918 research outputs found

    Emotional crisis in a naturalistic context: characterizing outpatient profiles and treatment effectiveness.

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    Crisis happens daily yet its understanding is often limited, even in the field of psychiatry. Indeed, a challenge is to assess the potential for change of patients so as to offer appropriate therapeutic interventions and enhance treatment program efficacy. This naturalistic study aimed to identify the socio-demographical characteristics and clinical profiles at admission of patients referred to a specialized Crisis Intervention Center (CIC) and to examine the effectiveness of the intervention. The sample was composed of 352 adult outpatients recruited among the referrals to the CIC. Assessment completed at admission and at discharge examined psychiatric symptoms, defense mechanisms, recovery styles and global functioning. The crisis intervention consisted in a psychodynamically oriented multimodal approach associated with medication. Regarding the clinical profiles at intake, patients were middle-aged (M = 38.56, SD = 10.91), with a higher proportion of women (62.22%). They were addressed to the CIC because they had attempted to commit suicide or had suicidal ideation or presented depressed mood related to interpersonal difficulties. No statistical differences were found between patients dropping out (n = 215) and those attending the crisis intervention (n = 137). Crisis intervention demonstrated a beneficial effect (p < 0.01) on almost all variables, with Effect Sizes (ES) ranging from small to large (0.12 < ES < 0.75; median = 0.49). However, the Reliable Change Index indicated that most of the issues fall into the undetermined category (range 41.46 to 96.35%; median = 66.20%). This study establishes the profile of patients referred to the CIC and shows that more than half of the patients dropped out from the crisis intervention before completion. Our findings suggest that people presenting an emotional crisis benefit from crisis intervention. However, given methodological constraints, these results need to be considered with caution. Moreover, the clinical significance of the improvements is not confirmed. Thus, the effectiveness of crisis intervention in naturalistic context is not fully determined and should be more rigorously studied in future research

    Processes of Change in Psychotherapy for Narcissistic Personality Disorder.

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    The present study aims at determining the role for outcome of potential processes of change in psychotherapy for narcissistic personality disorder (NPD). They were examined on three levels: the content, the process, and the relationship. A total of 161 patients suffering with NPD were recruited in a naturalistic setting as part of the present study. They underwent a long- term clarification-oriented psychotherapy. Sessions 15, 20, and 25 were video- or audio-recorded and analyzed with an observer-rated instrument that measures the quality of the interaction processes from the patient's and therapist's perspectives. Different self-report measures were used to assess therapy outcomes. In-session improvement was observed in both patient and therapist processes across sessions. Patient improvement in the three levels of processes was systematically related with outcome. Only partial relationships were found between therapist improvement and outcome. The present study represents the first systematic insight into core changes in patients with NPD undergoing psychotherapy

    Non-Amontons behavior of friction in single contacts

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    We report on the frictional properties of a single contact between a glassy polymer lens and a flat silica substrate covered either by a disordered or by a self-assembled alkylsilane monolayer. We find that, in contrast to common belief, the Amontons proportionality between frictional and normal stresses does not hold. Besides, we observe that the velocity dependence of the sliding stress is strongly sensitive to the structure of the silane layer. Analysis of the frictional rheology observed on both disordered and self-assembled monolayers suggests that dissipation is controlled by the plasticity of a glass-like interfacial layer in the former case, and by pinning of polymer chains on the substrate in the latter one.Comment: submitted to Eur. Phys. J.

    A new score for improving cardiovascular risk prediction and prevention.

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    The ultrasonographic detection of subclinical atherosclerosis (scATS) at carotid and femoral vascular sites using the atherosclerosis burden score (ABS) improves the risk stratification for atherosclerotic cardiovascular disease beyond traditional cardiovascular (CV) risk factors. However, its predictive value should be further enhanced. We hypothesize that combining the ABS and the Framingham risk score (FHRS) to create a new score called the FHRABS will improve CV risk prediction and prevention. We aim to investigate if incorporating the ABS into the FHRS improved CV risk prediction in a primary prevention setting. 1024 patients were included in this prospective observational cohort study. Carotid and femoral plaques were ultra-sonographic detected. Major incident cardiovascular events (MACEs) were collected. The receiver operating characteristic curve (ROC-AUC) and Youden's index (Ysi) were used to compare the incremental contributions of each marker to predict MACEs. After a median follow-up of 6.0 ± 3.3 years, 60 primary MACEs (5.8%) occurred. The ROC-AUC for MACEs prediction was significantly higher for the FHRABS (0.74, p < 0.024) and for the ABS (0.71, p < 0.013) compared to the FHRS alone (0.71, p < 0.46). Ysi or the FHRABS (42%, p < 0.001) and ABS (37%, p < 0.001) than for the FHRS (31%). Cox proportional-hazard models showed that the CV predictive performance of FHRS was significantly enhanced by the ABS (10.8 vs. 5.5, p < 0.001) and FHRABS (HR 23.30 vs. 5.50, p < 0.001). FHRABS is a useful score for improving CV risk stratification and detecting patients at high risk of future MACEs. FHRABS offers a simple-to-use, and radiation-free score with which to detect scATS in order to promote personalized CV prevention

    Slow dynamics and aging of a confined granular flow

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    We present experimental results on slow flow properties of a granular assembly confined in a vertical column and driven upwards at a constant velocity V. For monodisperse assemblies this study evidences at low velocities (1<V<100μm/s1<V<100 \mu m/s) a stiffening behaviour i.e. the stress necessary to obtain a steady sate velocity increases roughly logarithmically with velocity. On the other hand, at very low driving velocity (V<1μm/sV<1 \mu m/s), we evidence a discontinuous and hysteretic transition to a stick-slip regime characterized by a strong divergence of the maximal blockage force when the velocity goes to zero. We show that all this phenomenology is strongly influenced by surrounding humidity. We also present a tentative to establish a link between the granular rheology and the solid friction forces between the wall and the grains. We base our discussions on a simple theoretical model and independent grain/wall tribology measurements. We also use finite elements numerical simulations to confront experimental results to isotropic elasticity. A second system made of polydisperse assemblies of glass beads is investigated. We emphasize the onset of a new dynamical behavior, i.e. the large distribution of blockage forces evidenced in the stick-slip regime

    Anomalous acoustic reflection on a sliding interface or a shear band

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    We study the reflection of an acoustic plane wave from a steadily sliding planar interface with velocity strengthening friction or a shear band in a confined granular medium. The corresponding acoustic impedance is utterly different from that of the static interface. In particular, the system being open, the energy of an in-plane polarized wave is no longer conserved, the work of the external pulling force being partitioned between frictional dissipation and gain (of either sign) of coherent acoustic energy. Large values of the friction coefficient favor energy gain, while velocity strengthening tends to suppress it. An interface with infinite elastic contrast (one rigid medium) and V-independent (Coulomb) friction exhibits spontaneous acoustic emission, as already shown by M. Nosonovsky and G.G. Adams (Int. J. Ing. Sci., {\bf 39}, 1257 (2001)). But this pathology is cured by any finite elastic contrast, or by a moderately large V-strengthening of friction. We show that (i) positive gain should be observable for rough-on-flat multicontact interfaces (ii) a sliding shear band in a granular medium should give rise to sizeable reflection, which opens a promising possibility for the detection of shear localization.Comment: 13 pages, 10 figure

    Rheology of a confined granular material

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    We study the rheology of a granular material slowly driven in a confined geometry. The motion is characterized by a steady sliding with a resistance force increasing with the driving velocity and the surrounding relative humidity. For lower driving velocities a transition to stick-slip motion occurs, exhibiting a blocking enhancement whith decreasing velocity. We propose a model to explain this behavior pointing out the leading role of friction properties between the grains and the container's boundary.Comment: 9 pages, 3 .eps figures, submitted to PR
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