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PubMed1978

[Problems of bilinguism in psychotherapy].

The authors have attempted an introductory study of problems which are inherent to psychoanalytically oriented psychotherapy and psychoanalysis conducted in the second language of a bilingual therapist. This situation seems to be more complex than is usually admitted in current literature. The main problem encountered by the authors in their personal practice stems from the fact that the process of identification becomes complex when the therapist is confronted with regressive and/or progressive shifts in the course of the treatment.

Communication Barriers↗
PubMedDate not supplied

[On the aesthetical evidence in the psychotherapeutic meeting].

The therapeutic function of visual ideas and imaginations is focussed. Reminiscences, dreams and fantasies are not only understood as indications of an underlying truth, which is to be explored. They have an own truth content, which is esthetic. Their creation in the psychotherapeutic encounter unfolds curative affects, beyond analytic exploration of psychodynamic reasons.

Esthetics↗
PubMed1994

Rational and irrational. Remarks on the clinical gendering of language in psychoanalysis.

This paper extends Hartmann's skepticism about the heuristic value of the polarized terms "rational" and "irrational" lest they be used for future theory building. Clinically--now, as in ancient times--a close correlation exists between this polarity and that of common-parlance value judgments--"masculine/rational/positive" and "feminine/irrational/negative." Primitive ambivalence concerning the repudiation of femininity is explored here in both sexes. A suggestion is raised that it may be the female's capacity for pregnancy, rather than the infantile reaction to genital difference, that is the most vital underpinning of the age-old negative view of women.

Adult↗
PubMed1994

Adapted cuing technique: facilitating sequential phoneme production.

ACT is a visual cuing technique designed to facilitate dyspraxic speech by highlighting the sequential production of phonemes. In using ACT, cues are presented in such a way as to suggest sequential, coarticulatory movement in an overall pattern of motion. While using ACT, the facilitator's hand moves forward and back along the side of her (or his) own face. Finger movements signal specific speech sounds in formations loosely based on the manual alphabet for the hearing impaired. The best movements suggest the flowing, interactive nature of coarticulated phonemes. The synergistic nature of speech is suggested by coordinated hand motions which tighten and relax, move quickly or slowly, reflecting the motions of the vocal tract at various points during production of phonemic sequences. General principles involved in using ACT include a primary focus on speech-in-motion, the monitoring and fading of cues, and the presentation of stimuli based on motor-task analysis of phonemic sequences. Phonemic sequences are cued along three dimensions: place, manner, and vowel-related mandibular motion. Cuing vowels is a central feature of ACT. Two parameters of vowel production, focal point of resonance and mandibular closure, are cued. The facilitator's hand motions reflect the changing shape of the vocal tract and the trajectory of the tongue that result from the coarticulation of vowels and consonants. Rigid presentation of the phonemes is secondary to the facilitator's primary focus on presenting the overall sequential movement. The facilitator's goal is to self-tailor ACT in response to the changing needs and abilities of the client.(ABSTRACT TRUNCATED AT 250 WORDS)

Apraxias↗
PubMed1995

Temporality and modes of language.

After reviewing some literary, philosophical and psychoanalytic conceptions of time, the author distinguishes between the sensation of time, in which rhythm is all-important, and its representation. The timeless unconscious, which can, however, be rendered temporal through the transference, is contrasted with the sequential chronology of preconscious and conscious functioning. Language, and in particular metaphorical language, is deemed to play a vital part in the structuring of the psyche, and is mediated by the object; the contingency of metaphor is held to be essential because otherwise the object will impose itself too directly, causing the previously undifferentiated death drive to predominate. A primal temporality must, in the author's view, have been laid down in the form of an unrepresentable auto-erotic datum before the individual can perceive himself as a living subject and conceive of lineal and irreversible time with its implications of castration and death; there is no such thing as a timeless subject. All pathologies of temporality are considered by the author to be at the same time pathologies of subjectivation and of language. The paper ends with a clinical illustration in which a key time-related defence of the patient is overcome by an intervention outside the strict time frame of the setting that proves mutative and enables her to recover her personal rhythm as a subject.

Female↗
PubMed1996

An intention-based language for representing clinical guidelines.

Automated support for guideline-based care would be enhanced considerably by a standard representation of clinical guidelines. To faciliate use and reuse, we suggest a representation that includes the explicit intentions of the guideline's author. These intentions include the desirable actions of the care provider and the patient states to be achieved before, during, and after the administration of the guideline. Intentions are temporal patterns of provider actions or patient states to be maintained, achieved, or avoided. We view automated support as a collaborative effort of the health-care provider and an automated assistant and involves several different tasks. We defined the syntax and, the semantics of a text-based language (ASBRU) for representation and annotation of clinical guidelines. The language supports maintenance of the automated assistant's knowledge base and could improve the quality and flexibility of the automated assistant's recommendations. In the ASGAARD project, we are developing reasoning mechanisms that use the ASBRU language for execution and critiquing tasks in conjunction with online electronic patient medical records.

Expert Systems↗
PubMed1997

Defining and describing complementary and alternative medicine. Panel on Definition and Description, CAM Research Methodology Conference, April 1995.

The definition of complementary and alternative medicine has been much debated in recent years as this type of therapy has increasingly become a focus of public and academic attention. Individual authors typically stipulate a definition for purposes of their particular articles, and definitions have varied with the perspectives and affiliations of authors. The panel on definition and description of the 1995 Office of Alternative Medicine CAM Research Methodology Conference proposed a definition of the field of complementary and alternative medicine for use by the Office of Alternative Medicine in delineating its research jurisdiction. In addition, the panel suggested a set of descriptive parameters for qualitative research on complementary and alternative medicine and a minimum descriptive standard for both qualitative and quantitative research in the field. The results of the panel's deliberations and the justifications for their outcomes are discussed here.

Complementary Therapies↗
PubMed1979

Establishing functional language in an autistic child: a cooperative approach.

The case study of a 7-yr-old boy who was diagnosed as autistic is reported. The cooperative efforts of a teacher of the severely emotionally disturbed, a speech pathologist, and the child's parents were combined to create an optimal situation for the facilitation of behavior change and language development. Examples of the procedures used and the child's progress over a 2 1/2-yr period are presented and described.

Autistic Disorder↗
PubMed2006

Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis.

CONTEXT: Concern regarding the adverse effects of estrogen and other hormones for treating menopausal symptoms has led to demand for other options; however, the efficacy and adverse effects of nonhormonal therapies are unclear. OBJECTIVE: To assess the efficacy and adverse effects of nonhormonal therapies for menopausal hot flashes by reviewing published randomized controlled trials. DATA SOURCES: MEDLINE (1966-October 2005), PsycINFO (1974-October 2005), and the Cochrane Controlled Clinical Trials Register Database (1966-October 2005) were searched for relevant trials that provided data on treatment of menopausal hot flashes using 1 or more nonhormonal therapies. STUDY SELECTION: All English-language, published, randomized, double-blind, placebo-controlled trials of oral nonhormonal therapies for treating hot flashes in menopausal women measuring and reporting hot flash frequency or severity outcomes. DATA EXTRACTION: Trials were identified, subjected to inclusion and exclusion criteria, and reviewed. Data on participants, interventions, and outcomes were extracted and trials were rated for quality based on established criteria. A meta-analysis was conducted for therapies with sufficient trials reporting hot flash frequency outcomes. DATA SYNTHESIS: From 4249 abstracts, 43 trials met inclusion criteria, including 10 trials of antidepressants, 10 trials of clonidine, 6 trials of other prescribed medications, and 17 trials of isoflavone extracts. The number of daily hot flashes decreased compared with placebo in meta-analyses of 7 comparisons of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) (mean difference, -1.13; 95% confidence interval [CI], -1.70 to -0.57), 4 trials of clonidine (-0.95; 95% CI, -1.44 to -0.47), and 2 trials of gabapentin (-2.05; 95% CI, -2.80 to -1.30). Frequency was not reduced in meta-analysis of trials of red clover isoflavone extracts and results were mixed for soy isoflavone extracts. Evidence of the efficacy of other therapies is limited due to the small number of trials and their deficiencies. Trials do not compare different therapies head-to-head and relative efficacy cannot be determined. CONCLUSION: The SSRIs or SNRIs, clonidine, and gabapentin trials provide evidence for efficacy; however, effects are less than for estrogen, few trials have been published and most have methodological deficiencies, generalizability is limited, and adverse effects and cost may restrict use for many women. These therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Management of acute, severe asthma in children.

OBJECTIVE: To briefly present the current options available for the treatment of acute, severe asthma in children, with a special focus on emergency department and inpatient treatment, and to describe newer therapies that may aid treatment in the future. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (1966-May 2001) of the English-language literature pertaining to drug therapy of acute asthma was performed. Key word searches included acute asthma, albuterol, ipratropium, corticosteroids, magnesium, and theophylline. Additional articles from these sources and published national guidelines were identified. Relevant studies pertaining to current therapy of acute asthma in pediatric patients were selected; if there were minimal pediatric data, adult data were included. DATA SYNTHESIS: Asthma is a chronic, inflammatory disorder of the airways. Acute exacerbations can occur and are challenging to manage. Albuterol, ipratropium, and systemic corticosteroids have been shown to be effective in acute asthma exacerbations. Because some patients do not respond to maximal therapy, older therapies such as magnesium and theophylline are being reevaluated. Theophylline may have some therapeutic effect, but given its toxicity profile, it is unclear whether it offers any advantage over maximal beta(2)-agonist therapy. There are only minimal published data evaluating the use of magnesium in pediatrics, and most are small trials or case reports. Newer therapies such as ventilation strategies with heliox and intravenous leukotriene modifiers currently being evaluated may or may not prove to be beneficial in the future. CONCLUSIONS: beta(2)-agonists, ipratropium, and corticosteroids remain the most useful therapeutic agents for acute asthma exacerbations in pediatric patients. However, these agents are not ideal in all patients and, given the existing questions regarding safety and/or efficacy of available alternatives, more effective options are needed.

Acute Disease↗
PubMed2000

Gastroesophageal reflux disease in asthma: effects of medical and surgical antireflux therapy on asthma control.

OBJECTIVE: To critique the English-language reports describing the effects of medical and surgical antireflux therapy on respiratory symptoms and function in patients with asthma. METHODS: The Medline computerized database (1959-1999) was searched, and all publications relating to both asthma and gastroesophageal reflux disease were retrieved. RESULTS: Seven of nine trials of histamine-receptor antagonists showed a treatment-related improvement in asthma symptoms, with half of the patients benefiting. Only one study identified a beneficial effect on objective measures of pulmonary function. Three of six trials of proton pump inhibitors documented improvement in asthma symptoms with treatment; benefit was seen in 25% of patients. Half of the studies reported improvement in pulmonary function, but the effect occurred in fewer than 15% of patients. In the one study that used optimal antisecretory therapy, asthma symptoms were improved in 67% of patients and pulmonary function was improved in 20%. Combined data from 5 pediatric and 14 adult studies of anti-reflux surgery indicated that almost 90% of children and 70% of adults had improvement in respiratory symptoms, with approximately one third experiencing improvements in objective measures of pulmonary function. CONCLUSIONS: Fundoplication has been consistently shown to ameliorate reflux-induced asthma; results are superior to the published results of antisecretory therapy. Optimal medical therapy may offer similar results, but large studies providing support for this assertion are lacking.

Adult↗