The tell-tale tasks: a review of saccadic research in psychiatric patient populations

This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric patient populations are discussed in detail, with particular emphasis on findings regarding error rates, response latencies, and any specific task parameters that might affect those variables. Findings regarding the symptom, neurocognitive, and neural correlates of saccadic performance and the functional significance of patients’ saccadic deficits are also discussed. We also discuss the saccadic deficits displayed by various patient groups in terms of circuitry (e.g. cortical/basal ganglia circuits) that may be implicated in the underlying pathophysiology of several of these disorders. Future directions for research in this growing area are offered.     

Smooth pursuit in schizophrenia: a meta-analytic review of research since 1993

Abnormal smooth pursuit eye-tracking is one of the most replicated deficits in the psychophysiological literature in schizophrenia [Levy, D. L., Holzman, P. S., Matthysse, S., &; Mendell, N. R. (1993). Eye tracking dysfunction and schizophrenia: A critical perspective. Schizophrenia Bulletin, 19, 461–505]. We used meta-analytic procedures to quantify patient-control differences in eye-tracking and to evaluate potential moderators of effect size including patient and target characteristics and characteristics of the control population (matched or not). The magnitude of patient-control differences in pursuit depended on the measure. Global measures had large effect sizes. Among specific measures, maintenance gain and leading saccades yielded large effect sizes, with gain also yielding the narrowest confidence interval. Effect sizes associated with specific measures of smooth pursuit vs. specific measures of intrusive saccades did not clearly implicate one system over the other. Patient demographics and target characteristics generally had little influence on effect sizes. However, studies that failed to sex-match patients and controls tended to have smaller effect sizes for maintenance gain and catch-up saccade rate. Average effect sizes and confidence limits for global measures of pursuit and for maintenance gain place these measures alongside the very strongest neurocognitive measures in the literature [Heinrichs, R. W. (2004). Meta-analysis, and the science of schizophrenia: Variant evidence or evidence of variants? Neuroscience and Biobehavioral Reviews, 28, 379–394] for distinguishing between patients with schizophrenia and controls.     

Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study

Patients with schizophrenia have disproportionately high rates of emergency medical service use, likely contributing to the high cost this illness places on society. The aim of this study was to examine the impact of a theory-based, behavioral intervention on immediate and long-term use of emergency medical services. Older patients with schizophrenia (n=240) were randomized to receive either a behavioral, skills-building intervention known as Functional Adaptation and Skills Training (FAST) or a time-equivalent attention-control condition (AC). Logistic regression analyses indicated that AC participants were nearly twice as likely to use emergency medical services in general (OR=2.54; p=0.02) and emergency psychiatric services in particular (OR=3.69; p=0.05) during the active intervention phase of the study. However, there were no differences between the interventions in terms of emergency service use during the long-term follow-up phase of the study (i.e., 6-18 months post-baseline). The FAST intervention appears efficacious for reducing the short-term risk of using emergency medical services. However, the long-term efficacy of the FAST intervention appears less clear. Future studies may want to provide more powerful maintenance sessions to encourage continued use of skills in patients' real-world settings.     

Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

对听感觉运动门控自上而下调节的动物模型和神经机制

对惊反射的前脉冲抑制是减少干扰影响、保护脑内信息加工的重要机制。它既是研究感觉运动门控的模型, 也是探究精神分裂症机制的模型。前脉冲抑制可被选择性注意和情绪等高级认知活动所调节。本论文工作围绕着恐惧条件化和知觉空间分离去掩蔽(空间选择性注意)对听觉前脉冲抑制多层次化的自上而下调节, 在大鼠行为模型、神经通路、神经电生理机制等几个层次上开展了系统性研究, 并引入了精神分裂症的神经发育模型, 证实早期社会隔离饲养对前脉冲抑制注意调节的破坏影响。本论文研究成果不仅对认识正常情况下脑在复杂刺激场景中的信息加工机制有重要意义, 以感觉运动门控认知调节功能缺失为基础的动物模型也将推动精神分裂症心理学和神经生物学机制的研究。     

Exaggerated leftward bias in the mental number line of patients with schizophrenia

Several visuo-motor tasks can be used to demonstrate biases towards left hemispace in schizophrenic patients, suggesting a minor right hemineglect. Recent studies in neglect patients used a new number bisection task to highlight a lateralized defect in their visuo-spatial representation of numbers. To test a possible lateralized representational deficit in schizophrenia, we used the number bisection task in 11 schizophrenic patients compared to 11 healthy controls. Participants were required to orally indicate the central number of an interval orally presented. Whereas healthy subjects showed no significant bias, schizophrenic patients presented a significant leftward bias. Therefore, these results suggest an impairment in higher order representations of the number space in patients with schizophrenia, an impairment that is qualitatively similar to the deficit described in neglect patients.     

Mother, Melancholia, and Play in Erik H. Erikson’s Childhood and Society

In an earlier article on Erik H. Erikson’s earliest writings (Capps, 2007), I focused on the relationship between the child’s melancholia and conflict with maternal authority, and drew attention to the restorative role of humor. In this article, I discuss two of the three chapters in part three, “The Growth of the Ego,” of Erikson’s first major book, Childhood and Society [Erikson, Childhood and society. New York: W. W. Norton, 1950, Childhood and society (rev. edition). New York: W. W. Norton, 1963]. I explore the same theme of the relationship of melancholia and the mother, but focus on the restorative role of play. I interpret the differences between the two cases in light of Sigmund Freud’s essay, “Mourning and Melancholia” [Freud, Mourning and melancholia. In S. Freud, General psychological theory (pp. 164–179). P. Rieff (ed.). New York: Collier Books. 1963].

Cultural Variability in the Manifestation of Expressed Emotion

We examined the distribution of expressed emotion (EE) and its indices in a sample of 224 family caregivers of individuals with schizophrenia pooled from 5 studies, 3 reflecting a contemporary sample of Mexican Americans (MA 2000, N =126), 1 of an earlier study of Mexican Americans (MA 1980, N =44), and the other of an earlier study of Anglo Americans (AA, N =54). Chi-square and path analyses revealed no significant differences between the 2 MA samples in rates of high EE, critical comments, hostility, and emotional over-involvement (EOI). Only caregiver warmth differed for the 2 MA samples; MA 1980 had higher warmth than MA 2000. Significant differences were consistently found between the combined MA samples and the AA sample; AAs had higher rates of high EE, more critical comments, less warmth, less EOI, and a high EE profile comprised more of criticism/hostility. We also examined the relationship of proxy measures of acculturation among the MA 2000 sample. The findings support and extend Jenkins' earlier observations regarding the cultural variability of EE for Mexican Americans. Implications are discussed regarding the cross-cultural measurement of EE and the focus of family interventions.     

Impaired self-reflection in psychiatric disorders among adults: A proposal for the existence of a network of semi independent functions

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: (a) sense of ownership of one’s own thoughts and actions, (b) emotional awareness, (c) distinction between fantasy and reality and (d) the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another.