Unusual course of a status epilepticus. (Case contribution to the problem of "interparoxysmal petit-mal-status")]

This is a record of a strange course of the petit mal status which persisted for almost four days following a series of grands maux. During the status, it was possible to observe in electroencephalogram a 2-2.5/sec and, finally, 2.5-3.5/sec spike and wave pattern which could be interrupted after the administration of 100 mg of diazepam. In contrast with the normally observed twilight state, this particular course of the petit mal status ("interparoxysmal petit mal status") is characterized by a marked disturbance of consciousness. There was no response to an intravenous administration of 750 mg of diphenylhydantoin.     

原发性甲亢合并严重肝损伤患者的循证治疗

为原发性甲亢合并严重肝损伤患者制定循证治疗方案。根据PICO原则,提出临床问题并转换成便于检索的形式,检索美国国家指南交换中心（NGC）、Cochrane图书馆（2010年第3期）、PubMed（1995-2010．11）和维普数据库（CHKD,1995～2010．11）。根据检索结果,制定治疗方法,2月后患者肝功能、...     

Cognitive Processing Therapy Delivered in 5 Days via Telehealth to a Gay Latino Adolescent: A Clinical Case Study

Cognitive Processing Therapy (CPT) has been thoroughly investigated as an efficacious treatment for posttraumatic stress disorder (PTSD). However, for many, the barriers to receiving treatment in the traditional weekly, in-person format prevent engagement. Recent evidence suggests alternative modalities, such as telehealth, and condensed administration of treatment protocols may reduce barriers, increasing treatment completion. This case study reports the treatment of a gay-identifying adolescent Latino male who received 10 sessions of CPT over the course of 5 consecutive days (CPT-5). The patient experienced significant reduction in PTSD symptoms over the course of treatment, dropping below the clinical threshold for PTSD diagnosis by the 10th session. Treatment gains were maintained, and continued, 6 weeks posttreatment. Further, the patient reported marked reduction in suicidality and substance use. In conclusion, the administration of CPT-5 via telehealth holds promise as an effective evidence-based treatment for adolescents with PTSD, including those holding multiple historically marginalized identities, though further investigation through clinical trials is warranted.     

Everyone Must Get a Turn: From Omnipotence to Respect for Otherness: Reply to Commentary

The authors conceptualize Davies's account of the difficult session with her patient Karen as a mentalization mismatch: an expectable failure on the analyst's part to understand the mental state of the patient. In response, the patient used projective identification to re-create the link to the analyst that was temporarily severed. They argue that the therapeutic impasse produced by Karen's successful externalization of a persecuting part of her self is more than repetition of a past relationship. It is the current experience of a disorganized self: a pervasive state for the borderline patient, and a temporary but no less disorganized state in the analyst.     

Mindfulness: A Proposed Common Factor

Mindfulness is proposed as a core psychotherapy process. It is defined as a state of psychological freedom that occurs when attention remains quiet and limber, without attachment to any particular point of view. It can be shown that this process is collaborativefy employed by psychotherapist and patient within all psychotherapy orientations, and also by the integrative psychotherapist when making optimal choices among orientations. This article addresses (1) the defining attributes of mindfulness, (2) relevant conceptual approaches that lend theoretical support for a mindfulness factor, (3) two attentional forms of mindfulness that seem to have particular correspondence with either psychodynamic or cognitive-behavioral therapy, (4) clinical applications, and (5) the role of mindfulness for the integrative decision-making process.     

Polygraphic therapy control in Gilles de la Tourette syndrome--a case report

In a female patient with Gilles-de-la Tourette syndrome (GTS) the clinical improvement during drug therapy of haloperidol and clomipramine was proved with the help of a polygraphic method (simultaneous recording of different electrophysiological and vegetative parameters). Before intensifying therapy symptoms of vegetative irritation, motoric discharge patterns with high amplitude in correlation with movements and permanent activity with low amplitude even in a state of external motoric rest were found. After intensifying therapy vegetative stabilization and ceasing of any electrical activity in the EMG could be demonstrated. It is concluded that the effects of therapy in GTS may be checked and quantified by means of polygraphic methods.     

青少年脊柱侧弯的临床诊治进展

青少年特发性脊柱侧弯（AIS）既对患儿及家庭所造成的痛苦,也对患者家庭和国家财政都造成沉重的经济负担,引发各国及各级政府的高度关注。但是,随着对AIS了解的深入,质疑和犹豫也逐渐产生。本文回顾当前关于AIS的临床和基础研究结果,发现其中许多研究结论都充满了临床悖论。本文还通过总结作者单位的临床经验,提出的AIS诊治新原则。该原则利用脊柱对于AIS的充分代偿能力,改变聚焦于纠正脊柱畸形的传统理念,尽量维护脊柱的代偿平衡,同时避免对AIS患儿的歧视性宣传,避免诱导其发生心理自卑感。通过借鉴“代偿稳定、阴阳自和”等中医哲学理念可以在AIS等脊柱损伤退变性疾病的临床诊治过程中为患者争取最为实效的临床利益。     

Employing multiple theories and evoking new ideas: the use of clinical material

In this paper, I wish to illustrate how working with a patient who had a certain kind of narcissistic difficulty led me to develop particular clinical strategies to facilitate the development of a sturdier sense of self, greater affect tolerance and modulation, the diminution of harshness of her superego, and the ownership of projected parts of herself, and to decrease paranoid ideation. I call upon concepts from various theoretical schools of psychoanalysis to make sense of the dynamic intricacies of the patient's psychological organization as they revealed themselves in the analytic process. These conceptualizations of the patient's difficulties and of clinical interventions to address them result in a hybrid theory of both theory and technique. What transpired in the clinical work also led me to propose an additional way to understand this kind of patient's difficulties with accepting interpretations or any view that differed from the patient's subjectivity. I am proposing that 'otherness' itself, rather than only specific conflictual aspects of the self, is disowned. It is the analyst's empathic stance toward all that is repudiated--the specific disowned aspects of the self and 'otherness' itself--along with empathy for the patient's conscious state that will enable reinternalization and ultimately healing.     

Severity Indices of Personality Problems (SIPP-118) in adolescents: reliability and validity

The Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008) is a self-report questionnaire focusing on core components of (mal)adaptive personality functioning. The SIPP-118 was developed and validated in an adult population. In adult populations, the 16 facets of the SIPP-118 fit into 5 higher order domains: self-control, identity integration, relational capacities, social concordance, and responsibility. In this study we present the 1st psychometric properties of the SIPP-118 in adolescents. We compared the SIPP-118 scores of a patient and a nonpatient sample of adolescents, and compared personality disordered and non-personality disordered adolescents. In addition, the relationship between scores on the SIPP-118 and other clinical instruments (Symptom Checklist-90-Revised; SCL-90-R; Derogatis, 1975; Dimensional Assessment of Personality Pathology-Basic Personality; DAPP-BQ; Livesley & Jackson, 2002) was investigated. The questionnaires were completed by 378 adolescent patients and 389 adolescents in the community. Facets appeared to be homogeneous, as alpha coefficients ranged from .62 to .89, indicating moderate to acceptable reliability. Also, more pathological SIPP-118 scores were found in the patient sample, and more specifically in the personality disordered sample, suggesting that the facet scores of the SIPP-118 can discriminate between various populations (divergent validity). Correlation with other clinical instruments was moderate to high (-.82 to .10). Taken together, the SIPP-118 seems to be a promising instrument measuring personality pathology in adolescents.     

When Avoidance Is Mutual Regulation: Disorganized Attachment and Analytic Attunement

This paper looks at and counters the notion that the analyst’s reluctance to know, to comprehend and interpret, the fuller meaning of a patient’s behavior is a countertransference avoidance. Drawing on attachment theory and infant research that has not yet been fully integrated into the clinical literature, the author believes that the movement from enactment to the expression of dissociated feeling is a process that leads to the creation of previously unknown meaning within an analytic impasse. The infant research literature and the literature on disorganized attachment is referenced to elucidate aspects of the clinical process. The clinical material presented involves the analyst’s failure to engage a patient’s chronic lateness, a failure that represented a mutual avoidance. The meaning of this enactment was locked in the patient’s traumatic past and could not be transmuted into new relational experience until the analyst had emerged from her own dissociative state. The therapeutic space created by their mutual avoidance, contrary to being a stalemate, became a protective space that held the meaning that was hibernating in dissociation. For the patient, the dissociated memory of traumatic abuse was linked, actually and symbolically, to her pervasive lateness. What was represented in the chronic lateness was discovered by analyst and patient together, along with the feelings engendered by “waiting.”     

Severity Indices of Personality Problems (SIPP-118): development, factor structure, reliability, and validity

This article describes a series of studies involving 2,730 participants on the development and validity testing of the Severity Indices of Personality Problems (SIPP), a self-report questionnaire covering important core components of (mal)adaptive personality functioning. Results show that the 16 facets constituted homogeneous item clusters (i.e., unidimensional and internally consistent parcels) that fit well into 5 clinically interpretable, higher order domains: self-control, identity integration, relational capacities, social concordance, and responsibility. These domains appeared to have good concurrent validity across various populations, good convergent validity in terms of associations with interview ratings of the severity of personality pathology, and good discriminant validity in terms of associations with trait-based personality disorder dimensions. Furthermore, results suggest that the domain scores are stable over a time interval of 14-21 days in a student sample but are sensitive to change over a 2-year follow-up interval in a treated patient population. Taken together, the final instrument, the SIPP-118, provides a set of 5 reliable, valid, and efficient indices of the core components of (mal)adaptive personality functioning.     

生物自组织临界性与肿瘤

分析了局部组织由再生、化生和癌变呈现的各种宏观行为和性质,从生物自组织临界性的角度讨论了这类行为和性质的演化模式及机制,指出肿瘤实质是局部组织经历一系列临界状态下相变造成的。     

知情不同意

自主原则是医学伦理学的基本原则之一,自主权是患者的基本权利.从临床实践出发,分析了患者知情后拒绝治疗的自主选择与其他利益相冲突的情况,总结了医生尊重患者自主权利的伦理条件,对指导临床实践具有一定的现实意义.     

Imagining Fear: Attachment,Threat, and Psychic Experience

Attachment theory is today considered an integral part of contemporary psychoanalytic theory and practice, and yet the theoretical and clinical implications of Bowlby’s emphasis on fear and the search for safety have been largely overlooked. From Bowlby’s perspective, the dynamic relationship between the experience of threat and attachment shapes the development and maintenance of essential relationships, the organization of psychic structure, and the nature of defenses and adaptation. This element of attachment theory—which alerts us to the ways in which the infant or child is compelled to seek safety when in a state of fearful arousal—is particularly relevant to the clinical situation. It helps us imagine moments of fearful arousal in our patients’ pasts, attend to their manifestations in the present, and understand current suffering in light of the long-term sequelae of adaptations that were crucial to survival. Finally, it helps us find language that brings alive or mentalizes these aspects of the patient’s early experience such that transformation is possible.     

Questionnement éthique dans la clinique de l’éveil de coma : un cheminement nécessaire au processus de subjectivation du patient et… du soignant

For the last six years, our clinical practice of patients in coma arousal care has led us to wonder about the subjective precariousness. In this clinical care, we must think about the ethical question of patient's subjective existence continuity. We wonder how the patient can be considered as a subject. On the one hand, it is based on the clinical and neuropsychological coma arousal care and on the other hand on particular patient–caregiver relationship, illustrated by a clinical situation. It seems that it depends on the ethical behaviour of the caregiver in front of a patient in an important subjective precariourness while the caregiver is powerful.     

Validity of the Millon Clinical Multiaxial Inventory in the assessment of affective disorders

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 270 adult outpatients with major affective disorders at the same time that a semistructured, diagnostic interview was conducted by a clinician. The mood of the patient was then rated, and the clinician completed the Hamilton Depression Rating Scale and the Mania Rating Scale. A consensual diagnosis was arrived at by the team of investigators using DSM-III criteria. Significant correlations were found between four MCMI affective scales and the global mood state of the patient. Analysis of covariance indicated that the MCMI affective scales are significantly related to DSM-III affective disorders even after the effect of the current mood of the patient is partialled out. The clinical usefulness of each of the scales is discussed.     

What kind of society permits child abuse?

Child maltreatment is conceptualized as a social welfare problem inevitably created by the isolation that individualistic culture creates. The „defective parent”︁ model for detecting abusive persons is described as inconsistent, unfeasible and contradictory. Attention must be focused on basic institutional and social forces which permit abuse. The social and economic context for families is seen as the setting that transforms risk for abuse into actual abuse. It is strongly suggested that integration of formal and informal systems of child protective services is needed to protect and enhance the welfare of children and families.     

On psychoanalytic supervision

The author provides both a theoretical context for, and clinical illustrations of, the way in which he thinks and works as a psychoanalytic supervisor. The analytic supervisory experience is conceived of as a form of 'guided dreaming'. In the supervisory relationship, the supervisor helps the analyst to dream (to do conscious and unconscious psychological work with) aspects of the analytic relationship that the analyst is unable to dream or is only partially able to dream. It is the task of the supervisory pair to 'dream up' the patient, that is, to create a 'fi ction' that is true to the supervisee's emotional experience with the analysand. To carry out this work, the supervisor must provide a frame that ensures the supervisee's freedom to think and dream and be alive to what is occurring in the analytic and the supervisory relationship, as well as in the interplay between the two. In one of the clinical illustrations presented, the author illustrates his conception of the importance of the feeling on the part of supervisor and supervisee that (at least occasionally) they have 'time to waste'. Such a state of mind may provide an opportunity for a type of freely associative thinking that enhances the range and depth of what can be learned from the supervisory experience. In another clinical example, the author describes his own experience in supervision with Harold Searles, which contributed to his conception of the supervisory process.     

CONGRUENCE OF WORK-RELATED NEEDS AND ABILITIES: TRANSITIONAL PSYCHIATRIC PATIENTS AND NORMALS1

Work-related needs and abilities appear to be significant factors in the vocational adjustment of psychiatric patients. When vocationally oriented patients were compared to a carefully matched normal sample, the patients were found to have significantly less agreement between their work needs and their work abilities. Although no difference was found to exist between the work needs of the patients and the matched normals, the work-related abilities of the patients were distinctly lower than those of the normal population, implying that the appropriate focus of vocational rehabilitation counseling is the augmentation of patient assets. Persons most likely to have incongruity vocationally between their needs and abilities are male psychiatric patients, aged 24 to 36, who have less than a high school education.     

Empathy,Emotion, and <Emphasis Type="Italic">Ekstasis</Emphasis> in the Patient–Physician Relationship

The place of clinical empathy in humanizing the medical encounter is discussed. Clinical empathy is viewed as having both cognitive and affective elements. It is argued that genuine empathy involves recognizing what the suffering of the patient feels like. This reaching out to the patient is connected with the Christian theological concept of ekstasis. Ekstasis has as its goal the establishment of communion. It is further argued that ekstasis and communion are the fundamental moments in clinical empathy.