Digital motion phenomenology of depression.

The long-term objective of our project is to use motion capture technology to identify and characterize body alterations in motion associated with depression that have not been previously recognized or characterizable. These motion phenomena will be studied to determine their utility in the nosology and subtyping of depression. Quantitatively, they may have a significant impact in the areas of research, education and the clinical management of depression; and allow the creation of "virtual humans" which manifest depressive digital motion phenomena that can be used to train researchers, trainees and clinicians.

Presence as an emotional experience.

Presence or the sense of "being there" has been discussed in the literature as an essential, defining aspect of Virtual Reality (VR). The VR literature includes definitions rooted in behavioral response, signal detection theory, and philosophy, but has generally ignored the emotional aspects of experience. The purpose of this paper is to reexamine the concept of presence in terms of people's emotional engagement with reality and their environment. Emotions are an essential part of how people experience the world. Any theory of presence must take emotional factors into account. This thesis has implications about how research should be conducted to further our understanding of presence. Validated psychological techniques for assessing emotions by subjective report, behavioral observations, and facial analysis can all be applied to increase our understanding of virtual presence. Further understanding of the interaction between presence and emotional state will improve our understanding of the construct of presence as well as better inform us about how virtual environments can be applied in creating emotional effects or treating emotional disorders.

The use of an information system architecture modeling tool in the development of disease management systems.

UNLABELLED: A Disease Management System (DMS) refers to an integrated healthcare delivery system that provides patient centered care throughout the course of the disease independent of delivery site. A fundamental barrier for the development, implementation and monitoring of a DMS is lack of an appreciation by care providers of the complexity of these systems, and what is required for their maintenance. Foremost in the development of these systems is the presence of information systems that attempt to deal with the temporal, spatial and information needs of the DMS. PURPOSE: The Zachman Framework for Information Systems Architecture is used in many industries in the development of information systems. Its choice is based on the recognition of a need for a methodology in the conceptualization and modeling of complex information systems. This paper provides a brief overview of the Zachman Framework and its potential application in DMS development. In particular it will be the focus on the need for "perspective" clarification as the first step in the development of such complex systems. RESULTS: This paper reviews DMS and their potential information needs. The clarification of "perspectives" provides a method toward team building and unification of purpose by decreasing conflict and recognizing the unique contributions that each perspective holder makes.

Mental health implications for presence.

"Presence," as discussed in the virtual reality (VR) literature, is the sense of truly being in a virtual place. This literature explores many aspects of presence including interactive and environmental factors. This exploration has generally ignored the impact of the individual's mental status on the experience of presence. Mental disorders such as depression, anxiety, and psychosis may each define a population with specific tendencies to respond to VR in particular ways. To fully understand the experience of presence in virtual environments, we must understand more about the impact of different mental states on presence. Such an understanding will improve our insight into the construct of presence, assist in improved design of virtual environments, and better inform us about how virtual environments can be applied in the treatment of emotional disorders.

Comparing virtual and real worlds for acrophobia treatment.

Traditional treatment of phobias involves a process of gradual exposure to the feared object. Virtual Reality (VR) environments have been used to effectively treat phobias by simulating feared situations, yet these initial studies have been performed by comparing the effect to no-treatment conditions. We are in the process of comparing VR exposure treatment to "gold-standard" in-vivo exposure treatment by replicating an actual in-vivo exposure area in a VR model. The process of controlling for differences between the two environments highlights a general procedure of selecting elements in virtual environment design, targeted towards producing particular emotional effects. It also raises questions about the necessity for highly realistic simulation in VR phobia treatment.

An informatics curriculum for psychiatry.

Information technology is growing at a tremendous rate, becoming a part of all aspects of the practice of psychiatry. Medical informatics is the study of the use of information in medicine. As information management becomes a greater part of the definition of psychiatric practice, it becomes critical that an understanding of medical informatics principles as applied to psychiatric practice should be incorporated into psychiatric residency training. The authors outline the components and objectives of such a curriculum, focusing on basic tasks of patient care, communication, education, and practice management. The authors conclude with a discussion of issues affecting implementation, including assessment of resources and program planning.

The potential relevance of attachment theory in assessing relatedness with virtual humans.

Primary efforts to create virtual humans have been in the production of computer generated ergonomically correct objects that look like humans. Although there has been concern with essential human factors, absent are the metrics of human relatedness, or the ability to assess the degree to which a virtual human elicits human emotions. We discuss the potential application of attachment theory as a context for the development of such an assessment paradigm, and specifically the application of the Ainsworth Strange Situation in the evaluation of a "Virtual Mom". Virtual relatedness fidelity is discussed as a macrometric to define relatedness that would occur with virtual humans. Potential lessons learned are discussed as they apply to the selection of those to develop the model, and its impact on the introduction of virtual humans into clinical psychiatry and psychology.

Current limitations into the application of virtual reality to mental health research.

Virtual Reality (VR) environments have significant potential as a tool in mental health research, but are limited by technical factors and by mental health research factors. Technical difficulties include cost and complexity of virtual environment creation. Mental health research difficulties include current inadequacy of standards to specify needed details for virtual environment design. Technical difficulties are disappearing with technological advances, but the mental health research difficulties will take a concerted effort to overcome. Some of this effort will need to be directed at the formation of collaborative projects and standards for how such collaborations should proceed.

The Internet and the future of psychiatry.

OBJECTIVE: The Internet is a rapidly growing communications resource that is beginning to have an impact on medicine, and it is anticipated that the Internet will soon have a major effect on psychiatry. It is essential for psychiatrists to have a conceptual framework for understanding the many aspects of the Internet. METHOD: Using a four-layer model, the authors describe the components of the Internet and how these work together to establish communication. They discuss some of the practical implications of the model, potential future applications of the Internet, and some of the challenges its use will create. RESULTS: In the Internet model described, the bottom three layers involve hardware and modes of information transmission; the fourth layer is human interaction. The Internet has great potential in psychiatric education, clinical care, research, and administration, but major adjustments in individual and organizational expectations and responses will be needed. These changes relate to the speed, dispersion, volume, privacy, and permanence of communication. CONCLUSIONS: The growth of the Internet and related information technologies is inevitable and has diverse technical and social implications. As psychiatrists, we must remain effective communicators of information and adjust to a changing world with new roles and skills that will permit us to best serve our professional mission.

Effects of depression on memory performance and metamemory in children.

OBJECTIVE: To investigate the effects of depression on memory performance and metamemory in children. METHOD: Performance on automatic memory tasks (frequency of occurrence), effortful memory tasks (Children's Auditory Verbal Learning Test), and a Metamemory Battery were examined in 21 unmedicated, depressed children and 21 nondepressed controls (matched for age, gender, and full-scale IQ). Subjects were divided into three groups based on depression severity (high depressed, low depressed, nondepressed). RESULTS: High depressed patients demonstrated performance deficits relative to nondepressed and low depressed children on the Children's Auditory Verbal Learning Test, Immediate Recall trial. Both groups of depressed children performed more poorly on the Metamemory Battery when compared to nondepressed children. Severity of depression differentiated overall performance. Metamemory performance of depressed subjects indicates possible difficulty with overestimation of memory abilities. No differences were found on automatic memory task performance. CONCLUSIONS: Memory impairment in depression varies as a function of severity and may be evident only when a certain level of depression is reached. Overestimation of memory ability by depressed children may be an attempt to compensate for feelings of inadequacy or inferiority. It may also lead depressives to use poor judgment in selecting appropriate solutions for problems. Targeting these cognitive distortions could be a focal point of clinical and educational interventions.

Is there a role of serotonin in the disruptive behavior disorders? A literature review.

ABSTRACT The basic and clinical research literature is reviewed to assess the possible role of serotonin (5HT) in the modulation of brain functions that appear to be altered in the disruptive behavior disorders of childhood. Although the number of 5HT cell bodies are remarkably few, numbering in the thousands, they project extensively to almost all brain areas and appear involved in a large number of psychophysiologic functions. This supports a dimensional (symptom-related) rather than a categorical (diagnoses-related) view of central 5HT dysfunction in human behavior. There is substantial evidence implicating 5HT systems in the modulation of motor activity, impulsive aggression, and learning and memory. In both animals and humans, reductions in 5HT function appear to exacerbate hyperactivity and aggression, and agents that potentiate 5HT transmission reduce activity and aggression. Nonetheless, the clinical literature is insufficient to implicate 5HT systems in ADHD. Aggression in adults directed at the self and others may be associated with altered indices of central 5HT activity, regardless of psychiatric diagnoses. Initial findings on aggression in children and adolescent populations are consistent with adult data. When selective serotonergic agents are used clinically to treat hyperactivity or aggression, their clinical effects appear acutely, in contrast with the time course of their antidepressant and anxiolytic actions. This suggests that the therapeutic effect on activity and aggression may be related to the acute activation of serotonergic receptors rather than to the down-regulatory changes that appear after long-term treatments and that coincide with the onset of antidepressant effects. Learning disabilities have been frequently associated with disruptive behavior disorders in children. Serotonergic systems appear to play a role in memory and learning processes, but it is likely that different memory and performance functions may be differentially regulated by serotonergic neural networks. Controlled trials of specific 5HT reuptake blockers, selective 5HT agonists, and 5HT antagonists should be encouraged, both in acute and chronic administration, in order to examine their potential for treating childhood hyperactivity, conduct disorders, and perhaps also the learning deficits present in these children.

Acute and chronic administration of trazodone in the treatment of disruptive behavior disorders in children.

We report the results of an open trial of trazodone in the treatment of severe behavioral disturbances in a sample of 22 hospitalized children previously found to be unresponsive to other treatments. Response to treatment was assessed by overall clinical criteria and improvements in individual symptom dimensions during the inpatient hospitalization. Thirteen children (67%) were found to benefit from the introduction of trazodone. Aggressive, impulsive behaviors were symptoms most frequently improved by this agent. Three of those found to be nonresponders actually worsened in symptomatology. A follow-up interview of the parents was conducted 3-14 months after discharge from the inpatient unit, for those children who initially responded to trazodone administration. The results of this interview suggest that the effect of trazodone was persistent for a prolonged period of time after the initial inpatient trial. Trazodone appears to be of value in the management of severe behavioral disturbances in children. The possible mechanism of action of trazodone is discussed.

A double-blind, placebo-controlled study of the effect of imipramine on TRH-induced urinary urgency in healthy men.

We studied the effect of imipramine (IMI) on thyroid releasing hormone (TRH)-induced urinary urgency as a way of investigating the mechanism of the beneficial effect of IMI on enuresis. In a double-blind study, 12 normal, healthy men between 21 and 39 yr of age ranked their urge to urinate at 30-sec intervals following IV injection of TRH (500 micrograms) or saline. The subjects then were randomly assigned to either IMI (1 mg/kg) or placebo groups for 10 days, and the procedure was repeated. Compared to saline, TRH produced a significant elevation in urinary urgency in all subjects. IMI did not significantly blunt TRH-induced urinary urgency. Thus, the mechanism by which IMI affects enuresis is likely not mediated at the level of the urinary urgency induced by TRH.

Utility of an oral diffusion sink (ODS) device for quantification of saliva corticosteroids in human subjects.

Measurement of cortisol by assay of single blood or saliva samples is inherently imprecise due to the episodic secretion of cortisol. In addition, assay of blood usually quantifies total cortisol, rather than separating free hormone, which is proportionately the much smaller fraction. Furthermore, the free fraction may be disproportionately higher in hypercortisolism. Urinary free cortisol is one measure that provides both a time integral and a focus on the free fraction, but it is inconvenient and prone to collection error in unsupervised ambulatory subjects. The Oral Diffusion Sink (ODS) apparatus takes up corticosteroids from saliva according to first-order kinetics and may provide a practical alternative. We assessed the utility of the ODS in a study of seven healthy volunteers admitted to the CRC for three days. Data on day two from 0700-1100 h and 1100-1500 h were compared between the ODS and three other means of assessing cortisol: urinary free cortisol (UFC), blood, and saliva. The subjects all tolerated wearing the ODS device without any complaint. High correlations were observed between ODS values vs. data for UFC, plasma, and saliva determinations. In summary, the ODS device was well tolerated and collected reliable corticosteroid data, and thus provides a new, non-invasive methodology for studies of HPA function in health and disease.

An open clinical trial of trazodone in aggressive children.

ABSTRACT In open clinical trials that incorporated an ABA design, trazodone was found to be effective in treating aggression in three children (ages 7-9) whose primary diagnoses were disruptive behavior disorders. In two patients, trazodone 75 mg daily was used alone, and in one subject the same dose was used in combination with l-tryptophan 1000 mg daily. At a mean dose of trazodone 0.35 mg/kg daily, significant improvement in aggressive behavior was noted within 7-days. No major problems with side effects were noted, though an increased frequency of penile erections was reported by the 9-year-old during the first week of treatment. Trazodone did not appear to act through its antidepressant or anti-ADHD properties. The efficacy of this selective serotonin reuptake inhibitor in treating aggressive symptoms in children is consistent with previous findings that implicate decreased levels of serotonin in the etiology of aggression.

Characterization of beta-endorphin-related peptides in the caudal medulla oblongata and hypothalamus of the prenatal, postnatal and adult rat.

A comparison was made of beta-endorphin (B-END) concentrations versus post-translation products during the perinatal period in the hypothalamus and the caudal medulla oblongata. The concentration of B-END-like immunoreactivity did not differ statistically between embryonic day 21 (E21) and postnatal day 1 (P1) in either area. There were significant differences in forms, with a shift from larger precursors at E21 to smaller peptides at P1, with the predominant form of B-END being the 31 residue form at E21 in both regions. B-END varied between the two regions at P1, the 27-26 residue predominant in the hypothalamus, and the 31 residue in the caudal medulla.

Formulating a role for occupational therapy in child psychiatry: a clinical application.

Occupational therapy is in need of role clarification within the specialty of child psychiatry. The literature reveals that occupational therapy is often undelineated or unrecognized by child psychiatry, has limited efficacy research, and may be at risk for losing its practice with children hospitalized for psychiatric disturbances. This paper outlines steps for the formulation of a specialized role for occupational therapy within this specialty. The Model of Human Occupation (Kielhofner, 1985) is suggested as a basis for conceptualizing this role. A clinical study focused on the evaluation of adaptive functioning with use of the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984, 1985) is presented as an example of a way in which occupational therapy can provide assessment data valuable to the interdisciplinary clinical team. The role of occupational therapy in both short-term and long-term hospitalization of children with psychiatric disturbances is described.