Psychopathology of progressive paralysis. Remarks on some personal cases

Four of our own cases that presented a clinical picture of dementia are discussed. A study of the relative literature has failed to reveal any "swing" in the pattern of the clinical condition: Just as it did ninety years age, paralytic dementia accounts today for well over 60% of all cases, those clinical pictures erroneously regarded as "typical" "classic", accounting for a mere 10%-15% of cases. The need for routine lues serology is pointed out.     

Rubinstein-Taybi syndrome.

Rubinstein-Taybi Syndrome was first described in 1957 but only in 1963 as a distinguishable type of moderate mental retardation. The cause is still unknown although some type of genetic origin is possible. No consistent chromosomal abnormality has been demonstrated, the chromosomal analysis is normal, and cases are generally not considered hereditary. The recurrent risk for siblings is approximately 0.1% but may be as high as 50% for offspring of patients with the syndrome. The Rubinstein-Taybi syndrome is not at present detectable before birth and is evenly found in both males and females. The syndrome was thought to be rare but an increase in the number of reported cases each year suggests it is not as rare as estimated. It is thought to occur in about 1 in 300,000 births, and since it has become readily identifiable, more than 400 cases have been reported worldwide.     

Role of specific similarity in a medical diagnostic task.

Three experiments are reported showing that diagnosis of skin disorders by medical residents and general practitioners was facilitated by similar cases previously seen in the same context. Diagnosis of similar cases was facilitated more than that of dissimilar cases in the same diagnostic category, demonstrating that facilitation was not solely due to activation of the diagnostic category as a whole. Because diagnosis was posed in a multiple-choice format that always included the correct diagnosis, the relative disadvantage of dissimilar items was not due to the unavailability of the category name. The similarity effect also occurred with 2-week delay between the initial case and the test cases. Variations in diagnostic procedure, ranging from giving a quick first impression to arguing for given alternative diagnoses before selection, did not interact with the effect of similarity. This result suggests that the similarity effect is not strongly dependent on a particular diagnostic strategy.     

Correspondence between outcomes of brief and extended functional analyses.

We compared results obtained from 50 sets of functional analysis data from assessments of self-injurious behavior (SIB), 35 of which showed clear response patterns and 15 of which were undifferentiated, with those obtained from two abbreviated methods of assessment: (a) a brief functional analysis, consisting of the first session of each condition from the full functional analysis, and (b) a within-session analysis, in which data from the brief analysis were regraphed to show minute-by-minute changes in response rates during a session. Results indicated that outcomes of the brief and within-session analyses corresponded with those of the full functional analyses in 66.0% and 68.0% of the cases, respectively. Further examination of results indicated a tendency for the brief analysis to identify a large proportion of positive cases (both true and false positives) and for the within-session analysis to identify a large proportion of negative cases (true and false negatives).     

Lesion localization of phonological agraphia.

Phonological agraphia is a neurolinguistically specific profile of spelling impairment. It is characterized by an impairment in spelling pronounceable pseudowords ('sild') and by an impairment in spelling real words related to their familiarity, length, and often, part of speech (Shallice, 1981; Roeltgen, 1985; Bub & Chertkow, 1988). We report two cases of phonological agraphia, each with a different lesion profile. Analysis of the small number of published cases that include lesion data, plus our own cases, suggests that phonological agraphia can be produced by lesions in a wide range of perisylvian cortical regions that have in common some role in central phonological processes.     

γ-Hydroxybuttersäure (GHB) als K.O.-Mittel und sexuelle Delinquenz

Especially γ- Hydroxybutyric acid (GHB, ?Liquid Ecstasy“) and its precursors γ-Butyrolakton (GBL) and 1,4-Butandiol (BDO) which are transformed to GHB in humans, have been observed as knock-out substances with sexual offences. A low single dose GHB (adults about 1–2 g per os) to a person that is not used to take GHB can have a mild exhilarating, euphoric, anxiolytic, and relaxing effect. With increasing dosage (from 2,5 g) drowsiness, vertigo, nausea, vomiting, disorientation, agitation, myoclonia, and bradycardia will arouse. A dosage of 3–4 g per os (adults) results in consciousness and respiratory depression within minutes. A dosage of 4–5 g can cause a comatous state. In 2008 22 sexual offence cases with hints for the use of narcotics were examined in our toxicological laboratory: blood and urine samples in 11 cases, blood only in 7 cases, urine samples only in 4 cases. The average time interval between the offence and blood taking was 6.2 hrs, and between offence and giving an urine sample 14.6 hrs. A GHB concentration higher than the physiological level could not be detected in any of the cases. In 12 cases cannabinoides (n?=?7), amphetamine (n?=?2), cocaine (n?=?1), diazepam (n?=?3) as well as fluoxetin, citalopram, and dihydrocodein (n?=?1 each) could be detected. With a very short half life of GHB and its precursors a fast collecting of blood and urine is essential, when it is believed that GHB had been used. In these cases also a good and proper interview of the victim is of significant importance, especially concerning the phase of the intoxication as well as the recovery phase.     

Scopophilia and object loss.

The study of a case of voyeuristic perversion and of some previously published cases of simple scopophilia suggests that fear of object loss early in life may be an important factor predisposing one to a propensity for voyeurism. The increased need to maintain visual contact with the object and to incorporate it visually leads to a hypercathexis of the visual function which is at the base of voyeurism. This need later becomes sexualized, while still retaining its pregenital connotations. Although object loss was apparently significant in the case of the patient described in this paper, it is not necessarily a factor in all cases of perverse voyeurism and, when present, may be considered as only one element in its pathogenesis.     

Outcomes of systemic/strategic team consultation: I. Overview and one-month results

This is the first in a series of reports on an experimental, small-sample study of systemic/strategic team consultations. This report describes a "Milan-informed" method of team consultation for resolving therapy impasses. It then focuses on the initial one-month outcomes from the larger 3-year project. Eleven therapists were asked to select two ongoing cases matched for difficulty. While all cases continued in regular therapy, one of each therapist's cases was also selected at random to participate in a systemic/strategic, five-part team consultation. Analyses of one-month follow-up data showed that clients who participated in the team consultation were more likely to achieve their main and overall treatment goals than clients who received only regular therapy (p's less than .05, eta2 as a measure of effect size ranging from 32% to 41%). The strong findings of this initial study encourage more widespread use of team consultations as a context for treatment, training, and research.     

D. Z. Phillips and reasonable belief

As an illustration of what Phillips called the “heterogeneity of sense,” this essay concentrates on differences in what is meant by a “reason for belief.” Sometimes saying that a belief is reasonable simply commends the belief’s unquestioned acceptance as a part of what we understand as a sensible outlook. Here the standard picture of justifying truth claims on evidential grounds breaks down; and it also breaks down in cases of fundamental moral and religious disagreement, where the basic beliefs that we hold affect our conception of what counts as a reliable ground of judgment. Phillips accepts the resultant variations in our conceptions of rational judgment as a part of logic, just as Wittgenstein did. All objective means of determining the truth or falsity of an assertion presume some underlying conceptual agreement about what counts as good judgment. This means that the possibility of objective justification is limited. But no pernicious relativism results from this view, for as Wittgenstein said, “After reason comes persuasion.” There is, moreover, a non-objective criterion of sorts in the moral and religious requirement that one be able to live with one’s commitments. In such cases, good judgment is still possible, but it differs markedly from the standard model of making rational inferences.     

Use of the analyst as a fetish.

In some cases a gratifying transference fantasy is the subject of progressive analytic work, while in other cases the same type of fantasy eludes investigation, and its enactment causes treatment to become an unproductive endless task. One cause for the latter difficulty can be that the patient uses his or her analyst as a fetish, permitting the distinction between reality and fantasy to remain inconclusive, so that relinquishment of magical expectations does not take place. The particular form of thinking involved in use of the analyst as a fetish is described. The role of illusion, its various clinical manifestations, the countertransference reactions they can evoke, and the technical problems posed are discussed. Special attention is given to the crucial issue of termination. By considering extreme instances in which use of the analyst as a fetish predominates, the author hopes to call attention to a phenomenon that appears to some degree in many, if not all, analyses.     

Intention and Permissibility: T. M. Scanlon

It is clearly impermissible to kill one person (or refrain from giving him treatment that he needs in order to survive) because his organs can be used to save five others who are in need of transplants. It has seemed to many that the explanation for this lies in the fact that in such cases we would be intending the death of the person whom we killed, or failed to save. What makes these actions impermissible, however, is not the agent's intention but rather the fact that the benefit envisaged does not justify an exception to the prohibition against killing or the requirement to give aid. The difference between this explanation and one appealing to intention is easily overlooked if one fails to distinguish between the prospective use of a moral principle to guide action and its retrospective use to appraise the way an agent governed him or herself. Even if this explanation is accepted, however, it remains an open question whether and how an agent's intention may be relevant to the permissibility of actions in other cases.     

Legal trends in bioethics.

Directives given in advance of need and substituted consent cases include: the New York trial court that denied the request of a patient's son for an order revoking the health care proxy his mother had given to his sister, the tape-recorded telephone conversation between the son and his mother was ruled to be insufficient evidence of the mother's desire to revoke the proxy, the mother was not fully responsive or articulate enough to convey her thoughts concerning the proxy. By the end of 1991, all states except Pennsylvania and Nebraska had enacted some form of advance directive legislation. The article highlights legislation from Arizona, California, Connecticut, Illinois, Hawaii, Louisiana, Nevada, New Hampshire, New Jersey, North Carolina, Ohio, and Virginia. A study from Mount Sinai School of Medicine in New York comparing the views of surrogate decision makers with the decisions of currently competent, chronically ill, elderly patients found that surrogates were unable to predict the patients' wishes about resuscitation. AIDS developments include: The Centers for Disease Control (CDC) abandoning its plan to publish a list of categories of exposure-prone invasive procedures. The appropriation bill for the Treasury, Postal Service and General Government requires that states adopt CDC's guidelines or their equivalent within one year, or risk losing all Public Health Service funding. The article highlights 2 court cases relating to AIDS questions. The section on assisted suicide discusses the medical license suspension of Jack Kevorkian and his "suicide" machine. On the discontinuation of treatment, the authors discuss several court cases. patients' rights examples include the Washington State decision imposing a duty on the examining doctor to disclose abnormal test results to the person being examined, regardless of whether a doctor-patient relationship exists. Other topics include reproductive issues, the right to treatment, and treatment refusals.     

Parameterization of connectionist models.

We present a method for estimating parameters of connectionist models that allows the model's output to fit as closely as possible to empirical data. The method minimizes a cost function that measures the difference between statistics computed from the model's output and statistics computed from the subjects' performance. An optimization algorithm finds the values of the parameters that minimize the value of this cost function. The cost function also indicates whether the model's statistics are significantly different from the data's. In some cases, the method can find the optimal parameters automatically. In others, the method may facilitate the manual search for optimal parameters. The method has been implemented in Matlab, is fully documented, and is available for free download from the Psychonomic Society Web archive at www.psychonomic.org/archive/.     

Experimental evidence for a minimalist account of English resumptive pronouns.

In this article we provide evidence for a Minimalist account of English-type resumptive pronouns. Our findings provide empirical support for syntactic theories that, like Minimalist accounts, allow for competition among derivations. According to our account, resumptive pronouns are spell-outs of traces. For reasons of economy, the resumptive pronoun surfaces only when the derivation with the trace is precluded by syntactic principles. This account predicts that resumptive pronouns should only improve violations of constraints on representation, and not violations of constraints on movement. We tested this prediction by conducting an acceptability judgment task with 36 native speakers of English. The results bore out our prediction; subjects preferred the resumptive pronoun over the trace in cases where the trace itself was illicit, but not in cases where only the movement operation was illicit.     

Race, income, and perceptions of the U.S. court system

This article reports on the effect of income within race on African Americans' perception of the courts. Our findings are somewhat consistent with the previous research on black middle-class relative dissatisfaction with various American institutions. That is, unlike whites and Latirios in our study, we find that higher-income African Americans are more skeptical of the notion that blacks receive equal treatment in the courts. This same group also reported less confidence in the court's handling of specific types of cases (e.g., civil, criminal and juvenile delinquency cases.) However, better off blacks were more likely than poor blacks to have confidence in the U.S. Supreme Court and community courts. These findings point a more complex account of African American perceptions of the courts, an account that draws a distinction between diffused and specific support of the courts.     

Determinants of attentive blank stares. An EFRP study

Attentive blank stares mean a failure to notice changes in a visual scene, despite looking at the area of change (Caplovitz, Fendrich, & Hughes, 2008). In this research project we have shown that people differ in terms of attentive blank stare incidences. Novices tend to fail to notice changes in the target area more often than experts. This effect is greater in persons with low visual working memory capacity (VWMC) than with high VWMC. In addition, in a group of novices with low VWMC, attentive blank stares are more frequent compared to a group with high VWMC. Attentive blank stares did not disappear even after the high VWMC group were given expertise training. With the method of eye-fixation-related potentials (EFRP) we analyzed the amplitude of lambda response, which may reflect the state of the attentional system, during encoding information about a change, prior to a decision whether a change has occurred or not. We demonstrate that the cases of attentive blank stares are accompanied by significantly lower amplitude of the lambda response compared with cases involving change detection. In addition, we discovered greater lambda responses in a group with expertise who noticed the change than in novices. The EFRP record coming from occipital electrodes in the 80–180 ms window function was marked by left-sided asymmetry in the cases of change detection and by right-sided asymmetry in the cases of attentive blank stares.     

Aphasia in left-handers. Comparison of aphasia profiles and language recovery in non-right-handed and matched right-handed patients.

The present retrospective analysis reports two studies. In Study 1, clinical aspects of aphasia are compared in right-handed (RH) and non-right-handed (NRH) patients; in Study 2, recovery from aphasia is compared in RH and NRH aphasic patients with a minimum of 5 months of daily language rehabilitation. From a continuous series of 1200 brain-damaged subjects, 24 NRH patients with a vascular lesion documented by computerized tomography were selected. In 19 cases the lesion was in the left hemisphere and in 5 cases in the right hemisphere. For 14 NRH patients, a RH subject with similar lesion, matched for age, education, length of illness, etiology (ischemic vs. hemorrhagic), and, when possible, sex was found. Presence and type of aphasia were compared in the two patients of the same pair and were found similar except for Pair 14; the RH subject had global aphasia and the NRH had conduction-like aphasia. Fifteen NRH patients were rehabilitated and reexamined at least 5 months after the first examination. Recovery of the 12 patients with a left-hemisphere lesion was compared with recovery of a group of RH subjects and no significant differences were found. Recovery of the three patients with right-hemisphere lesions is described. It is concluded that differences in type of aphasia and recovery between RHs and NRHs have been overemphasized in the past and must be reconsidered.     

High rates of paraquat-induced suicide in southern Trinidad.

The suicide rate in Trinidad and Tobago is much greater than that of its English-speaking Caribbean neighbors. Many of these suicides are paraquat induced. This research reviewed the deaths due to suicide in the area with the greatest agricultural activity in Trinidad for 1996 and identified, for further demographic and etiological investigation, cases in which paraquat was ingested as the agent of suicide. Of 48 cases of suicide for the year, 39 (81.3%) were due to paraquat poisoning. The incidence of paraquat-induced suicide was 8.0 per 100,000. Among the males, 47.8% were in the age group 25-34 (p < 0.001), and among the females 50.0% were in the 15-24 age group (p < 0.05). Family-of-origin disputes were the most frequently cited precipitant, followed by marital problems. Individuals of East Indian origin accounted for 89% of the suicide victims (p < 0.001). When compared with suicide by other methods in the country, these findings confirm that paraquat poisoning is a significant means of suicide in Trinidad and that young East Indian individuals are particularly vulnerable.     

Virtual environments for motor rehabilitation: review.

In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.     

Injury control. A promising field for psychologists.

Injury is the fourth leading cause of death for all Americans and the most frequent cause of death for those from age 1 to 45. Moreover, injury is associated with higher treatment costs and with greater lost life-years than the other three leading causes of death. Traffic accidents are the leading cause of severe brain injury, including most paraplegic and quadriplegic cases. Because injury control is essentially psychological, there are many opportunities for psychologists to contribute, both to scientific research on the causes of injury and to clinical interventions for injury control.