Michael Evangeli

Face processing in schizophrenia: Parallels with the effects of amygdala damage

Various lines of research into the neurobiological basis of schizophrenia have implicated the temporal lobes and underlying structures, including the amygdala. Against the background of recent neuropsychological studies highlighting the role of the amygdala in social information processing, and theoretical formulations which conceive of schizophrenia as a neuropsychological disorder of social cognition, the present study examined the performance of schizophrenic individuals on tasks which previous studies have shown to be sensitive to amygdala damage. Tests of face perception, verbal fluency, memory, visual perception, and verbal comprehension were administered to 12 schizophrenics, 12 depressed controls, and 12 normal controls, matched for age, gender, and intellectual level. Group analysis of data showed impairment in schizophrenia of some functions thought to rely on the amygdala, particularly facial fear perception. However, examination of single cases showed that some individuals with schizophrenia were not impaired on any amygdala-related functions. Further, impairments were noted in tasks thought not to be related to the amygdala (e.g. nonaffective memory and facial identity matching). These results further highlight the heterogeneity of functioning in schizophrenia, while providing evidence that amygdala pathology may be present in some individuals with the condition. Implications for the view of schizophrenia as a disorder of social cognition, the neural basis of which involves the amygdala, are discussed.

An evaluation of a brief motivational interviewing training course for HIV/AIDS counsellors in Western Cape Province, South Africa

Abstract HIV/AIDS counselling in South Africa covers a range of areas of prevention and treatment with a commonly used model of lay counsellors trained by non-governmental organisations and working alongside professionals in public health settings. This study presents a single group evaluation of a six-session (12-hour) course of Motivational Interviewing (MI) delivered to 17 HIV/AIDS lay counsellors working in peri-urban settings in Western Cape Province, South Africa. Counsellors reported that they used MI techniques both at the start and at the end of the training. In addition, they reported confidence in their ability to influence their clients’ motivation at both time points. The results from the ratings of role play performance showed that there was a marked change in emphasis over the group of counsellors from MI non-adherent practice before training (with advice giving, directiveness, control and confrontation) to more MI adherent practice (asking permission before giving advice, emphasising client autonomy, affirming the client and stressing the clients responsibility to change) at the end of the training. Only a small proportion of the counsellors reached the level of beginning proficiency (according to the Motivational Interviewing Treatment Integrity code) on the measure of the ratio of MI adherent to non-adherent responses. The ratio of reflections to questions and the percentage of open questions also showed improvements in performance across the group but generally to levels below that suggesting beginning proficiency in MI. There was no evidence of any change on global therapist ratings (of empathy and the spirit of MI, i.e. collaboration, evocation and autonomy support) or the percentage of complex reflections across the group of counsellors. Possible explanations for the results and public health implications are discussed.

Trauma‐related guilt and posttraumatic stress among journalists

This study explored the psychological impact of exposure to work-related trauma among journalists. It was hypothesised that positive associations would exist between (a) exposure and PTSD symptoms, (b) exposure and guilt cognitions, and (c) guilt cognitions and PTSD symptoms, and that the relationship between exposure and PTSD symptoms would be mediated by guilt cognitions. The sample consisted of 50 journalists (response rate = 15%), who had recently been exposed to work-related trauma. They were predominantly male, aged 40 years or older, well-educated, and most had worked in journalism for at least 15 years. Participants completed an online questionnaire that explored their work-related experiences of trauma, PTSD symptoms, and trauma-related guilt cognitions. The findings showed that higher levels of exposure to work-related trauma were significantly associated with higher levels of PTSD symptoms (r = .36) and trauma-related guilt cognitions (r = .29). Guilt cognitions were significantly and positively independently associated with PTSD symptoms (r = .12) and were consistent with partial mediation of relationship between exposure to work-related trauma and PTSD symptoms. This study provides greater insight into the psychological processing of work-related traumatic events among journalists and emphasizes the importance of posttrauma appraisals of guilt regarding their experiences.

A longitudinal study of child sleep in high and low risk families: Relationship to early maternal settling strategies and child psychological functioning

OBJECTIVES To investigate whether sleep disturbances previously found to characterise high risk infants: (a) persist into childhood; (b) are influenced by early maternal settling strategies and (c) predict cognitive and emotional/behavioural functioning. METHODS Mothers experiencing high and low levels of psychosocial adversity (risk) were recruited antenatally and longitudinally assessed with their children. Mothers completed measures of settling strategies and infant sleep postnatally, and at 12 and 18 months, infant age. At five years, child sleep characteristics were measured via an actigraphy and maternal report; IQ and child adjustment were also assessed. RESULTS Sleep disturbances observed in high-risk infants persisted at five years. Maternal involvement in infant settling was greater in high risk mothers, and predicted less optimal sleep at five years. Poorer five year sleep was associated with concurrent child anxiety/depression and aggression, but there was limited evidence for an influence of early sleep problems. Associations between infant/child sleep characteristics and IQ were also limited. CONCLUSIONS Early maternal over-involvement in infant settling is associated with less optimal sleep in children, which in turn, is related to child adjustment. The findings highlight the importance of supporting parents in the early development of good settling practices, particularly in high-risk populations.

Coping and psychological adjustment in adolescents with vertically acquired HIV

Abstract Children with vertically acquired HIV face the challenges of adolescence in addition to the demands of coping with their illness. The relationship between coping and psychological adjustment has been widely studied in adults and children with chronic diseases but it is poorly understood in adolescents with HIV. This study aimed to identify whether a UK sample of adolescents with vertically acquired HIV had poor psychological adjustment and to clarify the relationship between coping and psychological adjustment in this sample. Thirty adolescents with vertically acquired HIV (aged 11–17) filled in questionnaires of coping and psychological adjustment and a correlational design was used to determine if specific coping styles were related to quality of psychological adjustment. Results showed that younger children had lower levels of psychological adjustment than older adolescents, although as a group the adolescents scored within normal ranges. Psychological adjustment was significantly related to two coping styles, Ventilating feelings and Being humorous. Exploratory analysis examined the extent of HIV disclosure in this sample and the degree of satisfaction felt about the nature of communication about the diagnosis. The results showed that participants had few confidants but were satisfied with the nature of communication about their status. The level of satisfaction was not related to adjustment. On the basis of the results, potential clinical implications for adolescents with vertically acquired HIV who might be struggling not only with the challenging demands of adolescence but also with their illness are discussed. The need to adopt a developmental approach to coping and psychological adjustment is emphasized.

Offence-related posttraumatic stress disorder (PTSD) symptomatology and guilt in mentally disordered violent and sexual offenders

The aim of this research was to investigate trauma symptomatology specifically related to perpetrating a violent offence in a sample of mentally disordered offenders. We were particularly interested in measuring the association between offence-related guilt cognitions and offence-related trauma symptomatology. Data were collected from 45 inpatients at a regional and local secure unit. The measures administered were the Detailed Assessment of Posttraumatic Stress, the Trauma-Related Guilt Inventory, the Gudjonsson Blame Attribution Inventory, and the Positive and Negative Affect Scale. Other factors, including age, diagnosis, severity of the violent act, substance misuse and psychosis at the time of the offence, and relationship to the victim, were considered in relation to both trauma symptomatology and guilt cognitions. Results indicate that higher levels of trauma symptomatology are associated with higher levels of guilt cognitions. This remained significant once variance associated with offence severity and negative affect was accounted for. The results are discussed and the implications for assessment and treatment of this client group are considered.

Which Psychosocial Factors are Related to Chelation Adherence in Thalassemia? A Systematic Review

Good adherence to iron chelation therapy in thalassemia is crucial. Although there is evidence that adherence is related to regimen factors, there has been less emphasis on the relationship between psychosocial (psychological, demographic and social) factors and adherence. We present a systematic review of psychosocial correlates of chelation adherence in thalassemia. Nine studies met the inclusion criteria. Information was extracted regarding the study characteristics and the relationship between psychosocial factors and chelation adherence. Methodological quality was rated. The studies took place in a range of countries, were mostly cross sectional in design, and examined adherence to deferoxamine (DFO) only. Sample sizes ranged from 15 to 1573. A variety of psychosocial variables were examined. Definitions of adherence varied between studies and non adherence rates were also variable (9 to 66%). Older age was consistently associated with lower levels of chelation adherence. There were few other consistent findings. The methodological quality of studies was variable. There is a need for more methodologically sophisticated and theoretically informed studies on psychosocial correlates of chelation adherence. We offer specific suggestions.

Who, then what? The need for interventions to help young people with perinatally acquired HIV disclose their HIV status to others.

There has been considerable interest in paediatric HIV disclosure. This is the process leading to full disclosure (when the condition is named for the HIV-positive child, usually by a caregiver or healthcare worker). WHO guidelines state that children should be aware of the name of their condition by the age of 12, with younger children told their status incrementally to accommodate their cognitive skills and emotional maturity in preparation for full disclosure [3]. There is evidence, however, of variation in the age of full disclosure with this taking place later in resource-limited contexts than in other parts of the world [4]. Being aware of one’s status (full disclosure) is a prerequisite for onward disclosure and there is evidence of more onward disclosure if children are aware of their status earlier [5]. How one was disclosed to, for example, if there was an opportunity to ask questions about HIV and to feel listened to, may also impact on onward disclosure decision-making.

HIV Disclosure Anxiety: A Systematic Review and Theoretical Synthesis.

HIV disclosure can help people living with HIV to access social support, enhance antiretroviral adherence, facilitate engagement in care and reduce unprotected sex. Given interpersonal risks associated with HIV disclosure, however, anxiety about sharing one’s status is common. To investigate anxiety about HIV disclosure in HIV-positive populations, we conducted a systematic review of qualitative and quantitative studies, with 119 studies included. The review demonstrated that perceived interpersonal risks are associated with HIV disclosure and outlined evidence of associations with anxiety, fear and worry. We present a new cognitive model of HIV disclosure anxiety adapted from clinical theories of health and social anxiety, consistent with evidence from the review. The model attempts to explain the development and maintenance of anxiety in individuals whose functioning is most affected by concerns about sharing their status. Implications for helping people living with HIV struggling with significant levels of anxiety about HIV disclosure are discussed.

Habit reversal training and educational group treatments for children with tourette syndrome: A preliminary randomised controlled trial.

Quality of life of children with Tourette Syndrome (TS) is impacted greatly by its symptoms and their social consequences. Habit Reversal Training (HRT) is effective but has not, until now, been empirically evaluated in groups. This randomised controlled trial evaluated feasibility and preliminary efficacy of eight HRT group sessions compared to eight Education group sessions. Thirty-three children aged 9-13 years with TS or Chronic Tic Disorder took part. Outcomes evaluated were tic severity and quality of life (QoL). Tic severity improvements were found in both groups. Motor tic severity (Yale Global Tic Severity Scale) showed greatest improvements in the HRT group. Both groups showed a strong tendency toward improvements in patient reported QoL. In conclusion, group-based treatments for TS are feasible and exposure to other children with tics did not increase tic expression. HRT led to greater reductions in tic severity than Education. Implications, such as cost-effectiveness of treatment delivery, are discussed.