Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received 10, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a ‘good responder’ with improved naming and phrase length; P2 was a ‘poor responder’ without improved naming.Pre-TMS (10 years poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named). At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p < .02; p < .05, respectively). At 16 mo. there was also greater activation in L than R SMA (p < .08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14 to 18 pictures, post-TMS (2–43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from three words pre-TMS, to 5–6 words post-TMS.Pre-TMS (1.5 years poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1–2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at one word, post-TMS.Lesion site may play a role in each patient’s fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke’s area, in parts of BA 21 and 37, whereas P1 did not.The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia.     

The Delinquency Outcomes of Boys with ADHD with and Without Comorbidity

This study examined the association between childhood ADHD and juvenile delinquency by examining data from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of individuals diagnosed with ADHD in childhood (ages 5–12) and recontacted in adolescence and young adulthood for yearly follow-up (age at first follow-up interview M = 17.26, SD = 3.17). Participants were 288 males with childhood ADHD and 209 demographically similar males without ADHD who were recruited into the follow-up study. Delinquency information gathered yearly during the second through eighth follow-up provided a comprehensive history of juvenile delinquency for all participants. Four childhood diagnostic groups [ADHD-only (N = 47), ADHD + ODD (N = 135), ADHD + CD (N = 106), and comparison (N = 209)] were used to examine group differences on delinquency outcomes. Analyses were conducted across three dimensions of delinquency (i.e., severity, age of initiation, and variety). Individuals with childhood ADHD + CD displayed significantly worse delinquency outcomes than the other three groups, across almost all indices of offending. When compared to comparison participants, boys with ADHD-only and ADHD + ODD in childhood displayed earlier ages of delinquency initiation, a greater variety of offending, and higher prevalence of severe delinquency. These findings suggest that although childhood ADHD + CD creates the greatest risk for delinquency, boys with ADHD-only and ADHD + ODD also appear at a higher risk for later offending. The patterns of offending that emerged from the PALS are discussed in the context of the relationship between ADHD, comorbidity, and delinquency.     

The European Clinical Specialization on Fluency Disorders (ECSF)

The European Clinical Specialization on Fluency Disorders (ECSF) project consists of one-year post-qualification fluency specialization training and a harmonized graduate fluency program. It was developed by eight European universities/colleges to provide the means whereby graduates would meet comparable standards of competence to practice in the field of fluency disorders. In this paper we describe criteria that guided the consortium in their decision making process to create an optimal learning environment for participants. A review of the first completed course cycle, with 23 international participants, is discussed.Educational objectives: After reading this article, the reader will be able to: (1) articulate the rationale for development of the ECSF-course; (2) summarize the content of both the harmonized undergraduate fluency course and the postgraduate fluency specialization course; (3) summarize the benefits of the suggested model for fluency specialization.     

Too much information: the perils of nondiagnostic information in negotiations

Two studies showed that possessing information about a negotiation counterpart that is irrelevant to the negotiation task can impair negotiators' effectiveness because such knowledge impedes effective information exchange. In Study 1, negotiators who possessed diagnostic and nondiagnostic forms of information were each less likely to exchange information about their preferences within the negotiation. However, only those negotiators who possessed nondiagnostic information achieved inferior negotiation outcomes as a result. In Study 2, negotiators possessing nondiagnostic information about their counterparts in electronically mediated negotiations were more likely to terminate the search for mutually beneficial outcomes prematurely and declare impasses. They were also less able to use diagnostic forms of information to make mutually beneficial trade-offs. As a result, negotiators in these dyads achieved inferior outcomes.     

Everyday antiracism in interpersonal contexts: Constraining and facilitating factors for ‘speaking up’ against racism

Everyday conversations among non‐Indigenous Australians are a significant site in which racism towards Indigenous Australians is reproduced and maintained. This study explores the possibilities of everyday antiracism by asking how people negotiate racist discourses in interpersonal contexts. Twelve first year psychology students (10 female, 2 male, aged 18–50) who had completed a compulsory Indigenous studies course were recruited as participants. Semi‐structured interviews were thematically analysed for the constraints and facilitators for responding to racism in everyday contexts. As constraints against speaking up, participants offered ‘social expectations to fit in’, ‘fear of provoking aggression and conflict’, assessments of ‘the type of relationship’, whether they ‘could make a difference’ and the ‘type of racism’. As a facilitator for speaking up, participants reported they were confident in challenging erroneous statements when they felt well informed and authoritative about the facts. The research suggests that everyday antiracism requires a preparedness to deal with possible discomfort and ‘bad feeling’ which participants reported avoiding. The paper concludes with suggestions for stimulating critical thinking and intergroup dialogue in relation to everyday antiracism. Copyright © 2011 John Wiley & Sons, Ltd.     

Social Cognition and Interpersonal Impairment in Young Adolescents with ADHD

The purpose of this study is twofold. First, it aims to examine whether the impairment in peer functioning and social-cognitive deficits (i.e., hostile attribution bias, social comprehension, social problem-solving) found in elementary school aged children with ADHD also occur in adolescence. Second, it aims to provide evidence for a predictive relationship between these social-cognitive deficits and an adolescent’s functional impairment in the social domain. To address these aims, several social-cognitive tasks were administered to a small sample of young adolescents with ADHD (N = 27) and a comparison sample without an ADHD diagnosis (N = 18). Parent report of functional impairment and peer sociometric data were also gathered. Comparisons of both parent and peer report of adolescent social functioning suggest that individuals with ADHD continue to experience difficulties with peers into the adolescent years and data from the social-cognitive tasks show evidence of social comprehension and problem-solving deficits. Further analyses indicated a significant link between functional impairment and social cognition. Findings herein are discussed in the context of both the developmental changes that arise during adolescence and consideration of the importance of social cognition for understanding the impaired social functioning experienced by adolescents with ADHD.     

Investigating a socially anxious‐impulsive subgroup of adolescents: A prospective community study

Previous research has identified a subgroup of socially anxious adults who are both anxious and impulsive. To date, however, this subgroup has not been identified in adolescence. Therefore, in this study we aimed to identify this subgroup in a sample of adolescents. In addition, we hypothesized that this subgroup would be higher on problem behaviors, and that these processes would be moderated by gender. We used longitudinal data from 714 adolescents who were in the 7th and 8th grades at Time 1. They were followed annually for three years. Cluster analyses identified an anxious‐inhibited subgroup as well as an anxious‐impulsive subgroup in early adolescence (Time 1). The socially anxious‐impulsive adolescent boys were generally higher on both intoxication frequency and delinquency compared with all other adolescents in all clusters at each time point. Findings suggest that social anxiety subgroups may differ on problem behavior, and that early detection of an anxious‐impulsive subgroup may be important to prevent maladjustment, especially for adolescent boys.     

American Medicine as Religious Practice: Care of the Sick as a Sacred Obligation and the Unholy Descent into Secularization

Modern medicine serves a religious function for modern Americans as a conduit through which science can be applied directly to the human body. The first half of this paper will focus on the theoretical foundations for viewing medicine as a religious practice arguing that just as a hierarchical structured authoritarian church historically mediated access to God, contemporary Western medicine provides a conduit by which the universalizable truths of science can be applied to the human being thereby functioning as a new established religion. I will then illustrate the many parallels between medicine and religion through an analysis of rituals and symbols surrounding and embedded within the modern practice of medicine. This analysis will pay special attention to the primacy placed on secret interior knowledge of the human body. I will end by responding to the hope for a “secularization of American medicine,” exploring some of the negative consequences of secularization, and arguing that, rather than seeking to secularize, American medicine should strive to use its religious features to offer hope and healing to the sick, in keeping with its historically religious legacy.     

Dreamwork beyond psychoanalysis

Abstract

Dr. Montague Ullman's work with dream groups is the main subject of this paper. After detailing his method there follows an account of the author's experience in a dream workshop run by Dr. Ullman. The theoretical issues involved in this work are discussed, particularly the ideas of Trigant Burrow, an early American analyst who believed in species connectedness, and David Bohm's theory of implicate order. Dr. Ullman's intention to return to the healing process in dreams to ordinary people is connected with the author's paper “Thoughts on the Healing Process.” The implications for psychoanalysis of these holistic ideas are considered.     

Failure to Mentalize Self and Masochistic Functioning

Mentalization includes the ability to apprehend and reflect upon one's subjective state, as well as an appreciation of one's agency (Fonagy & Target, 2006 Fonagy, P. and Target, M. 2006. The mentalization-focused approach to self pathology. Journal of Personality Disorders, 20(6): 544–576. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Masochism is a character pattern that is traditionally defined as pleasure in pain or suffering (Million, 1996 Million, T. M. 1996. Disorders of personality: DSM-IV and beyond , 2nd, New York: John Wiley and Sons.  [Google Scholar]). In some cases the etiology of this character pattern may mirror failures on the part of the caregiving surround that contribute to deficits in the ability to mentalize self (Fonagy, Gergely, & Target, 2007 Fonagy, P., Gergely, G. and Target, M. 2007. The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology and Psychiatry, 48(3/4): 288–328. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Benjamin, 1988 Benjamin, J. 1988. The bonds of love: Psychoanalysis, feminism, and the problem of domination, New York: Pantheon Books.  [Google Scholar]). When this occurs masochism may be more profitably understood as an inability to register pain, rather than pleasure in pain. A case example demonstrates that when a deficit in mentalization underlies masochistic functioning, treatment may include interventions aimed at helping the patient improve the ability to reflect upon his or her mental state, especially negative affect such as pain and anger, and connect to a sense of agency.