The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions

Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined.     

La plasticité neuronale : un nouveau paradigme entre neurosciences et psychanalyse

New neurobiological evidence for neuronal plasticity, demonstrating that experience leaves a structural and functional trace in the neuronal network, has raised questions about the organic and psychological causality of mental phenomena and calls in question our current views, suggesting that psychological events may have the potential to shape synaptic organization. Plasticity shows that the neuronal network remains open to change, to contingency: the brain must then be thought of as a highly dynamic organ constantly interacting with the environment as well as the psychological life of each person. Plasticity maintains the capacity to modify what has come before, allowing the person to respond to unpredictability, thereby constructing his or her individuality. Hence, plasticity entails moving on to a new paradigm. If neuronal networks are biologically determined, yet endowed with the capacity to be modified, and if the person participates in the emergence process, then it follows that neuroscience embodies, like psychoanalysis, the notions of both uniqueness and diversity. Thus, neuroscience and psychoanalysis come together around the question of the emergence of individuality, a process in which they both contribute to each other. What is at stake is not merely the logic of proof — validating psychoanalysis on the basis of neuroscience — but rather the realisation of the power of the paradigm shift brought about by the evidence of plasticity, through which contingent experience constantly modifies the brain of an evolving person.     

Psychometric Properties of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) in Chilean Children and Adolescents

In recent years, there has been a considerable increase in the development of assessment tools for obsessive-compulsive symptomatology in children and adolescents. The Obsessive Compulsive Inventory-Child Version (OCI-CV) is a well-established assessment self-report, with special interest for the assessment of dimensions of Obsessive Compulsive Disorder (OCD). This instrument has shown to be useful for clinical and non-clinical populations in two languages (English and European Spanish). Thus, the aim of this study was to analyze the psychometric properties of the OCI-CV in a Chilean community sample. The sample consisted of 816 children and adolescents with a mean age of 14.54 years (SD = 2.21; range = 10–18 years). Factor structure, internal consistency, test-retest reliability, convergent/divergent validity, and gender/age differences were examined. Confirmatory factor analysis showed a 6-factor structure (Doubting/Checking, Obsessing, Hoarding, Washing, Ordering, and Neutralizing) with one second-order factor. Good estimates of reliability (including internal consistency and test-retest), evidence supporting the validity, and small age and gender differences (higher levels of OCD symptomatology among older participants and women, respectively) are found. The OCI-CV is also an adequate scale for the assessment of obsessions and compulsions in a general population of Chilean children and adolescents.     

孤独症儿童生存质量、睡眠质量现状调查及睡眠障碍的影响因素分析

摘要 目的：分析孤独症儿童生存质量、睡眠质量现状,探讨其睡眠障碍的影响因素。方法：选择2017年1月至2019年12月期间我院收治的孤独症儿童100例作为研究组,另选同期于我院进行体检的健康儿童100例作为对照组,分别应用生存质量简易量表、社会支持评定量表、儿童睡眠质量调查问卷调查两组生存质量、社会支持情况、睡眠质量。应用单因素及多因素Logistic回归分析孤独症儿童睡眠障碍的影响因素。结果：研究组儿童生存质量简易量表的主观标准评分、客观标准评分及社会支持评定量表的主观支持评分、客观支持评分、对社会支持的利用度评分、总分均显著低于对照组（P＜0.05）。研究组入睡困难、睡眠不安、间断睡眠、夜惊、夜间尿床、打鼾、梦呓、梦游、张口呼吸、夜间磨牙、睡眠出汗发生率均显著高于对照组（P＜0.05）,两组梦魇发生率比较无统计学差异（P>0.05）。研究组患儿中存在睡眠障碍的46例,无睡眠障碍的54例。单因素分析显示,睡眠障碍组父母关系差、家族精神病史、新生儿窒息史、出生体重<2500 g比例显著高于无睡眠障碍组（P＜0.05）。多因素Logistic回归分析显示,父母关系差、有家族精神疾病史、有新生儿期窒息史、出生体重<2500 g是孤独症儿童睡眠障碍的危险因素（P＜0.05）。结论：与健康儿童相比,孤独症儿童生存质量、社会支持情况较差,睡眠障碍发生率也较高,父母关系差、有家族精神疾病史、有新生儿期窒息史、出生体重<2500 g是孤独症儿童睡眠障碍的危险因素。     

Immigrant Civic Engagement: New Translations

This study used a mixed methods methodology to investigate the reliability and validity of the Ounce Scale, an authentic, observational assessment of infants' and toddlers' development from birth through 42 months of age. Quantitative cross-sectional data were collected from 287 children and 124 teachers in seven urban Early Head Start programs; qualitative data were derived from interviews with 21 teachers and seven supervisors. Data were collected across eight age groups. Results showed moderate reliability of the Ounce Scale and provided evidence of agreement with criterion measures for concurrent validity. Receiver operating characteristic curve (ROC) analyses demonstrated very good levels of accuracy in predicting which children were at-risk or not at-risk. Hierarchical regression analyses indicated that, after controlling for child and family variables, the Ounce Scale contributed significantly to explaining the variance in children's performance on the criterion measures. Analysis of qualitative interview data elaborates on these findings in terms of the strength-based philosophy of the caregivers, the binary structure of the scale, the cultural context in which the scale was used, and the need for additional professional development. Discussion also centers on the relationship between norm-referenced and performance-based assessments in early childhood.     

Aggression in low functioning children and adolescents with autistic disorder

Background

Parents, caregivers and mental health professionals have often reported violence and aggression in children or adolescents with autistic disorder. However, most of these observations derived from anecdotal reports, and studies on frequency and characterization of aggression in autism remain limited. Our objective was to better characterize and understand the different types of aggressive behaviors displayed by a large group of individuals with autism in different observational situations.

Methodology/Findings

The study was conducted on 74 children and adolescents with autism and 115 typically developing control individuals matched for sex, age and pubertal stage. Other-Injurious Behaviors (OIB) were assessed in three observational situations (parents at home, two caregivers at day-care, a nurse and a child psychiatrist during blood drawing) using validated scales. The frequency of OIB was significantly higher in individuals with autism compared to typically developing control individuals during the blood drawing (23% vs. 0%, P<0 .01). The parents observed significantly less OIB in their children than caregivers (34% vs. 58%, P<0.05). In addition, the most frequent concurrent behaviors occurring just before the appearance of OIB in individuals with autism were anxiety-related behaviors and excitation according to the parental as well as the caregiver observation.

Conclusions/Significance

The results suggest that in a stressful situation, such as the blood drawing, individuals with autism release their stress through behaviors such as OIB, whereas typically developing individuals regulate and express their stress through cognitive skills such as mental coping strategies, symbolization skills with representation and anticipation of the stressful situation, social interaction and verbal or non-verbal communication. The findings underline also the key role of the environment in assessing OIB and developing therapeutic perspectives, with an individual who modulates his/her behavior according to the environment, and an environment that perceives this behavior and reacts to it with different tolerance thresholds according to the observers.     

Characteristics of invariant recognition of visual objects in preschool children with typical and atypical development

The invariant recognition ability of five- to six-year-old children with typical and atypical patterns of development in terms of the shape of visual images varying in color, size, and location has been studied. It has been shown that the typically developing children of this age are able to identify the invariant form of a visual object regardless of any changes in its color, size, or location. The children with neurodevelopmental disorders have difficulties with identifying the shape of a visual object when its location among a large number of figures is changed. The children with early infantile autism exhibit different degrees of visual perceptual deficit. The children with the milder forms of autistic disorders have difficulties only with recognizing the shape of an image when its location is changed; the children with more severe forms of disorders showed a serious impairment of invariant recognition regardless of image color, size, and location.     

The maternal effect in infantile autism: Elevated DNA damage degree in patients and their mothers

Infantile autism is a common disorder of mental development; besides hereditary predisposition, various environmental factors, including the condition of the mother’s body during pregnancy (“maternal effect”), have a significant impact on its appearance. Oxidative stress is suggested to play a key role in the pathogenesis of infantile autism. It causes a prominent genotoxic effect, which is realized through appearance of single and double strand breaks of the nuclear DNA. In patients with infantile autism and their mothers we evaluated the degree of DNA damage by using the DNA comet assay and determining the comet tail moment and DNA percent ratio in the tail. These two parameters demonstrated strong correlation (r = 0.90). Mean and median values of both parameters were significantly higher in samples from autistic children, than in agematching healthy controls. Interestingly, these parameters were also higher in healthy mothers of autistic children and they did not differ from the values in the group of autistic children. In the control group of healthy women of reproductive age, who had no children with autism, the mean value of the DNA comet tail moment significantly differed from the group of mothers of autistic children, but not from the control group of healthy children. The results suggest that mentally healthy mothers of autistic children have some genotoxic factors, which can determine development of the pathological process in the fetus via the environmental “maternal effect” during gestation.     

Body Morph Assessment: Preliminary Report on the Development of a Computerized Measure of Body Image

STEWART, TIFFANY M., DONALD A. WILLIAMSON, MONIQUE A. M. SMEETS, AND FRANK L. GREENWAY. Body morph assessment: preliminary report on the development of a computerized measure of body image. Objective: To develop a prototype of the Body Morph Assessment (BMA), and to test the reliability and validity of this new measure of body image. The BMA is a realistic and relatively simple procedure that uses computer morphing for the assessment of body image. For the purposes of this preliminary study, a prototype of the BMA was developed for usage with white women ranging from very thin to obese. Research Methods and Procedures: A total of 72 subjects participated in tests of reliability, content, and convergent validity of the BMA. Results: The reliability and validity of the BMA was supported by the results of this study. In a test of convergent validity, the measures of current, ideal, and reasonable body size were positively correlated with their equivalents from a similar body image assessment procedure. In addition, reliability coefficients were found to be satisfactory for all variables. Participants found the human figural stimuli to be realistic. Discussion: These preliminary findings support the reliability and validity of the BMA with white women. Given these positive findings, we plan to extend the procedure to males and to other racial and ethnic groups.     

情绪的脑机制研究在社会认知神经科学中的进展

社会认知神经科学是近几年国外新兴起的交叉学科,旨在阐述社会性、情绪性的体验与行为的心理和神经基础。它综合了认知神经科学与社会心理学研究的长处,对刻板印象、态度与态度改变、他人知觉、自我认知以及情绪与认知交互作用等方面进行了深入研究。主要范式是应用认知神经科学的方法来验证社会心理学在这些范畴上的各种不同理论观点,并在某些方面取得了突破性进展,但仍存在着广泛的发展空间。随着当前各种脑成像技术的革新,人们对情绪状态下大脑的神经活动的了解在原来认知的层面上有了进一步提升。本文主要阐述社会认知神经科学在情绪的脑机制研究上所取得的进展。     

Identification of Biomarkers of Impaired Sensory Profiles among Autistic Patients

BackgroundAutism is a neurodevelopmental disorder that displays significant heterogeneity. Comparison of subgroups within autism, and analyses of selected biomarkers as measure of the variation of the severity of autistic features such as cognitive dysfunction, social interaction impairment, and sensory abnormalities might help in understanding the pathophysiology of autism.ResultsWhile none of the studied markers correlated with CARS and SRS as measure of cognitive and social impairments, six markers significantly correlated with sensory profiles of autistic patients. Multiple regression analysis identifies a combination of PGES, mPGES-1, and PE as best predictors of the degree of sensory profile impairment. Library identification resulted in 100% correct assignments of both autistic and control participants based on either set 1 or 2 biomarkers together with a satisfactory rate of assignments in case of sensory profile impairment using different sets of biomarkers.ConclusionThe two selected sets of biomarkers were effective to separate autistic from healthy control subjects, demonstarting the possibility to accurately predict the severity of autism using the selected biomarkers. The effectiveness of the identified libraries lied in the fact that they were helpful in correctly assigning the study population as control or autistic patients and in classifying autistic patients with different degree of sensory profile impairment.     

A historical perspective on the collaboration between psychoanalysis and neuroscience

The aim of this article is to present and discuss the connections between psychoanalysis and neuroscience from a historical viewpoint. We start by examining how Sigmund Freud can be viewed as a pioneer in the interaction between these two fields. Freud was himself a neurologist and had maintained an interest in biology as he developed the key concepts of psychoanalysis. His ideas regarding psychosomatics are described. We will also explore how the concept of drive is essential to the connection between psychoanalysis and neuroscience. Then, we describe several key actors and historical events and characters at the interface of these two fields, namely Sándor Radó Lawrence S. Kubie and Mc Culloch, the debates that took place during the Macy conferences, as well as the positions of Jacques Lacan, George L. Engel, and Eric Kandel. Finally, we present a synthesis of the main fields in which the connections between psychoanalysis and neuroscience are already fruitful, and those where they should be developed: the classification of mental diseases, the link between the scientific and psychic dimensions, therapeutics, the organization of the body, intersubjectivity, the subjective division and ambivalence, as well as transferential effects like such as the placebo and nocebo effects. In the conclusion, we advocate several strategic alliances and underscore the complementarity between rigorous scientific experimentation and the individualized psychoanalytic approach.     

Linking neuroscience and psychoanalysis from a developmental perspective: Why and how?

This paper aims to develop the rational to support why and how we should link neuroscience and psychoanalysis. Many of these points are derived from child development and child psychiatry. Neuroscience investigates developmental questions in a different way than psychoanalysis, while psychoanalysis itself has shifted towards new developmental paradigms. The rapprochement between neuroscience and psychoanalysis allows a new understanding of some concepts, including embodiment of mind, consciousness and attachment. The “double reading” paradigm allows a better understanding of symptomatic configurations. Linking neuroscience and psychoanalysis may improve treatments and result in new experimental neuroscientific paradigms involving changing the research object, changing the state of the research object, and investigating the structural changes in the brain following psychotherapy. The last aim is to create an epistemology of the articulation between the theoretical frameworks through phenomenology, “complementarism” and neuropsychoanalysis. We argue that it is necessary for clinicians to be aware of the advancements in each field. This is not only an epistemological question; we assume that new findings in neuroscience will change the way psychoanalysts think and approach treatment of their patients. We hope the present research will contribute to change the way that neuroscientists think and will provide new options to their set of experimental paradigms.     

Metaphorical and Associative Thinking in Healthy Children and in Children with Asperger's Syndrome at Different Ages

The study of healthy children and patients with childhood autism (Asperger's syndrome) showed that metaphorical thinking is normally efficient at the age of 7–8 years and that autistic children have an impaired ability to understand metaphors and idioms widely used in verbal communication. The deficit of metaphorical thinking in autism is thought to be due to a decreased activity of the right hemisphere. In a study of associative thinking, healthy schoolchildren displayed a high degree of association between words describing sensual objects and autistic patients displayed an impairment of objective associations and a predominance of proper names, which is indicative of the left-hemispheric type of association. The impairment of the speech and mental activity (metaphorical and associative thinking) testified to changes in the interhemispheric interaction in autistic children, which is likely to show up in a decreased functional activity of the right hemisphere and an increased activity of the left hemisphere.     

Stereotypes of autism

In their landmark papers, both Kanner and Asperger employed a series of case histories to shape clinical insight into autistic disorders. This way of introducing, assessing and representing disorders has disappeared from today''s psychiatric practice, yet it offers a convincing model of the way stereotypes may build up as a result of representations of autism. Considering that much of what society at large learns on disorders on the autism spectrum is produced by representations of autism in novels, TV-series, movies or autobiographies, it will be of vital importance to scrutinize these representations and to check whether or not they are, in fact, misrepresenting autism. In quite a few cases, media representations of talent and special abilities can be said to have contributed to a harmful divergence between the general image of autism and the clinical reality of the autistic condition.     

Relationship Between Sonic Hedgehog Protein, Brain-Derived Neurotrophic Factor and Oxidative Stress in Autism Spectrum Disorders

The etiology of autism spectrum disorders (ASD) is not well known but oxidative stress has been suggested to play a pathological role. We report here that the serum levels of Sonic hedgehog (SHH) protein and brain-derived neurotrophic factor (BDNF) might be linked to oxidative stress in ASD. By using the whole blood or polymorphonuclear leukocytes, we demonstrated that autistic children produced a significantly higher level of oxygen free radicals (OFR). In addition, we found significantly higher levels of serum SHH protein in children with mild as well as severe form of autism. We also found that the serum level of BDNF was significantly reduced in autistic children with mild form of the disorder but not with severe form of the disorder. Our findings are the first to report a correlation between SHH, BDNF and OFR in autistic children, suggesting a pathological role of oxidative stress and SHH in autism spectrum disorders.     

“Let's Talk about Sex”: A Qualitative Study of Rwandan Adolescents' Views on Sex and HIV

Objective

This qualitative study explored the views and experiences of adolescents with perinatally acquired HIV in Kigali, Rwanda, regarding sex, love, marriage, children and hope for the future.

Design

The study enrolled 42 adolescents who had received combination antiretroviral therapy for at least 12 months, and a selection of their primary caregivers. Study methods included 3 multiple day workshops consisting of role-playing and focus group discussions (FGDs) with adolescents, 8 in-depth interviews with adolescents, and one FGD with caregivers.

Results

The adolescents reported experiencing similar sexual needs and dilemmas as most other adolescents, but with an added layer of complexity due to fears related to HIV transmission and/or rejection by partners. They desired more advice from their parents/caregivers on these topics. Although they struggled with aspects of sex, love, marriage and having children, most agreed that they would find love, be married and have children in the future. The two most discussed HIV-related anxieties were how and when to disclose to a (potential) sex/marriage partner and whether to have children. However, most adolescents felt that they had a right to love and be loved, and were aware of prevention-of-mother-to-child-transmission (PMTCT) options in Rwanda. Adolescents generally spoke about their future role in society in a positive manner.

Conclusion

Strengthening the life skills of HIV-positive adolescents, especially around HIV disclosure and reduction of HIV transmission, as well as the support skills of parents/caregivers, may not only reduce onward HIV transmission but also improve quality of life by reducing anxiety.     

The Kiddie-SADS allows a dimensional assessment of externalizing symptoms in ADHD children and adolescents

Objective of the study was the investigation of the psychometric properties of a scale derived from the Kiddie-SADS used for a dimensional assessment of externalizing symptoms in children and adolescents. The scale consists of 26 DSM-IV Kiddie-SADS items for attention deficit hyperactivity disorder (ADHD, 18 items) and oppositional defiant disorder (ODD, 8 items). Patients and their mothers were interviewed separately on the patients' symptoms during the last 2 weeks prior to interview. An ADHD-ODD sum score ranging between 0 and 26 was computed reflecting the number of fulfilled diagnostic criteria within the 2-week period under investigation. Interviews were videotaped and re-rated by an independent second rater. Additionally, mothers filled out two questionnaires on their children's symptoms (FBB-HKS, a German ADHD scale based on ICD-10 and DSM-IV criteria; strength and difficulties questionnaire, SDQ). We investigated 59 patients affected by AD(H)D according to DSM-IV recruited from our Department for Child and Adolescent Psychiatry (39 males, 20 females; mean age: M=9.66, SD=2.30). Inter-rater correlation regarding the ADHD-ODD scores was r=0.98 with no significant differences in mean sum scores between rater 1 and rater 2. Internal consistency of the ADHD-ODD scale was 0.85 (Cronbach's alpha). Item difficulties and discriminative power of the items also proved to be adequate. Convergent and discriminant validity were indicated by middle to high correlations with mother-ratings of the children's externalizing symptoms and a low correlation with ratings of internalizing symptoms. Factor analysis revealed a three-factor solution mainly covering inattentive, hyperactive and oppositional symptoms. In summary, ADHD and ODD sections of the Kiddie-SADS allow a reliable and valid dimensional assessment of externalizing symptoms in AD(H)D children and adolescents.