Reduced nonverbal interpersonal synchrony in autism spectrum disorder independent of partner diagnosis: a motion energy study.

BACKGROUND: One of the main diagnostic features of individuals with autism spectrum disorders is nonverbal behaviour difficulties during naturalistic social interactions. The 'Interactional Heterogeneity Hypothesis' of ASD proposes that the degree to which individuals share a common ground substantially influences their ability to achieve smooth social interactions. METHODS: To test this hypothesis, we filmed 29 autistic and 29 matched typically developed adults engaged in several conversational tasks. Windowed cross-lagged correlations were computed using the time series of motion energy of both individuals in a dyad. These coefficients were then compared across the three dyad types that were homo- or heterogenous with respect to diagnosis: pairs of two autistic individuals, two typically developed individuals or pairs of one autistic and one typically developed person. RESULTS: We found that all dyad types achieved above-chance interpersonal synchrony, but that synchrony was more expressed in typical dyads compared to both autistic and mixed dyads. LIMITATIONS: The method presented here provides only one, albeit objective and robust, approach to explore synchrony. The methodological choices as well as the lack of consideration for other communication modalities may limit our interpretation of the findings. Moreover, the sample size is small with respect to exploring associations between synchrony and various outcome and social skill measures. CONCLUSIONS: The present results do not provide support for the Interactional Heterogeneity Hypothesis given that autistic individuals do not coordinate better when interacting with another autistic individual, compared to when interacting with a typical individual.

Sequences of emotions in patients with borderline personality disorder.

OBJECTIVE: To investigate sequences of emotions (temporal dependence of emotions) to identify specific patterns of borderline personality disorder (BPD). METHOD: The perceived emotions of 50 BPD patients and 50 healthy controls (HC) were monitored by using a hand-held computer system for a 24-h period in a daily life setting. Participants were prompted four times per hour to assess their current perceived emotions. Differences between BPD patients and HC in terms of activation, persistence and down-regulation of emotions were analyzed. RESULTS: Healthy controls in contrast to BPD patients more often activated joy and interest. BPD patients more often experienced persistence of anxiety and sadness. BPD patients more frequently switched from anxiety to sadness, from anxiety to anger and from sadness to anxiety. Anger was predominantly preceded by anxiety. CONCLUSION: Persistence of sadness and anxiety, as well as emotional oscillating between anxiety, sadness and anger are important aspects of the emotional dysregulation in BPD patients.

Outcomes of a cognitive-behavioral day treatment program for a heterogeneous patient group.

This paper describes a day treatment program that provides predominantly cognitive-behavioral therapy for a heterogeneous group of patients. Preliminary results of the program are also presented. Assessment tools included the Beck Depression Inventory, the Symptom Checklist, and a questionnaire on changes in social life. Instruments were administered at admission, at discharge, and six months after discharge. The patients showed significant improvement in scores on all instruments at discharge. Improvements were stable after six months for all diagnostic categories-depression, eating disorders, and personality disorders. The program shows promise as an effective treatment approach for patients with various psychiatric diagnoses.

Effects of high-dose heroin versus morphine in intravenous drug users: a randomised double-blind crossover study.

The purpose of this study is to evaluate the effects of high doses of injected opiates as prescribed maintenance in intravenous drugs users. This was accomplished via a randomised double-blind study with crossover at an outpatient clinic in Bern, Switzerland. The subjects were 39 patients with a long history of intravenous opioid use and persistent abuse despite treatment; they were randomly allocated to two groups. Group A was started on controlled injection of graduated doses of morphine up to a satisfying individual dose and was then switched as a double blind to heroin at a randomly determined day between week three and four. Subsequently this group was given heroin for the remaining two to three weeks of the study. Group B was started on heroin and was then switched to morphine in the same manner. Equipotent solutions of 3% morphine and 2% heroin were administered. The main outcome measures were clinical observations, structural interviews and self report of subjective experiences to assess the effects of the drugs. In 16 cases, the study had to be discontinued owing to severe morphine-induced histamine reactions. Thirteen participants in Group B presented these adverse reactions on the day of the switch-over. Full data were thus only obtainable for 17 participants. Average daily doses were 491 mg for heroin and 597 mg for morphine. The findings indicate that heroin significantly produced a lower grade of itching, flushing, urticaria and pain/nausea. A negative correlation between dose and euphoria was observed for both heroin and morphine. The authors concluded that as heroin produces fewer side effects it is the preferred high-dose maintenance prescription to morphine. The perceived euphoric effects are limited in both substances.

Efficacy of crisis intervention.

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.

Dynamical analysis of schizophrenia courses.

In order to assess the working hypothesis that schizophrenia may be viewed as a nonlinear dynamical disease, we examined the long-term psychoticity dynamics of 14 patients. The data consist of daily ratings of psychopathology observed for 200 or more consecutive days in each patient. We implemented nonlinear dynamical analysis methods with a potential of being applicable even to relatively short and noisy time series: two different forecasting approaches combined with surrogate methods that allow statistical testing in each single case. The resulting classification of dynamics gives evidence that eight patients show nonlinear evolutions of symptom courses. Four cases can be modeled linearly, two as random processes. Thus, a larger proportion of the schizophrenic psychoses we studied shows nonlinear time courses. In this way the validity of the concept of dynamical diseases could be supported on statistical grounds in this important area of psychopathology. The nonlinear view-a low-dimensional nonlinear system generating psychotic symptoms--may provide the foundation for a more parsimonious theory of schizophrenia compared to traditional multicausal models. In several of the nonlinear cases we also observed the qualitative "fingerprint" of deterministic chaos: a decay of deterministic features of the course of disorder with time.

The dynamics of psychosocial crises: time courses and causal models.

The time courses of 34 psychosocial crises were studied at an inpatient psychiatric crisis intervention unit. For data acquisition, patients were instructed to rate their tension, activity, and mood in self-report scales, three times a day. The onset of crises before index admission was assessed by retrospective interviews. A combination of pre/post comparisons and time series analyses was used to evaluate the effectiveness of crisis intervention and to specify typologies of crises. Although distinct crisis trajectories were found at the group level that clearly reflect global treatment effects, there was little indication of specificity using a pre/post design. Consequently, the use of more find-grained longitudinal methods is proposed. Time series models of individual patients (single systems approach) are helpful in designing appropriate therapeutic strategies. Agglutination of single case models points to distinct crisis courses, in which a cluster of depressive reactions is prominent. Consequently, a dynamic systems approach is suggested for application in psychiatry and psychology.