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Psychopathology and Mental Status Examination

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  • Fondazione San Sebastiano della Misericordia di Firenze
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Abstract

The term “psychopathology” is employed in a number of different ways. In the present chapter, it is used with specific reference to defining, understanding, and categorizing symptoms of mental suffering, as reported by people with intellectual disability (ID) and/or autism spectrum disorder (ASD) and observed through their behavior. After a description of the three parts into which the human psyche is traditionally divided (cognition, affection, and conation), specific aspects and symptoms are treated within the various stages of the present state examination. Descriptive evaluation of psychopathology and the present state examination represent fundamental phases of the psychiatric assessment of the person with ID and/or ASD, although scarce attention received to date in clinical practice and research.KeywordsPsychopathologyPresent state examinationCognitionAffectionVolition/conationIntellectual disabilityAutismSense perceptionMoodThought

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... The present state examination of the person with IDD and/or ASD requires specific care and techniques as it represents a fundamental clinical moment in the direct evaluation of psychopathological symptoms. Without it, psychodiagnostic tests and questionnaires are of limited value (Bertelli et al., 2022b). ...
... In most cases, they are well accepted by the person who acts them, even desirable. They can be mainly focused on the sensory stimulation and management of sensory overload (Ruzzano et al., 2015) or serve as self-reassurance or aid in coping with stress by providing a semblance of predictability and a sense of control over the environment (Zandt et al., 2007;Deb and Roy, 2022;McDougle et al., 1995;Gross-Isseroff et al., 2001), as in Cases 1 and 2. They can even function as an inherently motivating source of fulfilment and satisfaction (Bertelli et al., 2022b). Stereotypies may be verbal such as echolalia, vocalizations or phonic mannerisms, but also fine or gross motor-oriented behaviours like grimacing, shrugging the shoulders, hand flapping or body rocking (Ahearn et al., 2007;Goldman et al., 2009). ...
Article
Purpose In persons with an intellectual developmental disorder, obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) are often difficult to differentiate, particularly when patients present major communication difficulties and low accessibility to subjective symptoms and clinicians are poorly trained in the specific psychopathological phenomenology. OCD and ASD share some important symptoms such as repetitiveness of behaviours, low flexibility to contextual variations or a narrow range of interests. The purpose of this study is to identify and describe symptomatological specificities, including how they manifest at behavioural level. Design/methodology/approach The present study is a retrospective case series study ( n = 3) focusing on in-depth assessment, detection and comprehension of symptomatological specificities as well as on the direct observation of behavioural symptoms. Findings Some symptoms such as signs of sudden autonomous nervous system activation or behavioural equivalents of obsessive thoughts are crucial in achieving an effective differential or comorbidity diagnosis. These symptoms can be identified through a multidisciplinary and comprehensive evaluation, integrating present clinical and test findings with a thorough developmental and medical history. Symptoms should also be interpreted in the light of antecedent, contextual and personal factors. Originality/value Differential diagnosis between OCD and ASD in persons with major cognitive and communication issues is a rather neglected research area, although it has significant implications for treatment planning and implementation.
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En el presente artículo realizamos un análisis del estatus ontológico de la noción de psicopatología que se deriva de cuatro aproximaciones metodológicas a su estudio, a saber: aproximación psiquiátrica, fenomenológico-existencial, constructivista-histórica y antipsiquiátrica. Por medio de una metodología de revisión bibliográfica sistematizada y siguiendo el marco de trabajo metaframework ReSiste-CHS (Revisiones Sistematizadas en Ciencias Humanas y Sociales), sostendremos que dicha noción presenta divergencias en al menos tres puntos: (i) la relevancia de la sintomatología como característica, (ii) la existencia o inexistencia del sufrimiento psíquico y (iii) la relevancia de los factores sociales en su configuración. En el apartado introductorio abordaremos las consideraciones históricas generales relacionadas con el estudio de los trastornos mentales. En el segundo apartado nos referiremos a la metodología empleada para la realización del artículo. En el tercer apartado expondremos los rasgos fundamentales de las cuatro metodologías de estudio mencionadas anteriormente, dividiendo la descripción en los siguientes puntos: orientación, etiología, clasificación, diagnóstico y tratamiento. En el cuarto apartado contrastaremos los conceptos de psicopatología que pueden ser extraídos de ellas. A modo de conclusión, propondremos una sistematización de las condiciones mínimas que debe cumplir una noción de psicopatología que sea fructífera desde un punto de vista teórico y práctico. Estas condiciones incluyen un posicionamiento crítico ante los extremos reduccionista y relativista, la consideración del sufrimiento psíquico como rasgo constitutivo y núcleo fundamental de este género de experiencia, así como una dimensión ética relacionada con su abordaje. Por último, mostraremos algunas limitaciones y futuras directrices que se derivan del trabajo realizado.
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Importance Enhanced selective attention toward nonsocial objects and impaired attention to social stimuli constitute key clinical features of autism spectrum disorder (ASD). Yet, the mechanisms associated with atypical selective attention in ASD are poorly understood, which limits the development of more effective interventions. In typically developing individuals, selective attention to social and nonsocial stimuli is associated with the informational value of the stimuli, which is typically learned over the course of repeated interactions with the stimuli. Objective To examine value learning (VL) of social and nonsocial stimuli and its association with selective attention in preschoolers with and without ASD. Design, Setting, and Participants This case-control study compared children with ASD vs children with developmental delay (DD) and children with typical development (TD) recruited between March 3, 2017, and June 13, 2018, at a university-based research laboratory. Participants were preschoolers with ASD, DD, or TD. Main Outcomes and Measures Procedure consisted of an eye-tracking gaze-contingent VL task involving social (faces) and nonsocial (fractals) stimuli and consisting of baseline, training, and choice test phases. Outcome measures were preferential attention to stimuli reinforced (high value) vs not reinforced (low value) during training. The hypotheses were stated before data collection. Results Included were 115 preschoolers with ASD (n = 48; mean [SD] age, 38.30 [15.55] months; 37 [77%] boys), DD (n = 31; mean [SD] age, 45.73 [19.49] months; 19 [61%] boys), or TD (n = 36; mean [SD] age, 36.53 [12.39] months; 22 [61%] boys). The groups did not differ in sex distribution; participants with ASD or TD had similar chronological age; and participants with ASD or DD had similar verbal IQ and nonverbal IQ. After training, the ASD group showed preference for the high-value nonsocial stimuli (mean proportion, 0.61 [95% CI, 0.56-0.65]; P < .001) but not for the high-value social stimuli (mean proportion, 0.51 [95% CI, 0.46-0.56]; P = .58). In contrast, the DD and TD groups demonstrated preference for the high-value social stimuli (DD mean proportion, 0.59 [95% CI, 0.54-0.64]; P = .001 and TD mean proportion, 0.57 [95% CI, 0.53-0.61]; P = .002) but not for the high-value nonsocial stimuli (DD mean proportion, 0.52 [95% CI, 0.44-0.59]; P = .64 and TD mean proportion, 0.50 [95% CI, 0.44-0.57]; P = .91). Controlling for age and nonverbal IQ, autism severity was positively correlated with enhanced learning in the nonsocial domain (r = 0.22; P = .03) and with poorer learning in the social domain (r = −0.26; P = .01). Conclusions and Relevance Increased attention to objects in preschoolers with ASD may be associated with enhanced VL in the nonsocial domain. When paired with poor VL in the social domain, enhanced value-driven attention to objects may play a formative role in the emergence of autism symptoms by altering attentional priorities and thus learning opportunities in affected children.
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Background Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders. It is not clear whether working memory (WM) deficits are commonly experienced by individuals with ASD. Aim To determine whether individuals with ASD experience significant impairments in WM and whether there are specific domains of working memory that are impaired. Methods We conducted a meta-analysis using four electronic databases EMBASE (OVID), MEDLINE (OVID), PsychINFO (EBSCOHOST), and Web of Science, to examine the literature to investigate whether people with ASD experience impairments related to WM. Meta-analyses were conducted separately for phonological and visuospatial domains of WM. Subgroup analyses investigated age and intelligence quotient as potential moderators. Results A total of 29 papers containing 34 studies measuring phonological and visuospatial domains of WM met the inclusion criteria. WM scores were significantly lower for individuals with ASD compared to typically developed (TD) controls, in both the visuospatial domain when investigating accuracy (d: -0.73, 95% CI -1.04 to -0.42, p < 0.05) and error rates (d: 0.56, 95% CI 0.25 to 0.88, p<0.05), and the phonological domain when investigating accuracy (d:-0.67, 95% CI -1.10 to -0.24, p>0.05) and error rate (d: 1.45, 95% CI -0.07 to 2.96, p = 0.06). Age and IQ did not explain the differences in WM in ASD. Conclusions The findings of this meta-analysis indicate that across the lifespan, individuals with ASD demonstrate large impairments in WM across both phonological and visuospatial WM domains when compared to healthy individuals.
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Psychopathology is the scientific exploration of abnormal mental states that, for more than a century, has provided a Gestalt for psychiatric disorders and guided clinical as well as scientific progress in modern psychiatry. In the wake of the immense technical advances, however, psychopathology has been increasingly marginalized by neurobiological, genetic, and neuropsychological research. This ongoing erosion of psychiatric phenomenology is further fostered by clinical casualness as well as pressured health care and research systems. The skill to precisely and carefully assess psychopathology in a qualified manner used to be a core attribute of mental health professionals, but today's curricula pay increasingly less attention to its training, thus blurring the border between pathology and variants of the “normal” further. Despite all prophecies that psychopathology was doomed, and with neurobiological parameters having yet to show their differential-diagnostic superiority and value for differential indication, psychiatric diagnosis continues to rely exclusively on psychopathology in DSM-5 and ICD-11. Their categorical systematic, however, is equally challenged, and, supported by advances in machine learning, a personalized symptom-based approach to precision psychiatry is increasingly advocated. The current paper reviews the objectives of psychopathology and the recent debate on the role of psychopathology in future precision psychiatry—from guiding neurobiological research by relating neurobiological changes to patients' experiences to giving a framework to the psychiatric encounter. It concludes that contemporary research and clinic in psychiatry do not need less but rather more differentiated psychopathologic approaches in order to develop approaches that integrate professional knowledge and patients' experience.
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We have previously observed that participants with autism spectrum condition (ASC) are more influenced by visual distractors during a tactile task compared with controls (Poole, Gowen, Warren, & Poliakoff, 2015). This finding suggests that changes in multisensory processing could underpin differences in sensory reactivity in ASC. Here we explore the cognitive mechanisms underlying this effect. Adults with ASC ( n = 22) and matched neurotypical (NT) controls ( n = 22) completed 3 tasks involving similar stimuli. In Experiment 1, we again showed that when participants with ASC were performing a tactile task they were distracted more by visual stimuli compared with NTs. In Experiment 2, however, no differences between the groups were observed on an alternative visual-tactile task (temporal order judgment) requiring attention to both the stimuli. That is, ASC performance was typical when the task did not require the visual stimuli to be suppressed. Furthermore, in Experiment 3 the effects of visual distractors were comparable between the groups when the tactile target was replaced with a visual target. When comparing performance across Experiments 1 and 3, NT participants were better able to suppress visual distractors when the target was tactile than when the target was visual (Experiment 1 vs. 3), but this crossmodal benefit was not observed in participants with ASC. The effects of visual distractors were comparable regardless of the target modality suggesting that the efficacy of visual-tactile selective attention may be reduced in ASC.
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Prospective memory (PM) is the ability to remember to carry out a planned intention at an appropriate moment in the future. Research on PM in ASD has produced mixed results. We aimed to establish the extent to which two types of PM (event-based/time-based) are impaired in ASD. In part 1, a meta-analysis of all existing studies indicates a large impairment of time-based, but only a small impairment of event-based PM in ASD. In Part 2, a critical review concludes that time-based PM appears diminished in ASD, in line with the meta-analysis, but that caution should be taken when interpreting event-based PM findings, given potential methodological limitations of several studies. Clinical implications and directions for future research are discussed.
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Faces are one of the most socially significant visual stimuli encountered in the environment, whereas pareidolias are illusions of faces arising from ambiguous stimuli in the environment. Autism spectrum disorder (ASD) is characterised by deficits in response to social stimuli. We found that children with ASD (n = 60) identify significantly fewer pareidolic faces in a sequence of ambiguous stimuli than typically developing peers. The two groups did not differ in the number of objects identified, indicating that the children with ASD had a specific lack of attention to faces. Pareidolia have considerable potential as naturalistic and easy-to-create materials for the investigation of spontaneous attention to social stimuli in children with ASD.
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There is ample behavioral evidence of diminished orientation towards faces as well as the presence of face perception impairments in autism spectrum disorder (ASD), but the underlying mechanisms of these deficits are still unclear. We used face-like object stimuli that have been shown to evoke pareidolia in typically developing (TD) individuals to test the effect of a global face-like configuration on orientation and perceptual processes in young children with ASD and age-matched TD controls. We show that TD children were more likely to look first towards upright face-like objects than children with ASD, showing that a global face-like configuration elicit a stronger orientation bias in TD children as compared to children with ASD. However, once they were looking at the stimuli, both groups spent more time exploring the upright face-like object, suggesting that they both perceived it as a face. Our results are in agreement with abnormal social orienting in ASD, possibly due to an abnormal tuning of the subcortical pathway, leading to poor orienting and attention towards faces. Our results also indicate that young children with ASD can perceive a generic face holistically, such as face-like objects, further demonstrating holistic processing of faces in ASD.
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This paper presents the findings from a systematic review which investigated the use of phenomenological research interviews in studies involving people with intellectual disability. A search of four electronic databases and the subsequent application of inclusion criteria resulted in 28 relevant publications. Selected articles were reviewed and key data extracted using CASP guidelines, with findings presented by examining the influencing philosophy or theory, the method of recruitment and data collection, the relationship between researcher and participants, the rigour of data analysis and finally a statement of findings. The results show people with mild and moderate intellectual disability, included as participants in phenomenological research investigating a range of issues that are important in their lives. A critical discussion focuses on the main characteristics of phenomenology and points to implications for further research. Creating awareness of research among people with intellectual disability is important, and finding the best way to ensure findings are disseminated in accessible formats is recommended. Researchers are also challenged to consider Heideggerian hermeneutic phenomenology as a method with the potential to fully explore the experiences of people with intellectual disability.
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Background: Aging with intellectual disability has become an important topic in light of the significant increase in life expectancy of this population. More specifically, the combination of gender, age and intellectual disability raises unique social issues. Aim: The aim of this research was to capture and analyze the aging experience of women with intellectual disability from their own voice and viewpoint, within the Israeli experience. Methods: A phenomenological qualitative method was used in this study. In depth interviews were conducted with nineteen women with mild to moderate intellectual disability. Findings: Four key themes arose from the interviews: (1) the importance of work and reluctance to retire; (2) ageism and the fear of getting old; (3) The importance of a significant partner in old Age; and (4) Today's positive self-perception. Conclusion: A meaningful aging process can be constructed within the context of gender and disability. It was manifested in this study as a disability-neutral experience. However, ageism and negative attitudes towards old age still need to be addressed.
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World Psychiatry. February, 2014. LETTER TO THE EDITOR Moving beyond intelligence in the revision of ICD-10: specific cognitive functions in intellectual developmental disorders. A lower level of intelligence, as measured by IQ, has historically been the central defining criterion of mental retardation (MR). The use of IQ scores in terms of standard deviation units from the mean is the basis for defining MR in the ICD-10 and DSM-IV-TR, and more recently for defining intellectual disability (ID) in the DSM-5. Similarly, ID is defined by the American Association on Intellectual and Developmental Disabilities as an IQ score approximately two standard deviations below the mean (1). However, in recent years, an increasing number of researchers and clinicians have expressed the view that measurements of IQ fail to capture individual differences in cognitive dysfunction. The heterogeneity of cognitive dysfunction and consequent adaptive behavior profile in persons with MR is one of the reasons leading the working group in charge of this issue within the revision of the ICD-10 to propose a new definition for intellectual developmental disorders (IDD) in the upcoming 11th edition of the diagnostic system (2). In 2011, the WPA Section on Psychiatry of Intellectual Disability started a mini-Delphi process with an international panel of experts to produce a consensus document on this issue. The present letter reports the results of the systematic mapping (3) of the international literature included in this process, focusing on current models of intelligence, multi-component and specific cognitive functions, and the relationship between intellectual and affective assessment, as relevant for defining IDD. A total of 7,948 articles matched the key words. After titles were checked, 3,179 were selected. After abstracts were read, 2,497 were excluded as they were not relevant to the mapping topic, and 114 were excluded because they were not in English. After reading the remaining articles in full, 177 papers were included as relevant to search questions. The mapping of current theoretical approaches identified limitations of IQ as an indicator of the adaptive complexity and dynamism of human intellectual functioning and pointed out the need for a shared model and comprehensive definition of intelligence. Of the available approaches, the most frequently used refers to a unitary capacity, articulated in complex functions. A second evolving group of theories identifies a key role of interdependent but specialized factors, such as specific cognitive functions. There is a neurobio- psychological evidence in support of both approaches, but multi-component models seem to prevail. Experimental data indicate that the same IQ score can correspond to very different cognitive profiles, and that functional limitations and problem behaviors associated with IDD correlate with impairment of specific cognitive functions more than with IQ (4,5). To address the limitations of the current conceptualization of MR, the ICD-11 working group proposed revised diagnostic criteria for IDD, based on a more articulated model of cognitive impairment. This approach juxtaposes a new concept of cognitive characterization to that of intelligence and complements the measurement of IQ with the assessment of specific cognitive functions and a contextualised description of consequent adaptive and learning difficulties (2). Within this new approach, cognitive skills should be assessed through tests, semi-structured observations, and direct clinical examination. The tests should combine the measurement of IQ with that of several aspects of executive functioning, including perceptual reasoning, processing speed, verbal comprehension, as well as the assessment of attention, perception and working memory. The evaluation should aim to identify the cognitive dysfunctions that have the greatest negative impact in terms of behavior, adjustment, autonomy, and above all quality of life, across the lifespan. The instruments to assess specific cognitive functions should have a low cost, in order to allow fast assimilation by professionals practicing in low-income countries (6). Production and distribution by international non-profit organizations could greatly facilitate this effort. In conclusion, within the proposed ICD-11 framework for characterization of IDD, there is a need for neuropsychological measures that can be readily adapted to different levels of severity, and that are easy to apply in clinical and research practice. The evolving understanding of how environmental and cultural factors influence development should promote a continuing search for assessment models and practices that capture developmental pathways of cognition in persons with IDD. Naturalistic, multidisciplinary and multicentric studies could provide useful data to this purpose (7). Marco O. Bertelli1, Luis Salvador-Carulla2, Daniela Scuticchio1, Niccolo Varrucciu1, Rafael Martinez-Leal3, Sally-Ann Cooper4, Rune J. Simeonsson5, Shoumitro Deb6, Germain Weber7, Rex Jung8, Kerim Munir9, Colleen Adnams10, Leyla Akoury-Dirani11, Satish Chandra Girimaji12, Gregorio Katz13, Henry Kwok14, Carolyn Walsh15 1Research and Clinical Centre (CREA), San Sebastiano Foundation, Florence, Italy; 2Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia; 3Intellectual Disability - Developmental Disorders Research Unit (UNIVIDD), Fundacion Villablanca, Reus, Spain; 4Institute of Health and Wellbeing, University of Glasgow, UK; 5School Psychology Program, University of North Carolina, Chapel Hill, NC, USA; 6Division of Neuroscience, Imperial College, London, UK; 7Faculty of Psychology, University of Vienna, Austria; 8Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA; 9Developmental Medicine Center, Boston Children’s Hospital, Boston MA, USA; 10Department of Psychiatry and Mental Health, University of Cape Town, South Africa; 11Psychiatry Department, American University of Beirut Medical Center, Beirut, Lebanon; 12Child and Adolescent Psychiatry Department, National Institute of Mental Health and Neurosciences, Bangalore, India; 13Centro Terape`utico Interdisciplinario, Naucalpan, Mexico; 14Psychiatric Unit for Learning Disabilities, Kwai Chung Hospital, Hong Kong, China;15Harvard Medical School, Boston, MA, USA References 1. American Association on Intellectual and Developmental Disabilities. Intellectual disability: definition, classification, and systems of supports, 11th ed. Washington: American Association on Intellectual and Developmental Disabilities, 2011. 2. Salvador-Carulla L, Reed GM, Vaez-Azizi LM et al. Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD- 11. World Psychiatry 2011;10:175-80. 3. Rutter D, Francis J, Coren E et al. SCIE systematic research reviews: guidelines, 2nd ed. London: Social Care Institute for Excellence, 2010. 4. Friedman NP, Miyake A, Corley RP et al. Not all executive functions are related to intelligence. Psychol Sci 2006;17:172-9. 5. Johnson W, Jung RE, Colom R et al. Cognitive abilities independent of IQ correlate with regional brain structure. Intelligence 2008;36:18-28. 6. World Health Organization. Atlas: Global resources for persons with intellectual disabilities. Geneva: World Health Organization, 2007. 7. Bender A, Beller S. The cultural constitution of cognition: taking the anthropological perspective. Front Psychol 2011;2:1-6. DOI 10.1002/wps.20094 p93-94
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Volition refers to a capacity for endogenous action, particularly goal-directed endogenous action, shared by humans and some other animals. It has long been controversial whether a specific set of cognitive processes for volition exist in the human brain, and much scientific thinking on the topic continues to revolve around traditional metaphysical debates about free will. At its origins, scientific psychology had a strong engagement with volition. This was followed by a period of disenchantment, or even outright hostility, during the second half of the twentieth century. In this review, I aim to reinvigorate the scientific approach to volition by, first, proposing a range of different features that constitute a new, neurocognitively realistic working definition of volition. I then focus on three core features of human volition: its generativity (the capacity to trigger actions), its subjectivity (the conscious experiences associated with initiating voluntary actions), and its teleology (the goal-directed quality of some voluntary actions). I conclude that volition is a neurocognitive process of enormous societal importance and susceptible to scientific investigation. Expected final online publication date for the Annual Review of Psychology Volume 70 is January 4, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Article
Purpose of review: Current diagnostic criteria for intellectual disability categorize ability as measured by IQ tests. However, this does not suit the new conceptualization of intellectual disability, which refers to a range of neuropsychiatric syndromes that have in common early onset, cognitive impairments, and consequent deficits in learning and adaptive functioning. A literature review was undertaken on the concept of intelligence and whether it encompasses a range of specific cognitive functions to solve problems, which might be better reported as a profile, instead of an IQ, with implications for diagnosis and classification of intellectual disability. Recent findings: Data support a model of intelligence consisting of distinct but related processes. Persons with intellectual disability with the same IQ level have different cognitive profiles, based on varying factors involved in aetiopathogenesis. Limitations of functioning and many biopsychological factors associated with intellectual disability are more highly correlated with impairments of specific cognitive functions than with overall IQ. Summary: The current model of intelligence, based on IQ, is of limited utility for intellectual disability, given the wide range and variability of cognitive functions and adaptive capacities. Assessing level of individual impairment in executive and specific cognitive functions may be a more useful alternative. This has considerable implications for the revision of the International Classification of Diseases and for the cultural attitude towards intellectual disability in general.
Conference Paper
Introduction Despite the increasing evidence of common neurodevelopmental alterations and high simultaneous or sequential co-occurrence, the relationship between specific cognitive dysfunctions and psychiatric vulnerability has not been adequately studied, not even in people with intellectual developmental disorders (IDD), whose rate of mental health problems is up to 4 times higher than the general population. Aim The aim of the present paper is to investigate the correlation between specific cognitive dysfunctions or dysfunctional cognitive patterns and the presence of specific psychiatric symptoms and syndromes in people with IDD. Methods A sample of 52 individuals with IDD consecutively attending a clinical facility for multidisciplinary evaluation, in Florence, Italy was assessed through the SPAID (psychiatric instrument for intellectual disabled adult) system, the WAIS III - R (Wechsler adult intelligence scale III – Revised), the TMT (trial making test), and other neuropsychological tools. Psychiatric diagnoses were formulated by expert clinicians in accordance to DC-LD or DM-ID criteria. The main procedure of the data statistical elaboration was the calculation of frequency and correlation indexes. Results Some relevant correlations have been found, that between executive frontal functions, autistic traits and impulse control disorder, and that between working memory and bipolar disorder were among the strongest. Conclusions In people with IDD some cognitive alterations or ‘characteristics’ significantly correlate with the presence of psychiatric disorders. The possibility to understand the nature of this relationship seems to increase with the degree of specificity of variables in both the cognitive and the psychopathological assessment.
Book
There are almost as many explanations for psychiatric disorders as there are patients with them. Each explanation is intriguing, some of them are systematic, all of them have intellectually powerful champions. Yet their very multitude is a scandal. It provokes the professionally debilitating challenge: Why does every psychiatric explanation satisfy some people and not others? Recently this question has received a simple answer. We cannot satisfactorily explain that which we lack the skill to describe. To develop the fundamental skill a student must see many patients under the direction of an experienced and involved instructor to whom he can show his results, accept correction and advance in his abilities. But we need a means to amplify the clinical experience, a text to supplement the instructor in bringing forth and strengthening the vocabulary needed to describe the phenomenology, presentations and distinctions amongst psychiatric patients. A "programmed text" such as this one is a satisfactory means because it can cover rapidly many themes and variations of a vast clinical experi- ence. It can permit the reader to progress at his own speed but bring a sense of mastery to him as he progresses. He can check his knowledge as he sees patients on the clinical services. This kind of text combined with patient practice is thorough, fast and fun, but should succeed in the important task of rapidly building for the student an authentic set of terms and concepts suitable for both clinical work and research.
Chapter
Within cognitive domains, memory is one of the most investigated processes in people with intellectual disability (ID), and studies have documented severe deficits in its functioning. Data indicate that memory impairment is not homogeneous across all individuals with ID, but it is related to the specific etiology of ID.The chapter reviewed literature on memory and learning in individuals with ID considering memory as multicomponential, enlisting multiple cognitive functions, and changing over developmental time. The profiles of memory and learning exhibited by well-defined etiological groups of neurodevelopmental disorders, as Williams syndrome (WS) and Down syndrome (DS), were analyzed.In studies on DS, a widespread deficit in the explicit domain of long-term memory (LTM) compared to the implicit one was demonstrated, while studies on WS have showed more mixed results. Regarding the implicit LTM domain, there is evidence of an opposite implicit LTM profiles in individuals with DS (relatively preserved) and with WS (relatively impaired), indicating that the assumed proficient implicit LTM abilities cannot be confirmed in all individuals with ID.Results on short-term memory (STM) and working memory (WM) also showed peaks and valleys in profiles related to specific etiologies of ID and even the relationship between STM and WM, and academic achievement differs according to the different etiologies of ID.In conclusion, differential patterns of memory abilities are documented across different etiological groups of individuals with ID, and the irregularities in the memory profile may reflect discrepancies in the maturation of different cerebral networks linked to a specific genotype.
Book
This collection examines the many internal and external factors affecting cognitive processes. Editor Shulamith Kreitler brings together a wide range of international contributors to produce an outstanding assessment of recent research in the field. These contributions go beyond the standard approach of examining the effects of motivation and emotion to consider the contextual factors that may influence cognition. These broad and varied factors include personality, genetics, mental health, biological evolution, culture, and social context. By contextualizing cognition, this volume draws out the practical applications of theoretical cognitive research while bringing separate areas of scholarship into meaningful dialogue.
Article
Background People with intellectual disabilities (ID) are rarely asked about their experiences as users of psychological services and little is known about the views of clients with ID who have undergone cognitive behavioural therapy (CBT). This study aimed to gather the views of adults with ID who had recently taken part in a cluster randomised control trial (RCT) of a staff-delivered manualised CBT anger management group intervention. MethodA qualitative method, Interpretative Phenomenological Analysis (IPA), was employed and eleven participants were interviewed. The interviews took place after the intervention, within two weeks of the end of the group, to gain an understanding of service users' experiences of participating in a CBT group. ResultsIPA of the interview transcripts indicated that the intervention was experienced as effective and enjoyable and a number of themes were identified including: the importance of relationships', a new me', new and improved relationships', presenting myself in a positive light' and what the group didn't change'. Conclusions The results will be discussed in the context of applying group CBT for adults with ID and implications for service development.
Article
L’autisme est un trouble précoce du développement qui s’accompagne généralement de déficits cognitifs altérant les apprentissages et l’intégration sociale. Notre revue de la littérature s’intéresse au fonctionnement de la mémoire chez les sujets avec autisme. Celle-ci n’est pas perturbée dans son ensemble, seuls certains sous-types de mémoire s’avèrent altérés avec des différences notables selon les études. La mémoire à court terme/mémoire de travail est intacte, sauf quand les tâches sont complexes ou qu’il s’agit de tâches spatiales. En mémoire à long terme épisodique, les tâches explorant le rappel libre et la reconnaissance pour du matériel simple sont correctement réalisées alors que celles explorant le rappel de stimuli plus complexes, verbaux et spatiaux, s’avèrent perturbées. La mémorisation de certains types d’informations contextuelles est déficitaire dans ses aspects les plus sociaux. La remémoration consciente, signe d’une mémorisation plus complète, est moins fréquente que le sentiment de familiarité. L’ensemble de ces troubles pourrait s’expliquer par une moindre utilisation des stratégies d’organisation du matériel à mémoriser, en particulier lors de la récupération et rendre compte de quelques uns des symptômes cliniques de l’autisme, en particulier les anomalies de la communication sociale.
Article
The paper offers a conceptual and phenomenological analysis of the language of depersonalization. The depersonalization syndrome or disorder has no known common pathogenesis and shows no characteristic behavioral manifestations. A conceptual analysis of the key terms in the subjective complaints would therefore have consequences for clinical research into the phenomenon of depersonalization. Characteristic reports of depersonalization symptoms are arranged according to their conceptual and psychological kinship. A scheme, which aims to separate reports that reflect an underlying depersonalization experience from similar remarks that are common in everyday language but are not considered to be connected with depersonalization, is outlined. Further, we focus on the two dominating criteria found in the literature on depersonalization, the feelings of unreality and the so-called as-if character. Two different uses of the phrase "I feel unreal" are made explicit in order to avoid conflation. The as-if element, which usually accompanies depersonalization complaints, is discussed in the light of potential epistemologic reservations, which may motivate the use of as-if locutions. Finally, we suggest how occurrences of metaphorical language may be understood when patients verbally attempt to articulate depersonalization symptoms.
Article
"The magnitude of [anxiety] is measured by its effect upon… the rate with which [hungry] rats pressed a lever under periodic reinforcement with food. Repeated presentations of a tone terminated by an electric shock produced a state of anxiety in response to the tone… . When the shock was thus preceded by a period of anxiety it produced a much more extensive disturbance in behavior than an 'unanticipated' shock… . During experimental extinction of the response to the lever the tone produced a decrease in the rate of responding, and the terminating shock was followed by a compensatory increase in rate which probably restored the original projected height of the extinction curve. The conditioned anxiety state was extinguished when the tone was presented for a prolonged period without the terminating shock. Spontaneous recovery from this extinction was nearly complete on the following day." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Multiple sleep problems have been reported in children with Autism Spectrum Disorder (ASD). The association of poor sleep with problematic daytime behaviors has been shown in small studies of younger children. We assessed the relationship between sleep and behavior in 1784 children, ages 2–18, with confirmed diagnosis of ASD participating in the Autism Treatment Network. Sleep problems were identified using the Children's Sleep Habits Questionnaire (CSHQ). The Parental Concerns Questionnaire (PCQ) was used to evaluate behavioral concerns and to define good or poor sleepers. Poor sleepers had a higher percentage of behavioral problems on all PCQ scales than good sleepers. Over three-fourths had problems with attention span and social interactions. Further delineation of this phenotype will help guide future interventions.Research highlights▶ Sleep and associated problematic behaviors were studied in 1784 children and adolescents with ASD. ▶ Our research found an association of sleep and daytime behavior from childhood through adolescence. ▶ Children/adolescents who were reported to be poor sleepers had a higher percentage of behavioral problems than good sleepers.
Article
The scope of the present review is to criticize the trivial meanings of 'psychopathology' and re-examine its technical meanings and the role that psychopathology as the discipline that studies abnormal mental phenomena can play in today's clinical practice and research, and in the conceptualization of mental disorders. I will first describe and discuss the way the term 'psychopathology' is mainly used in current psychiatric literature. This meaning, I will argue, is trivial. Then, I will move on to its technical meanings, including three classic sub-areas: descriptive, clinical and structural psychopathology, stemming from the studies of Karl Jaspers, Kurt Schneider and the phenomenological movement in psychiatry. I will address the meanings of the term 'psychopathology' in current literature and contrast it with its meanings in continental 20th century tradition. The relevance of the discipline of psychopathology for psychiatry is three-fold: it is the common language that allows psychiatrists to understand each other; it is the basis for diagnosis and classification; it makes an indispensable contribution to understanding the patients' personal experiences.
Article
We replicated a program to increase indices of happiness among people with profound multiple disabilities and conducted a component analysis of the program. The program involved presentation and contingent withdrawal of stimuli that had been identified as preferred based on preference assessments and staff opinion. The program was implemented with 3 adult students and was accompanied by increased happiness indices for each student. Subsequent implementation of the two types of stimuli indicated that preferred stimuli based on preference assessments were more consistently accompanied by increased happiness indices than were preferred stimuli based on staff opinion. Social validity measures supported the definition of happiness, in that raters' subjective opinions of the students' happiness coincided with the observed happiness indices. Results are discussed regarding the importance and practical implications of using preference assessments for determining stimuli for increasing happiness indices. Future research areas are suggested, focusing on increasing happiness and other quality-of-life indicators during the daily routines of people with profound disabilities.
Article
Self-injurious behavior was examined in a case study of head-banging by an 8-year-old girl with profound mental retardation and an autistic disorder. Trajectories of the arm movements and impact forces of the head blows were determined from a dynamic analysis of videotapes. Results revealed a high degree of cycle-to-cycle consistency in the qualitative dynamics of the limb motions, with one hand motions being faster than those with two hands (inphase and antiphase) and the motions with the helmet about 25% faster than those without the helmet. The impact force of SIBs as a percentage of body weights are near the low end of forces generated in boxing blows and karate hits.