The dreaming brain/mind, consciousness and psychosis

Several independent lines of research in neurobiology seem to support the phenomenologically-grounded view of the dreaming brain/mind as a useful model for psychosis. Hallucinatory phenomena and thought disorders found in psychosis share several peculiarities with dreaming, where internally generated, vivid sensorimotor imagery along with often heightened and incongruous emotion are paired with a decrease in ego functions which ultimately leads to a severe impairment in reality testing. Contemporary conceptualizations of severe mental disorders view psychosis as one psychopathological dimension that may be found across several diagnostic categories. Some experimental data have shown cognitive bizarreness to be equally elevated in dreams and in the waking cognition of acutely psychotic subjects and in patients treated with pro-dopaminergic drugs, independent of the underlying disorder. Further studies into the neurofunctional underpinnings of both conditions will help to clarify the use and validity of this model.     

A cross-cultural study of family functioning

The Family Assessment Device (FAD) was used to compare patterns of family functioning in two cultural settings, North America and Hungary. The sample size consisted of 95 nonclinical North American families and 58 nonclinical Hungarian families. No cross-cultural differences were found in the families' general functioning nor in their affective involvement or affective responsiveness as measured by the FAD. Hungarian families, however, perceived their functioning as significantly better than the North American families in problem-solving and in communication. North American families rated themselves significantly better than the Hungarians in setting family rules and boundaries and in meeting their family responsibilities. Results from this study suggest that cultural values can affect a family's functioning and that differences in areas of family functioning can be captured using the FAD. A discussion of broad societal values of the two cultures was used to interpret the contrasting patterns of family functioning.Cross-cultural studies serve many purposes. In general they provide knowledge about the different cultures under investigation. As such, they broaden and enrich our perspectives of ourselves and the world around us. More specifically they highlight similarities and differences across cultures, information that can be helpful in further refining our understanding of the impact of diverse and varying socio-political forces.A topic of particular interest to family therapists and researchers is family functioning in different cultural settings. In spite of continuing research in this area, few studies examine cross-cultural patterns of family interactions and even fewer do so with instruments specifically designed to assess family functioning.From a family perspective, particularly looking at pathology in family functioning, cross-cultural comparisons can be used to highlight areas of dysfunction common to families irrespective of the cultural context. From a cross-cultural perspective, family comparisons can be used to point out the cultural effects and emphases given to different dimensions of functioning within a common system (i.e., the family unit).Both conceptual and methodological problems have contributed to shortcomings in previous cross-cultural studies (Fabrega, 1974; Kleinman, 1987; Flaherty et al., 1988; Rogler, 1989). A basic criticism of such studies has been the assumption that meanings and values in one culture are equivalent to those in another.Another issue, which is particularly pertinent to our study, is the use of an instrument which is developed in one culture and administered in another cultural setting. A potential problem this raises is inferring cultural differences between groups when the translated and the original instruments are not actually comparable in meaning. In fact, one objective of the study was to see whether our own self-report measure of family functioning, the Family Assessment Device (FAD, Epstein et al., 1978, 1983), could be successfully used in another cultural setting.The following report is part of a larger research project, conducted in 1986–87, that compared depressed and nonclinical families across two cultures. The findings presented here are comparisons between nonclinical Hungarian and nonclinical North American families. In our earlier study differences in family interactions between clinically depressed and nonclinical families were evident in both cultural settings (Keitner et al., in press). It was not clear, however, if significant cross-cultural differences in family functioning would be found for the normal group of families and, if so, how these would differ from their ill counterparts. Inclusion of the normal families thus served two purposes, as controls in the larger study to test within cultural differences and as comparison groups in a separate analysis to test between cultural differences.A specific objective of this study was to contrast patterns of perceived family functioning in nonclinical Hungarian families and North American families. Another objective was to determine if the Family Assessment Device (FAD), a self-report measure of family functioning, could be successfully used in different cultural contexts. Hungary was chosen as an appropriate country of study for several reasons. It is at the crossroads of East and West, sharing enough similarities with western culture to validate comparisons, yet different enough in both its cultural and sociopolitical system that some differences could be expected to emerge. Because it is likely that the Hungarian social system is less familiar to readers than that of North American, the results are discussed with particular reference to Hungary.We would like to thank Drs. J. Furedi and T. Kurimay for help in translating the Family Assessment Device and Professors J. Szilard and Muszong-Kovacs for their support of this study. This work was supported in part by the Firan Foundation.     

Performance of disabled and normal readers on the continuous performance test

Twelve-year-old reading-disabled children of normal intelligence were compared on the Continuous Performance Test with two control groups of normal intelligence and reading ability either of the same age or of the same reading age as the reading-disabled group. Signal-detection analysis showed that the reading-disabled were more conservative than chronological-age controls in their willingness to identify the target letter sequence. Although this conservative performance was shared by the reading-age controls, the readingdisabled suffered an additional handicap of relatively frequent anticipatory errors. Groups also differed on a sensitivity measure, suggesting a deficit in working memory in the reading-disabled children.This research was supported by the New Zealand Neurological Foundation. We thank the children and school staff for their willing cooperation. We are indebted to the research students who found the subjects and helped collect the data.     

Family therapy for bulimia nervosa in adolescents: an exploratory study

Family therapy has only rarely been reported as a treatment for bulimia nervosa and not specifically’for adolescents. This account describes family therapy with eight adolescents who suffered from bulimia nervosa. Change was measured by assessing symptomatic behaviours and global measures of family and social function prior to treatment and again one year later. At reassessment there was a significant reduction in bulimic behaviours although many had some continuing symptoms. Some aspects of the therapy are described and implications for further study of treatment for adolescent bulimia are discussed.     

Health Care Reform and Psychologists in Medical Schools: Stress, Challenge, and Change

Psychologists from 45 academic health science centers throughout the United States and Canada gathered at Georgetown University for a national conference November 2–5, 1995 organized by the Association of Medical School Psychologists. This paper introduces the proceedings of that conference described in the next four articles in this issue of the Journal of Clinical Psychology in Medical Settings[Volume 4, number 1]. Papers prepared by the working groups focus upon clinical services, education and training, research, and governance and administration within the academic medical setting.     

Medical Center Politics and Decisions: A Discussion

Presented as part of a symposium at the 1996 American Psychological Association Convention in Toronto, Canada, this paper reflects an historical overview of the political issues faced by psychologists in academic medical centers. Ivan Mensh, Ph.D., senior psychologist and founding member of the Association of Medical School Psychologists, suggests that those psychologists involved in medical education should learn who the decision makers are and how decisions are made at academic medical centers in order better to assure the continued viability of psychology in those settings.     

An Examination of the Role of Personality in Work Accidents Using Meta-analysis

Personality has been studied as a predictor variable in a range of occupational settings. The study reported is based on a systematic search and meta-analysis of the literature, using the "Big Five" personality framework. The results indicated that there was substantial variability in the effect of personality on workplace accidents, with evidence of situational moderators operating in most cases. However, one aspect of personality, low agreeableness, was found to be a valid and generalisable predictor of involvement in work accidents. The implications of the findings for future research are discussed. Although meta-analysis can be used to provide definite estimates of effect sizes, the limitations of such an approach are also considered.
La personnalité a étéétudiée comme variable prédictrice dans un ensemble de situations professionnelles. Ce travail s'appuie sur une investigation approfondie et une méta-analyse de la littérature faisant appel au modèle de la personnalité du « Big Five >>. Les résultats montrent qu'il existe de fortes variations en ce qui concerne le rôle de la personnalité dans les accidents du travail, avec l'interférence de facteurs situationnels dans la plupart des cas. Cependant, un aspect de la personnalité, une « agreeableness >> basse, apparaît comme étant un prédicteur valide et général de l'implication dans les accidents du travail. On réfléchit à l'intérêt de ces résultats pour de futures recherches. La méta-analyse peut certes procurer une évaluation précise de l'impact d'une variable, mais il faut aussi prendre en considération les limites de cette approche.     

Clinical events in coronary patients who report low distress: adverse effect of repressive coping

OBJECTIVE: Coronary artery disease (CAD) patients who report low distress are considered to be at low psychological risk for clinical events. However, patients with a repressive coping style may fail to detect and report signals of emotional distress. The authors hypothesized that repressive CAD patients are at risk for clinical events, despite low self-rated distress. DESIGN: This was a prospective 5- to 10-year follow-up study, with a mean follow-up of 6.6 years. At baseline, 731 CAD patients filled out Trait-Anxiety (distress), Marlowe-Crowne (defensiveness), and Type D scales; 159 patients were classified as "repressive," 360 as "nonrepressive," and 212 as "Type D." MAIN OUTCOME MEASURES: The primary endpoint was a composite of total mortality or myocardial infarction (MI); the secondary endpoint was cardiac mortality/MI. RESULTS: No patients were lost to follow-up; 91 patients had a clinical event (including 35 cardiac death and 32 MI). Repressive patients reported low levels of anxiety, anger and depression at baseline, but were at increased risk for death/MI (21/159 = 13%) compared with nonrepressive patients (22/360 = 6%), p = .009. Poor systolic function, poor exercise tolerance, 3-vessel disease, index MI and Type-D personality--but not depression, anxiety or anger--also independently predicted clinical events. After controlling for these variables, repressive patients still had a twofold increased risk of death/MI, OR = 2.17, 95% CI = 1.10-4.08, p = .025). These findings were replicated for cardiac mortality/MI. CONCLUSION: CAD patients who use a repressive coping style are at increased risk for clinical events, despite their claims of low emotional distress. This phenomenon may cause an underestimation of the effect of stress on the heart. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Pre-emptive perception

How can an action to a target be selected without yet knowing what it is? Pre-emptive perception (PEP) is a framework which orders neuronal mechanisms in association with voluntary actions before an action is started and until it is completed. It is assumed that PEP serves the purpose of perception, but a conscious, perceptual identification of the goal is not obligatorily completed during the time period of PEP itself. The concept of PEP is that the brain pre-emptively optimizes an action plan to maximize eventual perception, even before being sure what the goal is. Experimental studies of voluntary saccadic eye movements are considered as prototypic activity within the framework of PEP. The core concept of pre-emption is that a particular saccade is selected while a large number of other possible actions are deselected. Pre-emptive computations include mechanisms associated with internal context and reward. Neurophysiological studies which show anatomically and functionally separate cortical and some subcortical neuronal groups in computing saccades are summarized. There is a potential relationship of PEP as a neurobiological framework and some philosophical concepts. Terms for processes between planning and action, such as intention, anticipation, and attention, are often incongruent in everyday language and in epistemology. It is proposed here that a scrutiny of these terms can be rigorously approached by temporal subdivision of PEP and conversely, clear definitions of these terms can lead to organized experimental designs of cognitive neurobiology. The temporal subdivision of PEP allows a critique of The Will in the definition of Schopenhauer and distinguishes it from the 'free will'.