Schweizer Archiv fur Neurologie, Neurochirurgie und Psychiatrie = Archives suisses de neurologie, neurochirurgie et de psychiatrie最新文献

After having described the differences between "authority" and "power", nowadays somewhat outdated, we show that in medicine the "authority" belongs to the physician and that the doctor's "power", always surrounded by a halo of magic, is desired by the patient. This situation is the same in psychotherapy during which the psychotherapist defines authoritatively, that is as the "author", the treatments setting whereas the patient desires on almighty therapist. The authority co-exists with power and the treatment consists in increasing the authority and even the patients power and reducing the therapists power. A few remarks on Freud's authority and on the power desired by the leaders of some psychotherapeutic schools introduce more subtle considerations on the dialectic power - authority during psychoanalytically inspired psychotherapies and group psychotherapies.

A review of the factors susceptible to explain the inner life of the depressed person and help to elaborate a psychotherapeutic approach.

This is a report on clinical findings after 100 extra-intracranial bypass procedures for cerebral ischemia. The patients presented with transient ischemic attacks, prolonged ischemic neurological deficits, completed strokes, low perfusion syndromes and ischemic ocular diseases. The microvascular anastomosis is performed between a branch of the external carotid artery and a cortical branch of the middle cerebral artery. In 10 patients we performed a bilateral bypass. We had no mortality. The morbidity was 5%, the patency rate 96%. The effect of the microvascular procedure can be determined by comparing the postoperative follow-up (averaging 22 months) and the natural course of cerebrovascular disease. Clinical benefit is gained in the elimination of transient ischemic attacks. Patients considered candidates for diagnostic studies are those presenting with completed strokes. Finally in patients with large aneurysms extra-intracranial bypass procedures may prove to be of value, when carried out in a combined approach.

The authority of the therapist is described in reference to a model of the framing of development based on General Systems Theory, as an essential property of the therapist-patient relationship that insures the hierarchical structure of the therapeutic system. The hierarchically superior position of the therapist is based on the relatively great (long term) constancy of his/her functioning mode in therapy, securing the dynamic stability of the therapeutic system. To insure his/her own development (evolution), the therapist himself (herself) needs to be framed by hierarchically superior systems. The importance of the relative autonomy of the therapist in face of the risk of loosing or overdoing his (her) own authority is briefly discussed.

Schizophrenic existence is the experience of an awful negativism, which comes from the depth of the Unconscious and appears at the surface of the conscience as the destruction of all positive symbols of life. Interpretations of psychodynamic mechanisms, of transference and countertransference, of dreams and fantasies must be rooted in the dominant therapeutic endeavour of creating with the remaining potentialities of the patient new positive symbols of the schizophrenic existence. The author's experience in the 30 years of his dealing with schizophrenic patients is here summarized.

The cells of the cerebrospinal fluid consist of three systems: the lymphatic immune-competent system, the "mononuclear phagocyte system (MPS)" and the reticulo-histiocytic system (RHS). Within the lymphatic cells the lymphocytic line and the plasmocytic line must be considered separately, although the two cell-lines are from their origin functionally inter-connected; they constitute the immune-system. To the "mononuclear phagocyte system" belong the monocytes and the macrophages. The reticulo-histiocytic system includes the cell-forms which are definitely excluded from the "mononuclear phagocyte system". The investigations show that most of the cells in the CSF originate from the blood.

The terms "authoritarian" and "authority" are defined in the context of the process of education. Certain historic, cultural and anthropological aspects of father's role, some newer empirical results concerning the importance of the father for the psychic development of the child and the connection of father and authority are discussed under sociocultural and psychoanalytic viewpoints. Especially the relation between the father and the child in the preoedipal and oedipal phase is treated. This on the back-ground of the dialectic triangle of having a father, becoming father and being father.

The concept of a psychiatric night clinic is shown on the basis of an experience made over 10, respectively 7 years in two such clinics belonging to a sociopsychiatric service. The importance of this halfway-house within the framework of a sociopsychiatric treatment is discussed as well as the indicative criteria, the therapeutic effect, the duration of the stay in the clinic, the organisational structure and the relationship with the family members.

In order to define some principal clinical characteristics of the hospitalised depressives, the authors have examined a group of 100 depressed patients consecutively admitted to the Psychiatric University Clinic of Lausanne. The clinic is at the same time a sector hospital. The depressives constituted 21% of all hospitalised patients. The number of depressives admitted during the duration of the study (6 months) permitted to calculate a hospitalisation rate of 86 patients per 100 000 inhabitants and per year. The 100 patients were subclassified in patients with a short depressive reaction, neurotic depressives, and endogenous depressives. Each of the 3 subgroups had about the same size. A modified version of the ICD 9 was used for the diagnostic classification. As a whole, the patients showed serious psychiatric manifestations and the majority presented suicidal tendencies. Besides, there were found characteristics which are not considered to be associated with depressions in general: an elevated proportion of unmarried persons in the total group, psychopathic traits among the reactive and neurotic depressives, and a considerable proportion of parental loss in early childhood in these two last mentioned subgroups. Furthermore, an accumulation of chronic and therapy resistant cases was observed in the group of neurotic depressives. A third of the endogenous depressives had been resistant to the ambulatory antidepressive treatment; a part of these patients responded well to the treatment in the hospital.

Men consider only those motives valuable, which originate from inborn patterns of behaviour, and that means in the first place most of the different activities in the course of living together. In primitive communities, when holding together and wrestling with a combined effort against natural adversities or rival tribes, each individual acquires a homogeneous basis of habits in doing and thinking which become irrefutable matters of course.--In case of economical surplus consolidation of bigger social units gets under way.--That leads step by step--starting always from pioneering élites--in the course of many generations to increasing awareness in the conduct of life and at the same time to dwindling of the emotionally fixed matters of course. In the final stage of evolution, therefore, everyone should consequently acquire for himself a framework of habits and attitudes, representing a compromise between selfish and altruistic tendencies and granting his thoughts and actions steadiness, assurance, and self-confidence.--If, however, owing to affluence, adverse living conditions do not force joint exertions and concord, individualistic expansion, competition, and rivalry arise and undermine the human relations. As a result increasingly self-realization is claimed to the debit of the fellow-men. But in view of the fact that the individual as a gregarious being cannot exist without trustworthy social ties and esteem, a rising number of men comes into a conflict between individualistic desire for expansion and yearning for the security of a community. Exposed to such a situation a lot of people are unable to adjust to a harmonious living together.