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Search Results: 1 - 10 of 32288 matches for " Peter Fonagy "
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Mentalization-based treatment for patients with borderline personality disorder: an overview
Eizirik, Mariana;Fonagy, Peter;
Revista Brasileira de Psiquiatria , 2009, DOI: 10.1590/S1516-44462009000100016
Abstract: objective: to describe the concept of mentalization, and its application in understanding the development of psychopathology in patients with borderline personality disorder; to give an account of the main features of mentalization-based treatment; to summarise the evidence supporting its effectiveness. discussion: mentalization is a predominantly preconscious mental activity that enables the individual to understand him/herself and others in terms of subjective states and mental processes. psychological trauma in childhood is associated with deficits in mentalization and with the development of borderline personality disorder. mentalization-based treatment is a psychodynamically-oriented manualized psychotherapy for borderline personality disorder that aims to develop a therapeutic process in which the patient's capacity for mentalization becomes the focus of treatment. randomized controlled trials have demonstrated the effectiveness of this treatment for patients with borderline personality disorder. conclusions: the development of a psychodynamically-oriented therapeutic intervention that specifically targets the deficits involved in the psychopathology of borderline personality disorder is a crucial step in increasing the effectiveness of treatment. mental health professionals should be adequately prepared to deliver effective interventions to their patients, such as mentalization-based treatment.
Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression
David Taylor, Jo-anne Carlyle, Susan McPherson, Felicitas Rost, Rachel Thomas, Peter Fonagy
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-60
Abstract: INDEX GROUP: Patients with treatment resistant/treatment refractory depression. DEFINITION & INCLUSION CRITERIA: Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, ≥14 on the HRSD or ≥21 on the BDI-II, plus complex personality and/or psycho-social difficulties. EXCLUSION CRITERIA: Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years. DESIGN: Pragmatic, randomised controlled trial with qualitative and clinical components. TEST INTERVENTION: 18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort. CONTROL CONDITION: Treatment as usual, managed by the referring practitioner. RECRUITMENT: GP referrals from primary care. RCT MAIN OUTCOME: HRSD (with ≤14 as remission). SECONDARY OUTCOMES: depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records). FOLLOW-UP: 2 years. Plus: a). Qualitative study of participants’ and therapists’ problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change.TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials. We discuss some of the consequent problems and suggest how they may be mitigated.Current Controlled Trials ISRCTN40586372Worldwide, depressive disorders have consistently been shown to be the largest contributor to the burden of human disease [1,2]. This is connected with the fact that depres
Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: study protocol for a randomised controlled trial
Ian M Goodyer, Sonya Tsancheva, Sarah Byford, Bernadka Dubicka, Jonathan Hill, Raphael Kelvin, Shirley Reynolds, Christopher Roberts, Robert Senior, John Suckling, Paul Wilkinson, Mary Target, Peter Fonagy
Trials , 2011, DOI: 10.1186/1745-6215-12-175
Abstract: Improving Mood with Psychoanalytic and Cognitive Therapies, the IMPACT Study, will determine whether Cognitive Behavioural Therapy or Short Term Psychoanalytic Therapy is superior in reducing relapse compared with Specialist Clinical Care. The study is a multicentre pragmatic effectiveness superiority randomised clinical trial: Cognitive Behavioural Therapy consists of 20 sessions over 30 weeks, Short Term Psychoanalytic Psychotherapy 30 sessions over 30 weeks and Specialist Clinical Care 12 sessions over 20 weeks. We will recruit 540 patients with 180 randomised to each arm. Patients will be reassessed at 6, 12, 36, 52 and 86 weeks. Methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, research assessors independent of treatment team and blind to randomization, analysis by intention to treat, data management using remote data entry, measures of quality assurance, advanced statistical analysis, manualised treatment protocols, checks of adherence and competence of therapists and assessment of cost-effectiveness. We will also determine whether time to recovery and/or relapse are moderated by variations in brain structure and function and selected genetic and hormone biomarkers taken at entry.The objective of this clinical trial is to determine whether there are specific effects of specialist psychotherapy that reduce relapse in unipolar major depression in adolescents and thereby costs of treatment to society. We also anticipate being able to utilise psychotherapy experience, neuroimaging, genetic and hormone measures to reveal what techniques and their protocols may work best for which patients.Current Controlled Trials ISRCTN83033550First depressive episodes tend to arise in vulnerable individuals exposed to current chronic psychosocial adversities and acute adverse life events [1-3]. Later episodes of recurrent disorder are however associated with fewer external s
Natural Rights, Morality, and the Law  [PDF]
Drum Peter
Beijing Law Review (BLR) , 2011, DOI: 10.4236/blr.2011.21004
Abstract: It is argued that despite attempts to discount the importance of natural rights for morality, they are fundamental to it; therefore, so too are natural rights to the legitimacy of the law.
Price Stability and the Growth Maximizing Rate of Inflation for Ghana  [PDF]
Peter Quartey
Modern Economy (ME) , 2010, DOI: 10.4236/me.2010.13021
Abstract: Monetary policy in Ghana, which is typical of many central banks, over the years, has focused on ensuring price stability or low inflation. The aim of the policy of price stability is to provide a stable environment for real sector activities to flourish. However, the outcome of the policy on real sector activities has not been subjected to any empirical investigation and this forms the focus of the study. For instance, the Central Bank has focused on single digit inflation and whether such a low rate is growth maximizing is yet to be ascertained. The study therefore investigates the revenue maximizing and the ‘growth maximizing’ rate of inflation for Ghana using data from Bank of Ghana and WDI. The study finds that economic performance is higher under low inflation era than when inflation is high. It also established the revenue maximizing rate of inflation using the Laffer curve approach is lower than the growth maximizing rate of inflation. Also, from the results, it can be deduced that the single digit inflation target set by the Central bank is not growth maximizing.
Aristotle’s Definition of Place and of Matter  [PDF]
Peter Drum
Open Journal of Philosophy (OJPP) , 2011, DOI: 10.4236/ojpp.2011.11006
Abstract: The accuracy of Aristotle’s definition of place is defended in terms of his form-matter theory. This theory is in turn defended against the objectionable notion that it entails matter is ultimately characterless.
Adapted Caussinus-Mestre Algorithm for Networks of Temperature series (ACMANT)  [PDF]
Peter Domonkos
International Journal of Geosciences (IJG) , 2011, DOI: 10.4236/ijg.2011.23032
Abstract: Any change in technical or environmental conditions of observations may result in bias from the precise values of observed climatic variables. The common name of these biases is inhomogeneity (IH). IHs usually appear in a form of sudden shift or gradual trends in the time series of any variable, and the timing of the shift indicates the date of change in the conditions of observation. The seasonal cycle of radiation intensity often causes marked seasonal cycle in the IHs of observed temperature time series, since a substantial portion of them has direct or indirect connection to radiation changes in the micro-environment of the thermometer. Therefore the magnitudes of temperature IHs tend to be larger in summer than in winter. A new homogenisation method (ACMANT) has recently been developed which treats in a special way the seasonal changes of IH-sizes in temperature time series. The ACMANT is a further development of the Caussinus-Mestre method, that is one of the most effective tool among the known homogenising methods. The ACMANT applies a bivariate test for searching the timings of IHs, the two variables are the annual mean temperature and the amplitude of seasonal temperature-cycle. The ACMANT contains several further innovations whose efficiencies are tested with the benchmark of the COST ES0601 project. The paper describes the properties and the operation of ACMANT and presents some verification results. The results show that the ACMANT has outstandingly high performance. The ACMANT is a recommended method for homogenising networks of monthly temperature time series that observed in mid- or high geographical latitudes, because the harmonic seasonal cycle of IH-size is valid for these time series only.
Random but System-Wide Unique Unlinkable Parameters  [PDF]
Peter Schartner
Journal of Information Security (JIS) , 2012, DOI: 10.4236/jis.2012.31001
Abstract: When initializing cryptographic systems or running cryptographic protocols, the randomness of critical parameters, like keys or key components, is one of the most crucial aspects. But, randomly chosen parameters come with the intrinsic chance of duplicates, which finally may cause cryptographic systems including RSA, ElGamal and Zero-Knowledge proofs to become insecure. When concerning digital identifiers, we need uniqueness in order to correctly identify a specific action or object. Unfortunately we also need randomness here. Without randomness, actions become linkable to each other or to their initiator’s digital identity. So ideally the employed (cryptographic) parameters should fulfill two potentially conflicting requirements simultaneously: randomness and uniqueness. This article proposes an efficient mechanism to provide both attributes at the same time without highly constraining the first one and never violating the second one. After defining five requirements on random number generators and discussing related work, we will describe the core concept of the generation mechanism. Subsequently we will prove the postulated properties (security, randomness, uniqueness, efficiency and privacy protection) and present some application scenarios including system-wide unique parameters, cryptographic keys and components, identifiers and digital pseudonyms.
Enlarged cauda equina nerve roots in Cerebrotendinous Xanthomatosis  [PDF]
Peter Kalina
Open Journal of Clinical Diagnostics (OJCD) , 2011, DOI: 10.4236/ojcd.2011.13006
Abstract: CXT is a rare inherited autosomal recessive lipid storage disease due to the impaired metabolic pathway of cholesterol secondary to a deficiency in 27- sterol hydroxylase, an enzyme in the synthesis of chenodeoxycholic acid (CDCA), a primary bile acid. Abnormal bile acid synthesis leads to elevated plasma Cholestanol (a derivative of cholesterol) accumulation, especially in the lens, central nervous system (CNS) and tendons.
Spinal Cord Compression by Thoracic Vertebral Hemangioma—A Case Report  [PDF]
Peter Kalina
Open Journal of Medical Imaging (OJMI) , 2012, DOI: 10.4236/ojmi.2012.21005
Abstract: A 68 year old with lower extremity numbness, vibratory sensation loss, coldness and burning of his feet, unsteady gait, frequent falls and a sensory level had an MRI demonstrating aT7 and T8 vertebral body/posterior element lesion with epidural extension, cord compression and foraminal extension (Figures 1-5). Decompressive laminectomy/resection confirmed vertebral hemangioma, a common benign neoplasm that typically remains asymptomatic, found incidentally in 10% of the population. Progressive vertebral body hemangiomas may cause cord or nerve root compression due to epidural tumor extension, expanded bone, hematoma or fracture. Radiographs demonstrate course vertical striations caused by thick trabeculae. CT in indolent lesions demonstrates fat density while compressive lesions demonstrate soft tissue density. Indolent lesions follow fat signal on MRI; symptomatic lesions are T1 isointense/T2 hyperintense. Work-up for aggressive hemangiomas includes angiography to determine vascularity, identify feeding/draining vessels and identify blood supply to the cord. Biopsy helps differentiate hemangioma, lymphoma, myeloma or metastasis. Management of symptomatic hemangiomas includes vertebroplasty for pain, radiation for pain, compression or pre-op and decompressive laminectomy for epidural disease. Embolization of feeding vessels may be performed pre-op or may be curative. Hemangioma causing cord compression and neurologic symptoms by extraosseous extension is much less common than benign hemangioma. Imaging features may suggest potential for progression.
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