Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans

PurposePrior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans.ProceduresVeterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity.Main findingsInsomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity.ConclusionsSymptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD

Altruismo normal y patológico

La bibliografía psicoanalítica sobre altruismo es escasa, a pesar de todo lo que se ha escrito sobre este tema desde una perspectiva sociobiológica. Freud (1917) describió por primera vez el concepto en "Teoría de la Libido y Narcisismo". En 1946, Anna Freud acuñó la expresión "renuncia altruista" para describir la psicodinámica del comportamiento altruista en un grupo de sujetos inhibidos que mostraban impulsos de origen neurótico a hacer el bien a los demás. La utilidad y aplicabilidad clínica de esta formulación, junto con la frecuente coexistencia de masoquismo y altruismo, animó a los psicoanalistas a considerar toda forma de altruismo como fundamentada en el masoquismo. Desde entonces se ha producido una fusión de los dos conceptos en gran parte de la bibliografía analítica. En este artículo se revisa la comprensión psicoanalítica del altruismo y se propone una ampliación del concepto hasta incluir una forma normal. Se describen cinco tipos de altruismo: protoaltruismo, altruismo generativo, altruismo conflictivo, pseudoaltruismo y altruismo psicótico. El protoaltruismo tiene raíces biológicas y puede ser observado en los animales. En los humanos, el protoaltruismo incluye la crianza y protección tanto materna como paterna. El altruismo generativo es el placer no conflictivo en auspiciar el éxito y/o el bienestar de otro. El altruismo conflictivo es altruismo generativo que ha sido arrastrado al conflicto, pero en el cual el placer y la satisfacción del otro (un sustituto en representación del sujeto) se disfruta verdaderamente. El pseudoaltruismo se origina en un conflicto y sirve como mecanismo defensivo que oculta el sadomasoquismo subyacente. El altruismo psicótico es definido como las formas, a veces extravagantes, de comportamiento cuidador y la consecuente autorrenuncia observadas en individuos psicóticos, frecuentemente basadas en fenómenos delirantes. Consideramos que la ¿renuncia altruista¿ de Anna Freud combina aspectos tanto de altruismo conflictivo como de pseudoaltruismo. Se discuten dos ejemplos clínicos

An Empirical Study of the Psychodynamics of Suicide

This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66830/2/10.1177_00030651980460030701.pd

High Field/High Frequency Saturation Transfer Electron Paramagnetic Resonance Spectroscopy: Increased Sensitivity to Very Slow Rotational Motions

Saturation transfer electron paramagnetic resonance (ST-EPR) spectroscopy has been employed to characterize the very slow microsecond to millisecond rotational dynamics of a wide range of nitroxide spin-labeled proteins and other macromolecules in the past three decades. The vast majority of this previous work has been carried out on spectrometers that operate at X-band (∼9 GHz) microwave frequency with a few investigations reported at Q-band (∼34 GHz). EPR spectrometers that operate in the 94–250-GHz range and that are capable of making conventional linear EPR measurements on small aqueous samples have now been developed. This work addresses potential advantages of utilizing these same high frequencies for ST-EPR studies that seek to quantitatively analyze the very slow rotational dynamics of spin-labeled macromolecules. For example, the uniaxial rotational diffusion (URD) model has been shown to be particularly applicable to the study of the rotational dynamics of integral membrane proteins. Computational algorithms have been employed to define the sensitivity of ST-EPR signals at 94, 140, and 250 GHz to the correlation time for URD, to the amplitude of constrained URD, and to the orientation of the spin label relative to the URD axis. The calculations presented in this work demonstrate that these higher microwave frequencies provide substantial increases in sensitivity to the correlation time for URD, to small constraints in URD, and to the geometry of the spin label relative to the URD axis as compared with measurements made at X-band. Moreover, the calculations at these higher frequencies indicate sensitivity to rotational motions in the 1–100-ms time window, particularly at 250 GHz, thereby extending the slow motion limit for ST-EPR by two orders of magnitude relative to X- and Q-bands