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PubMed1987

Characterization of the resulting incapacitation following unexpected +Gz-induced loss of consciousness.

+Gz-induced loss of consciousness (G-LOC) results in incapacitation which can be characterized by the unconscious period (absolute incapacitation) and a subsequent period of confusion/disorientation (relative incapacitation). The sum of the absolute and relative incapacitation periods represents the total incapacitation period and may be equated to the overall length of time a pilot would be in uncontrolled flight should G-LOC occur. Reviewing the centrifuge induced G-LOC episodes in 55 subjects allowed a detailed description of G-LOC. The absolute incapacitation period was 16.6 s with the subsequent relative incapacitation being 14.5 s resulting in an overall total incapacitation of 31 s. The G-LOC incapacitation was dependent on the rate of onset of the +Gz-stress and the +Gz level where G-LOC occurred. G-LOC episodes could be subdivided into 2 separate types: Type I being shorter unconsciousness episodes without convulsive movements, and Type II being longer unconsciousness with more frequently associated dream states and convulsive type movements. This detailed description of G-LOC allows a more complete understanding of the phenomenon and establishes the basis for research toward decreasing the resulting incapacitation from G-LOC. Minimizing G-LOC incapacitation and enhancing recovery should enhance safety in the aviation environment of the high-performance-fighter aircraft pilot.

Acceleration↗
PubMed1978

Very prolonged unresponsive state following brain injury.

A study was made of patients suffering from a prolonged unconscious state following brain injury from road accidents, cardiac arrest, falls and post-operative unconsciousness after cardiac surgery. Seventeen patients (Group A) were admitted to Harzfeld Hospital several months after the injury in a state of continued unresponsiveness; 6 others (Group B) were admitted because of rehabilitation potential despite unconsciousness, or because of behaviour difficulties in their rehabilitation. The duration of unresponsiveness ranged from 3 months to 4 years. Observation and follow-up showed late neurologic recovery after 1 year or more in 6 subjects as shown by ability to swallow, improved posture of the head or trunk, limb movement and increased awareness. Five of the Group B subjects were discharged, 4 in a markedly improved state. Eleven of 17 unresponsive subjects of Group A died, and 6 remain alive in hospital, 2 significantly improved. The duration of hospital care was 12.8 months in Harzfeld Hospital, and a total of 21.9 months from the time of injury. Those who still survive in hospital have now a mean stay of 50 months. Complications, and implications for treatment are described and the attitude thought appropriate to the management of these long-term patients in the face of their families is discussed in the light of our experience over 6 years.

Brain Injuries↗
PubMed1978

Moral masochism.

The author questions the existence of unconscious guild and unconscious need for punishment. His thesis is that the self-destructive acts and sufferings of the moral masochist are not caused by an unconscious need for punishment, but rather by a flight from severe castration anxiety into masochistic acts. The analysis of the latent castration anxiety leads to the maturation of the superego. Clinical material from one case is used to support this thesis. Further material from the same case shows how the moral masochism of adolescence and adulthood grew out of the feminine masochism of latency. In addition, the author discusses another case of moral masochism which reviews the intricate relationship between psychic health and moral codes. The importance of the cultural atmosphere is emphasized, particularly what the moral masochist extracts from it.

Anxiety, Castration↗
PubMed1984

Disturbances of the sense of time with special reference to the experience of timelessness.

Disturbances of the experience of time are examined, with emphasis on the effects of the vicissitudes of the sense of self, affect, unconscious fantasies, and ideas concerning death. The manifest experience is interpreted as a derivative of unconscious, conflict-laden fantasies. Disturbances of the experience of time may be regarded as specific types of affective states, pleasurable or unpleasurable, the quality of the experience being determined by the nature of the underlying unconscious ideational content. Two experiences of timelessness are analyzed, in which the sense of timelessness was determined by the wish to extend time indefinitely. Many elements have been condensed into this basic wish which, as in a dream, was momentarily experienced as already realized.

Adult↗
PubMed1978

[Respiratory depression after fentanyl and antagonism by naloxone (author's transl)].

The postoperative respiratory depressant effect of fentanyl in combination with flunitrazepam (Rohypnol) was assessed in awake and in unconscious patients. In awake patients respiratory function was measured with blood-gas analyses. For measurements in unconscious patients the administration of nitrous oxide/oxygen was continued postoperatively and the respiratory depression was judged from the increase in respiratory minute volume after the i.v. administration of 0.05 mg naloxone (Narcan). In the group of awake patients blood-gasvalues were within the normal range after anaesthesia with flunitrazepam (1 mg) and fentanyl (0.80 mcg/kg body weight/10 min anaesthesia; last fentanyl given 40 min before the end of the operation), and the administration of naloxone was without any effect. If, however, naloxone was given while the patients were kept under light nitrous oxide/oxygen anaesthesia, the effect was different. The respiratory minute volume was considerably less than its predicted value in all groups of patients having received fentanyl, and naloxone caused a marked increase in respiratory minute volume and in respiratory rate. In a group of patients which have received no opiate but enflurane, naloxone showed no effect. After premedication with pethidine as compared with flunitrazepam the effect of naloxone on ventilation was more pronounced. This marked difference in the postoperative effect of fentanyl on ventilation depending on the state of consciousness has to be attributed to an interaction between a residual respiratory depressant effect of fentanyl and the effect of unconsciousness. Since after the combined use of flunitrazepam and fentanyl deep postoperative sleep occurs quite frequent, a residual effect of fentanyl should always be antagonized with naloxone to protect the patients from a possible hazardous effect of this interaction.

Adolescent↗
PubMed1982

[Some features of electrical and mechanical stunning in ruminants].

The present studies are concerned with methods of mechanical and electrical stunning as used in ruminants. The object is to acquire a scientific basis for the correct use of these procedures in slaughter-houses. In all experiments studies on living animals, cerebral activity (electro-encephalogram) was measured using electrodes which had been surgically implanted the previous day. When animals are stunned by concussion, unconsciousness is not induced in every case. When a slaughtering mask was frontally or occipitally applied to the head, unconsciousness was produced. To effectively induce unconsciousness, the bolt of the captive bolt pistol should carry sufficient energy to damage the cerebral cortex and the deeper portions of the brain directly or by shock waves following penetration of the cranium. The forces which may be developed by the variously coloured cartridges of the brands of captive bolt pistol differ markedly. Regulations regarding the relationship between the colour of the cartridge and the potential forces would appear to be essential.

Abattoirs↗
PubMedDate not supplied

[Anna, Irma and Dora--the key to the mothers in the creation of psychoanalysis].

As a science caught up between the mythical and the rational, psychoanalysis is subject to the pulls of two opposing currents, a creative enlightened one concerned with the investigation of the unconscious, and a conservative counter-current observable in the psychoanalytic theory of femininity. In her analysis of these warning elements the author goes back to the genesis of psychoanalysis and its creator and takes a close look at the primal myth (the legend of Breuer and Anna O.), the primal dream (Irma), and finally the primal analysis (the case of Dora). King's analysis demonstrates that Freud unconsciously appropriated female psychic features and--in unconscious identification with the mother of the Urszene, bound up with adolescent regression and attendant bi-sexual grandeur fantasies--imagined himself as ideal woman and "conceiver". By appropriating female potency for himself and thus making the opposite sex superfluous, Freud's theory of femininity leaves the place of women vacant, relegating them to the role of a defective entity, a castrated man, rather than acknowledging their otherness. In King's view, this phallic monism is inextricably interwoven with adolescent bisexual identifications and fantasies of grandeur about Freud's own gender, while denying gender-difference genuine recognition and integration.

Adolescent↗
PubMed1994

On formulating clinical fact to a patient.

This paper approaches the issue of formulation to the patient by examining the interpretations offered to one patient concerning her reactions to three analytic holiday breaks. Detailed material from several sessions is presented in the context of the author's attempt to try to understand how she arrived at what she said and understood and how the interchange with her patient developed. The author suggests that the material shows a gradual deepening both in her understanding and in her patient's insight into the patient's responses to being left; to recognising that her analyst was pursuing an independent life of her own; and to becoming aware of her unconscious beliefs about her analyst's unconscious motives for leaving. The author concludes that her method of arriving at formulations varied. Generally speaking, conceptualisation of clinical facts does precede formulation to the patient and is then succeeded by validation or non-validation. In one instance, however, formulation, guided perhaps by an unconscious hunch on the part of the analyst, preceded conceptualisation. This particular formulation also led to far-reaching and integrating interpretations. The implication is that there are several methods of arriving at valuable formulations of clinical fact, none of which should necessarily be privileged.

Adult↗
PubMed1994

Comments on the conceptualisation of clinical facts in psychoanalysis.

Perception is an active process involving a complex system of perceptual and cognitive structures. Facts reflect the ways in which we organise the data received by our senses, and this organisation is highly selective. The private theories of psychoanalysis play a major role in the organisation of facts and in their conceptualisation. It is important that there should be more attention to clinical theories and technical frames of reference, and as an illustration of this a clinico-technical conceptualisation which has been found useful is presented in some detail. This makes use of the concepts of the present and past unconsciouses, in this way emphasising the topographical dimension which had come to be under-stressed in Freud's structural theory and in subsequent ego psychology. The past unconscious can be regarded as a sort of 'template' (structures, rules, schemata, etc.) developed in the child in the first few years of life. This contributes to the form of fantasies and behaviour arising in the depths of the present unconscious, in which system such representational content is acted on by defences and other mechanisms to prevent 'child-like' content from disrupting the older individual's equilibrium. The censorship between the present unconscious and consciousness is considered, and the view taken that the primary focus of the analytic work is in relation to this censorship. The links between the analytical aim of making previously unacceptable mental content acceptable to the individual, on the one hand, and the roles of construction and reconstruction, on the other, are discussed in relation to psychoanalytic technique.

Adolescent↗
PubMed1976

The misalliance dimension in Freud's case histories: i. The case of Dora.

This paper presents an effort to identify sectors of therapeutic misalliance between Freud and his patient Dora based on modifications in the framework of the analytic relationship and situation. Use is made of a template based on the current ground rules and boundaries of the patient-analyst relationship, and three deviations from this template are identified in Freud's analytic work with Dora. The intrapsychia and interactional sequelae of these deviations in technique for Dora and for the course of her analysis are traced out. The consequent sectors of misalliance are identified and the participation of both Dora and Freud is described, as are their respective, largely unconscious efforts to modify these areas of unconscious collusion. Stress is placed on Dora'a unconscious preceptions of the actual implications of Freud's modifications in the frame. The role of Freud's failure to rectify these deviations and to analyze their implications for Dora are considered, including their influence on the patient's premature termination of her analysis.

Attitude↗
PubMed1993

A phantasy of infection.

'A phantasy of infection' is a case study of the role of unconscious phantasy in the experience of illness. This paper discusses a phantasy that was brought to light during the psychoanalysis of a homosexual man who has been diagnosed as HIV-positive. The paper concentrates on the difference between this patient's conscious knowledge of his infection and an unconscious phantasy which was reawakened and elaborated in this situation. Detailed clinical material is presented to illustrate the point that the often unexpected and strange relation the patient has to his infection can be explained only through an understanding of such unconscious phantasies as they are lived-out and analysed in the transference.

Adult↗
PubMed1993

[Nutritional assessment for patients with neurosurgical diseases].

There have been few guidelines in the field of nutritional management with regard to neurosurgical patients. In this review, caloric intake and nutritional parameters were measured in 24 patients in the acute stage and 32 patients in the chronic stage (prolonged unconscious state). We ascertained (1) whether the caloric intake was adequate or not, (2) the relationship between the grade of neurological damage and the nutritional assessment, and (3) we discussed the relationship between diseases and the nutritional assessments. The acute-stage patients, 14 male and 13 female, consisted of both a neurologically good prognostic group and a neurologically poor prognostic group. All of the prolonged-unconscious patients revealed poor prognosis. The nutritional assessment was referred to such parameters as, diet and nutrition, anthropometric measurements, laboratory tests, immunological parameters and prognostic nutritional index. The results were, 1) the acute stage patients received less caloric intake than their resting energy expenditure, 2) the neurologically poor prognostic patients showed muscle atrophy and decrease of creatinine-height index which represents muscle content, 3) there was no significant differences between the assessment parameters in each disease, and 4) serum electrolytes decreased in prolonged-unconscious patients with a small amount of caloric intake.

Acute Disease↗
PubMed1993

Convergences and divergences in contemporary psychoanalytic technique.

A broad survey of the psychoanalytic field reveals both convergences and divergences in technique. The major convergences include earlier interpretation of the transference, increased focus on transference analysis, as well as growing attention to countertransference analysis and increasing concern with the risks of 'indoctrinating' patients. Greater emphasis is found on character defences and the unconscious meanings of the 'here-and-now'. Also noted are trends toward translating unconscious conflicts into object-relations terminology, as well as toward considering a multiplicity of royal roads to the unconscious. Regarding divergences, significant controversies continue about the importance of the 'real' relationship, and the therapeutic versus the resistance aspect of regression. Divergences also continue regarding reconstruction and recovery of preverbal experience, drawing the lines between psychoanalytic psychotherapy and psychoanalysis, the role of empathy, and the relation of historical to narrative truth.

Countertransference↗
PubMed1996

The concept of psychic reality--how useful?

The author argues that Freud coined the phrase 'psychic reality' to indicate how neurotic patients and others treat unconscious psychic concepts and fears as if they were real. They respond to the challenges of everyday life not in terms of objective reality, but rather in keeping with their inner 'psychic' reality. With the development of different schools of thought in psychoanalysis, opinions as to precisely what constitutes the contents and character of unconscious mental functioning differ enormously, to the extent that there is no general agreement as to the nature and quality of unconscious mental elements. Psychoanalysts do not have a shared view of what constitutes psychic reality, with the result that genuine scientific interchange has become increasingly difficult and attenuated. The author considers that what is required is the exploration and enunciation of an agreed upon methodological approach to the interpretation of clinical data and thence to the formulation of mutually acceptable psychoanalytic concepts.

Communication Barriers↗
PubMed1995

Psychological vicissitudes of theory in clinical work.

The author discusses the ways in which psychoanalytic theories, like other theories, attempt to systematise the understanding of observations. Freud remarked that systems also have unconscious meanings. The author discusses these unconscious vicissitudes of psychoanalytic theories of both clinical and more abstract kinds, at various levels of psychological function. Learning psychoanalysis repeats in some respects the developmental processes of learning about 'reality'. The role of authority and superego function in learning and utilising theories is emphasised. The enduring unconscious relationship of theory to authority contributes to adherence to, misapplications of, and rejection of theories, as well as to anti-theoretical attitudes. The concept of an 'analysing instrument' illustrates the way in which a useful exploratory idea may acquire prescriptive and constrictive implications. Analysis of the analyst's attitudes towards theory and its applications is an aspect of countertransference analysis.

Authoritarianism↗
PubMed2005

First prospective study of the recognition process of melanoma in dermatological practice.

BACKGROUND: Early detection is crucial to improve melanoma prognosis. Different diagnostic guides such as the ABCD rule (asymmetry [A], irregularity of borders [B], unevenness of distribution of color [C], and diameter [D]) have been proposed to identify melanoma, but their efficacy in real life is questionable. We investigated the recognition process of melanoma by dermatologists to use as a model to improve self-detection in the general population and to train students and general practitioners. OBJECTIVES: To understand the major principles of the recognition process of nevi and melanoma unconsciously used by dermatologists. DESIGN: Prospective survey recording the immediate perceptions of dermatologists of the morphologic features of the lesion and intuitive diagnostic opinion about 4036 consecutive resected nevi and melanoma. SETTING: One hundred thirty-five volunteer dermatologists in their daily practices. MAIN OUTCOME MEASURES: Perceptions of the image best explaining the diagnostic opinion and best predicting the final diagnosis by univariate and multivariate analysis. RESULTS: The immediate diagnostic opinion of the dermatologist is mainly explained by an unconscious reference to the overall pattern compared with the common nevi, but also compared with the other nevi of the individual (the "ugly duckling sign"). The dermatologist's ability to discriminate between nevi and melanoma relies on the assessment of the overall pattern, the ugly duckling sign, and the knowledge of a recent change. A separate or combined analysis of individual morphologic criteria such as ABCD does not seem to play a major role in this recognition process. CONCLUSIONS: Persons most skilled at the clinical detection of melanoma seem to unconsciously rely on cognitive (overall pattern) and comparative (ugly duckling sign) processes rather than an algorithm of morphologic criteria (ABCD). These concepts could be tested in the medical training of general practitioners and education of the general population, where they might be more efficient than algorithms such as the ABCD criteria.

Adult↗
PubMed1986

Head injuries in a population study.

In a population study of altogether 1,112: 60-, 50-, and 30-year-old men performed in Göteborg, Sweden, data on head injuries suffered during life were obtained by personal interview. Two head injury concepts were used, one wide definition to cover all sorts of head injuries (HI-w) and one restricted only to delineate head injuries with evidence of presumed brain involvement (HI-r). 24% of the 60-year-old men, 21% of the 50-year-old men and 23% of the 30-year-old men reported at least one head injury with unconsciousness. When taking only the 3 first decades of life into account a significantly higher proportion of men in the youngest cohort had been unconscious than in the older ones, and the youngest men also had a significantly higher incidence of both HI-w and HI-r than the older men. Accidents at home, in roads and in sports/recreational areas dominated in childhood, place of work in adult age. HI-r accidents occurred somewhat more often in roads and sports/recreational areas than HI-w accidents. Falls, traffic and blows/impacts were the most common causes. Falls dominated in childhood. Motor vehicles were more often involved in childhood accidents in the youngest cohort than in the two older ones. The proportion of self-care decreased due to a strong secular trend. Out-patient care increased due to both a secular trend and to the age of the victim. The proportion of in-patient care increased with the age of the victim but showed no evident secular trend. 1/5 to 1/3 of all head injuries with unconsciousness were not medically attended.

Accidents, Home↗
PubMed1990

Metabolism and elimination of rhodamine 123 in the rat.

Little is known of the pharmacology of rhodamine 123 (RH-123), an agent reported to have carcinoma-selective experimental antitumor activity. Accordingly, using a high-performance liquid chromatographic assay system with fluorescence detection, we examined the plasma decay and the biliary and urinary elimination of parent drug and metabolites in female Sprague-Dawley rats receiving RH-123 at an intravenous dose (5 mg/kg) equivalent to the therapeutic dose used in murine tumor models. Following drug administration to unconscious animals, plasma levels of drug-associated fluorescence fell in a triphasic manner (t1/2 alpha, 15 min; t1/2 beta, 1 h; t1/2 gamma, 4.7 h). In plasma, unchanged drug predominated but lower levels of the deacylated metabolite rhodamine 110 (RH-110) and two unknowns were also detectable throughout the study. Drug fluorescence was recovered extensively in both urine and bile. In unconscious animals with ureteral cannulae, urinary excretion (11.4% of the dose in 6 h) occurred predominantly as unchanged RH-123 (97% of the total), with low levels of RH-110 (2.4%) and two unknowns (less than 0.6% combined) also being present. Similarly dosed conscious animals (without surgical intervention) housed in metabolic cages showed a comparable pattern of urinary excretion, with 11.9% of the drug dose being recovered in 6 h and 21.9%, by 48 h. Biliary drug elimination accounted for 8% of the delivered dose in 6 h in unconscious animals and for 11% by 36 h in conscious animals fitted with biliary cannulae. In contrast to urinary excretion, in which unchanged drug predominated, only 50% of the fluorescence recovered in bile was attributable to RH-123. The remainder was due to a number of products that were detectable throughout the study. Of these, one present at significant levels was identified as a glucuronide conjugate of RH-123, based on the liberation of parent drug when the purified metabolite was incubated with beta-glucuronidase or hydrolyzed with 1 N hydrochloric acid. Further studies with a radiolabeled form of RH-123 are necessary to establish the identity of the remaining unknowns disclosed in this work.

Animals↗