Mariely Lima

Can Dogs Prime Autistic Children for Therapy? Evidence from a Single Case Study

BACKGROUND AND OBJECTIVES Canine-assisted therapy has been receiving growing attention as a means of aiding children with autism spectrum disorder (ASD). Yet, only limited studies have been done and a great deal of literature related to this intervention is anecdotal. The present study aims at providing additional quantitative evidence on the potential of dogs to positively modulate the behavior of children with ASD. SETTINGS/LOCATION, SUBJECTS, AND INTERVENTIONS A 12-year-old boy diagnosed with ASD was exposed, at his usual treatment location (the Portuguese Association for Developmental Disorders and Autism at Vila Nova de Gaia, Portugal), to the following treatment conditions: (1) one-to-one structured activities with a therapist assisted by a certified therapy dog, and (2) one-to-one structured activities with the same therapist alone (as a control). To accurately assess differences in the behavior of the participant between these treatment conditions, the therapist followed a strict research protocol. The behavior of the participant was continuously video-recorded during both treatment conditions for further analysis and comparison. Treatment outcomes: In the presence of the dog, the participant exhibited more frequent and longer durations of positive behaviors (such as smiling and positive physical contacting) as well as less frequent and shorter durations of negative behaviors (such as aggressive manifestations). CONCLUSIONS These findings are in accordance with previous experimental work and provide additional support for the assertion that dogs can prime autistic children for therapy. Ultimately, this study may contribute toward a change for full acceptance of canine-assisted therapy programs within the medical milieu. Additional studies using a similar research protocol on more autistic children will certainly help professionals to work on the most effective methods to individually serve this population through canine-assisted interventions.

Finding an Ally: Can Dogs Help Therapists Promote Communication in Individuals with Profound Intellectual and Multiple Disabilities?

Dear Editor, Dog-assisted interventions have long been practiced, and there is now a considerable body of research demonstrating its efficacy, namely, to enhance communication skills in a number of populations (e.g.,). In face of this evidence, academics and clinicians involved in the research and implementation of effective communication programs for persons with profound intellectual and multiple disabilities (PIMD) cannot be but impressed with the dearth of empirical studies on these individuals. Aside from Heimlich, investigators have not yet focused on the potential of dogs as allies to help promote communication in individuals with PIMD. Thus, to us, it seems crucial to prioritize research on dog-assisted interventions for these persons to keep up with the scientific advances that have already benefited the functional communication training of individuals with a variety of other diagnoses. Individuals with PIMD have little or no apparent understanding of verbal language, and they primarily communicate in a nonor presymbolic way via an unconventional and idiosyncratic repertoire of behaviors. Given their difficulties in producing readable signals, they are often left with a feeling of helplessness and incompetence, with the potential that passivity, lack of interest, frustration, boredom, and/or challenging behaviors will rapidly develop and hinder the acquisition of communicative skills. Could dogs help therapists to promote communication in these individuals? We propose that, in a preliminary stage, studies should be directed at assessing whether dogs—as stimuli providing multisensory stimulation in a unique interactive style—can be pleasant, attention getting, and relaxing stimuli with which these individuals can positively engage. In a following stage, studies should be designed to determine whether dogs may consistently represent preferences and could potentially be used as reinforcers when teaching cause–effect skills to individuals with PIMD. One can entertain the hypothesis that the unambiguous behaviors (e.g., barking, jumping, licking, rolling) that trained dogs can exhibit as contingent responses to potential communicative signals may be highly motivating and satisfying for, at least, certain individuals with PIMD. As a consequence, dogs’ responses may help these individuals to learn that some elements of the environment may be responsive and controllable. Also, individuals may profit, from the multiple opportunities that naturally occur in the presence of the dog, to practice alternative modes of behavior (contrasting, for instance, to the loud, erratic, aggressive, or unpredictable manifestations that are common elements of the behavioral repertoire of persons with PIMD). Finally, future empirical studies could also try to relate the effects of the presence of dogs on the mood, attitude, and sensitivity of the therapists during functional communication training sessions (as proposed by Krugger and Serpell). It is our belief that future studies, using rigorous scientific protocols, may highlight important positive aspects of dogassisted interventions for improving communication in individuals with PIMD. Indeed, clinically speaking, we share Kruger and Serpell’s view in that it may be hard to imagine a better combination of attributes: a tool that can have the potential to simultaneously alert, engage, prime, and relax individuals with such profound levels of disabilities.

Can you Know me Better? An Exploratory Study Combining Behavioural and Physiological Measurements for an Objective Assessment of Sensory Responsiveness in a Child with Profound Intellectual and Multiple Disabilities

BACKGROUND Sensory assessment of individuals with profound intellectual and multiple disabilities (PIMD) can be difficult for several reasons, including the idiosyncratic reactions that these individuals exhibit to environmental stimuli. This case report presents a combination of behavioural and physiological measurements aimed at providing an objective assessment of the sensory responsiveness of a child with PIMD. MATERIAL AND METHODS The participant was presented with a set of nineteen stimuli commonly used during sensory interventions. Responsiveness to these stimuli was assessed in terms of motor movements, heart rate and electrodermal responses. RESULTS Although the child only exhibited consistent motor reactions to three of the items, he showed consistent physiological reactions to a total of ten stimuli. CONCLUSIONS Obtained data, although preliminary, suggest that combining behavioural and physiological measurements may constitute a useful resource for assessing the actual responsiveness of individuals with PIMD. With such a resource, people close to these individuals could fine tune their interventions and guarantee their well-being.

Dogs on the front line of care: Timely information for family physicians

A is a serious allergic reaction that is rapid in onset and might cause death. It is fatal in around 1% of cases. Studies have shown that there is underuse of intramuscular epinephrine as a first-line treatment despite the international guidelines. It has been demonstrated that many pediatricians have difficulties in anaphylaxis diagnosis and management. My personal observation is that there is delay or failure to use IM epinephrine, which is lifesaving, in cases of anaphylaxis. This is the first study on anaphylaxis in Kuwait. The aim of which is to assess the knowledge on anaphylaxis management among pediatricians and pediatric emergency physicians and factors influencing their practice. The ultimate goal is to be able to provide appropriate tools (updated ER protocol, scientific days, and workshops) to improve patient care and outcome. This is a survey questionnaire that will cover aspects on management based on the international guidelines. The study population is going to be pediatricians in the wards, clinics, ER or PICU, where they might encounter anaphylactic reactions.ii

Dogs as co-therapists for individuals with Autism spectrum disorder: 50 years after a first Psychiatrist?s insight

P memory is critical to everyday remembering, whether it be remembering to meet with friends on time or remembering to take an important medication on a regular basis. Prospective memory has been shown in the past to be compromised by the chronic use of a range of recreational drugs, including ecstasy, cannabis, alcohol and more recently, tobacco smoking. One developing area of research has focused on what impact exposure to second-hand smoke or “passive smoking” (where a non-smoker is exposed another person’s tobacco smoke in public or enclosed spaces) might have upon health and cognitive function. There is now widespread scientific consensus that exposure to second-hand smoke is harmful. Previous research has sug-gested that exposure to second-hand smoke not only has a detrimental effect upon health, but is also associated with poorer cognitive performance and educational achievement in chil¬dren, adolescents and adults. The current review will focus on recent evidence which suggests that prospective memory deficits are also associated with exposure to second-hand smoke in young adults. The review will also consider putative some potential psychopharmacological mechanisms involved, as well considering limitations and future directions within this field of research.Material and Methods: A convenient sample of 41 patients with major depressive disorder and 40 healthy age-matched controls were participants of this study. The patients were interviewed face to face according to DSM-IV diagnostic criteria. Depression score was measured using completed Beck Depression Inventory in both groups. The serum level of the interleukins of IL-21, IL-17, and TGF-β were assessed using ELISA-kits.P memory is critical to everyday remembering, whether it be remembering to meet with friends on time or remembering to take an important medication on a regular basis. Prospective memory has been shown in the past to be compromised by the chronic use of a range of recreational drugs, including ecstasy, cannabis, alcohol and more recently, tobacco smoking. One developing area of research has focused on what impact exposure to second-hand smoke or “passive smoking” (where a non-smoker is exposed another person’s tobacco smoke in public or enclosed spaces) might have upon health and cognitive function. There is now widespread scientific consensus that exposure to second-hand smoke is harmful. Previous research has sug-gested that exposure to second-hand smoke not only has a detrimental effect upon health, but is also associated with poorer cognitive performance and educational achievement in chil¬dren, adolescents and adults. The current review will focus on recent evidence which suggests that prospective memory deficits are also associated with exposure to second-hand smoke in young adults. The review will also consider putative some potential psychopharmacological mechanisms involved, as well considering limitations and future directions within this field of research.Introduction: The depressive disorder in children is a common condition that affects the physical, emotional, social development and often persists into adulthood. Childhood depression is a public health problem affecting, in the world, 2.8% of children under 13 years old. In Brazil, the prevalence of depression in childhood is 0.2% and 7.5% for children under 14 years old. However, the theoretical contributions about the neuroanatomical changes in patients with childhood depression are quite inconsistent. Therefore, the purpose is a systematic review about the neuroanatomical changes present in patients with childhood depression. Methods: Systematic review of the literature January 1, 2010 to January 16, 2014 to the descriptors “Depression” (MeSH), “Child” (MeSH), “Anatomy” (MeSH) and their respective terms in English on the basis data: MEDLINE and SciELO. Results: Neuroimaging studies have shown that the hippocampus is about 4-5% lower in patients with major depression than in healthy controls, and this reduction in hippocampal volume constantly noted in children with a family history of major depressive disorder. In addition, the orbitofrontal cortex, cingulate gyrus, and the basal ganglia were also found reduced in patients with major depression. Conclusion: Taking into account the possible influences and structural and functional brain changes over depressive disorder, longitudinal studies are necessary from the use of neuroimaging methods, in order to understand what the possible variations in the cytoarchitecture of the nervous system that best indicate and /or that are pathognomonic in childhood depression.Objectives: Bipolar disorder is characterised by cognitive deficits and deficits in social functioning both during acute stages and in clinical remission. One concept used to examine the underlying mechanisms of social impairment in neuropsychiatric disorders is social cognition, involving the ability to understand and respond to the thoughts and feelings of others. Thus, Theory of mind (ToM), the ability to represent one’s own and others mental states, has been an important area of research in bipolar affective disorder. Results have been mixed so far, mainly due to possible confounding effects of neurocognition, as well as clinical factors such as stage of illness and current mood. The present study explores ToM in bipolar disorder patients during the stage of clinical remission. Method: 20 patients diagnosed with bipolar disorder according to ICD-10, currently in remission and 20 healthy controls were recruited. Remission was determined by 3 month symptom-free period clinically and with YMRS scores< 4 and HAM-D score < 7. The Faux Pas test was used for ToM assessment. In this test, the subject is read 10 stories containing social faux pas and 10 control stories containing minor conflict, but no faux pas. The subject is required to identify the faux pas by taking perspective of the other person’s mental state. The data was analyzed using the computer software program, Statistical Package for Social Sciences-version 11.5 (SPSS-11.5) for Windows®, with different parametric and nonparametric tests, as indicated. The level of significance was taken as p < 0.05 (two tailed). Results: There was significant difference in performance on faux pas stories in patient population as compared to controls. Bipolar disorder patients failed to recognize the faux pas committed by the characters in the stories. There was no significant difference in performance of the control stories in patient population as compared to controls. There was no correlation of poor performance on faux pas stories and clinical characteristics of patients like age, education, age of onset of illness, duration of illness, duration of remission, positive family history, YMRS and HAM-D scores. Conclusions: The study revealed deficits in recognizing social cues by bipolar patients as compared to normal controls. Similar performance on control stories indicate that there is no difficulty in understanding a regular social context. This deficit seen in remission phase indicates that social cognition remains impaired in bipolar patients even after apparent clinical recovery.D the first part of the lecture the author will discuss the diagnosis and clinical picture of PTSD. She will then briefly present emotional processing theory to help understand why some traumatized individuals recover and others develop chronic PTSD and how we can conceptualize Prolonged Exposure (PE) therapy within this theory. Next, she will provide an overview of the efficacy of different cognitive behavioral programs that have been found helpful in ameliorating PTSD symptoms, with emphasize on PE, illustrating the treatment via video clips of patients. Finally, she will discuss the dissemination of PE in clinical practices of civilian community, veterans, and military in the US, and other countries.A dysfunction of the lateral habenula (LHb) is implicated in several psychiatric disorders including drug abuse, bipolar disorder, alcohol dependence and schizophrenia. Previous work with psychophysically-based studies suggests that electrolytic lesion of the LHb, which lies in the dorsal diencephalic conduction system, degrades the intracranial self-stimulation (ICSS). This experiment was aimed at studying the importance of the LHb in brain reward stimulation, and its connection with other areas that support operant responding for ICSS. For this purpose, rats were trained to receive an electrical stimulation at the lateral hypothalamus (LH), a region in the brain implicated in reward and motivation. The change in reward was measured daily for two weeks, and Fos-like immunoreactivity was quantified at the end of the experiment. The expression of c-fos was measured in several forebrain and midbrain regions in order to visualize the neurons that were activated by the stimulation. The same experiment was done in rats that received a stimulation at the LH following an electrolytic lesion at the LHb. Results show that a lesion at the LHb produced a large and long-lasting attenuation of reward, which was generally associated with reduced c-fos expression. Since an alteration in reward is an important characteristic of several psychiatric disorders, identifying the role of the LHb in the brain reward circuitry will constitute an important step towards a better understanding of the neurobiological bases of these disorders.There is more need in the pharmacotherapeutical treatment, particularly in psychopharmacotherapy, to take into account the psychological factors that influence the effectiveness or ineffectiveness of treatment. It’s important to takes into account the holistic approach to the patient and a “brain-mind” concept is also inevitable in this approach. Inefficiency of pharmacotherapy, treatment-resistence, non-adherence, nocebo etc. are only some of the phenomena that require a psychodynamic approach and the kind of creativity in prescribing drugs. Psychiatry 2015; 12, 2: 85–89 key words: inefficiency of pharmacotherapy, psychodynamic approach, holistic approach Address for correspondence: prof. dr. sc. Mirela Vlastelica Vukasovićeva 10, 21000 Split, Croatia, Tel. 00385 91 410 0091, e-mail: mirela.vlastelica@yahoo.com Mirela Vlastelica Private Psychiatric Office, Split, Croatia; Department of Psychological Medicine, School of Medicine, University of Split, Croatia How to deal with psychopharmacotherapeutic inefficiency Jak radzić sobie z nieskutecznością psychofarmakoterapiD the first part of the lecture the author will discuss the diagnosis and clinical picture of PTSD. She will then briefly present emotional processing theory to help understand why some traumatized individuals recover and others develop chronic PTSD and how we can conceptualize Prolonged Exposure (PE) therapy within this theory. Next, she will provide an overview of the efficacy of different cognitive behavioral programs that have been found helpful in ameliorating PTSD symptoms, with emphasize on PE, illustrating the treatment via video clips of patients. Finally, she will discuss the dissemination of PE in clinical practices of civilian community, veterans, and military in the US, and other countries.