Biomedical subjects

P C Watson

Publications and source records attributed to P C Watson.

11 recordsLinked to original sources

PubMed2006

Understanding of basic financial concepts among adults with mild learning disabilities.

OBJECTIVE: In the context of recent legal and social policy developments, which encourage clinicians to support vulnerable adults in making their own financial decisions, we explored understanding of basic financial concepts among adults with mild learning disabilities. METHOD: Using the literature about typically developing children, five measures entailing identification and ordering tasks were devised and were used to examine understanding of quantity, numbers and money among 30 men and women using specialist clinical services (mean FSIQ = 61.80; SD=10.59). RESULTS: The concept of quantity was easier to understand than those of numbers and money, and task difficulties increased with the magnitudes involved. The different types of conceptual understanding were closely related. CONCLUSIONS: These measures may be useful for analysing difficulties in, and informing interventions to maximize, independent financial decision making.

Adolescent↗

PubMed2005

Capacity to make financial decisions among people with mild intellectual disabilities.

BACKGROUND: Although there has been growing recognition of the importance of enabling people with intellectual disabilities (ID) to be more directly involved in managing their own financial affairs, so far, little is known about this aspect of their decision- making. METHOD: Using vignettes and semi-structured interviews, the financial decision-making abilities of men and women with mild ID (n=30; mean FSIQ =61.80; SD=10.59) were compared with those of their counterparts in the 'general population' (n=16; mean FSIQ=101.56; SD=7.62) and 'very able' individuals (n=14; mean FSIQ=123.93; SD=7.60). RESULTS: Whilst the financial decision-making abilities of participants with ID were generally weaker than those of other participants, the differences were not discrete, and many individuals were judged to be able to make at least some personal financial decisions. For all three groups, understanding information relevant to the decision, and reasoning with it, were the hardest parts of the process. CONCLUSIONS: The findings support a functional approach to the assessment of financial decision-making for both legal and clinical purposes, but raise concerns about mental incapacity legislation and assessment.

Adolescent↗

PubMed2005

The relationships among three factors affecting the financial decision-making abilities of adults with mild intellectual disabilities.

BACKGROUND: Among adults with intellectual disabilities (IDs), there is a need not only to assess financial decision-making capacity, but also to understand how it can be maximized. Although increased financial independence is a goal for many people, it is essential that individuals' decision-making abilities are sufficient, and many factors may affect the development of such abilities. METHOD: As part of a wider project on financial decision-making, we analysed previous data from a group of 30 adults with mild IDs, identifying correlations among four variables: (i) financial decision-making abilities; (ii) intellectual ability; (iii) understanding of some basic concepts relevant to finance; and (iv) decision-making opportunities in everyday life. RESULTS: The analysis indicated a direct relationship between ID and basic financial understanding. Strong relationships of a potentially reciprocal nature were identified between basic financial understanding and everyday decision-making opportunities, and between such opportunities and financial decision-making abilities. CONCLUSIONS: The findings suggest that the role of intellectual ability in determining financial decision-making abilities is only indirect, and that access to both basic skills education and everyday decision-making opportunities is crucial for maximizing capacity. The implications of this are discussed.

Adolescent↗

PubMed2005

Self-harm, capacity, and refusal of treatment: implications for emergency medical practice. A prospective observational study.

OBJECTIVES: In the context of increasing attention to the rights of adults to make treatment decisions for themselves, this study investigated, among patients who have engaged in self-harm (i) the extent of valid decision making; (ii) the impact of mental disorders; and (iii) the effect of systematically providing relevant clinical information. DESIGN: A prospective observational study. SETTING: The emergency department of a large teaching hospital in southeast England. PARTICIPANTS: Seventy one adult men and women who had presented for treatment following self-harm. MAIN OUTCOME MEASURES: Semi-structured interviews were used to make clinical judgements about participants' capacity to consent before, and following, the presentation of simple written information about the proposed treatment(s). Demographic data, and data about mental disorder and alcohol misuse, were also collected. RESULTS: Based on accepted legal criteria, only 28/71 (39.4%) of the patients were judged to have capacity to consent to the proposed intervention(s) initially. However, the number of patients judged to have capacity improved significantly (p<0.001) after the presentation of written information, to 45/71 (63.4%). Those judged incapable were significantly more likely (p<0.01) to refuse treatment. Continuing incapacity was significantly associated only with cognitive impairment (p<0.001) and/or severe psychiatric disturbance (p<0.01). CONCLUSIONS: Consistent with current views, capacity is not static, even among patients who have engaged in self-harm, but can be improved through a simple intervention. The findings are consistent with recent guidance about supporting this vulnerable group of patients, many of whom are ambivalent about treatment.

Adult↗

PubMed2001

Longitudinal profiles of semantic impairment for living and nonliving concepts in dementia of Alzheimer's type.

Two types of theoretical account have been proposed to explain the phenomenon of category-specific impairment in tests of semantic memory: One stresses the importance of different cortical regions to the representation of living and nonliving categories, while the other emphasize the importance of statistical relationships among features of concepts belonging to these two broad semantic domains. Theories of the latter kind predict that the direction of a domain advantage will be determined in large part by the overall damage to the semantic system, and that the profiles of patients with progressive impairments of semantic memory are likely to include a point at which an advantage for one domain changes to an advantage for the other. The present series of three studies employed semantic test data from two separate cohorts of patients with probable dementia of Alzheimer's type (DAT) to look for evidence of such a crossover. In the first study, longitudinal test scores from a cohort of 58 patients were examined to confirm the presence of progressive semantic deterioration in this group. In the second study, Kaplan-Meier survival curves based on serial naming responses and plotted separately for items belonging to living and nonliving domains indicated that the representations of living concepts (as measured by naming) deteriorated at a consistently and significantly faster rate than those of nonliving concepts. A third study, carried out to look in detail at the performance of mildly affected patients, employed an additional cross-sectional cohort of 20 patients with mild DAT and utilized a graded naming assessment. This study also revealed no evidence for a crossover in the advantage of one domain over the other as a function of disease severity. Taken together with the model of anatomical progression in DAT based on the work of Braak and Braak (1991), these findings are interpreted as evidence for the importance of regional cerebral anatomy to the genesis of semantic domain effects in DAT.

Aged↗

PubMed2000

The capacity of people with a 'mental disability' to make a health care decision.

BACKGROUND: Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a 'mental disability' (i.e. mental illness (chronic schizophrenia), 'learning disability' ('mental retardation', or intellectual or developmental disability), or, dementia) and a fourth, comparison group. METHODS: The three 'mental disability' groups (N = 20 in the 'learning disability' group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the 'general population' comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability. RESULTS: Compared with the 'general population' group, capacity to make the particular decision was significantly more impaired in the 'learning disability' and 'dementia' groups. Importantly, however, it was not more impaired among the 'mental illness' group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the 'mental disability' groups, one participant benefited only when responding did not require any expensive verbal ability. CONCLUSIONS: Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a 'mental disability'. The methodology may be extended to assess capacity to make other legally-significant decisions.

Adolescent↗

PubMed2000

Improvement or simply practice? The effects of twenty repeated assessments on people with and without brain injury.

Measuring recovery of function may mean testing the same individual many times, a procedure that is inevitably open to improvement due to learning on the specific tests rather than recovery per se. This is particularly likely to be an issue with measures of memory performance. We therefore studied the performance of normal and brain-injured people across 20 successive test sessions on measures of orientation, simple reaction time, forward and backward digit span, visual and verbal recognition, word list learning and forgetting, and on three semantic memory measures, namely, letter and category fluency and speed of semantic processing. Differences in overall performances between the two groups occurred for all tests other than orientation, digit span forward, and simple reaction time, although the tests differed in their degree of sensitivity. The tests varied in the presence or absence of practice effects and in the extent to which these differed between the two groups. Data are presented that should allow investigators to select measures that are likely to optimize sensitivity while minimizing possible confounding due to practice effects.

Adult↗

PubMed1999

Measuring recovery from post traumatic amnesia.

Three groups of participants were assessed. Each participant was tested on 20 occasions. The groups comprised people (i) in post traumatic amnesia (PTA) following severe head injury (n=9), (it) with severe head injury but not in PTA (n=10), and (iii) with no history of head injury or other neurological condition (n=13). Subjects were given several tests of memory, attention and learning in order to determine which tests were good at (a) distinguishing people in PTA from those not in PTA, and (b) monitoring recovery over time. The results indicate that people in PTA have a wide range of deficits and their cognitive recovery is a gradual process rather than an all-or-none phenomenon. In terms of measurement, the study suggests that a good test of PTA should include orientation questions, together with a reaction time measure, a visual recognition test and a speed of information processing measure. Most of the tests administered were good at distinguishing between brain-injured and nonbrain-injured people, although only two tests distinguished between the two brain-injured groups, i.e. those in PTA and those out of PTA. Almost all tests were good at monitoring recovery from PTA.

Adult↗

PubMed1998

Category specific semantic loss in dementia of Alzheimer's type. Functional-anatomical correlations from cross-sectional analyses.

In the context of focal brain injury, selective loss of semantic knowledge in the domain of either natural kinds or artefacts is usually considered to reflect the differential importance of temporal and frontoparietal regions to the representations of perceptual and functional attributes, respectively. It is harder to account far as a feature of a more diffuse process, and previous cross-sectional analyses of patients with dementia of Alzheimer's type (DAT) have differed over whether category effects occur. In our series of 58 patients with probable DAT, we demonstrated a significant group advantage for artefacts, and explored possible reasons for the inconsistency of this finding in other studies. A multiple single-case strategy revealed not only individuals with consistent advantages for artefacts but also individuals with consistent advantages for natural kinds. By ranking the individuals according to measures of naming performance and global intellectual ability, we showed that the strength of the group advantage for artefacts was dependent on the former but not the latter variable. The findings are discussed in the context of two competing theories of semantic breakdown in DAT. One differentiates between domains of knowledge in terms of the structure of semantic representations within a single distributed network; the other emphasizes the importance of different brain regions in the category distinction. We conclude that our findings are in keeping with the predictions of the latter hypothesis.

Aged↗

PubMed1996

A practical framework for understanding compensatory behaviour in people with organic memory impairment.

This paper describes a framework for understanding compensatory behaviour in people with organic memory impairment. It builds on a theoretical framework proposed by Bäckman and Dixon (1992) who distinguish four steps in the evolution of compensatory behaviour: (a) origins, (b) mechanisms, (c) forms, and (d) consequences. Although this framework is useful in understanding compensation in neurologically impaired adults, other factors need to be taken into account. Using data from a long-term follow-up study it is shown that age, severity of memory impairment, and additional cognitive deficits are important variables in predicting independence and use of compensations several years post-rehabilitation. The paper concludes with a consideration of how the framework might be used in future studies.

Adult↗

PubMed1993

To what extent do anxiety and depression interact with chronic pain?

In 61 patients with generalized musculoskeletal pain, severity of anxiety and depression correlated significantly with self-reported impact of illness and physician-rated disability. Depression was significantly associated with pain-frequency, whereas anxiety was unrelated. Depressed mood was more closely tied to patients' ability to function than to their experience of pain.

Adaptation, Psychological↗