El proceso de la formación psicoanalítica / The process of psychoanalytic formation / Le processus de la f ormation psychanalytique

Se trata de una conferencia pronunciada por Ferenczi en 1928 en Madrid. En ella aborda aspectos fundamentales de la formación del psicoanalista. Afirma que la condición sine qua non es el conocimiento y observación de uno mismo a través del análisis personal, previo a cualquier formación teórica y práctica. Explica cómo solo a través de la introspección y la comprensión de los propios procesos psíquicos e intelectuales es posible capacitarse para la comprensión de las mociones psíquicas y afectivas ajenas. Expone la importancia de la asociación libre y el análisis de los sueños, así como de que el análisis sea conducido por otro, por las limitaciones inevitables del autoanálisis. El análisis de la transferencia, el vencimiento de las resistencias realizado con tacto y firmeza por otro conducen a la independencia del analizando con respecto del analista, específica del método psicoanalítico. Compara la formación del psicoanalista con la del artesano. A continuación habla de la creación de la API bajo su iniciativa y de las complejas vicisitudes de la institucionalización del psicoanálisis, alentando a la constitución en España de un grupo propio para el desarrollo del psicoanálisis en torno a la figura -elogiada por él- de Luis López-Ballesteros

In a lecture given in Madrid in 1928, Ferenezi addresses fundamental aspects of the psychoanalyst's training, contending that its sine qua non condition is self-knowledge and observation through personal analysis, prior to any theoretical or practical training. He explams how it is only through introspection and understandmg of one s own psychic and intellectual processes that one can develop the skills to understand the psychic and aff ective motions of another. He expounds upon the importance of free association and dream analysis, as well as of the analysis being directed by another, owing to the inevitable limitations of self-analysis. Transference analysis, the overcoming of resistances undertaken with tact and firmness by another lead to the analysand's independence in relation to the analyst, which is specific to the psychoanalytic method. He compares psychoanalytic formation to learning a craft. He then discusses the creation of the IPA on his initiative and the complex vicissitudes of the institutionalisation of psychoanalysis, encouraging the constitution in Spain of its own group for the furtherment of psychoanalysis, based around the much-lauded figure of Luis López Ballesteros

Il s'agit d'une conférence faite par Ferenczi en 1928 a Madrid dans laquelle il aborde des aspects fondamentaux de la formation du psychanalyste. Il affirme que la condition sine qua non est la connaissance et l'observation de soi-méme a travers l'analyse personnelle, préalable a n'importe quelle formation théorique et pratique. Il explique qu'il est seulement possible de se former pour la compréhension des motions psychiques et affectives des autres a travers l'introspection et la compréhension des propres processus psychiques et intellectuels. Il expose l'importance del' association libre, del' analyse des réves et qu' également l'analyse soit conduite par un autre, en raison des limitations inévitables de l'autoanalyse. L'analyse du transfert, la victoire sur les résistances réalisée avec tact et fermeté par un autre conduisent a l'indépendance de l'analysant vis a vis de l'analyste, spécifique a la méthode psychanalytique. Il compare la formation du psychanalyste avec celle de l'artisan. Finalement il parle de la création de l'IPA sous son initiative et les complexes vicissitudes de l'institutionnalisation de la psychanalyse, en encourageant la constitution en Espagne d'un groupe propre pour le développement de la psychanalyse autour de la figure -saluée par lui- de Luis López Ballesteros

Confusión de lenguas entre los adultos y el niño. El lenguaje de la ternura y de la pasión / Confusion of tongues between the adults and the child. The language of tenderness and of passion

El título original de este trabajo, Las pasiones de los adultos y su influencia sobre el desarrollo del carácter y de la sexualidad del niño, da cuenta de la hipótesis fundamental del autor sobre la importancia del traumatismo y, en particular, del traumatismo sexual como factor patógeno. Denuncia que los niños son víctima de violencia y de violaciones o seducciones incestuosas mucho más a menudo de lo que se cree, y considera que esto va a traer una serie de consecuencias psíquicas, tales como el mecanismo de identificación con el agresor, la introyección del sentimiento de culpa, la fragmentación o atomización y la confusión. Asimismo, pueden padecer una inhibición sexual o desarrollar una perversión. El autor plantea revisar la teoría sexual y genital aludiendo a la importancia del factor exógeno, de la pasión del adulto, como condicionante del sadomasoquismo en el niño. Partiendo de su experiencia clínica, y a raíz de ciertas dificultades de la técnica, como la excesiva docilidad de algunos de sus pacientes, el autor se replantea los efectos de sus propias resistencias como analista, y modifica su técnica haciendo hincapié en la comprensión, la simpatía Y la confianza que le permitirán acceder al material oculto (AU)

The original title of this text, The passions of adults and thezr influente on the sexual and character development of the child illustrates the author's fundamental hypothesis on the importance of trauma, particularly of sexual trauma as a pathogenic factor. He claims that children are the victims of violence and incestuous rape or seduction much more freequently than was thought, and considers that these abuses will give rise to important psychic consequences, such as the mechanism of identification with the aggressor, the introjection of guilt, fragmentation or atomization and confusion. In addition, they could also suffer from sexual inhibition or develop a perversion. The author suggests to review sexual and genital theory in order to include the passion of the adult, meaning the importance of the exogenous factor as a determinant for the development of sadomasochism in the child. Drawing upon his clinical experience, and as a result of certain technical problems, such as the excessive docility of some of his patients, the author reconsiders the effects of his own resistances as an analyst, and modifies his technique with an emphasis on understanding, a sympathetic stance and trust, enabling him to gain access to the hidden material (AU)

Darbepoetin alfa once monthly corrects anaemia in patients with chronic kidney disease not on dialysis.

AIM: While darbepoetin alfa (DA) can be administered once monthly (QM) to maintain haemoglobin (Hb) concentrations in anaemic patients with chronic kidney disease not on dialysis (CKD-ND), the QM use of DA for anaemia correction has not been previously investigated. METHODS: In this randomized, double-blind, non-inferiority, active-controlled study, adult subjects with CKD-ND, Hb levels <10 g/dL, and not treated with an erythropoiesis-stimulating agent were randomized 1:1 to receive DA every 2 weeks (Q2W) or QM for 33 weeks with initial doses of 0.75 µg/kg Q2W or 1.5 µg/kg QM. Subjects were treated to target Hb levels of 10-12 g/dL and ≥1 g/dL increase from baseline. The primary end-point was Hb change between baseline and the evaluation period (weeks 29-33), with a non-inferiority margin of -0.5 g/dL. RESULTS: Three hundred and fifty-five subjects received ≥1 dose of DA. Mean (95% confidence interval [CI]) change in Hb between baseline and the evaluation period was 2.16 (1.98-2.33) g/dL for the Q2W group and 1.97 (1.80-2.14) g/dL for the QM group, the mean (95% CI) difference in Hb change being -0.19 (-0.43 to 0.05) g/dL. Most subjects (97.9% Q2W; 98.1% QM) achieved a Hb level ≥10.0 g/dL and ≥1.0 g/dL increase in Hb from baseline. Mean DA (SD) weekly equivalent doses over the evaluation period were 0.20 (0.23) and 0.27 (0.31) µg/kg per week for the Q2W and QM groups, respectively. Safety profiles were similar between groups. CONCLUSION: In subjects with CKD-ND, QM dosing was non-inferior to Q2W dosing for anaemia correction and had a similar safety profile.

El desarrollo del sentido de realidad y sus estadios / The development of the sense of reality and its stages

El autor toma como punto de partida la transición del principio del principio del placer al principio de realidad. Este funcionamiento, ya secundario, propio del hombre adulto normal en su vida de vigilia, coexiste con otros más primarios (sueños, neurosis, fantasías), más vinculados con el principio del placer. Toma como referencia la omnipotencia del pensamiento y los actos obsesivos mágicos para rastrear los restos de la omnipotencia infantil, que el autor remonta a la vida intrauterina, en que supuestamente todo deseo del feto es satisfecho por la madre, y no diferenciándose apenas el yo del mundo exterior (fase introyectiva). Contrapone a esta fase, aquella en que progresivamente, y ya después del nacimiento, se produce un mayor desajuste entre la irrupción de los deseos y la posibilidad de satisfacción de los mismos por el mundo exterior, que cada vez se va diferenciando más como hostil y diferente al yo (fase proyectiva). Pone en relación el desarrollo de este esquema ontogénico con los puntos de fijación supuestamente implicados en la neurosis obsesiva, la histeria de conversión, la paranoia y la parafrenia. Finalmente, tiende puentes entre lo acontecido en la ontogénesis y lo que hipotéticamente sucedió en la filogénesis (AU)

The author takes as his point of departure the transition from the pleasure principle to the reality principle. This, now a secondary function belonging to the normal adult in his or her waking, exist alongside other more primary functions (dreams, neuroses, fantasies), more closely connected with the pleasure principle. The author takes omnipotence of thought and obsessive magical acts as reference points to track down the remnants of infantile omnipotence, tracing it back to intrauterine life, where purportedly the foetus’ every desire is automatically satisfied by the mother, the ego barely differentiated from the external world (the introjective phase). He contrast this phase with the phase in wich, progressively, and immediately after birth, a major mismatch occurs between the emergence of desires and the external world’s ability to satisfy them, a world increasingly distinguished as being at odds with and distinct from the ego (the projective phase). He compares and contrasts the development of this ontogenic structure with the fixation points said to be at play in obsessional neurosis, conversion hysteria, paranoia and paraphrenia. Finally, the author builds bridges between the actual ontogenetic events and what hypothetically took place in phylogenesis (AU)

Introdução pelo Dr. S. Ferenczi a A questão da análise leiga, de Sigmund Freud: edição americana (Brentano's ltd) de setembro de 1927 / Introduction by Dr. S. Ferenczi to Freud's The question of lay-analysis

Nesta introdução ao trabalho de Freud: A questão da análise leiga, para a edição americana de 1927, o autor ressalta as qualidades pessoais e a visão ampla do mestre ao defender a formação analítica para os não-médicos. Aponta a crítica que Freud faz a charlatões que utilizam a psicanálise sem o devido preparo para tal, ao mesmo tempo que considera que entre os charlatões encontram-se também homens de formação médica.Considera o texto do qual faz a introdução um esboço completo e lúcido da psicanálise e talvez o livro mais fácil para a compreensão e apreensão da essência da psicanálise. Finalmente defende a vocação da psicanálise para estender-se a outros campos, como a antropologia, a sociaologia, a educação, a história, a psicologia da arte, entre outros (AU)

Confusão de línguas entre os adultos e a criança: a linguagem da ternura e da paixão

O autor aborda aqui a delicada questão do amor transferencial por meio da comparação da sedução de uma criança feita por um adulto. Faz um paralelo desta situação com a vivida pelo paciente, que pode tornar-se submisso ao analista pela transferência (AU)

The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis.

BACKGROUND: While frequent or occasional symptomatic intradialytic hypotension (IDH) may influence patient well-being, its effects on survival-independent of comorbidities-has not previously been investigated. In this study, therefore, our objective was to assess the effect of frequent IDH (f-IDH) or occasional IDH (o-IDH) on survival. METHODS: During a 10 month run-in period in 1998, 77 patients with f-IDH (> or =10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 patients of a dialysis network. Eighty-five patients who had no hypotensive episodes (no-IDH) during this run-in phase served as controls. Patients were followed for a median of 27 months (range: 0.3-37) and survival of patients in the three groups was compared by log-rank test. Independent association of f-IDH and o-IDH with survival, compared with no-IDH, was assessed by a proportional hazards model that included patient demographics, laboratory data and antihypertensive medication as well as comorbidity. RESULTS: Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH and 33 (39%) with no-IDH died during the follow-up. Mortality rates (deaths/100 patient years) were 37 (log-rank P = 0.013 vs no-IDH), 26 (log-rank P = 0.375 vs no-IDH) and 21 in the three groups, respectively. This indicates significantly decreased survival in patients with f-IDH as compared to those with no-IDH. In multivariate proportional hazards regression, however, where age, sex, time spent on dialysis, presence of coronary heart disease, diabetes, Kt/V, albumin level and use of beta-blockers, calcium-channel blockers and long-acting nitrates has been adjusted for, neither f-IDH nor o-IDH was associated with survival. CONCLUSIONS: Mortality in patients with f-IDH is significantly higher than in those without such events. After adjustments for covariates, however, there is no independent effect of frequent or occasional episodes of IDH on mortality.

Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis-associated hypotension.

BACKGROUND: Symptomatic dialysis hypotension (DH) continues to be a common problem. By comparing patients prone and resistant to DH, several dialysis session and patient related characteristics have been identified that confer susceptibility to DH. Less is known, however, about the comparison of patients with frequent and only occasional DH. The aim of the study was to compare clinical and dialysis-session- (complicated by hypotension) related data between those with frequent (fDH) and those with occasional dialysis hypotension (oDH). METHODS: Nine hundred and fifty-eight patients at 11 dialysis units were followed for 10 months and characteristics of patients with fDH (> or = 10 hypotensive events necessitating medical intervention) (n = 96) were compared to that of patients with oDH (1 or 2 events/10 months) (n = 130). Significant and independent predictors of fDH were obtained by multivariate logistic regression. RESULTS: Significant differences between fDH vs. oDH patients were older age (64.4 vs. 56.9 years, p < 0.001), more females (66 vs. 46%, p < 0.005) in fDH. More fDH patients had diabetes (27 vs. 15%, p < 0.05) and less had glomerulonephritis (15 vs. 35%, p < 0.001) as the cause for ESRD. Coronary artery disease (68 vs. 50%, p < 0.01) and long-acting nitrate treatment (51 vs. 30%, p < 0.001) was more frequent while treatment with ACEI (33 vs. 48%, p < 0.05) or Ca-channel blockers (40 vs. 53%, p < 0.05) were less frequent in patients with fDH. Patients with fDH had higher serum phosphorus levels (1.99 vs. 1.79 mmol, p < 0.005). Dialysis session related data were similar but the hypotensive episode occurred earlier during dialysis in fDH (136 vs. 156 min, p < 0.01). In multivariate analysis, significant independent predictors of fDH were older age (OR = 1.04 [1.02-1.07]), lack of glomerulonephritis as renal diagnosis (2.63 [1.18-5.87]), high phosphorus levels (5.0 [2.45-10.0]), lack of use of Ca-channel blockers (2.09 [1.12-3.91]), and the use of nitrates (2.38 [1.24-4.55]). CONCLUSION: Features of the dialysis sessions complicated by DH seem to be similar between patients with fDH and oDH, while patient characteristics such as older age, renal diagnosis other than glomerulonephritis, higher serum phosphorus levels, use of nitrates, and lack of use of calcium channel blockers are significantly and independently associated with fDH.