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On January 1, 1994, enrollment in an accredited proficiency testing program became mandatory under the CLIA regulations for physicians performing moderate and high complexity tests in their offices. Physicians not enrolled in programs are in violation of the standard.
In a recent paper Britton attempted to distinguish between a phantasy that has achieved the status of a belief and one that has not, and between a belief and knowledge. The author argues that, in the light of the seventeenth-century controversy between Descartes and Spinoza, both of these distinctions are untenable. Descartes argued, as Britton does, and as Freud did, that phantasies or ideas are not accepted as beliefs until they are tested against reality. Furthermore, Britton maintains that for a belief to acquire the status of knowledge, it must be supported by incontrovertible evidence. Spinoza, on the other hand, proposed the seemingly preposterous notion that a comprehended proposition is automatically believed. Doubt may subsequently be engendered by disconfirming evidence. As it turns out, research in a number of domains suggests that Spinoza was correct and Descartes was wrong. This evidence and its clinical implications are discussed. As suggested by Bion, instilling doubt regarding deeply ingrained (Spinozan-formed) phantasies is a principal goal of treatment.
Reality monitoring of verbal memories was compared with decisions about pictorial memories in this study. Experiment 1 showed an advantage in memory for imagined over perceived words and a bias to respond "perceived" on false alarms. Experiment 2 showed the opposite pattern: an advantage in memory for perceived pictures and a bias to respond "imagined" on false alarms. Participants attribute false alarms to whichever class of memories has the weakest trace strengths. The relative strength of memories of imagined and perceived objects was manipulated in Experiments 3 and 4, yielding changes in source attribution biases that were predicted by the strength heuristic. All 4 experiments generalize the mirror effect (an inverse relationship between patterns of hits and false alarms commonly found on recognition tests) to reality monitoring decisions. Results suggest that under some conditions differences between the strength of memories for perceived and imagined events, rather than differences in qualitative characteristics, are used to infer memory source.
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Measures of activity have changed in ways that their utility in screening for neurotoxicity has vastly improved. New computer pattern recognition systems now provide rapid, objective tools for identifying animal behavior. Advances in data analysis procedures have replaced the percent change in overall activity level with measures of initiations, total time and temporal structure for multiple behaviors and sequences. These advances can distinguish hyperactivities induced by different mechanisms and rank their neurotoxic potential, a feat not possible with photocell devices generally used in laboratories today. With the recent technological improvements, it is possible that a measure of activity will become one of the best predictors of malfunction in the central nervous system.
This multiple case report presents two groups of survivors from aneurysms of the anterior communicating artery (ACoA); amnesic and non-amnesics, to examine the similarities and differences in neuropsychological profiles. All six patients were consecutive admissions to acute inpatient rehabilitation, and exhibited generally intact attention, concentration and intellectual ability. Confabulation and personality changes were observed only among the amnesic ACoA patients. However, difficulties in concept formation and perseverative responding was observed in all subjects. A neurobehavioral hypothesis addressing the underlying mechanism of the main features of the "ACoA syndrome" is presented.
Drawing from a number of qualitative studies, a set of basic principles is presented for development of sound, effective nutrition education material. First, research is needed each and every time a new intervention or materials development project is initiated. This research should include formative, process, and outcome testing. Second, reality checks are needed. Programs and materials need to be tested in the settings and for the purpose for which they are intended. Third, messages need to be tailored to the audience. Certain concepts, such as the Dietary Guidelines, may be more or less universal, but the actual educational process and materials need to be tailored to specific target groups. Generic messages do not work. Sound scientific methodology is readily available as well as empirical principles to guide in the development and testing of nutrition education programs and materials, but each new intervention must be tested because there is always a creative element involved. Research will be ineffective, however, unless the right questions are asked and the right people (usually requiring a multidisciplinary team) are used to find the answer.
Schizophrenic (n = 21) and manic (n = 19) patients were followed up an average of 8 months after an index assessment during an acute admission. These patients were tested at both assessments with laboratory tasks measuring distractibility and reality monitoring and were examined with clinical ratings of positive and negative thought disorder. For manic patients, none of the measures predicted the patients' clinical state of followup, while negative thought disorder, although rare, was temporally stable. For the schizophrenic patients, both negative thought disorder and distractibility were temporally stable, and more severe negative thought disorder was found at index assessment in patients who were psychotic at followup. The differential utility of laboratory and clinical indices for the prediction of overall clinical state is related to these data.
Using the criteria of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D), we assessed the incidence of feelings of unreality among a sample of 70 persons who had sustained head injuries. Among those whose head trauma could be classified as mild, more than 60% complained of a depersonalization syndrome. Among those with a significant period of unconsciousness, only 11% had similar complaints. There was a high comorbidity with post-traumatic stress disorder and vertigo. Feelings of unreality were not associated with cognitive impairment or elevated personality test scores, nor were there significant relationships with gender or involvement in litigation. A conservative estimate of incidence of depersonalization among persons with minor head trauma is 13%, while, at the upper end, as many as 67% of persons who sustain mild head injury may experience feelings of unreality.
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A neuropsychological etiology has been suggested for lack of insight in schizophrenia patients, mainly based on frontal, right parietal, right hemisphere, or diffuse cerebral dysfunctions. The aim of this study ws to investigate the neuropsychological pathogeny of lack of insight in schizophrenia patients. We examined a sample of 40 DSM-III-R schizophrenia inpatients admitted because of a recrudescence of symptoms. Schizophrenic symptoms were evaluated through the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Neurologic explorations included an assessment of frontal neurologic signs, abnormal involuntary movements, and soft neurologic signs. Lack of insight was assessed through three items from the Manual for the Assessment and Documentation of Psychopathology (AMDP). A global index from these three items (lack of feeling ill, lack of insight, and uncooperativeness) was obtained. A neuropsychological battery composed of tests involving many functional areas of the brain was used. No correlation between bad performance and lack of insight was found on any test. On the contrary, lack of insight was associated with better performance on immediate verbal, immediate visual, and delayed visual memory tasks. Moreover, the three components of lack of insight were extracted as an independent factor when they were included together with the positive and negative symptoms, neurologic abnormalities (frontal and soft neurologic signs, and abnormal movements), and a global measure of cognitive performance. The results of the study do not support the neuropsychological hypothesis of lack of insight.(ABSTRACT TRUNCATED AT 250 WORDS)
To assess the level of concordance between two published measures of dream bizarreness, 100 randomly selected dreams from 93 college students were scored for primary process using the Auld, Goldenberg, and Weiss scale and for dream distortion using Zepelin's scale. This analysis yielded a strong relationship between these measures, indicating adequate concurrent validity for the content analysis of the construct of dream bizarreness.
Drawings done by a patient before examination led to the suspicion of cataphasia, in view of previous experience of similar pictures drawn by verbigerate patients, and this proved to be so. We assume that the verbigerate affection of the thinking process is pictorially reflected in spontaneous casual drawing. In a less spontaneous situation, on other hand, the patient will not be so completely disorganised, and thus the author of an utterly confused drawing can still retain some measure of mental control in the course of tests.
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This overview of attempts to shed light on the pathogenesis of delusions provides a sense of promise, because we are grappling with the right problems, and reasons for both optimism and skepticism. Optimism is justified because some of the approaches have yielded empirical support and can be tested profitably in research. Skepticism is warranted because we remain unclear about precisely what delusions are; and we have as yet no means of identifying them with a laboratory test. Hence, we must rely on the problematic nature of clinical observation of the inner experiences of patients to make progress. The different mechanisms proposed still require considerable testing, but scrutiny of current results suggests that anomalous experience as a stimulus for delusion formation has been better documented than proposals invoking disordered reasoning or motivational deviances. Nevertheless, no view is as yet established, and each may have some relevance to solving the delusion puzzle.
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Nowhere in medicine is a test or battery of tests more needed than in the diagnosis of adverse reactions to foods. Such tests are not at present a reality. Research produces tests that individually appear to show validity, but when challenged with the entire range of possible adverse reactions and their results, the tests fall short. Considering the range of mechanisms involved in adverse reactions to foods, this is to be expected. There is a tendency to discount positive test results when they fail to cover all of the parameters desired. The inherent weakness in any test is that all available formats explore a single or limited reaction route. The reality is the presence of multiple routes, multiple target organs, and multiple external variables not subject to programming into a single test. Considering the range of possibilities, it is amazing that any existing tests show any clinical validity at all. We as scientists should not denigrate any study that shows a significant degree of reliability, even within a limited range. This simply halts progress. An encouraging study should be used as a stepping stone to a more comprehensive format for evaluating the overall range of adverse reactions and providing us with at least some inroads in coping with this most difficult problem. To quote Sir Peter Medawer on receiving the Nobel Prize in Science: "Nothing must be said or written that diminishes the likelihood that someone else will get at the truth."