Where in the brain is the self?

Localizing the self in the brain has been the goal of consciousness research for centuries. Recently, there has been an increase in attention to the localization of the self. Here we present data from patients suffering from a loss of self in an attempt to understand the neural correlates of consciousness. Focusing on delusional misidentification syndrome (DMS), we find that frontal regions, as well as the right hemisphere appear to play a significant role in DMS and DMS related disorders. These data are placed in the context of neuroimaging findings.     

A Descriptive Study of Pain and Quality of Life following Guillain-Barré Syndrome: One Year Later

Guillain-Barré syndrome (GBS) is a debilitating immunopathy that afflicts approximately 5,000 patients annually in the United States, a number that represents roughly half of the incidence of spinal cord injuries (J. M., Meythaler, 1997). Of these 5,000 new cases per year, 4–15% will die, 20% will possess deficits in ambulation or require ventilator assistance more than one year later, and more than two-thirds will have persistent fatigue (J. M., Meythaler, 1997; Hughes et al., 2003). These figures suggest that GBS is currently a legitimate cause of long-term disability.Many secondary complications may follow GBS that include dysautonomia, deep vein thrombosis, anemia, immobilization, and pain and sensory involvement (J. M., Meythaler, 1997; J. M. Meythaler, M. J. De Vivo, and W. C. Braswell, 1997). These medical complications have not been studied systematically, and the psychosocial complication of pain following GBS has certainly been overlooked in the literature. The present paper utilized a limited sample of 18 patients (N = 18) with persistent motor deficits at least one year after onset of GBS. We examined their pain and perceived quality of life as part of an ongoing federally funded study which will ultimately attempt to determine if 4-aminopyridine (4-AP) significantly improves motor function in patients with residual weakness from GBS. Findings suggest that while most persons do not rate themselves as depressed one year after GBS onset, 22% of respondents did exceed the cutoff for clinical depression on the CES-D. Age and gender do not appear to be related to any component of pain in GBS; however, self-ratings of physical and mental health do appear to be significantly related to pain experience. The nature of this relationship was not determined, and merits further investigation in future studies.     

Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome

Although separate lines of behaviorally oriented pain research have drawn attention to the importance of pain catastrophizing and trait worry, little is known about how they work together to influence aspects of chronic pain. Integrating pain research with the broader anxiety, cognitive science, and learning literature, we hypothesized that the process (vs. content) of worry influences pain through catastrophizing. One hundred and eighty-six consecutive patients diagnosed (Rome II) with irritable bowel syndrome completed measures of three dimensions of pain (sensory pain, affective pain, long-term suffering), pain intensity, trait anxiety, worry, catastrophizing, and somatization during baseline assessment of an NIH-funded clinical trial of two psychological treatments. Worry was most strongly associated with the emotionally unpleasant aspects of pain, particularly suffering. Multivariate mediational analyses showed that catastrophizing mediated the link between worry and suffering. Worry, catastrophizing and control variables accounted for 46% of the variance in suffering. Chronic pain patients who worry excessively engage in more catastrophic thinking and through this cognitive process experience more intensely the suffering component of pain. Data are consistent with the notion that worry functions as an "experiential avoidance" strategy for aversive features of pain. Findings are discussed with respect to their relevance to behavioral models for understanding and treating anxiety-related chronic pain disorders.     

The Role for Occupational Therapists in Community Mobility Training for People With Autism Spectrum Disorders

Symptoms and behaviors of Autism Spectrum Disorders can challenge community mobility, thus hindering independence and participation in occupation. Community mobility, also called travel training, helps people make journeys safely using public transportation, enabling engagement in activities/services otherwise unavailable. Yet, few articles have been written about this topic for people with Autism Spectrum Disorders. The purpose of the authors in this article is to: (1) explain the need for travel training with people diagnosed with Autism Spectrum Disorders; (2) describe specific travel training assessments; (3) review literature on travel training programs; and (4) define a role for occupational therapy in travel training with individuals diagnosed with Autism Spectrum Disorders.     

Therapeutic interventions in infancy: Two contrasting cases of persistent crying

Infants are liable to many symptoms of emotional disturbance. However, it is now widely agreed that there is no such thing as individual psychopathology in infancy. Infantile disturbances are considered to be a function of current relationships. The paper briefly summarises available psychodynamic approaches to problems in infant relationships. It argues that more case-studies of therapeutic interventions in infancy are needed to increase our understanding of early disturbances and of their treatment. Two contrasting case-studies of intervention in persistent crying attempt to understand what may sustain this distressing problem. In each case the possible meaning of the crying, both to the babies and to their families, is considered.     

The child's experience of Munchhausen syndrome by proxy

This paper examines the emotional impact of Munchhausen syndrome by proxy on a child aged 6 who had been poisoned by her mother. It describes her treatment in child psychotherapy over twenty months at the Cassel Hospital where the family worked towards her successful rehabilitation home. The work with her showed her experience of dangerous relationships in her family that left her distrustful of any new relationship, and doubtful of her capacity to be close without being destructive. Like her parents, she was terrified of facing the murderous feelings in the family, retreating into denial when life was too painful. The paper describes three phases of treatment: fear of separation and preoccupation with the trauma of poisoning, ambivalence about facing the destructiveness in the family and the move into more appropriate latency behaviour as she prepared to go home with her parents. It concludes with an overview of the impact of Munchhausen syndrome by proxy on the developing child, as shown in this treatment: the delay in emotional and cognitive development, the interference with the capacity to relate, the retreat into illness under stress, and the fear of permanent damage caused by the emotional and physical abuse.     

On not being able to enter Noah's Ark

The paper describes the psychoanalytic psychotherapy of a patient who had originally been referred at the age of 15 because of his social isolation. In fact, he suffered from high-functioning Asperger's syndrome and lived in an almost delusional world populated by a number of imaginary companions, which he used to counteract a deep void and sense of deadliness within him. After five years of therapy, the patient was able to move on, allowing him to be successful in his academic studies, and to abandon his imaginary friends. This paper focuses on a subsequent phase of the therapy when the patient, as a young man, began to show an interest in and attraction to the world of intimate relationships. The paper is grounded in Meltzerian theory, especially his ideas about the role of beauty in the mother–child relationship, and about the world of intimate links as opposed to conventional ones.     

‘A kaleidoscope of themes’: intensive psychotherapy with a girl on the autistic spectrum

This paper is an account of the intensive psychotherapy of a young girl on the autistic spectrum. It describes her confusing presentation and how this suggested a tendency to oscillate between mainly unintegrated states of mind. Important themes that emerged included the phantasy of inhabiting a claustrum; the use of adhesive identification to defend against the bodily felt terror of separation; and fear of damage to the maternal object. The paper also discusses the trans-generational aspects of her difficulties and considers how her therapy helped growth to take place.     

Development and validation of the Granada Burnout Questionnaire in Spanish police

The goal of the present study is to develop a questionnaire, with proper psychometric properties and current norms, to evaluate the burnout syndrome in Spain. The operative definition of burnout proposed by Maslach and Jackson is used to define three dimensions (Emotional exhaustion, Depersonalization and Personal accomplishment). A total of 2,403 national Spanish police participated. Evidence of construct validity was checked through cross validation (showing a good fit of the three factors model to the data). Using the MBI, NEO-FII and CECAD evidence of convergent validity and criteria validity were developed (showing that the relations are similar to the ones that appear in other research). The discrimination, mean, standard deviation, and typical error of the average of the items composing the various dimensions were analyzed. Both the Cronbach's alpha coefficient and the conditional standard error of measurement (CSEM) were calculated for each of the dimensions. The results showed good internal consistency (all α values > .85). Finally, the questionnaire was scaled using T scores. The psychometrical properties reported here support the use of this new questionnaire for the burnout evaluation in Spanish police.     

Extended network learning error: A new way of conceptualising chronic fatigue syndrome

Abstract

The cause of chronic fatigue syndrome (CFS) is controversial: psychological, hypothalamic and immune mechanisms have been proposed as well as the possibility of some form of interaction between these mechanisms. Patients' own conceptual models vary and sometimes adversely affect self-management. This paper suggests an interactional way of conceptualising CFS using developments in complexity theory (networks, parallel processing or connectionism). I propose that the neurological, immune and endocrine systems are pan of a single, self-regulatory, extended brain-body network. Furthermore, that CFS is caused by self-organisational change in this extended network created by normally adaptive error-sensitive learning rules that malfunction when physiological and psychological challenges coincide. This psychoneuroimniunoendocrinological model shows how previously proposed mechanisms could interact to cause CFS. explains the heterogeneity of the presentation of the disease, and provides a conceptual model that may be acceptable to patients but is also consistent with effective self-management.