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A proposal to classify happiness as a psychiatric disorder.

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains--that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant.

Affect↗

Familial mental retardation: a continuing dilemma.

The heterogeneous nature of mental retardation, as well as certain common practices of workers in the area, has resulted in a variety of conceptual am biguities. Considerable order could be brought to the area if, instead of viewing all retardates as a homogeneous group arbitrarily defined by some I.Q. score, workers would clearly distinguish between the group of retardates known to suffer from some organic defect and the larger group of retardates referred to as familial retardates. It is the etiology of familial retardation that currently constitutes the greatest mystery. A number of authorities have emphasized the need for employing recent polygenic models of inheritance in an effort to understand the familial retardate. While appreciating the importance of environment in affecting the distribution determined by genetic inheritance, these workers have argued that familial retardates are not essentially different from individuals of greater intellect, but represent, rather, the lower portion of the intellectual curve which reflects normal intellectual variability. As emphasized by the two-group approach, retardates with known physiological or organic defect are viewed as presenting a quite different etiological problem. The familial retardate, on the other hand, is seen as a perfectly normal expression of the population gene pool, of slower and more limited intellectual development than the individual of average intellect. This view generates the proposition that retardates and normals at the same general cognitive level-that is, of the same mental age-are similar in respect to their cognitive functioning. However, such a proposition runs headlong into findings that retardates and normals of the same mental age often differ in performance. Such findings have bolstered what is currently the most popular theoretical approach to retarded functioning-namely, the view that all retardates suffer from some specific defect which inheres in mental retardation and thus makes the retardate immutably "different" from normals, even when the general level of intellectual development is controlled. While these defect or difference approaches, as exemplified in the work of Luria, Spitz, Ellis, and Lewin and Kounin, dominate the area of mental retardation, the indirect, and therefore equivocal, nature of the evidence of these workers has generated considerable controversy. In contrast to this approach, the general developmental position has emphasized systematic evaluation of the role of experiential, motivational, and personality factors. As a central thesis, this position asserts that performance on experimental and real-life tasks is never the single inexorable product of the retardate's cognitive structure but, rather, reflects a wide variety of relatively nonintellective factors which greatly influence the general adequacy of performance. Thus, many of the reported behavioral differences between normals and retardates of the same mental age are seen as products of motivational and experiential differences between these groups, rather than as the result of any inherent cognitive deficiency in the retardates. Factors thought to be of particular importance in the behavior of the retardate are social deprivation and the positive- and negative-reaction tendencies to which such deprivation gives rise; the high number of failure experiences and the particular approach to problem-solving which they generate; and atypical reinforcer hierarchies. There is little question that we are witnessing a productive, exciting, and perhaps inevitably chaotic period in the history of man's concern with the problem of mental retardation. Even the disagreements that presently exist must be considered rather healthy phenomena. These disagreements will unquestionably generate new knowledge which, in the hands of practitioners, may become the vehicle through which the performance of children, regardless of intellectual level, may be improved.

Humans↗

Dissociating neuro-cognitive component processes: voxel-based correlational methodology.

Relating behavioural deficits to lesion site has long been an important tool for localising the brain bases of cognitive function. Voxel-based methods, based on statistical analyses of structural brain images, allow a major step forward in the effectiveness of this approach. These methods provide a fine-grained assessment of damaged tissue by assigning a continuous value to each voxel over the entire brain. This information, correlated with continuous behavioural data reflecting specific aspects of cognition, offers new opportunities for identifying the neural organisation underlying cognitive function. The research reported here demonstrates the ability of this correlational methodology to differentiate between the neuro-cognitive components involved in word recognition and lexical decision, providing an important new tool for directly linking brain areas to specific aspects of psychological performance.

Acoustic Stimulation↗

Neurobehavioral correlates of perceived mental and motor slowness in HIV infection and AIDS.

The authors assessed 72 human immunodeficiency virus (HIV)-infected patients with a self-rating slowness scale (SRSS) concerning mental and motor slowness in their activities of daily living. In order to understand the relationship between complaints of slowness and predictor variables, the investigators developed a preliminary model using multiple regression analysis. Reports of slowness on the SRSS were independently associated with self-reported cognitive and neurological symptoms and with peripheral neurological syndromes (e.g., neuropathy, myopathy). Lesser contributions to self-perceived mental and motor slowness were found for neuropsychological measures of information processing speed, severity of the infection, depression, HIV encephalopathy, and sociodemographic factors (e.g., age, education). The relationship among the predictor variables showed that complaints of slowness reflect neurological, psychiatric/psychological, and cognitive symptomatology of the HIV infection.

AIDS Dementia Complex↗

Corpus callosum size and neuropsychologic impairment in adolescents who were born preterm.

Prematurity is associated with cerebral abnormalities that might account for poorer cognitive performance. The aim of our study was to investigate the correlations between corpus callosum reductions and neuropsychologic performance in adolescents who were born preterm. Twenty-five subjects born before 33 weeks' gestation were compared with 25 subjects born at term and of similar age, gender, and sociocultural status. All subjects underwent magnetic resonance imaging and neuropsychologic examinations. Premature subjects performed worse than controls in global cognitive functioning, verbal memory, and verbal fluency. Corpus callosum measurements showed a global reduction owing mainly to thinning in the splenium, posterior midbody, and genu. Corpus callosum size significantly correlated with gestational age, Wechsler Performance IQ, and memory performance. These results suggest that cerebral growth during infancy does not compensate for corpus callosum reduction and that this reduction reflects neuropsychologic deficit. The cognitive impairment can arise from the paucity of the complex interneuronal connections owing to fiber damage, particularly myelinated fibers.

Adolescent↗

Do self-reports of perceptual anomalies reflect gating deficits in schizophrenia patients?

Jin and colleagues presented an innovative study examining P50 suppression and patients' self-reported perceptual anomalies as two related operational measures of sensory gating deficits in schizophrenia patients. They found that those schizophrenia patients who endorsed experiences of sensory inundation had normal levels of P50 suppression, whereas patients who tended to endorse fewer complaints of perceptual anomalies had P50 suppression deficits. Jin et al's finding challenges the common belief that P50 suppression deficits are associated with cognitive and sensory anomalies reflecting poor gating in schizophrenia patients. This article comments on how the dissociation between phenomenological experiences of gating disturbances and P50 suppression might be explained by the limits of self-report in schizophrenia patients who have deficient insight and self-awareness. We hypothesize that the self-reported inability to screen out irrelevant stimuli reflects a voluntary, controlled process that is different from the involuntary, automatic process measured by P50 suppression.

Attention↗

Cognitive performance, mood and experimental pain before and during morphine-induced analgesia in patients with chronic non-malignant pain.

This paper investigates subjective, behavioral and neurophysiological changes due to treatment with oral sustained-release morphine in six patients with severe non-malignant pain. Patients rated their mood and clinical pain on visual analog scales (VAS). Experimental pain reactions were quantified by ratings on categorical scales and evoked cerebral potentials (LEP) in response to standardized laser stimuli. A standard auditory oddball task provided reaction time (RT), errors, N1 and P2 of late auditory evoked potentials (AEP), and a P300 component. It was used to measure vigilance and cognitive performance. In parallel with clinical pain reduction, laser pain ratings and LEP amplitudes were significantly reduced. In contrast, auditory P2 and P300 amplitude were found to be even enlarged under morphine. RT and mood also failed to indicate any sedation. It is concluded that LEP indicated the analgesic morphine effects whereas late potentials and P300 from auditory stimuli reflected the perceptual-cognitive status which, instead of being deteriorated by morphine-induced sedation, improved probably due to the removal of pain as a mental stressor.

Adult↗

The strong connection between sensory and cognitive performance in old age: not due to sensory acuity reductions operating during cognitive assessment.

Cognitive aging research has documented a strong increase in the covariation between sensory and cognitive functioning with advancing age. In part, this finding may reflect sensory acuity reductions operating during cognitive assessment. To examine this possibility, the authors administered cognitive tasks used in prior studies (e.g., Lindenberger & Baltes, 1994) to middle-aged adults under age-simulation conditions of reduced visual acuity, auditory acuity, or both. Visual acuity was lowered through partial occlusion filters, and auditory acuity through headphone-shaped noise protectors. Acuity manipulations reduced visual acuity and auditory acuity in the speech range to values reaching or approximating old-age acuity levels, respectively, but did not lower cognitive performance relative to control conditions. Results speak against assessment-related sensory acuity accounts of the age-related increase in the connection between sensory and cognitive functioning and underscore the need to explore alternative explanations, including a focus on general aspects of brain aging.

Adult↗

Consultation with children in hospital: children, parents' and nurses' perspectives.

AIMS AND OBJECTIVES: To explore children's, parents' and nurses' views on participation in care in the healthcare setting. BACKGROUND: Children have a right to be consulted and involved in their care. DESIGN: The grounded theory method was used and data were collected through in-depth interviews, questionnaires and observation. Sample consisted of 11 children, 10 parents and 12 nurses from four paediatric wards in two hospitals in England. RESULTS: Parents felt that children should be involved in the decision-making process thereby enhancing and promoting children's self-esteem and positive self-regard, which would consequently enhance their overall welfare. Likewise, children expressed the need for consultation and information so that they could understand their illness; be involved in their care, and prepare themselves for procedures. However, children's own opinions and views were underused and they had varying experiences of being consulted about their care and treatment. Nurses appeared to hold varying and discrepant views on the involvement of children in decisions and for some nurses, the child's involvement seemed to be dependent on the child's cognitive maturity and being defined as a rational subject. CONCLUSION: Health professionals' communication behaviour may reflect recognition of children's cognitive abilities rather than their competence to understand. The fact that children's nurses appeared to make decisions about involving children in decision making in the absence of a reliable framework was a significant finding and highlights a real problem in the current climate. RELEVANCE TO CLINICAL PRACTICE: Nurses faced with workforce pressures may encounter considerable challenges to facilitating children's involvement in decisions about their care. Hence it is imperative that nurses' examine the basis of their decisions and use more explicit criteria for determining children's involvement.

Attitude of Health Personnel↗

Donepezil for dementia in Parkinson's disease: a randomised, double blind, placebo controlled, crossover study.

OBJECTIVE: To study the safety and efficacy of a cholinesterase inhibitor, donepezil hydrochloride, for the treatment of dementia in Parkinson's disease (PD). METHODS: This was a randomised double blind, placebo controlled, crossover study in 22 subjects with PD and dementia. Participants were randomised to receive either donepezil followed by identical placebo, or placebo followed by donepezil. Donepezil was administered at 5-10 mg/day. Treatment periods were 10 weeks with a washout period of 6 weeks between the two periods. The primary outcome measure was the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAScog). RESULTS: Donepezil was well tolerated and most adverse events were mild. There was no worsening of PD symptoms as measured by the total or motor sections of the Unified Parkinson's Disease Rating Scale.There was a 1.9 point trend toward better scores on the ADAScog on treatment compared with placebo that was not statistically significant. The secondary cognitive measures showed a statistically significant 2 point benefit on the Mini Mental Status Examination and no change on the Mattis Dementia Rating Scale (MDRS). The Clinical Global Impression of Change (CGI) showed a significant 0.37 point improvement on donepezil. No improvement was observed on the MDRS or the Brief Psychiatric Rating Scale. Carryover between treatment periods was observed but was not statistically significant. CONCLUSIONS: Donepezil was well tolerated and did not worsen PD. There may be a modest benefit on aspects of cognitive function. The possible clinical benefit measured by CGI was reflected in only one of the cognitive scales used in this study.

Aged↗

The association between cognitive impairment and physical disability in multiple sclerosis.

BACKGROUND: The association between cognitive impairment and physical disability was examined in a larger, more representative sample of patients with multiple sclerosis (MS) than in previous studies. METHOD: Two hundred and fifty-three patients attending an MS clinic were assessed with respect to physical disability using the Expanded Disability Status Scale and cognitive impairment using a battery of neuropsychological tests. RESULTS: Physical disability correlated with duration of disease; cognitive impairment did not. Virtually all measures derived from the cognitive battery were significantly correlated with physical disability. Three measures of speeded information processing and one involving delayed recall of verbal material were unique predictors of disability status. The relationship between cognitive impairment and physical disability was equivalent for patients with shorter (< 3 years) versus longer (> 10 years) disease duration. Cognitive impairment correlated with the rate of disability progression as reflected by the progression index. CONCLUSION: Cognitive impairment is more closely associated with physical disability than most previous studies indicate. This relationship appears to be stable throughout the duration of MS, although this conclusion is qualified by the cross-sectional design of the study. Further attention should be paid to cognitive impairment as a possible predictor of the rate of patients' physical decline.

Adult↗

Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety.

Recent studies suggest that cognitive and behavioral interventions have enduring effects that reduce risk for subsequent symptom return following treatment termination. These enduring effects have been most clearly demonstrated with respect to depression and the anxiety disorders. It remains unclear whether these effects are a consequence of the amelioration of the causal processes that generate risk or the introduction of compensatory strategies that offset them and whether these effects reflect the mobilization of cognitive or other mechanisms. No such enduring effects have been observed for the psychoactive medications, which appear to be largely palliative in nature. Other psychosocial interventions remain largely untested, although claims that they produce lasting change have long been made. Whether such enduring effects extend to other disorders remains to be seen, but the capacity to reduce risk following treatment termination is one of the major benefits provided by the cognitive and behavioral interventions with respect to the treatment of depression and the anxiety disorders.

Anxiety↗

Increased serum matrix metalloproteinase 9 levels in systemic lupus erythematosus patients with neuropsychiatric manifestations and brain magnetic resonance imaging abnormalities.

OBJECTIVE: To evaluate whether serum matrix metalloproteinase 9 (MMP-9) levels are associated with neuropsychiatric manifestations, particularly cognitive dysfunction, as evaluated by neuropsychological testing and brain magnetic resonance imaging (MRI) abnormalities in patients with systemic lupus erythematosus (SLE). METHODS: MMP-9 determinations were made in 44 patients with SLE and 43 healthy controls who underwent a clinical neurologic and neuropsychological investigation in order to identify neuropsychiatric manifestations. Cerebral MRI scans with volumetric estimation of intracranial cerebrospinal fluid spaces, T1-weighted lesions, and T2-weighted lesions were performed for all subjects. SLE activity was assessed by the European Consensus Lupus Activity Measure (ECLAM) index, and accumulated neuropsychiatric abnormality was assessed by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index. RESULTS: No significant difference was found in serum MMP-9 levels between the overall group of SLE patients and controls. However, SLE patients who had at least 1 neuropsychiatric manifestation (NPSLE patients) had significantly higher serum MMP-9 concentrations than did SLE patients without neuropsychiatric syndromes (P = 0.009). Among patients with NPSLE, those with cognitive deficits had significantly higher concentrations of serum MMP-9 than did those with normal cognitive function (P = 0.027). Furthermore, serum MMP-9 levels had a significant positive correlation with the volumes of T1-weighted and T2-weighted lesions in the brain MRI (P = 0.031 and P = 0.015, respectively). The concentration of serum MMP-9 correlated significantly with the SLICC index but not with the ECLAM index. CONCLUSION: Elevated levels of serum MMP-9 in patients with SLE may reflect neuropsychiatric involvement, particularly cognitive dysfunction. The serum MMP-9 concentration may be associated with small- vessel cerebral vasculopathy and increased risk of cerebral ischemic events in patients with SLE.

Adult↗

An interpersonal-epistemological curriculum model for nurse education.

This paper proposes a curriculum model for nurse education which holds forms of knowledge and interpersonal relationships as key issues if nurse education is to develop autonomous, reflective, critical practitioners. By adopting areas of cognitive interest, principles of andragogy and the concept of reflection-in-action, the model provides a heuristic tool which attempts to enable the provision of a nurse education which is devoted to adult learning processes and relevant to the development of education in the practice setting. The technical, practical and emancipatory areas of cognitive interest provide an understanding of learning domains which require different knowledge bases, methods of learning and forms of assessment to each other. The pedagogy/andragogy dichotomy is presented to reflect two teaching paradigms. The former approach is derived from the activity of teaching children and provides for passive dependence. The latter is more appropriate to adult learning and student self-direction. The model attempts to promote the transitional dynamic which moves the student nurse toward a state of greater self-direction. Finally, the concept of reflection-in-action is discussed in an attempt to ensure that the areas of cognitive interest and the learning strategies are inextricably linked to the practice component of a professional nurse education. All three dimensions are combined to show how each should develop in unison as the professional education of the nurse proceeds along a chronological dimension.

Clinical Competence↗

The role of maternal cognitive ability on child health.

Little is known about the mechanisms through which mother's cognitive ability operates in enhancing her children's health. This paper analyzes how maternal returns to cognitive ability on children's height reflect contemporaneous endowments and childhood background of the mother. Results suggest that maternal returns to cognitive ability on child height are less likely to reflect observed mother's childhood endowments as measured by parental transmission of knowledge or school quality, but are more likely to be associated with learning to be a mother, and with a better capacity to take advantage of household and community available resources.

Adolescent↗

Parallel distributed processing and neural networks: origins, methodology and cognitive functions.

Parallel Distributed Processing (PDP), a computational methodology with origins in Associationism, is used to provide empirical information regarding neurobiological systems. Recently, supercomputers have enabled neuroscientists to model brain behavior-relationships. An overview of supercomputer architecture demonstrates the advantages of parallel over serial processing. Histological data provide physical evidence of the parallel distributed nature of certain aspects of the human brain, as do corresponding computer simulations. Whereas sensory networks follow more sequential neural network pathways, in vivo brain imaging studies of attention and rudimentary language tasks appear to involve multiple cortical and subcortical areas. Controversy remains as to whether associative models or Artificial Intelligence symbolic models better reflect neural networks of cognitive functions; however, considerable interest has shifted towards associative models.

Artificial Intelligence↗

Sustained involvement of a frontal-parietal network for spatial response selection with practice of a spatial choice-reaction task.

With practice, performance on a task typically becomes faster, more accurate, and less prone to interference from competing tasks. Some theories of this performance change suggest it reflects a qualitative reorganization of the cognitive processing required for successful task performance. Other theories suggest this change in performance reflects a more quantitative change in the amount of processing required to perform the task. Neuroimaging research results provide some support for both of these broad theories. This inconsistency may reflect the complex nature of the effect of practice on cognitive and neural processing. Our current experiment addresses this issue by investigating the effect of practice of a relatively easy perceptual-motor task on the frontal-parietal brain network for a specific cognitive process (viz. spatial response selection). Participants were scanned during three functional magnetic resonance imaging sessions on separate days within 4 days while they performed a relatively easy spatial perceptual-motor task. We found sustained activity with practice in right dorsal prefrontal cortex; and sustained but decreasing activity in bilateral dorsal premotor, left superior parietal, and precuneus cortices, supporting a quantitative decrease in difficulty of response selection with practice. Conversely, we found a qualitative change in activity with practice in left dorsal prefrontal cortex. This brain region is outside the response selection network for this task and showed activity only during novel task performance. These results suggest that practice produces both qualitative and quantitative changes in processing. The particular effect of practice depends on the cognitive process in question.

Adult↗

The negative effect of alexithymia on the outcome of group therapy for complicated grief: what role might the therapist play?

Alexithymia is a patient characteristic that reflects deficits in the cognitive processing and regulation of emotions. It is generally considered to have an adverse effect on the outcome of psychotherapy. Little is known about the processes through which alexithymia exerts this effect. One proposed mechanism suggests that patients with alexithymia trigger negative therapist reactions that contribute to poor outcome for such patients. This study examined whether therapist reactions to a patient mediate the relationship between alexithymia and outcome in group psychotherapy for complicated grief. Alexithymia was assessed with the Toronto Alexithymia Scale-20. Therapist reactions to a patient, reflecting the therapist's perceptions of a patient's positive qualities, personal compatibility, and significance as a group member, were assessed with a cohesion questionnaire. Outcome in several areas of functioning was measured. We found that alexithymia (specifically, greater difficulty in communicating feelings and greater tendency to engage in externally oriented thinking) was associated with less favorable outcome and that this relationship was mediated by therapist reactions to a patient. The mediation provided by therapist reactions to a patient accounted for approximately one third to one half of the direct effect of alexithymia on psychotherapy outcome. This suggests that therapist reactions to a patient represent a major mechanism through which alexithymia exerts its effect.

Adult↗