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PubMed2001

Neuropsychological test scores, academic performance, and developmental disorders in Spanish-speaking children.

Limited information is currently available about performance of Spanish-speaking children on different neuropsychological tests. This study was designed to (a) analyze the effects of age and sex on different neuropsychological test scores of a randomly selected sample of Spanish-speaking children, (b) analyze the value of neuropsychological test scores for predicting school performance, and (c) describe the neuropsychological profile of Spanish-speaking children with learning disabilities (LD). Two hundred ninety (141 boys, 149 girls) 6- to 11-year-old children were selected from a school in Bogotá, Colombia. Three age groups were distinguished: 6- to 7-, 8- to 9-, and 10- to 11-year-olds. Performance was measured utilizing the following neuropsychological tests: Seashore Rhythm Test, Finger Tapping Test (FTT), Grooved Pegboard Test, Children's Category Test (CCT), California Verbal Learning Test-Children's Version (CVLT-C), Benton Visual Retention Test (BVRT), and Bateria Woodcock Psicoeducativa en Español (Woodcock, 1982). Normative scores were calculated. Age effect was significant for most of the test scores. A significant sex effect was observed for 3 test scores. Intercorrelations were performed between neuropsychological test scores and academic areas (science, mathematics, Spanish, social studies, and music). In a post hoc analysis, children presenting very low scores on the reading, writing, and arithmetic achievement scales of the Woodcock battery were identified in the sample, and their neuropsychological test scores were compared with a matched normal group. Finally, a comparison was made between Colombian and American norms.

Achievement↗
PubMed2006

Anatomy of learning: instructional design principles for the anatomical sciences.

Teaching anatomy is becoming increasingly challenging due to the progressive evolution of university teaching missions, student populations, medical and undergraduate curricula, coupled with a paucity of empirically tested evidence-based instructional practices in the anatomical and medical education literature. As a mechanism to confront these pedagogical challenges, recent advances in educational psychology are analyzed for developing a framework to guide educational reform efforts. Extensive research in educational psychology over the last 100 years has resulted in four major theories on human learning that have facilitated a paradigm shift from teacher-centered to learner-centered classrooms and are described here in temporal order of development: behavioral theory, information processing theory, metacognitive theory, and social constructivist theory. Each theory is analyzed in detail and is used to construct instructional design principles for enhancing anatomical education research and practice. An example of a cognitively based learning environment for an undergraduate anatomy course is presented. Preliminary results suggest that intentionally drawing on different theories of learning when making instructional decisions gave students the learning support they needed to be successful and nearly doubled the course's student retention rate over a 3-year period.

Anatomy↗
PubMed2001

Clinical implications of research on countertransference: science informing practice.

This article presents a clinically oriented synthesis of research findings pertaining to countertransference (CT). Findings are organized around five therapy-relevant questions concerning the origins, triggers, manifestations, management, and effects of CT. To date, research has focused primarily on impediments posed by therapists' CT reactions and mechanisms for managing them. It is argued that future research needs to be directed toward better understanding how therapists can use CT to enhance their work with clients.

Cognition↗
PubMed2000

Experience-dependent phase-reversal of hippocampal neuron firing during REM sleep.

The idea that sleep could serve a cognitive function has remained popular since Freud stated that dreams were "not nonsense" but a time to sort out experiences [S. Freud, Letter to Wilhelm Fliess, May 1897, in The Origins of Psychoanalysis - Personal Letters of Sigmund Freud, M. Bonaparte, A. Freud, E. Kris (Eds.), Translated by E. Mosbacher, J. Strachey, Basic Books and Imago Publishing, 1954]. Rapid eye movement (REM) sleep, which is associated with dream reports, is now known to be is important for acquisition of some tasks [A. Karni, D. Tanne, B.S. Rubenstein, J.J.M. Askenasy, D. Sagi, Dependence on REM sleep of overnight improvement of a perceptual skill, Science 265 (1994) 679-682; C. Smith, Sleep states and learning: a review of the animal literature, Biobehav. Rev. 9 (1985) 157-168]; although why this is so remains obscure. It has been proposed that memories may be consolidated during REM sleep or that forgetting of unnecessary material occurs in this state [F. Crick, G. Mitchison, The function of dream sleep, Nature 304 (1983) 111-114; D. Marr, Simple memory: a theory for archicortex, Philos. Trans. R. Soc. B. 262 (1971) 23-81]. We studied the firing of multiple single neurons in the hippocampus, a structure that is important for episodic memory, during familiar and novel experiences and in subsequent REM sleep. Cells active in familiar places during waking exhibited a reversal of firing phase relative to local theta oscillations in REM sleep. Because firing-phase can influence whether synapses are strengthened or weakened [C. Holscher, R. Anwyl, M.J. Rowan, Stimulation on the positive phase of hippocampal theta rhythm induces long-term potentiation that can be depotentiated by stimulation on the negative phase in area CA1 in vivo, J. Neurosci. 15 (1977) 6470-6477; P.T. Huerta, J.E. Lisman, Bidirectional synaptic plasticity induced by a single burst during cholinergic theta oscillation in CA1 in vitro, Neuron 15 (1995) 1053-1063; C. Pavlides, Y.J. Greenstein, M. Grudman, J. Winson, Long-term potentiation in the dentate gyrus is induced preferentially on the positive phase of theta-rhythm, Brain Res. 439 (1988) 383-387] this experience-dependent phase shift, which developed progressively over multiple sessions in the environment, is consistent with the hypothesis that circuits may be restructured during REM sleep by selectively strengthening recently acquired memories and weakening older ones.

Animals↗
PubMed2001

Progress in the neural sciences in the the century after Cajal (and the mysteries that remain).

One hundred years after Santiago Ramon y Cajal provided critical evidence for the "neuron doctrine," his cellular view of the brain remains the basis of modern neural science. This article begins with a review of how the early work of Ramon y Cajal, Charles Sherrington, and John Eccles and their contemporaries laid the groundwork for our current understanding of he information processing of neural systems and for understanding the task faced by studies of how the brain develops. The visual system is examined in some detail as a model for experimental investigation into the structure, operational mechanisms, and functions of large neural systems. Discussion of the phenomena of visual awareness and consciousness, links between the visual system and other brain systems, and disorders that disrupt voluntary control of cognition and emotion lead to a broader consideration of the problem of consciousness.

Animals↗
PubMed2005

Reflections of an eclectic skeptic.

Following primary and secondary education in Europe, I came to the United States for further education. After majoring in engineering, I shifted to liberal arts and social sciences. I minored in mathematics, philosophy, and education at the undergraduate level and physiology at the graduate level, ultimately obtaining a PhD in personality psychology. My interests were primarily academic, but I did not neglect the emerging field of clinical psychology. After working in hospitals for 9 years, I joined the faculty of Michigan State University where I established the psychological clinic and served as its director for 13 years. Subsequently, during 2 sabbaticals in Israel, I researched personality development in unconventional family settings (the kibbutz). I also studied such diverse issues as motivation for parenthood, time perception and time perspective, and cognition in psychopathology. After editing several textbooks on assessment techniques, I initiated the series of triennial Murray lectures that highlighted the dynamic approach to the study of personality.

Aged↗
PubMed2003

Medical nutrition therapy of overweight adolescents.

The long-term goal of medical nutrition therapy for adolescents who are overweight or at risk for becoming overweight is to promote healthy lifestyle behaviors. These behaviors will, in turn, improve metabolic parameters and self-esteem while helping the adolescent achieve and maintain a desirable body weight. The identification of anthropometric, metabolic, nutritional, and environmental risk factors present in the child and family will help formulate the medical nutrition intervention. A well-balanced diet that supports growth and development, aerobic exercise, and cognitive behavioral strategies are essential components of an intervention program. Frequent and long-term monitoring by a registered dietitian and pediatrician will reinforce lifestyle changes and support the adolescent and family in achieving realistic goals of weight loss or weight maintenance. This article covers the assessment and interventions necessary for successful nutrition therapy for obese and superobese adolescents.

Adolescent↗
PubMed1997

Dysphagia--ingestion or deglutition?: a proposed paradigm.

The current classifications of dysphagia are based on local structural or central nervous system pathology causing dysfunction of the aerodigestive tract. The result is a clinical science grounded in the analysis of the swallow with its lingual, pharyngeal, and esophageal stages. Adding bolus preparation to the swallowing paradigm improves but still constrains the study of dysphagia and treatment of the dysphagic patient. Those pre-oral facets of mealtime behavior that may evoke or exacerbate dysphagia remain beyond the existing classification boundaries imposed by the conceptual swallow and anatomic aerodigestive tract. We offer a more inclusive strategy for investigating dysphagia based on a five-stage process of ingestion: pre-oral (anticipatory), preparatory, lingual, pharyngeal, and esophageal. The first stage considers the interaction of pre-oral motor, cognitive, psychosocial, and somataesthetic elements engendered by the meal. The limited literature regarding the interaction of the pre-oral stage with other ingestion stages, in both normal subjects and patients with cortical, basal ganglia, and psychogenic diseases, is reviewed. The neurophysiologic and clinical justifications for embracing a pre-oral stage, and thus for the paradigm shift from deglutition to ingestion, are presented.

Deglutition Disorders↗
PubMedDate not supplied

Advanced application of magnetic resonance imaging in human brain science.

Magnetic resonance imaging (MRI) has revolutionized the practical demands of clinical neurology. This technology promises now to advance neurology in theoretical and applied realms of fundamental human brain science. We emphasize here two domains in which these advances will occur. The first is volumetric morphometry of the human brain. With MRI the multiple levels of processing of the brain may be characterized in terms of their absolute volumes and their relative sizes, perspectives indispensable for our understanding of the development and operation of neural systems. Volumetric morphometry also promises substantial increases in the specificity and sensitivity of neurological diagnosis, particularly where applied to disorders where structural abnormalities will be reflected only in volumetric abnormalities. The second direction of advance considered here is application of MRI in cortical mapping in support of cognitive neuroscience. In this application MRI provides means to map at high resolution the distribution of subcomponents of neural systems activated by behavioral paradigms. This line of investigation will carry forward rapidly our understanding of how the information processing algorithms of the brain are mapped upon the coordinates of the various gray matter structures of the brain. Among the practical consequences of this application will be a reasoned design of surgical field in tumor and epilepsy surgery.

Adult↗
PubMed1991

[The role of the Academia Brasileira de Neurologia in the teaching of neurology. A personal view].

The Brazilian Academy of Neurology (ABN) may play an important role for a better education of medical students and residents in neurology in Brazil. Its field of action ranges from suggesting a core curriculum in neurology to Medical Schools and Residency Programs to assess the quality of teaching they offer in order to guide students and graduates who apply for positions. In addition to that ABN may be itself a teaching institution offering educational activities in a Program of Continuing Medical Education with a well-designed system of credits. Courses on basic sciences, methods of diagnosis and therapeutic advances, symposia and workshops as well as a Programmed Teaching in Neurology suitable to residents and practitioners are to be included. A video collection and a bank of data on the current literature may widen the available set of services. The ABN Committee on Teaching is to play a central role defining policy, deciding on priorities, planning and establishing timing and placing of all educational activities. Of utmost importance is to define humanistic qualities desirable in the neurologist identifying qualities students and residents bring to the educational process and those acquired in the practice of neurology. The cognitive dimensions of moral and ethics can be taught and should be regularly included in the educational activities sponsored by the Academy.

Academies and Institutes↗
PubMed2005

[Which evaluations are fundamental for medical training in pharmacotherapy?].

In Germany the medical profession is regulated by the state. The state defines the contents of the medical training within the clear boundaries of scientific medicine, which differs from science or biological medicine. The concepts and practice of many complementary therapeutic or diagnostic methods such as homeopathy do not fit within this state-set frame. Medical students, therefore, must be well acquainted with accepted scientific criteria by which we evaluate the value and validity of various therapeutic approaches. Lecturing pharmacotherapy implies posing questions such as: How do I come to statements which can be falsified? Within which constructs are they valid? Within which social context are they meaningful? Which aspects of reality must stay out of focus in order to reach such statements? This will help students to understand the frequent cognitive dissociations between doctors and patients as to concepts of disease and therapy, and the potential reasons why patients often prefer alternative medicine. Alternative methods can be openly discussed and evaluated on the basis of a critical methodology. For the sake of optimal patient care, "pluralistic" approaches towards setting valid therapeutic rules and standards are no alternative during the periods of basic medical training.

Complementary Therapies↗
PubMed2005

Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants.

OBJECTIVE: Societies and cultures have been described as being individualistic or collectivist (also called ego-centric or socio-centric). Similarly individuals are idiocentric or allocentric. METHOD: Using migration, migrants, ethnic minorities, collectivism and individualism, four databases of Embase, Medline, PsychInfo and Social Sciences abstracts were searched. Other key words included mental disorder, mental distress, psychiatric and psychological disorders. In addition, hand searches were conducted from the relevant books, monographs and secondary references. RESULTS: Migration, cultural identity and mental distress are linked. In addition, social support can provide a buffer against mental illness. Other vulnerability factors in migrants include the type of society they originate from and the type of society they settle in. CONCLUSION: When individuals migrate from one type of culture to another it is likely that depending upon their own personality traits (along with their biopsycho-social vulnerabilities) may develop psychiatric disorders. The cognitions and idioms of distress will be influenced by cultural factors. The clinicians must take into account cultural background when planning any interventions to enable a stronger therapeutic alliance.

Acculturation↗
PubMed2005

Therapeutic working relationships with people with schizophrenia: literature review.

AIM: The aim of this paper is to review the evidence for the necessity and sufficiency of therapeutic relationships when working with people with enduring mental health problems, such as schizophrenia. BACKGROUND: The value of therapeutic relationships in mental health nursing has been the subject of some debate within the profession. This debate has centred on the spectrum of beliefs about therapeutic relationships, ranging from the position that the relationship is both necessary and sufficient to enable change, to more technical approaches, to therapeutic intervention which de-emphasises the influence of the relationship. METHODS: Searches for published material in English between 1986 and 2003 were carried out using the following databases: Cumulative Index of Nursing and Allied Health Literature; MEDLINE; Applied Social Sciences Index and Abstracts; Sociological abstracts; and social service abstracts. The search terms were: therapeutic alliance; therapeutic relationship; working alliance; and nurse-patient relationships. Papers chosen for inclusion in the review were those with a research focus on the elements and potential benefits/costs of therapeutic relationships in nursing. RESULTS: People who experience a relationship as being therapeutic appear to have better outcomes. A consistent finding of a number of meta-analyses is that therapeutic relationships characterized by facilitative and positive interpersonal relationships with the helper have in-built benefits, and that this is an important element of advanced techniques. In order for cognitive behavioural therapy to be successful, people need to feel understood and involved in the therapeutic relationship. CONCLUSION: Therapeutic relationships are necessary but not sufficient to enable change when working with people with schizophrenia.

Cognitive Behavioral Therapy↗
PubMed2006

[A clinical psychiatric study about post-stroke depression].

We examined the clinical characteristics of post stroke depression (PSD) patients in a rehabilitation hospital. The subjects were inpatients at the Ibaraki Prefectural University of Health Sciences Hospital who had been diagnosed with stroke and admitted between May 2002 and January 2004. Of 123 patients enrolled, 18 were diagnosed with PSD. We investigated the clinical differences between PSD patients and non-depressed (ND) patients. There were no significant differences between PSD and ND groups in terms of sex, age, past psychiatric history, family psychiatric history, stroke diagnosis, or neurological symptoms. The scores of PSD patients on Zung's self-rating depression scale and the Hamilton depression rating scale were significantly higher than those of ND patients. Furthermore, the Activities of Daily Living measured by the Functional Independence Measure and cognitive function evaluated by the Mini-Mental State Examination of ND patients were significantly better than those of PSD subjects. These results suggest that the detection of PSD in stroke patients is important for promoting their rehabilitation and improving their Activities of Daily Living and cognitive function.

Depression↗
PubMed1999

From the gate to the neuromatrix.

The gate control theory's most important contribution to understanding pain was its emphasis on central neural mechanisms. The theory forced the medical and biological sciences to accept the brain as an active system that filters, selects and modulates inputs. The dorsal horns, too, were not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occurred. The great challenge ahead of us is to understand brain function. I have therefore proposed that the brain possesses a neural network--the body-self neuromatrix--which integrates multiple inputs to produce the output pattern that evokes pain. The body-self neuromatrix comprises a widely distributed neural network that includes parallel somatosensory, limbic and thalamocortical components that subserve the sensory-discriminative. affective-motivational and evaluative-cognitive dimensions of pain experience. The synaptic architecture of the neuromatrix is determined by genetic and sensory influences. The 'neurosignature' output of the neuromatrix--patterns of nerve impulses of varying temporal and spatial dimensions--is produced by neural programs genetically build into the neuromatrix and determines the particular qualities and other properties of the pain experience and behavior. Multiple inputs that act on the neuromatrix programs and contribute to the output neurosignature include. (1) sensory inputs (cutaneous, visceral and other somatic receptors); (2) visual and other sensory inputs that influence the cognitive interpretation of the situation; (3) phasic and tonic cognitive and emotional inputs from other areas of the brain; (4) intrinsic neural inhibitory modulation inherent in all brain function; (5) the activity of the body's stress-regulation systems, including cytokines as well as the endocrine, autonomic, immune and opioid systems. We have traveled a long way from the psychophysical concept that seeks a simple one-to-one relationship between injury and pain. We now have a theoretical framework in which a genetically determined template for the body-self is modulated by the powerful stress system and the cognitive functions of the brain, in addition to the traditional sensory inputs.

Animals↗
PubMed2003

Outcome predictors in substance use disorders.

Given the heterogeneous nature of substance abuse, it is notable that several predictors of response are independent of the primary drug of abuse or the treatment setting [208]. Although the strength of the relationship of predictor to outcome varies, the following factors have been identified consistently: severity of dependence or withdrawal; psychiatric comorbidity; substance-related problems; motivation (abstinence commitment); length of treatment; negative affective states; cognitive factors; personality traits and disorders; coping skills; multiple substance abuse; contingency contracting or coercion; genetic factors; sleep architecture; urges and craving; self-efficacy; and economic and social factors. Although it is well known that severity of dependence (including polysubstance abuse), serious psychiatric comorbidity, and social problems are associated with poor treatment response, only recently has research examined the efficacy of intervention strategies that specifically address these problems. Adequate treatment of psychiatric comorbidity and improvement in social, economic, and family functioning lead to better treatment outcomes. The development of specific techniques to enhance self-efficacy, motivation, coping skills, and functioning in the community are concrete examples of how the identification of factors associated with positive outcomes has led to the development of new treatments. Despite significant accomplishments, the field is left with many unanswered questions. Although several biologic markers, such as neuroendocrine response and sleep architecture, show promise as outcome predictors, it is not known whether these are critical factors in the initiation of substance use or its progression to dependence. Determining whether biologic markers are epiphenomena reflecting the amount and duration of substance abuse or are fundamental to the pathophysiology of dependence is a matter of urgent concern. With some exceptions, identification of biologic predictors has not led to innovative therapies. One of these exceptions is the development of naltrexone for the treatment of alcoholism, which was based in a solid theoretical rationale and followed by hypothesis-driven experiments. Similar opportunities should emerge from current basic science and clinical research. The application of pharmacogenetic techniques to the field of addiction also holds great promise. As future studies are undertaken, researchers and clinicians must be mindful that differences in outcome predictors across drugs of abuse and treatments may emerge as subgroups of individuals with addictive disorders and new therapies are identified. There is already evidence that early onset alcoholism is associated with poor response under some circumstances, yet may be a predictor of response to targeted pharmacotherapy with ondansetron [64, 112]. As the ability to subtype disorders based on meaningful biologic differences grows, it is anticipated that several relevant outcome predictors that are specific for pharmacotherapy will emerge.

Biomarkers↗
PubMed2005

Posttraumatic stress disorder: a state-of-the-science review.

This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition.

Adaptation, Psychological↗
PubMedDate not supplied

Class specificity and the lexical encoding of participant information.

It is commonly assumed across the language sciences that some semantic participant information is lexically encoded and some is not. In this article, we propose that semantic obligatoriness and verb class specificity are criteria which influence whether semantic information is lexically encoded. We present a comprehensive survey of the English verbal lexicon and two continuation studies which confirm that both factors play a role in the lexical encoding of participant information.

Cognition↗