A case study evaluation of the effects of different techniques for the treatment of anomia

Abstract

This study sought to demonstrate the relative effects of different techniques for treatment of the severe anomia of a 67 year-old aphasic woman. Both a semantic and a word form problem underlaid the anomia. A single subject approach was employed with an alternating treatment design to contrast four therapy conditions and two control conditions. Condition 1 involved semantic matching tasks and word form training (mentally visualising the written word, naming with the help of the first letter), condition 2 involved semantically unrelated matching tasks and word form training, condition 3 involved semantic matching tasks, condition 4 involved semantically unrelated matching tasks. In the two control conditions, the patient was only provided with the opportunity to try to name the pictures. With the first therapy condition, the criterion for the termination of therapy was reached. Moreover, there were overall significant differences between the different conditions. Some maintenance of the effects of therapy were observed two days later. No generalisation to untreated items was observed, although the patient seemed to be better at identifying the first syllables of words when naming. These results demonstrate that techniques which are designed for remediating particular anomic problems are a better means of therapy than techniques which are not.     

Contributions of the hippocampal subfields and entorhinal cortex to disambiguation during working memory

The hippocampus and medial temporal lobes (MTL) support the successful formation of new memories without succumbing to interference from related, older memories. Computational models and animal findings have implicated the dentate gyrus (DG), CA3, CA1, and entorhinal cortex (EC) in the disambiguation and encoding of well‐established, episodic events that share common elements. However, it is unknown if these hippocampal subfields and MTL (entorhinal, perirhinal, parahippocampal) cortices also contribute during working memory when overlapping stimuli that share related features are rapidly encoded and subsequently maintained over a brief temporal delay. We hypothesized that activity in CA3/DG hippocampal subfields would be greater for the rapid encoding of stimuli with overlapping features than for the rapid encoding of stimuli with distinct features. In addition, we predicted that CA1 and EC, regions that are associated with creating long‐term episodic representations, would show greater sustained activity across both encoding and delay periods for representations of stimuli with overlapping features than for those with distinct features. We used high‐resolution fMRI during a delayed matching‐to‐sample (DMS) task using face pairs that either shared (overlapping condition, OL) or did not share (non‐overlapping condition, NOL) common elements. We contrasted the OL condition with the NOL condition separately at sample (encoding) and during a brief delay (maintenance). At sample, we observed activity localized to CA3/DG, the subiculum, and CA1. At delay, we observed activity localized to the subiculum and CA1 and activity within the entorhinal, perirhinal, and parahippocampal cortices. Our findings are consistent with our hypotheses and suggest that CA3/DG, CA1 and the subiculum support the disambiguation and encoding of overlapping representations while CA1, subiculum and entorhinal cortex maintain these overlapping representations during working memory. © 2013 Wiley Periodicals, Inc.     

Ontogeny of the Therapeutic Alliance in Borderline Patients

The development of the therapeutic alliance is explored in a prospective study of 33 borderline personality disorder patients. Assessments of the alliance were made by both the patients and their therapists using the Penn Helping Alliance Questionnaire at six weeks, six months, and then annually for up to five years.The major findings were: (1) The alliance was rated highly by both patients and therapists throughout treatment; (2) the alliance showed steady and significant improvement over time (and no significant deterioration at any point); (3) patients and therapists corresponded closely in their assessments; (4) therapists rated the alliance higher than did patients at three and four years; (5) therapist ratings of the alliance at six weeks was predictive of subsequent dropping out; but (6) early alliance scores were not strongly related to subsequent level of change. These results frame issues for future research in this area.Die Entwicklung der therapeutischen Allianz wurde in einer prospektiven Studie bei 33 Patienten mit Borderline-Persönlichkeitsstörungen überprüft. Die Einschätzungen der Allianz wurden sowohl von den Patienten als auch von ihren Therapeuten mit Hilfe des Penn Helping Alliance Fragbogens nach sechs Wochen, sechs Monaten und dann jährlich über den Zeitraum von fünf Jahren vorgenommen.Die Ergebnisse der Studie sind: 1) Die Allianz wurde sowohl von den Patienten als auch von den Therapeuten über die gesamte Behandlung hinweg hoch eingeschätzt; 2) Die Allianz verbesserte sich stetig und signifikant innerhalb des Behandlung-szeitrwams und wies keine signifkante Verschlechterung an irgendeiner Stelle des Prozesses auf; 3) Patienten und Therapeuten stimmten in ihren Einschätzungen weitgehend überein; 4) Therapeuten schätzten die Allianz im dritten und vierten Jahr höher ein als die Patienten; 5) Die Einschätzung der therapeutischen Allianz nach sechs Wochen durch den Therapeuten kann spétere Therapieabbrüche vorhersagen, aber 6) die frühen Allianzwerte waren nicht sehr ausgeprägt bezogen auf spätere Veränderungswerte. Die Ergebnisse stecken den Rahmen für zukünftige Studien in diesem Bereich ab.Le développement de l'alliance thérapeutique est exploré dans une étude prospective sur 33 patients avec trouble de la personnalité borderline. Des évaluations de l'alliance ont été faites par les patients et leur thérapeute à l'aide du Questionnaire Penn Helping Alliance, à six semaines, six mois et ensuite annuellement pendant cinq ans.Les découvertes majeures ont été: 1) L'alliance a été à évaluée ‘forte’ à la fois par les patients et les thérapeutes pendant le traitement; 2) L'alliance a montré une amélioration stable et significative à travers le temps (et à aucun moment il n'y a eu de détérioration significative); 3) Les évaluations des patients et des thérapeutes correspondaient fortement; 4) Les thérapeutes ont évalués l'alliance plus forte que l'ont fait les patients aprés trois et quat ans; 5) Les évaluations de l'alliance par les thérapeutes étaient prédictives d'un subséquent désistement; mais 6) Les scores de l'alliance précoce n'étaient pas fortement liés à un subséquent niveau de changement. Ces résultats formulent des points intéressants de discussion pour de futures recherches dans ce domaine.     

Adrenoleukodystrophy in Norway: High Rate of De Novo Mutations and Age-Dependent Penetrance

To investigate X-linked adrenoleukodystrophy in an unselected population, we performed a population based, cross-sectional prevalence study, supplemented by a retrospective study of deceased subjects. Sixty-three subjects (34 males, 29 females) belonging to 22 kindreds were included. Thirty-nine subjects (13 males, 26 females) were alive, and 24 (21 males, 3 females) were deceased on the prevalence day. The point prevalence of X-linked adrenoleukodystrophy in Norway on July 1, 2011, was 0.8 per 100,000 inhabitants. The incidence at birth in the period 1956-1995 was 1.6 per 100,000 inhabitants. An age-dependent penetrance was observed among males and females, with more severe phenotypes appearing with rising age. Only 5% of deceased males had not developed cerebral leukodystrophy. No female older than 50 years was neurologically intact. Sixteen mutations in the ABCD1 gene were identified. De novo mutations were found in 19% of probands. The frequency of X-linked adrenoleukodystrophy was lower in Norway than reported in the literature. A more severe natural course than previously reported was observed, indicating a need for better follow-up of both male and female patients. Given the high rate of de novo mutations, identification programs such as newborn screening may be required to offer timely treatment to all patients.     

The influence of current mood on affective startle modulation

The affect-modulated startle response is a reliable indicator of the affective processing of stimuli. It may be influenced by trait and state affective variables as well as psychopathological status. The aim of the present study was to determine the influence of the current mood state on startle modulation. Forty-five healthy volunteers viewed affective stimuli while eye blink responses and subjective emotional ratings were assessed. In addition, the current state of mood was assessed, pre and post the experimental procedure. Subjects were divided into those that were in a more positive and those that were in a more negative mood based on a median split. Compared to subjects in a positive mood those in a more negative mood showed significantly reduced startle amplitudes after viewing the negative and neutral stimuli. The results of the present study show that changes in startle responses are not only related to the current state of psychopathology but also to the general affective state of the participants during the assessments.