Neuropsychological dysfunction in patients suffering from end-stage chronic obstructive pulmonary disease.

Few studies have examined the neuropsychological sequelae associated with end-stage pulmonary disease. Neuropsychological data are presented for 47 patients with end-stage chronic obstructive pulmonary disease (COPD) who were being evaluated as potential candidates for lung transplantation. Although patients exhibited a diversity of neurocognitive deficits, their highest frequencies of impairment were found on the Selective Reminding Test (SRT). Specifically, over 50% of the patients completing the SRT exhibited impaired immediate free recall and consistent long-term retrieval deficits, while more than 44% of these individuals displayed deficient long-term retrieval. Deficient SRT long-term storage strategies, cued recall, and delayed recall were exhibited by between 26% and 35% of these patients, while more than 32% of this sample displayed elevated numbers of intrusion errors. Over 31% of the patients completing the Wisconsin Card Sorting Test (WCST) failed to achieve the expected number of categories on this measure, while more than 23% of these individuals demonstrated elevated numbers of perseverative errors and total errors. Clinically notable frequencies of impairment (greater than 20% of the sample) were also found on the Trail Making Test (TMT): Part B and the Wechsler Memory Scale-R (WMS-R) Visual Reproduction II subtest. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) personality assessments indicated that patients were experiencing a diversity of somatic complaints and that they may have been functioning at a reduced level of efficiency. These findings are discussed in light of patients' end-stage COPD and factors possibly contributing to their neuropsychological test performances. Implications for clinical practice and future research are also included.

An examination of the efficacy of Ginkgo biloba extract EGb761 on the neuropsychologic functioning of cognitively intact older adults.

OBJECTIVES: Few investigations have examined the effectiveness of Ginkgo biloba extract for enhancing cognitive abilities in individuals with no history of significant neurocognitive dysfunction. The purpose of this research was to examine the relatively short-term (i.e., 6 weeks) efficacy of Ginkgo biloba extract EGb 761 on the cognitive functioning of cognitively intact persons over the age of 55 years via a diverse battery of neuropsychologic tests and measures. PARTICIPANTS: From the 48 cognitively intact participants between the ages of 55 and 86 years who initially enrolled in this study, 21 males and 19 females successfully completed the study's protocol and provided valid data sets. DESIGN: A 6-week, double-blind, fixed-dose, placebo-controlled, parallel-group experimental design was utilized. Participants were randomly assigned to either a Ginkgo biloba extract EGb 761 (180 mg/d) or placebo control group. To evaluate participants' cognitive and behavioral functioning, series of neuropsychological tests were administered to them prior to the initiation of the Ginkgo biloba extract/placebo therapy (i.e., pretreatment baseline) and again, just prior to the termination of the treatment regimen (i.e., after 6 weeks). RESULTS: Participants who received 180 mg of Ginkgo biloba extract EGb 761 daily for 6 weeks exhibited significantly more improvement on a task assessing speed of processing abilities (i.e., Stroop Color and Word Test color-naming task) by the end of treatment as compared to participants who received placebo. Trends favoring improved performances in the Ginkgo biloba group were also demonstrated in three of the four remaining tasks that involved a timed, speed of processing component, although they did not reach statistical significance. Furthermore, a significant relationship was found between the type of treatment (Ginkgo biloba extract or placebo) and participants' ratings of their overall abilities to remember. Specifically, more participants in the Ginkgo biloba extract group rated their overall abilities to remember by the end of treatment as "improved," as compared to the placebo group. In contrast, no significant differences were found between the Ginkgo biloba and placebo groups by treatment end on any of the four objective memory measures. CONCLUSIONS: Taken together, the findings from standardized neuropsychologic assessment and a subjective, self-report questionnaire suggested that relatively short-term (i.e., 6 weeks) utilization of Ginkgo biloba extract EGb 761 may prove efficacious in enhancing certain neurocognitive functions/processes of cognitively intact older adults.

Neuropsychological sequelae in a series of patients with end-stage cystic fibrosis: lung transplant evaluation.

There has been a relative absence of studies that examine the neuropsychological profiles of patients suffering from cystic fibrosis. Data are presented here for 18 individuals with end-stage cystic fibrosis who were also potential candidates for lung transplantation. Neuropsychological test results indicated a diversity of memory and executive control deficits, the most frequent of which were immediate and delayed free recall and retrieval impairments on a memory measure involving noncontextual verbal material. The majority of this sample of patients suffering from cystic fibrosis also exhibited clinically significant elevations on the Minnesota Multiphasic Personality Inventory-2 and Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-2/MMPI-A), which are suggestive of heightened levels of psychological distress (e.g., depressive symptomatology) and multiple somatic complaints. These findings are discussed in light of factors associated with end-stage cystic fibrosis. Implications for clinical practice and future research are also provided.

Longitudinal neuropsychological evaluation of a case of pineal tumor occurring in an adolescent girl.

There has been a relative absence of studies that have longitudinally examined the neuropsychological profiles of patients suffering from pineal tumors. A case is reported of an adolescent girl with a pineoblastoma and spinal metastases who received extensive chemotherapy and cranio-spinal irradiation. Neuropsychological assessments conducted approximately 5 months and 2.5 years posttumor diagnosis revealed a diversity of impairments indicative of mild to moderate neuropsychological dysfunction. By the 2nd evaluation (2 years postbaseline) there was evidence of increased neurocognitive impairment suggestive of greater dysfunction of the patient's right, versus left, cerebral hemisphere. Overall, the patient's neuropsychological profile coincided with the Syndrome of Nonverbal Learning Disabilities as proposed by Rourke and his colleagues (Rourke, 1987, 1988, 1995; Rourke & Tsatsanis, 1996). These findings are discussed in light of the Syndrome of Nonverbal Learning Disabilities (and the related white matter model) and the possible negative impact of the patient's pineal tumor and subsequent chemotherapy and cranio-spinal irradiation on her neuropsychological functioning.

Cessation of long-term naltrexone administration: longitudinal follow-ups.

Longitudinal follow-ups of the cessation of long-term Naltrexone administration (1 year of drug therapy) were conducted with a young woman (in her early 30s) with profound mental retardation who had previously displayed dramatic decreases in her self-injurious behaviors (SIB) both during, and for a period of at least 6 months following termination of drug treatment. After 2 and 4 years, post-Naltrexone therapy, the subject continued to exhibit near-zero rates of SIB episodes despite significant turnovers in her direct care staff by the 2-year follow-up, and changes in her physical/living environment and fellow residents by 4-year follow-up. These findings provide further support to the idea that long-term Naltrexone administration may result in highly durable reductions in SIB long after treatment ends and argue against certain aspects of the subject's environment affecting her rates of SIB significantly. These results are discussed in light of the endogenous opiate system theories of SIB. A functional analysis and discussion of the effectiveness of behavioral treatments for her few remaining SIB episodes are also provided.

Neuropsychological test performances of young depressed outpatient women. An examination of executive functions.

Thirty young, unmedicated, outpatient, depressed women were compared to an equal number of matching controls on a series of neuropsychological tests purported to be sensitive to the executive functions. Specifically, the measures included the Design Fluency Test, Hand Dynamometer tasks of grip strength, perseveration, and fatigue, the FAS Verbal Fluency Test, the Stroop Color and Word Test, and the Trail Making Test (Parts A and B). Despite past research which has indicated anterior hemispheric asymmetries and impaired neurocognitive performances in depressives, this research failed to identify any reliable differences between depressed and nondepressed women on any of the neuropsychological measures. These results argue against the frequently held stereotype that depressed individuals typically display impaired performances on neurocognitive tasks. Furthermore, since the profile of the depressed sample appeared to differ significantly from past studies, a discussion is provided as to how the characteristics of this group may have impacted the results. Implications of these findings for clinical practice and future research are also provided.

Spinal cord injury and anxiety: a comprehensive review.

Although there have been past literature reviews which have addressed the psychological adjustment, consequences, and impact/reaction to spinal cord injury, as well as reviews of depression after spinal cord injury, there appears to be an absence of reviews which have focused primarily on the relationship between spinal cord injury and anxiety. The purpose of this paper is to present a comprehensive review of the relatively recent (the past 23-31 years depending on the database utilized) scientific literature as it pertains to anxiety reactions in spinal cord injured individuals. Specifically, this paper provides reviews of the prevalence/presence of anxiety reactions, as well as the correlates of anxiety, in the spinal cord injured population. Furthermore, this paper reviews the relatively few articles which have addressed the treatment of such symptomatology in spinal cord injured individuals. Methodological concerns and limitations of the existing literature and directions for future research are also provided.

Neuropsychological dysfunction in severe accidental electrical shock: two case reports.

There has been a relative absence of studies that have longitudinally examined the neuropsychological profiles of women who have sustained severe accidental electrical shocks. A case is reported of a college-educated woman who received an estimated 120-V electrical shock. Neuropsychological assessments conducted at 2 months, and at 1 and 2 years postinjury, revealed a diversity of deficits indicative of diffuse, mild to moderate neurocognitive dysfunction, as well as symptomatology consistent with depression and posttraumatic stress disorder. For comparison, a second case of a man who received a 69,000-Velectrical injury is also presented. Although only minimal neurocognitive deficits were observed in this individual, he exhibited a similar psychological profile. The results of this study are discussed in light of the contrasting neurocognitive findings but consistent psychological presentations across the two cases.

Utilization of a comprehensive sensory stimulation program with a comatose tetraplegic patient.

To date, there has been a relative absence of studies which have examined the utility and effectiveness of sensory stimulation procedures in comatose, spinal-cord-injured patients. This report describes the interdisciplinary utilization (within an acute care setting) of a comprehensive sensory stimulation programme with a 21-year-old, comatose, tetraplegic male patient. To promote behavioural arousal, multiple sensory stimulation sessions were conducted with the patient daily. Within each session (and across sensory modalities), the effectiveness of sensory stimulation procedures was evaluated via use of A-B-A within-subject designs. Results indicated that the patient exhibited significantly greater behavioural arousal during sensory stimulation (B1), as compared to pre-(A1) and post-(A2) treatment baselines. There was also a non-significant trend of increased behavioural arousal during the post- as compared to the pre-treatment baselines (i.e. carry-over effect). By termination of this programme, the patient exhibited an overall increased level of arousal/behavioural responsiveness (i.e. decreased coma) as compared to his level at the initiation of this programme. These findings are discussed in light of factors that may affect the effectiveness and implementation of such sensory stimulation programmes with comatose, tetraplegic patients in acute care settings.

Age differences in hemispheric activation to sensory condition.

The effects of combinations of bright or dim light and noise levels on hand strength, fatigue, motor perseveration, and tapping rate were evaluated in 13 undergraduate and 13 elderly females. Increments in the intensity of sensory conditions produced opposite effects on grip strength at the left, as opposed to the right hand. Reliable asymmetry in hand strength (right > left) was observed in bright but not dim lighting in the younger group. In the elderly group, the extent of asymmetrical hand strength was related to the combination of light and noise intensity. Data suggest that increments in sensory conditions may differentially activate the cerebral hemispheres of the elderly and younger groups affecting grip strength. Results are discussed in relation to the hemiaging hypothesis.

Hemispheric asymmetry as a function of handedness: perception of facial affect stimuli.

Hemispheric asymmetry in 14 left- and 14 right-handed persons shown tachistoscopically presented emotional stimuli to left and right visual fields was examined using a forced-choice, reaction-time paradigm in which subjects were asked to identify positive and negative faces. Neutral faces were included within the two-alternative forced-choice paradigm. Reaction time and response-bias measures were recorded. Analysis indicated differential lateralization for left-handed and right-handed subjects with respect to neutral affective stimuli. While right-handed subjects' perceptions of neutral stimuli remained consistent across visual fields, left-handed ones identified neutral stimuli as more positive (happy) when presented to the left visual field and negative (angry) when presented to the right visual field. Implications for differential lateralization patterns among left- and right-handed adults are discussed.

The neuropsychology of depression and its implications for cognitive therapy.

The past few years have witnessed a growing interest in the specialty of neuropsychology as well as continued support for cognitive therapy of depression. The purpose of this paper is the examination of the neuropsychology of depression and its implications for A. T. Beck's cognitive theory and therapy of depression ([1963] "Thinking and Depression: Idiosyncratic Content and Cognitive Distortions," Archives of General Psychiatry, Vol. 9, pp. 324-333; [1964] "Thinking and Depression," Archives of General Psychiatry, Vol. 10, pp. 561-571; [1967] Depression: Clinical, Experimental, and Theoretical Aspects, New York: Harper & Row). Specifically, the neuropsychological and cognitive theory and therapy literatures related to depression are reviewed followed by an integration of these areas. Neuropsychological evidence is presented that both supports cognitive theory and therapy of depression and helps explain why such therapy may prove ineffective in treating depression. Implications for clinical practice, including neuropsychological assessment of depressives, and potential future research directions are also provided.

Cerebral asymmetry in facial affect perception by women: neuropsychological effects of depressed mood.

40 right-handed women, half of whom had been classified with depressed mood and the other half as nondepressed, participated in a tachistoscopic study of the influence of depressed mood on the cerebral hemispheric processing of Ekman and Friesen's 1976 happy, sad, and neutral emotional faces using a forced-choice reaction-time paradigm with only happy and sad alternatives as response manipulanda. The women with depressed mood were also characterized by elevated scores on both state and trait anxiety, suggestive of an anxious-depressive state with heightened arousal. Primary findings for the tachistoscopic data indicated that women with depressed mood as compared to nondepressed women displayed significantly faster reaction times to sad faces presented in the right visual field and happy faces presented in the left visual field. These results are suggestive of differential arousal of both the left and right cerebral hemispheres in this sample of anxious-depressed women and are discussed in light of arousal theory.

Functional asymmetry in the motor performances of women: neuropsychological effects of depression.

The influence of depression on the cerebral hemispheric motor functioning of 40 right-handed women, half of whom had been classified as depressed, the other half as nondepressed, was examined. The depressed women were also characterized by elevated state and trait anxiety, suggestive of an anxious-depressive state with heightened arousal. A hand dynamometer was used as a standardized measure of hemispheric motor functioning such as hand-grip strength, perseveration, and fatigue. Primary findings indicated that depressed women displayed significantly less perseveration at the left hand than did nondepressed women, but a nonsignificant trend only was noted for less perseveration at the right hand. These results suggest possible differential arousal of the left and right cerebral hemispheres in this sample of anxious-depressed women and are discussed in terms of arousal theory.

Dual diagnosis: prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation.

The prevalence of psychiatric disorders in a large residential population (N = 1,273) of individuals with mental retardation was examined. We found that the point prevalence rate for dual diagnoses based on DSM-III-R criteria was 15.55% (n = 198). Rates for specific psychiatric disorders were also provided by level of retardation and sex. Results were compared to similar epidemiological studies and discussed in light of factors hypothesized to affect diagnosis of psychiatric disorders among individuals with mental retardation.

Cessation of long-term naltrexone therapy and self-injury: a case study.

The cessation of long-term Naltrexone administration was investigated through a double-blind, placebo-controlled, withdrawal design in a 28-year-old, profoundly mentally retarded woman with a history of severe self-injurious behavior (SIB). The subject had previously exhibited a dramatic decrease in SIB subsequent to Naltrexone administration. At the end of 1 year of continuous drug treatment, the subject displayed a near-zero rate of SIB episodes. This near-zero rate continued through placebo and no-drug phases of the study and at 6-month (no-drug) follow-up. This trend suggests not only that Naltrexone may be effective in reducing SIB, but that long-term administration may produce durable results after treatment cessation. Findings are discussed in relation to the endogenous opioid system theories of SIB.

John N. Buck (1906-1983): did he practically establish clinical psychology in Virginia?

A posthumous biographical profile is presented of John N. Buck, an early clinical psychologist who gained national recognition for his diverse contributions to the field. In addition to developing the House-Tree-Person (H-T-P) Projective Technique and an array of other psychological inventories, he was instrumental in establishing clinical psychology in Virginia. Buck served on the first Examining Board for Certification of Clinical Psychologists in Virginia (and the nation) and was later its chairman. He published his research in peer-reviewed journals and presented guest lectures at respected universities. These professional achievements were quite remarkable in light of the fact that Buck was paraplegic and had no college degree and only scattered formal training in psychology.

Gilles de la Tourette disorder among individuals with severe or profound mental retardation.

There have been limited reports on the incidence of Gilles de la Tourette disorder among individuals with mental retardation. Only three cases have been reported in people with severe or profound mental retardation. In this paper three additional case reports of people with severe or profound mental retardation and Tourette disorder were presented. Issues related to the diagnosis of Tourette disorder in this population were discussed.

The Takeda Model UA-751 blood pressure and pulse rate monitor.

The performance of the Takeda Model UA-751 oscillometric blood pressure and pulse rate monitor was compared with readings taken using auscultatory technique and the mercury manometer. Significant correlations (p less than 0.0001) were found between the clinical standard and the UA-751 on measurements of systolic (r = 0.85) and diastolic (r = 0.77) blood pressure. Comparison of the pulse rate measurements obtained using the Grass Polygraph with those of the UA-751 resulted in a reliable correlation (r = 0.98; p less than 0.0001), as well. The results provide empirical support for the validity of the UA-751 under controlled laboratory conditions. However, the results suggest heightened error in the measurement of systolic pressure when the UA-751 is used by individuals who have high blood pressures.