Managed Mental Health Care: Intentional Misdiagnosis of Mental Disorders

Managed health care regulations affect the manner in which counselors provide and deliver services. Counselors are challenged by ethical and legal dilemmas when diagnostic codes in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) are not honored for insurance reimbursement. In this article, the authors examine violations of codes of ethics and legal statutes and the consequences related to intentional misdiagnosis of mental disorders for reimbursement. They explore implications for counselors and offer suggestions for professional conduct.     

Speech rate as a sticky switch: a multiple lesion case analysis of mutism and hyperlalia

Though it has long been known on the basis of clinical associations and serendipitous observation that speech rate is related to mood and psychomotor baseline, it is less known that speech rate is also related to libido and to immune function. We make the case for a bipolar phenomenon of "psychic tonus," encompassing all these dimensions. The elated, agitated, libidinal, immunofacilitated, and talkative pole is an "approach" disposition primarily activated by the normal left hemisphere-especially, though not exclusively, its frontal lobe. The dejected, lethargic, delibidinized, immunosuppressed, and mute pole is an "avoidance" disposition primarily activated by the normal right hemisphere-especially, though not exclusively, its frontal lobe. In support of this proposed model, we present new evidence, via meta-analysis of previously published single lesion case reports, of a highly significant association between right hemisphere lesions and non-aphasic hyperlalia, and between left hemisphere lesions and non-aphasic mutism.     

Autonomic correlates of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children

Numerous studies have revealed autonomic underarousal in conduct-disordered adolescents and antisocial adults. It is unknown, however, whether similar autonomic markers are present in at-risk preschoolers. In this study, the authors compared autonomic profiles of 4- to 6-year-old children with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD; n = 18) with those of age-matched controls (n = 20). Children with ADHD and ODD exhibited fewer electrodermal responses and lengthened cardiac preejection periods at baseline and during reward. Although group differences were not found in baseline respiratory sinus arrhythmia, heart rate changes among ADHD and ODD participants were mediated exclusively by parasympathetic withdrawal, with no independent sympathetic contribution. Heart rate changes among controls were mediated by both autonomic branches. These results suggest that at-risk preschoolers are autonomically similar to older externalizing children.     

Hemispheric lateralization of the EEG during wakefulness and REM sleep in young healthy adults

EEG recordings confirm hemispheric lateralization of brain activity during cognitive tasks. The aim of the present study was to investigate spontaneous EEG lateralization under two conditions, waking and REM sleep. Bilateral monopolar EEG was recorded in eight participants using a 12-electrode montage, before the night (5 min eyes closed) and during REM sleep. Spectral analysis (0.75-19.75 Hz) revealed left prefrontal lateralization on total spectrum amplitude power and right occipital lateralization in Delta activity during waking. In contrast, during REM sleep, right frontal lateralization in Theta and Beta activities and right lateralization in occipital Delta activity was observed. These results suggest that spontaneous EEG activities generated during waking and REM sleep are supported in part by a common thalamo-cortical neural network (right occipital Delta dominance) while additional, possibly neuro-cognitive factors modulate waking left prefrontal dominance and REM sleep right frontal dominance.     

Frequency effects with visual words and syllables in a dyslexic reader

The present study investigated the nature of the inhibitory syllable frequency effect, recently reported for normal readers, in a German-speaking dyslexic patient. The reading impairment was characterized as a severe deficit in naming single letters or words in the presence of spared lexical processing of visual word forms. Three visual lexical decision experiments were conducted with the dyslexic patient, an unimpaired control person matched to the patient and a control group: Experiment 1 manipulated the frequency of words and word-initial syllables and demonstrated systematic effects of both factors in normal readers and in the dyslexic patient. The syllable frequency effect was replicated in a second experiment with a more strictly controlled stimulus set. Experiment 3 confirmed the patient's deficit in activating phonological forms from written words by demonstrating that a pseudohomophone effect as observed in the unimpaired control participants was absent in the dyslexic patient.     

Emotion recognition in stroke patients with left and right hemispheric lesion: results with a new instrument-the FEEL Test

The aim of this study was to investigate the effect of a stroke event on people's ability to recognize basic emotions. In particular, the hypothesis that right brain-damaged (RBD) patients would show less of emotion recognition ability compared with left brain-damaged (LBD) patients and healthy controls, was tested. To investigate this the FEEL Test (Facially Expressed Emotion Labeling) was used, a computer based psychometric test that assesses one's ability to recognize facially displayed basic emotions via a forced-choice paradigm. We examined 24 patients after a stroke event (13 RBD, 11 LBD) and compared them with a matched group of healthy controls (HC, n=29). Results showed that the stroke patients performed significantly worse in the FEEL Test than did HC (p<.001). This deficit was especially evident for negative emotions (fear, anger, sadness, and disgust). In contrast to other studies we did not find any significant differences between RBD and LBD patients in their ability to recognize emotions. These results indicate that a stroke event has a negative effect on the recognition of facially displayed emotions but suggest that this effect is apparently not dependent on the side of the brain damage.