Thoughts on representation in therapy of Holocaust survivors1

This paper presents the problems of representation and lack of representation in treating Holocaust survivors, through clinical vignettes and various theoreticians. The years of Nazi persecution and murder brought about a destruction of symbolization and turning inner and external reality into the Thing itself, the concrete, or, in Lacan’s words, ‘The Thing’. The paper presents two ideas related to praxis as well as theory in treating Holocaust survivors: the first is related to the therapist’s treatment of the Holocaust nightmare expressing the traumatic events just as they happened 63 years previously; the second deals with the attempt at subjectification, in contrast to the objectification forced by the Nazis on their victims.     

Genetic Counseling in the Era of Genomics: What’s all the Fuss about?

As genomic sequencing becomes more widely available in clinical settings for diagnostic purposes, a number of genetic counseling issues are gaining precedence. The ability to manage these issues will be paramount as genetic and non-genetic healthcare professionals navigate the complexities of using genomic technologies to facilitate diagnosis and inform patient management. Counseling issues arising when counseling for diagnostic genomic sequencing were identified by four genetic counselors with 10 years of collective experience providing genetic counseling in this setting. These issues were discussed and refined at a meeting of genetic counselors working in clinical genomics settings in Melbourne, Australia. Emerging counseling issues, or variations of established counseling issues, were identified from the issues raised. Illustrative cases were selected where pre- and post-test genetic counseling was provided in clinical settings to individuals who received singleton or trio WES with targeted analysis. Counseling issues discussed in this paper include a reappraisal of how genetic counselors manage hope in the genomic era, informed consent for secondary use of genomic data, clinical reanalysis of genomic data, unexpected or unsolicited secondary findings, and trio sequencing. The authors seek to contribute to the evolving understanding of genetic counseling for diagnostic genomic sequencing through considering the applicability of existing genetic counseling competencies to managing emerging counseling issues and discussing genetic counseling practice implications.     

Cognitive disruption and altered hippocampus synaptic function in Reelin haploinsufficient mice

The heterozygote reeler mouse (HRM) shows many neuroanatomical and biochemical features that are also present in some human cognitive disorders, such as schizophrenia. In the present study, hippocampal dependent plasticity and cognitive function of the HRM were characterized in detail in an attempt to reveal phenotypic functional differences that result from Reelin haploinsufficiency. The HRM and wild type mice show similar levels of overall activity, coordination, thermal nociception, startle responses, and anxiety-like behavior. In addition, both genotypes show similar shock threshold, identical cued freezing behavior and comparable spatial learning in Morris water maze tasks. However, a significant reduction in contextual fear conditioned learning was observed in the HRM. Electrophysiological studies in hippocampal CA1 synapses revealed a plethora of differences between genotypes. The HRM exhibits reduced field excitatory postsynaptic potentials in responses to similar synaptic inputs, lowered paired pulse facilitation ratio and impaired long-term depression and tetanus-induced long-term potentiation (LTP). Also, deficits were detected in LTP elicited by theta burst stimulation or by a whole cell pairing protocol. These physiologic differences could not be accounted for by changes in the overall amount of glutamate receptor subunits. In addition, it was determined that network-driven excitatory and inhibitory activities recorded in CA1 pyramidal neurons showed that the HRM had comparable amplitude and frequency of spontaneous excitatory postsynaptic currents, but a marked reduction in spontaneous inhibitory postsynaptic currents. Thus, the HRM exhibits a specific hippocampal-dependent learning deficit accompanied with a pronounced impairment of hippocampal plasticity and functional inhibitory innervation.     

P50 Suppression in Children with Selective Mutism: a Preliminary Report

Evidence suggests that children with selective mutism (SM) display significant aberrations in auditory efferent activity at the brainstem level that may underlie inefficient auditory processing during vocalization, and lead to speech avoidance. The objective of the present study was to explore auditory filtering processes at the cortical level in children with SM. The classic paired-click paradigm was utilized to assess suppression of the P50 event-related potential to the second, of two sequentially-presented clicks, in ten children with SM and 10 control children. A significant suppression of P50 to the second click was evident in the SM group, whereas no suppression effect was observed in controls. Suppression was evident in 90% of the SM group and in 40% of controls, whereas augmentation was found in 10% and 60%, respectively, yielding a significant association between group and suppression of P50. P50 to the first click was comparable in children with SM and controls. The adult-like, mature P50 suppression effect exhibited by children with SM may reflect a cortical mechanism of compensatory inhibition of irrelevant repetitive information that was not properly suppressed at lower levels of their auditory system. The current data extends our previous findings suggesting that differential auditory processing may be involved in speech selectivity in SM.     

Justifying Counterproductive Work Behaviors and an Integrity‐based Conditional Reasoning Test: Back to the drawing board?

Conditional reasoning tests (CRT) were proposed as an innovative approach to implicitly measure the rationalizations toward counterproductive work behaviors (CWB) often associated with overt integrity tests. The authors first set out to map a typology of justification mechanisms for general CWB, and to then validate a new integrity‐based CRT in both honest and faking testing conditions. Unfortunately, while demonstrating encouraging construct and criterion validity in the honest testing condition, the test was less resistant to faking than originally anticipated, and ceased to be valid in the faking condition. Overall, the results provide theoretical insight toward understanding how employees justify CWB, but raise concerns regarding the potential operational limitations of at least some CRTs.     

A Developmental Trajectory in Implicit Memory is Revealed by Picture Fragment Completion

Dissociations between performance on implicit and explicit tasks have often been taken as evidence that different neural structures subserve the two types of memory. One such dissociation involves developmental differences that emerge in explicit tasks, but which appear to be absent in implicit tasks. Such findings are consistent with the idea that implicit memory is subserved by a more primitive system that evolves earlier at both phylogenetic and ontogenetic levels. The present paper reviews previous studies that claimed to find evidence that implicit memory is fully developed in very young children. Issues of measurement error, ceiling effects, and insufficient power brought up questions about those studies with respect to the developmental issue. The present study compares performance on implicit (picture fragment completion) and explicit (free recall and recognition) memory tasks with groups ranging in age from 5–28 years. We find a reliable developmental trend in both implicit and explicit performance in which the former cannot be attributed to the operation ofexplicit memory processes. Thus, we conclude that implicit memory, like explicit memory, develops with age.     

Reprint of ‘Age-related changes in executive control and their relationships with activity performance in handwriting’

Deterioration in the frontal and prefrontal cortex associated with executive functions (EF) occurs with age and may be associated with changes in daily performance. The aim of the present study was to describe changes occurring with age in Executive Functions (EF) and handwriting activity, as well as to analyze relationships between age, EF and handwriting performance. The study population included 80 healthy participants (aged 31 to 76+) living in the community. After answering five questions about their writing habits, the participants completed the Behavioral Assessment of the Dysexecutive Syndrome (BADS). In addition, they performed a handwriting task on a digitizer included in the Computerized Penmanship Evaluation Tool (ComPET), which provides kinematic measures of the handwriting process. Significant differences were found between the four age groups for both EF and temporal and spatial handwriting measures. A series of regressions indicated that age predicted 35% of the variance of the BADS profile score (EF control) and 32% of the variance of in-air time while writing. The results of this study indicated age effect on both EF control and handwriting performance. Possible implications for further research and clinical evaluation and intervention are discussed.     

Attachment Styles and Attraction to Death: Diversities Among Eating Disorder Patients

The current research was aimed at examining how attachment styles are connected to attraction to death among eating disorder (ED) patients. A sample of 34 anorexic and 34 bulimic patients was matched by age, sex, and socioeconomic status to 37 normal controls. They were administered the Adult Attachment Scale, the Beck Depression Inventory, and the Multi-Attitude Suicidal Tendency Scale. Results show that ED patients scored significantly higher on the insecure attachment scale and were less attracted to and more repulsed by life than controls. No significant differences were found on death variables. A significant difference between the three attachment styles was found beyond depression. The results suggest a model that may explain the diversities of attachment styles and the relationship with death among ED patients. Insecure attachment style may explain the repulsion by life, while the illness itself may serve as a false “secure base” and may protect from the fear of death. Clinicians may thus attempt to replace the “illness secure base” by enriching the attraction to life.     

Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.