Cognitive Behavior Therapy for Psychotic Disorders: Current Issues and Future Developments

There is accumulating evidence, reviewed by Caudiano (this issue), that cognitive behavior therapy (CBT) is an effective adjunct treatment for schizophrenia. Schizophrenia treatment and research provides a range of challenges that are probably not present in other mental health problems. These include contextual issues, clinical issues, scientific and methodological issues, practical and pragmatic issues, public concern, and human rights issues. This paper discusses these issues with emphasis on the clinical and research challenges for the future.     

图片学习测验在识别老年人轻微认知功能损害中的作用

目的　分析图片学习测验在识别老年人轻微认知功能损害 (MCI)中的作用。方法　选择符合MCI诊断标准的老年人 4 8例与正常对照组 5 6名完成图片学习测验、简易智能状态检查、听觉词语学习测验及多种非记忆测验。结果　图片学习测验的 3个记忆指标 (图片短时记忆、延迟记忆和学习记忆 )在MCI与正常对照组之间有非常显著的差异。已经给出这三个图片记忆指标区分MCI与正常老年人的划界分、敏感性和特异性。结论　图片记忆操作简便、信度和效度好 ,可以作为临床医师筛选MCI的有效工具     

Abnormal behavior of elderly people residing in institutions of medical and social welfare systems

Abstract We investigated factors correlated with abnormal behavior in the elderly residing in a special nursing home (group A) and a psychiatric hospital (group B) using the dementia behavior disturbance scale, the mini mental state examination, the Japanese version of the Philadelphia Geriatric Center morale scale, and the ADL assessment scale. The cognitive function of group B was decreased compared with that of group A, but most activities of daily living (ADL) in the latter group were disrupted compared with those in the former. Only a few categories of ADL correlated with abnormal behavior in group A, whereas cognitive function, quality of life, and most categories of ADL correlated with abnormal behavior in group B. These results suggest that factors correlated with abnormal behavior in the elderly differ within institutions of medical and social welfare systems.     

Procedural memory stimulation in Alzheimer's disease: impact of a training programme

The study evaluates the efficacy of a procedural memory stimulation programme in mild and mild-moderate Alzheimer's disease (AD). Twenty basic and instrumental activities of daily living have been selected, and divided into two groups, comparable for difficulty. Ten normal elderly subjects (age 68.0±4.8 years; MMSE score: 28.7±0.9; education: 7.6±3.5 years) were asked to perform the two groups of daily activities and the time required to perform the tasks of each group was recorded and used as a reference. Ten mild and mild-moderate AD patients (age 77.2±5.3 years; MMSE score: 19.8±3.5; education: 7.3±4.7 years) without major behavioural disturbances constituted the experimental group. Patients were evaluated in all 20 daily activities and the time employed was recorded at baseline and after a 3-week training (1 h/d, 5 d/week) period. Five patients were trained during the 3 weeks on half of the 20 daily activities and the other five patients were trained on the remainder. This procedure was adopted in order to detect separately the improvement in "trained" and "not trained" activities, allowing to control better the effects of the intervention. The assessment of the functional impact of the training was directly measured, through the variation of time employed to perform tasks before and after training. After 3 weeks of training a significant improvement was observed for the trained activities, from 3.6 to 1.9 standard deviations below the performance of the normal elderly controls ( P <0.05). AD patients improved also in not-trained activities from 3.5 to 2.7 standard deviations below the controls'performance ( P <0.05). The rehabilitation of activities of daily living through developing procedural memory strategies may be effective in mild and mild-moderate AD patients.     

Cognitive behaviour therapy approach to disputing automatic thoughts: a two-stage model

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self-evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two-stage practise-based disputing model, guided by research, that aims to 'bring' an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.     

Wives prefer reading: Stress and female sexuality

A clinical discussion is presented of sources of sexual stress for women and how they might interfere with healthy sexual functioning. Several therapeutic techniques to reduce sexual stress are described and clinical case examples are given to clarify their use in clinical practice.     

Effect of cognitive and motor tasks on postural stability in Parkinson's disease: a posturographic study.

To analyse the effect of concomitant cognitive or motor task performance on balance control in Parkinson's disease (PD), we performed a posturographic study in 24 PD patients and in 20 sex- and age-matched control subjects. Postural sway was measured with eyes open (EO) and eyes closed (EC) during quiet stance and during performance of calculation or motor sequence of thumb opposition to the other fingers. No difference of centre of foot pressure (COP) parameters was observed during quiet standing (either EO or EC) between patients and controls, but visual deprivation induced in both groups a worsening of postural stability. COP area was significantly increased in PD patients during dual task performance, whereas no difference of COP path and x-y axes was observed. The effects induced by the performance of cognitive or motor task were significantly more evident in PD patients with clinical evidence of postural instability (presence of prior falls in the history). This study demonstrates that dual task interference on postural control can be observed in PD patients during performance of cognitive as well as motor tasks. The balance deterioration during dual task performance was significantly enhanced in patients with history of prior falls. These findings have some implications for the strategies to be used in reducing the risk of fall in PD.     

Detecting cumulative trauma disorders in workers performing repetitive tasks

On-site testing of 157 poultry processors disclosed that 50% had three or more abnormal upper extremity findings out of a total of 22 possibles. The average worker had five to six abnormal findings. Impaired pinch strength, decreased vibration sensitivity in the fingertips, and reports of current numbness were the most prevalent. Of workers with signs, 25% reported no symptoms, whereas only 8% of workers reported symptoms but had no signs. The investigators concluded that this measurement method has utility for assessments of worker populations to determine prevalence of CTDs and, potentially, for preclinical detection of these disorders to permit early intervention, reduce medical costs, and minimize disability. The need for accurate measurement to enhance early detection and prevention is discussed.     

癫(癎)患者认知功能影响因素的研究

目的:研究癫患者认知功能的影响因素。方法:对166例癫患者进行认知评定。认知评定工具:听觉词语测验、逻辑记忆测验、数字符号转换测验、Stoop字色干扰测验、连线测验、言语流畅性测验、Rey-Osterrieth复杂图片测验及Boston命名测验。影响因素与认知功能评分之间采用一元线性相关及多元逐步回归分析。结果:患者年龄、性别、文化程度、起病年龄、病程、发作频率、发作持续时间、全身强直阵挛发作(GTCS)、复杂部分性发作(CPS)及抗癫药物数量与患者的认知功能有相关性。结论:癫患者的起病年龄与其认知损害成正比,病程越长对癫患者的认知损害越明显,原发或继发全身性强直阵挛发作与言语功能损害、复杂部分性发作与言语记忆损害之间的关系密切,用药种类与记忆、注意力以及精神运动能力的损害有关。     

对社区老人认知功能干预的近期效果

目的:探索对社区老人认知功能干预的近期效果。方法:对某社区65岁以上自愿参加的老人进行为期12周(共24次)的认知功能干预;采用老年成套神经心理测验(NTBE),比较干预组(44名自愿参加的老人)和对照组(51名完成基线和随防评估的老人)认知功能差异。结果:在干预前后两组NTBE的自身比较中:干预组在视觉匹配和推理等项目得分的差异有统计学意义,对照组在运动测验、前摄抑制和学习效应指数等得分的差异有统计学意义。通过Logistic回归分析,认知干预和NTBE相关的项目如下:听觉词汇学习4正确、听觉词汇学习4重复、分类测验、小标记测验、视觉匹配和推理、听觉词汇8插入和连线测验1顺序提示数共7项,均呈正相关。结论:综合认知训练干预在短期内能改善或延缓部分认知功能的衰退,逻辑推理能力是社区老人认知干预的易感领域。