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A clear indicator of the influence of energetic factors on performance is performance variability over time prostate forum order 5 mg fincar with visa. Researchers of cognition have used the debate over whether particular processes are limited or unlimited in capacity as a fruitful ground for study man health base order fincar overnight. For example, theories of serial and parallel processing have emerged in both the attention and memory literature in support and rejection of capacity limited processes. Although not strictly coupled, serial processing is often considered in the context of limited capacity, whereas parallel processing is thought to be unlimited in capacity. This coupling bears out in visual search studies that have found preattentive processes that are thought to be parallel and unlimited in capacity, versus focal attentive processes that are serial and limited in capacity (Duncan & Humphreys, 1989; Treisman & Gelade, 1980; Wolfe, 1994). Similarly, in memory research, Jacoby (1991) distinguished automatic from controlled processing, with similar parallel and unlimited capacity (automatic) versus serial and limited capacity (controlled) distinctions. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Synonyms Reduplication delusion; Reduplicative paramnesia Short Description or Definition Cross References Attention Attention/Executive Function Parallel Processing Serial/Sequential Processing Short-Term Memory Span Test Working Memory Delusions are defined as false beliefs based on incorrect inference about external reality, and firmly sustained in spite of the opinions of others or contrary evidence (American Psychiatric Association, 1987). Capgras syndrome (Capgras & Reboul-Lachaux, 1923) is a type of reduplication delusion involving the belief that persons well-known to the patient, such as family members, have identical doubles or are imposters. The double or imposter is sometimes perceived as differing Capgras Syndrome C 485 slightly in some physical characteristic from the ``genuine' person, but the patient may have difficulty verbalizing the precise nature of this ``difference. Doppleganger or subjective doubles is the belief that the patient himself has a double or impersonator (Christodoulou, 1978). Fregoli syndrome is the belief that a person is capable of taking on the appearance of others, while retaining his/her own psychological identity (Courbon & Fail, 1927). Intermetamorphosis is the belief that people are changing in both physical and psychological identity to become another person (Courbon & Tusques, 1932). Capgras syndrome must be distinguished from purely perceptual or hallucinatory disturbances, and from generalized disturbance of cognition. That is, in order to be properly and convincingly diagnosed as a delusion, the disturbance must involve a mistaken belief (not merely a misperception) and must be persistent (not a transitory effect of confusion). For example, in autoscopy, the patient experiences a second self, as in the subjective doubles variant of Capgras. However, the phenomena differ in that the double is actually seen in autoscopy, rather than believed to be active elsewhere, as in subjective doubles. The prosopagnosic person may fail to recognize his wife, whereas the Capgras patient will insist that the present person is an imposter and that the ``real' wife is somewhere else. Patients in confusional states or dementia may express strange beliefs, but the beliefs typically change from hour to hour and do not persist once the confusion resolves. Patients with Capgras syndrome are usually described as forthcoming and cooperative. Although they insist that their delusional beliefs are true, they often admit to puzzlement or bemusement regarding aspects of the delusion. Rather than escalate their defenses by becoming hostile, they are more likely to confabulate an explanation. For example, a patient with a delusion of duplication (Malloy, 1991) was asked how she could have two sets of children with identical names. She appeared momentarily puzzled and then stated, ``My husband was in the Navy, and we moved around a lot; it was hard to keep that straight. Several researchers have found that about 25% of Alzheimer patients display delusions involving misidentification of people. C Natural History, Prognostic Factors, Outcomes About 58% of Capgras patients who receive adequate neurodiagnostic workups are found to display primary psychiatric disorder, uncomplicated by demonstrable neurologic disease (Dohn & Crews, 1986). Although psychological factors can be important in the production of delusions, a critical review of the literature by Malloy and Richardson (1994) demonstrated that delusions can also result from identifiable neurologic disease, from generalized disturbances to focal lesions. They found that Capgras and its variants have been reported in association with a variety of systemic diseases and diffuse neurologic disorders. In terms of focal lesions such as tumors and stroke, that review demonstrated that the right hemisphere or bilateral lesions were invariably found on neuroimaging, with no exclusively left-hemisphere lesions.

They are affectively labile with dramatic shift in the outward expression of emotion prostate 5k greensboro purchase fincar 5 mg without prescription, but yet they report not feeling the emotion that corresponds to this expression prostate cancer with bone metastasis proven fincar 5 mg. Alterations in self-awareness and consciousness also occur as a result of damage to specific brain regions. This fact is significant since it suggests that certain functional anatomic systems play an important role in the experience of consciousness, though probably not as a function of any one of these systems alone. Subcortical lesions affecting the mid-brain, brain stem and thalamus often cause dramatic alterations in level of consciousness. The reticular system which generates ascending activation to cortical areas plays a well established role in this phenomenon, with damage to this system contributing to problems with arousal and alertness. Persistent vegetative state is a clinical illustration of this, as these unfortunate patients exhibit impaired higher cortical functions, have persevered circadian sleep-wake cycles and autonomic function. Compared to healthy people who are awake, patients with this syndrome have impaired connectivity between brainstem and thalamic areas and the cortex. This results in a reduced cortical activation, with generalized slowing consistent with coma. These subcortical areas are clearly essential for maintaining normal consciousness, since disconnecting them from cortical areas impairs alertness, attention, and other cognitive functions linked to consciousness. The activation and arousal associated with this functional anatomic system makes an essential contribution to is a necessary part of the maintaining consciousness, thought this activation is not sufficient to account for the full dynamic of consciousness. The thalamus appears to play an important role in consciousness, but as a convergence site of reticular C 686 C Consciousness activation from lower brain systems and because of its role in integrating this activation with cortical input. Bilateral ablation of the central medial zone of the intralaminar nucleus of the thalamus produces coma and persistent vegetative states. This thalamic area is affected by general anaesthetics and drugs that cause sedation, suggesting that it is necessary for anti-psychotic drugs. This evidence suggests that a functioning thalamus is necessary, but not sufficient, for human consciousness, though again this area alone is not sufficient to account for all aspects of consciousness. Patients with bilateral occipital damage who exhibit blind sight are clearly experiencing some alteration in consciousness and self-awareness. For these individuals, altered consciousness has not affected all aspects of self-awareness and identity. Damage to other cortical areas may also produce specific impairments of awareness and self-consciousness. For example, the neglect syndrome commonly associated with right inferior parietal damage often results in anosognosia and impaired awareness of what is being neglected. For some of these patients, the alteration in awareness and consciousness extends beyond the limits of the spatial disturbance that is observed. Yet, typically patients with these lesions do not lose their sense of self completely. They may show diminished ability for self-reflect, but usually show abilities in this regard as long as not tied to the types of spatial processing that is affected. The frontal cortex seems to have be the cortical area with greatest influence on consciousness, self-regulation and self-referential processes. The famous case of Phineus Gage, the railroad worker who suffered severe frontal damage when a spike penetrated his brain provided historical illustration of this. Following his injury Gage became indifferent to social consequences and showed little self-regard for his own behavior (Harlow, 1848). While it is impossible to accurately evaluate the nature of change in his subjective sense of consciousness and selfawareness based on the historical record, it seems clear from clinical descriptions that his self-awareness was dramatically altered. In modern case study, Eslinger and his colleagues (1986) have demonstrated impaired empathy associated with frontal lobe disturbance, which affects social reasoning, judgment and perspective taking. There is strong evidence from studies of neglect syndrome that medial frontal and anterior cingulate cortical areas play a major role in ``intention' (Cohen, 1993). The intent and plan for action seems to be an important element of consciousness, as this capacity is linked to the experience of drive and spontaneity. An illustration of this is seen in patients who undergo cingulotomy, as their primary long-term neurocognitive deficit involves diminished performance on tests requiring intention, and also reduced spontaneity, initiative, and creative impulse.

Epidemiology Dysarthria is a subset of a larger group of communication disorders referred to as motor speech disorders androgen hormone during pregnancy buy fincar american express. Therefore mens health watches buy fincar 5 mg without prescription, epidemiology of dysarthria is best represented by the epidemiology of the References and Readings Haywood, H. Table 1 Types and characteristics of dysarthria and associated level of nervous system involvement Type of dysarthria Level of nervous system damage Lower motor neuron: Damage to the cranial or spinal nerves including the nuclei, axons, or neuromuscular junctions that make up the motor units Primary characteristics Muscle weakness, hypotonia, diminished reflexes, atrophy, fasciculations. Speech may be characterized by imprecise consonants, hypernasality, breathy phonation, reduced breath support, and abnormal prosody. Levels of the speech mechanism may be independently impaired by individual damage to cranial nerves such as breathy phonation from a vocal cord paralysis or distorted tongue tip articulation due to hypoglossal nerve damage Spasticity and weakness in the speech muscles results in harsh, strained-strangled phonation, low-pitch, short phrases, imprecise articulation, hypernasality, slow rate, abnormal prosody with monopitch and monoloudness, excess and equal stress Primarily a disorder of articulation resulting from weakness and incooordination of speech; imprecise consonants, irregular articulatory breakdowns, harsh vocal quality in some patients. Often symptoms are mild, temporary, and resolve spontaneously or with minimal intervention Muscular discoordination resulting in ``drunken-like' speech, with imprecise articulation and irregular articulatory breakdowns, distorted vowels, prolonged phonemes, slow rate, abnormal prosody, and harsh vocal quality Reduced range and force of movement as well as rigidity; slow individual but also fast repetitive speech movements. Hypophonia or reduced loudness, repeated phonemes, palilalia, rapid or ``blurred' speech, short rushes of speech, variable rate often increased, reduced amplitude of articulation, abnormal prosody and reduced facial expression. Slow speech initiation Involuntary movements interfere with normal control of speech. Abnormal movements are often evident in other parts of the body and the larger physical movements of the body impact the motor control of each level of the speech mechanism. Unexpected inhalations and exhalations, irregular articulatory breakdowns, abnormal prosody, voice tremor, spasms, strained, harsh voice, abnormal prosody, voice stoppages, excess loudness, and hypernasality may be present Any combination of the characteristics of the six types of dysarthrias listed above. Brain stem strokes, for example, may cause spastic dysarthria Unilateral damage to the upper motor neurons. Etiologies include: cerebellar tumors, cerebellar atrophy or degenerative diseases of the cerebellum Subcortical, basal ganglia control circuits; Extrapyramidal system involvement Parkinsonism is the most common cause of hypokinetic dysarthria Hypokinetic Hyperkinetic Subcortical, basal ganglia control circuits; often of unknown etiology. May be medication-related (tardive dyskinesia); etiologies include: fast movement disorders such as tremors, chorea, myoclonus, athetosis, dystonia Mixed Neurological damage to more than one level of the nervous system. Duffy (1995) cited a review of the distribution of acquired communication disorders at the Mayo Clinic between 1987 and 1990 and found that 34. When dysarthria co-occurs with aphasia, impaired cognition, language, and even personality changes may be present. Speech is one of the critical skills that enable an individual to function independently. When an individual loses the ability to communicate effectively, they often are deemed unsafe to live independently or to make decisions autonomously. D Evaluation Natural History, Prognostic Factors, Outcomes An influential classification system based on perceptual judgments of dysarthria, reflecting neuromuscular condition and probable neuroanatomic origin, emerged from the Mayo Clinic studies (Darley, Aronson, & Brown, 1969a, b). These authors described distinctive speech patterns for the various types of dysarthria resulting from lesions in different regions of the nervous system. The onset, progression, and prognosis for dysarthria vary depending on the type and severity of the etiology and the level(s) of nervous system involvement causing the dysarthria. As one can predict, dysarthria resulting from an etiology that has a predicted pattern of neuromuscular recovery has a better prognoses than a dysarthria that is caused by a degenerative neuromuscular disease. The goals of the motor speech evaluation include: (a) To describe the characteristics of speech (b) To differentially diagnose the type of dysarthria (c) To confirm the presence of neurologic disease and the level of nervous system involvement (d) To determine the severity of the speech impairment (e) To determine the presence of other neurologic communication disorders (f) To determine prognosis for recovery (g) To define an intervention plan the components of the motor speech exam include: gathering of a thorough history of the onset and progression of the symptoms, identifying salient speech features and confirmatory signs. After gathering relevant history of the speech symptoms and observing and measuring motor speech behaviors, the data are analyzed. The collection and analysis of data from the history and motor speech exam lead to diagnosis and recommendations. The motor speech exam examines the symmetry, strength, speed, range, steadiness, tone, and accuracy of neuromuscular features of speech. The anatomic structures and physiologic functions of each level of the motor speech system are examined in isolation and in coordination with the rest of the system in contextual speech tasks. The oral mechanism and motor speech exam consists of studying the structures and functions of respiration, phonation, articulation, resonance, and prosody. Examples of confirmatory signs are suck and gag reflexes; tongue Neuropsychology and Psychology of Dysarthria Dysarthria is a motor speech impairment caused by a neurologic disease or disorder, which may present with 908 D Dyscalculia wiggle or rapid lateral movements of the tongue; cough and glottal attack, which indicates whether the vocal folds adduct; presence of fasciculations on the chin or tongue; and/or evidence of atrophy of the tongue. Uninhibited laughter or crying represent frontal lobe release signs of pseudobulbar affect and are indicative of bilateral upper motor neuron damage.

The final stage involved evaluation of criterion-related validity using diagnostic information provided by clinicians prostate cancer 911 purchase fincar online pills. Other modifications to the current version of the test include a weighting of items for individual scales based on relevance to corresponding disorders mens health yoga get started guide proven 5 mg fincar, reduction in the number of items per scale, and the inclusion of additional validity scales and personality disorder scales. A separate normative sample for a correctional population consists of 1,676 male and female inmates. Although formal research has not been done to assess the utility of these scales, they are routinely used in the correction of base rate scores and in the interpretation of results. There was no difference between the litigant and nonlitigant patients in this sample with regard to scale elevations. The authors further identified three distinct subtypes of addicts within this scale elevation. In a study of neuropsychological function in patients in a residential long-term substance abuse treatment facility, Fals-Stewart and Lucente (1994) found that patients with cognitive impairment showed the highest elevations on the avoidant, antisocial, paranoid, and thought disorder scales. Elevations on the antisocial scale and greater cognitive impairments were shown to be negatively correlated with treatment success. Personality characteristics of drug addicts and alcoholics on the Millon Clinical Multiaxial Inventory. Effect of neurocognitive status and personality functioning on length of stay in residential substance abuse treatment: An integrative study. Modern psychopathology: A biosocial approach to maladaptive learning and functioning. Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting. Gerard Prize, Society for Neuroscience (1987) Fellow, Society of Experimental Psychologists, U. Soon after participating in seminars led by Donald Hebb, she decided to enter the Ph. Following her 1955 presentation with Penfield at the American Neurological Association Meeting in Chicago of two cases of unilateral temporal lobectomy, the neurosurgeon William Scoville invited Milner to study the amnestic patient H. They jointly published their work with such patients in the 1957 Journal of Neurology, Neurosurgery, and Psychiatry article entitled, ``Loss of recent memory after bilateral hippocampal lesions. Although he was unable to recall new information and struggled to convert short-term memory to long-term storage, H. Her diligence was invaluable as she found that despite profound declarative memory impairment, H. At the time, her novel perspective on memory/amnesia raised more questions than it provided answers. Consequently, the medical community received her ideas with mixed reviews, since no animal models for human amnesia had been established. Together with Corkin and Teuber, she published an article in Neuropsychologia (``Further analysis of the hippocampal amnesic syndrome: A 14-year follow-up study of H. In 1962, Branch, Rasmussen, and Milner published a study of short-term memory after intracarotid injection of sodium amytal. Marilyn Jones-Gotman, one of her graduate students, found a similar paucity of output on a nonverbal fluency task. With another student, Lilli Prisko, she found that patients with frontal lobe lesions were highly susceptible to interference from previous learning rather than deficient in their ability to retain new information over a short time interval. Milner and Philip Corsi, another student, determined that the frontal lobes mediate temporal ordering of recent events. With the advent of new technology, Milner became intrigued with and involved in various neuroimaging studies to further her understanding of cerebral bloodflow changes during performance of various cognitive tasks. Milner used neuroimaging to analyze blood flow in healthy normal individuals to gain insight into atypical individuals with brain lesions. Starting in the early to mid-1990s, Milner and Denise Klein, a previous graduate student, focused their research predominantly on the neural substrates involved when normal bilingual individuals perform tasks in their first as compared to their second language. Throughout her years of clinical, research, and other professional endeavors, Milner has been an invaluable mentor to numerous graduate students.

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