Perinatal maternal undernutrition programs the offspring hypothalamo-pituitary-adrenal (HPA) axis

There is now compelling evidence, coming both from animal and human studies that an early exposure to undernutrition is frequently associated with low birth weight and programs HPA axis alterations throughout the lifespan. Although animal models have reported conflicting findings arising from differences in experimental paradigms and species, they have clearly demonstrated that such programming not only affects the brain but also the pituitary corticotrophs and the adrenal cortex. In fetuses, maternal undernutrition reduces HPA axis function and implicates a reduction of placental 11beta-HSD2 activity and a greater transplacental transfer of glucocorticoids (GRs). In young adults, usually only fine HPA axis alterations were observed, whereas in older ones, maternal undernutrition was frequently associated with chronic hyperactivity of this neuroendocrine axis. In humans, evidence of HPA axis dysregulation in people who were small at birth has recently emerged. Thus, we suggest that such alterations in adults may be implicated in the aetiology of several disorders related to the metabolic syndrome as well as to immune or inflammatory diseases. To reverse such programming, recent experimental reports have shown that postnatal environmental interventions, dietary modifications and the use of agents modulating the epigenomic state could partly restore physiological functions and thus open new therapeutic strategies.     

Leadership and Rehabilitation Training for Troubled Adolescents in a Tri-ethnic Setting

In many school systems in the country, especially in urban areas, large numbers of adolescent students feel alienated and frustrated because they are not allowed to participate in the decision-making process and in school activities. The result of this lack of participation is illustrated by the large number of adolescents who drop out, are pushed out, or are suspended and expelled. Unless these students become involved, rehabilitated, and their leadership potential is developed, the gap will continue to widen between those who have assumed leadership through authority (administrators, teachers, and counselors) and those who are most affected by a lack of involvement (students).     

A randomized clinical trial of inpatient family intervention: VI. Mediating variables and outcome

In a randomized clinical trial of Inpatient Family Intervention (IFI) for 169 inpatients with schizophrenia, affective disorder, and a residual group of other diagnoses, results suggested significant effects favoring IFI for patients and their families. The treatment effects were limited to females and to two diagnostic groups: chronic schizophrenia patients and the bipolar subgroup of affective disorders.     

Gender-Role Cognition in Three-Year-Old Boys and Girls

Although the multidimensionality of gender roles has been well established, few researchers have investigated male and female roles separately. Because of the substantial differences in the ways male and female roles are portrayed in our culture, boys and girls may think and learn about these roles differently. The male role is more clearly defined, more highly valued, and more salient than the female role; thus, children's cognitions about these two roles may be expected to differ. The present study addressed the question of whether there is sex-typical variation in gender labeling, gender-role knowledge, and schematicity. Participants were 120 families; 15% were from minority ethnic groups, and 17% were single-parent families; 25% of the parents had a high school education or less. Results indicated that at 36 months of age, boys were less able to label gender and less knowledgeable about gender roles than were girls. Boys' knew more about male stereotypes than female stereotypes, whereas girls knew considerably more than boys about the female role and as much as boys about the male role. Boys and girls were found to be similar in gender schematicity. Traditionality of parental attitudes regarding child-rearing and maternal employment were not strongly related to children's gender cognition.     

Talking about medication

With the increasing use of psychotropic medication concomitant with psychoanalysis, attention must be given to the challenges created by complaints of medication side effects. When confronted with these side effects, analysts may experience specific, uniquely actualized countertransference anxieties that can prompt the abandonment of transference analysis. Particular countertransference fantasies that arise in combined treatments are examined, as are the reasons for the analyst's suspension of curiosity and openness and its clinical consequences. In these situations, effective analysis requires the analyst to be "bilingual," to hold in mind both the analytic and the pharmacological model.     

Patient autonomy and the challenge of clinical uncertainty

Bioethicists have articulated an ideal of shared decision making between physician and patient, but in doing so the role of clinical uncertainty has not been adequately confronted. In the face of uncertainty about the patient's prognosis and the best course of treatment, many physicians revert to a model of nondisclosure and nondiscussion, thus closing off opportunities for shared decision making. Empirical studies suggest that physicians find it more difficult to adhere to norms of disclosure in situations where there is substantial uncertainty. They may be concerned that acknowledging their own uncertainty will undermine patient trust and create additional confusion and anxiety for the patient. We argue, in contrast, that effective disclosure will protect patient trust in the long run and that patients can manage information about uncertainty. In situations where there is substantial uncertainty, extra vigilance is required to ensure that patients are given the tools and information they need to participate in cooperative decision making about their care.