This early phase study examined the effects of a series of ten standard-protocol acupuncture treatments over four weeks in 12 healthy, but symptomatic, menopausal women. Two biologic markers, heart rate variability to evaluate effects of acupuncture on the autonomic nervous system as it relates specifically to the heart, and interleukin 6, a proinflammatory cytokine, to capture physiologic impact of acupuncture on the immune-inflammatory response, were collected.Women who exhibited significant menopausal symptoms, as measured by a minimum score of 22 out of a possible 44 points on the Menopause Rating Scale (MRS), underwent 10 sessions of a standard acupuncture point protocol intervention over a four-week period. Symptoms were evaluated for 28 days using the MRS. After the intervention was complete, one final open-ended question was asked of each participant to explore subjective experiences not captured by the validated instrument. Physiologic measurements included a 30-minute continuous measure of electrocardiogram data before and during acupuncture, as well as pre and post acupuncture measures of serum interleukin 6 at the first and final acupuncture treatment. Heart rate variability was assessed using spectral analysis, and interleukin 6 changes were measured using ELISA. Analysis included linear regression, Wilcoxon Signed Ranks test and Spearman correlation coefficients.After the acupuncture intervention, menopausal symptoms improved significantly. Heart rate variability did not show consistent or predictable intra or inter-subject changes, however several components of HRV, interleukin 6 and symptoms were found to have significant correlations.A larger study was deemed feasible. Menopause symptoms improved. Heart rate variability showed no consistent changes or trends. Interleukin 6 decreased in seven subjects, between the first and tenth acupuncture treatment, but did not reach statistical significance.This small project suggests that heart rate variability, when measured at each acupuncture treatment, does not change in a consistent or predictable manner. Rather, acupuncture may provide a modulating influence that depends on the body's functional state at each treatment.

Major Depressive Disorder (MDD) is a highly prevalent mental disorder that will affect 12.2% of Canadians over the course of their lifetimes, and 4.8% annually (Patten, et al., 2006). One of the most robust findings in the MDD literature is that the gold-standard treatments – Cognitive-Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and anti-depressant medications - are equal in their efficacy, and superior to placebo. However, it is unclear whether rates of remission for certain types of symptoms differ among treatments with theoretically different mechanisms. This study re-analyzed data from the Treatment of Depression Collaborative Research Program, which included 158 adults with MDD randomized to CBT, IPT, imipramine or placebo. We statistically derived 4 factors from the baseline Hamilton Depression Rating Scale. We hypothesized that the rate of remission of somatic factors (sleep and appetite) would be most rapid in the group receiving imipramine plus clinical management (IMI-CM), and that the rate of remission for cognitive-affective factors would be fastest in IPT and CBT. Hierarchical regression analyses predicted the sum of symptom scores corresponding to each factor using linear and quadratic time (measured in weeks). Treatment-by-time interactions were entered in a stepwise fashion. There were no significant interactions found in the appetite factor, suggesting that all therapies acted on these symptoms at similar rates. Consistent with hypotheses, IMI-CM produced more rapid remission in sleep symptoms compared to psychotherapy. Surprisingly, IMI-CM was also more rapid at relieving cognitive-affective symptoms. The results lend partial support to the idea that different treatments for MDD may target specific symptoms at different rates according to their underlying mechanisms of action. The findings present some exciting possibilities for elevating response rates through empirically-based “tailored treatments”. / Thesis (Master, Psychology) -- Queen's University, 2009-09-03 14:41:46.163

Posttraumatiskt stressyndrom (PTSD) är en sjukdom som är traumarelaterad och svår att få en övergripande bild av då statistiken för antalet drabbade är bristfällig framför allt av ett stort mörkertal. Symtombilden vid denna sjukdom är mycket individuell och de upplevda symtomen är många, vilket skapar en svårighet i att diagnostisera sjukdomen. Vem som helst kan drabbas när som helst under sin livstid och att få en behandling som fungerar är problematisk då ingen exakt bot finns. Under ett trauma påverkas vårt alarmsystem i kroppen för att varna om fara och då har hjärnstrukturen amygdala en övergripande roll. Eftersom amygdala har stor betydelse för vår uppfattning om faror har därför denna studie valt att se om dessa traumatiska händelser orsakar symtomen vid PTSD. Mer specifikt var syftet med denna litteraturstudie att se om förändringar i amygdala och närliggande regioner kan vara bidragande till symtomen som upplevs av individer med PTSD samt vilka neurologiska förändringar som skett/finns i dessa hjärnregioner som kan ha en bidragande faktor till uppkomsten av sjukdomen. Av sex utvalda orginalartiklar kunde det sammantaget konstateras att vissa neurologiska förändringar som amygdala aktivitet och kortikal volym möjligtvis kan ha en koppling till vissa upplevda symtom som bland annat förhöjd vaksamhet och känsloregleringsförmåga. Artikel 1 visade på minskad volym av grå substans i premotorcortex och i främre cingulate cortex (p<0.05)samt att de med PTSD hade svårare att hantera vardagliga utmaningar, var mindre positiva och mer negativa (p<0.0001).Artikel 2 visade på att volymen av grå substans hade korrelationer med svårighetsgraden av PTSD samt symtombilden. Artikel 3 visade att individer med PTSD hade en minskad aktivitet i högra och vänstra amygdala och ventrala striatum (p<0.005). Där emotionellt avtrubbande hade korrelationer med högra ventrala striatum(p<0.05).Artikel 4 såg att de med PTSD hade förändrad cortex, i högra hemisfären var det åttaregioner och i den vänstra sex regionersom antagligen hade samband med totala CAPS poäng. Artikel 5visade att PTSD gruppen hade en ökad respons i högra amygdala vid syn av skrämmande ansikten (p<0.05) samt att högra amygdala aktiviteten hade samband med symtomet förhöjd vaksamhet. Artikel 6 visade att förmågan att reglera känslor var förändrad hos individer med PTSD. Både vid intensifiering av en känsla (amygdala (p<0.04), bakre cingulate cortex (p<0.01), främre cingulate cortex (p<0.04), middle cingulate cortex (p<0.02), vänstra inferior frontal cortex (p<0.04), vänstra putamen (p<0.04), bilaterala inferior parietal loben (p<0.03)) samt vid minskning av känsla (inferior frontal cortex (p<0.01), vänstra putamen (p<0.02), bilaterala inferior parietal loben (p<0.01), insula (p<0.03)).Denna studie kunde alltså inte påvisa tydliga hjärnområden, kopplade till amygdala, vilka hade förändringar som kan ha orsakat uppkomsten av ångestrelaterade besvär vid PTSD. Eftersom hjärnan är mycket komplex och kan bearbeta intryck på väldigt olika sätt kan dessa resultat kanske förklaras med hjälp av att de olika typer av trauman som individerna utsattes för i stor utsträckning påverkade skilda hjärnregioner. Det är alltså därför viktigt att fler studier, med större deltagarantal och likartade traumatiska händelser, fortsätter belysa PTSD symtom och deras koppling mot amygdala och närliggande hjärnregioner för att öka förståelsen för uppkomsten av PTSD. Eftersom kunskapen idag är begränsad vid behandling av PTSD-relaterad symtom behövs dessa frågeställningar klarläggas för att snabbare kunna ställa diagnos och kunna ge tidigbehandling till individer med PTSD. / Post-traumatic stress disorder (PTSD) is a trauma-related disorder that is difficult to get an overall picture of because of lack of statistics regarding affected individuals, most likely due to a large number of unrecorded cases. The symptoms of this disease are very individual and the perceived symptoms are many, which create a difficulty in diagnosing the disease. Anyone can be affected at any time during his or her lifetime, where effective treatment still needs to be developed. During a trauma our alarm systems in the body warns us of danger and then the brain structure amygdala has a central role. Because the amygdala is of great importance for our understanding of dangers, this study set out to examineif these traumatic events cause the symptoms of PTSD. More specifically, the purpose of this study was to examine if changes in the amygdala and nearby regions may contribute to the symptoms experienced by individuals with PTSD, as well as if the neurological changes that occurred in these brain regions may be a contributing factor to the onset of the disease. Of the six selected original articles it could be noted that certain neurological changes, including amygdala activity and cortical volume, could be linked to certain perceived symptoms together with heightened alertness and emotional regulation skills. Article 1 showed reduced volume of gray matter in the premotor cortex and the anterior cingulate cortex (p <0.05), and those individuals with PTSD had more difficulties handling everyday challenges together with less positive attitudes (p <0.0001). Article 2 showed that the volume of gray matter had correlations with the severity of PTSD and symptoms. Article 3 showed that individuals with PTSD had a decreased activity in the right and left amygdala and ventral striatum (p <0.005). There, emotional numbing had correlations with right ventral striatum (p <0.05). Article 4 showed that those with PTSD had altered cortex in the right hemisphere was the eight regions and in the left six regions that probably was associated with total CAPS score. Article 5 indicated that PTSD group had a higher response in the right amygdala at sight of the faces daunting (p <0.05) and the right amygdala activity was associated with elevated symptom vigilance. Article 6 showed that the ability to regulate emotions was altered in individuals with PTSD. Both the intensification of a sense (amygdala (p <0:04), the posterior cingulate cortex (p <0:01), anterior cingulate cortex (p <0:04), middle cingulate cortex (p <0:02), left inferior frontal cortex (p <0:04) left putamen (p <0.04), bilateral inferior parietal lobe (p <0.03)) and the reduction of sensation (the inferior frontal cortex (p <0.01), the left putamen (p<0.02), bilateral inferior parietal lobe (p <0.01 ), insula (p <0:03)). This study could thus not demonstrate distinct brain areas, linked to amygdala, which had changes that may have caused the onset of anxiety-related disorders in PTSD. Since the brain is very complex and can process impressions in very different ways, these results may be explained by the different types of trauma that the individuals were exposed to,which in turn could affect different brain regions. It is thus important that more studies with larger number of participants, and similar traumatic events, continues highlighting PTSD symptoms and their relationship to amygdala and related brain regions to increase understanding of the onset of PTSD. As knowledge today is limited in the treatment of PTSD-related symptoms, these issues must be continuously examined to develop earlier diagnosecriterias and finally propose proper treatments for individuals with PTSD.

No description available.

A predominance of symptomology related to neurological dysfunction has been reported for at least some learning disabled (LD) students. This investigation examined the self-reported neuropsychological symptoms of LD and normal students in grades 3 through 12. Determination of group membership based on the childrens' responses to items on the Neuropsychological Symptom Inventory (NSI) was made for all subjects in the study.A discriminant analysis was conducted in order to determine the degree of group separation based on the item responses and which reported symptoms add significantly to that separation. Out of 40 possible items, 19 added to the discriminant function. Prediction of group membership was accomplished with a high degree of accuracy. Nearly 80% of the total population examined were correctly classified according to actual group membership. Of the LD population, 32% were identified as normal but only 16% of the normal population were misdiagnosed as LD. Additionally, nine individual symptoms were identified as reported by a greater percentage of LD students than normals.The results of this investigation suggest that the NSI as a screening instrument may be valuable for some populations. The 80% accuracy rate with the low number of false-positives (16%) is extremely encouraging. Additional research with the NSI to validate the presence of the symptomology reported would add to the already existing data related to the neuropsychological implications related to learning disabilities. / Department of Educational Psychology

Objective: To explore adult cancer symptom management by home care nurses. Scoping review: A scoping review was conducted to describe interventions used by nurses for cancer symptom management in the home care setting. Five included studies revealed that home care nursing contributed to positive client- and system-level outcomes. Study: A mixed-methods descriptive study explored usability of a set of 13 cancer treatment-related symptom management protocols for nurses in the home care setting. Thirty-eight nurses in home care participated. Qualitative and quantitative data indicated the protocols were highly usable. Several barriers suggested they would be better used as resources to support and train nurses rather than documentation tools. Conclusions: Few studies have evaluated interventions for cancer symptom management by home care nurses. This set of protocols was well-received, but further research is required to determine their effectiveness and interventions for implementing with home care nurses providing cancer symptom management.

Background: Brain tumors are the most common solid tumors found in children. Current research is determining whether diagnosing brain tumors earlier will help improve prognosis and reduce long-term deficits; however, childhood brain tumors are often diagnosed late with a median time of 1-4 months from onset of symptoms. Prolonged symptom intervals before diagnosis have been associated with life-threatening risks, neuro-cognitive disabilities, and detrimental professional relationships between healthcare providers and families. Pediatric brain tumor clinical presentations are often non-specific and resemble less serious illnesses; therefore, healthcare providers are failing to include this in their differential diagnoses list. Purpose: To assess healthcare provider knowledge of signs and symptoms of pediatric brain tumors using The Brain Pathways Guideline. Methods: A one group pre-test and post-test e-mailed separately to nurse practitioners that have active membership in National Association of Pediatric Nurse Practitioners (NAPNAP) Arizona Chapter. Results: The Wilcoxon Signed Rank Test revealed that the matched test scores were not statistically significant (p=0.157) after viewing The Brain Pathways Guideline educational materials. Conclusion: The results of this study did not show a statistically significant difference in the test scores and therefore it cannot be concluded that presenting an evidence-based guideline to assist healthcare providers to assess and diagnose patients with brain tumors will be helpful to improve pre-diagnostic symptom intervals.

No description available.

This current study empirically tested elements of Ehlers and Clark's (2000) cognitive model of Posttraumatic Stress Disorder (PTSD) symptom maintenance using path analysis and structural equation modeling (SEM). Ehlers and Clark's model suggests that a reciprocal relationship between cognitive appraisals of the traumatic event and characteristics of the trauma memory maintain symptoms by increasing one's sense of current threat. Participants in the current study were 405 undergraduates at a Midwestern university who each reported having experienced at least one traumatic event during his/her lifetime. Path analysis was utilized to examine the possibility that one's posttraumatic cognitions may mediate the relationship between the centrality of the traumatic event to one's sense of self and one's current level of PTSD symptoms. The reverse mediation was also tested for each of the PTSD symptom clusters. Results indicate that both event centrality and posttraumatic cognitions are unique and independent predictors of current symptom level. SEM procedures were used to examine possible mediation as well as to test a reciprocal relationship between these predictors. Results are generally consistent with those from the path analysis although additional research is necessary before any firm conclusions can be stated. Overall, the results of this study support aspects of the cognitive model of PTSD; cognitive appraisals of the self and memory characteristics of the event were highly related to levels of distress. However, the current study suggests that overly integrated trauma memories lead to greater distress and not poorly integrated ones as suggested by Ehlers and Clark. The relationship between trauma memories and PTSD is in need of further study as is the role of memory and cognitions in the temporal development of PTSD.

PORTUGAL, Monica Maria de Andrade Torres. A formação do analista: um sintoma da psicanálise. 2017. 207f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Educação Brasileira, Fortaleza (CE), 2017. / Submitted by Gustavo Daher (gdaherufc@hotmail.com) on 2017-06-07T14:50:50Z No. of bitstreams: 1 2017_dis_mmatportugal.pdf: 965864 bytes, checksum: cb6186a356331310d514f953d44c7415 (MD5) / Approved for entry into archive by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2017-06-08T11:46:40Z (GMT) No. of bitstreams: 1 2017_dis_mmatportugal.pdf: 965864 bytes, checksum: cb6186a356331310d514f953d44c7415 (MD5) / Made available in DSpace on 2017-06-08T11:46:41Z (GMT). No. of bitstreams: 1 2017_dis_mmatportugal.pdf: 965864 bytes, checksum: cb6186a356331310d514f953d44c7415 (MD5) Previous issue date: 2017 / Este trabalho dissertativo se insere no campo da formação do analista, a qual, con-forme convencionado, fundamenta-se em três condições: análise pessoal, estudo da teoria e supervisão ou controle clínico. Contudo, essas três condições esbarram jus-tamente no que Freud asseverou acerca das três profissões impossíveis – analisar, educar e governar. De modo efetivo, há demanda por formação, e essa, grosso mo-do, vem se realizando a partir da lógica de uma profissão sob os auspícios de uma instituição psicanalítica. A história do movimento psicanalítico, inicialmente com Freud e depois com Lacan, reflete as lutas em torno da concepção do ato de institu-ir, revelando as contradições emanadas do processo de formação do profissional analista. Trata-se de pesquisa imanente aos textos de Freud e Lacan, portanto uma pesquisa bibliográfica, cotejados com escritos de outros autores que trataram sobre os conflitos que cercam a questão da formação. O trajeto tem como lastro as elabo-rações de Lacan sobre o conceito de Escola e a teoria dos discursos, a partir da li-gação que ele estabeleceu entre o discurso do analista, do universitário e do mestre aos três impossíveis de Freud: analisar, educar e governar. Esse conceito foi desen-volvido para contemplar os diferentes laços sociais na fala do sujeito no dispositivo analítico e transposto para o campo da formação psicanalítica, considerando que essa tem uma análise como conditio sine qua non. Lacan liga a noção de sintoma em Freud a Marx e concebe que o sintoma é efeito do real. Além do sintoma, cate-gorias como tempo e dinheiro são somadas à discussão, pois são condições para uma análise. A categoria dinheiro é tratada a partir de Freud, com aportes de Marx e Simmel. Por um lado, a relação sintoma-saber-verdade transparece, sob o discurso do analista, a partir da extração de gozo no real, dimensão alinhada ao impossível, seguindo Lacan; por outro lado, a psicanálise padece do sintoma na formação do analista como uma profissão, pois se trata de um laço social impossível de ser geri-do sob o discurso do capitalista, porquanto esse subsume o sujeito no objeto, como objeto de consumo. Essa incompatibilidade lógica transparece na prática como um permanente impasse: esse será o ponto essencial a ser tratado ao longo da presen-te pesquisa.