持续性植物状态若干问题的探讨

明确意识的含义及意识障碍的分类是分析持续性植物状态的前提。根据多年临床经验对持续性植物状态的定义、评分标准、诊断与鉴别诊断进行深入割析。植物状态的研究取得相当进展,但从诊断、评分到治疗手段仍面临诸多困惑,而神经干细胞移植和神经电刺激术是未来希望所在。     

Pain in children: A review of the literature from a developmental perspective

Abstract

This article presents a review of the current psychological literature about pediatric pain. Prevalence and types of pain problems encountered in children are considered briefly, followed by a developmental perspective on the experience of pain in children, encompassing physical, cognitive, social and behavioral factors. A discussion of the clinical significance of pain in children includes its use in differential diagnosis and the impact of pain on a developing child. Recommendations are made for assessing pain and factors relevant to managing its effects in children. The review concludes with an overview of clinical techniques for management, and recommendations for future research.     

The role of cardiovascular risk factors in Alzheimer's disease

The distinction between Alzheimer's disease and vascular dementia, the two most common types of dementia, has been undermined by recent advances in epidemiologic, clinical, imaging, and neuropathological studies. Cardiovascular risk factors, traditionally regarded as distinguishing criteria between the two entities, have been shown to be associated with both AD and vascular dementia. In this article, we propose mechanisms of action of cardiovascular risk factors in AD, suggest possible explanations for the overlap with vascular dementia and discuss the implications this might have on future differential diagnosis, research, and treatment strategies.     

Amnestic episodes. (Isolated episodes of confusion with amnesia, amnesic ictus, transient global amnesia)]

The author, by giving an outline of one particular case as well as a survey of the relevant literature on transient global amnesia, describes the characteristic clinical picture that is characterized by a sudden loss of what is known as the short-time memory, which usually lasts for several hours, as well as by retrograde amnesia which sometimes dates back to many years. The condition gradually fades away within a few hours or during a night's sleep, and what remains is lack or loss of memory for the episodic period or sometimes retrograde amnesia. Relapses were not observed in the majority of patients. The disease usually develops in people in their sixth to eighth decades of life. The cause of the disease is not yet fully understood. Accordingly, it is justified to use such terms as autochthonous or cryptogenic amnestic episodes. The disease is also discussed from a differential diagnosis point of view.     

Trying to enter the long black branches: some technical extensions of the work of Frances Tustin for the analysis of autistic states in adults

The author suggests a number of technical extensions/clinical applications of Frances Tustin's work with autistic children, which are applicable to the psychoanalysis of neurotic, borderline and psychotic adults. These are especially relevant to those individuals in whom early uncontained happenings (Bion) have been silently encapsulated through the use of secretive autosensual maneuvers related to autistic objects and shapes. Although such encapsulations may constitute obstacles to emotional and intellectual development, are consequential in both the relational and vocational spheres for many analysands and present unending challenges for their analysts, the author demonstrates ways in which it may be possible to detect and to modify these in a transference-centered analysis. A detailed process of differential diagnosis between autistic states and neurotic/narcissistic (object-related) states in adults is outlined, along with several clinical demonstrations of the handling of a variety of elemental terrors, including the 'dread of dissolution.' The idiosyncratic and perverse use of the analytic setting and of the analyst and issues of the analysand's motivations are considered and illustrated. A new model related to 'objects in the periphery' is introduced as an alternative to the more classical Kleinian models regarding certain responses and/or non-responses to transference interpretation. Issues a propos the countertransference are also taken up throughout.     

An individual differences additive model: An alterating least squares method with optimal scaling features

An individual differences additive model is discussed which represents individual differences in additivity by differential weighting of additive factors. A procedure for estimating the model parameters for various data measurement characteristics is developed. The procedure is evaluated using both Monte Carlo and real data. The method is found to be very useful in describing certain types of developmental change in cognitive structure, as well as being numerically robust and efficient.The work reported here was partly supported by Grant A6394 to the first author by the Natural Sciences and Engineering Research Council of Canada.     

腰腿痛患者现病史的客观采集及其评价

腰腿痛患者的现病史采集比较困难,临床上经常引发混乱,甚至会被忽略。作者根据临床经验总结了一套相对系统和客观的分析思路。借此启发和提示临床医生临诊分析的主观能动性。作者还通过时现病史采集在医学发展史上的地位变化的回顾,提出了现代临床医学对患者症状特征进行归纳分析的重要性。     

Self-disclosure with all-male groups

Given the relational deficits men bring to a group, therapist self-disclosure is particularly pertinent with all-male groups. The use of this intervention reflects the author's long experience with such groups. The author writes from an interpersonal, collaborative model of group therapy, and discusses types of self-disclosure and the guiding principles in their use. Drawing primarily from his own practice, the author presents and discusses clinical vignettes that illustrate both helpful and nonhelpful uses of self-disclosure.     

Between Intrinsic and Extrinsic Motivation: Examination of Reasons for Academic Study based on the Theory of Internalization

In contrast with the view that intrinsic and extrinsic motivation are antagonistic, the view proposed in this article is that they are anchors of a continuous variable. According to the theory set out here, intrinsic motivation develops by means of internalization. This gives rise to four types of motivation: external, introjected, identified, and intrinsic. The main purpose of this study was to construct a scale to measure these four types of motivation for academic achievement and then to examine its validity. The Stepping Motivation Scale, created by the author, was administered to 483 junior high school students. Intercorrelations among the four subscales conformed to a simplex structure, and documented a continuum from extrinsic to intrinsic motivation. To clarify the distinction among the four types of motivation, relevant variables such as causal attributions and coping behaviors in failing situations, beliefs in links between extrinsic and intrinsic motivation, and teachers' evaluation of students' motivation were related to motivation types. A difference in motivational types was exhibited in the differential patterns of correlations.     

肿瘤标记物在大肠癌临床诊治中的应用进展

总结肿瘤标记物在大肠癌临床诊治中的应用进展。对有关大肠癌临床诊治中肿瘤标记物的文献进行综述,重点讨论血清、基因和急性期蛋白三类标记肿瘤物对大肠癌临床诊治方面的价值和潜力。结果是恰当选择肿瘤标记物有助于大肠癌临床诊治。目前,基因和急性期蛋白为大肠癌肿瘤标记物探索的新方向,有望成为提高大肠癌诊治效率的新检查方法。三类肿瘤标记物对大肠癌诊治有临床意义,联合检测可提高大肠癌诊治的准确性和有效性。     

Psychodynamic group psychotherapy.

The author provides an overview of critical factors in the working phase of group psychotherapy from the perspective of psychodynamic theory. The discussion is organized around a clinical vignette to illustrate various types of intervention such as past, here and now, future; individual, interpersonal, group as a whole; in group--out of group; affect-cognition; and understanding--corrective emotional experience. The critical "windows into the unconscious," transference, counter-transference, and free association, are also discussed in terms of the clinical example. The author concludes his article with a few thoughts about the future of psychodynamic theory in relationship to group treatments.     

Cervical arteriovenous malformation of the right vertebral artery

The authors report on a cervical arteriovenous malformation in the current region of the A. vertebralis dextra. The clinical neurological deficiencies improved after ligature of this artery. Attention is drawn to problems of differential diagnosis and the differentiated application of neuroradiological methods of examination.     

Clergy in crisis: when human power isn't enough

The author cites current research and more than a decade of clinical work with hundreds of clergy from a variety of denominations to suggest an approach for empowerment and renewal by addressing the tension between the call to ministry and the need for self-validation. He describes a short-term, multi-counselor, intensive intervention for clergy in crisis and offers two heuristic models designed to facilitate integration of the domains of clinical diagnosis and spiritual discernment.     

A dual conception of narcissism: positive and negative organizations

The author explores Freud's concept of narcissism, as well as other discussions of narcissism in the psychoanalytic literature. He introduces the dual conception of positive narcissism and negative narcissism, illustrated by two clinical vignettes. Subsequent discussion elaborates on these two types of narcissism, and also addresses life narcissism, death narcissism, and primary narcissism. The latter is considered in light of the influence of infant observational research on the prevailing view of this concept and the misunderstandings that arise from that approach.     

Biographic diagnosis--a critical review

Within the framework of clinical psychology and stress research biographic diagnosis is becoming more and more important. In addition to classical anamnesis, the virtues and limitations of so-called biographic questionnaires and life-event inventories, the chief methods of biographic diagnosis, have been discussed for several years. Following a brief evaluation of anamnesis and biographic questionnaires, the author derives conclusions, based on a method-critical analysis of life-event research, for the arrangement of such life-event inventories.     

皮亚杰理论近期的若干发展──差别观点的贡献

皮亚杰认知发展理论的一个新趋势是从智力发展的认识论过渡到智力发展的心理学,差别心理学的近期实验研究为这一过渡提供了方法。后皮亚杰学派理论对差别心理的强调在教育学和临床心理学中有着重要意义。     

手术治疗Duane眼球后退综合征的临床分析

探讨Duane眼球后退综合征（DRS）的临床特征,鉴别诊断以及手术治疗的方法和效果。对自2003年~2010年16例因DRS行手术治疗的患者资料进行回顾性总结和分析,观察项目包括患者的性别和年龄、DRS类型和临床表现、手术治疗方式和效果。16例患者中,男7例,女9例。左眼受累11例,右眼受累5例,左眼易患病。I型10例...     

On psychotic transference and countertransference

Following a brief discussion of the primary types of psychotic transferences, viewed from a theoretical position combining ego psychology with an object relations approach, the author presents detailed clinical material illustrating these transferences. The analyst's countertransference in work with such patients is also discussed in depth, including its use as a unique window into the patient's inner world.     

早期检测血浆N-端脑利钠肽前体在高龄呼吸困难患者诊治策略中的应用价值

N-端脑利钠肽前体具有快捷、简易、安全可靠、耐受性好的特点,在呼吸困难的鉴别诊断上有其独特优势,已成为近年来临床开展的一项新技术。在高龄呼吸困难患者中具有光明的应用前景,本文就早期检测血浆N-端脑利钠肽前体在高龄呼吸困难患者诊治中的应用作一讨论。     

Depression After Traumatic Brain Injury: A Review of Evidence for Clinical Heterogeneity

Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.