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PubMed2001

[Investigation to sequelae of acute encephalopathy].

We investigated 22 children with sequelae of acute encephalopathy. The patients were divided into 4 groups; group I with almost complete recovery (2 cases), group II with mild mental deterioration (4 cases), group III with severe mental deterioration (8 cases) and group IV with severe mental deterioration and severe physical disabilities (8 cases). There was no difference between 4 groups with regard to the past history, and status at the onset. The period of rehabilitation in hospital was different, being 0.4 month in group I, 2.6 months in group II, 3.0 months in group III and 3.6 months in group IV. The rehabilitation approach consisted mainly of medical therapy and range of motion exercise in the early stage followed trainings for walking and cognition. Family support was essential during the entire course. Evaluation with the functional independence measure was very useful for the rehabilitation.

Activities of Daily Living↗
PubMedDate not supplied

Sexual dysfunction, Part II: Diagnosis, management, and prognosis.

BACKGROUND: Sexual problems are common but infrequently diagnosed. They are classified into four major categories: (1) sexual desire disorders, (2) sexual arousal disorders, (3) orgasmic disorders, and (4) sexual pain disorders. METHODS: MEDLINE files from 1966 to the present were searched using the specific sexual dysfunctions as key words along with the general key word "sexual dysfunction" to review the published literature. Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: The key to diagnosis often rests on the physician's willingness to raise the issue with patients. A rational protocol can be followed to identify causative organic and psychogenic factors using the psychosexual and medical history, a comprehensive physical examination, psychological assessment instruments, laboratory tests, and special procedures. Current psychological treatment includes one or more of the following components: sensate focus exercises, cognitive-behavioral therapy, relaxation training, hypnosis and guided imagery, and group therapies. Specific techniques, such as directed self-stimulation, the stop-start and squeeze techniques, the sexological examination, systematic desensitization, and Kegel exercises, are added therapy when appropriate. Marital therapy to improve communication and resolve conflict is also part of standard therapy. Medical management can include pharmacologic agents to correct endocrine dysfunctions or to alter the progression of the sexual response. Surgical management can involve arterial revascularization, venous ligation, and penile implants. A noninvasive vacuum constriction device is also used to treat erectile disorders. The long-term prognosis of the sexual dysfunctions varies with the type of disorder and its causes. Generally good results (80 to 95 percent satisfaction) are obtained when treating vaginismus, dyspareunia, male erectile disorders, and female orgasmic dysfunctions. Long-term results are modestly successful (40 to 80 percent) when treating inhibited male orgasm and premature ejaculation. Long-term success is poorest at present for treating sexual desire disorders.

Clinical Protocols↗
PubMed2005

Compensating strategies for impaired episodic memory and time orientation in a patient with Alzheimer's disease.

A dedicated training program for teaching a patient with Alzheimer's disease to independently use an agenda is presented. This training capitalises on preserved cognitive abilities and incorporates principles from learning theories. This case study reports the effective use of a memory book for daily life activities and of a digital clock for time reorientation.

Activities of Daily Living↗
PubMed1991

Assessment of elderly people in general practice. 1. Social circumstances and mental state.

A survey of patients aged 75 years and over registered with general practitioners in north and north west London was carried out by trained interviewers to investigate cognitive impairment. A random sample of 239 patients was selected for the more detailed home assessment. General practitioners had seen nearly two thirds (65.3%) of their patients aged 75 years and over in the three months prior to the study, the majority of these consultations (82.1%) being initiated by the patient and occurring at the surgery. Half of the patients lived alone (50.2%), nearly one in three had no living siblings (31.9%), a similar proportion had no living children (29.5%), and contact with neighbours and relatives was relatively infrequent. One in five elderly patients had evidence of depression (22.0%) although this appeared to be severe in only two cases, and 36 participants (15.1%) had scores on the mini-mental state examination suggesting cognitive impairment. General practitioners underdiagnosed both dementia and depression. The population contained a small group of people who consumed alcohol on a daily basis (10.5%). This study showed that an annual assessment of elderly people as required by the new general practitioners' contract would yield much new evidence of depression and dementia and assist in the identification of heavy drinkers. Up to 30% of patients aged 75 years and over are likely to require further assessment on the basis of screening tests for depression and cognitive impairment, although it remains unclear to what extent identification of these patients will lead to improvements in outcome for them or their carers.

Aged↗
PubMed1993

[Deinstitutionalization of chronic psychiatric patients exemplified by a public psychiatric hospital].

Basing on the multifarious phenomena of hospitalism in chronically mentally ill patients the authors report on a survey of known facts and analyses to enable focussing of appropriate on-target measures were taken to arrive at conclusions for caring for these long-term patients: 1. Fixing the deadline of the study; 2. Determining the quality of patient care; 3. Analysing the experiences collected in respect of the integrated training programme to promote cognitive, communicative and social abilities and skills among the patients in resident living quarters within the confines of the hospital. An attempt is made to arrive at an overall evaluation of the measures taken so far in respect of de-hospitalisation and in building up complementary settlements outside the hospital but close to communal institutions.

Adult↗
PubMed1993

What does the American Board of Surgery In-Training/Surgical Basic Science Examination tell us about graduate surgical education?

BACKGROUND: This research sought to identify the strengths and weakness in residents' basic science knowledge and, second, to determine whether they progressively improve in their abilities to recall basic science information and clinical management facts, to analyze cause-effect relationships, and to solve clinical problems. METHODS AND RESULTS: Basic science knowledge was assessed by means of the results of the January 1990 American Board of Surgery's In-Training/Surgical Basic Science Exam (IT/SBSE). Postgraduate year (PGY) 1 residents' scores were compared with those of PGY5 residents. Content related to a question was considered "known" if 67% or more of the residents in each of the two groups answered it correctly. Findings showed 44% of the content tested by the basic science questions were unknown by new and graduating residents. The second research question required the 250 IT/SBSE questions to be classified into one of three levels of thinking abilities: recall, analysis, and inferential thinking. Profile analysis (split-plot analysis of variance) for each pair of resident levels indicated significant (P < 0.001) differences in performance on questions requiring factual recall, analysis, and inference between all levels except for PGY3s and PGY4s. CONCLUSIONS: The results of this research enable program directors to evaluate strengths and weaknesses in residency training curricula and the cognitive development of residents.

Analysis of Variance↗
PubMed1995

[Psychoeducational-psychotherapeutic treatment of schizophrenic patients and their caregivers. Results of a 1-year catamnestic study].

In this study we look into the question of whether, in addition to neuroleptic treatment, relapse rates among schizophrenic patients can be reduced by means of a combined psychoeducational and psychotherapeutic intervention strategy for patients and their relatives. In a randomized controlled intervention study in an outpatient routine treatment setting, psychoeducational training for medication management, cognitive therapy and work with relatives' groups were compared with each other and with a control group. The patients continued their standard treatment, including neuroleptic relapse prevention. The study comprised 191 chronic DSM-III-R schizophrenics. Data were collected before and after an 8-month intervention phase and at the 1-year follow-up. The group receiving all three treatments had the lowest relapse rates. Moreover, numerous gains recorded in subjective findings suggest that therapeutic work with schizophrenic patients and their relatives is of clinically significant benefit.

Adolescent↗
PubMed1995

Combining pharmacotherapy with psychotherapy for substance abusers with borderline personality disorder: strategies for enhancing compliance.

DBT is a comprehensive, behaviorally oriented treatment designed for highly dysfunctional individuals meeting criteria for BPD. Many of these criteria are characteristic of drug abusers, and some of the problems encountered in treatment of drug abusers, especially when various treatments are combined, are similar. The basic armamentarium of the DBT therapist is the balancing of validation and acceptance treatment strategies with problem-solving procedures, including contingency management, exposure-based procedures, cognitive modification, and skills training. In addition, a number of specific strategies have been woven together to enhance compliance and to reduce the staff splitting that is so frequent with this population. Those described in this chapter include orienting and commitment strategies and the focus in DBT on reducing therapy-interfering behavior and on consultation with the client rather than with the client's network.

Assertiveness↗
PubMed2005

Intrahippocampal administration of the branched-chain alpha-hydroxy acids accumulating in maple syrup urine disease compromises rat performance in aversive and non-aversive behavioral tasks.

Maple syrup urine disease (MSUD) is an inherited metabolic disease predominantly characterized by neurological dysfunction. Although a variable degree of psychomotor/delay/mental retardation is found in a considerable number of MSUD patients, the mechanisms underlying the neuropathology of this disorder are yet not defined. The present study investigated the effect of acute intrahippocampal administration of the branched-chain alpha-hydroxy acids (BCHA) accumulating in MSUD on rat behavior in non-aversive (open field) and aversive (inhibitory avoidance) tasks. Cannulated 60-day-old male Wistar rats received bilateral intrahippocampal injection of alpha-hydroxyisocaproic acid (HIC, 1.5 micromol), alpha-hydroxyisovaleric acid (HIV, 2.5 micromol), alpha-hydroxy-beta-methyl-n-valeric acid (HMV, 1.5 micromol), or NaCl (2.5 micromol)(controls) immediately after or 10 min before training. Testing session was performed 24 h later. Administration of the hydroxy acids immediately after training caused no effect on the cognitive performance of the rats. In contrast, HIV and HMV administered 10 min before training provoked a habituation deficit in the open field task. Motor activity, assessed by crossing responses, was the same for the groups infused with BCHA and NaCl. The effect of MK-801, succinate, creatine, and the antioxidants ascorbic acid plus alpha-tocopherol on the behavioral alterations provoked by HIV in the open field task revealed that only the energetic substrates (succinate and creatine) prevented these effects, reflecting a possible compromise of brain energy production by HIV. We also observed that rats pretreated with HIC, HIV, or HMV did not increase their latency in the testing session in the step-down inhibitory avoidance task, revealing an impairment of retrieval (memory retention or acquisition) in this task. Furthermore, no differences between controls and rats receiving BCHA were detected in the latency to leave the platform in the training test, suggesting similar motor activity of all groups. The data indicate that the alpha-hydroxy acids accumulating in MSUD impair cognition and may be implicated in the neuropathology and psychomotor delay/mental retardation observed in the affected patients.

Animals↗
PubMed2003

Neural correlates of training-related memory improvement in adulthood and aging.

Cognitive studies show that both younger and older adults can increase their memory performance after training in using a visuospatial mnemonic, although age-related memory deficits tend to be magnified rather than reduced after training. Little is known about the changes in functional brain activity that accompany training-induced memory enhancement, and whether age-related activity changes are associated with the size of training-related gains. Here, we demonstrate that younger adults show increased activity during memory encoding in occipito-parietal and frontal brain regions after learning the mnemonic. Older adults did not show increased frontal activity, and only those elderly persons who benefited from the mnemonic showed increased occipito-parietal activity. These findings suggest that age-related differences in cognitive reserve capacity may reflect both a frontal processing deficiency and a posterior production deficiency.

Adult↗
PubMed1977

A special tutorial for minority medical students: an account of a year's experience.

A small number of minority medical students were referred for a year-long tutorial to improve their problem-solving skills and to assist them in retaking failed basic science courses. Both the operation of the tutorial and attemtps to reconstruct what had gone wrong the previous year brought attention to the crucial importance of affective factors in the students' learning efforts. It proved to be possible to elucidate some of the dynamics whereby affective reactions apparently enter into instructor-student interactions and are significantly involved in the process of adjusting to medical school. Following the tutorial, which dealt with issues of trust and self-esteem as well as with cognitive problems, the students all had a successful year and were able to rejoin the main stream of students entering clinical training. It was concluded that cognitive problems of medical students experiencing academic difficulty may not be resolvable without dealing with affective considerations. Recommendations are given for dealing with affective issues.

Adult↗
PubMed2004

Experiential versus rational training: a comparison of student attitudes toward homosexuality.

Based on Epstein's (1994a) cognitive-experiential self-theory, two new training interventions were designed to teach students about gay, lesbian and bisexual issues. The efficacy of these theoretically based interventions was assessed in a short-term (7-week, three occasion) longitudinal study. Fifty undergraduate psychology students were randomly assigned to one of three treatment groups: Rational Training, Experiential Training, or Control Group. A residualized change score procedure was used to analyze change in levels of sexual prejudice and affect across the three types of measurement (pre-test, post-test, and follow-up). A 3 (Rational Training, Experiential Training, Control Group) x 2 (Low Sexual Prejudice, High Sexual Prejudice) MANOVA revealed that after the training, participants in the Experiential Group (affective training) had more accepting attitudes toward homosexuality compared to the Control Group. In addition, participants in the Experiential Group experienced more positive affect compared to the Rational and Control Groups and experienced more negative affect compared to the Rational Group. Findings are discussed and suggestions for future research are provided.

Adult↗
PubMed2025

Psychological interventions for children with chronic physical conditions: a systematic review assessing the role of coping, emotional and cognitive processes.

OBJECTIVES: Coping, emotional and cognitive processes are crucial in child development, particularly in children with pediatric chronic physical conditions (CPC). No systematic review in pediatric psychology has investigated the effectiveness of interventions on these processes concurrently. This review addresses this gap by focusing on the effectiveness of psychological interventions on coping, emotional and cognitive processes in children with CPCs. METHODS: Five electronic databases were searched for studies assessing at least one of these processes. Only randomized-controlled trials with children (8-12&#x2009;years) with a CPC (e.g. diabetes, asthma), which implemented a psychological intervention were included. This study is registered in (CRD42021233505). RESULTS: Ten intervention studies were identified. While cognitive interventions (Cogmed) showed some improvements in working memory, the effects varied across studies despite similar methodologies. Coping interventions (e.g. Coping Skills Training) showed little effect on coping strategies or psychological health variables and were no more beneficial than control groups. No study trained coping, emotional processes and cognitive processes together. CONCLUSION: This review shows current limitations in evaluating psychological interventions targeting coping, cognitive or emotional processes in children with CPCs, limiting a comprehensive understanding of the interventions' action mechanisms. Systematically including underlying processes in intervention studies could help to better adjust those interventions.

Humans↗
PubMed1982

Cognitive self-control factors in EMG biofeedback.

This study investigated the efficacy of manipulation of cognitive self-control expectancy in EMG biofeedback training. It was predicted that a treatment procedure, which includes a positive-cognitive stage that establishes and reinforces a positive self-control belief system and also includes a training stage in EMG biofeedback, will be more effective in achieving a reduction in EMG activity than a treatment procedure which includes a negative-cognitive stage and which also includes ambiguous features prior to training and a treatment approach solely concerned with training. The study consisted of four groups with 10 subjects in each. In one group, expectation for inner control ability was created prior to actual training in reducing EMG activity. In the second group, expectation for negative self-control ability was created prior to EMG training. The third group only underwent the actual training in EMG. The fourth group served as a control group. The results show that the positive-cognitive self-control group was significantly more effective in reducing muscle activity than the other groups.

Adult↗
PubMed1988

Steps toward a cognitive-behavioral model of relaxation.

The prevailing model of relaxation posits a generalized state of reduced arousal, a position inconsistent with much relaxation research and clinical practice. This paper proposes an alternative model based on cognitive-behavioral principles. It hypothesizes that relaxation training has three effects: (a) reduced arousal, (b) development of cognitive skills of focusing, passivity, and receptivity, and (c) acquisition of increasingly abstract and differentiated cognitive structures supportive of relaxation. According to this perspective, different approaches to relaxation are not interchangeable but have quite different effects. Clinical implications are discussed.

Arousal↗
PubMed2000

Measuring team knowledge.

Multioperator tasks often require complex cognitive processing at the team level. Many team cognitive processes, such as situation assessment and coordination, are thought to rely on team knowledge. Team knowledge is multifaceted and comprises relatively generic knowledge in the form of team mental models and more specific team situation models. In this methodological review paper, we review recent efforts to measure team knowledge in the context of mapping specific methods onto features of targeted team knowledge. Team knowledge features include type, homogeneity versus heterogeneity, and rate of knowledge change. Measurement features include knowledge elicitation method, team metric, and aggregation method. When available, we highlight analytical conclusions or empirical data that support a connection between team knowledge and measurement method. In addition, we present empirical results concerning the relation between team knowledge and performance for each measurement method and identify research and methodological needs. Addressing issues surrounding the measurement of team knowledge is a prerequisite to understanding team cognition and its relation to team performance and to designing training programs or devices to facilitate team cognition.

Cognitive Science↗
PubMed2000

Introduction to cognitive processes of expert pilots.

This report addresses the historical problem that a very high percentage of accidents have been classified as involving "pilot error." Through extensive research since 1977, the Federal Aviation Administration determined that the predominant underlying cause of these types of accidents involved decisional problems or cognitive information processing. To attack these problems, Aeronautical Decision Making (ADM) training materials were developed and tested for ten years. Since the publication of the ADM training manuals in 1987, significant reductions in human performance error (HPE) accidents have been documented both in the U.S. and world wide. However, shortcomings have been observed in the use of these materials for recurrency training and in their relevance to more experienced pilots. The following discussion defines the differences between expert and novice decision makers from a cognitive information processing perspective, correlates the development of expert pilot cognitive processes with training and experience, and reviews accident scenarios which exemplify those processes. This introductory material is a necessary prerequisite to an understanding of how to formulate expert pilot decision making training innovations; and, to continue the record of improved safety through ADM training.

Accidents, Aviation↗
PubMed2003

[Communication and interaction in psychosomatic education: use of standardized patients].

An amendment to the German medical curriculum in April 2002 will place communication and social skills at the centre of medical training. In addition to providing cognitive knowledge, psychosomatic courses offer the opportunity to integrate affective learning, with a focus on communication and interaction processes. In winter term 2001/2002 a training with standardised patients was implemented and evaluated as part of the psychosomatic internship of the Department of General Internal and Psychosomatic Medicine at the Medical Hospital of the University of Heidelberg. Quantitative and qualitative results showed that training with standardised patients is well accepted and that acceptance is independent of student gender, career choice, or interests. These training units are easy to integrate into psychosomatic practical courses. The results discussed here will focus on the role and importance of various elements of medical training.

Adult↗