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Selective pharmacological activation of limbic structures in human volunteers: a positron emission tomography study.

Using a pharmacological probe, procaine hydrochloride, the authors elicited consistent and selective activation of anterior limbic and paralimbic structures in normal human volunteers as documented by H215O positron emission tomography. This activation was associated with a range of emotional, somatic, and visceral experiences, often similar to those experienced during the aura of temporal lobe epilepsy. Several subjects also experienced panic attacks. This study confirms that selective anterior limbic/paralimbic activity in normal human volunteers evokes many emotional phenomena as well as common "ill-defined" symptoms observed in clinical conditions. The present combination of procaine challenge and neuroimaging provides a noninvasive procedure to probe the contribution of different anterior limbic and paralimbic structures to normal human emotions and to neuropsychiatric disorders.

Adult↗

Cognitive function and dissociative disorder status among veteran subjects with chronic posttraumatic stress disorder: a preliminary study.

Twenty-seven veteran subjects with chronic posttraumatic stress disorder (PTSD) were evaluated for dissociative disorders. Ten subjects met criteria for one or more dissociative disorders, and 17 subjects did not meet dissociative disorder criteria. Neurocognitive profiles of the two groups differed in several areas, with veterans meeting diagnostic criteria for both PTSD and a dissociative disorder and demonstrating considerably greater deficits in attention, autobiographical memory, and verbal memory than PTSD subjects without comorbid dissociative disorder diagnosis.

Adult↗

A bushel of shoes.

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Depersonalization↗

Classification of amok in DSM-IV.

Culture-bound syndromes have been described worldwide in many individuals and, for certain syndromes, in epidemic proportion, yet these disorders have been classified as rare and exotic conditions warranting minimal attention. Development of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and the tenth edition of the International Classification of Diseases offers an opportunity for providing a more sophisticated classification of these phenomena. The authors examine amok, a syndrome first described in Malaysia that consists of homicidal frenzy preceded by a state of brooding and ending with somnolence and amnesia. They discuss the concept of and criteria for a culture-specific disorder and propose that amok be classified as a culture-specific explosive behavioral disorder in DSM-IV.

Antisocial Personality Disorder↗

Reflections on the special senses in relation to the development of affect with special emphasis on blindness.

In congenital blindness, the absence of vision can be compensated for by the utilization of the tactile and auditory senses, resulting in normal affect and ego development. Some of the major problems in the way of such compensation were noted. Adventitious blindness produces disruption of ego functions, with severe affect manifestations, notably grief and mourning reactions and actual dependency. The factors favoring successful or unsuccessful resolution of mourning and restoration of normal ego functions were indicated.

Adolescent↗

Psychoanalytic perspectives on emptiness.

A clinical example illustrates the thesis that the experience of feeling empty, like any other mental event, can be understood in terms of the conflicting wishes, prohibitions , compromises, and gratifications that color any experience in ways that clarify its meaning. Theoretical hypotheses which explain mental events and experiences as the result of deficiencies of structures are difficult to translate into therapeutic practices. This is especially true in the case of the experience of emptiness which, in and of itself and often vigorously, asserts an absence of content. The equating of deficiencies of structures, however formulated, with deficiencies in mental content or activity can result in unconsciously joining the empty patient in repudiating important aspects of internal life, maintaining ultimately pathological gratifications , and often contributing to treatment stalemates in which the "absence of content" is often preferred to the presence of frightening wishes, fantasies, and memories.

Adult↗

Psychoanalysis and time.

Psychoanalysis is fundamentally related to time because it is an effort to understand how disturbances in the present are determined by events in the past. Technically, we know that the patient who is reporting immediate perceptions is not aware of the passage of time, but he becomes self-conscious as undesirable elements threaten to appear in his associations. Time is not sensed by direct awareness, nor is it an agent of action or events. Various functions of the ego influence how time is experienced consciously, leading to phenomena such as déjà vu, a sensation of timelessness, misjudgment of time duration, the experience of premonition. Psychoanalysis more than any other discipline sheds light on the coexistence of past, present, and future, as influenced by unconscious fantasy thinking. The analyst's understanding of the patient's associations is guided by temporal factors such as context and contiguity, succession of similar or opposite elements. Basically, the self is a time-bound concept; identity implies that a self is the same entity at different points in time. There is a deep-seated rebellion against the tyranny of time, beginning with need frustration in the infant and culminating in the knowledge that man is destined to lose the struggle against death.

Awareness↗

Understanding negative hallucination: toward a developmental classification of disturbances in reality awareness.

Negative hallucinations are explored from a psychodynamic viewpoint in four cases of neurosis. Next, shifting to the level of clinical theory, negative hallucinations are contrasted with five better-studied disturbances in reality awareness. It is noted that all six function as screen phenomena, and all occur in everyday contexts. These and other phenomenological issues lead to an assertion that negative hallucinations are regressive perceptual phenomena, similar in form to both preconscious perceptions and infantile amnesia. Finally, developmental considerations are used to derive a coherent hierarchy of disturbances in reality awareness.

Adult↗

After the analysis: analyst as both old and new object.

In the course of followup study of satisfactorily analyzed former patients, there are observed two sets of phenomena: (1) recurrence of the analytic transference neurosis, and (2) rapid recovery from this transference neurosis. These phenomena are telescoped repetitions of the analysis and reflect the ongoing mental representation of the analyst as a displacement from the objects of the past, organized into the transference neurosis. The spontaneous and rapid recovery from the transference neurosis in followup study repeats the "cure" of the analysis and the new ongoing representation of the analyst as a nonconflicted object. This new image of the analyst is based on both the resolution of the transference neurosis and new displacements from positive experiences with significant figures from the past.

Adaptation, Psychological↗

Epidemic koro in West Bengal, India.

The present study draws attention to the recent sudden outbreak of Koro in epidemic form in the rural areas of West Bengal, India. The details of three such cases are reported.

Adolescent↗