Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods

Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.     

Shallow versus deep response-dependence

This paper explores a distinction between two types of response-dependence (RD) account (shallow vs. deep). This distinction is inherent in much of the existing literature, however it is neither widely nor well understood, and has never been drawn explicitly. The distinction is often taken to be a metaphysical, or ‘realism-relevant’ one—i.e. deep RD accounts entail qualified realism (or perhaps anti-realism), while shallow RD accounts are metaphysically neutral. I argue that the distinction is not reliably realism-relevant. I formulate a weaker version of the distinction that may help prevent some common and understandable confusion about RD biconditionals and their relationship to realism. The weaker distinction rests on the different roles assigned to RD biconditionals by the two types of account.     

Phonological similarity effects in simple and complex span tasks

Three experiments were conducted to examine the effect of phonological similarity in simple and complex memory span tasks. In Experiment 1, participants performed either a simple or a complex span task, and the memoranda within lists were either phonologically similar or distinct. Phonologically similar lists consisted of words that rhymed.The simple span task was word span. There were two complex span tasks; one was the original reading span task, and the other was a variant of reading span in which all the sentences within a list were contextually related. The classic phonological similarity decrement was observed in word span. In contrast, phonological similarity facilitation was observed in both versions of reading span. This facilitation effect was further investigated in Experiment 2 using two new versions of reading span. In Experiment 2, the sentences in reading span were either short or long, and the memoranda were presented separately from, and were unrelated to, the sentences. Again, words within phonologically similar lists rhymed, and again, facilitation was observed. In Experiment 3, phonological similarity was operationalized in terms of feature overlap, rather than rhyme. The classic phonological similarity decrement was still observed in word span, but facilitation was not observed in complex span. The results suggest that phonological similarity, when operationalized using words that rhyme, serves as a list retrieval cue and that complex span tasks are more dependent on cue-driven memory retrieval mechanisms than are simple span tasks.     

Modulation of N400 in chronic non-fluent aphasia using low frequency Repetitive Transcranial Magnetic Stimulation (rTMS)

Low frequency Repetitive Transcranial Magnetic Stimulation (rTMS) has previously been applied to language homologues in non-fluent populations of persons with aphasia yielding significant improvements in behavioral language function up to 43 months post stimulation. The present study aimed to investigate the electrophysiological correlates associated with the application of rTMS through measurement of the semantic based N400 Event-related brain potentials (ERP) component. Low frequency (1 Hz) rTMS was applied to the anterior portion of the homologue to Broca’s area (pars triangularis), for 20 min per day for 10 days, using a stereotactic neuronavigational system. Twelve non-fluent persons with aphasia, 2-6 years post stroke were stimulated. Six participants were randomly assigned to receive real stimulation and six participants were randomly assigned to receive a blind sham control condition. ERP measures were recorded at baseline, 1 week and 2 months subsequent to stimulation. The findings demonstrate treatment related changes observed in the stimulation group when compared to the placebo control group at 2 months post stimulation indicating neuromodulation of N400 as a result of rTMS. No treatment related changes were identified in the stimulation group, when compared to the sham group from baseline to 1 week post stimulation. The electrophysiological results represent the capacity of rTMS to modulate neural language networks and measures of lexical-semantic function in participants with non-fluent aphasia and suggest that time may be an important factor in brain reorganization subsequent to rTMS.     

The role of the human extrastriate visual cortex in mirror symmetry discrimination: a TMS-adaptation study

The human visual system is able to efficiently extract symmetry information from the visual environment. Prior neuroimaging evidence has revealed symmetry-preferring neuronal representations in the dorsolateral extrastriate visual cortex; the objective of the present study was to investigate the necessity of these representations in symmetry discrimination. This was accomplished by the use of state-dependent transcranial magnetic stimulation, which combines the fine resolution of adaptation paradigms with the assessment of causality. Subjects were presented with adapters and targets consisting of dot configurations that could be symmetric along either the vertical or horizontal axis (or they could be non-symmetric), and they were asked to perform a symmetry discrimination task on the targets while fixating the center of the screen. TMS was applied during the delay between the adapter and the test stimulus over one of four different sites: Left or Right V1/V2, or left or right dorsolateral extrastriate cortex (DLO). TMS over both Left and Right DLO reduced the adaptation effect in detecting vertical and horizontal symmetry, although the Left DLO effect on horizontal symmetry and the Right DLO effect on both vertical and horizontal symmetry were present only when considering subjects who showed a behavioral adaptation effect in the baseline No-TMS condition. Application of TMS over the Left or Right V1/V2 did not modulate the adaptation effect. Overall, these data suggest that both the Left and Right DLO contain neuronal representations tuned to mirror symmetry which play a causal role in symmetry discrimination.     

An Assessment of Time Involved in Pre-test Case Review and Counseling for a Whole Genome Sequencing Clinical Research Program

Whole genome sequencing (WGS) is being used for evaluation of individuals with undiagnosed disease of suspected genetic origin. Implementing WGS into clinical practice will place an increased burden upon care teams with regard to pre-test patient education and counseling about results. To quantitate the time needed for appropriate pre-test evaluation of participants in WGS testing, we documented the time spent by our clinical research group on various activities related to program preparation, participant screening, and consent prior to WGS. Participants were children or young adults with autism, intellectual or developmental disability, and/or congenital anomalies, who have remained undiagnosed despite previous evaluation, and their biologic parents. Results showed that significant time was spent in securing allocation of clinical research space to counsel participants and families, and in acquisition and review of participant’s medical records. Pre-enrollment chart review identified two individuals with existing diagnoses resulting in savings of $30,000 for the genome sequencing alone, as well as saving hours of personnel time for genome interpretation and communication of WGS results. New WGS programs should plan for costs associated with additional pre-test administrative planning and patient evaluation time that will be required to provide high quality care.