Cognitive function in diabetes mellitus: the effects of duration of illness and glycaemic control.

Post-mortem studies suggest that chronic, poorly controlled diabetes mellitus might be associated with degenerative changes in the central nervous system. However, the evidence that these changes are reflected in any impairment of cognitive performance is equivocal. The study reported here evaluated the effects of duration of illness and glycaemic control upon memory function in 40 cases of insulin-dependent diabetes mellitus (IDDM). Duration of illness was inversely related to performance, but degree of glycaemic control had no effect at all. This suggests that any impairment of cognitive function associated with IDDM is more likely to be attributable to the impact of suffering from a life-threatening disease rather than to organic neurological damage. The effect of chronicity was somewhat more pronounced in the case of concrete material than in the case of abstract material, and it is suggested that chronic IDDM might be associated with a specific impairment in elaborative encoding.

A comparison of practices, attitudes and interactions in two established units for people with a psychiatric disability.

This study evaluates and compares aspects of residential care in a community hostel setting and a hospital setting for people with a psychiatric disability. The clients were assessed to establish their level of general functioning, the comparison indicating there was no significant difference between the two groups on the measure used. A previously published protocol was used as a method of comparing the units. The findings indicated that the hospital unit was more individually orientated both in practices and staff attitudes, and had staff who were more optimistic about clients' potential accomplishments. No differences were found between perceived involvement of staff in decision making, or staff resident interactions. These findings have implications for the 'Care in the Community' movement, as they indicate that the nature of a service is as important as its location. They suggest that the relocation of services to the community in itself will not automatically overcome some of the difficulties associated with institutional care.

Causal attributions of doctor and patients in a diabetes clinic.

This study investigated the level of congruence in causal attributions and diabetes-specific perceived control between doctor and patients during routine diabetes clinic consultations. The effectiveness of a strategy for improving the congruence of doctor and patients' attributions was examined. Fifty-four patients with poorly controlled insulin requiring diabetes mellitus were assigned to one of three forms of consultation: (1) routine consultation, (2) a consultation where doctor and patient explicitly negotiated and agreed the nature of the problem(s) to be discussed, (3) consultation as in (2) but doctor and patient negotiated and agreed not only the problems but also their causal attributions for the problems discussed. Analysis of covariance demonstrated that the experimental manipulations were successful in improving problem and attribution congruence across the groups. Predicted mismatches in perceived control between doctor and patient in Group I were demonstrated, and, as expected, were reduced in Groups II and III. The clinical implications of differing levels of congruence in attributions and perceived control were considered in analyses of glycaemic control and patients' satisfaction with their consultation.

A controlled comparison of the effects of social skills training and remedial drama on the conversational skills of chronic schizophrenic inpatients.

This study compared the effects of social-skills training, remedial drama and group discussion on the conversation skills of chronic schizophrenic patients. After 16 one-hour treatment sessions only the social-skills training resulted in significant improvement, which was maintained at two-month follow-up. Although there was little evidence to support generalisation, the results are seen as indicating the usefulness of social-skills training in improving the performance level of chronic schizophrenic inpatients and in maintaining their social functioning. The implications for future rehabilitation practice are discussed.

The effects of biofeedback and guided imagery on finger temperature.

This study was concerned with a comparison of the effects of biofeedback and of imagery on finger temperature increase. Twelve volunteer unpaid adults were randomly allocated to one of two groups: finger temperature biofeedback or guided imagery. All subjects received two baseline and five 15 min treatment sessions, during which stimulus presentation was carefully controlled. The biofeedback group rapidly established a superior ability to increase finger temperature; whereas guided imagery was consistently associated with temperature decrease. Some tentative evidence was produced which questioned the alleged importance of cognitive and interpersonal factors in biofeedback training. Implications for theoretical accounts of the mechanism of finger temperature control (via autogenic training or biofeedback), and for developing effective biofeedback procedures are drawn.