Fernando Lolas

EPQ-R and Suicide Attempt: The Relevance of Psychoticism

In a sample of 63 female suicide attempters, EPQ-R Psychoticism appeared as the most relevant dimension related to hopelessness, suicidal ideation and number of previous attempts. Extraversion correlated negatively with most measures associated with the attempt (depression, hopelessness, suicide ideation, suicide intention and number of previous attempts). Neuroticism showed a tendency to correlate with two measures of suicide ideation. Data are discussed in terms of the usefulness of the EPQ-R for suicide evaluation and prevention.

Augmenting/reducing and personality: a psychometric and evoked potential study in a Chilean sample

Abstract Correlations between Vandos RAS scores, EPQ-R variables and amplitude/intensity slopes of vertex auditory evoked potentials in a Chilean sample of 17 male and 17 female young normal volunteers are presented. RAS was positively associated with Extraversion and Psychoticism and negatively with Lie. Electrocortical measures (P 1 -N 1 and N 1 -P 2 slopes) behaved differently in males and females. No association with age was found for psychometric variables. Findings suggest a modulating influence of sex. The pattern of relationships between personality variables studied seems to be generalizable across cultures and suggests a compensatory relation between overt behaviour and central nervous system properties.

On the Measurement of Alexithymic Behavior

It is suggested in this paper that alexithymia may be a graded behavioral characteristic in much the same way as psychological dimensions are. Under this assumption every person would possess an alexithymic score, however low it could be, and the basis for distinguishing between diagnostic groups would thence be quantitative rather than qualitative. The measurement of alexithymia in any given individual poses two main problems: the nature of the underlying phenomenon and the instruments that should be used for its depiction. Whether alexithymia is a trait, a state, or both cannot be answered confidently at present. On the other hand, its quantitative assessment depends upon an interaction between phenomenon, observer and situation. Some data bearing on the application of the Beth Israel Alexithymic and Psychosomatic Questionnaire by informed and uninformed interviewers suggest the need for reliability studies of this instrument. Also advanced is the possibility that some aspects of the syndrome (reflected differently in the questionnaire items) might be easier to detect or more amenable to quantitative assessment, thus suggesting that some weighting of items is needed in order to obtain a total alexithymia score.

The Gottschalk-Gleser Content Analysis Method of Measuring the Magnitude of Psychological Dimensions: Its Application in Transcultural Research:

Content analysis of verbal communications as a means of measuring psychological states and traits has achieved an important place in medicine and the behavioural sciences. Such use is based on the plausible idea that the words people choose to express themselves reveal significant information about how they are feeling and thinking. 33,67, 92 That words may mask genuine feelings and thoughts is not incompatible with the validity of content analysis as a measurement method. Even when words are used to cover up mental experiences or to deceive, content analysis may help elucidate the genuine subjective state of the individual. And whereas the reliability of assessing mental processes through the analysis of verbal communication reaches a convincing level of significance, 33,63 the assessment of mental processes based upon non-verbal communication is fraught with low reliability. 4

Hemispheric asymmetry of augmenting/reducing in visual and auditory evoked potentials ☆

The concept of augmenting/reducing (A/R) postulates a central mechanism controlling the intensity of incoming signals and affecting the response to them. Using a kinesthetic figural aftereffect (KFA) task, Petrie (1967) classified as augmenters (Aug) subjects who judged a standard stimulus as larger after kinesthetic stimulation, and reducers (Red) as showing the opposite tendency. The stimulus intensity control mechanism could also be inferred from amplitude changes in evoked potential (EP) components elicited by stimuli of different intensities. The amplitude/intensity slope function of the vertex visual evoked potential (VEP) PIN, component became a standard measure of A/R (Buchsbaum et al. 1983). Although correlations between KFA scores and VEP slope have been reported, the crossmodal stability of A/R has been questioned (Kaskey et al. 1980; Raine et al. 1981). Absence of auditory reducing at the vertex and no correlations between visual and auditory P,N, or

Neuroticism, Extraversion and Slow Brain Potentials

Peak amplitude and area under the curve of average vertex slow potentials recorded during the foreperiod of a reaction time task were found to discriminate between high- and low-neuroticism subjects, defined according to the Eysenck Personality Inventory. High-neuroticism subjects developed smaller peak amplitude, greater area and longer reaction times, presenting a high extinction rate when the imperative stimulus was omitted. Differences between extraverts and introverts were found within the low-neuroticism group and for area values, extraverts exhibiting larger area. A significant interaction effect of extraversion and neuroticism on slow-potential parameters was evidenced. Results are interpreted in terms of heightened arousal and disrupted focused attention in high-neuroticism subjects. Although evolutionary indexes of slow potentials could differentiate between extraverts and introverts, further work using inhibition indicators is needed to further clarify the differences between them. The data reported also suggest that different aspects of overt behavior would be associated diversely with slow-potential parameters.

Psychiatry: a specialized profession or a medical specialty?

The paper by Heinz Katschnig is a thoughtful description of the challenges faced by psychiatrists worldwide, providing an interesting opportunity to reflect upon what the profession really means. The dilemma may be put through the following question: if psychiatry (and psychiatrists) are the solution, which is in fact the problem? The “eliminative procedure” should lead us to question what would happen if the psychiatric profession disappears. Would health of the populations deteriorate? Would people suffer more? Would anyone notice that we do not have psychiatrists anymore? All these are hard questions. They are hard to pose and hard to answer. A profession is an institutionalized response to a social demand. A demand is not simply a need or a wish. It is a need or a wish consciously perceived by people and for whose satisfaction they are willing to pay, i.e., to provide practitioners with honor (honoraria), money, prestige, power or love. It is important to stress that the perceived need or desire lies in the people and not in the providers of the services 1. One of the most unfortunate developments of postmodernist societies consists in the development of expertocracies, that is, groups of experts who believe that progress and advancement rely exclusively on their own needs and interests. Sometimes, this development leads to ignore the original demand which created the expertise. Experts are concerned with the improvement of their knowledge base, refer to their peers for approval and acceptance and contend to know the real needs of people without confronting changing realities. The typical paternalism of the medical profession, characterized by beneficence without autonomy, is a rough form of expertocratic thinking based on the idea that “doctors know best”. The fact that psychiatrists are criticized is a warning that the profession should review the fundaments of its alleged power and influence on human affairs. As many other knowledge-based professions, the cognitive side of this knowledge has been considered the basis of professional power for psychiatrists. However, in terms of specialized information, current psychiatry could be subsumed under neurology, psychology, social work, or policy making. Searching for power in the knowledge base is not appropriate, or it has not been appropriate considering the results. The fashionable “evidence-based” practice does not apply to many psychiatric practices in diagnosis, treatment, or prevention. The many aspects of a seemingly heterogeneous profession, ranging from Bohemian speculation to hardcore empirical research, do not find a reasonable harmonization within individual practice of psychiatrists. In order to honor all the heterogeneous discourses constituting the historical knowledge base, they should resemble “Renaissance men” and this is seldom the case, particularly in an era of state-controlled or market-driven practice 2. If anything, what needs to be done is to reformulate the actual demand for a profession comprising so many disparate discourses and so different practices. This reformulation can only be done on the basis of a dispassionate analysis of what people really demand and what current health care systems permit. However, the defense of the psychiatric profession nowadays cannot be based exclusively on the knowledge base, contested by other professions and limited by laws, regulations, and pressure groups within society. As a proposal, I strongly believe that what people may really appreciate, and thus may justify an expert role of the kind psychiatrists might be able to provide, is not so much “evidence-based” practice as “value-based” integration of discourses and knowledge 3. The psychiatrist could represent that kind of general harmonizer of information that uses it in a prudent form and can be a counselor, a therapist and a health promoter without colliding with physicians, psychologists, lawyers, or social workers. From competition to integration, going through the intermediate stage of cooperation, psychiatrists could be the systemic organizers of health care and research and not insist to remain one among many medical specialties which, by necessity, could render its claims irrelevant. Psychiatry should become a specialized profession, solving the problems of integrality of approach and human relevance that no other prudent expert could provide. This, of course, might mean reorienting teaching, training, and practice, but is based on a perception of real demand and a response to the challenges now being uncovered and discussed 4.

Effects of stimulation intensity, gender and handedness upon auditory evoked potentials

Left handers and women show less anatomical brain asymmetry, larger corpus callosum and more bilateral representation of specific functions. Sensory and cognitive components of cortical auditory evoked potentials (AEP) have been shown to be asymmetric in right handed males and to be influenced by stimulus intensity. In this study the influence of sex, handedness and stimulus intensity upon AEP components is investigated under basal conditions of passive attention. 14 right handed males, 14 right handed females, 14 left handed males, and 14 left handed females were studied while lying awake and paying passive attention to auditory stimulation (series of 100 binaural clicks, duration 1 msec, rate 1/sec, at four intensities). Cz, C3 and C4 referenced to linked mastoids and right EOG were recorded. Analysis time was 400 msec, average evoked potentials were based on 100 clicks. Stimulus intensity and gender affect early sensory components (P1N1 and N1P2) at central leads, asymmetry is influenced only by handedness, right handers showing larger P1N1 amplitudes over the right hemisphere.

The psychosomatic approach and the problem of diagnosis

This paper examines some of the characteristics and aims of the process of medical diagnosis and the problems posed by the seeming opposition between disease-centered and person-centered diagnosis. The latter was one of the basic tenets of the psychosomatic approach from its inception. Its application to medical practice, however, has been hindered by the lack of an appropriate theoretical framework which might help avoid the one-sidedness prevailing in the discourse of different medical specialties. The building up of an integrative medicine has proceeded on the basis of addition and not on the basis of organic development from a theory-derived set of principles. In order to circumvent the problems associated with such state of affairs, it is proposed that multiaxial systems of diagnosis, like the ones currently in use in psychiatry, be adopted. These should be improved and expanded in order to take into account additional dimensions and data sources not hitherto taken into consideration.

DEZ ANOS DE EXPERIÊNCIA DO COMITÊ DE ÉTICA EM PESQUISA DA SECRETARIA DE SAÚDE DO DISTRITO FEDERAL, BRASIL

The objective of this article is to relate the experience of the Research Ethics Committee of the Secretary of Health, Federal District, Brazil (CEP/SES/DF) during 10 years (1997-2007) from its creation. It deals with a descriptive and documentary evaluation, in the form of case studies, utilizing all projects subject to protocol in CEP/SES/DF (Number 052/08) during that period. The most frequent conflicts were: terms of free and informed consent (30%), identification page (25%), methodology (20%), curriculum vitae (12%), budget (9%), others (4%). The activity report of CEP/SES/DF in 10 years revealed, as a result of its productivity, legitimacy in the process of ethical analysis of protocols which confirms the protection of research participants.