Richard J. Siegert

Depression in multiple sclerosis: a review

Several studies have reported high rates of depression in multiple sclerosis (MS) with a lifetime prevalence of ∼50% and an annual prevalence of 20% not uncommon. Concern about the potential of new drug treatments to exacerbate or precipitate depression in MS has led to increased interest in the relation between MS and depression. This review on MS and depression identifies the following key issues: How common is depression in people with MS? Is depression in MS associated with lesions in specific regions of the central nervous system? Is there an increased risk of suicide in MS? Is there a higher than expected incidence of anxiety disorders in MS? Are fatigue and depressed mood related in MS? Is there a relation between depression and cognitive impairment in MS? Which psychosocial variables affect the development of depression in MS? Does treatment with interferon increase the risk of depression? How effective are treatments for MS patients with depression? Each of these issues is briefly reviewed with critical commentary, and some priorities for future research are suggested.

Toward a comprehensive theory of child sexual abuse: A theory knitting perspective

Abstract In recent years a number of multifactorial theories of child sexual abuse have been developed. The most influential are Finkelhors (1984) Precondition Model of child sexual abuse; Hall and Hirschmans (1992) Quadripartite Model; and Marshall and Barbarees Integrated Theory (1990). While all three of these important theories have a number of strengths, each has serious weaknesses that limit its ability to provide a satisfactory explanation of child sexual abuse. In this paper we attempt to integrate the best elements of the three theories into a comprehensive etiological theory, or at least the beginnings of such a theory. After outlining the concept of theory knitting we briefly summarise each of the multifactorial theories and their major strengths and weaknesses. We then develop a comprehensive theoretical framework (the Pathways Model) integrating both the overlapping and unique elements of these broad perspectives with some additional concepts derived from various psychological domains. In the final section of the paper we consider the adequacy of the Pathways Model.

Theory of mind in schizophrenia: A critical review

Introduction. Friths (1992) neuropsychological theory of schizophrenia posits a number of fundamental cognitive impairments underpinning the characteristic symptoms of this disorder. One of these is an impairment in the ability to correctly interpret and predict the mental states of other people, so-called theory of mind (ToM). There is already a substantial body of evidence that ToM is impaired in people with schizophrenia. Our aim was to critically review this literature. Method. A narrative review of the research literature was completed. Electronic searches of both Medline and PsycInfo were conducted to locate relevant articles. The bibliographies of relevant articles were scrutinised and in some cases researchers were contacted directly. Results. A total of 30 studies that all examined some aspect of ToM in people with schizophrenia were located. These were summarised and key issues on this topic were identified. Conclusions. There is considerable evidence that ToM is impaired in people with schizophrenia. However, this is perhaps the only unequivocal finding on the topic to date. Issues that demand further clarification include: Is the deficit a state or a trait? How to measure ToM in schizophrenia research, and whether certain symptoms or groups of symptoms are associated with the ToM deficit. These issues are considered and the evidence evaluated. Some priorities for future research are suggested.

Attachment Style and Intimacy Deficits in Sexual Offenders: A Theoretical Framework

In the past few decades a number of theories have been developed to further our understanding of various aspects of sexual offending. Recent work has focused on the relationship between early interpersonal experiences and the presence of intimacy deficits in sexual offenders. The present paper develops a comprehensive attachment model of intimacy deficits in sexual offenders by drawing extensively upon the burgeoning interface between the attachment literature and social cognition research. In particular, the concept of an internal working model, as developed by Bowlby, is introduced as a bridge between early attachment experience and adult intimacy problems. It is suggested that a comprehensive model of intimacy deficits in relation to the sexual offender must pay attention to attachment style, the internal working model, and current behavioral strategies for gaining or avoiding intimacy. The clinical and research implications of this model are presented and discussed.

Is goal planning in rehabilitation effective? A systematic review

Objective: To determine the evidence regarding the effectiveness of goal planning in clinical rehabilitation. Design: Systematic review. Method: MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, American College of Physicians (ACP) Journal Club, and the Database of Abstracts of Reviews of Effects (DARE) were searched for randomized controlled trials on the therapeutic effectiveness of goal planning in the rehabilitation of adults with acquired disability. Studies were categorized by patient population and the clinical context of the study. Data were analysed using best-research synthesis, based on methodological quality determined by Physiotherapy Evidence Database (PEDro) scale scores. Results: Nineteen studies were included in this review. Study populations in these papers included patients with neurological disorders, psychiatric disorders, musculoskeletal disorders, cardiovascular disorders, respiratory disorders and dietary/endocrine disorders. Six studies investigated the immediate effects of goal planning on patient behaviour. Thirteen studies investigated the effects of goal planning in the context of a rehabilitation programme lasting more than one week. Some limited evidence was identified that goal planning can influence patient adherence to treatment regimes and strong evidence that prescribed, specific, challenging goals can improve immediate patient performance in some specific clinical contexts. However, evidence regarding how these effects translated to improved outcomes following rehabilitation programmes was inconsistent. Conclusions: This review identified that while some studies demonstrated positive effects associated with goal planning in local contexts, the best available empirical evidence regarding the generalizable effectiveness of goal planning was inconsistent and compromised by methodological limitations.

Is implicit sequence learning impaired in Parkinson's disease? A meta-analysis

The aim of the present study was to examine impairment of implicit learning in Parkinsons disease (PD) by means of a meta-analysis of studies that used the serial reaction time (SRT) task. The authors performed a systematic review and meta-analysis of published journal articles (1987-2005) that used the SRT task with patients with PD. The principal outcome measures used to compare studies were (a) the difference in reaction time between the last block of ordered sequence trials and the randomized block for PD and control participants and (b) fixed and random effects pooled estimates by the inverse weighting method. Six studies, including 67 patients with PD, met the inclusion criteria. The meta-analysis showed that implicit learning was impaired in PD, relative to healthy controls, with a standardized mean difference of 0.73 (95% confidence interval = 0.38, 1.07). Implicit sequence learning appears to be impaired in patients with PD. Some common methodological weaknesses and limitations in the reporting of statistical data are discussed.

Areas of consensus and controversy about goal setting in rehabilitation: a conference report

Objective: To consider clinical issues surrounding goal setting in neurological rehabilitation, and to identify priorities for future research. Participants: Twenty-four rehabilitation professionals were invited to attend because they had taught or published on the topic of goal setting. In addition two patient groups were represented. Evidence: (1) The results of a systematic literature review, (2) presentations given during the two-day conference by investigators working within the field of goal setting, (3) questions and statements from conference attendees during open discussion, (4) a report initially formulated by a panel composed of four of the conference attendees, and then circulated to all attendees for comment, (5) views of the conference attendees gathered using a modified Delphi technique. Consensus: There were significant areas of consensus about goal setting. The Delphi studies highlighted and confirmed these areas of general agreement with consensus that goal setting is a core component of the rehabilitation process, and that goals should be specific, ambitious, relevant and time limited, with incremental steps that lead to progressive achievement. It was also agreed that that goal setting has a major impact on the relationship between patient and professional, with the availability of professional time and expertise being key to the success of the process. Controversy: Areas in which there was more controversy centred on the evaluation of goal achievement and the benefits of ambitious rather than achievable goals. The need for patient-centred goal setting was recognized, although it was felt at times that there were conflicts that prevented this being attainable.

Schizophrenia, theory of mind, and persecutory delusions.

Introduction. There is already a substantial body of evidence supporting Friths (1992) theory that theory of mind (ToM) is impaired in people with schizophrenia. However, a specific relationship between impaired ToM and paranoid delusions, while intuitively reasonable, has only been demonstrated in two studies to date. Correspondence should be addressed to Richard J. Siegert, Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine & Health Sciences, University of Otago, PO Box 7343, Wellington South, New Zealand; e‐mail: rsiegert@wnmeds.ac.nz This research was supported by a Victoria University Science Faculty research grant. Thanks to Max Coltheart and other members of the Macquarie Centre for Cognitive Science who provided valuable feedback and support in the early stages of this research. Preliminary results were presented at the Australian Conference of Cognitive Neuropsychology and Neuropsychiatry, Deakin University, 2001. Methods. A total of 25 participants with schizophrenia were classified as paranoid or nonparanoid and compared with 38 healthy controls on a variety of ToM tasks. These tasks included verbal and nonverbal, and first and second order ToM tasks. Results. Participants with schizophrenia performed significantly more poorly than healthy controls on both the first and second order verbal ToM tasks but not on the nonverbal ToM tasks. However, the ToM deficit was only observed for those participants with schizophrenia who had persecutory delusions. There was also a strong relationship observed between the severity of persecutory delusions and length of illness. Conclusions. This study represents only the third demonstration of a specific link between paranoid delusions and ToM impairment. Reasons why previous findings on this issue have been so inconsistent are considered. Further research is needed to explore the relationships among paranoia, ToM, and length of illness.

Preserved implicit learning on both the serial reaction time task and artificial grammar in patients with Parkinson's disease.

Thirteen nondemented patients with Parkinsons disease (PD) were compared with age-matched controls on two standard tests of implicit learning. A verbal version of the Serial Reaction Time (SRT) task was used to assess sequence learning and an artificial grammar (AG) task assessed perceptual learning. It was predicted that PD patients would show implicit learning on the AG task but not the SRT task, as motor sequence learning is thought to be reliant on the basal ganglia, which is damaged in PD. Patients with PD demonstrated implicit learning on both tasks. In light of these unexpected results the research on SRT learning in PD is reconsidered, and some possible explanations for the sometimes conflicting results of PD patient samples on the SRT task are considered. Four factors which merit further study in this regard are the degree to which the SRT task relies on overt motor responses, the effects of frontal lobe dysfunction upon implicit sequence learning, the effects of cerebellar degeneration, and the degree to which the illness itself has advanced.

A systematic review of psychological treatments for mild traumatic brain injury: An update on the evidence

Mild traumatic brain injury (MTBI) is common and results in persisting disability for a minority of cases. Evidence guiding clinical management of this more complex group is lacking. This study systematically reviews psychological/neuropsychological treatments for adults with MTBI, with an emphasis on external validity. A total of 8 further studies were found adding to 10 from previous reviews. Although the methodological quality remains poor, mild supportive evidence was found for educational interventions provided early following injury. However, the routine provision of interventions for all MTBI cases may not be effective. Continuing and novel research efforts are needed to identify factors associated with poor outcomes to enable efficient targeting of healthcare resources.