A Difficult Beginning: Commencement and Birth in the Analysis of an Adolescent.

The author distinguishes between two kinds of beginning, conceptually tied to two ways of approaching the psychoanalytic situation described as epistemological and ontological. Through a clinical case, the author shows how her work with a troubled adolescent had two beginnings that corresponded to these types. In this way, she tries to expand on the literature about the ontological turn, focusing on what beginning means in this context. For treatment to succeed, a birth must emerge, a transformative moment with the potential for significant change. The combined ability to transform the most primitive, somatopsychic pain can be more effective if shared by analysts and patients in a predominantly aesthetic form.

Online Questionnaire with Fibromyalgia Patients Shows Negative Correlations between Disease Severity and Adherence to Mediterranean Diet.

Fibromyalgia (FM) is a multidimensional disorder in which intense chronic pain is accompanied by a variety of psychophysical symptoms that impose a burden on the patients' quality of life. Despite the efforts and the recent advancement in research, FM pathogenesis and effective treatment remain unknown. Recently, the possible role of dietary patterns and/or components has been gaining attention. The current study aimed to investigate a potential correlation between adherence to the Mediterranean diet (MedDiet) and FM severity in a sample of Italian FM patients. An online survey was designed, composed of customized questions and validated questionnaires with the aim of investigating the intensity and type of pain, the presence of other psychophysical symptoms, the overall impact of FM, general food and lifestyle habits, and adherence to the MedDiet. The collected responses were analyzed for descriptive statistics, linear regression, and propensity score analyses. The results show that, despite considerable use of pharmaceuticals and supplements, FM participants suffered from a high-severity grade disease. However, those with good adherence to the MedDiet experienced a lower pain intensity and overall FM impact. A propensity score analysis indicates a positive influence of the MedDiet against FM severity, thus unveiling the need for well-designed intervention studies to evaluate the therapeutic potential of different dietary patterns.

Online Questionnaire with Fibromyalgia Patients Reveals Correlations among Type of Pain, Psychological Alterations, and Effectiveness of Non-Pharmacological Therapies.

Fibromyalgia (FM) is a chronic pain syndrome with an unclear etiology. In addition to pain, FM patients suffer from a diverse array of symptoms and comorbidities, encompassing fatigue, cognitive dysfunction, mood disorders, sleep deprivation, and dizziness. Due to the complexity of FM, the diagnosis and treatment of it are highly challenging. The aim of the present work was to investigate some clinical and psychological characteristics of FM patients, and to uncover possible correlations with pharmacological and non-pharmacological therapies. We conducted a cross-sectional, questionnaire-based study aimed at evaluating pain, psychological traits, and the self-perceived effectiveness of pharmacological and non-pharmacological treatments in an Italian population of FM patients. Descriptive statistics, correlation, and inference analyses were performed. We found a prevalence of a neuropathic/nociplastic type of pain, which correlated with psychological traits such as anxiety, low mood, psychophysical discomfort, and the inability to relax. The pain type and psychological traits proved to play a role in determining the self-perceived effectiveness of therapeutic interventions. Patients revealed a better response to non-pharmacological therapies, particularly dietary interventions, relaxation techniques, and psychotherapy rather than pharmacological interventions. The sum of our data indicates that for better outcomes, the type of pain and psychological traits should be considered for tailor-made treatments considering non-pharmacological protocols as a complement to the use of drugs.

PO2 21% oxygenated hypothermic machine perfusion in kidney transplantation: Any clinical benefit?

BACKGROUND: In deceased donor kidney transplantation (KT), the use of hypothermic machine perfusion (HMP) has been acquiring the status of best practice in the pre-transplant management of kidney grafts. Two types of HMP are currently available, oxygenated HMP and non-oxygenated HMP. However, data on the real clinical impact of oxygenation on KT outcome are still heterogeneous. METHODS: Retrospective study on a cohort of 103 patients transplanted with a single kidney graft that was managed either with end-ischemic oxygenated (O2 group, Waves Machine, n = 51, 49.5%) or non-oxygenated HMP (no-O2 group, Life Port Kidney Transporter Machine, n = 52, 50.5%), during the period January 2016-December 2020. Oxygenation was performed at pO2 21%. RESULTS: The median cold ischemia time was 29 h:40 min [IQR 26 h:55 min-31 h:10 min] and the prevalence of grafts from extended criteria donors (ECD) was 46.7%, with a median kidney donor profile index (KDPI) of 72 [41-94]. The study groups were homogeneous in terms of recipient characteristics, ischemia times and donor characteristics. O2 and no-O2 groups showed comparable outcomes in terms of delayed graft function (O2 vs no-O2, 21.5% vs 25%, p = 0.58), vascular (0.2% vs 0.2%, p > 0.99) and urologic (13.7% vs 11.5%, p = 0.77) complications, and episodes of graft rejection (11.7% vs 7.7%, p = 0.52). At 1 year follow up, even creatinine serum levels were comparable between the groups (1.27 mg/dL [1.09 and 1.67] vs 1.4 mg/dL [1.9-1.78], p = 0.319), with similar post-transplant trend (p = 0.870). No significant benefit was either observed in ECD or KDPI > 60 subgroups, respectively. CONCLUSIONS: Oxygenation at pO2 21% during HMP seems not to significantly enhance the KT outcomes in terms of postoperative complications or graft function.

Vestibular Disability/Handicap in Fibromyalgia: A Questionnaire Study.

Fibromyalgia (FM) is a poorly understood, central pain processing disorder characterized by a broad range of symptoms, such as chronic pain, sleep disruption, chronic fatigue, and psychosomatic symptoms. In addition, recent studies have shown that FM patients also experience dizziness. We aimed to establish a prevalence rate of vestibular symptoms in a population of FM patients through a battery of questionnaires investigating socio-demographic, clinical and psychological characteristics, combined with the Dizziness Handicap Inventory (DHI) and the Situational Vertigo Questionnaire (SVQ). A total of 277 respondents, officially diagnosed with FM, completed the full study, while 80 controls were also included for DHI and SVQ questionnaires. We found that FM participants were significantly affected by vestibular symptoms, which correlated with FM-associated pain and non-pain symptoms. The dizziness reported by FM participants showed peculiar features suggesting an FM-intrinsic mechanism of vestibular dysfunction, possibly linked to migraine and dysautonomia conditions. Correlations between dizziness and depressive mood (or neuroticism), revealed an impact of dizziness on psychological status, leading to depressive reactions and interpersonal difficulties, and possibly involving a noxious, self-sustained stress condition. In conclusion, data showed a manifesting dizziness condition in FM patients that warrants careful clinical attention due to its possible inherent role in the syndrome.

From crumpled-up paper to origami: an analyst learns to play.

In the course of an analysis, the analytic relationship can go through moments of difficulty generated by patient and analyst while they learn to "play" together. In this paper, different kinds of difficult relational moments are illustrated through fragments of a child analysis, and some components are explored that can catalyze the creative transformation of turbulence and the resumption of analytic "play." In particular, the author hypothesizes that some conscious feelings described by Winnicott as characterizing play, understood as the optimal functioning of the analytic process, can be indicators of the efficiency of--or, conversely, of difficulties in--the unconscious oneiric work carried out by the couple. These indicators may be useful in monitoring the process not so much in the immediate moment, but rather over a medium to long period. Considering these indicators can initiate the revival of a playful equilibrium in the bi-personal system on which play and the analytic field are based.

Development and Validation of an Italian Adaptation of the Psychosocial Aspects of Hereditary Cancer Questionnaire.

Individuals that attend cancer genetic counseling may experience test-related psychosocial problems that deserve clinical attention. In order to provide a reliable and valid first-line screening tool for these issues, Eijzenga and coworkers developed the Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire. The aim of this work was to develop an Italian adaptation of the PAHC (I-PACH). This prospective multicenter observational study included three stages: (1) development of a provisional version of the I-PAHC; (2) pilot studies aimed at testing item readability and revising the questionnaire; and (3) a main study aimed at testing the reliability and validity of the final version of the I-PAHC with the administration of a battery comprising measures of depression, anxiety, worry, stress, and life problems to 271 counselees from four cancer genetic clinics. Adapting the original PAHC to the Italian context involved adding two further domains and expanding the emotions domain to include positive emotions. While most of the items were found to be easy to understand and score, some required revision to improve comprehensibility; others were considered irrelevant or redundant and therefore deleted. The final version showed adequate reliability and validity. The I-PAHC provides comprehensive content coverage of cancer genetic-specific psychosocial problems, is well accepted by counselees, and can be considered a sound assessment tool for psychosocial issues related to cancer genetic counseling and risk assessment in Italy.

Intimacy and Autism: An Apparent Paradox.

The concept of intimacy includes the idea of being open to others. But autistic patients have a hard time dealing with relationships, and for a therapist to become "autistic" is therefore an emotional paradox. Intimacy is a condition that involves others and requires the ability to maintain a condition in which emotional background noise doesn't interfere, and the body is free enough of anxiety to allow people to get onto the same wavelength. For psychoanalysts, the ambiguity of the situation lies in the fact that, as in any therapy, becoming "autistic" with autistic people means seeking empathy with the patient, but also protecting ourselves, sometimes in an unconscious way, from contact with overwhelming feelings. So, oscillating in a contiguous-autistic state of mind is both a positive and a negative therapeutic fact; on the other hand, maintaining the paradox can be a valuable tool in psychoanalytic therapy.

SEEKING COMFORT IN AN UNCOMFORTABLE CHAIR.

The author explores the concept of comfort in relation to the setting. The concept of comfort, an unusual word in the psychoanalytic lexicon, describes the intuitive and complex experience of patient and analyst being together in the analytic office. The couch and the chair are not the only tools of the setting, but they are potential instruments with which to study the therapeutic process, both in high-frequency therapy and in lower-frequency treatments. To describe the transformations that an alternative experience of comfort can promote, the author looks at the intersection of this concept with the body-mind relationship and with the Bionian concept of binocular vision.

Caudal mucogingival lesions secondary to traumatic dental occlusion in 27 cats: macroscopic and microscopic description, treatment and follow-up.

The main aim of this retrospective study was to describe clinical and histopathological findings in cats with mucogingival lesions developed at the contact point of the premolar and molar teeth of the opposite quadrant. Cases were retrieved following manual review of the medical records, dental records and photographic documentation of all feline dental patients visited in the period between February 2001 and August 2011. Cats showing different lesions at different times were calculated as multiple cases. A total of 27 cats (31 cases) with 44 lesions (26 proliferations [59%], 11 clefts [25%] and seven foveae [16%]) were included. Mean age at the time of the first visit was 6.6 years. The lesion object of the study was the main reason for presentation in only five cases (16%). Proliferations showed two different histopathological patterns and had characteristics in common with human oral pyogenic granuloma. Successful treatment was achieved in all cases by removing the occlusal contact by dental extraction or coronal reduction, possibly associated with lesion excision. This study underlines the need for a thorough oral examination and evaluation of dental occlusion in all patients. Causes for the development of traumatic occlusion may include an acquired overbite (possibly secondary to selective dental extraction), congenital or post-traumatic malocclusion, abnormal latero-lateral mobility of the mandible, occlusal drift of the premolar and molar teeth, and/or alveolar bone expansion.

The anteroom: a camera obscura for grasping aspects invisible in the classical setting.

The anteroom, is not only an architectural space, but also a location in the field where analyst and patient meet in a different frame of mind from the therapeutic attitude that characterizes their relationship in the consulting room. Drawing a parallel with the variations in perception generated by the camera obscura in the experience of a painter, the author investigates how new aspects of the conscious and unconscious relationship between analyst and patient can emerge within a different setting. Observation of these variations suggests the possibility of regarding the setting no longer as an invariant of the field, but instead as one of the factors that can actively mold the analytic relationship.

The use of child drawings to explore the dual↔group analytic field in child analysis.

Awareness that the child is part of a complex relational system has ensured that all child analysts agree on the necessity of establishing a therapeutic alliance with the parents. Unconscious conflictual dynamics involve the child analyst and include him, from the time of the initial consultation, in an analytic field that is closer to that of a group than to the bi-personal set-up of therapy with adults. Through a clinical example, the author hypothesizes that the child's drawings and play can be viewed as tools capable of mapping the unconscious emotions present in an analytic field that extends beyond the analyst-child couple. Play and drawings can be used in the relationship with the parents not in an explanatory sense, but as a probe with which to explore the universe of unconscious emotions present in the group field. The images or the story of the play used with this particular modality prove to be an attractive pathway that is effective in facilitating the alpha function of each of the members of the group. Furthermore, in this sense, they create the conditions for an occasion through which the parents can become more aware of their own unconscious emotions that have been entrusted to the child and expressed through his symptomatology. The possibility for the little group of subjects involved in a child analysis for oscillation in a dual-group field permits not only a shared experience of knowledge, but also a shared creativity aimed at knowledge of emotional truth (O).

From one room to the other: a story of contamination. The relationship between child and adult analysis.

Does the analyst who works with both children and adults using ostensibly the same theoretical model perform similar mental operations in these two fields? The author suggests that child analysis is rooted in a different creative process from that of adults. Comparing the analysis of children to painting and that of adults to writing, and making use of the debate between Virginia Woolf and her sister Vanessa Bell on the relative merits of words and images, the author explores the psychoanalytic debate on the role of child analysis in the development of psychoanalytic theory and practice. Child analysis, initially regarded as an application of psychoanalysis, ended up acting as a catalyst for a true epistemological revolution in the 20th century through the work of Klein and Bion. Playing is not only an alternative medium to words for representing the unconscious but a different method for giving shape to representations through a specific creative process. The reverie which is born in the child analyst's consulting room reproduces itself through the body's actions during play, whereas in the adults' consulting room the analyst's capacity to dream presupposes the suspension of action. Child analysis, deploying a distinctive creative process that makes use of the body and serves itself of action in its development, may be said to rest on a similar creative process to that of figurative art. For this reason, the child analyst's mind relates to objects in a different way, being in a more prolonged state of fusion with these as a result of 'concentration of the body'. The significance of the unspeakable things that take place can often only be conceptualized in après-coup. Although this difference in the development of the process suggests a significant distinction between the two 'arts' of child and adult analysis, the aesthetic sensitivity acquired through child analysis can be profitably used with adults, as will be demonstrated with the help of several clinical examples.

A 'quantum' of truth in a field of lies: the investigation of emotional truth in a child analysis.

Following Bion's ideas of analytical research the author intends to consider the need to pursue emotional truth between patient and psychotherapist in order to produce a psychological development. It is shown through the analysis of a child how emotional falsification can distort first of all the definition of the child identity. Successively the attention is focused on how lies, as an unconscious element that twist the research of the truth, obstruct the development of thoughts able to transform emotions.Using a quantisation physical model of space, the author hypothesises that the transformation of ß elements in α elements is always in an unstable equilibrium. The distortion of emotional truth co-produced by lies affects the oscillation ß↔α at a primitive level of transformation, changing the "physical" state of the analytical field from conductor to insulator. The most important consequence of the particular point of view suggested by the quantistic model is that in the third analytical space the same definition of α elements or ß elements depends on the analyst's point of view. This change of perspective can vitalise the analytical thinking of patient and analyst during an impasse.

O uso de desenhos de crianças na exploração do campo analítico dual<->grupal em análise de crianças / The use of child drawings to explore the dual<->group analytic field in child analysis / La utilización de dibujos de niños para explorar el campo analítico dual<->grupal dentro del análisis de niños

O entendimento de que a criança é parte de um sistema relacional complexo assegurou que todos os analistas de crianças concordassem sobre a necessidade de estabelecer uma aliança terapêutica com os pais. A dinâmica inconsciente de conflitos envolve o analista de crianças e o inclui, desde a primeira consulta, em um campo analítico que é mais próximo daquele de um grupo do que do sistema bipessoal da terapia com adultos. Com o auxílio de um exemplo clínico, a autora apresenta a hipótese de que os desenhos e as brincadeiras da criança podem ser vistos como ferramentas capazes de mapear as emoções inconscientes presentes no campo analítico que se estendem para além da dupla criança-analista. Brincadeiras e desenhos podem ser usados na relação com os pais, não com um sentido explanatório, mas como uma sonda com a qual explorar o universo das emoções inconscientes presentes no campo do grupo. As imagens ou as histórias de brincadeiras usadas nessa modalidade particular se apresentam como um caminho atraente e que é eficaz para facilitar a função alfa de cada um dos membros do grupo. Além disso, nesse sentido, criam as condições para uma situação através da qual os pais podem tomar conhecimento das suas emoções inconscientes que foram transmitidas para a criança e expressas através de sua sintomatologia. A possibilidade para o pequeno grupo de sujeitos envolvidos em uma análise de criança de oscilar em um campo dual-grupal permite não apenas uma experiência compartilhada do conhecimento mas também uma criatividade compartilhada voltada para o conhecimento da verdade emocional (O)...

Awareness that the child is part of a complex relational system has ensured that all child analysts agree on the necessity of establishing a therapeutic alliance with the parents. Unconscious conflictual dynamics involve the child analyst and include him, from the time of the initial consultation, in an analytic field that is closer to that of a group than to the bi-personal set-up of therapy with adults. Through a clinical example, the author hypothesizes that the child's drawings and play can be viewed as tools capable of mapping the unconscious emotions present in an analytic field that extends beyond the analyst-child couple. Play and drawings can be used in the relationship with the parents not in an explanatory sense, but as a probe with which to explore the universe of unconscious emotions present in the group field. The images or the story of the play used with this particular modality prove to be an attractive pathway that is effective in facilitating the alpha function of each of the members of the group. Furthermore, in this sense, they create the conditions for an occasion through which the parents can become more aware of their own unconscious emotions that have been entrusted to the child and expressed through his symptomatology. The possibility for the little group of subjects involved in a child analysis for oscillation in a dual-group field permits not only a shared experience of knowledge, but also a shared creativity aimed at knowledge of emotional truth (O)...

La comprensión de que el niño es parte de un sistema relacional complejo aseguró que todos los analistas de niños pasasen a concordar con la necesidad de establecer una alianza terapéutica con los padres. La dinámica inconsciente de conflictos envuelve el analista de niños y lo incluye, desde la primera consulta, en un campo analítico que se corresponde más con el de un grupo que con el de un sistema bipersonal como lo es el del análisis de adultos. Con auxilio de un ejemplo clínico, la autora presenta la hipótesis de que los dibujos y juegos de los niños pueden ser vistos como herramientas capaces de mapear las emociones inconscientes presentes en el campo analítico que se extienden para más allá de la dupla niño-analista. Juegos y dibujos pueden ser usados en la relación con los padres, no con un sentido explicativo, más como una sonda con la cual explorar el universo de las emociones inconscientes presentes en el campo del grupo. Las imágenes o los relatos acerca de juegos usados en esa modalidad particular surgen como un camino atractivo y eficaz para facilitar el desarrollo de la función alfa de cada uno de los miembros del grupo. Además, y en ese sentido, crean condiciones para que los padres tomen conocimiento de sus emociones inconscientes que les fueron transmitidas a los niños y expresadas a través de la sintomatología. Al pequeño grupo de sujetos comprometido en un análisis de niños, la posibilidad de oscilar en un campo dual-grupal, les permite vivenciar una experiencia compartida del conocimiento así como también su creatividad conjunta volcada hacia el conocimiento de la verdad emocional (O)...

O quanto ainda é necessário interpretar o brincar na análise infantil? considerações na esteira das ideias de Bion / ¿Cuán necesario es todavía interpretar el juego en el análisis infantil? consideraciones con base en las ideas de Bion / How it is still necessary to interpret the play in child analysis? considerations in the wake of Bion’s ideas

Partindo da observação de uma interação criativa entre pai e filho na vida cotidiana, os autores questionam a necessidade da interpretação verbal na prática atual da análise infantil. No modelo bioniano a capacidade dos pais de sonhar os elementos β que excedem a capacidade transformadora das emoções inconscientes da criança é indispensável para o crescimento da pequena função α que a criança possui e para o desenvolvimento do seu continente mental. Utilizando o modelo da membrana biológica, os autores hipotetizam um modelo para descrever os elementos que facilitariam a capacidade da criança de utilizar e reelaborar ela mesma as rêverie dos pais e como esses elementos pertenceriam mais ao campo não verbal que ao campo verbal. Através de um exemplo clínico, os autores mostram como esse modelo encontra uma confirmação na prática analítica e permite que a dupla analista-criança sonhe em conjunto as emoções inconscientes que se coagulam no campo bi-pessoal. A brincadeira compartilhada com o analista, mais do que a interpretação verbal, é capaz de ajudar a criança a desenvolver o seu processo criativo de tal forma que, agora, tal processo possa manifestar-se através de uma representação consciente-inconsciente que fica explícita nos personagens da brincadeira ou no desenho

Starting from the observation of a creative interaction between father and son in the daily life, the authors question the verbal interpretation need in the current practice of child analysis. In the bionian model, the parent’s capacity to dream the β elements which exceed the transforming capacity of the unconscious emotions of the child are indispensable for the growth of the small α function that the child posseses and for the development of his or her mental continent. Using the biological membrane’s model, the authors hypothesize a model to describe the elements which would facilitate the child’s own capacity to utilize and redesign the parent’s rêverie and how these elements would belong more to the nonverbal field than to the verbal field.Through a clinical example, the authors show how this model finds a confirmation in the analytical practice and allows the couple, child-analyst to dream together the unconscious emotions that coagulate in the bi-personal field. The play shared with the analyst, more than the verbal interpretation, is capable of helping the child develop his or her own creative process in such a way that, now, such process could manifest through a consciousunconscious representation which is explicit in the characters of the play and of the drawing

Partiendo de la observación de una interacción creativa entre padre e hijo en la vida cotidiana, los autores cuestionan la necesidad de la interpretación verbal en la práctica actual del análisis infantil. En el modelo bioniano, la capacidad de los padres de soñar los elementos β que exceden la capacidad transformadora de las emociones inconscientes del niño es indispensable para el crecimiento de la pequeña función α que posee el niño para el desarrollo de su continente mental. Utilizando el modelo de la membrana biológica, los autores presentan la hipótesis de un modelo para describir los elementos que facilitarían la capacidad del niño de utilizar y reelaborar él mismo la rêverie de sus padres y cómo esos elementos pertenecerían más al campo no verbal que al campo verbal. A través de un ejemplo clínico, los autores muestran como ese modelo encuentra una confirmación en la práctica analítica y permite que la pareja analista-niño sueñe en conjunto las emociones inconscientes que se coagulan en el campo bi-personal. El juego compartido con el analista, más que interpretación verbal, es capaz de ayudar al niño a desarrollar su proceso creativo de tal manera que, ahora, ese proceso se pueda manifestar a través de una representación consciente-inconsciente que queda explícita en los personajes del juego o en el dibujo