A thematic framework of illness narratives produced by stroke patients.

PURPOSE: The present study aims at elucidating the impact of stroke on psychosocial functioning of stroke survivors. METHODS: Data were investigated using interpretative thematic analysis of illness stories produced by 29 patients. RESULTS: Eight themes emerged from the data: Medical Information; Interpersonal Changes; Cognitive, Physical and Emotional Functioning; Strategies of Coping; Social Support; and Information Irrelevant to the Question. The most frequent organization of the themes followed the course of medical intervention and rehabilitation. Narrations of individual patients varied in terms of the presence of particular themes, the amount of information on each topic and organization. CONCLUSIONS: The results suggest that the analysis of non-guided illness narratives can be effectively used to identify the thematic areas important to individual stroke patients. The thematic content analysis of stroke stories can allow health professionals to better understand the patient's state of knowledge related to illness as well as his or her socio-psychological functioning which may be useful in the course of planning further assessment and rehabilitation of patients with stroke. Implications for Rehabilitation Experience of illness and life changes following stroke should be recognized as central to the provision of targeted rehabilitation. To understand the subjective perspective a content analysis of the content narrative is recommended. Our study highlights seven general thematic categories that may be regarded as key. The categories may be useful for clinicians to help individuals to clarify their main concerns following a stroke.

[Premorbid adjustment of 100 hospitalized adolescent patients]. / Przystosowanie przedchorobowe 100 hospitalizowanych pacjentów mlodziezowych.

Premorbid adjustment of 100 hospitalized adolescent patients and its correlation with some clinical variables was assessed and compared with a group of 100 healthy adolescents. The hospitalized group of patients was divided into four diagnostic subgroups according to the diagnostic criteria of ICD 9: psychoses, neuroses, conduct and personality disorders and anorexia nervosa. The following assessment tools were used: Premorbid Adjustment Scale in Polish adaptation of A. Grzywa, List of demographic variables, List of Organic Risk Factors, Inventory of Developmental Psychopathology and the Brief Psychiatric Research Scale (BPRS). SPSS was used to analyze the results. The results confirmed the hypothesis of different levels of premorbid adjustment in hospitalized and healthy adolescents as well as in hospitalized adolescents and original control group of the research of A. Grzywa. Contrary to our expectations and data from the literature premorbid adjustment was lowest in the group of patients with conduct disorders and not as was expected in the group of psychotic adolescents. It was also confirmed that the differences in the level of premorbid adjustment between the group of hospitalized adolescents and control groups were smaller in the period of early childhood than in later developmental periods. Pronounced difficulties in adjustment were observed in all diagnostic subgroups in the period of late adolescence.

The mental health of offspring of patients suffering from endogenous affective disorder (II follow-up study).

In the offspring of patients with affective disorder various psychological disorders were found in 25% subjects. In offspring of healthy persons only 10% were found to have psychological disorders.

[Personality assessment of primary school children (VIII grade) with depressive features (preliminary description)]. / Ocena osobowosci mlodziezy z cechami depresyjnymi w populacji szkolnej klas VIII.

235 primary school children (VIII grade) aged about 14 years, meeting the criteria for depressive syndrome were assessed by the IPAT High School Personality Questionnaire of R.B. Cattell (14 factors version). Results show that the personality of adolescents with depressive syndrome is characterized by a tendency to isolation and conflictual relations with peers. The results point also to the difference between depressive girls and boys. Girls' personality has more features similar to adult depressive personality such as introversion, schizothymia, isolation and irritability. In boys only the scale of isolation was alleviated. It is planned to compare these results with the results of a control group of normal adolescents.

[Organic risk factors and developmental psychopathology in a group of 100 hospitalized adolescents]. / Obciçzenia organiczne i psychopatologia rozwojowa w grupie 100 hospitalizowanych pacjentów mlodziezowych.

In the Psychiatric Clinic for Children and Adolescents, a group of 100 hospitalized adolescents were assessed with respect to organic risk factors and developmental psychology, using original questionnaires drawn up by the clinic. Pathology during infancy, early childhood and the results of psychological tests assessing changes in the C.N.S. differentiated 4 diagnostic subgroups: psychoses, neuroses, anorexia and conduct and personality disorders. Organic risk factor indicators were most frequent in the subgroup of conduct and personality disorders. Some indicators of developmental pathology such as speech impediments, eating disorders and conduct disorders, correlated highly with psychiatric diagnosis during adolescence.

[The psychological health of offspring of patients suffering from endogenous affective disorder (II a follow-up study)]. / Stan zdrowia psychicznego potomstwa osób z endogennymi chorobami afektywnymi (II badania katamnestyczne).

In the off-spring of patients with affective disorder various psychological disorders were found in 25% subjects. In the off-spring of healthy persons only 10% were found to have psychological disorders.

Discourse in aphasia: integration deficits in processing reference.

The present study investigated moderately impaired aphasic subjects' ability to integrate information across sentences by having them identify antecedents for ambiguous pronouns in brief narratives. In order to disambiguate the pronouns, the subjects had to consult either textual cues and/or extratextual cues. In addition, the subjects' ability to retrieve factual information was measured by having them identify explicitly stated noun referents. The results show that the aphasic subjects had significant difficulty using textual cues to resolve referents when the referents were not readily accessible through world knowledge. The patients had little difficulty interpreting referents which were recoverable from world knowledge or were stated explicitly. The explanatory power of world knowledge effects, grammatical class effects, memory effects, and linguistic integration effects in accounting for the deficit pattern observed is considered.

[Agrammatism in a patient with a lesion of the left temporal lobe. A case report]. / Cechy agramatyzmu u osoby z uszkodzeniem lewego plata skroniowego. Opis przypadku.

A case of aphasia following left temporal lobe lesions is reported. The studied material was collected in a number of various tests including constructing of sentences and longer oral and written texts. A neurolioguistic analysis made possible an insight into the nature of the speech system in this case and characterization of disturbances in morphological aspects and their effect on syntaxis and coherent language. The observation lasting 4 years permitted an evaluation of changes taking place in language recovery during that time period.

[Use of discourse analysis for evaluation of the condition of patients with dementia of the Alzheimer type]. / Zastosowanie analizy dyskursu do oceny stanu pacjentów z demencja typu Alzheimera.

The study was concerned with the ability to discourse in a group of 10 patients with minor or moderately severe disturbances in Alzheimer disease and in a control group of healthy subjects. The aim the study was to answer the question whether patients with this disease have language deficits, and if they have, then at what level they appear and what is their influence on the communication ability. The experimental task included production of a narrative and a procedural discourse. The results were analysed from the standpoint of grammar of clauses and their informative contents. The analysis showed that the patients had no deficit in respect to the extent of the discourse, its complexity and grammar correctness. However, errors were found in the contents of the discourse. In particular, the discourse of the patients had a greater number of irrelevant and incorrect propositions. The possible explanation of the demonstrated deficit pattern is discussed stressing the importance of progmatic and cognitive factors. The conclusion is that language disorders in these patients should not be regarded as a type of aphasia.

Disruption of reference in aging.

A homogeneous sample of normal adults living in a religious order in a study of age effects on reference as a cohesive device in discourse production and comprehension. Narrative and procedural discourse were examined across various levels of complexity and stimulus/response requirements. Results indicate that significant ambiguity of reference emerges in the younger elderly group (age 64-76) in comparison to the middle-aged group (age 27 to 55), and increases markedly in the older elderly group (age 77-92). Related impairments of comprehension and cognition were also observed. These findings are interpreted to be general features of linguistic variation with advancing age. Communicative consequences of ambiguous reference are discussed.

Discourse performance in older adults.

Thirty-three elderly women, whose mean age was 76.2 years, and eighteen middle-aged women, whose mean age was 45.6 years, were assessed on a number of linguistic discourse tasks. The women were well educated, and most of them were or had been engaged in the teaching profession. Each woman was given narrative discourse tasks involving recall of stories, summarizing stories, giving the morals of the stories, procedural discourse tasks, interview to assess cognitive functioning and communicative abilities, and the following cognitive tests: Block Design, Symbol-Digit, Raven Coloured Progressive Matrices, and Word Fluency. The findings were that the older group generally performed more poorly than did the middle-aged group on most of the discourse tasks and cognitive tests. Within the older group, measures of quality of discourse were generally negatively related to age and positively related to scores on cognitive tests.

Subcortical aphasia with deep dyslexia: a case study of a Japanese patient.

The reading performance of a Japanese Broca-type aphasic patient on a single-word reading test was investigated. The result indicated that the subject fits the symptom complex of deep dyslexia in more than one aspect. Unique characteristics of this subject included (1) the isolated subcortical site of the lesion, which apparently produced deep dyslexia, and (2) double dissociations between kanji and kana processing and between oral reading and reading comprehension. The performance of this subject was compared with that of another Japanese deep dyslexic subject in S. Sasanuma (1980, In M. Coltheart, K. Patterson, & J. C. Marshall (Eds.), Deep dyslexia, London: Routledge & Kegan Paul). A theoretical implication was attempted based on a dual coding process scheme by S. Sasanuma and O. Fujimura (1978, Cortex, 7, 1-18).

Disruption of written language in aphasia: a case study.

This study documents the performance of a Wernicke aphasic on production of written discourse. The discourse data consisted of spontaneously produced texts of three different types: narrative discourse, personal and formal letters, and expository discourse. A detailed description of the language of this aphasic at a sentence and discourse level revealed preservation of discourse structure through proper use of cohesive devices despite severe disruption of linguistic structure at a sentence level.

Production of narrative discourse in aphasia.

The study described the abilities of a group of 15 moderately impaired aphasics and 15 normals to produce narrative discourse. The experimental tasks included telling stories, summarizing stories, and giving morals to stories. The data were analyzed in terms of sentential grammar, discourse grammar, and subjective ratings of content and clarity of language. The results showed that aphasics produced well-structured discourse. The language of the aphasics' discourse was reduced in both complexity and amount, as compared to that produced by normals. The reduction of language reflected selective reduction of hierarchically organized information. The findings of the study confirm the results of previous research on mildly impaired aphasics, which also showed preservation of discourse structure with selective reduction of information.

Production of procedural discourse in aphasia.

The abilities of a group of 15 moderately impaired aphasics and 15 normals to produce procedural discourse are described. The experimental tasks included producing four procedures of varying levels of complexity. The data were analyzed in terms of sentential grammar, discourse grammar, and subjective ratings of content and clarity of language. The results showed that aphasics produced well-structured discourse. The language of the aphasics' discourse was reduced in both complexity and amount, but was not qualitatively different from the language produced by the normals. The reduction of language in the procedures reflected selective reduction of hierarchically organized information. The investigation suggests that aphasics are capable of manipulating different types of information and that they might be helped in this by utilizing instrumental scripts which are representation of knowledge underlying procedures.

Competence in independently living older adults: assessment and correlates.

Twenty-seven independently living older adults (18 women and 9 men) ranging in age from 65 to 87 years were interviewed in order to assess their competence. "Competence" was defined as effectiveness in dealing with the problems and opportunities characteristic of one's environment. Each participant completed the Block Design and Similarities subtests of the WAIS and the Associate Learning subtest of the Wechsler Memory Scale. Each participant was required to produce three samples of procedural discourse and one of narrative discourse. Participants were rated for competence on the basis off the interview and for quality of interview, procedural, and narrative discourse. The reliability of the competence rating was estimated as .70 for a single rater and as .90 for the average of four raters. Competence correlated significantly with most of the cognitive measures and with each of the three quality of discourse ratings.