Loss-related mental states impair executive functions in a context of sadness

Stress and anxiety have been shown to temporally impair executive functions, but the role of other emotions, such as sadness, has been inconclusive. Moreover, the role of affect regulation in this relationship has not been extensively studied. The present research investigated whether certain types of mental states (mental output resulting from the use of affect regulation within a specific context or with respect to a specific material or theme) relative to the context of loss would predict impairment of executive functions. Participants were randomly assigned to read either a loss-related newspaper article inducing sadness or a neutral newspaper article. Results showed that low mental states relative to loss (maladaptive affect regulation) predicted impairment of executive functions following an induction of sadness, but not following the neutral induction. Conversely, high mental states (adaptive affect regulation) were not predictive of impairment of executive functions in both the sadness and neutral condition. These findings have implications for the boundaries within which emotion can disrupt high-order cognitive processes.

Attenuated Mitral Leaflet Enlargement Contributes to Functional Mitral Regurgitation After Myocardial Infarction

BACKGROUND

Mitral leaflet enlargement has been identified as an adaptive mechanism to prevent mitral regurgitation in dilated left ventricles (LVs) caused by chronic aortic regurgitation (AR). This enlargement is deficient in patients with functional mitral regurgitation, which remains frequent in the population with ischemic cardiomyopathy. Maladaptive fibrotic changes have been identified in post-myocardial infarction (MI) mitral valves. It is unknown if these changes can interfere with valve growth and whether they are present in other valves.

OBJECTIVES

This study sought to test the hypothesis that MI impairs leaflet growth, seen in AR, and induces fibrotic changes in mitral and tricuspid valves.

METHODS

Sheep models of AR, AR + MI, and controls were followed for 90 days. Cardiac magnetic resonance, echocardiography, and computed tomography were performed at baseline and 90 days to assess LV volume, LV function, mitral regurgitation and mitral leaflet size. Histopathology and molecular analyses were performed in excised valves.

RESULTS

Both experimental groups developed similar LV dilatation and dysfunction. At 90 days, mitral valve leaflet size was smaller in the AR + MI group (12.8 ± 1.3 cm² vs. 15.1 ± 1.6 cm², p = 0.03). Mitral regurgitant fraction was 4% ± 7% in the AR group versus 19% ± 10% in the AR + MI group (p = 0.02). AR + MI leaflets were thicker compared with AR and control valves. Increased expression of extracellular matrix remodeling genes was found in both the mitral and tricuspid leaflets in the AR + MI group.

CONCLUSIONS

In these animal models of AR, the presence of MI was associated with impaired adaptive valve growth and more functional mitral regurgitation, despite similar LV size and function. More pronounced extracellular remodeling was observed in mitral and tricuspid leaflets, suggesting systemic valvular remodeling after MI.

Insomnia and hypertension: A systematic review

Insomnia is a prevalent sleep disorder that is associated with a multitude of health consequences. Particularly, insomnia has been associated with cardiovascular disease and its precursors, such as hypertension and blood pressure (BP) non-dipping. The present systematic review aimed to summarize the evidence on the concurrent and prospective associations between insomnia and hypertension and/or BP. Using electronic search engines (PubMed, SCOPUS, PsycINFO), 5,618 articles published from January 1970 to December 2017 were identified, and 64 met the inclusion criteria (26 to 162,121 participants; age range: 18-100; 46.4% male). Insomnia was based on diagnostic or non-diagnostic criteria. Hypertension was based on self-or physician-reports, antihypertensive medication use, and/or measured BP. Findings indicate that when insomnia is frequent, chronic, and/or accompanied with short sleep duration or objective markers of arousal, there is a strong association with hypertension/BP. Based on limited studies, hypertension did not significantly predict future insomnia in middle-aged adults, but did in older adults. Based on a majority of case-control studies, no differences in BP were found between participants with and without insomnia. Further research is needed to identify putative pathophysiological mechanisms underlying the link between insomnia and hypertension. The impact of insomnia therapy on BP should also be further examined in the future.

Linguistic styles and complementarities in analyzing character

This paper discusses and illustrates some technical implications of D. Liberman's contributions to character analysis. Psychoanalysis is an extended conversation, and character structure is expressed linguistically as part of an interactive linguistic field. Liberman's notions of linguistic styles and communicative interaction define a unique analytic surface from which to examine the syntactic, semantic and pragmatic aspects of character. The presence of a rigid and defensive linguistic style reflects resistance and communicative impasse within the transference and countertransference matrix. A fully interactive communicative experience integrates all aspects of the conversation and allows both participants to take part in a shared semantic field, the precondition to the generation of new meanings. Liberman suggests responding to miscommunication by means of a methodical linguistic attitude. Various such complementary responses are explored through several vignettes, with a particular focus on the interplay of the epic and narrative modes.

Multi-Modality Imaging in the Evaluation and Treatment of Mitral Regurgitation

OPINION STATEMENT

Mitral regurgitation (MR) is frequent and associated with increased mortality and morbidity when severe. It may be caused by intrinsic valvular disease (primary MR) or ventricular deformation (secondary MR). Imaging has a critical role to document the severity, mechanism, and impact of MR on heart function as selected patients with MR may benefit from surgery whereas other will not. In patients planned for a surgical intervention, imaging is also important to select candidates for mitral valve (MV) repair over replacement and to predict surgical success. Although standard transthoracic echocardiography is the first-line modality to evaluate MR, newer imaging modalities like three-dimensional (3D) transesophageal echocardiography, stress echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) are emerging and complementary tools for MR assessment. While some of these modalities can provide insight into MR severity, others will help to determine its mechanism. Understanding the advantages and limitations of each imaging modality is important to appreciate their respective role for MR assessment and help to resolve eventual discrepancies between different diagnostic methods. With the increasing use of transcatheter mitral procedures (repair or replacement) for high-surgical-risk patients, multimodality imaging has now become even more important to determine eligibility, preinterventional planning, and periprocedural guidance.

Longitudinal follow-up of Riata leads reveals high annual incidence of new conductor externalization and electrical failure

BACKGROUND AND PURPOSE

Riata(TM) defibrillation leads are susceptible to conductor externalization. The point prevalence of insulation defect in Riata(TM) leads is up to 33 %, but prospective data concerning incidence of new lead abnormalities are lacking. The purpose of our study was to determine the annual incidence of new conductor externalizations and electrical lead failure.

METHODS

A prospective observational study was conducted at a single tertiary center. One hundred forty-one patients were followed over 12 months. A posterior-anterior (PA)/lateral chest x-ray (CXR) with zooming was performed at baseline and at 12 months to screen for conductor externalization. Electrical abnormalities and clinical outcome were also assessed.

RESULTS

The overall incidence of new insulation defects was 8.5 % at 12 months. High-risk leads for new conductor externalization were lead models 1580, 1582, and 1590 with an annual rate of 11.9, 11.1, and 10 %, respectively. New conductor externalizations were three times more common in 8 Fr leads compared to 7 Fr leads. The overall incidence of new electrical dysfunction was 6.4 % at 12 months. Electrical dysfunction was significantly higher in abnormal leads (25 % [3/12], 4.7 % [6/129]; p = 0.03) and mostly driven by high ventricular pacing thresholds. There was no difference in inappropriate shock or failure of high-voltage therapy.

CONCLUSION

The annual incidence of new insulation defects in Riata(TM) leads is much higher than previously reported. Lead models 1580, 1582, and 1590 are at highest risk for new conductor externalization. Electrical dysfunction in Riata(TM) leads is also much higher than reported and is associated with conductor externalization.

Verbal elaboration of distinct affect categories and BPD symptoms

OBJECTIVES

The present study explores the relationship between the mentalization of distinct affect categories and the severity of borderline personality disorder (BPD) symptoms. Mentalization is assessed by both the level of verbal elaboration (VE) achieved by discrete affects (explicit mentalization) and the proportion of these individual affects in verbal expression (implicit mentalization).

DESIGN AND METHODS

Sixty-four outpatients completed a series of questionnaires and took part in an interview designed to produce eight relationship episodes that involved four basic emotions: sadness, joy, anger, and fear (two of each). Affect mentalization was assessed with the Grille de l'Élaboration Verbale de l'Affect (GEVA), an observer-rated measure of levels of elaboration of verbalized affect, and the measure of affect content (MAC), which identifies the content of the verbalized affect (e.g., anger). Diagnostic criteria were obtained with the BPD scale of the Structured Clinical Interview for DSM-IV (SCID-II) questionnaire. Alexithymia was assessed with the 20-item Toronto Alexithymia Scale (TAS-20).

RESULTS

The severity of BPD symptoms was related to lower levels of VE of sadness. It was also associated with a higher frequency of hostility directed against others. The level of VE of sadness and the proportion of hostility showed incremental predictive value of borderline symptomatology over demographic information, the presence of a depressive disorder and alexithymia.

CONCLUSIONS

These findings point to an association between the severity of BPD symptoms and a difficulty mentalizing specific affective domains largely recognized as being central to borderline pathology, namely sadness and hostility.

Differential diagnosis between borderline personality disorder and organic personality disorder following traumatic brain injury

Organic personality disorder (OPD) is the traditional diagnostic category used to account for personality disturbances after traumatic brain injury (TBI). The recent use of Axis-II personality disorders, notably borderline personality disorder (BPD), has appeared in the TBI literature as an alternative to OPD. This would presumably offer a better description and understanding of the multiple clinical manifestations of these personality changes and disorders. This article offers a view that it is possible and fruitful to use both diagnoses in a complementary manner. An accurate recognition of the respective phenomenologies of both BPD and OPD is a key factor in achieving a differential diagnosis, including, if required, a dual diagnosis. The phenomenology of both conditions in reference to DSM-IV criteria is compared and illustrated through two clinical vignettes.

Analyzing forms of superego functioning as mentalizations

The concept of mentalization seeks to understand the transformation processes of physical quantity into psychical quality through the emergence, development and organization of mental representations. Often discussed in relation to the functioning of both the id and the ego, it is here proposed that the degree of mentalization also determines the level of functioning and maturity of the hostile, self-punitive superego. Luquet's description of four layers of thought (primary mental representations, metaprimary thinking, metaconscious intuitive thinking, conscious verbal thought) serves as a guide to explore issues of the forms of thinking involved in punitive superego activity. Technical implications are also examined to suggest that three steps can be differentiated in the developing capacity to represent the superego and to become conscious of its workings. The first objective is to help the ego observe its own activity, in the face of a still, unobserved hostile endopsychic agent (Gray, 1994). The second step is to meet the form and intentions of this agent, to facilitate its mental representation and elaboration. Achievement of the final step implies a growing capacity to take some responsibility for this hostile inner agent, once its activity is comparatively more available to self-observation.

Dimensions of mentalisation: outlining levels of psychic transformation

The authors of this paper use the term 'mentalisation' as a supra-ordinate concept that encompasses processes of representation, symbolisation and abstraction. Mentalisation is defined as a preconscious or ego function that transforms basic somatic sensations and motor patterns through a linking activity (Freud's notion of Bindung). This binding proceeds from initial associations of somatic/motoric substrata with mental representations, on to the multiplication and organisation of these representations, thus allowing the emergence of mental contents and structures of higher levels of complexity (symbolism and abstraction). Inspired by the contributions of Marty, Luquet and Bion, the authors propose a conceptual model of formal levels of mental elaboration. Mentalisation is defined as consisting of two theoretically separate and independent dimensions. Each presents levels of a hypothesised and gradually increasing mental elaboration. The first dimension considers different channels of drive-affect expression: somatic and motor activity, imagery and verbalisation. The second specifies five descriptive levels of affect tolerance and abstraction: disruptive impulsion (acting out), modulated impulsion (catharsis), externalisation, appropriation and abstract-reflexive meaning association. A clinical case illustrates how the two dimensions may influence listening and interpreting. Some metapsychological aspects of the process of mentalisation are discussed.

Overall maturity of object relations as assessed by the McGill Object Relations Scale

The McGill Object Relations Scale (MORS) is an instrument for assessing levels of drive-based object relations along a continuum of positions representative of psychosexual development. Its theoretical foundations as well as empirical antecedents are presented, and its rating procedure is demonstrated through a case application. The MORS was applied, by five experienced psychiatrists, to 67 adult patients seeking psychoanalytic psychotherapy, in order to assess interrater reliability, internal structure, and construct validity. Results indicate that overall maturity of object relations stems from structural indices of self-object differentiation determined by a particular configuration of many positions, rather than from the thematic aspects included in the individual psychosexual positions.

Countertransference as instrument and obstacle: a comprehensive and descriptive framework

A comprehensive and descriptive approach to counter-transference phenomena is proposed. Three types of mental activity are distinguished: the objective-rational attitude is an adaptive, relatively nondefensive mode of observation; the reactive mental state corresponds to the classical notion of unconscious counter-transference as an obstacle and a defense; by contrast the reflective attitudes involve preconscious and conscious psychical activity. Reflective activity involves four phases: (1) during emergence, an inner reaction appears; (2) immersion, through a regressive exploration, leads to introjective identification; (3) integrative elaboration involves a shift in cathexis, more distance, and an organization of the regressed contents, while (4) an interpretation is forming in mind. Three case examples from the literature serve to illustrate.

The specificity of hermeneutics in psychoanalysis: leaps on the path from construction to recollection

Psychoanalysis is the search for and revelation, through interpretation and construction, of unknown, unconscious implications. But the question is raised: are the meanings being uncovered or are we providing them? This basic realist-idealist contraposition is at the heart of current discussions about the hermeneutic trend in psychoanalysis. Ricoeur's often misrepresented contribution serves as a basis for understanding Freud's method as forming a 'hermeneutic constellation', evolving within a 'moderate', in contrast to a 'radical-idealist' hermeneutic psychoanalysis. Ahumada's recent charge of 'verbal creationism' and Laplanche's re-framing of interpretation between determinism and hermeneutics are discussed in order to specify the more moderate position taken in this paper. It is argued that although they are correct in pointing to potential excesses, both authors misrepresent the hermeneuticist trend as unnecessarily idealistic. A case example from a session illustrates the discussion.

Voluntary control of autonomic responses: a case for a dialogue between individual and group experimental methodologies

This paper discusses the general methodological controversy between individual and group research approaches by comparing the main characteristics of these two methods as applied to the specific context of basic research on voluntary heart rate control. A review of the literature published over the past 19 years in this area of study shows an imbalance in the frequency of utilization of these two methods that strongly favors shortterm group designs. Implications of this research tendency are discussed. The relevance and the advantages of applying the individual approach to voluntary autonomic control research are outlined. This area is particularly amenable to the individual approach because the phenomena under study seem to be characterized by, among other things, a smaller intrasubject than intersubject variability. It is suggested that the present imbalanced tendency in the choice of a research method be corrected and that researchers adopt a more flexible attitude in the choice of the best method for studying each specific problem.

Voluntary heart rate deceleration: a critical evaluation

This experiment was designed as a test of the view that the human heart rate (HR) deceleration response can be brought under voluntary control, when some form of exteroceptive feedback is available. Sixteen female volunteers were randomly assigned to two groups. The first group received instructions to decrease their HR plus a continuous negative (failure) binary feedback, while the second group received only the instructions. Each subject was given four sessions of HR deceleration training. Two identical tests were presented, one before and the other after the series of training sessions. These tests were divided into two parts. In the first part, subjects attempted to decrease their HR while undergoing an ischemic arm pain stress. In the second part, subjects performed a 40-trial HR discrimination task. The results indicate that all subjects decrease HR during both rest and voluntary control periods within each training session, but there are no significant group differences, no improvement in HR deceleration control over the four training sessions, and no difference in performance between rest and voluntary control periods. Similarly HR, blood pressure (BP), and the HR x BP product levels during the ischemic stress condition and the HR discrimination performance do not show group differences. It is suggested that the HR deceleration response may not meet the criteria generally applied to the definition of a voluntary response.

Information and reward in voluntary heart rate control

Two studies are reported which examined the relative effects of the pressence and absence of monetary incentives and instructions in a heart rate (HR) regulation task. Twelve male undergraduates were offered seven sessions of feedback assisted voluntary HR control training. In Experiment 1 six S s attempted to increase their HR with the aid of a "success," or positive binary visual signal. In Experiment 2 six S s were instructed to decrease their HR and were assisted by a "failure," or negative binary visual signal. In both studies the presence or absence of E's specific instructions to control HR was systematically varied from sessions 4 to 7. S s were paid on only half of the feedback trials of each session. These variables were thus systematically varied in a within-subject design. The main results suggest that (a) the instructions and monetary incentives significantly facilitated HR acceleration while showing no effects on HR deceleration; (b) in the no-instructions, no-incentive condition, HR control was minimal. The general hypothesis that Estes' interpretation of information and reward apply to human voluntary HR control received some support. It would appear that contrary to a traditional view, the exteroceptive feedback per se does not necessarily act as a reinforcer of the behavior, as witnessed for instance in the no-instructions, no-incentive conditions.