Patterns of hypnotic response, revisited.

It has long been speculated that there are discrete patterns of responsiveness to hypnotic suggestions, perhaps paralleling the factor structure of hypnotizability. An earlier study by Brenneman and Kihlstrom (1986), employing cluster analysis, found evidence for 12 such profiles. A new study by Terhune (2015), employing latent profile analysis, found evidence for three such patterns among highly hypnotizable subjects, and a fourth comprising subjects of medium hypnotizability. Some differences between the two studies are described. Convincing identification of discrete "types" of high hypnotizability, such as dissociative and nondissociative, may require a larger dataset than is currently available, but also data pertaining directly to divisions in conscious awareness and experienced involuntariness.

[On the concept of lucidity]. / Sobre el concepto de lucidez.

Kraepelin's concept of clarity of awareness (lucidity) had a stable signification during more than hundred years. It is the basis of most of current theories of disturbed consciousness. However, two alternative definitions that arise in Buenos Aires produce confusion due to their conceptual overlap. We discuss these definitions and propose a classification of disorders of consciousness that rely on traditional point of view.

Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis.

The integrated model of insight in schizophrenia suggests that poor insight is the result of multiple factors which compromise persons' abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses. This model hypothesizes that metacognitive deficits, or difficulties forming a complex and integrated understanding of the self and others, influence insight, regardless of other proximal causes including clinical profile. To explore this possibility, we performed a latent class analysis on 324 adults with schizophrenia or schizoaffective disorder. This analysis produced 4 groups on the basis of assessment of insight and Positive and Negative Syndrome Scale (PANSS) positive, negative, cognitive, and hostility symptoms. The resultant groups were characterized as: Good Insight/Low Symptoms (n = 71), Impaired Insight/High Negative Symptoms, (n = 43), Impaired Insight/High Positive Symptoms (n = 50) and Impaired Insight/Diffuse Symptoms (n = 160). When we compared metacognitive function as assessed with the Metacognition Assessment Scale - Abbreviated (MAS-A) across groups, we found that the good insight group had better overall metacognition as well as higher levels of self-reflectivity, awareness of the other and mastery as compared to all 3 groups with impaired insight. When controlling for total symptoms, all differences in metacognitive function between the good insight and the impaired insight groups remained significant. These results are consistent with the view that, independent of symptoms, impaired metacognition contributes to difficulties integrating information and hence impedes insight, or awareness of psychiatric challenges. Consistent with extant literature, results suggest that interventions focusing on metacognition as the target may lead to improved insight.

A study on diabetes-related self-care plan and its determinants among diabetes patients in a Warangal region, Telangana, India

Abstract The prevalence of epidemiological diseases, including diabetes, has continued to increase because of the adaption of Western culture and the lack of self-care activities among patients with diabetes. Therefore, in this cross-sectional study, we aimed to assess self-care plans and determinants among diabetes outpatients in Warangal. We conducted a prospective observational study among diabetes outpatient clinic in Warangal, India over 6 months from October 2019 to March 2020. We used the expanded Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A P value of less than < 0.05 was considered statistically significant. Respondents (mean age, 52.3 (standard deviation (SD), 11.01) years) had an overall SDSCA score of 49.18 ± 3.57 (SD). Mean scores for the diet, physical activity, foot care, medication adherence, and blood sugar testing scales were 12.79 (SD, 1.61), 10.24 (SD, 1.77), 15.67 (SD, 1.5), 5.66 (SD, 1.17), and 4.80 (SD, 0.68), respectively. Patients' age, education, disease duration and hemoglobin A1C (HbA1C) levels of <7.5% (P < 0.001)) had significantly higher mean scores for blood sugar testing, diet, physical activity, and adherence (P < 0.001). The employment status is associated with all the domains of Summary of Diabetes Self-Care Activities (P < 0.001). Taken together, our results revealed that patients with diabetes in Warangal had poor self-care planning, highlighting the need for strengthening initiatives that generate awareness regarding diabetes and improving related self-care practices

Bispectral electroencephalographic analysis of head-injured patients in the emergency department.

OBJECTIVES: Bispectral analysis of single-lead electroencephalographs (BIS) has proven valuable in assessing the level of awareness in sedated patients. In this study, the authors sought to determine if BIS values had a predictive value in patients with traumatic brain injuries (TBIs). Therefore, the objective was to determine in emergency department (ED) patients presenting with head trauma whether BIS and Glasgow Coma Scale score (GCS) prior to sedation would be sensitive and specific in predicting TBI. METHODS: A convenience sample of patients with known or suspected head trauma presenting between June and August of both 2001 and 2002 were entered into the study by having a BIS monitor placed immediately on presentation to the ED. BIS and GCS scores were collected every 2 minutes. Head computed tomography (CT) results and discharge dictations were then evaluated to determine the presence of TBI. RESULTS: Fifty-two patients were entered into the study; 13 were excluded due to receiving sedatives prior to enrollment. Of the remaining 39 patients, 14 had intracranial hemorrhage on initial head CT. Of these 14, two had BIS scores over 95. Both of these were neurologically intact at discharge. Eleven of the 12 remaining patients died or left the hospital neurologically impaired. Of the patients with no abnormalities on initial head CT, 19 of 25 had initial BIS scores >95 and all left the hospital neurologically intact. Of the patients with normal initial head CT and initial BIS scores < 95, four of six died or were neurologically impaired at discharge. Twenty of 39 patients presented with an initial GCS of 15; four of 20 had an initial BIS score < 95, three of whom were neurologically impaired at discharge. The 16 of 20 with BIS >95 left the hospital neurologically intact. All patients with a GCS of 14 had BIS scores >95 and left the hospital neurologically intact. All patients with a GCS of 13 had initial BIS scores < 95 and were neurologically impaired at discharge. One patient with a GCS of 11 and a BIS score of 67 left the hospital neurologically intact; all other patients with a GCS < 12 had a BIS < 95 and left the hospital with a neurologic deficit. CONCLUSIONS: BIS scores obtained prior to sedative medicines in the face of trauma are predictive of TBI and neurologic outcome at discharge.

Attention versus consciousness in the visual brain: differences in conception, phenomenology, behavior, neuroanatomy, and physiology.

A common confound between consciousness and attention makes it difficult to think clearly about recent advances in the understanding of the visual brain. Visual consciousness involves phenomenal experience of the visual world, but visual attention is more plausibly treated as a function that selects and maintains the selection of potential conscious contents, often unconsciously. In the same sense, eye movements select conscious visual events, which are not the same as conscious visual experience. According to common sense, visual experience is consciousness, and selective processes are labeled as attention. The distinction is reflected in very different behavioral measures and in very different brain anatomy and physiology. Visual consciousness tends to be associated with the "what" stream of visual feature neurons in the ventral temporal lobe. In contrast, attentional selection and maintenance are mediated by other brain regions, ranging from superior colliculi to thalamus, prefrontal cortex, and anterior cingulate. The author applied the common-sense distinction between attention and consciousness to the theoretical positions of M. I. Posner (1992, 1994) and D. LaBerge (1997, 1998) to show how it helps to clarify the evidence. He concluded that clarity of thought is served by calling a thing by its proper name.

Evaluation of adherence to pharmacological treatment

The adherence to therapy associated with the socio-demographic variables and the habits of patients with hypertension and/or diabetes mellitus were investigated in this study. The registration forms of 105 patients in the Hiperdia program in the municipality of Campina Grande-PB were used as a data collection instrument, applying the Morisky-Green test (MGT) and Batalla test (BT) to assess compliance treatment. For the MGT, there was a prevalence of non-adherent individuals (76.2%) and the type of predominant behavior was unintentional. The internal consistency of the responses obtained through the MGT presented good reliability, according to the value of 0.69 obtained by Cronbach's alpha. For the BT, there was a predominance of adherence (68.6%) and the alpha value was 0.80, showing a high reliability level. It was found that a diet lacking in salt is a strong impact variable for determining the adherence to the BT. Given the representativity of the tests, there is a need to amend the interferences that facilitate the low adherence to drug treatment. The results of this study can be used to construct strategies that will address these difficulties and optimize the adherence level and quality of life of patients.

The role of memory in awareness of memory deficits in Alzheimer's disease, schizophrenia, and brain injury.

Patients with neuropsychiatric disorders such as Alzheimer's disease (AD), schizophrenia (Sz), and brain injury (BI) often show memory deficits and lack of awareness of those deficits. This study aimed to investigate the role of memory in awareness of memory deficits and illness in multiple patient groups. Comparison of awareness profiles between groups can reveal common or distinct patterns of awareness and predictors, which may inform theories about the structure of awareness. Using the same standardized measures, AD (N = 27) Sz (N = 31), and BI (N = 26) patients were compared on memory functioning, awareness of illness, and awareness of memory deficits-measured by discrepancy of pretest estimate and actual test scores. All groups were poor at pretest estimation of memory functioning, particularly the AD and BI groups. In AD, patients with the lowest memory functioning rated their performance highest. The BI group and to a lesser extent the AD group showed improved estimations of performance following the memory test. Those with the poorest memory showed the greatest improvement in ratings accuracy post test. The relationship between memory and awareness of memory was stronger than the association between memory and awareness of illness. There was a double dissociation between awareness of memory and awareness of illness across patient groups. The study shows that awareness of memory is linked to memory functioning, while memory is only modestly related to awareness of illness. Dissociations in the role of memory in different domains of awareness and "online" awareness of performance provide information to refine cognitive models of awareness. However, the results should be interpreted with caution given the heterogeneous nature of the sample.

Além das curvas de crescimento: investigando o atendimento pediátrico e as práticas de puericultura na formação em residências médicas / Beyond growth curves: investigating service pediatric care and childcare practices in training in medical residencies

Este Trabalho de Conclusão de Curso (TCC) investiga a prática da puericultura e o atendimento pediátrico por residentes, com foco no aprendizado, confiança e atualizações dos profissionais, proporcionados pelos programas de residência médica. Os resultados revelam que a atualização é crucial para garantir a qualidade do atendimento, considerando as constantes evoluções na área pediátrica. Aspectos como crescimento, desenvolvimento neuropsicomotor, vacinação, diário alimentar e dinâmica familiar são fundamentais na consulta de puericultura e a conscientização sobre a importância da vacinação também é relevante. Promover programas de residência médica com formação teórica sólida e baseada em evidências científicas é essencial para o desenvolvimento de profissionais preparados para uma prática pediátrica de excelência, beneficiando diretamente a saúde das crianças e adolescentes atendidos. Palavras-chave: Medicina baseada em evidências. Puericultura. Hospitais de Ensino. Pediatria. Residência médica.

Mindfulness and its relationship to emotional regulation.

Research on the effectiveness and mechanisms of mindfulness training applied in psychotherapy is still in its infancy (Erisman & Roemer, 2010). For instance, little is known about the extent and processes through which mindfulness practice improves emotion regulation. This experience sampling study assessed the relationship between mindfulness, emotion differentiation, emotion lability, and emotional difficulties. Young adult participants reported their current emotional experiences 6 times per day during 1 week on a PalmPilot device. Based on these reports of emotions, indices of emotional differentiation and emotion lability were composed for negative and positive emotions. Mindfulness was associated with greater emotion differentiation and less emotional difficulties (i.e., emotion lability and self-reported emotion dysregulation). Mediational models indicated that the relationship between mindfulness and emotion lability was mediated by emotion differentiation. Furthermore, emotion regulation mediated the relationship between mindfulness and both negative emotion lability and positive emotion differentiation. This experience sampling study indicates that self-reported levels of mindfulness are related to higher levels of differentiation of one's discrete emotional experiences in a manner reflective of effective emotion regulation.

Perception versus reality awareness of physical activity levels of British children.

BACKGROUND: Interventions to increase children's physical activity have had limited success. One reason may be that children and their parents overestimate children's levels of physical activity, although there is a small amount of data on this topic. PURPOSE: This study aims to assess awareness of physical activity levels among British school children aged 9-10 years and their parents. METHODS: Physical activity was measured using an accelerometer in a cross-sectional study of 1892 children (44% male; M age=10.3 years, SD=0.3) from 92 Norfolk schools (Sport, Physical Activity and Eating Behavior: Environmental Determinants in Young People [SPEEDY] study). Data were collected between April and July 2007 and analyzed in 2008. Inactive was defined as <60 minutes/day of moderate and vigorous physical activity. Agreement between physical activity perception (child- and parent-rated) and objective physical activity was assessed. Associations between biological (height, weight, fat mass index); parental (support, BMI, physical activity); and peer factors (support, objective physical activity) and child and parental physical activity awareness were studied using multinomial logistic regression. RESULTS: In all, 39% of girls and 18% of boys were inactive. A total of 80% of parents of inactive children wrongly thought that their child was sufficiently active. In all, 40% of inactive children overestimated their physical activity level. Compared to parents who accurately described their children as inactive, parents who overestimated were more likely to have girls (p=0.005), to have a child with a lower fat mass index (p<0.001), or to report more parental and peer support (p=0.014 and p<0.001, respectively). CONCLUSIONS: Most parents of inactive children wrongly consider their children to be sufficiently active; parents of children with a lower fat mass index appear to assume that their children are adequately active. Increasing awareness regarding health benefits of physical activity beyond weight control might help reverse misperceptions of physical activity levels and encourage behavior change.

Awareness of dysphagia by patients following stroke predicts swallowing performance.

Patients' awareness of their disability after stroke represents an important aspect of functional recovery. Our study aimed to assess whether patient awareness of the clinical indicators of dysphagia, used routinely in clinical assessment, related to an appreciation of "a swallowing problem" and how this awareness influenced swallowing performance and outcome in dysphagic stroke patients. Seventy patients were studied 72 h post hemispheric stroke. Patients were screened for dysphagia by clinical assessment, followed by a timed water swallow test to examine swallowing performance. Patient awareness of dysphagia and its significance were determined by detailed question-based assessment. Medical records were examined at three months. Dysphagia was identified in 27 patients, 16 of whom had poor awareness of their dysphagic symptoms. Dysphagic patients with poor awareness drank water more quickly (5 ml/s vs. <1 ml/s, p = 0.03) and took larger volumes per swallow (10 ml vs. 6 ml, p = 0.04) than patients with good awareness. By comparison, neither patients with good awareness or poor awareness perceived they had a swallowing problem. Patients with poor awareness experienced numerically more complications at three months. Stroke patients with good awareness of the clinical indicators of dysphagia modify the way they drink by taking smaller volumes per swallow and drink more slowly than those with poor awareness. Dysphagic stroke patients, regardless of good or poor awareness of the clinical indicators of dysphagia, rarely perceive they have a swallowing problem. These findings may have implications for longer-term outcome, patient compliance, and treatment of dysphagia after stroke.

Illness awareness in cancer patients: a conceptual framework and a preliminary classification hypothesis.

The study describes the initial phases of research aimed at developing a methodology for assessing awareness in cancer patients. A first sample of cancer patients (n = 36) was interviewed about their knowledge of the diagnosis and their perception of treatment goals and outcomes. Thirteen domains which refer both to cognitive and emotional areas were identified, and considered as content valid by a panel of six experts. A second sample of patients (n = 54) participated in a semi-structured interview developed to explore awareness by means of the domains identified. Seven patterns of awareness were identified, ranging from 'completely aware patient' to 'completely unaware patient'. Twenty of the 54 patients (37.0%) were completely aware, 19 (35.2%) were partially aware with defence mechanisms and 15 (27.8%) were not aware of their diagnosis. Patients from the National Cancer Institute were more frequently aware (54.3%) compared with the patients interviewed in the community hospitals (5.3%) (p < 0.001). A computerized content analysis allowed the identification of two main groups of patients on the basis of the content of the recorded interviews. This independent classification agreed with the classification of the patients performed by the psychologists, suggesting the validity of the procedure of awareness evaluation proposed in this study.

Ethanol-related visits by adolescents to a pediatric emergency department.

The objectives of this study were to determine if the presence of ethanol (ETOH) in patients 10 to 20 years of age is associated with injury and if the patient's mental status reliably predicts their blood ethanol concentration. The study was designed as a retrospective, case-controlled report from a children's hospital emergency department. The data are from 45 patients 10 to 20 years old in whom ETOH was detected on toxic screen and 37 patients (N-ETOH) 10 to 20 years old in whom a toxic screen did not reveal ETOH. Injury occurred in 51% of the ETOH group and 8% (P = 0.0001) of the N-ETOH group. A correlation between blood ETOH level and mental status was found only at the extremes of blood ETOH levels. We conclude that the presence of ETOH may predispose adolescents to injury, requiring treatment in an emergency department. Except at the extremes of ETOH levels, mental status does not predict blood levels. A prospective assessment of mental status and blood ETOH levels in adolescents is needed before mental status assessment can replace the determination of blood ETOH concentrations.

Correlates of insight in serious mental illness.

This study extends research into insight by examining its relationship to a variety of demographic, clinical, neurocognitive, and psychosocial variables among a broad diagnostic sample of 211 adults with serious mental illness. Participants completed a full battery of instruments measuring these variables. Results support a relationship between ratings of poor insight and a psychotic (vs. mood) diagnosis, increased psychiatric symptoms, poorer social skills, and negative medication attitudes. Minorities and those with a substance abuse diagnosis were also more likely to be rated as having poor insight. No relationship was found between level of insight and age, gender, education level, neurocognitive deficits, hospitalization history, size of one's social network, or quality of life measures. Results are discussed in the context of improving the measurement and assessment of insight, conceptualizing interventions aimed at addressing level of insight, and improving outcomes for patients with severe and persistent mental illness. Findings also support a need for continued investigation of how mental illness is understood, experienced, and expressed across diverse groups of people living with mental illness.

Epileptic seizures and pseudoseizures from the viewpoint of the hierarchy of consciousness.

Epileptic seizures and pseudoseizures in temporal lobe epilepsies were studied from the viewpoint of the hierarchy of consciousness. Twenty-two patients with temporal lobe epilepsies (TLE) who showed true amnesia or impairment of consciousness developing from the dreamy state, even though their actions and movement continued, were selected among 160 patients with TLE, nine patients with manifested pseudoseizures, pseudoseizure status, and complex partial seizure status (CPSE) were investigated. Twelve patients in whom impairment of consciousness followed the dreamy state recognized their own existence and maintained some self-directed consciousness. The other 10 patients with amnesia were aware of their goals. Furthermore, pseudostatus ranged from epileptic seizures during pseudoseizure status to pseudoseizures during status epilepticus (SE). In some cases of CPS, awareness and self-directed consciousness were only partially pseudoseizures, disorders of self-directed consciousness are assumed to influence awareness and arousal.