The relationship between self-esteem and functional outcome in the acute stroke-rehabilitation setting.

Objective: To explore the relationship between self-esteem and functional recovery in patients with acute stroke. Design: A nonconsecutive sample of stroke survivors received ratings of functional status and completed self-report measures of self-esteem and depressive symptoms. Bivariate correlational analyses and multivariate regression analyses explored the relationships of functional status and self-report of self-esteem and depressive symptoms. Setting: Acute inpatient rehabilitation hospital. Participants: A group of 176 right- or left-hemisphere stroke participants. Main Outcome Measures: Self-care and mobility domain scores (based on Functional Independence Measure ratings) at admission and discharge. Efficiency scores for each domain. Visual Analogue Self-Esteem Scale (S. M. Brumfitt & P. Sheeran, 1999) and Geriatric Depression Scale (J. A. Yesavage et al., 1983). Results: Regression analyses indicated that lower self-esteem ratings were related to poorer discharge self-care and mobility scores and poorer efficiency in these domains, whereas ratings of depressive symptoms were not. However, interactions between self-esteem ratings and ratings of depressive symptoms were noted. Exploratory analyses suggested that self-esteem ratings mediated the relationship between ratings of depressive symptoms and functional outcome indices. Conclusions: Self-esteem ratings may have a mediating/moderating role in the relationship between emotional functioning and functional outcome. This may have implications for research in this area and the type of mental health treatment available to stroke rehabilitation patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frames of reference in unilateral neglect and visual perception: A computational perspective.

Neurological patients with unilateral neglect fail to orient and respond to stimuli on one side, typically the left. A key research issue is whether neglect is exhibited with respect to the left side of the viewer or of objects. When deficits in attentional allocation depend not merely on an object's location with respect to the viewer but on the object's intrinsic extent, shape, or movement, researchers have inferred that attention must be operating in an object-based frame of reference. Simulations of a view-based connectionist model of spatial attention prove that this inference is not logically necessary: Object-based attentional effects can be obtained without object-based frames. The model thus explains away troublesome phenomena for view-based theories of object recognition. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The association of level and stability of self-esteem and depressive symptoms in the acute inpatient stroke rehabilitation setting.

Purpose: Explore the relationship of level and stability of self-esteem with self-reported depressive symptoms during acute inpatient stroke rehabilitation. Research Method: A consecutive sample of 79 participants was administered measures of state self-esteem and mood twice a day for 4 consecutive days. The Geriatric Depression Scale (GDS) was administered at the end of the 4 days. Self-esteem level was calculated by averaging the total self-esteem scores across the assessments, and self-esteem stability was operationalized as the standard deviation of self-esteem total scores. Mood level and stability were calculated likewise. Results: Regression analysis indicated that self-esteem stability moderated self-esteem level in predicting GDS scores, with stable lower self-esteem level associated with the most reported depressive symptoms. Unstable higher self-esteem levels were associated with more depressive symptoms than stable higher self-esteem. This interaction was demonstrated after controlling for mood level and stability, suggesting the independence of self-esteem stability from mood characteristics. Conclusion: Self-esteem stability may be an important variable in identifying individuals at risk for emotional disturbance following stroke. Further exploration of self-esteem stability correlates in this setting is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflections on blindsight: Neuroimaging and behavioural explorations clarify a case of reversed localisation in the blind field of a patient with hemianopia.

Blindsight refers to residual visual abilities of patients with primary visual cortex lesions. Most of this research uses single case studies, most famously patient GY. We examined a patient (DC) after surgical resection of V1 who demonstrated robust but reversed blind field target localisation, mislocalising midline blind field targets to the periphery and vice versa. This pattern was reliable across multiple sessions and was not because of extraocular light scatter. We then used functional magnetic resonance imaging to examine neural responses to blind field motion stimuli with no evidence of motion-selective activation in DC's extrastriate cortex in the damaged hemisphere, in stark contrast to GY who showed robust bilateral activation in response to blind field stimuli. This suggests that DC's blind field performance may not represent true blindsight. Follow-up testing with the target—background contrast reversed (i.e., black targets/white background), eliminated DC's reversed localisation, strongly suggesting that she was employing an unusual decision criterion based on intraocular light scatter. DC's failure to demonstrate true blindsight may be related to the age at which she acquired her lesion—much later in life than GY. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New subscales for an anchored version of the Brief Psychiatric Rating Scale: Construction, reliability, and validity in acute psychiatric admissions.

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)