When soothing succeeds: Simulating a risk for repeated shaking in abusive head trauma in infants

PurposeTo investigate the observation that perpetrators of abusive head trauma engage in repeated shakings because shaking “works” to quiet the infant.MethodsSixty first-time parent couples individually cared for a programmable model infant in two consecutive 7-min trials. After six minutes of consolable followed by inconsolable crying, parents selected one of three soothing techniques. For trial one, parents were randomized to a “Successful” or “Failed” Soothing Condition. Whether the soothing technique was repeated after trial two was determined by the study investigators. Parents rated their frustration after each trial.ResultsAs hypothesized, parents were more likely to repeat a soothing technique that “worked” in trial one. Compared to fathers, mothers reported more frustration when soothing failed.ConclusionsThat caregivers were more likely to repeat a successful soothing technique converges with perpetrator confessions that crying cessation after shaking may be a reason why shaking is used repeatedly in response to crying.     

Dissociable spatial memory systems revealed by typical and atypical human development

Rodent lesion studies have revealed the existence of two causally dissociable spatial memory systems, localized to the hippocampus and striatum that are preferentially sensitive to environmental boundaries and landmark objects, respectively. Here we test whether these two memory systems are causally dissociable in humans by examining boundary‐ and landmark‐based memory in typical and atypical development. Adults with Williams syndrome (WS)—a developmental disorder with known hippocampal abnormalities—and typical children and adults, performed a navigation task that involved learning locations relative to a boundary or a landmark object. We found that boundary‐based memory was severely impaired in WS compared to typically‐developing mental‐age matched (MA) children and chronological‐age matched (CA) adults, whereas landmark‐based memory was similar in all groups. Furthermore, landmark‐based memory matured earlier in typical development than boundary‐based memory, consistent with the idea that the WS cognitive phenotype arises from developmental arrest of late maturing cognitive systems. Together, these findings provide causal and developmental evidence for dissociable spatial memory systems in humans.     

证素辨证新体系的内容及科学意义

提取并规范50项辨证要素,构建起证素辨证新体系,是继承基础上的创新.证素的纲领性与组合的复杂性,是科学的认知论,符合中医辨证思维规律.     

“精英症候群”:社会病理分析及对策——医学社会学的解释视角

转型期中国社会的精英群体普遍面临着身体与精神的双重危机。从医学社会学的独特解释视角来看,这一非正常的“精英症候群”实质上是反复循环状态下生产与再生产的一种“社会病”。在社会病理分析的基础上,从社会结构、社会评价体系、预防与保障机制诸方面为“精英症候群”会诊。     

A collaborative family-systemic approach to treating chronic illness: irritable bowel syndrome as exemplar

This article describes an evolving collaborative relationship between a family therapist and a physician focused on the treatment of irritable bowel syndrome, a highly prevalent disorder which has several psychological characteristics. We began with a unique approach utilizing (1) simultaneous treatment by both specialists; (2) a focus on the relationship context of illness. This approach draws on family systemic theory and practice as well as a circular model of mind and body interaction. Because the intervention was significantly helpful to patients, the premises which informed it were then incorporated into a five session group treatment model. Results and clinical report support the efficacy of a collaborative systemic approach between a medical specialist and family psychologist in treating adult chronic illness.     

Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety

This study sought to identify brain regions that underlie symptom changes in severely affected IBS patients undergoing cognitive therapy (CT). Five healthy controls and 6 Rome II diagnosed IBS patients underwent psychological testing followed by rectal balloon distention while brain neural activity was measured with O-15 water positron emission tomography (PET) before and after a brief regimen of CT. Pre-treatment resting state scans, without distention, were compared to post-treatment scans using statistical parametric mapping (SPM). Neural activity in the parahippocampal gyrus and inferior portion of the right cortex cingulate were reduced in the post-treatment scan, compared to pre-treatment (x, y, z coordinates in MNI standard space were -30, -12, -30, P=0.017; 6, 34, -8, P=0.023, respectively). Blood flow values at these two sites in the controls were intermediate between those in the pre- and post-treatment IBS patients. Limbic activity changes were accompanied by significant improvements in GI symptoms (e.g., pain, bowel dysfunction) and psychological functioning (e.g., anxiety, worry). The left pons (-2, -26, -28, P=0.04) showed decreased neural activity which was correlated with post-treatment anxiety scores. Changes in neural activity of cortical-limbic regions that subserve hypervigilance and emotion regulation may represent biologically oriented change mechanisms that mediate symptom improvement of CT for IBS.     

Similarities Between the Psychological Profiles of Complex Regional Pain Syndrome and Conversion Disorder Patients

The psychological profile of 17 Complex Regional Pain Syndrome type I (CRPS) and 20 Conversion Disorder (CD) patients were compared, using the Minnesota Multiphasic Personality Inventory (MMPI) and standardized, semistructured psychological interviews. Both groups presented abnormally high somatization scores. Low anxiety scores in both groups indicate that somatization may have served as a defense mechanism to bind anxiety. Depression was apparent in both groups, indicating that psychological distress accompany these syndromes. About one third of the participants in both groups presented comorbid Axis I disorders, mostly depression and PTSD. CRPS patients have traditionally been looked upon as suffering from mainly organic symptoms, whereas CD patients have been labeled as psychiatric patients. These results may indicate the need to reexamine the traditional classifications in respect to disorders that involve body and mind.     

Spatial breakdown in spatial construction: evidence from eye fixations in children with Williams syndrome

We investigated the role of executive and spatial representational processes in impaired performance of block construction tasks by children with Williams syndrome (WS), a rare genetic defect that results in severely impaired spatial cognition. In Experiment 1, we examined performance in two kinds of block construction tasks, Simple Puzzles, in which block faces contained a single color, and Complex, in which some block faces contained an arrangement of two colors. WS and control children were comparable in their ability to solve simple puzzles, and showed similar eye-fixation patterns, suggesting that basic executive processes were intact. However, WS children were severely impaired in their ability to solve complex puzzles. In these puzzles, WS children fixated the complex puzzle models and checked their partial solutions less often than normal children, but they were comparable in their ability to detect errors in their copies and almost exclusively made repairs to copies that were, in fact, incorrect. We conjecture that the abnormal fixation patterns were a consequence of impoverished spatial representations, rather than a cause of it. This conjecture was tested in Experiment 2, where we examined children's capacity to match and place individual blocks without engaging the complex executive processes required to carry out a complete puzzle solution. We found serious deficiency among WS children in both aspects of spatial representation. Moreover, estimates of the errors in representing the identity and location of model blocks derived from Experiment 2 provided a good account of the observed errors in the block construction task of Experiment 1.     

Assessment of the influence of background noise on escape-maintained problem behavior and pain behavior in a child with Williams syndrome

We examined the influence of background noise on levels of problem behavior and pain behavior under functional analysis conditions for a child with a diagnosis of Williams syndrome and hyperacusis. Background noise was associated with increases in escape-maintained problem behavior and increases in pain behavior such as clasping ears and crying. When the child was fitted with earplugs, there were substantial reductions in both problem and pain behavior under the background noise condition.