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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Starting from the metaphor of the person as a motivated storyteller, a theory of meaning construction and reconstruction is presented. Two motives are assumed to be particularly influential in the process of meaning construction: The striving for self-enhancement and the longing for contact and union with somebody or something else. A self-confrontation method is discussed and illustrated, enabling clients to perform, in close cooperation with the psychotherapist, a self-investigation on the content and organization of their personal meaning units. The method represents a gradual transition between assessment and change. Three functions of the method are discussed: assessment, process promotion, and evaluation. These functions are illustrated with a diversity of clinical phenomena: the finding of a central theme in the client's self-narrative, the experience of hopelessness and helplessness, the organized nature of depression, and the construction of a scenario for emerging from a depressive state. Finally, the multivoiced and dialogical nature of the self is illustrated by the dream of a murderer who was perceived by the client as both inside and outside the self. Special attention is given to the shifting boundaries between self and nonself.
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PMID:Self-narrative as meaning construction: the dynamics of self-investigation. 1104 71

The enduring and contentious hypothesis that sleepwalking and night terrors are symptomatic of a protective dissociative mechanism is examined. This is mobilised when intolerable impulses, feelings and memories escape, within sleep, the diminished control of mental defence mechanisms. They then erupt but in a limited motoric or affective form with restricted awareness and subsequent amnesia for the event. It has also been suggested that such processes are more likely when the patient has a history of major psychological trauma. In a group of 22 adult patients, referred to a tertiary sleep disorders service with possible sleepwalking/night terrors, diagnosis was confirmed both clinically and polysomnographically, and only six patients had a history of such trauma. More commonly these described sleepwalking/night terrors are associated with vivid dream-like experiences or behaviour related to flight from attack. Two such cases, suggestive of a dissociative process, are described in more detail. The results of this study are presented largely on account of the negative findings. Scores on the dissociation questionnaire (DIS-Q) were normal, although generally higher in the small "trauma" subgroup. These were similar to scores characterising individuals with post-traumatic stress disorder. This "trauma" group also scored particularly highly on the anxiety, phobic, and depression scales of the Crown-Crisp experiential index. In contrast the "no trauma" group scored more specifically highly on the anxiety scale, along with major trends to high depression and hysteria scale scores. Two cases are presented which illustrate exceptional occurrence of later onset of sleepwalking/night terrors with accompanying post-traumatic symptoms during wakefulness. It is concluded that a history of major psychological trauma exists in only a minority of adult patients presenting with sleepwalking/night terror syndrome. In this subgroup trauma appears to dictate the subsequent content of the attacks. However, the symptoms express themselves within the form of the sleepwalking/night terror syndrome rather than as rapid eye movement sleep related nightmares. The main group of subjects with the syndrome and with no history of major psychological trauma show no clinical or DIS-Q evidence of dissociation during wakefulness. The proposition that, within the character structure of this group, the mechanism still operates but exclusively within sleep remains a possibility.
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PMID:Is there a dissociative process in sleepwalking and night terrors? 1126 87

The author begins by pointing out that myths have always been powerful vehicles for the projection of ubiquitous unconscious fantasies. Having noted the importance of certain male protagonists of the Greek myths in Freud's theories, she observes that their female counterparts exert an equal fascination and suggests that the Medea myth as recounted by Euripides can be invoked to elucidate a central unconscious fantasy found to underlie the psychogenic frigidity and sterility of several of her female patients. The manifestation of this 'Medea fantasy' is illustrated by a clinical account in which a dream is analysed. The author next summarises the Medea story as told by Euripides and attempts a psychoanalytic interpretation of it. She draws attention to features of the 'unconscious truth' inherent in the myth that were shared by all the members of her group of patients. A case history then shows how the progressive understanding and working through of the Medea fantasy led to a change in the analysand's experience of femininity and enabled her to have children. It is postulated that both early infantile sexual fantasies and repressed memories of early object-relations traumas such as maternal depression combine with ubiquitous bodily fantasies to produce the unconscious Medea fantasy.
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PMID:The 'Medea fantasy'. An unconscious determinant of psychogenic sterility. 1134 Oct 65

Sexual assault survivors with post-traumatic stress disorder (PTSD) were assessed for frequency of nightmares, measured retrospectively on the Nightmare Frequency Questionnaire (NFQ) and prospectively on nightmare dream logs (NLOG). Retrospective frequency was extremely high, averaging occurrences every other night and an estimated number of nightmares greater than five per week. Test-retest reliability data on the NFQ yielded weighted kappa coefficients of .85 (95% CI, .74-.95) for nights and .90 (95% CI, .83-.97) for nightmares. Correlations between retrospective and prospective nightmare frequencies ranged between .53 (P = .001) for nights and .63 (P = .001) for nightmares. Correlations between frequency and distress measures (anxiety, depression, post-traumatic stress) yielded coefficients ranging from (r = .28-.53). Compared with intrusive, cumbersome and time-consuming prospective measurements, the NFQ appears reliable, convenient, and equally useful in assessing nightmare frequency in a group of sexual assault survivors. Nightmare frequency, prevalence, distress and impairment are discussed.
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PMID:Nightmare frequency in sexual assault survivors with PTSD. 1219 43

To examine the relationship between the emotional quality of dreams, REM sleep variables and suicidal tendency in depressed individuals, 26 depressed volunteers (10 males and 16 females) were assessed with the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS), and underwent 3 nights of polysomnography. There was a significant negative correlation between suicidality scores and REM latency and a positive correlation between suicidality and REM percent. Suicidal subjects had a significantly shorter mean REM latency and a higher mean REM percentage than the non-suicidal subjects. As expected in normal subjects, 20 subjects had an increase in dream-like quality (DLQ) of REM reports between the first and second halves of the night. The six subjects with a negative DLQ difference also scored as suicidal. A reduction in dream-like quality of the REM content reports between the first and second halves of the night was found to be associated with suicidal tendency. The findings may indicate that these subjects fail to self-regulate mood and integrate affect into long-term memory networks during sleep. Theoretical and clinical implications of these findings in depression are discussed.
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PMID:REM sleep, dream variables and suicidality in depressed patients. 1286 Mar 58

Although many patients are surviving longer than in the past, a cancer diagnosis may shatter the dream of a dignified old age for elderly patients. Cancer diagnosis and treatment often produce psychologic stresses resulting from the actual symptoms of the disease, as well as perceptions of the disease and its stigma. Concerns related to cancer have particular meaning for aging individuals who undergo these situations in the context of retirement, widowhood, other medical disabilities and other losses. Today, patients and families are more interested in treatment issues, and quality of life, both during and after treatment. In this article we discuss late life depression, anxiety and delirium as they relate to elderly patients coping with cancer.
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PMID:Psychiatric issues in older cancer patients. 1460 82

The contribution of increased rapid eye movement (REM) pressure through repeated, mild, reduction of (REM) sleep to remission from untreated depression was studied over a 5-month period in 20 depressed and 10 control volunteers. Sixty percent of the depressed subjects were in remission at the end of the study. Sixty-four percent of the variance in remission could be accounted for by four variables: the initial level of self-reported symptoms, the reported diurnal variability in mood, the degree of overnight reduction in depressed mood following interruptions of REM sleep and the quality of dream reports from these awakenings. Increased REM pressure is beneficial for those who are able to construct well-organized dreams.
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PMID:REM sleep reduction, mood regulation and remission in untreated depression. 1465 50

Hallucinations are a common feature of certain degenerative diseases with a risk of dementia such as Alzheimer's disease, Lewy body dementia, and Parkinson's disease. Obtaining valid epidemiological data is nevertheless quite difficult because of methodological problems. As a rule, hallucinations are more prevalent in Lewy body disease than Parkinson's disease or Alzheimer's disease. The prevalence in parkinsonian dementia is about the same as in Lewy body disease. Complex visual hallucinations predominate, auditory or tactile hallucinations are more exceptional. Minor forms (illusions, sensation of presence) are also observed. Recurrence is common, mainly in the evening or at night. Patients with advanced mental impairment generally take the hallucinations for reality. The hallucinations can be associated with psychological and behavioral disorders such as delusionnal idea or identification disorders. It is important to search for other causes of hallucinations such as drugs, ocular disorders, or depression, but many of these disorders are common comorbidities in elderly patients with degenerative disease. There is no unique model fitting all the hypothesized pathogenic mechanisms. Complex visual hallucinations most likely arise from abnormal activation of the extra-striat temporal associative regions, but only hypothetical mechanisms have been proposed. Genetic studies and functional imaging have not provided convincing evidence. Current focus is placed on an imbalance between deficient cholinergic transmission and preserved or augmented monoaminergic transmission at the cortical level, but other neurotransmission systems could be involved. The dream dysregulation mechanism proposed in Parkinson's disease cannot be generalized. The link between cognitive disorders and hallucination is also poorly understood: hallucinations are associated with more severe cognitive impairments or more rapid cognitive deline in Parkinson's disease and Alzheimer's disease, but the association with specific cognitive disorders remains to be fully explored.
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PMID:[Hallucinations and dementia. Prevalence, clinical presentation and pathophysiology]. 1511 51

Nightmares can be defined as very disturbing dreams, the events or emotions of which cause the dreamer to wake up. In contrast, unpleasant dreams can be defined in terms of a negative emotional rating of a dream, irrespective of whether or not the emotions or events of the dream woke the dreamer. This study addresses whether frequency of unpleasant dreams is a better index of low well-being than is frequency of nightmares. A total of 147 participants reported their nightmare frequency retrospectively and then kept a log of all dreams, including nightmares, for 2 weeks, and rated each dream for pleasantness/unpleasantness. Anxiety, depression, neuroticism, and acute stress were found to be associated with nightmare distress (ND) (the trait-like general level of distress in waking-life caused by having nightmares) and prospective frequency of unpleasant dreams, and less so with the mean emotional tone of all dreams, or retrospective or prospective nightmare frequency. Correlations between low well-being and retrospective nightmare frequency became insignificant when trait ND was controlled for, but correlations with prospective unpleasant dream frequency were maintained. The reporting of nightmares may thus be confounded and modulated by trait ND: such confounding does not occur for the reporting of unpleasant dreams in general. Thus there may be attributional components to deciding that one has been awoken by a dream, which can affect estimated nightmare frequency and its relationship with well-being. Underestimation of nightmare frequency by the retrospective questionnaire compared with logs was found to be a function of mean dream unpleasantness and ND.
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PMID:The relationship of nightmare frequency and nightmare distress to well-being. 1517 92

To investigate the relationship between nightmares and melancholic features (MF) in depression, we compared depressed patients with and without MF (n=82 and n=75, respectively) regarding the presence of nightmares. Nightmares were significantly more frequent in patients with MF. Depressed mood in the morning may be related to negative dream content.
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PMID:Nightmares and terminal insomnia in depressed patients with and without melancholic features. 1574 Oct 5


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