Rheumatoid arthritis prevention in arthralgia: fantasy or reality?

The concept of a 'window of opportunity' in treating a disease assumes the existence of a time frame during which the trajectory of the disease can be effectively and permanently modified. In rheumatoid arthritis (RA), optimal timing of this period is presumed to be during the phase before arthritis is clinically apparent and disease is diagnosed. Several proof-of-concept trials of treatment during the 'arthralgia' phase of RA have been completed in the past 4 years, with the underlying notion that temporary treatment at this stage could prevent the development of RA or induce a sustained reduction in the burden of disease. This Review summarizes the results of these trials and reflects on the outcomes in relation to the patients' perspectives. Overall, the majority of symptomatic at-risk individuals could benefit from a fixed period treatment, even if RA does not develop. Various factors must be taken into consideration when translating these findings into clinical practice. More evidence is needed to target the individuals at highest risk, and additional tools are needed to monitor treatment and guide decisions about whether treatment can be discontinued. Without these tools, there is a paradoxical risk of seemingly increasing the incidence of the disease and prolonging disease duration, which is the opposite of what the concept of intervening in the window of opportunity entails.

Financial freedom, final fantasy, 'formative ageing': A study of ageing single women and retirement in contemporary China.

This article aims to continue a conversation sustained in this journal during the last three decades; a conversation that seeks to promote critical thinking on age and ageing through the lens of gender and sexuality. I do so by considering a specific group of Chinese women: single women living in Beijing or Shanghai. I invited 24 of them, born between 1962 and 1990, to share their imaginations about retirement, in the Chinese context, where the mandatory retirement age for women is 55 or 50 (60 for men). My aims are three-fold: to insert this group of single women into retirement and ageing studies; to recuperate and document their retirement imaginations; and ultimately, to draw insights from their subjective accounts, to revisit dominant paradigms of ageing, notably so-called successful ageing. Empirical data show how these single women treasure financial freedom, but usually without taking concrete steps towards its accomplishment. They also embrace a diversity of imaginations about where and with whom they want to spend their retirement life, and what they want to do - both long-held dreams and new careers. Inspired by yanglao, a term they use instead of retirement, I argue the term 'formative ageing' is a more inclusive and less normative way of looking at ageing.

O florir da violeta: um estudo de caso em avaliação terapêutica / The flowering of violet: a case study in therapeutic assessment / La flor de la violeta: un estudio de caso en evaluación terapéutica

A Avaliação Terapêutica (AT) é um processo avaliativo e interventivo proposto para ser semiestruturado e colaborativo com o objetivo de promover mudanças positivas no cliente, que é convidado a ter uma participação ativa durante o processo. Na AT, os resultados dos testes psicológicos padronizados ganham destaque como facilitadores do processo de autoconhecimento do cliente. Desse modo, usualmente, integram-se os achados de testes psicológicos de autorrelato com os métodos projetivos para gerar informações que possam ampliar a visão que o cliente tem de si. Neste artigo, buscou-se compreender o potencial de uso dos testes psicológicos e da relação colaborativa a partir de um caso atendido na perspectiva da AT. A participante, Violeta (nome fictício), foi atendida em 10 sessões com duração entre 60 e 115 minutos. Foram utilizados os testes psicológicos Escala de Bem-Estar Psicológico (Ebep), Escala de Vulnerabilidade e Estresse no Trabalho (Event), Bateria Fatorial de Personalidade (BFP), Método de Rorschach e Inventários de Habilidades Sociais 2 (IHS-2). Observou-se que, durante o processo, Violeta ampliou sua autopercepção, o que possibilitou mudanças no modo de agir em seus relacionamentos amorosos e na reflexão sobre como sua postura era vista por si e por seus colegas de trabalho. Acredita-se que a AT cumpriu com o objetivo de estabelecer uma experiência terapêutica que possibilitasse mudanças positivas para a cliente. Este estudo de caso contribuiu para ampliar a compreensão sobre a importância e o uso dos testes psicológicos neste modelo de avaliação psicológica.(AU)

The Therapeutic Assessment (TA) is an evaluative and interventional process proposed to be semi-structured and collaborative with the objective of promoting positive changes in the client, who is invited to have an active participation during the process. At the TA, the results of standardized psychological tests are highlighted as facilitators of the client's self-knowledge process. In this way, the findings of psychological self-report tests are usually integrated with projective methods to generate information that can broaden the client's view of themselves. In this article, understanding the potential use of psychological tests and of the collaborative relationship from a case treated from the TA perspective was sought. The participant, Violet (fictitious name), was assisted in 10 sessions lasting between 60 and 115 minutes. The psychological tests Psychological Well-Being Scale (EBEP), Vulnerability and Stress at Work Scale (EVENT), Personality Factorial Battery (BFP), Rorschach Method and Social Skills Inventories 2 (IHS-2) were used. It was observed that, during the process, Violet increased her self-perception, which allowed changes in her way of acting in her love life and in her reflection on how her posture was seen by herself and herco-workers. It is believed that TA fulfilled the objective of establishing a therapeutic experience that would enable positive changes for the client. This case study contributed to broaden the understanding about the importance and use of psychological testing in this psychological assessment model.(AU)

La Evaluación Terapéutica (ET) es un proceso de evaluación e intervención que se propone ser semiestructurado y colaborativo, con el objetivo de lograr cambios positivos en el cliente, quien es invitado a tener participación activa durante el proceso. En la ET se destacan los resultados de las pruebas psicológicas estandarizadas como facilitadoras del proceso de autoconocimiento del cliente. Los hallazgos de las pruebas psicológicas de autoinforme suelen integrarse con métodos proyectivos para generar información que pueda ampliar la visión que el cliente tiene de sí mismo. En este artículo se buscó comprender el uso potencial de las pruebas psicológicas y de la relación colaborativa a partir de un estudio de caso tratado desde la perspectiva de la ET. Atendieron a la participante Violeta (nombre ficticio), en 10 sesiones que duraron entre 60 y 115 minutos. Se utilizaron las pruebas psicológicas Escala de Bienestar Psicológico (EBEP), Escala de Vulnerabilidad y Estrés en el Trabajo (EVENT), Batería de Factorial de la Personalidad (BFP), Método de Rorschach e Inventario de Habilidades Sociales 2 (IHS-dos). Se observó que, durante el proceso, Violeta amplió su autopercepción, lo que permitió cambios en la forma de actuar en sus relaciones amorosas y en el reflejo de como ella y sus compañeros de trabajo veían su postura. Así, se cree que ET ha cumplido el objetivo de establecer una experiencia terapéutica que permitió cambios positivos a la cliente. Este estudio contribuyó a ampliar la comprensión sobre la importancia y el uso de las pruebas psicológicas en este modelo de evaluación psicológica.(AU)

A relação com o saber nas atividades lúdicas escolares / The relationship with knowledge in school recreational activities / La relación con el saber en las actividades lúdicas escolares

O brincar é uma atividade importante para o desenvolvimento infantil, porque melhora aspectos cognitivos, emocionais e físicos. Além disso, jogos e brincadeiras podem ser explorados como recurso educacional. Partindo do entendimento da ludicidade enquanto um processo subjetivo, este trabalho investigou a relação com o saber estabelecida durante as brincadeiras, buscando compreendê-las em suas dimensões epistêmica, social e identitária. Dezesseis estudantes do 5º ano do ensino fundamental foram entrevistados a partir de um roteiro baseado no instrumento "balanço do saber", proposto por Bernard Charlot. As questões foram adaptadas para possibilitar apreender o que as crianças dizem aprender durante as brincadeiras em que participam, com ênfase naquelas realizadas em sala de aula. Os resultados da análise de conteúdo realizada mostraram que, apesar de existirem conflitos sobre como se estabelecem as funções lúdica e educativa, quando a brincadeira infantil é utilizada como recurso pedagógico, os sujeitos podem identificar benefícios no processo de aprendizagem por meio dela. Aponta-se, também, a necessidade de considerar a condição social da criança no ambiente escolar para o sucesso ao utilizar essas atividades como práticas pedagógicas.(AU)

Child's play is an important activity for child development since it improves cognition, emotional, and physical aspects. Games can also be explored as an educational resource. Starting from the understanding that playfulness is a subjective process, this work has investigated the relationship to the knowledge stablished during games, aiming to understand it in its epistemic, social, and identitary dimensions. A group of 16 5th grade students were interviewed from a script based on the instrument "balance of knowledge," as proposed by Bernard Charlot. The questions were adapted to enable the apprehension of what children say they learn on the games they play, emphasizing those which are played in classrooms. The results of the content analysis performed have showed that, despite the conflicts on how both playful and educative functions are stablished when child's play is used as a pedagogic resource, the subjects can identify benefits on the process of learning with it. The need to consider the child's social condition in the school environment to reach success when using these activities as pedagogical practices is also pointed out.(AU)

Jugar es una actividad importante para el desarrollo de los niños, porque mejora aspectos cognitivos, emocionales y físicos. Por tanto, los juegos son explorados como recurso educativo. Partiendo de la comprensión de que lo lúdico es un proceso subjetivo, este trabajo analizó la relación con el saber que se establece durante el juego, con el objetivo de comprenderlo en sus dimensiones epistémica, social e identitaria. Se entrevistó a dieciséis estudiantes de quinto grado a partir de un guion basado en el instrumento "balance del saber" propuesto por Bernard Charlot. Las preguntas fueron adaptadas para permitir la aprehensión de lo que los niños dicen que aprenden en sus juegos, enfatizando los que se juegan en las aulas. Los resultados del análisis de contenido realizado mostraron que, a pesar de que existen conflictos sobre cómo se establecen ambas funciones lúdica y educativa cuando se utiliza el juego infantil como recurso pedagógico, los niños pueden identificar beneficios en el proceso de aprendizaje a través del juego. Se señala la necesidad de considerar la condición social del niño en el entorno escolar para alcanzar el éxito al utilizar estas actividades como prácticas pedagógicas.(AU)

A large-scale prospective study of big wins and their relationship with future financial and time involvement in actual daily fantasy sports contests.

OBJECTIVE: Early big wins might have a psychological impact upon gamblers that increases their likelihood of intemperate gambling; however, there has been a paucity of empirical research examining this effect using actual gambling data. METHOD: We assessed the effects of daily fantasy sports (DFS) big wins on subsequent play by analyzing a prospective dataset from a major DFS provider (N = 34,596 DFS subscribers) representing over 18 million entries into DFS contests. RESULTS: We found that experiencing a big win in DFS is associated with subsequently increased DFS engagement (i.e., increased contest entry fees and contest entries) and losses (i.e., higher net loss). However, the effect of a big win on engagement and losses decays over time. Whereas theorists have highlighted the effects of early big wins, our analyses indicated that later big wins had a relatively stronger effect on DFS engagement. Sensitivity analyses confirmed the robustness of most results, with somewhat greater support for big wins' effects on engagement metrics than losses. CONCLUSION: Our results collectively indicate the existence of a big win effect in DFS. For some players, big wins might instill unrealistic expectations about future probabilities of winning and lead to increased-and potentially excessive-engagement. Explanations from cognitive psychology (e.g., the illusion of control) and behavioral psychology (e.g., operant conditioning) might help to explain the big win effect. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"The state They're in": Unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities.

Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent 'Fantasy Paradigms'. This paper explores one example of such 'Fantasy' intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services.

The contribution of the TIPE (Test di Induzione PsicoErotica: PsychoErotic Induction Test) to the assessment of erotic fantasies in subjects affected by gender dysphoria: a case series.

Research into sexual aspects poses a fascinating challenge that is highly cogent to clinical profiling disciplines, but also constitutes a more 'narrative and culturally oriented' approach to medicine and psychology. Assessments of subjects affected by gender dysphoria and their internal, relational and sexual world is a still more complex task, since these are very distressing and tormented issues for the subjects under study. Psychodiagnostics can be an important element in the various investigative, evaluative and therapeutic pathways. The authors have focused attention on the TIPE (Test di Induzione PsicoErotica: PsychoErotic Induction Test), an Italian projective psychodiagnostic tool that is used to explore the psychoerotic fantasies of subjects affected by gender dysphoria. The TIPE tests protocols of two samples of subjects have been examined. They projected particularly rich narrative aspects of the subjects' psychoerotic imaginary world. The first sample, a clinical series, consisted of a total of eleven subjects, nine men and two women, mean age 43 years, who were undergoing assessment, firstly psychotherapeutic and then medicolegal, for sex rectification purposes; the second sample, the controls, consisted of fourteen subjects, nine men and five women, mean age 28 years, all heterosexual and with a problem-free history of sexual identity.

Fantasy-Driven Versus Contact-Driven Users of Child Sexual Exploitation Material: Offender Classification and Implications for Their Risk Assessment.

Since the advent of the Internet, convictions for the possession, display, trading, and distribution of child sexual exploitation material (CSEM) have risen steadily, but little is known about their appropriate assessment and treatment, especially concerning their risk of reoffending. It has been suggested that a conceptual distinction of fantasy- versus contact-driven CSEM users might be of merit. Sixty-eight offenders recruited from sex offender treatment providers were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the findings showed differences in the psychological profiles between CSEM users and contact child sex offenders. Numerical and spatial methods of data analysis were used to identify subgroups of CSEM users; these confirmed the twofold distinction of fantasy- versus contact-driven offending. The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors; potentially differentiating distinct offender subgroups with different risks and needs. The current study informed the development of an empirical model of CSEM users that could aid in the assessment of risk of reoffending and cross-over to contact sex offending.

An Analysis of Self: The Development and Assessment of a Measure of Selfobject Needs.

Based on the psychoanalysis of adults with borderline and narcissistic personality disorder symptoms, Kohut ( 1971 , 1977, 1980, 1984) formulated a theory of self psychology that emphasized the importance of early developmental experiences; most centrally, the empathic attunement of caregivers as key ingredients for fostering the capacity for healthy self-regulation and interpersonal relations. Kohut elaborated 3 critical selfobject needs (i.e., idealizing, mirroring, and twinship) that were ideally satiated by these early experiences, deeming the fulfillment of these needs as essential for developing a healthy sense of self. The research presented here sought to develop a self-report measure, titled the Arble Estimate of Selfobject Pursuits (AESOP), capable of assessing the selfobject needs identified by Kohut. Across 2 studies involving 686 and 672 respondents, participants completed the AESOP. In the first study, an exploratory factor analysis supported the theorized 3-factor structure. In the second study, a confirmatory factor analysis indicated adequate-to-strong model fit and cluster analysis with theoretically related measures supported the AESOP's discriminant and convergent validity. Further research is encouraged to elaborate the implications of these preliminary findings.

Contradictions in the American dream: High educational aspirations and perceptions of deteriorating institutional support.

This study examines contradictions in the "American Dream" during the Great Recession: young adults maintained high educational aspirations, yet perceived little opportunity for their educational achievements to help them fulfil their dreams of financial prosperity and work stability. Based on in-depth interviews with 85 young college students and recent graduates, this study found that college enrolment was propelled by the recession, as a college degree, and often a graduate or professional degree, was perceived as an increasingly necessary credential. Despite these high educational aspirations, students and recent graduates were fearful about their capacity to find future work and they expressed concerns about the collapse of employment opportunity. Many were also wary of educational institutions, which they viewed as unable to prepare them for a shrinking job market. These perceptions reveal a contradiction in the "American Dream:" although young adults have high aspirations and achievements, they have lost confidence in the educational and work institutions upon which they must depend.

Assessment of Sexual Fantasies in Psychiatric Inpatients With Mood and Psychotic Disorders and Comorbid Personality Disorder Traits.

INTRODUCTION: Sexuality is an important aspect of quality of life and sexual fantasies comprise a normal part of human sexuality. However, the nature of sexuality and sexual fantasies of patients with mental illness remains an understudied area. AIM: To investigate the nature and frequency of sexual fantasies in psychiatric patients, the present study compared the frequency of four types of sexual fantasies across four different mood and psychotic diagnoses and three personality disorder clusters. METHODS: Study participants included 133 psychiatric inpatients recruited from an urban hospital. Sexual fantasies were compared across patients with schizophrenia, bipolar disorder, schizoaffective disorder, major depressive disorder and three nonclinical samples from the literature and then correlated with personality cluster scores. MAIN OUTCOME MEASURES: Subjects were administered the Structured Clinical Interview for DSM-IV for Axis I and for Axis II Disorders. Sexual fantasies were assessed by the Wilson Sexual Fantasies Questionnaire, which measures four types of sexual fantasies (exploratory, intimate, impersonal, and sadomasochistic). RESULTS: Within the entire sample, there were significant differences across sexual fantasy types, with subjects scoring highest on intimate sexual fantasies and then exploratory, impersonal, and sadomasochistic. There were no significant differences across mood and psychotic diagnostic groups for any of the sexual fantasy scales and the scores were within the normative range of nonclinical samples. Patients with high cluster B scores scored significantly higher on all four fantasy scales than those without. Patients with high cluster A scores scored lower on intimate fantasies, but there was no association between cluster C scores and sexual fantasies. The association between cluster B and sexual fantasies remained consistent across Structured Clinical Interview for DSM-IV for Axis I diagnoses (no interaction effect). CONCLUSION: Patients with severe mental illness report sexual fantasies that are largely affiliative in nature and consistent with normative patterns. This suggests that assessment and treatment of sexual issues in the mentally ill should be part of the clinical routine as it is in healthy individuals.

[Work and epilepsy--facts and phantasies]. / Arbeit und Epilepsie--Fakten und Fantasien.

Epilepsies can affect ability to work in a certain workplace and reintegration capacity not only due the seizures, but also due to possible accompanying neurological, neuropsychological and psychiatric symptoms. Epileptic seizures can lead to injuries of the patient himself and of other persons. Assessment of this aspect in a certain workplace requires not only a detailed knowledge of the nature of this job, but also of the semiology and frequency of seizures must be considered. Both attacks and concomitant symptoms (e.g. memory impairment, depression, etc.) have to be assessed with regard to prognosis and treatment status. As part of the patient's duty to cooperate with the social insurance system it is expected that he is concerned about the regular intake of antiepileptic pharmacotherapy, possibly also of psychiatric medications. Epilepsy surgery is, however, not regarded as a reasonable treatment.

Positive thinking about the future in newspaper reports and presidential addresses predicts economic downturn.

Previous research has shown that positive thinking, in the form of fantasies about an idealized future, predicts low effort and poor performance. In the studies reported here, we used computerized content analysis of historical documents to investigate the relation between positive thinking about the future and economic development. During the financial crisis from 2007 to 2009, the more weekly newspaper articles in the economy page of USA Today contained positive thinking about the future, the more the Dow Jones Industrial Average declined in the subsequent week and 1 month later. In addition, between the New Deal era and the present time, the more presidential inaugural addresses contained positive thinking about the future, the more the gross domestic product and the employment rate declined in the presidents' subsequent tenures. These counterintuitive findings may help reveal the psychological processes that contribute to an economic crisis.

'Shooting at the sun god Apollo': the Apollonian-Dionysian balance of the TimeSlips Storytelling Project.

In The Birth of Tragedy, Friedrich Nietzsche celebrated the dueling forces of reason and emotion as personified by the ancient Greek gods Apollo and Dionysus. A subtle Apollonian-Dionysian balance can be observed in TimeSlips, a group-based creative storytelling activity developed in the 1990s and increasingly used in dementia care settings worldwide. This article explains how the Apollonion-Dionysian aspects of TimeSlips are beneficial not only for persons with dementia, but also for their carers. Narrative data from medical students at Penn State College of Medicine who participated in TimeSlips at a local retirement community are shared.

Gone exercising: mental contrasting promotes physical activity among overweight, middle-aged, low-SES fishermen.

OBJECTIVE: Fantasy realization theory (Oettingen, 2012) proposes that fantasizing about a desired future or dwelling upon negative reality rarely changes behavior whereas mentally contrasting fantasy with reality can be an effective behavior change technique. This is because mental contrasting energizes people to overcome obstacles that stand in the way of their desired future. The present study tested whether mental contrasting promotes rates of physical activity among overweight, middle-aged, and low-SES men. METHOD: A randomized controlled trial was conducted with members of an angling club in the north of England (N = 467). At baseline, participants completed a postal questionnaire that measured cognitions about physical activity. The intervention was embedded in the questionnaire for relevant participants. Behavior was followed up via telephone at 1 month and 7 months postbaseline. The key outcome measure was a validated, self-report measure of physical activity (Godin, Jobin & Bouillon, 1986) taken at all three time-points. RESULTS: Longitudinal, explanatory, and intention-to-treat analyses each indicated that mental contrasting was effective in enhancing rates of physical activity. Mental contrasting also aided the translation of beliefs about the value and worth of physical activity (instrumental attitudes) into action. CONCLUSION: Mental contrasting appears to be an effective self-regulatory intervention for promoting physical activity and warrants further tests in health psychology.

Recalled peritraumatic reactions, self-reported PTSD, and the impact of malingering and fantasy proneness in victims of interpersonal violence who have applied for state compensation.

The present study explores the associations between three types of peritraumatic reactions (dissociation, distress, and tonic immobility) and posttraumatic stress disorder (PTSD) symptoms in a sample of 125 victims of interpersonal violence who had applied for compensation with the Dutch Victim Compensation Fund (DCVF). In addition, the confounding roles of malingering and fantasy proneness are examined. Results indicate that tonic immobility did not predict PTSD symptom levels when adjusting for other forms of peritraumatic reactions, whereas peritraumatic dissociation and distress did. However, after the effects of malingering and fantasy proneness had been controlled for, malingering is the only factor associated with increased PTSD symptomatology. Implications for policy practice as well as study strengths and limitations are discussed.

The characteristics of online sex offenders: a meta-analysis.

There is much debate as to whether online offenders are a distinct group of sex offenders or if they are simply typical sex offenders using a new technology. A meta-analysis was conducted to examine the extent to which online and offline offenders differ on demographic and psychological variables. Online offenders were more likely to be Caucasian and were slightly younger than offline offenders. In terms of psychological variables, online offenders had greater victim empathy, greater sexual deviancy, and lower impression management than offline offenders. Both online and offline offenders reported greater rates of childhood physical and sexual abuse than the general population. Additionally, online offenders were more likely to be Caucasian, younger, single, and unemployed compared with the general population. Many of the observed differences can be explained by assuming that online offenders, compared with offline offenders, have greater self-control and more psychological barriers to acting on their deviant interests.