EDP (electronic data processing)-oriented special documentation in neurology--extension to a computer epicrisis

The contribution describes a final neurological documentation system for in-patients that permits the computerized print-out of an epicrisis. The computer automatically summarizes the elementary findings and presents them as a number of important neurological syndromes. The structure of the documentation and the experience gained in the course of many years of routine application are described. The system has proved to be basically sound under the conditions existing at a university hospital and a specialized hospital for psychiatry and neurology and has proved applicable for a large proportion of the patients without major restrictions.     

Conditioning of a discriminative drug stimulus: Overshadowing and blocking like procedures

Interactions between a drug discriminative stimulus ( D , 17.5 mg/kg of pentobarbital vs. N , saline) and exteroceptive stimulus conditions (light vs. dark) were examined in a T-maze, shock-escape task using conditioning procedures pertaining to the phenomena of "overshadowing" and "blocking". From an operational point of view, in the "overshadowing" procedure the stimulus compound is introduced from the outset of the training, whereas in the "blocking" procedure the stimuli components are introduced sequentially. When the compound discriminations were established, dose-generalization tests with various doses of pentobarbital (range 5.6–17.5 mg/kg) as well as saline (1 ml/kg) were carried out under both elements (light and dark) of the exteroceptive stimulus dimension. Prior training with drug ( D vs. N ) neutralized the potential influence of the exteroceptive dimension (light vs. dark); conversely training with the exteroceptive stimuli prior to the drug training accentuated the control over behavior by the visual stimuli. Dose-generalization results intermediate to those described above were observed in the group trained to discriminate the stimulus compound ( D plus light vs. N plus dark) from the outset of training. It may therefore be concluded that exteroceptive stimuli can compete with interoceptive drug stimuli for associative strength in the procedure used. Thus, the formal similarities between drug discriminative stimuli and more conventionally studied exteroceptive, sensory signals are furthered by the data.     

On the conflict between logic and belief in syllogistic reasoning

Three experiments are reported that investigate the weighting attached to logic and belief in syllogistic reasoning. Substantial belief biases were observed despite controls for possible conversions of the premises. Equally substantial effects of logic were observed despite controls for two possible response biases. A consistent interaction between belief and logic was also recorded; belief bias was more marked on invalid than on valid syllogisms. In all experiments, verbal protocols were recorded and analyzed. These protocols are interpreted in some cases as providing rationalizations for prejudiced decisions and, in other cases, as reflecting a genuine process of premise to conclusion reasoning. In the latter cases, belief bias was minimal but still present. Similarly, even subjects who focus primarily on the conclusion are influenced to an extent by the logic. Thus a conflict between logic and belief is observed throughout, but at several levels of extent.     

Hierarchical factor solution of coding and planning processes: Any new insights?

Hierarchical factor solution was used in the present paper in order to examine if two coding processes, simultaneous and successive, would load on a general 2nd level factor. It was further used to test if the coding processes and a factor representing planful behavior will not share the same general factor, revealing their relative independence as expected from a theoretical model of cognitive functions. Results supported the grouping of the coding tasks within a general factor, as well as the emergence of two general factors, one each for coding and planning. Further correlational evidence supported the relative independence of these two kinds of cognitive processes. These findings were discussed in the context of a general factor of intelligence.     

Disintegrated experience: the dissociative disorders revisited

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.     

Processing of threat-related information in rape victims

We investigated selective processing of threat information in persons with posttraumatic stress disorder (PTSD) by using a modified Stroop procedure. Subjects were 15 rape victims with PTSD, 13 rape victims without the disorder, and 16 nontraumatized control subjects. They were asked to name the color of four types of words: specific threat (rape-related) words, general threat (related to physical harm and death) words, neutral words, and nonwords. Rape victims with PTSD evidenced a longer response latency for color naming of rape-related words than for other target-word types. Response latencies of non-PTSD victims and nonvictim control subjects did not differ across word types. Possible mechanisms underlying the selective processing of threat material are considered, and clinical implications are discussed.     

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anxiety induced by cardiac perceptions in patients with panic attacks: a field study

In panic disorder bodily sensations appear to play an important role as a trigger for anxiety. In our psychophysiological model of panic attacks we postulate the following vicious circle: individuals with panic attacks perceive even quite small increases in heart rate and interpret these changes as being catastrophic. This elicits anxiety and a further increase in heart rate. To evaluate this model we conducted a field study of 28 subjects with panic attacks and 20 healthy controls. A 24 hr ambulatory ECG was recorded and the subjects were instructed to report any cardiac perceptions during this period and to rate the anxiety elicited by these perceptions. The incidence of cardiac perceptions was about the same in both groups, but only subjects with panic attacks reported anxiety associated with such perceptions. Analysis of the ECGs revealed that in both groups heart rate accelerations preceded cardiac perceptions. Following cardiac perceptions, the healthy controls showed a heart rate deceleration, whereas the subjects with panic attacks had a further acceleration. This heart rate increase after cardiac perceptions was positively related to the level of anxiety elicited by the perceptions. These results provide clear evidence in support of the vicious circle model of panic attacks.     

Dichotic listening during forced-attention in a patient with left hemispherectomy

A young left-handed girl with an extensive posttraumatic lesion in the left hemisphere was tested with dichotic listening (DL) under three different attentional instructions. The major aim of the study was to evaluate a structural vs attentional explanation for dichotic listening. As both her expressive and receptive language functions were intact after the lesion, it was assumed that the right hemisphere was the language-dominant one. In the free-report condition, she was free to divert attention to and to report from both ear inputs. In the forced-right condition, she was instructed to attend to and report only from the right ear input. In the forced-left condition, she was instructed to attend to and to report only from the left-ear input. Her performance was compared with data from a previously collected sample of normal left-handed females. Analysis showed that the patient, in contrast to the normal sample, revealed a complete right-ear extinction phenomenon, irrespective of attentional instruction. Furthermore, she showed superior correct reports from the left ear, compared with those of the normal sample, also irrespective of attentional instruction. It is concluded that these results support a structural, rather than attentional explanation for the right-ear advantage (REA) typically observed in dichotic listening. The utility of validating the dichotic listening technique on patients with brain lesions is discussed.