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Freud tells us that patients who suffer but also take pleasure in suffering their own exceptionality will make themselves known to the analyst via an explicit refusal to renounce any satisfaction, or submit to the temporary discomforts that therapy must entail: ‘They say that they have renounced enough and suffered enough, and have a claim to be spared any further demands; they will submit no longer to any disagreeable necessity, for they are the exceptions and, moreover, intend to remain so’ (1916b, 312). Accounting for these ‘Exceptions’ in his paper ‘Some Character-Types Met with in Psycho-Analytic Work’, Freud notes that their sense of suffering stems from experiences in early childhood over which they had no control. The ‘privileges’ claimed by the ‘Exceptions’ are a form of recompense or retribution for ‘an unjust disadvantage’ of which they know themselves to be ‘guiltless’ (313). To explore the consequences that this sense of injustice might have on the development of character, Freud takes as his lead example the eponymous protagonist of Shakespeare’s Richard III whose villainous intentions are bound up with his congenital deformity, or physical lack. Here is the excerpt from the soon-to-be King Richard’s complaint that Freud reproduces in his text: But I, that am not shaped for sportive tricks, Nor made to court an amorous looking-glass

The question ‘what does it mean to have something in common?’ is at the heart of the narcissistic dilemma of social recognition. Because it engages with the unresolved intricacies of differentiation and identification — differentiation from the other; identification with the other — it is also the basis upon which narcissism intersects with sociology. Writing of Gemeingeist (common spirit), Freud alerts us to the fantasy structure of every social bond: ‘What appears [as] Gemeingeist,[&] does not belie its derivation from what was originally envy’ (1921, 120). Paying short shrift to the idea of a primary harmony, then, Freud suggests that the ‘appearance’ of a common ‘social feeling’ has at its root an appropriative fantasy. Hence he reveals the devious operations of power that paradoxically maintain the semblance of social cohesion. And yet, his demystifying impulse — exposing the aggression concealed by a fantasy of social harmony — is countermanded by an equal appreciation for the power of fantasy itself. It is ‘in the nature of an [narcissistic] identification’ says Freud, to turn ‘what was first a hostile feeling into a positively-toned tie’ (121). In other words, in Freud’s mind there is a clear association between the present achievement of a common bond and the past narcissistic fantasy of undifferentiated self-hood. In this chapter I am concerned to connect the complexities of what I have begun to call narcissistic sociability to the construction of a sociological discourse which takes as its object the dissolution of social bonds in the period of modernity.

It is an historical coincidence that just as Freud proposed his theory of narcissism as a treatise on love, which is of course a treatise on self-love, the old aggressive impulse was finding a new level of cultural expression with the First World War. Freud’s paper, although we cannot say it is a direct response to this historical moment, nonetheless captures some of its cultural contradictions: When the idea of a military heroism was about to be mobilised and then obliterated once and for all, and the potency of the individual was to be radically undermined by the technological and bureaucratic decrees of war, Freud attended to the question of individual integrity without irony. The First World War is the plenary event of late nineteenth/early twentieth-century theories about the dissolution of social bonds, and it is also the event that shattered the myth of the coherent individual subject: ‘Since that time’, Peter Sloterdijk tells us, ‘broken modes of consciousness visibly reign: irony, cynicism, stoicism, melancholy, sarcasm, nostalgia […]’ (122). Although we can perhaps see the argument for reading Freud’s paper as a kind of nostalgia before the event — nostalgia for an integrated self before the self-shattering of the war — I shall read it as a paper that foregrounds the difficulties of boundary crossings, the necessity of illusions of integrity and self-sufficiency, and the formative link between defining (and loving) the self and defining social relations.

In 1920, facilitated by his nephew and would-be American emissary Edward Bernays, Freud was in liaison with Cosmopolitan magazine regarding the commission of a series of popular articles on psychoanalysis. Freud proposed to write on the topic of not using psychoanalysis in polemics. However, when the editors suggested that, given the taste of the general public, he’d be better off writing on ‘The Wife’s Mental Place in the Home’ or ‘The Husband’s Mental Place in the Home’, Freud responded with indignation. It is a matter of record that Freud abandoned this project, admonished his nephew, and passed over forever the opportunity to be listed as a contributor to Cosmopolitan magazine (see Jones, 1957: 30–31). Still, it would only be a matter of time before psychoanalysis, at least in its therapeutic guise, inveigled its way into the popular print media.

In his work of 1921 ‘Group Psychology and the Analysis of the Ego’, Freud, not uncharacteristically, deploys an animal metaphor to describe the form of narcissism. Arthur Schopenhauer’s ‘company of porcupines’ crowding themselves close together ‘one cold winter’s day’ proves an apt image for describing the dynamics of group identification. As soon as the porcupines feel ‘one another’s quills’ they are induced to separate again — their movement to integration continually thwarted by the counter-movement to separation. With this mobility, ‘driven backwards and forwards’, the narcissism of groups is seen to resemble the narcissism of individuals (101). We saw in the last chapter that narcissism was considered by Freud to be an intermediary process, as much as a fixed state, and, moreover, a process with two directions: the construction of the ego at the level of primary narcissism moving forward out of autoeroticism towards the external world; and regression at the level of secondary narcissism moving backwards to the ego away from the external world. This circularity is implicit in Freud’s conception of the ego-ideal where the process of idealisation (where a person may love ‘what he himself would like to be’ (1914a, 90)) implies its inversion: the failure of living up to this ideal and thereby forcing a split in the fabric of the ego. Thus, ironically, the narcissist’s failure of autonomy is structurally written in to his project of self-idealisation.

I have been making the claim throughout this book that Narcissus can be raised from his recent history of negative attribution and brought centre-stage in the performance of sociability. Of course, some might argue that Narcissus should be left exactly where he is: they might say that it is simply not possible to relocate him in this way for he will refuse to be enticed from the imaginary enclosure he cohabits with his own self-image, and even if, hypothetically, we could lure him away from himself, it would be dangerous to do so (remember that Narcissus’ certain fate was punishment for his disregard of others’ interests). But then again, if we believe the critics of ‘cultural narcissism’, Narcissus has long since broken free from his fixation at the poolside, and can be found circulating destructively in the economic and libidinal systems of late modern capitalism. With Narcissus’ entry into the market, the critical declinists perceived a threat to the impersonality of public culture and its opportunities for aesthetic forms of sociability. Contrariwise, I have been concerned to show Narcissus’ communicative side; his capacity for charm, and his active seduction of his self that inevitably leaves its mark on the other. Rather than banish Narcissus back into ‘splendid isolation’, I should like to see him feature more vitally within contemporary psychosocial discourse.

Vitamin D plays crucial roles in neuroprotection and neurodevelopment, and low levels are commonly associated with schizophrenia. We considered if the association was spurious or causal by examining the association of Vitamin D with Leukocyte Telomere Length (LTL), a marker of cellular aging. Vitamin D levels in 22 well-characterized schizophrenia cases were examined with respect to symptoms, cognition, and functioning. LTL was assessed using quantitative polymerase chain reaction (qPCR). The results showed that 91% (20) had deficient or insufficient Vitamin D levels, which were associated with excitement and grandiosity, social anhedonia, and poverty of speech. Sex-specific analyses showed strong associations of hypovitamintosis D to negative symptoms and decreased premorbid adjustment in males, and to lesser hallucinations and emotional withdrawal, but increased anti-social aggression in females. In females LTL was furthermore associated with Vitamin D levels. This study demonstrates a relationship of low vitamin D levels with increased cellular aging in females. It is also the first study to demonstrate potential sex-specific profiles among schizophrenia cases with hypovitaminosis.

Leukocyte telomere length (LTL) is longer in association with advanced paternal age, but this association has not been examined along with family history (FH) in schizophrenia. LTL was measured by PCR and compared across cases and controls as part of a study to examine the characteristics of paternal age related schizophrenia. The 53 schizophrenia cases had similar mean LTL as 20 controls, although cases were significantly older than controls and overwhelmingly smoked cigarettes. Multivariate analyses showed that a FH of schizophrenia was associated with longer LTL in both male and female cases. Later paternal age was also related to longer LTL in male cases, but with shorter LTL in female cases. Male cases with older fathers and a FH had the longest LTL. The genetic architecture associated with a familial risk for schizophrenia may include pathways that lengthen LTL. Paternal aging conferred an additional increase in LTL lengthening in male cases, but reduced LTL in female cases. The gender difference in LTL for paternal aging is consistent with the severe illness features reported for female cases with older fathers and could implicate epigenetic alterations in the paternal X chromosomal region with advanced paternal age in association with the risk for schizophrenia.

The diagnosis of schizophrenia includes “positive” and “negative” symptoms. These titles were developed to respectively reflect if the symptoms are additions to normal experiences, such as delusions and hallucinations, or if they refer to the absence or the loss of normal emotional function or behavior. This paper describes the history of the negative symptom concept, from its origins up to the considerations for the DSM-5, including the steps that produced the current conceptualizations. The DSM-5 only includes deficits in emotional expression and avolition as negative symptoms, which can be assessed from interview information. Factor analyses show they encompass most other negative symptom items. In addition to using these negative symptoms in a categorical manner to make a diagnosis, the DSM-5 has quantitative severity ratings of the negative symptoms, along with ratings of delusions, cognitive symptoms, motor symptoms, disorganization, depression and mania. With this approach, the different symptom domains, including negative symptoms, can be measured and tracked over time. Another change in the DSM-5 is the dropping of the schizophrenia subtypes that have been included in earlier volumes, as they were not useful in treatment decisions or prognosis. An intended outcome of these changes in DSM-5 is for clinicians to directly treat the individual psychopathological domains of the disorder for optimizing individual outcomes. Finally, this paper includes descriptions of the negative symptom items from over a dozen different scales.

This article describes strategies to build and enhance mentor/protégé relationships, expand nurses' experience, and help new nurses develop.

Learn strategies to build and enhance mentor-protege relationships, expand your experience, and help new nurses develop.

Cannabis use is reported to increase the risk for psychosis, but no prospective study has longitudinally examined drug use and symptoms concurrently in clinical high risk cases.We prospectively followed for up to 2 years 32 cases who met research criteria for prodromal psychosis to examine the relationship between substance use and clinical measures.Cases with a baseline history of cannabis use (41%) were older, but did not differ in clinical measures. Longitudinal assessments showed these cases had significantly more perceptual disturbances and worse functioning during epochs of increased cannabis use that were unexplained by concurrent use of other drugs or medications.These data demonstrate that cannabis use may be a risk factor for the exacerbation of subthreshold psychotic symptoms, specifically perceptual disturbances, in high risk cases.

Analysis of 163 putative Shigella isolates from Canada and the USA showed biochemical reactions consistent with Shigella species, although none of the isolates reacted with antiserum raised against any of the well-established or provisional Shigella serotypes. All these isolates, provisionally designated serotype SH108, were positive for the ipaH gene and the invasion-associated locus. All fermented mannitol, were serologically indistinguishable from each other and showed no reaction in antisera prepared against Escherichia coli serotypes O1 to O181. PCR-RFLP analysis of the genes involved in O-antigen synthesis revealed a common pattern among these isolates that was distinct from recognized Shigella serotypes and E. coli. Between 1999 and 2003, isolates from across Canada were submitted to the National Laboratory for Enteric Pathogens for antibiotic susceptibility testing, phage typing and PFGE. These assays revealed heterogeneity among the members of this serotype. Antimicrobial susceptibility testing with seven antibiotics identified six profiles, with 90 % (45/50) of the isolates resistant to four or more antibiotics and 72 % (36/50) resistant to five or more. All isolates were typable using a panel of 16 phages, with 11 different phage types (PTs) represented. The most common PTs found were PT 3 (64 %), PT 6 (10 %) and PT 16 (6 %). Analysis of XbaI-restricted genomic DNA revealed 16 highly related patterns that were not readily distinguishable from those obtained for some other Shigella serotypes. The World Health Organization Collaborating Center for Shigella has added serotype SH108 to the Shigella scheme as S. boydii serotype 20 (serovar nov.). Strain SH108 (isolate 99-4528) is the reference strain for this serotype.

Abstract 1460 Background: FLT3 internal tandem duplication (itd) mutations are found in 25% of adult patients with acute myeloid leukaemia (AML) and are associated with an adverse prognosis. This mutation results in constitutive activation of downstream pathways. Distinct biological subgroups can be identified based on FLT3-itd mutation type: clones with heterozygous FLT3-itd mutated/wildtype; homozygous mutated FLT3 allele; FLT3 heterozygous biallelic mutant and clones with evidence of overexpression of FLT3-itd. There is evidence to suggest that these mechanisms are important in the clonal evolution of AML cells. We sought to investigate their clinical impact. Method: Itd mutation analysis within exon 14 and/or exon 15 of the FLT3 gene was carried out at diagnosis by PCR of genomic DNA (gDNA) and cDNA for all new AML referrals in the region over 8 years. PCR products were identified and sized using fluorescent based fragment analysis. Allelic ratio (AR) and expression ratio (ER) (mutation: wild type ratio in gDNA and cDNA respectively) was determined from the relative peak heights. High relative expression was defined as 10 fold difference of ER/AR. Copy neutral loss of heterozygosity for the wild type allele resulting in homozygosity of the FLT3-itd mutation (acquired isodisomy (AID)) was determined by analysis of microsatellite markers along chromosome 13. Overall survival (OS) (time of diagnosis to death), event free survival (EFS) (time from diagnosis to induction failure, relapse or death) was calculated. Survival rates were estimated by the Kaplan-Meier method. Differences between the survival distributions were compared with the log-rank test. Results: 177 patients positive for the FLT3-itd mutation were identified. Median follow-up for patients alive was 3.4 years. A separate group of 49 patients tested negative for this mutation during this period had better OS and EFS (p=0.02) compared to the patients who were FLT3-itd positive (median survival 1715 and 307 days respectively). Patients who were FLT3-itd positive had statistically significant (p Patients with lower AR (less than/equal to 0.3) as compared to higher AR (greater than 0.3) had an improved OS (p=0.018) and EFS (p=0.02). The impact of AR on OS had borderline significance (p=0.05) when only patients treated with intensive chemotherapy were considered. AID provides true evidence of FLT3 mutant homozygosity and was detected in 15 (142 tested) patients. In 38 patients who relapsed and had samples at these stages, 5 had developed AID, but were heterozygous (mutant/wildtype) at diagnosis. 6 patients with multiple FLT3-itd products may comprise patients who have multiple different mutant/wildtype clones but may include patients with a second, independent FLT3-itd mutation resulting in biallelic heterozygous mutations, although this cannot be confirmed. A high relative expression level of FLT3-itd was seen in 12 patients. The clinical significance of these findings is uncertain due to the small numbers. Conclusion: The impact of FLT3-itd mutation and other known prognostic factors has been confirmed in a heterogeneous, real life cohort of patients. An AR over 1 provides firm evidence of loss of the wild type allele (9 patients). AID also occurs at an AR of less than 1 because of the presence of normal cells or due to preferential amplification of the wildtype allele. Direct testing for AID is a more sensitive measure of FLT3 mutant homozygosity (detected in 14% of tested patients). The development of AID in patients who relapse may be an important mechanism by which an AML clone gains a further advantage. Lower AR was associated with improved survival. In the context of a high blast count (median bone marrow blast 80%), this implies having a small sub-clone of FLT3-itd positive cells is advantageous to having a larger FLT3-itd clone in their population of AML cells. Disclosures: No relevant conflicts of interest to declare.

In this paper I work from the premise that the Freudian dialectic of honesty and deception challenges the order of ‘authentic’ expression by positing unconscious dissemblance as primary to the structure of the mind. The device that facilitates my reading is irony. I explore the place of irony within psychoanalytic discourse and formulate a distinction between a reading of irony as conscious application (a technique for living), and a reading of irony as unconscious mechanism (the dissembling unconscious).

The aim of this study was to investigate the internal reliability and convergent validity of the 1993 McGreal and Joseph Depression-Happiness Scale. Internal reliability was satisfactory and higher scores on the scale were associated with lower scores of 60 working adults on the General Health Questionnaire of Goldberg and Williams.

BackgroundCOVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19.MethodsThis preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery.ResultsBoth C19+ and C19-groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for ∼50% of participants and was best predicted by time since illness onset.ConclusionsAs smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4