Spatial neglect, Balint-Homes' and Gerstmann's syndrome, and other spatial disorders

Brain-damaged patients with lesion or dysfunction involving the parietal cortex may show a variety of neuropsychological impairments involving spatial cognition. The more frequent and disabling deficit is the syndrome of unilateral spatial neglect that, in a nutshell, consists in a bias of spatial representation and attention ipsilateral to of extrapersonal, personal (ie, the body) space, or both, toward the side of the hemispheric lesion. The deficit is more frequent and severe after damage to the right hemisphere, involving particularly the posterior-inferior parietal cortex at the temporo-parietal junction. Damage to these posterior parietal regions may also impair visuospatial short-term memory, which may be associated with and worsen spatial neglect. The neural network supporting spatial representation, attention and short-term memory is, however, more extensive, including the right premotor cortex. Also disorders of drawing and building objects (traditionally termed constructional apraxia) are a frequent indicator of posterior parietal damage in the left and in the right hemispheres. Other less frequent deficits, which, however, have a relevant localizing value, include optic ataxia (namely, the defective reaching of visual objects, in the absence of elementary visuo-motor impairments), which is typically brought about by damage to the superior parietal lobule. Optic ataxia, together with deficits of visual attention, of estimating distances and depth, and with apraxia of gaze, constitutes the severely disabling Balint-Holmes' syndrome, which is typically associated with bilateral posterior parietal and occipital damage. Finally, lesions of the posterior parietal lobule (angular gyrus) in the left hemisphere may bring about a tetrad of symptoms (left-right disorientation, acalculia, finger agnosia, and agraphia) termed Gerstmann's syndrome, that also exists in a developmental form.     

Authenticity and the Analytic Process

In this paper we first make a differentiation between phenomena that can be defined as spontaneous and others that can be defined as authentic. We then attempt to present authenticity as a process rather than an outcome. Finally, we try to understand the location of authentic phenomena in the sensorial and pre-symbolic communicative register. We situate authentic phenomena in the register of sensorial and pre-symbolic communication. The authentic process becomes manifest, step by step in the analytic process (Borgogno, 1999), through the vivid iconic and sensorial elements that happen to cross the analytic field. Through two brief clinical vignettes, we seek to document the progression of the analytic process, in one case through the analyst's capacity for rêverie (Bion, 1962; Ogden, 1994, 1997; Ferro, 2002, 2007), and in the other through the sensorial elements with which analyst and patient are able to tune in to each other.     

Heart rate variability and drawing impairment in hypoxemic COPD

We studied 54 patients with hypoxemic chronic obstructive pulmonary disease (COPD). The Mini Mental State Examination and the Mental Deterioration Battery were used for neuropsychological assessment. Heart rate variability (HRV) was assessed based on 24-h Holter ECG recording. Mann–Whitney test was used to compare HRV parameters of patients performing normally or abnormally on individual neuropsychological tasks. Spearman’s rho was used to investigate the correlations between HRV parameters and neuropsychological scores, indexes of health status or COPD severity. Patients with defective performance at copying drawings with landmarks (CDL) test (N = 23) had lower very low frequency (VLF) power with respect to patients with normal performance (N = 31) (24 h: median 213; interquartile range 120–282 vs. 309; 188–431 ms², p = 0.043; daytime: 202; 111–292 vs. 342; 194–397 ms², p = 0.039). The CDL score correlated with the VLF power (24 h: ρ = 0.27, p = 0.049; daytime: ρ = 0.30, p = 0.028), and the normalized low frequency/high frequency (LF/HF) ratio (24 h: ρ = 0.27, p = 0.05; daytime: ρ = 0.33, p = 0.015). Sympathetic modulation decreased for increasing severity of COPD. In conclusion, drawing impairment correlates with depressed sympathetic modulation in patients with COPD, and both might be indexes of COPD severity.     

Alienating identifications and the psychoanalytic process1

The transmission of psychic life from one generation to the next can result in unconscious, alienating identifications when the parents have not been able to elaborate a process of mourning for their own childhoods. In this article, the author describes the nature of these identifications, constructed around insufficiently symbolized experiences, as revealed during the psychoanalytic process. These unconscious, alienating identifications raise some arduous technical problems for the psychoanalyst as they lead the patient to carry out complex enactments that erase the normal transference markers. The psychoanalyst may then be tempted to resort to pejorative theoretical concepts, such as the death drive. And yet, unknown to the analysand, the insufficiently symbolized psychic elements contain a potential for transformation that may lead to reconstructions and dis‐alienating interpretations. The author distinguishes between alienating identifications and fantasies of identification when the latter transiently appear during the psychoanalytic process. These identification fantasies symbolically register the emotional experience undergone during the analytic sessions and contribute to the integration of insufficiently symbolized psychic elements. These theoretical considerations are fully illustrated by the clinical report of some analytic sessions.     

Self-Regulatory Dysfunctions in Personality Disorders: The Role of Poor Self-Monitoring and Mindreading

To understand how persons self-regulate, we need, as Cervone, Shadel, Smith, and Fiori (2006 ) assert, to refer to personality science, with which it is possible to identify the multifarious psychological elements and processes helping or hindering action programming, overcoming difficulties, and error correction. Personality disorder research and personality science itself demonstrate that dysfunctions in two skills—self-monitoring and mindreading—worsen self-regulation and lead individuals to fail chronically to achieve goals in the social domain. Here we describe how poor self-reflection and biased mindreading impair self-regulation in personality disorders and other clinical conditions and make some suggestions about how to tackle them in psychotherapy.     

Drawing perseveration in neglect: Effects of target density

In cancellation tasks, patients with unilateral spatial neglect typically fail to mark targets within the side of the sheet contralateral to the side of the lesion (contralesional). Moreover, they can show a perseverative behaviour, which consists in repeatedly cancelling stimuli, mainly in the side of the display ipsilateral to the side of the lesion (ipsilesional). We investigated in 13 right‐brain‐damaged patients with left spatial neglect and perseverative behaviour whether and how different densities of horizontal targets modulated omission and perseverative errors. We found that the density of targets modulated the patients’ distribution of neglect (area of omission), but not its extent, as indexed by the percentage of omissions. Specifically, the area of omissions tightened when target density increased leftwards. On the other hand, target density did not affect the distribution of perseverative behaviour (area of perseveration), as well as its extent, as indexed by the percentage of perseverations. Correlation analyses showed that both the extent and the distribution of omissions were positively correlated to clinical measures of spatial neglect. Conversely, perseverations did not show such a correlation. These findings support the view that two different pathological mechanisms might be involved in left spatial neglect and in ipsilesional perseverative behaviour.