Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: a cross-sectional clinical study

Although intrusive images are a hallmark of post-traumatic stress disorder (PTSD) and also occur in depression, little is known about the differences and similarities of such images in these conditions. Our study focuses on the qualities and triggers of intrusive images and responses to them in three groups--patients with PTSD, and depressed patients with and without trauma (n=65)-to highlight the diagnostic specificity of intrusive images for PTSD and depression. We distinguished intrusive images from verbal intrusive cognitions such as rumination and intrusive (brief) lexical thoughts. Consistent with the literature, the intrusive images of PTSD patients had a more "here-and-now quality" and were perceived more visually compared to those of both depressed groups. The groups showed a good deal of similarity concerning other image qualities. Most importantly, the intrusive images in PTSD and depressed patients with and without trauma were perceived as similarly distressing. Rumination and intrusive (brief) lexical thoughts were two of the five most named triggers of intrusive images. Limitations, such as the lack of a control group, and the clinical implications of these results are discussed, demonstrating the need to help non-PTSD patients with and without trauma to deal with intrusive images.     

Enhancing exposure-based therapy from a translational research perspective

Combining an effective psychological treatment with conventional anxiolytic medication is typically not more effective than unimodal therapy for treating anxiety disorders. However, recent advances in the neuroscience of fear reduction have led to novel approaches for combining psychological therapy and pharmacological agents. Exposure-based treatments in humans partly rely on extinction to reduce the fear response in anxiety disorders. Animal studies have shown that D-cycloserine (DCS), a partial agonist at the glycine recognition site of the glutamatergic N-methyl-D-aspartate receptor facilitates extinction learning. Similarly, recent human trials have shown that DCS enhances fear reduction during exposure therapy of some anxiety disorders. This article discusses the biological and psychological mechanisms of extinction learning and the therapeutic value of DCS as an augmentation strategy for exposure therapy. Areas of future research will be identified.     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.     

Further examination of factors that influence preference for positive versus negative reinforcement

Factors that influence choice between qualitatively different reinforcers (e.g., a food item or a break from work) are important to consider when arranging treatments for problem behavior. Previous findings indicate that children who engage in problem behavior maintained by escape from demands may choose a food item over the functional reinforcer during treatment (DeLeon, Neidert, Anders, & Rodriguez-Catter, 2001; Lalli et al., 1999). However, a number of variables may influence choice between concurrently available forms of reinforcement. An analogue for treatment situations in which positive reinforcement for compliance is in direct competition with negative reinforcement for problem behavior was used in the current study to evaluate several variables that may influence choice. Participants were 5 children who had been diagnosed with developmental disabilities and who engaged in problem behavior maintained by escape from demands. In the first phase, the effects of task preference and schedule of reinforcement on choice between a 30-s break and a high-preference food item were evaluated. The food item was preferred over the break, regardless of the preference level of the task or the reinforcement schedule, for all but 1 participant. In the second phase, the quality of the break was manipulated by combining escape with toys, attention, or both. Only 1 participant showed preference for the enriched break. In the third phase, choice of a medium- or low-preference food item versus the enriched break was evaluated. Three of 4 participants showed preference for the break over the less preferred food item. Results extend previous research by identifying some of the conditions under which individuals who engage in escape-maintained behavior will prefer a food reinforcer over the functional one.     

基层医院口腔科如何构建和谐医患关系

基层医院口腔科容易引起医患纠纷,本文从基层医院口腔科以及口腔医生的角度谈谈如何构建和谐的医患关系。基层医院口腔医生要掌握扎实的专业理论知识和操作技能以及加强自身修养,并进行良好的医患沟通;基层医院口腔科要营造舒适的就医环境,合理收费,严格的消毒灭菌。构建和谐医患关系在口腔治疗中的起重要作用。     

肿瘤分子生物学行为与其影像表现关系的探讨

肿瘤基因表达与其影像表现有一定的相关性,为我们用无创的影像学方法显示肿瘤的生物学特征提供了可能。探寻肿瘤分子生物学特性与其影像表现的内在联系,以期对肿瘤浸润和转移做出正确的诊断,从而为临床选择治疗方案、判断疗效和评估预后等提供更多、更有价值的信息。     

医科生医德认知度影响因素分析

通过对医务人员和在校医科生的广泛问卷调研,我们发现,医科生还普遍存在着医学伦理学基础知识不牢、过于重视医学专业知识的学习而轻视人文哲学社会科学知识的学习,以及轻视高尚人生观的追求等诸多问题。为此,我们可以采取多种综合性的措施来强化医德教育的有效性,全面提升医学生的医德认知度水平。关键词:医德认知度;医德修养;创新;     

高等医学院校医事法学教育亟待加强

通过千余份问卷调查研究,透视出医学生对医事法律认知程度普遍偏低的状况,进而从医学院教育方针,以及医学生法律意识、自我教育能力等方面,分析、探究原因,寻求改进医事法学教育滞后问题,加速培养学医懂法医学人才的途径与方法。     

签署知情同意书有助于改善医患关系

当前医疗活动中由于缺乏人文关怀、患者对医务人员信任度下降以及医患之间信息不对称,导致现阶段医疗投诉以及医疗纠纷逐年上升,投诉和纠纷内容多样且性质趋于严重复杂。在签署医疗知情同意书时,适时给予病人情感上的关爱,重视病人心理需求,采取医学技术与人文关怀相结合的医疗活动,有助于在现代医学模式基础上构建和谐的医患关系。     

南京居民医疗服务潜在需求成因分析及其合理转化建议

通过南京市8个区、县4873户居民的基线调查,掌握居民对医疗服务的实际利用情况,通过比较医疗需求与利用之间的差距,发现存在很大的潜在医疗服务需求市场。从医疗服务供需双方分析其产生的原因,找出医疗服务需求与利用的主要影响因素,从而探讨如何将这部分潜在需求合理转化。