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An analysis of categorical perception of facial emotion in schizophrenia.

BACKGROUND: Emotion perception deficits have been extensively documented in schizophrenia and are associated with poor social functioning. Yet fundamental questions about the nature and scope of these impairments remain unanswered from commonly used experimental tasks. An alternative categorical perception paradigm that focuses on distinguishing boundaries between emotions was used to evaluate whether schizophrenia patients demonstrate atypical patterns of categorical perception and a negativity bias in the identification of ambiguous facial expressions. METHOD: 47 schizophrenia outpatients and 31 nonpsychiatric controls completed a forced-choice emotion identification task. Stimuli consisted of a series of digitized facial images that were morphed in 10% signal intensity increments along continua between pairs of emotions (happy-sad; fearful-happy; angry-fearful; angry-sad) and presented in a random order. For each emotion continuum, measures of the response slope and the location of the boundary shift point between emotions were calculated for each group. RESULTS: The schizophrenia group demonstrated significantly shallower response curves than controls across all emotion continua. Despite these generally less precise demarcations between emotions, patients did not significantly differ from controls in the location of the shift point between emotions on any of the continua. CONCLUSIONS: Schizophrenia patients demonstrated impaired categorical perception of facial expressions with generally less sharp categorizations of ambiguous stimuli to one emotion category or another. However, patients did not demonstrate a negativity bias in their processing of ambiguous facial expressions. The emotional continuum paradigm can help to clarify the nature and boundaries of affect perception deficits in schizophrenia.

Adolescent↗

'It might happen or it might not': how patients with multiple sclerosis explain their perception of prognostic risk.

This qualitative study aimed to examine risk perception and seriousness of wheelchair dependence in patients with multiple sclerosis. Perceived absolute risk and perceived seriousness were assessed for 2-year, 10-year and lifetime prognosis of wheelchair dependence using visual analogue scales (VAS). In semi-structured interviews, patients (n = 85) were asked to elucidate these VAS scores. Explaining perceived absolute risk, patients mentioned disease-related factors as well as psychological factors. Uncertainty about future disease progression was a predominant factor for all patients, even those with low and high perceptions of risk. Wheelchair dependence was perceived as a serious outcome primarily because of its possible implications, such as loss of independence. When perceptions of 2-year, 10-year and the lifetime prospect of wheelchair dependence were compared, it was found that patients discriminated in their perception of absolute risk, but less in that of seriousness. Comparison of quantitative and qualitative assessments indicated good construct validity for perception of the absolute risk and seriousness of wheelchair dependence.

Adult↗

Perceptions about the local neighborhood and walking and cycling among children.

BACKGROUND: This study examined associations between perceptions of the local neighborhood and walking and cycling among children. METHODS: Children aged 5-6 years (n=291) and 10-12 years (n=919) were recruited from 19 Australian primary schools. Parents reported their child's usual walking or cycling to local destinations and their perceptions of their neighborhood. Ten- to twelve-year-olds were asked their perceptions of traffic, strangers, road safety and sporting venues, and their perceptions of their parent's views on these issues. RESULTS: Five- to six-year-old boys whose parents believed there was heavy traffic in their area were 2.8 times more likely (95%CI=1.1-6.8), and 5- to 6-year-old girls whose parents owned more than one car were 70% less likely (95%CI=0.1-0.8), and whose parents believed that public transport was limited in their area were 60% less likely (95%CI=0.2-0.9) than other children to walk or cycle at least three times per week. Parental belief that there were no lights or crossings was associated with walking or cycling among 10- to 12-year-old boys (OR=0.4, 95%CI=0.2-0.7). Among older girls, parent's belief that their child needed to cross several roads to reach play areas (OR=0.4, 95%CI=0.2-0.8) and that there is limited public transport in their area (OR=0.7, 95%CI=0.4-0.97), and child's belief that there were no parks or sports grounds near home (OR=0.5, 95%CI=0.3-0.8) were associated with a lower likelihood of walking or cycling. CONCLUSION: Perceptions of the local neighborhood may influence children's physical activity.

Bicycling↗

Perception of self in the intensive care unit after cardiac surgery among adult Taiwanese and American-Chinese patients.

A descriptive qualitative design was used to compare Taiwanese and American-Chinese patients' perceptions of self during their ICU recovery transition from cardiac surgery. A convenience sample consisting of 35 adult patients having cardiac surgery was obtained from two study sites in Taiwan (N = 30) and the USA (N = 5). Data were gathered through semi-structured interviews and analyzed by qualitative content analysis. Patients' perceptions of self in the ICU included global sensations of abnormality, 'Tong-Kou' (Chinese, meaning physiologically and/or psychologically painful), and "Chin-Son' (Chinese, meaning physiologically and/or psychologically relaxed). The specific perceptions were the physical, psychological, cognitive, social, and spiritual self. The nature and conceptual definition of Chinese patients' perceptions of self, as well as the impact of these perceptions on their recovery in the ICU were further delineated.

Adult↗

Clustering patients according to health perceptions: relationships to psychosocial characteristics and medication nonadherence.

BACKGROUND: Little is known about how patients rate their health perceptions. Our objectives were to identify systematic multivariate patterns of perceptions using cluster analysis, and to investigate associations among the clusters, psychosocial characteristics and medication nonadherence. METHODS: Demographic, clinical and psychosocial data on 200 patients with inflammatory bowel disease (IBD) were collected prior to the index office visit and health perceptions were collected afterwards. Cluster analysis using a k-means method was used to identify subgroups of patients based on their responses to the Patient-Physician Discordance Scales (PPDS), an instrument that assesses perceptions of health status and of the clinical visit. RESULTS: We identified five different patient groups: a "healthy, not distressed, good communication, low expectation for medication/testing" group; a "healthy, relatively distressed, good communication, high expectation for medication, low expectation for testing" group; a "symptomatic, distressed, good communication, high expectation for medication/testing" group; a "healthy, not distressed, good communication, high expectation for medication/testing" group; and a "relatively healthy, relatively distressed, poor communication, low expectation for medication/testing" group. After adjustment for age, sex, language, form of IBD, and disease activity, statistically significant between-clusters differences were found in psychological distress, social support satisfaction and medication nonadherence. CONCLUSIONS: Distinct patterns of patients' health perceptions correlated with psychological health and adherence to treatment. This categorization may be used to help identify patients at higher risks for ineffective communication and nonadherence to medication.

Adolescent↗

Gender differences in emotional disability and negative health perception in cardiac patients 6 months after stent implantation.

OBJECTIVES: In this study we evaluate gender differences in affective adaptation and health perception in patients 6 months after stent implantation. BACKGROUND: Assessment of gender-specific behavioral strategies to cope with serious cardiac disease conditions has not been given much attention until now. Preliminary data suggest greater impairments in female patients, which might be of clinical relevance. METHODS: Three hundred seventeen patients were eligible for the 6-month follow-up investigation, 78 (24.6%) of whom were women. The women were significantly older but did not differ from men in their cardiac risk features and treatment procedures. There were no gender differences in prevalence of hypertension, hypercholesterolemia, and family history. Men had a significantly higher prevalence of smoking than women, whereas women had a significantly higher prevalence of diabetes than men. A structured interview and a standardized psychodiagnostic assessment was carried out, which covered domains of affective dysfunction (depression, anxiety, intrusion, and avoidance), vegetative symptoms (sleeping disorders), and parameters of negative health perception. RESULTS: There were no significant gender differences in the prevalence of depressive symptoms. Women exhibited higher mean values of anxiety than men, which did not reach significance. Sleeping disorders were significantly more prevalent in women. The absolute level of being distressed by intrusive thoughts and avoidance behavior related to the severe underlying disease process was low in the total group of patients examined. Measurable gender differences did not emerge. Fifty-one (16.5%) patients exhibited pessimistic anticipation of dire consequences and severe signs of negative health perception (NHP group). There was a trend, although not statistically significant, toward more women being in the NHP group. The distribution of cardiac risk factors, however, was completely balanced in the NHP(+) and NHP(-) patient groups. Objective somatic cardiac disease parameters did not account for the negative health perception. NHP was, however, associated with significantly more prestent angina pectoris (p < 0.040) and poststent angina pectoris (p < 0.0001). High levels of anxiety, depression, and of disturbed sleep also led to a sharp separation between patients with high degrees of an anticipated incapacitation due to the disease process. Univariate regression analysis suggested an effect of female gender on the occurrence of NHP (odds ratio 1. 70; 95% CI 0.88 to 3.25), which was of borderline significance. Control for confounders in a multiple regression model, however, eliminated the gender effect (odds ratio 1.04, 95% CI 0.48 to 2.23). Poststent chest pain (odds ratio 7.75, 95% CI 3.28 to 18.32) and sleeping disorders (odds ratio 1.32, 95% CI 1.16 to 1.51) were identified as the most powerful confounders of the gender-NHP association. CONCLUSION: Contrary to expectation, women were not per se more distressed than men in all areas of adaptation of the midterm course after stent implantation, although the higher levels of anxiety and sleeping disorders in women deserve attention. A considerable proportion of patients exhibited a pessimistic disease perspective independent of their somatic status, which was associated with affective morbidity. The tendency toward more negative health perception in women may be due to their more frequent occurrence of chest pain and sleeping disorders.

Adaptation, Psychological↗

Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists.

OBJECTIVE: To assess recent trends in professional satisfaction, perceptions of ability to provide high-quality care, and perceptions of ability to obtain needed services for patients in a national sample of obstetricians and gynecologists; to compare obstetrician-gynecologists with physicians in other specialties; and to identify demographic, professional, and practice characteristics associated with high career satisfaction. METHODS: We used data from the 1996-1997 (n=12,385; response rate, 65%) and 1998-1999 (n=12,280; response rate, 61%) waves of the nationally representative Community Tracking Study physicians' survey. The principal outcome measures were one item related to overall career satisfaction, six items measuring physicians' perceptions of their ability to provide high-quality care, and five items measuring physicians' perceptions of their ability to obtain needed services for patients. All results were weighted and adjusted to reflect the complex survey design. RESULTS: In 1996-1997, 34% of obstetrician-gynecologists (n=545) were very satisfied with their careers, and 24% were very or somewhat dissatisfied. Up to 45% perceived significant barriers to the delivery of high-quality care, and up to 58% were unable to "almost or almost always" obtain necessary services for patients. Results in 1998-1999 (n=484 obstetricians and gynecologists) were similar, except for a deterioration in perceived amount of time with patients and ability to obtain high-quality ancillary services. In comparison with primary care physicians, obstetrician-gynecologists were less satisfied (P=.001); in comparison with both primary care physicians and general surgeons, they had more problems delivering high-quality care (P<.001) and greater difficulties obtaining needed services for patients (P<.001). Controlling for selected demographic and professional characteristics, higher career satisfaction was associated with age greater than 65 years, practicing in small metropolitan areas and in academic settings, and having better perceptions of quality and ability to obtain services (P<.05). CONCLUSION: Although most obstetricians and gynecologists are satisfied with their careers, many are experiencing significant professional distress.

Adult↗

School-age children's perceptions of a person who stutters.

UNLABELLED: The present study examined the perceptions school-age children have of stutterers. Four groups of fourth and fifth grade students viewed a videotape with either the speaker stuttering or not stuttering while reading a poem. A semantic differential scale of bi-polar adjective pairs was used to rate the speaker on intelligence and personality traits. The current study found that there is a significant difference between school-age children's perceptions of stutterers and nonstutterers with the ratings for the disfluent speaker more negative than the ratings for the fluent speaker. It was found that children did not rate personality and intelligence related traits differently. This information can be used to validate the need for education regarding stuttering for children and those who work with children. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1). identify perceptions of stutterers by a variety of groups; (2). discuss the implications of research on perceptions of stutterers; and (3). compare/contrast children and adults and their perceptions.

Attitude↗

Comparisons of American-Chinese and Taiwanese patients' perceptions of dyspnea and helpful nursing actions during the intensive care unit transition from cardiac surgery.

OBJECTIVE: To compare perceptions by American-Chinese and Taiwanese patients who received ventilatory assistance of acute episodes of dyspnea and the related helpful nursing actions in the intensive care unit (ICU) after cardiac surgery. DESIGN: A descriptive qualitative design. SETTING: Two medical hospitals in northern California and Taiwan. PATIENTS: A purposive sample consisting of 30 adult Chinese patients who experienced acute episodes of dyspnea while receiving assistance from a volume-cycled ventilator following cardiac surgery in the ICU from one study site in the United States (n = 10) and one study site in Taiwan (n = 20). OUTCOME MEASURES: The perceptions, natures, helpful nursing actions, and conceptual definition of the acute episode of dyspnea from the patients' perspective. INTERVENTION: Data were gathered through semi-structured interviews and analyzed by qualitative content analysis. RESULTS: All American-Chinese and Taiwanese subjects experienced physical discomforts, including tightness and congestion in the chest, labored breathing, sweating, palpitations, pain, and loss of vitality. Seventy percent of American-Chinese subjects and 90% of Taiwanese subjects reported having a mortal fear of death during and after the acute episode of dyspnea. The nature of the patients' perceptions of dyspnea revealed in this study can be categorized as unpredictability, sequence, intercorrelation, and exhaustion. Data analysis shows that the acute dyspneic process includes the immediate, following, later, and final transitions. Helpful nursing actions were identified as comforting, companionship, allowing self-concentration, and providing information. CONCLUSION: Both American-Chinese and Taiwanese patients' perceptions of acute episodes of dyspnea and helpful nursing actions were identified and compared. Finally, the conceptual definition of patients' perceptions of acute dyspnea and a conceptual framework for this phenomenon were further tentatively developed to depict and delineate this phenomenon.

Asian↗

The effect of patient race and socio-economic status on physicians' perceptions of patients.

Despite its potential influence on quality of care, there has been little research on the way physicians perceptions of and beliefs about patients are affected by patient race or socio-economic status. The lack of research in this area creates a critical gap in our understanding of how patients' demographic characteristics influence encounter characteristics, diagnoses, treatment recommendations, and outcomes. This study uses survey data to examine the degree to which patient race and socio-economic status affected physicians' perceptions of patients during a post-angiogram encounter. A total of 842 patient encounters were sampled, out of which 193 physicians provided data on 618 (73%) of the encounters sampled. The results of analyses of the effect of patient race and SES on physician perceptions of and attitude towards patients, controlling for patient age, sex, race, frailty/sickness, depression, mastery, social assertiveness and physician characteristics, are presented. These results supported the hypothesis that physicians' perceptions of patients were influenced by patients' socio-demographic characteristics. Physicians tended to perceive African-Americans and members of low and middle SES groups more negatively on a number of dimensions than they did Whites and upper SES patients. Patient race was associated with physicians' assessment of patient intelligence, feelings of affiliation toward the patient, and beliefs about patient's likelihood of risk behavior and adherence with medical advice; patient SES was associated with physicians' perceptions of patients' personality, abilities, behavioral tendencies and role demands. Implications are discussed in terms of further studies and potential interventions.

Attitude of Health Personnel↗

The effect of face inversion on activity in human neural systems for face and object perception.

The differential effect of stimulus inversion on face and object recognition suggests that inverted faces are processed by mechanisms for the perception of other objects rather than by face perception mechanisms. We investigated the face inversion using functional magnetic resonance imaging (fMRI). The principal effect of face inversion on was an increased response in ventral extrastriate regions that respond preferentially to another class of objects (houses). In contrast, house inversion did not produce a similar change in face-selective regions. Moreover, stimulus inversion had equivalent, minimal effects for faces in in face-selective regions and for houses in house-selective regions. The results suggest that the failure of face perception systems with inverted faces leads to the recruitment of processing resources in object perception systems, but this failure is not reflected by altered activity in face perception systems.

Brain↗

Directors' perceptions of the effects of managed care in outpatient substance abuse treatment.

This study examines the perceptions of unit directors' regarding the effects of managed care on outpatient treatment and operations. Specifically, we propose that perceptions vary as a function of managed care penetration, managed care complexity, and the stringency of managed care oversight procedures. Data are from a nationally representative sample survey of 236 outpatient substance abuse treatment organizations conducted in 1995. Study findings support the thesis that directors' perceptions vary systematically with specific attributes of managed care. Specifically, directors' perceptions of positive managed care effects are associated with two managed care oversight procedures: (a) managed care limits on the number of sessions provided; and (b) managed care requirements for follow-up after treatment. Directors perceptions of negative effects of managed care are significantly related to (a) managed care penetration, (b) managed care complexity; and (c) four different managed care oversight procedures. These results have implications for treatment given the rapid growth in managed behavioral care.

Ambulatory Care↗

Parents' and physicians' perceptions of childhood epilepsy.

STATEMENT OF THE PROBLEM: There is increasing interest in reducing burden of illness in families with childhood epilepsy. Evidence suggests that burden of illness is more related to parents' perception of seizure control than actual seizure control. This study examined the extent to which parents could describe their children's epilepsy and its impact. The degree of concordance between parents' and physicians' perceptions of epilepsy, and its effect on parents' satisfaction with care was also examined. METHOD: The study involved 37 parents and 1 paediatric neurologist. A questionnaire measured parents' perceptions of seizures and satisfaction with care. A physician questionnaire was piloted for comparison with parent responses. RESULTS: Parents were able to describe and distinguish seizure types, characteristics and impact of epilepsy. Results indicate a low degree of concordance between parents' and physician's perceptions for global, medical and everyday aspects of epilepsy. Preliminary evidence suggests that satisfaction with care may be positively related to degree of concordance. CONCLUSIONS: It is feasible to examine burden of illness from the parents' perspective. More attention should be paid to the parent-physician relationship in order for physicians to appreciate parents' perceptions. Future research is needed to replicate the findings in a larger sample of parents and paediatric neurologists.

Adolescent↗

Subjective perception of seizure precipitants: results of a questionnaire study.

We evaluated self-perception of seizure precipitants in 149 adult subjects with epilepsy: 71% of the subjects reported at least one factor that, according to the perception, increased the risk of suffering from a seizure. The subjects most often reported psychological stress, change of weather and sleep deprivation. Among the disease-related factors, seizure frequency and the state of consciousness at the onset of the seizures influenced perception of precipitants. Furthermore the perception of some precipitants was dependent on such social variables as rural versus urban surroundings. It is argued that the perception of seizure precipitants is the result of a combination of physiologically based temporal and causal correlations and of beliefs of the patient about such relationships. Hence reports of seizure precipitants are determined by somatic as well as psychological factors. Efforts to clarify the relationship between possible precipitants and the occurrence of seizures should be intensified. In addition the great importance of seizure precipitants in lay theories of epilepsies should be considered in counselling patients with epilepsies.

Adolescent↗

A perceptibility curve comparison of Ultra-speed and Ektaspeed Plus films.

OBJECTIVE: The purpose of this study was to evaluate the subjectively assessed contrast difference between Kodak's Ultra-speed and Ektaspeed Plus dental radiography films (Eastman Kodak, Rochester, N.Y.) through the use of perceptibility curves. DESIGN: Four series of 22 radiographs were exposed at 70 and 90 kVp with each film type by means of a Gendex 1000 dental radiography unit (Gendex Corp., Milwaukee, Wis.) for times ranging from 0.05 to 5 seconds at 10 ma. The test object consisted of a 7-mm-thick rectangular aluminum block with 10 circular depth cuts, each 2 mm in diameter, which created wells varying in depth from 50 to 500 microns. The corresponding films were processed concurrently (for 4.5 minutes) in total darkness with fresh Kodak Readymatic solutions (Eastman Kodak) held at a constant temperature of 28 degrees C. The resulting radiographs were viewed in a predetermined random order under ideal conditions by 10 dentists. The evaluators recorded the maximum number of perceptible images on each film. A pair of perceptibility curves were generated at 70 and 90 kVp by plotting the log relative exposure versus the mean number of perceptible images. RESULTS: There was no statistical difference between the two film types with respect to the mean number of perceptible images, as analyzed by Wilcoxon's signed rank test (p = 0.22; p = 0.44). CONCLUSIONS: There is no subjectively assessed contrast difference between Kodak s Ultra-speed and Ektaspeed Plus films at 70 and 90 kVp.

Absorptiometry, Photon↗

Keeping perception accurate.

Perception should change if an error in perception is detected. Yet how can information that comes through the senses ever indicate that those very senses aren't accurate? Knowledge of objects that arises independently of sensory experience can be used to check the sensory information for errors. For instance, an a priori constraint that one object cannot be in two places at the same time would lead to error detection if the sensory systems suggest that one object is in two places. Variants on the classic prism-adaptation phenomenon have revealed new rules about changes in space perception. These variants involve specifying new unusual mappings between visual space and motor (proprioceptive) space, and testing for generalization to novel untrained locations. The research has suggested that there is a preference for changes in space perception that shift space rigidly everywhere, that shrink or expand space uniformly, and that preserve the one-to-one relationship between modalities. Finally, this review discusses the issue that perception must change to remain accurate in the face of childhood growth and adult drift.

Journal Article↗

Attentional modulation of visual motion perception.

How is the perception and processing of visual motion affected by attention? This review examines recent research in cognition, perception and neurophysiology that explores how ongoing behavioural tasks (and the attentional states they impose) modulate the processing of visual motion. Although traditional views hold that motion is processed in an obligatory, 'pre-attentive' manner, evidence for processing in a task-independent manner is scant. Recent studies of human perception that have measured motion priming, motion aftereffects, uncertainty effects, and motion-interaction effects indicate instead that even simple aspects of motion processing may be substantially affected by whether motion information in a task is used or ignored by the perceiver. Single-unit studies in brain areas sensitive to visual motion in monkeys, and functional imaging studies on humans, also indicate that task and attentional state affect activity levels in brain regions thought to be important in motion perception. This review brings together these converging findings of attentional modulation of motion perception and considers them in light of object-oriented theories of attention.

Journal Article↗

Transcranial magnetic stimulation (TMS) of the sensorimotor cortex and medial frontal cortex modifies human pain perception.

OBJECTIVE: Although recent neuroimaging studies have shown that painful stimuli can produce activity in multiple cortical areas, the question remains as to the role of each area in particular aspects of human pain perception. To solve this problem we used transcranial magnetic stimulation (TMS) as an 'interference approach' tool to test the consequence on pain perception of disrupting activity in several areas of cortex known to be activated by painful input. METHODS: Weak CO(2) laser stimuli at an intensity around the threshold for pain were given to the dorsum of the left hand in 9 normal subjects. At variable delays (50, 150, 250, 350 ms) after the onset of the laser stimulus, pairs of TMS pulses (dTMS: interpulse interval of 50 ms, and stimulus intensity of 120% resting motor threshold) were applied in separate blocks of trials over either the right sensorimotor cortex (SMI), midline occipital cortex (OCC), second somatosensory cortex (SII), or medial frontal cortex (MFC). Subjects were instructed to judge whether or not the stimulus was painful and to point to the stimulated spot on a drawing of subject's hand. RESULTS: Subjects judged that the stimulus was painful on more trials than control when dTMS was delivered over SMI at 150-200 ms after the laser stimulus; the opposite occurred when dTMS was delivered over MFC at 50-100 ms. dTMS over the SII or OCC failed to alter the pain threshold. CONCLUSIONS: These results suggest that TMS to SMI can facilitate whereas stimulation over MFC suppresses central processing of pain perception. Since there was no effect of dTMS at any of the scalp sites on the localization task, the cortical locus for point localization of pain may be different from that for perception of pain intensity or may involve a more complex mechanism than the latter. SIGNIFICANCE: This is the first report that TMS of SMI facilitates while that of MFC suppresses the central processing of pain perception. This raises the possibility of using TMS as a therapeutic device to control pain.

Adult↗