雷公藤多苷对肝脏的双重作用及其思考

文献研究表明,雷公藤多苷既可治疗肝脏疾病,又能引起肝脏毒性。本文对其双重作用从不同角度进行了分析,认为药物均存在治疗作用和毒副作用的双重效应,且与用药剂量、时间密切相关,并从严控剂量时间、加强监测、重视“治未病”、改进剂型等方面提出了应对措施。     

高龄老年高血压患者的降压治疗策略

80岁以上高龄老年高血压患者的降压治疗随着人口老龄化而越来越受关注。评估高龄高血压患者降压治疗的获益与风险,在循证医学基础上进行个体化治疗,依据全身情况和耐受程度调整血压控制水平,慎重选择药物,平稳缓慢降压,将使高龄高血压患者最大程度受益。     

Good vibrations: Analytic process as coupled oscillations

This paper develops a new model for the action of psychoanalysis based on concepts from non-linear dynamics (chaos theory and complexity theory). It shows that the analyst–analysand couple may be conceptualized as a new configuration with its own properties that promote complex development in both members of the couple. These developments are an emergent result of the formation of the analyst–analysand couple and are significantly independent of the particular content of the manifest interaction of the couple. The well-studied phenomena of coupled oscillators suggest the specific features of the analysand–analyst interaction that are likely to be most important in conceptualizing analytic change. The model has substantial clinical applications since efforts to arrange for a coupled oscillator system that is central to it are distinct from many of the traditional considerations associated with creating an analytic situation.     

Therapeutic factors in interactional inpatient groups: Results from a Turkish sample

Therapeutic factors in an inpatient group from Turkey are presented. A total of 40 patients were seen over a period of 2 years and each patient was given Yalom's (1983) 60-item therapeutic factor list on discharge. The first four most valued therapeutic factor groups were Catharsis, Existential Factors, Cohesiveness and Hope. There were significant differences in the highly valued factors in different diagnostic groups. Patients with diagnoses of anxiety/somatization and borderline/identity problem preferred factors resembling those in many out-patient studies. The results are discussed in the light of relevant literature.     

Don't get stuck in the mother: regression in analysis

This paper was part of an afternoon workshop on regression. It re views the author's recollections of her own analysis and clinical work with the purpose of discovering the sources of her own ideas on regression. Two specific forms of regression are then delineated – negative therapeutic reaction as described by Rosenfeld and 'umbilical transference' as a possible future development.     

Temenos Lost: Reflections on Moving

This article examines some clinical dilemmas engendered by moving. At such times, certain patients (or the analysts themselves) may lose their sense of containment that the therapeutic space has provided. When such a disruption threatens the course of treatment, this changed condition may be archetypaily termed 'temenos lost'. Consideration of this condition has led the author to reconceptualize healing as composed of two distinct components: the healing relationship and the healing space. Together, these components define the healing archetype. Using two historical examples, the King's Evil in Tudor England and healing pilgrimages in Israel, he shows how each component may indeed operate independently. More often, however, they function together. Using an extended published case (Volkan 1984), the author examines various aspects of how patients and analysts cope with 'temenos lost'. He emphasizes the importance of the emotional atmosphere in the physical setting, anticipatory anxiety of losing the temenos, and the basic anxiety that the move will damage the analysis. The importance of the rite of re-entry for the patient is emphasized as a symbolic way of resolving 'temenos loss' that permits a healing move into a 'temenos regained'.     

Hoisted by their own petards: Philosophical positions that self-destruct

Philosophers have not resisted temptation to transgress against the logic of their own conceptual structures. Self-undermining position-taking is an occupational hazard. Philosophy stands in need of conceptual therapy.The author describes three conceptions of philosophy: the narcissistic, disputatious, and therapeutic. (i) Narcissistic philosophy is hermetic, believing itself to contain all evidence that can possibly be relevant to it. Philosophy undertaken in this spirit has led to defensive, monadically isolated positions. (ii) Disputatious philosophies are fundamentally question-begging, animated by assumptions that philosophical adversaries reject. (iii) The intention of therapeutic philosophy is to study philosophical positions from the standpoint of their internal consistency, or lack of it. In particular, its interest is in positions that either compel assent, because they cannot be rejected without self-referential inconsistency, or self-destruct because self-referential inconsistency cannot be avoided. The article's focus is on the latter. Several examples of self-undermining positions are drawn from the history of philosophy, exemplifying two main varieties of self-referential inconsistency: pragmatical and projective.