Loss-related mental states impair executive functions in a context of sadness.

Stress and anxiety have been shown to temporally impair executive functions, but the role of other emotions, such as sadness, has been inconclusive. Moreover, the role of affect regulation in this relationship has not been extensively studied. The present research investigated whether certain types of mental states (mental output resulting from the use of affect regulation within a specific context or with respect to a specific material or theme) relative to the context of loss would predict impairment of executive functions. Participants were randomly assigned to read either a loss-related newspaper article inducing sadness or a neutral newspaper article. Results showed that low mental states relative to loss (maladaptive affect regulation) predicted impairment of executive functions following an induction of sadness, but not following the neutral induction. Conversely, high mental states (adaptive affect regulation) were not predictive of impairment of executive functions in both the sadness and neutral condition. These findings have implications for the boundaries within which emotion can disrupt high-order cognitive processes.

Attenuated Mitral Leaflet Enlargement Contributes to Functional Mitral Regurgitation After Myocardial Infarction.

BACKGROUND: Mitral leaflet enlargement has been identified as an adaptive mechanism to prevent mitral regurgitation in dilated left ventricles (LVs) caused by chronic aortic regurgitation (AR). This enlargement is deficient in patients with functional mitral regurgitation, which remains frequent in the population with ischemic cardiomyopathy. Maladaptive fibrotic changes have been identified in post-myocardial infarction (MI) mitral valves. It is unknown if these changes can interfere with valve growth and whether they are present in other valves. OBJECTIVES: This study sought to test the hypothesis that MI impairs leaflet growth, seen in AR, and induces fibrotic changes in mitral and tricuspid valves. METHODS: Sheep models of AR, AR + MI, and controls were followed for 90 days. Cardiac magnetic resonance, echocardiography, and computed tomography were performed at baseline and 90 days to assess LV volume, LV function, mitral regurgitation and mitral leaflet size. Histopathology and molecular analyses were performed in excised valves. RESULTS: Both experimental groups developed similar LV dilatation and dysfunction. At 90 days, mitral valve leaflet size was smaller in the AR + MI group (12.8 ± 1.3 cm2 vs. 15.1 ± 1.6 cm2, p = 0.03). Mitral regurgitant fraction was 4% ± 7% in the AR group versus 19% ± 10% in the AR + MI group (p = 0.02). AR + MI leaflets were thicker compared with AR and control valves. Increased expression of extracellular matrix remodeling genes was found in both the mitral and tricuspid leaflets in the AR + MI group. CONCLUSIONS: In these animal models of AR, the presence of MI was associated with impaired adaptive valve growth and more functional mitral regurgitation, despite similar LV size and function. More pronounced extracellular remodeling was observed in mitral and tricuspid leaflets, suggesting systemic valvular remodeling after MI.

Insomnia and hypertension: A systematic review.

Insomnia is a prevalent sleep disorder that is associated with a multitude of health consequences. Particularly, insomnia has been associated with cardiovascular disease and its precursors, such as hypertension and blood pressure (BP) non-dipping. The present systematic review aimed to summarize the evidence on the concurrent and prospective associations between insomnia and hypertension and/or BP. Using electronic search engines (PubMed, SCOPUS, PsycINFO), 5,618 articles published from January 1970 to December 2017 were identified, and 64 met the inclusion criteria (26 to 162,121 participants; age range: 18-100; 46.4% male). Insomnia was based on diagnostic or non-diagnostic criteria. Hypertension was based on self-or physician-reports, antihypertensive medication use, and/or measured BP. Findings indicate that when insomnia is frequent, chronic, and/or accompanied with short sleep duration or objective markers of arousal, there is a strong association with hypertension/BP. Based on limited studies, hypertension did not significantly predict future insomnia in middle-aged adults, but did in older adults. Based on a majority of case-control studies, no differences in BP were found between participants with and without insomnia. Further research is needed to identify putative pathophysiological mechanisms underlying the link between insomnia and hypertension. The impact of insomnia therapy on BP should also be further examined in the future.

Multi-Modality Imaging in the Evaluation and Treatment of Mitral Regurgitation.

OPINION STATEMENT: Mitral regurgitation (MR) is frequent and associated with increased mortality and morbidity when severe. It may be caused by intrinsic valvular disease (primary MR) or ventricular deformation (secondary MR). Imaging has a critical role to document the severity, mechanism, and impact of MR on heart function as selected patients with MR may benefit from surgery whereas other will not. In patients planned for a surgical intervention, imaging is also important to select candidates for mitral valve (MV) repair over replacement and to predict surgical success. Although standard transthoracic echocardiography is the first-line modality to evaluate MR, newer imaging modalities like three-dimensional (3D) transesophageal echocardiography, stress echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) are emerging and complementary tools for MR assessment. While some of these modalities can provide insight into MR severity, others will help to determine its mechanism. Understanding the advantages and limitations of each imaging modality is important to appreciate their respective role for MR assessment and help to resolve eventual discrepancies between different diagnostic methods. With the increasing use of transcatheter mitral procedures (repair or replacement) for high-surgical-risk patients, multimodality imaging has now become even more important to determine eligibility, preinterventional planning, and periprocedural guidance.

PA/Lateral chest X-ray is equivalent to cine-fluoroscopy for the detection of conductor externalization in defibrillation leads.

BACKGROUND: Riata™ and Riata ST defibrillation leads (St. Jude Medical, Sylmar, CA, USA) are susceptible to insulation defects with conductor externalization. Cine-fluoroscopy is considered to be the gold standard for the documentation of insulation defects, but similar detection rates have been reported for posterior-anterior (PA)/lateral chest x-ray (CXR) with zooming. OBJECTIVE: Prospective single-center study to assess the diagnostic equivalence of a PA/lateral CXR with zooming for the detection of Riata insulation defects in a direct comparison to cine-fluoroscopy. METHODS: Seventy-eight consecutive patients underwent 3-view cine-fluoroscopy and a PA/lateral CXR. All CXRs and cine-fluoroscopy images were reviewed by blinded electrophysiologists and staff radiologists. RESULTS: Forty-four of 78 patients had an abnormal cine-fluoroscopy (56%). The diagnostic correlation between PA/lateral CXR and cine-fluoroscopy was excellent (κ = 0.90; 95% confidence interval 0.80-1.00). PA/lateral CXR was equivalent to cine-fluoroscopy for the detection of conductor externalization showing a sensitivity of 97.7% and a specificity of 91.2%. The mean radiation effective dose of CXR was significantly lower compared to cine-fluoroscopy (0.09 millisievert [mSV] vs 0.85 ± 0.47 mSv; P < 0.001). Also, CXR was significantly less expensive. CONCLUSION: PA/lateral CXR with zooming is equivalent to cine-fluoroscopy for the detection of Riata insulation defects and should be considered as the preferred screening method.

Longitudinal follow-up of Riata leads reveals high annual incidence of new conductor externalization and electrical failure.

BACKGROUND AND PURPOSE: Riata(TM) defibrillation leads are susceptible to conductor externalization. The point prevalence of insulation defect in Riata(TM) leads is up to 33 %, but prospective data concerning incidence of new lead abnormalities are lacking. The purpose of our study was to determine the annual incidence of new conductor externalizations and electrical lead failure. METHODS: A prospective observational study was conducted at a single tertiary center. One hundred forty-one patients were followed over 12 months. A posterior-anterior (PA)/lateral chest x-ray (CXR) with zooming was performed at baseline and at 12 months to screen for conductor externalization. Electrical abnormalities and clinical outcome were also assessed. RESULTS: The overall incidence of new insulation defects was 8.5 % at 12 months. High-risk leads for new conductor externalization were lead models 1580, 1582, and 1590 with an annual rate of 11.9, 11.1, and 10 %, respectively. New conductor externalizations were three times more common in 8 Fr leads compared to 7 Fr leads. The overall incidence of new electrical dysfunction was 6.4 % at 12 months. Electrical dysfunction was significantly higher in abnormal leads (25 % [3/12], 4.7 % [6/129]; p = 0.03) and mostly driven by high ventricular pacing thresholds. There was no difference in inappropriate shock or failure of high-voltage therapy. CONCLUSION: The annual incidence of new insulation defects in Riata(TM) leads is much higher than previously reported. Lead models 1580, 1582, and 1590 are at highest risk for new conductor externalization. Electrical dysfunction in Riata(TM) leads is also much higher than reported and is associated with conductor externalization.

Mental States Task (MST): development, validation, and correlates of a self-report measure of mentalization.

OBJECTIVES: Mental states refer to the quality of one's capacity to mentally elaborate and open up to his or her subjective experience. The Mental States Task (MST) was developed to evaluate individual differences relative to this capacity. METHOD: Using the MST, participants described a story from an emotionally challenging image and responded to a set of items about their cognitive and emotional processes while completing the task. The validation of the French version of the MST comprises two samples: 264 undergraduate/graduate students with a mean age of 27.27 years (Sample 1), and 206 students with a mean age of 26.61 years (Sample 2). The validation of the English version of the MST also includes two samples: 110 undergraduate students with a mean age of 20.15 years (Sample 3) and 188 students with a mean age of 20.90 years (Sample 4). RESULTS: Results suggest that 6 mental states can be distinguished and that the MST presents an adequate factorial structure, in both its French and English versions. The MST scores were associated with mental state scores derived from a content analysis method and with other related constructs (e.g., authenticity, empathy). CONCLUSIONS: Overall, findings provide convincing evidence of validity and reliability for the MST as an assessment tool of mental states. This innovative measure is likely to facilitate the clinical and empirical investigation of mentalization.

Detection of high incidence of Riata lead breaches by systematic postero-anterior and lateral chest X-ray in a large cohort.

AIMS: Insulation breaches with externalization of conductor cables have been described for St-Jude Medical Riata™ defibrillation leads. Published data on the incidence of Riata lead abnormalities are quite heterogeneous. The objective of this study was to estimate systematically the prevalence of lead abnormalities using a postero-anterior (PA) and lateral chest X-ray (CXR). METHODS AND RESULTS: From 2002 to 2008, 552 Riata defibrillation leads were implanted at our centre. We evaluated patients for potential insulation breaches. A PA and lateral CXR was obtained. Chest X-rays were reviewed by two electrophysiologists using a zooming function with magnification up to factor 7.5 and were classified as normal or abnormal for the presence of conductor externalization. A total of 284 patients were included. Riata lead models were 1570, 1580, 1582, 1590, 1592, 7000, 7002, and 7022. The total frequency of radiological lead defects was 24.3%. Insulation breaches occurred at zones of major lead curvature. Mean maximal spacing between extruding lead components was 3.6 ± 1.9 mm (range 2.0-12.4). Abnormal CXRs were more frequent in 8F leads (31.4% vs. 6.3%; P < 0.001). Most defects occurred with lead models 1582 (41.2%) and 1580 (31.4%). Mean time since implantation was longer in abnormal leads (6.7 vs. 5.9 years; P < 0.001). Abnormal leads had higher pacing thresholds (1.1 ± 0.8 V vs. 0.9 ± 0.4 V; P = 0.02). CONCLUSION: The incidence of insulation breach in Riata leads is much higher than quoted by the manufacturer or reported by most of the literature. A PA and lateral CXR with zooming appears adequate to identify lead breaches when reviewed by an electrophysiologist. Riata lead breaches without electrical abnormalities present a management dilemma and will require further studies.

Verbal elaboration of distinct affect categories and BPD symptoms.

OBJECTIVES: The present study explores the relationship between the mentalization of distinct affect categories and the severity of borderline personality disorder (BPD) symptoms. Mentalization is assessed by both the level of verbal elaboration (VE) achieved by discrete affects (explicit mentalization) and the proportion of these individual affects in verbal expression (implicit mentalization). DESIGN AND METHODS: Sixty-four outpatients completed a series of questionnaires and took part in an interview designed to produce eight relationship episodes that involved four basic emotions: sadness, joy, anger, and fear (two of each). Affect mentalization was assessed with the Grille de l'Élaboration Verbale de l'Affect (GEVA), an observer-rated measure of levels of elaboration of verbalized affect, and the measure of affect content (MAC), which identifies the content of the verbalized affect (e.g., anger). Diagnostic criteria were obtained with the BPD scale of the Structured Clinical Interview for DSM-IV (SCID-II) questionnaire. Alexithymia was assessed with the 20-item Toronto Alexithymia Scale (TAS-20). RESULTS: The severity of BPD symptoms was related to lower levels of VE of sadness. It was also associated with a higher frequency of hostility directed against others. The level of VE of sadness and the proportion of hostility showed incremental predictive value of borderline symptomatology over demographic information, the presence of a depressive disorder and alexithymia. CONCLUSIONS: These findings point to an association between the severity of BPD symptoms and a difficulty mentalizing specific affective domains largely recognized as being central to borderline pathology, namely sadness and hostility.

Mental states as part of countertransference responses in psychotherapists facing reports of traumatic events of mourning and sexual violence.

The study aims to compare the mental states and countertransference responses of 92 psychodynamically oriented psychotherapists, male and female, experienced and inexperienced, facing written reports of real patients who experienced traumatic events. Two vignettes were presented: one of a sexual violence, the other the sudden death of a significant person. The Mental States Rating System (MSRS; Bouchard, Picard, Audet, Brisson, & Carrier, 1998), the MSRS Self-Report (Goldfeld & Bouchard, 2004), and the Inventory of Countertransference Behavior (ICB; Friedman & Gelso, 2000) were used. Results showed that the mourning vignette led to more reflective responses (MSRS) and the rape case was associated with more negative countertransference reactions (ICB). Female participants were more reflective (MSRS); male therapists used less mentalized states (MSRS Self-Report) and expressed more negative reactions (ICB) for both scenarios. Experienced therapists showed more positive reactions on the ICB. The construct validity of the instruments is discussed in relation to the findings.

Adaptação transcultural do Mental States Rating System para o português brasileiro / Cross-cultural adaptation of the Mental States Rating System to Brazilian Portuguese

INTRODUÇÃO: O artigo apresenta a adaptação transcultural do Mental States Rating System, uma escala de análise de conteúdo do discurso, seja ele falado, descrito ou filmado, que abrange de modo amplo tipos de contratransferência. MÉTODO: Foram realizadas as etapas de equivalência conceitual, equivalência de itens, equivalência semântica, equivalência operacional, equivalência funcional e aprovação da versão final pelo autor original do instrumento. RESULTADOS: Os critérios de equivalência foram satisfeitos, tendo a versão final sido aprovada pelo autor do instrumento original. CONCLUSÃO: A adaptação do Mental States Rating System disponibiliza para uso um instrumento que não só abrange todas as categorias de contratransferência descritas na literatura, mas as amplia, através da Teoria dos Estados Mentais. Constitui, desse modo, uma ferramenta de grande utilidade para pesquisa em psicoterapia e psicanálise, onde a contratransferência tem se mostrado um importante recurso, tornando-se ainda mais crucial nas patologias fundamentadas em estágios precoces do desenvolvimento, nos casos graves e nos traumas severos.

INTRODUCTION: This article presents a cross-cultural adaptation of the Mental States Rating System, a content analysis scale applied to spoken, written or taped material, which covers a wide range of countertransference categories. METHOD: The following steps were performed: conceptual equivalence, item equivalence, semantic equivalence, operational equivalence, functional equivalence, and approval of the final version by the author of the original instrument. RESULTS: The study has reached the objectives of equivalence, and the final Brazilian Portuguese version has been approved by the original author. CONCLUSION: The study provides a Brazilian Portuguese version of an instrument that not only covers all the range of categories encompassed by countertransference described in the literature, but also expands it through the Mental States Theory. This represents a valuable tool for research on psychotherapy and psychoanalysis, where countertransference has proved to be an important resource, especially for the treatment of diseases based on early stages of development, for severe mental diseases and severe trauma.

Assessing verbal elaboration of affect in clinical interviews: exploring sex differences.

Recent interest in the transformative impact of reflective mechanisms on affect regulation has led to a focus on forms of "mentalized affectivity." This article aims at describing a method for assessing affect mentalization as it appears in verbal data. The method will be illustrated by a preliminary exploration of sex differences in the verbal expression of affect in a clinical setting. The Grille de l'Elaboration Verbale des Affects (GEVA) was applied to the transcribed first evaluation interview of 18 female and 18 male patients seeking psychotherapy. Controlling for GAF and language, results reveal that women take more ownership of their affect and are more expressive, verbally and nonverbally, than men, who are more mentally externalizing and use the motor modality more often than women.

Differential diagnosis between borderline personality disorder and organic personality disorder following traumatic brain injury.

Organic personality disorder (OPD) is the traditional diagnostic category used to account for personality disturbances after traumatic brain injury (TBI). The recent use of Axis-II personality disorders, notably borderline personality disorder (BPD), has appeared in the TBI literature as an alternative to OPD. This would presumably offer a better description and understanding of the multiple clinical manifestations of these personality changes and disorders. This article offers a view that it is possible and fruitful to use both diagnoses in a complementary manner. An accurate recognition of the respective phenomenologies of both BPD and OPD is a key factor in achieving a differential diagnosis, including, if required, a dual diagnosis. The phenomenology of both conditions in reference to DSM-IV criteria is compared and illustrated through two clinical vignettes.

Inhibition and object relations in borderline personality traits after traumatic brain injury.

This study aims to assess the nature and severity of borderline traits after traumatic brain injury (TBI). Thirty subjects with moderate or severe TBI were compared to 30 normal controls on the Revised Diagnostic Interview for Borderlines (DIB-R), a dimensional measure of borderline traits, the Go-no go inhibition task, the Complexity of Representations of People and Affect-Tone Relationships Paradigms, two scales from the Social Cognition and Object Relations Scale (SCORS) evaluating the quality of object relations, an estimation of pre-morbid borderline severity, the Beck Depression Inventory (BDI) and various neuropsychological measures. Results indicate that TBIs present more borderline symptoms and traits than controls. However, the severity of borderline symptomatology remains comparatively low for the vast majority. As expected, the TBI group showed a poorer performance on the Go-no go task, a characteristic neuropsychological inhibition deficit. Yet, both samples present similar profiles on the SCORS. Finally, the DIB-R was correlated with the Affect-Tone scale, the BDI and with the pre-morbid severity estimation. Results suggest that post-TBI borderline traits remain rare and relate more to the affective quality of object relations, negative affects and pre-morbid borderline pathology than inhibition deficits.

Analyzing forms of superego functioning as mentalizations.

The concept of mentalization seeks to understand the transformation processes of physical quantity into psychical quality through the emergence, development and organization of mental representations. Often discussed in relation to the functioning of both the id and the ego, it is here proposed that the degree of mentalization also determines the level of functioning and maturity of the hostile, self-punitive superego. Luquet's description of four layers of thought (primary mental representations, metaprimary thinking, metaconscious intuitive thinking, conscious verbal thought) serves as a guide to explore issues of the forms of thinking involved in punitive superego activity. Technical implications are also examined to suggest that three steps can be differentiated in the developing capacity to represent the superego and to become conscious of its workings. The first objective is to help the ego observe its own activity, in the face of a still, unobserved hostile endopsychic agent (Gray, 1994). The second step is to meet the form and intentions of this agent, to facilitate its mental representation and elaboration. Achievement of the final step implies a growing capacity to take some responsibility for this hostile inner agent, once its activity is comparatively more available to self-observation.

Linguistic styles and complementarities in analyzing character.

This paper discusses and illustrates some technical implications of D. Liberman's contributions to character analysis. Psychoanalysis is an extended conversation, and character structure is expressed linguistically as part of an interactive linguistic field. Liberman's notions of linguistic styles and communicative interaction define a unique analytic surface from which to examine the syntactic, semantic and pragmatic aspects of character. The presence of a rigid and defensive linguistic style reflects resistance and communicative impasse within the transference and countertransference matrix. A fully interactive communicative experience integrates all aspects of the conversation and allows both participants to take part in a shared semantic field, the precondition to the generation of new meanings. Liberman suggests responding to miscommunication by means of a methodical linguistic attitude. Various such complementary responses are explored through several vignettes, with a particular focus on the interplay of the epic and narrative modes.

Configuraçäo adaptativa e o nível de maturidade dos mecanismos de defesa / Adaptative configuration and maturity level of defense mechanisms

Dentre os recursos que o Ego possui para garantir a estabilidade adaptativa, destacam-se os mecanismos de defesa. Este conceito teórico inspirou a presente pesquisa, que procurou determinar as relaçöes entre uma medida da configuraçäo adaptativa de sujeitos que buscavam psicoterapia psicanalítica e os níveis de maturidade dos mecanismos de defesa. Duas escalas, desenvolvidas a partir da experiência clínica, foram utilizadas: Escala Diagnóstica Adaptativa Operacionalizada - EDAO e Defense Mechanisms Rating Scales - DMRS. De um total de 36 sujeitos, previamente avaliados com a EDAO, seleciou-se 20 apresentando adaptaçäo estável. 10 eram adaptados näo eficaz moderados e 10 näo eficaz severos. Quando se considerou as defesas em funçäo do nível de maturidade, verificou-se que os dois grupos se diferenciavam em funçäo do emprego das defesas dos níveis extremos de maturidade. Os níveis intermediários näo se mostraram discriminativos. Correlaçöes significantes foram observadas entre os escores globais das duas escalas

Adaptaçäo e nível de patologia / Adaptation and level of patology

Examina a pressuposiçäo segundo a qual é possível encontrar uma correspondência entre uma classificaçäo nosológica ampla e a eficácia da adaptaçäo. Os Ss. eram pacientes ambulatoriais que buscavam psicoterapia, que completaram o Millon Clinical Multiaxial Inventory - I (MCMI-I), e foram avaliados com a Global Assessment Scale (GAS) por seus entrevistadores. Baseados nas transcriçöes da primeira entrevista, dois juízes os avaliaram de acordo com a Escala Diagnóstica Adaptativa Operacionalizada (EDAO). Os resultados mostram que: 1) a GAS e a EDAO podem ser usadas na determinaçäo da severidade da patologia; 2) sujeitos apresentando patologia mais severa, de acordo com o MCMI-I, efetivamente apresentam adaptaçäo näo eficaz severa, mas patologia moderada näo necessariamente está associada à adaptaçäo moderada

Adaptacao e nivel da patologia

Examina a pressuposicao segundo a qual e possivel encontrar uma correspondencia entre uma classificacao nosologica ampla e a eficacia da adaptacao. Os Ss. eram pacientes ambulatoriais que buscavam psicoterapia, que completaram o Milton Clinical Multiaxial Inventory - 1 (MCMI-I), e foram avaliados com a Global Assessment Scale (GAS) por seus entrevistadores. Baseados nas transcricoes da primeira entrevista, dois juizes os avaliaram de acordo com a Escola Diagnostica Adaptativa operacionalizada (EDAO). Os resultados mostram que : 1. a GAS e a EDAO podem ser usadas na determinacao da severidade da patologia; 2. sujeitos apresentando patologia mais severa, de acordo com o MCMI-I, efetivamente apresentam adaptacao nao eficaz severa, mas patologia moderada nao necessariamente esta associada a adaptacao moderada.

Configuracao adaptativa e o nivel de maturidade dos mecanismos de defesa

Dentre os recursos que o Ego possui para garantir a estabilidade adaptativa, destacam-se os mecanismos de defesa. Este conceito teorico inspirou a presente pesquisa, que procurou determinar as relacoes entre uma medida da configuracao adaptativa de sujeitos que buscavam psicoterapia psicanalitica e os niveis de maturidade dos mecanismos de defesa. Duas escalas, desenvolvidas a partir da experiencia clinica, foram utilizadas: Escala Diagnostica Adaptativa Operacionalizada - EDAO e Defense Mechanisms Rating Scales - DMRS. De um total de 36 sujeitos, previamente avaliados com a EDAO, selecionou-se 20 apresentando adaptacao estavel. 10 eram adaptados nao eficaz moderados e 10 nao eficaz severos. Quando se considerou as defesas em funcao do nivel de maturidade, verificou-se que os dois grupos se diferenciavam em funcao do emprego das defesas dos niveis extremos de maturidade. Os niveis intermediarios nao se mostraram discriminativos. Correlacoes significantes foram observadas entre os escores globais das duas escalas.