The structure of posttraumatic stress symptoms.

Posttraumatic stress disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. and 4th ed.; American Psychiatric Association, 1987, 1994, respectively), is characterized by 17 symptoms, descriptively clustered into 3 groups: (a) intrusions, (b) hyperarousal, and (c) avoidance and numbing. The present study sought to identify the basic dimensions (factors) that underlie these symptoms. Two samples were assessed: 103 victims of motor vehicle accidents and 419 United Nations peacekeepers deployed in Bosnia. A principal axis factor analysis was conducted for each sample. In each sample, 2 correlated factors were obtained, which were very similar across samples. Factor 1 was labeled Intrusions and Avoidance, and Factor 2 represented Hyperarousal and Numbing. These factors loaded on a single higher order factor. The higher order factor accounted for 13% to 38% of variance in symptom severity, and the lower order factors accounted for an additional 8% to 9% of variance. If the authors assume that each factor corresponds to a distinct mechanism (R. B. Cattell, 1978), then the results suggest that posttraumatic stress reactions arise from a general mechanism, with contributions from 2 specific mechanisms.

Cross-validation of WAIS-R prototypical patterns of intellectual functioning using neuropsychological test scores.

A heterogeneous sample of neuropsychiatric patients were classified with respect to the nine prototypical patterns of intellectual functioning observed previously in the WAIS-R standardization sample. Of the manifestly right-handed patients, all but 9.9% could be classified with respect to membership in a prototypical group. This suggested that the most frequent consequences of neuropsychiatric disorders may be to produce patterns which are similar to those found in the standardization sample. However, the prevalence of these groups within the neuropsychiatric sample was dramatically different from those found in the standardization sample. Prototypical patterns with lower levels of overall functioning were also found to have lower scores on neuropsychological tests consistent with a wide range of cognitive, psychomotor, and memory deficits. By demonstrating an association between group membership and neuropsychological performance, these results contribute to the cross-validation of the prototypical patterns observed in the WAIS-R standardization sample.

Parallel distributed processing and neuropsychology: a neural network model of Wisconsin Card Sorting and verbal fluency.

Neural networks can be used as a tool in the explanation of neuropsychological data. Using the Hebbian Learning Rule and other such principles as competition and modifiable interlevel feedback, researchers have successfully modeled a widely used neuropsychological test, the Wisconsin Card Sorting Test. One of these models is reviewed here and extended to a qualitative analysis of how verbal fluency might be modeled, which demonstrates the importance of accounting for the attentional components of both tests. Difficulties remain in programming sequential cognitive processes within a parallel distributed processing (PDP) framework and integrating exceedingly complex neuropsychological tests such as Proverbs. PDP neural network methodology offers neuropsychologists co-validation procedures within narrowly defined areas of reliability and validity.

Primacy and recency effects in the assessment of memory using the Rey Auditory Verbal Learning Test.

The present study examined the manifestation of the primacy and recency effects in patients with anterior brain damage, posterior brain damage, and psychiatric inpatients with no known organic impairment. All three groups of patients demonstrated both a primacy and a recency effect on the Rey Auditory Verbal Learning Test (RAVLT). Differences among the three groups with respect to the magnitude of primacy and recency as well as with other variables reflecting free recall were nonsignificant. These findings limit the use of primacy and recency for the differentiation of memory deficits due to organic and nonorganic causes.

Parallel distributed processing and neural networks: origins, methodology and cognitive functions.

Parallel Distributed Processing (PDP), a computational methodology with origins in Associationism, is used to provide empirical information regarding neurobiological systems. Recently, supercomputers have enabled neuroscientists to model brain behavior-relationships. An overview of supercomputer architecture demonstrates the advantages of parallel over serial processing. Histological data provide physical evidence of the parallel distributed nature of certain aspects of the human brain, as do corresponding computer simulations. Whereas sensory networks follow more sequential neural network pathways, in vivo brain imaging studies of attention and rudimentary language tasks appear to involve multiple cortical and subcortical areas. Controversy remains as to whether associative models or Artificial Intelligence symbolic models better reflect neural networks of cognitive functions; however, considerable interest has shifted towards associative models.

Electrocortical mapping, MRI, and neuropsychological measures: evidence of Alzheimer's disease in the presence of vascular lesions.

We report here a case study of a 76-year-old woman with a high school education, whose presenting psychiatric symptomatology indicated dementia of unknown etiology. Neuropsychological test results were consistent with AD, but diagnosis was complicated by an MRI showing a large right hemisphere cortical infarct and scattered subcortical changes leading to a diagnosis of possible AD. Electrocortical mapping showed the right hemisphere infarct, and gave independent evidence suggestive of AD in the relatively intact left hemisphere. This case demonstrates the utility of multidimensional assessment as an aid to differential diagnosis.

Birth weight and pathogenesis in phenylketonuria.

The birthweights of an ethnically homogeneous sample of infants with phenylketonuria, their unaffected siblings, and control infants were compared after adjusting for the effects of: mother's age, mother's date of birth, mother's height and obstetric history, the length of gestation, the infant's sex, the place and date of birth. There were no significant differences between the infants with phenylketonuria and their unaffected siblings either in adjusted or unadjusted birthweights. Control infants had slightly, but statistically significant, greater adjusted and unadjusted birthweights than the combined phenylketonuria and unaffected sibling groups. This effect of the phenylketonuria gene is a previously unreported finding but unlikely to be related to the pathogenesis of phenylketonuria. Our results do not provide support for the "justification" hypothesis that the mental and neurological defects in phenylketonuria result from prenatal tyrosine deprivation which would be reflected in lower birthweights.

Differences in neuropsychological performance in psychiatric, anterior- and posterior-cerebral dysfunctioning groups.

The neuropsychological performance of psychiatric, anterior- and posterior-cerebral dysfunctioning groups was compared using both raw scores and scores statistically adjusted for the effects of age, education, gender, and overall level of intellectual functioning. Between 5% and 37% of the variance of the subtests of the WAIS-R and between 9% and 58% of the variance associated with the neuropsychological variables was accounted for by the demographic variables. Using raw scores, ten of the twenty-five tests showed significant overall differences among the groups, while only five of the contrast using adjusted scores were significant. Anterior- and posterior-cerebral dysfunctioning groups generally were significantly more impaired than the psychiatric group. Memory and problem-solving variables were the most sensitive to the removal of demographic variance, while psychomotor test scores were the most robust. Differences among cerebrally impaired and psychiatric groups may be obscured by demographic variables or levels of general intellectual functioning.

Neuropsychological "systems efficiency" and positron emission tomography.

Positron emission tomography (PET) has dramatically improved our ability to examine the functioning of the living brain. PET studies of neural pathways of the major sensory modalities--auditory, visual, somatosensory--have confirmed many traditional neuropsychological concepts, such as cross-lateral representation and regional functioning to particular primary sensory cortical areas. Other PET studies have used radioisotopes to examine relationships between radiopharmaceutical agents and neurobehavioral functioning in both normal and neuropathological states. In some areas, PET methodology requires further refinement. For example, effort should be made to develop the technology to do multiple scans within a short time frame; statistical procedures to examine relationships between neuropsychological tasks and the activity or presence of radiopharmaceutical agents in multiple sites; adequate controls for experimental error; and activation paradigms controlling the nonspecific effects of simple arousal. PET activation models of cognition suggest that a "systems efficiency" approach to assessing neuropsychological test performance involving both serial and parallel processing would be useful. These developments will improve empirical methodology and our understanding of brain-behavior relationships.

Systems model of cortical organization: positron emission tomography and neuropsychological test performance.

Positron Emission Tomography (PET) has allowed researchers to examine in vivo brain-behavior relationships. Correlations of metabolic increases measured by PET with simple sensory tasks involving hearing, vision, and tactile/motor responses have generally produced metabolic changes in agreement with known neuronal pathways. However, complex neuropsychological tests such as Raven's Matrices and Verbal Fluency have resulted in cortical activation of unexpected areas as well as some negative correlations between test performance and metabolism. These observations provide the first demonstration of complex relationships between neuropsychological functioning and activation of the normal brain. Since PET technology offers a means of computing the simultaneous proportional contribution of multiple brain regions, the issue of "localization" of neuropsychological test performance might appropriately be considered for redefinition in terms of a "systems" approach. In spite of the advances brought about by PET, methodological problems still remain for researchers. Future studies will need to take into account the subtle regional effects of neuropsychological paradigms.

A comparison of treatment modes in the management of myofascial pain dysfunction syndrome.

This research compares different treatment regimes for the management of chronic facial pain associated with the masticatory musculature. Twenty-one females meeting specific criteria were randomly assigned to one of three treatment conditions: a dental splint and physiotherapy program; a relaxation program utilizing progressive muscle relaxation, biofeedback, and stress management techniques; or a minimal treatment program involving transcutaneous electrical nerve stimulation. Improvement was assessed through a dental examination, self-monitoring of pain, and an assessment of EMG activity during resting and task conditions. Significant changes were obtained in response to all treatment programs. The treatment programs differed only in the relative pattern of treatment effects obtained from the self-report monitoring of pain. The data are consistent with the concept of MPD as a psychological response to stress which maintains chronic pain through increased muscle tension in the jaw.

Social influences on factored dimensions of the McGill Pain Questionnaire.

The McGill Pain Questionnaire (MPQ) was administered to 268 subjects following electrical stimulation to pain-tolerance limits. Subjects received stimulation under four social modeling conditions: tolerant, intolerant, control, and no model. The number of factors and degree of obliqueness most appropriate for the MPQ scores were determined using multiple criteria. Five factors, reflecting 46.6% of the total variance, were derived and labelled as follows: affective-arousal, sensory-pressure, perception of harm, somesthetic pressure, and cutaneous sensitivity. The various modeling conditions did not produce any significant between-group differences on the factors. The repeated demonstration that the MPQ assesses substantially more than the three components originally proposed suggests that considerable caution is warranted with respect to using the 'sensory-evaluative-affective' method of scoring this test. Considered in relation to previous research, the present findings are consistent with the conclusion that social influences affect fundamental components of subjective reactions to pain.

Treatment of burns casualties after fire at Bradford City football ground.

On 11 May 1985 the main stand of Bradford City Football Club caught fire. Within four minutes the stand was alight from end to end. Fifty three people were burnt to death and about 250 injured; 83 required admission to hospital, and 55 of these were treated by primary excision of their burns and skin grafting. In such disasters the help of staff from other hospitals and areas is essential. Patients should be assessed to see whether they have burns that will ultimately be fatal; if they have they should not be sent to regional burns units, where they would take up beds that could be used for patients with treatable burns. All districts should ensure that their plans for accidents in which burns injuries predominate are adequate.

Use of background interference procedure to assess visual retention deficits in multiple-sclerosis, psychiatric, and brain-damaged patients.

The performances of three groups of patients were compared during two conditions of interference on a visual retention task. During the noninterference condition, the psychiatric, multiple-sclerosis, and brain-damaged patients functioned at a comparable level. The introduction of a distracting background reduced the level of functioning for only the brain-damaged group. This effect remained significant for the correct score when age and postmorbid intelligence functioning were controlled. These results were interpreted as reflecting the cortical nature of the deficits in resisting the distracting influence of the background interference procedure. Serial testing was recommended for the evaluation of the multiple-sclerosis group.

An operation for the treatment of cutaneous neurofibromatosis.

An operation for the rapid removal of multiple cutaneous neurofibromata is described. It is possible to excise about 250 lesions during an operation lasting 1 hour.

An application of the background interference procedure to the Benton Visual Retention Test.

This study involved applying Canter's Background Interference Procedure to the Benton Visual Retention Test. In a heterogeneous sample of psychiatric and brain-damaged patients, it was found that brain-damaged patients reproduced fewer designs and made more errors in reproducing those designs than did psychiatric patients. Right-hemisphere and diffusely brain-damaged patients reproduced fewer designs correctly and made more errors than did left-hemisphere damaged patients. This pattern was maintained when the effects of level of intellectual functioning and age were statistically controlled. These results suggest that the Background Interference Procedure in conjunction with the Benton Visual Retention Test may make a contribution to the assessment of brain-injured patients.