Psychotherapy of borderline psychotic children

This presentation of excerpts from the literature synthesizes many suggestions by various therapists concerning the treatment methods of borderline psychotic children. The importance of providing a stable, auxiliary ego for the child to introject emerges clearly and is clinically demonstrated. Comments on the author's own experiences are included.     

Detection of phenylketonuria in autistic and psychotic children

Sixty-five children with pervasive developmental disturbance (autism and atypical childhood psychosis) were screened by standard urinary amino acid detection testing methods. Three of the children showed abnormalities in these screening tests, leading to the diagnosis of phenylketonuria. This was verified by repeated urinary testing and blood phenylalanine determinations. The children with phenylketonuria were treated with low-phenylalanine diets and have shown improvement in functioning and developmental level since treatment. Urinary genetic screening should be a standard test for all children being evaluated for serious developmental disturbances of childhood.     

Drivelike motivational properties of competitive behavior.

Three experiments with 136 undergraduates demonstrated an empirical correspondence between drive effects and the drivelike motivation aroused by competition, and contributed to an accumulating body of literature that attributes aversively motivating properties to competitive behavior. Exps I and II centered on an instrumental escape conditioning model from which predictions were derived and tested. Competitive analogs of drive intensity and intermittent shock effects served to pinpoint the source of drive to the competition between opponents. The drivelike properties aroused by competition were further examined in the context of the standard learning paradigm of a test for the energizing effect of an irrelevant drive on behavior. Exp III produced a pattern of results that strongly suggests, as is characteristic of known drives, that the drive aroused by competition exerted a general energizing effect on behavior. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual motor performance of psychotic children.

Explored visual motor deviations by means of a Childhood Psychosis Scale applied to the Primary Visual-Motor Test protocols of 130 psychotic children (6–12 yrs), and 507 normal and retarded (IQ range 35–79) controls. 45.4% of the psychotic sample achieved critical scores on the scale as compared to 1.7% of the normal Ss and 12.9% of the retarded Ss. It was possible to match 94 of the psychotic children with nonpsychotic controls on the basis of CA and MA. Significantly more psychotics than matched controls were high scorers. Correlations with MA were moderately significant for each group. In IQ comparisons, significantly more psychotics who were retarded had critical scores than did normal-IQ psychotics. Age at diagnosis, type and length of treatment, recency of diagnosis, and degree of organicity did not discriminate between high- and low-responding psychotics. Base rate problems and theoretical aspects of the scale items are discussed. The scale appears useful as a screening device for normal and retarded children under the age of 13 yrs, with particular utility in detecting psychotic aspects of functioning among the retarded. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thinking disorders in parents of young psychotic children.

Tested 17 parents of young psychotic children on the Object Sorting Test. 2 control groups were used. The sample differed from the replicated studies in that parents of adult schizophrenics were tested. Since childhood psychosis has substantial differences from adult schizophrenia, it was anticipated that parents of psychotic children would not show the same extent of thought impairment found in parents of adult schizophrenics. The Ss, however, showed more thought impairment than parents of normal children. Mothers showed more impairment than fathers. Findings were interpreted to suggest circumscribed test anxiety in association with a psychotic child rather than representing a formal thought disorder. (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some principles of sensory analysis.

Proposes 2 principles of sensory analysis concerning sensory discrimination and small, near-threshold stimuli that are incorporated into a simple model that is applied to the discrimination of differences in luminance. The phenomena surveyed include signal-detection operating characteristics, psychometric functions, and thresholds both for discriminations between 2 separate stimuli and for the detection of increments superimposed on a uniform luminance. The wide variety of phenomena that can be related to each of the 2 principles is discussed, including the Craik-Cornsweet Illusion, modulation transfer functions for sinusoidal gratings, negative masking, and the pedestal effect. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autocontrol of sensory reinforcement in children.

Conducted 2 experiments with 7-yr-olds (N = 96) from schools in a black lower socioeconomic status neighborhood to test the hypothesis that self-production of sensory reinforcement enhances its effect relative to identical reinforcement which is externally provided. Completion of an FR-50 work period led to a 30-sec reinforcement period, where different groups either controlled visual input or received the same input externally controlled. It was found that, over extended trials, the group with autocontrol of visual input completed more trials before dropping out and responded at a higher rate during the reinforcement period than did groups with the externally-produced input. It is concluded that self-production is an important factor in determining the effectiveness of sensory reinforcement. (16 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The clinical relevance of reduced sensory stimulation.

Reviews theoretical and empirical connections between psychopathology, therapy, and reduced sensory stimulation. Decreases in sensory and social stimulation have been found to cause or aggravate psychological as well as physical dysfunctions in a wide variety of contexts. Such deprivation in infancy may lead to irreversible damage, while even brief periods of deprivation in adulthood have effects which, although temporary, are quite dramatic. At the same time, there is evidence that sensory deprivation is a promising therapeutic method or adjunct to other methods. (172 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of sensory block in epidural anaesthesia by electric stimulation

The onset of sensory block in lumbar epidural anesthesia was investigated in 26 patients, aged 18 to 84 years, employing the loss of discrimination to cold and pinprick, as well as by determining threshold electric stimulation (threshold intensities). A standard dose of 2% mepivacaine with adrenaline, 5 micrograms.ml-1, (0.1 ml per cm body height) was given and the patients' ability to discriminate stimuli within dermatomes T8, T10, T12, L2, L4 and S1 was investigated at five min intervals for 30 min after injection. From the results of the study it is concluded that i) The interval to peak analgesic efficacy of the anaesthetic solution used is < 30 min when assessments are based on the patients' ability to discriminate cold or pinprick but > 30 min when determinations of threshold intensities are employed. ii) Cold discrimination is lost earlier than discrimination to pinprick and at lower threshold intensities. iii) Threshold intensities describe the time course of onset of sensory block more precisely than results of testing by cold or pinprick. iv) The onset of sensory block was found to be positively correlated to the age of patients in the following respects: a) Threshold intensities during early onset in all investigated dermatomes except L2. b) Intensity of block in T8, T10, and S1 at the end of the study period. c) Time to loss of discrimination to cold and pinprick in T12, L2 and S1, and d) Threshold intensities at loss of discrimination to cold and pinprick. We propose that determinations of threshold intensities offer distinct advantages over conventional testing by cold and pinprick discrimination, especially when detailed analyses of the sensory blocking effects of local anaesthetic drugs are being investigated.     

Variables affecting stimulus fading and discriminative responding in psychotic children.

Overselective attention in autistic children has proven detrimental to learning when prompt-fading techniques are used, as autistics often respond exclusively to the prompt (the extra guiding stimulus) and fail to learn about the training stimuli. Exp I investigated stimulus variables in prompt fading that might reduce the attentional requirements for discrimination learning. Ss were 8 institutionalized autistic children, each of whom was either mute or echolalic, with minimal intelligible verbal behavior. Two variables were assessed: distinctive vs nondistinctive feature fading, which signified whether a prompt was a feature contained only in the positive stimulus (S+) or contained both in S+ and in the negative stimulus, and within- vs extrastimulus fading, which signified whether the prompt was superimposed on S+ during fading or presented spatially separate from S+. Significant main effects were found for both variables, due to the success of the within-stimulus and the distinctive feature conditions; the combination of within-stimulus and distinctive feature fading was the most effective procedure. Exp II was conducted with the same Ss to assess whether they were still responding only to that pretrained feature after fading. Results show that discriminative responding was maintained when the pretrained feature was made irrelevant, showing that Ss attended to multiple features of S+, but that it was disrupted when the whole letter containing the pretrained feature was made irrelevant, showing that Ss still learned a restricted portion of the S+ word. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of three reinforcement modifications on perseveration in psychotic children.

A study of an operant conditioning approach to the treatment of schizophrenic and autistic children showed agreement with an earlier comment by Leff. The authors conclude further that procedures derived from the basic principles of operant technology may facilitate the realization of effective treatment aids in the area of childhood psychosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of NGF and sensory nerve stimulation on collateral sprouting and gene expression in adult sensory neurons

Cerebroside sulfate activator protein (CSAct or saposin B) is one of a group of heat stable, low-molecular-weight proteins that appear to share a common structural motif. These have been referred to as saposin-like proteins and are thought to share a multiple amphipathic helical barrel structure with a conserved pattern of disulfide linkages. Porcine kidney CSAct was prepared in high purity and consisted of three major glycosylated subforms. The protein was studied by physical-chemical methods and evaluated by various methods for structural prediction. All suggest that CSAct has high amounts of alpha-helical conformation and little if any beta-sheet. Circular dichroism (CD) studies indicate 45-50% helical conformation depending on buffer and temperature. There was only a moderate loss in helical content with increasing temperature and no indication of thermal denaturation. Fourier transform infrared spectroscopy (FTIR) measurements on deuterium hydrated self-films also indicated a predominantly helical structure. Helical axis orientation was investigated by both oriented CD and FTIR dichroism, which suggested that the helical axes were roughly parallel and oriented along the axis of the surface on which the self-films had been deposited. One-dimensional nuclear magnetic resonance spectra showed large chemical shift dispersion, indicating a defined tertiary structure with little variation between 6 and 85 degrees C. NOESY spectra failed to show the strong NOE cross peaks expected for a highly helical conformation. This may indicate short-term conformational flexibility within the helices or molecular aggregation at the high protein concentrations employed. These observations are consistent with the 3-4-helix bundle motif suggested for saposin-like proteins by various predictive algorithms.     

Can sensory stimulation improve the functional outcome in stroke patients?

After obtaining informed consent, we randomized 78 patients with severe hemiparesis of the left or right side within 10 days of stroke onset: 40 to a control group receiving daily physiotherapy and occupational therapy, and 38 to a group that, in addition, we treated with sensory stimulation (acupuncture) twice a week for 10 weeks. The median age was 76 years for both groups. Motor function, balance, and ADL (Barthel's Index) were assessed before the start of treatment and at 1 and 3 months after stroke onset; ADL was also assessed after 12 months. We assessed the quality of life (QL) using the Nottingham Health Profile 3, 6, and 12 months after stroke onset. Patients given sensory stimulation recovered faster and to a larger extent than the controls, with a significant difference for balance, mobility, ADL, QL, and days spent at hospitals/nursing homes. Whether acupuncture per se is responsible for the differences requires further study.     

Modulation of voltage-activated calcium currents by mechanical stimulation in rat sensory neurons

We examined the effects of mechanical stress, induced by a stream of bath solution, on evoked action potentials, electrical excitability, and Ca2+ currents in rat dorsal root ganglion neurons in culture with the use of the whole cell patch-clamp technique. Action-potential duration was altered reversibly by flow in 39% of the 51 neurons tested, but membrane potential and excitability were unaffected. The flow-induced increases and decreases in action-potential duration were consistent with the different effects of flow on two types of Ca2+ channel, determined by voltage-clamp recordings of Ba2+ currents. Current through omega-conotoxin-sensitive (N-type) Ca2+ channels increased by an estimated 74% with flow, corresponding to 23% increase in the total high voltage-activated current, whereas current through low-threshold voltage-activated (T-type) channels decreased by 14%. We conclude that modulation of voltage-activated Ca2+ currents constitutes a route by which mechanical events can regulate Ca2+ influx in sensory neurons.     

Effects of sensory restriction upon responses to cortical stimulation in rats.

Assigned 43 Long-Evans hooded rats to 7 groups receiving normal, visually restricted, or auditory restricted rearing experience. Ss were then implanted with bipolar pairs of electrodes in the auditory and visual projection areas. Electrical stimulation of the cortex was used as a discriminative stimulus for a lever-pressing response. The ease of using electrical stimulation of visual or auditory cortex as a discriminative stimulus was related to Ss' paranatal sensory experience. Deleterious effects were limited to the restricted cortical projection area, and there were suggestions of facilitated performance in response to stimulation of the nonrestricted cortical areas. These effects were absent when restriction was induced in adulthood. (28 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A therapeutic milieu for establishing and expanding communicative behaviors in psychotic children

This study describes a clinical intervention program that was used to facilitate development of receptive and expressive language skills in a group of four psychotic children. A group format utilizing an interactive language development teaching procedure combined with a therapeutic milieu was shown to be effective in establishing and expanding communicative behaviors in psychotic children. Nine diagnostic measures were utilized to assess children's performance prior to therapy and at the end of three-month and six-month intervals. Results indicated substantial reduction of delayed and immediate echolalia, jargon, inappropriate stress, pitch, and intonation. Substantial improvement was noted in expressive syntactic and morphological functioning and in the children's ability to generate novel utterances about day-to-day experiences, family, and toys. Increases in children's concept of body image and ego functioning paralleled their improvement in receptive and expressive language development.     

Fixation of spinal reflex alterations in spinal rats by sensory nerve stimulation.

Two preparations in which sensory nerve stimulation was used to obtain peripherally induced spinal fixation in spinal rats are described. In the first preparation, proportionally greater amounts of persisting poststimulation flexor muscle contraction, as measured by a force displacement transducer, were produced as stimulation time was increased from 10 min to 40 min. In the second preparation, sensory nerve stimulation was delivered, and evoked whole-nerve responses were recorded from a flexor motor nerve. Results indicated that 30 min or more of sensory nerve stimulation produced increases in response amplitude and area that persisted for at least 30 min after stimulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)