A model of intervention at a psychoanalytic parent/child drop-in group in a poor district of Lima,Peru

The psychoanalytically informed work of a team of workers at a drop-in centre for families in a poor district of Lima is described. Interventions involve: accepting, connecting, playing and empowering. Clinical vignettes are used to illustrate the ways in which these interventions aim to help families. The acceptance of difficult feelings provides containment for attendees; acceptance of individuality fosters a greater capacity to mentalise. In viewing the patient as the relation between parents and child, connections are forged and encouraged between family members. Questions and difficulties that parents express are relayed to children in a palatable way, modelling the inclusion of children in the family dialogue. Playing is advocated and encouraged and elements of the fluid ‘frame’ impact on how playful interactions are shaped. Empowering takes place through encouraging reflexivity and dissolving fantasies of passivity. Questions about child behaviour are reflected back to the questioner or to other attendees, and pathologising diagnostic terms, if raised by families, are challenged and investigated, rather than accepted, encouraging families to carry on thinking. The implications of this model of work are discussed.     

Thalamic fear

This paper suggests that some neuroscience concepts particularly concerned with brain pathways in trauma and fear, as well as the neurobiology of emotion, provide an additional vertex to the psychoanalytic understanding of patients' material. The role of the body has been neglected in psychoanalytic thought and formulations in favour of purely ‘mental’ experience. The paper attempts to show how neuro-psychoanalytic understanding, which is conveyed to patients through interpretation, can increase their depth of understanding. Different types of memory are delineated and the paper describes a simplified schema of emotional processing, drawing on Damasio's distinction between emotion as an instinctual body based experience and its mental representation as feeling. Clinical examples are used to illustrate the usefulness of the distinction. The concept of emotional regulation is discussed as well as showing how its failure is associated with the appearance of persecutory superego structures.     

Clinical commentary by David Trevatt,Clinical Manager of ‘Hear and Now’ Adolescent Counselling Service,Redbridge and Manager of Open Door's Parenting Teenagers Project,Haringey

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.     

The partnership between the Early Intervention Institute,St Petersburg,and the Anna Freud Centre,London

The authors describe study and teaching links between the Early Intervention Institute in St Petersburg and the Anna Freud Clinic in London. Some brief clinical examples from a variety of settings are given as well as a longer case presentation. The impact of widespread institutional care, alcoholism and terrible housing conditions on child mental health are illustrated. This raises questions about the role of child psychotherapy when social conditions are so harsh. The case material indicates that, despite this, children can be helped in some measure to feel more secure, by the therapist providing constancy and reliability within an often frightening and dangerous external world.     

Online mental health resources for adolescents: Overview of research and theory

Adolescents use the Internet at higher rates than any other age group. The Internet therefore offers an obvious opportunity for the provision of mental health information for them. Little is known, however, about adolescent behaviour online, especially access of age‐appropriate mental health resources. This review of the published literature examines theoretical and research studies to develop an understanding of adolescent mental health‐seeking behaviour on the Internet. It is clear that adolescents do seek health information online, but little is known about its content, nature or mode of delivery. There appears to be no research specific to mental health resources for adolescents online.     

RECENT STUDIES ON FEEDING PROBLEMS IN CHILDREN WITH AUTISM

This paper reviews recent studies on behavioral interventions for children with autism and feeding problems. The applicability of interventions that have been tested with other populations of children with feeding problems is discussed, as well as directions for future research.     

Aggressive behavior,related conduct problems,and variation in genes affecting dopamine turnover

A number of dopamine‐related genes have been implicated in the etiology of violent behavior and conduct problems. Of these genes, the ones that code for the enzymes that influence the turnover of dopamine (DA) have received the most attention. In this study, we investigated 12 genetic polymorphisms in four genes involved with DA functioning (COMT, MAOA and MAOB, and DβH) in 179 incarcerated male Russian adolescents and two groups of matched controls: boys without criminal records referred to by their teachers as (a) “troubled‐behavior‐free” boys, n=182; and (b) “troubled‐behavior” boys, n=60. The participants were classified as (1) being incarcerated or not, (2) having the DSM‐IV diagnosis of conduct disorder (CD) or not, and (3) having committed violent or nonviolent crimes (for the incarcerated individuals only). The findings indicate that, although no single genetic variant in any of the four genes differentiated individuals in the investigated groups, various linear combinations (i.e., haplotypes) and nonlinear combinations (i.e., interactions between variants within and across genes) of genetic variants resulted in informative and robust classifications for two of the three groupings. These combinations of genetic variants differentiated individuals in incarceration vs. nonincarcerated and CD vs. no‐CD groups; no informative combinations were established consistently for the grouping by crime within the incarcerated individuals. This study underscores the importance of considering multiple rather than single markers within candidate genes and their additive and interactive combinations, both with themselves and with nongenetic indicators, while attempting to understand the genetic background of such complex behaviors as serious conduct problems. Aggr. Behav. 36:158–176, 2010. © 2010 Wiley‐Liss, Inc.     

关注幽门螺杆菌治疗中的实际问题

我国对Hp感染诊断和治疗有自己的标准,也有很多成熟的经验,但在根除HP治疗过程中,存在诸多问题,如过度医疗、适应证掌握不严格、第一次根除失败后再次治疗不规范等。我们应共同关注这些问题,提高Hp根除率,降低治疗中的副作用,对HP的许多未知问题从不认识到认识。