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PubMed2002

Health characteristics and health services utilization in older adults with intellectual disability living in community residences.

BACKGROUND: The health status and health needs of adults with intellectual disability (ID) change with advancing age, and are often accompanied by difficulties with vision, hearing, mobility, stamina and some mental processes. AIM: The present study collected health status information on a large cohort of adults with ID aged > or = 40 years living in small group, community-based residences in two representative areas of New York State, USA. METHOD: Adult group home residents with ID aged between 40 and 79 years (n = 1371) were surveyed to determine their health status and patterns of morbidity. RESULTS: Most subjects were characterized as being in good health. The frequency of cardiovascular, musculoskeletal and respiratory conditions, and sensory impairments increased with age, while neurological, endocrine and dermatological diseases did not. Psychiatric and behavioural disorders declined with increasing age, at least through 70 years of age. Although most conditions increased with age, their frequency varied by sex and level of ID. Frequencies of age-related organ system morbidity were compared to data from the National Health and Nutrition Evaluation Survey III. It was found that adults with ID had a lower overall reported frequency of cardiovascular risk factors, including hypertension and hyperlipidaemia, and adult-onset diabetes. Inconsistencies with mortality data among older adults with ID were observed (which showed equal if not greater prevalence of deaths as a result of cardiovascular disease and cancer). CONCLUSION: These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases.

Adult↗
PubMed2000

'Science', 'critical thinking' and 'competence' for tomorrow's doctors. A review of terms and concepts.

CONTEXT: The recommendations of the General Medical Council in Tomorrow's Doctors renewed efforts to define core knowledge in undergraduate medical education. They also encouraged better use of the medical knowledge base in nurturing clinical judgement, critical thinking, and reflective practice. What then does the medical world understand by 'science', 'critical thinking' and 'competence', given the need to address both growth and uncertainty in the knowledge base and to practise evidence-based healthcare? AIM AND OBJECTIVES: This review aims to outline the role of these key concepts in preparing undergraduate medical students for professional practice. Specifically, it explores: the fallibility of the 'scientific' foundations of medical practice; the role of understanding and thinking in undergraduate medical education; the need for a broad interpretation of competence and its relationship to transferability, and the nature of clinical judgement. COMMENT: Tensions are seen to lie in the varying interpretations of clinical decision making as art or science; the varying characterizations of the nature of skilled performance in the novice, the competent and the expert practitioner, and the varying reactions to the acceptability and usefulness of 'meta-' concepts in capturing the essence of professional practice. Habitual self-conscious monitoring of mental processes may be the key to the flexible transfer and application of knowledge and skills across the contexts, characterized by uncertainty and incomplete evidence, for which doctors must be prepared.

Clinical Competence↗
PubMed2003

Working memory controls involuntary attention switching: evidence from an auditory distraction paradigm.

One function of working memory is to protect current mental processes against interference. In contrast, to be able to react flexibly on unpredictable environmental changes working memory should not totally be encapsulated from processing task unrelated information; that is, it should remain distractible. By manipulating the task load of the primary task in an auditory distraction paradigm we investigated how these opposing functions are coordinated by working memory. The behavioural results show that distraction effects were still present but reduced markedly with higher task demands. This suggests that working memory exerts some control over involuntary attention. In addition, event-related brain potentials related to the different processing stages reveal that the preattentive change detection system underlying distraction was not modulated by task demand whereas distraction per se was. The present data suggest that working memory is able to coordinate the maintenance of distractibility and the focus on the task at hand.

Acoustic Stimulation↗
PubMed2002

Maurice Ravel and right-hemisphere musical creativity: influence of disease on his last musical works?

The problem of finding correspondence between a particular neuronal organization and a specific function of the human brain remains a central question of neuroscience. It is sometimes thought that language and music are two sides of the same intellectual coin, but research on brain-damaged patients has shown that the loss of verbal functions (aphasia) is not necessarily accompanied by a loss of musical abilities (amusia). Amusia without aphasia has also been described. This double dissociation indicates functional autonomy in these mental processes. Yet verbal and musical impairments often occur together. The global picture that emerges from studies of music and its neural substrate is by no means clear and much depends on which subjects and which aspect of musical abilities are investigated. An illustration of these concepts is provided by the case of the French composer Maurice Ravel, who suffered from a progressive cerebral disease of uncertain aetiology, with prominent involvement of the left hemisphere. As a result, Ravel experienced aphasia and apraxia and became unable to compose. The available facts favour a clinical diagnosis of primary progressive aphasia (PPA), with the possibility of an overlap with corticobasal degeneration (CBD). In view of Ravel's clinical history, we propose that two of his final compositions, the Bolero and the Concerto for the Left Hand, include certain patterns characteristic of right-hemisphere musical abilities and may show the influence of disease on the creative process.

Aphasia↗
PubMed2003

Normal patterns and variants in single-photon emission computed tomography and positron emission tomography brain imaging.

One of the most important issues in evaluating functional brain scans for research or clinical purposes is to be able to identify normal variants. Determining the baseline "normal" state of the brain is not easy to characterize since many normal brain functions and mental processes affect brain activity. This article reviews issues pertaining to the technical and neurophysiological aspects of functional brain imaging that might alter "normal" activity and will also consider how normal brain activity changes throughout the lifespan.

Adolescent↗
PubMed1982

An effective paradigm for conditioning visual perception in human subjects.

Repeated pairing of an auditory conditioned stimulus with a weak visual unconditioned stimulus produced extended image sequences and visual responses conditioned to the tone alone. The experiment is set into the context of Pavlov's view of Helmholtz's "unconscious inference" thus providing experimental evidence linking the higher mental process of perception with classical conditioning.

Adolescent↗
PubMed1989

Misaligned maps lead to predictable errors.

Three experiments were conducted to investigate the ability of subjects to make judgments of direction when using misaligned maps. Two hypotheses were proposed (i) errors would fall into two lawful categories--mirror-image errors and alignment errors; (ii) the effect of map orientation would generalize to a different mode of responding than has been used in previous studies. Support for both hypotheses was obtained. The results are discussed in terms of the mental processes used to align maps to spaces, and the task demands required by different response modes.

Adult↗
PubMed2000

Learning and memory.

Memory is one of the most fundamental mental processes. Neuroscientists study this process by using extremely diverse strategies. Two different approaches aimed at understanding learning and memory were introduced in this symposium. The first focuses on the roles played by synaptic plasticity, especially in long-term depression in the cerebellum in motor learning, and its regulatory mechanism. The second approach uses an elegant chick-quail transplantation system on defined brain regions to study how neural populations interact in development to form behaviorally important neural circuits and to elucidate neurobiological correlates of perceptual and motor predispositions.

Animals↗
PubMed1999

The neural substrate and temporal dynamics of interference effects in working memory as revealed by event-related functional MRI.

Research on the prefrontal cortex (PFC) of monkeys and humans indicates that this region supports a heterogeneous repertoire of mental processes that contribute to many complex behaviors, such as working memory. Anatomical evidence for some of these processes derives from functional neuroimaging experiments using blocked experimental designs, which average signal across all components of many trials and therefore cannot dissociate distinct processes with different time courses. Using event-related functional MRI, we were able to isolate temporally the neural correlates of processes contributing to the target presentation, delay, and probe portions of an item-recognition task. Two types of trials were of greatest interest: those with Recent Negative probes that matched an item from the target set of the previous, but not the present, two trials, and those with Nonrecent Negative probes that did not match a target item from either the present or the two previous trials. There was no difference between the two trial types in target presentation (i.e., encoding) or delay-period (i.e., active maintenance) PFC activation, but there was significantly greater activation for Recent Negatives than Nonrecent Negative activation associated with the probe period within left ventrolateral PFC. These findings characterize spatially and temporally a proactive interference effect that may reflect the operation of a PFC-mediated response-inhibition mechanism that contributes to working memory performance.

Adult↗
PubMed1999

Reaction times are faster in HIV-seropositive patients on antiretroviral therapy: A preliminary report.

We evaluated subclinical mental and motor slowing in 142 HIV-seropositive patients without dementia, using computerized simple and choice reaction time tasks and self-report measures of psychological distress. Patients on antiretroviral therapy at the time of testing (n = 79) had significantly faster choice reaction times (p < 0.05), indicating faster mental processing speed, than untreated patients (n = 63). These faster RTs could not be attributed to differences in age, education, risk factors, degree of immunosuppression, substance abuse history, peripheral neuropathy, or psychological distress. Reaction time tasks should be investigated further as potential outcome measures in clinical trials, particularly for subjects with few or no overt cognitive deficits.

Adult↗
PubMed2002

Johann August Philipp Gesner (1738-1801). A review of his essay "The language amnesia" in the bicentennial anniversary of his death.

On the 200th anniversary of Johann August Philipp Gesner's death, this paper summarizes and discusses a paper on language amnesia published in 1770. The author had clear knowledge of selective mental impairments resulting from brain diseases, and of separate mental representations for words and their underlying concepts. However, to explain the language impairment, Gesner suggested that it would not be caused by focal damage to a specific anatomic and functional unit of the mind, but is the consequence of a general sluggishness of the mental processes.

Aphasia↗
PubMed2002

Numbers and letters: exploring an autistic savant's unpracticed ability.

This paper describes an individual with autism and high-level calendar calculation ability who could perform a set of unpracticed letter/number association tasks. The savant's performance was compared with that of two control participants, one a departmental secretary and the other a professor of mathematics. The facility with which the savant could master the rules governing the relationships between the series of items suggests that he possessed a flexibility of mental processing transcending his ability of calendar calculation. Furthermore, he could recalibrate previous knowledge to solve new hitherto unpracticed tasks. When presented with novel problems, the savant, unlike the mathematician, made no initial errors at all on any of the presented tasks, thereby indicating his fast and spontaneous recognition of new rules and of new relationships between items. It is concluded that a cognitive style of 'weak central coherence' as adopted by autistic savants may protect single representations from being retained in the form of stable enduring wholes, and that such a segmentation strategy may allow for the transformation, reorganization and reconstruction of the relationship between single items of information.

Autistic Disorder↗
PubMed1993

Etienne Félix d'Hénin de Cuvillers: a founder of hypnosis.

Etienne Félix d'Hénin de Cuvillers (1755-1841) was one of the few followers of Mesmer who continued to study, practice, and refine animal magnetism after its eclipse resulting from the 1784 publication of the essentially negative investigatory reports of the French commissions. He differed from Mesmer in that he denied the existence of a magnetic fluid, emphasized the role of mental processes in mesmerism and in general behavior, and anticipated the much later psychodynamic constructs of transference and countertransference. In addition, he used and publicized a system of scientific nomenclature based upon the "hypn-" prefix for which Braid has usually, but inaccurately, been given credit for originating.

France↗
PubMed2006

Anatomy of a hypnotic response: Self-report estimates, actual behavior, and physiological response to the hypnotic suggestion for arm rigidity.

The present study closely examines subject response to the arm-rigidity item of the HGSHS:A. Subject behavior, subject self-report, and surface EMG of the biceps and triceps muscles were monitored. Two distinct ways of passing the item were observed and verified by EMG recordings: some subjects (tremblers) exerted muscular effort to bend the arm and kept it rigidly straight. Others (nontremblers) passively kept the arm straight without exerting muscular effort to bend, even though they reported exerting effort to bend their arm. These two behaviorally and physiologically different methods of passing the item support the idea of individual differences in hypnotic responding and suggest that subjects may be using different mental processes to pass the item.

Adult↗
PubMed2003

Dissociation and neuroscience: history and new perspectives.

History of the study of dissociation begins in the second half of the nineteenth century. It begins in the works of Hughlings Jackson and Pierre Janet, and markedly influences development of psychoanalysis and other psychological trends. According to the modern definition, dissociation represents a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness. Dissociative symptoms occur mainly due to some traumatic events and probably cannot be generally explained on the basis of neurological focal lesion. However, from recent findings, it may be inferred that temporal lobe epileptic activity is important in the generation of dissociative symptoms. Recent findings show that neural networks provide an attractive framework for modeling dissociative mental processes and dissociative mechanisms. In the article we propose a new theoretical connection among neural network models of dissociation, Freeman's model of chaos in the brain and electrophysiological findings regarding dissociative states. Concluding remarks are concerned with connections of dissociation and inter-hemispheric communication.

Dissociative Disorders↗
PubMed1992

Induced arousal and orienting tasks as determinants of intentional recall.

In this study, the author examined the effects of intention to learn, noise, and different types of orienting tasks on short-term and long-term recall for 15 Hindi paired-associates. Intention to learn improved recall, as did encoding of semantic features, and noise impaired both short-term and long-term recall. The analysis of short-term recall scores indicated that there were no significant interactions between these factors, but the analysis of long-term recall scores indicated that there were significant interactions between noise and orienting tasks and between intentionality and orienting tasks.

Adolescent↗
PubMed1992

The development of a capacity for imagination in early childhood.

Imagination as a mental capacity is part of a line of development that begins in the earliest symbiotic interactions between mother and infant, takes further shape as the child moves from dyadic to triadic relations, and culminates in a fully mature capacity to reflect upon in thought one's wishes and feelings vis-à-vis multiple others. Particularly for the 3- to 5-year-old child, imagination represents a special mode of mental functioning which allows him to expand his internal object world, motivates him toward increasingly complex relationships with others, and is a central precondition for the creation of the self-defining fantasies characteristic of the oedipal phase. The central neurocognitive precondition for an imaginative capacity is the ability to distinguish thought from action and understand that others as well as oneself are motivated to act because of mental states such as feelings, beliefs, and fantasies. In this paper, we present a view of imagination that integrates observations from psychoanalytically informed studies of the emergence of fantasy play in the oedipal phase with findings from recent work on how children acquire an understanding of their own and others' mental processes.

Child↗
PubMed2005

A girl's experience of congenital trauma: The healing function of psychoanalysis in the adolescent years.

This paper addresses the centrality of conflict in psychic trauma, as evidenced in the psychoanalytic treatment of an adolescent girl with a congenital life-threatening and disfiguring condition that necessitated multiple surgical procedures in early childhood. The focus is twofold: to elucidate certain characteristics of analysis in the adolescent phase that promote the integration of early trauma; and to shed light on the modes of therapeutic action of psychoanalysis. Case material is presented indicative of the psychic consequences of early medical traumata, including the impairment of the ego's capacity to utilize anxiety as a signal function that mobilizes defense, the failure of repetition to effect mastery of the trauma, the predominant use of aggression in the interest of defense, and distortions in self and object representations. The author offers evidence to show that conflicts over aggression and oedipal desires, characteristic of adolescent girls who have not been subject to trauma, were involved in the defensive function of her patient's pervasive sense of defectiveness. She postulates that the interpretation of conflict and defense is the analyst's attuned response to the mind of the patient, and points to the resulting increase in the capacity to observe and to exercise volitional control over heretofore unconscious, automatic mental processes as evidence of the mutative function of dynamic interpretation.

Abnormalities, Multiple↗