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Relationships between subjective cognitive decline and white matter hyperintensities on t2 flair imaging in normal elderly volunteers [Meeting Abstract]

Rothstein, A; Masurkar, A
Background and Aims: White matter hyperintensities (WMH) on the MRI FLAIR sequence may reflect cerebral small vessel disease, impacting age-related cognitive decline and Alzheimer's disease (AD). However, it is not clear how WMH in normal individuals relates to subjective cognitive decline (SCD), proposed to be a prodromal stage of AD.
Method(s): We performed a cross-sectional analysis of 194 cognitively normal elder volunteers with SCD seen in the NYU Alzheimer's Disease Center from 1/2017-10/2019. Evaluations included medical history, neuropsychological testing, SCD ratings, and MRI. They were divided into two groups based on extent of WMH on MRI axial FLAIR: moderate-to-severe (n=29) and none-to-mild (n=165).
Result(s): The groups performed similarly on cognitive testing, and had equivalent rates of hippocampal atrophy on MRI. Hypertension was more prevalent in the moderate-severe WMH group (67% vs. 25%, p=0.003). Moderate-severe WMH subjects had slightly higher SCD magnitude measured on the Brief Cognitive Rating Scale (21.68 vs. 20.53, p=0.04). They also expressed more concern about nonamnestic cognition on the Cognitive Change Index, questions 13-20 (13.35 vs. 10.92, p=0.003), specifically with everyday decision making (p=0.006) and shifting from one activity to the next (p=0.007). On the Geriatric Depression Scale, they were more likely to endorse emptiness (11% vs. 2%, p=0.04) and not feeling wonderful to be alive now (18% vs. 6%, p=0.049).
Conclusion(s): In SCD, WMH associates with hypertension and contributes to the character of cognitive concern and concomitant affective symptoms. WMH should be further studied as an important vascular modulator of this prodromal stage of AD
EMBASE:634007085
ISSN: 1747-4949
CID: 4784622

Supervisory countertransferences and impingements in evaluating readiness for graduation: Always present, routinely under-recognized

Ehrlich, Lena Theodorou; Kulish, Nancy Mann; Fitzpatrick Hanly, Margaret Ann; Robinson, Marianne; Rothstein, Arden
Utilizing detailed, in-depth material from supervisory hours from around the world (explored in End of Training Evaluation groups), this paper shows that supervisors are subject to multiple, diverse and, at times, ongoing intense countertransferences and impingements on their ability to evaluate candidates' progress. Multiple external and internal sources of these impingements are explored. It is suggested that supervisory countertransferences and their manifestation in parallel enactments remain under-recognized, their impact underappreciated, and the information they contain underutilized. It is argued that the recognition, containment, and effective use of the parallel process phenomena and supervisory countertransferences are essential in order to evaluate candidates' progression and readiness to graduate. Common signals of such entanglements in the supervisor's evaluative function are identified. Three remedies, each of which provides a 'third,' are offered to assist supervisors in making effective use of their countertransference: self-supervision, consultation, and institutional correctives.
PMID: 27543849
ISSN: 1745-8315
CID: 2518892

Developing psychoanalytic cases and the candidates who will analyze them: an educational initiative

Rothstein, Arden
An educational initiative, Psychoanalytic Case Development Supervision, began as an ad hoc practical response when nearly half the candidates in a talented class lacked the psychoanalytic case required for progression. All incoming candidates were assigned a supervisor with whom to meet weekly to consider clinic applicants and patients in their psychotherapy practices for analysis. Gradually it has become clear that readying candidates, in highly individualized ways, to engage in intensive work is as important as developing patients. Not only has this program yielded beneficial results for progression; it has also contributed to a subtle paradigm shift in pedagogy centering on two contemporary controversies: objective assessment of analyzability vs. subjectivity in recommending analysis, and the value of a categorical distinction, based on frequency of sessions and use of the couch, between psychoanalysis and psychoanalytically oriented psychotherapy. A four-year process of discovery-drawing on interviews with forty-nine participants (educators, supervisors, candidates)-is contextualized within the literature on these controversies. Participants' reflections are discussed, as are other features of the program and future directions for this work in progress
PMID: 20234011
ISSN: 0003-0651
CID: 108437

Plea for a balanced conception of AD/HD and its diagnosis and treatment

Rothstein, A
AD/HD may be overlooked as well as too zealously and concretely overdiagnosed. When this condition is properly identified, it is most fruitfully understood in a balanced manner that is integrated with an appreciation of its inevitable shaping influence on the patient's perceptions, self-experience, and psychodynamic constellation, including central unconscious fantasies. This exploration is necessarily multifaceted: the patient's internal experience of states of distractibility, impulsivity, and hyperactivity, their incorporation in unconscious fantasies, and their employment in the service of both self-punitive urges and defenses against the 'unpleasure' (Brenner, 1982) associated with psychic conflicts. Psychoanalysts are in a unique position to grasp these complex relationships. Familiarity with diagnostic issues, the developmental impact of AD/HD, common difficulties such patients present in treatment, and typical countertransference responses will enrich their psychoanalytic work. Interrelationships between AD/HD and the patient's psychic world are presented as they arose in the analysis of a child and an adult
ISI:000177147500006
ISSN: 0735-1690
CID: 32351

Sleeping and dreaming on the couch viewed from the perspective of compromise formation therapy

Rothstein, Arden
Emphasizes that sleeping and dreaming on the couch are best understood as enactments motivated by complexes of conscious and unconscious fantasies conceptualized as compromise formations. This theoretical perspective counters an unnecessarily limiting tendency to view these phenomena primarily as resistance or acting out in the transference with predominantly preoedipal determinants. The author's clinical experiences with sleeping and dreaming on the couch in 2 cases revealed prominent erotic transference manifestations.
PSYCH:1999-10173-005
ISSN: 0033-2828
CID: 25067

Learning disabilities and psychic conflict: A psychoanalytic casebook

Rothstein, Arden Aibel; Glenn, Jules
Madison, CT, US: International Universities Press, Inc
Extent: viii, 504 p.
ISBN: 082362952x
CID: 637

Neuropsychological dysfunction and psychological conflict

Rothstein, A
The author examines the interplay between neuropsychological dysfunction and psychological conflict. Two ideas are emphasized. First, clinicians may overlook or subtly de-emphasize the contribution of neuropsychological dysfunction to patients' difficulties. Second, when neuropsychological difficulties are diagnosed, there is value in being acquainted with the details of the dysfunction and exploring the specific ways in which they are elaborated in fantasy and interwoven in the patient's psychodynamic constellation (including their employment for defensive and superego purposes). This perspective is contrasted with more general formulations concerning the patient's experience of her/ himself as damaged. A case serves to illustrate such a clinical process of discovery.
PMID: 9577855
ISSN: 0033-2828
CID: 3799452

Turning points in psychoanalysis

Rothstein, Arden
This panel discussion explores turning points in psychoanalysis, a phrase used to indicate a moment of movement or a change in direction, or alternately, a decision to end the analysis. The phrase is usually invoked in stalled analyses with very difficult patients. Turning points may be initiated by analyst or analysand. The problems leading up to them are manifold. Patients may rigidly cling to a view of the analyst and/or themselves, or to a fantasy of the manner in which analysis helps, either of which defies analysis. These may belie intense anxiety about overly intense affects and about exploring unconscious conflicts, or a reluctance to give up the possibility of instinctual satisfaction. The analyst, too, may be unwilling to give up cherished aspects of technique or perspectives on the patient, despite the latter's regression. Panel members provide clinical vignettes and detailed cases exemplifying turning points.
PSYCH:1997-39061-013
ISSN: 0003-0651
CID: 25069

Male experience of elective abortion: Psychoanalytic perspectives

Chapter by: Rothstein, Arden
in: Psychiatric aspects of abortion. Issues in psychiatry by Stotland, Nada L. [Eds]
Washington, DC, US: American Psychiatric Press, Inc. xi, 210pp
pp. 145-158
ISBN: 0880484519
CID: 2702

Learning disorders: An integration of neuropsychological and psychoanalytic considerations

Rothstein, Arden; Benjamin, Lawrence; Crosby, Melvin; Eisenstadt, Katie
Madison, CT, US: International Universities Press, Inc
Extent: xvii, 381 p.
ISBN: 0823629562
CID: 638