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PubMed1983

Reality orientation with elderly patients in the community: an empirical evaluation.

There is now good evidence that elderly mentally impaired patients can be re-orientated for time, place and person using the technique of reality orientation (RO). To date, all empirical trials demonstrating this have been carried out on elderly institutionalized patients. This technique however might be of greater value to those elderly dementing patients still living with relatives in the community but attending geriatric psychiatry day hospitals, where they could receive RO in a consistent and systematic way. The results of an empirical study of RO with a group of such patients is reported. These showed that day hospital patients could be effectively re-orientated and that concomitant with changes in level of orientation of the patients, there were parallel changes in the patients' behaviour at home, reported stress on relatives and in relatives' mood.

Aged↗
PubMed2006

Neural processes underlying memory attribution on a reality-monitoring task.

A relatively common form of memory distortion arises when individuals must discriminate items they have seen from those they have imagined (reality monitoring). The present fMRI investigation (at 1.5 T) focused on the processes that relate to memory assignment regardless of accuracy (e.g. that correspond with the belief that an item was presented as a picture, regardless of whether that belief is correct). Prior to the scan, participants (n = 16) viewed concrete nouns and formed mental images of the object named. Half of the names were followed by the object's photo. During the scan, participants saw the object names and indicated whether the corresponding photo had been studied. Activity in visual-processing regions (including the precuneus and fusiform gyrus) corresponded with the attribution of an item to a pictorial presentation. In contrast, activity in regions thought to be important for self-referential processing (including the ventromedial prefrontal cortex and posterior cingulate gyrus) was associated with attribution to a nonpresented source. These neural findings converge with behavioral evidence indicating that individuals use the amount of different types of information retrieved (e.g. perceptual detail, information about cognitive operations) to determine whether an item was imagined or perceived.

Adult↗
PubMed2006

Parents often do not recognize overweight in their child, regardless of their socio-demographic background.

To involve parents successfully in the treatment of overweight in their child, they first need to be aware of the problem and its accompanying health risks. Data on 1840 9-11 year olds from the Rotterdam Youth Health Monitor were analysed to investigate whether awareness of parents differs according to socio-demographic characteristics. In the case of overweight children, 50% of the parents do not recognize that their child is overweight. Except for age none of the investigated socio-demographic characteristics, including ethnicity and parental education, was associated with awareness. Parents of obese children show greater awareness than parents of overweight children.

Age Factors↗
PubMed2000

Reality orientation for dementia: a systematic review of the evidence of effectiveness from randomized controlled trials.

The effectiveness of classroom reality orientation (RO) in dementia was evaluated by conducting a systematic literature review. This yielded 43 studies, of which 6 were randomized controlled trials meeting the inclusion criteria (containing 125 subjects.) Results were subjected to meta-analysis. Effects on cognition and behavior were significant in favor of treatment (cognition standardized mean difference [SMD] = -0.59; 95% confidence interval [CI] -0.95(-)-0.22; behavior SMD = -0.64, 95% CI = -1.20(-)-0.08). The evidence indicates that RO has benefits on both cognition and behavior for dementia sufferers. However, a continued program may be needed to sustain potential benefits. Future research should evaluate RO in well-designed multicenter trials.

Aged↗
PubMedDate not supplied

Some realities and results of proficiency testing of laboratories performing toxicological analyses.

The results of proficiency testing and performance monitoring of laboratories that undertake the identification and quantitation of drugs present in physiological specimens on a fee-for-service basis are examined. In spite of an accompanying history strongly suggesting the presence of one or more specific compounds in a given specimen, a surprising number of laboratories failed in the identification of the compound or false identification was encountered. Similarly, a disappointing number of the reported quantitative results were outside an arbitrarily assumed acceptable range of 85 to 115% of the various target (putative) values. The results reported by referee laboratories were also less uniform than expected. Considering the charges made to customers for such analyses, it is reasonable to expect a better quality of performance. Some comments on the possible means of achieving this will be made.

Diagnostic Errors↗
PubMed1989

Self, identity, and subjective experiences of schizophrenia: in search of the subject.

Schizophrenia is an I am illness--one that may overtake and redefine the identity of the person. This essay explores concepts of personhood and subjectivity from social science that are useful in understanding the experiencing subject in schizophrenia. Relationships between the self and sickness have not been investigated adequately with reference to their influence on prognosis. Chronicity is conceived of as a loss of self and of positive social roles and identity. Methods for the study of self and identity in relation to schizophrenia include analysis of illness-identity representations made by persons with schizophrenia.

Adaptation, Psychological↗
PubMed1993

Schizophrenic delusions: a phenomenological approach.

The issue of specificity of delusions in schizophrenia is still a matter of debate. The authors analyze the delusion formation in schizophrenia from a prototypical, phenomenological point of view, focusing on the subject's experience. This perspective links delusion formation to the autistic predisposition, which is considered here as the elementary phenotypic expression of the vulnerability to schizophrenia. Autism is viewed as a defective preconceptual (i.e., before language) attunement to the world. It impedes the individual's sharing of "common sense" with others and impairs the ability to project into the future. The development of delusions is illustrated, in part, by Klaus Conrad's work on the onset of paranoid schizophrenia. Delusions are viewed as transformations of the structure of experiencing. When threatened in future ability to be, the autistic, vulnerable person looks for the clues to becoming by attributing significance to disparate elements of the environment, which become self-referential. The link established between these disparate elements is based on universal characteristics that give the schizophrenic delusion a metaphysical quality. The transitivistic experience in delusions of control and omnipotence points to a specific way of crossing the border between "mine" and "yours" (disturbances of the experiencing "I"). What strikes a clinician in these delusions is that the normally tacit link between the sense of being and the sense of acting becomes quite apparent. The authors also propose a specificity in the themes of schizophrenic delusions. Delusions acquire a schizophrenic quality when ontological (i.e., universal) elements of the discourse between the locutor and the Other dominate at the expense of the worldly elements. It is emphasized that delusional content and form are dialectically related and hardly distinguishable. The authors consider the delusion formation as a phenomenon of emergence, a situation in which a new qualitative order arises from the reorganization of essentially unchanged elements. To consider schizophrenia as an emergent, particular way of experiencing, related to the autistic defect, has important consequences for research and for treatment. A dialectic exchange is needed between prototypical models generated by phenomenological inquiry and empirical, operational validation of testable aspects of such models.

Activities of Daily Living↗
PubMed1995

First person account: schizophrenia--adrift in an anchorless reality.

The article that follows is part of the Schizophrenia Bulletin's ongoing First Person Accounts series. We hope that mental health professionals--the Bulletin's primary audience--will take this opportunity to learn about the issues and difficulties confronted by consumers of mental health care. In addition, we hope that these accounts will give patients and families a better sense of not being alone in confronting the problems that can be anticipated by persons with serious emotional difficulties. We welcome other contributions from patients, ex-patients, or family members. Our major editorial requirement is that such contributions be clearly written and organized, and that a novel or unique aspect of schizophrenia be described, with special emphasis on points that will be important for professionals. Clinicians who see articulate patients, with experiences they believe should be shared, might encourage these patients to submit their articles to First Person Accounts, Division of Clinical and Treatment Research, NIMH, 5600 Fishers Lane, Rm. 18C-06, Rockville, MD 20857.

Adult↗
PubMed1997

Electrophysiological brain activity and memory source monitoring.

To investigate brain mechanisms involved in identifying the origin of memories, event-related potentials (ERPs) were recorded as participants discriminated previously presented (old) from new items or identified their earlier source (picture, word, or new). Differences in ERPs between old-new recognition and source identification were focused at frontal sites. For source identification, prominent negative deflections at occipital or frontal sites occurred depending on encoding task. These results support a model in which memory attributes are distributed neocortically and the frontal lobes are critical for source monitoring.

Discrimination Learning↗
PubMed2004

Decoupling beliefs from reality in the brain: an ERP study of theory of mind.

Theory of mind, attributing behaviors to mental states, is a cognitive ability central to human social interactions. To investigate the neural substrates of theory of mind reasoning, we recorded human event-related brain potentials (ERP) while participants made judgments about belief and judgments about reality. A late ERP component (peaking around 800 ms post-stimulus) with a left frontal scalp distribution, which was inconsistent with a source in the anterior paracingulate cortex and consistent with a source possibly in the left orbitofrontal cortex, differentiated judgments about belief and about reality. This late left frontal component is probably associated with the decoupling mechanism that distinguishes mental states from reality.

Adult↗
PubMed1997

Discrimination accuracy and decision biases in different types of reality monitoring in schizophrenia.

A reality monitoring task was administered to 31 schizophrenic patients and 31 normal controls. Twenty-four items were produced, either orally by the experimenter, orally by the subjects, or seen as pictures. Subjects were later read a list of 48 items and were asked to indicate if each item was new, self-generated, experimenter-generated, or presented as a picture. Results showed that schizophrenic patients were impaired in discriminating old items from new, with a higher bias than controls toward reporting new items as if they were old (false alarms). In addition, patients were impaired in discriminating self-generated items from externally generated items, with a higher bias than controls toward attributing self-generated items to an external source. Lastly, they were significantly impaired in discriminating the modality (auditory versus visual) in which the event was presented. The bias toward remembering orally produced items as pictures was correlated with positive symptomatology and was significantly higher than controls in patients with high levels of positive symptoms. This suggests that mental imagery may play a role in positive symptomatology. These results demonstrate the relevance of studying decision biases along with discrimination performance for the understanding of the mechanisms of reality monitoring impairment in schizophrenia.

Adult↗
PubMed1998

Word recognition, discrimination accuracy, and decision bias in schizophrenia: association with positive symptomatology and depressive symptomatology.

The purpose of this experiment was to replicate and extend to a memory task Bentall and Slade's (1985) finding that hallucinations in schizophrenic patients were linked to a liberal decision bias. A word recognition task was administered to 40 schizophrenic patients and 40 normal controls that yielded two indices of performance: an index of discrimination accuracy (Pr) and one of decision bias (Br). Patients obtained a lower Pr than controls, whereas Br was similar in both groups. In patients, Br was selectively correlated with positive symptomatology: the more the positive symptoms, the more liberal the bias. In particular, there was a specific correlation between decision bias and hallucinations. Conversely, Pr was inversely correlated with severity of depression, but not with either positive or negative symptoms. Thus, positive symptomatology may be linked more to difficulties in distinguishing between representations of internal versus external events than to deficits in encoding external events.

Adult↗
PubMed1999

Neuropsychology and the self-concept.

The biological basis of the self is discussed in relation to neuropsychological findings in cases with focal brain injury. This material demonstrates that the self is deposited at an early phase in the process of object realization and distributes into the private space of imagery and the external space of object perception. A disruption or truncation of this process results in an erosion of the self that is similar across the different perceptual modalities. From the pattern of pathological breakdown, it is concluded that the self is a categorical, relational entity that achieves autonomy in the context of an act of cognition that is fully derived, i.e., actualizes completely. The autonomy depends on the completeness of this derivation. The preliminary locus of the self in the mental state entails a holistic or multimodal phase of potential before perceptual individuation. The relation of the self-concept to antecedent phases in the microgenesis of a cognition, the relation to feeling, personal history, and the immediate past, points to a limbic transition in the outward development of the mental state.

Cognition↗
PubMed1999

Response to sexual assault: a relational perspective.

It has been suggested that although the severity of the stressor is the primary determinant of acute posttraumatic stress disorder (PTSD) symptoms, pre-existing personality patterns may be the primary contributors to the development of chronic PTSD symptomatology. The authors postulate that of the multiple personality factors that influence behavior and response to traumatic events, relational capacity or the ability to sustain interpersonal relationships provides an overarching construct for understanding the contribution of social contextual factors to post-trauma response. The results of this exploratory study support the authors' hypothesis that relational capacity is a significant factor in explaining persistent PTSD symptoms in a sample of adult women who have been raped. Significant correlations were found between measures of relational capacity, the Bell Object Relations Inventory and the Inventory of Interpersonal Problems and measures of distress, the Posttraumatic Symptom Scale, and the Beck Depression Inventory.

Adaptation, Psychological↗