Impaired awareness of movement disorders in Parkinson’s disease

Background

This study analyzed the presence of awareness of movement disorders (dyskinesias and hypokinesias) in 25 patients with Parkinson’s disease (PD) and motor fluctuations (dyskinesias, wearing off, on–off fluctuations). Of the few studies that have dealt with this topic, none have analyzed the differences in the awareness of motor deficits by comparing the on and off states using motor scales and an extensive battery of tests to assess cognitive and behavioral functioning.

Methods

PD patients were compared on three different scales that we have devised to measure awareness of movement disorders: Global Awareness of Movement (GAM) Disorders, dyskinesia/hypo-bradykinesia rating scales.

Results

Data showed that PD patients had greater awareness and psychological suffering in the off state than in the on state. In particular, they were troubled by motor disabilities related to hypokinesias and had mood-related symptoms and a perception of disability in activities of daily living. Interestingly, patients only showed a selective reduction of awareness of movement disorders associated with executive functions and related to dyskinesias in the on state, compared to a preserved awareness of hypokinesias in the off state. On the contrary, no association with executive functions was found in the off state.

Conclusion

Our findings suggest that the dopaminergic overstimulation of mesocorticolimbic pathways may cause a dysfunction of prefrontal–subcortical connections related to the impaired insight.     

Expressed emotion and Milan systemic intervention: a pilot study on families of people with a diagnosis of schizophrenia

This article presents the results of a pilot study carried out on families of people with a diagnosis of schizophrenia (high‐frequency users of psychiatric services) using a standardized version of systemic family intervention based on the Milan Approach (‘Circular Interview’). We used expressed emotion (EE) to compare and assess two homogeneous samples of families, a treatment group (n = 10) and a control group (n = 8). We found that families participating in circular interviews showed a reduction in criticism, while 30% of their members with a diagnosis of schizophrenia relapsed. Families not receiving treatment showed no changes in EE levels, while 62.5% of their members with a diagnosis of schizophrenia relapsed. Although the difference in relapse rates is not statistically significant, these results justify further studies on the use of nondirective systemic intervention with families of people with a diagnosis of schizophrenia.     

Group Cancellation and Resolution

We establish a connection between the geometric methods developed in the combinatorial theory of small cancellation and the propositional resolution calculus. We define a precise correspondence between resolution proofs in logic and diagrams in small cancellation theory, and as a consequence, we derive that a resolution proof is a 2-dimensional process. The isoperimetric function defined on diagrams corresponds to the length of resolution proofs.     

Impaired discriminative fear-conditioning resulting from elevated fear responding to learned safety cues among individuals with panic disorder

Classical fear-conditioning is central to many etiologic accounts of panic disorder (PD), but few lab-based conditioning studies in PD have been conducted. One conditioning perspective proposes associative-learning deficits characterized by deficient safety learning among PD patients. The current study of PD assesses acquisition and retention of discriminative aversive conditioning using a fear-potentiated startle paradigm. This paradigm was chosen for its specific capacity to independently assess safety- and danger learning in the service of characterizing putative anomalies in each type of learning among those with PD. Though no group difference in fear-potentiated startle was found at retention, acquisition results demonstrate impaired discriminative learning among PD patients as indexed by measures of conditioned startle-potentiation to learned safety and danger cues. Importantly, this discrimination deficit was driven by enhanced startle-potentiation to the learned safety cue rather than aberrant reactivity to the danger cue. Consistent with this finding, PD patients relative to healthy individuals reported higher expectancies of dangerous outcomes in the presence of the safety cue, but equal danger expectancies during exposure to the danger cue. Such results link PD to impaired discrimination learning, reflecting elevated fear responding to learned safety cues.     

Being seen or being watched? A psychoanalytic perspective on body dysmorphia

The focus of this paper is on individuals who present as excessively preoccupied with their body, perceiving some aspect(s) to be 'ugly' such that they feel compelled to alter and/or conceal this 'ugly' body part. These difficulties are understood as symptoms of an underlying narcissistic disturbance. The author suggests that the relative pervasiveness of an identification with a 'super'-ego accounts for the degree of severity of the disturbance (increasing the compulsion to alter and/or conceal the hated body part) and that it has implications for the patient's accessibility in analytic treatment. Understanding the vicissitudes of the development of the body–self in the context of the earliest relationship with the 'object of desire' is core to helping these patients because of the quality of the identifications that ensue and that are then enacted the transference.     

The influence of instructions and terminology on the accuracy of remember–know judgments

The remember–know paradigm is one of the most widely used procedures to examine the subjective experience associated with memory retrieval. We examined how the terminology and instructions used to describe the experiences of remembering and knowing affected remember–know judgments. In Experiment 1 we found that using neutral terms, i.e., Type A memory and Type B memory, to describe the experiences of remembering and knowing reduced remember false alarms for younger and older adults as compared to using the terms Remember and Know, thereby increasing overall memory accuracy in the neutral terminology condition. In Experiment 2 we found that using what we call source-specific remember–know instructions, which were intended to constrain remember judgments to recollective experiences arising only from the study context, reduced remember hits and false alarms, and increased know hits and false alarms. Based on these data and other considerations, we conclude that researchers should use neutral terminology and source-specific instructions to collect the most accurate reports of the experiences of remembering and knowing arising from the study context.     

Intellectual Humility as Attitude

Intellectual humility, I argue in this paper, is a cluster of strong attitudes (as these are understood in social psychology) directed toward one's cognitive make‐up and its components, together with the cognitive and affective states that constitute their contents or bases, which serve knowledge and value‐expressive functions. In order to defend this new account of humility I first examine two simpler traits: intellectual self‐acceptance of epistemic limitations and intellectual modesty about epistemic successes. The position defended here addresses the shortcomings of both ignorance and accuracy based accounts of humility.     

Multiple Imputation for Bounded Variables

Missing data are a common issue in statistical analyses. Multiple imputation is a technique that has been applied in countless research studies and has a strong theoretical basis. Most of the statistical literature on multiple imputation has focused on unbounded continuous variables, with mostly ad hoc remedies for variables with bounded support. These approaches can be unsatisfactory when applied to bounded variables as they can produce misleading inferences. In this paper, we propose a flexible quantile-based imputation model suitable for distributions defined over singly or doubly bounded intervals. Proper support of the imputed values is ensured by applying a family of transformations with singly or doubly bounded range. Simulation studies demonstrate that our method is able to deal with skewness, bimodality, and heteroscedasticity and has superior properties as compared to competing approaches, such as log-normal imputation and predictive mean matching. We demonstrate the application of the proposed imputation procedure by analysing data on mathematical development scores in children from the Millennium Cohort Study, UK. We also show a specific advantage of our methods using a small psychiatric dataset. Our methods are relevant in a number of fields, including education and psychology.