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PubMed1976

[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↗
PubMed1993

Clarithromycin as monotherapy for eradication of Helicobacter pylori: a randomized, double-blind trial.

UNLABELLED: Current regimens to eradicate Helicobacter pylori usually consist of metronidazole plus a bismuth compound, as well as a third agent such as tetracycline. Such regimens are not ideal because organisms may be metronidazole-resistant, side-effects occur, and compliance is often poor. This randomized, double-blind study was designed to assess the ability of clarithromycin, a new macrolide antimicrobial, as monotherapy to eradicate H. pylori. Thirty-seven healthy volunteers who were H. pylori positive by 13C-urea breath test plus histology and/or culture completed 14 days of oral therapy with clarithromycin in one of three dosages. Eradication, defined as all three tests negative at 4-6 wk after the end of therapy, was achieved in 2/13 (15%) with clarithromycin 500 mg bid, 4/11 (36%) with 1000 mg bid, and 7/13 (54%) with 500 mg qid. Isolates of H. pylori were resistant to clarithromycin prior to therapy in 12% of subjects, and became resistant during therapy in 21% of subjects. Taste perversion, the most common side effect, resulted in one subject terminating therapy. CONCLUSIONS: Whereas clarithromycin is a promising antimicrobial in the eradication of H. pylori, it is not sufficient to be used as monotherapy.

Adult↗
PubMed1993

Death in America: a clinician's perspective.

In America today, the practices of medicine and law have so interfered with the dying process that death has become a perversion of the natural process. In order to better understand death in American society, this article addresses the moral-ethical issues, individual rights, state regulatory laws, and other medico-legal concerns.

Advance Directives↗
PubMed1993

Between conventionality and aggression: the boundaries of passion.

This paper explores changes in the recent psychoanalytic theory regarding the preconditions and structural characteristics of sexual love. In briefly reviewing Freud's contributions and subsequent developments regarding infantile sexuality and the perversions, the oedipal constellation, superego development and mass psychology, a common frame is provided for the description of the love life of the sexual couple. In this context, this paper also explores how contemporary psychoanalytic formulations may help to clarify certain conflicts between conventional morality and the psychological reality of the couple in love.

Aggression↗
PubMed1993

Gadodiamide injection. First human experience with the nonionic magnetic resonance imaging enhancement agent.

The safety, tolerance, and pharmacokinetics of gadodiamide injection (Omniscan, Sanofi Winthrop Pharmaceuticals, New York, NY) were evaluated in an open, ascending-dose study in 20 healthy male volunteers. Gadodiamide injection was administered intravenously at doses of 0.05, 0.1, 0.2, and 0.3 mmol/kg. Mild adverse events were experienced by nine subjects. These events included, but were not limited to, light-headedness, dizziness, and perversion of taste or smell. There was one occurrence of injection-associated discomfort that resolved within seconds. Vital sign and electrocardiogram measurements did not show any clinically relevant changes. There were no clinically significant changes in laboratory parameters, but minor transient elevations in serum iron were detected. These elevations typically occurred 8 and 48 hours after administration of gadodiamide injection and were not dose related. The pharmacokinetics of gadodiamide injection were evaluated in the 0.1-mmol/kg and 0.3-mmol/kg dose groups with the serum time-concentration data fitted to an open two-compartment model and the urine time-concentration data fitted to a one-compartment model. The serum elimination half-life was approximately 70 minutes, and urinary recovery was greater than 95% by 72 hours after administration.

Adult↗
PubMed1996

Changing paradigms in medical payment.

The enormous level and rate of increase in health care expenditures in the United States during the past several years has been well documented. A combination of increased health insurance coverage and advances in medical technology, coupled with perverse economic incentives resulting in supplier-induced demand and cost-unconscious demand from patients, has created this explosion in health care spending. This explosive increase has given rise to a variety of private and public sector initiatives to reform the system. With a greater concentration of purchasing power among managed care payors and increased competition among providers, a trend toward dramatically reduced payment for providers continues. Under capitation, the most rapidly growing form of managed care, providers have contracts from insurance companies that call for them to provide care for a fixed per patient annual payment, regardless of what this provision actually costs. This form of per capita payment typically offers drastically reduced payment to providers, forcing them to adopt a cost-reduction strategy. Providers must contain costs while enhancing quality or else perish in this new cost-conscious environment. This new payment paradigm means that price, which is often dictated by the payors, including government, determines the providers' cost rather than cost determining price as it was under the traditional indemnity insurance schemes. It is this new imperative to contain costs while maintaining or else improving the quality of health outcomes that is behind many of the recent mergers and other collaborative activities that we are witnessing nationwide among hospitals and other health care organizations.

Capitation Fee↗
PubMedDate not supplied

[Evaluation of autonomy in chronic mental patients. Problems, assessment tools, results].

The autonomy of adult patients suffering from chronic psychiatric disorders is a notion in which we need to take an interest due to evolutions in patient care. The tendency of deinstitutionalization in the United States, in Italy and to a lesser degree in France has generated certain perverse effects when: capacities for self sufficiency, learning abilities to be developed, and substitutes to be set up, were not correctly evaluated from the outset. Many methods conceived mainly in the United States and in Canada were elaborated with such a diversity of approaches that, even today, for self-sufficiency, an instrument for evaluation which is universally prevalent and used, still does not exist in the way that has been possible for other clinical dimensions. The ability to accomplish the daily tasks for survival, the ability to reach decisions in life, the ability to enter into and sustain relationships with others do not embrace the dimensions explored by the scales of general psychopathology, of functional repercussions or of the quality of life. Moreover, the evaluation of these abilities is highly dependent on cultural characteristics. To adapt the existing methods to the French sociological realities or to conceive and elaborate simple and reliable procedures from our practices in professional and social reinsertion is a compulsory step in developing research in this field. Public Authorities and the teams on the ground should grasp the characteristics for innovation and its abilities for raising the hopes of patients, every bit as much as the actual progress in therapeutic practice.

Activities of Daily Living↗
PubMed1977

[Multiple sex drive abnormalities in a patient with Klinefelter's syndrome].

The authors report various sexual instinct disturbances and, more specifically, exhibitionism and pedophilia of a 25-year-old patient with Klinefelter's syndrome. The patient had committed several punishable offenses and was referred to our specialty clinic for psychologic and psychiatric examinations. Aspects of psychopathology and causal etiopathogenetic relationships of the authors' own observations are discussed and compared with those reported in the literature. Environmental factors are considered to be primarily responsible for the development of sexual perversions. The Klinefelter syndrome as such may be regarded as being of predispositional importance only.

Adult↗
PubMed1995

The ring of the narcissist.

The author has not attempted a complete exposition of the meaning of rings--which can refer to and symbolise many aspects of relationships with other human beings from 'transitional objects' of early development (Winnicott) to all sorts of bonds of loyalty, friendship, and love in the life of the child and the adult. He stresses the meanings of the ring from the point of view of early narcissistic development--the 'body ego' time of early development in which symbolism (in Freud's sense) develops. The clinical and literary examples therefore illustrate the use of rings as magical narcissistic symbols--part subject and part object--derived developmentally from the body ego and ultimately from the body sphincters. Endowed with these regressive primitive meanings, rings are felt to have magical powers that can either preserve or destroy, and that can control emotions in the self and in others. In the course of ordinary or pathological narcissistic regressions, rings (consciously associated with many positive feelings and achievements) also partake, in so far as they are 'Freudian' symbols, of qualities associated with developmentally early defensive mechanisms and modes of psychic functioning (projection, introjection; idealisation, devaluation). In the cases cited, rings seemed specifically associated with (and to symbolise) sphincteric (largely anal) narcissistic defensiveness--the mind functioning as an emotional sphincteric counterpart primarily deadening and distancing affect but intermittently letting through primitive rage and primal polymorphous perverse sexual impulses.

Ego↗
PubMed1996

["Body psychosis": an interpretative hypothesis about some psychiatric disorders].

The authors propose to group some clinical entities as Delusional hypochondria, Dysmorphophobia, Nervous Anorexia, under the term of Body Psychosis. These are considered as psychoses endowed in the body (naturally we are speaking not about the anatomical body, but the phenomenological one, the personal experienced body). The specific clinical frame is justified by the following considerations: 1) in a psychopathological light all the disorders imply an altered relationship with the personal experienced body; 2) in a prognostic light the "experienced body" involvement given specific and common features; 3) clinically a one-other manifestation change is always possible; 4) relationally the human contact (and the medical one too) with this kind of patient got very specific features that often provoke dramatic and perverse changes in the same relation, especially in a sadomasochistic sense. The personal nosological frame is stressed within the actual psychiatric diagnostic classification (ICD 10, DSM IV).

Anorexia Nervosa↗
PubMed1995

[Social anomie and the renewed increase of mental health problems at the work place].

Several studies on mental health in the workplace show a renewed increase of mental health problems. These problems, related to workplace relations, present social causes of a much larger degree; for instance, the social anomy afflicting Québec is rippling through the workplace, much like what many other industrialized societies are experiencing during this end of century. The sensitive social balance, in principle under the responsibility of social institutions and government, has given business the opportunity to occupy a central position and become the major forum for an individual's search for identity. This centrality carries with it a certain number of strong contradictions and disappointments because, in spite of the rhetoric and its illusions, corporations are loyal to economic logic and take a perverse ownership of one of the individual's most important values, namely the quest and desire to be defined as a person and to be acknowledged as such. As a result, individuals often find themselves in a fragile state, at times even left with deconstructed psyches.

Anomie↗
PubMedDate not supplied

[Catecholamines, their precursors and metabolites in human fatigue after exertion].

Alterations in metabolism of catecholamines were studied in sportsmen after development of acute fatigue as a result of the test physical loading. Three types of the alterations were characterized on the basis of differences in excretion with urine of free and sulphate-bound adrenaline, noradrenaline, of their precursors DOPA and dopamine as well as acid metabolites (vanillyl mandelic acid). The first type of the alterations in catecholamines metabolism comprized the cases, when excretion of catecholamines, their precursors and metabolites did not increase; this appears to relate to the partial exhaustion of hormones and peripheric mediators of sympathoadrenal system. The second type was characterized by decreased excretion of the substances studied, by development of the "perversed" reactions due to modifications in the regulatory system, which led to the inhibition of the system instead of its stimulation. The third type was manifested as the hyperfunction of the system. The increased synthesis of catecholamines during the hyperfunction suggests that this process serves as a compensatory reaction to their preceding elevated secretion; the phenomenon appears to depend on the increased secretion of the newly formed catecholamines. Excretion of catecholamines and their precursors was decreased for a long time after development of chronic fatigue in the resting state and the increase in excretion of the substances studied was not observed after physical loading.

Adolescent↗
PubMedDate not supplied

[The place of endocrinology in the management of transsexualism].

Transsexualism is not a sexual perversion but rather a gender identity disorder. The patient claim for his personal and public image and condition. The diagnosis problems arise from the lack of clinical, biological or hormonal typical signs. The pathogenesis is unclear but works in progress suggest somatic alterations. These alterations might be pre or perinatal hormonal changes and/or alterations in cerebral structures involved in sexual differentiation. Transsexualism is not a treatable disease using currently available treatments. Only hormonal and surgical treatments with sex reassignment might answer to the patient's request and improve his mental condition. Hormonal treatment might only prescribed after a consensus statement of about the sex reassignment of the patient and under medical follow-up. An early and strict medical follow-up of the patients by a multi specialist medical team is required and have to warrant the etic aspects. This is mostly important for the approval for sex reassignment from the authorities.

Endocrinology↗
PubMed1996

The status of psychic reality in adolescence. An adult female patient's quasi-adolescent material and the analyst's counter transference response.

The author holds that the crisis of adolescence is in fact one of psychic reality, its elements being loss of boundaries, externalisation and the involvement of a third party. In this view, it is essential to conceive of adolescence differently from adulthood, in that, for example, an adolescent's acting out may not be solely a matter of regression but to a considerable extent a consequence of his or her physical development. It is noted that the boundaries between psychic and material reality are fluid throughout life and that adolescents crave identificatory models. The author stresses the importance of the psychic reality of the other in the adolescent's crisis. After considering various views, including those of Freud, on psychic reality and the crises of adolescence, he illustrates his thesis by the clinical example of two adolescent episodes of perversion forming part of an adult female patient's material. In the author's view, these instances of acting out had helped the patient to regain her auto-erotic capacity in the pleasure of fantasy life. He considers that a mutative interpretation must touch upon the primal fantasy and therefore involve the entire person of the analyst in the transference.

Acting Out↗
PubMed1977

The evolution of a shoe fetish.

This paper deals with clinical material gathered from the long-term, psychoanalytically-oriented treatment of a patient with a shoe fetish. Genetic and dynamic aspects of this problem are emphasized. The combination of a dominating mother and a passive and absent father, the sharing of a bed with an older sister until age eleven, and the receipt of frequent enemas contributed directly to the development of the fetish, the most crucial determinant being the commulative traumatic effect of the enemas. During adolescence, the patient also resorted to transvestism to deal with the intensification of castration fears. Becoming a husband and father threatened to disrupt his tenuous defenses and forced him to seek therapy for two years, during which he was able to gain sufficient insight to forego the fetish and to engage in heterosexual activity in reasonably conflict-free manner. Previous theorectical contributions on the subject are included and theorectical issues are dealt with, particularly the role of the core fantasy of the phallic woman in the perversions.

Adult↗
PubMed1996

Beyond the he and the she: toward the reconciliation of masculinity and femininity in the postoedipal female mind.

This paper concerns a postoedipal psyche organization in the female mind whereby early overinclusive body-ego representations and cross-sex identifications are recuperated symbolically in the context of a differentiated female identity. This reintegration allows the female to symbolize what has been "lost" upon awareness of sex differences, play out masculine aspects without there being a threat to her core, primary feminine identity, and by linking rather than prohibiting cross-gender representations, provide imaginative elaboration and empathic access to another as a subject. This state does not reflect a denial of difference; rather, it reflects a psychic organization that uses symbolization to play with differences. Bisexual conflict can be mastered rather than repressed. Such mastery transcends normative, rigid, polarized sexual positions and gender conformity, perversions, and disturbed gender identity. Within the classical discourse, this mastery is suggested as an expansion of our limited and archaic notions of a genital stage specifically for the female. A new elaboration of a specific female genital stage can deepen our understanding of adult femininity and the development of cross-gender transference.

Adolescent↗
PubMed1998

Managing physician resources: East and West.

AIM: To examine the current physician supply in western countries, Central and Eastern Europe (CEE), and the Newly Independent States (NIS) of the former Soviet Union. To assess the current management of physician resources in these regions and the potential for their future management. METHODS: Description and analysis of current physician to population ratios, graduating physician to population ratios, and specialty distribution of physicians. RESULTS: Maldistribution of physician resources, both by specialty and geographically, exists in the East and the West. The management of physician resources varies widely in the West, from virtually no attempts to manage the resources in the United States to increasingly regulatory methods in Canada. The CEE and the NIS face problems in managing physician resources as the movement to primary care continues. At the same time, changes in payment mechanisms create new and often perverse incentives for physicians, in addition to the problems inherited from the centrally managed systems. CONCLUSIONS: Countries in the East and West face challenges in managing physician resources to overcome the current maldistribution of those resources. Efforts must be made to make the medical education system responsive to the future physician supply needs. This is especially true in the East where health systems continue the transition from centrally managed to more market based systems.

Europe↗