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[Borderline personality disorders in somatic illness].

The borderline personality disorders are very frequent in modern society because of cultural and social reasons. The authors analyze the disturbed mental processes (impulsiveness and memory) because they represent risk factors for the treatment of diseases. On the base of experience of consultation-liaison psychiatry, the authors show some guidelines in the medical practice (primary care and general hospital) in order to overcome the troubles of the treatment.

Borderline Personality Disorder↗

[Peculiarities of interhemisphere interaction at different levels of consciousness].

Transition from wakefulness to drowsiness was used as a model of a gradual decrease in the consciousness level. Subjects' self-reported changes in the contents of consciousness, namely: the intensity and quality of involuntary mental processes, served as an indicator of the consciousness level. Each observed level of consciousness was shown to be characterised by a certain EEG profile. It was also shown that the state in which the subject signals of a slowdown of the "internal speech" or the "lapse of thoughts" corresponds to the lowest level of activation. In this case, the interhemisphere connections involving the main mechanism of cognitive information transmission, i.e. the EEG high-frequency rhythms, becomes suppressed.

Brain↗

[The psychobiology of Hans Lungwitz (1881-1967)].

Hans Lungwitz began to formulate his concept of philosophical and medical anthropology in 1924, and continued to develop it until his death in 1967. From his long experience as a neurologist, he arrived at a comprehensive theory of psychobiology which describes mental processes as biological / physiological function of neural structures in the human brain. Lungwitz's approach to holistic biological view of thought and experience to brain function and reflex behaviour, and provides a holistic biological view of the human brain, free from metaphysics. This is shown here as: the subject-object-relationship, the human being described as a reflex system; the psychobiology of language and speech; the way a person perceives (Weltanschauung); illness as infantilism in general and recover therefrom, especially in the context of treatment by the method of cognitive therapy, inaugurated by Lungwitz.

Anthropology↗

Cognitive theories and the design of e-learning environments.

Cognitive development refers to a mental process by which knowledge is acquired, stored, and retrieved to solve problems. Therefore, cognitive developmental theories attempt to explain cognitive activities that contribute to students' intellectual development and their capacity to learn and solve problems. Cognitive developmental research has had a great impact on the constructivism movement in education and educational technology. In order to appreciate how cognitive developmental theories have contributed to the design, process and development of constructive e-learning environments, we shall first present Piaget's cognitive theory and derive an inquiry training model from it that will support a constructivism approach to teaching and learning. Second, we will discuss an example developed by NASA that used the Web as an appropriate instructional delivery medium to apply Piaget's cognitive theory to create e-learning environments.

Cognitive Science↗

Benefits of exercise for older adults. A review of existing evidence and current recommendations for the general population.

Currently available data are of variable rigor and from a variety of sources, yet they do support several conclusions about the potential value of exercise for whole groups of elderly persons. (1) Exercise of moderate intensity may benefit many elderly persons in numerous and complementary ways (e.g., cardiovascular status, fracture risk, functional ability, and mental processing). (2) There are few complications associated with such increases in activity. Indeed, a remarkable aspect of research on exercise in the elderly has been the virtual absence of reports of serious cardiovascular or musculoskeletal complications in any published trials. Cardiac rehabilitation programs, enrolling many persons over 65 years of age with known coronary artery disease, also report few major cardiovascular complications. Thus, exercise should be viewed as safe for most older adults. (3) Exercise in the elderly probably needs to be tailored, and when possible, individualized, with the specific objectives of the person or group in mind. Some benefits are probably related to the intensity of exercise (e.g., cardiovascular disease), others due to the type of exercise (weight-bearing versus nonweight-bearing for osteoporosis, or racket sports for hand-eye coordination), and still others possibly relate to the setting in which exercise occurs (social-psychological benefits). (4) The authors believe the known physiologic effects of exercise on age-related changes and existing clinical research support the general notion that vigorous weight-bearing exercises such as walking are the safest, cheapest, easiest, and most widely beneficial for the average senior. (5) Research has yet to define good ways by which to stimulate large numbers of sedentary elderly persons to exercise regularly. The potential and complementary benefits appear to be great enough to justify widespread efforts at the community and individual level, however.

Activities of Daily Living↗

Essential fatty acids, DHA and human brain.

Essential fatty acids cannot be synthesized in the body but they are required for maintenance of optimal health. There are two classes of polyunsaturated fatty acids (PUFAs)--omega-6 and omega-3. The parent omega-6 fatty acid, linoleic acid (LA) is desaturated in the body to form arachidonic acid while parent omega-3 fatty acid alpha-linolenic acid (ALA) is desaturated by microsomal enzyme system through a series of metabolic steps to form eicosapentaenoic acid (EPA) and decosahexaenoic acid (DHA). But there is a limited metabolic capability during early life to metabolize PUFAs to more active long-chain fatty acids. There is a critical role of EFAs and their metabolic products for maintenance of structural and functional integrity of central nervous system and retina. Most of the brain growth is completed by 5-6 years of age. At birth brain weight is 70% of an adult, 15% brain growth occurs during infancy and remaining brain growth is completed during preschool years. DHA is the predominant structural fatty acid in the central nervous system and retina and its availability is crucial for brain development. It is recommended that the pregnant and nursing woman should take at least 2.6 g of omega-3 fatty acids and 100-300 mg of DHA daily to look after the needs of her fetus and suckling infant. The follow-up studies have shown that infants of mothers supplemented with EFAs and DHA had higher mental processing scores, psychomotor development, eye-hand coordination and stereo acuity at 4 years of age. Intake of EFAs and DHA during preschool years may also have a beneficial role in the prevention of attention deficit hyperactivity disorder (ADHD) and enhancing learning capability and academic performance.

Brain↗

The psychoanalytic view of phobias. Part II: Infantile phobias.

The psychoanalytic literature on infantile phobias, despite disclaimers by several of its prominent authors, seems to demonstrate a growth in knowledge of these conditions and an increasing respect for methodology. It is also noteworthy in its close adherence to the presentation of clinical material. Looking at phobia from this developmental viewpoint has caused us to modify our definition of phobia, adding independence from immediate, fear-provoking stimuli and requiring an inference on the part of the observer because of some integral mental process which is nontransparent. These additions are further specifications of the meaning of the term in general; they are not intended to be limited to infantile phobias. Phobic syndromes can certainly arise well before age four, well before there is any evidence of a child's having entered the oedipal phase of development. Nevertheless, because of the early genital phase, castration reactions, albeit with a somewhat different meaning, usually appear to be involved in the symptom formation. There is also a suggestion that all infantile phobias may begin to arise at this period of development. The symptom pictures in the cases of the children reported in the psychoanalytic literature are very similar. We seem to have described a disorder which, we can hypothesize, has its beginnings in the early genital phase, may emerge as a psychopathological condition at that time, or may reach proportions sufficient to interfere with function or development only several years later. The disorder appears to make use of inherited reflex-like patterns of response to certain stimuli as dangers. On the basis of the reported psychoanalytic experience, we cannot really generalize much about psychogenetics or psychodynamics. Psychoanalysts have applied their ideas about neurotic symptom formation in general to these cases. Just why the illnesses assume these particular forms in these particular children is unclear. The only steps toward specification have been hypotheses introduced by Anna Freud and Owen Renik. Anna Freud hypothesized that a major condensation occurs to focus infantile anxieties on a single symbol, thus causing sharply focused, rather than generalized, anxiety. Renik related self-object differentiation and cognitive development to such "symbolization" in infancy, explaining phobic object formation in terms of primary and secondary process representations and their interaction. Although we have descriptively defined a syndrome "phobia," it is not yet clear whether the disorders of infancy and childhood which fit that definition have significant similarities--descriptively or psychodynamically--with conditions which develop later in life and also appear to fit the descriptive parameters.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

[EEG frequency: amplitude characteristics at different levels of consciousness].

Relationship was studied between the level of consciousness and the level of the brain activation. State of transition from wakefulness to drowsiness was used as a model of gradual decrease in the level of consciousness. A change in the intensity and quality of appearing involuntarily mental processes served as an index of the level of consciousness as determined by subjects' self-reports. It was found that a certain EEG profile corresponded to each level of consciousness under study. The data obtained showed that the lowest level of activation corresponded to a state in which a subject develops inhibition of "internal speech", "failure of thoughts". In this case, the dynamics of the EEG high frequency rhythm changes was possibly related to the mechanism of transmission of cognitive information.

Adult↗

Neuroethics: a guide for the perplexed.

Like filings to a magnet, issues of all shapes, sizes, and degrees of importance are sticking to the idea of neuroethics. Martha Farah, an early thinker in this new field, proposes that, numerous as they are, the problems actually fall into just three categories. She finds that neuroethics has made a quick start sizing up many practical--and some unique--questions swirling up from brain science, but, she writes, watch for challenges that reach beyond these to the metaphysical. Neuroscience may one day explain in terms of neural tissue virtually all aspects of human cognition and emotion--realms traditionally deemed apart from physical law. Thus, we should also expect neuroethics to grapple with our fundamental distinction between persons and mere "things." If mental processes prove to result from purely physical events, this opens to question our notions of consciousness, spirituality, free will, and moral responsibility.

Behavior↗

Monitoring and predicting cognitive state and performance via physiological correlates of neuronal signals.

Judgment, decision making, and situational awareness are higher-order mental abilities critically important to operational cognitive performance. Higher-order mental abilities rely on intact functioning of multiple brain regions, including the prefrontal, thalamus, and parietal areas. Real-time monitoring of individuals for cognitive performance capacity via an approach based on sampling multiple neurophysiologic signals and integrating those signals with performance prediction models potentially provides a method of supporting warfighters' and commanders' decision making and other operationally relevant mental processes and is consistent with the goals of augmented cognition. Cognitive neurophysiological assessments that directly measure brain function and subsequent cognition include positron emission tomography, functional magnetic resonance imaging, mass spectroscopy, near-infrared spectroscopy, magnetoencephalography, and electroencephalography (EEG); however, most direct measures are not practical to use in operational environments. More practical, albeit indirect measures that are generated by, but removed from the actual neural sources, are movement activity, oculometrics, heart rate, and voice stress signals. The goal of the papers in this section is to describe advances in selected direct and indirect cognitive neurophysiologic monitoring techniques as applied for the ultimate purpose of preventing operational performance failures. These papers present data acquired in a wide variety of environments, including laboratory, simulator, and clinical arenas. The papers discuss cognitive neurophysiologic measures such as digital signal processing wrist-mounted actigraphy; oculometrics including blinks, saccadic eye movements, pupillary movements, the pupil light reflex; and high-frequency EEG. These neurophysiological indices are related to cognitive performance as measured through standard test batteries and simulators with conditions including sleep loss, time on task, and aviation flight-induced fatigue.

Aerospace Medicine↗

[Neurosciences and philosophy of mind].

In this paper we argue that the interaction between neurosciences and philosophy of the mind is on the way to understand consciousness, and to solve the mind-body or mind-brain problem. Naturalism is the view that mental processes are just brain processes and that consciousness is a natural phenomenon. It is possible to construct a theory about its nature by blending insights from neuroscience, philosophy of the mind, phenomenology, psychology and evolutionary biology.

Consciousness↗

Emotional dysfunction in a geriatric population: staff observations and patients' reports.

This study was designed to determine the following about a geriatric rehabilitation population: (1) the relationship between patients' self-reports of depression and anxiety and staff observations of compromised participation in treatment secondary to emotional dysfunction; (2) the relationship of observations among different disciplines; and (3) changes that may occur to staff observations during the patient's hospitalization. The Geriatric Depression Scale, the depression and anxiety subtests of the Brief Symptom Inventory, and the Modified Mini-Mental State Exam were administered to geriatric patients on admission to and discharge from two DRG-exempt acute rehabilitation units. In addition, day nurses, evening nurses, occupational therapists, and physical therapists rated the same geriatric patients on how frequently their emotional functioning interfered with rehabilitation. Significant correlations were obtained between staff observations and patients' reports of emotional dysfunction, with occupational therapists' ratings generally the most highly correlated with patients' reports. At admission, day and evening nurses reported significantly greater patient emotional dysfunction than did occupational therapists, who reported significantly greater emotional dysfunction than did physical therapists. These differences, however, were not evident by time of discharge. Thus, staff members can provide reliable information to mental health professionals in determining the effect of emotional functioning on rehabilitation participation. However, level of compromised participation secondary to emotional dysfunction reported by staff appears to be contingent on which rehabilitation discipline is asked and when during the patient's hospitalization the inquiry is made. Also, patients who generally participated less in treatment tended to be older, depressed women with less education and greater cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

[A psychophysiological approach toward the problem of consciousness].

Psychophysiological analysis of the relationship between the level of consciousness and the brain activation permitted an identification of three levels of consciousness at the transition from wakefulness to sleep. A change in the intensity and quality of involuntarily mental processes served as an index of the level of consciousness according to subjects' self-reports. It was found that a certain EEG profile corresponds to each level of consciousness under study. Data obtained showed that the lowest level of activation corresponds to a state in which a subject notes an inhibition of "internal speech", "failure of thoughts". At this case the dynamics of the EEG high frequency rhythm changes which is possibly related to the mechanism of transmission of cognitive information.

Adolescent↗

[Influence of educational status on a screening test for dementia, the Mini-Mental State Examination].

This study aimed to examine the relationships between the educational level and the Mini-Mental State Examination (MMSE) total scores and its different items. In a survey dealing with cerebral aging, the MMSE administered 2,792 subjects aged 65 years and over, who continued to live at home. The total score decreased with age and increased markedly when the educational level rose. The proportion of failures was higher than or equal to 10% for 12 of the 30 MMSE items, including the 5 items designed to measure attention ability (serial subtractions) and the 3 ones exploring delayed memory. Regarding these 12 items, the percentage of failures increased homogeneously with age, but the relationship with educational level was heterogeneous: it was very strong for the calculation items, weaker for the delayed memory items. These results pointed to the complex relationships between MMSE scores and educational level, and suggested a possible bias related to the screening tool in dementia surveys.

Aged↗

Conversion disorder revisited.

Conversion disorder is defined as a psychiatric illness whose symptoms or deficits, affecting voluntary motor or sensory function, cannot be explained by a neurological or general medical condition. Proposing a strategy in the search for the neural mechanisms underlying conversion disorder is a difficult task, partly because key features of the illness inherently lie on a continuum with other psychiatric disorders, such as depression and posttraumatic stress disorder. Recent brain imaging studies have revealed neural circuits involved in complex mental processes potentially related to conversion disorder. These studies are reviewed, together with neuroimaging work in conversion disorder and brain imaging studies that have enriched the conceptualization of memory and emotion in posttraumatic stress disorder and major depression. Analysis of this information from a symptom-based rather than a disease-category perspective leads to a brain-based cognitive model of conversion disorder. This model suggests that disconnected crosstalk between the individual subdivisions of the anterior cingulate and the prefrontal cortex might provide a neuroscientific basis for the psychodynamic dissociation hypothesis, traditionally the bedrock explanation of the relationship between internal conflict and physical deficit. The model also suggests novel research approaches, as well as opportunities for potential therapeutic interventions.

Brain↗

Diagnosis and treatment of temporal lobe epilepsy.

Of the 1,200,000 Americans with partial epilepsy, temporal lobe epilepsy (TLE) occurs in more than 400,000. Temporal lobe seizures are usually stereotypic in their symptoms and duration. A typical sequence is an aura followed by arrest of motor behavior, blank stare, and automatisms. Patients with TLE often show impairments in attention, memory, mental processing speed, executive functions, mood, personality, and drive-related behaviors. Interictal depression occurs in approximately one third of TLE patients. TLE is diagnosed by a history of characteristic partial seizure symptoms. The diagnosis is confirmed by the capture of a typical episode during an electroencephalogram (EEG) or video-EEG, with epileptiform activity over one or both temporal regions. Video-EEG monitoring has revolutionized diagnosis and should be considered in patients in whom diagnosis is uncertain. TLE is treated with medications, resective surgery, and vagus nerve stimulation. Epilepsy surgery should be considered in all patients with refractory partial epilepsy.

Epilepsy, Temporal Lobe↗

[The clinico-biochemical characteristics of persons with paraphilias and a chromosome anomaly (47, XYY)].

The authors describe the results of a comprehensive examination of 5 persons with chromosomal aberration (47, XYY) manifesting the signs of deviation from normal sexual behavior. The examined were shown to have common dysontogenesis that manifested itself by retardation of the biological basis of sexuality, psychosexual formation together with retardation of the mental processes on the whole. Whatever variants of deviations from normal sexual behavior the common feature was predominance in the libido structure of sadistic aims, that contributed to the revealing of aggressive sexual behavior. Material changes were discovered by radioimmunoassay in the function of the hypothalamohypophyseal and gonadal system in persons with the "YY syndrome". The levels of prolactin and luteinizing hormone along with the LH/FSH ratio appeared significantly elevated. Disorders were also identified in the hypothalamohypophyseal and thyroid system. It is assumed that the discovered changes influence the serotoninergic mechanisms by which aggressive and pathological sexual behavior is formed in such persons.

Gonadal Steroid Hormones↗

[Psychological characteristics of patients with vasovagal syncope: and observational study on sixty subjects].

BACKGROUND: Based on the relevant literature, the aim of this study was to analyze the psychosocial characteristics of patients with vasovagal syncope and to evaluate these factors as possible etiopathological components. METHODS: The study sample consisted of 60 subjects divided as follows: the syncope group (n = 30) and the control group (n = 30, without prominent diseases). The two groups were matched with regard to age, sex, education and civil status. Each participant filled in the Twenty-Item Toronto Alexithymia Scale, acceptance of emotions scale, profile of mood state, attachment style questionnaire, and childhood traumatic events scale. RESULTS: The syncope group showed a higher number of somatic diseases (p < 0.0002) and a higher drug use (p < 0.0001) than the control group. Moreover, the syncope group showed higher scores at the childhood traumatic events scale (p < 0.04) and more difficulties in emotion regulation (p < 0.02). The syncope group also showed higher scores at the need for approval scale (p < 0.0006) and lower scores at the confidence scale (p < 0.02) of the attachment style questionnaire, which reflect an insecure style of relationship with others. CONCLUSIONS: A high number of traumatic events in infancy and adolescence, difficulties in the expression of emotions and an insecure style of relationship seem to characterize subjects with vasovagal syncope. These data show that syncope could be at least partiality due to a relational and emotional imbalance that finds expression through the body in the presence of insufficient mental processing. Treatment of this syndrome should therefore take these aspects into consideration.

Adult↗