Basic Self‐Awareness

Basic self‐awareness is the kind of self‐awareness reflected in our standard use of the first‐person. Patients suffering from severe forms of depersonalization often feel reluctant to use the first‐person and can even, in delusional cases, avoid it altogether, systematically referring to themselves in the third‐person. Even though it has been neglected since then, depersonalization has been extensively studied, more than a century ago, and used as probe for understanding the nature and the causal mechanisms of basic self‐awareness. In this paper, I argue that depersonalized patients indeed have an impaired basic self‐awareness, and that their study allows us both to favor one specific theory of basic self‐awareness and to understand what is wrong with its rivals. According to the favored theory, which I call Cartesian, we are basically self‐aware in virtue of being acquainted with ourselves through introspection.     

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.     

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.     

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.