Prospective assessment of late-luteal phase dysphoric disorder

This investigation evaluated a method for the prospective assessment of the symptoms of premenstrual syndrome (PMS). The American Psychiatric Association has proposed a diagnostic category for PMS in the DSM-III-R entitled late-luteal phase dysphoric disorder (LLDD). The criteria for this disorder include prospective documentation of at least two symptomatic cycles. Two groups of women were studied, one group that met the DSM-III-R diagnostic criteria for LLDD and a comparison group that did not. Subjects recorded symptoms related to PMS for two menstrual cycles. A clinically significant worsening of symptoms was defined as a symptom increase during the premenstruum of greater than one standard deviation above normal. These effect sizes were then used to determine if the subject met the DSM-III-R criteria for prospective confirmation. Data analysis showed that although the LLDD group showed evidence for PMS in several symptom groups, only a minority (31%) met the requirement of prospective confirmation of significant PMS symptoms for the two cycles recorded. These results were discussed in terms of the need for prospective behavioral assessment of LLDD and the implications of these findings for past and future research.Portions of this paper were derived from the master's thesis of the first author.     

Premonitory urges are associated with decreased grey matter thickness within the insula and sensorimotor cortex in young people with Tourette syndrome

Tourette syndrome (TS) is a neurological disorder characterized by vocal and motor tics and is associated with cortical–striatal–thalamic–cortical circuit (CSTC) dysfunction and hyperexcitability of cortical limbic and motor regions, which are thought to lead to the occurrence of tics. Importantly, individuals with TS often report that their tics are preceded by ‘premonitory sensory phenomena’ (PSP) that are described as uncomfortable cognitive or bodily sensations that precede the execution of a tic, and are experienced as a strong urge for motor discharge. While the precise role played by PSP in the occurrence of tics is controversial, PSP are nonetheless of considerable theoretical and clinical importance in TS, not least because they form the core component in many of the behavioural therapies that are currently used in the treatment of tic disorders. In this study, we investigated the brain structure correlates of PSP. Specifically, we conducted a whole‐brain analysis of cortical (grey matter) thickness in 29 children and young adults with TS and investigated the association between grey matter thickness and PSP. We demonstrate for the first time that PSP are inversely associated with grey matter thickness measurements within the insula and sensorimotor cortex. We also demonstrate that grey matter thickness is significantly reduced in these areas in individuals with TS relative to a closely age‐ and gender‐matched group of typically developing individuals and that PSP ratings are significantly correlated with tic severity.     

Frontal deficits differentiate progressive supranuclear palsy from Parkinson's disease

The clinical differentiation of progressive supranuclear palsy from Parkinson's disease can be challenging, due to overlapping clinical features and a lack of diagnostic markers. Abnormalities in cognitive function form part of the clinical spectrums of these diseases and distinctive cognitive profiles may be helpful in differentiating these diseases in the diagnostic period. A comprehensive neuropsychological test battery was administered to 12 patients with clinically diagnosed progressive supranuclear palsy and 12 patients with Parkinson's disease matched for age and disease duration. Effect size (Cohen's d) was calculated for cognitive tests that were significantly different between groups. Patients with progressive supranuclear palsy performed significantly worse than those with Parkinson's disease on measures of processing speed, verbal fluency, planning, verbal abstract reasoning, verbal memory, and made more perseverative responses on a set shifting task. Measures of executive function, manual dexterity and processing speed were most diagnostically useful (Cohen's d > 2.0) in differentiating between progressive supranuclear palsy and Parkinson's disease. These findings suggest that more severe and prominent ‘frontal’ cognitive deficits in patients with progressive parkinsonism would be helpful in predicting progressive supranuclear palsy rather than Parkinson's disease and these findings may contribute to the development of diagnostic criteria.     

Judgment of blame in teenagers with Asperger's syndrome

The judgment of blame was studied in a group of 28 teenagers, 14 with Asperger syndrome (AS) and 14 typically developed. Teenagers in each group were matched by age, cognitive development and academic level. They were presented with 12 short vignettes in which they had to judge an action according to the intent of the actor (deliberate and accidental), the consequences of the action (presence and absence) and the seriousness of the situation (low, medium and high). Results showed a significant difference in the patterns of judgment of both groups. The AS group judged the action according to the physical consequence of the action more than the intent of the actor; the opposite was observed with the control group. In addition, the AS teenagers were less capable than the control group of grading injury to a person when apportioning blame especially when they were not familiar with the social situations. This result suggests that the judgement of the seriousness of the outcome of the social interaction is linked with its level of familiarity. Furthermore, result are congruent with the assumption that two different cognitive structures, deontic reasoning and perspective taking, are involved in the judgment of blame.     

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother

I describe the therapy of a 20-year-old woman who believed that her difficulties in concentrating and remembering were caused by her 'ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.     

Empowering Parents: The Use of the Parent as Researcher Paradigm in Early Intervention

Whilst family-focussed models of service delivery are proving more effective in early intervention, it is the parents who ultimately carry the burden of responsibility. They often evolve their own strategies for coping with difficulties and solving problems within a family context. Through case study analysis, I report on some of the key outcomes of early intervention for families of very young children with disabilities. The analysis challenges traditional definitions of the family and suggests a recontextualisation of this concept. Similarly parental perceptions of the style of early intervention services are contrasted with those models reported to be effective by professionals. In striving for optimal effectiveness in early intervention, the unique knowledge and understanding of parents is pivotal, and ways are suggested of objectively collecting and collating that knowledge to inform practice and identify important research questions. This case study analysis has led to the evolution of the parent as researcher paradigm, and the implications for the practical implementation of this model will be considered.     

Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Configural and local processing of faces in children with Williams syndrome

Three experiments investigated face processing in children with Williams syndrome (WS). In Experiment 1, the ability to discriminate different aspects of faces was compared between WS subjects and a group of children individually matched for chronological age (CA-matches) and another group matched for mental age (MA-matches). In Experiments 2 and 3, the ability to process the local and configural aspects of geometrical patterns and faces was assessed within the same groups of subjects. The results indicated that the WSs' overall performance on face recognition was below that of the CA-matches, but similar to that of the MA-matches. This study revealed in addition that the CA- and MA-matches showed a bias toward a configural mode of face and geometrical shape processing, whereas children with WS did not show any bias. These findings suggest that face processing undergoes an abnormal developmental course in WS.     

Follow-up survey of pregnancies with diagnoses of chromosomal abnormality

A small clinical survey was undertaken at East Carolina University School of Medicine to examine the factors which influenced the decisions of five families to continue pregnancies after a chromosomal abnormality was detected. Little has been published concerning the psychosocial effects after continuing pregnancies in which the fetus was diagnosed with a chromosome abnormality by amniocentesis. In order to identify the factors that influenced their decisions, an interview with each couple was undertaken using a 25-part questionnaire. This paper addresses the method of interviewing, case material, and background concerning each couple and the summary of the results.