Patients' information needs and decision-making processes: what can be learned from genetic counselees?

This field study investigated the information needs and decision-making strategies of 161 genetic counselees interviewed just prior to counseling. Patients were interested mostly in information about the outcomes and consequences of the alternative options at their disposal and about measures to defuse the risks. They wanted mainly information stated with certainty and were less interested in probability information. There was no difference in the search for information between the alternative eventually chosen and the one not chosen. There was a difference, however, among types of decisions and the interest in the various categories of information. These findings were interpreted within the theoretical model of decision making in natural risky situations (O. Huber, 1997). Practical implications for shared medical decision making are presented.     

Strength of scopolamine-induced amnesia as a function of time between training and testing

Variations in the strength of scopolamine-induced amnesia as a function of age of the habit were studied in Swiss Webster mice. Animals were trained in an active avoidance task to a criterion of 9/10 avoidances and immediately following training injected with scopolamine hydrochloride (1.0 mg/kg) or saline. Retention of the avoidance learning was evaluated by testing different groups of animals 1, 3, 7, 10, 14, and 28 days following training. The retention test consisted of five trials in which the CS but not the UCS was presented. Results indicated that saline-treated mice exhibited near-perfect retention up to 14 days post-training with forgetting beginning to be apparent at 28 days. Scopolamine treatment produced strong amnesia in animals tested 1 and 3 days post-training but normal retention in animals tested 7 and 10 days after learning. The amnesia abruptly reappeared at 14 days after which time it remained stable. The marked similarity of the scopolamine retention curve to changes in the strength of memory of discrimination learning in undertrained rats reported by Deutsch suggested that scopolamine resulted in the storage of a weak memory of the avoidance response. To explore this idea further we trained mice to a criterion (4/5) which would result in a weak avoidance response and tested different groups 1, 3, 10, 14, and 28 days following learning. Results showed that strength of the memory of avoidance learning increased up to 10 days and then decreased abruptly at 14 days thus replicating the general shape of the retention curve produced by injecting scopolamine following strong training. These data suggest that scopolamine disrupts processes essential for the formation of durable memories.     

Conditional reflexes as related to hypnosis and hypnotic techniques

Hypnosis has never been adequately explained in terms of conceptual framework of most schools of psychotherapy. The psychoanalytic concept that it consists of submission and surrender of important ego functions to the therapist does not explain all observed facts. During my wartime studies and since, I have been impressed by the observation that the patient’s ego is by no means powerless and defenseless, even during a deep state of trance, i.e., in states of trance sufficiently deep to eliminate awareness of painful body injuries (1965). Erickson (1954) has shown on many occasions that in resistant subjects one of the best ways to induce trance is to encourage the patient to resist as much as he can. Haley (1963) has pointed out in detail that at the beginning of any hypnotic relationship there evolves a subtle battle for “one-upmanship.” These observations certainly show that surrender in the psychological sense is by no means an aspect of even the most successfully induced trance states.     

Detection errors in a task with articulatory suppression: Phonological receding and reading

In two experiments, subjects read passages of text and circled instances of a target letter under normal conditions or while engaged in articulatory suppression. In Experiment 1, subjects searching for the letter e made a disproportionately large number of errors on the word “the” and more errors when e occurred in unstressed than in stressed syllables of three-syllable words. In Experiment 2, subjects searching for the letter f made an exceedingly large number of errors on the word “of.” Articulatory suppression significantly reduced the stress effect in the three-syllable words but did not reduce the tendency to make errors on “the” or “of,” suggesting that phonological recoding is responsible for this effect of stress but does not influence the unitization processes of reading.     

Behavioral effects of sucrose on preschool children

Despite speculation that sucrose consumption affects behavior, little empirical information is available. Accordingly, this study investigated the effect of sucrose consumption on the behavior of eight preschool children. Children were tested individually using a double-blind, crossover design. On separate mornings each child received 6 ounces of juice, sweetened on one morning with sucrose and on the other with an artificial sweetener. Children were observed for 90 minutes following the drinks, alternating between 15-minute sessions of work on structured tasks and 15-minute sessions of free play. Following the sucrose drink the children showed a decrement in performance in the structured testing situation, and they demonstrated more inappropriate behavior during free play. These differences in behavior were most pronounced approximately 45 to 60 minutes after the drinks. Thus, the study provides objective evidence in young children of a rather subtle, yet significant, time-dependent behavior effect of sucrose ingestion.This research was funded in part by grants from the General Research Grants Committee, University Hospital, Boston University Medical Center, and from the University of Connecticut Research Foundation. The project was conducted at the Clinical Research Center, Massachusetts Institute of Technology (National Institute of Health/General Clinical Research Center Grant 5M01-RR00088-20). We would like to express our appreciation to the many staff members of the Clinical Research Center for their extensive cooperation in helping us to plan and carry out this study, and to the director and staff of Technology Children's Center for their assistance in helping us to reach interested families. We also would like to thank the parents and children who participated in the study. Portions of this paper were presented at the annual meeting of the American Psychological Association, Toronto, August 1984.     

Information and Counseling: A Dilemma

The revolutionary changes in data processing, and the resulting increases in the quantity and quality of information about counselees and their prospective environments, will make the work of the counselor more difficult in several ways. The one problem that is highlighted is the difficulty of maintaining a true counseling process and relationship while at the same time collecting necessary information about the client and about the environments regarding which he must make decisions. 2 solutions and their relative merits are discussed, one involving separation of the information and counseling functions, and the other requiring an integration of the functions by a single counselor.     

We have a prejudice against ourselves—Sentiment,ethics, and reason

Briefly stated my point is that the well-being of each person in a community conceived abstractly may be all too easily sacrificed for the sake of the abstraction. Physicians may offer critically ill patients places in programs of experimental treatment, but there is commonly a catch to the offer. To take part in a program of clinical experiment a patient must not only risk a possible failure of a fresh drug and the chance of destructive side effects from the drug, but the patients must risk only getting the traditional treatment along with a placebo rather than the experimental drug. Placebo control, double blind critical protocols for testing effects of fresh drugs on critically ill patients are a commonplace. I question the scientific objectivity of the protocols and the underlying ethic, and suggest use of alternate protocols. Experimental tests in the treatment gram-negative bacteria blood infections, muscular dystrophy, and AIDS and AIDS-related diseases are examples.     

FACIAL EXPRESSION AND SPEECH: NEUROANATOMICAL CONSIDERATIONS

This paper discusses the neuroanatomy and pathology of facial expression and findings on the neuroanatomical connections between expressions of the face and speech. The facial musculature is briefly dealt with in terms of its innervation by the facial nerve and its relationship to the soft palate at the peripheral system level. After considering the facial nuclei, the supranuclear innervation of volitional and emotional facial expression is reviewed. Then supranuclear relations between facial movements and some speech organs are considered. Finally, attention is paid to aspects of facial paralysis stemming from peripheral and central origins.