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Medium 9781607320982


Christopher M. Filley University Press of Colorado ePub

Agnosia is fundamentally a disorder of recognition (Bauer and Demery 2003; Greene 2005). Like aphasia and apraxia, it may follow a focal cerebrovascular event but can also be seen in degenerative disease. A patient with agnosia fails to recognize an object even when primary sensory modalities have registered its features adequately. From the Greek meaning “absence of knowledge,” the term was first introduced by Sigmund Freud in his early monograph on aphasia (Freud 1891). Since then, no syndrome in behavioral neurology has engendered more debate, confusion, and controversy. It has been commented, for example, that the number of suggested mechanisms for visual agnosia nearly equals the number of reported cases of the syndrome (Benson and Greenberg 1969). A consideration of agnosia challenges the student of behavior because of the complexity of patients with various agnosias and the conceptual difficulties inherent in the organization of higher sensory function.

The detection of agnosia in an individual patient is rarely straightforward. Affected persons may not offer specific complaints that suggest agnosia, and findings may be subtle on examination. A visual agnosic, for example, often struggles to express visual dysfunction, reverting to generic complaints such as blurred vision or difficulty focusing that prompt an unrevealing optometric or ophthalmoscopic examination. Similarly, a patient with auditory agnosia commonly complains of hearing loss that results in an audiogram that will not explain the auditory symptoms. Recognizing agnosia from the clinical history requires special attention to potential higher sensory dysfunction, and when suspected, this can become a focus of the mental status examination. Detailed testing for agnosia is not necessary except in unusual cases, as the syndrome is sufficiently uncommon that cases can be considered on an individual basis (Chapter 2). Agnosic deficits may appear, however, in the course of the clinical history-taking; examples would be reports of difficulty recognizing a familiar object, face, or sound. Problems may also be uncovered in the mental status examination, such as comprehension deficit suggesting pure word deafness, and even in the elemental neurologic examination when a person has impairments in visual or tactile function or of higher sensory processing. Extra time and ingenuity are often required to elicit and interpret the agnosias, but the results of this effort can be informative and clinically useful (Strub and Black 1993; Cummings and Mega 2003).

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Medium 9780253014863

2 Pilgrim Ships and the Frontiers of Contagion: Quarantine Regimes from Southeast Asia to the Red Sea / Eric Tagliacozzo

Tim Harper Indiana University Press ePub

2   Pilgrim Ships and the Frontiers of Contagion

Quarantine Regimes from Southeast Asia to the Red Sea

Eric Tagliacozzo

Disease was an important yardstick in how Europeans conceptualized the rest of the world during the past several hundred years.1 This was particularly so as the Industrial Age wore on, and definite links started to be established between sanitation and public health in the metropolitan capitals of the West.2 Yet, as Myron Echenberg has shown to such devastating effect in his book Plague Ports, the industrialization of steam-shipping, increased transoceanic travel, and global commerce all went hand in hand, and in fact facilitated the spread of pathogens on a heretofore unparalleled scale.3 Technology enabled the spread of virulent microbes in ways that previously would have taken much longer periods of time. The non-West may have been seen as filthy, diseased, and dangerous by Europeans, therefore, but in the very act of conquering the rest of the world with state-of-the-art technologies, the West also laid some of the preconditions necessary for a number of diseases to spiral out of control.

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Medium 9780253006455

17 The Identification and Role of Sex-Determining Genes

Elof Axel Carlson Indiana University Press ePub

Life can be resilient and vulnerable at the same time. We rejoice at stories of Olympic medalists who overcome severe injury or a childhood marked with tragedy. At the same time, nature can dish out genetic disorders resulting in births incompatible with life—severely limiting in organ function or leaving an adult with chronic illness. What makes life so vulnerable is the nature of genetic material. Something as simple as altering or removing one nucleotide pair out of some three billion present in a sperm or an egg can result in one of those debilitating or lethal genetic conditions. That doesn’t happen if one pulls a single brick out of a multistoried building. It won’t collapse no matter where that brick is removed. If the gene happens to involve the sex-determining programs in the embryo, the results can be quite dramatic.

The sex-determining genes can be found on the sex chromosomes and the autosomes. This is no surprise, because many organ systems are involved in sex pathologies. They can result from abnormalities of the pituitary gland, the hypothalamus, the adrenal cortex, the gonads, or those embryonic structures that will form the internal and external genitalia. A major gene involved in male sex determination is the SRY gene. It is on the Y chromosome and located at Yp11.3, i.e., on the short or p arm of the Y chromosome at band region 11.3 (Figure 17.1). Andrew H. Sinclair found the SRY gene while he was working with Peter Goodfellow’s laboratory at Cambridge University in 1990.1 Prior to that, in 1987, David C. Page believed that what was called the “testes determining factor” (TDF) was a zinc finger gene in a different region.2 The TDF was known to be Y-associated from cytological studies of certain partial or complete sex reversals. Thus, a baby with X isoYp sex chromosomes has a duplication of the p arm. Such an individual is a male and sterile, because the q arm of the Y provides the genes associated with spermatogenesis, but otherwise functional. But a baby with X isoYq has a duplication of the q of the Y chromosome and an intact X chromosome and is missing the short arm of the Y chromosome. Because such babies are born as females with no testes, that is where the testes determining factor has to be located. The gonads of such babies are streaks, like those of babies with Turner syndrome. They also show other symptoms similar to those associated with Turner syndrome, suggesting that some growth factor is associated with the Yp region.

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Medium 9781782201168

1 - Work with the Parents

Romana Negri Harris Meltzer Trust ePub

The post-partum days of a pregnancy are critical for the mother psychologically as well as: in reviewing the experience of giving birth, from the original phantasies of conception and pregnancy to the relationship with the newborn infant. During this stage the feelings and expectations that once focused on the future baby become blurred owing to the emergence of infantile parts of the self; these ask to be contained and comforted, in order that the woman's natural maternal instinct can express itself in her relationship with the baby. The baby needs to be fed, supported, and comforted by its mother in order to begin its new existence. This is a very critical time for the woman, who is in a fragile condition: “that very special condition which is similar to an illness even though it's perfectly normal”, as Winnicott (1958) has described it. This state should gradually disappear after a few days or weeks, thanks also to the relationship that is established between the mother and the newborn (“breast relationship” and “holding”) and to their mutual adjustment.

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Medium 9781855754324


Jan Abram Karnac Books ePub

1   A journey through dependency

2   The fact of dependence

3   The fear of WOMAN

4   Relative dependence

5   De-adaptation and failing

6   The beginning of an intellectual understanding

7   Awareness—towards independence

T he reality of the infant's dependence on his environment determines his emotional development. Winnicott postulates three stages of dependency: “absolute dependence”, “relative dependence”, and “towards independence”. The infant's successful negotiation of the first two stages of dependency relies on a good-enough environmental provision from the very beginning. It is the establishment of these stages that will facilitate the stage of maturity—named “towards independence”.

1   A journey through dependency

Winnicott's acknowledgement of the “fact of the infant's dependence” really began from 1945 as he recognized “there's no such thing as an infant” (see Introduction), but he began theorizing the sequential stages of dependence during the 1960s in the following papers: “The Theory of the Parent–Infant Relationship” (1960c), “Providing for the Child in Health and Crisis” (1965x [1962]), and “From Dependence towards Independence in the Development of the Individual” (1965r [1963]).

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Medium 9781855751101

Twelve. Phases in Psychotherapy

Frances Tustin Karnac Books ePub

IN this chapter various phases of the psychotherapeutic process with psychotic children will be described. These will be in the sequence in which they are likely to occur when treatment is carried out in the firm containing setting described in the previous chapter. In this manner of presentation, treatment will seem to be much more easy, smooth-flowing process than it actually is. In practice, one phase overlaps with the next one, and there are set-backs in response to such events as holiday breaks or disturbing happenings at home or at school. However, in looking back over the whole course of treatment the following phases can be discerned in therapy with E.S.A. and R.S.A.(i) children.


This is an extremely difficult phase in that we have to attempt/tfycAotherapy with a child who to all intents and purposes has very little psychic life other than that of sensation, in which, in some cases, he has lived too much. The feeble flame of his psychic life has to be fanned by every means at our disposal. He has to be helped to respond to the outside world in a more realistic way. Autistic objects have to give place to trait’ sitional objects and finally to symbol formation. This often has to be done whilst we become increasingly aware of our own insecurities and uncertainties.

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Medium 9781930538757

15 Research With Special Populations

Christine Hedges Sigma Theta Tau International ePub

“How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and strong.”

–George Washington Carver

Marie Boltz
James E. Galvin


• Nurses are ideally positioned to lead research initiatives with vulnerable persons.

• Nurses need to consider several sources of vulnerability related to health, social, and economic factors when planning research studies.

• Nurses promote equitable access to research opportunities, as well as responsible and respectful research conduct, consistent with federal regulations.

Consider this research study: You plan to pilot a sleep protocol intervention to promote sleep quality and minimize the use of sedative hypnotics on a medical unit. Older adults with cognitive impairment (CI), including dementia, are at particularly high risk for the negative effects of sleep problems, including delirium and falls. This very group has often been excluded from clinical research at your institution because of consent issues. How can you offer the opportunity to persons with CI to be involved in a manner that is ethical and respectful?

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Medium 9780253010544

8 Care Work and Violent Men

Anna Aulette-Root Indiana University Press ePub

Chapter 7 Described the problems with care work that women do, especially for their children, but problems also exist in the care work they do for the men in their lives. Ironically, the discussion of care work for men in our interviews with the women was mostly talk about men within a context of abuse. The women are caring for men partners, despite their own HIV-related problems and, even more surprisingly, despite the abuse inflicted upon them by the men for whom they are caring. Women drew on discourses of femininity in describing how men need their care, even in abusive situations. Some of the women acknowledged that being a “proper wife,” which includes caring for men’s sexual needs, has taken a toll on their physical health, yet they continue not only to live with their male partners but also to take care of them. The following excerpts illustrate the women’s struggles to take care of men, many times in the midst of an abusive relationship.

Shareen’s trouble started when she got married, two years before we interviewed her. A short time into the marriage she found out about her husband’s positive HIV status when she visited him in the hospital. She had taken the liberty of reading his medical chart at the foot of his bed, which listed him as being HIV positive. Once she learned that he had tested positive, she believed it was necessary to have herself tested for the virus. She explained to us how painful it was to get tested secretly and alone while he was in the hospital.

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Medium 9781855758094

CHAPTER TWELVE: Diagnosing mental illness

W.M. Bernstein Karnac Books ePub

Scientific understanding progresses through three basic stages: description, prediction, and control. Careful observation and description of salient, palpable aspects of natural phenomena is where understanding begins. It is the “fire and water” stage: an Aristotelian differentiation of one thing from another. Once objects are defined, the questions become: “How are these things related in time and space?” “Are they in causal relationships?” This is where experimental science comes in. Galileo's experimental studies of gravity stand in contrast to Aristotelian methods based on the hope that describing every last detail on an object's surface will reveal some “essence” or truth lying underneath.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) contains descriptions of mental conditions. The first DSM was issued in 1952. It has been revised four times to date and a fifth revision is expected in 2013. The impetus for creating such a manual was the wide disagreement about what constituted “mental illness”. The old story was that if you had ten psychoanalysts examine the same patient you would get back ten different diagnoses. It made sense to try to develop reliable categories for psychiatric disorders.

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Medium 9781782201168

10 - The Treatment and Development of Children with Cerebral Palsy

Romana Negri Harris Meltzer Trust ePub

In a work devoted to trauma due to physical handicap in children, Shirley Hoxter (1986) clearly explains the development possibilities of children affected by cerebral palsy. She states it in a very simple sentence: “The child who is affected by a physical handicap from its birth, starts life with parents being shocked by its condition, and goes on growing up in a society which also is shocked by its existence.” This sentence highlights the three protagonists whose role is fundamental in the child's emotional, relational, and cognitive development – namely, the child, the parents, and the society (represented generally by the health carers).

The child

As already stated at the beginning of this book, the literature illustrates how the child's existential condition during its early life depends strictly on the functioning of its relationship with its mother, where the primitive interacting processes play an essential role in its further development. And it is clear that a serious disruption in their accomplishment must occur in the newborn who develops cerebral palsy. This is due mainly to its separation from the mother, owing to the need to keep the child in the incubator. Aguilar (1990) has stated that this condition of disruption was present in 63% of the 92 cases of cerebral palsy he has studied. In addition to this (as I have already mentioned), these children also experience intense suffering from the brain disorder (Stewart, 1985) and from the invasive medical techniques. This pain imparts to them a gloomy, sullen, complaining, unpleasant expression, making it difficult for them to experience the “aesthetic conflict” with their mother (see Chapter 1), with possible negative implications for their cognitive and emotional development.

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Medium 9781855751101

Seven. Systems of Pathological Autism

Frances Tustin Karnac Books ePub

THE formulations which will be suggested in this and the following chapters are based on a large quantity of observational and clinical material from which selected examples have been quoted in previous chapters. In the present chapter three main systems of pathological autism will be described and differentiated from each other. A precipitating factor for all types of pathological autism seems to be the mouth-experienced ‘hole’ type of depression associated with feelings of terror, helplessness and defectiveness. This has been termed psychotic depression. The first system of pathological autism to be discussed will be termed Abnormal Primary Autism (A.P.A.). Abnormal Primary Autism is an abnormal prolongation of primary autism due to one or other of the following factors:

i. Gross lack of essential nurturing. 2. Partial lack of essential nurturing.

(a) Due to grave deficiencies in nurturing figures.

(b) Due to impediments in the child.

(c) Due to an interweaving of factors (a) and (b).

As Bowlby (1969) has emphasized, infants need other things than the provision of food. Two of the essential ingredients in their nurturing seem to be the provision of bearable sensory stimulation from without, and the relief of excitements arising from stimulation from both internal and external sources. They also need parents, particularly a mother who has been enabled to bear the inevitable frustrations and difficulties associated with differentiating herself from the outside world, and with making intra-psychic differentiations. Parents or a marriage partner who are/is too malleable can prevent these processes from taking place satisfactorily.

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Medium 9781855754324


Jan Abram Karnac Books ePub

1   The concept of aggression in psychoanalysis

2   Primary aggression

3   The baby's ruthlessness

4   The analyst's aroused hatred

5   The evolution of aggression in the developing child

6   The task of fusion

7   The need for opposition and the reality of the external object

8   Ruthless love

9   Tolerance of destructiveness leading to concern

10   Survival: from object-relating to object-usage

11   The death instinct and the father

A ggression in the individual begins, for Winnicott, in the womb and is synonymous with activity and motility. Early on in his work, Winnicott refers to “primary aggression” and states that instinctual aggressiveness is originally part of appetite.

Aggression changes its quality as the infant grows. This change absolutely depends on the kind of environment in which the infant finds himself. With good-enough mothering and a facilitating environment, aggression in the growing child becomes integrated. If the environment is not good enough, aggression manifests itself in a destructive, antisocial way.

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Medium 9781855753600

8. Delivery: the narrative of the end interviews

Janine Sternberg Karnac Books ePub

The participants were interviewed again after an academic year of studying infant observation, and this time they were able to refer frequently to experiences in which they had recently been involved. The interviewees spoke freely about what they felt the experience had shown them and, as was outlined in chapters 2 and 6, their statements were analysed using grounded theory method. The statements were gathered into the seven categories described in chapter 6, and each group’s responses were treated as a distinct entity. As one would expect, there was a difference in emphasis within the groups in the ways they addressed each category, and in the amount of attention each was given.

All groups spoke of this, both explicitly and in relation to other issues, though it is not always clear whether what is being talked of should be categorized as reflection on feelings, as obviously these interviewees were all talking after the event.

The AFC group

This group were very open about how they had been stirred up by the experience of observing and spoke at times of leaving the observations with a feeling of depression. They made passing references to anxiety as well as referring to it more directly. The rapidity of changing emotions without understanding how or why was also mentioned. The sense of exclusion from the mother-infant couple and then feeling that the mother was deliberately keeping the child away were painful experiences for the observer. The agony of watching an underfed baby not being fed was conveyed in the discussion, as were the painful feelings stirred up by being aware of the vulnerability of infants. All are compounded by the “intensity of emotion” that surrounds infants. This group also spoke about how painful it was to realize in the seminar the partial nature of what they had seen.

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Medium 9781780647463

11: Endoscopy

Scott, D.E. CABI PDF



Learning Objectives

1. Indications and uses for endoscopy.

2. The entry point and major internal landmarks.

3. Knowing what “normal” looks like.

The avian anatomy is well suited for endoscopic evaluation, due to the presence of a system of air sacs. Endoscopy is a valuable tool in the diagnosis and treatment of many disease processes since it allows direct access to various lesions in a relatively non-invasive manner (Fig. 11.1). Proper technique, however, can be challenging and practice with cadavers is recommended prior to working with actual patients.

and the biopsy samples are miniscule. Instruments closer to 2 mm in width are more clinically useful

(Fig. 11.3).

A video camera and monitor are crucial since they allow the operator to remain in a comfortable, standing position while performing the procedure. Without the camera, the operator must view through the scope itself, and this means bending over and placing the head in the sterile field.

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Medium 9781855754195

5: Deep impact: “They are all nutcases”

Michael Gunter Karnac Books ePub

Martin had twice been brought in to us in an ambulance after threatening his mother. The first time it was reported that he had initially pestered his mother because he wanted to buy some things. During the car journey he had smashed the rear view mirror and damaged the dashboard. Back at home, he had taken the family phone to his room and locked himself in. The mother had complained about telephone bills amounting to hundreds of euros. In the end he had smashed the phone. On a number of occasions he had threatened her with a knife. The mother also reported that she herself had needed admission to hospital for psychotherapeutic treatment because of the stress the boy had caused her. Martin had been placed in a residential home at that time, but she had taken him back home after massive pressure, in actual fact after threats (which were not detailed) from him. Before this period in the residential home, Martin had already been admitted for child psychiatric treatment at the age of nine. He had threatened to kill his mother and himself. There were repeated aggressive outbursts at home, during which he would destroy objects. He had already injured his mother and used abusive language to her. He completely lost control if his mother scolded him.

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