Governing therapy choices: Power/Knowledge in the treatment of progressive renal failure

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed.     

Reflecting on imagery: A clinical perspective and overview of the special issue of Memory on mental imagery and memory in psychopathology

The authors provide an overview of the papers in the special issue of Memory on mental imagery and memory in psychopathology. The papers address emotional, intrusive mental imagery across a range of psychological disorders including post‐traumatic stress disorder (PTSD), agoraphobia, body dysmorphic disorder, mood disorders, and psychosis. They include work on information processing issues including modelling cravings, conditioning, and aversions, as well as imagery qualities such as vividness and emotionality. The overview aims to place the articles in a broader context and draw out some exciting implications of this novel work. It provides a clinical context to the recent growth in this area from a cognitive behavioural therapy (CBT) perspective. We begin with PTSD, and consider links to imagery in other disorders. The clinical implications stemming from this empirical work and from autobiographical memory theory are discussed. These include consideration of a variety of techniques for eliminating troublesome imagery, and creating healthy, realistic alternatives.     

Tom Thumb in hospital: The fairy tale workshop in a paediatric oncology and haematology ward

Abstract

Definitions of and attitudes towards countertransference have changed throughout the twentieth century. From being seen as a contaminant in the analytical process, countertransference has come to be seen by many therapists as a potentially useful source of information about a client and his or her problems. There are dangers as well as benefits associated with analysis and utilization of countertransference. This article reviews these issues and proposes some guidelines that therapists may find useful when contemplating their countertransference reactions to clients, and when considering how best to utilize these.     

Disturbances of consciousness in dementia with Lewy bodies associated with alteration in nicotinic receptor binding in the temporal cortex

Disturbances of consciousness, including fluctuations in attention and awareness, are a common and clinically important symptom in dementia with Lewy bodies (DLB). In the present study we investigate potential mechanisms of such disturbances of consciousness (DOC) in a clinicopathological study evaluating specific components of the cholinergic system. [3H]Epibatidine binding to the high-affinity nicotinic receptor in the temporal cortex (Brodmann's areas 20 and 36) differentiated DLB cases with and without DOC, being 62-66% higher in those with DOC (F=4.5,p=.025). The were no differences between DLB patients with or without DOC in 125I-labeled alpha-bungaratoxin binding to the low-affinity nicotinic receptor, [3H]pirenzepine binding to the muscarinic M1 receptor, or in choline acetyltransferase activity. These findings provide support for the hypothesis that cholinergic activity is an important neural correlate if consciousness and suggest a mechanism of DOC in DLB involving alterations in the nicotinic receptor, composed of predominantly alpha4 and beta2 subunits.     

Loving the One You Hurt: Positive Effects of Recounting a Transgression against an Intimate Partner

Intimate partners described a past transgression in which one of them had been a victim and the other a perpetrator and then evaluated each other and their relationship. Participants had been randomly assigned to the perpetrator or victim role. Perpetrators described their actions as more justifiable, perceived greater improvement since the transgression, and were more optimistic about the future of their relationship than were their victims or control participants. The results support the authors' contention that temporal appraisals are an important mechanism enabling people to maintain positive images of themselves and their relationships.     

Metabolic control and auditory information processing at altered glucose levels in insulin-dependent diabetes

Previous work with a visual reaction time (RT) paradigm showed rate of mental processing to be slowed during a state of brain energy depletion (i.e., hypoglycemia). The present study employed an analog auditory RT paradigm to determine if modality differences in processing information might occur in response to glucose alteration. A balanced crossover design was used in which men with insulin-dependent diabetes completed RT tasks of increasing complexity at each of the following glucose levels: hypoglycemia (60 mg/dL), normoglycemia/control (110 mg/dL), and hyperglycemia (300 mg/dL). Results revealed two performance groups. A convergent group displayed slower RT responding during hypoglycemia, consistent with the visual RT pattern of results. A divergent group displayed better responding on one RT measure during hypoglycemia, and generally poorer responding on all RT measures during the other glucose conditions. Subjects in the divergent group maintained more stringent metabolic control and tended to have experienced more episodes of hypoglycemic unconsciousness. The present results provide the first evidence that more stringent metabolic control may be related to generally slower rates of processing auditory information. Possible explanations for these findings include hypotheses of immutable structual derangement, state-dependent performance effects, and a U-shaped response curve.     

Motivational pathways underlying the onset and maintenance of viewing child pornography on the Internet

The staggering rate at which incidents of child pornography (CP) are increasing highlights the need for proactive approaches to this problem. Improving the efficacy and accessibility of interventions designed for individuals who view CP provides one means of addressing this growing concern. This article explores the self-identified motivations underlying the onset and maintenance of viewing Internet-based CP among a sample of 20 men receiving treatment for this behavior. Our findings suggest two primary motivational pathways, namely a desire to achieve sexual gratification and/or an attempt to avoid emotional pain. We propose a behavioral facilitation process, initiated by extensive exposure to Internet pornography, to explain the use of CP in men without a sexual interest in children. We also discuss factors that appeared to facilitate the maintenance of this behavior. Our findings indicate that social skills deficits, maladaptive coping strategies, and a lack of sexual education require further investigation regarding their role in promoting or precluding desistance from viewing CP.