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Results for “Reality Testing”

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PubMed1991

Though disorder in high-functioning autistic adults.

Examined thought disorder in a sample (n = 11) of high-functioning autistic young adults and older adolescents (mean IQ = 83) utilizing objective ratings from the Thought, Language and Communication Disorder Scale (TLC Scale) and projective data from the Rorschach ink blots. Results from the TLC Scale pointed to negative features of thought disorder in this sample (e.g., Poverty of Speech). Rorschach protocols revealed poor reality testing and perceptual distortions in every autistic subject, and also identified several areas of cognitive slippage (e.g., Incongruous Combinations, Fabulized Combinations, Deviant Responses, Inappropriate Logic). Comparing TLC Scale and Rorschach results to schizophrenic reference groups, autistic subjects demonstrated significantly more Poverty of Speech and less Illogically on the TLC Scale, and on the Rorschach they evidenced features of thought disorder that are encountered also in schizophrenia. Results are discussed in relation to the measures employed, and to areas of similarity and difference between autism and schizophrenia.

Adolescent↗
PubMed1994

Did I unplug the iron or did I only look at it? External source monitoring across the adult life span.

Adult age differences in external source monitoring were examined using three types of materials differing in degree of salience. Young (mean age = 25.2 years), young-old (mean age = 66.0 years), and old adults (mean age = 74.7 years) learned organizable words, objects, and subject-performed tasks, with a blocked or random presentation. Later, subjects were asked to recognize the items and to identify their origins. Results indicated an age-related deficit in both item memory and external source monitoring as reflected by lower recognition performance, and more source confusion errors with increasing age. A strong positive relationship between episodic item memory and source memory was found for all age groups. Overall, the results suggest that age deficits in source monitoring may be determined by the same factors as age deficits in item memory.

Adolescent↗
PubMed1995

Munchausen by proxy victims in adulthood: a first look.

Very little is known about the long-term impact of Munchausen by Proxy abuse on children, as many victims probably are never identified and most have been lost to follow-up soon after termination of protective services supervision. This exploratory study examined the childhood experiences and long-term psychological outcomes for 10 adults, ranging from 33 to 71 years of age, who were self-identified victims of illness fabrication by a parent. Subjects completed a 33-item questionnaire including demographic and open-ended questions and a checklist of PTSD symptoms, supplemented by telephone interviews. Subjects described a range of experiences from poisonings and induced bone fractures to symptom exaggeration. Subjects generally felt unloved and unsafe in childhood; a few were directly aware of their parent's deceptions. They made limited attempts to alert others, with little success. Subjects reported significant emotional and physical problems in childhood, and problems in adulthood including insecurity, reality-testing issues, avoidance of medical treatment and posttraumatic stress symptoms. Most of their siblings were also abused, physically or medically. Some subjects express considerable residual anger towards the abusing mothers, but a surprising degree of sympathy for the fathers who passively colluded or failed to protect. Some of the MBPS parents have continued fabricating their own medical illnesses or harassing their adult children with fabricated dramas even decades later.

Adaptation, Psychological↗
PubMed1996

Interactional group discussion: results of a controlled trial using a behavioral intervention to reduce the use of injections in public health facilities.

Injections are commonly overused in Indonesia. More than 60% of patients attending public health facilities receive at least one injection, which increases clinical risk and has adverse economic impact. This study assesses the efficacy of an innovative behavioral intervention, the Interactional Group Discussion (IGD), for reducing the overuse of injections. This study was a controlled trial in a single district with 24 public health centers randomized to intervention and control groups. Prescribers in the intervention group were invited to one IGD, each of which consisted of 6 prescribers and 6 patients; a total of 24 IGDs were held in a 4-week period, and all invited prescribers participated. The groups, which lasted 90-120 minutes, were facilitated by a behavioral scientist and a clinician, who also served as a scientific resource person. The hypothesized mechanism of behavior change involved reality testing prescribers' assumptions about patient beliefs, imparting scientific information about injection efficacy, and establishing peer norms about correct behavior. Outcomes were measured by a retrospective prescribing survey covering the periods 3 months before and 3 months after the intervention, with samples of 100 prescriptions per center per month. Rates of injection and average number of drugs per prescription were computed separately for each center, and t-tests were used to compare pre-post changes in outcomes in both groups. Results showed a significant decrease in injection use from 69.5 to 42.3% in the intervention group, compared to a decrease from 75.6 to 67.1% among controls [-18.7.0% intervention vs control, 95% CI = (-31.1%, -6.4%), P < 0.025]. There was also a significant reduction in average number of drugs per prescription [-0.37 drugs prescribed per patient, 95% CI = (-0.04, -0.52), P < 0.05], indicating that injections were not substituted with other drugs. We conclude that the IGD significantly reduces the overuse of injections. It is suggested to try out other behavioral interventions to improve the rational use of drugs.

Adolescent↗
PubMed1982

A one year follow-up of the multimodal treatment for chronic pain.

Twenty-three outpatients with chronic pain began a 3-part treatment package designed to provide symptom control, stimulus control and social system modification. Fourteen patients completed the full course of therapy. The remaining 9 patients were designated as partial completers. A mean of 22.9 weekly hour long therapy sessions resulted in statistically significant decreases in pain, depression, anxiety and medication intake. These improvements were maintained at 1 year follow-up. This study is consistent with the notion that chronic pain is maintained by a combination of inter- and intrapersonal factors. A controlled comparison of this treatment program with other treatments for chronic pain is indicated.

Adult↗
PubMed1984

Thalamic attention circuitry normal and psychotic.

Cortex is not preprogrammed to recognise transthalamic sensory patterns or to prioritize them for motor reaction. Network subsets for these abilities are taught into neocortex in early life from the hippocampi where species-significant pattern-recognition and reaction-prioritizing ARE genetically preprogrammed. Thereafter whenever an indoctrinated subset of cortex is activated via thalamic sensory relay nuclei it axonally activates a specific subset of neurons within the thalamic pulvinar. Pulvinar analogically integrates this with concurrent specific inputs from the thalamic dorsomedial nucleus which itself is integrating inputs from the prefrontal cortex (goals) and the amygdaloid nuclei (moods). The pulvinar's specific integral is then axonally projected back to cortex UNDER NON-SPECIFIC BOOST from the thalamic centromedian nucleus. This ensures unitary attention focussing influenced by acquired priorities. Given that neocortex is genetically organized as a classifying mechanism, it also permits virtually limitless part-novel learning and best-match reality-testing of percepts (and concepts in humans). In schizophrenia the non-specific booster system is bilaterally blocked at the centromedian nucleus. In mania the non-specific thalamic system is shunted, at midbrain, into the non-specific direct cortical system. In melancholia both of these brainstem systems are subnormal in non-specific output. Figure 1 schematizes the main axonal circuitry. Analogical integration occurs within predominantly dendro-dendritic networks.

Attention↗
PubMedDate not supplied

A case-specific approach to the treatment of alcoholism: the application of control mastery theory to alcoholics anonymous and professional practice.

Effective treatment of alcoholism requires adopting a psychodynamically informed case-specific approach. Control mastery theory provides a powerful way to understand and treat the alcoholic patient. The theory posits that individuals hold unconscious pathogenic beliefs that contribute to the development and maintenance of alcoholism. The primary therapeutic goal is to create a safe atmosphere that enables patients to disabuse themselves of their maladaptive beliefs and their attendant guilt. In this way, patients become freer to more accurately test reality and thus more effectively pursue normal developmental goals. The treatment of the alcoholic patient progresses through phases, each of which poses different therapeutic challenges. The salient therapeutic tasks addressed in this article are denial, containing affect, relapse prevention, and Alcoholics Anonymous involvement. By understanding the individual's unique pathogenic belief system, the therapist is better equipped to help the patient through the generic phases and tasks of the recovery process.

Alcoholics Anonymous↗
PubMed2005

The use of relaxation, hypnosis, and imagery in sport psychiatry.

Hypnosis is a procedure during which a mental health professional suggests that a patient experience changes in sensations, perceptions, thoughts, or behavior. The purpose of this article is to briefly describe the use of various methods of relaxation, hypnosis, and imagery techniques available to enhance athletic performance. The characteristics that these techniques have in common include relaxation, suggestibility, concentration, imaginative ability, reality testing, brain function, autonomic control, and placebo effect. Case studies are provided for illustration.

Adolescent↗
PubMed2006

End-to-end security in telemedical networks--a practical guideline.

The interconnection of medical networks in different healthcare institutions will be constantly increasing over the next few years, which will require concepts for securing medical data during transfer, since transmitting patient related data via potentially insecure public networks is considered a violation of data privacy. The aim of our work was to develop a model-based approach towards end-to-end security which is defined as continuous security from point of origin to point of destination in a communication process. We show that end-to-end security must be seen as a holistic security concept, which comprises the following three major parts: authentication and access control, transport security, as well as system security. For integration into existing security infrastructures abuse case models were used, which extend UML use cases, by elements necessary to describe abusive interactions. Abuse case models can be constructed for each part mentioned above, allowing for potential security risks in communication from point of origin to point of destination to be identified and counteractive measures to be directly derived from the abuse case models. The model-based approach is a guideline to continuous risk assessment and improvement of end-to-end security in medical networks. Validity and relevance to practice will be systematically evaluated using close-to-reality test networks as well as in production environments.

Access to Information↗
PubMed2005

Reality monitoring and motor memory in checking-prone individuals.

Studies concerning reality monitoring and motor memory abilities in checkers have provided mixed results. The aim of this study was to re-examine this question by asking 75 undergraduate students to perform, watch the experimenter perform, imagine themselves performing, imagine the experimenter performing, or verbally repeat different daily actions. Two groups were created (checking-prone and nonchecking-prone subjects) based on participants' checking subscores on the revised version of the Obsessive-Compulsive Inventory. First, results suggested that checking-prone subjects have a poorer motor memory than nonchecking-prone participants. Second, our data indicated that checking-prone participants confused actions they had performed with actions the experimenter had performed more often than nonchecking-prone participants. In other words, checking-prone participants remembered events from an observer's viewpoint. Finally, our findings suggest that dissociation could be a mediating variable between some of the reality monitoring abilities and checking.

Adult↗
PubMed1993

Different patterns of confabulation.

In this study we investigated the amnesic-confabulatory condition of two patients, M.B. and S.D., exhibiting different patterns of confabulation. Neuropsychological examination showed in M.B. a normal intellectual efficiency and a selective deficit of episodic memory, whereas S.D. was impaired in tests of intellectual efficiency, episodic memory, semantic knowledge and frontal functions. The relation of confabulation to retrieval conditions and the degree of impairment of the semantic memory system was investigated with a set of questions involving the retrieval of various kinds of information. In M.B. confabulation was restricted to episodic memory tasks, whereas in S.D. it also affected the retrieval of semantic information. S.D.'s confabulatory reports were 'semantically anomalous', whereas the semantic structure of M.B.'s confabulations was appropriate. Further investigation using the encoding specificity paradigm showed an interaction of encoding/retrieval conditions in M.B. but not in S.D. This pattern of results is discussed in terms of a different level of disruption of processes that normally monitor the retrieval of information. It is further argued that the confabulation content must be considered in terms of its semantic structure and relies on the level of integrity of semantic knowledge.

Aged↗
PubMedDate not supplied

The psychology of factitious disorders. A reconsideration.

Factitious disorder (FD) is a form of somatization that involves apparent deception, simulation of illness, and imposture. This deception may be distinguished from other forms of lying in that patients with FD may suffer from underlying disturbances in the sense of reality and in reality testing. These features may be associated with a poorly consolidated sense of self and with difficulty regarding emotional experience as real. Factitious behavior may serve to stabilize the sense of self by concretizing and legitimizing the subjective experience of distress and by evoking responsiveness of a care-giver in a relatively safe, structured context. A psychotherapeutic stance focused on identifying and validating the patient's subjective experience may lead to a reduction in factitious behavior and to a more authentic and stable sense of self, in which emotional as well as physical experience is regarded as real. However, most patients with FD refuse treatment. Further, psychosis and suicidality are complications that may occur during the course of psychotherapy.

Adult↗
PubMed2006

Psychomotor development and psychopathology in childhood.

The sensorimotor developmental phase, leading to a gradual acquisition of skilled actions, is of crucial importance for the young child and its growing sense of competence. Three vital steps in motor development are mentioned: first, the smooth and spontaneous movements of the "graceful and elegant" baby, expression of his well-being and vitality, with their profound effect on the mother-infant relationship; second, the emergence of intentional and goal-oriented acts leading to Funktionslust and playful repetitions; and finally, the development of symbolic acts and increasing technical capacity to use playthings in imaginative play. The psychodynamic significance of the most important motor milestones for the child's ego development is set out. Motility is one of the most important avenues for exercising such functions as mastery, integration, reality testing (self-preservation), and control of impulses. One may consider this early childhood period of rapid motor development as the motor phase of ego and libido development. Hence, many forms of developmental psychopathology are attended with motor impairment or insufficient motor mastery and integration. From that clinical perspective pass in review: perinatal complications and motor disturbance, attention deficit/hyperactivity disorder, dissociated motor development, low birth weight children and their developmental difficulties, developmental coordination disorder, aspects of pervasive developmental disorder, and stereotypic movement disorder.

Child↗
PubMed2001

Brain sources of EEG gamma frequency during volitionally meditation-induced, altered states of consciousness, and experience of the self.

Multichannel EEG of an advanced meditator was recorded during four different, repeated meditations. Locations of intracerebral source gravity centers as well as Low Resolution Electromagnetic Tomography (LORETA) functional images of the EEG 'gamma' (35-44 Hz) frequency band activity differed significantly between meditations. Thus, during volitionally self-initiated, altered states of consciousness that were associated with different subjective meditation states, different brain neuronal populations were active. The brain areas predominantly involved during the self-induced meditation states aiming at visualization (right posterior) and verbalization (left central) agreed with known brain functional neuroanatomy. The brain areas involved in the self-induced, meditational dissolution and reconstitution of the experience of the self (right fronto-temporal) are discussed in the context of neural substrates implicated in normal self-representation and reality testing, as well as in depersonalization disorders and detachment from self after brain lesions.

Brain Mapping↗
PubMed2003

Altered auditory processing in acutely psychotic never-medicated first-episode patients.

UNLABELLED: Individuals with psychosis fail to differentiate external impulses and suffer from distortions of reality testing. Schizophrenia group illnesses are also associated with deficits in working memory and perception. We examined the manifestations of a very early phase of psychotic illness to automatic auditory deviance detection to clarify the basic mechanisms underlying misinterpretations of perception. METHODS: Twenty-five never-medicated patients admitted for hospital evaluation of acute psychosis were studied. Fifty-eight EEG channels were recorded during an auditory oddball paradigm. Event-related potentials (ERPs) time-locked to non-attended deviant auditory stimuli were studied in patients and compared with healthy controls. Auditory processing was examined both at the level of the measured biosignals (standard and deviant responses) and with subtraction waveforms. Topographical differences were characterized using global field power (GFP) and minimum norm estimates. RESULTS: The maximum GFP amplitudes and mean amplitudes of the 58 channels within the time windows corresponding to the previously known 'N2b', 'P3a' and 'P3b' components were clearly reduced in patients when compared to healthy controls. However, the groups did not differ during attention-independent automatic processing corresponding to the 'N1' and 'MMN' components, or with respect to the peak latencies of the GFP maxima. CONCLUSIONS: Impairment of the processing of a deviance in simple auditory input in acutely ill drug-naive first-episode psychotic patients only appears in attention-dependent processing after about 250 ms. The alterations in auditory processing differed between stimulus types, suggesting at least two mechanisms underlying the auditory discrimination impairments in acute psychosis. After 250 ms there was a linear and gradually increasing difference in magnitude between the groups in their responses to deviant stimuli, probably related to arousal. In addition, however, there was a striking difference between the groups in the processing of standard stimuli. The early processing was similar in patients and controls, but the striking difference appeared in later processing. The sensory memory deficits associated with psychosis may be explained by an abnormality in sensory model formation rather than by impaired deviant detection.

Acoustic Stimulation↗
PubMed1995

Ecological measures of cognitive functioning: a validation study.

Observed cognitive decline in the elderly has been widely reported in the literature. The relation of experimental cognitive ability measures to real-world cognitive competence has been questioned. This research examines the validity of English-language versions of two measures of everyday competency: the Memory in Reality test involving object placement recall and the Coin Test, a money-sorting task. The measures were developed as part of a Swedish epidemiologic study. Validity was evaluated by comparison of these tasks with standard cognitive tests and with a measure of metamemory. It was expected that the ecological measures would have a stronger association with metamemory than the standard tests. Subjects were 93 community-dwelling women, aged 75 and older. The ecological tasks correlated positively with the standard tests, but there were inconsistent relations of both standard and ecological measures with metamemory. The results partly support use of these measures for evaluating everyday functioning.

Activities of Daily Living↗
PubMed2001

Phantasies, neurotic-beliefs, and beliefs-proper.

This paper presents a philosophical analysis of three cognitive states familiar and important to psychoanalysts--phantasy, neurotic-belief, and belief-proper. It explores the differences among these three propositional attitudes and finds that the development of secondary process capacities of reality testing and truth directness out of earlier primary process operations (themselves prior to considerations of truth or falsity) plays a crucial role. Difficulties in the proper typing of cognitive states are discussed, as are the consequences of such confounds. This use of a philosophical method serves to sharpen the familiar psychoanalytic clinical concepts of phantasy and neurotic-belief. In addition, these same clinical concepts, once properly specified, have much to offer the philosophy of mind, where current understanding of representational cognitive states is restricted to those that are largely conscious and rational. When psychoanalytic concepts such as phantasy and neurotic-belief can be better integrated within the discipline of philosophy of mind, both philosophers and psychoanalysts will have a more complete and adequate theory of mind.

Culture↗
PubMed2002

Postoperative psychological functioning of adolescent transsexuals: a Rorschach study.

The Rorschach Comprehensive System was used to assess postoperative psychological functioning in transsexuals who applied for sex reassignment in adolescence. We investigated a group of 22 consecutive adolescent transsexuals, who were otherwise psychologically well adapted. Nineteen subjects provided valid Rorschach protocols before and after sex reassignment. The most notable change found was an increase in X + %, reflecting a decrease in both distorted perception and idiosyncratic perception. Little support was found for the idea of major psychological deterioration for the patients as a group. Rather, the results suggest stability in psychological functioning over time. The Rorschach findings are consistent with questionnaire data from earlier studies, with the exception that the Rorschach data may point to some improvement in reality testing.

Adolescent↗