Knowing "what" and knowing "when"

The ability to situate autobiographical memories accurately in the "time-line" of one's own life is a particular aspect of retrograde memory that has received little attention in well-controlled, systematic studies. Here, we addressed this issue by testing the hypothesis that patients with basal forebrain damage would be impaired in their ability to place various autobiographical memories accurately on a 'time-line' of their life. Seven such subjects were contrasted with 11 medial temporal lobe subjects, 8 brain-damaged comparison subjects, and 18 normal comparison subjects, using a procedure in which subjects placed autobiographical events on a time-line of their life. The basal forebrain group was very impaired in this task, relative to the other groups, and on average, misplaced events by more than five years. Although the basal forebrain group was also impaired in retrieving the contents of autobiographical memory, they did not differ statistically from the medial temporal lobe group in this regard (and the medial temporal lobe group did not have impaired time placement of memories). The results indicate an intriguing dissociation between "knowing what" and "knowing when," and suggest that the basal forebrain contains structures that are especially important for "knowing when." Our findings are compatible with the view that the basal forebrain participates critically in retrieval strategies important for memory chronology, which contrasts with the medial temporal lobe's critical role in relational memory per se.     

"Objective" methods and "subjective" experiences

Current psychiatric research and practice emphasize measurement of operationalized variables, quantification, and rigorous hypothesis testing. The fact that mental states can be subjectively experienced and that thoughts can refer to things and events outside the mind suggests that such objectifying methods alone may not provide a complete approach to mental life. Other complementary but systematic methods can be described which stress that (1) words are often natural expressions, not labels, of experiences; (2) usefulness, not agreement with observation, can sometimes validate psychological expressions; (3) some data can only be gathered by interactive involvement, not dispassionate observation; (4) a goal of inquiry can be interpretation, not hypothesis testing; and (5) understanding may require a holistic approach which expands rather than constricts the realm of relevant data.     

The "forty-nine" and "seventeen" problems]

The single most common age of murderers in Japan is 49. Individuals aged between 45 and 54 are, however, likely to commit not offences but suicides comparing with other generations. One factor behind this phenomenon is the trend toward company downsizing, which is thought to affect the mental attitude of workers. This trend is destroying the Japanese lifetime employment system and undermining worker's loyalty to the company. On the other hand, in the broader category of felony crimes (assault, burglary, arson, murder), offenders aged 17 are the most common in Japan. This is thought to be partly due to the effect of so-called "school collapse" (school system failure) on the mental attitude of students. "School collapse" implies dysfunction of educational practice as a result of chattering, bullying and violence in the classroom. It is the reflection of students' dissatisfaction with the group-oriented school system. Therefore, students are unable to find any purposes in school and exhibit aggressive behaviours. In terms of mental health for both middle-age and teenage generations, it is necessary to devise new strategies whereby people can break away from the pressure of loyalty to the group. For both "normal" and "disabled" workers, rights of recuperations, adequate unemployment benefits policy, and support system for occupational change should be established. Simultaneously, for both "normal" and "disabled" students, reform of the school system under the concepts of diversity of education, rights of selection, and rights of refusal is urgently necessary. With respect to forensic psychiatry, without the provision of social supports, labeling of conduct disorder as well as other disorders should be avoided. In particular, instead of introducing security hospitals, drastic improvements of medical reformatories and medical prisons are necessary to provide adequate medical and social supports for offenders with psychiatric disorders.     

The "where" and "what" in developmental dyscalculia

Developmental dyscalculia (DD) is a congenital deficit that affects the ability to acquire arithmetical skills. Individuals with DD have problems learning standard number facts and procedures. Estimates of the prevalence rate of DD are similar to those of developmental dyslexia. Recent reports and discussions suggest that those with DD suffer from specific deficits (e.g., subitizing, comparative judgment). Accordingly, DD has been described as a domain-specific disorder that involves particular brain areas (e.g., intra-parietal sulcus). However, we and others have found that DD is characterized by additional deficiencies and may be affected by domain-general (e.g., attention) factors. Hence "pure DD" might be rather rare and not as pure as one would think. We suggest that the heterogeneity of symptoms that commonly characterize learning disabilities needs to be taken into account in future research and treatment.     

Perceived social support and dysfunctioning in "clinical" and "normal" adolescents

The purpose of this study was to examine the extent to which inpatient and non-patient samples of youngsters differ from each other with regard to prevalence and co-occurrence of emotional and behavioural problems and negative perceptions of family, school and peers. The sample comprised 202 12-21-year-old adolescents: 101 psychiatric inpatients and 101 matched "community-based" youngsters. Possible differences between the subgroups were tested by means of multi-variate analysis of variance and relative risk ratios.All specific problems and combination patterns were reported significantly more often by the "inpatient" than by the "non-patient" youngsters. However, after correcting for differences in base rates, only the combination of emotional and/or behavioural problems and family problems remained significant. The combination of emotional and family problems was reported about 12 times more often and the combination of behavioural and family problems even about 21 times more often by adolescents in the "clinical" sample than by those in the "normal" sample.Two important conclusions were drawn: (1) co-occurrence in itself did not appear to be the distinguishing factor between the "clinical" and the "normal" sample; and (2) a dominant role of negatively perceived family support in adolescent functioning was suggested. The implications of these findings are discussed.     

Dynamics of self-esteem in "poor-me" and "bad-me" paranoia

ABSTRACT: The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved ("poor me"; PM), b) individuals who believed that persecution is justified ("bad me"; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed.     

"Positive" and "negative" movement disorders in schizophrenia.

Investigations aimed at identifying the clinical characteristics that discriminate tardive dyskinesia (TD) from non-TD patients have yielded disparate findings. We have suggested, based on pharmacological and neuroradiological studies, that TD in schizophrenia may be a covariate of positive symptoms while drug-induced parkinsonism (DIP) may relate to negative symptoms. To investigate this hypothesis, we examined in 47 institutionalized schizophrenic patients the relationship of TD and DIP with psychopathology clusters rated on the Positive and Negative Syndrome Scale. We found that involuntary movements of TD were significantly associated with the activation cluster (p < .01), whereas DIP was significantly associated with the anergia cluster (p < .01). These findings thus support the position that TD is a specific facet of the positive syndrome in schizophrenia, while DIP is a specific feature of the negative syndrome. Clinically, the data suggest that schizophrenic patients with predominant positive symptoms may be at increased risk for TD, while those with prominent negative features could be at increased risk for DIP. In analogy with the positive/negative dichotomy, we propose that TD could be regarded as a "positive," while DIP as a "negative" movement disorder.     

Differences between patients classified as "recovered" or "improved" and "unchanged" or "deteriorated" in a psychotherapy outcome study

The concepts of statistical and clinical significance of pre-post-changes have been used to class patients into four groups of therapy outcome: "recovered", "improved", "unchanged" and "deteriorated". Aim of this study is to investigate the advantages of this classification in comparison to a simple division into "successful" and "not successful". 43 patients were examined before and after an in-patient psychotherapy and again two years later with several test inventories. Therapy outcome was measured by the changes in the Global Severity Index of the SCL-90-R. "Recovered" and "improved" patients did only differ in regard to their initial symptom severity, but not in regard to the amount of symptom reduction or stability of therapy effect. "Deteriorated" patients could reduce their increase in symptoms until follow-up. Our results do not indicate a general advantage of the classification into four outcome groups over a division into "successful" / "not successful".     

"Organic" and "functional" diseases of the nervous system.

The aim of this paper is to discuss whether in the realm of diseases of the nervous system the concept of "dysfunctional" versus "organic" disorders is still useful. The knowledge on the Common Brain Stem System (CBSS) described by Hess is reviewed in order to underline its role as a control centre integrating all the homeostatic and adaptive nervous activities, and in this context, the nervous control of the cardiovascular system is examined, particularly in relation to higher nervous activities. The neurogenic syncopes are chosen as examples of the either "organic" or "dysfunctional" conditions whose semeiotic and pathophysiological distinctive features are analysed. In conclusion the distinction between "organic" diseases and "dysfunctional" disorders seems to be still justified, mainly for the nervous affections involving the homeostatic-adaptive properties of the CBSS.