'I'm cured but....': perceptions of illness following treatment.

The current qualitative research studied representations of illness posttreatment from a heart transplant group, a panic disorder group, and a tic disorder group. All three groups were preoccupied with perceptions about the impact of the illness, perception of self and the perception of how others view the ill person. The heart transplant group seem to adopt an active style of coping compared to the panic disorder group who presented a more passive, anticipatory mode of coping, and the tic group who were preoccupied with control over the perceptions of others. This qualitative information could help optimize adaptation strategies.

Acute scrotal swelling in Henoch-Schonlein syndrome: evaluation with testicular scanning.

Acute scrotal swelling may accompany Henoch-Schonlein syndrome and may be the presenting manifestation mimicking testicular torsion. Two patients with scrotal involvement were recently evaluated with nuclear imaging to assess testicular perfusion. One patient had normal perfusion, and the other had increased perfusion. Scan results allowed expectant management and avoided the need for exploratory surgery to rule out testicular torsion.

Clinical and psychological features distinguishing obsessive-compulsive and chronic tic disorders.

Medical and biogenetic research has suggested that obsessive-compulsive disorder and chronic (multiple) tic disorder may share a common etiology. This article reviews corresponding evidence for psychological similarities and differences between the two disorders. There are similarities in self-management strategies, psychological traits (both report high scores on different aspects of perfectionism) and in the ego-syntonic-ego-dystonic cycle of the impulsive-compulsive behavior. Situational cues likely to elicit or worsen the problem differ between the disorders as do associated emotions, comorbidity and background styles of action. In both disorders, cognitive factors, such as anticipations and appraisals of the problem, can play a role in onset and maintenance of the problem, and this raises the question as to whether cognitive or behavioral factors are best addressed in treatment. Psychological characteristics, such as lack of confidence, may contribute to apparent performance deficit. Psychological evaluation, particularly functional analysis, may aid in differential diagnosis between the two disorders, lead to improvement in treatment matching, and in understanding of the multidetermined etiology.

Slow potential correlates of attention dysfunction in senile dementia: II.

The CNV was recorded from Fz and Cz placements in five seniles and five normal elderly subjects over two sessions under five ISI levels. In the first session 32 trials each of five foreperiods with 2, 4, 6, 8 and 10 sec ISIs were recorded. The second session involved presentation of 32 trials of five foreperiods with 1.4, 1.8, 2.2, 2.6 and 3.0 sec ISIs. The use of a repeated measures within subjects design was to avoid the confounding effect of between subject variance. The results suggested that difference between groups in preparatory strategies as measured by amplitude and latency of the CNV were exacerbated for longer ISIs. Though the seniles seemed able to 'keep time' with small changes in ISI the effort invested in preparation of response was far lower than that of the normals. CNV amplitude and latency and RT measures showed that for both groups the optimal preparatory interval was around 2 sec, the seniles requiring a slightly shorter interval than the normal to synchronise preparation and response. Cortical topography differences suggested that the seniles' preparatory strategies were predominantly influenced by the extent of their initial frontal orienting response and that the seniles showed less differentiation between frontal and central recordings. The seniles' dependence on frontal orienting suggests that their performance does not benefit from preparatory set and results in a more stimulus bound divisive set. Implications of these qualitative differences in attentional strategy for behavioural management of senile patients are discussed.

Field dependence, laterality and the EEG.

There is evidence that an individual's 'cognitive style' is related to lateralization of function in the brain, and that this in turn is associated with characteristic EEG coherence spectra. We tested the hypothesis that field dependence (a measure of cognitive organization) and hand preference (a measure of functional organisation) relate to EEG coherence measures in a specific way. The predicted associations were based on the proposal that right preferent individuals have a more specific, and left preferents a more diffuse, system of functional units in the cortex. The association between alpha band resting EEG coherence (sampled on two occasions for both hemispheres from 12 right and 12 left preferent individuals), field dependence (Nyborg's criterion of frame dependence on a rod and frame test), and laterality scores (questionnaire and manual performance), was measured by Kendall's coefficient of concordance (W). Significant associations support the proposed model except for coherence within the left preferents' right hemisphere. It is argued that the right hemisphere is more specifically organised in strong sinistrals than the general model would predict. These and other results support the use of EEC coherence measures in the study of cerebral functional organisation.

Dizziness: behavioural, subjective and organic aspects.

The aim of the study was to investigate the relationship between medical and behavioural aspects of dizziness, and the subjective experiences before, during and after an 'attack'. Clinical and self-report data were collected on 60 patients who attended a neuro-otology clinic and whose main complaint was dizziness. The results indicated little direct correlation between subjective experience and organic severity, though there was some correlation between types of movement provocation and both subjective and organic factors. Correspondence analysis of self-reported dizzy sensations revealed four principal clusters. There was a clear distinction between attacks characterized by sensations of actual loss of balance and those preceded by autonomic sensations. Two types of mainly psychologically generated dizziness were proposed: one characterized by inhibition of sensory-motor processes and breathing problems; the other by a range of sympathetic signs. It is suggested that the reporting of sensations should be considered as an independent part of dizziness behaviour and not as a by-product of the physiological disturbance.

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders.

The aim was to evaluate the efficacy of a manualized cognitive-behavioural program based on habit reversal for the management of chronic tic disorder (CTD) and habit disorder (HD). Forty-seven CTD and 43 HD received a 4-month treatment program. Thirty-eight (22 CTD, 16 HD) were placed on a waitlist control group, which subsequently received treatment. The treatment approach combined awareness training, relaxation (including modification of a tension-producing style of action), and habit-reversal training, with more general cognitive restructuring of anticipations linked to ticcing. Sixty-five percent of completers reported between 75 and 100% control over the tic. At 2-year follow-up, 52% rated 75-100% control. There were also significant changes post-treatment in measures of self-esteem, anxiety, depression and style of planning action. Successful tic/habit modification was associated in CTD and HD groups with successful change in style of planning action. There were no consistent differences in any outcome measures between CTD and HD groups.

Construing contexts: problems and prospects of George Kelly's personal construct psychology.

Kelly's concept of man is that of a scientist formulating hypotheses about the world and revising them in the light of their predictive utility. His position is one of subjective realism by which each of us interprets the world according to personal dimensions termed constructs. Establishing knowledge about how others construe the world is made possible in clinical situations by recourse to two Kellyan methods: the character sketch and the role construct repertory test. The former relies on clinical observation, the latter on statistical sophistication. This divergence in methods has led to an ideological split in the following that Kelly spawned, which need not, however, be a barrier to clinical research in this field. Although not all cognitive therapists are constructivists, they share with the latter the desire to look for core patterns underlying individual maladaptive thoughts and actions. Kelly's methods can be applied to the functional analysis favoured by cognitive behaviourists, with clinical gains resulting from the quicker access this provides to personal meaning. But cognitive psychology's schematic approach to organization is a challenge to Kelly's, which conceives of everyday experience solely in terms of the logical nature of construing. Some constraints and assumptions of Kelly's dialectical logic may be avoided by adopting a more phenomenological approach to construing.

Personal constructs associated with tics.

Thirteen subjects experiencing chronic tics kept diaries noting frequency, intensity and degree of control of their tic during their daily routines for one week. Three examples of high-, medium- and low-risk situations were chosen as elements and, using a modified form of Kelly's repertory grid, bipolar constructs were elicited by comparing the three types of situations. Principal dimensions extracted from INGRID analyses differed across individuals but related to three principal areas; self-image, degree of task involvement and type of task demand. Feelings of impatience and frustration frequently accompanied tic onset. Subjects' cognitive evaluations of their tic situations may be important in tic management.

A dialogical approach to obsessions.

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

Relation of eye movements to errors on the Rod-and-Frame Test.

By a selective-attention model of rod-and-frame test performance frame-independent (small error) subjects are better able than frame-dependent (large error) subjects to select out relevant cues (the rod) while suppressing irrelevant ones (the frame). However, certain clinical studies have implied that smaller errors can be obtained by employing eye-movement strategies that ignore rather than actively suppress irrelevant cues. In this study the number, magnitude, and rate of eye movements were measured in 15 subjects actively engaged in the test. While no discernible relationship of these variables to test errors was determined for frame-dependent subjects, significant negative correlations of rate and magnitude of movement with errors were demonstrated for frame-independent subjects. Group differences were observed in number and magnitude of eye movements. These findings are discussed as support for the hypothesis of selective attention.

Changes in construals of tic-producing situations following cognitive and behavioral therapy.

12 clients suffering from chronic tics participated in one of two treatment programs, either a behavioral group using competing response therapy or a group using Beck-style cognitive restructuring. A repertory grid based upon the personal construct psychology of George Kelly was administered to all clients before and after treatment. The grid comprised a set of elements made up of situations with high, medium, and low risk of eliciting tics, and constructs were derived from comparisons between them. Clients' ratings of the elements on the constructs were subjected to a principal components analysis using an INGRID program. Following treatment the total variation around construct means decreased in both groups but significantly more in the cognitive group, indicating a narrowing of the difference in their perceptions of situations which formerly indicated high and low risk of inducing tics.

[Cognitive aspects and treatment of delusional disorders.]. / Le traitement du trouble délirant et ses aspects cognitifs.

This article reviews the cognitive phenomenology of delusional disorders (DD) and examines the current cognitive models. Some case studies have shown considerable promise concerning the utilisation of cognitive behavioral therapy (CBT) for the treatment of DD, even if this approach is in its infancy. Although the stages of CBT to treat DD are very similar to that of other psychotic disorders, there are also considerable differences. However, it is essential to combine several strategies in order to modify inferences specific to DD. The clinical evaluation of delusions as well as the application of CBT as a treatment is illustrated in two cases with a diagnosis of DD with persecutory subtype. The cases required different time periods for different stages of CBT and highlight the importance of tailoring CBT according to need.

Cognitive behaviour therapy and medication in the treatment of obsessive-compulsive disorder.

OBJECTIVE: To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive-compulsive disorder (OCD). METHOD: Forty-eight participants (43 completers) were recruited into two protocols. In the first protocol, 21 people with OCD were randomly allocated to either a standard medication (fluvoxamine) or standard placebo condition for a 5-month period. Both these groups subsequently received CBT for a further 5 months. In the second protocol, 22 people with OCD received CBT, one group was already stabilized on an antidepressant of choice; the second group was drug naïve. RESULTS: All active treatments, but not the placebo, showed clinical improvement. There was no difference in treatment response to CBT regardless of whether participants had previously received medication or placebo. CONCLUSION: CBT has a more specific antiobsessional effect than medication but CBT plus medication shows greatest overall clinical improvement in mood.

Evaluation of an inference-based approach to treating obsessive-compulsive disorder.

This study evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. "Maybe the door is open", "My hands could be dirty") as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.

The EEG as a measure of cerebral functional organization.

Evidence suggests that anomalies of functional organization in the brain may be present in some psychiatric disorders and that EEG differences between psychiatric patients and appropriate control groups may depend on them. It is therefore of practical importance to develop further ways of examining the association between the EEG and such organization. The change in inter-hemisphere coherence (a measure of EEG synchronicity) in the alpha frequency band when carrying out a task is shown to discriminate a group of II right from II left preferent normal individuals. Since right and left preference is associated with differences in cerebral functional organization, the coherence measure may be a useful way of studying this feature of psychiatric illness.

Cognitive style, cortical function, and electroconvulsive therapy.

Performance on the rod and frame test (RFT) was measured over three separate occasions in three groups of 20 depressive patients and a nonpatient control group. Depressive patients were selected into three groups according to whether they had been prescribed one of three forms of treatment: bilateral electroconvulsive therapy (ECT), nondominant unilateral ECT, or a course of antidepressant drugs. The RFT was administered on three occasions: before treatment, 1 week after completion of treatment, and at 3 months follow-up. The control group received no treatment, but were tested at comparable periods. The RFT was scored as mean absolute error and also as separate frame-dependent, rod-dependent, and constant error components. All depressive groups showed improved error measures post-treatment. The two ECT groups showed less frame dependence post-treatment than the drug group. The group receiving bilateral ECT showed a greater decrease in the mean error of performance than the unilateral group. Right-sided unilateral ECT affected frame dependence in patients who were initially frame independent, rather than in those who were initially frame dependent. The results indicated that the effect of ECT may depend on a patient's initial pretreatment cognitive style.

Evaluation of a computer interview system for use with neuro-otology patients.

The effectiveness, feasibility and credibility of a computer assessment package was evaluated in a group of 60 neuro-otological outpatients. The computer system was compared with a standard questionnaire and used to elicit basic neuro-otological information prior to clinical interview. The majority of patients (81%) preferred computer assessment. There were no differences in attitude or difficulties between diagnostic groups. Older patients had more difficulties and took longer than younger patients. The computer system was also more efficient than the form from an information handling and administrative point of view.

Priapism: current concepts.

The treatment options for the management of the patient with priapism have changed markedly within the past several years. When possible, the underlying cause of the priapism should be identified. Therapy should be guided by the results of aspiration of the blood-filled corpora cavernosa of the erect penis. Early intervention through pharmacologic manipulation or surgical shunting should not be delayed while trying conservative measures.