Effectiveness of nanofiltration in removing small non-enveloped viruses from three different plasma-derived products.

The objective of this study was to assess the ability of nanofiltration of albumin solution, prothrombin complex (PTC) and factor IX (FIX) to remove two small, non-enveloped DNA viruses, parvovirus B19 (B19V) and torque teno virus (TTV). Virus removal was investigated with down-scale experiments performed with sequential steps of 35-nm and 15-nm nanofiltrations of products spiked with virus DNA-positive sera. Viral loads were determined by real-time PCRs. The 15-nm nanofiltration removed more than 4.0 B19V log from all the products, TTV was reduced of more than 3.0 log from albumin solution and FIX by 35-nm and 15-nm nanofiltrations, respectively, being viral DNA undetectable after these treatments. Traces of TTV were still found in PTC after the 15-nm nanofiltration. In conclusion, nanofiltration can be efficacious in removing small naked viruses but, since viruses with similar features can differently respond to the treatment, a careful monitoring of large-scale nanofiltration should be performed.

Dangerous transitions and the traumatized adolescent.

One of the developmental tasks for the adolescent is to construct a new transitional space that leads to internal changes and adapts to the external world. When a nurturing matrix is unavailable, adolescents experience the entrance into the adult world as a dangerous transition. The author bases his arguments on psychoanalytic theories, mostly Winnicott's, and illustrates these with clinical material. He suggests that, even though these traumatized adolescents experienced nonfunctional transitional spaces, it is proven that they could be treated psychoanalytically. Here, the main task of the analyst is to establish a holding environment as a type of transference, resulting in less emphasis on interpretation of inner conflicts.

Schizophrenia and oxymorons.

From the viewpoint of character structure, patients with schizophrenia can be seen as the diametric opposite of persons with a nonpsychotic organization. They construct adaptations and defenses to deal with an externalized primitive mental orientation, whereas nonpsychotic persons tend to develop defensive mechanisms to render these primitive parts inactive. Patients with schizophrenia do not have a continuum between primary process id levels and secondary process reality operations. Thus polarities are not differentiated, leading to a series of paradoxes and oxymorons. These patients may view themselves as omnipotent and grandiose, yet at the same time lead a miserable, drab existence. Primitive parts of the personality may feel alive and powerful, whereas the ego is viewed as dead--the fundamental oxymoron of the living dead. The author presents several illustrative case vignettes of these features.

Treatment issues with borderline patients and the psychosomatic focus.

I have discussed a group of borderline patients who can be conceptualized as having defects in character structure. There is no smooth, hierarchically arranged continuum from lower id-oriented to higher ego, secondary-process organized psychic levels. They suffer from psychic discontinuity, characterized by psychic lacunae, empty spaces devoid of psychological content. These lacunae are often the locus of somatic disruptions, a psychosomatic focus, which are manifested as psychosomatic symptoms. Though the treatment of these patients can be stormy, and, in some instances impossible, providing a setting in which these patients can comfortably regress and eventually get in touch with split-off parts of the self can lead to a manageable therapeutic interaction. On occasion, this might be life-saving.

The creative person as maverick.

The innate talents that are the essence of creativity are associated with a particular type of character structure. The child's creative potential has to be supported by the infantile milieu, which also happens to have a characteristic stamp. Within this context of personality configurations and developmental antecedents associated with creative ability, there can be considerable variation. I am not postulating a specific or stereotypic creative character. There are, however, certain qualities that can be found in various character types (and can even exist alongside psychopathology) that are often found in creative scientists and perhaps artists as well. I believe the maverick often possesses these character traits and many of the scientists I have had the opportunity of treating proudly considered themselves mavericks. The creative personality is characterized by paradoxes; these cast it in the maverick mold. Possessors of this personality belong and do not belong. They do not break the rules but bend them a little. They are nonconformists but not rebels. They display many features that do not seem to belong together. The paradoxical qualities that dominate the creator's personality and behavior are the outcome of a certain fluidity of character and ego boundaries. The creative process involves a broad range of functioning and traverses various levels of the psyche, frequently reaching down to the very earliest, primary-process-oriented parts of the self. Ego boundaries, in turn, can become quite fluid and permeable, even though they are ordinarily firmly established and well structured. It is this broad spectrum, a prominent feature of the creative process (Giovacchini, 1965, 1971, 1981), that has been often confused with psychopathology. These paradoxical elements are the outcome of an infantile environment that has provided considerable gratification. Again the early milieu of creative personalities may be extremely varied, but there has always been some person or persons who have had a considerable emotional investment in the child. As the developing psyche incorporates and introjects these gratifying and security-establishing experiences, they become amalgamated into the self-representation. In the face of adversity, they provide confidence and reassurance and allow the creator to soothe him- or herself when upset by inner tension. Consequently, creative scientists do not depend so much on the outer world as they do on inner resources. One scientist told me that he could not understand how anyone could ever be bored. Even if he were denied access to his work, he could always find something interesting to do or explore.(ABSTRACT TRUNCATED AT 400 WORDS)

Erotism and chaos.

There is a continuum from primitive, undifferentiated feelings that are simply the manifestations of homeostatic balance and imbalance to highly differentiated, pleasurable erotic feelings that characterize mature, intimate love relationships. Sensory reactions are elevated from simple reflex levels to highly complex, sophisticated affects that involve wide areas of the psyche. Thus, affects are associated with integration and organized psychic structure. Consequently they may function in various ways. Freud developed a continuum for anxiety as initially functioning as a conversion reaction enabling sexual feelings that cannot reach mentational levels or be consummated in erotic activity to be discharged. It reaches a final level of organization where it serves as a signal calling various defenses into play as emerging instinctual impulses threaten to upset psychodynamic equilibrium. I have focused on how affects, erotic feelings in particular, have an organizing function that binds a primitive inner agitation that occurs during what is called a prementational stage of the neonatal period. This is a stage that precedes psychological processes. Sexual feelings are generated as an attempt to bind inner chaos that stems from an amorphous, inchoate psychic state. Erotic feelings are experienced in order to smoothe inner tension. The patient tries but seldom achieves calm because the affective binding and structuralizing process, in itself, becomes painful and disruptive. I present several clinical incidents and also refer to so-called treatment relationships where the therapist absorbs the patient's chaos and then acts out sexually which leads to a total breakdown of the therapeutic setting.

The psychoanalytic paradox: the self as a transitional object.

I have focused upon a group of patients whose biological needs for nurture and comfort were adequately met but whose mothers never related to them beyond simple caretaking. They never smiled at their children inasmuch as they derived no pleasure from playing with them or in their emerging sense of aliveness. From both the analyses of mothers and these patients, it appears that the mothers used their children as transitional objects. In turn, the children's emotional development became fixated in the in-between transition space. This fixation led to specific types of character structure and ego defects. Early development levels did not form a smooth continuum with higher later acquired adaptive ego states. There seem to be extensive lacunae in the middle layers of the psychic apparatus which manifested themselves as defective modulating elements. These patients showed extremes of behavior, marked polarities of sane, sensitive rationality to psychoticlike irrational episodes. There were no transitional gray areas between black and white. They exhibited a peculiar kind of fragmentation or splitting in which connecting bridges between higher and lower levels were missing. There are many such patients who seek treatment. However, they present special problems in therapy which can be explained in terms of the psychoanalytic paradox. The psychoanalytic paradox refers to a treatment impasse caused by an imbrication of psychopathology and various attributes of the psychoanalytic method. The mother's attitude toward her infant child has some similarity to the low-keyed objective analytic attitude, what has been sometimes referred to as analytic neutrality. These patients require different modes of relating which indicate that the therapist is, unlike the mother, very much concerned with their patient's developing autonomy and their entering and exploring the external world. These variations of analysis are not modifications or deviations of analysis. They are elements of the analytic process necessary for the treatment of specific types of psychopathology. Just as each patient is unique and the transference manifests itself in a particular fashion which then causes the analyst to make certain interpretations, the variations of technique discussed in this article address themselves to the construction of a holding environment appropriate for this group of patients.

The analytic introject and ego development.

A discussion of "Introjection and the Idealizing Transference" by Theodore L. Dorpat, M.D. Ego defects during analysis can be converted into defensive adaptations and then become legitimate analytic material. Two clinical vignettes of patients suffering from an inability to maintain mental representations without reinforcement from external percepts are presented. These patients suffered from an inability to internalize experiences with the outer world and external objects. The resulting ego impoverishment was experienced as tormenting feelings of inadequacy and helpless vulnerability. In treatment, these feelings caused the analyst to feel the same hopelessness the patient did. The analyst, once he regained the analytic composure to view all of the patient's productions in terms of their transference potential and adaptive significance, became a synthesizing force. His presence, in essence, held the patient together. The patient gradually was enable to internalize the analyst as a unifying modality and form an analytic introject. The formation of analytic introject is the outcome of specific clinical interactions. The author discusses the interplay of counter-transference frustration and structuralizing interpretations, even what might be considered wrong interpretations, and stresses the various factors during treatment involved in the acquisition of psychic structure in a particular clinical context.