Drug treatment of epilepsy: when does it fail and how to optimize its use?

Although modern community-based studies have shown that a majority of people with newly diagnosed epilepsy will enter long-term remission, seizures remain refractory to treatment in a substantial proportion of this population--perhaps as much as 40%. A consensus is being reached that, for operational purposes, pharmacoresistance can be suspected when two appropriately chosen, well-tolerated, first-line antiepileptic drugs (AEDs) or one monotherapy and one combination regimen have failed due to lack of efficacy. Poor prognostic factors include lack of response to the first AED, specific syndromes, symptomatic etiology, family history of epilepsy, psychiatric comorbidity, and high frequency of seizures. These observations suggest that prognosis can often be determined early in the course of the disorder. We propose a management paradigm that aims to maximize the chance of successful AED therapy, including the early use of "rational polytherapy" for patients not responding to monotherapy, and to identify efficiently patients suitable for "curative" resective surgery, in particular those with mesial temporal lobe epilepsy. An orderly approach to each epilepsy syndrome will optimize the chance of perfect seizure control and help more patients achieve a fulfilling life.     

Senior capstone design and ethics: A bridge to the professional world

A senior level capstone design experience has been developed and offered with a particular emphasis on many of the professional issues raised in Accreditation Board for Engineering and Technology (ABET) Engineering Criterion IV. The course has sought to develop student awareness of the ethical foundation of the engineering profession, the global and societal framework within which engineers practice, and the environmental impact on engineering. The capstone design course also focused upon improving the technical communications skills of the graduating senior class with both extensive instruction in writing and multiple workshops dealing with the art of making an effective oral presentation. The effectiveness of the design course was assessed using Kirkpatrick’s model for evaluating training programs. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Psychopathy and physiological response to emotionally evocative sounds

Despite considerable evidence that psychopathic criminals are deviant in their emotional reactions, few studies have examined responses to both pleasurable and aversive stimuli or assessed the role of different facets of psychopathy in affective deviations. This study investigated physiological reactions to emotional sounds in prisoners selected according to scores on the 2 factors of Hare's Psychopathy Checklist--Revised (PCL-R; R. D. Hare, 1991). Offenders high on the PCL-R emotional-interpersonal factor, regardless of scores on the social deviance factor, showed diminished skin conductance responses to both pleasant and unpleasant sounds, suggesting a deficit in the action mobilization component of emotional response. Offenders who scored high only on the social deviance factor showed a delay in heart rate differentiation between affective and neutral sounds. These findings indicate abnormal reactivity to both positive and negative emotional stimuli in psychopathic individuals, and suggest differing roles for the 2 facets of psychopathy in affective processing deviations.     

MMPI-2 profile code types and measurement error

We studied simulated MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) code type stability and change expected with measurement error for 12 MMPI-2 well-defined mean code type profiles. Profile scores for the 2 scales defining the code type were systematically varied to represent target code type profiles at 9 different levels of T-score profile definition. We randomly generated samples of 50 simulated, estimated true score profiles at each level of profile definition for each code type around the estimated true scores for each scale at each level of profile definition. Two sets of simulated profiles were developed. The first simulation was based on the reported means, test-retest reliabilities, and the standard errors of measurement for the MMPI-2 normative group. The second simulation was based on the means, standard deviations, and estimated retest stability for a clinical group of psychiatric patients. We calculated frequencies and percentages of simulated profiles with the highest estimated true scores on the same 2 scales as the original code type profile. Percentages of simulated profiles with the same 2 highest scales as the original code type profiles increased from 27% to 37% for the 3-point level of definition, 37% to 49% for the 5-point definition, 46% to 61% for 7-point definition, 63% to 78% for 10-point definition, 78% to 89% for 13-point definition, 83% to 93% for 15-point definition, and greater than 90% for profile definition greater than 15 points.     

Perceptions of Ethical Behaviour among Business Faculty in Canada

Faculty members at Canadian business schools were surveyed regarding their ethical perceptions of behaviours related to undergraduate instruction. Fifty-five behavioural statements were listed and respondents were asked to rate the extent to which they felt each behaviour was ethical or unethical. The only item that respondents endorsed as unequivocally unethical (90% indicated it was definitely unethical) was Becoming sexually involved with an undergraduate in one of your classes. We also compared the results of our sample to those of an American sample. Overall, an interesting pattern of differences emerged between the responses obtained in Canada and the U.S. In general, the direction of the significant differences was such that Canadian professors viewed the behaviours in question as less ethical than did their American counterparts.     

The developmental ecology of urban males' youth violence

Data from a longitudinal study of 294 African American and Latino adolescent boys and their caregivers living in poor urban communities were used to test a developmental-ecological model of violence. Six annual waves of data were applied to evaluate the relations between microsystem influences of parenting and peer deviance (peer violence and gang membership), macrosystem influences of community structural characteristics and neighborhood social organization, and individual involvement in violence (level and growth). Structural equation modeling analyses showed that community structural characteristics significantly predicted neighborhood social processes. Parenting practices partially mediated the relation between neighborhood social processes and gang membership. Parenting practices was fully mediated in its relation to peer violence by gang membership. Gang membership was partially mediated by peer violence level in its relation to individual violence level. Although the overall set of relations does not satisfy mediation requirements fully in all instances, the model was validated for the most part, supporting a focus on a multilevel ecological model of influences on risk development.     

Do age of onset and course of illness define biologically distinct groups within atypical depression?

Illness course separates patients with atypical depression into tricyclic responders and nonresponders as does perceptual asymmetry. The authors therefore investigated whether the course-of-illness parameters would define groups within atypical depression differing in brain laterality. Patients with atypical depression were assessed for illness course and brain laterality. Two patient groups were defined, 1 with onset prior to age 20 plus a very chronic course, and a 2nd group having later onset or less chronic illness. Patients reporting early onset of very chronic dysphoria showed significantly less right-ear (left-hemisphere) accuracy and also differed in characteristic perceptual asymmetry when compared to patients with later onset or less chronicity. Course of illness may usefully define more homogeneous depressive subgroups within atypical depression.     

The use of latent trajectory models in psychopathology research

Despite the recent surge in the development of powerful modeling strategies to test questions about individual differences in stability and change over time, these methods are not currently widely used in psychopathology research. In an attempt to further the dissemination of these new methods, the authors present a pedagogical introduction to the structural equation modeling based latent trajectory model, or LTM. They review several different types of LTMs, discuss matching an optimal LTM to a given question of interest, and highlight several issues that might be particularly salient for research in psychopathology. The authors augment each section with a review of published applications of these methods in psychopathology-related research to demonstrate the implementation and interpretation of LTMs in practice.     

An approach for practice administration and interpretation of the MMPI-2

This paper discusses one teaching approach for practice administration and interpretation of the MMPI-2 in a graduate course on personality assessment. After graduate students practice scoring and interpreting the MMPI-2 inventory completed with specific response sets and practice interpreting MMPI-2 profiles of cases prepared for teaching and practice in interpretation, students practice administering and interpreting the MMPI-2 for volunteer test-takers who complete the inventory with a simulated stress response set. The simulated stress response set approach may be helpful in providing skill-building practice in the early phases of learning the MMPI-2 with volunteer test-takers, while minimizing some of the ethical concerns raised regarding actual administrations with nonclient volunteers in the early phases of training in assessment.