Do adapted vignettes improve medical decision‐making capacity for individuals with Alzheimer's disease?

Medical decision‐making capacity (MDC) is known to decline in individuals with Alzheimer's disease (AD). The vignette method uses hypothetical information as a prerequisite for measuring the capacity to make well‐informed decisions to clinical trials. Our aim was to investigate if adapted vignettes can help individuals with mild AD to assimilate information, make decisions and express them in an understandable way, compared to corresponding decisions based on linguistically more demanding vignettes, as measured by the Swedish Linguistic Instrument for Medical Decision‐making (LIMD). Two vignettes from LIMD were altered linguistically with the aim to facilitate understanding for individuals with AD. An experimental within‐subject design was used to study the influence on MDC of readability (original/adapted vignettes) and content (two different clinical trials). We included 24 patients with mild AD in this prospective study, which read all four vignettes along with a few other tests. This allowed us to investigate the association between MDC and cognitive function. Adapted vignettes did not yield significant differences regarding MDC as compared with original vignettes using a two‐way repeated measures analysis of variance. A difference was found between the two clinical trials where LIMD score was significantly higher for Kidney disease than hypertension vignettes. Our results indicate that adapted vignettes may not improve MDC for individuals with mild AD. MDC was affected by which clinical trial the vignettes regarded, which implies that other factors affecting MDC need to be investigated, like length of text and vocabulary used.     

Quantitative and qualitative evaluation of neuromotor behaviour in children with a specific speech and language disorder

Several studies have described problems in a wide area of motor functions in language impaired children. The purpose of this study was to identify the nature of the motor deficits in two subgroups of language impaired children. A standard neurological examination was performed on 18 children with an expressive language disorder and 21 children with a receptive language disorder. The motor performance of the language disordered children was compared with the motor performance of 23 normal children. The standard neurological examination allowed for a qualitative and quantitative assessment of five specific neurological subsystems. Handedness was determined for all children. The language impaired children had more motor problems than the control children on most neurological subsystems. There were few statistically significant differences between the two groups of language impaired children. An excess in left‐handedness was established in the group of children with a receptive language disorder. There was a co‐occurrence of verbal and non‐verbal deficits in language impaired children. As these motor problems put an additional burden on the development of language impaired children, they should be diagnosed as early as possible. Copyright © 2002 John Wiley & Sons, Ltd.     

Unconscious modulation of the conscious experience of voluntary control

How does the brain generate our experience of being in control over our actions and their effects? Here, we argue that the perception of events as self-caused emerges from a comparison between anticipated and actual action-effects: if the representation of an event that follows an action is activated before the action, the event is experienced as caused by one's own action, whereas in the case of a mismatch it will be attributed to an external cause rather than to the self. In a subliminal priming paradigm we show that participants overestimated how much control they had over objectively uncontrollable stimuli, which appeared after free- or forced-choice actions, when a masked prime activated a representation of the stimuli immediately before each action. This prime-induced control-illusion was independent from whether primes were consciously perceived. Results indicate that the conscious experience of control is modulated by unconscious anticipations of action-effects.     

Longing for tomorrow: phenomenology,cognitive psychology,and the methodological bases of exploring time experience in depression

The subjective experience of time in depression has been described to be altered in complex ways, with sensations of particular slowness, delay or stillness being the most often named articulations. However, the attempts to provide empirical evidence to the phenomenon of “time slowing down in depression” have resulted in inconsistent findings. In consequence, the overall claim that depressive time somehow differs from ordinary time has often been discarded as unfounded. The article argues against such conclusion, contending that the described ambiguity might be caused by the methods employed to assess the phenomenon under observation. In the first part of the article, a reconceptualization of the experience of time in depression is proposed on the grounds of classic and contemporary phenomenological psychiatry. This leads to identify the essential features of depressive time as described both in clinical and philosophical contexts. In the second part, a critique of the existing methods of time perception assessment is conducted, with a specific focus on duration estimation and time passage perception tasks. The above-mentioned core features serve as guidelines in discussing to what degree such methods fit the phenomenon at stake. Finally, an alternative and innovative method is put forward, that might not only help to explore the scope of existing methods but might itself present an alternative to such: the micro-phenomenological interview.     

Ältere Menschen als Zeugen vor Gericht

This article provides an overview of the current empirical literature concerning older adults as eyewitnesses. Aging affects perception, memory and eyewitness testimony in many older adults (aged 65 years and above). As a group, they provide shorter accounts in free call, fewer correct and more incorrect details. Often they have to be asked more questions than young witnesses in order to obtain the same amount of information. Age differences have also been demonstrated for answers to questions. There are some promising attempts to improve older witnesses’ testimony, such as the Cognitive Interview. However, replication studies are still needed here. It remains unclear if older witnesses are generally more vulnerable to suggestions than young witnesses. There is some evidence that at least in some situations this seems to be the case. In photographic line-ups young and older adults show similar positive identification rates, but older adults have higher false alarm rates. When viewing mug books, older adults are more likely to make a choice than young adults, which can lead to higher rates of possibly false identification in a subsequent line-up. With increasing age age differences between young and old witnesses also increase. However there is considerable interindividual variation in witness performance: some witnesses are impacted by age early-on, while others remain highly functioning until very old age.     

Conditionals As Representative Inferences

According to Adams (Inquiry 8:166–197, 1965), the acceptability of an indicative conditional goes with the conditional probability of the consequent given the antecedent. However, some conditionals seem to be inappropriate, although their corresponding conditional probability is high. These are cases with a missing link between antecedent and consequent. Other conditionals are appropriate even though the conditional probability is low. Finally, we have the so-called biscuit conditionals. In this paper we will generalize analyses of Douven (Synthese 164:19–44, 2008) and others to account for the appropriateness of conditionals in terms of evidential support. Our generalization involves making use of Value, or intensity. We will show how this generalization helps to account for biscuit conditionals and conditional threats and promises. Finally, a link is established between this analysis of conditionals and an analysis of generic sentences.

     

„Cognitive Behavioral Analysis System of Psychotherapy“

There are a number of evidence-based methods of psychotherapy for the treatment of depression but most treatment approaches have shown low or moderate success in the subgroup of chronic depression (duration >?2 years) as compared to episodic depression. This could be related to a higher rate of early trauma and specific deficits in cognitive and interpersonal functioning within this group of patients. James McCullough has developed a psychotherapeutic approach known as cognitive behavioral analysis system of psychotherapy (CBASP) specifically for chronic depression to overcome these deficits. In CBASP early negative experiences are associated with current interpersonal problems and a systematic relearning process is initiated. The approach integrates behavioral, cognitive and interpersonal strategies. The CBASP approach is empirically supported by study results and has shown to be effective in both inpatient and outpatient settings. This article presents the development of the approach and therapeutic strategies as well as techniques of CBASP are described.     

Social proximity in early mother–infant interactions: implications for gender differences?

In an exploratory study, we investigated degrees of social proximity between mothers and their 9-month-old children. Twenty-four Swedish mother–infant dyads (12 boys and 12 girls) were observed during a brief free play episode. Social proximity was measured through nine items focusing on both communication and social interaction. Overall, we found that mother–daughter dyads displayed significantly higher degrees of social proximity than mother–son dyads. More specifically, mothers with daughters displayed more physical and visual contact, and were also rated as more sensitive than mothers with sons. It was also found that girls were judged as being more compliant than boys. ©1997 John Wiley & Sons, Ltd.