Dissociation, memory commission errors, and heightened autonomic reactivity

If dissociative symptoms are manifestations of a psychological defense mechanism, one would expect people who have such symptoms to react with lower levels of physiological arousal and with memory omissions to emotionally provocative material. The current study tested this assumption in a sample of undergraduates. Sixty-two undergraduate students viewed a highly emotional video fragment. Pearson's product-moment correlations were calculated between dissociation (as indexed by the Dissociative Experiences Scale, DES) and all dependent measures. High dissociators exhibited elevated skin conductance responses (SCRs) to the fragment. Memory for the video fragment was then tested. While omission errors were unrelated to dissociation, high dissociators exhibited a tendency to produce commission errors. This could not be explained by a reduced working memory capacity. However, fantasy proneness was found related to high dissociators' commission errors. Thus, it seems that a pattern of heightened emotional reactivity and commission errors is typical for people with elevated dissociation scores. This pattern is difficult to reconcile with the defensive function ascribed to dissociation.     

Working memory structure and intellectual disability

The working memory of people with intellectual disability has been found to generally lag behind their mental age. However, studies concerning the structure of working memory or its connections to other cognitive functions are rare. The present study employs a versatile battery of tests for the evaluation of working memory structure in adults with intellectual disability of unknown aetiology. In addition, connections between working memory and cognitive skills valid for everyday functioning are evaluated. Working memory performance in the study participants was found to stem from two distinct components which could be regarded to represent phonological and general working memory. General working memory was closely related to intelligence, whereas phonological working memory was not. The subjects in the study group differed in their working memory profiles. These distinct profiles were significantly related to academic skills (e.g. reading, writing and mathematics) and sentence comprehension because the profile of the working memory predicted these abilities even when the intelligence and educational background of the participants was taken into consideration.     

Work performance skills in adults with and without high functioning autism spectrum disorders (HFASD)

The Autism Work Skills Questionnaire (AWSQ) consists of 78 items, divided into 6 domains; 5 domains focus on employment skills, the 6th relates to one's sensory needs within the work environment. Initial internal consistency reliability for the AWSQ has been established. The purpose of this study was to examine its discriminate validity between people with HFASD to controls with Typical Development (TD). The AWSQ was completed by a convenience sample of 102 TD subjects (25 women, 77 men) and 37 subjects with HFASD (7 women, 30 men), both groups were aged 20–40. From the TD sample, 37 individuals were further matched to those with HFASD.Significant differences were found between the work skills of people with and without HFASD. Differences were found in almost all the domains of the AWSQ. Significant correlations were found between the different categories among people without HFASD as opposed to a small number of correlations among people with HFASD. These findings suggest a unique working profile among those with HFASD, in comparison to the TD sample, and highlight the importance of assessing their unique abilities and challenges in order to provide people with HFASD with a job that matches their interests and working profiles.     

Psychiatric hospitalizations during the last 12 months before suicide

OBJECTIVES: Suicide victims frequently have had contact with the mental health care system before they died. In this study, the rates, numbers and lengths of psychiatric hospitalizations of suicide victims during the last year before their suicide commission were assessed. METHODS: The quarterly and monthly hospitalization rates during the last 12 months of 665 individuals who committed suicide were compared. RESULTS: Of the suicide victims, 16.4% had been hospitalized at least once. The period after a recent discharge bore the highest risk for suicide commission, with 4.7% (28.4% of those hospitalized) committing suicide within 1 week after their discharge and 7.8% (47.7%) committing suicide within 1 month. Hospitalization rates were significantly higher in the last 3 months as compared with the preceding quarters. CONCLUSION: Increasing utilization of inpatient treatment facilities should prompt a particularly profound suicide risk assessment and postdischarge treatment planning.     

The supportive role of the community mental handicap nurse

In the last few years there has been an encouraging growth in the number of mental handicap nurses working in the community. The role they have to play in providing a service to mentally handicapped people and their carers is becoming increasingly recognised. Amongst the functions of the community mental handicap nurse is that of giving support to families. The following article attempts to identify some aspects of this supportive work and to suggest some ways in which the nurse may usefully fulfil this function.     

Mental incapacity defenses at the War Crimes Tribunal: questions and controversy

Following a report from the Secretary General in May 1993, the United Nations Security Council adopted Resolution 827 and its Statute establishing an International War Crimes Tribunal for the Former Yugoslavia (ICTY) located in The Hague, The Netherlands. Although such action has been discussed in the past, this is the first time the international community has established a tribunal to indict and try individuals for war crimes. The crimes had been previously "created" by multilateral international treaties. The ICTY Rules of Procedure and Evidence allowed for "any special defense, including that of diminished or lack of mental responsibility." Precise legal parameters of the defense were not specified. In 1998, a defendant at the ICTY "Celebici" Trial named Esad Landzo raised the defense of diminished mental responsibility. The Celebici Trial Chamber thus became the first legal body to consider reduced mental capacity as it applies to international criminal law. This article is an examination of the application of the affirmative defense of diminished responsibility at the ICTY and relates the process to the need for further definition of mental incapacity defenses at the newly established International Criminal Court (ICC). At the ICC preparatory commission, drafting material elements of crimes was emphasized, with less consideration given to mental elements. That diminished capacity and diminished-responsibility defenses have often confused scholars and practitioners alike is explored in this article with suggestions for further directions.     

Neocortical disruption and behavioral impairments in rats following in utero RNAi of candidate dyslexia risk gene Kiaa0319

Within the last decade several genes have been identified as candidate risk genes for developmental dyslexia. Recent research using animal models and embryonic RNA interference (RNAi) has shown that a subset of the candidate dyslexia risk genes--DYX1C1, ROBO1, DCDC2, KIAA0319--regulate critical parameters of neocortical development, such as neuronal migration. For example, embryonic disruption of the rodent homolog of DYX1C1 disrupts neuronal migration and produces deficits in rapid auditory processing (RAP) and working memory--phenotypes that have been reported to be associated with developmental dyslexia. In the current study we used a modified prepulse inhibition paradigm to assess acoustic discrimination abilities of male Wistar rats following in utero RNA interference targeting Kiaa0319. We also assessed spatial learning and working memory using a Morris water maze (MWM) and a radial arm water maze. We found that embryonic interference with this gene resulted in disrupted migration of neocortical neurons leading to formation of heterotopia in white matter, and to formation of hippocampal dysplasia in a subset of animals. These animals displayed deficits in processing complex acoustic stimuli, and those with hippocampal malformations exhibited impaired spatial learning abilities. No significant impairment in working memory was detected in the Kiaa0319 RNAi treated animals. Taken together, these results suggest that Kiaa0319 plays a role in neuronal migration during embryonic development, and that early interference with this gene results in an array of behavioral deficits including impairments in rapid auditory processing and simple spatial learning.     

Changing Attitudes: A Teaching Initiative in the Medical School

In this paper we describe an innovatory teaching programme for medical students which is designed to promote more positive images of people with learning disabilities (L.D.). The programme involves small groups of medical students working in partnership with equal numbers of people with L.D. on a specific task of mutual interest. In educational terms, the programme was highly successful; students enjoyed the experience and found it both interesting and relevant to their medical studies. At the end of the programme students had acquired a greater respect for the abilities of people with L.D. and were more positively inclined towards them and their rights as citizens. However, the evidence also suggested that they continued to regard people with L.D. as somehow qualitatively different from non-handicapped people — less able, more dependent and child-like.     

Effects of the alpha-2 adrenoceptor agonist guanfacine on attention and working memory in aged non-human primates

Alpha-2 adrenergic receptors are potential targets for ameliorating cognitive deficits associated with aging as well as certain pathologies such as attention deficit disorder, schizophrenia and Parkinson's disease. Although the alpha-2 agonist guanfacine has been reported to improve working memory in aged primates, it has been difficult to assess the extent to which these improvements may be related to drug effects on attention and/or memory processes involved in task performance. The present study investigated effects of guanfacine on specific attention and memory tasks in aged monkeys. Four Rhesus monkeys (18-21 years old) performed a sustained attention (continuous performance) task and spatial working memory task (self-ordered spatial search) that has minimal demands on attention. Effects of a low (0.0015 mg/kg) and high (0.5 mg/kg) dose of gunafacine were examined. Low-dose guanfacine improved performance on the attention task [i.e. decreased omission errors by 50.8 ± 4.3% (P = 0.001) without an effect on commission errors] but failed to improve performance on the spatial working memory task. The high dose of guanfacine had no effects on either task. Guanfacine may have a preferential effect on some aspects of attention in normal aged monkeys and in doing so may also improve performance on other tasks, including some working memory tasks that have relatively high attention demands.     

Empirically Defined Patterns of Executive Function Deficits in Schizophrenia and Their Relation to Everyday Functioning: A Person-Centered Approach

Executive function (EF) deficits in schizophrenia (SZ) are well documented, although much less is known about patterns of EF deficits and their association to differential impairments in everyday functioning. The present study empirically defined SZ groups based on measures of various EF abilities and then compared these EF groups on everyday action errors. Participants (n?=?45) completed various subtests from the Delis–Kaplan Executive Function System (D-KEFS) and the Naturalistic Action Test (NAT), a performance-based measure of everyday action that yields scores reflecting total errors and a range of different error types (e.g., omission, perseveration). Results of a latent class analysis revealed three distinct EF groups, characterized by (a) multiple EF deficits, (b) relatively spared EF, and (c) perseverative responding. Follow-up analyses revealed that the classes differed significantly on NAT total errors, total commission errors, and total perseveration errors; the two classes with EF impairment performed comparably on the NAT but performed worse than the class with relatively spared EF. In sum, people with SZ demonstrate variable patterns of EF deficits, and distinct aspects of these EF deficit patterns (i.e., poor mental control abilities) may be associated with everyday functioning capabilities.     

Arithmetic fact retrieval and working memory in schizophrenia.

Despite its importance in every-day life and vocational rehabilitation, arithmetic ability has rarely been investigated in schizophrenic patients. Those few studies reporting arithmetic deficits in schizophrenia, however, administered complex calculation tasks which drew not only on arithmetic abilities, but also on working memory resources known to be impaired in schizophrenia. In the present study, arithmetic abilities and working memory functions were investigated in schizophrenic patients (n=24) and healthy control subjects (n=24). Arithmetic fact retrieval was assessed in single-digit multiplication and corresponding division problems using a result verification task which minimized working memory demands. Problem size and the disparity of the proposed result were manipulated. The storage component of working memory was tested with a digit span forward task and the executive control component with a digit span backward as well as with verbal fluency tasks. Schizophrenic patients performed worse than controls only in the executive tasks. Digit span forward was preserved. In the arithmetic tasks, groups did not differ from each other, and a similar pattern of task manipulations was obtained. Hence, despite the executive control deficit retrieval of arithmetic facts is preserved in schizophrenia. Moreover, the same underlying cognitive processes as in control subjects are involved.     

Philippa Russell

• • Philippa Russell has a son with a learning disability.
• • She has been involved in lots of work and campaigns to make things better for people with learning disabilities.
• • Philippa believes people with learning disabilities and carers should work together.
• • She is now head of a new commission for carers that should change things for the better.

     

Managing Psychotic Illness in Young People: A Practical Overview

Background:  The management of early onset psychosis poses a significant challenge to professionals working in Child and Adolescent Mental Health Services. Young people with psychotic illness often present with a mixed clinical picture and a wide variety of attendant issues. Over the last decade there has been accumulating research, mainly based on work with adults, regarding the efficacy and effectiveness of medical and psychosocial interventions for patients with schizoaffective spectrum disorders. This article takes a symptoms-based approach, collating and summarising recent evidence, where it exists, regarding best practice when managing young people affected by schizophrenia, schizoaffective or bipolar affective disorder.     

Working memory: neuropsychological and neurobiological issues

Working memory denotes an ability to remember information for a short-time and to manipulate it. The memory allows including correct information depending on the situation, to keep the information on present activities for a while and enables changing the reaction according to new criteria. The relation between working memory and efficiency of complex cognitive processes and also with the control of emotional processes, plasticity of behaviour and consciousness was demonstrated. Working memory is connected with the activity of the dorsolateral prefrontal cortex of the brain. Recently, it has been shown, that working memory disturbances play an important role in the aetiopathogenesis of psychiatric disturbances such as schizophrenia, bipolar affective disorder or obsessive-compulsive disorder. Working memory disturbances are also shown in a proportion of healthy first-degree relatives of patients with schizophrenia or bipolar disorders. Working memory disturbances are presently regarded as a cognitive endophenotypic marker of vulnerability to these illnesses. In recent years, an association between working memory abilities and activity of different neurotransmitters, especially with the dopaminergic system in the brain, has been shown. Molecular genetic studies show an association between working memory abilities and polymorphism of the dopaminergic system genes in schizophrenia and polymorphism of BDNF gene in bipolar affective disorders. So far not much data about the genetics of working memory in healthy subjects has been gathered. Currently in Poland such research is carried on in the Clinical Neuropsychology Unit Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz in cooperation with the Department of Adult Psychiatry and Laboratory of Psychiatric Genetics University of Medical Sciences in Poznań.     

The discrepancy between verbal and visuoperceptual IQ in children with a specific learning disorder: An analysis of 1624 cases

Children with a specific learning disorder (SLD) are often characterized by marked intellectual strengths and weaknesses. In the last few years, research has focused on a common discrepancy between low working memory and processing speed on the one hand, and high verbal and visuoperceptual intelligence on the other. SLD profiles featuring a specific discrepancy between verbal and visuoperceptual abilities have been only marginally considered, however, and their systematic comparison vis-à-vis typically-developing (TD) populations has yet to be conducted. The present study examined a dataset of 1624 WISC-IV profiles of children with a diagnosis of SLD. It emerged that the proportion of children with a Verbal Comprehension Index (VCI) at least 1.5 SD (22 standardized points) lower than their scores on the Perceptual Reasoning Index (PRI) was larger than the proportion of SLD children with the opposite discrepant profile; it was also larger than the same proportion found among TD children. Comparing the two discrepant profiles revealed that the children also differed by type of learning difficulty, gender, and performance in the WISC-IV Symbol search task. Further examination suggested that children who were discrepant and also distinctly poor in visuoperceptual intelligence were particularly slow in general processing.     

Trauma and suicidality in war affected communities

PurposeThe aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered.Materials and methodsIn the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed.ResultsIn the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%).Discussion and conclusionsNumber of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war.     

Long-term enhancement of maze learning in mice via a generalized Mozart effect

OBJECTIVES: An animal model of the 'generalized Mozart effect' (GME) - enhanced/normalized higher brain function in response to music exposure - has been established. We extend those results in two studies using another species (mice). Study 1: (1) maze testing after music exposure was extended to a minimum of 6 hours; (2) no exposure to music in utero. Study 2: (1) music exposure time further reduced; (2) maze testing extended to 24 hours. METHODS: Study 1: two mouse groups were exposed to music continuously for 10 hours per day for 10 weeks (Group I: Mozart's Sonata K.448, Group II: Beethoven's Fur Elise). After 10 weeks, the ability to negotiate a T-maze was assessed (recording working time in maze, number of errors). Maze ability was tested 6 hours following the last music exposure. Study 2: two mouse groups were exposed periodically to music (58% silence) 10 hours per day for 10 weeks. Experiments after 10 weeks examined the groups' abilities to run the maze (recording working time/errors). Experiments were conducted 24 hours following the last music exposure. RESULTS: The Mozart group exhibited significant enhancements compared with the control mice in both studies, i.e. significantly lower working time (p<0.05) and committed fewer errors. DISCUSSION: Observation of GME in another species supports its generality for the mammalian cortex. The absence of a GME in fMRI studies for the control music also indicates a neurophysiological basis. With extended exposure, GME is a long-term effect, indicating potential clinical importance. It has been demonstrated that GME reduces neuropathological spiking significantly in epileptics. We discuss the relevance of this study for epilepsy treatment.     

Working memory and relational reasoning in Klinefelter syndrome.

Klinefelter syndrome (KS) is a sex chromosome abnormality associated with male infertility and mild cognitive deficits. Individuals with KS have been reported to have impaired verbal ability, as well as deficits in executive function. To further understand the nature of their deficits, we assessed specific elements of frontal lobe function such as working memory and relational reasoning. Men with KS exhibited a deficit in a transitive inference task in which participants ordered a set of names based on a list of propositions about the relative heights of the people named. This deficit was present even for items in which the propositions were given in order, so a chaining strategy could be used. Men with KS are also impaired on the n-back task, which uses letters as stimuli. In contrast, these men performed as well as controls in nonverbal reasoning (Raven's Progressive Matrices). These results suggest that men with KS have intact nonverbal reasoning abilities, but that a difficulty in encoding verbal information into working memory may underlie their executive and linguistic impairments.     

Spatial Working Memory Deficits in Autism

Previous studies have reported working memory deficits in autism, but this finding has been inconsistent. One possibility is that deficits in this domain may be present only when working memory load exceeds some limited capacity. High-functioning individuals with autism performed the CANTAB computerized test of spatial working memory. Individuals with autism made more errors than a matched group of typically developing controls on this task, and were less likely to consistently use a specific organized search strategy to complete the task. Overall, these results demonstrate reduced spatial working memory abilities in autism, and extend previous findings by demonstrating that these deficits are significant when tasks impose heavier demands on working memory.     

Loss of deep dyslexic reading ability from a second left-hemispheric lesion

It has been hypothesized that the residual reading ability in people with deep dyslexia (an acquired dyslexia in which the subjects make semantic paralexias, eg, child read as boy) utilizes right hemispheric structures. A patient who was deep dyslexic following an initial left hemispheric stroke was studied. Following a new left hemispheric stroke, he lost his residual reading ability. In this patient, deep dyslexic reading abilities were dependent on left hemispheric structures.