寻找丢失的自我——精神分裂症患者的自我面孔识别

为探索精神分裂症患者自我面孔识别的能力以及在视听整合任务中面孔对声音身份识别(同性和异性)的影响, 选取34名住院精神分裂症患者和26名健康被试, 分别进行单通道动态自我面孔识别任务、单通道自我声音识别任务和视听整合任务的3个实验。结果发现：精神分裂症患者的单通道自我面孔识别能力和自我声音识别能力与健康组无区别, 但在视听整合任务中, 精神分裂症患者的声音身份识别受到视觉通道面孔识别的影响。结果表明, 精神分裂症患者有自我面孔识别的能力, 自我面孔会促进自我声音的识别, 并抑制对同性他人声音和异性他人声音的识别。     

Are cognitive symptoms of schizophrenia mediated by abnormalities in emotional arousal?

We tested 28 individuals with schizophrenia (SZ) and 16 healthy individuals on a test of logical reasoning and "cognitive gating," defined as the ability to discriminate between relevant and irrelevant information in confirming or disconfirming a given belief. The Logical Reasoning and Cognitive Gating Task tests both processes under neutral and affect-laden conditions. This is done by presenting formally identical constructs using benign and emotionally arousing language. When separated by symptom profiles, we found statistically significant differences for performance and arousal response between patients with delusions, patients with formal thought disorder, and patients with neither delusions nor formal thought disorder, as well as between patients and healthy controls. When analyzed by error type, we found that nearly all errors by delusional patients were caused by overly restrictive information choice, a pattern that may be related to a delusional patient's tendency to "jump to conclusions" on Bayesian probabilistic tasks. This is in contrast to patients with formal thought disorder, whose low performance resulted also from overly extensive information choice. The tendencies towards restriction were exacerbated by arousal, which is consistent with studies on cognition and arousal in healthy individuals. After briefly examining research on emotional arousal and SZ, and the interaction between emotional arousal and restriction of perceptual cues in healthy individuals, we conclude by suggesting a model which accounts for the distinctive cognitive characteristics of delusional patients by their possessing distinct vulnerabilities to emotional arousal. Specifically, these results suggest the possibility that delusional patients process information in a manner that is essentially intact. However, delusional patients may possess an acute vulnerability to emotional arousal that might cause delusional individuals to behave cognitively as if they were healthy individuals under significantly more severe forms of stress.     

Suicide prevention in the psychiatric hospital

It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to severe depression. A treatment strategy that differentiated between regressive and progressive therapeutic measures was developed for patients admitted to a psychiatric hospital. Regressive, as opposed to progressive, treatment meant that the patient was temporarily relieved of virtually all responsibilities for self and others. Progressive measures were strictly avoided for all patients with symptoms of depression, regardless of the primary diagnosis. This strategy was tested on 5,149 inpatients and day patients over a period of 6.25 years and compared with 6,891 patients over the 15.75 years prior to this period. The suicide rate was 97 (per 100,000 admissions) compared with 319 in the previous period. The treatment method appears to be able to reduce the suicide rate. Although this result was achieved with hospital patients, it suggests that a regressive treatment method could be promising if developed for outpatient treatment as well.     

Evolving from Clinical to Positive Psychology: Understanding and Measuring Patients’ Strengths: A Pilot Study

Empirical evidence suggests that concentrating on patients’ internal and external strengths serves a preventative function against psychopathology. However, standardized tools assessing strengths of patients suffering from mental disorders are rare and often limited to research purposes. As current practice in mental health rarely stresses the importance of patients’ personal resources, the feasibility of strengths-based assessments has rarely been validated within such a population. We designed a new instrument, the Strengths Q-sort Self-Assessment Scale, aimed at identifying patients’ strengths profile. This new scale measures 30 strengths classified in three sections: (i) personal characteristics, (ii) hobbies/passions, (iii) environmental/social strengths. In order to be adjusted for patients with cognitive or language impairments, this instrument is based on a Q-Sort method with figurative items. The aim of this study was to test the feasibility and acceptability of this scale in a sample of 21 psychiatric patients. Preliminary results showed that this tool can easily be administered and is well appreciated by patients. Feedback from clinicians highlight the benefits of identifying the strengths profiles in order to help defining realistic shared clinical objectives based on patients’ strengths.     

It's either a cook or a baker: patients with conduction aphasia get the gist but lose the trace

Patients with conduction aphasia have been characterized as having a short-term memory deficit that leads to relative difficulty on span and repetition tasks. It has also been observed that these same patients often get the gist of what is said to them, even if they are unable to repeat the information verbatim. To study this phenomenon experimentally, patients with conduction aphasia and left hemisphere-injured controls were tested on a repetition recognition task that required them to listen to a sentence and immediately point to one of three sentences that matched it. On some trials, the distractor sentences contained substituted words that were semantically-related to the target, and on other trials, the distractor sentences contained semantically-distinct words. Patients with conduction aphasia and controls performed well on the latter condition, when distractors were semantically-distinct. However, when the distractor sentences were semantically-related, the patients with conduction aphasia were impaired at identifying the target sentence, suggesting that these patients could not rely on the verbatim trace. To further understand these results, we also tested elderly controls on the same task, except that a delay was introduced between study and test. Like the patients with conduction aphasia, the elderly controls were worse at identifying target sentences when there were semantically-related distractors. Taken together, these results suggest that patients with conduction aphasia rely on non-phonologic cues, such as lexical-semantics, to support their short-term memory, just as normal participants must do in long-term memory tasks when the phonological trace is no longer present.     

Identity matching and oddity learning in patients with moderate to severe Alzheimer-type dementia

Discrimination learning was investigated in patients with moderate to severe Alzheimer-type dementia (AD), comparing their performance with age-matched controls. Four AD patients were trained to criterion on identity matching and then shifted to the same task with novel stimuli. The AD patients showed no savings in learning to match novel stimuli, whereas a comparative group of four control subjects rapidly learned the novel matching discrimination, maintaining criterion performance on the transfer test. A second group of four patients was initially trained on oddity, taking a similar number of trials to reach criterion as the matching group. When these patients were subsequently shifted to the matching task with novel stimuli, they performed substantially worse than the first group of patients who had learned the matching task in the first stage. The lack of positive transfer in the shift between matching to matching suggests that the AD patients solved the identity-matching task on the basis of stimulus-response associations rather than a rule. The presence of negative transfer after shifting from oddity to matching may be explained by a pre-disposition to respond to a novel stimulus that is carried over into the matching task, but this warrants further investigation, as indicated in the discussion.     

Visual imagery and knowledge about the visual appearance of objects in patients with posterior cerebral artery lesions

The purpose of this study was to explore whether patients with left posterior cerebral artery (PCA) lesions have defective mental visual imagery and to differentiate whether such a deficit stems from a loss of knowledge about the visual appearance of objects or from an inability to create mental visual images out of preserved visual knowledge. Normal controls and patients with either left or right PCA lesions were asked to verify low- and high-imagery sentences and then to verify pictorial representations of the predicates of high-imagery sentences. High-imagery questions concerned either the shape or the color of objects. In addition, perceptual discrimination of shape and color was assessed. Patients with right PCA lesions were impaired on the perceptual discrimination tasks. Left PCA patients did not significantly differ from controls on low-imagery sentences but scored significantly lower on shape and color questions. Their impairment was distinctly more severe with the pictorial than with the verbal versions of shape and color questions. In comparison to patients with occipital left PCA lesions, patients with temporo-occipital left PCA lesions were selectively impaired on verbal and visual color questions. It is concluded that patients with left PCA lesions lack knowledge about shape and color of objects, but that their ability to convert visual knowledge into mental images is preserved.     

癌症要告知实情吗？

面对癌症病人,应该不应该告知实情?这是临床医务人员常常面临的问题,目前尚无统一的标准。新的医疗事故处理条例规定、病人得知癌病的途径、临床治疗现状等方面分别论述告知癌症病人实情的理由。探讨了癌症告知策略:面对家属直言相告、面对病人通过交谈了解病人的性格特点、文化层次和情感类型,列举了不同类型的病人告知的方法。论述其告知病情后如何让病人走出误区,消除恐惧,把生存的压力转变成求生的动力,从而达到配合治疗,使病人敢于正视疾病,面对明天可能发生的任何事情。     

Hypnotic susceptibility in patients with conversion disorder

Conversion disorder has been associated with hypnotic susceptibility for over a century and is currently still believed to be a form of autohypnosis. There is, however, little empirical evidence for the relation between hypnotic susceptibility and conversion symptoms. The authors compared 50 patients with conversion disorder with 50 matched control patients with an affective disorder on measures of hypnotic susceptibility, cognitive dissociation, and somatoform dissociation. Conversion patients were significantly more responsive to hypnotic suggestions than control patients. In addition, conversion patients showed a significant correlation between hypnotic susceptibility and the number of conversion complaints. These results provide the first evidence of a relationship between hypnotic susceptibility and the presence and number of conversion symptoms.     

Recognition,recollection, familiarity and executive function in medicated patients with moderate Parkinson's disease

There is conflicting evidence about whether Parkinson's disease (PD) is associated with deficiencies in recognition memory (RM) and the processes which underlie it, namely recollection (a form of recall) and familiarity (a feeling of memory in the absence of recall). The aims of the current study were to examine forced‐choice verbal RM (assessed with the Warrington Recognition memory Test), yes‐no RM, recollection, familiarity and executive functioning in 17 patients with moderate PD and 17 healthy volunteers matched for age and premorbid intelligence. We predicted that patients with moderate PD would display a significant recollection deficit on the yes‐no RM test, because their strategic memory processing that depends on executive functioning and is necessary for efficient encoding and/or retrieval, was disrupted. In contrast, familiarity memory, which is not dependent on these processes, and forced‐choice RM (which is largely dependent on familiarity) should show higher levels of preservation. We also predicted that recollection should be correlated with severity of executive dysfunction. Our findings revealed that the PD patients were as likely to accurately discriminate between targets and distractors as the healthy volunteers on both RM tests. However, the PD patients were significantly less reliant on recollection‐driven recognition decisions on the yes‐no RM test when compared with the healthy control group. The patients also displayed executive function deficits, but these were not correlated with recollection. The extent to which the PD patients' reliance on familiarity at the expense of recollection is explained by impairments in strategic memory processes/executive function and/or medial temporal lobe retrieval processes needs further exploration.     

Deutende Interventionstechniken bei Patienten mit schweren Persönlichkeitsstörungen

The growing influence of ego-psychology, self psychology, object relations theory, and interpersonal concepts on the psychoanalytic psychotherapy of patients with personality disorders is reflected in a preference of relational therapeutic strategies and in a controversial discussion of interpretative techniques. It is shown that interpretative strategies are of invaluable importance in many patients with personality disorders. However, modifications of technique necessary for this group of patients should be considered. Especially, transference interpretation in the here and now can be of great use even in the treatment of patients with severe personality disorders. It is of outstanding relevance for the therapist to understand the interactional message a patients infers from his interpretation and to take into account the patient's reaction to the interpretation.     

Artificial grammar learning in Alzheimer’s disease

Patients with early Alzheimer’s disease (AD) exhibit impaired declarative memory although some forms of nondeclarative memory are intact. Performance on perceptual nondeclarative memory tasks is often preserved in AD, whereas conceptual nondeclarative memory is often impaired. A conceptual nondeclarative learning task that has been studied in amnesic patients is the artificial grammar learning (AGL) task. Healthy participants and patients with impaired declarative memory both acquire information about an underlying rule structure in this task and exhibit the ability to identify rule-conforming items, despite the subjective experience of guessing at the response. In this study, 12 patients diagnosed with early AD were tested on the AGL task and a matched recognition task. The patients were able to reliably distinguish rule-conforming items from others, indicating successful AGL. Performance of the AD patients was impaired, relative to controls, on a similar recognition task, although they were found to use information about the grammaticality of study items in an attempt to improve their recognition performance. The AD patients showed a dissociation similar to that seen in anterograde amnesia: impaired recognition memory in conjunction with successful AGL. This finding suggests that the brain areas that support AGL are not compromised early in the course of AD. In addition, the nondeclarative memory of the AD patients acquired during AGL appeared to influence their performance on a declarative memory task, suggesting an interaction between this nondeclarative memory task and declarative memory.     

活动性肺结核患者生活废弃物处理现状研究

了解居家治疗的活动性肺结核患者生活废弃物的处理现状及认知态度.本研究采用多阶段随机抽样方法,选取720例居家治疗的活动性肺结核病患者,使用自制调查问卷进行回顾性调查,采用多因素回归对居家治疗活动性肺结核病患者生活废弃物处理的影响因素进行分析.研究发现超过半数患者对生活废弃物处理持积极态度,但仅有19.6％的患者能正确处理生活废弃物.Logistic回归分析发现患者对生活废弃物处理的态度、对督导态度以及是否有专人督导是能否正确处理生活废弃物的影响因素.因此,对患者普及生活废弃物处理的意义及方法,加强对患者督导有助于改善居家治疗活动性肺结核病患者生活废弃处理现状,对于预防结核病传播、实施遏制结核病策略具有重要意义.     

Preliminary results of a pilot program on depression in patients with congestive heart failure

While the sample size is too small to warrant conclusions, these preliminary results suggest that assessment of depression would be worthwhile for patients diagnosed with congestive heart failure. 32 out of 54 patients with congestive heart failure scored positive for depression. When psychiatric treatment was given, there was a decrease in depressive symptoms for four of the six patients at the 6-mo, retest. A decrease in depressive symptoms was found for two of the six untreated patients, and the remaining four patients had worse scores on the Zung Depression Inventory. Primary care physicians, who typically meet with such patients regularly, are encouraged to screen for depression, as their clinical assessments in this study were associated with scores on the Zung Depression Inventory. These observations support a full scale investigation with a much larger sample size and a requisite medical cost comparison.     

Psychiatric Symptoms and Quality of Life in Patients Affected by Epidermolysis Bullosa

The aim of our study was to provide a psychosocial and psychiatric evaluation of patients with epidermolysis bullosa (EB; a rare genetic disorder characterized by skin fragility), to assess psychological status, ascertain the presence of any psychiatric disorders and understand the impact of EB on quality of life. Twenty-five patients were assessed using a case record form and several standardized instruments. In 82% of patients, EB had a negative impact on quality of life and 80% of patients experienced psychiatric symptoms. Our findings revealed a high prevalence of psychosocial problems and psychiatric symptoms in patients with EB and suggested that a combined bio-psychosocial approach is the most appropriate therapeutic intervention.     

Effect of Partners’ Disgust Responses on Psychological Wellbeing in Cancer Patients

The aim of this study was to explore quantitatively the relationship between disgust responses in cancer patients and their partners, and in turn their relationship to patients’ psychological well-being. We recruited 50 participants with heterogeneous cancer diagnoses and their partners from cancer-related groups (e.g., charities). Patients completed questionnaires to determine levels of disgust propensity, disgust sensitivity, self-disgust, and symptoms of anxiety and depression. Disgust propensity and sensitivity were also assessed in their partners. Partners’ disgust sensitivity was significantly positively correlated with cancer patients’ self-disgust, disgust propensity, and depression. Path analyses suggested that patients’ self-disgust plays a role in mediating the effect of partners’ disgust sensitivity on patients’ psychological well-being. This study provides the first quantitative evidence that psychological well-being in cancer patients is contingent on their partners’ sensitivity to disgust, and that patients’ self-disgust plays a mediating role. Focusing therapeutically on disgust responses could well be beneficial to people with cancer.     

An advanced specialist-level training programme in psychodynamic individual psychotherapy of psychotic and borderline patients: the Finnish approach

Most training programmes in individual psychotherapy, including psychoanalytic training are, in practice, restricted to the treatmentof lessdisturbed patients than those who have succumbed to psychotic or severely borderline-level disorders. This has had a delaying effect on the development of psychotherapy with such patients. Psychotherapy of severely disturbed patients is usually regarded as a difficult domain and is often practised only by psychoanalysts or other psychotherapists specially dedicated to working with patients of this kind. Between 1994 and 1997, an advanced multi-professional training programme in psychodynamic individual therapy with an emphasis on borderline and psychotic-level disorders was organized through the Centre for Extension Studies of the University of Turku, Finland, to close the gap in systematic training for the treatment of the most serious psychic disorders, and also to integrate some of the special requirements of public and private psychiatric health care. Here we briefly describe the main elements of our training programme as well as some of our training experiences. It is important to emphasize that the training was not meant to replace psychoanalytic training. It is a question of a separate multi-professional programme based on psychoanalytic premises but with particular objectives of its own.     

The MMPI‐2 in chronic psychiatric illness

While previous studies on the MMPI‐2 in patients with schizophrenia and depression have used mixed samples of both early stage and chronic psychiatric patients. Here, it is investigated whether chronicity itself might have a differential effect on the MMPI‐2 profiles of these patients and whether demoralization ‘associated with long‐term illness’ affects the scales of the MMPI‐2. Thirty long‐term patients with schizophrenia, 30 long‐term patients with depression, and 30 healthy participants completed the MMPI‐2. Groups were compared on Clinical Scales and on the Restructured Clinical (RC) Scales. Patients with schizophrenia differed from patients with depression on 14 MMPI‐2 scales and from healthy controls on 10 scales, generally showing mean UT‐scores < 65, indicating a subjective experience of (near) normal functioning. Patients with depression differed from healthy controls on 17 scales mostly with UT‐scores > 65, indicating impaired functioning. Demoralization was higher in patients with depression than in patients with schizophrenia and both psychiatric groups differed from the healthy control group. It is concluded that long‐term patients with depression show impaired functioning and high demoralization, while long‐term patients with schizophrenia surprisingly show near normal functioning and less demoralization.     

Neuropsychological profile in patients with schizotypal personality disorder or schizophrenia

Neuropsychological impairments have been consistently reported in patients with schizophrenia. As little is known whether subjects with schizotypal personality disorder exhibit neurocognitive dysfunction similar to that in schizophrenia, we assessed the neuropsychological profile of 15 subjects with schizotypal personality disorder and compared it with that for 15 patients with schizophrenia and for 15 psychiatrically normal volunteers. All participants were administered a standard neuropsychological battery assessing language ability, spatial ability, visuomotor function, verbal memory, visual memory, auditory attention, visual attention, and executive function. Performance on most of the cognitive domains was impaired in patients with schizotypal personality disorder but less than patients with schizophrenia. Specifically, impairment in verbal memory and visuomotor ability in patients with schizotypal personality disorder and patients with schizophrenia were comparable, while patients with schizophrenia performed worse on the test of executive function than did patients with schizotypal personality disorder. As a whole, cognitive deficits in patients with schizotypal personality disorder were qualitatively similar to, but quantitatively milder than, those for patients with schizophrenia. The results suggest that cognitive abilities related to frontotemporal lobe function are disturbed across these schizophrenia-spectrum disorders.