Cognitive distortions in the poetry of Anne Sexton.

Cognitive therapists have described cognitive distortions that are frequently associated with depression. These distortions include arbitrary inference, selective abstraction, overgeneralization, magnification and minimization, personalization, and dichotomous thinking, which are often present in suicidal individuals. This article suggests it is useful to conceptualize cognitive distortions in literary terms and uses the professional oeuvre of confessional poet Anne Sexton to identify salient examples.

Health psychology and public policy: the political process.

During the past 20 years, psychologists have successfully modified federal statutes, resulting in recognition of the profession's clinical and research expertise. Despite these successes, professional psychology's training institutions have largely failed to address basic issues in health policy and the implications of national health policy for psychology. The importance of public health programs under Title VII of the Public Health Act and the significance of full inclusion of psychology in all federal health programs, including Titles XVIII (Medicare) and XIX (Medicaid), are poorly understood by most health psychologists. Federal health policy decisions, including management of excessive federal health spending, will dictate the growth and opportunities for health psychologists. Understanding federal health spending and recent federal initiatives such as Resource Based Relative Value Scale, Diagnostic Related Groups, and practice guidelines will be of benefit to health psychologists.

Maintaining the confidentiality of computerized mental health outcome data.

The emergence of managed behavioral health care has increased the value of data describing outcomes of mental health treatment. At the same time, increased development of the national information infrastructure and other computer linkage systems has facilitated the flow of information among a wide network of data systems. These two developments create a dynamic tension between the need to share information and the need to protect the privacy of mental health clients and the confidentiality of their computerized records. This problem is exacerbated by the cost associated with potential solutions. Unfortunately, policy development in this area has lagged behind rapid developments in technology. The mental health administrator must balance the three components of this conflict (the increasing need for information transfer, the protection of confidentiality, and cost) without a great deal of guidance. This article offers recommendations that may help the mental health administrator manage this conflict.

Inhibitors of blood platelet cAMP phosphodiesterase. 2. Structure-activity relationships associated with 1,3-dihydro-2H-imidazo[4,5-b]quinolin-2-ones substituted with functionalized side chains.

A series of 1,3-dihydro-2H-imidazo[4,5-b]quinolin-2-one derivatives, substituted at the 7-position with functionalized side chains, was synthesized and evaluated as inhibitors of human blood platelet cAMP phosphodiesterase (PDE) as well as ADP- and collagen-induced platelet aggregation, in vitro. Structural modifications focused on variation of the side-chain terminus, side-chain length, and side-chain connecting atom. Functionality incorporated at the side-chain terminus included carboxylic acid, ester and amide, alcohol, acetate, nitrile, tetrazole, and phenyl sulfone moieties. cAMP PDE inhibitory potency varied and was dependent upon the side-chain terminus and its relationship with the heterocyclic nucleus. Methylation at N-1 or N-3 of the heterocycle diminished cAMP PDE inhibitory potency. Several representatives of this structural class demonstrated potent inhibition of ADP- and collagen-induced blood platelet aggregation and were half-maximally effective at low nanomolar concentrations. Amides 13d, 13f, 13h, 13k, 13m, and 13w are substantially more potent than relatively simply substituted compounds. However, platelet inhibitory properties did not always correlate with cAMP PDE inhibition across the series, probably due to variations in membrane permeability. Several compounds inhibited platelet aggregation measured ex vivo following oral administration to rats. Ester 11b, acid 12b, amide 13d, and sulfone 29c protected against thrombus formation in two different animal models following oral dosing and were found to be superior to anagrelide (2) and BMY 20844 (5). However, ester 11b and acid 12b demonstrated a unique pharmacological profile since they did not significantly affect hemodynamic parameters in dogs at doses 100-fold higher than that required for complete prevention of experimentally induced vessel occlusion in a dog model of thrombosis.

1,3-Dihydro-2H-imidazo[4,5-b]quinolin-2-ones--inhibitors of blood platelet cAMP phosphodiesterase and induced aggregation.

A series of 1,3-dihydro-2H-imidazo[4,5-b]quinolin-2-one derivatives was synthesized and evaluated as inhibitors of cAMP hydrolysis by a crude human platelet phosphodiesterase preparation and as inhibitors of ADP- and collagen-induced aggregation of rabbit blood platelets. The parent structure 7a, demonstrated potent inhibitory activity that was enhanced by the introduction of alkyl, alkoxy, or halogen substituents at the 5-, 6-, 7-, and 8-positions. Methylation at N-1 or N-3 produced weaker inhibitors of cAMP PDE and platelet aggregation. 1,3,9,9a-Tetrahydro-2H-imidazo[4,5-b]quinolin-2-ones (6) were found to be equipotent with their fully oxidized congeners (7). On the basis of platelet inhibitory properties in vitro, efficacy at preventing thrombus formation in animal models of thrombosis, and a favorable hemodynamic profile, 1,3-dihydro-7,8-dimethyl-2H- imidazo[4,5-b]quinolin-2-one (7o, BMY 20844) was selected for advancement into toxicological evaluation and clinical trial. An efficient synthesis of 7o is described.

Clinical judgment in forensic neuropsychology: a comment on the risks of claiming more than can be delivered.

There is a vast and growing literature in psychology demonstrating the general limits of human judgment and clinical inference. These findings clearly apply in the new specialty of clinical neuropsychology, and there is little empirical research to support the widespread belief that judgmental accuracy correlates substantially with experience, professional stature, or reputation as a neuropsychologist. However, the demand characteristics of expert testimony in the forensic arena may encourage individual neuropsychologists to state or intimate that they have unique or special expertise in understanding brain-behavior relationships, or in predicting outcomes following cerebral insult or injury. These claims will be increasingly difficult to substantiate as attorneys become more conversant with the literature on human judgment.

A Bayesian approach for dealing with uncertainties in detection of coronary artery stenosis using a knowledge-based system.

A knowledge-based system that combines subjective Bayesian methods with rules specified by cardiologists to diagnose coronary artery stenosis from postexercise myocardial perfusion scintigrams is discussed. This expert system was used to determine which of the three main coronary arteries had the dominant stenosis. The system also indicated when a patient had a normal myocardial perfusion pattern (no stenosis). The system was run on a set of scans from 91 patients, and the results were compared with an existing expert system that uses the Dempster-Shafer theory of evidence for dealing with uncertainties. The system was able to determine the coronary artery with the dominant stenosis over 90% of the time when supplied with prior knowledge that all the patients have single-vessel stenosis. The system was also able to determine with good accuracy whether a patient had a stenosed coronary artery or normal myocardial perfusion when no prior information was available. The program can be used initially to screen out patients with normal scintigrams. Once the patients with normal scintigrams have been removed, the expert system can then be run on the remaining patients and utilize prior knowledge that they have stenosed coronary arteries. This improves the reliability of the diagnosis.

Clinical judgment and decision making in neuropsychology.

We review the literature on clinical judgment and statistical/actuarial prediction both in clinical psychology and in neuropsychology and we attempt to place these findings within the broader context of judgment theory. Current research on judgment in neuropsychology is consistent with research in other areas that documents the limitations of humans as judges and argues for increased utilization of actuarial methods and decision aids. In addition, there are virtually no data suggesting judgmental accuracy is related to experience, acknowledged expertise, or confidence in the accuracy of one's predictions. We attempt to identify judgment practices which contribute to diagnostic error in neuropsychology and we make recommendations that neuropsychologists can use to increase their judgmental accuracy. Research priorities in this area are discussed.

Recognition of emotion in hemifaces presented to the left and right visual fields.

Thirty-two right-handed subjects (16 males and 16 females) participated in a choice reaction time experiment replicating two previous studies which demonstrated the superiority of the left hemisphere in rapidly identifying facial emotion as either positive or negative. Slides of hemifaces split along the vertical axis, showing either positive (happiness, surprise) or negative (anger, disgust, or sadness) affect were presented tachistoscopically to either the left or right visual field. A 2 X 2 X 2 mixed ANOVA revealed main effects for visual field and type of affect. In contrast to earlier studies which presented full face stimuli, presentation of hemifaces produced a strong left visual field advantage and, as expected, positive faces produced faster reaction times than negative faces.

Hemispheric differences in the perception of positive and negative faces.

Thirty-two right-handed subjects (15 males and 17 females) participated in a study investigating the effects of the perception of positive and negative emotional stimuli on choice reaction time. Slides of faces showing positive (happy, surprise) or negative (anger, disgust, sadness) affect were presented via a tachistoscope to either the right or left visual field. A 2 X 2 X 2 X 2 mixed analysis of variance with repeated measures over the factors of hand used by visual field by affect across sex of subject revealed a main effect for visual field (with slightly faster responses to stimuli presented in the right visual field) and a strong affect by visual field interaction with positive facial slides identified more quickly than negative facial slides when presented to the right visual field.

Superiority of the left hemisphere in the recognition of emotional faces.

Thirty-two right-handed university students (16 males and 16 females) participated in a choice reaction time study assessing the perception of hemispheric differences in positive (happiness, surprise) and negative (anger, disgust) facial affect. Subjects were exposed to slides of facial expressions in either the left or right visual field, and latency of affect identification was measured by having each subject move a lever forward or backward in a specified direction to indicate the emotion perceived. An analysis of variance with repeated measures over hand used, visual field, and affect across sex of subject revealed significant main effects for visual field, affect and sex of subject. In contrast to prior studies, the emotional faces were perceived faster in the right visual field than in the left visual field. This finding is explained in terms of the more demanding analytical task chosen in contrast to previous research which typically employed a holistic matching or recognition task. The faster perception of positive affect may be attributed to the increased salience of the facial cues present in those faces displaying happiness or surprise. Finally, the faster response of males supports existing data suggesting greater cerebral lateralization in the male brain.

The comparative efficacy of relaxation training and masseter EMG feedback in the treatment of TMJ dysfunction.

The present series of single case studies was designed to evaluate the comparative efficacy of masseter EMG feedback with progressive relaxation training in the treatment of TMJ dysfunction. Study 1 employed a multiple baseline design across the symptoms of jaw pain, jaw tension and shoulder pain in a patient with chronic TMJ problems. The results indicated that relaxation training was the treatment responsible for improvements in subjective ratings of jaw pain and tension, whereas masseter EMG feedback provided little additional benefit. Trapezius EMG feedback was necessary to provide improvements in ratings of shoulder pain. Study 2 consisted of four single case designs in which masseter EMG feedback and relaxation training were compared with four TMJ patients. Results indicated that relaxation produced clear improvements in pain and tension ratings for two patients, a combination of EMG feedback and relaxation training resulted in slight improvements in one patient, and neither treatment procedure was effective for the final patient. The possibility of wide-scale application of relaxation training with TMJ patients and the need for further controlled research of masseter EMG feedback were discussed.

A comparison of the Halstead-Reitan Neuropsychological Battery and computerized tomography in the identification of brain disorder.

An attempt was made to compare the diagnostic conclusions of the Halstead-Reitan battery with the diagnosis of the computerized tomography (CT) scanner), which has recently created profound changes in neuroradiological practice. Subjects were 45 patients whose neurological diagnosis was used as a criterion for CT, EEG, and three Halstead-Reitan diagnostic statements (Halstead Impairment Index, Rennick Average Impairment Rating, and clinical interpretation). Results indicated no false positive errors with the CT and the highest overall accuracy rate with a clinical interpretation of the Halstead-Reitan tests. The complementary roles of these varied neurodiagnostic methods, which provide different kinds of pertinent neurological information, are stressed.

MMPI results of male candidates for transsexual surgery.

The MMPI was administered to a group of 27 male transsexual candidates for sex change surgery, and their test results were compared with those of 24 male kidney transplant surgical candidates and 26 males suspected of having a psychophysiological disorder. The data revealed a notable absence of psychopathology among the transsexuals as well as the kidney patients, while the psychophysiological patients showed the expected elevations in the Hypochondriasis, Depression, and Hysteria scales. The results were in keeping with previous research of male-to-female sex change candidates that reject the notion that transsexuals invariably suffer major emotional disturbance.