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PubMed2000

Effect of a subanesthetic dose of ketamine on memory and conscious awareness in healthy volunteers.

RATIONALE: Ketamine is an NMDA receptor antagonist with psychotogenic and cognitive effects in healthy volunteers and schizophrenic patients which has been proposed to be a useful tool to investigate neurobiological basis of schizophrenia. OBJECTIVE: The present study characterized the effects of a subanesthetic dose of ketamine on memory and related subjective states of awareness in healthy volunteers. METHODS: Twenty-six subjects were given either a 60-min ketamine (0.5 mg/kg per hour) or a placebo infusion. To obtain constant plasma ketamine throughout the experiment, ketamine was administered using a computer-controlled infusion system. Subjects carried out episodic memory tasks involving words presented before and during infusion. Memory performance was assessed with recognition and free recall tasks. Subjective states of awareness were assessed using an experiential approach. Levels of psychopathology were evaluated with BPRS. RESULTS: Ketamine impaired performance in free recall and recognition of words presented during, but not before, infusion. There were no differences between groups concerning states of awareness associated with recognition memory. Subjects under ketamine had higher BPRS total scores as well as BPRS negative and positive cluster scores than control subjects. CONCLUSIONS: Ketamine decreases episodic memory performance by impairing encoding, but not retrieval processes. It does not selectively impair subjective states of awareness associated with recognition memory as it has been seen in patients with schizophrenia. Ketamine might mimic the memory impairment associated with acute, but not chronic, forms of schizophrenia.

Adult↗
PubMed2005

The use of visual feedback is independent of visual awareness: evidence from visual extinction.

Milner and Goodale (The visual brain in action, Oxford Press, 1995) made a distinction between vision for perception and vision for action. In contrast to perception, many action tasks have strict temporal constraints, which can only be met if the visual information is relayed directly to the motor system without first passing through a conscious decision making process. Milner and Goodale therefore predict that visual stimuli do not have to reach visual awareness in order to guide rapid motor responses. Online visual feedback provides a good example of visual information that is used under tight temporal constraints to guide rapid motor responses. Online visual feedback provides information about the position of the moving limb. This information can be used to improve the accuracy of our movements. If vision for action operates independently of visual awareness, visual feedback should be beneficial even if the subject is unaware of this information. We tested this prediction in a patient (V.E.) with left-sided visual extinction, a condition in which a visual stimulus typically fails to reach awareness if a second stimulus is presented simultaneously at a more rightward location. V.E. was asked to point towards a central target with his left hand. In some trials a light-emitting diode (LED) provided brief visual feedback from the moving hand. However, in the majority of trials, V.E. was unaware of this LED, due to his extinction. His performance was nevertheless significantly better when visual feedback was present, regardless of whether or not the information was available for verbal report. We conclude that visual awareness is not essential for the effective use of online visual feedback.

Aged↗
PubMed2000

Awareness of illness and outcome in schizophrenia.

The purpose of the present study was to investigate whether awareness of illness affects specific measures of outcome in schizophrenia. Patient awareness was evaluated using a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD). Patient outcome was assessed by means of the Strauss-Carpenter scale. Our findings indicate that lack of awareness of "negative symptoms" has a considerable impact on outcome: in fact "Social Contacts" highly correlated with Blunt Affect, Anhedonia and Asociality items on the SUMD. Lack of awareness seems then to be a powerful predictor of poor outcome.

Adult↗
PubMed2004

Psychiatric morbidity among cancer patients and awareness of illness.

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient's environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.

Academic Medical Centers↗
PubMed2006

Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process.

BACKGROUND: Because increasing numbers of people now survive for months or years with advanced cancer, communication between patients, service providers, and family caregivers often continues over long periods. Hence, understanding of the goals of medical treatment may develop and change as time elapses and disease progresses. This understanding is closely related to the "awareness of dying," which has been studied in both qualitative and quantitative research. However, when both a patient and family caregiver are involved, the question of "awareness" becomes more complex. A recent longitudinal study reported on patient and caregiver knowledge of treatment goals, but no comparison of such knowledge using matched interview schedules and paired data analysis has been provided. This report examines patterns of awareness and factors associated with these patterns. MATERIALS AND METHODS: One hundred sixty-three patients with incurable cancer and their nominated principal family caregivers (136) were recruited from The Canberra Hospital Oncology Services. Participants' understanding of the treatment goals were measured by interview questions at weeks 1 and 12. RESULTS: One-third of both patients and caregivers understood that the treatment goal was not curative; however, not all patient and caregiver pairs had the same understanding. In 15% of pairs, both patient and caregiver believed that the goal of treatment was curative, while another 13% said that they did not know the aim of the treatment. Thirty-nine percent of pairs registered incongruent responses in which only one member of the pair understood that the treatment was not intended to cure the disease. Over time, a few respondents changed their perception of the treatment goals toward accurate clarification. Bivariate analysis using an awareness variable, constructed for the purpose, showed that in 6 months before death, at least one person in 89% of pairs understood that the treatment was noncurative. Time-to-death, gender, and place of residence were also important predictors of knowledge. CONCLUSIONS: Discrepancies between patients and their caregivers may complicate the delivery of effective care when patients are seriously ill. Misunderstanding or uncertainty about treatment goals will obstruct proper informed consent. Health professionals providing care for families dealing with advanced cancer must recognize that the discussion of treatment goals is a dynamic process, which may require them to extend their communication skills.

Adult↗
PubMed2005

Parental awareness of health and community resources among immigrant families.

OBJECTIVES: To examine the association between parental immigrant status and awareness of health and community resources to help address common family problems. METHODS: Using the 1999 National Survey of America's Families, a survey of the health, economic, and social characteristics of children and adults, bivariate and multivariate analyses were conducted on 35,938 children to examine the relationship between parents' immigrant status (U.S.-born citizens, naturalized citizens, and noncitizens) and their responses to questions about their awareness of specific health and community resources. RESULTS: Compared to U.S.-born citizens, noncitizens were at the highest risk of not being aware of health and community resources for most outcomes, followed by naturalized citizens. The services of which noncitizens were most likely to be unaware were places to get help for family discord, child care issues, and family violence. Multivariate analyses indicate that parental race/ethnicity, education level, employment status, and child age were other significant independent risk factors. CONCLUSIONS: Immigrant parents are at particularly high risk of alienation from systems of health care and support services that are available to low-income and other vulnerable populations in the United States. These findings clearly document disparate awareness among parents of different immigrant status. Community and health resources should reach out to immigrant populations, in linguistically and culturally appropriate ways, to alert them to the availability of their services.

Adolescent↗
PubMed2004

Morphological awareness in developmental dyslexia.

This study examines morphological awareness in developmental dyslexia. While the poor phonological awareness of dyslexic children has been related to their difficulty in handling the alphabetical principle, less is known about their morphological awareness, which also plays an important part in reading development. The aim of this study was to analyze in more detail the implications of the phonological impairments of dyslexics in dealing with larger units of language such as morphemes. First, the performance of dyslexic children in a series of morphological tasks was compared with the performance of children matched on reading-level and chronological age. In all the tasks, the dyslexic group performed below the chronological age control group, suggesting that morphological awareness cannot be developed entirely independently of reading experience and/or phonological skills. Comparisons with the reading-age control group indicated that, while the dyslexic children were poorer in the morphemic segmentation tasks, they performed normally for their reading level in the sentence completion tasks. Furthermore, they produced more derived words in the production task. This suggests that phonological impairments prevent the explicit segmentation of affixes while allowing the development of productive morphological knowledge. A second study compared dyslexic subgroups defined by their degree of phonological impairment. Our results suggest that dyslexics develop a certain type of morphological knowledge which they use as a compensatory reading strategy.

Attention↗
PubMed1990

The effects of learning two languages on levels of metalinguistic awareness.

The purpose of this study is to determine whether a bilingual environment-the juxtaposition of two language systems learned simultaneously-enhances children's awareness of the language(s) they are learning to speak. The study explores the development of metalinguistic awareness at three different levels of explicit knowledge about language in monolingual children, and assesses the effects of a bilingual experience on this developmental process. To observe the development of metalinguistic awareness and to test the bilingual hypothesis, we compared metalinguistic skills in 32 Spanish-speaking and 32 English-speaking monolinguals and in 32 Spanish-English bilinguals aged 4:5 to 8:0. The Spanish and English metalinguistic tests each contained 15 different ungrammatical constructions (e.g., "Steven and Robert is a brother") and 15 grammatically correct "fillers." For each item, the children were asked in the appropriate language to note whether the construction was correct or incorrect, to correct the errors they noted, and to explain why those errors were wrong. We found that the monolingual children followed the same sequence in acquiring the ability to detect, to correct, and to explain grammatical errors; in particular, they progressed from a content-based orientation to a form-based orientation to language at each of the three levels. However, we noted different outcomes in terms of the types of grammatical constructions that were easy for monolinguals to master at each level-the constructions that were easy to detect and correct were distinct from those that were easy to explain. The bilingual experience was found to speed the transition from a content-based to a form-based approach to language at certain levels of awareness (detection and correction), but had less of an effect on explanations. Moreover, the bilingual experience did not appear to affect the types of grammatical constructions that were easy to master at any of the three levels. These data suggest that the experience of learning two languages hastens the development of certain metalinguistic skills in young children, but does not alter the course of that development. Thus, while learning two languages may enhance a speaker's "ear" for regularities of form, it does not appear to augment his grammatical "mind" for understanding those regularities.

Awareness↗
PubMed1987

Levels of somatic awareness in relation to angiographic findings.

One hundred and forty men, aged 32-75, were interviewed in hospital prior to cardiac catheterization. The interview included questions on activity limitations and events provoking chest symptoms, as well as measures of somatic awareness (MSPQ), psychological distress (GHQ) and social desirability response set (Marlowe-Crowne scale). On the basis of catheterization results patients were classified according to the number of vessels with 50% or more blockage. Stepwise discriminant function analysis identified six predictors (MSPQ score, age, previous MI status, two of 10 events provoking chest symptoms, and GHQ score) which correctly classified 57% of the patients according to their number of vessels blocked. MSPQ scores bore the greatest univariate relationship to blockage group, and examination of the group means for these scores showed that the more blockage, the lower the level of bodily awareness, particularly among patients with no previous infarction. In the context of MSPQ results with other samples, it is suggested that there may be an optimal level of somatic awareness. While patients who are catheterized with little blockage may be overly sensitive to bodily symptoms and sensations, those who are not catheterized until several blockages exist may have dangerously low levels of bodily awareness.

Adult↗
PubMed1995

Accurate awareness of heartbeat in hypochondriacal and non-hypochondriacal patients.

We measured the accurate awareness of resting heartbeat in a sample of medical out-patients meeting DSM-III-R criteria for hypochondriasis (n = 60), and in a comparison group of non-hypochondriacal patients (n = 60) from the same general medical clinic. Patients also completed subjective self-report ratings of their sensitivity to benign bodily sensation and of functional somatic symptoms. Hypochondriacal patients did not differ significantly from non-hypochondriacal patients in their accurate awareness of heartbeat. They did, however, consider themselves more sensitive to benign bodily sensation and report more functional somatic symptoms. Within each sample, the only statistically significant association found was a negative correlation (r = -0.32, p = 0.025) between heartbeat awareness and the severity of hypochondriacal symptoms among the hypochondriacal patients. These results suggest that hypochondriacs may not be more accurately aware of normal cardiac activity, and therefore that hypochondriacal somatic complaints may not result from an unusually fine discriminative ability to detect normal physiological sensations that non-hypochondriacal individuals do not perceive.

Adult↗
PubMed1995

Cerebral correlates of visual awareness.

While it may be a long time before we can specify the mechanisms through which a brain process achieves awareness, it may be possible to determine as a first step whether awareness is limited to the products of certain kinds of processing. In the domain of vision, for example, perceptual awareness might only be attainable in association with object-centred coding, configural representations of space, and other such forms of abstracted (non-retinocentric) coding. It appears that these forms of visual coding are anatomically restricted to telencephalic structures, and indeed it has been argued that they may be peculiar to, or at least visually dependent upon, the 'ventral stream' of visual areas with the cortex. It is suggested here that such a brain process would still not be able to enter visual awareness unless it was selectively amplified through neuronal gating of the kind that has been shown to be correlated with selective spatial attention. The present paper explores the extent to which this putative dual requirement for visual consciousness might form a basis for understanding the various phenomena of "covert vision" seen in patients suffering from hemianopia, apperceptive agnosia, and unilateral spatial neglect.

Agnosia↗
PubMed1987

Awareness of inner experience: a systems perspective on self-regulatory process in early development.

This brief synopsis of an organizational perspective on early development represents an integration of three major areas of the author's research: that of a detailed observational study of early mother-infant interaction over the first three years of life; that of a continuous neonatal state and caregiving interactional monitoring method over the first two months of life; and that of a 25- to 30-year follow-up on the same infants observed initially. From these data a ground plan is proposed for our thinking about the individual's life span trajectory as a unique construction within a unique context for that individual's interactional and adaptive self-regulatory strategies. Beginning with a review of biological principles, the paradoxical integration of complexity and unity in living systems is traced from the conceptualization of infant state and observations on its regulation through the role of state in the origins of awareness of inner experience, to the consolidation and validation of the self as agent in self-regulation. Central to integration is the recognition process, stemming from one's awareness that another is aware of what one is aware of within oneself. The constructionist perspective on the critical role of specificity in this organizing process is illustrated by reference to the negotiation between caregiver and infant of seven issues of adaptive coordination over the first three years of life. Finally, five propositions are formulated describing such specificity in this organizing process, as one that underlies integration of levels of the living system relating the biological, the developmental, the shaping of the life span trajectory, and the reconstructive therapeutic process.

Awareness↗
PubMed1991

Intra-anesthetic awareness.

Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operations can be done on a relaxed but fully aware patient. The problem of intra-anesthetic awareness still exists despite the advances in anesthetic drugs and monitoring. This article reviews the subject from some aspects including its causes, signs, tests and medico-legal points. Awareness during anesthesia can be looked at as 'the invisible scars of surgery.'

Anesthesia, General↗
PubMed2005

Smoker awareness of and beliefs about supposedly less-harmful tobacco products.

BACKGROUND: Cigarette manufacturers in the United States have begun marketing cigarette brands claiming to reduce smokers' exposure to selected toxins in tobacco smoke. Little data exist on smokers' awareness, use, and beliefs about these products. METHODS: Data from the U.S. arm of the International Tobacco Control Policy Four-Country Survey (ITC-4), a telephone survey of 2028 adult current cigarette smokers in the United States conducted between May and September 2003, were analyzed. Respondents were asked to report their awareness, beliefs, and use of products marketed as less harmful than traditional cigarettes and of smokeless tobacco (SLT) products. RESULTS: Close to 39% of smokers were aware of "less-harmful" cigarettes, but only 27% of them could name a specific brand of such cigarettes. The brand named most often was Quest (25.7%), followed by Eclipse (7.6%), Winston (5.7%), herbal cigarettes (3.3%), "smoke-free" cigarettes (2.9%), Marlboro Blend #27 (1.9%), and Omni (1.9%). Of those who named a brand, 25% believed such products were less harmful than "ordinary cigarettes." In contrast, 82% of cigarette smokers were aware of SLT products, but only 10.7% of these believed that SLTs were less harmful than ordinary cigarettes. CONCLUSIONS: Smokers hold beliefs about the relative safety of supposedly less-harmful tobacco products that are opposite to existing scientific evidence. These results highlight the need to educate smokers about the risks of alternatives to conventional cigarettes, and the need to regulate the advertising and promotion of such alternatives.

Adult↗
PubMed2004

Awareness of behavioral, cognitive, and physical deficits in acute traumatic brain injury.

OBJECTIVE: To compare awareness of deficit in 3 domains of function (physical, cognitive, behavioral/emotional) in acute traumatic brain injury (TBI), controlling for severity of impairment in the different domains. DESIGN: Inception cohort. SETTING: Three inpatient rehabilitation programs. PARTICIPANTS: People with acute TBI (N=161), tested as soon as feasible after posttraumatic amnesia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Awareness Questionnaire (AQ) completed by the person with TBI and the treating neuropsychologist; and self- and clinician-rating scores calculated in the 3 domains. RESULTS: For participants who were rated by clinicians as more impaired in at least 1 domain (ie, scored lower on the AQ), self-ratings differed significantly from one another in all 3 domains, with behavioral self-ratings highest, physical self-ratings lowest, and cognitive self-ratings intermediate. In subgroups of participants rated at the same level by clinicians in all 3 domains, physical self-ratings were also lowest, that is, more consonant with clinician ratings. Participants tended to rate themselves as relatively unchanged in cognitive and behavioral domains regardless of the level of clinician ratings on these factors. CONCLUSIONS: Patterns of discrepant awareness of deficit in different functional areas seen in postacute TBI also appear to be present acutely and are not entirely related to differential severity of deficit. We discuss several possible reasons for discrepant awareness of deficit, including differences in internal and external feedback, cultural and psychologic factors, and different levels of ambiguity inherent in causal explanations for different types of problems.

Activities of Daily Living↗
PubMed2004

In sight but out of mind: do competing views test the limits of perception without awareness?

Over a century's worth of research suggests that "perception" without awareness is a genuine phenomenon. However, relatively little research has explored the question of whether all visually presented information activates representations in long term memory without awareness. Two experiments explored the use of a figure-ground display consisting of competing views in which one view dominates the other such that subjects are (initially) unaware of the non-dominant view. Neither experiment provided evidence that the non-dominant view (an embedded word) activated its representation in long term memory when the subject failed to report being aware of the embedded word in that priming was not seen on a subsequent stem completion task. In contrast, priming was seen when subjects reported being aware of the embedded word. It is suggested that two competing figure-ground relations are not concurrently computed unconsciously.

Awareness↗
PubMed2004

No pause for a brief disruption: failures of visual awareness during ongoing events.

Past research has repeatedly documented the close relationship between visual attention and awareness. Most recently, research exploring change blindness, inattentional blindness, repetition blindness, and the attentional blink has converged on the conclusion that attention to one aspect of a scene or event may lead to a highly circumscribed awareness of only the specific information attended, while other information, even that which is spatially or temporally nearby can go completely unnoticed. In the present report, we extend these observations to the dynamic allocation of attention during a well-structured meaningful event. In two experiments, subjects viewed brief videos of simple events and were told to pay close attention to them. During the events, an unexpected disruption consisting of a brief low spatial frequency motion field occurred. Despite intensive questioning and opportunities for recognition, the majority of subjects reported no awareness of 200, 400, or 600 ms disruptions. In a second experiment, blank-screen disruptions were added, and these resulted in no increase in detection. We conclude that visual attention may result in far more transitory awareness of visual information than previously appreciated.

Attention↗
PubMed2006

Diminished episodic memory awareness in older adults: evidence from feeling-of-knowing and recollection.

The ability to reflect on and monitor memory processes is one of the most investigated metamemory functions, and one of the important ways consciousnesses interacts with memory. The feeling-of-knowing (FOK) is one task used to evaluate individual's capacity to monitor their memory. We examined this reflective function of metacognition in older adults. We explored the contribution of metacognition to episodic memory impairment, in relation to the idea that older adults show a reduction in memory awareness characteristic of episodic memory. A first experiment showed that age affects the accuracy of FOK when predictions are made on an episodic memory task but not on a semantic memory task, suggesting a particular role for episodic memory awareness in metacognitive evaluations. A second experiment showed that the age-difference in episodic FOK accuracy was removed if one took into account subjective reports of memory awareness, or recollection. We argue that the FOK deficit specific to episodic memory is based on a lack of memory awareness manifest as a recollection deficit.

Adult↗