Progression along the bipolar spectrum: a longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders

Little longitudinal research has examined progression to more severe bipolar disorders in individuals with "soft" bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a nonpatient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of "soft" bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.     

Impaired verb fluency: a sign of mild cognitive impairment

We assessed verb fluency vs. noun and letter-based fluency in 199 subjects referred for cognitive complaints including Subjective Cognitive Impairment, Mild Cognitive Impairment, and Alzheimer's disease. ANCOVAs and factor analyses identified verb, noun, and letter-based fluency as distinct tasks. Verb fluency performance in Mild Cognitive Impairment differed significantly from Subjective Cognitive Impairment and Alzheimer's disease. Reduced verb fluency thus appears to be a linguistic marker for incipient dementia. One possibility is that the verb fluency deficit in Mild Cognitive Impairment results from degenerative processes known to occur in the parahippocampal region.     

Zur Dynamik der Interaktion in der Supervision

The manifold functions of a supervisor in following the course of complex processes together with the trainee, are: ? to keep the goals of the supervision in view, ? to establish a teaching alliance and to support the wish and ambitions of the candidate to learn, ? to build a platform for the complex interactions with the trainee with regard to the dynamics of the training situation and keeping in mind the institutional influences, ? to lay down the setting for the work, ? to explore and to reflect how transference and counter-transference influence the interaction between patient and analyst as well as between trainee and supervisor, ? to examine these interactions together focussing continuously on the interaction between candidate and patient, and to encourage the candidate to do the same on his own, ? to continuously formulate hypotheses about the core conflict, the transference phenomena and resistance of the patient, ? to explore and reflect on the cooperative work.     

Alcohol: Effects on Neurobehavioral Functions and the Brain

Alcoholism results from an interplay between genetic and environmental factors, and is linked to brain defects and associated cognitive, emotional, and behavioral impairments. A confluence of findings from neuroimaging, physiological, neuropathological, and neuropsychological studies of alcoholics indicate that the frontal lobes, limbic system, and cerebellum are particularly vulnerable to damage and dysfunction. An integrative approach employing a variety of neuroscientific technologies is essential for recognizing the interconnectivity of the different functional systems affected by alcoholism. In that way, relevant experimental techniques can be applied to assist in determining the degree to which abstinence and treatment contribute to the reversal of atrophy and dysfunction.     

Disrupted narrative and narrative symbol

In this article a specific type of narrative, which often appears in analytic sessions, is discussed. It is characterized by a seemingly ordinary, everyday topic and by a peculiar disruption of the narrative flow. The threefold structure of this type of narrative is described, along with its main characteristics. One element of this type of narrative is very similar to symbolic content or complex symbolic structures, e.g. dreams, the sort of material that can be used for the purpose of interpretation. The similarities as well as the differences are elaborated in the article. Thanks to the observed general structure and ‘symbolic’ nature of some parts of the narrative, it is easy to notice some of the unconscious elements, which are not familiar to the patient's ego, and to make an interpretation. Because these elements are close to the threshold of consciousness, the patient willingly accepts an interpretation based on them. This is especially true for patients whose dominant function is thinking. A temporary, working name for this type of narrative is proposed in the article: ‘disrupted narrative’ ? and for its disruptive part ‘narrative symbol’.     

Space and Language in Conceptualizing Identity

In this paper, we discuss the conceptualization of space as a dimension relevant to personal identity and the central role that is attributed to language with respect to its constitution. It is argued that the identification with a certain geographical space and the use of (a) certain language(s) or linguistic variety can be regarded as crucial for the self-definition of individuals and also groups. We pursue a threefold goal: (1) to highlight the contribution of geographical research to our understanding of the self as a phenomenon situated in space; (2) to discern merits, but also problems related to the recent strong emphasis of the role of language with respect to identity constitution, especially in constructivist and poststructuralist approaches; and (3) on the basis of these findings, to draw conclusions concerning the given and constructed elements of identity, with a particular focus on space and language. In addition to a survey of relevant theoretical positions, empirical examples are presented with the aim to illustrate how geographically marked identity is constituted.

     

Effect of Body Image on Tunisian Women’s Sexual Functioning

The objective of this study was to identify the perception of body image by Tunisian women and their spouses and to examine its impact on female sexuality. Our study involved 300 Tunisian women who had been married for at least 1 year and consulted in primary care medicine during the months of June and July 2016. Each participant completed a questionnaire covering four areas: women’s perception of their body, the perception of the spouses of the latter as it was reported by the participants, sexual activity, and the impact of body perception on sexual activity. The participants were satisfied with their bodies in 51% of cases. This satisfaction was associated with perceiving the body as physically attractive (p?=?0.007), young (p?=?0.047) and as a source of confidence (p?<?0.001). Compared to women dissatisfied with their bodies, those satisfied declared satisfaction of sexual desire (p?=?0.005), reaching orgasm (p?=?0.001), taking the initiative in sexual activity (p?=?0.003) and preparation for sex (p?=?0.006). Perceived satisfaction of the partner with the female body was related to a more positive sexuality in women, specifically to women’s sexual satisfaction (p?=?0.018), women taking sexual initiative (p?=?0.014) and preparation for sex (p?=?0.001). Our study indicates the important impact of a positive perception of the body image of Tunisian women by themselves and by their spouses on their sexuality. It would be interesting to consider these aspects in the management of female sexual disorders.