Charlotte Sheard

Pre-frontal structural and functional deficits associated with individual differences in schizotypal personality

This study tests the hypothesis that pre-frontal deficits underlie schizotypal personality in the normal population. Personality measures assessing features of DSM-IIIR schizotypal personality disorder (SPD) were related to left and right pre-frontal brain area assessed by magnetic resonance imaging (MRI), and neuropsychological measures of pre-frontal functioning (Wisconsin Card Sorting Task, WCST) in a group of non-institutionalized, unmedicated normal subjects. High schizotypal scores were significantly associated with reduced pre-frontal area and more WCST perseveration errors; conversely no relationships were observed between these pre-frontal measures and measures of psychosis-proneness unrelated to SPD traits. Pre-frontal structural findings were not found to be mediated by temporal lobe and posterior cortical structural deficits, height, weight, socio-economic status, education level and sex differences, while pre-frontal functional findings were not mediated by non-prefrontal cognitive ability. These findings of pre-frontal structural and functional deficits associated with schizotypal personality provide some initial converging support for a pre-frontal explanation of individual differences in schizotypal personality in the general population.

Evaluating the reliability and validity of three tools to assess the quality of health information on the Internet

The quality of Internet information needs to be evaluated and several tools exist for this purpose. However, none have demonstrated reliability and validity. This study tested the internal consistency and validity of the information quality tool (IQT), quality scale (QS) and DISCERN using 89 web sites discussing smoking cessation. The inter-rater reliability of the tools was established by exploring the agreement between two independent raters for 22 (25%) of the sites. The IQT and DISCERN possessed satisfactory internal consistency (as measured by Cronbachs alpha). The IQT, QS and DISCERN showed satisfactory inter-rater reliability (as measured by kappa and intraclass correlations). The IQT, QS and DISCERN correlated positively with each other, supporting the convergent validity of the tools. This study provides some evidence for the reliability and validity of the IQT, QS and DISCERN, although this needs testing in further research with different types of Internet information and larger sample sizes.

An evaluation of structural and functional prefrontal deficits in schizophrenia: MRI and neuropsychological measures

Magnetic resonance imaging was used to assess prefrontal brain structure in 17 schizophrenic, 18 psychiatric control, and 19 normal control subjects of comparable age, social background, and educational status, while three neuropsychological measures were used to assess prefrontal functioning. Schizophrenic patients had significantly smaller prefrontal areas than both psychiatric control and normal control subjects in all three planes. When posterior brain area and temporal lobe were entered into statistical analysis as covariates, they did not explain the prefrontal deficits. Schizophrenic patients made more perseveration errors on the Wisconsin Card Sorting Task and had fewer correct responses on the Spatial Delayed Response Task than normal control subjects. Schizophrenic patients performed more poorly than psychiatric control subjects on the Block Design Test. No group differences were found on three other nonfrontal tasks. These data lend some support to the role of prefrontal deficits in the development of schizophrenia.

Impact of Facial Paralysis on Patients With Acoustic Neuroma

Objective To assess the psychological distress, the ways of coping with that stress, and the self‐esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored.

Evaluating the reliability of DISCERN: a tool for assessing the quality of written patient information on treatment choices

Patients require good quality, evidence based information so that they can participate actively in the decision making process. The DISCERN instrument has been developed to help patients rate the quality of written information materials about treatment choices. This study evaluated the reliability of DISCERN using 31 information leaflets discussing treatment options for prostate cancer. The index of agreement between two independent raters was substantial for the overall quality rating (kappa=0.65, 95% confidence interval 0.49, 0.82), indicating that the instrument could be used to discriminate reliably between low and high quality prostate cancer publications. Healthcare professionals should inform patients of the availability of the instrument and encourage its use by patients who regularly attend to written sources of information on treatment choices. Early indications show that DISCERN could enable both patients and healthcare professionals to discriminate between the plethora of variable quality information currently available.

The reliability of assessment criteria for undergraduate medical students' communication skills portfolios: the Nottingham experience.

Introduction  Some educators have argued that portfolios should not be assessed summatively because there is little evidence supporting the reliability of their assessment. This study aims to determine the reliability of assessment criteria used for a portfolio at the University of Nottingham.

Severe intellectual disability and transition to adulthood

Institutional and psychological aspects of transition were explored with parents and staff involved with five young adults with severe intellectual disability whose challenging behaviour diminished after they made the transition, and five whose challenging behaviour remained high. They were selected from a previously surveyed cohort. Grounded theory analysis of interviews suggested little connection between the perspectives of parents and staff. The impact these differences have on communication about challenging behaviour was explored, and recommendations for service changes are made.

Parental information needs in chronic renal failure and diabetes mellitus

Abstract The information needs of parents of children with end stage renal failure (ESRF) or with insulin dependent diabetes mellitus (IDDM) were assessed by questionnaires over a 2-year period. Questionnaires were posted on seven occasions at 4-monthly intervals and were sent to both mothers and fathers. Most information needs were reported to be for detailed test results, for new information about the condition and about the childs future social development. Questions responsible for the three highest scores were concerned with the future: the childs fertility; their social, career and marriage prospects; and the hope for a new improved treatment. For the IDDM mothers, scores were significantly different depending on age of the child (P=0.02). Change in treatment mode had no significant effect on the information needs of parents of children with ESRF (P=0.81). Occupation was significantly associated with the mean general information needs scores for parents, with occupations of a lower socioeconomic status associated with higher information needs scores. There were no significant differences between the reported mean general information needs scores of parents of children with ESRF and of parents of children with IDDM (P=0.69) or between mothers and fathers mean general information needs scores (P=0.58). Conclusion Multidisciplinary team members need to tailor information to the needs of the individual families and be sensitive to socioeconomic factors and communication issues.

Neuroanatomical bases of electrodermal hypo-responding: A cluster analytic study

Schizophrenics and other psychiatric patients have been found to have a high incidence of electrodermal hypo-responding. Different neural mechanisms may underlie hypo-responding in these groups. The present study utilized cluster analysis of magnetic resonance imaging (MRI) and electrodermal orienting data to examine the neuroanatomical correlates of electrodermal hypo-responding in 15 schizophrenics, 15 psychiatric controls (predominately affective disorders), and 15 normal controls. The number of electrodermal responses was recorded during a standard orienting paradigm. MRI scans were obtained, yielding area measures for the pre-frontal cortex and lateral ventricle-brain ratios (VBRs). The number of electrodermal orienting responses and the MRI measures were transformed into zeta-scores and entered into an agglomerative hierarchical cluster analysis, which yielded three clusters. A 3 x 3 Chi-square analysis revealed that the three clusters significantly differed according to diagnostic group. Analyses of variance (ANOVAs) revealed that the first two clusters had significantly fewer electrodermal orienting responses than the third cluster (predominately normals). Further, the first cluster (predominately schizophrenics) had significantly smaller frontal lobes than the other two clusters. Additionally, the three normals in the first cluster had relatively high levels of schizotypy. The second cluster (predominately affective disorders) had significantly larger VBRs than the other two clusters. Schizophrenics in the three clusters differed with respect to gender composition and positive symptoms. Thus, diminished pre-frontal area may underlie electrodermal hypo-responding in a subgroup of schizophrenics and schizotypals, while enlarged ventricles may underlie the same phenomenon in the affective disorders and another subgroup of schizophrenics.

Development of a reliable and valid questionnaire to test the prostate cancer knowledge of men with the disease

Several prostate cancer knowledge questionnaires exist but none have demonstrated both reliability and validity when used by men with the disease. This study aims to develop a reliable and valid knowledge questionnaire for men with prostate cancer. After developing a 40-item Prostate Cancer Knowledge Questionnaire (PCKQ-40) in phase I, it was piloted in phase II with 391 medical students. This resulted in the reduction of the tool by removing items of poor discriminatory value. A balance between true and false items and content domains was also maintained in the reduced scale. The PCKQ-12 had a moderate internal consistency. Phase III of the study assessed the reliability and construct validity of the tool by measuring the prostate cancer knowledge levels of men with prostate cancer (n=28), men with other cancers (n=10) and men without cancer (n=84). Men with prostate cancer achieved significantly higher PCKQ-12 scores compared with men without cancer, supporting the construct validity of the tool. The tools reliability was also confirmed with a moderate internal consistency. This study provides some evidence for the reliability and validity of the PCKQ-12 and supports its use with men with prostate cancer in further research.