抑郁性神经症患者精神创伤的临床调查与分析

通过调查与分析。希望进一步了解导致抑郁性神经症的精神创伤的性质和易感人群的年龄、教育程度和性别等方面的特点。为此类疾病的病因分析及其防治提供客观的依据。结果表明：1．不同的年龄、教育程度和性别均有各自敏感的生活事件,部分生活事件在任何年龄阶段、教育程度、性别的人群中都可构成精神创伤;2．家庭矛盾、个人发展、疾病、失去亲人等生活事件容易构成精神创伤,其中家庭矛盾尤为突出;3．不可控的生活事件是构成抑郁性神经症近、远期精神创伤的重要基础。可见,抑郁性神经症的发病与精神创伤关系密切;不同教育程度、年龄、性别对生活事件的体验及其导致精神创伤的程度不同。     

Measuring Daytime Drowsiness in Nursing Home Residents: The MSLT-NH

A standardized method of assessing daytime drowsiness in frail nursing home residents has not been previously available. We present here the development and test characteristics of an instrument to measure daytime drowsiness in nursing home residents with cognitive and functional impairment, the Multiple Sleep Latency Test-Nursing Home (MSLT-NH). In a standardized manner, the resident is tested three times in one day (at 9 a.m., 11 a.m., and 1 p.m.) to measure the amount of time until the subject falls asleep. The average sleep latency (minutes to fall asleep) is the measure of interest. We tested the MSLT-NH in 95 residents from six community nursing homes in the Los Angeles area (82% of subjects were female; 81% were white, mean age was 86.6 years and mean score on the Mini-Mental State Examination [MMSE] was 9.4). Interrater reliability of the MSLT-NH was quite good (correlations between raters ranged from 0.98 to 0.99; all p values were <.0001). Validity was assessed by comparing MSLT-NH results to simultaneous wrist activity estimation of sleep, and by comparing MSLT-NH findings to results from nighttime sleep estimation by wrist actigraphy the night prior to MSLT-NH. The percent agreement between MSLT-NH and wrist actigraph ranged from 77% to 79% MSLT-NH results were significantly associated with peak duration of nighttime sleep episodes the night prior to testing. The MSLT-NH was also quite acceptable for use in the NH setting. In conclusion, we have developed a promising measure of daytime drowsiness in NH residents. Further testing will help establish whether this test is a clinically useful measure of daytime drowsiness from medications or other conditions in the NH setting.     

Crossover between work and home in dyadic partner relationships

This study aimed at providing insight into the processes underlying crossover between "work" and "home" in dyadic partner relationships. Specifically, we examined to what extent husbands' work demands (work load and overtime hours) and psychological health (fatigue and depressive symptoms) "cross over" to their wives' home demands (home load) and psychological health. These associations were investigated among three couple groups, based on wives' working hours (i.e., more than 20 hours per week, from 1 to 20 hours per week, and not engaged in paid work) (253 couples in total). All husbands worked for at least 35 hours a week. Three possible crossover mechanisms were hypothesized: (i) time-based, (ii) strain-based, and (iii) empathy-based crossover. The results partially supported mechanisms (i) and (ii): when husbands reported higher work load (mechanism i) and more psychological health complaints (mechanism ii), their wives experienced higher home load. The results further supported mechanism (iii) that wives' and husbands' psychological health were associated. It is concluded that crossover from husbands to wives may occur through various mechanisms.     

Object loss, renewed mourning, and psychic change in Jane Austen's Persuasion

Austen's extraordinary realism in depicting the dynamic internal processes which follow on the heroine's loss in Persuasion becomes clear in the light of a psychoanalytic understanding of mourning. Persuasion dramatizes the effects of a mother's death in adolescence as these come into play at the time of the heroine's separation from her fiancée and her later mourning. The thesis of this paper is that, despite falling in love with the brilliant hero, an unfinished mourning and an unconscious identification with her dead mother helped to persuade the heroine Anne Elliot to break her engagement, to create a 'final parting' as her mother had done to her in dying. The heroine's internal monologues show that she has projected some of the darker feelings of mourning, her anger and resentment, on to the hero and that she reopens a complex mourning process, partly through the displacement of affect, showing how traumatic effects of loss can be worked through in deferred action, effecting positive psychic change.     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

Family functioning and involvement in home visiting: Examining program characteristics as moderators to support retention in services

Developing strategies to improve retention in home visiting programs is critical to their success. The purpose of the study is to examine how the content provided during home visits moderates the association between family risks (economic, household functioning, and conflict) and retention in services. Parents (n = 1,322) voluntarily enrolled in Healthy Families America (n = 618) and Parents as Teachers (n = 704). Family characteristics were collected using the Family Map Inventories. Multilevel analyses showed a moderating impact of the time home visitors spent supporting parent–child interaction for all family risks examined. Moderating effects demonstrated a stronger positive association between focusing on the parent–child relationship and retention at 6 and 12 months for parents demonstrating greater needs. There were no moderating effects of child development content or case management activities with retention at 6 and 12 months. Together, families were more likely to stay in services when home visitors focused on parent–child interaction and child development, but less likely retained with more case management. Parents with greater risks were more likely to remain in services with more time focused on supporting parent–child interactions. Findings suggest the need to support our home visiting workforce in their work to promote healthy parent–child relationships.     

Trauma theory in Sándor Ferenczi’s writings of 1931 and 19321

The author states that it is Ferenczi ’s writings of 1931 and 1932 that exhibit the most conspicuous departures from Freud ’s ideas and at the same time contain Ferenczi ’s most original contributions. The texts concerned – Confusion of tongues between adults and the child ( Ferenczi, 1932a ), the Clinical Diary ( Dupont, 1985 ), and some of the Notes and fragments ( Ferenczi, 1930–32 ), all of which were published posthumously – present valuable and original theories on trauma which are significant not only in historical terms but also because the ideas concerned are relevant to our conception of clinical psychoanalysis today. The aim of this paper is to give an account of Ferenczi ’s trauma theory as it emerges from his writings of 1931–32 and to specify the points on which he differs from Freud.     

Life at Home: Same Time,Different Places — An Examination of the HOME Inventory in Different Cultures

In this paper we review literature on the use of the HOME Inventory across cultures. We address issues pertaining to measurement equivalence and validity. Specifically, we focus on: (a) changes in the content of HOME made by researchers, (b) distributional properties of HOME scores, (c) the factor structure of HOME, and (d) correlations between HOME, family characteristics, child characteristics and environmental conditions. In most affluent, western countries, with their individualist orientations, HOME was used essentially as it was originally constructed. Researchers in less industrialized, more collectivist countries tended to express greater scepticism about the appropriateness of some HOME items, and several teams of researchers made modifications in the instrument. The HOME total score showed theoretically meaningful (and similar) correlations with family structure, family status and child outcome measures across many cultures. Evidence attesting to the cultural equivalence (and validity) of HOME subscales was far less plentiful and compelling. In general, there seemed greater cross-cultural equivalence for items assessing cognitively stimulating aspects of the environment than for items assessing socioemotional support. The usefulness of the Inventory in other cultures and for cross-cultural comparisons depends on the purposes one has for using a measure of the home environment. © 1996 John Wiley & Sons, Ltd.     

Improving mother–child interaction in low‐income Turkish–Dutch families: A study of mechanisms mediating improvements resulting from participating in a home‐based preschool intervention program

This study examined whether the effects on cognitive and language outcomes of a recently developed home‐based educational intervention program, Opstap Opnieuw, for 4–6‐years‐old disadvantaged children could be explained by improved mother–child interaction. The present sample (n=30) was drawn from a larger sample of Turkish–Dutch families (n=181) for which in a previous study significant effects of Opstap Opnieuw were found on children's (first) language and cognitive pre‐math skill, 5 months after the program ended. The present study focused on two facets of interaction quality as possible mediators of these program effects: the mean cognitive distancing level of mothers' communication and instruction behaviour as an indicator of the cognitive and verbal stimulation provided, and the degree of cooperation as an indicator of mothers' social‐emotional support to their children. Both measures were based on systematic observation of mother–child interaction during sorting tasks. Participation in the program appeared to improve mothers' social‐emotional support behaviour substantially, but not their cognitive distancing behaviour. For Turkish (first language) vocabulary, about half of the program effect appeared to be mediated by the improved social‐emotional support. For cognitive pre‐mathematical skills, two‐thirds of the program effect appeared to be mediated by improved social‐emotional support. Mothers' cognitive distancing was moderately‐strongly related to children's vocabulary development, but did not mediate program effects. Some implications of the results are discussed. Copyright © 2004 John Wiley & Sons, Ltd.