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PubMed1985

Treatment of acute carbon monoxide poisoning with hyperbaric oxygen: a review of 115 cases.

From January 1978 through March 1984, 115 cases of acute carbon monoxide poisoning were treated with hyperbaric oxygen. Exposure resulted from accidental sources (n = 39), attempted suicide (n = 47), and smoke inhalation (n = 29). Forty-one victims were never unconscious, 30 victims were unconscious at the scene but awoke before arriving at the hospital, and 44 victims were unconscious in the ED. Eleven patients (9.6%) died, and two victims (1.9% of the survivors) experienced major sequelae. All these patients were comatose on arrival. The remaining 102 patients recovered fully. Carboxyhemoglobin levels did not correlate with clinical findings, thereby demonstrating the variability between carbon monoxide exposure and impairment of the cellular cytochrome system. Hyperbaric oxygen therapy facilitates the rapid removal of carbon monoxide from the hemoglobin and cytochrome systems while reoxygenating compromised tissues, and it can be an effective treatment in reducing mortality and morbidity.

Acute Disease↗
PubMed2004

Performance of bispectral index and auditory evoked potential monitors in detecting loss of consciousness during anaesthetic induction with propofol with and without fentanyl.

BACKGROUND AND OBJECTIVE: To investigate and compare the performance of bispectral index (BIS) and auditory evoked response index (AAI) in detecting the transition from consciousness to unconsciousness during anaesthesia induction by propofol, alone and in combination with fentanyl. METHODS: Anaesthesia was induced with either an intravenous infusion of 30 mg kg(-1)h(-1) of propofol plus 2 microg kg(-1) of fentanyl (Group PF, n = 20) or an intravenous infusion of 30 mg kg(-1) h(-1) of propofol plus normal saline (Group P, n = 20). BIS, AAI and the doses of propofol administered were recorded at the end-point of unresponsiveness to verbal commands. The propofol plasma concentration was also measured. RESULTS: The propofol dose and plasma propofol concentration required to achieve loss of consciousness were significantly lower in patients pretreated with fentanyl (P < 0.001). The mean BIS value at loss of consciousness was significantly different between the two groups (74.10 in Group PF vs. 60.80 in Group P) (P < 0.001). However, no difference in the AAI was seen between the two groups at loss of consciousness (32.90 in Group PF vs. 31.80 in Group P) (P > 0.05). In both groups, the regression analysis values (r-values) between BIS and plasma propofol concentrations at the onset of unconsciousness were higher than those between AAI and propofol concentrations (0.553 vs. 0.180 in Group P; 0.432 vs. 0.308 in Group PF). CONCLUSIONS: These results show that a fentanyl bolus is effective in augmenting the hypnotic effect of propofol during anaesthesia induction. AAI appears to be able to measure the transition from consciousness to unconsciousness at similar values, regardless of whether or not fentanyl pretreatment is used whereas the BIS values were not independent of fentanyl pretreatment. This suggests that AAI may be a better indicator of conscious status during propofol/fentanyl anaesthesia, where it appears to be independent of the anaesthesia regimen.

Adolescent↗
PubMed2002

[ABC--DER TIP--STIMMT. Primary assessment of consciousness disorders].

A unconscious patient produces fear for laymen and uncertainty for professionals. Because acute changes in consciousness, that means changes in alertness or thinking, are challenges for every physician. Therefore the assessment of a unconscious patient demand a structural action. In this paper a reliable procedure is proposed in three steps. As a mnemonic serves the sentence "ABC (1st step)--DER TIP (2nd step)--STIMMT (3rd step)". The first step contains the ABC, which is usual in emergency medicine. In the second step neurological and other disabilities are noticed. An in the third step one tries, related to the findings from step one and two as well as from further examinations (CCT, lumbal puncture, lab-examines, ...), to find potential reasons for the unconsciousness of a patient.

Abbreviations as Topic↗
PubMed1998

Countertransference in the nurse-patient relationship: a review of the literature.

Countertransference is a psychoanalytical concept which, when applied to nursing, refers to the unconscious response of the nurse to the patient. Psychoanalytical concepts such as the unconscious are infrequently mentioned in the nursing literature and have received little research attention. In this paper the literature about the nurse's countertransference is reviewed. In order that the psychodynamic aspects of this phenomenon are more fully appreciated, both the concepts of the unconscious and transference are first described. The nurse's countertransference has many expressions. The literature under review has highlighted the expression of countertransference through physical symptoms, through the nurse's level of involvement with the patient and through the nurse's positive and negative descriptions of patients. The value of recognizing countertransference is universally acknowledged. It is suggested that countertransference in the nurse-patient relationship should be explored further. The knowledge provided would help provide greater insights into the nurse-patient relationship, and ultimately will be reflected in the quality of care which the patient receives.

Attitude of Health Personnel↗
PubMed1999

Adverse events in intensively treated children and adolescents with type 1 diabetes.

The main objective of this study was to examine the relation between adverse events and degree of metabolic control and multiple-dose treatment. A total of 139 children, aged between 1 and 18 y, prospectively registered severe hypoglycaemia with or without unconsciousness, as well as hospitalized ketoacidosis, during 1994-95. Treatment from onset was multiple-dose insulin (> 95% > or = 4 doses) combined with intense training and psychosocial support. Median HbA1c was 6.9% (ref. 3.6-5.4%). The incidence of severe hypoglycaemia with unconsciousness was 0.17 events per patient-year, having decreased from the 1970s to the 1990s, parallel to a change from 1-2 to > or = 4 doses per day. There was no correlation or association to the year mean HbA1c for severe hypoglycaemia. Severe hypoglycaemic episodes in 1995 correlated to severe hypoglycaemic episodes in 1994 (r=0.38; p<0.0001). Severe hypoglycaemia with unconsciousness increased during the spring season, and according to case records the assumed causes were mainly mistakes with insulin, food and exercise. Ketoacidosis was rare: 0.015 episodes per patient-year. We conclude that multiple-dose insulin therapy from the very onset of diabetes, combined with adequate self-control, active problem-based training and psycho-social support, may limit severe hypoglycaemia and ketoacidosis. Strategies aimed at minimizing severe hypoglycaemia without compromising metabolic control need to be evaluated.

Adolescent↗
PubMed2004

Cortical entropy changes with general anaesthesia: theory and experiment.

Commonly used general anaesthetics cause a decrease in the spectral entropy of the electroencephalogram as the patient transits from the conscious to the unconscious state. Although the spectral entropy is a configurational entropy, it is plausible that the spectral entropy may be acting as a reliable indicator of real changes in cortical neuronal interactions. Using a mean field theory, the activity of the cerebral cortex may be modelled as fluctuations in mean soma potential around equilibrium states. In the adiabatic limit, the stochastic differential equations take the form of an Ornstein-Uhlenbeck process. It can be shown that spectral entropy is a logarithmic measure of the rate of synaptic interaction. This model predicts that the spectral entropy should decrease abruptly from values approximately 1.0 to values of approximately 0.7 as the patient becomes unconscious during induction of general anaesthesia, and then not decrease significantly on further deepening of anaesthesia. These predictions were compared with experimental results in which electrocorticograms and brain concentrations of propofol were recorded in seven sheep during induction of anaesthesia with intravenous propofol. The observed changes in spectral entropy agreed with the theoretical predictions. We conclude that spectral entropy may be a sensitive monitor of the consciousness-unconsciousness transition, rather than a progressive indicator of anaesthetic drug effect.

Anesthesia, General↗
PubMed1986

A case-control study of amyotrophic lateral sclerosis.

The authors conducted a study of 518 amyotrophic lateral sclerosis patients identified between 1977 and 1979 and 518 controls to investigate putative risk factors for this disease. Occupations at risk of electrical exposure were reported more often by patients (odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.4-13.0) as were electrical shocks producing unconsciousness (OR = 2.8, 95% CI = 1.0-9.9). Although an overall excess of physical trauma associated with unconsciousness was observed in the amyotrophic lateral sclerosis patients (OR = 1.6, 95% CI = 1.0-2.4), the effect was inversely associated with duration of the unconscious episodes, suggesting an effect of recall bias. Only slight differences were found for surgical traumata to the nervous system. Parkinsonism was reported more often among first degree relatives of cases (OR = 2.7, 95% CI = 1.1-7.6). The frequencies of prior poliomyelitis or other central nervous system diseases were similar for patients and controls. Occupational exposure to selected toxic substances was similar for patients and controls except for the manufacture of plastics (OR = 3.7, 95% CI = 1.0-20.5), although few details of these exposures were provided. No differences in occupations with exposure to animal skins or hides were observed.

Amyotrophic Lateral Sclerosis↗
PubMed2002

Development of brain damage as measured by brain impedance recordings, and changes in heart rate, and blood pressure induced by different stunning and killing methods.

Poultry are electrically stunned before slaughter to induce unconsciousness and to immobilize the chickens for easier killing. From a welfare point of view, electrical stunning should induce immediate and lasting unconsciousness in the chicken. As an alternative to electroencephalography, which measures brain electrical activity, this study used brain impedance recordings, which measure brain metabolic activity, to determine the onset and development of brain damage. Fifty-six chickens were surgically equipped with brain electrodes and a canula in the wing artery and were subjected to one of seven stunning and killing methods: whole body electrical stunning; head-only electrical stunning at 50, 100 or 150 V; or an i.v. injection with MgCl2. After 30 s, the chickens were exsanguinated. Brain impedance and blood pressure were measured. Extracellular volume was determined from the brain impedance data and heart rate from the blood pressure data. An immediate and progressive reduction in extracellular volume in all chickens was found only with whole body stunning at 150 V. This treatment also caused cardiac fibrillation or arrest in all chickens. With all other electrical stunning treatments, extracellular volume was immediately reduced in some but not all birds, and cardiac fibrillation or arrest was not often found. Ischemic conditions, caused by cessation of the circulation, stimulated this epileptic effect. A stunner setting of 150 V is therefore recommended to ensure immediate and lasting unconsciousness, which is a requirement for humane slaughter.

Animals↗
PubMed1985

Further data on the effects of subliminal symbiotic stimulation on schizophrenics.

This investigation further examined the effects of activating unconscious symbiotic fantasies in schizophrenics. One hundred twenty-eight hospitalized schizophrenic men who qualified as "relatively differentiated" on the Adjective Rating Scale were randomly assigned to four groups. Each group was assessed for pathological thinking, pathological nonverbal behavior, and self-esteem before and after the subliminal exposure of an experimental and control stimulus. The control stimulus for all groups was the message PEOPLE ARE WALKING and the experimental stimuli were the messages MOMMY AND I ARE ONE, MOMMY IS ALWAYS WITH ME, MOMMY FEEDS ME WELL, and I CANNOT HURT MOMMY (one for each group). One half of each group was subliminally exposed to verbal messages only and one half to verbal messages accompanied by congruent pictures. The first stimulus (MOMMY AND I ARE ONE) was intended to activate unconscious symbiotic fantasies that in a number of prior studies reduced pathology in groups of relatively differentiated schizophrenics. The other stimuli were intended to activate reassuring unconscious fantasies about "mommy" that were not specifically symbiosis-related. Only the MOMMY AND I ARE ONE stimulus led to more adaptive behavior and did so on all three dependent variables. This supported the supposition, also borne out in two other studies, that it is specifically symbiosis-related gratifications that are ameliorative for schizophrenics. The above results were considerably stronger for the subgroup that was exposed to a picture accompanying the MOMMY AND I ARE ONE message. This was viewed as probably the result of the pictorial representation serving as a concretization of the more abstract verbal message and as such being more relevant to the relatively primitive mode of thinking in schizophrenia.

Adolescent↗
PubMed2003

Picture interpretation and Jungian typology.

This study examined a Jungian picture interpretation schema, which utilizes a specific quadrant method. This proposed schema, which is used in training at the C. G. Jung Institute in Zürich, attaches significance to specific areas of a drawing. The upper left of a drawing is associated with the father; the lower left with the unconscious; the lower right with the mother; and the upper right with the future. Three questions served as the foci of this study: Is the schema valid? Do certain types within Jung's personality theory respond better than others to the schema? Does the schema work best when it elicits a strong affective response from the person who created the picture? Subjects took one of two tests: a space domain test, or a colour associative test. The results revealed only two significant effects: a positive association (in the space domain test) between unconscious material with the unconscious quadrant and a negative association (in the colour associative test) of mother material with the mother quadrant. These results suggest that the Jungian quadrant schema used to interpret drawings is invalid and of minimal practical utility. Other methods of picture interpretation are discussed as well as suggestions for future research that would be helpful to this field.

Art↗
PubMed2005

The influence of complexes on implicit learning.

A century ago, Jung looked into the unconscious through complexes by using word association tests. Jung wrote, 'modern psychology with its investigation of complexes has opened up a psychic taboo area riddled with hopes and fears', and complexes remain an unexplored taboo area of research. In the present study, we have investigated the influence of complexes on unconscious cognitive processing, in particular on implicit learning. We have found that complexes shown to disturb conscious cognitive processing in fact enhanced the attention of the subjects and their performance on an implicit learning task. These results suggest that complexes are not just abstractions, but have various actual influences on both conscious and unconscious processing.

Adolescent↗
PubMed1991

Primordial image and the archetypal design of art.

This paper extends Jung's work on the relationship of art to (postulated) archetypes of the collective unconscious. Archetypes of the collective unconscious, according to Jung, are revealed to ego consciousness only by way of images--images of a specific form. Jung suggests that archetypes, primordial images, combine two aspects in a single form and are therefore paradoxical. The wise old man and youth and hermaphrodites illustrate Jung's definition of a primordial image. My study of Jung's illustrations concludes that he is referring to what I term double-figures as the design form of primordial imagery. I elaborate upon the design form of double-figures, and illustrate my conception of archetypal imagery through comparative analysis of nine cases of double-figure imagery from selected prehistoric and contemporary societies. Double-figures, as archetypal primordial imagery of the collective unconscious, are spontaneously generated, autonomous, and known to a wide variety of societies. I distinguish between form and content in the study of primordial imagery, and conclude with a summary of the importance of Jung to the cross-cultural study of art.

Art↗
PubMed1993

'In a dark time, the eye begins to see'.

In this paper I discuss a patient whose shadow became his rival, or as Jung put it, 'The shadow is lived'. I describe the beginning of a process of the assimilation of shadow contents, whereby the rupture between ego and shadow can no longer be maintained. I also discuss how it is primarily through the mutual experience and analysis of archetypal images that the unconscious contents become more integrated. In my clinical illustrations I also explore the relationship between my patient's fight with his shadow and his experiences of childhood shame. I consider how fear expressed through a panic attack may open a royal door to the unconscious, and the way in which its mediation through empathy and analysis can lead to unconscious infantile contents becoming more accessible. In addition, I show how, once some of the fear had subsided, it became possible for play to enter into the analysis.

Adult↗
PubMedDate not supplied

Images of life on the verge of death: dreams and drawings of people with AIDS.

TOPIC: Dreams of people with AIDS help illuminate unconscious activities that can be used to guide the people to a peaceful death. PURPOSE: To explore dreams of the people with AIDS in an attempt to understand unconscious processes SOURCE: Dreams and drawings of three people with AIDS. CONCLUSIONS: Dreams and drawings can be used to understand the unconscious processes of people with AIDS and to help them toward a peaceful death.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Interactional obstacles to empathic relating in the psychotherapy of narcissistic disorders.

Psychotherapy with narcissistic patients exposes therapists to a set of interactional pressures which threaten to disrupt the desired therapeutic stance of empathic relatedness. The therapeutic relationship is a field of unconscious mutual influence in which therapists' own narcissistic vulnerabilities are threatened by narcissistic patients' characteristic interpersonal style. A typical constellation of countertransference feelings and reactions is aroused, characterized by a temporary or chronic state of narcissistic symmetry between patients and therapists. In this relational state both patients and therapists unconsciously defend their respectively tenuous sense of self-esteem from the perceived threat posed by the other, using similar defensive narcissistic strategies. Unless this interactional narcissistic symmetry is diffused a therapeutic impasse ensues, which may jeopardize the therapeutic alliance. This potential is exacerbated in the case of those therapists with characterological narcissistic features, as they unconsciously require constant affirmation from their patients in order to enhance their deficient self-esteem. Enduring, understanding, and adaptively processing narcissistic countertransference responses facilitates the resumption of the desired empathic stance, characterized by an optimal condition of narcissistic asymmetry between therapists and patients.

Adult↗
PubMed2004

Success and succession.

The etymology of the word success and its relationship to succession is elucidated. Linkage is made to the consequences of unconscious "legitimate" and "illicit" fulfillments in life. This is explored in the writings of Freud and others. Emphasis is placed on guilt, a major factor blocking the attainment of success. This guilt derives from unconscious parricide, which permeates and contaminates themes of succession. How early objects, particularly oedipal ones, are "killed off" in the process of gaining autonomy and achievement without literally invoking unconscious murder is explored. The retaliatory aspects of failure are also addressed. Illustrations employing case material are used to highlight these theoretical constructs.

Achievement↗
PubMed1993

The couple's constructive and destructive superego functions.

Just as the couple becomes the repository of both partners' conscious and unconscious sexual fantasies and desires, and of their consciously and unconsciously activated internalized object relations, so does the couple activate both partners' conscious and unconscious superego functions. The interaction of the partners' superego over time results in the forging of a new system, which I am calling the couple's superego. The functions of the couple's joint superego structure is described, as are the symptoms of superego pathology in the couple's love life. The vicissitudes of gratitude and guilt, of stereotyping and conventionality, of deceptiveness and long-range destructive and self-destructive scenarios, are explored in the context of a spectrum reflecting the severity of joint superego pathology. A clinical case vignette illustrates some of these developments in a couple's life.

Adult↗
PubMed1977

Male homosexual psychodynamics and the Rorschach test.

A review of contradictory findings regarding Wheeler's Rorschach content signs of male homosexuality suggested that negative findings may have resulted from a focus on homosexual populations characterized by minimal arousal of underlying unconscious conflicts. It was hypothesized that activating these unconscious psychodynamics would enhance the discriminative power of the Wheeler signs. Inkblot protocols obtained in an earlier study from matched groups of homosexuals and heterosexuals under two experimental conditions -- involving subliminal exposure of either an incest-related or a neutral control stimulus -- were scored for Wheeler signs. The incest condition brought about a significantly greater incidence of the signs in homosexual records only, suggesting that the intensification of unconscious incest wishes stimulates homosexual reactions, consonant with psychoanalytic formulations.

Adolescent↗