Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Commentary on Takahashi's "Is MPD really rare in Japan?"

p. 066-06

A reader's guide to Pierre Janet on Dissociation: A neglected intellectual heritage

p. 003-016A century ago there occurred a peak of interest in dissociation and the dissociative disorders, then labeled hysteria. The most important scientific and clinical investigator of this subject was Pierre Janet (1859-1947), whose early body of work is reviewed here. The evolution of his dissociation theory and its major principles are traced throughout his writings. Janet's introduction of the term "subconscious " and his concept of the existence of consciousness outside of personal awareness are explained. The viability and relevance of dissociation as the underlying phenomenon in a wide range of disorders is presented. It is proposed that, Janet's theory and methodology of psychological analysis and dynamic psychotherapy are cogent and relevant for today's students and practitioners

Abreaction re-evaluated

p. 127-140Contemporary clinicians working in the field of multiple personality disorder (MPD) generally agree that pathogenic traumatic memories are at the root of this dissociative disorder. Examination of contemporary studies, however, shows that diagnostic and therapeutic conceptualization remains muddled and frequently contradictory. This confusion stems back to Breuer and Freud's "Studies of Hysteria," in which they used two contradictory models concerning the nature and treatment of traumatic memories. The first model was in terms of dissociation and integration, processes which already had a French pedigree (particularly with Pierre Janet), and the second was their own model which they developed in terms of the principle of psychological constancy and abreaction. In the literature on trauma since Breuer and Freud, e.g., studies on post-traumatic stress during and after World Wars I and II and the Vietnam war, different authors have emphasized either one or both models. The present authors critically re-evaluate abreaction and advocate the dissociation-integration model as the basis for further conceptualization, discussing the role of emotional expression within it

Treatment strategies for complex dissociative disorders: two dutch case examples

p. 157-165In the Netherlands, the diagnosis of dissociative identity disorder (DID) is widely accepted, although skeptics also have made their opinions known. Dutch clinicians treating DID patients generally follow the common three-phase model for treatment of post-traumatic stress. Given the fact that they usually deal with complicated cases and enmeshed patients (cf. Horevitz E. Loewenstein, 1994), most often treatment is restricted to Phase 1: stabilization and symptom reduction. Treatment of higher functioning patients, on the other hand, usually aims at processing of traumatic memories and complete personality integration as well. In this article, two Dutch cases are described in detail, with a special emphasis on the clinical deliberations which, in the first case, led to the decision to proceed to trauma treatment, and which led in the second case to the decision to refrain from it

The use of imagery in phase 1 treatment of clients with complex dissociative disorders

The “standard of care” for clients with complex dissociative disorders and other complex trauma-related disorders is phase-oriented treatment. Within this frame, therapeutic progress can be enhanced by the use of imagery-based therapeutic techniques. In this article, the emphasis is on their application in phase 1 treatment, stabilization, symptom reduction, and skills training, but attention is also paid to applications in phase 2 and phase 3 treatment. Many of the existing imagery techniques are geared toward clients becoming more able to function in a more adaptive way in daily life, which, however, requires the involvement of various dissociative parts of the personality. Such collaborative involvement is also essential in the later treatment phases. Therefore, understanding the dissociative nature of these disorders is helpful in the judicious application of these techniques

Discussion of: "metaphors of agency and mechanisms in dissociation"

p. 164-16

Introduction to the Amsterdam Papers

p. 077-07

Ian Hacking on Pierre Janet: a critique with further observations

p. 080-08

Multiple personality disorder in Europe: impressions

p. 102-118Based on his personal knowledge of the field in the Netherlands and on written reports from colleagues in other European countries, the author presents an impressionistic overview of the state of affairs in the field of diagnosis and treatment of MPD in Europe. His main impression is of the relatively advanced state of affairs in the Netherlands, although many problems are still encountered. In Britain a few serious developments take place, but mainstream psychiatry is unsupportive. In other European countries developments lag behind even more, but there are also signs that changes for the better will occur. Special attention is given to a systematic study regarding Swiss psychiatrists’ familiarity with MPD. Finally, a number of lessons for spreading knowledge about MPD and dissociation and for mutual support among MPD clinicians are presented