Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Matthias Vogel ◽  
Frank Meyer ◽  
Jörg Frommer ◽  
Martin Walter ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
General Surgery ◽  
Psychological Trauma ◽  
Hierarchical Organization ◽  
Hernia Surgery ◽  
The Unconscious ◽  
Cardiac Cancer ◽  
Posttraumatic Symptoms ◽  
Large Numbers ◽  
Total Knee ◽  
Psychosomatic Problems

AbstractBackgroundSurgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient’s capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized.MethodThe present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery.ConclusionAspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core.ImplicationsNot least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.

4. Agents, networks, degree, and recirculation

2014 ◽  
Author(s):  
John H. Holland
Keyword(s):  
Signal Processing ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Hierarchical Organization ◽  
Look Ahead ◽  
Large Numbers ◽  
Action Sequences ◽  
Complex Adaptive ◽  
Performance Capability ◽  
Different Levels

‘Agents, networks, degree, and recirculation’ explains that when studying complex adaptive systems (CAS) in a grammar-like way, agents serve as the ‘alphabet’. The hierarchical organization of CAS implies different kinds of agents at different levels, with correspondingly different grammars. The interactions of signal-processing agents at a point in time can be specified by a network—a snapshot of the agents’ performance capability. The combination of high fanout (the richness of an agent’s interactions) and hierarchical organization results in complex networks that include large numbers of sequences that form loops. More complex loops allow the CAS to ‘look ahead’, examining the effects of various action sequences without actually executing the actions.

scholarly journals Traumatic influence of the attitude towards one’s own gender as a factor in the development of eating disorders

2021 ◽  
Vol 273 ◽  
pp. 10046
Author(s):  
Aleksandr Tsapenko
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Statistical Method ◽  
Adolescent Girls ◽  
Psychological Trauma ◽  
The Body ◽  
Short Term ◽  
The Unconscious ◽  
The World ◽  
The Given

At present, the amount of people suffering from various types of eating disorders is steadily increasing all over the world. A large proportion is occupied by people with manifestations of anorexia. Primarily this disorder affects female representatives at the age of 13-20 years. Taking into account the severity of the consequences that anorexia leads to, cases of death are increasingly being recorded, including adolescents. That’s why the question of providing effective assistance to such patients is especially relevant. However, without establishing the true causes, the results achieved during the treatment may be only short-term. In this connection, the author made an attempt to look at the problem more deeply. Thus, the article is devoted to the consideration of the causes of anorexia of adolescent girls, lying in the field of the unconscious, in particular, in a deep psychological trauma received in childhood. According to the author, the reasons of this trauma are the perception as a humiliation of the manifestations of the brother’s admiration or friends’ son from the girl’s parents, as opposed to the lack of attention, warmth and care towards her. The arising misunderstanding of the reason for such a different attitude contributes to the formation of a girl’s confidence that it is better to be a boy and, as a result, an unwillingness to be a woman. This, in turn, leads to anorexic behavior, as anorexia can inhibit the transformation of the body into a woman. The given assessment was confirmed in a conducted study among 128 girls aged 13-18 years with various eating disorders, including 46 with manifestations of anorexia nervosa. The substantiation of the hypothesis put forward at the beginning of the study was checked by means of a statistical method - the Fisher-φ test.

scholarly journals Lessons Learned from the Student’s Surgery Academic League: Is It Worth It?

2020 ◽  
Vol 44 (1) ◽  
Author(s):  
Luiz Eduardo Correia Miranda ◽  
Ana Clara Galindo Miranda ◽  
Diego Laurentino de Lima ◽  
Ana Karla Alves Arraes
Keyword(s):  
Inguinal Hernia ◽  
Medical Students ◽  
General Surgery ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Lessons Learned ◽  
University Hospital ◽  
Undergraduate Medical Students ◽  
Hernia Surgery ◽  
Inguinal Hernia Surgery

Abstract: Introduction: One of the great challenges of a medical school curriculum is to offer training in basic surgical techniques, which allows graduates to develop competences to take care of simple cases presented in the primary care level of SUS. In order to approach the problem of the technical-surgical qualification of medical students and taking advantage of the interest raised by students’ leagues, a surgical care project directed at patients with inguinal hernia was proposed and carried out, based on the students’ academic leagues. The aim of this study is to disclose and discuss the results and the academic experience learned from a students’ league in surgical learning. Methods: This report encompasses the three-year experience of an academic league aiming to approach the problem of the technical-surgical qualification of medical students and which takes advantage of the academic leagues among undergraduate medical students. The participants comprised one general surgery professor, one anesthesiologist, and undergraduate medical students interested in the surgical clinic, from the School of Medicine, University of Pernambuco, Recife (PE), Brazil. Results: Twenty-four students were included. Ninety-six patients were submitted to surgery. Two seminars with nine lectures and one workshop on surgical skills were held. One paper entitled “League of Inguinal Hernia Surgery” was presented. We did not observe hernia recurrences; the surgical complications were minimum and small in number. The students showed fast development of surgical, interpersonal, and communication skills. However, this education model included a small number of students and offered heavy competition to the general surgery residents in their first year at the University Hospital. Conclusion: The academic league in surgery allows a rich pedagogical experience, offering the opportunity for human and technical qualification. However, the proposed model has limitations. In our opinion, it does not represent a solution for the flaws and omissions observed in the school’s curricular grid.

Healing Worldwide Wounds- Applied Trauma Theory and Relational Dynamics

2014 ◽  
Vol 3 (2) ◽  
pp. 1-14 ◽  
Author(s):  
David S. Bathory
Keyword(s):  
Decision Making ◽  
Historical Trauma ◽  
Cultural Influences ◽  
Psychological Trauma ◽  
Trauma Theory ◽  
Group Interventions ◽  
Relational Dynamics ◽  
Large Numbers ◽  
Large Populations ◽  
Biological Substrates

Psychological trauma has been explored to better understand the developmental, cognitive, psychodynamic, social, neuro-biological and chemical consequences due to exposure. Large populations who are exposed to trauma are often studied for their development of subsequent symptoms and psychopathology, but non-pathological and group interventions are infrequently addressed. Applied Trauma Theory (Bathory, 2013b) provides a means and structure for applying theory into practice for non-pathological responses in trauma subjected factions. By incorporating the research from the field of trauma, correlations from neurobiology and psychological applications a culturally customized intervention may be created. Sotero's Model of Historical Trauma discusses a heightened resiliency that occurs due to exposure to traumatic events (Sotero, 2006). Augmenting these models of trauma to adjoin culturally significant values provides a means of creating interventions that are potentially able to help vast numbers of people (such as populations exposed to war and disasters). This paper reviews the biological substrates of trauma, the roles of two major neurotransmitters (norepinephrine and dopamine), and their psychological expression in regard to age and cultural influences. This paper explores the underlying principles of Relational Dynamics and its' influence on decision making. Finally it notes applications that address the needs of large numbers of people exposed to trauma, and potential uses and misuses of this theory.

scholarly journals Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA)

2019 ◽  
Vol 8 (5) ◽  
pp. 697 ◽  
Author(s):  
Matthias Vogel ◽  
Martin Krippl ◽  
Lydia Frenzel ◽  
Christian Riediger ◽  
Jörg Frommer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Childhood Trauma ◽  
Knee Arthroplasty ◽  
Pain Catastrophizing ◽  
Brief Symptom Inventory ◽  
Hierarchical Organization ◽  
Knee Oa ◽  
Dissociative Experiences ◽  
Total Knee ◽  
Order Factor

Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and TKA. Non-parametric correlation, linear regression, and an exploratory factor analysis comprising the PCS and the FDS-20 in aggregate were run. The three factors: (1) PC factor, (2) absorptive detachment, and (3) conversion altogether explained 60% of the variance of the two scales. Dissociative factors were related to childhood trauma, and the PC-factor to knee-pain. The latter was predicted by absorptive detachment, i.e., disrupted perception interfering with the integration of trauma-related experiences possibly including invasive surgery. Absorptive detachment represents negative affectivity and is in control of pain-related anxieties (including PC). The clinical associations of trauma, psychopathology, and maladaptation after TKA may be reflections of this latent hierarchical organization of trauma-related dissociation and PC.

scholarly journals The rare travellers

2021 ◽  
Vol 8 (10) ◽  
pp. 3133
Author(s):  
Vinamra Mittal ◽  
Divyanshu Ghildiyal ◽  
P. K. Sachan
Keyword(s):  
Hernia Repair ◽  
General Surgery ◽  
Clinical Symptoms ◽  
Hernia Surgery ◽  
Time Intervals ◽  
Diagnostic Dilemma ◽  
Mesh Migration ◽  
Diagnostic Threshold ◽  
Surgery Department ◽  
Open Hernia Repair

Hernia surgery constitutes one of the major daily operative procedures in the general surgery department. Using of mesh with tension free repair is the most widely used technique. Mesh migration and subsequent perforation account as one of the very rare complications following laparoscopic or open hernia repair. The complications following surgery present with symptoms at different time intervals and are sometimes very difficult to diagnose. We present here a couple of cases of mesh migration resulting in varied clinical symptoms and a diagnostic dilemma. With more emphasis being on non-fixation of meshes in the recent literatures, a lower clinical and diagnostic threshold should be incorporated in diagnosing such complications.

scholarly journals The Psychological Makeup of Scottie’s Character in Alfred Hitchcock’s Vertigo

2021 ◽  
Author(s):  
Kifah Ali Al Omari ◽  
Baker M Bani-Khair
Keyword(s):  
Psychological Trauma ◽  
Point Of View ◽  
The Other ◽  
Dream Work ◽  
The Unconscious ◽  
The Past ◽  
Other Hand ◽  
Psychoanalytic Theories

This paper aims at studying the psychological makeup of Scottie’s character in Vertigo (1958), a film directed by Alfred Hitchcock and usually considered one of his masterpieces. The paper emphasizes the importance of analyzing Scottie’s character from a psychoanalytic point of view, especially the images, dreams, and schizophrenic duality of his personality. The significance of the study lies in its attempt to resolve the argument about Scottie’s story. Some critics consider this story a fictional dream that resulted from the conflict that Scottie suffered from in the past in intense psychological trauma. On the other hand, the story is a complex murder story planned by an evil character called “Gavin.” To resolve this conflict of opinion, this paper tries to explain the complexity of Scottie’s surface and analyze it according to some psychoanalytic theories and concepts such as Freud’s theory of the Unconscious, and the idea of fantasy, and the dream work. The researchers conclude that considering Vertigo a dream is one of the ways that help to resolve the conflict about Scottie’s character and the film as a whole.

scholarly journals The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Hernia ◽  
2019 ◽  
Vol 23 (6) ◽  
pp. 1081-1091 ◽  
Author(s):  
F. Köckerling ◽  
A. J. Sheen ◽  
F. Berrevoet ◽  
G. Campanelli ◽  
D. Cuccurullo ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
General Surgery ◽  
Learning Curves ◽  
Cochrane Library ◽  
Hernia Surgery ◽  
Surgery Training ◽  
Hernia Registry ◽  
Tailored Approach ◽  
General Surgery Training

Abstract Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required ‘tailored’ approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a ‘tailored’ approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50–100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.

scholarly journals The Psychological Makeup of Scottie’s Character in Alfred Hitchcock’s Vertigo

2021 ◽  
Vol 5 (4) ◽  
pp. 172-179
Author(s):  
Kifah (Moh’d Khair) Ali Al Omari ◽  
Baker M Bani-Khair
Keyword(s):  
Psychological Trauma ◽  
Point Of View ◽  
The Other ◽  
Dream Work ◽  
The Unconscious ◽  
The Past ◽  
Other Hand ◽  
Psychoanalytic Theories

This paper aims at studying the psychological makeup of Scottie’s character in Vertigo (1958), a film directed by Alfred Hitchcock and usually considered one of his masterpieces. The paper emphasizes the importance of analyzing Scottie’s character from a psychoanalytic point of view, especially the images, dreams, and schizophrenic duality of his personality. The significance of the study lies in its attempt to resolve the argument about Scottie’s story. Some critics consider this story a fictional dream that resulted from the conflict that Scottie suffered from in the past in intense psychological trauma. On the other hand, the story is a complex murder story planned by an evil character called “Gavin.” To resolve this conflict of opinion, this paper tries to explain the complexity of Scottie’s surface and analyze it according to some psychoanalytic theories and concepts such as Freud’s theory of the Unconscious, and the idea of fantasy, and the dream work. The researchers conclude that considering Vertigo a dream is one of the ways that help to resolve the conflict about Scottie’s character and the film as a whole.

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