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PubMed2006

The beneficial effects of additional task load, positive affect, and instruction on the attentional blink.

The attentional blink reflects the impaired ability to identify the 2nd of 2 targets presented in close succession--a phenomenon that is generally thought to reflect a fundamental cognitive limitation. However, the fundamental nature of this impairment has recently been called into question by the counterintuitive finding that task-irrelevant mental activity improves attentional blink performance (C. N. L. Olivers & S. Nieuwenhuis, 2005). The present study found a reduced attentional blink when participants concurrently performed an additional memory task, viewed pictures of positive affective content, or were instructed to focus less on the task. These findings support the hypothesis that the attentional blink is due to an overinvestment of attentional resources in stimulus processing, a suboptimal processing mode that can be counteracted by manipulations promoting divided attention.

Adolescent↗

PubMed2005

Validation of the Beck Depression Inventory-II in a low-income African American sample of medical outpatients.

The psychometric properties of the Beck Depression Inventory-II (BDI-II) are well established with primarily Caucasian samples. However, little is known about its reliability and validity with minority groups. This study evaluated the psychometric properties of the BDI-II in a sample of low-income African American medical outpatients (N=220). Reliability was demonstrated with high internal consistency (.90) and good item-total intercorrelations. Criterion-related validity was demonstrated. A confirmatory factor analysis supported a hierarchical factor structure in which the BDI-II reflected 2 first-order factors (Cognitive and Somatic) that in turn reflected a second-order factor (Depression). These results are consistent with previous findings and thus support the use of the BDI-II in assessing depressive symptoms for African American patients in a medical setting.

Adult↗

PubMed2005

Evidence-based approaches to assessing couple distress.

This article describes a conceptual framework for couple-based assessment strategies grounded in empirical findings linking couple distress to a broad range of both individual and relationship characteristics. These characteristics can contribute to, exacerbate, or result from relationship problems. On the basis of these findings, the authors articulate specific targets of clinical inquiry reflecting relationship behaviors, cognitions, and affect as well as features of individual distress. Guided by this framework, empirically supported assessment strategies and techniques emphasizing relationship functioning across diverse methods are proposed, including the clinical interview, analog behavioral observation, and both self- and other-report measures. Discussion concludes with specific recommendations regarding clinical assessment of couple distress and directions for further research.

Adult↗

PubMed2004

Cognitive change in obese adolescents losing weight.

OBJECTIVES: To investigate how obese adolescents think about themselves in terms of exercise, eating, and appearance and whether these cognitions change over the course of a residential weight loss camp. RESEARCH METHODS AND PROCEDURES: Obese adolescents [N = 61; age, 14.1 (+/-0.2) years; BMI, 33.9 (+/-0.7) kg/m(2)] completed assessments of body weight and height and self-esteem and a sentence-completion test eliciting thoughts and beliefs about exercise, eating, and appearance at the start and end of the camp (mean stay, 26 days). They were compared with a single assessment of 20 normal-weight adolescents [age, 15.4 (+/-0.2) years; BMI, 21.8 (+/-0.5) kg/m(2)]. RESULTS: The obese adolescents lost 5.7 kg and reduced their BMI SD score by 0.25. Camp residence was associated with a significant reduction in the number of negative automatic thoughts and an increase in positive thoughts, especially related to exercise and appearance. There was no change in conditional beliefs, either functional or dysfunctional. Including BMI SD score change as a covariate took away all the main and interaction effects of time, showing that cognitive change was largely accounted for by the reduction in weight. Despite this improvement, campers remained cognitively more negative and dysfunctional than the normal-weight comparison adolescents. DISCUSSION: Obese adolescents not only lost weight, but they improved their self-representation, specifically in terms of automatic thoughts about exercise and appearance. Although these are short-term cognitive changes, they reflect positively on the camp experience and show the value of psychological improvement in assessing obesity-treatment outcomes.

Adolescent↗

PubMed1999

Education for community psychiatric nurses: content, structure and trends in recruitment.

Under the auspices of the Standing Advisory Group for Community Psychiatric Nursing Education, annual surveys of the leaders of the UK's post-registration courses for community psychiatric nurses (CPNs) have taken place since the 1987-88 academic year. In this paper, findings are reported from the 1997-98 survey. Thirty-two of the 39 course leaders running post-qualifying programmes for CPNs (English National Board course 812 or equivalent, and Specialist Practitioner courses) in the 1997-98 academic year responded to a nine-page postal questionnaire. Responses suggested that the majority of courses for CPNs are now offered at first degree level, with most students completing their programmes of study and clinical practice in one full-time academic year. Most courses appeared to include education in key areas of specialist content pertinent to contemporary CPN practice. Examples included: evidence-based psychosocial interventions; collaborative working with users of mental health services; inter-professional issues; cognitive-behavioural interventions; reflective practice and clinical supervision; and medication-related issues. Overall, however, courses for CPNs appeared to be characterized by considerable variations in specialist content. Possible explanations for this are offered, along with suggestions for future research.

Career Choice↗

PubMed2004

Contextual tensions of the clinical environment and their influence on teaching and learning.

BACKGROUND: Academic medical centres face major challenges, and finding creative, effective strategies to support patient care and teaching are critical for survival. At the centre of these challenges is clinical teaching. AIM: To characterise how context influences clinical teaching. METHODS: Multiple embedded case-study design analysed 3 internal medicine in-patient teams. Direct observations, interviews and documents were data sources. Triangulated data, audit trails and member checks enhanced trustworthiness. RESULTS: Three tensions influenced clinical teaching: 1, patient census; 2, time sensitivity of the context; and 3, the multiple and conflicting commitments of participants. Patient census exhibited the greatest influence and was the catalyst for teaching, learning, and the allocation of total time. Time functioned as an important element influencing the pace of action, reflective and interpretative cognitive processes of the team, time available for action, and the general fatigue of the team. Conflicts among the multiple roles of ward team members disrupted individual and team teaching and learning. CONCLUSION: Clinical teaching is an open system influenced by multiple forces. Learning, teaching and patient care were very closely coupled, and learning knowledge and using knowledge were parts of the same process within the clinical context.

Clinical Competence↗

PubMed1997

[Post-traumatic stress disorder. New research findings].

This article reviews recent research results on posttraumatic stress disorder (PTSD). Epidemiological studies show that PTSD is a common disorder within the normal population with a high degree of chronic courses. Degree of severity as well as dissociative symptoms during the traumatic event seem to have an impact on course and outcome of PTSD. A genetic disposition, familial psychopathology and premorbid personality traits as background variables seem to have an influence on the development of PTSD whereas coping strategies, as well as social support, modify the course of the disease. The investigation of biological parameters refers to the hypothalamic-pituitary-adrenal-axis system, provocation studies, psychophysiological studies, and studies of the endogenous opiate system. In regard to therapy studies only those with a randomised allocation to two different therapies as well as with a control group without therapy or a waiting list group are considered, using the DSM-III or DSM-III-R diagnostic criteria for PtSD. Five pharmacological studies could show a positive effect by antidepressants. Six behaviour therapy studies (two systematic desensitisation and four flioding) produced an improvement of PTSD symptomatology. The pathogenetic models discussed here are memory imprinting, kindling, dysregulation of the opioid neuromodulation, classical conditioning and disturbed cognitive schemas, which reflect as single models only a facet of the pathogenesis.

Humans↗

PubMed2002

The body in adolescent diaries. The case of Karen Horney.

The role of the body and its functions in the psychic life of the individual has occupied a central place in psychoanalytic thinking and writing. Developmentally, the body and the ego as a psychic organization have an integral, mutual relationship which becomes particularly important during adolescence, when the body matures physically while at the same time cognition, self-reflection, and social relations develop. This contribution presents results of the content analyses, focusing on the body, of 40 diaries written by twenty women during their adolescent years, compared with Karen Horney's adolescent diaries. In contrary to these diaries of the other young women, Karen Horney's adolescent diaries lack a focus on the body. Instead, idealized relationships with teachers are frequently mentioned. Only in the last diary, written at the transition to young adulthood, is the body, with a focus on sexual relations, more prominent. This discrepancy between Horney and female age-mates in normative samples is noteworthy. It is discussed here with emphasis on theoretical approaches about the body in adolescence in psychoanalysis, the importance of body and sexuality in Karen Horney's later life, Horney's contributions to female psychoanalysis, and her relationship with her father.

Defense Mechanisms↗

PubMed1997

Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development.

Investigated problem-solving ability and reported regimen adherence among children, early adolescents, and middle adolescents with IDDM in response to hypothetical social situations where a choice between diabetes regimen adherence and peer desires must be made. Sixty-seven 8- to 17-year-olds with IDDM from two distinct U.S. geographical areas participated. Results indicated that compared to children with IDDM, adolescents with IDDM had better problem-solving abilities in response to social pressure situations, possibly reflecting their greater cognitive maturity. However, adolescents were also more likely to choose behaviors that are less regimen adherent. Differences in levels of problem-solving ability and adherence between the two regional subsamples were also found. Similar developmental patterns were found in both groups, showing the robust nature of the observed age-related trend of decreasing adherence in social situations despite increasing problem-solving abilities. Findings were interpreted in the context of normal adolescent development. Results are conceptually important for those interested in the transaction between peer and social influences and adherence for children and adolescents with IDDM, as well as other health behaviors.

Adolescent↗

PubMed1999

What does the P300 brain response measure in children? New insight from stimulus sequence studies.

The decrease in the P300 brain response latency with increasing age is often taken to reflect maturation of cognitive processes in children. We found that in abnormally distractible children the auditory P300 latency decreased significantly when the inter-target interval (ITI) increased in a stimulus discrimination task. We speculate that the sensory memory trace of the target stimulus may decay in distractible children during longer ITIs, and consequently the next target stimulus may activate the brain's orienting networks that are known to generate shorter latency brain responses. The relative strength by which the functionally different neural networks underlying the cognitive brain responses are activated may contribute significantly to the latency measures of these responses. The presumption that a short P300 latency equals to fast processing may thus be over-simplistic, especially in children.

Acoustic Stimulation↗

PubMed1998

Longitudinal study of inflammatory factors in serum, cerebrospinal fluid, and brain tissue in Alzheimer disease: interleukin-1beta, interleukin-6, interleukin-1 receptor antagonist, tumor necrosis factor-alpha, the soluble tumor necrosis factor receptors I and II, and alpha1-antichymotrypsin.

There is evidence consistent with the hypothesis that inflammatory and immune mechanisms are involved in the pathogenesis of Alzheimer disease (AD). We have investigated whether the levels of inflammatory associated proteins in serum or lumbar cerebrospinal fluid (CSF) reflect the progressive cognitive decline and brain atrophy of AD-patients. Levels of interleukin-1beta(IL-1beta), IL-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), the soluble TNF receptors type I and II (sTNFR I and II), and the acute phase protein alpha1-antichymotrypsin (x1-ACT) were determined in paired serum and CSF samples taken yearly over a period of 2-5 years from pathologically confirmed AD patients (n = 8) and normal controls or non-AD subjects with other CNS pathology (n = 9). No significant differences were found between AD subjects and controls in the mean levels of the above mediators. There was also no correlation in either subject group between the levels of these inflammatory mediators in serum or CSF, and the change in cognitive status or the progression of the atrophy of the medial temporal lobe measured by X-ray computed tomography (CT). The concentrations of IL-1beta, IL-6, and TNF-alpha were determined in brain tissue specimens of five to nine different brain regions in six of the AD patients and four of the non-AD subjects. The levels of IL-1beta and IL-6 in the various brain regions were not significantly different in the AD and the non-AD group. However, in AD patients the level of TNF-alpha was significantly lower in the frontal cortex (32%, p = 0.024), the superior temporal gyrus (57%, p = 0.021), and the entorhinal cortex (49%, p = 0.009) compared with non-AD subjects. Low levels of TNF-alpha in the brain areas that showed neuropathology in AD may indicate a dysregulation of the inflammatory process in AD. Despite this finding, this study does not support the use of measurements of any of the inflammatory mediators investigated here as a diagnostic parameter for AD, due the large overlap in the levels of these factors between AD patients and other subjects, and the poor relation to clinical signs of AD.

Aged↗

PubMed2003

Reports of head injury and symptom knowledge among college athletes: implications for assessment and educational intervention.

OBJECTIVE: To identify the prevalence of head injuries and related symptoms among college athletes and examine knowledge of head injury consequences and behavioral tendencies of athletes in the presence of symptoms. DESIGN: Retrospective survey. PARTICIPANTS: A total of 461 male and female athletes beginning competitive play at the University of Akron (Akron, OH) during the years 1995 to 2001. MAIN OUTCOME MEASURES: Responses to survey questions were analyzed to determine the frequency of concussions and injury-related symptoms (eg, dizziness, headache, nausea or vomiting) in addition to behavioral responses in the presence of certain symptoms (eg, playing with headache, failure to report symptoms while playing). Written responses to queries regarding symptom knowledge were analyzed for thematic content and were used to identify deficiencies in signs and symptoms of concussion. RESULTS: Nearly 32% of all athletes had experienced a blow to the head causing dizziness, with over 1/4 confirming various somatic symptoms following a blow to the head (eg, seeing stars, nausea or vomiting, head pain). Continuing to play despite symptom presence was noted (eg, dizziness, 28.2%; headache, 30.4%), with 19.5% reporting a concussion diagnosis. Knowledge of head injury consequences was found to be deficient, with 56% indicating no knowledge of the possible consequences following a head injury. Of those providing responses, the majority reflected awareness of cognitive (eg, memory problems) and physical (eg, brain damage) consequences. CONCLUSIONS: A sizable number of athletes may enter collegiate play with a previous concussion diagnosis, and many more are likely to have experienced symptoms suggestive of a mild head injury. Of considerable concern is the tendency to play while symptomatic (eg, headache, dizziness) and the failure to report symptoms while playing--especially among football players (25.2%). The apparent deficiency in athlete knowledge of head injury consequences raises concern regarding athlete recognition of potentially problematic symptoms and represents an important area for educational intervention.

Athletic Injuries↗

PubMed2006

Measurement of health-related quality of life in survivors of cancer in childhood in Central America: feasibility, reliability, and validity.

Cancer is the commonest cause of disease-related death in children over 5 years of age in various parts of Latin America, but the survival rates are improving. This study assessed the health status and health-related quality of life (HRQL) of more than 200 survivors of cancer in childhood in the countries of a Central American consortium devoted to pediatric hematology-oncology. Patients' self-reports and parental proxy assessments were collected using interviewer-administered Spanish-language questionnaires, and physicians provided assessments using self-complete questionnaires, based on the complementary Health Utilities Index (HUI) Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems. Inter-rater agreement, measured by intra-class correlation (ICC), was fair to moderate (0.34 0.60) for all 3 pairs of assessors for readily assessable attributes: HUI2 sensation, HUI3 vision, HUI3 hearing, and HUI3 ambulation. Less than 40% of the patients reported being in perfect health. More than 20% reported being in health states with HRQL scores corresponding to moderate or severe disability, notably in the attributes of emotion and cognition. The results reflect a common profile in survivors of cancer in childhood, including those from industrialized societies. This study illustrates the feasibility of collecting reliable and valid information on HRQL in the developing country context, raising the prospect that such information could be used to influence clinical practice.

Adolescent↗

PubMed2006

Visuoperceptual learning in alcoholic Korsakoff syndrome.

Relative to the characteristically profound deficits of explicit memory, components of implicit memory remain largely intact in patients with alcohol-induced Korsakoff syndrome (KS). Perceptual priming occurs in KS and transfer of learning has been consistently observed on mirror reading, a perceptual reversal task. Although priming also occurs with fragmented pictures, a perceptual closure task, it is unclear whether transfer of learning can occur. This study examined visuoperceptual learning in 4 men with alcoholic KS, 9 recently detoxified alcoholic men (ALC), 21 healthy age-matched normal control men (NC), and 6 young normal control men (YNC). Subjects were tested with the Gollin Incomplete Pictures Test at initial and 1-hour and 1-day retest sessions. Both alcoholic groups (KS, ALC) were impaired in visuoperceptual ability. All subject groups showed visuoperceptual learning. The KS group showed additional learning after continued exposure to the stimuli, despite their nonmnemonic visuospatial deficits and profound explicit memory impairment for the test stimuli. Transfer of learning to similar but new stimuli was not evident in either the KS or young healthy control subjects; learning occurred only for the specific items presented. The persistence of learning beyond the life of the percept, which was independent of declarative features (such as item recall), suggests that perceptual learning and memory reflects an intact cognitive memory process in KS. This process is likely mediated by posterior cortical networks relatively unaffected in KS and that are independent of the hippocampal-diencephalic declarative memory system.

Aged↗

PubMed1992

Cognition in relapsing-remitting multiple sclerosis: a multichannel event-related potential (P300) study.

Auditory event-related potentials (AERP) were elicited in 47 patients with relapsing-remitting (RR) multiple sclerosis (MS) and 24 age-matched controls. MS patients had significantly prolonged N2 and P3 latencies as well as low P3 amplitude compared with controls. Seven of them exceeded 3 standard deviations from the control mean values. The observed N2 and P3 alterations are associated with the patients' disability status as it is defined by the Kurtzke expanded disability status scale (EDSS), but are not related to the duration of the disease. A possible cognitive decline as reflected in the observed AERP components alterations in MS patients is subsequently discussed.

Adult↗

PubMed1986

Electrodermal activity, dental anxiety, and fear of dentistry in a group of parenteral drug addicts.

The present study was undertaken in order to evaluate whether electrodermal activity was a useful tool with which to measure dental anxiety in a group of drug addicts. Electrodermal activity was compared to the subjects' self-reported feelings during ordinary dental treatment sessions. In the first part of the study the level of electrodermal activity during treatment sessions was videotaped and recorded on paper by means of a polygraph. The patients were interviewed using a semi-structured questionnaire dealing with the addicts' dental anxiety and fear. In connection with the interviews the addicts completed Corah's Dental Anxiety Scale (CDAS). There was no recognizable pattern in electrodermal activity when this was compared with the patients' feelings during the treatments. Median CDAS was 9.5. In the second part of the study, electrodermal activity was recorded on the polygraph only. This group also completed a CDAS questionnaire. No correlation between the patients' self-reported highest level of anxiety and level of electrodermal activity, number of fluctuations or amplitude in relation to specific dental stimuli was found; agreement was found in two, three and none of 10 cases respectively. Median CDAS was 10.0. It could be concluded that, although the study revealed apprehension and situational anxiety among the addicts, no correlation to electrodermal activity was found. This discrepancy between the physiological and cognitive data probably reflects the uncertainty of these measures under the given circumstances.

Adult↗

PubMedDate not supplied

Nursing diagnosis and depressive illness.

In nursing practice, clinicians have identified specific nursing diagnoses that repeatedly emerge in depressed individuals. Specifically, chronic low self-esteem, powerlessness, and hopelessness have been linked with depressive illness and reflect Beck's cognitive theory of depression, which postulates that depressive symptoms result from a negative view of self, world, and future. The purpose of this analysis was to validate defining characteristics of three nursing diagnoses while evaluating the usefulness of the Cognitive Triad Index for specifying critical and supporting indicators for these nursing diagnoses in a population of 63 depressed adult inpatients. A patient-focused clinical diagnostic validation model was used. Results are discussed in light of previously specified defining characteristics for these diagnoses and directions for future research related to clinical validation of these diagnoses are recommended.

Adult↗

PubMed1988

Event related potentials from closed head injury patients in an auditory "oddball" task: evidence of dysfunction in stimulus categorisation.

Event-related potentials (ERPs) were recorded from 19 closed head injury (CHI) patients, at least 6 months after injury, and an equal number of control subjects, during a task requiring the covert counting of rare auditory "target" stimuli against a background of frequent "non-targets". In both groups, ERPs to targets contained enhanced frontal N2 and parietal P3 components. N2 was larger in amplitude in the CHI patients than in the controls, and its peak latency was delayed. P3 amplitude was smaller in the patients, but its latency was not significantly different from that of the control group. The delay in N2 latency is interpreted as evidence of an increase in the time needed to achieve stimulus categorisation in CHI patients. The larger N2s in this group are thought to reflect the additional cognitive effort required after CHI to cope with the task. The negative findings with respect to P3 latency suggest that this may be a less sensitive measure of information-processing efficiency in this task than the latency of N2.

Adult↗