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PubMedDate not supplied

Stuttering: neuropsychiatric features measured by content analysis of speech and the effect of risperidone on stuttering severity.

Positron-emission tomographic (PET) studies and genetic research of stuttering have recently revealed underlying cerebral neurobiologic contributing factors in this disorder. We aimed to assess whether cognitive impairment and other neuropsychiatric dimensions could be detected through computerized content analysis of short samples of speech from stutterers, and whether administration of risperidone in a double-blind placebo-controlled study could decrease the severity of stuttering, as well as any of the neuropsychiatric features of these stutterers. A group of 21 stutterers with the developmental form of stuttering, an onset before age of 6 years, aged 20 to 74 years, and who were otherwise free of major medical or psychiatric problems, initially gave a 5-minute tape-recorded speech sample in response to purposely ambiguous instructions to talk about any interesting or dramatic life experiences. Then, half of these subjects (n = 10) were randomly selected to receive 6 weeks of risperidone treatment up to 2.0 mg/d and the other half (n = 11) were administered a placebo. Both groups of subjects gave a second verbal sample after 6 weeks of treatment. Significantly elevated cognitive impairment and social alienation-personal disorganization scores, derived from the computerized content of the initial 5-minute speech samples, were found. After 6 weeks, the risperidone group improved significantly on a measure of severity of stuttering but did not improve on the percentage of time spent stuttering. The placebo group did not improve on either measure of stuttering. The psychopathological processes of subjects who received risperidone treatment, including those with elevated cognitive impairment and social alienation-personal disorganization, did not change significantly. However, stutterers who had lower scores on verbal content analysis-derived shame anxiety, guilt anxiety, or hostility inward measures improved significantly more with risperidone than stutterers with higher scores on these measures. The findings of elevated cognitive impairment and social alienation-personal disorganization scores of adult stutterers with the early developmental form of stuttering are consistent with the neurobiologic abnormalities found in PET-scan and genetic research involving stutterers. Risperidone (< or =2.0 mg/d) can reduce the severity of stuttering while not significantly affecting the magnitude of neuropsychiatric dimensions such as cognitive impairment or social alienation-personal disorganization. The less the inward shame, guilt, or hostility of the stutterers, the better the beneficial effect of risperidone on the severity of stuttering.

Adult↗

PubMed2001

Anger, negative emotions, and cardiovascular reactivity during interpersonal conflict in women.

OBJECTIVE: In order to evaluate the relationship between women's subjective emotional discomfort with anger and cardiovascular responses to stress, cardiovascular and affective responses were examined during two anger-provoking conditions: one in which anger would be in self-defense, and one in which anger would be in defense of a significant other. METHODS: A total of 42 healthy, normotensive women aged 18-35 years recruited a close female friend to participate in the study with them, and were randomly assigned to one of two harassment conditions: (i) Self-Harass, where women were harassed while performing a math task; (ii) Friend-Harass, where women witnessed a close female friend being harassed while their friend performed a math task. RESULTS: Self-Harass and Friend-Harass women reported feeling equally angry, annoyed, and irritated (all P's<.01) during their respective anger-provocation conditions. However, Self-Harass women reported experiencing significantly greater increases in feelings of depression and guilt during anger provocation (P's<.05) relative to Friend-Harass women. Interestingly, it was also the Self-Harass women who exhibited significantly greater elevations in heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), forearm blood flow (FBF), and significant reductions in forearm vascular resistance (FVR; P's<.001) relative to Friend-Harass women during anger provocation. CONCLUSIONS: Results suggest that women may experience other negative emotions (e.g., guilt, depression) when anger is in self-defense relative to when it is in defense of others, and that these emotions may play a more important role than anger in moderating cardiovascular reactivity (CVR) during interpersonal conflict.

Adult↗

PubMed1999

Cognitive distortions and blame attribution in sex offenders against adults and children.

OBJECTIVE: Sexual offenders tend to hold attitudes and beliefs which minimize and justify their offending behavior. It was hypothesized that distorted thinking supporting sexual offending and blame attribution would differ depending on the offence characteristics of different groups of sexual offenders. METHOD: Two groups of sexual offenders separated on the basis of the age of their victims (sex offenders against children, 36; sex offenders against adults, 30) were compared on measures of cognitive distortions relating to sex with children and rape and a measure of blame attribution which assesses external, mental element, and guilt feeling attributions. RESULTS: Child sexual offenders endorsed more cognitive distortions relating to sex with children, but there were no group differences in cognitive distortions relating to rape. Those who offended against adults reported more external attributions and child offenders reported more guilt feeling attributions. Mental element attribution related to alcohol intoxication and use of violence in the offence, but was not related to group differences. CONCLUSIONS: Results are interpreted as suggesting that child sex offenders support their offending by more enduring distorted cognitions, while those who offend against adults use blame attributions associated with the particular offence.

Adult↗

PubMed2001

Emotion traits in older suicide attempters and non-attempters.

BACKGROUND: Emotion is a flourishing area of cross-disciplinary research that can inform traditional approaches to psychopathology. The present study examines emotion traits associated with attempted suicide in a depressed older sample. METHODS: Seven emotion traits were compared in depressed inpatients, age 50 years or older, who either had made a suicide attempt after age 50 (n=47) or had never made a suicide attempt (n=38) as assessed by self-report and a review of available medical records. RESULTS: In univariate analyses controlled for age and sex, late-life suicide attempters were lower in Warmth and Positive Emotions than non-attempters. However, only lower Anxiety was associated with attempter status when all seven emotion traits were included as predictors. Of the attempters, those who had made a greater number of attempts reported lower Positive Emotions and higher Anger/Hostility and Guilt, though only lower Positive Emotions had a significant effect independent of the other emotions. In a subsample of 41 patients whose index admission was precipitated by an attempt, lower Anger/Hostility was associated with higher intent to die, and lower Anger/Hostility and lower Guilt was associated with higher lethality of method. LIMITATIONS: The assessments of emotion traits may have been colored by transient moods, including, for the recent attempters, moods associated with the aftermath of their attempt. Participants who completed the key measures may not be representative of older attempters. CONCLUSIONS: Emotion traits are associated with suicidal behavior in older depressed patients, and the specific type of emotion and the direction of its association depends on the specific suicide variable examined. Emotion traits may be helpful in assessing suicide risk.

Age Factors↗

PubMed1999

Clinical, demographic and social characteristics of psychotic depression.

The goal of this study was to compare the clinical, demographic and social characteristics of psychotic and non-psychotic depression in the elderly and younger age groups. Depressed patients (n = 674) meeting DSM-III-R criteria for major depressive episode were classified into two groups, psychotic and non-psychotic, based on the presence of delusions or hallucinations. The patients with psychotic and non-psychotic depression were compared on clinical, demographic, and social characteristics. Bivariate analyses revealed that younger age, psychomotor retardation, guilt, feelings of worthlessness, history of delusions in the past, and increased suicidal ideation and intent were found more commonly in psychotic as compared to non-psychotic depression. A fully adjusted logistic regression model also confirmed younger age, history of past delusions, and increased feelings of worthlessness to be associated more with psychotic than with non-psychotic depression. Trends were observed for psychotic depression to be associated with poor subjective social support and with bipolar illness. Cerebrovascular risk factors and gender composition did not differ significantly in the psychotic vs. non-psychotic groups. The study confirms previously described findings such as increased guilt, increased psychomotor retardation and increased suicidality in psychotic depression in a large sample of depressed patients. The study also introduces the concept of age as an important variable influencing psychotic depression. The limitation of this finding is that it is applicable to tertiary care samples. Further studies are needed to confirm this finding in other subgroups.

Adolescent↗

PubMed2004

Clinical correlates of neurological change in posttraumatic stress disorder: an overview of critical systems.

Knowledge about the biological basis of psychological trauma is changing at an exponential rate. A PsychlNFO search on the search terms "locus coeruleus" and "PTSD" revealed one peer-reviewed journal article between 1982 and 1992 and 51 in the subsequent decade. A similar search revealed zero articles on "hippocampus" and "PTSD" between 1982 and 1992 and 170 in the past decade. As clinicians, it is important to become increasingly familiar with this growing literature to use that knowledge to treat and educate patients. Imagine the relief that can be provided to survivors of trauma if clinicians can tell them that they have a good idea about what causes their symptoms and even clearer ideas about how to treat them.One ancillary but invaluable outcome to this work is the fact that understanding the neurological underpinnings of PTSD will go a long way to establishing a necessary equilibrium in nature and nurture's role in the etiology and maintenance of the disorder. In its early conceptualization, PTSD was thought by many to be an ordinary reaction to an extraordinary event, thus placing responsibility for the disorder firmly in the hands of environmental factors. A subsequent emphasis on vulnerability and resiliency factors in the disorder, however, gave the impression that genetic and potentially hard-wired neurological factors were dominant in the expression of the disorder. Appreciating the balance between nature and nurture in the development of stress disorders like PTSD will allow clinicians and patients alike to appreciate the role of personal responsibility in the process of recovery. A parallel, albeit more mature process, has occurred in the area of schizophrenia in the past four decades. Early conceptualizations of schizophrenia placed a heavy burden on parenting and behavioral factors, leaving the patients angry at their parents and parents with unnecessary guilt. The later dominance of genetic and biological theories in the disorder allayed parents of their guilt, but left both parents and patients wondering what might be done in the face of such an affliction. Modern theories of schizophrenia seem to have achieved an appropriate balance that recognizes biological vulnerabilities, but also emphasizes familial and patient responsibilities in recovery and care. In PTSD, a similar equilibrium needs to be found, and understanding the neurobiology of the disorder will go far in achieving that goal. When it is understood how trauma affects the brain and how treatment produces neurobiological changes that may remediate trauma-related effects, the patient will be in a better position to make choices about what can and cannot be done in the process of recovery. Giving patients this critical internal locus of control will provide therapeutic benefits such as confidence,self-esteem, and hope that are likely to enhance changes that occur with intervention.

Amygdala↗

PubMed1984

Children's responses to emergency department care.

Children's responses in, and to, the emergency department (ED) were investigated. Data collected in 1975 by Resnick and Hergenroeder at the Pediatric Trauma Center of the Johns Hopkins Hospital were reanalyzed. One coder recorded all patient information, scored the Behavioral Rating List (BRL) designed for the study, and kept an anecdotal record of the responses and activities of patients and parents while in the ED. Principal components analysis of the items of the BRL found two types of response--protest and withdrawal. Of all the personal variables, only the child's age was found to be related significantly to the type of stress response exhibited. The verbalization categories of fears, curiosity, and concern about the immediate future were also found to be significant with respect to stress response. For the situational variables, the degree of injury or amount of time spent in the facility did not predict the patient's stress response. Parents' presence or proximity did not affect the child's response significantly. Parental responses of quieting and personal guilt were related significantly to child's protest score; parents of boys quieted their children significantly more often than did parents of girls; and with age, parental responses of quieting, personal guilt, and affection decreased significantly, while responses of guilt/punishment and anger increased significantly.

Adolescent↗

PubMedDate not supplied

Sexuality and aged women in nursing homes. In the face of overwhelming evidence that sexuality is essential to health and identity, society continues to make the aged sexually invisible.

Despite all evidence that sexuality in all its forms is essential to health and identity, society continues to make the aged sexually invisible; some aged people continue to suffer guilt for having sexual feelings or acting sexually, and many aged people internalize the misconception that they are asexual. Aged women, in the main, have had their sexuality defined as being dependent on males and youthful beauty. Pfeiffer, cited in Reinzo, points out that as we age "sexual needs may not only be continuing but actually heightened due to losses in other areas of life." Elderly women ache for closeness, touch, and intimacy, but may be afraid to reach out to other women in this way. They have often lost control over much of their lives, and the only pleasure available to them may be self-pleasuring and fantasy, but guilt, lack of privacy, and fear of being "caught" remove this option. Their self-image and self-esteem are diminished. Women reacting to a definition imposed on them forfeit the pleasures of wholeness. The solution will be found when they assert their rights as individuals and claim their bodies as their own. Before elderly women can feel and be treated as fully human, it must be recognized that to be fully human is to be fully sexual, whatever our age. Gerontologic nurses who hold ageist views of elderly women's sexuality are not providing holistic care. It is not possible to provide care that aims at maximizing potential, independence, and control, while denying or ridiculing a "core" aspect of identity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2001

Frequencies of signs and symptoms in mixed and pure episodes of mania: implications for the study of manic episodes.

1. In a previous report the authors compared the frequency of 20 classical and mixed manic signs and symptoms in subjects meeting DSM-III-R criteria for Bipolar Disorder, manic or mixed. In that report, the authors commented that a possible limitation of the study was the diagnosis of mixed and pure mania using DSM-III-R criteria that may be too rigid The authors now address that issue, adopting a ROC-derived definition of mixed mania 2. Three hundred sixty-three subjects meeting DSM-III-R criteria for Bipolar Disorder, manic or mixed, were evaluated by rating 20 signs and symptoms of mania. The frequencies of these signs and symptoms were computed and compared for both mixed and pure subtypes, determined by the ROC-derived definition. 3. Mood lability, dysphoric mood, guilt, anxiety, and suicidality were more frequently observed in the mixed manic group In contrast, euphoria and grandiosity were more frequently observed in the pure manic group. Nonetheless, non-trivial rates of dysphoric mood, irritability and anxiety were still observed in the pure groups, despite the adoption of a less restrictive definition of mixed states. The current results are similar to the results obtained using DSM-III-R criteria for Bipolar Disorder, manic and mixed. Although rates of dysphoric mood, anxiety, lability, guilt and suicidality were lower in the manic group, each of these symptoms may be observed in pure manic episodes, underscoring the importance of recognition and evaluation of these features in formal studies of "pure" as well as mixed manic episodes.

Adult↗

PubMed2000

Criterion validation of the Edinburgh postnatal depression scale as a screening tool for depression in patients with advanced metastatic cancer.

It is estimated that 25% of palliative care patients will have identifiable symptoms of depression. Near the end of life, the distinction between what can be called "appropriate sadness" and depression may be difficult. Many palliative care units use rating scales to help identify patients who may be depressed. It is believed that symptoms such as guilt, worthlessness, and hopelessness may be more discriminating than other symptoms for depression within this population. The Edinburgh postnatal depression scale (EPDS) was devised for use in women in the postnatal period and does not contain any somatic-type symptoms. It consists of 10 items, each rated on a four-point scale, and includes items on guilt, thoughts of self-harm, and hopelessness. It has not previously been used for screening in cancer patients. In a study of 100 inpatients receiving palliative care, a cutoff of 13 on the EPDS had a sensitivity of 81% and a specificity of 79% for detecting cases of depression. There was a low rate of misclassifications. This study suggests that the EPDS may be useful as a screening instrument for palliative care patients.

Adult↗

PubMed1989

The loss of early pregnancy.

It is often assumed that early loss of pregnancy is not followed by emotional distress. When such distress does occur, it often goes undetected. Early loss of pregnancy is frequently followed by typical grief such as that occurring after any bereavement. Most recent studies have shown that although social termination of pregnancy in the first trimester has few adverse psychological sequelae for most women, there are vulnerable women who do experience significant emotional distress afterwards. Risk factors for poor psychological outcome include poor social support, past psychiatric history and ambivalence about the termination. The procedures used for second trimester terminations of pregnancy are likely to be a particular source of distress. Psychiatric disorder may also follow if termination is refused. Careful assessment of all women before social termination will identify vulnerable women who may benefit from counselling and support afterwards. After spontaneous abortion or miscarriage, many women experience significant emotional distress, which persists for several months. Guilt and anger are common. Some women are particularly vulnerable to developing psychiatric disorder after spontaneous abortion, for example women with a past psychiatric history, poor social support, previous spontaneous abortion and personality traits such as neuroticism. Many women would benefit from follow-up and support afterwards; extra support and reassurance are often needed during the next pregnancy. Termination for fetal abnormality is more likely to induce grief than relief for many women; these pregnancies are usually wanted, second trimester terminations are distressing, and there is often guilt at destroying a life and/or opting out of rearing a handicapped child. Recent research has demonstrated substantial levels of psychiatric morbidity after termination for fetal abnormality, particularly in those with a past psychiatric history, those with poor social support, and those who feel they have opted out of bearing a handicapped child. Women receive little support of follow-up after such terminations, yet many would benefit from it. Such women are in particular need of reassurance and support during a subsequent pregnancy.

Abortion, Induced↗

PubMed2002

Shame and severity of bulimic symptoms.

Initial research suggests that self-conscious affect such as shame may perpetuate bulimic symptoms among individuals suffering from bulimia nervosa (BN). This investigation reports findings from two studies that examine the relation of shame to bulimic symptoms. In the first study, the relation of shame to bulimic symptoms was examined among 137 female college undergraduates. Shame accounted for a significant portion of variance in bulimic symptoms after controlling for age, weight status, guilt, and depressed mood. A second study examined the severity of shame in 30 bulimic patients compared to 28 eating-disordered patients with subclinical symptoms. Although patients with more severe bulimic symptoms exhibited higher levels of shame, this relation was not independent of the shared relation with depression and guilt. Findings are discussed in terms of the role of shame in bulimic symptoms.

Journal Article↗

PubMed1998

Counselling strategies for parents of infants with congenital heart disease.

Congenital heart disease is a significant cause of morbidity and mortality in the newborn. Its diagnosis may lead to a crisis in the affected families; there are the perceived implications of having an abnormality of so vital an organ. To that may be added the assumed guilt or blame, grief and at times anger, frequently experienced by parents of abnormal infants. It often befalls the paediatric cardiologist to initiate counselling while providing the expert information concerning the abnormality and its optimum management. Such counselling differs from that needed for minor lesions as compared for more complex abnormalities where a fatal outcome may ensure. While it is important to provide an accurate diagnosis and management plan to the parents, early detailed information is often confusing and may not be assimilated at a time of great stress. The parents seem more concerned as to whether the infant will survive, what the long term outlook will be, whether he or she will attend school, play, work and so on. With the more severe cardiac abnormalities, especially where there is a family history, one need be aware of the often perceived guilt of the parents. At times, it may be necessary to help the parents retain sufficient 'self-control', delaying the grieving process to enable them to contribute to the decision making. Where the infant has died, a follow-up appointment can facilitate grieving and help deal with unresolved issues. Through skilled counselling, the cardiologist in addition to his/her diagnostic and management skills, may meaningfully influence the ongoing care of the infant. They may help avoid the development of unrealistic fears or an over-optimistic outlook, thereby fostering the normal development of the child.

Adult↗

PubMed2002

The effects of general pretrial publicity on juror decisions: an examination of moderators and mediating mechanisms.

Two studies examined three moderators (gender, attitudes, and media slant) and four mediators (accessibility, evidence importance, evidence plausibility, and standards of guilt) of general pretrial publicity's influence on juror decisions. In Study 1, participants who watched a prodefense rape story were more likely to report that they would need more inculpatory evidence to convict a defendant of rape than were participants who watched a proprosecution rape story. In Study 2, participants watched news stories, one of which was a proprosecution rape story, a prodefense rape story, or a nonrape story. In an ostensibly unrelated study, participants indicated their attitudes toward rape, watched a rape trial, and provided trial and witness ratings. Accessibility did not mediate the media effects on participants' judgments of rape importance; however, attitudes moderated media effects. Rape news influenced juror ratings of the importance of evidence about the complainant's behavior. Finally, media altered the standards participants used to determine defendant guilt. Implications for understanding the mechanisms responsible for pretrial publicity effects are discussed.

Adult↗

PubMed2003

Jurors' perceptions of adolescent sexual assault victims who have intellectual disabilities.

Children and adolescents with intellectual disabilities are especially likely to be sexually abused. Even so, their claims are not likely to be heard in court, possibly because people assume that jurors will not believe them. We tested this assumption in a mock-trial study in which 160 men and women watched videotaped excerpts from an actual trial. As predicted, when the 16-year-old sexual assault victim was portrayed as "mildly mentally retarded" instead of as "having average intelligence," jurors were more likely to vote guilty and had more confidence in the defendant's guilt; considered the victim to be more credible and the defendant to be less credible as witnesses; and rated the victim as more honest, less capable of fabricating the sexual abuse accusation, and less likely to have fabricated the sexual abuse accusation. Men and women were affected similarly by the disability manipulation, but women were generally more pro-prosecution in their case judgments and perceptions than were men. Finally, jurors who had more liberal views toward persons with disabilities were more likely than other jurors to make pro-prosecution judgments on measures of guilt. Implications for psychological theory and the law are discussed.

Adolescent↗

PubMed2004

Anatomy of regret: a developmental view of the depressive position and a critical turn toward love and creativity in the transforming schizoid personality.

This article deals with critical psychic transformation in a schizoid personality disorder that evolves in an object relations psychoanalysis in which "developmental mourning" plays a central role. Within a mourning process that allows for the grieving of loss related to arrested separation-individuation development, the analysand confronts the existential grief of regret that had always unconsciously haunted her. The unconscious guilt related to the existential grief of regret had caused much dissociation of self-experience and affect states. The analysand acknowledges her own part in the destruction of primal and current relationships after the traumatic impact of her early life is understood. This allows her to repair current relationships, both within her internal and external worlds so that she can open to capacities for love and creativity. The analysand's courage to consciously grapple with her regret (loss and guilt combined) allows her to relinquish self-sabotaging character defenses such as contempt and emotional withdrawl. Consequently, a second marriage is salvaged and enriched, and the analysand's relationship with her two children is dramatically improved.

Adult↗

PubMed2005

[Certain or possible lethal medical malpractice: what is to do afterwards?].

In case of a possible or certain lethal case of medical malpractice the following procedure is recommended: 1. Scrutinize every death of a patient during or after a medical treatment. Address the following questions: "Did everything proceed correctly?", "Could death have been prevented?", "This should not have been happened". 2. Report to the head physician, to the hospital management and administration in order to coordinate the further procedures. 3. Save all the evidence: Perfusions, empty phials, opened drug packages. Leave all catheters, tubes, drainages on the body! Leave any technical equipment, for example anesthetic machines untouched. Save all prior blood and urine samples taken from the patient. Seal medical history and documentations. 4. Order a memory protocol of the events by all involved persons. 5. Refrain from clinical autopsy. Forensic autopsy, indicated in these circumstances, can only be authorized by the district attorney (see point 7). If in doubt, seek counseling from an institute of forensic medicine by telephone (if requested: anonymously). 6. Put "non natural death" on the death certificate in case of a certain and unclear death in case of a possible medical malpractice. 7. Report any possible or certain case of lethal medical malpractice to the district attorney (obligation to report). The district attorney will authorize a 8. Inform the relatives of the deceased. Apologize, show regret and concern but do not address the question of guilt. 9. Inform your third party insurance (this does not mean an admission of guilt).

Autopsy↗

PubMed1999

Stability and change in mothers' representations of their relationship with their toddlers.

This study examined several issues in the developmental dynamics of parents' representations of their relationship with their toddlers. The authors studied 125 mothers and their firstborn toddler sons over a 13-month period. Mothers took the Parent Development Interview twice, when children were 15 and 28 months of age. Home observations of parent-child interactions and maternal ratings of daily hassles were collected when children were 21 and 27 months of age. The 3 factors that characterized mothers' representations of their 15-month-old firstborn sons (Joy-Pleasure/Coherence, Anger, Guilt-Separation Distress) also fit the data very well for their 28-month-old sons. Although there were no changes in average levels of mothers' (a) joy, pleasure, and coherence and (b) guilt and separation distress from 15 to 28 months, there was a significant increase in mothers' levels of anger. Stability analyses suggested a dynamic relationship between mothers' representations of joy, pleasure, and coherence and of anger over the 13-month period. Finally, changes in mothers' representations were predictable by positive mothering (which led to increased joy, pleasure, and coherence) and by parenting daily hassles (which led to more anger).

Adult↗