Cardiac autonomic reactivity and recovery in predicting carotid atherosclerosis: the cardiovascular risk in young Finns study.

The present study examined the association of cardiac autonomic task-induced reactivity and recovery to preclinical atherosclerosis. Thirty-three men and 33 women aged 24-39 years participated in the ongoing epidemiological Cardiovascular Risk in Young Finns study. The authors measured heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) during the mental arithmetic and speech tasks in 1999. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex (IMT) with ultrasound in 2001. Higher HR, RSA, and PEP reactivity were associated with lower IMT values even after adjusting for cardiovascular risk factors (lipid levels, obesity, and blood pressure). In addition, better HR recovery after the mental arithmetic task was associated with lower IMT values, and this association persisted after all adjustments. Thus, higher task-induced cardiac autonomic reactivity and better HR recovery were related to less preclinical atherosclerosis. The authors concluded that cardiac pattern of reactivity and quick recovery may be associated with better cardiovascular health, and therefore all reactivity occurring in challenging situations should not automatically be considered as potentially pathological.     

THE MEANING OF DREAMS IN THE PSYCHOTIC STATE: THEORETICAL CONSIDERATIONS AND CLINICAL APPLICATIONS

The authors consider that the Freudian theory of dreams is not directly applicable to psychotic and borderline patients with their constantly varying states of mental integration. Because these patients' dreams lack associations, the usual psychoanalytic approach cannot be used to ascertain their meaning. After reviewing the literature on the specific quality of dreams in the psychotic state, the authors point out that such dreams have nothing to do with the metaphorical language of the dream work but instead express the concreteness of the hallucinatory construction. For this reason, a dream's meaning may fail to be understood by the patient even if it seems clear to an observer. Yet the analyst's reception of a 'psychotic dream' is a unique and essential source of valuable information on the manner of construction of the delusional system, allowing analytic work on the psychotic nucleus. In the authors'view, such dreams may help the analyst and the patient— while still lucid—to acquire insight, thus affording a stable foundation for emergence from psychosis. The paper includes some case histories, in one of which a psychotic female patient is enabled by work on dreams to reconstruct a psychotic episode and thereby to ward off an imminent fresh lapse into psychosis.     

A process model of buyer responses to salesperson transgressions and recovery efforts: the impact of salesperson orientation

Despite the damaging effects often associated with salesperson transgressions, our understanding of how buyers respond to these transgressions and the recovery efforts that typically follow is limited. The authors address this shortcoming across two studies of professional buyers. In the first, the authors examine buyers’ responses to salesperson ethical and service transgressions as moderated by their perceptions of the salesperson (i.e. whether they perceive the salesperson as being selling-oriented (SO) or customer-oriented (CO)). In the second study, the authors contrast the effects of an apology versus compensation in examining buyers’ responses to the overall transgression and recovery episode. Although study results indicate that a customer orientation amplifies buyers’ responses to the initial transgression, they also indicate that buyers’ responses to the overall episode are primarily a function of whether the recovery effort conforms to their expectations. Hence, while favorable salesperson perceptions (i.e. being perceived as CO) are detrimental in the context of the initial transgression, they are beneficial in the context of the overall transgression and recovery episode.     

Existential crises in two religious patients: Vicissitudes of faith and the emergence of the true self

The authors present two clinical cases involving an existential crisis which led the patients to lose what had been the foundation in their lives, their faith. Although the therapeutic settings differ – the first patient had a few psychotherapy sessions following a psychotic episode with a mystical background, while the second was in the final stage of analytic treatment – the authors highlight how in both clinical cases a loss of faith becomes a total and urgent crisis of the Self. The fracture which ensues seems to generate an intense engagement of the body which, paradoxically during a loss of faith, induces an experience of ecstasy of the kind that has traditionally been reported. In the first case the experience of ecstasy was lived first‐hand by the patient who thereafter redefined the psychotic breakdown as a “moment of truth”; whereas the second patient, through a deep projective identification, induces an eerie countertransferential feeling of ‘metaphysical’ shortfall in the agnostic psychoanalyst, triggering bewilderment, physical discomfort and awe in him. In both cases the authors believe that the notable somatic involvement may be correlated to a potentially profound and unprecedented contact with the True Self.     

Subtypes of limbic system dysfunction evoking homicide in limbic (?) Psychotic trigger reaction and temporal lobe epilepsy--evolutionary constraints

Within an evolutionary context two subtypes of limbic system dysfunctioning are compared: (1) the previously proposed limbic psychotic trigger reaction, in which nondrive motivated homicide is triggered by a specific individualized external stimulus, which evokes a brief-lasting active reliving of past (moderately) stressful, frequently repeated ("kindled"?) situations. The brief-lasting out-of-character homicidal episode with flat affect is typically associated with first-time formed or unformed hallucinations of various modalities and with overactivation of the autonomic nervous system. There is no (noticeable) loss of consciousness, enabling the patient's full recall (at times with suicidal attempts) (Pontius, 1981, 1984, 1987). (2) A rare case of homicide during a fugue state with echopraxia in temporal lobe epilepsy is discussed.     

积极情绪加速心血管反应恢复的自主神经活动机制

通过对不同情绪唤醒状态下的心率变异性（HRV）和呼吸性窦性心率不齐（RSA）分析,探讨了积极情绪加速高唤醒消极情绪引起的心血管反应向基线恢复的自主神经活动机制。实验表明：与在观看高唤醒恐惧影片结束后观看悲伤影片和中性视频比较,观看高唤醒恐惧影片结束后观看快乐影片加速了高唤醒恐惧影片引起的心率、指脉等心血管反应向基线的恢复;与在观看高唤醒恐惧影片结束后观看悲伤视频和中性视频材料比较,观看高唤醒恐惧影片结束观看快乐影片后的恢复期,被试的迷走神经激活水平迅速增强,迷走神经激活水平甚至超过基线期。因此,积极情绪加速高唤醒消极情绪刺激引起的心血管反应向基线恢复,其自主神经活动机制是在积极情绪状态下个体有更强的迷走神经激活。     

Differenzialdiagnose schizoaffektive Störung versus bipolare Störung

This case presentation describes a 22-year-old woman after an episode of psychotic mania. Manic-psychotic and depressive episodes, partially with psychotic symptoms, and different diagnoses have been documented for the past 5 years, raising the question of the differential diagnosis between bipolar disorder and schizoaffective disorder. Depending on the classification (ICD-10 versus DSM-5), schizoaffective disorder is defined differently. According to ICD-10, schizoaffective episodes can be diagnosed when affective and schizophrenic symptoms occur simultaneously. In a different approach, DSM-V requires psychotic symptoms in the absence of major mood episodes for at least 2 weeks in the course of the disorder.     

On the nature of intuitive and delusional thought: Its implications in clinical work with psychotic patients

The author tries to differentiate intuitive imagination from delusional imagination and hypothesises that psychosis alters the system of intuitive thinking, which consequently cannot develop in a dynamic and selective way. Scholars of different disciplines, far removed from psychoanalysis, such as Einstein, Hadamard or Poincar, believe that intuitive thinking works in the unconscious by means of hidden processes, which permit a creative meeting of ideas. Thanks to Bion's work, psychoanalysts have begun to understand that waking thinking is unconsciously intertwined with dream‐work. The delusional construction is similar to a dreamlike sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the ‘dreamer's’ awareness. It is a dream that never ends. On the contrary, the real dream disappears when it has brought its communicative task to an end. In the analysis of psychotic patients it is very important to analyse the delusional imagination which dominates the personality and continuously transforms the mental state, twisting emotional truth. The delusional imagination is so deeply rooted in the patient's mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re‐emerges under new configurations. The psychotic core remains encapsulated; it produces unsteadiness and may induce further psychotic states in the patient. The author reports some analytic material of a patient, who, after a delusional episode treated with drugs, shows a vivid psychotic functioning. Some considerations are added on the nature of the psychotic state and on the therapeutic approach used to transform the delusional structure. This paper particularly deals with the difficulty in working through the psychotic episode and in ‘deconstructing’the delusional experience because of the terror connected with it. In the reported case, the analytic work changed the delusional construction into a more benign one characterised by phobic qualities. The analysis of the psychotic transference allowed the focus to be on the hidden work which had been continuously influencing the transferential picture of the analyst and the patient's psychic reality.     

Mediation of the stigma in the influence of negative symptomatology over recovery in psychosis

Background/Objective: The interest in recovery processes in psychotic disorders has boosted the necessity of knowledge about the factors that could influence in such recovery. Negative symptomatology and the stigma have been negatively linked to the recovery process in psychosis. The aim of this investigation is to improve the understanding of how the recovery process is affected by negative symptomatology based on the analysis of the mediating effects of the internalized stigma. Method: The sample was composed of 114 people that had experienced, at some point in their life, at least one clinically relevant psychotic episode. CAPE-42, STORI and ISMI were used for the evaluation. The macro PROCESS for SPSS was used. The indirect effect was calculated using 10.000 samples of bootstrap for the bootstrap confidence intervals (IC) corrected for bias. Results: The results show that the influence of negative symptomatology predicts the stigmatization of the person regarding his disorder. This predicts a negative influence in the recovery process of the psychosis. Conclusions: These results back the importance of adding the reduction of the stigma as a specific strategy to improve the recovery process in psychotic disorders.     

Psychophysiological profiles of batterers: autonomic emotional reactivity as it predicts the antisocial spectrum of behavior among intimate partner abusers

On the basis of studies finding heart rate deceleration among severely violent (SV) batterers (J. M. Gottman et al., 1995) and unsuccessful psychopaths (S. S. Ishikawa, A. Raine, T. Lencz, S. Bihrle, & L. Lacasse, 2001), this study compares the physiological reactivity of SV batterers (n=35) with low-level violent (LLV) batterers (n=37) and nonviolent men (n=21) during 2 laboratory tasks. Men's heart rate and skin conductance level were recorded during baseline, a conflict discussion, and a standardized anger induction. Results suggest that autonomic hyporeactivity is a risk marker for antisocial features among SV men, whereas autonomic hyperreactivity is a risk marker among LLV men. Psychophysiological responding appears to be a stronger correlate of general antisocial behavior than of intimate partner abuse.     

Clinical and cisternographic differential diagnosis between presenile dementia and Hakim syndrome

The authors compared with regard clinical and the radionuclide cisternography examination 27 patients with Hakim-Syndrome and 11 with Alzheimer-Disease. In all cases, dementia was a stable symptom. Patients with Hakim-Syndrome have an early gait disturbance, ataxia and epileptic seizures. Only in case of patients with Alzheimer-Disease we found aphasia, apraxia and psychotic disorders. 24 hours after the injection radionuclide cisternography showed ventricular retention and absence of parasagital accumulation only in patients with Hakim-Syndrome. Lighter changes (mixed cisternographic pattern) were found in patients with Alzheimer-Disease as well.     

Interacting Cache memories: evidence for flexible memory use by Western Scrub-Jays (Aphelocoma californica)

When Western Scrub-Jays (Aphelocoma californica) cached and recovered perishable crickets, N. S. Clayton, K. S. Yu, and A. Dickinson (2001) reported that the jays rapidly learned to search for fresh crickets after a 1-day retention interval (RI) between caching and recovery but to avoid searching for perished crickets after a 4-day RI. In the present experiments, the jays generalized their search preference for crickets to intermediate RIs and used novel information about the rate of decay of crickets presented during the RI to reverse these search preferences at recovery. The authors interpret this reversal as evidence that the birds can integrate information about the caching episode with new information presented during the RI.     

Recognizing Trauma and Posttraumatic Stress Disorder Symptoms in Individuals With Psychotic Disorders

The majority of individuals diagnosed with a psychotic episode also meet symptom criteria for posttraumatic stress disorder (PTSD; Mueser, Lu, Rosenberg, & Wolfe, 2010 ). Unfortunately, trauma from both previous life events and the experiences of a psychotic episode as well as PTSD symptoms are rarely recognized in this population. Steps to assessing trauma history and PTSD symptoms and initiating treatment in a client diagnosed with a psychotic disorder are highlighted.     

Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations

This meta-analysis included 729 studies from 161 articles investigating how acute stress responsivity (including stress reactivity and recovery of hypothalamic-pituitary-adrenal [HPA] axis, autonomic, and cardiovascular systems) changes with various chronic psychosocial exposures (job stress; general life stress; depression or hopelessness; anxiety, neuroticism, or negative affect; hostility, aggression, or Type-A behavior; fatigue, burnout, or exhaustion; positive psychological states or traits) in healthy populations. In either the overall meta-analysis or the methodologically strong subanalysis, positive psychological states or traits were associated with reduced HPA reactivity. Hostility, aggression, or Type-A behavior was associated with increased cardiovascular (heart rate or blood pressure) reactivity, whereas anxiety, neuroticism, or negative affect was associated with decreased cardiovascular reactivity. General life stress and anxiety, neuroticism, or negative affect were associated with poorer cardiovascular recovery. However, regarding the sympathetic nervous system and parasympathetic nervous system, there were no associations between the chronic psychosocial factors and stress reactivity or recovery. The results largely reflect an integrated stress response pattern of hypo- or hyperactivity depending on the specific nature of the psychosocial background.     

Correlates of suicidality among patients with psychotic depression

The independent association of age and other factors with suicidality in patients with major depression with psychotic features was examined. Of the 183 study participants, 21% had a suicide attempt during the current episode. Male gender, Hispanic background, past suicide attempt, higher depression scores, and higher cognitive scores were each independently associated with greater intensity of current suicidality. Older age was independently associated with a lower risk of a lifetime suicide attempt. These findings reinforce the evidence that patients with psychotic depression are at high risk for suicide and underscore the importance of examining correlates of suicidality specific to patients with psychotic depression.     

Clinical correlates of anhedonia and perceptual aberration in first-episode patients with schizophrenia and affective disorder.

We examined the association between scales measuring physical anhedonia, social anhedonia, and perceptual aberration and premorbid functioning, clinical state, and current level of adjustment in 91 psychotic subjects. The patients were examined at the onset of their first psychotic episode and again 18 months later. For patients with schizophrenia, anhedonia was significantly related to premorbid functioning. No association was found between the scales and clinical state or level of adjustment at intake or follow-up. In affective disorder patients, no correlation was found between premorbid functioning (a stable characteristic) and scale scores, but moderately large correlations emerged between the scales and clinical state and level of adjustment at both assessment times. These results suggest that schizophrenic and affective disorder patients endorse items on these scales for different reasons. We hypothesize that for patients with schizophrenia, the scales assess enduring personality characteristics, whereas for the affective disorder patients, they assess clinical condition at the time of testing.     

Cardiovascular reactivity to and recovery from psychological challenge as predictors of 3-year change in blood pressure.

The authors examined whether cardiovascular reactivity to and recovery from psychological challenge predict 3-year change in blood pressure (BP) among 216 initially normotensive, community-dwelling adults. Clinic BP assessments were conducted at baseline and follow-up. BP and heart rate (HR) readings were obtained before, during, and after 5 psychological tasks at baseline. Following adjustment for traditional predictors of BP and lifestyle factors, poorer systolic BP recovery across the tasks was associated with greater 3-year increases in clinic systolic and diastolic BP. Both diastolic BP recovery and HR recovery were also related to 3-year change in clinic BP, though cardiovascular reactivity measures were not. These findings suggest that the duration of stress-related cardiovascular responses may be important for predicting longitudinal changes in BP.     

Context-processing deficits in schizophrenia: diagnostic specificity, 4-week course,and relationships to clinical symptoms

Previous research on schizophrenia suggests that context-processing disturbances are one of the core cognitive deficits present in schizophia. However, it is not clear whether such deficits are specific to schizophrenia as compared with other psychotic disorders. To address this question, the authors administered a version of the AX Continuous Performance Test designed to assess context processing in a sample of healthy controls, patients with schizophrenia, and patients with other psychotic disorders. Participants were tested at index (when medication naive and experiencing their first contact with psychiatric services) and 4 weeks later, following medication treatment. At index, patients with schizophrenia and the psychotic comparison group demonstrated similar impairments in context processing. However, context-processing deficits improved in the psychotic comparison group at 4 weeks but did not improve in patients with schizophrenia.     

Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders

The Beck Cognitive Insight Scale (BCIS; Beck, Baruch, Balter, Steer, & Warman, 2004) was administered to 42 (28%) inpatients with psychotic disorders, 52 (35%) with a bipolar disorder, and 56 (37%) with a major depressive disorder (MDD). The hypotheses were (a) that the mean level of cognitive insight in a psychotic or a bipolar disorder is lower than that in a MDD, (b) that the mean levels of cognitive insight in psychotic and bipolar disorders were comparable, and (c) that the mean BCIS index score for a bipolar disorder in which the most recent episode had been mania is lower than the mean BCIS index score for a bipolar disorder in which the most recent episode had been mixed or depressed. All three hypotheses were supported. The results were discussed as supporting cognitive insight as a psychological construct that varies predictably according to the nature of a psychiatric disorder.     

A behavioral link between the oculomotor and cardiovascular systems

Although the eyes and the heart serve very different purposes, each receives autonomic innervation. Capitalizing on recent theoretical and technological innovations in the understanding and assessment of oculomotor and cardiovascular behavior, three experiments measured behavioral covariation between the oculomotor and cardiovascular systems. Measures of dark focus and dark vergence indexed oculomotor tone, and the spectral decomposition of variations in heart rate indexed cardiovascular control mechanisms. In Experiment 1, individual differences in cardiovascular parameters could predict individuals’ dark vergence (R²=.806) but not their dark focus (R²=.404). In Experiment 2, the same parameters were measured from subjects who experience either panic attacks (n=11) or blood phobia (n=9). Heart rate was positively correlated with dark vergence and the two subject groups were separable based on both oculomotor and cardiovascular variables. Using a within-subjects approach, Experiment 3 found that both dark vergence and dark focus tended to be nearer during sympathetic dominance of the heart than during parasympathetic dominance, within-subjects variations in cardiovascular parameters could predict dark focus, and between-subjects variations in interbeat intervals could predict dark vergence. Shared patterns of autonomic activation may be responsible for this eye-heart link.