The impact of prefrontal cortex for selective attention in a visual working memory task.

In this study, a variant of the n-back task was used to investigate electrophysiological correlates of top-down processes in visual-object working memory. Event-related potentials were used to replicate results concerning an attention related modulation of neural processes and to investigate the involvement of prefrontal cortex in this modulation. 16 healthy subjects executed an n-back task with sequentially presented faces and scenes. Attention was selectively directed to only one stimulus category. We found an enhancement of the N170 amplitudes for relevant stimuli compared to irrelevant or neutral stimuli. Late frontal amplitudes were stronger positive for relevant compared to neutral stimuli indicating selective attention processes of working memory. Evidence for selective inhibition was not found.

Psychosocial aspects of Parkinson's disease.

Although Parkinson's disease has a definite neurologic basis, patients and relatives experience a multitude of stresses, only partly related to motor symptoms. Subjective and behavioral problems may be regarded as secondary disease symptoms. In an integrated approach, patients and relatives receive psychological counseling and learn new coping strategies for everyday situations. Results show that even elderly patients can make use of structured psychological interventions and change dysfunctional behaviors and cognitions. Measures specifically adjusted to Parkinson's disease are aimed at helping patients make better use of the beneficial effects of medication and counteract the possible negative effects of social and emotional stressors. Relatives need information about the disease and training to cope adequately with difficult caring situations. Future evaluation of medical treatment of Parkinson's disease should consider the interaction of psychological factors and symptom intensity. This interaction may result in momentary changes in the effects of medication because of psychological conditions. In the early stages of the disease, medication has the most positive effect, and psychological interventions should also have the most benefit.

Sleep disturbances in Parkinson's disease patients and spouses.

OBJECTIVES: The prevalence of self-rated sleep disturbance in patients with Parkinson's disease (PD) and their spouses was compared with healthy controls, and the association of sleep disturbance with demographic, psychological, and disease variables was assessed. DESIGN: The sleep ratings from three groups, PD patients, their spouses, and healthy controls, were compared using analyses of variance. Stepwise regressions were used to predict sleep disturbance for each group and gender. SETTING: Participants completed questionnaires as part of a nationwide survey in Germany. PARTICIPANTS: Participants included 153 PD-spouse pairs and a group of 103 healthy controls. MEASUREMENTS: Zung Self-Rating Depression Scale and self-ratings of sleep disturbance, stress level, and disease symptoms (for PD patients). RESULTS: Sleep disturbances were significantly higher in women than in men in all groups. For PD patients, sleep disturbance occurred frequently in 25% of male and 41% of female participants and was best predicted by the patient's depression rating. For spouses, frequent sleep disturbance was reported by 27% of male and 48% of females and was likewise predicted by the spouse's own rating of depression. A second, relatively less common type of sleep disturbance was also reported by spouses. This disturbance was associated with waking during the night to help the patient and was best predicted by patient factors. CONCLUSION: Improvement of sleep quality of caregivers may be an important component of treatment to reduce distress caused by PD.

Visual palatability of food in patients with eating disorders and dieting women.

The effects of 19 meals of different caloric content on slides on palatability and hypothetical duration of consumption were investigated in 7 patients with anorexia nervosa, 17 patients with bulimia nervosa at the beginning and after 8 weeks of hospital treatment. Nine healthy females served as controls. At the beginning of treatment, palatability of low caloric food was significantly higher and hypothetical duration of consumption of high caloric food was significantly longer in patients when compared to controls. After 8 weeks, in the patients palatability of low caloric food had decreased. Dislike for high caloric food remained stable in anorexics.

Repeated exposure of flight phobics to flights in virtual reality.

The present study examined the effects of repeated exposure of flight phobics to flights in virtual reality (VR). Flight phobics were randomly assigned either to complete one VR test flight followed by four VR exposure flights (VR group; N=15) in one lengthy session or to complete one VR test flight followed by a lengthy relaxation training session (relaxation group; N=15). All participants completed a second VR test flight at the end of the session. Fear reports and physiological fear reactions (heart rate, skin conductance level) during VR exposures were registered, and fear of flying was assessed psychometrically from 3 weeks before to 3 months after exposure. Exposure to VR flights elicited subjective and physiological fear responses in flight phobics, and these responses attenuated within and across VR flights. Fear reduction associated with repeated VR exposure was greater than fear reduction caused by relaxation training. Fear of flying improved in both treatment groups, but several outcome measures indicated greater effects in the VR treated group than in the relaxation group. These findings indicate that exposure in virtual reality may offer a new and promising approach for the treatment of fear of flying.

Parkinson's disease--medical education and psychosocial aspects.

This article describes the attempt to develop educational material for patients suffering from Parkinson's disease (PD) and for their partners. The material relates to the neuropathology of PD. The extent of the degeneration of dopaminergic neurons in the substantia nigra, present at the outbreak of the disease, is illustrated to the patient. The substantia nigra is explained as a TV-broadcasting system, the nerve fibers to the so-called striatum as cables and the striatum itself is explained as a TV-set with 2 channels (called dopamine D 1-receptor and dopamine D 2-receptor). The action of anti-Parkinsonian agents is exemplified with the substance L-DOPA, a precursor of the transmitter dopamine. The patient and his partner are introduced to the time-course of the L-DOPA concentration in blood after oral intake of the substance (the pharmacokinetics of L-DOPA). The pharmacokinetics can explain the clinical improvement and the long-term effects of L-DOPA therapy. The second part reports on psychosocial problems that Parkinsonian patients and their spouses encounter and how psychological interventions may help to solve some of these psychosocial problems.

Partnership and depression in Parkinson's disease.

In this study, the influence of partnership on depression and coping with Parkinson's disease has been investigated. Twenty-three single female patients, 46 married patients (23 female, 23 male) with unimpaired partnership and 42 patients (21 female, 21 male) whose partnership had worsened since the onset of disease, were compared with regard to depression and self reported extent of psychosocial distress. Single female patients tended to have higher depression scores than patients in a stable partnership, especially in items concerning personal worthlessness and senselessness of life. Patients differed in the extent of distress concerning social behavior, psychological problems/anxiety and efficiency. Within the group of single female patients two subgroups emerged: (1) patients with low extent of distress in all aspects; (2) patients who were highly distressed by psychological problems and physical disability but weakly distressed from social interaction. Male and female patients living in a stable partnership reported only a generally low to moderate extent of distress. More than half of the male and female patients who reported an impairment of their relationship also had scores of moderate to severe depression. These patients also had the highest extent of distress in each of the aspects assessed. The results are discussed with regard to possible interactive effects of the disease, quality of the partnership and availability of coping strategies.

Behavioral analysis of the freezing phenomenon in Parkinson's disease: a case study.

The "freezing" phenomenon was examined in a 77 yr old male patient suffering from Parkinsons's disease (PD). Motor blocks occurred several times a day, mainly affected walking, and lasted mostly between 2 and 5 min. Behavioral analysis showed that freezing was elicited and intensified not only by external factors (limited space and room to move), but also by negative cognitions, negative emotions and tension. The most effective behavior to overcome freezing was a combination of relaxation and loud rhythmic counting. Effectiveness in overcoming freezing correlated positively with self-rated mobility before trials. Relaxation training improved self-rated mobility. It is suggested that relaxation training and cognitive techniques should be used to reduce tension, negative thoughts and negative emotions contributing to freezing and to improve the ability to cope with freezing.

[Emotional processing of facial expressions in normal and pathological ageing]. / Procesamiento emocional de las expresiones faciales en el envejecimiento normal y patológico.

INTRODUCTION: Many studies have shown that in both normal and pathological ageing there is a deterioration of emotional processing, especially as regards negative emotions such as fear. AIM: To review the most important neurological and psychological research carried out to study emotional processing and relate it to the cognitive deterioration that characterises normal ageing and neurodegenerative diseases. DEVELOPMENT: Here, we discuss the two main lines of research, i.e. the socio emotional approach, which claims that as we get older we gain a better understanding of our emotions because of a deeper knowledge of social relationships, interpersonal enrichment and the importance of goals that are linked to our emotional life; and, on the other hand, the neuropsychological approach, which studies the areas of brain activation involved in processing emotional facial expressions and the underlying mental processes. CONCLUSIONS: Both approaches underline the deficient processing of negative emotions that comes with age, while processing of positive emotions remains relatively intact. Recent research suggests that deficits in emotional processing depend on the cognitive deterioration that characterises ageing. When the task requires resources from working memory, which is one of the first systems to deteriorate in ageing, the result is compromised emotional processing. Yet, when the task requires the use of implicit memory, no age-related alterations are observed in emotional processing.

Patterns of psychological problems in Parkinson's disease.

OBJECTIVE: To identify patterns of psychological problems in Parkinson's disease (PD). METHOD: A sample of 3075 patients was surveyed to determine frequencies of psychological problems and cross-validated cluster analyses were computed to identify patterns of these problems. RESULTS: An increase of symptoms during arousal was reported by 68%, sleep disturbances by 32% of the sample, and sexual problems by 57% of men and 22% of women. Less frequently reported were difficulties in communicating (27%), needing help of others (38%), and depressive moods (20%). Four patterns of psychological problems were identified: general low stress, general high stress, sexual and social problems, and non-social problems. CONCLUSION: The study confirms the clinical observation that PD patients differ not only in degree, but also in structure of psychological stress. Social and non-social stress constitute principal types of stress experienced in PD. This distinction should be taken into account for any approach to support people with PD.

Early stages (P100) of face perception in humans as measured with event-related potentials (ERPs).

According to current ERP literature, face specific activity is reflected by a negative component over the inferior occipito-temporal cortex between 140 and 180 ms after stimulus onset (N170). A recently published study (Liu et al., 2002) using magnetoencephalography (MEG) clearly indicated that a face-selective component can be observed at 100 ms (M100) which is about 70 ms earlier than reported in most previous studies. Here we report these early differences at 107 ms between the ERPs of faces and buildings over the occipito-temporal cortex using electroencephalography. To exclude contrast differences as the main factor for this P100 differences we replicated this study using pictures of faces and scrambled faces. Both studies indicated that face processing starts already at approximately 100 ms with an initial stage which can be measured not only with MEG but also with ERPs.

Nonverbal expression of psychological states in psychiatric patients.

Nonverbal behavior, especially facial expression, appears as one of the most important means for communicating affective states. Studies on groups of psychiatric patients and control subjects are reported in which nonverbal behavior is analyzed from videotaped dialogues. Using a quantitative approach, results on facial behavior, speech, and gaze are described, which shed light on the expressive and communicative functions of nonverbal behavior. From longitudinal observations on depressed patients it emerged that individual-specific associations have to be taken into account for the relationship between expressive behavior and mood changes. The predominance of facial behavior in the speaker role of an individual found in patients and control groups points to the integrated communicative function of the verbal and nonverbal elements. However, recovered schizophrenic patients exhibited a dissociation of these elements. Implications for our understanding of nonverbal communications are discussed.

[Psychological aspects of neurotransplantation]. / Psychologiche Aspekte der Neurotransplantation.

The psychological situation of Parkinson patients and the functions and roles of others involved--doctors, donors, caregivers--are discussed with reference to ethically based decisions about neurotransplantation. Psychological stressors and changes of psychological functions in Parkinson's disease are described. Possible psychological risks due to short and long term changes, especially changes in emotionality, are discussed. Proposals are made for pre- and post-transplantation care involving broad neuropsychological follow up testing and psychological counseling, particularly to deal with unfulfilled expectations.

Facial expression as a behavioral indicator of emotional states.

This article gives an overview of possibilities for the assessment of facial behavior. With regard to validity, results from a longitudinal study of 36 depressed patients and nine controls as well as of ten schizophrenic patients and their relatives will be referred to. These results are used to illustrate the following principles which have to be taken into account when studying facial behavior: a) communication strongly facilitates facial expression, b) activation of facial behavior follows the "principle of least effort", and c) the principle of individual specificity applies to the association of nonverbal behavior and mood states. Making allowance for these principles has, among others, consequences a) for situations or conditions under which to asses behavior (specifically conditions of communication), b) for data analysis (e.g., dealing with frequent and rare events), and c) for empirical or experimental strategies (e.g., aggregation of single-case longitudinal comparisons). From the results on facial behavior during depression it can be concluded that the nonverbal reaction tendencies of endogenous and neurotic depressed patients differ. Moreover, the differential behavioral patterns observed cast doubt on the assumption of a homogeneity of affects in depression. Taking into account the conditions which govern it, facial behavior has proved to be a valid and, especially, a differential indicator for pathologic affective states and their changes. Given the fact that a psychiatric illness generally incorporates emotional problems it is more than surprising that little attention has been paid to the systematic study of emotional behavior. Some of the reasons for this will be clarified in the following.

Chocolate eating in healthy men during experimentally induced sadness and joy.

The study compared influences of qualitatively different emotions on eating. Motivation to eat, affective responses to chocolate and chewing of chocolate were investigated in healthy normal weight males during experimentally induced emotions. Subjects abstained from eating 2 h (n = 24) or 8 h (n = 24) before testing. They received pieces of chocolate after viewing film clips presented to induce anger, fear, sadness and joy. Motivation to eat and most affective responses to eating chocolate were higher after 8 h than after 2 h of deprivation. Sadness and joy affected motivation to eat in opposite directions: joy increased and sadness decreased appetite (p < 0.001). In joy, a higher tendency to eat more chocolate was reported (p < 0.001), and chocolate tasted more pleasant (p < 0.001) and was experienced as more "stimulating" than in sadness (p < 0.01). No effects of deprivation could be found for chewing time and number of chews. Results indicate that the quality of emotions can affect motivation to eat and affective responses to eating chocolate. Our findings on decreased eating responses to sadness in healthy males and the contradictory increased eating responses to sadness reported by others supports two types of emotion-induced changes of eating: emotion-congruent modulation of eating and eating to regulate emotions.

Spontaneous and posed facial expression in Parkinson's disease.

Spontaneous and posed emotional facial expressions in individuals with Parkinson's disease (PD, n = 12) were compared with those of healthy age-matched controls (n = 12). The intensity and amount of facial expression in PD patients were expected to be reduced for spontaneous but not posed expressions. Emotional stimuli were video clips selected from films, 2-5 min in duration, designed to elicit feelings of happiness, sadness, fear, disgust, or anger. Facial movements were coded using Ekman and Friesen's (1978) Facial Action Coding System (FACS). In addition, participants rated their emotional experience on 9-point Likert scales. The PD group showed significantly less overall facial reactivity than did controls when viewing the films. The predicted Group X Condition (spontaneous vs. posed) interaction effect on smile intensity was found when PD participants with more severe disease were compared with those with milder disease and with controls. In contrast, ratings of emotional experience were similar for both groups. Depression was positively associated with emotion rating but not with measures of facial activity. Spontaneous facial expression appears to be selectively affected in PD, whereas posed expression and emotional experience remain relatively intact.

[Recommendations for standarsized psychological diagnosis in Parkinson patients]. / Vorschläge für eine standardisierte psychologische Diagnostik bei Parkinsonpatienten.

In addition to the motor symptoms of Morbus Parkinson, a number of cognitive and emotional changes take place. The diagnosis of these concomitant symptoms has received increasing attention in research and clinical practice. Global rating scales offer economical advantages but generally do not satisfy the requirements of psychometric criteria, and they do not suffice in light of the multidimensional symptoms of the disease. Based on recent research results, recommendations from the CAPSIT protocol (Core Assessment Program for Surgical Interventional Therapies) for diagnosis of neurosurgically treated Parkinson's patients, and the restraints of everyday clinical work, we propose a standardized neuropsychological diagnostic routine. It includes diagnostic methods that are in use internationally and so timesaving and easily accessible that they can be considered suitable for routine diagnostics. Data comparison among various treatment centers can thus take place more easily. We have included only methods that differentiate well and whose test criteria offer a basis for thorough consultation as well as planning and evaluation of multidimensional therapy.

The effects of neuroleptics on facial action in schizophrenic patients.

This paper describes the influence of neuroleptic therapy on facial action in drug-naive schizophrenics. In a comparative study of medicated and unmedicated schizophrenic patients, the coordinates of 12 small light-reflecting points, attached to subjects' faces, were computer-recorded and analyzed automatically during a semi-standardized clinical interview. In addition, facial activity in videotaped interviews was coded using the Facial Action Coding System (FACS). Each sample group comprised of eight patients with the DSM-III-R diagnostic criteria "schizophrenia" or "schizophreniform disorder". Subjects were studied on two occasions, one shortly after admission to the hospital, the other three weeks later. Group 1 was unmedicated during the first session, whereas group 2 was medicated throughout the study. Three weeks after the start of medication, at the second interview, both recording methods showed a reduction in facial activity and facial expression across all subjects in group 1. The facial action of patients in group 2, however, remained unchanged.