The Pittsburgh Initial Neuropsychological Testing System (PINTS): A neuropsychological screening battery for psychiatric patients

This paper presents a new neuropsychological screening battery for psychiatric patients. It takes 1.5 to 2 hr to administer and briefly assesses general level of performance, memory, language skills, attention, and spatial-constructional abilities. Scoring and profiling are computerized. Initial validation based on discriminant analysis of a group of brain-damaged and non-brain-damaged psychiatric patients yielded a diagnostic accuracy level of 84.51%. Cross-validation on a different population led to a substantial attrition of classificatory accuracy, but cross-validation based on a comparison between two samples drawn from a homogeneous population yielded substantially less attrition. It was concluded that while the battery discriminates accurately in a homogeneous population, it is necessary to develop separate norms for populations varying in level of impairment.     

Symptom schemata in chronic respiratory patients

In view of evidence that illness prognoses and adaptive functioning may be influenced by the accuracy of people's knowledge about their physical symptoms, the present study extended these findings to the chronic care population. It was hypothesized that individuals hold beliefs and develop theories about their physical symptoms and that the accuracy of these beliefs is predictive of the individuals' general level of adaptive functioning. A modified version of an instrument designed to measure the accuracy of illness schemata was employed with a sample of 31 chronic respiratory patients. Accuracy rating correlated positively and significantly with ratings of adaptive functioning, whereas no relationship was observed between adaptive functioning and severity of the patients' medical condition. Well-informed patients functioned at a higher level physically, psychologically, and socially than less-informed patients. These findings point to the importance of patient education for prognosis. Possible mediating factors are discussed.     

Encopresis in adolescence: two case studies.

Encopresis is an underreported psychopathological symptom of adolescence, not necessarily defining a specific diagnostic entity. The two cases presented offer an opportunity to evaluate encopresis occurring in markedly different adolescent pathological entities and developmental backgrounds. The first patient presented a longitudinal life course wherein toilet training and fecal considerations were prominent throughout his development. Indeed, this young man had such areas of cohesive functioning, as to be appropriately considered within the range of characterological pathology, severe, though it may be. In marked contrast, the second patient's encopresis represented but a small part of a totally encompassing psychotic disintegration.     

Methodological and theoretical issues in neuropsychological assessment

While there are philosophical and theoretical differences between neuropsychologists and behavior therapists, it is suggested that a significant reconciliation can be achieved in regard to assessment and treatment of the brain-damaged patient. While brain damage is often viewed as an irreversible disorder, there is evidence that substantial recovery of function can occur, particularly when adequate retraining is provided. There are practical and empirical considerations that suggest that neuropsychological tests are currently the best tools available for behavioral assessment of brain-damaged patients. However, the results of these tests can be used not only diagnostically but also to identify target behavioral deficits that may be rehabilitated through systematic retraining efforts. Such rehabilitation efforts can be optimally planned, implemented, and evaluated through an alliance between the neuropsychologist, who identifies the ability and deficit pattern, and the behavior therapist, who devises and evaluates the retraining program. It is possible that the successes of behavior therapy in numerous clinical and educational applications can be repeated in the cases of brain-damaged patients. However, such success would appear to be contingent on appreciation of the high degree of specificity often seen in neurological deficit patterns and the great complexities involved in the relationships between brain function and behavior.     

Instrumental cardiovascular conditioning: A review

This paper reviews experiments, hypotheses, and current controversies about instrumental cardiovascular conditioning. Demonstrations of such conditioning in curarized animals challenged a differentiation between instrumental and classical learning on the basis of their respective effector systems but did not prove direct operant learning by the autonomic nervous system. In humans, ethical prohibition of curarization and lack of adequate controls for respiration and muscle tension have resulted in incomplete understanding of the roles of voluntary, somatic mediators. Despite a variety of potential clinical applications of biofeedback, the available literature lacks studies of its efficacy compared to more standard modes of therapy. The physiological mechanisms and central neural pathways involved ininstrumental cardiovascular conditioning remainalmost totally unknown.     

Lump detection in simulated human breasts

Sixteen observers palpated silicone models of human breasts containing lumps 1.6-12.1 mm in diameter. Detectability depended on the size of the lump, producing a systematic psychometric function. In eight observers who participated in three or more sessions, performance improved with practice, with most improvement occurring within one or two 26-trial sessions. Three-week retention measures disclosed no appreciable decrease in performance, but a significant correlation was found between the number of lumps detected and duration of trial (p < .01). There was no difference in performance between four observers who used their preferred hands and four observers who used their nonpreferred hands. These data establish that examination of breast models for the detection of lumps simulating cancer is a task amenable to experimental analysis.     

Dialectical Behavior Therapy and Motivational Interviewing: Conceptual Convergence,Compatibility, and Strategies for Integration

Dialectical behavior therapy (DBT) and motivational interviewing (MI) are two widely used and efficacious psychosocial interventions. An immense and growing number of studies examine DBT, MI, or adaptations of these approaches across diverse treatment contexts and across various clinical populations. Because DBT and MI are in high demand, it is probable that trainees and established practitioners will encounter one or both treatments over the course of their careers. Although MI and DBT initially evolved in distinct contexts for different populations, these approaches share a number of common fundamental principles. Each provides distinct and complementary strategies for enhancing clients’ motivation and ability to change. For some, an integrative or sequenced application of MI and DBT may enhance client care. The present article highlights areas of divergence, convergence, and opportunities for integration, and offers practical tips for applying DBT and MI in conjunction.