探索产科领域的百慕大之谜

妊娠肝内胆汁淤积症(ICP)往往在妊娠晚期发生胎儿猝死,但机制尚不清楚.孕妇和胎儿体内高浓度胆汁酸水平是ICP的显著临床特点.胆汁酸对实验动物心肌细胞具有毒性作用.深入研究胆汁酸对胎儿心脏的毒性作用,有可能揭示胎儿死亡之谜.     

意识:大脑整体运动态

简要叙述有关意识问题的不同理论观点,同时从一个全新的角度提出对意识内涵的理解:意识是大脑整体运动态,是能够与环境相互作用形成心理现象的大脑"运动态".意识是大脑运动的固有属性,大脑运动的本质功能就是产生意识.意识随着大脑的进化而进化,同时又是大脑进化的动因.     

Intending and Causing

In much of the contemporary discussion of end of life cases, active killing is forbidden doctors, whereas the passive bringing about of death is, e.g., a rather common occurrence in our hospitals. In the former sorts of cases, doctors are held to be causes of death; in the latter sorts of cases, they are held not to be. If they did not cause a death, even though they did passively bring it about, we cannot use casual responsibility for a death in order to raise possible questions about moral responsibility for that death. I here look at part of this insistence that doctors are not a part cause of death and call it into question.     

The death instinct and the mental dimension beyond the pleasure principle in the works of Spielrein and Freud

In ‘Destruction as Cause of Come‐into‐being’, Spielrein argues for the need of postulating the existence of a death instinct in mental functioning. The idea that she thus anticipated the concept of death instinct Freud introduced in 1920 is often found in psychoanalytic literature. But the specific meaning of Spielrein's hypothesis is seldom discussed, as well as the extent to which she anticipated Freud's concept. In fact, there are important differences between their views. Besides, a closer analysis of Spielrein's text reveals other ideas that come close to fundamental aspects of Freud's theories from 1920 onwards, particularly the assumption of a more primordial mental functioning than the one regulated by the pleasure principle. But also here there are important differences between the views sustained by both authors. With this in view, the objective of this paper is firstly to discuss some hypotheses formulated by Spielrein in her 1912 work in order to elucidate her concept of death instinct as well as her hypothesis of the existence of a more primitive mental functioning than the one governed by the pleasure principle. Next, the question of the possible similarities and differences with regard to Freud's concepts is also addressed.     

Advances in functional brain imaging technology and developmental neuro‐psychology: their applications in the Jungian analytic domain

Analytical psychology shares with many other psychotherapies the important task of repairing the consequences of developmental trauma. The majority of analytic patients come from compromised early developmental backgrounds: they may have experienced neglect, abuse, or failures of empathic resonance from their carers. Functional brain imagery techniques including Quantitative Electroencephalogram (QEEG), and functional Magnetic Resonance Imagery (fMRI), allow us to track mental processes in ways beyond verbal reportage and introspection. This independent perspective is useful for developing new psychodynamic hypotheses, testing current ones, providing diagnostic markers, and monitoring treatment progress. Jung, with the Word Association Test, grasped these principles 100 years ago. Brain imaging techniques have contributed to powerful recent advances in our understanding of neurodevelopmental processes in the first three years of life. If adequate nurturance is compromised, a range of difficulties may emerge. This has important implications for how we understand and treat our psychotherapy clients. The paper provides an overview of functional brain imaging and advances in developmental neuropsychology, and looks at applications of some of these findings (including neurofeedback) in the Jungian psychotherapy domain.     

Treatment of developmental stress disorder: mind,body and brain – analysis and pharmacology coupled

The schism between psychiatry, psychology and analysis, while long present, has widened even more in the past half‐century with the advances in psychopharmacology. With the advances in electronic brain imaging, particularly in developmental and post‐traumatic stress disorders, there has emerged both an understanding of brain changes resulting from severe, chronic stress and an ability to target brain chemistry in ways that can relieve clinical symptomatology. The use of alpha‐1 adrenergic brain receptor antagonists decreases many of the manifestations of PTSD. Additionally, this paper discusses the ways in which dreaming, thinking and the analytic process are facilitated with this concomitant treatment and hypervigilence and hyper‐arousal states are signficiantly decreased.     

Influence of Motor Cortex Stimulation During Motor Training on Neuroplasticity as a Potential Therapeutic Intervention

Rehabilitation options to promote neuroplasticity may be enhanced when patients are engaged in motor practice during repetitive transcranial magnetic stimulation (rTMS). Twelve participants completed 3 separate sessions: motor practice, motor practice with rTMS, and rTMS only: motor practice consisted of 30 isometric contractions and subthreshold rTMS was 30, 3-s trains at 10 Hz. Assessments included the Box and Block Test (BBT), force steadiness (10% of the maximum voluntary contraction), and TMS (cortical excitability, intracortical inhibition, and intracortical facilitation). Participants significantly increased BBT scores following the combined condition. Force steadiness improved after all 3 conditions (p < .05). TMS outcomes depended on intervention condition with significant increases in facilitation following the motor practice plus rTMS condition. All interventions influenced motor control, yet are likely modulated differently when combining motor practice plus rTMS. These results help guide the clinical utility of rTMS as an intervention to influence motor control.     

Metamemory following childhood brain injury: A consequence of executive impairment

In this study, we investigated the influence of children’s level of executive functioning on two types of metamemory knowledge following a traumatic brain injury (TBI). For this purpose, 22 children (aged 7 to 14 years) who had sustained a moderate to severe TBI and 44 typically developing children were recruited. The children with TBI were divided into two groups according to the severity of their executive impairment. Injury severity was determined by the Glasgow Coma Scale (GCS) score on admission or by the duration of unconsciousness. All children were then tested on both their knowledge of general memory functioning and their level of memory self-awareness, respectively assessed using the total number of correct responses on an adapted version of a metamemory interview and a self-other discrepancy score on a questionnaire evaluating everyday memory abilities. Data analyses revealed that participants with TBI who suffered impaired executive functions demonstrated less general metamemory knowledge, and underestimated the frequency of their memory problems, compared with children with TBI who had preserved executive functions and with control participants. Considering the well-established effect of metamemory knowledge on people’s spontaneous implementation of strategies, the interest and the importance of these findings on both theoretical and clinical grounds are discussed.     

Missing piece of the puzzle in the science of consciousness: Resting state and endogenous correlates of consciousness

Consciousness still stands as one of the most interesting and the most elusive problems of neuroscience. Finding its correlates is the first step toward its satisfactory explanation. Several theories have proposed its correlates but none of them seem to be generally accepted even though most of them share some very similar elements. These elements are the activity of the thalamus, which is considered by some as the central region for consciousness, and gamma synchronization, which should be the general principal for the emergence of conscious experience. However, all of these proposed theories share one characteristic and that is that they do not take into consideration the recently discovered endogenous activity of the brain, which is generally associated with the default mode network. Although the activity of this large scale brain network is in correlation with various levels of consciousness it is still missing in discussions of consciousness. This review recognizes the importance of endogenous activity and points out the important discoveries of endogenous activity that could be an important step toward a satisfactory explanation of consciousness.     

Émotions et stratégies d’adaptation de prestataires de soins suite à des décès maternels dans le Nord-Kivu

This qualitative study describes the emotional structure and coping strategies associated with maternal death in North Kivu. Based on a heuristic approach, the methodology is based on an iterative process of explicating the experience of maternal death as experienced by the care teams. In conjunction with the transactional model of Lazarus and Folkman, the results focus on four themes: openness to spiritual values, telescoping age identification, use of hygiene strategies and rationalization. The study suggests the establishment of psychological support mechanisms for providers after a maternal death.