Conjoint Psychotherapy of Marital Pairs

Many traditional concepts are being challenged in contemporary psychiatric practice, including the classical “one-to-one” relationship of individual psychotherapy. Where the patient''s presenting difficulties include significant inability to function or feel happy in the marital role, the technique of conjoint psychotherapy (having both partners treated simultaneously by the same doctor) may be indicated. Conjoint therapy is envisaged as a continuum, embracing a considerable range of situations where it is sound practice to see husband and wife together. The treatment plan has three stages: complaint, clarification, and compromise, each of which presents specific features and pitfalls. Emphasis is placed on dealing with individual psychopathology of each partner, both per se and in relation to the marital situation. Results to date suggest that conjoint treatment represents a promising therapeutic modality. Even in cases where individual psychopathology cannot fully be resolved, certain plateaus of satisfaction may be attained as communication improves.     

Pitfalls in fine needle aspiration cytology.

A review of pitfalls encountered in fine needle aspiration cytology (FNAC) of all organs and tissues and based mainly on the author's 35-year experience of diagnostic FNAC in clinical practice is presented. Diagnostic difficulties are usually related to deviations from common cytological criteria that may occur in some lesions. Others are due to the effects of the sampling procedure or of the preparation of samples. A few basic rules are proposed, which may help to avoid some of the diagnostic pitfalls.     

Adoption and Children with Learning and Behavior Problems

One representative case study is used to illustrate the complex interaction of factors that can lead to tragic family dysfunction when an adopted child has learning and behavior problems. The presence of neurodevelopmental problems in an adopted child, special adoption issues and interparental and intraparental conflicts combine to place the child and his family at high risk. The child''s neurodevelopmental difficulties are expressed primarily as subtle learning and behavior problems which make him a focus for parental conflict. In addition, the adoption issues of difference, impermanence, feelings of mutual obligation and fear of abandonment are generally poorly understood and form the basis for the development of unique interactional patterns of communication. Finally, in the families studied, it was often found that the adopting parents had serious personal and/or marital difficulties.     

Marital therapy for the elderly.

Little attention has been paid to marital therapy for the elderly in spite of its relevance to morale and emotional problems. Physical illness is of particular significance in altering the dynamics of the marital relationship. Retirement and financial problems, as well as changes in sexual activity and gender roles, are also important. However, radical changes in patterns of behaviour cannot be expected. Therapeutic techniques must be altered for this age group, and the therapist must be active, giving and concretely helpful. As with therapy for younger couples, children may need to be involved in the therapy sessions. Family physicians should be a main source of help for marital problems among the elderly. However, because problems related to countertransference must be faced, working with the elderly will not be for everyone.     

Retentissement sexuel, conjugal et social d’une population d’hommes stériles consultants en Andrologie: le point de vue du psychiatre de liaison

Material and methods

The study population consisted of 39 subjects divided into two groups: 21 azoospermic males and 18 oligoazoospermic males. These men were selected in andrology departments over a period of six months. The andrology and liaison psychiatry departments of Lille university hospital established a general infertility questionnaire. This semi-structured questionnaire comprising 40 questions was based on clinical experience and describes the clinical and symptomatic context of infertility. An individual 50-item questionnaire was then used to analyse the psychosocial, marital and sexual effects of male infertility and the representation of the psychiatrist in the andrology department.

Results

One third of patients discovered the diagnosis of infertility when the biologist gave them the results of the semen analysis. Our patients initially envisaged marital, psychological and social problems, but very few sexual problems. They imagined that infertility was more disturbing for women than for men, from a psychological and sexual point of view. 82% of our subjects imagined that their partner had no sexual problems. 48.7% of them thought that their partner had no psychological difficulties related to their infertility. The oligoasthenospermia group considered that the partner had significantly more “psychological difficulties” compared to the azoospermia group. 41% of our patients felt guilty towards their partner because of their infertility diagnosis. 10.3% of patients presented sexual disorders before the diagnosis of male infertility and 25.6% presented sexual disorders after this diagnosis. Contrary to data in the literature, a major change of sexuality was not observed in the majority of the couples after the diagnosis. When sexuality changed, it generally consisted of a reduction of the frequency of sexual relations. Among the patients who reported sexual difficulties, only 40% related them to infertility. 50% did not report any relationship between the psychological difficulties related to infertility and the sexual difficulties. Contrary to the data in the literature, neither the loss of spontaneity during sexual relations, nor the complementary investigations necessary for artificial insemination had any influence on sexuality. 89.8% of our patients are ready to change their sexual practices in order to be more fertile without causing any sexual or psychological problems. However, only 34.3% of patients reported a concern about reproductive efficacy during sexual relations. A more marked sexuality/reproduction dissociation was observed in oligoazoospermic males than in azoospermic males. 28.2% of patients reported that talking about their sexual and/or psychological problems with a psychiatrist was helpful.

Conclusion

Many contradictions and underestimations were observed in the answers to the questions. We confirmed the existence of a psychological and sexual distress, but which was quantitatively less severe than that described in “gynaecological” populations. However, a real psychological and sexual distress does exist in our population, which is why we propose from the outset a psychosomatic and sexological treatment of infertility in order to prevent the onset of these sexual difficulties. Our questionnaire was based on clinical experience and helped our patients to identify their psychological and sexual difficulties related to infertility and its treatment. It would therefore be useful for the practitioner, andrologist or psychiatrist, to help the patient express the effects related to this “new medicalized sexuality”.     

Prenatal echographic diagnosis of corpus callosum agenesis. The Nancy experience 1982-1989

In this report we present the Nancy experience on the prenatal echographic diagnosis of corpus callosum agenesis in a consecutive series of 17 patients. The pitfalls and difficulties in the prenatal echographic diagnosis of ACC is emphasized. They are related with the particular development of the corpus callosum and the limitations of diagnostic procedures. Moreover, the variability of corpus callosum anomalies is illustrated, and the difficulties in establishing long term prognosis in the individual patient documented.     

Bereavement counselling after sudden infant death.

Of 14 families who suffered a sudden infant death, eight were followed up intensively over several months and offered individual counselling, parents'' group meetings, and interviews with doctors as a way of helping them come to terms with their feelings of loss. Five couples accepted short term support from their health visitor, and one refused help. Many families experienced considerable stress including marital conflict, difficulties with surviving children, and anxiety about future children becoming victims of the sudden infant death syndrome. It was concluded that medical social workers, health visitors, hospital paediatricians, general practitioners, and parent self help groups are in key positions to help. The success of such help is likely to depend on the confidence that each helper has that his or her contribution will be valued by the bereaved family.     

Myasthenial gravis; problems in diagnosis

The possibility of myasthenia gravis must be considered in patients persistently complaining of weakness and fatigue. There may be many difficulties and pitfalls in differentiating myasthenia gravis from other disorders in which muscular weakness is a common complaint. Observation of a group of 36 patients with myasthenia gravis, and another group of 30 cases involving the differential diagnosis of myasthenia gravis, led to a conclusion that a physician should apply criteria carefully before arriving at a diagnosis of myasthenia gravis and instituting drug therapy, since nonmyasthenics may frequently respond with subjective improvement temporarily following administration of cholinergic drugs.Myasthenia gravis may be a more common disorder than was suspected in the past.     

MYASTHENIA GRAVIS—Problems in Diagnosis

The possibility of myasthenia gravis must be considered in patients persistently complaining of weakness and fatigue. There may be many difficulties and pitfalls in differentiating myasthenia gravis from other disorders in which muscular weakness is a common complaint.Observation of a group of 36 patients with myasthenia gravis, and another group of 30 cases involving the differential diagnosis of myasthenia gravis, led to a conclusion that a physician should apply criteria carefully before arriving at a diagnosis of myasthenia gravis and instituting drug therapy, since nonmyasthenics may frequently respond with subjective improvement temporarily following administration of cholinergic drugs.Myasthenia gravis may be a more common disorder than was suspected in the past.     

Relation between Belief and Performance in Perceptual Decision Making

In an uncertain and ambiguous world, effective decision making requires that subjects form and maintain a belief about the correctness of their choices, a process called meta-cognition. Prediction of future outcomes and self-monitoring are only effective if belief closely matches behavioral performance. Equality between belief and performance is also critical for experimentalists to gain insight into the subjects'' belief by simply measuring their performance. Assuming that the decision maker holds the correct model of the world, one might indeed expect that belief and performance should go hand in hand. Unfortunately, we show here that this is rarely the case when performance is defined as the percentage of correct responses for a fixed stimulus, a standard definition in psychophysics. In this case, belief equals performance only for a very narrow family of tasks, whereas in others they will only be very weakly correlated. As we will see it is possible to restore this equality in specific circumstances but this remedy is only effective for a decision-maker, not for an experimenter. We furthermore show that belief and performance do not match when conditioned on task difficulty – as is common practice when plotting the psychometric curve – highlighting common pitfalls in previous neuroscience work. Finally, we demonstrate that miscalibration and the hard-easy effect observed in humans'' and other animals'' certainty judgments could be explained by a mismatch between the experimenter''s and decision maker''s expected distribution of task difficulties. These results have important implications for experimental design and are of relevance for theories that aim to unravel the nature of meta-cognition.     

Physicians debate Internet-related marital problems on CMA's online service

The Internet itself has been the topic recently on the CMA''s Internet-based discussion group for physicians, Clinical Q&A. A recent discussion involved physicians from around the country who have dealt with patients with marital problems related to the Internet. They concluded that the Internet may have made problems manifest, but the underlying issue--marital disharmony--already existed.     

Development of an anesthesia data warehouse: Preliminary results

Hospital information system manages patient's hospitalization information across different applications and databases. As statistics are performed with difficulties on these different databases, the university hospital of Lille developed an anesthesia data warehouse. This common structure stores data related to anesthesia procedures and patient hospital stay. In that way, the joint analysis on intervention's events and patient's outcome is possible. However, data quality remains one of the main issues in this kind of project. Indeed, errors in patient identifier result in difficulties to link data between the different sources. This problem will be approached in the next phase of the project.     

Paracrine Effect of Mesenchymal Stem Cells Derived from Human Adipose Tissue in Bone Regeneration

Mesenchymal stem cell (MSC) transplantation has proved to be a promising strategy in cell therapy and regenerative medicine. Although their mechanism of action is not completely clear, it has been suggested that their therapeutic activity may be mediated by a paracrine effect. The main goal of this study was to evaluate by radiographic, morphometric and histological analysis the ability of mesenchymal stem cells derived from human adipose tissue (Ad-MSC) and their conditioned medium (CM), to repair surgical bone lesions using an in vivo model (rabbit mandibles). The results demonstrated that both, Ad-MSC and CM, induce bone regeneration in surgically created lesions in rabbit''s jaws, suggesting that Ad-MSC improve the process of bone regeneration mainly by releasing paracrine factors. The evidence of the paracrine effect of MSC on bone regeneration has a major impact on regenerative medicine, and the use of their CM can address some issues and difficulties related to cell transplants. In particular, CM can be easily stored and transported, and is easier to handle by medical personnel during clinical procedures.     

Variations in historical natural fertility patterns and the measurement of fertility control

This paper looks at 2 main issues: 1) Henry's definition of natural fertility--that which is not controlled within marriage in a parity-specific way; and 2) the use of standard age-specific marital fertility schedules to measure the extent of fertility control. The authors note a number of conceptual difficulties inherent in Henry's definition and which detract from its usefulness. In particular, prolonged lactation and taboos against sexual intercourse are capable of depressing fertility within marriage, while still allowing it to be described as natural. This paper explores some of the consequences of the identified difficulties for the measurement of fertility control within marriage. Regional as well as temporal variations are to be expected in the pattern of marital fertility. The factors affecting natural fertility may be broadly divided into the physical and the psychological. Needed are a variety of standard marital fertility schedules specific to the underlying fertility conditions of the particular population under investigation. The universal applicability of a single standard is placed in doubt. The greatest problem, however, with the application of the idea of natural fertility to historical populations is that its definition rests upon a number of behavioral characteristics amongst a population, whereas its identification must normally proceed in reverse, arguing backwards from the pattern observed to the behavioral processes and conditions which might have produced that pattern. The arguments presented are illustrated by a detailed example drawn from the fertility patterns of Britain, Denmark and Sweden.     

Infidelity,jealousy, and wife abuse among Tsimane forager–farmers: testing evolutionary hypotheses of marital conflict

The role of men's jealousy over a wife's infidelity in precipitating marital conflict and wife abuse is well documented. The role of women's jealousy over a husband's infidelity has received little attention, which is puzzling given high potential costs to women of withdrawal of paternal investment. We address this gap by investigating marital conflict and wife abuse among Tsimane forager–farmers of Bolivia. We test predictions derived from male jealousy and paternal disinvestment hypotheses, which consider threats and consequences of infidelity by women (male jealousy hypothesis) and men (paternal disinvestment hypothesis). The paternal disinvestment hypothesis proposes that wife abuse is employed by husbands to limit wives' mate retention effort and maintain men's opportunities to pursue extrapair sexual relationships. Interviews were conducted among husbands and wives in the same marriages using a combination of open-ended and structured items. Spouses agree that the most frequently reported type of marital argument is women's jealousy over a husband's infidelity (N=266 arguments). Roughly 60% of abusive events occurred during arguments over men's diversion of household resources (N=124 abusive events). In multivariate analyses, likelihood of wife abuse is greater in marriages where husbands have affairs, where wives are younger, and where spouses spend more time apart (N=60 husbands, 71 wives). While we find strong support for both male jealousy and paternal disinvestment hypotheses, it is men's infidelity, not women's, that precipitates most instances of marital conflict and wife abuse. We conclude that men's aggression towards their wives facilitates men's diversion of family resources for their selfish interests.     

Children's health and their mothers’ risk of divorce or separation

Abstract

The purpose of this study is to determine how children's health conditions are related to their mothers’ risk of divorce or separation. The study is based on data from over 7,000 children born to once‐married mothers identified in the 1988 Child Health Supplement to the National Health Interview Survey. The effects of 15 childhood health conditions on the mothers’ risk of divorce are estimated with Cox's proportional hazard models. Controlling for demographic, marital, and reproductive measures, we find that mothers’ prospects for divorce are affected both positively or negatively by their children's health status, depending on the type of childhood condition and, in the case of low birth weight children, timing within the marriage. Women whose children have congenital heart disease, cerebral palsy, are blind, or had low birth weight appear to have higher risks of marital disruption than mothers of healthy children. In contrast, mothers whose children have migraines, learning disabilities, respiratory allergies, missing/deformed digits or limbs, or asthma have somewhat lower rates of divorce.     

Social characteristics and fertility: A study of Two Religious Groups in Metropolitan New York

Abstract

Reproductive time lost through marital dissolution is a potential factor in decreased fertility. This study of survey data from six Latin America metropolitan areas shows that, among variables examined, type of marital union is the primary determinant of reproductive time lost. The study establishes that appreciably more reproductive time is lost from consensual unions than from legal ones. It also indicates that this difference cannot be explained by such social‐background characteristics as a woman's place of birth or educational attainment.     

Breast cancer: when proteomics challenges biological complexity

Proteomics is now entering into the field of biomedicine with declared hopes for the identification of new pathological markers and therapeutic targets. Current proteomic tools allow large-scale, high-throughput analyses for the detection, identification, and functional investigation of low-abundant proteins. However, the major limitation of proteomic investigations remains the complexity of biological structures and physiological processes, rendering the path of exploration of related pathologies paved with various difficulties and pitfalls. The case of breast cancer illustrates the major challenge facing modern proteomics and more generally post-genomics: to tackle the complexity of life.     

The measurement of blood and plasma nitrite by chemiluminescence: pitfalls and solutions

There are a number of difficulties involved in the quantification of nitrite in biological systems. These difficulties result from oxidation of nitrite (within minutes) by heme proteins, such as hemoglobin, myoglobin, cytoglobin, and neuroglobin; its low levels in vivo; and its ubiquitous presence in laboratory buffers and glassware. The goal of this review is to present an assay suitable for the sensitive and specific measurement of intravascular nitrite in mammals using the chemiluminescence-based nitric oxide analyzer and to inform the reader on how to evade the pitfalls pertinent to nitrite determination in biological matrices.     

Growth hormone therapy in Canada: end of one era and beginning of another.

This paper reviews the difficulties in diagnosing a true deficiency of growth hormone (GH), the long-term results of therapy, the Canadian experience in treating GH deficiency, including the contributions made by the Medical Research Council''s Therapeutic Trial of Human Growth Hormone, and the occurrence of Creutzfeldt-Jakob disease in recipients of GH therapy. It also speculates on potential alternatives to treatment with GH derived from human pituitaries.