Omnipotence in the transference and in the countertransference

The concept of omnipotence refers to a primitive fantasy, a mechanism of defense, and a pathological psychic structure. Omnipotence and its derivative defensive operation, omnipotent control, are highly prevalent in borderline personality organization. Three clinical vignettes illustrate these mechanisms in the treatment of patients with borderline, narcissistic, and obsessive personality disorders, respectively. These vignettes illustrate the transference developments when omnipotence and omnipotence control are dominant, and the therapeutic approach to these conditions.     

RICOEUR'S PHILOSOPHY AND ITS IMPLICATIONS FOR PSYCHOANALYSIS

In differentiation of early and mature shame, the phenomenological content of shame changes with the development of a stable self-state. In this hypothesis, early shame refers to a person's dependence upon mirroring himself and in being mirrored by an outer object, while mature shame refers to introspection and self-reflection. From a developmental psychological point of view, the connection between self-development and mirroring is expounded. Mirroring is defined as a psychic dialectic process between the inner psychic reality and the outer reality. Early shame is connected to dyadic mirroring, which refers to attachment and empathy. Mature shame is connected to triadic mirroring, which refers to separation and reflection. Early shame emerges from discrepancies between the infant's expectations of a complementary affective response and the mother's response, and is defined as an early marker of differences in the mother/infant unit. It is argued that early shame in smaller ‘doses’ has a regulating function on self-development by maintaining the psychic dialectic process, while in larger ‘doses’, it has a disturbing effect on the self-development, resulting in pathological shame. In the therapeutic process, early shame appears as shame scenarios illustrated in the text by a clinical vignette.     

Improving neglect by TMS

Hemispatial neglect refers to the defective ability of patients to explore or act upon the side of space contralateral to the lesion and to attend to stimuli presented in that portion of space. Evidence from animal models suggests that many of the behavioural sequelae associated with visual neglect may result not solely from the size of the lesion, but also from a pathological state of increased inhibition exerted on the damaged hemisphere by the contralesional hemisphere. On the basis of these potential mechanisms underlying neglect, in this review we discuss therapeutic approaches, focusing particularly on recent research using transcranial magnetic stimulation (TMS). This technique, besides representing an ideal tool to investigate visuo-spatial attentive mechanisms in humans, has shown promising beneficial effects that might have an impact on clinical practice.     

赌博游戏中的near-miss效应

near-miss效应是指在赌博中, 与一般的输钱和赢钱相比, “几乎赢(near-miss)”的输钱会诱发个体更高的生理唤醒和更强的赌博动机, 从而导致个体持续赌博的一种现象, 是导致赌博成瘾的主要诱因之一。针对这种现象的研究范式大致有三种：老虎机/类老虎机任务、轮盘任务和刮刮乐彩票任务。这种现象的理论解释目前主要有认知曲解假说、控制幻觉理论和受挫假说。near-miss效应的脑机制和病理研究才刚刚起步, 所涉及到的脑功能区域主要包括脑岛、腹侧纹状体等。未来的研究应在near-miss效应发生机制的理论模型建构、研究范式多样化、研究技术多模态化、病理机制和临床干预等方面进一步展开。     

Worry and Pathological Worry in Patients with Psoriasis: Cross Sectional and Longitudinal Analyses of the Penn State Worry Questionnaire (PSWQ) in Four Samples of Patients

The purpose of the present study was to examine the psychometric properties of the Penn state Worry Questionnaire (PSWQ) in patients with psoriasis. A series of cross-sectional and longitudinal studies were undertaken to assess the reliability, stability and validity of the measure. Patients with psoriasis from four samples (consecutive attendees, anxious patients, depressed patients, and 6-month follow-up of consecutive attendees) completed the PSWQ and measures assessing related constructs of anxiety and depression (HADS) and coping (COPE). The clinical severity of patients psoriasis was also assessed by dermatologists using the Psoriasis Area and Severity Index (PASI). Exploratory factor analysis was undertaken and receiver operator characteristic (ROC) analyses were used to examine the clinical utility of the PSWQ cut-off score for normal and pathological worry. Exploratory factor analysis suggested that the PSWQ is essentially unidimensional in patients with psoriasis. Intraclass correlation demonstrated that, over a 6-month period, the reproducibility of the PSWQ total scale was good in patients with anxiety and moderate in patients with depression. ROC analysis suggested that the optimum cutoff differentiating pathological worry was > 60, which is commensurate with findings in adult mental health more generally. The PSWQ cutoff for pathological worry showed a lower specificity for depression than anxiety. The PSWQ is an appropriate measure of pathological worry in patients with psoriasis. The cutoff on the scale for pathological worry demonstrates appropriate conceptual overlap with subordinate distress categories of anxiety and depression.     

Spatial hemineglect in humans

The term `spatial hemineglect' refers collectively to disorders of spatial cognition, which concern specific sectors of space with reference to a given coordinate system. Patients with cerebral lesions involving the posterior-inferior parietal and the premotor cortex, most often in the right hemisphere, sometimes fail to explore the extra-personal and personal sectors of space contralateral to the side of the lesion, are not aware of stimuli presented in these portions of space, or of contralateral body parts and their disordered function. In addition to these negative signs patients may also show positive pathological manifestations, such as avoidance or withdrawal from the contralateral side of space, and delusional views concerning contralateral body parts. The many varieties of this disorder can occur in dissociated forms, suggesting a multifaceted organization of the internal representation of space, of spatial attention, and of their neural correlates. Many manifestations of hemineglect are modulated in a similar fashion by specific sensory stimulation that also affects visuo-motor processes in normal subjects. This ongoing sensory modulation might update the internal representations of space in a continuously changing environment, and contribute to the formation, around the vertical orientation of gravity, of our subjective unitary experience of space.     

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.     

心理学视野下的社会变迁研究：研究设计与分析方法

近年来,社会变迁导致的文化、心理与行为变化及其相互建构已经成为心理学的研究热点。社会变迁研究通常涉及和变迁相关的时间效应、时代效应以及和变迁无关的年龄效应。在考察变迁趋势及其影响因素时,常用的研究设计有跨时间比较、跨代际比较、跨地区比较(历史重构)等方法;常用的分析方法有传统的相关和回归分析和现代的时间序列分析(比如交叉滞后相关和格兰杰因果检验)等。由于每一种设计都有其优点和不足,在具体研究中,研究者要根据研究的问题和可操作性选择合适的方法;如果可能,最好同时采用多种方法,以寻求基于不同方法的聚合证据。     

Zur Prävalenz von Depersonalisation und Derealisation in der stationären Psychotherapie

Depersonalization (DP) and derealization (DR) remain poorly recognized in clinical routine. Active exploration through structured interviews is strongly recommended, because patients rarely describe spontaneously their experiences with DP/DR. 143 psychosomatic, first-admission inpatients were interviewed about the 1-month prevalence of DP/DR using the Structured Clinical Interview for DSM-IV dissociative disorders. Additionally, the German questionnaires of the Cambridge Depersonalization Scale, the Dissociative Experiences Scale, the SCL-90-R and the Inventory of Interpersonal Problems were used. In the sample we found a prevalence of 23.1% (N=33) for depersonalization-derealization syndrom (ICD-10 F48.1) and 7% (N=10) for secondary pathological DP/DR. A total percentage of 62.9% reported DP/DR to some degree or other. There was a noticeably high co-occurrence of anxiety disorders in patients with pathological DP/DR. Patients with pathological DP/DR were generally more impaired, suffered many more interpersonal problems and were particularly characterized by introversion. Considering the high prevalence of this phenomenon, more attention should be paid to DP/DR in routine diagnostic procedures, treatment and research.     

On the astonishing clinical irrelevance of neuroscience

The clinical work of psychoanalysts can be thought of in both a narrow and a broad sense. In the narrow sense, it refers to what is commonly thought of as psychoanalytic technique, the methods analysts use to understand their patients and to convey that understanding to them. In the broad sense, it refers to the entirety of their work as clinicians: the content of understanding, as well as such things as diagnosing, estimating analyzability, recommending therapy, and prescribing medication. The current enthusiastic expectation that neuroscience will have an immediate and direct impact on clinical work in the narrow sense is misguided, but neuroscientific discoveries, it is argued, will have a major impact on psychoanalytic theory in the not too distant future. The resulting changes in metapsychology will ultimately have reverberations on clinical work in the broad sense, although psychoanalytic technique, the analyst's basic approach to patients, will remain essentially the same.     

Introduction: The Difficult-to-Reach Patient and the Difficult-to-Find Dyad

In this brief introductory paper, Cooper introduces a panel by four analysts who consider their work with particularly challenging patients. This introduction emphasizes the dyadic nature of difficulty in initiating therapeutic work with the patients described here. The author refers to the genre employed in these papers as a less heroic genre than is sometimes used in psychoanalytic papers—a welcome development, as these authors courageously describe the fraught and sometimes failed attempt to engage their patients.     

论责任心的类型与层级

责任心的类型多种多样,并且,自个体步入前习俗水千开始,其责任心就既不再是有与无的关系,也不是一个平面关系,而是一个呈金字塔形的层级关系。就正确责任心而言,将“他律型责任心”与“自律型责任心”、“硬角色责任心”与“软角色责任心”进行排列组合,并考虑到量的差异,就生出了发展水平高低不同的多层次责任心：其中,拥有他律型硬角色责任心,是做个有责任心之人的底线。拥有第二层次的责任心有两种典型做法：一是拥有一般水平的自律型硬角色责任心;二是拥有他律型软角色责任心。个体二旦拥有一般水平的自律型软角色责任心,其责任心就达到了第三层次。拥有第四层次的责任心有两种典型做法：拥有高水平的自律型硬角色责任心,或拥有舍小我成大我且自律型软角色责任心。拥有高水平自律型软角色责任心,是做一个有责任心之人的最高境界。     

Pathologischer PC-/Internetgebrauch

An increasing number of people have difficulties in limiting private PC/internet use. Especially, MMORP games (massively multiplayer online role-playing games) like ?World of Warcraft“, action games (?Ego-shooters“) like ?Counterstrike“, surfing and chatting are very time-consuming and for some people can reach a pathological level. When real life disappears from a person’s sight and he is almost permanently focusing on the virtual world, we speak about ?pathological PC/internet use“. The great amount of time spent online for non-work or non-school related purposes is one major symptom. In the AHG clinic Münchwies an in-patient program for pathological PC/internet users has been developed. which focuses on group therapy and is based on integrative cognitive behavioural therapy. Difficulties with motivation, compliance, interaction, attachment organisation and self-structuring of those patients are addressed in addition to the core symptoms. A major goal is to centre the patient’s activities and interests back towards real life in order to establish functioning social-interactive relationships again and to reduce the PC/internet use strictly to professional and necessary private activities.     

Do patients with OCD and pathological gambling have similar dysfunctional cognitions?

The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models.     

Boredom proneness in pathological gambling

To test the hypothesis that pathological gamblers seek stimulation as a means of reducing aversive under-aroused states of boredom and/or depression, the Beck Depression Inventory, Zuckerman's Sensation Seeking Scale and a Boredom Proneness Scale were administered to 48 diagnosed pathological gamblers and a control group of 40 family physician patients. Analyses of variance showed pathological gamblers obtained significantly higher boredom proneness and depression scores than those of controls. That the Boredom Proneness Scale failed to correlate with the Zuckerman Boredom Susceptibility subscale suggested the two measure differing dimensions. Results indicated the possible existence of three subtypes of pathological gamblers, one group characterized by boredom, another by depression, and a third by a mixture of both depression and boredom.     

Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Naturalistic observations of pathological behavior in hospitalized psychiatric patients

Naturalistic observations were conducted on 19 acutely ill psychiatric patients in the hospital ward milieu. The study was designed to determine relationships between selected social and environment variables and overt atypical behavior. Patients were observed on an individual basis with time-sampling techniques. In total, 16 pathological behaviors were coded and the most frequent (postural deviance, pace, agitation, hyperactivity, withdrawal, foot shake/body sway, leg swing) were selected in order to determine variation in frequency of these behaviors as a function of the following variables: area within hospital, week of hospitalization, distance between the focal subject and his/her nearest neighbor, number of people in an area, and time of day. Results showed differential changes in pathological behavior as a function of week of hospitalization, number of people in a given area, and distance from the focal subject's nearest neighbor. There was no significant change in the frequency of pathological behaviors as a function of area within hospital or time of day. In addition, most pathological behaviors decreased significantly when patients were engaged in the sending or receiving of verbal behavior. Cluster analyses revealed varying degrees of dissociation between pathological behaviors and social-interaction behaviors. These results support (a) a nonunitary concept of the general category pathological and (b) the view that there are inhibitory effects of social interaction on the enactment of atypical behaviors. Clinical implications of these findings are discussed.R.H.P. completed this research during his tenure as a postdoctocal fellow in the Department of Psychiatry, Human Ethology Laboratory, UCLA (NIMH Fellowship 1 F32MHO7627-01). Support for this research also came from the Veterans Administration.     

Acoustically evoked brain stem potential in Wilson disease

By 48 patients with Wilson's disease the brainstem acoustic evoked potentials were stated. There were 35 pathological findings (73%), 13 were normal (27%). The waves, determined by the middle and upper brainstem (Pons and Mesencephalon) showed most of all pathological changes. Those patients with forms of Wilson's disease called Pseudoskelerose and Pseudoparkinson showed the most pathological findings. But one could watch these findings by about 30% of patients in preclinical stage. This method can possibly be used for early detection of disorders of brainstem functions and in the same way it can be used for control of treatment by patients in preclinical stage.     

Comparison between immigrant and Spanish native-born pathological gambling patients

The study compared clinical, psychopathological, and personality profiles between immigrants and Spanish native-born pathological gambling patients. A total of 1,601 native-born and 133 immigrant patients attending treatment at a specialized hospital unit were administered a battery of questionnaires during clinical assessment. Outcome measures were compared between both groups and the incremental predictive accuracy of the area of origin was examined using a regression model. Native-born Spaniards showed a mean 2.6 yr. greater duration of the disorder, while immigrants scored higher on South Oaks Gambling Screen, frequency of going to casinos, and total money spent (in a single day and/or to recover losses). General psychopathology and personality scores did not differ between the cohorts. However, immigration from Asia had a statistically significantly incremental validity for pathological gambling in South Oaks Gambling Screen scores. Both cohorts shared more similarities than differences in their gambling profiles.