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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_405"
                     title="Difficult Childhood Lingers in the Mind (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18312?impressionId=1265791014579"
                     
      &lt;p&gt;Adversities faced in childhood have effects on mental health far into the future, researchers affirmed.&lt;/p&gt;
&lt;p&gt;Mental illness in adulthood was increasingly likely the more traumas faced in childhood, Ronald C. Kessler, PhD, of Harvard, and colleagues reported in the February issue of the &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Childhood difficulties potentially explained 32.4% of all the psychiatric disorders examined, they said, based on analyses of the National Comorbidity Survey Replication.&lt;/p&gt;
&lt;p&gt;Adversities relating to family dysfunction  --  substance-abusing parents, sexual or physical abuse in the home, neglect, etc.  --  appeared to have the strongest link to onset and persistence of psychiatric disorders, they reported.&lt;/p&gt;
&lt;p&gt;These findings match folk wisdom and decades of research into the negative effects of child maltreatment, commented John McGrath, MD, PhD, of the Queensland Centre for Mental Health Research in Wacol, Australia, and colleagues in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;But the lack of specificity between certain exposures to particular mental health outcomes  --  such as the death of one&apos;s mother leading to depression  --  was notable, the editorialists said.&lt;/p&gt;
&lt;p&gt;&quot;Thus, childhood trauma upsets the orderly psychological and biological cascades of development, leaving the affected individual at increased risk of a wide range of adverse mental health outcomes,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Rather than continue to rehash the epidemiology, it&apos;s time to focus on prevention and intervention, McGrath&apos;s group emphasized.&lt;/p&gt;
&lt;p&gt;&quot;It is unrealistic to think that we could protect all children from all adversities, but can we identify factors that bolster resilience and focus our efforts on the most vulnerable subgroups?&quot; they asked.&lt;/p&gt;
&lt;p&gt;The researchers examined joint associations of 12 retrospectively reported childhood adversities with lifetime incidence of disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in the National Comorbidity Survey Replication I, a cross-sectional survey of a nationally-representative sample of adults in 9,282 American households.&lt;/p&gt;
&lt;p&gt;Among the respondents, 53.4% reported at least one childhood adversity, most commonly parental divorce (17.5%), family violence (14.0%), family economic problems (10.6%), and parental mental illness (10.3%).&lt;/p&gt;
&lt;p&gt;These adversities were all individually and significantly linked to first onset of psychiatric disorders with odds ratios of 1.5 to 1.9 for dysfunctional family factors (physical abuse, sexual abuse, neglect, parental mental illness, parental substance abuse, parental criminality, or family violence) and 1.0 to 1.5 for other factors like life-threatening childhood physical illness, extreme poverty, parental divorce, or loss of or separation from parents.&lt;/p&gt;
&lt;p&gt;Despite some apparent but not significantly meaningful variation in type of adversity with type of psychiatric disorder, the researchers said they could rule out that all types were the same for future mental health risk (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Problems tended to cluster, though. Among people who faced one adversity in childhood, 51.2% to 95.1% faced others as well, depending on the adversity.&lt;/p&gt;
&lt;p&gt;Risk of mental illness rose with number of issues faced in childhood from an odds ratio of 1.3 for one up to 3.4 for six and 3.2 for seven or more adversities.&lt;/p&gt;
&lt;p&gt;&quot;This subadditive pattern has important implications for intervention because it means that prevention or amelioration of only a single childhood adversity in youths exposed to many childhood adversities is unlikely to have important preventive effects,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Overall, childhood adversities were projected to account for 44.6% of childhood-onset disorders, 32.0% of adolescent-onset disorders, and 28.6% of adult-onset disorders.&lt;/p&gt;
&lt;p&gt;The researchers also looked at persistence through the second part of the National Comorbidity Survey Replication which went beyond just core diagnostic assessment in 5,692 respondents.&lt;/p&gt;
&lt;p&gt;In a complex multivariate interactive analysis, childhood adversity from dysfunctional family factors appeared significantly linked to persistence in a given year (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) whereas the number of factors was not significant.&lt;/p&gt;
&lt;p&gt;These significant factors were parental mental illness, physical abuse, sexual abuse, and neglect, but they carried modest effects individually with odds ratios of 1.2.&lt;/p&gt;
&lt;p&gt;But in one simulation, not being exposed to childhood trauma would only increase the time since the most recent episode of psychiatric illness by 1.6%, suggesting &quot;quite modest&quot; substantive importance in determining persistence.&lt;/p&gt;
&lt;p&gt;&quot;These results indirectly suggest that the public health implications of childhood adversities are greater for primary than for secondary prevention because the associations of childhood adversities with disorder onset are much stronger than the associations with persistence,&quot; Kessler&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that recall bias may have limited their study such that the results could be considered an &quot;upper bound&quot; for the real association and that the study could not prove causality.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Comorbidity Survey Replication is supported by a grant from the National Institute of Mental Health with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, a grant from the Robert Wood Johnson Foundation, and the John W. Alden Trust.&lt;/p&gt;&lt;p&gt;The analyses were supported by a grant from the NIMH; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; grants from the U.S. Public Health Service; an award from the Fogarty International Center; the Pan American Health Organization; Eli Lilly; Ortho-McNeil Pharmaceutical; GlaxoSmithKline; and Bristol-Myers Squibb.&lt;/p&gt;&lt;p&gt;Kessler reported financial conflicts of interest with GlaxoSmithKline, Kaiser Permanente, Pfizer, sanofi-aventis, Shire Pharmaceuticals, Wyeth-Ayerst, Eli Lilly, Bristol-Myers Squibb, Johnson &amp;amp; Johnson Pharmaceuticals, and Ortho-McNeil Pharmaceutical.&lt;/p&gt;&lt;p&gt;The editorialists reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_180"
                     title="APsaA: Connecting Online with Patients in China"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18016?impressionId=1265791014579"
                     
      &lt;p&gt;NEW YORK  --  As some analysts become comfortable with the notion of &quot;the chair,&quot; instead of &quot;the couch,&quot; others are welcoming yet another setting: the computer screen.&lt;/p&gt;
&lt;p&gt;Though it may be controversial among the conservative clinicians, researchers have been using a popular online video chat program known as Skype to reach faraway patients, particularly those in China.&lt;/p&gt;
&lt;p&gt;Ubaldo Leli, MD, an analyst in private practice in New York City, is vice president of the China American Psychoanalytic Alliance (CAPA), an organization that treats patients and trains mental health professionals in China.&lt;/p&gt;
&lt;p&gt;At a session at the American Psychoanalytic Association meeting here, Leli said he conducted his first Skype analysis with a Chinese patient in 2004.&lt;/p&gt;
&lt;p&gt;&quot;When I did my first Skype analysis, I had many doubts,&quot; he said. &quot;Will the analytic process develop? Will there be language differences? Cultural differences?&quot;&lt;/p&gt;
&lt;p&gt;He soon began to feel that the Skype analysis was &quot;similar to any type of analysis.&quot;&lt;/p&gt;
&lt;p&gt;He recalled one Chinese patient who was seated on his own couch in his own living room, with his computer (and hence, Leli on video chat) behind him, as in a typical analytic setting.&lt;/p&gt;
&lt;p&gt;&quot;He was talking, and then he stopped, and I asked him why he stopped,&quot; Leli recalled. &quot;He replied that he sensed a change in my breathing and thought I wanted to say something.&quot;&lt;/p&gt;
&lt;p&gt;The popular Skype software (available at skype.com) is a free download that allows users to make free voice or video calls (if both sides are equipped with Web cameras) anywhere in the world. The company also provides low-cost long distance calls between Skype users and standard local phone customers. Other programs provide many of the same features.&lt;/p&gt;
&lt;p&gt;Although Skype can create a sense of connectedness, Elise Snyder, MD, an analyst from New Haven, Conn., and president of CAPA, said it &quot;simultaneously provides intimacy and distance.&quot; Patient and analyst are in separate spaces, and are often divided by many hours  --  about 13 with Chinese patients.&lt;/p&gt;
&lt;p&gt;And it introduces issues of language and culture that are not typically present in analysis. Snyder said these are &quot;not insurmountable, but they are present.&quot;&lt;/p&gt;
&lt;p&gt;Lana Fishkin, MD, who is on the board of directors of CAPA, said from a cultural standpoint, sex is often a troublesome issue in remote sessions. While discussion of sex is a usual component of analysis in America, it&apos;s rarely mentioned among Chinese patients.&lt;/p&gt;
&lt;p&gt;During analysis, Fishkin said she&apos;s &quot;hesitant to point out that it&apos;s absent, because I&apos;m not sure what it means in Chinese culture.&quot;&lt;/p&gt;
&lt;p&gt;She also called attention to differences within the Chinese culture itself.&lt;/p&gt;
&lt;p&gt;&quot;There have been huge changes over just one generation in China that both we and they have to deal with,&quot; she said.&lt;/p&gt;
&lt;p&gt;Ralph Fishkin, DO, who is also on CAPA&apos;s board, said language issues can be tricky as well.&lt;/p&gt;
&lt;p&gt;&quot;You have to pay more attention to the word the person uses and what exactly they mean by it,&quot; he said. &quot;You have to ask yourself if you&apos;re precisely understanding their feelings.&quot;&lt;/p&gt;
&lt;p&gt;He added that the process of analysis itself is different in the context of Skype: &quot;You&apos;re in your room, they&apos;re in their room. It&apos;s like making a house call at the same time the patient is coming to your office.&quot;&lt;/p&gt;
&lt;p&gt;Some audience members at the session pointed out that there&apos;s no data on the subjective impact of the &quot;space&quot; that patient and the analyst are in. They also questioned the analyst&apos;s ability to maintain perfect eye contact with the patient, as well as the potential to pick up on other body language that would be perceived during an in-person session.&lt;/p&gt;
&lt;p&gt;Yet one of CAPA&apos;s goals is to train Chinese analysts so patients there can have one-on-one interaction.&lt;/p&gt;
&lt;p&gt;Snyder said next year&apos;s class has 100 applicants, among whom 40 or 50 will be accepted to the program.&lt;/p&gt;
&lt;p&gt;She noted that the &quot;community interested in analysis is small in China,&quot; which can create ethical dilemmas. Shanghai may have 22 million inhabitants, but psychoanalysts will be familiar with everyone in their community, including patients.&lt;/p&gt;
&lt;p&gt;&quot;It does raise ethical issues in confidentiality,&quot; she said.&lt;/p&gt;
&lt;p&gt;Psychoanalysis via Skype can also help analysts keep in touch with patients who used to come to in-person sessions but have since moved away  --  although there are no data on how many currently practice this type of remote analysis.&lt;/p&gt;
&lt;p&gt;&quot;Skype is only the beginning,&quot; Leli said. &quot;There are all sorts of new technological developments that will modify the way we think about the analytic frame.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_179"
                     title="APsaA: Do We Need the Past to Imagine the Future?"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18012?impressionId=1265791014579"
                     
      &lt;p&gt;NEW YORK  --  Imagining future events depends on much of the same cognitive and neural machinery as remembering past events, researchers said here.&lt;/p&gt;
&lt;p&gt;In several brain imaging studies, similar areas of the hippocampus were activated when patients recalled past events or imagined future ones, Daniel L. Schacter, PhD, of Harvard University, said during a plenary session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;Memory can be thought of as a tool used by the brain to allow us to generate predictions and simulations of upcoming events,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter and colleagues have conducted several studies involving the link between memory and imagining future events. They&apos;ve found that in remembering past events, patients&apos; brains don&apos;t just replay the scenario the way a computer pulls up a file.&lt;/p&gt;
&lt;p&gt;&quot;We don&apos;t need to preserve every detail,&quot; he said. &quot;We&apos;re good at preserving the gist and meaning, and that serves us pretty well.&quot;&lt;/p&gt;
&lt;p&gt;In imagining future events, those remembered details tend to be recombined into a novel event.&lt;/p&gt;
&lt;p&gt;&quot;We link bits and pieces of information from different sources,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter began wondering why humans may have this type of memory system rather than a literal one, and it led him to conduct several brain imaging studies.&lt;/p&gt;
&lt;p&gt;In their earliest work, Schacter and his colleagues were &quot;struck by the similarity we saw&quot; in the brain regions that became active when patients remembered past events or dreamed up possible future scenarios. The hippocampus was especially active.&lt;/p&gt;
&lt;p&gt;Schacter devised that the remembered details are not stored in one place, but are are reactivated during retrieval and reintegrated by the hippocampus into a coherent event.&lt;/p&gt;
&lt;p&gt;Yet the researchers noticed that a couple of regions activated selectively when patients imagined the future  --  particularly the anterior hippocampus.&lt;/p&gt;
&lt;p&gt;That region may play a role in &quot;active recombining that&apos;s critical to imagining one&apos;s future,&quot; he said.&lt;/p&gt;
&lt;p&gt;Based on their findings, the researchers formed the Constructive Episodic Simulation Hypothesis, which essentially states that imagining the future requires a system that can flexibly combine details from past events into novel scenarios.&lt;/p&gt;
&lt;p&gt;One caveat: although this theorized system is well-suited to simulate future events, it runs the risk of misrecombination that can result in memory errors, such as false recognition.&lt;/p&gt;
&lt;p&gt;Schacter questioned whether the findings &quot;tell us something new about the hippocampus, or do we already know this because the hippocampus is involved in encoding information and memory? And maybe future simulation is just piggybacking on the role of the hippocampus in encoding.&quot;&lt;/p&gt;
&lt;p&gt;Either way, he said, the process is &quot;crucial for adaptive functioning.&quot;&lt;/p&gt;
&lt;p&gt;Henry F. Smith, MD, a psychiatrist in private practice in Cambridge, Mass., said that the &quot;simulation of future events may be what the brain does when we&apos;re not perceiving the present  --  we call it daydreaming.&quot;&lt;/p&gt;
&lt;p&gt;&quot;But,&quot; he added, &quot;if the memory of the past and the simulation of the future use the same brain system, maybe that&apos;s the reason [memories] get all jumbled up.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_177"
                     title="APsaA: Top Psychoanalytic Journals Lack Rigorous Research (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18010?impressionId=1265791014579"
                     
      &lt;p&gt;NEW YORK  --  The top three psychoanalytic journals are short on original research on psychoanalysis, researchers said.&lt;/p&gt;
&lt;p&gt;Combined, the journals produced fewer than 10 original research articles annually over a seven-year period, Jane G. Tillman, PhD, of the Austen Riggs Center in Stockbridge, Mass., and colleagues reported in a poster session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s not very many in a scientific field,&quot; Tillman said.&lt;/p&gt;
&lt;p&gt;Calls for rigorous psychoanalytic research studies have become more common in the past decade, as an increasing number of analysts have committed to demonstrating the validity and efficacy of what they do.&lt;/p&gt;
&lt;p&gt;But the debate also goes to the heart of the discipline itself.&lt;/p&gt;
&lt;p&gt;Critics argue that because psychoanalysis attempts to explain everything, it&apos;s not falsifiable and can&apos;t state a null hypothesis; thus it&apos;s not a proper science.&lt;/p&gt;
&lt;p&gt;While some analysts say psychoanalysis is an hermeneutic discipline because of its reliance on the interpretation of texts, others argue that it is indeed a science and must demonstrate validity and efficacy via a solid methodology.&lt;/p&gt;
&lt;p&gt;To shed light on the debate, the researchers investigated whether there were significant differences in the number of research articles published in the three major psychoanalytic journals: the &lt;em&gt;International Journal of Psychoanalysis&lt;/em&gt;, the &lt;em&gt;Journal of the American Psychoanalytic Association&lt;/em&gt;, and &lt;em&gt;Psychoanalytic Psychology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;They also looked at the characteristics of research samples in the studies, as well as the predominant methodologies.&lt;/p&gt;
&lt;p&gt;Between 2001 and 2008, they found 76 original research articles, which yielded a mean of 9.5 total articles per year  --  only about three in each journal.&lt;/p&gt;
&lt;p&gt;There were no significant differences in the number of research articles published each year by all three journals.&lt;/p&gt;
&lt;p&gt;About 40% of studies used interviews for their data collection.&lt;/p&gt;
&lt;p&gt;The researchers said their survey &quot;raises questions about the status of psychoanalytic research&quot; in these journals.&lt;/p&gt;
&lt;p&gt;Tillman said the absence of serious methodological and research education at many psychoanalytic training institutes may play a role in the lack of research.&lt;/p&gt;
&lt;p&gt;&quot;It really cuts down on the interest,&quot; she said. Yet she also acknowledged that it&apos;s &quot;hard to reduce the complexity of psychoanalysis into well-defined variables.&quot;&lt;/p&gt;
&lt;p&gt;The researchers questioned whether the major psychoanalytic journals receive more submissions of research articles than they print but reject them because of poor quality or poor fit with the aims of the journal.&lt;/p&gt;
&lt;p&gt;Or perhaps psychoanalytic researchers tend to publish in journals that are not identified as specifically psychoanalytic in order to broaden their readership, they suggested.&lt;/p&gt;
&lt;p&gt;Tillman said further research is necessary to find out. Also, based on the high percentage of interviews used in data collection, developing &quot;clear methodologies for working with the interview data&quot; may help increase the rigor of studies.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_176"
                     title="APsaA: Away from the Couch and into the Community"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18009?impressionId=1265791014579"
                     
      &lt;p&gt;NEW YORK  --  Psychoanalysts should get out of their offices and engage their community more frequently, researchers said here.&lt;/p&gt;
&lt;p&gt;Harold Kudler, MD, of the VA in Durham, N.C., reported on four initiatives in his home state that got analysts involved in their communities at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;It all comes down to the idea that psychoanalysts need to get more involved in their communities, and by doing so, we make people more aware of what we do,&quot; Kudler said during a poster session.&lt;/p&gt;
&lt;p&gt;He noted that analysts are often portrayed as &quot;introspective denizens of their own quiet offices.&quot; But when they engage the larger community, both are enriched, he added.&lt;/p&gt;
&lt;p&gt;The impetus toward community involvement came when Kudler learned that only 45% of eligible patients seek treatment at VA hospitals. He wanted to branch out and raise awareness of the services his agency offered.&lt;/p&gt;
&lt;p&gt;The researchers&apos; first initiative was a concert to raise funds for a psychoanalytic preschool, the Lucy Daniels Center for Early Childhood. Kudler said the fundraiser sparked new levels of volunteerism within the center and generated &quot;a new base of support to build on for years to come.&quot;&lt;/p&gt;
&lt;p&gt;For the other three initiatives, the researchers reached out with the help of the North Carolina Psychoanalytic Foundation, focusing on children&apos;s and veterans&apos; issues.&lt;/p&gt;
&lt;p&gt;One project was a day-long program on bullying in a Durham, N.C., inner-city school, which Kudler said inspired involvement and sponsorship from across the community.&lt;/p&gt;
&lt;p&gt;The foundation also partnered with North Carolina state officials to create a training program for local providers regarding military issues. These included military culture, deployment stress, common effects on the veteran and on the family, recommended interventions, and appropriate resources.&lt;/p&gt;
&lt;p&gt;Finally, the organization appointed one member to serve as an adviser to a national multimedia children&apos;s program regarding military deployment issues.&lt;/p&gt;
&lt;p&gt;Kudler said he and his colleagues and the foundation are looking for other venues to integrate with their community. He said they are consulting with businesses, religious groups, and other organizations involved in community support.&lt;/p&gt;
&lt;p&gt;He emphasized that the &quot;psychoanalytic community is a vital part of the greater community. Their mutual health and their futures naturally intertwine.&quot;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>