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PubMed2005

Neurocognitive impairment as a moderator in the development of borderline personality disorder.

Borderline personality disorder (BPD) is characterized by a pervasive instability of interpersonal relationships, affects, self-image, marked impulsivity, dissociation, and paranoia. The cognitive dimension of the disorder has received relatively little attention and is poorly understood. This paper proposes that neurocognitive impairment is a key moderator in the development of BPD and elaborates a possible pathway for the expression of the cognitive domain. Neurocognitive impairment is hypothesized to moderate the relationship between caretaking and insecure disorganized attachment and pathological dissociation in the formation of the disorder contributing to impaired metacognition and a range of cognitive difficulties. The empirical evidence from studies of cognitive processes, brain function, attachment, and dissociation that support this theory are reviewed and discussed. Areas for future research that might verify or refute this theory are suggested.

Adolescent↗
PubMed1994

Working memory and bias in reasoning across the life span.

Age differences in syllogistic reasoning in relation to crystallized and fluid ability were studied in 278 adults from 19 to 96 years of age. Two reasoning tasks, the evaluation and the construction of conclusions for syllogisms of varying complexity and believability, a vocabulary test, and 3 tasks of working memory were administered. The magnitude of age-related variance on selected reasoning tasks was only partially reduced by statistically controlling measures of both working memory and vocabulary. Additional age-related effects on reasoning were found to be significantly associated with number of mental models and bias produced by conflict between belief and logic. A significant bias was also found toward acceptance of invalid syllogisms as valid, even when contents were abstract. These sources of error in logic are discussed in relation to Johnson-Laird's (1983) theory of mental models and Evan's (1989) account of bias in human reasoning.

Adult↗
PubMed2005

Seeing it my way: a case of a selective deficit in inhibiting self-perspective.

Little is known about the functional and neural architecture of social reasoning, one major obstacle being that we crucially lack the relevant tools to test potentially different social reasoning components. In the case of belief reasoning, previous studies have tried to separate the processes involved in belief reasoning per se from those involved in the processing of the high incidental demands such as the working memory demands of typical belief tasks. In this study, we developed new belief tasks in order to disentangle, for the first time, two perspective taking components involved in belief reasoning: (i) the ability to inhibit one's own perspective (self-perspective inhibition); and (ii) the ability to infer someone else's perspective as such (other-perspective taking). The two tasks had similar demands in other-perspective taking as they both required the participant to infer that a character has a false belief about an object's location. However, the tasks varied in the self-perspective inhibition demands. In the task with the lowest self-perspective inhibition demands, at the time the participant had to infer the character's false belief, he or she had no idea what the new object's location was. In contrast, in the task with the highest self-perspective inhibition demands, at the time the participant had to infer the character's false belief, he or she knew where the object was actually located (and this knowledge had thus to be inhibited). The two tasks were presented to a stroke patient, WBA, with right prefrontal and temporal damage. WBA performed well in the low-inhibition false-belief task but showed striking difficulty in the task placing high self-perspective inhibition demands, showing a selective deficit in inhibiting self-perspective. WBA also made egocentric errors in other social and visual perspective taking tasks, indicating a difficulty with belief attribution extending to the attribution of emotions, desires and visual experiences to other people. The case of WBA, together with the recent report of three patients impaired in belief reasoning even when self-perspective inhibition demands were reduced, provide the first neuropsychological evidence that the inhibition of one's own point of view and the ability to infer someone else's point of view rely on distinct neural and functional processes.

Frontal Lobe↗
PubMed2005

Processing demands in belief-desire reasoning: inhibition or general difficulty?

Most 4-year-olds can predict the behavior of a person who wants an object but is mistaken about its location. More difficult is predicting behavior when the person is mistaken about location and wants to avoid the object. We tested between two explanations for children's difficulties with avoidance false belief: the Selection Processing model of inhibitory processing and a General Difficulty account. Children were presented with a false belief task and a control task, in which belief attribution was as difficult as in the false belief task. Predicting behavior in light of the character's desire to avoid the object added more difficulty in the false belief task. This finding is consistent with the Selection Processing model, but not with the General Difficulty account.

Chi-Square Distribution↗
PubMed1996

Theory of mind abilities in individuals with autism, Down syndrome, and mental retardation of unknown etiology: the role of age and intelligence.

We examined theory of mind abilities of individuals with autism, mental retardation (MR) of unknown etiology, Down syndrome, and normal children. On false belief and deception tasks, normal children performed better than all clinical groups, while no differences emerged among the clinical groups. The groups with MR performed better than the group with autism on the value task only. For individuals with autism, theory of mind abilities correlated with verbal ability. For individuals with MR nonverbal abilities correlated with deception and false belief scores. Findings are discussed in terms of the specificity of the theory of mind deficit to autism.

Adolescent↗
PubMed1998

Children's understanding of pictorial and mental representations.

Two studies demonstrate dissociation between children's understanding of pictorial representations (photos and drawings) and mental representations (beliefs). In Study 1, 37 preschoolers were tested on false belief, appearance-reality, false photo, and false drawing tasks. The false picture tasks were significantly easier, and no correlation was found between children's performances on false belief and false picture tasks. In Study 2, 30 children who failed a false belief pretest were randomly assigned to 3 training groups: Belief (trained on false belief tasks), Picture (trained on false picture tasks), or Control (trained on number conservation tasks). Training was conducted in 2 sessions over the course of 2 weeks; tasks were presented and feedback was provided. All children were posttested on theory of mind tasks, false picture tasks, and a number conservation task. The posttest results showed differential patterns of performance, with the Belief group scoring highest on the theory of mind posttests, the Picture group scoring highest on the false picture posttests, and the Control group scoring highest on the number conservation posttest. Results are discussed with respect to competing models of theory of mind development.

Attention↗
PubMed1987

Reality perceptions of television: a comparison of emotionally disturbed, learning disabled, and nonhandicapped children.

The Stony Brook Videotest (SBV), a measure of reality perceptions of television programs and commercials, was administered to 38 emotionally disturbed (ED), 35 learning disabled (LD), and 159 nonhandicapped elementary school children. The ED and LD children scored significantly lower than the comparison group, indicating that ED and LD children are less able to distinguish between reality and fantasy on television. The clinical implications of these findings and possible remedial actions are discussed.

Affective Symptoms↗
PubMed1994

Proficiency testing: now it is a reality.

On January 1, 1994, enrollment in an accredited proficiency testing program became mandatory under the CLIA regulations for physicians performing moderate and high complexity tests in their offices. Physicians not enrolled in programs are in violation of the standard.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Psychic reality and unconscious belief: a reconsideration.

In a recent paper Britton attempted to distinguish between a phantasy that has achieved the status of a belief and one that has not, and between a belief and knowledge. The author argues that, in the light of the seventeenth-century controversy between Descartes and Spinoza, both of these distinctions are untenable. Descartes argued, as Britton does, and as Freud did, that phantasies or ideas are not accepted as beliefs until they are tested against reality. Furthermore, Britton maintains that for a belief to acquire the status of knowledge, it must be supported by incontrovertible evidence. Spinoza, on the other hand, proposed the seemingly preposterous notion that a comprehended proposition is automatically believed. Doubt may subsequently be engendered by disconfirming evidence. As it turns out, research in a number of domains suggests that Spinoza was correct and Descartes was wrong. This evidence and its clinical implications are discussed. As suggested by Bion, instilling doubt regarding deeply ingrained (Spinozan-formed) phantasies is a principal goal of treatment.

Freudian Theory↗
PubMed1997

Role of memory strength in reality monitoring decisions: evidence from source attribution biases.

Reality monitoring of verbal memories was compared with decisions about pictorial memories in this study. Experiment 1 showed an advantage in memory for imagined over perceived words and a bias to respond "perceived" on false alarms. Experiment 2 showed the opposite pattern: an advantage in memory for perceived pictures and a bias to respond "imagined" on false alarms. Participants attribute false alarms to whichever class of memories has the weakest trace strengths. The relative strength of memories of imagined and perceived objects was manipulated in Experiments 3 and 4, yielding changes in source attribution biases that were predicted by the strength heuristic. All 4 experiments generalize the mirror effect (an inverse relationship between patterns of hits and false alarms commonly found on recognition tests) to reality monitoring decisions. Results suggest that under some conditions differences between the strength of memories for perceived and imagined events, rather than differences in qualitative characteristics, are used to infer memory source.

Adult↗
PubMed1998

[The initial and continuing education of hospital nursing personnel: alternating practical work with education].

Who, as a trainer, has never heard this irritating leitmotiv on the lips of those who work in the area? Therefore, each of them is convinced that the other is wrong or does not do what he should. Beyond the anecdote, the problem of the difficult conjunction between school and the real world is posed. Two places and two logics: the first one is concerned with learning, the second one considers production as its daily objective. But the words of our imaginary interlocutor also remind us of the confrontation between two fields: theory and practice and their apparently irrecondilable nature. Two disconnected worlds in which the students come and go with the frequent impression that they live two lives. There is a lot of professional literature on the subject of the "hands on" theory of education. The pedagogical device to which we refer enables the trainee to eventually make a link between what he learns at school and what he does during his training period. Once this has been asserted, it seems to us that the problem still remains unresolved. How can you create links between theory and practice? Which skills are required for the trainers? Which training device is necessary? The hypothesis of the paper we are presenting is that the question of work is at the centre of the problematics of "hands on" education. Work appears as the interface between the world of school and the one of field work. This assertion means that the practive produces knowledge just as research does and we must therefore accept that the practitioners carry on their work thanks to the accumulation, the construction and the transmission of this practical knowledge. Assuming that the question of work serves as a link between theory and practive means reconciling the vision of the teacher and the one of the practitioner. It implies that the trainer must make the effort of going on the field to observe, to understand and formalize what this knowledge coming from the daily experience is made of. This know-how is the result of the mobilization of the intelligence of the operators who are faced all the time with the hazards of real life. In the following work, we intend to put a pedagogical practice to the test of reality, according to the above mentioned hypothesis, to test its effectivity, to sort out the possibilities of change it enables it imposes and to mark its limits. Our wish is not to make the absolute proof of the validity of a point of view. We know by experience that the reality often escapes its observer and that trying to get in contact with it to possibly change it, means that you must be faced with it through action, and you must admit that success will not always be the result of your attempts.

Clinical Competence↗
PubMed2006

Feeling and time: the phenomenology of mood disorders, depressive realism, and existential psychotherapy.

Phenomenological research suggests that pure manic and depressive states are less common than mixtures of the two and that the two poles of mood are characterized by opposite ways of experiencing time. In mania, the subjective experience of time is sped up and in depression it is slowed down, perhaps reflecting differences in circadian pathophysiology. The two classic mood states are also quite different in their effect on subjective awareness: manic patients lack insight into their excitation, while depressed patients are quite insightful into their unhappiness. Consequently, insight plays a major role in overdiagnosis of unipolar depression and misdiagnosis of bipolar disorder. The phenomenology of depression also is relevant to types of psychotherapies used to treat it. The depressive realism (DR) model, in contrast to the cognitive distortion model, appears to better apply to many persons with mild to moderate depressive syndromes. I suggest that existential psychotherapy is the necessary corollary of the DR model in those cases. Further, some depressive morbidities may in fact prove, after phenomenological study, to involve other mental states instead of depression. The chronic sub-syndromal depression that is often the long-term consequence of treated bipolar disorder may in fact represent existential despair, rather than depression proper, again suggesting intervention with existential psychotherapeutic methods.

Awareness↗
PubMed1989

Evolution of motor activity tests into a screening reality.

Measures of activity have changed in ways that their utility in screening for neurotoxicity has vastly improved. New computer pattern recognition systems now provide rapid, objective tools for identifying animal behavior. Advances in data analysis procedures have replaced the percent change in overall activity level with measures of initiations, total time and temporal structure for multiple behaviors and sequences. These advances can distinguish hyperactivities induced by different mechanisms and rank their neurotoxic potential, a feat not possible with photocell devices generally used in laboratories today. With the recent technological improvements, it is possible that a measure of activity will become one of the best predictors of malfunction in the central nervous system.

Amphetamine↗