Offering predictive testing for Huntington disease in a medical genetics clinic: Practical applications

Predictive testing for Huntington disease is presently offered in a select few medical genetics centers in the United States. This is in part due to the labor intensive counseling and psychological testing suggested by the research protocols. We discuss some specific suggestions for establishing programs for Huntington disease predictive testing within pre-existing medical genetics clinics to encourage more centers to offer presymptomatic testing. This will allow more at risk individuals the opportunity to consider predictive testing and cut down the expenses of traveling to the few predictive testing centers that currently exist. The counseling principals will remain similar to those discussed here, even following the identification of the Huntington disease mutation.     

The importance of a holistic concept of health for health care. Examples from the clinic

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed.     

Internalistic foundationalism and the justification of memory belief

In this paper I argue that internalistic foundationalist theories of the justification of memory belief are inadequate. Taking a discussion of John Pollock as a starting point, I argue against any theory that requires a memory belief to be based on a phenomenal state in order to be justified. I then consider another version of internalistic foundationalism and claim that it, too, is open to important objections. Finally, I note that both varieties of foundationalism fail to account for the epistemic status of our justified nonoccurrent beliefs, and hence are drastically incomplete.     

The role of position in object selection in vision

Summary Within contemporary visual-information-processing psychology, two classes of selective-attention theories can be distinguished: position-not-special theories and position-special theories. The position-not-special theories postulate that attentional selection by colour, by form, and by position are equivalent selective operations. The position-special theories assume that selection by position is more basic or direct than selection by colour or by form. Examples of both types of theory are briefly described, and irrelevant and relevant evidence is critically discussed. It is concluded that the relevant evidence is directly compatible with the position-special views and that the position-not-special theories require additional extraneous assumptions. The position-special model presented in Van der Heijden (1992) is elaborated in further detail. It is shown that this model is compatible with two important and often substantiated assumptions of the position-not-special theories: the assumption that pre-attentive analysers organize the visual scene in objects against a background, and the assumption that visual-selective attention can be directed at objects isolated in this way. This position-special theory is a parsimonious theory because it can identify the mentalistic conceptselective attention with the materialistic conceptspatial position.     

Auditory accessory effects on visual processing

A series of experiments on intersensory facilitation demonstrates that non-informative sound of low to moderate intensity (30/80 dB) facilitates the reaction to a visual stimulus. By manipulating the preprocessing and perceptual stages of the visual signals, it appears that auditory intensity reduces choice reaction time independently from the positive influence of the intensity and duration of the visual imperative signal, but interacts with the effect of stimulus degradation. Degraded stimuli take more profit of the sound than intact stimuli. Besides a short-term activation effect, originated by accessories of the auditory modality, on the motor adjustment stage (cf. Sanders 1983), the results suggest that the accessory influences the stage of feature extraction.     

The Use of Psychoendocrine Strategies in Post-Traumatic Stress Disorder1

An overview is presented of a pilot psychoendocrine study of PTSD inpatients in comparison with several subgroups of schizophrenic and affective disorder patients. Using a hormonal profile including Cortisol, norepinephrine, epinephrine, testosterone, and thyroxine, it was found that the mean values for the PTSD group were at or near the extreme end of the range for every hormone measured, i.e., relatively low for Cortisol and high for the remaining hormones. The possible clinical meaning of these findings is considered in the light of prior psychoendocrine research on chronic stress. The hormonal alterations in PTSD appear to be persistent and suggest the possibility of being linked largely to traits or character structure, perhaps particularly to cognitive variables related to defense and coping mechanisms, as reviewed in detail for each hormonal system. There appears to be a potential for a fruitful union between the traumatic stress and psychoendocrine fields and some future strategies for developing and strengthening such a union are suggested.