A functional analysis of obsessive-compulsive problems with related therapeutic procedures

This report describes the application of a functional analysis to obsessions and compulsions. The approach emphasizes a search for the independent variables which maintain obsessive-compulsive behavior in the individual client: then therapeutic procedures are designed to counteract the specific maintaining variables. The application, and outcome, of this approach to two children and one adult is described.     

The Professional Autonomy of the Medical Doctor in Italy

This contribution deals with the issue of the professional autonomy ofthe medical doctor. Worldwide, the physician's autonomy is guaranteedand limited, first of all, by Codes of Medical Ethics. InItaly, the latest version of the national Code of MedicalEthics (Code 1998) was published in 1998 by the Federation ofprovincial Medical Associations (FnomCeO). The Code 1998acknowledges the physician's autonomy regarding the scheduling, thechoice and application of diagnostic and therapeutic means, within theprinciples of professional responsibility. This responsibility has tomake reference to the following fundamental ethical principles:(1) the protection of human life; (2) the protection of thephysical and psychological health of the human being; (3) therelief from pain; (4) the respect for the freedom and the dignityof the human person, without discrimination; (5) an up-to-datescientific qualification (Art. 5). The authors underline that autonomyis an anthropological – and consequently ethical –characteristic of the human person. Different positions on autonomy inbioethics (individualistic, evolutionistic, utilitarian andpersonalistic models) are explained. The relation between theprofessional autonomy of the physician and the autonomy of the patientand of colleagues is discussed. In fact, the medical doctor isobliged: (1) to respect the fundamental rights of the person,first of all his/her life; (2) to ensure the continuity of thecare, even if he can only relieve the patient's suffering; (3) tomaintain, except under certain circumstances, professional secrecy andconfidentiality regarding patients and their medical records. Moreover,the physician cannot deny the patient correct and appropriateinformation. He/she should not perform any diagnostic or therapeuticactivity without the informed consent of the patient and the medicaldoctor must give up medical treatment in case of documented refusal ofthe individual. Furthermore, the medical doctor has the right to raiseconscientious objections if he/she is requested to perform medicalactions that are contrary to his/her conscience or medical opinion,unless this attitude would seriously and immediately harm the patient.Regarding the relationships with colleagues, the physician is obliged tosolidarity, mutual respect, and care of sick colleagues. Finally, theauthors discuss the Italian legislation affecting the physician'sprofessional autonomy: (1) the SSN health care Acts; (2) theso-called Charter for Public Health Care Services; (3) the Acts onprivacy; (4) Good Clinical Practice.     

Recurrent criminal behavior and executive dysfunction

OBJECTIVE: To experimentally test the hypothesis that people who repeatedly participate in forms of non-violent crime exhibit an executive deficit detected in tests of high ecological validity, having changes in prefrontal functioning as neurophysiologic basis. PARTICIPANTS AND METHODS: A batteiy to assess executive dysfunction was administered--the Behavioural Assessment of the Dysexecutive Syndrome (BADS)--to an experimental group of 30 inmates convicted of crimes against property (mean age = 39.3, SD = 9.98), and a control group of 30 (mean age = 32.7, SD = 11.8), all male. RESULTS: The group of recurrent inmates performed significantly worse than the control group in their global scores on the battery, as well as in the majority of subscales. CONCLUSION: Without removing from consideration the fact that sample size was not very large and, primarily, alerting ourselves to the dangerous hypothesis of a "frontal criminogenesis," the authors interpret criminal recurrence and resistance to penal measures in terms of the scarcity of control that individuals from the experimental group have over their behavior and its respective consequences.     

On the Common Origin of Music and Philosophy: Plato,Nietzsche, and Benjamin

The essay shows the common ground between music and philosophy from the origin of Western philosophy to the crisis of metaphysical thinking, in particular with Nietzsche and Benjamin. At the beginning, the relationship between philosophy and music is marked by the hegemony of the word on the sound. This is the nature of the Platonic idea of music. With Nietzsche and Benjamin this hegemony is denied and a new vision of the relationship becomes possible. The sound is the origin both of language and of music. In thinking about this origin, philosophy shows that “thinking about music” is “thinking in music”, and that this thinking is the origin of philosophy itself.     

Small-sample characterization of stochastic approximation staircases in forced-choice adaptive threshold estimation

Despite the widespread use of up-down staircases in adaptive threshold estimation, their efficiency and usability in forced-choice experiments has been recently debated. In this study, simulation techniques were used to determine the small-sample convergence properties of stochastic approximation (SA) staircases as a function of several experimental parameters. We found that satisfying some general requirements (use of the accelerated SA algorithm, clear suprathreshold initial stimulus intensity, large initial step size) the convergence was accurate independently of the spread of the underlying psychometric function. SA staircases were also reliable for targeting percent-correct levels far from the midpoint of the psychometric function and performed better than classical up-down staircases with fixed step size. These results prompt the utilization of SA staircases in practical forced-choice estimation of sensory thresholds.     

The effects of bilateral presentations on lateralized lexical decision

We investigated how lateralized lexical decision is affected by the presence of distractors in the visual hemifield contralateral to the target. The study had three goals: first, to determine how the presence of a distractor (either a word or a pseudoword) affects visual field differences in the processing of the target; second, to identify the stage of the process in which the distractor is affecting the decision about the target; and third, to determine whether the interaction between the lexicality of the target and the lexicality of the distractor ("lexical redundancy effect") is due to facilitation or inhibition of lexical processing. Unilateral and bilateral trials were presented in separate blocks. Target stimuli were always underlined. Regarding our first goal, we found that bilateral presentations (a) increased the effect of visual hemifield of presentation (right visual field advantage) for words by slowing down the processing of word targets presented to the left visual field, and (b) produced an interaction between visual hemifield of presentation (VF) and target lexicality (TLex), which implies the use of different strategies by the two hemispheres in lexical processing. For our second goal of determining the processing stage that is affected by the distractor, we introduced a third condition in which targets were always accompanied by "perceptual" distractors consisting of sequences of the letter "x" (e.g., xxxx). Performance on these trials indicated that most of the interaction occurs during lexical access (after basic perceptual analysis but before response programming). Finally, a comparison between performance patterns on the trials containing perceptual and lexical distractors indicated that the lexical redundancy effect is mainly due to inhibition of word processing by pseudoword distractors.     

Neuroimaging Measures to Assess the Effectiveness of a Two-Day Marathon Group of Individuals with Early Developmental Trauma: A Pilot Study

Group therapy can be effective with individuals with developmental trauma who re-experience intense physiological traumatic distress and struggle with terror and despair. This modality can address the long-term ramifications of developmental trauma, including problems with perceptions, trust, emotional regulation, and loss of sense of self. Neuroimaging techniques can be combined with group therapy interventions as a way to empirically validate the effectiveness of group psychotherapy on brain structures and networks impacted by trauma. The neuroscience explaining overpowering traumatic responses and related emotions will be reviewed. Results of a pilot study combining group therapy with neuroimaging are presented.     

Psychopathic Traits Associate Differentially to Anger,Disgust and Fear Recognition among Men and Women

Psychopathy is characterized by deficits in empathy and violation of the rights of others. Recent data link psychopathy-based lack of empathy to deficits in emotion recognition (ER), in particular fear and sadness. However, questions remain about emotions like anger and disgust and some studies even report a positive relationship between psychopathy and ER. Notably, the overwhelming majority of these studies have been conducted only with men, and studies in the general population suggest that women have better ER than men. To our knowledge, only two small studies have explicitly examined ER and psychopathy among women and they did find deficits in anger and disgust recognition. Therefore, mixed findings about ER and psychopathy may be due to gender differences that need to be clarified. This study aimed at bridging this gap using a large sample of 129 male (49 %) and 132 female (51 %) participants who completed psychopathy self-reports, and a computerized facial ER task. Among women there were deficits and advantages in ER: High social dominance and lack of anxiety traits were related to decreased fear and anger recognition respectively. Traits characterized by impulsiveness and rebelliousness were associated with better disgust and anger recognition respectively. For men, psychopathic traits characterized by ruthless manipulation of others, as well as lack of fear, were related to deficits recognizing anger. These results suggest that among women some psychopathic traits may confer an advantage in ER and give impetus for studies examining gender differences in the neurobiological substrates and manifestation of the syndrome.     

Cross-modal plasticity and deafferentation

To interact successfully with the environment and to compensate for environmental challenges, the human brain must integrate information originating in different sensory modalities. Such integration occurs in non-primary associative regions of the human brain. Additionally, recent investigations have documented the involvement of the primary visual cortex in processing tactile information in blind humans to a larger extent than in sighted controls. This form of cross-modal plasticity highlights the capacity of the human central nervous system to reorganize after chronic visual deprivation.Edited by: Marie-Hélène Giard and Mark Wallace