Cognitive deficits of executive functions and decision‐making in obsessive‐compulsive disorder

The nature of cognitive deficits in obsessive‐compulsive disorder (OCD) is characterized by contradictory findings in terms of specific neuropsychological deficits. Selective impairments have been suggested to involve visuospatial memory, set shifting, decision‐making and response inhibition. The aim of this study was to investigate cognitive deficits in decision‐making and executive functioning in OCD. It was hypothesized that the OCD patients would be less accurate in their responses compared to the healthy controls in rational decision‐making on a version of the Cambridge gambling task (CGT) and on the color‐word interference test and on a version of the Tower of Hanoi test (tower test) of executive functioning. Thirteen participants with OCD were compared to a group of healthy controls (n = 13) matched for age, gender, education and verbal IQ. Results revealed significant differences between the OCD group and the healthy control group on quality of decision‐making on the CGT and for achievement score on the tower test. On these two tasks the OCD group performed worse than the healthy control group. The symptom‐dimension analysis revealed performance differences where safety checking patients were impaired on the tower test compared to contamination patients. Results are discussed in the framework of cognition and emotion processing and findings implicate that OCD models should address, specifically, the interaction between cognition and emotion. Here the emotional disruption hypothesis is forwarded to account for the dysfunctional behaviors in OCD. Further implications regarding methodological and inhibitory factors affecting cognitive information processing are highlighted.     

To know or not to know: an application of Bion’s K and –K to child treatment1

The authors discuss an application of Bion’s conceptualisation of thinking and non-thinking states (K and –K links) to the treatment of a nine-year-old girl. The authors consider Bion’s interrelated concepts such as K and –K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to child treatment. The afore-mentioned conceptual elements are used to elucidate case material over two consecutive hours. A K link is established between therapist and patient, the fragility of which link is then demonstrated by its deterioration into a –K link. Complex issues about knowing and not knowing are central in this girl’s clinical presentation. She was conceived through in vitro fertilisation (IVF), and subsequently diagnosed with cerebral palsy. The authors consider the emotional impact of this origin story and how the parents relate to it. The authors discuss how parents sometimes cope with perceived losses by wishing to shield or protect their children. This can have repercussions for children’s efforts to know (K) and not to know (?K). The fear that emotional knowledge will be too painful to bear can interfere with ‘learning from experience’. Bion’s premise that the purpose of analysis is the growth of the mind is synonymous with the child analyst’s goal of fostering development and understanding impediments to development.     

PSYKOANALYTISKT ORIENTERAD PSYKOTERAPI

The increasing discourse of the concept of intersubjectivity in modern psychoanalysis has pushed the interest in the intrapsychic and its emphasis on drive and object into the background. Authors who wish to avoid a one-sided focus on intersubjectivity usually subscribe to a dual dimensional approach, taking both perspectives into account. In this article, the analytic situation is described not in two, but in three dimensions, the analytic function constituting a third dimension necessary for the interplay between the other two dimensions. Focusing on the analyst's position, the author presents a model that consists of (1) the-analyst-as-subject, (2) the-analyst-as-function, and (3) the-analyst-as-object. The analytic function is understood to be invested with a particular form of desire and it is argued that the asymmetry between this desire of the analyst and the desire of the analysand is a central characteristic of the analytic situation.     

The present and absent object—on thinking and the capacity to symbolize

In this paper, Bion's different theories on the development of thinking will be introduced: on the one hand, his theory of thoughts as resulting from tolerance for the absence of the object, and on the other hand, dream thoughts and thoughts as resulting from the presence of the object, originally through the mother's containing function. The effects of failures in this development will be discussed; among other things, a hypertrophy of the apparatus of projective identification at the expense of thinking capacities. Briefly, a comparison will be made between a facilitating relation between container and contained and the oscillation between the paranoid-schizoid and depressive position, which Bion describes as a prerequisite for open symbolizing processes. Bion's theories and concepts will be supplemented by Winnicott's theories on the “creative illusion” and the breast/the mother as a “subjective object” as a precondition for the symbolizing capacity that later develops in the “potential space”. Very briefly, a comparison is made between Winnicott's term “the subjective object” and Segal's term “symbolic equation”. Clinical vignettes are interpolated.     

Reliability and plasticity of response inhibition and interference control

This study investigated the internal reliability, temporal stability and plasticity of commonly used measures of inhibition-related functions. Stop-signal, go/no-go, antisaccade, Simon, Eriksen flanker, Stroop and Continuous Performance tasks were administered twice to 23 healthy participants over a period of approximately 11 weeks in order to assess test–retest correlations, internal consistency (Cronbach’s alpha), and systematic between as well as within session performance changes. Most of the inhibition-related measures showed good test–retest reliabilities and internal consistencies, with the exception of the stop-signal reaction time measure, which showed poor reliability. Generally no systematic performance changes were observed across the two assessments with the exception of four variables of the Eriksen flanker, Simon and Stroop task which showed reduced variability of reaction time and an improvement in the response time for incongruent trials at second assessment. Predominantly stable performance within one test session was shown for most measures. Overall, these results are informative for studies with designs requiring temporally stable parameters e.g. genetic or longitudinal treatment studies.     

汉语学龄前儿童正字法意识的发展

本研究选择北京地区幼儿园3岁、4岁、5岁儿童各31、48、33名, 采用单部件意识测验和部件位置及功能意识测验系统探查了学龄前儿童的正字法意识各个层面的发展状况。单部件意识测验包括部件替换、部件缺失和部件旋转三个部分; 部件位置及功能意识测验分为假字和非字两个部分, 而非字又包括两形非字和形声非字。结果发现单部件意识测验中, 5岁组儿童在部件替换水平上的得分显著高于3岁组儿童, 而3岁组与4岁组、4岁组与5岁组儿童之间无显著差异; 部件缺失和部件旋转水平上, 三个年龄段的儿童的得分表现出明显的增长趋势。部件位置及功能意识测验中, 假字得分在三个年龄段之间无显著差异; 非字得分随年龄增长显著提高。这些结果表明, 单部件意识在学前期处于不断发展的阶段, 其中对部件替换的非字的拒绝能力发展较早, 部件缺失和部件旋转非字的拒绝能力发展较晚; 部件位置及功能意识在学前期已经开始发展, 3岁儿童已经具有假字符合正字法规则的认识, 但对非字违反部件位置合法性和功能完整性的认识直到4岁左右才开始萌芽, 5岁还未成熟。     

Interference suppression vs. response inhibition: An explanation for the absence of a bilingual advantage in preschoolers’ Stroop task performance

The well-documented advantage that bilingual speakers demonstrate across the lifespan on measures of controlled attention is not observed in preschoolers’ performance on Stroop task variations. We examined the role of task demands in explaining this discrepancy. Whereas the Color/Word Stroop used with adult participants requires interference suppression, the Stroop task typically used with preschoolers requires only response inhibition. We developed an age-appropriate conflict task that measures interference suppression. Fifty-one preschool children (26 bilinguals) completed this new Bivalent Shape Task and the Day/Night task used in previous research. Bilingual in comparison to monolingual children performed better on incongruent trials of the Bivalent Shape Task, but did not differ on other measures. The results indicate that the discrepancy between preschoolers and older individuals in performance on Stroop task adaptations results from characteristics of the task rather than developmental differences. Further, the findings provide additional support for the importance of interference suppression as a mechanism underlying the bilingual advantage.     

A group comparison of those with hypertension and other chronic illness: A factor and item level analysis of anger and hostility

Abstract

A considerable body of research has suggested that essential hypertension is related to both expressed anger and suppressed hostility. This study suggests and provides some evidence that these reported results may simply have arisen as the result of a lack of proper statistical control and differential item functioning across the items on which the measures were based. Three groups of respondents were selected (a) those diagnosed as having hypertension (b) a group who admitted to having a chronic medical condition unrelated to hypertension and (c) individuals who did not have a chronic medical condition. A confirmatory factor model was used to test the structure of a measure of expressed anger and suppressed hostility. Differences were then examined across the three conditions at both the factor and item levels within a MIMIC structure and controlling for age and gender. Differential effects were found between females and males on two observed measures of expressed anger. Age had a direct effect on both the measure of expressed anger and suppressed hostility. After the effects of age and gender were controlled, no statistically significant group differences were found. Previous results indicating a difference on expressed anger and suppressed hostility may, as in the present analysis, be put down to a combination of lack of appropriate statistical control, and to ignoring the differential pattern of responding across the observed measures.     

The effects of stressor predictability on lymphocyte proliferation in humans

Abstract

To demonstrate the effects of predictable and unpredictable stressors on immune function, 36 male subjects were randomly assigned to complete ten trials of either a predictable or unpredictable cold pressor task or a non-stressful warm pressor control task. The predictable and no-stressor groups were given information about the duration of each pressor trial and a countdown of seconds passed from beginning to end of each trial. The unpredictable stressor group received no information. Self-report, cardiovascular, and biochemical measures were taken throughout the tasks in order to ascertain the effectiveness of the predictability and stressor manipulations. Lymphocyte proliferation to concanavalin A (Con A) and pokeweed mitogen (PWM) were measured before, during and after the tasks. Lymphocyte proliferation to Con A (10/μg/ml) was significantly reduced only in response to the unpredictable stressor suggesting that predictability buffered the effect of the stressor on immune function. Proliferation to PWM followed a similar pattern but was not statistically significant. Blood pressure responses were negatively correlated with proliferation values suggesting that stressor predictability may attenuate stress-associated immune decreases by reducing sympathetic arousal.     

Attentional deficits in fibromyalgia and its relationships with pain,emotional distress and sleep dysfunction complaints

Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.