Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.     

Imaging the developing brain with fMRI

Advancements in magnetic imaging techniques have revolutionized our ability to study the developing human brain in vivo. The ability to noninvasively image both anatomy and function in healthy volunteers, including young children, has already enhanced our understanding of brain and behavior relations. The application of these techniques to developmental research offers the opportunity to further explore these relationships and allows us to ask questions about where, when and how cognitive abilities develop in relation to changes in underlying brain systems. It is also possible to explore the contributions of maturation versus learning in the development of these abilities through cross-sectional and longitudinal research involving training and intervention procedures. Current imaging methodologies, in conjunction with new and rapidly evolving techniques, hold the promise of even greater insights into developmental issues in the near future. These methodologies and their application to development and learning are discussed in the current paper.     

The role of cardiovascular risk factors in Alzheimer's disease

The distinction between Alzheimer's disease and vascular dementia, the two most common types of dementia, has been undermined by recent advances in epidemiologic, clinical, imaging, and neuropathological studies. Cardiovascular risk factors, traditionally regarded as distinguishing criteria between the two entities, have been shown to be associated with both AD and vascular dementia. In this article, we propose mechanisms of action of cardiovascular risk factors in AD, suggest possible explanations for the overlap with vascular dementia and discuss the implications this might have on future differential diagnosis, research, and treatment strategies.     

The effects of selective ibotenate lesions of the hippocampus on conditioned inhibition and extinction

Previously, Solomon (1977) reported that aspiration lesions of the dorsal hippocampus in rabbits had no effect either on the acquisition of Pavlovian conditioned inhibition or on performance during a subsequent retardation test. The present experiment confirmed and extended these findings by showing that rats with ibotenate lesions of the complete hippocampus (the dorsal and ventral hippocampus and the dentate gyrus) were also unimpaired on the same types of tasks. Additional tests with the same rats showed that removing the hippocampus significantly impaired extinction of responding to a stimulus that had been previously trained with an appetitive unconditioned stimulus. The performance of the lesioned rats on a summation test was also marginally, but not significantly, different from that of controls. The data are discussed with reference to the idea that the hippocampus is involved with the formation of some, but not all, types of inhibitory associations.     

Innate talents: reality or myth?

Talents that selectively facilitate the acquisition of high levels of skill are said to be present in some children but not others. The evidence for this includes biological correlates of specific abilities, certain rare abilities in autistic savants, and the seemingly spontaneous emergence of exceptional abilities in young children, but there is also contrary evidence indicating an absence of early precursors of high skill levels. An analysis of positive and negative evidence and arguments suggests that differences in early experiences, preferences, opportunities, habits, training, and practice are the real determinants of excellence.     

Electrodermal activity and extraversion: Caffeine,preparatory signal and stimulus intensity effects

The Eysenck hypothesis that introverts are more and extraverts less cortically aroused has been supported by the results of most electrodermal studies, though there is some inconsistency in the literature. Further tests of the hypothesis can be carried out using arousal-manipulation paradigms. Some studies have used caffeine or stimulus intensity to increase arousal, as was also the case in the present study. The latter, however, also introduced a preparatory signal, which may be expected under certain conditions, to reduce responses to the stimulus which follows it. Extraverts and introverts were randomly assigned to receive low, medium or high doses of caffeine or a placebo. Each S then heard two sets of tones with the tones in one set preceded by a preparatory signal. Results showed that the preparatory signal reduced phasic amplitudes only at the highest levels of stimulus intensity. Introverts had higher overall SCLs and response magnitudes. In addition, the preparatory signal had little effect on extraverts, but reversed dosage-related response patterns in introverts. Results were supportive of the basic Eysenck arousal hypothesis and also showed that the arousal difference leads to attentional variability between the two groups.     

Learning about water by hungry rats

In Experiments 1 and 2 hungry rats were trained in a straight alley with consistent food reward (FF), food and nonreward trials intermixed (FN), or food and water trials intermixed (FW). In Experiment 1 rats were tested with nonrewarded trials (extinction) and Groups FN and FW did not differ, both running faster then Group FF. In Experiment 2 rats were tested with consistent water reward, and Group FW ran faster then Group FN, which was superior to Group FF. In Experiment 3, one group of hungry rats was trained on a single alternating schedule of food and water in Phase 1 and was shifted to a single alternating schedule of food and nonreward in Phase 2 (Group FW); the second group (Group FN) received a single alternating schedule of food and nonreward in both phases. When Group FW was shifted to nonreward from water, performance to nonreward was temporarily disrupted. These results indicate that, contrary to previous conclusions, hungry rats can learn about water when drive is strong and food is received in the situation.     

Perceived probability and evaluation of balance,agreement, and attraction: Toward a solution of conflicting results

Fifty-four subjects rated sixteen hypothetical situations on four evaluative and four probability scales. The situations were of the P-O-X type, consisting of two persons and an issue. A2×2×2×2 factorial design was used to test the relative importance of attitude (P to × relation), issue (marijuana or premarital sex), agreement (P to × and O to × relations), attraction (P to O relation), and balance (agreement × attraction interaction) on the evaluation and probability variables. As predicted from a critical review of past research on balance theory, balance was the main determinant of perceived probability. Attraction was the main determinant of evalution. In light of a review of past balance research and of the present data, we propose to restrict the balance hypothesis to cognitive variables, i.e., expectancy and perceived probability. In addition, support was obtained for the hypothesis that the more dogmatic a person is, the more frequently he will perceive balanced relationships as occurring and the more positively he will evaluate balanced situations.