Use of Genetic Tests among Neurologists and Psychiatrists: Knowledge,Attitudes, Behaviors,and Needs for Training

This study explores neurologists’ and psychiatrists’ knowledge, attitudes, and practices concerning genetic tests. Psychiatrists (n?=?5,316) and neurologists (n?=?2,167) on the American Medical Association master list who had agreed to receive surveys were sent an email link to a survey about their attitudes and practices regarding genetic testing; 372 psychiatrists and 163 neurologists responded. A higher proportion of neurologists (74 %) than psychiatrists (14 %) who responded to the survey had ordered genetic testing in the past 6 months. Overall, most respondents thought that genetic tests should be performed more frequently, but almost half believed genetic tests could harm patients psychologically and considered legal protections inadequate. Almost half of neurologists (49 %) and over 75 % of psychiatrists did not have a genetics professional to whom to refer patients; those who had ordered genetic tests were more likely than those who did not do so to have access to a genetic counselor. Of respondents, 10 % had received patient requests not to document genetic information and 15 % had received inquiries about direct-to-consumer genetic testing. Neurologists reported themselves to be relatively more experienced and knowledgeable about genetics than psychiatrists. These data, the first to examine several important issues concerning knowledge, attitudes and behaviors of neurologists and psychiatrists regarding genetic tests, have important implications for future practice, research, and education.     

Social Cognition in Multiple Sclerosis: a Meta-Analysis

Multiple sclerosis (MS) is associated with cognitive decline and impairment in social functioning. Accumulating evidence suggests that patients with MS are impaired in social cognition, including theory of mind (ToM) and emotion recognition. In this meta-analysis of 24 studies, facial emotion recognition and ToM performances of 989 patients with MS and 836 healthy controls were compared. MS was associated with significant impairments with medium effect sizes in ToM (d?=?0.57) and facial emotion recognition (d?=?0.61). Among individual emotions recognition of fear and anger were particularly impaired. The severity of social cognitive deficits was significantly associated with non-social cognitive impairment. These deficits in social cognition may underpin difficulties in social functioning in MS. However, there is a need for further studies investigating the longitudinal evolution of social cognitive deficits and their neural correlates in MS.     

In Search of a Conceptualization of Multiple Sclerosis: A Historical Perspective

A thorough understanding of Multiple Sclerosis (MS) is necessary to offer individuals informed options for treatment and planning. To assist in this quest, the following historical analysis examined how MS has been conceived from the 14th century through the early 20th century. Primary sources were consulted whenever possible, and many of the original archival materials were accessed by the first author (MB) during an on-site visit to the Rare Book Room of the New York Academy of Medicine. There is a striking similarity between how MS symptoms have presented throughout history compared with the 21st century. Sensorimotor and cognitive sequelae have been observed in patients since the 1800s. Cognitive symptoms were acknowledged in the 1800s, but disregarded in the early 1900s and were not given recognition again until the latter part of the 20th century. If conceptualizations of MS are inaccurate, patients will not be served well. In contrast to the shared symptomatology across time, early conceptualizations of etiology and treatment choices differed dramatically from today, a genuine reflection of the times in which they were created.     

What Do We Know About Neuropsychological Aspects Of Schizophrenia?

Application of a neuropsychological perspective to the study of schizophrenia has established a number of important facts about this disorder. Some of the key findings from the existing literature are that, while neurocognitive impairment is present in most, if not all, persons with schizophrenia, there is both substantial interpatient heterogeneity and remarkable within-patient stability of cognitive function over the long-term course of the illness. Such findings have contributed to the firm establishment of neurobiologic models of schizophrenia, and thereby help to reduce the social stigma that was sometimes associated with purely psychogenic models popular during parts of the 20th century. Neuropsychological studies in recent decades have established the primacy of cognitive functions over psychopathologic symptoms as determinants of functional capacity and independence in everyday functioning. Although the cognitive benefits of both conventional and even second generation antipsychotic medications appear marginal at best, recognition of the primacy of cognitive deficits as determinants of functional disability in schizophrenia has catalyzed recent efforts to develop targeted treatments for the cognitive deficits of this disorder. Despite these accomplishments, however, some issues remain to be resolved. Efforts to firmly establish the specific neurocognitive/neuropathologic systems responsible for schizophrenia remain elusive, as do efforts to definitively demonstrate the specific cognitive deficits underlying specific forms of functional impairment. Further progress may be fostered by recent initiatives to integrate neuropsychological studies with experimental neuroscience, perhaps leading to measures of deficits in cognitive processes more clearly associated with specific, identifiable brain systems.     

Cognitive assessment in Chinese patients with aneurysmal subarachnoid hemorrhage

A subgroup of patients who survive aneurysmal subarachnoid hemorrhage (SAH) may have significant cognitive deficits. The aim of the current study was to determine the efficiency of cognitive tests and frequency of cognitive impairments associated with aneurysmal SAH in Chinese. A series of 116 patients with aneurysmal SAH were assessed before surgery. Only 37 patients have completed all tests. The other 79 patients had discontinued because of their clinical conditions, recurring severe headaches, refusing or misunderstanding due to low education. We found that one or more cognitive functions were impaired in 70.3% of the 37 patients, SAH patients were especially impaired in functions that are related to visual reproduction, verbal fluency, and executive functions. The results suggest that the patients have impressive cognitive deficits after aneurysmal SAH. A battery of appropriate cognitive tests should be developed for use by doctors and nurses.     

Neuropsychological profile of multiple sclerosis

Multiple Sclerosis (MS) is the most common non-traumatic neurological disorder among young and middle-aged people. The aim of the present study was to examine the cognitive functioning of a group of MS patients. A sample of 80 participants diagnosed with MS and 40 controls received a comprehensive neuropsychological battery. Participants with MS scored lower than controls on all of the neuropsychological tests and significantly lower (p < .05) on 84% (16/19) of them. The global neuropsychological profile of the MS group included deficits in executive function, speed of information processing, memory, visuo-spatial abilities and attention. Cognitive deficits are one of the main symptoms of MS. Recognition of these deficits is relevant both to the diagnosis and rehabilitation of this disorder.     

Cognitive impairment in the early phase of multiple sclerosis and its relationship with mood, demographic and clinical variables

Our aim was to study cognitive performance in the early phase of MS. In addition, we studied whether depression, demographic and clinical variables differentiate cognitively impaired patients from non-impaired patients. A group of 52 MS-RR patients with mild level of neurological disability and 51 healthy controls were administered a comprehensive neuropsychological battery. The MS group performed significantly worse on several measures of attention and processing speed and visuoperceptive/visuoconstructive tasks. Verbal memory is characterized by working memory deficits, whereas the visual memory impairment is attributable to deficits in acquisition and consolidation/recuperation. Results shows that cognitive impairment is evident even in MS patients in the early course of their disease. Depression scores were higher in cognitively impaired patients as compared with unimpaired patients. The effect of educational level suggests that higher education delays the onset of cognitive decline.     

汉语发展性阅读障碍亚类型的初步探讨

以阅读水平匹配组为参照对29名汉语发展性阅读障碍儿童的认知缺陷模式进行了分析,并考察了不同亚类型阅读障碍儿童的汉字识别模式。结果表明汉语发展性阅读障碍存在不同的亚类型,以语音缺陷型、快速命名缺陷型及两者结合的双重缺陷型为主,与英语国家研究中的双重缺陷假设一致。语音缺陷型儿童汉字识别时有更多的语义错误,对声旁中的部分语音线索不敏感;快速命名缺陷型儿童汉字识别时依赖声旁语音线索,表现出阅读发展的一般延迟;双重或多重认知缺陷型是阅读损伤最严重的亚类型     

阅读障碍与注意缺陷多动障碍儿童的语言加工和反应抑制

阅读障碍与注意缺陷多动障碍(ADHD)高度共病,以往研究结果显示两种障碍在语言加工、执行功能等领域的缺陷既相似又不同。本研究采用语音意识测验、快速命名测验、语素意识测验和停止信号任务,以及阅读广度测验,分别考察四组被试（阅读障碍组、ADHD组、双重障碍组、正常控制组）的基础语言加工、反应抑制和言语工作记忆能力,结果发现：阅读障碍组和双重障碍组在语言加工任务上的成绩均显著差于ADHD组和正常组;ADHD组和双重障碍组在停止信号任务上的成绩显著差于阅读障碍组和正常组;所有障碍组在阅读广度测验上的成绩显著差于正常组。表明阅读障碍的特异性缺陷体现在语言加工过程上,而注意缺陷多动障碍的特异性缺陷体现在反应抑制上。这对于今后单一障碍的研究及临床诊断和干预具有重要的参考价值。     

The mortality of psychoanalysts

The mortality rate for male psychoanalysts was compared to that for the general white male population; for male physicians; and for male psychiatrists and neurologists. For psychoanalysts the rate was found to be significantly lower than for any of the other three groups. Several possible explanations for this low mortality rate are considered. Two major factors may be the careful screening of candidates for psychoanalytic training and their personal analysis. Possible methods of controlling for these factors are suggested.     

抑郁症的脑功能整合异常-来自有效连接的证据

摘 要：抑郁症是一种常见的精神障碍。从疾病负担看,目前抑郁症已经成为世界第四大疾病,患病人数呈逐年上升的态势,给家庭和社会带来了沉重的负担。以往大多数对抑郁症的研究关注的是单个脑区结构或功能的损伤,而抑郁症通常伴随多脑区、多系统的异常,而不是单一脑区的损伤。近年来研究者开始关注抑郁症多个脑区之间的功能整合。利用功能整合的方法,动态监测抑郁症多个脑区间的相互作用,能进一步揭示抑郁症的脑网络机制。功能整合的研究方法主要包括功能连接和有效连接。有效连接刻画的是两个（或多个）脑区之间相互作用的因果关系,主要包括结构方程模型、动态因果模型、Granger 因果分析、生理心理交互作用等方法。通过对新近研究的梳理,总体而言,抑郁症的认知控制系统(如背外侧前额叶)和边缘系统（如杏仁核）的之间的有效连接减弱,即背外侧前额叶对杏仁核的抑制作用减弱,使得杏仁核对负性刺激的反应增强,出现了情绪加工偏差和认知偏差。认知控制系统和边缘系统之间有效连接的减弱能够解释抑郁症执行认知控制任务和情绪任务中的异常表现。     

What phonological deficit?

We review a series of experiments aimed at understanding the nature of the phonological deficit in developmental dyslexia. These experiments investigate input and output phonological representations, phonological grammar, foreign speech perception and production, and unconscious speech processing and lexical access. Our results converge on the observation that the phonological representations of people with dyslexia may be intact, and that the phonological deficit surfaces only as a function of certain task requirements, notably short-term memory, conscious awareness, and time constraints. In an attempt to reformulate those task requirements more economically, we propose that individuals with dyslexia have a deficit in access to phonological representations. We discuss the explanatory power of this concept and we speculate that a similar notion might also adequately describe the nature of other associated cognitive deficits when present.     

Examining the Link Between Hoarding Symptoms and Cognitive Flexibility Deficits

Executive functioning deficits have been found to underlie primary symptoms of hoarding, such as difficulty discarding belongings and significant clutter. Cognitive flexibility—the ability to inhibit irrelevant material and attend flexibly between different mental sets—may be impaired as well, as individuals experience difficulty staying on task and are often distracted by specific possessions that tend to evoke an exaggerated emotional response. The present study investigated cognitive flexibility deficits via eye-tracking technology as a novel approach. Participants (N = 69) with high and low self-reported hoarding symptoms were asked to respond to a series of auditory cues requiring them to categorize a small target number superimposed on one of three distractor image types: hoarding, nature, or a blank control. Across a range of behavioral and eye-tracking outcomes (including reaction time, accuracy rate, initial orientation to distractors, and viewing time for distractors), high hoarding participants consistently demonstrated greater cognitive inflexibility compared to the low hoarding group. However, high hoarding participants did not evidence context-dependent deficits based on preceding distractor types, as performance did not significantly differ as a function of hoarding versus nature distractors. Current findings indicate a pervasive, more global deficit in cognitive flexibility. Those with hoarding may encounter greater difficulty disengaging from previous stimuli and attending to a given task at hand, regardless of whether the context of the distractor is specifically related to hoarding. Implications and future directions for clarifying the nature of cognitive inflexibility are discussed.     

An intimate connection: Oliver Zangwill and the emergence of neuropsychology in Britain

In this article, the author argues that a number of conditions conspired to place the Cambridge psychologist Oliver Zangwill in a pivotal position for pursuing and promoting neuropsychology in Britain after World War II. In broad terms, these were the background and experience of Zangwill himself, the practical engagement of psychologists with patients with brain damage, neurologists, and psychiatrists, the introduction of medical reform including the establishment of a National Health Service, rekindled interest in cortical localization, and the elite social networks that existed in medicine and university life in postwar Britain. The author claims that the career of Zangwill reveals rather than obscures the importance of these wider conditions and demonstrates an unusually close connection between an individual and the emergence of a subdiscipline.     

Investigating the role of alexithymia on the empathic deficits found in schizotypy and autism spectrum traits

Alexithymia, the inability to identify and describe one’s emotional experience, is elevated in many clinical populations, and related to poor interpersonal functioning. Alexithymia is also associated with empathic deficits in individuals with autism spectrum disorders. Accordingly, a better understanding of alexithymia could elucidate the nature of social-cognitive deficits transdiagnostically. We investigated alexithymia and components of empathy in relation to schizotypal and autism spectrum traits in healthy college students. Specifically, we examined higher-order components of empathic processing that involve perspective taking and other-oriented concern, which are reduced in alexithymia.Higher-order empathic processing was inversely correlated with both schizotypal and autism spectrum traits. Bootstrapping techniques revealed that alexithymia had a significant indirect effect on the relationship between higher-order empathy and these personality traits; thus, alexithymia contributes uniquely to their relationship. These findings suggest alexithymia represents one possible mechanism for the development of empathic deficits in these populations.These results are consistent with the perspective that awareness of one’s own emotional state may predicate a successful empathic response to another’s. This work highlights the importance of a consideration of alexithymia in elucidating the nature of empathic deficits in various clinical populations, and points to a potential point of social intervention.     

Dementia in Parkinson disease: A neuropsychological analysis

An extensive set of neuropsychological measures was administered to 60 Parkinson's disease patients and age-, sex-, and education-matched controls in order to investigate the nature and prevalence of the cognitive deficit in the disease. Parkinsonian patients performed significantly poorer on all measures with the exception of tests for apraxia and object recognition, and on a test of vocabulary knowledge. Discriminant analysis of the test data revealed that over 93% of patients are impaired relative to matched controls, but that assigning a prevalence rate for dementia in the disease may be difficult due to the continuous distribution of cognitive deficits.     

Why the Brits are in two minds about therapy

Professor Frank Furedi is the author of a number of popular sociological discourses with a common theme that can be broadly summarised as betraying discomfort with 21st century western society's preoccupation with risk management. In this article, his arguments concerning the nature of what he calls 'therapy culture' are deconstructed for their essential conservative bias and persistent misunderstanding of the nature of modern psychological therapy. Three years ago, Furedi characterised counselling as 'one of the biggest cons of modern life' in conversation with the Health Editor of the Independent newspaper. My text highlights (1) the paucity of his evidence for this assertion and (2) his misguided grasp of the thrust of therapy since counselling is a difficult option whose sole goal is the stronger individualism and independence of the client—qualities he otherwise claims to admire.     

Neurological disorders and the structure of human consciousness

Recent studies that identify distinct neural correlates of perceptual awareness offer a promising step towards improved understanding of the neurological underpinnings of conscious experience. Such studies indicate that perceptual awareness is modular in nature, with neural correlates of awareness consisting of the specialized structures involved in perceptual processing. However, the integrative, multimodal nature of conscious experience appears to require a functional architecture that overcomes this modular segregation of function. We propose a model in which experience emerges from the dynamic interactions of specialized component processes via a distributed neural network. Such a model offers a mechanism to explain several empirical observations of the neural correlates of perceptual awareness, cognitive function, and symptoms of neurological damage.