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American Journal of Psychoanalysis Mar 2023Courage requires us to persist and persevere despite fear. We make choices everyday-some are courageous, and some are not courageous at all. This dimension of...
Courage requires us to persist and persevere despite fear. We make choices everyday-some are courageous, and some are not courageous at all. This dimension of psychoanalytic work is significant, yet relatively neglected in the psychoanalytic literature. Maintaining a courageous stance as an analyst can be challenging and threatening. Often, the therapist faces deeply rooted fears about abandonment, envy, competition, anger, or other forms of intense emotional arousal. This requires us to confront ourselves but also, at times, confront our patient's behaviors. It is crucial to think and act independently, and deal with their disapproval and opposition, despite the risks challenging patients present. Ultimately, we need to manage our vulnerable feelings while remaining authentic, rather than hiding behind an overly clinical stance. The author presents two patients who required and inspired the courage to face her own anxieties, ultimately contributing to the treatments' progress.
Topics: Female; Humans; Countertransference; Psychoanalytic Therapy; Emotions; Fear
PubMed: 36792690
DOI: 10.1057/s11231-023-09392-z -
World Journal of Otorhinolaryngology -... Mar 2018Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their...
Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.
PubMed: 30035257
DOI: 10.1016/j.wjorl.2018.03.001 -
Journal of Behavior Therapy and... Sep 2016Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and...
BACKGROUND AND OBJECTIVES
Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and uncertainty is a reduced accessibility of meaning ('semantic satiation').
METHODS
OCD patients (n = 24) and matched non-clinical controls (n = 24) repeated words 2 (non-perseveration) or 20 times (perseveration). They decided whether this word was related to another target word. Speed of relatedness judgments and feelings of dissociative uncertainty were measured. The effects of real-life perseveration on dissociative uncertainty were tested in a smaller subsample of the OCD group (n = 9).
RESULTS
Speed of relatedness judgments was not affected by perseveration. However, both groups reported more dissociative uncertainty after perseveration compared to non-perseveration, which was higher in OCD patients. Patients reported more dissociative uncertainty after 'clinical' perseveration compared to non-perseveration..
LIMITATIONS
Both parts of this study are limited by some methodological issues and a small sample size.
CONCLUSIONS
Although the mechanism behind 'perseveration → uncertainty' is still unclear, results suggest that the effects of perseveration are counterproductive.
Topics: Adult; Case-Control Studies; Dissociative Disorders; Female; Humans; Male; Obsessive-Compulsive Disorder; Uncertainty; Young Adult
PubMed: 26901818
DOI: 10.1016/j.jbtep.2016.02.001 -
Brain and Behavior Jul 2021Behavioral and cognitive changes can be observed across all Huntington disease (HD) stages. Our multicenter and retrospective study investigated the association between...
INTRODUCTION
Behavioral and cognitive changes can be observed across all Huntington disease (HD) stages. Our multicenter and retrospective study investigated the association between cognitive and behavioral scale scores in manifest HD, at three different yearly timepoints.
METHODS
We analyzed cognitive and behavioral domains by the Unified Huntington's Disease Rating Scale (UHDRS) and by the Problem Behaviors Assessment Short Form (PBA-s), at three different yearly times of life (t0 or baseline, t1 after one year, t2 after two years), in 97 patients with manifest HD (mean age 48.62 ± 13.1), from three ENROLL-HD Centers. In order to test the disease progression, we also examined patients' motor and functional changes by the UHDRS, overtime.
RESULTS
The severity of apathy and of perseveration/obsession was associated with the severity of the cognitive decline (p < .0001), regardless of the yearly timepoint. The score of irritability significantly and positively correlated with perseveration errors in the verbal fluency test at t0 (r = .34; p = .001), while the psychosis significantly and negatively correlated with the information processing speed at t0 (r = -.21; p = .038) and significantly and positively correlated with perseveration errors in the verbal fluency test at t1 (r = .35; p < .0001). The disease progression was confirmed by the significant worsening of the UHDRS-Total Motor Score (TMS) and of the UHDRS-Total Functional Capacity (TFC) scale score after two-year follow-up (p < .0001).
CONCLUSION
Although the progression of abnormal behavioral manifestations cannot be predicted in HD, the severity of apathy and perseveration/obsessions are significantly associated with the severity of the cognitive function impairment, thus contributing, together, to the disease development and to patients' loss of independence, in addition to the neurological manifestations. This cognitive-behavior pattern determines a common underlying deficit depending on a dysexecutive syndrome.
Topics: Adult; Cognition; Cross-Sectional Studies; Humans; Huntington Disease; Middle Aged; Problem Behavior; Retrospective Studies; Severity of Illness Index
PubMed: 34110097
DOI: 10.1002/brb3.2151 -
The Journal of Physician Assistant... Dec 2022The COVID-19 pandemic has disrupted almost every aspect of life globally, with higher education one of many direct targets. Institutions and educators have been faced...
The COVID-19 pandemic has disrupted almost every aspect of life globally, with higher education one of many direct targets. Institutions and educators have been faced with urgent crises of how to conduct business as usual while maintaining expectations of high standards and uncompromised goals. As physician assistant (PA) educators at Seton Hall University, we rallied and brainstormed approaches to daily instruction to keep students on track and faculty both effective and sane. We tapped technological resources offered by our university, learned countless new skills, and adapted classroom activities to online virtual platforms. Creativity and flexibility became the norm as we modified the way we did everything while remaining laser focused on the ultimate objectives. Our intention was to provide insight, motivation, and, at a minimum, an example of how to do things differently when faced with roadblocks. We were inspired by an editorial by Mary Jo Bondy, DHEd, MHS, PA-C, former CEO of the Physician Assistant Education Association, in which she called for collective innovation, collaboration, publication, and circulation of stories. With that charge, we assembled a detailed account of how a didactic team within our faculty maneuvered the challenges created by COVID-19, in hopes of adding to the arsenal of small triumphs in this uncharted territory.
Topics: Female; Humans; Physician Assistants; COVID-19; Pandemics; Faculty; Learning
PubMed: 36409244
DOI: 10.1097/JPA.0000000000000472 -
Cognition Nov 2020When humans and other animals make repeated choices, they tend to repeat previously chosen actions independently of their reward history. This paper locates the origin...
When humans and other animals make repeated choices, they tend to repeat previously chosen actions independently of their reward history. This paper locates the origin of perseveration in a trade-off between two computational goals: maximizing rewards and minimizing the complexity of the action policy. We develop an information-theoretic formalization of policy complexity and show how optimizing the trade-off leads to perseveration. Analysis of two data sets reveals that people attain close to optimal trade-offs. Parameter estimation and model comparison supports the claim that perseveration quantitatively agrees with the theoretically predicted functional form (a softmax function with a frequency-dependent action bias).
Topics: Animals; Decision Making; Humans; Reward
PubMed: 32679270
DOI: 10.1016/j.cognition.2020.104394 -
Neuropsychology Mar 2021Right brain-damaged patients may show omissions and/or additional marks in target cancellation. The latter is classified as perseverative behavior and has been...
Right brain-damaged patients may show omissions and/or additional marks in target cancellation. The latter is classified as perseverative behavior and has been attributed to defective response inhibition or attentional disengagement deficit. This study aimed at (a) verifying that consecutive (immediate) and return (temporally distant) motor perseverations could be due to different mechanisms; (b) investigating the relationships among different types of perseveration (e.g., consecutive, return, scribble), spatial neglect and the impairment in specific components of executive functioning. Seventeen right brain-damaged patients underwent letter, star, bell, and apple cancellation tasks. A global index for each type of perseveration found and Mean Position of Hits, as a neglect index, were calculated. The following components of executive functioning were evaluated: motor programming (Frontal Assessment Battery [FAB] subtest), inhibitory control FAB, interference sensitivity (FAB and Stroop color-word interference test), set-shifting (Weigl sorting test, Phonemic/semantic alternate fluencies), and working memory (Backward Digit span). Ten patients out of 17 showed some degree of perseveration. Regularized linear regression analyses demonstrated that interference sensitivity and Stroop test performances were related to return perseverations and backward digit to scribble ones. No significant relationships were found for consecutive perseverations and between neglect and any type of perseverations. The present study showed that return perseverations might have a distinct etiology from consecutive ones, being related to an inability to update and shift between action programs according to the visual stimuli. A finer classification of perseverations could help in unveiling the neuropsychological mechanisms underlying each type of behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: Adult; Aged; Aged, 80 and over; Brain Injuries; Brain Ischemia; Brain Neoplasms; Cerebral Cortex; Executive Function; Female; Functional Laterality; Humans; Intracranial Hemorrhages; Male; Memory, Short-Term; Middle Aged; Neuropsychological Tests; Perceptual Disorders; Prospective Studies; Psychomotor Performance; Stroop Test
PubMed: 33970664
DOI: 10.1037/neu0000730 -
Nature Biotechnology Sep 2018
Topics: Drug Approval; Drug Delivery Systems; Drug Development; Drug Industry; Humans; MicroRNAs; Oligonucleotides; RNA Interference; RNA, Small Interfering; United States; United States Food and Drug Administration
PubMed: 30188535
DOI: 10.1038/nbt.4255 -
Epilepsy & Behavior : E&B Apr 2022In a comparative cross-sectional study, 26 adult individuals with clinically typical, genetically confirmed Dravet syndrome (DS) and an equal number of individuals with...
In a comparative cross-sectional study, 26 adult individuals with clinically typical, genetically confirmed Dravet syndrome (DS) and an equal number of individuals with early onset, problematic epilepsy, and intellectual disability (ID) of comparable severity were included. The aim of the study was to find out whether patients with DS could be clearly distinguished from the comparison group with regard to neurological and behavioral symptoms. Significant differences were found in that individuals with DS clearly more frequently exhibited a symptom cluster characterized by bradykinesia, hypomimia, hypophonia, (spastic) increased muscle tone, ataxia, sthenic perseveration, and a special interest in colors. To these symptoms must be added, according to the findings of previous examinations, mastication, camptocormia/antecollis on the one hand, and the tendency to visual hallucinations on the other hand, in order to define one neuropsychiatric phenotype of DS in adulthood. To these symptoms must be added, according to the findings of previous investigations, crouch gait with camptocormia/antecollis on the one hand, and the tendency to visual hallucinations on the other hand, in order to define one outlined neuropsychiatric phenotype of DS in adulthood.
Topics: Adult; Cross-Sectional Studies; Epilepsies, Myoclonic; Epileptic Syndromes; Humans; Phenotype; Spasms, Infantile
PubMed: 35203016
DOI: 10.1016/j.yebeh.2022.108601 -
JAMA Network Open Aug 2023Little is known about temporal trends in children's well-being and how the COVID-19 pandemic may have influenced the well-being of young Australians. Certain demographic...
IMPORTANCE
Little is known about temporal trends in children's well-being and how the COVID-19 pandemic may have influenced the well-being of young Australians. Certain demographic groups may be more vulnerable to experiencing declines in well-being.
OBJECTIVE
To examine well-being trends over 6 consecutive years among South Australian students and explore the influence of sociodemographic characteristics.
DESIGN, SETTING, AND PARTICIPANTS
Longitudinal analyses of annual (2017 to 2022) cross-sectional data of students in grades 4 through 9 (n = 40 392 to 56 897 per year) attending South Australian government schools from the Well-being and Engagement Collection (WEC) census.
EXPOSURES
Calendar year (2017-2022) and sociodemographic characteristics (sex, school grade, parental education, language spoken at home, residential region) from school enrollment records.
MAIN OUTCOMES AND MEASURES
Students self-reported life satisfaction, optimism, happiness, cognitive engagement, emotional regulation, perseverance, worry, and sadness.
RESULTS
Over 6 years (2017 to 2022), a total of 119 033 students (mean [SD] age, 12.1 y; 51.4% male) participated in this study. Most well-being measures declined over time, with consistent worsening of well-being from 2020 onward. For example, compared with 2017, sadness was 0.26 (95% CI, 0.25-0.27) points higher in 2020 (standardized mean difference [SMD], 0.27) and remained elevated by more than 0.26 points (SMD, 0.27) in 2021 and 2022. At almost every time point, greatest well-being was reported by students of male sex (except cognitive engagement and perseverance), in earlier school grades, with highest parental education, speaking a language other than English at home, and residing in outer regional and remote settings (for satisfaction, optimism, and emotional regulation). Sociodemographic differences in well-being were generally consistent over time; however, sex differences widened from 2020 for all indicators except cognitive engagement and perseverance. For example, between 2017 and 2022, sadness increased by 0.27 (95% CI, 0.25-0.29) more points among females than males (SMD, 0.28).
CONCLUSIONS AND RELEVANCE
In this longitudinal analysis of annual census data, there were downward trends in students' well-being, especially since 2020. The largest sociodemographic disparities were observed for students of female sex, those in later school grades, and those with lowest parental education. Urgent and equitable support for the well-being of all young people, particularly those facing disparity, is imperative.
Topics: Child; Female; Adolescent; Male; Humans; Australia; Cross-Sectional Studies; Pandemics; COVID-19; South Australia
PubMed: 37606925
DOI: 10.1001/jamanetworkopen.2023.30098