实验性恶心与呕吐——大脑皮层与内脏相关研究的新途径

大脑皮层与内脏关系的脑机制是揭示心身疾病和心理疾病的重要依据。本文综述了经典条件学习与期待性恶心与呕吐的关系以及实验性恶心与呕吐的研究方法。作者认为,实验性恶心与呕吐结合脑成像技术是研究大脑皮层与内脏关系神经机制的重要途径。     

Test-retest reliability and concurrent validity of the Morrow Assessment of Nausea and Emesis (MANE) for the assessment of cancer chemotherapy-related nausea and vomiting

The present study evaluated the concurrent validity of two assessment approaches for the measurement of cancer chemotherapy-related nausea and vomiting. The results indicated that the concurrent validity between the Morrow Assessment of Nausea and Emesis (MANE; Morrow, 1984b) and continuous self-monitoring and the reliability on the MANE were moderate. The heterotrait-monomethod and heterotrait-heteromethod matrices demonstrated moderate correlations among the frequency, severity, and duration of anticipatory nausea and vomiting as well as high correlations among the frequency, severity, and duration of posttreatment nausea and vomiting. Additionally, the heterotrait-monomethod matrices show a number of correlations above chance between anticipatory and posttreatment symptoms. The results are discussed in light of future research endeavors.This research was supported in part by Research Grant IN-150 from the American Cancer Society.     

Anticipatory nausea and vomiting among cancer patients: A Review

Abstract

Anticipatory nausea and vomiting (ANV), as a side-effect of cancer chemotherapy, is a well recognized phenomenon. The literature is reviewed for data on: prevalence rates, factors contributing to onset and psychological treatments used to attempt a remission in the symptoms. From the available evidence it appears that ANV is a substantial problem with one major review indicating an average combined prevalence of 32%. Although explicable using a conditioning model it has a complex aetiology with emotional and cognitive elements, as well as specific pharmacological factors, playing a role in onset. ANV appears to be responsive to psychologically-based treatment methods, with a good outcome overall. However, more process evaluation is needed in order to understand aetiologic and treatment mechanisms and to determine how best to treat cases of ANV with different aetiologies. It is considered that procedures for identifying and referring patients with ANV should be routinely incorporated into the care of cancer patients receiving repeated cycles of chemotherapy.     

Speed of Eating as a Determinant of the Bulimic Desire to Vomit

ABSTRACT

A single-case controlled study found that a bulimic's desire to vomit was virtually eliminated by slowed eating, but not by rapid eating. The present study attempted to determine whether this same relation was exhibited by a larger number (N = 6) of bulimics who were instructed to eat at a fast or a slow rate in a between-subjects reversal design. For all 6 participants, the urge to vomit was found to be greater during fast versus slow eating after comparable amounts of food intake. Clinically, these results suggest that eating slowly might be incorporated into treatment for bulimic vomiting.     

I Working with dissociative dynamics and the longing for excess in binge eating disorders

In this paper the author describes her work with a woman who, in her mid 20s, sought analysis for her non‐vomiting binge eating disorder. The paper explores how two aspects of Jung's view of the psyche as healthily dissociable were used to think about the potential for change contained within the explosive, aggressive energies in this patient's bingeing. The resultant approach takes the patient's splitting defences, dissociations and self‐destructive behaviour as a point of access to her unconscious. Seen in this way, these behaviours contain the seeds of recovery and are the starting point for analysis rather than defences against it. The paper also brings a number of Jungian and post‐Jungian ideas into conversation with aspects of contemporary thinking about subjectivity, identity and the longing for excess developed by Leo Bersani and Judith Butler.     

Assessment and treatment of automatically reinforced self‐induced emesis

Frequent emesis can cause substantial deleterious effects to a child's health and environment. We conducted a functional analysis of a 3‐year‐old girl's self‐induced emesis and confirmed that emesis was maintained by automatic reinforcement. In a reversal design, we evaluated the efficacy of implementing response blocking at 100% and 50% treatment integrity levels on both attempts and successful production of emesis. One hundred percent blocking, but not 50% blocking, was successful in reducing attempts and emesis below baseline levels.     

From acting to communicating: The analysis of a boy with a pathological organization1

The author presents the analysis of an 8 year‐old boy prematurely born after a high‐risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non‐productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school‐both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make‐believe as well as the intense projective mental functioning.     

不同5-HT3受体拮抗剂预防腹腔镜术后恶心呕吐的临床观察

观察使用不同5-HT3受体拮抗剂预防全麻下腹腔镜手术术后恶心呕吐的临床效果。选择160例气管内插管全身麻醉下腹腔镜手术,随机分四组,每组40例,手术结束前30min分别静脉注射昂丹司琼4mg（A组）;托烷司琼2mg（B组）;格拉司琼3mg（C组）;D组为对照组。记录术后2h、6h、12h、24h患者恶心、呕吐出现的例数。结果四组患者术后恶心呕吐的发生率是一个逐渐下降的趋势,A、B、C三组与D组相比较有显著性差异（P〈0．05）;术后2h、6h、12hB组与A组、C组相比较有显著性差异（P〈0．05）;而术后24hA、B、C三组差异无统计学意义,A、B、C三组抑制恶心呕吐的有效率分别为67．5％、87．5％和70．0％,与对照组比较差异有统计学意义（P〈0．05）,随访患者24h内无与药物相关的不良反应。结论：三种药物都能有效地预防术后恶心呕吐,但12h内托烷司琼的有效性更为明显。     

实验性恶心与呕吐——大脑皮层与内脏相关研究的新途径

大脑皮层与内脏关系的脑机制是揭示心身疾病和心理疾病的重要依据。本文综述了经典条件学习与期待性恶心与呕吐的关系以及实验性恶心与呕吐的研究方法。作者认为,实验性恶心与呕吐结合脑成像技术是研究大脑皮层与内脏关系神经机制的重要途径。