Brain, behavior, connections and implications: psychodynamics no more.

The premise of this article is that the major conceptual approach to mental health in the 21st century is grounded in molecular biology. We introduce and discuss three aspects of molecular biology: the concept of neuroplasticity with attention to kindling and the sensitization effect, the effects of life events on brain and behavior, and the interaction of genes and the environment. Subsequent to each of these sections we include a discussion of the implications that these ideas have to nursing practice. In view of the implications that molecular biology has for psychiatric nursing research and practice, we conclude with a call for a re-conceptualization of the psychiatric mental health nursing enterprise and the need for a conceptual model that is comprehensive, integrative, and dynamic.

Opening caregiver minds: National Alliance for the Mentally Ill's (NAMI) provider education program.

The belief that poor parenting and dysfunctional families give rise to mental illness has been perpetuated by psychodynamic and family systems theories that lack supporting scientific evidence, and interventions based on these theories have failed to produce clinical improvements. Nevertheless the National Alliance for the Mentally III (NAMI) found that many clinical training programs continue to teach these outdated theories and interventions and that the mental health system is often destructive to family systems. This article describes a new 10-week program that is designed to educate service providers that will include families in the care of their chronically ill loved one. The program is based on a competence and adaptation rather than a pathology foundation and it shifts the discourse from causes to effects of illness.

Mechanisms of injury and death proximal to restraint use.

Restraints have been subsumed under the rubric of "interventions" in the nursing literature. However, alarming reports of lethal consequences proximal to their use raise the issue to a life and death matter that requires immediate attention from professionals. Little is known about the mechanisms of death and other adverse consequences of restraint use. This article describes these mechanisms and also considers some hypothesized factors and adverse effects associated with their use.

Echocardiographic and clinical spectrum of mitral anular calcification.

To establish the reliability of echocardiography in making the diagnosis of mitral anular calcification 10 consecutive patients with dense echoes at the mitral anular area were examined fluoroscopically, using an image intensifier. Nine of these had distinct mitral anular calcification. The echocardiographic reliability thus confirmed, 30 cases with similar findings were reviewed and the total group of 40 cases were used to define the echocardiographic spectrum of mitral anular calcification. This lesion extended variably from the anulus to involve the posterior left ventricular wall, mitral valve leaflets, aortic root, aortic valve and interventricular septum. The pleomorphic echocardiographic findings introduce difficulties in the diagnosis of pericardial effusion and mitral stenosis. Echocardiography is a reliable method of diagnosing mitral anular calcification, but care must be taken to avoid confusing this condition with others it resembles.

Superimposition of transmural infarction following acute subendocardial infarction; how frequent?

Thirty-five consecutive patients with acute subendocardial infarction admitted to the coronary care unit during a 15-month period were identified and analyzed for location of infarction, and for the in-hospital course in terms of recurrent chest pain, the occurrence of a second infarction, and the clinical status at the end of hospitalization. Thirteen patients developed a transmural infarction sometime between 3 and 21 days (average, ten days) after the initial subendocardial infarction. The transmural infarction was defined by a separate episode of severe and prolonged chest pain, late development of QRS alteration, and an appropriate elevation of the creatine phosphokinase concentration. Our experience with acute subendocardial infarction, hertofore regarded as a relatively benign event, indicates that the immediate prognosis of the patient who sustains his first episode of subendocardial infarction is not at all benign, and, indeed, subendocardial infarction frequently heralds transmural infarction within the acute phase of the disease.