First-Person Neuroscience: A new methodological approach for linking mental and neuronal states

Though the brain and its neuronal states have been investigated extensively, the neural correlates of mental states remain to be determined. Since mental states are experienced in first-person perspective and neuronal states are observed in third-person perspective, a special method must be developed for linking both states and their respective perspectives. We suggest that such method is provided by First-Person Neuroscience. What is First-Person Neuroscience? We define First-Person Neuroscience as investigation of neuronal states under guidance of and on orientation to mental states. An empirical example of such methodological approach is demonstrated by an fMRI study on emotions. It is shown that third- and first-person analysis of data yield different results. First-person analysis reveals neural activity in cortical midline structures during subjective emotional experience. Based on these and other results neural processing in cortical midline structures is hypothesized to be crucially involved in generating mental states. Such direct linkage between first- and third-person approaches to analysis of neural data allows insight into the "point of view from within the brain", that is what we call the First-Brain Perspective. In conclusion, First-Person Neuroscience and First-Brain Perspective provide valuable methodological tools for revealing the neuronal correlate of mental states.     

The doctor-patient relationship in the post-managed care era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a "post-managed care era," where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

CBT intensity and outcome for panic disorder in a primary care setting

A hybrid efficacy-effectiveness design in which participants (n = 91/93) were retained in the study regardless of whether or not they received treatment enabled evaluation of CBT intensity in relation to panic disorder in the primary care setting. CBT intensity was operationalized as number of cognitive-behavioral therapy sessions, number of follow-up booster phone calls, and secondarily, as number of cognitive behavioral coping and exposure strategies. Baseline psychosocial and demographic predictors of CBT intensity were analyzed first. Severity of anxiety sensitivity predicted number of cognitive behavioral sessions, but no baseline variables predicted number of follow-up booster phone calls or number of coping and exposure strategies. Multivariate logistic and linear regressions were used to evaluate the degree to which treatment intensity predicted 3-month and 12-month outcomes (anxiety sensitivity, phobic avoidance, depressive symptoms, disability, and medical and mental health functioning) after controlling for potential confounding baseline variables. Number of cognitive behavioral therapy sessions predicted lower anxiety sensitivity at 3 and 12 months, and number of follow-up booster phone calls predicted lower anxiety sensitivity, less phobic avoidance, and less depression at 12 months. These findings indicate that "dose" of psychotherapy was an important predictor of outcome. The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment.     

Outcome of patients rehabilitated through a New Zealand forensic psychiatry service: A 7.5 year retrospective study

This paper describes a 7.5 year retrospective study of all patients discharged from inpatient forensic services to forensic community team (FCT) follow-up from the Auckland Regional Forensic Psychiatry Service. Patients' files were studied for clinical, criminal, and risk data, type of service delivered, and final level of function achieved in the community. Rearrest, re-hospitalization, and reimprisonment data were obtained from clinical, court, and prison records.105 patients were included. The most common diagnosis was a psychotic disorder, and index offending behaviour was typically violent. The median period of inpatient stay was 36 months and mean subsequent FCT follow-up 21.7 months (SD 17.8). The majority of patients were from Maori and Pacific Island ethnic groups. At the end of the study, half were in independent living, half were in some form of employment, and 19% were readmitted to a forensic hospital.One patient was rearrested but not reimprisoned whilst under forensic community team care. However, 9 of the 48 who were discharged to general mental health services were rearrested and 5 reimprisoned. Only two offences were as serious as the original index offence.Broad based assertive, mandated, and committed forensic rehabilitation can achieve high quality outcomes. These levels of function may not be sustained under less assertive care.     

Training to use voice onset time as a cue to talker identification induces a left-ear/right-hemisphere processing advantage

We examined the effect of perceptual training on a well-established hemispheric asymmetry in speech processing. Eighteen listeners were trained to use a within-category difference in voice onset time (VOT) to cue talker identity. Successful learners (n=8) showed faster response times for stimuli presented only to the left ear than for those presented only to the right. The development of a left-ear/right-hemisphere advantage for processing a prototypically phonetic cue supports a model of speech perception in which lateralization is driven by functional demands (talker identification vs. phonetic categorization) rather than by acoustic stimulus properties alone.