ABSTRACT
As evolutionary models for single-nucleotide polymorphisms (SNPs) become available, methods for using them in the context of evolutionary information and expert prior information is a necessity. We formulate a probability model for SNPs as a Bayesian inference problem. Using this framework we compare the individual and combined predictive ability of four evolutionary models of varying levels of specificity on three SNP databases (two specifically targeted at functional SNPs) by calculating posterior probabilities and generating Receiver Operating Characteristic (ROC) curves. We discover that none of the models do exceptionally well, in some cases no better than a random-guess model. However, we demonstrate that several properties of the Bayesian formulation improve the predictability of SNPs in the three databases, specifically the ability to utilize mixtures of evolutionary models and a prior based on the genetic code.
Subject(s)
Evolution, Molecular , Mutation , Polymorphism, Single Nucleotide/genetics , Bayes Theorem , Likelihood Functions , Models, Genetic , Models, Statistical , Probability , Reproducibility of ResultsABSTRACT
An examination of the nightmares of four adults in analysis who had been sexually abused as children revealed a characteristic distortion of the body representation as it appeared in the manifest content of the dream. The authors believe that childhood sexual trauma has profound and pervasive effects on the development and consolidation of the body image. Experienced as a grave assault on body integrity and function, it mobilizes primitive anxieties and specific genital anxieties, resulting in distortion, fragmentation, or disintegration of the body representation. The frequently observed multiple somatization of victims of sexual abuse is attributable to such a damaged and persecutory body representation.
Subject(s)
Child Abuse, Sexual/psychology , Dreams , Personality Development , Psychoanalytic Interpretation , Psychoanalytic Therapy , Adolescent , Adult , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Child , Child Abuse, Sexual/therapy , Child of Impaired Parents/psychology , Child, Preschool , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Humans , Psychosexual DevelopmentABSTRACT
In this paper we argue that a candidate's reporting of her countertransference dream (CTD) in supervision, and its subsequent discussion, had two consequences. Firstly, it enabled the candidate to find her way out of an acute therapeutic impasse with her patient. Secondly, it provided important experimental and cognitive learning for the candidate, especially in the area of countertransference management and in the maintenance of her analytic work ego. This successful use of her CTD allowed her to enhance her self-analytical skills, with particular reference to her ability to monitor her own affective responses, and subsequent interpretive formulations, to her patient's contributions to the on-going transference-countertransference dynamic. Our findings concur with those of other authors who suggest that CTDs occur at conflict-laden times in analysis. In addition, we postulate a link between the parallelism phenomenon and CTDs as adaptive responses to internal and external challenges in the context of control analyses and supervision.
Subject(s)
Countertransference , Dreams , Psychoanalytic Interpretation , Psychoanalytic Therapy/education , Adult , Defense Mechanisms , Female , Humans , Psychoanalytic Theory , Transference, PsychologyABSTRACT
OBJECTIVE: To determine the effect of adjuvant psychological therapy on the quality of life of patients with cancer. DESIGN: Prospective randomised controlled trial comparing the quality of life of patients receiving psychological therapy with that of patients receiving no therapy, measured before therapy, at eight weeks, and at four months of follow up. SETTING: CRC Psychological Medicine Group of Royal Marsden Hospital. PATIENTS: 174 patients aged 18-74 attending hospital with a confirmed diagnosis of malignant disease, a life expectancy of at least 12 months, or scores on various measures of psychological morbidity above previously defined cut off points. INTERVENTION: Adjuvant psychological therapy, a brief, problem focused, cognitive-behavioural treatment programme specifically designed for the needs of individual cancer patients. MAIN OUTCOME MEASURES: Hospital anxiety and depression scale, mental adjustment to cancer scale, Rotterdam symptom checklist, psychosocial adjustment to illness scale. RESULTS: 156 (90%) patients completed the eight week trial; follow up data at four months were obtained for 137 patients (79%). At eight weeks, patients receiving therapy had significantly higher scores than control patients on fighting spirit and significantly lower scores on helplessness, anxious preoccupation, and fatalism; anxiety; psychological symptoms; and on orientation towards health care. These differences indicated improvement in each case. At four months, patients receiving therapy had significantly lower scores than controls on anxiety; psychological symptoms; and psychological distress. Clinically, the proportion of severely anxious patients dropped from 46% at baseline to 20% at eight weeks and 20% at four months in the therapy group and from 48% to 41% and to 43% respectively among controls. The proportion of patients with depression was 40% at baseline, 13% at eight weeks, and 18% at four months in the therapy group and 30%, 29%, and 23% respectively in controls. CONCLUSIONS: Adjuvant psychological therapy produces significant improvement in various measures of psychological distress among cancer patients. The effect of therapy observed at eight weeks persists in some but not all measures at four month follow up.
Subject(s)
Mental Disorders/etiology , Mental Disorders/therapy , Neoplasms/psychology , Psychotherapy , Adolescent , Adult , Aged , Anxiety/therapy , Attitude to Health , Depression/therapy , Female , Humans , Male , Middle Aged , Neoplasms/rehabilitation , Prospective Studies , Quality of LifeABSTRACT
This paper deals with patients who attempt suicide, focusing on their evaluation in the emergency room. It is suggested that as the actual risk of completed suicide in suicide attempters is low, the evaluating psychiatrist might preferentially focus on assessing the patient's motivation for self-destructive behaviour. Recent studies are reviewed which demonstrate a linkage between self-destructive acts and the status of relationships with significant others. An illustrative case history is presented.
Subject(s)
Emergency Services, Psychiatric , Mental Health Services , Motivation , Suicide, Attempted/psychology , Adult , Female , Humans , Patient Admission , Risk , Suicide PreventionABSTRACT
In this second part of a review of the psychoanalytic theory of depression the major themes of the theory, as they appear in the works of the major contributors, are discussed. It is difficult to approach the complexities and ambiguities of psychoanalytic theory in general, and the theory of depression in particular, without an historical perspective. Accordingly, the author decided to group the major themes of the theory under three headings: Instinct Theory, Structural Theory, Object Relations Theory. The themes included under Instinct Theory are constitutional factors, aggression and orality. Under the heading of Structural Theory those themes associated with the ego, with the concepts of narcissism and the self, and finally those associated with the superego are discussed. It is of note that under narcissism the work of both Kohut and Kernberg is considered, including its relevance to any investigation of depression. The concepts of object loss and object failure are discussed under the heading of Object Relations Theory. It is suggested that a psychoanalytic approach has much to offer both the clinician and the researcher in their attempts to develop a comprehensive theory to explain the protean manifestations of human depression.
Subject(s)
Depression/psychology , Psychoanalytic Theory , Aggression/psychology , Ego , Freudian Theory , Humans , Instinct , Narcissism , Object Attachment , Oral Stage , SuperegoABSTRACT
This article is the first of a two part review of the psychoanalytic theory of depression. In this first part of the review the work of the major contributors to the psychoanalytic theory of depression is discussed. The writings of Abraham, Freud, Rado, Klein, Jacobson, Benedek, Bibring, Spitz, Sandler and Bowlby, among other, are presented and critically reviewed by the author. The work of these authors has been selected for this review because they have made the most seminal contributions to the development of the psychoanalytic theory of depression. Necessarily those authors whose contributions have been largely clinical have not been included, the major focus of this review being theoretical. In reviewing the writings of the major contributions the major themes in the theory of depression can be discussed. These themes will form the subject of the next paper in this review.
Subject(s)
Depression/psychology , Psychoanalytic Theory , Adjustment Disorders/psychology , Adolescent , Adult , Affective Disorders, Psychotic/psychology , Aggression/psychology , Bipolar Disorder/psychology , Child , Child, Preschool , Conflict, Psychological , Defense Mechanisms , Depression/etiology , Ego , Freudian Theory , Humans , Infant , Maternal Deprivation , Mother-Child Relations , Object Attachment , Personality DevelopmentABSTRACT
Sex sterotypes, clinical observations, and psychoanalytic theory of sex differences are presented. Stereotypes show differences in areas of inhibition and clinical observations, differences related to the phallic and genital phases in psychosexual development. Divergent analytical views on the sexual development of boys and girls are discussed.
Subject(s)
Psychoanalytic Theory , Psychoanalytic Therapy , Female , Gender Identity , Hostility , Humans , Inhibition, Psychological , Love , Male , Professional-Patient Relations , Psychosexual Development , Sex Factors , Transference, PsychologyABSTRACT
We report two cases of self-enucleation and the case histories of the two schizophrenic men who carried out this drastic form of self-mutilation. In a review of the literature and consideration of the case material, it is concluded that castration fears, failure to resolve oedipal conflicts, repressed homosexual impulses, severe guilt, and self-punishment are ubiquitous phenomena in such cases. However, we conclude that psychosis, most probably schizophrenia, with a severe disturbance in body image, are necessary variables in the act of self-enucleation.
