医患沟通对医生刻板印象表达的影响

从沟通频次与刻板印象传递性质的关系入手,以住院患者和尚未成为住院患者的大学生为被试,采用系列再生范式,利用10条4人再生链,探讨了医患沟通频次对医生刻板印象表达的影响。结果显示,与医生沟通频次高的住院患者在再生链的第2个位置传递医生的积极信息高于消极信息,但是经过4人的传递,住院患者对医生刻板印象信息的传递在积极信息与消极信息没有差异。而与医生沟通频次低的大学生在再生链的后期表现出传递医生消极信息的倾向。该结果表明：沟通频次能够调节有关医生的消极刻板印象的传递—与医生沟通频次高的群体在传递医生的刻板印象信息时,在传递的早期具有积极的倾向性;但经过多人传递之后,在效价方面已经没有倾向性;与医生沟通频次低的群体倾向于传递医生刻板印象的消极信息。     

To drive or not to drive: Neuropsychological assessment for driver's license among stroke patients

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception , (II) spatial attention , (III) visuospatial processing , and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.     

Changes in psychological performance parameters of concentration and critical flicker-fusion frequency with advancing age and in relation to diffuse cerebral arterial affections of the circulation

Psychometric performance parameters and the critical flicker-fusion frequency are studied in various groups and in patients with chronic cerebral circulation trouble. Test d2 proves to be effective in the measuring of such impaired performance. There is a higher degree of correlation with Paul's addition test. A correlation between the performance parameters and the patient's age can be statistically substantiated. Among patients up to one third in the age group 55 and over show and affection of the cerebral performance turbances in spite of the absence of pathological clinical findings. The figure is twice as high in the group of patients undergoing treatment. The increased occurrence in old age shows the significance of pathological processes. There appears to be no relationship between critical flicker-fusion frequency and performance and stress factors. Individual correlations would support other physiological relations, such as an at present only hypothetical link with the psychic state (nervousness) of the test person. Our tables are suitable for practical purposes.     

Patterns of adaptation to Parkinson's disease

Forty-four 50- to 80-year-old Parkinson patients were interviewed about the effects of the disease on their lives. The Q-sort technique was used to analyze the interview data. In addition, the Symptom Checklist 90, the Mini-Mental State, and physician ratings of disease severity were obtained. Four clusters of patients were identified. Cluster I patients were sanguine and engaged; Cluster III patients were depressed and apprehensive about the future; Cluster III patients felt depressed, ashamed, and misunderstood; and Cluster IV patients were passive and resigned. Disease severity, but not demographic or other health variables, discriminated the groups. Patients with a mild to moderate impairment who adjusted effectively to their illness (Cluster I) were distinguished by an ability to put negative thoughts out of mind, by their belief that there are worse fates than having Parkinson's disease, and by efforts to influence certain aspects of their illness. The particular patterns of adaptation of the patients who were depressed and misunderstood (Cluster III) and passive and resigned (Cluster IV) seemed primarily a function of physical condition. This suggest that the degree to which personal attitudes can influence adaptation to somatic disease is limited by specific realities of the disease.     

Effect of age at the time of illness, tumor grade and Karnofsky value on the therapy result in patients with glioma of the cerebral cortex treated with combined therapy

49 patients with gliomas were investigated by means of life table analysis with regard to the influence of age, grade of the tumor and Karnofsky-score on the result of the treatment. The grade of the tumor and the age are factors of high prognostic value. They significantly influence the survival time of patients with gliomas treated by a combination treatment (operation, radiation, polychemotherapy; median survival times: grade 2: 50.4 months; grade 3: 28.5 months; grade 4: 18.9 months; group younger than 40 years: 49.2 months; older than 40 years: 21.9 months). Patients with different Karnofsky-scores show no differences concerning their median survival times (Karnofsky-score 50-70: 34.2 months; 80-100: 31.8 months).     

Imagination and Will

1. Evoked potentials generated by cerebral self-stimulation were studied in white rats. Stimulus trains of 30 biphasic rectangular waves of various repetition rates (30, 50, 100, 150, 200 pps) were employed. The pulses were always 4 msec in width and of fixed intensity at all repetition rates for a given animal. Potential changes during a 2-second interval after the termination of a stimulus train were recorded from various points in the cerebral mass and averaged electronically.

2. The early portion of the 2-second interval was characterized by rhythmic oscillations in the alpha range whose number and amplitude were related to repetition rate of the rectangular waves within the stimulus train. The periodicity of the oscillations when they occurred was not so affected and remained practically constant over subjects, intensity of stimulus, and repetition rate.

3. The number of oscillations was greatest at 200 and 150 pps and diminished with diminishing stimulus repetition rates, the drop being greatest below 100 pps.

4. There was a positive covariation between the rate of lever pressing for self-stimulation and the phenomenon of rhythmic after oscillations in the evoked potential. Animals who refused to press the lever for cerebral self-stimulation showed no rhythmic potentials when the stimulus was delivered by E; animals who had become pressers gave good after-discharges when so stimulated.     

Rorschach Responses and Aggressive Characteristics of MMPI F>16 Scorers

Psychiatric patients with MMPI F>16 scores (E group) were matched with patients having similar diagnosis but F scores of 3-12 (C group) to assess personality characteristics of high F scorers. In Experiment I, E and C group Rorschachs showed no significant differences on formal scored characteristics. E group patients marked a significantly greater number of “obvious” than “subtle” MMPI items. In Experiment II, there was no significant E and C group difference in Rorschach aggressive content. Data from the hospital charts indicated that F>16 scorers had a significantly higher frequency of overt, actively directed anger and suicidal behavior plus a greater total incidence of hostile behavior across a variety of categories.     

The Impact of Religious Connectedness on Health-Related Quality of Life in Patients with Diabetic Foot Ulcers

Religious connectedness is common phenomenon in Saudi Arabia and adjacent Gulf countries. An observational case control study was designed, enrolling 180 adult patients to report the association between religious connectedness and health-related quality of life (HRQL) in people with and without diabetes and foot ulcers. Sixty diabetic patients with foot ulcers (Group I) were compared with sixty diabetic patients without foot ulcer (Group II) and sixty healthy subjects (Group III) for assessment of their HRQL by using SF-36 questionnaire. The effect of religious connectedness was assessed using intrinsic/extrinsic religious connectedness scale. HRQL was found to be significantly lower in Group I compared with Group II and III as well as in group II compared with group III (P < 0.001). Group I patients showed a poorer HRQL with increased severity, duration and multiplicity of foot ulcers. There was a strong positive relationship between religious connectedness and HRQL as indicated by a positive correlation between religious connectedness scale and mental, physical component summary scores (r = 0.66 and 0.59 respectively and P < 0.001). While quality of life is generally poor in people with diabetic foot ulcers, there exists a strong positive relationship between religious connectedness and higher HRQL. These findings may have implications on improving outcomes.     

Feature processing during high-rate auditory selective attention

Auditory event-related brain potentials (ERPs) and reaction times were, analyzed in a selective attention task in which subjects attended to tone pips presented at high rates-Xinterstimulua intervals [ISIs] of 40-200 msec). Subjects responded to infrequent target tones of a specified frequency (250 or 4000 Hz) and location (left or right ear) that were louder than otherwise identical tones presented randomly to the left and right ears. Negative difference (Nd) waves were isolated by subtracting ERPs to tones with no target features from ERPs to the same tones when they shared target location, frequency, or both frequency and location cues. Nd waves began 60-70 msec after tone onset and lasted until 252–350 msec after tone onset, even for tones with single attended cues. The duration of Nd waves exceeded the ISIs between successive tones, implying that several stimuli underwent concurrent analysis. Nd waves associated with frequency processing had scalp distributions different from those associated with location processing, implying that the features were analyzed in distinct cortical areas. Nd waves specific to auditory feature conjunction were isolated. These began at latencies of 110–120 msec, some 30-40 msec after the Nds to single features. The relative timing of the different Nd waves suggests that auditory feaure conjunction begins after a brief parallel analysis of individual features but before feature analysis is complete.     

Vocal and manual response latencies to bilateral and unilateral tachistoscopic letter displays

Bilateral rows of eight letters and unilateral rows of four letters were presented in randomized sequences for 100 ms. Subjects were required to recall all letters in a trial (Experiment I); recall letters from one hemifield cued at exposure (Experiment II); recognize a single letter, making a vocal response (Experiment III); recognize a single letter, making a manual response (Experiment IV). In Experiments I, II and III, identification errors were fewer and vocal response latencies were faster for RVF stimuli, except in the bilateral condition on Experiment I; in Experiment IV manual response latencies were the same, for left and right, bilateral and unilateral conditions. Collectively, the results could not be satisfactorily accounted for by any one hypothesis: report-order, trace-scanning, or cerebral dominance. The relative contribution of each process to the laterality effect was discussed.     

Brain stem electrical responses of stutterers and normals by sex,ears, and recovery

Auditory brainstem electrical responses (BSER) of right and left ears of active stutterers, recovered stutterers, and nonstutterers, both male and female adults, were obtained at click rates of 11.1 and 71.1/sec. Latency intervals of waves I, III, and V were measured. The auditory systems of subjects were stressed using a rapid rate of 71.1 clicks/sec. The latency of wave V was used as the measure of the stress condition.Analysis of variance was used to determine statistical significances of main effects and interactions of mean BSER (waves I, III, V, and wave V in stress condition) of left and right ears of male stutterers (active and recovered), female stutterers (active and recovered), and male and female nonstutterers.With one exception, all main effects and all higher order interactions were nonsignificant. The one main effect that was significant was gender. Females have significantly faster rates of neural transmission than do males. The question was raised, does this finding contribute toward an explanation of the sex ratio in stuttering?     

The role of response-reward correlation in stimulus-response overshadowing

Rats pressed levers for food reward which was delivered, when appropriate, 0·4 s after the response. For one group, the delay interval was filled by a light cue; for the other group, the same number of lights was given but they were not correlated with food delivery. In Experiment I, all lever presses were reinforced and there were no differences in response rate between groups. In Experiments II and III, lever pressing was rewarded according to a VI and VR schedule respectively. Group differences were observed in Experiment II but they disappeared in Experiment III. The results of Experiments I and II show that a reward-related stimulus does not overshadow a lever response unless the stimulus is a better predictor of reward. Differences in salience or competition from sign-tracking behaviors were ruled out as causes of this phenomenon. Experiment III demonstrated, however, that a weak response-reward correlation is not a sufficient condition for the overshadowing effect. A fourth experiment replicated the results of Experiment III using naive animals. The results of these last two experiments are not consistent with an information theory approach unless (a) a response-units concept is adopted or (b) the cue involved in overshadowing is not the pre-food light but the end of a temporal interval, whose salience is enhanced by the light.     

Diagnostic value of the cerebrospinal fluid-blood lactate quotient in mental disorders in elderly persons]

The lactate levels of cerebrospinal fluid and blood were measured enzymatically and simultaneously in 40 gero-psychiatric patients. After calculating the fluid-blood-lactate-quotients, two distinct groups emerged, whose mean quotients showed significant difference. In the first group (15 patients) with a mean quotient of 1.06, the diagnosis of cerebral arteriosclerosis was clinically confirmed in only one case. In the second group (21 patients) with a mean quotient of 1.42, however, this occurred sixteen times, which represents a proportion of 2/3. Thus, it appears that a higher quotient suggests the diagnosis of cerebral arteriosclerosis. Further examinations are though necessary.     

Objectifying the effect of autogenic training on disordered ventilation in bronchial asthma]

Forty-one persons suffering from asthma (aged 20 to 55; duration of disease: greater than or equal 2 years) were divided into 2 groups and participated in courses of instruction in autogenic training. The control group was comprised of 14 patients. The effects of autogenic training on the maximum rate of expiration as well as the limiting respiratory value were recorded. The control group showed a seasonal decrease in the maximum rate of expiration and the limiting respiratory value by 10 to 20% in the period extending from April through November. The autogenic-training patients showed a temporally similar increase in the maximum rate of expiration of 27 and 22%, respectively (the difference to the control group being 47 and 42%, respectively). In 35 patients the increase in the limiting respiratory value was equal to or greater than the effect produced by novodrine. Catamnesis after one year (n = 40): Absence from work in a twelve-month period was 663 days prior to autogenic training and 77 days (11.6%) subsequent to autogenic training. Accordingly, autogenic training may be considered to be an objectively effective component of a combination of therapeutical methods used in the treatment of bronchial asthma.     

Enactive imagery in paired-associate learning

Three experiments were conducted to study the effects of enactive imagery (EI) on associative learning. In Experiment I, groups of Ss rated 226 verbs on EI and frequency. In Experiments II and III, Ss learned a 24- and a 16-item list, respectively. The lists consisted of the four possible stimulus-response combinations of high (H) and low (L) EI verb pairs: H-H, H-L, L-H, L-L. In both experiments, EI was found to be a significant factor on the stimulus side, performance being superior when the stimulus was of high EI. In Experiment III, the response EI main effect and the Stimulus by Response EI interaction were also found to be significant. The results indicated that like the imagery evoked by nouns, the EI evoked by verbs facilitates learning.     

An evolutionary theory of schizophrenia: cortical connectivity, metarepresentation, and the social brain

Schizophrenia is a worldwide, prevalent disorder with a multifactorial but highly genetic aetiology. A constant prevalence rate in the face of reduced fecundity has caused some to argue that an evolutionary advantage exists in unaffected relatives. Here, I critique this adaptationist approach, and review--and find wanting--Crow's "speciation" hypothesis. In keeping with available biological and psychological evidence, I propose an alternative theory of the origins of this disorder. Schizophrenia is a disorder of the social brain, and it exists as a costly trade-off in the evolution of complex social cognition. Paleoanthropological and comparative primate research suggests that hominids evolved complex cortical interconnectivity (in particular, frontotemporal and frontoparietal circuits) to regulate social cognition and the intellectual demands of group living. I suggest that the ontogenetic mechanism underlying this cerebral adaptation was sequential hypermorphosis and that it rendered the hominid brain vulnerable to genetic and environmental insults. I argue that changes in genes regulating the timing of neurodevelopment occurred prior to the migration of Homo sapiens out of Africa 100,000-150,000 years ago, giving rise to the schizotypal spectrum. While some individuals within this spectrum may have exhibited unusual creativity and iconoclasm, this phenotype was not necessarily adaptive in reproductive terms. However, because the disorder shared a common genetic basis with the evolving circuitry of the social brain, it persisted. Thus schizophrenia emerged as a costly trade-off in the evolution of complex social cognition.     

Heart rate variability in a binary choice reaction task: an evaluation of some scoring methods

Several scoring methods of heart rate variability have been investigated in a binary choice task. It was concluded that in this type of task the number of waves in the cardiotachogram and the sum of absolute differences between successive R-R intervals divided by the number of waves are the best indicators of the task levels (20, 30, 40, 50 and 60 binary choices per min). A detailed analysis of these scoring methods in different types of information processing tasks is recommended.     

Hippocampal sharp wave bursts coincide with neocortical "up-state" transitions

The sleeping neocortex shows nested oscillatory activity in different frequency ranges, characterized by fluctuations between "up-states" and "down-states." High-density neuronal ensemble recordings in rats now reveal the interaction between synchronized activity in the hippocampus and neocortex: Electroencephalographic sharp waves in the hippocampus were more probable during down-states than during up-states, and tended to coincide with transitions from down-states to up-states. The form of cortical activity fluctuations and their interactions with sharp waves depend on sleep depth: In deeper sleep stages, characterized by strong neocortical oscillation in the delta range or slower (approximately 0.8-4 Hz), sharp-wave-triggered peri-event time histograms (PETH) are consistent with a longer duration for down-states than for up-states. In lighter sleep, the sharp-wave-triggered PETH suggested longer up-states than down-states. These results highlight the interplay in the hippocampal/neocortical loop: Decreased neocortical input during down-states may be a factor in generation of sharp waves. In turn, sharp waves may facilitate down-to-up transitions. This interplay may reflect joint memory trace reactivation in the hippocampus and in the neocortex, possibly contributing to consolidation of long-term memory: Off-line reactivation of recent neural activity patterns in the hippocampus occurs during 50-100-msec electroencephalographic sharp waves, corresponding to pyramidal-cell population bursts. The neocortical up-states starting in correspondence with sharp waves may be influenced by the reactivated information carried by the hippocampal sharp wave.     

Mortality of geriatric and younger patients with schizophrenia in the community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.     

Redundancy effects in short-term memory

Five experiments are reported whose purpose was to demonstrate that short-term memory is improved by redundancy within the material. In Experiment I “tune” containing two, three, four and five tones of differing frequencies had to be coded into digits 1-5, to indicate the order of the pitches in a tune. Performance on stimuli containing correlated amplitude and duration were compared with the uni-dimensional condition. Experiment II repeated I, but required intensity to be coded. Experiment III required pitch coding under three conditions including that when amplitude and frequency were uncorrelated, and compared the performance of musically trained sunjects with nonmusicians. Experiment IV repeated III, but subjects were informed of the relation between dimensions. Experiment V involved “shadowing” the tunes by whistling simultaneously with the stimulus.

It was concluded (a) that intercorrelation improves, but zero correlation impairs short-term memory; (b) that knowledge of the relation between dimensions improves performance in the correlated condition, but does not prevent impairment under zero correlation; and (c) the performance of musically trained subjects exceeds that of controls and is unaffected by the presence of a correlated or uncorrelated dimension.