. How aggression toward another mixes with desire for another in the formation of early capacities for object relatedness is a central question for any developmental theory of aggression, for aggression is first experienced, shaped, refined, and remodeled in the context of loving relations. Studies from related disciplines provide observational data about how aggression is modified in the first five to six years of life and how the capacity to interpret the intentions of others is crucial to those modifications. Understanding the intentions of others relates also to the capacity to attribute affects, beliefs, and other mental states to others, a capacity referred to elsewhere as a theory of mind. The ability to reflect upon thoughts and feelings in oneself and others provides children with a fuller range of responses to their own and others' perceived aggression. Finally, external experiences of violence, abuse, and deprivation influence the child's experience of his own and others' aggression and prevent the normal modulation of aggression in the social matrix.

Aggression↗
PubMed1983

The structural theory and the representational world.

I have attempted to articulate a means of incorporating representational world concepts firmly within the structural theory, while still maintaining their clarity, a view which I believe can be useful both clinically and theoretically. It can facilitate an analyst's working with complex clinical material that reflects conflicts at multiple developmental levels, without forcing a premature commitment to restrictive conceptualizations which could impede his listening to the full richness of the material. In addition, I have argued that the perpetual resurgences of representational world psychologies may be understood as an indication of the need for the inclusion of those phenomena in our theory in a clear and integrated way. Finally, I have presented some basis for suggesting that the drive-defense and the representational world models represent coordinate aspects of the structural theory, each with its vantage points for highlighting and clarifying certain phenomena, but best used complementarily in our observations of psychopathology at all levels of development. I do not believe this represents a totally new view or departure within psychoanalytic thinking. On the contrary, I have assembled, organized, and attempted to make explicit certain understandings which I believe we often apply naturally through the use of empathy and intuitive gifts. In an analysis which is going well, an analyst operating within a drive-defense framework is almost certainly finding some natural way of dealing with self and object issues, even if he does not formulate them explicitly to himself. To set down and make explicit, however, the functions we may much of the time perform without awareness is worthwhile preparation against times of difficulty in understanding a particular case. At those times we need at our disposal as specific, as inclusive, and as illuminating a theory as we can find to assist us. It is that clinical need which has guided me in these attempts at theoretical clarification.

Adult↗
PubMed1985

The different narcissistic disturbances of personality and their psychotherapeutic approach.

Narcissism is defined as the self-representation which gives to the instances ego, id and superego as well as to the body the narcissistic cathexis which makes the individual feel an entity and continuity. Three kinds of narcissistic disorders are differentiated concerning their psychodynamics: Narcissistic personality disorders (narcissistic neuroses) with an ego basically able to function well, but a lack in the self; borderline conditions with a more or less severe ego pathology and the consecutive difficulty of the concerned individual to build up a consistent self; major depressions with a more or less pronounced emptiness or evacuation in the realm of narcissism. The psychotherapy of these three disorders is explained. The psychotherapy of narcissistic personality disorders (narcissistic neuroses) consists in a slightly modified psychoanalytic approach. The psychotherapy of borderline patients is described as an analytically oriented expressive one. The psychotherapy of major depressions consists in the depressive phases mainly of an empathic approach. In the intervals not only the almighty superego, but also the huge oral and narcissistic expectations as well as the defense mechanisms of the patients against them, as e.g. the lifelong pattern of law and order, should be worked through.

Borderline Personality Disorder↗
PubMed1982

The superordinate self in psychoanalytic theory and in the self psychologies.

The concept of the self has been used in several attempts to resolve the epistemological problems of what is subjective and what is objective, what is personal and what is organismic. In addition, it has been used to mediate between the hermeneutic and natural-science approaches to psychoanalytic explanation, between the motivational and causal dimensions of our theory and experience. In the case of Kohut, the self was initially invoked to deal with clinical difficulties associated with the analysis of patients with narcissistic personality disorders more recently, it has become the central article in a "self psychology" that addresses presumed deficiencies in the traditional psychoanalytic picture of psychopathology. But the concept of the self is not suited to be a panacea for resolving theoretical or clinical difficulties. The self as person refers to an entity that is both enduring and changing; it describes continuity in the face of change and change in the face of continuity. Abend (1974) comes closest to capturing this attribute of the self in his image of the tidal beach with a configuration that changes but an essence that remains the same. Eisnitz (1980) evokes something similar in his figure-ground conception of the self-representation. The crux of the matter is that the notion of self-experience includes a variety of phenomena that cannot be contained within a single self-construct--be it normal pathologic, grandiose, or otherwise. As a result of these considerations, I have argued against the use of the self as a superordinate concept in psychoanalytic theory and have focused on the shortcomings of three self psychologies that use the self in this way. I believe that Klein, Gedo, and Kohut all offer the self as a kind of conceptual tranquilizer for the philosophical, theoretical, and clinical dualities that are inherent in psychoanalytic work. Grossman addressed himself to these dualities as far back as 1967 and elaborated on the problems with Simon (1969) in a pathbreaking paper on anthropomorphism in psychoanalysis. Grossman and Simon contended that the controversy about anthropomorphism in psychoanalytic theory pertains to the basic confusion in psychology between meaning and causality. They submitted that until this confusion was dispelled and until some superordinate concept was found that could "encompass both kinds of discourse", attempts to transform psychoanalysis into a general psychology would result in failure.(ABSTRACT TRUNCATED AT 400 WORDS)

Drive↗
PubMed1989

Children's anticipation of impending surgery. Shifts in object-representational paradigms.

The authors used Rorschach assessments of the quality of object-representations to measure psychological shifts in children facing surgery. Fifteen children, ages 7 to 11, were given the Rorschach test three times: one week prior to elective hernia surgery, the day before the surgery, and 3 weeks after hospitalization. These children were compared with a nonsurgical group of 13 children matched for age and IQ and tested at the same time intervals. The authors hypothesized that the two groups would have similar Rorschach Mutuality of Autonomy (MOA) scale scores at Times 1 and 3, but would differ substantially at Time 2. This hypothesis was confirmed using the Mann-Whitney U test. Within the surgical group, there was an overall significant difference in MOA scores over time, and, as hypothesized, these children's scores at Time 2 were significantly more malevolent than at Time 1 (p less than .003). The effects of surgery were somewhat attenuated by Time 3, but the Time 3 MOA scores were still more malevolent than at Time 1 (p = .05) and were not significantly different from those at Time 2 (p = .18). The authors highlight the need to amply prepare children for even minor surgical procedures.

Child↗
PubMed1990

Perceived parental rearing style, parental divorce and transsexualism: a controlled study.

The parental representations of male-to-female and female-to-male transsexuals were rated using the EMBU inventory. Scores on the measure were compared against ratings returned by controls of similar biological sex, matched on age, educational level and number of female siblings in an ANCOVA design. In line with previous findings by Parker & Barr (1982), who studied male-to-female transsexuals only, these patients were found not to differ from the male controls in their scoring of their mothers, but did score their fathers as less emotionally warm, more rejecting and more protective. Extending the findings by Parker & Barr (1982), female-to-male transsexuals rated both parents as more rejecting and less emotionally warm, but only their mothers as more protective than their female control equivalents rated theirs. Parental divorce distinguished both patient groups from controls, although further analyses revealed this not to imply more parental absence in patients than in controls. Male and female transsexuals differed from each other in some respects (e.g. lower scores on parental emotional warmth and higher scores on maternal rejection for the female patients), while being comparable in other respects (e.g. parental divorce).

Adult↗