Post-stroke depression as a predictor of caregivers burden of acute ischemic stroke patients in China

Our aim was to explore the independent attribution of Post-stroke depression (PSD) to caregiver burden of acute ischemic stroke patients. A cross-sectional survey was performed with 271 acute ischemic stroke patients in the Huai-He Hospital and First People’s Hospital of Kaifeng City in China. PSD was assessed by Self-rating Depressive Scale, and caregiver burden was assessed by Zarit Caregiver Burden Interview. Clustered logistic regression was applied to identify the impact of PSD on caregiver burden. As results, female patients, normal muscle strength and PSD were associated with caregiver burden. PSD correlated with an independent influence of 17.2% on the risk of caregiver burden, The independent influence of PSD on caregiver burden was smaller than that of social-demographics of caregivers and clinical factors of stroke patients This study suggests that PSD may have a modest influence on caregiver burden.     

No escape from Allais: reply to Buchak

In Risk and Rationality, Lara Buchak advertised REU theory as able to recover the modal preferences in the Allais paradox. But we pointed out that REU theory only applies in the “grand world” setting, where it actually struggles with the modal Allais preferences. Buchak offers two replies. Here we enumerate technical and philosophical problems they face.

     

The neural underpinnings of facial emotion recognition in ischemic stroke patients

Deficits in facial emotion recognition occur frequently after stroke, with adverse social and behavioural consequences. The aim of this study was to investigate the neural underpinnings of the recognition of emotional expressions, in particular of the distinct basic emotions (anger, disgust, fear, happiness, sadness and surprise). A group of 110 ischaemic stroke patients with lesions in (sub)cortical areas of the cerebrum was included. Emotion recognition was assessed with the Ekman 60 Faces Test of the FEEST. Patient data were compared to data of 162 matched healthy controls (HC’s). For the patients, whole brain voxel-based lesion–symptom mapping (VLSM) on 3-Tesla MRI images was performed. Results showed that patients performed significantly worse than HC’s on both overall recognition of emotions, and specifically of disgust, fear, sadness and surprise. VLSM showed significant lesion–symptom associations for FEEST total in the right fronto-temporal region. Additionally, VLSM for the distinct emotions showed, apart from overlapping brain regions (insula, putamen and Rolandic operculum), also regions related to specific emotions. These were: middle and superior temporal gyrus (anger); caudate nucleus (disgust); superior corona radiate white matter tract, superior longitudinal fasciculus and middle frontal gyrus (happiness) and inferior frontal gyrus (sadness). Our findings help in understanding how lesions in specific brain regions can selectively affect the recognition of the basic emotions.     

Supervising away from home: clinical,cultural and professional challenges

This paper explores some challenges of supervising clinical work of trainees, known as ‘routers’, who live in countries with diverse cultural, social and political traditions, and the analysts who travel to supervise them. It is written as an evolving dialogue between the authors, who explore together the effects of their own culture of origin, and in particular the legacy and values of their own training institutes on the styles and models of analytic supervision. Their dialogue is framed around the meaning of home and experiences of homesickness for analysts working away from home in an interactive field of strangeness in countries where analytical psychology is a relatively new discipline. The authors outline the findings from their own qualitative survey, where other supervisors working abroad, and those they have supervised, describe their experiences and their encounters with difference. The dialogue ends with both authors discussing what they have learned about teaching and supervising abroad, the implications for more flexible use of Jungian concepts, and how such visits have changed their clinical practice in their home countries.     

Transitioning from a hospital rehabilitation programme to home: exploring the experiences of people with complex regional pain syndrome

Complex regional pain syndrome (CRPS) is difficult to diagnose and is characterised by burning pain in one or more limbs. Treatment is palliative not curative and focuses on improving function. This requires patients to make long-term changes to their behaviour. As with all such regimens, adherence is often poor. This study explored the lived experience of 10 patients who had returned home after completing a two-week in-patient treatment programme. The interviews focused on how they coped with the transition from hospital to home, and on the things that they considered had facilitated or hindered this transition. Battling for control was an overarching theme that connected the four superordinate themes: 'gaining momentum' that facilitated the implementation of treatment advice, 'distance from the pool of expertise' that detailed the barriers to adherence experienced; 'It helped me realise it was not all in my head' that detailed a facilitative process, and the 'nag list' that was a technique patients' used to garner support. This article offers insights into the transition experience. A key outcome is the recognition of the need to better prepare patients for their transition back home.     

Transitioning from a hospital rehabilitation programme to home: Exploring the experiences of people with complex regional pain syndrome

Complex regional pain syndrome (CRPS) is difficult to diagnose and is characterised by burning pain in one or more limbs. Treatment is palliative not curative and focuses on improving function. This requires patients to make long-term changes to their behaviour. As with all such regimens, adherence is often poor. This study explored the lived experience of 10 patients who had returned home after completing a two-week in-patient treatment programme. The interviews focused on how they coped with the transition from hospital to home, and on the things that they considered had facilitated or hindered this transition. Battling for Control was an overarching theme that connected the four superordinate themes: ‘Gaining Momentum’ that facilitated the implementation of treatment advice, ‘Distance from the pool of expertise’ that detailed the barriers to adherence experienced; ‘It helped me realise it was not all in my head’ that detailed a facilitative process, and the ‘nag list’ that was a technique patients’ used to garner support. This article offers insights into the transition experience. A key outcome is the recognition of the need to better prepare patients for their transition back home.     

Perceived social support and maternal adaptation during the transition from hospital to home care of high-risk infants

Forty-two mothers of high-risk infants who had been hospitalized in a newborn intensive care unit were interviewed approximately 2 months after hospital discharge. On standard questionnaires, they reported how much support they had received since discharge and their need for and satisfaction with support in three areas: Emotional, informational, and tangible support. Mothers also completed the Profile of Mood States, the Sleep, Feeding, and Crying Questionnaire, and the Impact of Event Scale and rated the severity of the infant's medical condition and expected developmental/health outcome. Measures of maternal adaptation and infant characteristics were subjected to exploratory factor analysis from which summary scores were constructed. One maternal adaptation factor and two infant status factors were examined in relation to social support variables, but no significant associations were found for the sample as a whole. However, satisfaction with each area of support was related to maternal adaptation when the infant's post-discharge status was relatively more severe. The results are discussed in terms of the crises of the hospital to home transition and the difficult tasks that face parents after the assumption of full responsibility for a vulnerable infant who required newborn intensive care.     

Testing conclusions from functional imaging of working memory with data from acute stroke

Functional imaging studies indicate that the left hemisphere mediates verbal working memory, while the right hemisphere mediates both verbal and spatial working memory. We evaluated acute stroke patients with working memory tests and imaging to identify whether unilateral dysfunction causes deficits in spatial and/or verbal working memory deficits. While left cortical stroke patients had verbal working memory impairments (p<0.003), right cortical stroke patients had both verbal p<0.007) and spatial working memory (p<0.03) impairments, confirming functional imaging results. Patients with transient ischemic stroke and patients with non-cortical stroke did not have significant deficits in working memory in either modality.     

Global cognitive function before,surrounding, and after ischemic stroke: the role of risk and protective factors varies with time among ischemic stroke survivors

An estimated 65% of individuals demonstrate multidomain cognitive impairment poststroke, although little is known about the varying role of cognitive risk and protective factors in preischemic, peri-ischemic, and postischemic stroke phases. Longitudinal changes in global cognitive function after ischemic stroke are not well characterized, especially in older adults over age 80. We examined global cognitive function trajectories in these three phases across a mean follow-up of 8.12 (2.30) years in 159 female stroke survivors aged 65–79 at baseline using linear mixed models with change points. In separate models controlling for demographic variables, we tested the interaction of baseline risk and protective factors with stroke phase on global cognitive function. None of the prestroke global cognitive function means or trajectories differed significantly. At the time of ischemic stroke, higher body mass index (BMI), the presence of hypertension (HTN), low optimism, and higher physical function were all associated with significantly greater mean decreases in global cognition (all p’s <.0.0001), but were not significantly different from the contrasting level (all p’s >0.05). Higher BMI, the presence of HTN, low optimism, and higher physical function were in turn protective of global cognitive decline postischemic stroke (all contrasting p values <.01). Baseline factors may play either a risk or a protective role in global cognitive function depending on the phase of ischemic stroke.     

缺血再灌注损伤的保护——预处理到后处理的哲学思考

缺血预处理是减轻缺血再灌注损伤的有效措施,是事物矛盾性的具体体现.缺血预处理把矛盾两个对立面统一起来,将损伤(缺血)转化为战胜损伤(减轻缺血再灌注损伤)的有效手段,同时缺血预处理也是外因和内因两者作用的辩证统一.缺血后处理是近年发现的能减轻缺血再灌注损伤的有效措施,在缺血后处理中亦体现了矛盾的对立统一规律及外因和内因两者相互作用的辩证统一规律.     

Use of automatic frequency analysis in the therapy of patients with acute ischemic insults

A series of EEG reading by automatic frequency analysis by means of Fast-Fourier transformation was taken, with a total of thirteen patients with acute ischemic infarction. Of the parameters under test, the total power-parameters, the relative performances of the delta and alpha wavebands, the delta/alpha index, and the alpha peak frequency variation proved their suitability in assessing clinical progress and in lateral localisation. Automatic frequency analysis adds to the range of tools available for EEG diagnosis, and can play its part in trend analysis during intensive therapy.     

Transfer of an escape response from tail shock to brain-stimulated attack behavior

Nine cats, each with two hypothalamic electrodes in sites which when stimulated produced either quiet attack or attack accompanied by certain forms of vocalization, were trained to escape from tail shock by jumping onto a stool. They were then tested for transfer of the escape response to brain stimulation. Stimulation of the seven sites that yielded quiet biting attack did not elicit the learned response of jumping onto the stool. Stimulation of eight of the 11 sites that yielded attack accompanied by vocalization did elicit the learned response. It was concluded that attack behavior elicited by brain stimulation should not be considered a special case of the response to aversive stimulation, but that attack and response to aversive stimulation involve independent but overlapping systems.     

Spillover of authenticity from work to home: The mediating role of affect

A growing area of research is beginning to examine the state-like nature of authenticity. The current study builds on this research by examining the (dis)continuity in state authenticity across two different social contexts: work and home. We surveyed 154 full-time employees twice a day for five consecutive workdays. Results showed that state authenticity at work and at home shared a relatively strong positive relationship that appeared to be mediated by the spillover of affect from one context to the next. This is consistent with prior work showing that affect tends to “spillover” from one context to the next and work that suggests a causal impact of affect on authenticity judgments. Implications for the study of state authenticity as well as work–home interaction are discussed.     

Phone follow up to families of COVID-19 patients who died at the hospital: families' grief reactions and clinical psychologists' roles

A proportion of persons affected by coronavirus disease-19 (COVID-19) die and do so in extraordinary circumstances. This can make grief management extremely challenging for families. The Clinical Psychology unit of an Italian hospital offered a bereavement follow-up call to such families. This study aimed to explore the families' experiences and needs collected during these calls, and the role that the psychologists played through the call. A total of 246 families were called over 3 months. Multiple qualitative methods included: (i) written reports of the calls with relatives of patients who died at the hospital for COVID-19; (ii) qualitative semi-structured interviews with psychologists involved in the calls; (iii) observation of psychologists' peer group discussions. A thematic analysis was conducted. Six themes emerged: without death rituals, solitary, unexpected, unfair, unsafe, coexisting with other stressors. Families' reactions were perceived by psychologists as close to a traumatic grief. Families' needs ranged from finding alternative rituals to giving meaning and expressing different emotions. The psychologists played both a social-institutional and a psychological-human role through the calls (e.g., they cured disrupted communication or validated feelings and choices). This study highlighted the potential of traumatic grief of families of COVID-19 victims, and provided indications for supporting them within the space of a short phone call.