Primary Care Medical Provider Attitudes Regarding Mental Health and Behavioral Medicine in Integrated and Non-integrated Primary Care Practice Settings

Primary care medical providers (PCPs) have become de facto providers of services for the management of both mental and chronic illnesses. Although some reports suggest that PCPs favor having Behavioral Health colleagues provide behavioral health services in primary care, others demonstrate this view is necessarily not universal. We examined attitudes regarding behavioral health services among PCPs in practices that offer such services via onsite behavioral health providers (n = 31) and those that do not (n = 62). We compared referral rates and perceived need for and helpfulness of behavioral health colleagues in treating mental health/behavioral medicine issues. In both samples, perceived need was variable (5?C100%), as were PCPs?? views of their own competence in mental health/behavioral medicine diagnosis and treatment. Interestingly, neither sample rated perceived access to behavioral health providers exceptionally high. Referral rates and views about the helpfulness of behavioral health services, except in relation to depression and anxiety, were lower than expected. These results suggest a need for increased collaboration with and education of PCPs about the roles and skills of behavioral health professionals.     

Executive function in CHARGE syndrome.

This study addressed the presence of executive dysfunction in children with CHARGE syndrome, a genetic disorder with multiple physical anomalies and severe challenging behaviors. Ninety-eight children were included in the study. More than half received clinically significant scores on the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) scales of Shift, Monitor, and the Behavioral Regulation Index, with additional high scores on Inhibit and the Global Executive Composite. Associations were found with the age the child first walked, scores on the Autism Behavior Checklist (ABC; Krug et al., 1993), and being classified as deafblind. Difficulties with making transitions and flexible problem solving, monitoring their work and their effect on others, and acting on impulse, may be related to the behavioral difficulties exhibited by children with CHARGE. Interventions targeting improved self-regulation may help to manage this challenging behavior.     

Integrity and Demandingness

I discuss Bernard Williams’ ‘integrity objection’ – his version of the demandingness objection to unreasonably demanding ‘extremist’ moral theories such as consequentialism – and argue that it is best understood as presupposing the internal reasons thesis. However, since the internal reasons thesis is questionable, so is Williams’ integrity objection. I propose an alternative way of bringing out the unreasonableness of extremism, based on the notion of the agent’s autonomy, and show how an objection to this proposal can be outflanked by a strategy that also outflanks the ‘paradox of deontology.’

Perirhinal cortex resolves feature ambiguity in configural object recognition and perceptual oddity tasks

The perirhinal cortex (PRh) has a well-established role in object recognition memory. More recent studies suggest that PRh is also important for two-choice visual discrimination tasks. Specifically, it has been suggested that PRh contains conjunctive representations that help resolve feature ambiguity, which occurs when a task cannot easily be solved on the basis of features alone. However, no study has examined whether the ability of PRh to resolve configural feature ambiguity is related to its role in object recognition. Therefore, we examined whether bilateral excitotoxic lesions of PRh or PPRh (perirhinal plus post-rhinal cortices) in the rat would cause deficits in a configural spontaneous object recognition task, and a configural simultaneous oddity discrimination task, in which the task could not be solved on the basis of features, but could only be solved using conjunctive representations. As predicted by simulations using a computational model, rats with PPRh lesions were impaired during a minimal-delay configural object recognition task. These same rats were impaired during a zero-delay configural object recognition task. Furthermore, rats with localized PRh lesions were impaired in a configural simultaneous oddity discrimination task. These findings support the idea that PRh contains conjunctive representations for the resolution of feature ambiguity and that these representations underlie a dual role for PRh in memory and perception.     

Expanding the aperture of psychological assessment: introduction to the special section on innovative clinical assessment technologies and methods

Contemporary psychological assessment is dominated by tried-and-true methods like clinical interviewing, self-report questionnaires, intellectual assessment, and behavioral observation. These approaches have served as the mainstays of psychological assessment for decades. To be sure, these methods have survived over the years because clinicians have found the information gleaned from these improves our understanding of the client, helps formulate a treatment plan, or aids in assessing outcome. However, are there any recent technological or methodological developments that might improve the clinical assessment enterprise? Some believe so. The purpose of this special section is to provide a snapshot of relatively newer clinical assessment technologies and methods that have been underutilized. Each article in this special section presents one or more assessment methods or techniques that are currently available and are showing some promise in clinical assessment.     

VIEWPOINT DEPENDENCE IN SCENE RECOGNITION

Abstract— Two experiments investigated the viewpoint dependence of spatial memories. In Experiment 1, participants learned the locations of objects on a desktop from a single perspective and then took part in a recognition test, test scenes included familiar and novel views of the layout. Recognition latency was a linear function of the angular distance between a test view and the study view. In Experiment 2, participants studied a layout from a single view and then learned to recognize the layout from three additional training views. A final recognition test showed that the study view and the training views were represented in memory, and that latency was a linear function of the angular distance to the nearest study or training view. These results indicate that interobject spatial relations are encoded in a viewpoint-dependent manner, and that recognition of novel views requires normalization to the most similar representation in memory. These findings parallel recent results in visual object recognition     

"If …": Satisficing algorithms for mapping conditional statements onto social domains

People regularly use conditional statements to communicate promises and threats, advices and warnings, permissions and obligations to other people. Given that all conditionals are formally equivalent--"if P, then Q"--the question is: When confronted with a conditional statement, how do people know whether they are facing a promise, a threat, or something else? In other words, what is the cognitive algorithm for mapping a particular conditional statement onto its corresponding social domain? This paper introduces the pragmatic cues algorithm and the syntactic cue algorithm as partial answers to this question. Two experiments were carried out to test how well these simple satisficing algorithms approximate the performance of the actual cognitive algorithm people use to classify conditional statements into social domains. Conditional statements for promises, threats, advices, warnings, permissions, and obligations were collected from people, and given to both other people and the algorithms for their classification. Their corresponding performances were then compared. Results revealed that even though these algorithms utilised a minimum number of cues and drew only a restricted range of inferences from these cues, they performed well above chance in the task of classifying conditional statements as promises, threats, advices, warnings, permissions, and obligations. Moreover, these simple satisficing algorithms performed comparable to actual people given the same task.     

Attention training improves aberrant neural dynamics during working memory processing in veterans with PTSD

Posttraumatic stress disorder (PTSD) is associated with executive functioning deficits, including disruptions in working memory (WM). Recent studies suggest that attention training reduces PTSD symptomatology, but the underlying neural mechanisms are unknown. We used high-density magnetoencephalography (MEG) to evaluate whether attention training modulates brain regions serving WM processing in PTSD. Fourteen veterans with PTSD completed a WM task during a 306-sensor MEG recording before and after 8 sessions of attention training treatment. A matched comparison sample of 12 combat-exposed veterans without PTSD completed the same WM task during a single MEG session. To identify the spatiotemporal dynamics, each group’s data were transformed into the time-frequency domain, and significant oscillatory brain responses were imaged using a beamforming approach. All participants exhibited activity in left hemispheric language areas consistent with a verbal WM task. Additionally, veterans with PTSD and combat-exposed healthy controls each exhibited oscillatory responses in right hemispheric homologue regions (e.g., right Broca’s area); however, these responses were in opposite directions. Group differences in oscillatory activity emerged in the theta band (4–8 Hz) during encoding and in the alpha band (9–12 Hz) during maintenance and were significant in right prefrontal and right supramarginal and inferior parietal regions. Importantly, following attention training, these significant group differences were reduced or eliminated. This study provides initial evidence that attention training improves aberrant neural activity in brain networks serving WM processing.