Functional hypothalamic amenorrhoea: leptin treatment, dietary intervention and counselling as alternatives to traditional practice - systematic review.

Functional hypothalamic amenorrhoea (FHA) is a neuroendocrine disorder caused by an energy deficit and characterized by low leptin levels. Based on this, previous studies have suggested that leptin administration may play a crucial role in FHA treatment. However, FHA is also associated with abnormal psychosocial and dietary behaviour that needs to be addressed. In this context, this systematic review examined the efficacy of leptin treatment, non-pharmacological therapy and nutritional interventions in FHA. PubMed, Medline and Cochrane Library databases were searched in order to find relevant papers, including randomized controlled trials, clinical trials, prospective studies and case reports. The effects of different treatments on reproductive function, hormonal status and bone markers were recorded. Studies regarding other forms of treatment were excluded. In total, 111 papers were retrieved. After the removal of 29 duplicate papers, the abstracts and titles of 82 papers were examined. Subsequently, 53 papers were excluded based on title, and seven papers were omitted based on abstract. The remaining 11 papers were used: three based on leptin treatment, three regarding non-pharmacological treatment and five regarding dietary intervention. This literature review indicates that all of these treatment strategies improved reproductive function and hormonal status significantly, although conclusive results could not be drawn on bone markers. While leptin may be a promising new treatment, social aspects of FHA should also be addressed. As a result, a multifaceted therapeutic approach should be applied to treat affected women.

Of God and Psychotherapy.

Psychotherapy is an instrument for remediation of psychological deficits and conflict resolution, as well as an instrument for growth and self-cultivation. In fact, psychotherapy is the finest form of life education. All of this is done without psychotherapists' playing a teacher, a minister, a priest, a rabbi, an imam, or a Buddhist monk, but by being familiar with what they know and more. That "more" is about understanding "the attributes" of gods and religions as they serve the all-too-human needs of believing and belonging. It is about the distillation of common psychological, sociological, moral, and philosophical attributes of religions, and the recognition that the attributes themselves are faith and God. Attributes that serve the affiliative needs define faith, for example, belonging is faith; attributes that serve the divine needs define God, for example, compassion is God. Those who have recovered from their primitive innocence need to formulate their ideas of God and religion, regardless of their affiliation with a religious community. One may need to resonate emotionally with the God of his or her religion, but intellectually need to transcend all its dogma and cultivate a personal concept of divinity free from any theological structure. Such an enlightened person achieves enduring equanimity by striving to own the attributes of Gods--to be godly. This is equally true for psychotherapists as it is for their patients.

The role of sex steroid hormones, cytokines and the endocannabinoid system in female fertility.

BACKGROUND: Marijuana, the most used recreational drug, has been shown to have adverse effects on human reproduction. Endogenous cannabinoids (also called endocannabinoids) bind to the same receptors as those of Δ(9)-tetrahydrocannabinol (THC), the psychoactive component of Cannabis sativa. The most extensively studied endocannabinoids are anandamide (N-arachidonoylethanolamine, AEA) and 2-arachidonoylglycerol. The endocannabinoids, their congeners and the cannabinoid receptors, together with the metabolic enzymes and putative transporters form the endocannabinoid system (ECS). In this review, we summarize current knowledge about the relationships of ECS, sex steroid hormones and cytokines in female fertility, and underline the importance of this endocannabinoid-hormone-cytokine network. METHODS: Pubmed and the Web of Science databases were searched for studies published since 1985, looking into the ECS, sex hormones, type-1/2 T-helper (Th1/Th2) cytokines, leukaemia inhibitory factor, leptin and reproduction. RESULTS: The ECS plays a pivotal role in human reproduction. The enzymes involved in the synthesis and degradation of endocannabinoids normalize levels of AEA for successful implantation. The AEA degrading enzyme (fatty acid amide hydrolase) activity as well as AEA content in blood may potentially be used for the monitoring of early pregnancies. Progesterone and oestrogen are involved in the maintenance of endocannabinoid levels. The ECS plays an important role in the immune regulation of human fertility. CONCLUSIONS: The available studies suggest that tight control of the endocannabinoid-hormone-cytokine network is required for successful implantation and early pregnancy maintenance. This hormone-cytokine network is a key element at the maternal-foetal interface, and any defect in such a network may result in foetal loss.

The advanced practice of psychotherapy.

The advanced practice of psychotherapy involves deconstructing and transcending separate schools in the search for universal healing processes. Knowledge from major psychotherapeutic schools over the last 100 years, as well as ancient teachings over the last 5000 years, is distilled in the training and formation of the psychotherapist. Five major elements of training (theory, technique, the patient, the therapist, and the patient/therapist relationship), as well as one element in the therapist's formation (the person), are presented. To be a true healer, the clinician must cultivate his or her soul and spirit. Only then can the therapist guide the patient to reach his or her authentic self.

Spiritual psychotherapy.

The author proposes the practice of spiritual psychotherapy, which transcends but does not preclude traditional modalities or strategies of treatment. The terms soul and spirit are distinguished as different transpersonal abstractions, yet are inextricably linked. The former aims at revealing the mystery of relatedness and intimacy in everyday life, the latter at finding the divine in universal life. For the spiritual therapist, these concepts are applied to a therapeutic context of care and compassion--which means love and belief beyond oneself. More specifically, the way to soulfulness requires Love of Others, Love of Work, and Love of Belonging, whereas the way to spirituality requires Belief in the Sacred, Belief in Unity, and Belief in Transformation. By cultivating a soulful and spiritual existence, thus conducting one's clinical practice on the basis of these six tenets of transcendence, the therapist can guide the patient to reach his or her own authentic self.

Academic psychiatry and managed care: a case study.

An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.

Gender differences in recalled parental childrearing behaviors and adult self-esteem.

A retrospective questionnaire study investigated gender differences in the relations between the self-reported self-esteem of 155 psychiatric adult outpatients and their recalled experience of their parents' behavior toward them as children. There were no significant sex differences in degree of self-esteem. However, it had a higher correlation to parenting variables for the men than for the women, with maternal predictor variables accounting for 36% and paternal predictors accounting for 32% of the variance in the men's self-esteem. Neither combined maternal nor combined paternal variables were significant predictors for women. For men, parental acceptance/ autonomy was significantly and positively related and inconsistency negatively related to self-esteem. Paternal rejection but not maternal rejection was significantly associated with low self-esteem only for the women. The greater amount of variance explained by childrearing variables in the men's self-esteem scores was attributed to the earlier ego development and consequent increased individuation in women.

The psychological mindedness scale : factor structure and relationship to outcome of psychotherapy.

Two studies are reported. The first examined the factor structure of the Psychological Mindedness (PM) Scale, and the second reassessed the scale's predictive validity. A principal components analysis (varimax rotation) of the data of 256 psychiatric outpatients produced five factors that accounted for 38% of the variance. A tentative definition of PM based on these factors is proposed. For a subsample of 116 patients who attended at least four psychotherapy sessions, PM was unrelated to levels of functioning and psychosocial symptoms at admission and was positively associated with number of sessions attended, consistent with findings of a preliminary investigation. Not replicated were significant correlations between PM and outcome measures derived from therapists' and an independent rater's evaluations. Initially high PM was significantly related to patients' self-ratings of symptoms and problems after discharge.

Transtheoretical practice of psychotherapy.

A developmental model forms the framework for the transtheoretical practice of psychotherapy. Major preoedipal and oedipal events, interfaced with significant two-person (mother-child) and three-person (father-mother-child) influences--dyadic deficit, dyadic conflict, triadic deficit, triadic conflict--are instrumental in the formation of different relationship patterns in treatment that transcend classical versus selfobject transferences. Therapeutic as well as countertherapeutic stances and strategies are elucidated.

Relationships between psychological mindedness and personality traits and ego functioning: validity studies.

Two studies further investigated the psychometric properties of the self-report Psychological Mindedness Scale (PMS), which has been shown to have good internal consistency and evidence of predictive and divergent validity. Its construct validity was investigated by assessing (1) whether total scores on the PMS of a group of medical students attending a personnel clinic in a psychiatric outpatient setting would be related in theoretically expected ways to their scores on a personality test; and (2) whether total scores on the PMS of a group of regular clinic patients would have the expected theoretical relationships to scores on a measure of ego functions. The findings of both studies provided support for the construct validity of the PMS.

Determinants of outpatients' satisfaction with therapists : relation to outcome.

This study investigated outpatients' satisfaction with therapists, as determined by their perceptions of therapists' behaviors and characteristics, and related patient satisfaction to measures of psychotherapy outcome derived from patients themselves, therapists, and an independent rater. After discharge, 138 demographically and diagnostically heterogeneous patients who had been in psychodynamically oriented psychotherapy returned mailed questionnaires. Therapist characteristics and behaviors such as being likeable, accepting, encouraging, and respectful, helping patients to understand themselves better, and not being "too quiet," as well as overall ratings of satisfaction with therapists, were significantly correlated with patients' ratings of improvement and of help received and with therapists' ratings of outcome.

Critical incidents in psychotherapy.

The critical-incident technique was used to obtain a list of patient behaviors that create special difficulties for the psychotherapist. The list was prepared by a group of seven clinicians during a series of meetings. Included in the list were such items as: insulting the therapist; coming late to the session; threatening suicide; and offering gifts. The list was given to 21 experienced psychiatrists who were asked to rate both the importance and the frequency of occurrence of each incident in their experience. The critical incidents could be divided into five major categories: threat of harm from the patient; criticism of the therapist or the therapy; occurrence of a major life crisis; attempts by the patient to seek friendship or seduction, and miscellaneous incidents, such as being consistently late. When ratings by the experienced psychiatrists were compared with those of 10 third-year psychiatric residents, it was found that the inexperienced psychiatrists in almost every case rated the incident as less important and more frequent than did the experienced clinicians. In terms of implications, knowledge of critical incidents in psychotherapy may provide a source of material for training purposes, may enable the development of modeling procedures for training in communication skills, and may encourage supervisors to focus attention on important therapeutic issues.

A developmental metatheory of psychopathology.

The author proposes an integrative model of psychopathology in light of the contemporary need to bridge diverse ideological frameworks. This model has its major foundations in drive, ego, object relations, and self psychoanalytic perspectives as they impact upon interactional patterns of infancy. The chronology of these theoretical orientations is presented as parallel to a changing focus upon different successive stages in the course of individual development. The longstanding controversy between conflict and deficit theories, which undergirds the various schools of thought, is addressed: a developmental orientation is offered as the overriding conceptual connection between them. Conflict and deficit phenomena are regarded as intertwined and not incompatible: Unconscious drives, desires and wishes, ego defenses, and compromise formations as well as object relationship deficiencies and structural voids and defects in the self are combined to encompass a broad spectrum of psychopathology and its sources: the above intrapsychic and interpersonal factors are interfaced with significant reciprocal dyadic (mother/child) and triadic (father/mother/child) influences upon ongoing maturational processes. For heuristic purposes, a fourfold matrix--dyadic deficit, dyadic conflict, triadic deficit, and triadic conflict--is delineated. Clinical characteristics and developmental precursors of each of the four prototypes, especially with regard to early relational events, are examined.

Strategies of therapist interventions : a preliminary empirical study.

Forty-one categories of patient communications just before therapist interventions were identified from a review of psychotherapy transcripts. For each communication type, a set of possible therapist interventions was constructed. Descriptions of these interactions were sent in the form of a questionnaire to 350 experienced clinicians, who were asked to indicate their degree of agreement with each possible response. Ratings from the 141 responding clinicians showed little relation to age, gender, experience level, or orientation but showed marked differences for different response alternatives. A separate group of seven experienced clinicians used these data to develop a new categorization of 15 types of therapist interventions and 5 types of patient communications. A tentative information-processing model of patient-therapist communications is proposed.