高血压脑出血急诊救治现状与进展

高血压脑出血是指在高血压的情况下发生的脑实质内出血。目前急诊综合救治中内科药物和外科手术治疗为主要的两种方法。内科治疗只适用于轻度脑出血和有手术禁忌证及配合急诊外科手术的综合救治,外科手术多用在中、重度脑出血病人治疗中。近年来开展的一种在CT下三维定位脑内血肿清除术,以其定位准确,脑损伤小,在急诊救治方面取得了一定效果,有待于进一步发展。     

视觉搜索左右视野靶时脑两半球加工特点

研究视觉分别搜索在左右视野靶时,脑两侧前额叶视觉加工的机制。14名有偿被试参加实验。实验任务是从正圆中所存在的垂直方向的箭头,搜索出水平方向箭头,并判断箭头方向。靶所在左右视野经过镜面处理完全对应。结果发现当靶出现约220ms后左右两侧脑区ERP出现分叉点,靶对侧与靶同侧的前脑区相比有非常显著的负向电位活动,对侧和同侧的N2延续40-80ms。分析认为靶对侧前额脑区N2负向活动增强是注意的等级提高,聚焦点收窄,使所要加工的靶在主效应脑区(靶视野对侧脑区)“跃显”出来,在得到正反馈诱导的同时,也得到更多的资源,靶同侧脑区N2可能与中断或阻止其他无关信息的涌入有关。     

Psychological Distress in Caregivers of Liver and Lung Transplant Candidates

Although organ transplantation represents a stressful experience for the entire family, surprisingly little research has focused on the adjustment of caregivers. The purpose of this study was to examine what caregivers report to be the greatest benefits and stressors pretransplant, the prevalence of psychological distress and caregiver strain in pretransplant caregivers as compared to normative populations, and the physical, psychological, and demographic variables that predict distress. Fifty-two caregivers of transplant candidates (28 liver and 24 lung) completed a series of questionnaires, including the Psychosocial Adjustment to Illness Scale (PAIS-SR), SF-36 Health Survey, Caregiver Strain Index (CSI), and qualitative questions about benefits and stressors. The most commonly reported benefit of being a caregiver could be categorized as Helping the Patient, and the most common stressors were associated with Uncertainty/Waiting/Fears. Compared to normative samples of caregivers of patients with Alzheimer's disease, caregivers of liver transplant candidates reported more caregiver strain; there were no differences for lung transplant caregivers. Caregiver social functioning was found to be the only significant predictor of caregiver distress, with those caregivers who report greater distress also reporting extreme and frequent interference with normal social activities. Implications of these findings for psychological interventions are discussed.     

Partial replication of two rumination-related candidate gene studies

Two recent papers associated candidate genes with brooding rumination, a possible cognitive endophenotype for depression, in children ages 8–14 years. Stone et al. reported that BDNF val66met polymorphism predicted brooding in adolescence. Woody et al. reported that children carrying at least one copy of a CRHR1 TAT haplotype reported less brooding than their peers in the presence of maternal depression. We attempted to replicate and extend these findings in a sample of twins aged 12–16 years. We analyzed the BDNF val66met (rs6265) polymorphism and two (rs242924 and rs7209436) out of three single nucleotide polymorphisms (SNPs) that Woody et al. used to create a CRHR1 haplotype. We controlled for maternal history of depression and clustering within families. Unlike Stone et al., we found higher brooding among BDNF Met carriers. This main effect was qualified by an interaction with pubertal status, with the effect driven by more physically mature participants. Similar to Woody et al., we found an interaction between CRHR1 SNPs and maternal depression, with the homozygous minor genotype acting as a protective factor against brooding in the presence of maternal depression. Findings provide partial support for the influence of candidate genes in two environmentally sensitive systems on brooding.     

Supervisory countertransferences and impingements in evaluating readiness for graduation: Always present,routinely under‐recognized

Utilizing detailed, in‐depth material from supervisory hours from around the world (explored in End of Training Evaluation groups), this paper shows that supervisors are subject to multiple, diverse and, at times, ongoing intense countertransferences and impingements on their ability to evaluate candidates’ progress. Multiple external and internal sources of these impingements are explored. It is suggested that supervisory countertransferences and their manifestation in parallel enactments remain under‐recognized, their impact underappreciated, and the information they contain underutilized. It is argued that the recognition, containment, and effective use of the parallel process phenomena and supervisory countertransferences are essential in order to evaluate candidates’ progression and readiness to graduate. Common signals of such entanglements in the supervisor's evaluative function are identified. Three remedies, each of which provides a ‘third,’ are offered to assist supervisors in making effective use of their countertransference: self‐supervision, consultation, and institutional correctives.     

Should a criminal receive a heart transplant? Medical Justice vs. Societal Justice

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled to at least a “decent minimum” level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of “rudimentary decent minimum” granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants.     

气质的遗传因素:基因多态性研究

气质是婴儿出生以后最早表现出来的一种人格特征,而人格特征的形成具有一定的生物学基础。气质作为人格特征的组成单元,与人格特征享有共同的生物过程。因此,与成年人人格特征相关的基因也有可能影响儿童气质。本文在成年人的人格特征研究的基础上,针对早期儿童发展的特点,讨论了可能影响早期儿童气质的候选基因。研究成人的人格特征与基因的相关性不能排除环境因素的影响,本文强调了对早期儿童气质与基因多态性之间的关系进行直接研究的重要性。     

The capacity to be an analyst: A contribution from attachment research to the study of candidate selection

In this paper the author discusses how the study of candidate selection, once a topic of vibrant research, has unfortunately languished. Certain qualities were thought to characterize the successful candidate. However, they were never successfully operationalized nor empirically tested. Possibly because of this lack of empirical data, selectors today have difficulty articulating their criteria and are relying on intuition. In order to provide a more rational basis for contemporary selection, the author looks to the attachment literature. This makes sense because attachment theory shares some basic assumptions of contemporary psychoanalysis. The Adult Attachment Interview (AAI) is a research tool that predicts the ability of a parent to convey attachment security. It is scored by attending to how a person speaks about his early attachment experiences. The AAI appears to tap into similar qualities to those selection researchers have sought in their candidates. Further, the scoring method of the AAI appears to be similar to the last attempt by selection researchers to operationalize them. Given these similarities, the author recommends an empirical study using the AAI to operationalize these qualities in analytic candidates. The study would test their importance for success in the training program, thus offering selectors some empirical grounding for their choices.     

Affect at the different phases of cognitive behavioral therapy: An evaluation of psychotherapy provided by candidates

The purpose of this study was to investigate the affect, as measured by “Positive and Negative Affect Schedule” (PANAS), its influence on psychopathology, and to examine the effect of changing affect during cognitive behavioral therapy (CBT). The study was carried out at the psychotherapy training center, Karlstad University. The hypothesis was whether clients with mental disorders have a self‐destructive affective personality (low PA and high NA) and healthy individuals have a self‐actualizing personality (high PA and low NA). Thirty‐two healthy participants and 44 clients participated in the study. The clients were asked to fill in the PANAS once throughout CBT, either during evaluation, treatment or finishing phase, accordingly there were three different groups at different therapy phases. The healthy subjects were also asked to fill in the self‐report scale once. The comparison of the three phases of therapy and the four affective personality types showed a significant difference between the phases of therapy and the four affective personality types: totally 16 (of 22) and eight (of nine) clients measured at the evaluation and treatment phases, respectively, had a self‐destructive personality. However, at the end of therapy five (of 13) clients had a self‐actualizing personality characteristics, while only three of them were self‐destructive. Furthermore, the results indicate that affective personality does not seem to be a basic and stable personality trait, which could be altered by therapy. The affections measured by PANAS may be influenced by psychopathology and CBT, when conducted by candidate therapists it can be effective in terms of affect changes.