Observed behaviors during clinical interviews predict improvement in depression

A considerable percentage of depressed patients do not respond to antidepressive treatment. Early indicators of prognosis are needed. The aims of this study are to examine (a) whether the interpersonal behavior of patients and psychiatrist, as assessed by means of direct observation of behavior during a baseline clinical interview, might have predictive value with respect to therapeutic outcome and (b) which predictive potency measures of psychomotor activation, as assessed by less refined methods, such as global clinical judgment, might have. In the analysis used, speech-pause behavior was taken as the basic structure of the interaction. The relations of other behaviors such as looking and hand and head movement with this structure were determined. Evidence is presented that in a group of 31 depressives, improvement after a period of 10 weeks was related to observed behaviors during a baseline interview. The behaviors of the patients are interpreted as relational or nonrelational. The relational behaviors (i.e., looking yesnodding, gesturing) occur less in patients who will improve, whereas the nonrelational behaviors (i.e., intensive body touching, head movements) occur more in these patients. The nonrelational behaviors are presumed to be indicative of the state of arousal. The predictive potency of these variables could not be explained by their relationship with the baseline severity of depression, which in itself also predicted improvement. Moreover, global clinical assessment of psychomotor activation (i.e., retardation and agitation) could not be related to outcome.     

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Anticipation across modalities in children and adults: Relating anticipatory alpha rhythm lateralization,reaction time,and executive function

The development of the ability to anticipate—as manifested by preparatory actions and neural activation related to the expectation of an upcoming stimulus—may play a key role in the ontogeny of cognitive skills more broadly. This preregistered study examined anticipatory brain potentials and behavioral responses (reaction time; RT) to anticipated target stimuli in relation to individual differences in the ability to use goals to direct action (as indexed by measures of executive function; EF). A cross-sectional investigation was conducted in 40 adults (aged 18–25 years) and 40 children (aged 6–8 years) to examine the association of changes in the amplitude of modality-specific alpha-range rhythms in the electroencephalogram (EEG) during anticipation of lateralized visual, tactile, or auditory stimuli with inter- and intraindividual variation in RT and EF. Children and adults exhibited contralateral anticipatory reductions in the mu rhythm and the visual alpha rhythm for tactile and visual anticipation, respectively, indicating modality and spatially specific attention allocation. Variability in within-subject anticipatory alpha lateralization (the difference between contralateral and ipsilateral alpha power) was related to single-trial RT. This relation was more prominent in adults than in children, and was not apparent for auditory stimuli. Multilevel models indicated that interindividual differences in anticipatory mu rhythm lateralization contributed to the significant association with variability in EF, but this was not the case for visual or auditory alpha rhythms. Exploratory microstate analyses were undertaken to cluster global field power (GFP) into a distribution-free temporal analysis examining developmental differences across samples and in relation to RT and EF. Anticipation is suggested as a developmental bridge construct connecting neuroscience, behavior, and cognition, with anticipatory EEG oscillations being discussed as quantifiable and potentially malleable indicators of stimulus prediction.     

All's well that ends well? Outcome bias in pilots during instrument flight rules

The objective of the present study was to examine if the Outcome Bias also occurs in pilots flying under instrument flight rules (IFR). In a scenario-based survey, 60 pilots evaluated weather-related decisions made by hypothetical pilots. Participants rated the decisions as better, less risky, and regarded the probability that they would have made the same decision as higher when they were followed by a positive outcome, than when they were followed by a negative outcome. This effect showed likewise for novice pilots and for experienced pilots. These findings could be relevant for the flight-related decision-making of pilots, which sometimes is affected by the decisions made by third-party pilots. In particular, decisions made by other pilots that have led to positive outcomes might be hastily followed, whereas those that have led to negative outcomes might be hastily rejected.     

Cognitive rehabilitation of chronic alcohol abusers

The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals’ abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.     

DIE MARXISMUS – DEBATTE IM “SILBERNEN ZEITALTER”

Im Anfang des 20.Jahrhunderts unterzog eine Reihe von jungen, später berühmt gewordenen Philosophen den Marxismus einer tiefen Kritik. Ihnen ist es gelungen, wichtige Defekte der revolutionären Doktrinen aufzudecken und ihre verhängnivsollen Konsequenzen vorwegzunehmen. Diese Kritik ist auch für die gegenwärtige geistig-politische Situation aktuell.     

Apocalyptic Argument and the Anticipation of Catastrophe: the Prediction of Risk and the Risks of Prediction

This essay proposes to extend the model of apocalyptic argument developedin my recent book Arguing the Apocalypse (OLeary, 1994) beyond the study ofreligious discourse, by applying this model to the debate over awell-publicized earthquake prediction that caused a widespread panic in theAmerican midwest in December, 1990. The first section of the essay willsummarize the essential elements of apocalyptic argument as I have earlierdefined them; the second section will apply the model to the case of the NewMadrid, Missouri, earthquake prediction, in order to demonstrate thatcertain patterns of reasoning characteristic of religious apocalyptic arepresent in the discourse over an anticipated local disaster. My ultimatepurpose is to show that predictions of global and local catastrophe mayserve as extreme cases that will illuminate the dynamics of predictiveargument in general. Thus my argument will seek to undercut Daniel Bellsdistinction between prophecy and prediction (Bell, 1973) by establishingthat these discourses share identifiable formal and substantivecharacteristics, and depend for their rhetorical effect on anxiety, hope,far, and excitement as modes of temporal anticipation.     

Three years follow-up of panic disorder patients: A naturalistic study

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.     

Antecedents of information-processing skills in infants: Habituation, novelty responsiveness, and cross-modal transfer

Three skills which characterize cognitive functioning in human infants in the middle of the first year of life—habituation, novelty responsiveness, and cross-modal transfer—predict mental ability in later childhood. Antecedents of each skill at 5 months postnatal were examined in a short-term prospective longitudinal study of infant ability and maternal intelligence and interaction style. Infant perceptuocognitive performance at 2 months, maternal intelligence, and maternal responsiveness at 5 months relate to the expression of the three infant cognitive skills, but in different ways. Variation in infant information-processing abilities can be explained by specific child and maternal factors that are evident soon after birth.