On the psychodynamics of collecting1

The urge to collect is a ubiquitous phenomenon which has anthropological, sociobiological and individual psychodynamic roots, but occurs far more frequently among men than women. The author examines the reasons for this gender difference and defi nes systematic collecting to distinguish it from addictive, obsessive and messy collecting, and from related phenomena such as perversion. The mode of collecting and choice of object are important indicators as to the unconscious psychodynamics of a collector and offer opportunity to describe his structural level. Collecting ranges across a broad spectrum, from an ego‐syntonic integrated mode, i.e. sublimation, to a neurotic defence against pre‐oedipal or oedipal traumas and confl icts. Alongside this drive‐theoretical approach, object and Kleinian theory are also applied to the understanding of collecting. Collecting represents a specifi c form of object relating and way of handling primary loss trauma, which is different from addiction, compulsion, or perversion. Under certain circumstances collecting can also result in a successful Gestalt or way of life. The paper concludes with a case study showing how collecting develops from a pre‐oedipal to a more integrated oedipal mode during the course of the analysis, which is refl ected in changes in the transference.     

Chickens or eggs? A follow‐up case study exploring links between physical and psychological impact of Tourette's syndrome and sexual abuse

This follow‐up case study highlights the complex relationship when working at the interface between physical and psychological symptoms. The paper draws upon conversations between an ex‐client and myself, held seven years after the end of our six year therapeutic relationship. Conversational interviews, based upon social constructionist beliefs, led to an unexpected exploration of the client's subsequent diagnosis of Tourette's syndrome (given several years after the end of therapy) and evolved into a struggle to reach a shared understanding of how she now makes connection between her problem with eating in public, her neck and facial tics, and childhood sexual abuse. Our research relationship provided both of us with a rare opportunity to reflect upon how she had made meaning of her counselling and its outcomes. The paper draws attention to the impact of counselling and therapy discourses concerning sexual abuse on the work we did at the time and asks how that work might be different today. It also helps us understand the layers of complexity and ambiguity contained within the client's stories. This multi‐layered case study represents the overlap and ‘messiness’ that mirrors the ‘lived experience’ of the persons involved, and provides an example of how co‐constructed research conversations can evoke stories that create meaning as they are told.     

重新审视肠易激综合征

肠易激综合征(IBS)作为新近日益受到重视的疑难疾病,以其固有的复杂性冲击着西医传统的疾病观。以其高发病率和对人类生活质量的严重影响促使复杂性探索研究在医学中应用并促进东方整体观在现代医学中复兴,从而用于解决诸如肠易激综合征等的医学疑难。重新审视IBS这种典型的心身相关特点显著的功能性疾病,促进对医学疑难问题研究和认识中观念的更新,特别是促进整体观在医学研究中的深化,从而有助于寻找到更有效的医学疑难病的解决方法。     

中医证的本质

根据现代医学理论、哲学原理等,对中医证本质的科学内涵进行理论探讨,提出中医证的本质是基因表达的改变,用现代科学理论阐明中医证的本质具有重大科学意义.     

Characteristics of perceived electromagnetic hypersensitivity in the general population

Health problems evoked in the presence of electrical equipment is a concern, calling for better understanding for characteristics of electromagnetic hypersensitivity (EHS ) in the general population. The present study investigated demographics, lifestyle factors, frequency and duration, coping strategies, proportion meeting clinical criteria for intolerance attributed to electromagnetic fields (EMF ) and comorbidity. Using data from a large‐scale population‐based questionnaire study, we investigated persons with self‐reported (n = 91) EHS in comparison to referents (n = 3,250). Middle age, female sex and poor perceived health was found to be associated with EHS . More than 50% in the EHS group reported having EMF ‐related symptoms more often than once a week, and the mean number of years experiencing EHS was 10.5. More than half of the EHS group reported that their symptoms started after a high‐dose or long‐term EMF exposure, that they actively tried to avoid EMF sources and that they mostly could affect the EMF environment. A minority of the EHS group had sought medical attention, been diagnosed by a physician or received treatment. Exhaustion syndrome, anxiety disorder, back/joint/muscle disorder, depression, functional somatic syndrome and migraine were comorbid with EHS . The results provide ground for future study of these characteristic features being risk factors for development of EHS and or consequences of EHS .     

DS14 is more likely to measure depression rather than a personality disposition in patients with acute coronary syndrome

It has been suggested that Type D Personality is a risk factor for acute coronary syndrome (ACS) and the DS14 has been developed for its assessment. However, some of the items on the DS14 seem to evaluate depressive symptoms rather than personality features. Therefore, the present study aims to verify whether an overlap exists between the constructs of Type D Personality and depression. Three‐hundred‐and‐four consecutive patients who were both presenting their first ACS and had no history of major depression completed the Hospital Anxiety and Depression Scale (HADS) and the DS14 to assess Type D personality at baseline and have been re‐evaluated at 1, 2, 4, 6, 9 and 12‐month follow‐ups. Out of 304 subjects (80.6% males), 40 were diagnosed as depressed. An exploratory factor analysis of HADS and the DS14 in the second month revealed that four out of seven items on the depressive subscale of HADS (HADS‐D) and six out of seven items on the Negative Affectivity (NA) subscale of the DS14 segregated on the same factor. Results were verified by a Partial Confirmatory Factor Analysis performed at the twelfth month when most of the patients achieved complete remission from the depressive episode. Temporal stability was poor for NA and Type D Personality and these construct co‐vary with HADS‐D over time. Our data suggests that NA and depression are overlapping constructs, supporting the idea that the DS14 measures depressed features, rather than a personality disposition.     

Motor excitability during movement preparation in Tourette syndrome

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the occurrence of motor and vocal tics. TS has been linked to the impaired operation of cortical‐striatal‐thalamic‐cortical circuits that give rise to hyper‐excitability of cortical motor areas, which may be exacerbated by dysfunctional intra‐cortical inhibitory mechanisms. That said, many individuals gain control over their tics during adolescence and it has been suggested that this increased control arises as a result of the development of mechanisms that operate to suppress corticospinal excitability (CSE) ahead of volitional movements. Here we used single‐pulse transcranial magnetic stimulation (TMS) in conjunction with a manual Go/NoGo task to investigate alterations in CSE ahead of volitional movements in a group of adolescents with TS (N = 10). Our study demonstrated that CSE, as measured by TMS‐induced motor‐evoked potentials (MEPs), was significantly reduced in the TS group in the period immediately preceding a finger movement. More specifically, we show that individuals with TS, unlike their age‐matched controls, do not exhibit the predicted increase in mean MEP amplitude and decrease in MEP variability that immediately precede the execution of volitional movements in typically developing young adults. Finally, we report that the magnitude of the rise in MEP amplitude across the movement preparation period in TS is significantly negatively correlated with clinical measures of motor tic severity, suggesting that individuals with severe motor tics are least able to modulate motor cortical excitability.     

Comprehension of direct and indirect sarcastic remarks in children and adolescents with Tourette’s syndrome

Previous research has reported that aspects of social cognition such as nonliteral language comprehension are impaired in adults with Tourette’s syndrome (TS), but little is known about social cognition in children and adolescents with TS. The present study aims to evaluate a measure of sarcasm comprehension suitable for use with children and adolescents (Experiment 1), and to examine sarcasm comprehension in children and adolescents with TS-alone or TS and attention deficit hyperactivity disorder (ADHD; Experiment 2). In Experiment 1, the measure of sarcasm comprehension was found to be sensitive to differences in nonliteral language comprehension for typically-developing children aged 10 to 11 years old compared to children aged 8 to 9 years old; the older group performed significantly better on the comprehension of scenarios ending with either direct or indirect sarcastic remarks, whereas the two age groups did not differ on the comprehension of scenarios ending with sincere remarks. In Experiment 2, both the TS-alone and TS+ADHD groups performed below the level of the control participants on the comprehension of indirect sarcasm items but not on the comprehension of direct sarcasm items and sincere items. Those with TS+ADHD also performed below the level of the control participants on measures of interference control and fluency. The findings are discussed with reference to the possible contribution of executive functioning and mentalizing to the patterns of performance.     

The effect of early life stress on the cognitive phenotype of children with an extra X chromosome (47,XXY/47,XXX)

Studies on gene–environment interactions suggest that some individuals may be more susceptible to life adversities than others due to their genetic profile. This study assesses whether or not children with an extra X chromosome are more vulnerable to the negative impact of early life stress on cognitive functioning than typically-developing children.

A total of 50 children with an extra X chromosome and 103 non-clinical controls aged 9 to 18 years participated in the study. Cognitive functioning in domains of language, social cognition and executive functioning were assessed. Early life stress was measured with the Questionnaire of Life Events. High levels of early life stress were found to be associated with compromised executive functioning in the areas of mental flexibility and inhibitory control, irrespective of group membership. In contrast, the children with an extra X chromosome were found to be disproportionally vulnerable to deficits in social cognition on top of executive dysfunction, as compared to typically-developing children. Within the extra X group the number of negative life events is significantly correlated with more problems in inhibition, mental flexibility and social cognition. It is concluded that children with an extra X chromosome are vulnerable to adverse life events, with social cognition being particularly impacted in addition to the negative effects on executive functioning. The findings that developmental outcome is codependent on early environmental factors in genetically vulnerable children also underscores opportunities for training and support to positively influence the course of development.