Combined visual and motor disorganization in patients with schizophrenia

Cognitive impairments are difficult to relate to clinical symptoms in schizophrenia, partly due to insufficient knowledge on how cognitive impairments interact with one another. Here, we devised a new sequential pointing task requiring both visual organization and motor sequencing. Six circles were presented simultaneously on a touch screen around a fixation point. Participants pointed with the finger each circle one after the other, in synchrony with auditory tones. We used an alternating rhythmic 300/600 ms pattern so that participants performed pairs of taps separated by short intervals of 300 ms. Visual organization was manipulated by using line-segments that grouped the circles two by two, yielding three pairs of connected circles, and three pairs of unconnected circles that belonged to different pairs. This led to three experimental conditions. In the “congruent condition,” the pairs of taps had to be executed on circles grouped by connecters. In the “non congruent condition,” they were to be executed on the unconnected circles that belonged to different pairs. In a neutral condition, there were no connecters. Twenty two patients with schizophrenia with mild symptoms and 22 control participants performed a series of 30 taps in each condition. Tap pairs were counted as errors when the produced rhythm was inverted (expected rhythm 600/300 = 2; inversed rhythm <1). Error rates in patients with a high level of clinical disorganization were significantly higher in the non-congruent condition than in the two other conditions, contrary to controls and the remaining patients. The tap-tone asynchrony increased in the presence of connecters in both patient groups, but not in the controls. Patients appeared not to integrate the visual organization during the planning phase of action, leading to a large difficulty during motor execution, especially in those patients revealing difficulties in visual organization. Visual motor tapping tasks may help detect those subgroups of patients

Internal validity of the French version of the Family Coping Questionnaire (FCQ): A confirmatory factor analysis.

Family members of patients with schizophrenia, especially when they assume caregivers' positions, experience difficulties to adapt to the situation. To gain insight into these caregivers' coping style is a challenge to decrease the stress of family members, and in this way, improve patient related outcome. The FCQ (Family Coping Questionnaire) is an adapted clinical assessment tool that focuses on specific ways to cope with dysfunction that characterize the psychotic pathology. The goal of this study was to provide validity evidence about the French version of the FCQ. Swiss and French family members of individuals suffering from schizophrenia (n = 204) responded to the FCQ. A confirmatory factor analysis (CFA) was applied estimating two models. The seven-factor model showed adequate fit to the data while the three-factor model fit was poor. This FCQ internal validation showed an adequate model fit with a French population including various family members (parents, siblings, etc.) of persons with enduring mental illness

Influencia de los AVA en el desarrollo de las competencias del componente de procesos físicos en el grado noveno de la Institución Educativa Misael Pastrana Borrero.

Este documento presenta los resultados del trabajo de grado realizado en la modalidad de Proyecto de investigación, bajo la asesoría de la doctora María Elena Rivas Arenas , el proyecto planteado se enfoca en dos líneas de investigación que se enmarcan dentro de los lineamientos de la escuela de ciencias de la educación ECEDU (Pedagogía, Didáctica y Currículo y Pedagogías mediadas), para lo cual se elige la investigación cuantitativa como modelo investigativo enfocado en el tratamiento de datos obtenidos a partir herramientas evaluativas que permiten determinar la efectividad de las herramientas pedagógicas y didácticas aplicadas para alcanzar el objetivo propuesto. El proyecto se realizó en la Institución Educativa Misael Pastrana Borrero, sede principal ubicada en la vereda el Alto, la cual ofrece enseñanza formal, en los niveles de educación preescolar, básica primaria, básica secundaria y media vocacional, en jornada única.This document presents the results of the degree work carried out in the research project modality, under the advice of Dr. María Elena Rivas Arenas, the proposed project focuses on two lines of research that are framed within the guidelines of the school of educational sciences ECEDU (Pedagogy, Didactics and Curriculum and Mediated Pedagogies), for which quantitative research is chosen as a research model focused on the treatment of data obtained from evaluative tools that allow determining the effectiveness of pedagogical and didactic tools applied to achieve the proposed objective. The project was carried out at the Misael Pastrana Borrero Educational Institution, headquarters located in the village of El Alto, which offers formal education at the levels of pre-school, elementary school, basic secondary and vocational media, in a single day

A cultura médica ambiental no desenvolvimento local da comunidade

A study was conducted with the objective of focusing attention on reflecting on the importance of the formation of environmental culture in the medical career, of relevance in the medical community and in society. Methods such as: analysis and synthesis, inductive-deductive, modeling, documentary analysis, dialectical hermeneutics were used. The application of the experimental methods allowed the elaboration of a model for the formation of the environmental culture in the professionals of the medical career with a holistic-configurational base when revealing the logic of the formation of this contextualized culture is projected as a solution of impact on the insufficiencies found with significance, transformation and systematization, in medical practice. The training of medical career professionals at the Faculty of Medical Sciences of Bayamo is not in line with the new requirements of the curriculum, which our society demands due to the inadequacies in the process of formation of environmental culture in the medical career.Se realizó un estudio con el objetivo de centrar la atención en reflexionar en la importancia de la formación de la cultura ambiental en la carrera de medicina, de relevancia en la comunidad médica y en la sociedad. Se utilizaron métodos como: análisis y síntesis, inductivo-deductivo, modelación, análisis documental, hermenéutico dialéctico. La aplicación de los métodos experimentales permitió la elaboración de un modelo para la formación de la cultura ambiental en los profesionales de la carrera de medicina con un basamento holístico-configuracional al revelar la lógica de la formación de esta cultura contextualizada se proyecta como una solución de impacto a las insuficiencias encontradas con significación, transformación y sistematización, en la práctica médica. La formación de los profesionales de la carrera de medicina en la Facultad de Ciencias Médicas de Bayamo no está acorde a las nuevas exigencias al currículo, que demanda nuestra sociedad debido a las insuficiencias en el proceso de formación de la cultura ambiental en la carrera de medicina.Foi realizado um estudo com o objetivo de focalizar a atenção na reflexão sobre a importância da formação da cultura ambiental na carreira médica, de relevância na comunidade médica e na sociedade. Foram utilizados métodos como: análise e síntese, indutivo-dedutivo, modelagem, análise documental, hermenêutica dialética. A aplicação dos métodos experimentais permitiu a elaboração de um modelo para a formação da cultura ambiental nos profissionais da carreira médica com base holístico-configuracional ao revelar a lógica da formação dessa cultura contextualizada como uma solução de impacto nas insuficiências encontradas com significado, transformação e sistematização, na prática médica. A formação de profissionais da carreira médica na Faculdade de Ciências Médicas de Bayamo não está de acordo com os novos requisitos do currículo exigidos por nossa sociedade devido às inadequações no processo de formação da cultura ambiental na carreira médica

Motor Agency: A New and Highly Sensitive Measure to Reveal Agency Disturbances in Early Psychosis

Background: Early diagnosis of young adults at risk of schizophrenia is essential for preventive approaches of the illness. Nevertheless, classic screening instruments are difficult to use because of the non-specific nature of the signs at this preonset phase of illness. The objective of the present contribution was to propose an innovating test that can probe the more specific symptom of psychosis, i.e., the sense of agency, which is defined as being the immediate experience of oneself as the cause of an action. More specifically, we tested whether motor agency is abnormal in early psychosis. Methods: Thirty-two young symptomatic patients and their age-matched controls participated in the study. 15 of these patients were at ultra high-risk for developing psychosis (UHR), and 17 patients were suffering from first-episode psychosis (FEP). Patients ’ neurocognitive capacities were assessed through the use of seven neuropsychological tests. A motor agency task was also introduced to obtain an objective indicator of the degree of sense of agency, by contrasting force levels applied during other and self-produced collisions between a hand-held objet and a pendulum. Results: As reported in the literature for adult controls, healthy adolescents used more efficient force levels in self than in other-imposed collisions. For both UHR and FEP patients, abnormally high levels of grip force were used for self-produced collisions, leading to an absence of difference between self and other. The normalized results revealed that motor agency differentiated patients from controls with a higher level of sensitivity than the more classic neuropsychological test battery

Active inference, sensory attenuation and illusions.

Active inference provides a simple and neurobiologically plausible account of how action and perception are coupled in producing (Bayes) optimal behaviour. This can be seen most easily as minimising prediction error: we can either change our predictions to explain sensory input through perception. Alternatively, we can actively change sensory input to fulfil our predictions. In active inference, this action is mediated by classical reflex arcs that minimise proprioceptive prediction error created by descending proprioceptive predictions. However, this creates a conflict between action and perception; in that, self-generated movements require predictions to override the sensory evidence that one is not actually moving. However, ignoring sensory evidence means that externally generated sensations will not be perceived. Conversely, attending to (proprioceptive and somatosensory) sensations enables the detection of externally generated events but precludes generation of actions. This conflict can be resolved by attenuating the precision of sensory evidence during movement or, equivalently, attending away from the consequences of self-made acts. We propose that this Bayes optimal withdrawal of precise sensory evidence during movement is the cause of psychophysical sensory attenuation. Furthermore, it explains the force-matching illusion and reproduces empirical results almost exactly. Finally, if attenuation is removed, the force-matching illusion disappears and false (delusional) inferences about agency emerge. This is important, given the negative correlation between sensory attenuation and delusional beliefs in normal subjects--and the reduction in the magnitude of the illusion in schizophrenia. Active inference therefore links the neuromodulatory optimisation of precision to sensory attenuation and illusory phenomena during the attribution of agency in normal subjects. It also provides a functional account of deficits in syndromes characterised by false inference and impaired movement--like schizophrenia and Parkinsonism--syndromes that implicate abnormal modulatory neurotransmission

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

Thérapie musicale individualisée et sentiment d’identité dans la maladie d’Alzheimer à un stade avancé : protocole à cas-unique d’une dyade patient aidé/conjoint-aidant

International audienceObjective. — The present study aimed to verify the effects of individualized music therapyon the sense of identity of an elderly subject suffering from Alzheimer’s disease, and that of his caregiver and spouse, while also considering the effect on the relationship within the caregiver/care receiver dyad. We postulate that individualised music therapy will strengthen each person’s sense of identity and thus promote the relationship with Self and with the Other.Patient and method. — Our interventional study is a single-case protocol. It was implemented over a period of three months in the home of a patient suffering from advanced Alzheimer’sdisease and his spouse and caregiver. An individualised music therapy system consisting of nineone-hour sessions, one session per week for the patient and one session every two weeks forthe caregiver, was proposed.Results. — At the end of the therapy, the results showed an improvement in the patient’s apathetic state, in his bodily expressiveness and in his social interactions via non-verbal communication. The caregiver’s sense of identity, assessed through self-satisfaction, self-image and representations of the ill person, was also improved.Discussion. — These results suggest that the musical experience, by mobilising the bodily, affective and sensory components of the Self, could enable each member of the dyad to deploy his or her own narrative and that it deserves to be given greater consideration, particularly with a view to strengthening the bond with the Other.Objectif. — La présente étude se propose de vérifier les effets d’une thérapie musicale individualisée sur le sentiment d’identité d’un sujet âgé souffrant de la maladie d’Alzheimer, et celui de sa conjointe-aidante, tout en considérant également l’effet sur la relation de la dyade aidant/aidé. Nous postulons que la thérapie musicale individualisée viendra renforcer le sentiment d’identité de chacun pour ainsi favoriser la relation à soi et à l’autre. Patients et méthode. — Notre étude de type interventionnelle porte sur un protocole à cas-unique. Elle s’est déroulée pendant trois mois au domicile d’un patient souffrant de la maladie d’Alzheimer à un stade avancé et de sa conjointe-aidante. Un dispositif de thérapie musicale individualisée composé de 9 séances d’une heure à raison d’une séance par semaine pour le patient et une séance sur deux pour la proche-aidante a été proposé.Résultats. — À l’issue de la thérapie, les résultats montrent une amélioration de l’état apathique du patient, de son expressivité corporelle et de son interaction sociale à travers sa communication non verbale. Le sentiment d’identité de la proche-aidante évalué au travers de la satisfaction de soi, de l’image qu’elle se porte ainsi que de la représentation qu’elle a de son proche-malade, est également amélioré. Discussion. — Ces résultats suggèrent que l’expérience musicale en mobilisant les parts corporelle, affective et sensorielle du Self permettrait à chacun des membres de la dyade de se raconter et mériterait d’être davantage considérée dans l’objectif notamment de renforcer le lien à l’autr

Pilot study about the efficacy of the ensemble (together) program: a tailored intervention for informal caregivers of people with severe psychiatric disorders

International audienceIntroduction: The demands of the informal caregiver role can have negative consequences on their everyday life. Recent studies have indicated that this role is related to a lower health state and reduced quality of life, which are associated with higher caregiver burden as well as poorer patient outcomes. Objectives: To evaluate the efficacy of a new tailored intervention for informal caregivers: the Ensemble (Together) program, compared to support as usual (SAU).Methods: A randomized controlled trial was performed on 18 informal caregivers of people with psychiatric disorders. Participants were randomized to receive one of two supports in an eight weeks period: Ensemble or SAU. Participants were assessed through 5 instrument tools: the ZARIT scale, the Brief Symptom Inventory, the Life Orientation Test, the Short-Form 36 scale and the Social and Occupational Functioning Assessment Scale. Assessments were completed by all participants three times: pre-post intervention and a 2 months follow-up. Scores of the two groups were then compared with regards to change over time for each of the variables using a mixed-model ANOVA with one between-subject factor (intervention) and one within-subject factor (time).Results: The preliminary results showed that the psychological health of informal caregivers following the Ensemble program is improved at the end of the intervention, as well as in comparison with the SAU groupConclusions: These preliminary results regarding the efficacy of the tailored Ensemble program suggest that individualized brief interventions for informal caregivers are particularly pertinent during both the acute and chronic phases of the disease