Multidisciplinary assessment and diagnosis of conversion disorder in a patient with foreign accent syndrome

Multiple reports have described patients with disordered articulation and prosody, often following acute aphasia, dysarthria, or apraxia of speech, which results in the perception by listeners of a foreign-like accent. These features led to the term foreign accent syndrome (FAS), a speech disorder with perceptual features that suggest an indistinct, non-native speaking accent. Also correctly known as psuedoforeign accent, the speech does not typically match a specific foreign accent, but is rather a constellation of speech features that result in the perception of a foreign accent by listeners. The primary etiologies of FAS are cerebrovascular accidents or traumatic brain injuries which affect cortical and subcortical regions critical to expressive speech and language production. Far fewer cases of FAS associated with psychiatric conditions have been reported. We will present the clinical history, neurological examination, neuropsychological assessment, cognitive-behavioral and biofeedback assessments, and motor speech examination of a patient with FAS without a known vascular, traumatic, or infectious precipitant. Repeated multidisciplinary examinations of this patient provided convergent evidence in support of FAS secondary to conversion disorder. We discuss these findings and their implications for evaluation and treatment of rare neurological and psychiatric conditions.     

Medication-assisted treatment research with criminal justice populations: challenges of implementation

Creating, implementing and evaluating substance abuse interventions, especially medication-assisted treatments, for prisoners, parolees, and probationers with histories of heroin addiction is an especially challenging endeavor because of the difficulty in coordinating and achieving cooperation among diverse criminal justice, substance abuse treatment, research, and social service agencies, each with its own priorities and agenda. In addition, there are special rules that must be followed when conducting research with criminal justice-involved populations, particularly prisoners. The following case studies will explore the authors' experience of over 10 years conducting pharmacotherapy research using methadone, buprenorphine, and naltrexone with criminal justice populations. The major obstacles and how they were overcome are presented. Finally, recommendations are provided with regard to implementing and conducting research with criminal justice populations. Copyright © 2011 John Wiley & Sons, Ltd.     

Correlates of level and change in the Mini-Mental State Examination

The goal of the current project was to determine (a) the cognitive abilities assessed by the Mini Mental State Examination (MMSE; M. F. Folstein, S. E. Folstein, & P. R. McHugh, 1975), (b) whether the same abilities are associated with MMSE performance among people of different ages, and (c) whether the same abilities are involved in changes within the same people over time. The authors therefore examined whether the initial levels of 5 cognitive ability constructs (vocabulary, reasoning, memory, space, and speed) predicted initial levels of MMSE performance and whether the initial levels or the changes in these 5 cognitive abilities predicted change in the MMSE performance. The major findings were that 3 cognitive constructs (vocabulary, reasoning, and memory) contribute to performance in the MMSE but that their respective contributions to the MMSE vary as a function of age and time. In particular, individual differences and change in the MMSE are primarily related to individual differences in reasoning among adults younger than about 70 years, whereas both initial level of MMSE performance and longitudinal change in MMSE performance primarily related to initial level and change in memory ability among adults older than 70 years. The results therefore imply that both the level of performance on the MMSE at a single point in time and the change in MMSE over time may represent somewhat different cognitive abilities at different ages.     

The organization of room geometry and object layout geometry in human memory

Research with humans and with nonhuman species has suggested a special role of room geometry in spatial memory functioning. In two experiments, participants learned the configuration of a room with four corners, along with the configuration of four objects within the room, while standing in a fixed position at the room's periphery. The configurations were either rectangular (Experiment 1) or irregular (Experiment 2). Room geometry was not recalled better than object layout geometry, and memories for both configurations were orientation dependent. These results suggest that room geometry and object layout geometry are represented similarly in human memory, at least in situations that promote long-term learning of object locations. There were also some differences between corners and objects in orientation dependence, suggesting that the two sources of information are represented in similar but separate spatial reference systems. [corrected]     

Memory consolidation in both trace and delay fear conditioning is disrupted by intra-amygdala infusion of the protein synthesis inhibitor anisomycin

Memory for delay fear conditioning requires the synthesis of new mRNA and protein in the basolateral amygdala. It is currently unknown whether similar molecular processes in the amygdala are required for the formation of trace fear memory, in which a stimulus-free interval is inserted between the conditional stimulus (CS) and unconditional stimulus (UCS). Here, we show that infusion of the protein synthesis inhibitor anisomycin into the basolateral amygdala disrupts consolidation of both trace and delay fear conditioning. This is the first evidence that protein synthesis in the amygdala is necessary for the formation of both trace and delay fear memory.     

The NEO Five-Factor Inventory: latent structure and relationships with dimensions of anxiety and depressive disorders in a large clinical sample

The present study evaluated the latent structure of the NEO Five-Factor Inventory (NEO FFI) and relations between the five-factor model (FFM) of personality and dimensions of DSM-IV anxiety and depressive disorders (panic disorder, generalized anxiety disorder [GAD], obsessive-compulsive disorder, social phobia [SOC], major depressive disorder [MDD]) in a large sample of outpatients (N = 1,980). Exploratory structural equation modeling (ESEM) was used to show that a five-factor solution provided acceptable model fit, albeit with some poorly functioning items. Neuroticism demonstrated significant positive associations with all but one of the disorder constructs whereas Extraversion was inversely related to SOC and MDD. Conscientiousness was inversely related to MDD but demonstrated a positive relationship with GAD. Results are discussed in regard to potential revisions to the NEO FFI, the evaluation of other NEO instruments using ESEM, and clinical implications of structural paths between FFM domains and specific emotional disorders.     

Confirmatory factor analysis of the WAIS-IV/WMS-IV

The Wechsler Adult Intelligence Scale-fourth edition (WAIS-IV) and the Wechsler Memory Scale-fourth edition (WMS-IV) were co-developed to be used individually or as a combined battery of tests. The independent factor structure of each of the tests has been identified; however, the combined factor structure has yet to be determined. Confirmatory factor analysis was applied to the WAIS-IV/WMS-IV Adult battery (i.e., age 16-69 years) co-norming sample (n = 900) to test 13 measurement models. The results indicated that two models fit the data equally well. One model is a seven-factor solution without a hierarchical general ability factor: Verbal Comprehension, Perceptual Reasoning, Processing Speed, Auditory Working Memory, Visual Working Memory, Auditory Memory, and Visual Memory. The second model is a five-factor model composed of Verbal Comprehension, Perceptual Reasoning, Processing Speed, Working Memory, and Memory with a hierarchical general ability factor. Interpretative implications for each model are discussed.     

"Doctor, would you prescribe a pill to help me … ?" a national survey of physicians on using medicine for human enhancement

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians' experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging.