Reaching Out to Problem Anger: Assessing the Effectiveness of One-Day Cognitive Behavioural Workshops in a Community Setting in the UK.

BACKGROUND: Problem anger is frequently experienced by the general population and is known to cause significant problems for the individual and those around them. Whilst psychological treatments for problem anger are becoming increasingly established, this is still an under-researched area of mental health. We present an evaluation of a series of one-day anger management workshops for the public, targeting problem anger with a cognitive-behavioural approach. AIMS: The main aim was to evaluate the effectiveness of a brief group-based anger intervention in terms of subjectively reported anger provocation levels and of depression and anxiety. METHOD: Workshop participants completed a number of questionnaire measures at baseline before the intervention and at 1 month follow-up. The key questionnaires measured self-reported anger provocation levels (Novaco Anger Scale-Provocation Inventory), depressive symptomatology (PHQ-9) and symptoms of generalized anxiety (GAD-7). Change scores were analysed using repeated measures analyses. RESULTS: We found a significant reduction in anger provocation among workshop participants at 1 month follow-up (p = .03). Reductions in depression and anxiety were not statistically significant. CONCLUSIONS: We conclude that this brief psychoeducational anger intervention was effective in a small community sample and suggest future work should assess the effectiveness on similar brief interventions using a larger client group and examine outcomes on a broader range of anger measures.

Persistent anterograde amnesia following limbic encephalitis associated with antibodies to the voltage-gated potassium channel complex.

OBJECTIVE: Limbic encephalitis (LE) associated with antibodies to the voltage-gated potassium channel complex (VGKC) is a potentially reversible cause of cognitive impairment. Despite the prominence of cognitive dysfunction in this syndrome, little is known about patients' neuropsychological profile at presentation or their long-term cognitive outcome. METHODS: We used a comprehensive neuropsychological test battery to evaluate cognitive function longitudinally in 19 patients with VGKC-LE. RESULTS: Before immunotherapy, the group had significant impairment of memory, processing speed and executive function, whereas language and perceptual organisation were intact. At follow-up, cognitive impairment was restricted to the memory domain, with processing speed and executive function having returned to the normal range. Residual memory function was predicted by the antibody titre at presentation. CONCLUSIONS: The results show that, despite broad cognitive dysfunction in the acute phase, patients with VGKC-LE often make a substantial recovery with immunotherapy but may be left with permanent anterograde amnesia.

Accelerated long-term forgetting (ALF) and transient epileptic amnesia (TEA): two cases of epilepsy-related memory disorder.

Temporal lobe epilepsy (TLE) has long been associated with memory impairment. Recently, two specific forms of memory complaint in this population have been identified: accelerated long-term forgetting (ALF) and transient epileptic amnesia (TEA). This paper presents neuropsychological data (standard neuropsychological tests and experimental measures) on two patients who presented in the epilepsy clinic with seemingly similar subjective reports of profound memory difficulties. This paper illustrates the differences between TEA and ALF. Our focus was on measuring long-term forgetting utilizing a novel visual and verbal test protocol, with responses elicited via verbal prompts over the telephone at intervals up to 30 days. Whereas patient SK had neuropsychological test evidence of problems with learning plus ALF at short and long intervals without clinical evidence of TEA, patient EB had clinically convincing TEA without neuropsychological test evidence of ALF. In particular, SK showed accelerated forgetting while EB did not. This detailed case work develops our understanding of ALF measurement and demonstrates that ALF and TEA can be dissociated.

Autobiographical memory and the self in a case of transient epileptic amnesia.

Transient epileptic amnesia (TEA) is characterized by deficits in autobiographical memory (AM). One of the functions of AM is to maintain the self, suggesting that the self may undergo changes as a result of memory loss in temporal lobe epilepsy. To examine this, we used a modification of a task used to assess the relationship between self and memory (the IAM task) in a single case, E.B. Despite complaints of AM loss, E.B. had no difficulty in producing a range of self-images (e.g., I am a husband) and collections of self-defining AMs in support of these statements. E.B. produced fewer episodic memories at times of self-formation, but this did not seem to impact on the maintenance of self. The results support recent work suggesting the self may be maintained in the absence of episodic memory. The application of tasks such as that used here will further elucidate AM impairment in temporal lobe epilepsy.

Assessing a Metacognitive Account of Associative Memory Impairments in Temporal Lobe Epilepsy.

Previous research has pointed to a deficit in associative recognition in temporal lobe epilepsy (TLE). Associative recognition tasks require discrimination between various combinations of words which have and have not been seen previously (such as old-old or old-new pairs). People with TLE tend to respond to rearranged old-old pairs as if they are "intact" old-old pairs, which has been interpreted as a failure to use a recollection strategy to overcome the familiarity of two recombined words into a new pairing. We examined this specific deficit in the context of metacognition, using postdecision confidence judgements at test. We expected that TLE patients would show inappropriate levels of confidence for associative recognition. Although TLE patients reported lower confidence levels in their responses overall, they were sensitive to the difficulty of varying pair types in their judgements and gave significantly higher confidence ratings for their correct answers. We conclude that a strategic deficit is not at play in the associative recognition of people with TLE, insofar as they are able to monitor the status of their memory system. This adds to a growing body of research suggesting that recollection is impaired in TLE, but not metacognition.

Assessment of everyday memory functioning in temporal lobe epilepsy and healthy adults using the multifactorial memory questionnaire (MMQ).

Temporal lobe epilepsy (TLE) is associated with differing degrees of objective and subjective memory impairment. Memory self-report is an important part of the assessment process but few reliable and valid measures have been researched with this group. We thus aimed to explore subjective impairments with a robust measure: the multifactorial memory questionnaire (MMQ; Troyer and Rich, 2002). This was administered to 82 people with TLE and an age and education matched control group of the same size. The questionnaire probes worries about memory (MMQ-contentment); subjective forgetfulness (MMQ-ability); and use of compensatory strategies (MMQ-strategy). The TLE group reported significantly more worries about their memory, more instances of forgetfulness and use of more strategies than control participants. Strategy use was related to demographic factors in controls but not in the TLE group. Analysis of epilepsy related factors indicated that hemispheric laterlisation subgroups did not differ from one another on any subscale, nor did participants grouped according to their use of one, several, or no anti-epileptic medications. Measures of chronicity including age of onset and illness duration also failed to correlate with the MMQ subscales. Because objective memory performance is often impaired in more chronic and intractable cases, the lack of difference in subjective complaint is surprising and warrants future research to examine the relationship between this questionnaire and standardized test scores. We conclude that the MMQ is a clinical measure that could be used either outside or in tandem with neuropsychological assessment to gauge everyday memory difficulties among epilepsy patients.

Persistent psychogenic déjà vu: a case report.

INTRODUCTION: Déjà vu is typically a transient mental state in which a novel experience feels highly familiar. Although extensively studied in relation to temporal lobe epilepsy as part of simple partial seizures, déjà vu has been less studied in other clinical populations. A recent review of temporal lobe epilepsy suggested a possible link between clinical levels of anxiety and debilitating déjà vu, indicating further research is required. Here, for the first time in the literature, we present a case study of a young man with anxiety and depersonalisation who reported experiencing persistent and debilitating déjà vu. This report therefore adds to the limited literature on the relationship between anxiety and déjà vu. CASE PRESENTATION: A 23-year-old White British man presented with a form of persistent déjà vu in 2010, approximately 3 years since symptom onset. He reported a history of anxiety and experiencing feelings of depersonalisation. Neurological assessment (electroencephalogram and magnetic resonance imaging) did not indicate any abnormalities. We assessed his recognition memory with a task used in patients with dementia who report similar experiences but lack awareness of their falseness. CONCLUSIONS: Our case's memory performance was more conservative than controls but did not indicate a memory deficit. Unlike other patients with chronic déjà vu (for example, in dementia), he is fully aware of the false nature of his déjà vu and this presumably leads to his intact recognition memory performance. We suggest that his persistent déjà vu is psychogenic and conclude that déjà vu should be further studied in psychiatric disorders.

Déjà experiences in temporal lobe epilepsy.

Historically, déjà vu has been linked to seizure activity in temporal lobe epilepsy, and clinical reports suggest that many patients experience the phenomenon as a manifestation of simple partial seizures. We review studies on déjà vu in epilepsy with reference to recent advances in the understanding of déjà vu from a cognitive and neuropsychological standpoint. We propose a decoupled familiarity hypothesis, whereby déjà vu is produced by an erroneous feeling of familiarity which is not in keeping with current cognitive processing. Our hypothesis converges on a parahippocampal dysfunction as the locus of déjà vu experiences. However, several other temporal lobe structures feature in reports of déjà vu in epilepsy. We suggest that some of the inconsistency in the literature derives from a poor classification of the various types of déjà experiences. We propose déjà vu/déjà vécu as one way of understanding déjà experiences more fully. This distinction is based on current models of memory function, where déjà vu is caused by erroneous familiarity and déjà vécu by erroneous recollection. Priorities for future research and clinical issues are discussed.

The role of age of acquisition in memory: effects on judgements of learning and recall.

Judgements of learning (JOLs) are self-made predictions of the likelihood that one will later recall information. The influence of stimulus characteristics on JOLs and recall continues to receive attention, yet there are still a number of unexplored lexical word features that may exert an effect on mnemonic processing. Using a standard cue-target paradigm, we focused on the role of word age of acquisition (AoA) and evaluated the role of both cue and target AoA on responses. We replicated the robust delayed-JOL effect and used a novel items analysis approach to examine the relationship between intrinsic word features and accuracy and reaction times for both JOLs and recall. A consistent effect of target AoA was found, even after controlling for a range of covariates previously shown to impact JOLs and recall. These results expand the role of AoA in word processing and suggest that it is a key variable in memory and metacognition; they also support Koriat's (1997) cue utilization framework.