Clinical Decision Making in Alzheimer's Disease

In the treatment of Alzheimer's Disease the occupational therapy goal is to enable persons to function as optimally as possible. Maximizing the patient's functioning in daily life necessitates a framework for clinical reasoning. Clinical reasoning currently emphasizes what persons can do but may fail to recognize the complex factors involved in what a person actually will do. A framework to guide clinical decision making for persons with Alzheimer's disease based on the model of human occupation was developed. The use of this framework is illustrated through a case application.     

The pattern of reading deterioration in dementia of the Alzheimer type: Observations and implications

Thirteen patients with dementia of the Alzheimer type (DAT) were tested for their ability to read aloud and to read with comprehension. Reading aloud was preserved in all but the most severely impaired cases and was found to be relatively independent of intellectual deterioration. Reading comprehension declined progressively with increasing dementia severity and correlated well with quantitative mental status assessments. The results suggest that the pattern of reading deterioration may aid in the clinical identification of DAT, that the disturbance of reading comprehension is a linguistic deficit rather than a product of visual-perceptual disturbances, and that the alexia is more consistent with an instrumental loss than a de-developmental model of dementia.     

How does crime pay? The differentiation of criminal specialisms by fundamental incentive

Most attempts to determine offence specialisms have not benefited from any formal psychological framework of behavioural differentiation. Bandura's framework (Social foundations of thought and action, 1986) of the fundamental incentives to human action offers an interesting perspective on what might underlie differential patterns of offending. The framework draws attention to the distinction between Material, Power/Status, and Sensory incentives, leading to the hypotheses that crimes which share any one of these incentives will be more likely to be committed by the same person, as revealed through high inter‐correlations, but be less highly correlated with crimes with different fundamental incentives. To test these hypotheses the correlations between 42 offending behaviours as self‐reported by 185 convicted young offenders were examined. A Multidimensional Scaling analysis of the inter‐correlations revealed three distinct styles of offending that could be related to Bandura's Material (Cronbach's α = 0.94), Power/Status (α = 0.90) and Sensory (α = 0.76) incentives. The identification of this psychological basis for the differentiation of criminal styles provides a model for considering offenders' patterns of specialisation which is of value both in clarifying the aetiology of different types of crime and in considering which crimes may be behaviourally equivalent when trying to link them to a common offender or infer offender characteristics from crime scene information. Copyright © 2006 John Wiley & Sons, Ltd.     

Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples

ABSTRACT

The authors attempt to apply knowledge of traumatization to clinical practice with couple dyads. Elaborating on the Couple Adaptation to Traumatic Stress (CATS) Model (Nelson Goff & Smith, 2005), the authors have worked to bridge the gap between a general understanding of trauma's impact on the couple relationship and couples' treatment. This article facilitates the application of the CATS Model to clinical work with couples impacted by trauma. Incorporating Herman's (1997) traumatic process with the original CATS Model, the authors created a more specific, clinically useful framework for clinicians. The goal of the current article is to provide clinicians with a pragmatic illustration articulating a clinical framework for understanding and treating posttraumaumitc symptoms and processes within the couple relationship. The main implication is that clinicians will be able to conduct effectively guided systemic therapy with distressed couples necessary to generate progress in the treatment of symptomatology and couple functioning of trauma survivors and their partners.     

Investigating visual knowledge in dementia of the Alzheimer type (DAT): evidence for a structured organization

Given that certain types of semantic dysfunction in DAT have been attributed to difficulties in accessing visual knowledge, the issues of integrity of access to, and format of storage, within the "visual store" are particularly important. In these experiments, we tested 10 DAT patients and matched controls on the reality decision and part-whole matching tasks. Visual knowledge was found to be significantly impaired in the DAT group. Moreover, DAT patients displayed disproportionate deficits in accessing visual knowledge of items from nonliving categories. Results are interpreted within a framework of differential hierarchical access to visual representations of perceptually similar and perceptually distinct categories of items.     

An analysis of competency to stand trial: an integration of case law and clinical knowledge

In the past three decades competency to stand trial has emerged as a central issue in mental health law and forensic psychology. This article combines legal and clinical frameworks for a more integrated understanding of competency to stand trial. The legal framework focuses on Supreme Court decisions beginning with Dusky and reviews several legal theories of competence. The empirical framework is investigated within Grisso's (1986) conceptualization of legal competencies. In addition, the efficacy of specialized forensic assessments is evaluated, including the newly developed MacArthur Structured Assessment of the Competencies of Criminal Defendants (MacSAC-CD). The article concludes with observations of competency as a construct and their implications for forensic practice. © 1998 John Wiley & Sons, Ltd.     

Dopamine transporter gene moderates response to behavioral parent training in children with ADHD: a pilot study

There is great variability in the degree to which children with attention deficit/hyperactivity disorder (ADHD) improve through behavioral treatments. This study investigates the influence of the dopamine transporter gene (SCL6A3/DAT1) on outcome of behavioral parent training (BPT). Study subjects were a subsample (n = 50, for whom DAT1 genotypes were available) of a randomized controlled BPT effectiveness study (N = 94) comparing BPT plus ongoing routine clinical care (RCC) versus RCC alone in referred children (4-12 years old) with ADHD. Treatment outcome was based on parent-reported ADHD symptoms and behavioral problems. Presence of 2 versus no or 1 DAT1 10-repeat allele served as moderator variable. Time × Treatment × Genotype effect was analyzed with repeated-measures analysis of variance, controlling for baseline medication status. Results indicate that DAT1 moderated treatment response (p = .009). In children with no or 1 DAT1 10-repeat allele, superior treatment effects of BPT + RCC compared with RCC alone were present (p = .005), which was not the case in children with 2 DAT1 10-repeat alleles (p = .57). Our findings suggest that genetic differences in DAT1 in children with ADHD influence their susceptibility to a behavioral intervention directed at shaping their environment through their parents. The role of the dopamine system in motivation and learning and in the aberrant sensitivity to reinforcement in children with ADHD may explain this moderating effect, given that the management of contingencies is typically addressed in BPT.     

Attribution in conversational context: Effect of mutual knowledge on explanation-giving

Attribution theorists typically have conceived the attribution process in terms of universal laws of cognitive functioning, independent of social interaction. In this paper we argue for the notion, grounded in recent ordinary language philosophy, that any consideration of the form of everyday explanation must take into account its function as an answer to a ‘why’ question within a conversational framework. Experiment 1 provides support for the idea that speakers should identify as causally relevant that necessary condition for the occurrence of an event about which the enquirer is ignorant. Experiment 2 replicates this basic finding and further demonstrates that speakers will change their explanations to enquirers believed to be sharing different knowledge about the same target event. Experiment 2 also assessed the role of individual differences in conversational rule-following, and found in apparent contrast some previous predictions that high self-monitoring individuals were no more likely than lows to tailor their explanations to suit the enquirer's knowledge state. If anything, the reverse occurred. Taken together, these experiments support the central contention of the abnormal conditions focus model (Hilton and Slugoski, 1986), that the common sense criterion of causality is that of an ‘abnormal condition’ rather than constant conjunction as instantiated in the ANOVA model of causal attribution (Kelley, 1967, 1973).     

Expressive prosodic patterns in individuals with Alzheimer's disease

This paper describes a useful technique for quantifying the degree of speech deficits in dementia of GDS 4 Alzheimer's type (DAT). Production of prosodic speech in DAT patients and healthy older controls was analysed using variation in fundamental frequency (F0) measures on a reading task. The prosogram computational model was used to analyze the prosodic contours of the speech samples, using melodic styling of F0 based on perceptual principles and prominence detection of spectral and amplitude fluctuations in the speech signal. Results revealed significant differences in most of these prosodic parameters among the DAT group. Normal pitch variation in speech and variations in syllable timing were reduced in the DAT group, these features cause "flat" speech prosody in these patients. These speech parameters may have diagnostic and prognostic value for Alzheimer's disease and therefore could be a useful aid in clinical trials.     

Affect in Ethical Decision Making: Mood Matters

Ethical decision-making research has centered on Rest’s (1986) framework that represents a rational, nonaffective model for ethical decision making. However, research in human cognition suggesting a “dual-processing” framework, composed of both rational and affective components, has been relatively ignored in the ethical decision-making literature. Examining dual-processing literature, it seems affect might be an important factor in decision making when a person’s mood is congruent with the task or situational context frame. Given that ethical decisions are serious and complex tasks, it is proposed here that inducing a negative affective state might produce mood congruence, reinforce the salience of emotion for ethical decision makers, and lead to differences in decision processing. Evidence is presented documenting differences in the decisions made by ethical decision makers in a negative affective state as compared to those in either a positive or neutral affective state.     

An Empirical Comparison of Three Theories of Nonverbal Immediacy Exchange

This study provides a contrastive test of three immediacy-exchange theories: Burgeon's expectancy violations theory (EVT), Cappella and Greene's discrepancy-arousal theory (DAT), and Andersen's cognitive valence theory (CVT). EVT predicts that high immediacy, by rewarding communicators, leads to an orientation response and positive behavioral and affective outcomes. In contrast, DAT and CVT predict aversive arousal and compensatory responses in response to high immediacy increases. Findings from opposite-sex friend dyads failed to find unequivocal support for a single theory. Targets showed a mix of reciprocal and compensatory responses in the higher immediacy condition, indicating that existing immediacy-exchange theories should consider incorporating elements from all three theories and perhaps from dialectics theory to explain the complex reactions that occur in response to high immediacy changes from friends.     

The effects of age and dementia of the Alzheimer's type on phonological false memories

The authors conducted 3 experiments that examined the effects of age and dementia of the Alzheimer's type (DAT) on phonological false memories. In addition, the study was designed to investigate the role of inhibitory control in mediating phonological false memories. In Experiment 1, both young-old and old-old participants exhibited increased susceptibility to false remembering, compared with young adults. In Experiment 2, auditory Stroop interference was used as an index of inhibitory abilities and was found to account for a significant percentage of the variance in false recollection. Experiment 3 provided converging evidence for the importance of inhibitory control in phonological false memories by demonstrating that DAT patients are more susceptible to false recall and recognition than healthy older adults. The results are discussed within the inhibitory deficit framework of cognitive aging.     

Role-Reversal: A Somewhat Neglected Mirror of Heritages of the Past

Within a clinical–theoretical framework focused on transference–countertransference dynamics, the authors reflect on role-reversal and on the reasons it has been neglected for a long time in literature. This primitive inter- and intra-psychic process, often at the forefront in our practice, will be discussed in its principal aspects (patient's unconscious identification with parents’ psychic culture and concomitant dissociation of the infant part of the self), signaling how the enactment can be an inevitable element which, putting into play the past dissociated object relationships, becomes a source of mutative understanding.     

The Space That Difference Makes: On Marginality,Social Justice and the Future of the Health Humanities

Feminist theorist and educator, bell hooks, asserts that to seek true liberation one must choose marginality. One must choose to occupy the space outside the binary between colonizer-colonized, hegemonic center-periphery, and us-them in order to create a location of possibility. This essay will reveal the practice of social justice as the navigation of the space that difference makes and argue that choosing marginality provides a framework for health humanities work towards social justice in health care. The space of the launderette that is depicted in Hanif Kureishi’s 1986 film, My Beautiful Laundrette, provides an example of choosing marginality and illustrates how difference structures both real and imagined spaces, which influences how individuals ultimately perceive one another. We will draw from the work of bell hooks; political geographer, Edward Soja; and Marxist philosopher, Henri Lefebvre, to demonstrate the importance of the health humanities’ position at the margin to traditional health care education.     

Tuning into the psychotic wavelength: Psychoanalytic supervision for mental health professionals

In this paper, material is presented from supervision groups run for mental health professionals in different mental health settings. I will argue that a psychoanalytic framework, which puts the transference and countertransference at the centre of clinical practice, offers an important model for thinking about psychosis and psychotic means of communication. When staff are able to ‘tune in’ to their patients' communications it can help to change a patient's monologue about his/her delusional world into a meaningful dialogue about their emotional world.     

Rational Choice,Personality, and HIV‐Preventive Behavior in the Presence of Opportunities1

In this paper, condom use or non‐use in sexual intercourse with casual partners is analyzed on the basis of ideas derived from the theory of planned behavior (Ajzen & Madden, 1986), which is combined with the general theory of crime (Gottfredson & Hirschi, 1990). An integrated model allows the assumption that persons who display low self‐control are likely to seek out opportunities to engage in sexual intercourse with casual partners and are likely to display attitudes and subjective norms favoring the non‐use of condoms. The study consists of an empirical examination of these assumptions. A standardized questionnaire (vignette technique) was presented to a quota sample of 837 German adults aged 18 to 65 years. Loglinear analyses were carried out to examine the integrative model. The results are discussed with regard to the effectiveness of the theoretical framework applied and with regard to previous research that has been conducted in this area.     

Beyond a single standard: levels of evidence approach for evaluating marriage and family therapy research and practice

Randomized clinical trial (RCT) research has come to dominate the research landscape of marriage and family therapy (MFT). Despite becoming the ‘gold standard’ for evaluating clinical research and clinical practices, there is a growing debate regarding the reliance on RCTs as the primary basis for evaluating clinical intervention in MFT. Given the natural diversity of clients, settings and clinical problems faced by practitioners and the relational and recursive interactional process of MFT, one of the major challenges for the field of MFT will be to come to grips with the research–practice gap by moving beyond a single methodological standard through adopting a ‘levels of evidence’ approach as a framework that promotes diverse research methods, different methodological criteria (depending on the method), and evaluation based on the accumulated type of evidence needed to answer a specific policy, clinical practice choice, or within a model clinical decision.     

Testing a computational model of interpersonal judgment with personal constructs

In a repertory grid experiment based on elicited personal constructs we tested several predictive implications of a computational model of interpersonal judgment developed by Lefebvre, Lefebvre, and Adams-Webber (1986). Results are compared with related findings within the framework of personal construct theory.