This letter reports the 20-year results in two men who underwent bilateral hand transplantation. Each of the patients can perform activities of daily living and, despite the effects of ...immunosuppressive therapy, are pleased with the functional outcome.
Like his other papers on technique, Freud's 1913 essay "On beginning the treatment" had an enduring influence on psychoanalysts for generations to come, providing them with a solid and ...worldwide-accepted conceptual basis on how to initiate psychoanalytic treatments. After a century of clinical experience and theoretical research, are all of Freud's rules and advice still valid today?
Playing and Reality Revisited is the first volume of a new IPA series dedicated to the greatest writings of psychoanalysis. More than forty years after its publication, Donald W. Winnicott's Playing ...and Reality is still a source of inspiration for numerous psychoanalysts. The authors have invited some of the most eminent specialists of Winnicott's thinking to write on the most significant themes that the author discovered and highlighted brillantly in his book. They show how such concepts as transitional object and phenomena, the use of an object, and mirroring, remain essential today, and explore the way in which Winnicott conceived playing, creativity, cultural experience and adolescence, demonstrating their contemporary relevance. This book is both an homage to Winnicott and a fascinating extension of his work.
Une identité recomposée Seulin, Christian
Revue française de psychanalyse,
2019, Volume:
83, Issue:
2
Journal Article
Peer reviewed
L’auteur, psychanalyste consultant en service de transplantation, décrit les aléas de la dynamique d’appropriation subjective des greffons dans les greffes bilatérales de mains et de face. Pour les ...greffés des mains, cela permet presque toujours une recomposition de l’identité subjective. Pour les greffés de face, une identité sociale est retrouvée, mais le rôle de la réflexivité dans le regard porté sur le visage comme la mise en jeu des zones érogènes entravent souvent d’authentiques retrouvailles identitaires.
The importance of psychosocial aspects in upper extremity transplantation (UET) has been emphasized since the beginning of the vascularized composite allotransplantation era. Herein a long-term UET ...failure mainly due to psychiatric disorders is reported. A young woman amputated in 2004 (electrocution) underwent bilateral UET in 2007. At the time of transplantation the patient underwent a psychological evaluation, which did not completely consider some traits of her personality. Indeed, she had an anxious personality and a tendency to idealize. The trauma of amputation, the injuries associated with the accident, and the short delay between the accident and the transplantation elicited vindictiveness, entitlement, and impulsivity. Following transplantation, she had a high anxiety level, panic attacks, depression, and hypomanic episodes. She was poorly compliant to the rehabilitation program and the immunosuppressive treatment. She developed 13 acute rejection episodes (reversed by appropriate treatment) but neither clinical signs of chronic rejection nor donor specific antibiodies. She developed many severe complications due to the treatment and the psychiatric disorders. At her request, after many interviews, the allografts were removed in 2018. Pathological examination and an angiography performed post-amputation revealed signs of graft vasculopathy of varying severity, in the absence of clinically overt chronic rejection. This case highlights the need to detect during the initial patients’ assessment even mild traits of personality disorders, which could herald psychiatric complications after the transplantation, compromising UET outcomes. It further confirms that skin and vessels are the main targets of the alloimmune response in the UET setting.
Like his other papers on technique, Freud's 1913 essay "On beginning the treatment" had an enduring influence on psychoanalysts for generations to come, providing them with a solid and ...worldwide-accepted conceptual basis on how to initiate psychoanalytic treatments. After a century of clinical experience and theoretical research, are all of Freud's rules and advice still valid today? The authors have asked ten eminent analysts to comment upon this seminal paper of Freud's, each of them focusing on one of the fundamental issues originally propounded by the "father of psychoanalysis". The result is an overall and careful view on the actuality of the technical bases of analysis, in what can be considered a good introduction to contemporary psychoanalytic theory and practice.
La sexualité infantile représente la potentialité des expressions les plus variées de la pulsion sexuelle satisfaisant une tendance générale au plaisir. Elle est à la source de la créativité. Après ...un retour sur le parcours freudien, l’auteur se penche sur ses conditions d’émergence et de transformations dans la cure d’adultes. Si l’expérience de satisfaction est un acquis, fruit de la répétition des expériences, la douleur est présente dès le début. L’auteur propose un modèle à la fois développemental et structural de l’émergence de la sexualité infantile qui articule refoulement primaire de la douleur des origines et naissance de la satisfaction hallucinatoire du désir, première forme de symbolisation de l’expérience de satisfaction. Dans le même mouvement, surgissent le moi, l’objet et le surmoi. Au cours de la maturation, cette structure va s’enrichir donnant naissance à des auto-érotismes dans lesquels se repère en fonction du degré de reconnaissance de l’objet un gradient d’objectalité. La sexualité infantile est une forme spécifique de plaisir tension où le désir coïncide avec le plaisir, comme dans le fantasme ou le rêve. Si la clinique du régime névrotique nous montre le jeu de la sexualité infantile, les situations limites posent le problème de sa création ou re-création en après-coup dans la cure, en appui sur les organisateurs psychiques de l’analyste, complexe d’Œdipe et fantasmes originaires, afin de permettre un affranchissement d’une co-excitation libidinale mortifère.
ABSTRACTUnder the auspices for the International Society on Hand and Composite Tissue Allotransplantation, a section of The Transplantation Society (IHCTAS), a meeting was convened on March 21-22, ...2014 in Paris to review the following areas that were deemed significant in the understanding of the psychosocial evaluation and outcomes of upper extremity transplant recipientsrequired domains of the evaluation, screening instruments, clinical monitoring pretransplant, clinical monitoring posttransplant, patient and team expectations, body image, psychiatric complications, functional goals and quality of life, ethics and media relations. Experts in the fields of psychiatry and psychology, transplantation, social work, ethics, and transplant administration met and reviewed center experiences and literature. The attendees highlighted the importance and the complexity of the psychiatric assessment in this field of transplantation. Moreover, the necessity to develop common instruments and evaluation protocols to predict psychosocial outcomes as well as to understand whether we are transplanting the right patients and how the transplantation is affecting the patients were pointed out. Psychiatric complications in upper extremity transplanted patients have been reported by the majority of teams. Preexisting psychiatric difficulties, the initial trauma of amputation, or adjusting to the transplantation process itself (especially the medical follow-up and rehabilitation process) appeared to be important factors. Monitoring during the whole follow-up was recommended to detect psychiatric issues and to facilitate and ensure long-term adherence. The participants proposed an annual meeting format to build upon the findings of this inaugural meeting to be called the Chauvet Workgroup meeting.
PDF
