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OBJECTIVES: Visceral adipose tissue (VAT) is highly associated with metabolic syndrome (MetS), which is rapidly increasing in young adults. However, accessible VAT measurement methods are limited, restricting the use of VAT in early detection. This cross-sectional study sought to determine if near-infrared reactance spectroscopy (NIRS)-derived VAT (VATNIRS) was associated with MetS in a multi-ethnic sample of young adults. METHODS: A total of 107 male and female (F:62, M:45) participants (age: 23.0 ± 4.3y; BMI: 27.1 ± 6.6 kg/m2) completed measurements of fasting blood pressure, blood glucose (FBG), blood lipids, and anthropometric assessments including waist circumference and VATNIRS. MetS severity (MetSindex) was calculated from the aforementioned risk factors using sex and race-specific equations. RESULTS: VATNIRS was higher in participants with, and at risk for, MetS compared to those with lower risks (all p < .001). VATNIRS was positively associated with MetSindex for all groups (all p < .001). VATNIRS showed positive associations with systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP), LDL-C and LDL-C-related biomarkers, and FBG; and negative associations with HDL-C and HDL-C-to-total cholesterol ratio (all p < .050). Associations between VATNIRS and blood pressure for females, and LDL-C and LDL-C-related biomarkers for males, were nonsignificant (all p > .050). VATNIRS was positively associated with DBP in African-American participants, and SBP in White participants, resulting in positive associations with MAP for both groups (all p < .050). CONCLUSIONS: VATNIRS is associated with MetS and individual MetS risks factors in a multi-ethnic sample of young adults; providing a noninvasive, cost-effective, portable, and accessible method that may assist in the early detection of MetS and other cardiometabolic abnormalities.

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Introduction: Prior studies report conflicting evidence regarding exercise pressor and metaboreflex responses in individuals with metabolic syndrome (MetS). Purpose: To test the hypotheses that 1) exercise pressor and metaboreflex responses are exaggerated in MetS and 2) these differences may be explained by elevated resting blood pressure. Methods: Blood pressure and heart rate (HR) were evaluated in 26 participants (13 MetS) during 2 min of handgrip exercise followed by 3 min of post-exercise circulatory occlusion (PECO). Systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP), along with HR and a cumulative blood pressure index (BPI), were compared between groups using independent samples t-tests, and analyses of covariance were used to adjust for differences in resting blood pressure, fasting blood glucose (FBG), and waist circumference (WC). Results: ΔSBP (∼78% and ∼54%), ΔMAP (∼67% and ∼55%), and BPI (∼16% and ∼20%) responses were significantly exaggerated in individuals with MetS during handgrip and PECO, respectively (all p ≤ 0.04). ΔDBP, ΔMAP, and BPI responses during handgrip remained significantly different between groups after independently covarying for resting blood pressure (p < 0.01), and after simultaneously covarying for resting blood pressure, FBG, and WC (p ≤ 0.03). Likewise, peak SBP, DBP, MAP, and BPI responses during PECO remained significantly different between groups after adjusting for resting blood pressure (p ≤ 0.03), with peak SBP, MAP, and BPI response remaining different between groups after adjusting for all three covariates simultaneously (p ≤ 0.04). Conclusion: These data suggest that exercise pressor and metaboreflex responses are significantly exaggerated in MetS independent of differences in resting blood pressure, FBG, or WC.

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In this article, the psychosocial themes emerging from an exploratory qualitative study are reported. Using a constant comparative method, the authors describe how older adolescents with cerebral palsy defined success in life and the factors they viewed as helping or hindering their success. Participants were 10 adolescents with cerebral palsy between 18 and 20 years of age who took part in a semistructured interview exploring their perceptions of success. For these adolescents, success meant being happy in life. Three key psychosocial factors were related to success in life: being believed in, believing in yourself, and being accepted by others (belonging). The findings are useful in guiding the design of services to meet the life needs of individuals with disabilities.

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This article is based upon a symposium presented at Vanderbilt University Medical Center on the Department of Psychiatry's 50th anniversary (September 20, 1997). The panel of psychotherapy scholar-clinicians discusses issues including: whether or not managed care and psychotherapy are compatible; the relevance of the Consumer Reports' psychotherapy study to MCOs' emphasis on brief therapy; how MCOs impact upon the therapist-patient relationship; the effects of MCOs on the psychotherapist's personal and professional identity; and training psychotherapists in the era of managed care. The paper is dedicated to Pietro Castelnuovo-Tedesco, M.D., Vanderbilt's Blakemore Professor of Psychiatry, who died on January 24, 1998.

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Psychoanalysis fits comfortably into the model of neither an experimental procedure nor a subjective experiencing. Yet it elicits both the deep-running skepticism of science and the passions of everyday life. A structure for incorporating both is suggested.

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Successful outpatient treatment of schizophrenic disorders largely depends on the patient's ability to form a treatment alliance with mental health professionals. However, even in the context of competent pharmacotherapy, symptoms of schizophrenia often persist under this alliance. The authors review five common syndromes occurring during the course of treatment of patients with schizophrenia that interfere with the therapeutic alliance: paranoia, denial of illness, stigma, demoralization, and terror from awareness of having psychotic symptoms. Mental health clinicians can use specific psychotherapeutic management techniques for these symptoms. Examples of these techniques include "sharing mistrust" for paranoid patients, providing patients who deny their illness with alternate points of view, making admiring and approving statements to demoralized patients, and normalizing experiences of stigmatized patients. The techniques do not require advanced psychotherapy training and can be used, with ongoing supervision, by bachelor's-level mental health workers.

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The two main problems of patients suffering from paranoid phenomena are discussed from a treatment perspective. These two problems arising from "having trusted too much" and having lost "ownership of the self" result in the classic projections and loss of initiative commonly seen in paranoid psychopathology. Clinicians must first ward off the patients' projections and help patients work toward a position of "healthy skepticism." This article shows: (1) the specific role of narcissism, its structures and processes, as they contribute to the internal changes needed to achieve this goal; (2) how clinicians can rekindle important sources of initiative and aspiration within the patient. Selfobject relationships, the agency of the ego ideal and the role of the affects of hope and affection, along with such specific interventions as "performative statements," have been offered as helpful tools for clinicians who work with paranoid patients.

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Paranoid phenomena can be seen to arise from pathological narcissism. As a result of certain kinds of trauma to the ego-ideal and/or losses of important self-object relationships, the self becomes dislodged from internal agencies and representations. Narcissistic cathexis of the self to these internal psychic structures loosens and hope, aspiration, affection and will become markedly diminished. Meaningful goals and choices become impossible to adopt and make. The paranoid patient is internally at "loose ends"; he is lost. Tragically, being gripped by the paranoid condition and its manifest delusional system is the only kind of security that the paranoid patient knows. No wonder it is so hard to give up. The vulnerability to paranoid phenomena may be seen to be a result of past experiences of subversion of "selfhood." In significant ways, the patient vulnerable to paranoid phenomena has not been adequately attended nor adequately "left alone." The self can be seen as arising out of crucial mother-infant exchanges that are paralleled by interactions between developing internal psychic structures. Out of these "reflections," the self is born. The narcisstic cathexis of self to the ego, superego and ego-ideal is the result of self-expression. If full self-ownership has not been possible then self-expression is vulnerable. Given these understandings of the relationship between paranoid phenomena and pathological narcissism, treatment will focus on reducing the threats to selfhood, refinding the self, and reestablishing ties to internal sources of affection, initiative and aspiration.

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Concepts of self of Grossman, Kohut, and Kernberg are briefly summarized and some limitations suggested. The author proposes a theoretical basis of the concepts of self and authentic self parallel to superego development and the concept of ownership of impulses and values.

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Physical medicine has a body of normal findings that make possible the definition of disease states. The routine procedures of psychiatry do not include any such tests of health. As a result, the psychiatric concept of illness has no stable base from which specific conditions can be described. The author suggests two human capacities, connectedness and self-protectiveness, that can be assessed by the psychiatrist in attempting to evaluate the patient's overall psychological health.

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The author presents a broad view of the principal forces at work in twentieth-century psychiatry. He describes the approach of the various psychiatries--psychoanalytic, biological, behaviorist, social, interpersonal, and existential--to the diagnostic enterprise and the therapeutic enterprise. He finds twentieth-century diagnosis dominated by objective-descriptive psychiatry and therapy by the extraordinary growth of psychotherapy in the industrial nations. The newer psychotherapeutic methods have made the first systematic additions since Freud to our understanding of the ways in which personal change occurs.

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The first interview presents dilemmas to the psychiatric practitioner. Is he or she to concentrate in objective-descriptive fashion, observing symptoms and signs, seeking the likely syndrome or disease concept? Is he or she to work associatively, toward unconscious themes as developed by the psychoanalytic schools? Would an existential approach be best, an attempt to understand the patient's life purposes and difficulties empathically? Alternatively, should the therapist grasp the patient's situation in interpersonal terms? The authors suggest that these decisions are less central than the need to establish a working relationship in order to continue the investigation or treatment and to uncover as much as possible of the relevant data, and that the newer schools of existential and interpersonal psychiatry offer the critical keys to achieving this.

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