Informed consent revisited: Japan and the U.S

Informed consent, decision-making styles and the role of patient-physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an "independent" and "interdependent" construal of the self and then highlight the possible implications maintained by this position in the context of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan.     

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.     

What is the relationship between synaesthesia and visuo-spatial number forms?

This study compares the tendency for numerals to elicit spontaneous perceptions of colour or taste (synaesthesia) with the tendency to visualise numbers as occupying particular visuo-spatial configurations (number forms). The prevalence of number forms was found to be significantly higher in synaesthetes experiencing colour compared both to synaesthetes experiencing taste and to control participants lacking any synaesthetic experience. This suggests that the presence of synaesthetic colour sensations enhances the tendency to explicitly represent numbers in a visuo-spatial format although the two symptoms may nevertheless be logically independent (i.e. it is possible to have number forms without colour, and coloured numbers without forms). Number forms are equally common in men and women, unlike previous reports of synaesthesia that have suggested a strong female bias. Individuals who possess a number form are also likely to possess visuo-spatial forms for other ordinal sequences (e.g. days, months, letters) which suggests that it is the ordinal nature of numbers rather than numerical quantity that gives rise to this particular mode of representation. Finally, we also describe some consequences of number forms for performance in a number comparison task.     

Self-stereotyping in the context of multiple social identities

This research examines self-stereotyping in the context of multiple social identities and shows that self-stereotyping is a function of stereotyped expectancies held in particular relationships. Participants reported how others evaluated their math and verbal ability and how they viewed their own ability when their gender or ethnicity was salient. Asian American women (Experiment 1) and European Americans (Experiment 2) exhibited knowledge of stereotyped social expectancies and corresponding self-stereotyping associated with their more salient identity. African Americans (Experiment 3) exhibited some knowledge of stereotyped social expectancies but no corresponding self-stereotyping. Correlational evidence and a 4th experiment suggest that self-stereotyping is mediated by the degree to which close others are perceived to endorse stereotypes as applicable to the self.     

Units of visual individuation in rhesus macaques: objects or unbound features?

Vision begins with the processing of unbound visual features, which must eventually be bound together into object representations. Such feature binding is required for coherent visual perception, and accordingly has received a considerable amount of study in several domains. Neurophysiological work, often in monkeys, has revealed the details of how and where feature binding occurs in the brain, but methodological limitations have not allowed this research to elucidate just how feature binding operates spontaneously in real-world situations. In contrast, behavioral work with human infants has demonstrated how we use simpler unbound features to individuate and identify objects over time and occlusion in many types of events, but this work has not typically been able to isolate the role of feature binding in such processing. Here we provide a method for assessing the spontaneity and fidelity of feature binding in non-human primates, as this process is utilized in real-world situations, including simple foraging behaviors. Using both looking-time and manual-search measures in a natural environment, we show that free-ranging rhesus macaques (Macaca mulatta) spontaneously bind features in order to individuate objects across time and occlusion in dynamic events. This pattern of results demonstrates that feature binding is used in subtle ways to guide ecologically relevant behavior in a non-human animal, spontaneously and reliably, in its natural environment.     

Introduction to Michotte's heritage in perception and cognition research

Several decades after Michotte's work was published, it continues to inspire current research in perception, cognition, and beyond. In this special issue we pay tribute to this heritage with a collection of empirical and theoretical papers on amodal completion and the perception of causality, two areas of research within which Michotte's work and ideas have had a lasting influence. As a background to better understand the remaining papers, we briefly sketch Michotte's life and work and the scope (in breadth and in depth) of his impact. We then review Michotte's seminal contributions to the areas covered in this special issue, some of the major research discoveries and themes in the intervening decades, and the major open questions and challenges we are still facing. We also include a sneak preview of the papers in this special issue, noting how they relate to Michotte's work and to each other. This review shows both how much influence Michotte has had on contemporary perception and cognition research, and how much important work remains to be done. We hope that the papers in this special issue will serve both to celebrate Michotte's heritage in this respect, and to inspire other investigators to continue the projects he began.     

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.     

Sabina Spielrein: out from the shadow of Jung and Freud

Abstract: Since the 1982 publication of Aldo Carotenuto's book, A Secret Symmetry: Sabina Spielrein Between Jung and Freud, there has been renewed interest in the life and work of Sabina Spielrein. She was Jung's first psychoanalytic case at the Burghölzli Hospital in 1904, and was referred to several times in The Freud/Jung Letters. Spielrein recovered, enrolled in medical school, and went on to become a Freudian analyst. Her most famous paper, published in 1912, ‘Destruction as a cause of coming into being’, was referred to by Freud in 1920 in relation to his Death Instinct theory. In the few Freudian publications on this controversial theory since 1920, Spielrein's contribution is consistently omitted. Jung also neglected to refer to her ‘Destruction’ paper in his early 1912 version of ‘Symbols of transformation’, even though he had edited her paper and had promised to acknowledge her contribution. He did refer extensively to Spielrein's first paper, her medical thesis, ‘On the psychological content of a case of schizophrenia’, published in 1911, as yet unpublished in English. In her paper Spielrein sought to understand the psychotic delusions of Frau M, a patient at the Burghölzli, much in the style of Jung's ‘Psychology of dementia praecox’ (1907). The purpose of this paper is to explore to what extent Spielrein's Frau M paper, and its companion ‘Destruction’ paper, make an original contribution to both Jung and Freud's emerging theories on the possible creative versus destructive outcomes of neurotic or psychotic introversion, culminating in Jung's concept of the ‘collective unconscious’ (1916) and Freud's concept of a ‘Death instinct’ (1920).     

Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders

Behavior analysis has been at the forefront in establishing effective treatments for children and adults with chronic tic disorders. As is customary in behavior analysis, the efficacy of these treatments has been established using direct-observation assessment methods. Although behavior-analytic treatments have enjoyed acceptance and integration into mainstream health care practices for tic disorders (e.g., psychiatry and neurology), the use of direct observation as a primary assessment tool has been neglected in favor of less objective methods. Hesitation to use direct observation appears to stem largely from concerns about the generalizability of clinic observations to other settings (e.g., home) and a lack of consensus regarding the most appropriate and feasible techniques for conducting and scoring direct observation. The purpose of the current study was to evaluate and establish a reliable, valid, and feasible direct-observation protocol capable of being transported to research and clinical settings. A total of 43 children with tic disorders, collected from two outpatient specialty clinics, were assessed using direct (videotape samples) and indirect (Yale Global Tic Severity Scale; YGTSS) methods. Videotaped observation samples were collected across 3 consecutive weeks and two different settings (clinic and home), were scored using both exact frequency counts and partial-interval coding, and were compared to data from a common indirect measure of tic severity (the YGTSS). In addition, various lengths of videotaped segments were scored to determine the optimal observation length. Results show that (a) clinic-based observations correspond well to home-based observations, (b) brief direct-observation segments scored with time-sampling methods reliably quantified tics, and (c) indirect methods did not consistently correspond with the direct methods.     

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.