Comparison of self-instruction and relaxation training in reducing impulsive and inattentive behavior of learning disabled children on cognitive tasks.
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Open surgery in VR: inguinal hernia repair according to Lichtenstein.
VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. A workstation consisting of two haptic devices and a 3D vision system is part of the VREST platform. Another part of the platform is a generic software environment in which lessons can be built by the teacher and performed by their students. Using the platform one can see, feel and decide as in reality. With the assessment tool the progress and skills of the students can be supervised. The first lesson build on the VREST platform is an inguinal hernia repair according to Lichtenstein. This is an open surgery procedure. The VREST platform is used prior to the first operating room surgery of the resident. Interactive models and case dependent feedback is used to enlarge the residents' cognition. This should reduce the training time in the operating room.
Computer Simulation↗
Neurocognitive ability in adults coping with alcohol and drug relapse temptations.
Coping is important for preventing relapse, but may be utilized differently depending on the individual's level of cognitive functioning. Impaired reasoning, attention, and memory are commonly observed in alcohol-dependent individuals. This study describes the prospective relationship between neuropsychological functioning and utilization of coping strategies in predicting outcome one year after discharge from an inpatient alcohol treatment program. Male veterans (n = 43) hospitalized in an alcohol treatment facility were given structured interviews, coping questionnaires, and neuropsychological testing, and were followed three and 12 months after discharge. Neuropsychological ability moderated the relationship between coping and drinking outcomes one year after treatment. This was particularly true for patients with better neurocognitive functioning. Specifically, patients with higher neurocognitive performances and more maladaptive coping responses, such as self-blame, had a greater percentage of drinking days at follow-up. Alcohol-dependent adults with good neuropsychological functioning may be able to benefit more from coping skills training. For those with neuropsychological deficits, coping skills training may need to take cognitive limitations into consideration.
Adaptation, Psychological↗
Development of a single-code/default coding strategy in pigeons.
We tested the hypothesis that pigeons could use a cognitively efficient coding strategy by training them on a conditional discrimination (delayed symbolic matching) in which one alternative was correct following the presentation of one sample (one-to-one), whereas the other alternative was correct following the presentation of any one of four other samples (many-to-one). When retention intervals of different durations were inserted between the offset of the sample and the onset of the choice stimuli, divergent retention functions were found. With increasing retention interval, matching accuracy on trials involving any of the many-to-one samples was increasingly better than matching accuracy on trials involving the one-to-one sample. Furthermore, following this test, pigeons treated a novel sample as if it had been one of the many-to-one samples. The data suggest that rather than learning each of the five sample-comparison associations independently, the pigeons developed a cognitively efficient single-code/default coding strategy.
Animals↗
Patterns of change during cognitive behavioral treatment for panic disorder.
The present investigation examined patterns of change in basic features of panic and anxiety during cognitive behavioral treatment for panic disorder. Data were collected in the context of a study comparing the efficacy of cognitive therapy (CT) and relaxation training, both administered without exposure-based treatments of any kind. Thirty-six panic disorder patients completed 10 weeks of either CT or relaxation training. Weekly measures of panic frequency, state and trait anxiety, and associated fears were obtained. Data were examined using both multivariate techniques (which conceptualize change as incremental) and analysis of response slopes (wherein change is conceptualized as continuous). Results indicated that during the first half of treatment, relaxation training led to greater reductions in state and trait anxiety and agoraphobic fear, whereas CT demonstrated a slight advantage on change in panic frequency. During the second half of treatment, CT produced faster reductions in state anxiety and agoraphobic fears. Over the entire treatment course, CT conferred an advantage in rate of change in social fears. The data provide support for the utility of a more process-oriented approach to the examination of treatment effects.
Adult↗
Comorbidity of mild cognitive disorder and depression--a neuropsychological analysis.
Mild cognitive impairment is found in many cases of depression, and it is mostly assumed to improve during the time course of depression remission. Recent data question the reversibility of low cognitive test performance in depression. The aim of this study is to determine the degree of reversibility and the proportion of patients who will not demonstrate reversibility of cognitive dysfunction. Consecutive inpatients suffering from depression (N=102) were investigated and N=82 matched control subjects. N=57 of the patients were diagnosed as major depression according to DSM-IV. A total of N=67 could be retested after remission of depression (N=32 of the patients with major depression) and a matched control group (N=62). Neuropsychological tests were applied in a test session which avoids the effects of fatigue in the patients by the short duration of strenuous tests. For most neuropsychological tests an impaired performance in the depressed patients was found. About one third of the depression subjects performed at an impaired level in tests of averbal memory and verbal fluency (below 5th percentile). In the follow-up investigation, a slight improvement in performance could be assessed for both the depression and the control group, which was, however, attributed to a general test training effect. No normalization of cognitive test performance was found in spite of complete recovery of the affective symptoms. No correlation between the duration of the disease before the index episode or number of episodes and cognitive deficits could be found. The data of the neuropsychological deficits of depressed patients, which are stable in the time course of the affective disorder, may indicate that these patients may suffer from comorbidity of both depression and mild cognitive disorder. The findings are discussed as 1) indicating only a minor impact of the depressed mood on the cognitive performance and 2) they are consistent with a role of brain lesions which have been reported in several studies in a subgroup of depression.
Cognition Disorders↗
Reflex sympathetic dystrophy in children. Clinical characteristics and follow-up of seventy patients.
We report on the experience with our first seventy patients who had reflex sympathetic dystrophy and were less than eighteen years old (average age, 12.5 years). In our series, the patients were predominantly girls (male to female ratio, 11:59) and the lower extremity was involved most often (sixty-one of the seventy patients). The average time from the initial injury to the diagnosis was one year, which indicates that the syndrome remains under-recognized in patients in this age-group. Conservative treatment with physical therapy, transcutaneous electrical nerve stimulation, psychological therapies including cognitive-behavioral management and relaxation training, and tricyclic anti-depressants was effective in improving the average scores for pain and function for forty patients. Sympathetic blocks were helpful for twenty-eight of thirty-seven patients. Thirty-eight of the seventy patients in the series continued to have some degree of residual pain and dysfunction. Reflex sympathetic dystrophy in children differs in presentation and clinical course from the syndrome in adults. It is best treated in a multidisciplinary fashion.
Algorithms↗
Psychological treatments for negative symptoms.
Psychological training programmes for patients presenting with negative symptoms have developed from an environmentally based approach (the token economy) through interactive programmes (social and life skills training) to programmes which focus directly on facilitating and enhancing the cognitive skills of the individual patient (self-instructional training and problem-solving). It is clear that this sequence of research has generated a range of approaches which are probably undervalued in the management of patients suffering from negative symptoms. Problems remain with respect to the generalisation of some procedures but it seems likely that these problems may be overcome by tailoring treatments to the particular cognitive deficits of different groups of patients. This will obviously require a detailed analysis of the structure of negative symptoms and the deficits associated with them. The distinction between difficulties in initiating behavior and difficulties in organising behaviour may prove to be particularly important in this respect.
Behavior Therapy↗
Efficacy and safety of donepezil in patients with Alzheimer's disease: results of a global, multinational, clinical experience study.
BACKGROUND: Donepezil has consistently been shown to be effective and well tolerated in the symptomatic treatment of Alzheimer's disease in placebo-controlled clinical trials. It has been shown to provide significant benefits in cognition, global function and activities of daily living in patients with mild-to-moderate Alzheimer's disease. However, in order to control for confounding factors, some clinical trials of donepezil have excluded patients with comorbid illness and concomitant medication use. OBJECTIVE: The objective of this study was to evaluate the efficacy, tolerability and safety of donepezil in a wider and more diverse sample of patients and centres than previous trials, reflecting routine clinical practice. METHODS: In this 12-week, open-label, multicentre trial, patients with probable mild-to-moderate Alzheimer's disease received donepezil 5 mg/day for 28 days, after which the dosage was increased to 10 mg/day according to the investigating clinician's judgement. Patients were enrolled at 246 study centres in 18 countries worldwide. Cognition was assessed by a trained clinician using the Mini-Mental State Examination (MMSE) at baseline, week 4 and week 12 (or last visit). Changes in patient activity and social interaction were evaluated using a caregiver diary. Each week, caregivers recorded their impression of change compared with baseline on three aspects of patient behaviour using a 5-point scale. Efficacy analyses were performed on the intent-to-treat population. Significance was determined using the paired t-test (0.05 significance level). Tolerability and safety were assessed by monitoring adverse events, physical examinations, vital signs, clinical laboratory test abnormalities and ECG findings throughout the study. RESULTS: A total of 1113 patients received donepezil (mean baseline MMSE score [+/-SD] 18.74 +/- 5.21). 989 (88.9%) patients completed the study; 59 (5%) patients discontinued because of adverse events. Most patients were taking at least one concomitant medication (n = 802; 72%) and had at least one comorbid medical condition (n = 745; 67%) on study entry. Donepezil significantly improved cognition compared with baseline at weeks 4 and 12, and at week 12 using a last observation carried forward (LOCF) analysis (all p < 0.0001). Mean change from baseline MMSE score (+/-SE) at week 12-LOCF was +1.73 +/- 0.10. Donepezil was also associated with significant improvements in patient social interaction, engagement and interest, and initiation of pleasurable activities at all weekly assessments and week 12-LOCF (all p < 0.0001). Donepezil was generally well tolerated; adverse events were consistent with the known safety profile of donepezil. CONCLUSION: Donepezil treatment resulted in statistically significant improvements in cognition and patient activity and social behaviour, and was generally well tolerated despite high levels of comorbid illness and concomitant medication use. The results of this open-label study in a large patient population are consistent with those from controlled trials and support that donepezil is effective in the treatment of mild-to-moderate Alzheimer's disease in everyday practice.
Adult↗
Training models for psychiatry in primary care: a new frontier.
OBJECTIVE: Under policies implemented by the Australian Government, the success of community mental health care has increasingly relied upon general practitioners (GPs) assuming an enhanced role in the delivery of evidence-based psychological treatment. In undertaking this role, it is crucial that GPs significantly build upon limited training in evidence-based psychological therapies such as cognitive behaviour therapy (CBT). This pilot study investigates the potential role of CBT group supervision as a training model. METHOD: Two groups of GPs (n = 9) and one comparison group of psychiatric registrars (n = 4) completed eight 1.5 h sessions of CBT group supervision over an 8 month period. Pre- to post-training measures were taken of GP performance (skills, knowledge and confidence) and the mental health outcomes of their patients. On the completion of group supervision, focus groups were conducted for in-depth feedback. RESULTS: Randomization tests indicated that GPs' confidence and knowledge in using CBT had improved over the course of group supervision. Results from focus groups confirmed that GPs' CBT skills had improved. CONCLUSIONS: Findings suggest that group supervision is a promising training model for psychiatry in primary care. Cognitive behaviour therapy should be replaced, however, with a briefer therapy model, such as brief CBT, better suited to a general practice environment. Future research needs to replicate these findings on a larger scale.
Adult↗
The brain-sex theory of occupational choice: a counterexample.
The brain-sex theory of occupational choice suggests that males and females in male-typical careers show a male pattern of cognitive ability in terms of better spatial than verbal performance on cognitive tests with the reverse pattern for females and males in female-typical careers. These differences are thought to result from patterns of cerebral functional lateralisation. This study sought such occupationally related effects using synonym generation (verbal ability) and mental rotation (spatial ability) tasks used previously. It also used entrants to these careers as participants to examine whether patterns of cognitive abilities might predate explicit training and practice. Using a population of entrants to sex-differentiated university courses, a moderate occupational effect on the synonym generation task was found, along with a weak (p < .10) sex effect on the mental rotation task. Highest performance on the mental rotation task was by female students in fashion design, a female-dominated occupation which makes substantial visuospatial demands and attracts many students with literacy problems such as dyslexia. This group then appears to be a counterexample to the brain-sex theory. However, methodological issues surrounding previous studies are highlighted: the simple synonym task appears to show limited discrimination of the sexes, leading to questions concerning the legitimacy of inferences about lateralisation based on scores from that test. Moreover, the human figure-based mental rotation task appears to tap the wrong aspect of visuospatial skill, likely to be needed for male-typical courses such as engineering. Since the fashion-design career is also one that attracts disproportionately many male students whose sexual orientation is homosexual, data were examined for evidence of female-typical patterns of cognitive performance among that subgroup. This was not found. This study therefore provides no evidence for the claim that female-pattern cerebral functional lateralisation is likely in gay males.
Adult↗
The effects of cognitive and somatic anxiety and self-confidence on components of performance during competition.
This study considered the influence of competitive anxiety and self-confidence state responses upon components of performance. Basketball players (n = 12) were trained to self-report their cognitive anxiety, somatic anxiety and self-confidence as a single response on several occasions immediately before going on court to play. Performance was video-recorded and aspects of performance that could be characterized as requiring either largely anaerobic power (height jumped) or working memory (successful passes and assists) were measured. Intra-individual performance scores were computed from these measures and the data from seven matches were subjected to regression analyses and then hierarchical regression analyses. The results indicated that, as anticipated, somatic anxiety positively predicted performance that involved anaerobic demands. Self-confidence, and not cognitive anxiety, was the main predictor of performance scores with working memory demands. It would appear that different competitive state responses exert differential effects upon aspects of actual performance. Identifying these differences will be valuable in recommending intervention strategies designed to facilitate performance.
Adolescent↗
Hallucination focused integrative treatment improves quality of life in schizophrenia patients.
OBJECTIVE: Psychosocial treatment seems to be effective in the management of schizophrenia, although less in the area of quality of life and social functioning. To study the effectiveness of a hallucination focused integrated treatment with cognitive-behaviour therapy and coping training among schizophrenia patients suffering from 'hearing voices'. METHOD: In a randomized controlled trial (RCT) with 31 patients in the integrated treatment condition and 32 patients in the routine care condition, quality of life was assessed with the self-report questionnaire of the WHO (Bref), and social role functioning with an interviewer based schedule, at entry and 9 (post-treatment) and 18 months later. RESULTS: Follow-up data suggest a significant improvement of quality of life and in particular in social role functioning (effect size 0.64) in favour of the integrated treatment. CONCLUSION: The integrated treatment seems to be effective in reducing overall disability levels and number of patients with serious disabilities.
Adaptation, Psychological↗
Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference.
OBJECTIVES: Firstly, to compare the effectiveness of a brief physiotherapy intervention with "usual" physiotherapy for patients with neck pain. Secondly, to evaluate the effect of patients' preferences on outcome. DESIGN: Non-inferiority randomised controlled trial eliciting preferences independently of randomisation. SETTING: Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire. PARTICIPANTS: 268 patients (mean age 48 years) with subacute and chronic neck pain, who were referred by their general practitioner and randomly assigned to a brief physiotherapy intervention (one to three sessions) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy, at the discretion of the physiotherapist concerned. MAIN OUTCOME MEASURES: The Northwick Park neck pain questionnaire (NPQ), a specific measure of functional disability resulting from neck pain. Also, the short form 36 (SF-36) questionnaire, a generic, health related, quality of life measure; and the Tampa scale for kinesophobia, a measure of fear and avoidance of movement. RESULTS: At 12 months, patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group (mean difference 1.99, 95% confidence interval 0.45 to 3.52; P = 0.01). Although the result shows a significant inferiority of the intervention, the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention (below 1.2 points of NPQ score). Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy. CONCLUSIONS: Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain. Patients with a preference for the brief intervention may do at least as well with this approach. Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further.
Adolescent↗
Behavioral efficacy of diazepam against nerve agent exposure in rhesus monkeys.
The possibility that nerve agents will be used on the battlefield is real. The traditional therapy against nerve agent exposure consists of pyridostigmine pretreatment and atropine-pralidoxime chloride therapy administered after nerve agent exposure. This therapy regimen is extremely effective in preventing mortality in laboratory animals exposed to multilethal concentrations of nerve agent, yet these animals often display convulsions, brain damage, and behavioral incapacitation. We report here that the addition of diazepam to the traditional therapy for nerve agent (soman) exposure not only decreases the incidence of convulsions, but also attenuates the cognitive impairments of rhesus monkeys trained on a Serial Probe Recognition (SPR) task. Monkeys which received diazepam treatment required only 6 days before their performance on the SPR task returned to presoman exposure levels, compared to nondiazepam-treated monkeys which required 15 days. Moreover, only 1 out of the 5 monkeys which received diazepam treatment suffered tonic-clonic convulsions; in contrast all 5 monkeys which did not receive diazepam treatment experienced severe convulsive episodes. These results suggest that diazepam would be an excellent adjunct to traditional nerve agent therapy to facilitate behavioral recovery from nerve agent intoxication that might be encountered by US military personnel on the battlefield or accidental organophosphate poisoning encountered in industrial or agricultural accidents.
Acetylcholinesterase↗
Training in virtual environments: transfer to real world tasks and equivalence to real task training.
Virtual environments (VEs) are extensively used in training but there have been few rigorous scientific investigations of whether and how skills learned in a VE are transferred to the real world. This research aimed to measure and evaluate what is transferring from training a simple sensorimotor task in a VE to real world performance. In experiment 1, real world performances after virtual training, real training and no training were compared. Virtual and real training resulted in equivalent levels of post-training performance, both of which significantly exceeded task performance without training. Experiments 2 and 3 investigated whether virtual and real trained real world performances differed in their susceptibility to cognitive and motor interfering tasks (experiment 2) and in terms of spare attentional capacity to respond to stimuli and instructions which were not directly related to the task (experiment 3). The only significant difference found was that real task performance after training in a VE was less affected by concurrently performed interference tasks than was real task performance after training on the real task. This finding is discussed in terms of the cognitive load characteristics of virtual training. Virtual training therefore resulted in equivalent or even better real world performance than real training in this simple sensorimotor task, but this finding may not apply to other training tasks. Future research should be directed towards establishing a comprehensive knowledge of what is being transferred to real world performance in other tasks currently being trained in VEs and investigating the equivalence of virtual and real trained performances in these situations.
Acoustic Stimulation↗
Relationship of arithmetic problem solving and reflective-impulsive cognitive styles in third-grade students.
Different individuals approach mathematical problems in a variety of ways, with these different approaches also reflected in over-all cognitive styles. This investigation had two purposes, first, to determine whether good and poor arithmetic problem solvers differ substantially in cognitive style, and second, to determine whether the students, after training in techniques of solving arithmetic problems, improve their performance with no significant change in cognitive style. A total of 98 third graders participated (mean age 8.1 yr.; 50 boys, 48 girls). The Matching Familiar Figure Test was used to classify the students by cognitive style as either Reflective or Impulsive. Students also were given training with different problem-solving exercises for different arithmetic problems. The training program in problem-solving strategies did not improve performance on arithmetic problems for Reflective students; however, Impulsive students' performance did improve after training.
Child↗
A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication.
OBJECTIVE: To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care. METHOD: A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol (n = 75) versus TAU SSRI plus brief CBT (n = 77). Participants were identified by a recent dispense of SSRI medication followed by telephone screening. Adolescents with a diagnosis of major depressive disorder (n = 152) were enrolled. The CBT program employed cognitive restructuring and/or behavioral activation training. Therapists consulted with prescribing pediatricians to improve medication adherence. RESULTS: Through 1-year follow-up, the authors found CBT advantages on the Short Form-12 Mental Component Scale (p = .04), reductions in TAU outpatient visits (p = .02), and days' supply of all medications (p = .01). No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the Center for Epidemiology Depression Scale (p = .07). CONCLUSIONS: The authors detected a weak CBT effect, possibly rendered less significant by the small sample and likely attenuated by the unexpected reduction in SSRI pharmacotherapy in the CBT condition. Small, incremental improvements over monotherapy, such as observed in this study, most likely represent the new norm in adolescent depression treatment research.
Adolescent↗