ATTACHMENT STYLE AND CLINICAL REHABILITATION: STROKE PATIENTS

M. Farinelli*°, L. Gestieri*°, S. Tabarroni*°, F. Baldoni*, R. Chattat*, M. Ercolani*, M.R. Leo°, C.A. Fossi°, G. Lupi° and N. Marasti°
*Department of Psychology, University of Bologna, Italy; °Villa Bellombra Rehabilitation Hospital, Bologna, Italy

Introduction: The literature indicates the existence of a close relationship between attachment style, illness and psychological distress. Attachment style plays a role in perception of symptoms, degree of recourse to health care (Ciechanowsky, 2002), susceptibility to illness, behaviour during illness (Maunder and Hunter, 2001), and the way in which conflicts, crises and adaptation are handled. Bowlby’s model helps us to understand the particular way in which different people react when they are affected by an acute and sudden pathological event. The physical threat implicit in the situation activates the patient’s attachment system, which in fact is already stimulated by the fact of hospitalisation (Blackwell, 1992). Only a few studies to date have investigated the role of attachment styles in specific chronic or acute physical illnesses. Bartholomew e Horowitz (1991) suggest that secure individuals with positive views of themselves and other people are more trusting, have no difficulty depending on others when it becomes necessary, and have good capacities of resilience. Insecure individuals, by contrast, are characterised – depending on their particular attachment style – by a fearful approach to relationships and by preoccupation associated with a compulsive recourse to health care, or by detachment to the point of excessive self-sufficiency. In the latter case, these circumstances make it difficult for patients to rely on others, to ask them for help and to depend on them if necessary. In the practice of clinical rehabilitation, the caregiver plays an active and participating role in the patient’s mental processes. Moreover, the attachment style of the caregiver is associated with a particular type of care (Feeney, 1996). Caregivers with a secure style tend to be empathic and to actively offer assistance, while those with an insecure style exhibit different types of non-responsive caregiving, depending on their particular type of insecurity.

Objectives: To examine attachment styles, psychological distress, functional recovery and the relationships between these three variables in hospitalised patients with stroke damage and in their caregivers compared to a control group of post-fracture patients and their respective caregivers. Hypotheses: We hypothesise that subjects with a secure attachment style will exhibit lower levels of psychological distress and higher levels of functional independence compared to those with an insecure style. We further expect that a relationship between patient and caregiver characterised by secure attachment strategies will be correlated with a more positive outcome of recovery compared to relationships based on an insecure style. Finally, differences may be found between patients with lesions of the right hemisphere, those with lesions of the left hemisphere and orthopaedic patients.

Description of the sample: The study excludes patients with severe cognitive deficits. The sample consists of 35 stroke patients (M = 66%, F = 34%; average age = 69 with SD = 9.7; married = 66%) and 30 patients with fractures (M = 27%, F = 73%; average age = 75 with SD = 9.3; married = 50%), as well as the patients’ caregivers. In the neurological patients, the cerebral lesion is located in the right hemisphere in 60% of the cases, while most of the strokes are ischaemic in nature (66%). A share of 70% of the patients with right-hemisphere lesions exhibits modifications in cognitive functioning (neglect: 38%). Among the patients with lesions of the left hemisphere, around 60% show alterations in the cognitive profile (aphasia: 43%). A share of 50% of the orthopaedic patients (74% of the cases with femoral fractures) exhibits modifications of the cognitive profile. The caregivers of the post-stroke patients (spouse: 43%, son or daughter: 46%) are more frequently women (57%) with an average age of 53; 74% are married. Men and women are equally represented among the caregivers of the orthopaedic patients (spouse: 47%, son or daughter 50%); these caregivers have an average age of 61, and 80% are married. Tools and methodology: The HAD (Hospital Anxiety and Depression scale by Zigmond and Snaith, 1983), with separate subscales for anxiety and depression, was used to assess the psychological distress of the patients on admission and on discharge. The patients’ level of functional independence was also tested on admission and discharge by means of the FIM scale (Functional Independence Measurement, by Dodds et al., 1993). The CES-D scale (Center of Epidemiologic Studies Depression scale, by Radloff, 1977 in the Italian form validated by Fava, 1982) was used to measure the presence and degree of depression in the caregivers, likewise on admission and discharge. The attachment style of both patients and caregivers was identified using RQ (Relationship Questionnaire by Bartholomew and Horowitz, 1991) and ASQ (Attachment Style Questionnaire by Feeney, 1996 in the Italian version validated by Fossati et al., 2003). The ASQ evaluates attachment style according to five key factors: “confidence discomfort with closeness”, “need for approval”, preoccupation with relationships” and “relationships as secondary”. Results: The preliminary findings appear to confirm most of the hypotheses formulated above.

Bibliography
1. Bartholomew, K., Horowitz, L.M. (1991) Attachment styles among young adults: A test of a four category model. Journal of Personality and Social Psychology, 61, pp. 226-244.
2. Blackwell, B. (1992) Sick-role susceptibility. Psychotherapy and Psychosomatics, 58, pp. 79-90.
3. Ciechanowsky, P.S., Walker, E.A., Katon, W.J., Russo, J.E. (2002) Attachment Theory: A Model for Health Care Utilization and Somatization. Psychosomatic Medicine, 64, pp. 660-667.
4. Dodds, T. A., Martin, D. P., Stolov, W. C., Deyo, R. A. (1993) A validation of the functional independence measurement and its performance among rehabilitation inpatients. Archives of Physical Medicine and Rehabilitation, 74(5), pp. 531-536.
5. Fava, G. A. (1982) Versione italiana del CES-D per la valutazione degli stati depressivi. In R. Canestrari (a cura di), Nuovi metodi in psicometria, O.S. Organizzazioni Speciali, Firenze, pp. 51-53.
6. Feeney, JA. (1996) Attachment, caregiving, and marital satisfaction. Personal Relationships, 3, pp. 401-416
7. Fossati, A., Feeney, J. A., Donati, D., Donini, M., Novella, L., Bagnato, M., Acquarini, E., Maffei, C. (2003) On the dimensionality of the Attachment Style Questionnaire in Italian clinical and nonclinical subjects. Journal of Social and Personal Relationships, 20, pp. 55-79.
8. Maunder, R.G., Hunter, J.J. (2001) Attachment and Psychosomatic Medicine: Developmental Contributions to Stress and Disease. Psychosomatic Medicine, 63, pp. 556-567.
9. Radloff L.S., (1977)The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 1977, pp.385-401.
10. Zigmond, A. S., Snaith, R. P. (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, pp. 361-370.

Contact Marina Farinelli at marina.farinelli@tiscali.it

TOWARDS MORE INTEGRATED NEUROANATOMICAL MODELS OF BORDERLINE PERSONALITY DISORDER

Jean Gagnon, PhD and Marc-André Bouchard
Université de Sherbrooke; Université de Montréal

In the neurobiological paradigm regarding Borderline Personality Disorder (BPD), there are a growing number of studies which call upon brain imaging techniques to obtain neuroanatomical data. The neuroanatomical models, which are currently being developed to account for this data, present some conceptual and methodological limits. In this chapter, psychological models of BPD are called upon to attempt to fill the conceptual gaps. The object relations model has the advantage of accounting for the subject’s subjective experience and his interactions with the environment based on concepts such as the representation of the self and of the object. Mark Solms's monism dualism vision of the brain-mind relation is used in the discussion as a point of contact between the object relations model and neuroanatomical data. At the methodological level, clinical control groups and neurobehavioral studies are proposed to formulate hypotheses specific to BPD and to direct neuroanatomical research.

Contact Jean Gagnon at Jean.Gagnon@USherbrooke.ca

NEUROSCIENTIFIC IMPLICATIONS FOR SELF AND IDENTITY ISSUES DURING ADOLESCENCE

Michael J. Gerson, PhD
California Lutheran University

The terms Self and Identity have been debated in psychoanalysis for many years and from many points of view. While there may not be a consensus in the theories about how to define the terms, there has been a persistent interest in understanding them (Schafer, 1973). Recent neuropsychological research has revisited these terms from the perspectives of self-knowledge, episodic and autobiographical memories, self-monitoring and, more generally, self-referential processing, to name just a few (Gallagher, 2000; Kelley, et al. 2002; Mitchell, et al., 2005; Northoff, et al, 2006; Ochsner, et al., 2005; ).

Psychoanalytic developmental theory has also been particularly focused on the role of Self and Identity during adolescence. A. Freud (1958), Erikson (1950), Schafer (1973) and Blatt (1995) have variously proposed that adolescence is a critical period in a person’s life where Self and Identity conflicts are likely to come forward. They each have offered their own rationales for why adolescence is such an important developmental milestone. Support for the relevance and pubertal timing of these crises or transitions is offered in sociological theories (Mead, 1943), anthropological studies (Eliade, 1957) and developmental psychology (Damon & Hart, 1988) as well.

Neuroscience research appears to offer some intriguing empirical data to help detail what we have long been struggling to understand. I intend to extrapolate evidence from the neuroscience research to build an argument for uniquely defining Self and Identity as separate, but complementary, processes. I will further clarify the processes of Self and Identity as relatively distinct mental phenomena and as useful constructs for psychotherapy. Case material from the psychoanalytic treatment of adolescent patients will be presented that illustrates the utility of differentiating these processes. In particular, adolescent emotional conflicts will be examined relative to passion and suffering as significant to Self and Identity processes. This shift in the adolescent’s emotional conflicts will be examined as illustrative of the neuropsychological and phenomenological transformations that take place during adolescence.

Contact Michael Gerson at michaelgerson@sbcglobal.net

NARCOLEPSY AS A MODEL FOR UNDERSTANDING PSYCHOANALYTIC ASPECTS OF SLEEP AND WAKING

David L Goldman, MD, FRCP
University of Western Ontario, Canada

Sinton and McCarley reaffirmed Kleitman’s assertion that an understanding of narcolepsy helps to explain the workings of the “physiological sleep-and-wakefulness cycle.” In the area of sleep medicine, Dinges showed how the unpredictable intrusions of microsleeps into waking life, analogous to narcolepsy, play an important role in motor vehicle crashes. Branching off from his previous work on sleep and dreams, Canadian psychoanalyst Clifford Scott explored the concept that psychoanalysis can repair the “broken links between sleep and the unconscious and waking and the conscious.” This presentation will, first, discuss under recognized narcoleptic symptoms and their unwelcome appearance in sleep-deprived drivers. Application of these observations, aided by Scott’s writings, to the analysis of, often, sleep-deprived patients facilitates an understanding of transition points between waking and sleep, that is, between secondary process mentation-the conscious, and the dreamy qualities associated with primary processes-the unconscious. Lewin’s descriptions of the “dream screen” and the “blank dream” provide intriguing bridging concepts that straddle the psychoanalytic and the neurophysiological. Finally, the two-domain template, elaborated by Reiser, to illustrate the relationship of dreams to “Brain-Body” and “Mind,” has relevance for the depiction of important aspects of sleep and wakefulness.

Anonymous (1954). The Psychoanalytic Quarterly 22, 1953, No. 2: Bertram D. Lewin. ‘Reconsideration of the dream screen.’ International Journal of Psychoanalysis, 35, 440-441.
Dinges, D.F. (1995). An overview of sleepiness and accidents. Journal of Sleep Research, 4, Suppl., 4-14.
Nielson, T., Stenstrom, P., Takeuchi, T., Saucier, S., Lara-Carrasco, J., Solomonova, E, & Martel, E. (2005). Partial REM-sleep deprivation increases the dream-like quality of mentation from REM sleep and sleep onset. Sleep, 28, 1083-1089.
Reiser, M.F. (1990). Memory in mind and brain. New York: Basic Books.
Scott, W.C.M. (1988). Repairing broken links between the unconscious, sleep and instinct; and the conscious, waking and instinct. Free Associations, 12, 84-91.
Sinton, C.M, & McCarley, R.W. (2004). Neurophysiological mechanisms of sleep and wakefulness: A question of balance. In A.Y. Avidan (Series Ed.), Seminars in Neurology: Vol. 24 (3). Introduction to sleep and its disorders (pp. 211-223).

Contact David Goldman at david.goldman@sjhc.london.on.ca

SELF IN CONFLICT: RECOVERY FROM NON-FLUENT APHASIA THROUGH SANDPLAY THERAPY

Kazuyuki Hirao*, Harumi Naka°, Keiichi Narita*, Miyako Futamura°, Jun Miyata*, Shizuko Tanaka*, Akiko Hayashi* and Norifumi Kishimoto*
*Kyoto University, Kyoto, Japan; °Shirayama Rehabilitation Hospital, Aichi, Japan

Introduction: Collaboration between subjective and objective approaches is a key concept of neuro-psychoanalysis. There is, however, still a great distance between psychological and biological perspectives in our clinical practices.

Recent advance of neuroimaging method enables us to see the “objective image” of mental apparatus in the form of a brain. Meanwhile, we can find the “subjective image” in patients’ nonverbal expressions, for example, their work created during sandplay (miniature garden) therapy.

In this study, we report a patient’s recovery from non-fluent aphasia and conflict. We examine this case from both neurobiological and psychotherapeutic perspectives by reviewing (1) neuropsychological assessment, (2) patient’s verbal expressions and (3) nonverbal expressions (sandplay), and aim to propose a possible collaborative approach.

Case: Mr “B” was a 63-year-old, right-handed male. He had been rather introverted and had a stutter before he suffered a stroke, which led to a cerebral infarction (an atherothrombosis in the left middle cerebral artery). Linear lesions were found mainly in the underlying white matter of the precentral gyrus, which indicated borderzone infarction. This caused him right-sided hemiplegia and with a non-fluent aphasia (Broca’s aphasia).

Clinical Course: One month after the stroke, his motor function and aphasia were getting better. At the time, comprehension, reading, writing and repetition were sufficiently good. However, his non-fluent speech still remained with stuttering and frequent interjection “Anoh...” His doctor assessed that it was mainly due to his psychological problem, and offered him a course of psychotherapy.
Meanwhile, from subjective perspective, Mr B felt more difficulty in speaking than before the stroke. At first, he refused psychotherapy, but later reluctantly agreed.

Psychotherapist suggested sandplay therapy to him. He gradually committed to it like a child. After transitional sandplay #3, he produced sandplay #4 which could be interpreted to symbolize nirvana. In the following session, he talked about his early life trauma (related to violence from his brother-in-law) and reflected on the previous sandplay saying “Anoh... I was in a crisis and threw myself on a ray of light.” “But I realized that I should let myself feel easy.” “That event is still traumatic for me. But this is my perspective. I suppose my brother had his own perspective.” In the successive sessions, he came to be able to express verbally what happened within himself saying “I fumble with words when ideas don’t take shape.” At last, he produced sandplay #7, in which a renewal world “wish for liberty” was expressed, and psychotherapy ended. At this time, his stuttering was eased and his words were enriched.

Discussion: There was a discrepancy between the doctor’s objective neuropsychological assessment and Mr B’s subjective feelings. From a neurobiological perspective, one speculation might be possible that his conflictive non-fluent speech with stuttering was affected by his lesions in prefrontal cortex during the recovery process of Broca’s aphasia.

Sandplay therapy has two unique characteristics: regression through playing and symbolization through nonverbal expression, which may facilitate the processing of a stuck conflict. After resistance, he seemed to regress in sandplay therapy, so that his sandplay went so far as to symbolize nirvana. After this, we can find the emergence of his reflective consciousness through his verbal and nonverbal expressions. This reflective consciousness seemed to lead to his verbal expression of trauma, the dissolution of conflict and the improvement of his non-fluent speech.

Without sandplay, we would not be able to follow the patient’s nonverbal subjective experience. This study suggests one possible clinical method integrating objective and subjective perspective, combining neuroimaging and sandtherapy image, which can be called “mind-imaging.”

Contact Kazuyuki Hirao at kazuyukihirao@gmail.com

AFFECTIVE MENTALIZING AND MEDIAL PREFRONTAL LOBE PATHOLOGY IN SCHIZOPHRENIA

Kazuyuki Hirao, Jun Miyata, Chihiro Namiki, Makiko Yamada and Toshiya Murai
Kyoto University, Kyoto, Japan

Background:Recent advance of affective and social neuroscience provides us instructive knowledge about the neural basis of interpersonal relationships. Among varieties of social cognition, the ability to infer the mental states of other individuals, often referred to as “mentalizing”, is considered to be one of the critical constituents in psychotherapy.

Social cognitive abilities have been widely investigated in individuals with neuropsychiatric disorders, including schizophrenia, who have substantial difficulty in interpersonal relationships. Meanwhile, recent neuroimaging studies have demonstrated regional brain structural/functional abnormalities in schizophrenia. However, the relationships between impaired social cognition and brain abnormalities in schizophrenia remain unclear. In this study, we focused on the two key components of social cognition, facial emotion recognition and mentalizing, and investigated the associations between the impairments and brain abnormalities in schizophrenia.

Methods: Twenty patients with schizophrenia and 20 group-matched healthy comparison participants underwent high-resolution magnetic resonance imaging (MRI) and were examined for social cognitive abilities based on facial emotion intensity recognition and affective mentalizing tasks. Voxel-based morphometry (VBM) was applied to investigate regional brain structural alterations and manual tracing volumetry was also applied to small structures of the medial temporal lobe such as amygdala.

Results: As for structural brain alterations, patients with schizophrenia exhibited gray matter reductions in the medial prefrontal cortex (MPFC), ventrolateral prefrontal cortex, left superior temporal gyrus, right insula, and amygdala. With regard to social cognitive abilities, the patients showed emotion-specific (sadness, surprise, disgust, and anger) impairments on the facial emotion intensity recognition task and performed poorly on the affective mentalizing task which requires the ability to infer the emotion of others in social situations. Importantly, correlation analyses demonstrated the associations between poor performance on facial emotion intensity recognition task and gray matter reduction in the amygdala of the patient group. Moreover, impaired affective mentalizing was associated with the MPFC reduction in the patients.

Discussion: Previous schizophrenia studies have investigated the relationships between impaired neurocognitive abilities (e.g., attention, working memory, and executive function) and frontal lobe dysfunction, especially in the dorsolateral prefrontal cortex. Recently, the study of social cognition in schizophrenia has received growing attention from the perspective of social neuroscience, and explored the relationships between impaired social cognitive abilities and brain abnormalities in the medial temporal structures or medial prefrontal cortex. Our findings suggest that in schizophrenia, structural abnormalities in the amygdala and MPFC make different contributions to impaired facial emotion intensity recognition and affective mentalizing in social situations, respectively. This study might help to better elucidate the underlying frontotemporal mechanisms for social cognitive impairments in schizophrenia as well as provide us some knowledge about the neural basis of abnormal interpersonal relationships.

References:
Namiki, C., Hirao, K., Yamada, M., Hanakawa, T., Fukuyama, H., Hayashi, T., Murai, T., 2007. Impaired facial emotion recognition and reduced amygdalar volume in schizophrenia. Psychiatry Res. Neuroimaging 156, 23-32.
Yamada, M., Hirao, K., Namiki, C., Hanakawa, T., Fukuyama, H., Hayashi, T., Murai, T., 2007. Social cognition and frontal lobe pathology in schizophrenia: A voxel-based morphometric study. Neuroimage 35, 292-298.

Contact Kazuyuki Hirao at kazuyukihirao@gmail.com

INCREASED WHITE MATTER HYPERINTENSITIES IN PANIC DISORDER BUT NOT IN POSTTRAUMATIC STRESS DISORDER

Yu Jin Lee, MD, PhD and Soon Jeong Lee, MD, PhD
Department of Psychiatry, Eunpyung Metropolitan Hospital, Seoul, Republic of Korea

Background: Prior reports have suggested that panic disorder (PD) subjects and posttraumatic stress disorder (PTSD) subjects may have abnormalities in neural circuits. To the best of our knowledge, there have been no previous reports regarding T2 white matter hyperintensities (WMH) on brain magnetic resonance imaging (MRI) in subjects with anxiety disorders. Consequently, the current study was conducted to assess the prevalence, severity, and location of WMH on brain MRI in PD, PTSD and control subjects. Methods: Axial T-2 weighted images and fluid attenuated inversion recovery (FLAIR) axial images were obtained using 3.0 Tesla GE whole body MR scanner for PD, PTSD and healthy comparison subjects. The severity of WMH was assessed separately for deep and periventricular WMH. Ordinal logistic regression models were used to assess the odds ratio for WMH by diagnosis controlling for age and sex. Results: Subjects with panic disorder had greater severity of WMH than subjects with PTSD and healthy comparison group. There was no significant difference in WMH severity between PTSD and control subjects. Conclusions: The current findings suggest that an increased severity/prevalence WMH may occur only to PD, but not to PTSD and that this may play an important role in the pathophysiology for PD.

KEYWORDS: panic disorder, white matter hyperintensities, brain magnetic resonance imaging

Contact Yu Jin Lee at ewpsyche@hanmail.net

EMPATHY IN INDIVIDUALS WITH PSYCHOPATHIC TRAITS: A NEUROPHYSIOLOGICAL INVESTIGATION OF THE SHARED REPRESENTATION SYSTEM

Louis-Alexandre Marcoux candidat au PhD recherche/intervention,
S. Lemelin and P.L. Jackson
Université Laval, Québec, Canada

Empathy and mind reading are some of the different processes by mean of which individuals establish meaningful interactions with others. It has been suggested that empathy and mind reading, as well as imitation, all share a common feature: they depend on the creation of a shared meaningful intersubjective space. Decety, Jackson & Brunet (2006) proposed a model of empathy that incorporates contemporary theoretical accounts and empirical findings on empathy (mainly from neuropsychology and neuroimaging research). The present project focuses on the affective resonance mechanism, which is one of the four key components of this neuropsychological model of empathy. It is suggested that observation or imagination of another person in a particular emotional state automatically activates both a mental and a cerebral representation of that state in the observer, and potentially triggers associated autonomic and somatic responses. Most cerebral structures and systems that have been shown to be important in processing emotions have also turned out to be important for social behaviour (e.g., specific regions in high-order sensory cortices, the amygdala, the orbitofrontal cortex). Concretely, the integrity of the sensorimotor system appears critical for the recognition of emotions displayed by others. In fact, this cerebral system seems to support the reconstruction of what it would feel like to be in a particular emotion, by means of simulation of the related body state (Damasio, 1994). For instance, current evidence shows that the perception of pain in others relies in good part on the activation of a mental representation of pain in the Self (Jackson et al., 2006). Moreover, it is now recognized that pain observation and pain empathy can involve both sensory discrimination and affective components of pain (Bufulari, 2007; Marcoux et al., 2007).

Psychopathy is a complex personality disorder that includes interpersonal and affective traits such as reduced guilt, empathy and attachment to significant others. Do these individuals, marked by emotional hypo-responsiveness, fail to mirror the emotions of others because of a lack of affective resonance? To date, we know that a crucial factor in care-based moral socialization is appropriate emotional responding to the distress of others. The neuroimaging literature on psychopathy has found that individuals with psychopathy show reduced activation of both the amygdala and the rostral anterior cingulated cortex in response to emotional words in the context of emotional memory paradigms (Kiehl et al., 2001) and during aversive conditioning (Flor et al., 2005). Research with subclinical populations has found that individuals with psychopathic traits show reduced amygdala responses to emotional expressions. The main argument of Blair (2006) is that the amygdala enables the forms of learning necessary to care about the welfare of others. However, we still do not know if the activation of the sensory mechanisms of these individuals are modulated normally by the observations of others pain.

We postulate, based on this recent neuropsychological model of empathy that individuals with marked psychopathic traits will have a diminished somatic sensory response and lower ratings of the pain intensity displayed by others compared to healthy controls. More specifically, we will investigate whether the activity of the somatosensory cortex related to a mechanical stimulation will be modulated by the observation of painful scenarios. In order to test these hypotheses, we propose two studies. We will first compare the neurophyiological and behavioral responses of graduate students with and without any psychopathic traits. We will administer the Levenson Psychopathy self report questionnaire to a large cohort of 200 students from which the lowest and the highest quartile (N=30) will be subjected to the electroencephalographic study. This study consists of a series of neutral and painful scenarios presented on a computer interface, while a 25hz mechanical stimulation is applied to one finger on the right hand of the participant. The purpose of this protocol is to investigate whether the basal activity of the somatosensory cortex is modulated when the participant is viewing painful scenarios with the help of an electrodes helmet. Then, in a second study, we will repeat the encephalographic protocol with a clinical population of 20 individuals with a borderline personality organization (including narcissism, malignant narcissism and antisocial disorders) marked by psychopathic traits. These individuals will be recruited in a specialized treatment center for severe personality disorder after a clinical assessment with the Psychopathy Checklist revised (Hare, 2003). If our hypotheses are confirmed, the findings of this research will help refine the neurobiological models of psychopathy and the etiology of this disorder. Also, this research attempts to bridge the gap between neurosociale science and clinical work. It is also based on a dimensional conception of personality disorder applied to a research context.

Contact Louis-Alexandre Marcoux at louis-alexandre.marcoux.1@ulaval.ca

A CHROMOPSYCHODYNAMIC FIELD THEORY

Donald Mender, MD
Yale University School of Medicine

This poster will present a neuroharmonic field construct which predicts, from formal aspects of Freud's structural theory, the theretofore topographically derived emergence of anatomically specific developmental cathexes.

The relevant general field construct begins by modeling ego, drive, and object, including negatively and positively valued components (i. e.: ego defenses and ego reality testing; death-oriented and erotic drives; punitive and ideal objects), as analogies to the 3 "colors" and 3 "anti-colors" of quantum chromodynamics. Given this formal group structure, the resulting local SU3 "psycho-symmetry" will generate a non-quantized but string-like gauge field whose curvature carries the intentionality of psychodynamic determination.

The imposition of varying boundary conditions, representing the continuous internal and external surface of the human body across the spectrum of ontogenically possible somatic conformations, will then produce a range of specific solutions to general gauge field equations. These solutions should describe distributed neuroharmonic waveforms that can test with anatomical specificity psychoanalytic predictions of libidinal "cathexes" at the so-called oral, anal, genital stages of development.

Contact Donald Mender at donald.mender@yale.edu

DOPAMINE RECEPTOR REGULATION AT THE INTERFACE OF HELPLESS BEHAVIOR AND GASTRIC ULCER FORMATION

Andrew Novick, Irene Yaroslavsky and Shanaz Tejani-Butt
Philadelphia College of Pharmacy; Psychoanalytic Center of Philadelphia; Young Investigators in Neuropsychoanalysis

Dopamine activity in the CNS facilitates affective states that energize the individual to pursue resources and strategies needed to cope to with stressors. Central dopamine is also involved in a brain-gut axis that is protective against stress-induced ulcers. Data is presented from the Wistar-Kyoto (WKY) rat, a selective strain that is more prone to ulcers as well helpless and immobile behavior in response to stressful stimuli when compared to Wistar controls. When exposed to an ulcerogenic stressor, WKY rats, unlike their Wistar counterparts, show a significant decrease in dopamine type-1 (D1) receptor binding in several brain regions, including the Nucleus Accumbens. Such downregulation of D1 receptors has been linked to helpless behavior and likely represents a decrease in dopaminergic tone. Similarly, reduced activation of D1 receptors promotes stress-ulcer formation. Thus the observed D1 downregulation in WKY rats may simultaneously lead to helpless behavior and gastric ulcer. When extrapolated to humans, these results present a neurobiological mechanism through which the reduction of drive by intrapsychic conflict and/or external stressors can promote somatization, particularly gastric ulcer.

Contact Andrew Novick at novick.andrew@gmail.com

ANTIDEPRESSANT EFFECTS OF OXYTOCIN: A METHANALYSIS

G. Ozkarar*, Bartoli F., S. Guaschino*, S. Bembich*, S. Demarini°,
C. Vecchiet* and A. Clarici*
*Department of Reproductive and Developmental Science, University of Trieste, Italy
°Neonatal Intensive Care Unit, IRCSS “Burlo Garofolo” Children Hospital, Trieste, Italy

Depression is a well-known psychopathological term used to describe a subjective experience characterized by withdrawal from lively interactions with the world and especially significant others. In psychoanalytic literature, the causes of depression can traced back in a disruption of early mother-infant interaction. One relatively untested hypothesis is that the consequent deficit in brain affective neurendocrinological systems for infant care is thus one of the sources of a predisposition to depression. Neuropeptides such as vasopressin and oxytocin are currently the most well established of such key neurmediator circuits, and some forms of depression may arise from deficits in these basic social and emotional control systems in the brain. In the present study we will evaluate this hypothesis by reviewing the literature on the role of oxytocin in relieving depressive symptoms either in mothers (who due to breastfeeding, show a hiher presence of endogenous oxytocin) or in adult individual who takes exogenous oxytocin (intranasally or for gynecological-obstetrical problems after delivery).
We found in the general literature that especially in clinical depression, where an incapacity exists to exploiting favourable environmental events (such as the support from significant others) oxytocin (known to affect the attachment related systems in the brain) appears to facilitate the developmental structuring of a relationship based on self and others’ trust and esteem and appears thus to be related to depressive symptoms relief. This preliminary metanalytic study anticipates the expected results from a project on the synergic effects of oxytocin and psychoanalytic psychoterapy in postpartum depression.

Contact Gokce Ozkarar at gokce113@yahoo.com

WHAT IS SELF-SPECIFIC? THEORETICAL INVESTIGATION AND CRITICAL REVIEW OF NEUROIMAGING RESULTS

Perrine Ruby and Dorothée Legrand
Institut Fédératif des Neurosciences, Lyon, France; Université Lyon, France; CFS, Center for Subjectivity Research, University of Copenhagen, Denmark

This paper proposes an investigation of the self, both at the theoretical level, using the operational notion of self-specificity, and at the neurophysiological level, synthesizing a wide range of neuroimaging results issued from studies investigating the "self", resting state, others’ mind reading, memory and reasoning. Our meta-analysis of neuroimaging data suggests that the cerebral network involved in self-relatedness evaluation (medial prefrontal cortex, precuneus, temporo-parietal junction, temporal poles) is not preferentially modulated by any self/others contrast but rather by the involvement of evaluative processing and memory recall. Therefore, we conclude that standard ways to tackle the self by considering self-representational processes of evaluation of self-related contents are not self-specific. Instead, we propose a paradigm shift in self research arguing that self-specificity characterizes non self-representational processes determining the perspective which relates any represented object to the representing subject. We propose that such relation is made possible at a basic level thanks to an integration of re-afferent information on the perceived object with efferent information on the action of the perceiving subject. Such operationalization of the first person perspective in functional terms allows for further investigations of self-specific processes at the neurophysiological level.

Keywords: First-person perspective, Sensori-motor integration, Re-afference, Self-related contents, Default mode, Shared representations, Theory of Mind, Reasoning,

CONSCIOUS AND UNCONSCIOUS ASPECTS OF SELF AND OBJECT REPRESENTATIONS AND THEIR NEUROBIOLOGICAL CORRELATES IN BIPOLAR DISORDER

Judit Somlai, Sidney J. Blatt, Lara . Chepenik, Fei Wang and Hilary P. Blumberg

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Background: Self and object representations are cognitive and affective schemas that organize and colour subjective experiences. Previous neuroimaging studies have showed abnormalities in bipolar disorder (BD) in brain regions that subserve the processing of stimuli with emotional valence. This study sought to examine the neural circuitry associated with the quality of self and object representations in BD.

Methods: Study subjects included adults with BD and a healthy comparison group. Spontaneous descriptions of the self, mother and father were analyzed with the assessment method devised by Sidney J. Blatt et al. to examine self and object representations in BD. Subjects participated in functional magnetic resonance imaging scanning. In the scanner a paradigm using emotional and neutral faces from the Ekman series served to engage the emotional circuitry.

Discussion: Preliminary findings regarding the quality of self and object representations and their associations with regional engagement within the emotional circuitry will be discussed.

Contact Judit Somlai at juditsomlai@yahoo.co.uk

DEEP REGRESSION AFTER SEVERE TBI - FIVE CASE REPORTS

A Sverdlik, E. Heled, R. Natovich and E. Agranov
Tel Hashomer Sheba Hospital, Israel

Though various mental changes are well-known complication of traumatic brain injury, there is paucity of data regarding regressive states after TBI. We described five young patients (four females and one male) with cognitive, mood and behavioral disturbances as a result of severe head trauma whose most common denominator and most prominent feature was deep regression with striking puerility, as if head injury turned then into children, mostly noisy, obstinate, and ill-bred ones. All of them but the male have been remaining in this state since gained the consciousness, with no or very insignificant dynamics, and it makes their rehabilitation impossible. Their clinical pictures seem to be very different from what we can usually see in head trauma rehabilitation or in general psychiatric practice. Hypothetical underline mechanisms of this phenomenon are discussed.

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