The Puzzles Test and the Red Shapes Test as new diagnostic tools for neglect syndrome

Introduction

Neuropsychological methods for diagnosing neglect syndrome (NS) are focused on identifying the inability of patients to respond to stimuli localized in contralesional space. There are a large number of methods capable of diagnosing spatial neglect, but at the same time having various limitations and restrictions in their use.

Objectives

To devise and to test universal diagnostic techniques for visuospatial neglect detection.

Methods

1) A.R. Luria test battery; Trail Making Test (Part A); the Bells Test; 2) Authors’ methods: the Puzzles Test, the Red Shapes Test. A total of 47 patients after stroke with right hemisphere damage participated in the study and were divided into a target (18 patients with NS) and a control (29 patients without NS) groups. The Puzzles Test consists of three tasks: turning over cards, completing a sentence using cards with letters, completing a picture. The Red Shapes Test consisted in the search for a variable number of geometric shapes. Objective indicators of the study: total task completion time, the number of left omissions.

Results

The sensitivity of the tests to NS was examined using the Mann-Whitney U-test. Differences in the number of omissions and task completion time between patients with and without spatial neglect were statistically significant regarding all tasks: turning over cards (p=0.01), completing a sentence (p<0.001), completing a picture (p<0.001), finding geometric shapes (p<0.01).

Conclusions

The Puzzles Test and Red Shapes Test along with the foreign tests (the Bells Test, Trail Making Test) are sufficiently effective methods for spatial neglect detection.

Disclosure

No significant relationships.

Core Competencies in Clinical Neuropsychology as a Training Model in Europe

The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement (about three quarters and above) on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research (a little over half), and even fewer to skills related to management, administration, and advocacy (fewer than half). European expert clinical neuropsychologists were in agreement with previous studies (including those conducted in the United States, Australia, and other countries) regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others.

Clinical Neuropsychology as a Specialist Profession in European Health Care: Developing a Benchmark for Training Standards and Competencies Using the Europsy Model?

The prevalence and negative impact of brain disorders are increasing. Clinical Neuropsychology is a specialty dedicated to understanding brain-behavior relationships, applying such knowledge to the assessment of cognitive, affective, and behavioral functioning associated with brain disorders, and designing and implementing effective treatments. The need for services goes beyond neurological diseases and has increased in areas of neurodevelopmental and psychiatric conditions, among others. In Europe, a great deal of variability exists in the education and training of Clinical Neuropsychologists. Training models include master’s programs, continuing education courses, doctoral programs, and/or post-doctoral specialization depending on the country, with no common framework of requirements, although patients’ needs demand equal competencies across Europe. In the past 5 years, the Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Association has conducted a series of surveys and interviews with experts in the field representing 30 European countries. The information, along with information from the existing literature, is used in presenting an overview of current and relevant topics related to policy and guidelines in the training and competencies in Clinical Neuropsychology. An option for the way forward is the EuroPsy Specialist Certificate, which is currently offered in Work and Organizational Psychology, and in psychotherapy. It builds upon the basic certificate and complements national standards without overriding them. General principles can be found that can set the basis for a common, solid, and comprehensive specialty education/training, sharpening the Neuropsychologists’ competencies across Europe. The requirements in Clinical Neuropsychology should be comparable to those for the existing specialty areas in the EuroPsy model. Despite the perceived challenges, developing a specialist certificate appears a step forward for the development of Clinical Neuropsychology. Recommendations are proposed toward a shared framework of competencies by the means of a common level of education/training for the professionals in Europe. Benchmarking training standards and competencies across Europe has the potential of providing protection against unqualified and ethically questionable practice, creating transparency, raising the general European standard, and promoting mobility of both Clinical Neuropsychologists and patients in Europe, for the benefit of the professional field and the population.

Training models and status of clinical neuropsychologists in Europe: Results of a survey on 30 countries

OBJECTIVE

The aims of the study were to analyze the current European situation of specialist education and training within clinical neuropsychology, and the legal and professional status of clinical neuropsychologists in different European countries.

METHOD

An online survey was prepared in 2016 by a Task Force established by the European Federation of Psychological Associations, and representatives of 30 countries gave their responses. Response rate was 76%.

RESULTS

Only three countries were reported to regulate the title of clinical neuropsychologist as well as the education and practice of clinical neuropsychologists by law. The most common university degree required to practice clinical neuropsychology was the master's degree; a doctoral degree was required in two countries. The length of the specialist education after the master's degree varied between 12 and 60 months. In one third of the countries, no commonly agreed upon model for specialist education existed. A more systematic training model and a longer duration of training were associated with independence in the work of clinical neuropsychologists.

CONCLUSIONS

As legal regulation is mostly absent and training models differ, those actively practicing clinical neuropsychology in Europe have a very heterogeneous educational background and skill level. There is a need for a European standardization of specialist training in clinical neuropsychology. Guiding principles for establishing the common core requirements are presented.

Personality, Psychopathological Symptoms and Illness Perception in Mental Disorders: Results from Russian MMPI-2 Validation Study

Introduction

According to common-sense model illness representation regulates her coping both in somatic and mental illnesses.

Objectives

As a personal reaction illness representation should partially depend not only on diagnosis and symptoms but also on personality. Aim is to identify direct and indirect effects of personality and psychopathological complaints in illness representation in mental disorders.

Methods

Eighty patients (20 males) from MMPI-2 validation sample (Butcher et al., 2001) filled revised version of Illness Perception Questionnaire and Symptom Checklist 90-R. Eleven patients met ICD-10 criteria for addictions, 28 – for mood disorders, 20 – for schizophrenia and schizotypal disorder, 21 – for acute stress reactions.

Results

According to moderation analysis, illness-related beliefs in mental disorders are relatively independent on clinical diagnosis and specific symptoms, but are associated with the overall level of psychopathological complaints. Regardless of the clinical group and complaints, depressive traits are associated with negative and emotional appraisal of illness. Social introversion and hypomanic activation serve as moderators of the relationship between complaints, illness duration and emotional representations.

Conclusions

Personality and overall level of psychopathological symptoms could be stronger predictor of illness-related beliefs than specific clinical factors in mental illness. Preliminary diagnostics of personality in mental illnesses could be used to reveal high-risk group for poor insight and non-compliance due to unrealistic beliefs. Research supported by the grant of President of the Russian Federation for the state support for young Russian scientists, project MK2193.2017.6.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Specifics of Psychological Consulting of Patients After TBI According to the Structure of Neuropsychological Deficit

Introduction

Present article introduces the case of a patient who had traumatic brain injury (TBI) in 2010. During examination V. demonstrated mild sensory aphasia, frontal lobes deficit, memory disorder, limiting beliefs, lack of adequate coping strategies, emotional reactions and disability to describe his feelings and body awareness.

Objectives and aim

Neuropsychological, correction and psychological counseling performance, considering neuropsychological deficit profile.

Methods

counseling was carried out over six weeks in the form of 2 hour sessions once a week. Speech perception impairment was taken into consideration. The process was started with frontal lobe deficit correction. Goal management training was used in conjunction with external control of distractions. Training in structured organization of information has highly improved memorization. Techniques of CBT were used to work with cognitive distortions, dysfunctional beliefs, and self-restricting behavior. Body-oriented therapy was offered to cope with stress factors and vegetative reactions.

Results

V. compensated memory disorder using external sources and motivation. Some adaptive strategies of interaction with people and the outer world were formed. He improved time management skills and learned to follow the priority of current task without distractions. Moreover, he actively started to use body-oriented techniques to regulate his emotional condition. A considerable progress was achieved in understanding his limits and difficulties in everyday life.

Conclusion

Implementation of psychological consulting according to neuropsychological deficit profile may be effective in interdisciplinary holistic rehabilitation of patients after TBI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Relationship Between Values of the Health Care and Cognitive Beliefs About Body, Illness and Treatment: Is There “Hypochondriac Discourse” in the Society?

Introduction

Social values of health and health care are considered as important factors of health behavior as well as sources of self-regulation in health and illness. However, emphasize on medicine, health and body that is widespread in mass media nowadays may increase hypochondriac-like beliefs and behavior as well as the risk for unexplained somatic symptoms in some individuals.

Objectives

Analysis of mass media revealed four models of health care value: health as a depletable resource requiring conservation, health as fragile value requiring protection and control, health as a necessary source of success and happiness, health as requiring periodic restoration by alternative medicine.

Aim was to investigate the relationship between these models and beliefs about body, illness and treatment.

Methods

One hundred and thirteen adults without history of mental or severe somatic illnesses filled checklist of values of health care, Cognitive Attitudes about Body And Health Scale (Rief et al., 1998), Compliance-related Self-Efficacy Scale (Tkhostov and Rasskazova, 2012).

Results

The models of health as a depletable resource and as fragile value are dominated in the sample. Agreement with these models of health care is, on the one hand, related to willingness to seek medical help and follow treatment, but, on the other hand, to an excessive attention to bodily sensations, somatosensory amplification, monitoring and catastrophization about bodily sensations.

Conclusions

Possible pathways linking “hypochondriac discourse” in the society in its various forms and cognitive beliefs typical for hypochondria and somatoform disorders will be discussed. Research supported by Russian Foundation for fundamental research, project 17-06-00849.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Pictorial Representation of Illness and Self-Measure as an Instrument for Diagnostic of Illness Representation in youth with Ultra-High risk for Psychosis

Introduction

Pictorial representation of illness and self-measure (PRISM) was developed as screening tool assessing implicit reaction to somatic illnesses. Conclusion is based on comparisons of the positions of illness-related (“Illness” and major symptoms) and unrelated (“Me”, “Family”, “Work/study”) objects on the list.

Objectives

Due to its easiness and implicitness PRISM could be promising addition to illness representation questionnaires in mental illnesses.

Aim was to reveal validity of the PRISM in youth with ultra-high risk for psychosis.

Methods

Eighty-one male patients 16–25 years old meeting criteria of ultra-high risk for psychosis; preliminary diagnoses of mood disorders 34, personality disorders 26, schizotypal disorder 21 patients) filled PRISM, beck cognitive insight scale, symptom checklist 90-r, illness perception questionnaire, quality of life and enjoyment questionnaire and happiness scale.

Results

According to hierarchical regression, conditional “Self-Illness” distance (after control for mean distances on the list) was related to less psychopathological complaints, lower subjective illness severity and emotional representations, higher treatment control and better quality of life. “Self-symptoms” distance was related to better cognitive insight, lower emotional representations and consequences and moderated the relationship between “Self-Illness” distance and appraisals of illness length and dynamic.

Conclusions

Conditional “Self-Illness” distance in PRISM could reflect cognitive appraisal of illness based on symptoms and related to life satisfaction while “Self-Symptoms” distance reflects merely emotional reaction based on cognitive insight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Neuropsychological Approach to the Consciousness in L.S. Vygotsky – A.N. Leontiev – A.R. Luria school

Introduction

Existing polysemy in definitions of human consciousness creates the major difficulty in its understanding. With the development of intensive care modern methods, the number of patients survived after coma and dwelling in disorders consciousness conditions rises.

Aims

Among, the most important practical questions of neuropsychology is estimation of the patient's consciousness current condition. The solvation of these problems requires precise denotation of consciousness neuropsychological criteria.

Methods

All of definitions of consciousness in Russian psychological school, have the binarity as a common feature: in one hand, in view of the world, yourself, and another hand–extraction and differentiation of yourself from the ambient world (self-consciousness).

Results

Neuropsychological model of consciousness (in particular, self-consciousness) includes all higher psychological functions (HPF). However, condition of none of them cannot be sufficient criterion of consciousness estimation. In Russian psychology it is suggested to study the consciousness through its own characteristic, among which one can designate reflexivity, which includes cognitions and personal meanings.

Conclusions

It is possible to determine the quality of consciousness at a specific instant of time, through the system of human relations, as activity is motivated the knowledge is acquired, the affective side of the activity is determined, the self-consciousness is formed exactly through the personal meaning. Personal meaning can act as that quantity of consciousness (self-consciousness) analyses where the external reality and human attitude to this reality are differentiated. One can judge about a degree of contact between a human and a real world by indirect difference between them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Disability as Psychological Barrier for Employment in Russia, Implications for Rehabilitation

Introduction

In Russia there was a misconception about employment of people with physical or cognitive disability that served as a psychological barrier for both employers and applicants. The situation has recently changed and special vacancies for invalids are open in some companies. A patient in residual period of traumatic brain injury (2010) attended our rehabilitation center with the request for employment. He grew up in orphanage and he had no experience of searching for vacancies by himself, also he had reduced communication skills. Moreover, TBI resulted in strong executive functions impairment.

Objectives and aim

Help V with employment.

Methods

Holistic rehabilitation program was developed for V. so he had a training in computer skills, CV writing and communication with employer. Cognitive-behavioral therapy methods were used while working on understanding of his limits and acceptance of his disability, and goal management training was applied to reduce frontal lobes dysfunction.

Results

After 1.5 months of counseling V. demonstrated significant improvement. He started to use e-mail and the Internet to find job openings. He was able to keep independent control of his activities. V. managed to accept his disability, so he declared it in his CV – it finally became crucial in his successful employment as clerk in a bank.

Conclusion

Holistic approach, which includes social work, neuropsychological rehabilitation and psychological support, is promising to overcome psychological barrier in employment of disabled people.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Interdisciplinary rehabilitation of a patient with right brain injury and recurrent depression

Introduction

Rehabilitaton of concurrent psychiatric disorder and brain injury is a major challenge. E. underwent neurosurgery for right fronto-parietal astrocytoma. Before illness he was managing automatization of big companies, but was fired after the operation. E. felt into severe depression and anxiety with catastrofization of his illness, suicidal ideation. He resisted multiple prescriptions for SSRI, admitting a sect pretending to “treat” oncology by “psychological” methods. Half a year after operation he attended our center.

Objectives and aim

To help E. return to paid employment.

Methods

E. was evaluated by neurologists, psychiatrist, neuropsychologists. Current depressive episode appeared to be the second one with underlying schizoid and perfectionist characteristics. He had moderate text comprehension difficulties, confabulations, slight executive dysfunction. Neuropsychologist educated patient on his difficulties and developed compensatory strategies – an alternative to catastrofisation. After psychoeducational session E. agreed to receive fluvoxamine. However, he deformed the received information due to brain injury, so psychotherapy had only minor effects. Infra-low frequency neurofeedback at T4P4 and T4Fp2 sites was started to promote restoration of right brain functions. E. gradually did better, and 3 months later was able to complete CBT course along with relaxation training.

Results

Improvements in emotional status along with ability to cope with cognitive difficulties allowed E. to return to a job similar to the previous. Six month after the start of treatment medications are tapered off, E. has no signs of depression and only slight anxiety.

Conclusions

Interdisciplinary holistic rehabilitation may be effective in concurrent psychiatric disorder and brain injury.

Disclosure of interest

The authors have not supplied their declaration of competing interest.