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BMC Medical Ethics Dec 2013Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of... (Review)
Review
BACKGROUND
Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions.
METHODS
A systematic review of the medical ethical and empirical literature concerning depression and DMC was conducted. Medline, EMBASE and PsycInfo databases were searched for studies of depression and consent and DMC. Empirical studies and papers containing ethical analysis were extracted and analysed.
RESULTS
17 publications were identified. The clinical ethics studies highlighted appreciation of information as the ability that can be impaired in depression, indicating that emotional factors can impact on DMC. The empirical studies reporting decision-making ability scores also highlighted impairment of appreciation but without evidence of strong impact. Measurement problems, however, looked likely. The frequency of clinical judgements of lack of DMC in people with depression varied greatly according to acuity of illness and whether judgements are structured or unstructured.
CONCLUSIONS
Depression can impair DMC especially if severe. Most evidence indicates appreciation as the ability primarily impaired by depressive illness. Understanding and measuring the appreciation ability in depression remains a problem in need of further research.
Topics: Comprehension; Decision Making; Depression; Depressive Disorder; Humans; Informed Consent; Judgment; Mental Competency; Patient Participation; Uncertainty
PubMed: 24330745
DOI: 10.1186/1472-6939-14-54 -
Seminars in Arthritis and Rheumatism Apr 2018To determine whether hand left/right judgements, tactile acuity, and body perception are impaired in people with hand OA. To examine the relationships between left right...
OBJECTIVES
To determine whether hand left/right judgements, tactile acuity, and body perception are impaired in people with hand OA. To examine the relationships between left right judgements, tactile acuity and hand pain. To explore the relationships between sensorimotor measures (left/right judgements and tactile acuity) and measures of hand function in people with hand OA.
METHODS
Twenty patients with symptomatic hand OA and 19 healthy pain-free controls undertook a hand left/right judgment task, a control left/right judgement task, two-point discrimination (TPD) threshold testing (assessing tactile acuity), a neglect-like symptoms questionnaire (assessing body perception) and several established measures of hand function.
RESULTS
Neglect-like symptoms were experienced more frequently in the hand OA group (P < 0.05). People with hand OA were slower (P < 0.05) and less accurate (P < 0.05) in the hand left/right judgement task when compared to healthy controls, with no significant difference in the control task. Significant associations were found between hand left/right judgement reaction time and pain intensity (P < 0.05) and accuracy and pain intensity (P < 0.05). TPD was not different between groups, and no correlation was found between TPD and left/right judgement performance. No association was found between left/right judgement performance and measures of hand function (all P > 0.05). However, TPD (tactile acuity) was related to several measures of hand function (all P < 0.05).
CONCLUSION
People with hand OA had more frequent neglect-like symptoms and were slower and less accurate compared to healthy controls at hand left/right judgments, which was indicative of disrupted working body schema. Future studies may wish to examine whether interventions targeting sensorimotor dysfunction are effective at reducing pain and improving hand function and dexterity in people with hand OA.
Topics: Aged; Case-Control Studies; Discrimination, Psychological; Female; Hand; Humans; Judgment; Male; Middle Aged; Osteoarthritis; Pain Measurement; Psychomotor Performance; Touch Perception
PubMed: 29153332
DOI: 10.1016/j.semarthrit.2017.09.008 -
Journal of Audiology & Otology Jan 2024The discrepancies between the objective and subjective measurements used to select and fit hearing aids indirectly impact the perceived benefit and perception in the...
BACKGROUND AND OBJECTIVES
The discrepancies between the objective and subjective measurements used to select and fit hearing aids indirectly impact the perceived benefit and perception in the presence of noise. This study aimed to bridge the gap between objective and subjective measurements in hearing aid fitting by adapting and validating the "Perceptual Performance Test (PPT)" in Malayalam. Subjects and.
METHODS
Standardized Malayalam-language sentences were used to adapt PPT and administer it to 65 native Malayalam speakers (30 normal and 35 hearing impaired). Performance and perception speech recognition thresholds in noise (SRTN) and Performance-Perceptual Discrepancy (PPDIS) were evaluated at various noise levels along with Hearing Handicap Inventory for the Elderly (HHIE) or Adults (HHIA).
RESULTS
Both perceptual and performance SRTNs were better among normal-hearing individuals than in the hearing-impaired group. Moreover, the participants with hearing impairment were found to have a significant effect of noise level on both the measures, which was otherwise not seen among normal-hearing individuals. The normative criteria for PPDIS were established to categorize the individuals as under-, over-, or accurate estimators. The performance and perception outcomes varied significantly between groups (normal hearing and hearing impaired) and across noise levels. Furthermore, there was a positive correlation between perceptual and performance SRTNs with emotional and social subscales and total HHIE/A scores. Additionally, a negative association was noted between PPDIS values and HHIE/A scores.
CONCLUSIONS
The adapted test is a valid and reliable tool for evaluating the benefit of hearing aids. PPDIS can provide crucial information to audiologists regarding an individual's judgement about their hearing ability, with an explanation for the discrepancy between objective and subjective reports of hearing impairments.
PubMed: 37953516
DOI: 10.7874/jao.2023.00073 -
Psychological Bulletin Nov 2009We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and... (Review)
Review
We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research.
Topics: Comprehension; Decision Making; Fuzzy Logic; Health Behavior; Humans; Individuality; Judgment; Models, Theoretical; Probability Learning; Problem Solving; Risk-Taking; Vulnerable Populations
PubMed: 19883143
DOI: 10.1037/a0017327 -
Philosophical Transactions of the Royal... Sep 2001The dearth of studies on amnesia in children has led to the assumption that when damage to the medial temporal lobe system occurs early in life, the compensatory... (Review)
Review
The dearth of studies on amnesia in children has led to the assumption that when damage to the medial temporal lobe system occurs early in life, the compensatory capacity of the immature brain rescues memory functions. An alternative view is that such damage so interferes with the development of learning and memory that it results not in selective cognitive impairments but in general mental retardation. Data will be presented to counter both of these arguments. Results obtained from a series of 11 amnesic patients with a history of hypoxic ischaemic damage sustained perinatally or during childhood indicate that regardless of age at onset of hippocampal pathology, there is a pronounced dissociation between episodic memory, which is severely impaired, and semantic memory, which is relatively preserved. A second dissociation is characterized by markedly impaired recall and relatively spared recognition leading to a distinction between recollection-based versus familiarity-based judgements. These findings are discussed in terms of the locus and extent of neuropathology associated with hypoxic ischaemic damage, the neural basis of 'remembering' versus 'knowing', and a hierarchical model of cognitive memory.
Topics: Amnesia; Cognition; Developmental Disabilities; Humans; Hypoxia-Ischemia, Brain; Infant; Mental Recall; Recognition, Psychology
PubMed: 11571034
DOI: 10.1098/rstb.2001.0951 -
Neuropsychologia Jan 2021Evidence from psycholinguistic research indicates that sentence processing is impaired in Primary Progressive Aphasia (PPA), and more so in individuals with agrammatic...
Evidence from psycholinguistic research indicates that sentence processing is impaired in Primary Progressive Aphasia (PPA), and more so in individuals with agrammatic (PPA-G) than logopenic (PPA-L) subtypes. Studies have mostly focused on offline sentence production ability, reporting impaired production of verb morphology (e.g., tense, agreement) and verb-argument structure (VAS) in PPA-G, and mixed findings in PPA-L. However, little is known about real-time sentence comprehension in PPA. The present study is the first to compare real-time semantic, morphosyntactic and VAS processing in individuals with PPA (10 with PPA-G and 9 with PPA-L), and in two groups of healthy (22 young and 19 older) individuals, using event-related potentials (ERP). Participants were instructed to listen to sentences that were either well-formed (n = 150) or contained a violation of semantics (e.g., *Owen was mentoring pumpkins at the party, n = 50), morphosyntax (e.g., *The actors was singing in the theatre, n = 50) or VAS (*Ryan was devouring on the couch, n = 50), and were required to perform a sentence acceptability judgment task while EEG was recorded. Results indicated that in the semantic task both healthy and PPA groups showed an N400 response to semantic violations, which was delayed in PPA and older (vs. younger) groups. Morphosyntactic violations elicited a P600 in both groups of healthy individuals and in PPA-L, but not in PPA-G. A similar P600 response was also found only in healthy individuals for VAS violations; whereas, abnormal ERP responses were observed in both PPA groups, with PPA-G showing no evidence of VAS violation detection and PPA-L showing a delayed and abnormally-distributed positive component that was negatively associated with offline sentence comprehension scores. These findings support characterizations of sentence processing impairments in PPA-G, by providing online evidence that VAS and morphosyntactic processing are impaired, in the face of substantially preserved semantic processing. In addition, the results indicate that on-line processing of VAS information may also be impaired in PPA-L, despite their near-normal accuracy on standardized language tests of argument structure production.
Topics: Aphasia, Primary Progressive; Comprehension; Electroencephalography; Evoked Potentials; Female; Humans; Language; Male; Semantics
PubMed: 33326758
DOI: 10.1016/j.neuropsychologia.2020.107728 -
Journal of Neurology, Neurosurgery, and... Nov 2015Executive and behavioural changes are well-recognised in classical amyotrophic lateral sclerosis (ALS), indicating a subclinical behavioural-variant frontotemporal...
OBJECTIVES
Executive and behavioural changes are well-recognised in classical amyotrophic lateral sclerosis (ALS), indicating a subclinical behavioural-variant frontotemporal dementia (bvFTD) in some patients. Social cognitive deficits in ALS have been recently described and an impairment was identified on a simple Theory of Mind (ToM) test, which assesses the judgement of the preference of another through direction of eye gaze. The present study further delineated this deficit, by distinguishing between Affective and Cognitive subcomponents, and determining the relationship to behavioural change, levels of empathy and self-awareness.
METHODS
The Cognitive-Affective Judgement of Preference Test was administered to 33 patients with ALS and 26 controls. Furthermore, a comprehensive neuropsychological battery and detailed behavioural assessment, with measures of empathy and awareness, were included.
RESULTS
Patients with ALS showed a significant impairment in Affective ToM only when compared with healthy controls, with a deficit in 36% of patients; 12% showed an isolated Affective ToM deficit while 24% showed more generic ToM dysfunction. A Cognitive ToM deficit was found in 27% of patients, with 3% showing an isolated Cognitive ToM deficit. The patients with ALS showed reduced empathy (Fantasy scale) and increased behavioural dysfunction with high levels of apathy. In addition, patients with either an Affective and/or Cognitive ToM deficit exhibited poor self-awareness of their performance and abnormalities on verbal fluency, while those with an Affective ToM deficit also displayed higher levels of apathy and a naming deficit.
CONCLUSIONS
Dysfunctional ToM is a prominent feature of the cognitive profile of ALS. This specific difficulty in identifying and distinguishing the feelings and thoughts of another from a self-perspective may underpin the social behavioural abnormalities present in some patients with ALS, manifest as apathy and loss of awareness.
Topics: Adult; Affect; Aged; Aged, 80 and over; Amyotrophic Lateral Sclerosis; Awareness; Cognition; Empathy; Female; Humans; Interpersonal Relations; Judgment; Male; Middle Aged; Neuropsychological Tests; Self Concept; Theory of Mind; Treatment Outcome
PubMed: 25476003
DOI: 10.1136/jnnp-2014-309290 -
Experimental Brain Research Mar 2022Temporal Binding Window (TBW) represents a reliable index of efficient multisensory integration process, which allows individuals to infer which sensory inputs from...
Temporal Binding Window (TBW) represents a reliable index of efficient multisensory integration process, which allows individuals to infer which sensory inputs from different modalities pertain to the same event. TBW alterations have been reported in some neurological and neuropsychiatric disorders and seem to negatively affects cognition and behavior. So far, it is still unknown whether deficits of multisensory integration, as indexed by an abnormal TBW, are present even in Multiple Sclerosis. We addressed this issue by testing 25 participants affected by relapsing-remitting Multiple Sclerosis (RRMS) and 30 age-matched healthy controls. Participants completed a simultaneity judgment task (SJ2) to assess the audio-visual TBW; two unimodal SJ2 versions were used as control tasks. Individuals with RRMS showed an enlarged audio-visual TBW (width range = from - 166 ms to + 198 ms), as compared to healthy controls (width range = - 177/ + 66 ms), thus showing an increased tendency to integrate temporally asynchronous visual and auditory stimuli. Instead, simultaneity perception of unimodal (visual or auditory) events overall did not differ from that of controls. These results provide first evidence of a selective deficit of multisensory integration in individuals affected by RRMS, besides the well-known motor and cognitive impairments. The reduced multisensory temporal acuity is likely caused by a disruption of the neural interplay between different sensory systems caused by multiple sclerosis.
Topics: Acoustic Stimulation; Auditory Perception; Humans; Judgment; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Photic Stimulation; Visual Perception
PubMed: 35094114
DOI: 10.1007/s00221-022-06310-0 -
Sleep Apr 2014Chronic insomnia is a prevalent sleep disorder that negatively affects daytime functioning and confers risk for the future development of psychiatric disorder. Patients...
STUDY OBJECTIVES
Chronic insomnia is a prevalent sleep disorder that negatively affects daytime functioning and confers risk for the future development of psychiatric disorder. Patients with insomnia often report problems with emotion regulation and impaired social interactions. Moreover, experimental sleep loss in healthy adults is associated with altered reactivity to and interpretation of emotional information. In the current study, we investigated socioemotional processing in patients with chronic insomnia disorder relative to healthy good sleepers.
DESIGN
Between-groups comparison.
SETTING
Sleep Research Laboratory.
PARTICIPANTS
Patients with well-defined psychophysiological insomnia (PI; n = 16), free from psychiatric disorder, and an age- and sex-matched control group of good sleepers (GS; n = 15).
INTERVENTIONS
N/A.
MEASUREMENT AND RESULTS
All participants completed a facial expression recognition task, between 18:00 and 19:00, requiring participants to categorize and rate the intensity of four emotional expression categories: anger, fear, happiness, and sadness. People with PI did not differ from GS with respect to categorization of facial expressions. However, in terms of intensity judgements, across all emotion categories, patients tended to rate faces as less emotionally intense (Cohen's d = 0.70). Specifically, they rated expressions displaying sadness and fear as significantly less emotionally intense than healthy GS (both P < 0.05; Cohen's d = 0.77 and 0.89, respectively). Measures of sleepiness (Psychomotor Vigilance Test, Karolinska Sleepiness Scale) or self-reported sleep were not reliably associated with emotional intensity ratings. However, anxiety and depression were negatively related to intensity ratings.
CONCLUSION
For the first time we show that chronic insomnia is associated with reduced ratings of emotion intensity for face expressions displaying sadness and fear. Further work is required to elucidate possible mechanisms and pathways underlying insomnia-related emotional impairment.
Topics: Anxiety; Attention; Case-Control Studies; Depression; Emotions; Facial Expression; Fatigue; Fear; Female; Happiness; Humans; Judgment; Male; Middle Aged; Pattern Recognition, Visual; Perception; Psychomotor Performance; Sleep Initiation and Maintenance Disorders
PubMed: 24899765
DOI: 10.5665/sleep.3588 -
British Journal of Psychology (London,... Aug 2018A growing body of evidence suggests that social exclusion impairs people's capacity for active deliberation and logical reasoning. Building on this finding and on the...
A growing body of evidence suggests that social exclusion impairs people's capacity for active deliberation and logical reasoning. Building on this finding and on the postulate from the dual-process theory that analytical thinking is essential in order to make good judgements and decisions, we hypothesized that social exclusion will alter judgement and choice behaviour. We tested this hypothesis in three experiments in which social exclusion was manipulated using the Cyberball paradigm, an online ball-tossing game in which participants either received the ball a fair number of times or were excluded by the other two players. We focused on a range of tasks designed to be sensitive to participants' ability to engage in analytical thinking and careful deliberation, including the cognitive reflection test (Experiment 1) and a set of anchoring, intertemporal preference, disjunction, and confidence tasks (experiments 2 and 3). Our results unanimously failed to support the hypothesis that social exclusion influences people's judgements and decision-making. We discuss the implications of our findings for social exclusion theory.
Topics: Adult; Aged; Choice Behavior; Cognition; Decision Making; Female; Humans; Judgment; Male; Middle Aged; Models, Psychological; Reproducibility of Results; Social Alienation; Social Isolation; Young Adult
PubMed: 29512152
DOI: 10.1111/bjop.12294