L’étude des troubles de la voix et de la parole est sortie du cadre de la recherche clinique. Par l’observation des dysfonctionnements, les chercheurs non cliniciens confrontent les résultats de leur recherche établis sur des corpus de parole « normale » à des situations de dysfonctionnement. Le défi est immense car le cadre « pathologique » induit une variation considérable dans ses manifestations de surface. Toute généralisation à une population clinique particulière nécessite l’observation d’un grand nombre de patients du fait (...) de la très forte variation interindividuelle. Il est donc important de capitaliser et mutualiser les enregistrements existants. Or pour être utilisables, ces enregistrements doivent répondre à de fortes exigences. Le maillon faible reste la normalisation et la structuration des données sur les locuteurs et leurs productions langagières. Concrètement, si les données sonores sont souvent accessibles, elles ne présentent au final aucun intérêt si les liens entre les enregistrements et les caractéristiques cliniques du locuteur sont rompus ou erronés. L’objectif de ce travail est de présenter différentes actions de terrain et de proposer des recommandations pour la structuration des données sonores, physiologiques et cliniques dans le cas de corpus de parole issue de patients atteints de troubles de la voix et de la parole. (shrink)

Humans' voice offers the widest variety of motor phenomena of any human activity. However, its clinical evaluation in people with movement disorders such as Parkinson's disease lags behind current knowledge on advanced analytical automatic speech processing methodology. Here, we use deep learning-based speech processing to differentially analyze voice recordings in 14 people with PD before and after dopaminergic medication using personalized Convolutional Recurrent Neural Networks and Phone Attribute Codebooks. p-CRNN yields an accuracy of 82.35% (...) in the binary classification of ON and OFF motor states at a sensitivity/specificity of 0.86/0.78. The PAC-based approach's accuracy was slightly lower with 73.08% at a sensitivity/specificity of 0.69/0.77, but this method offers easier interpretation and understanding of the computational biomarkers. Both p-CRNN and PAC provide a differentiated view and novel insights into the distinctive components of the speech of persons with PD. Both methods detect voice qualities that are amenable to dopaminergic treatment, including active phonetic and prosodic features. Our findings may pave the way for quantitative measurements of speech in persons with PD. (shrink)

Socio-emotional impairments are key symptoms of Autism Spectrum Disorders. This work proposes to analyze the neuronal activity related to the discrimination of emotional prosodies in autistic children as follows. Firstly, a database for single words uttered in Mexican Spanish by males, females, and children will be created. Then, optimal acoustic features for emotion characterization will be extracted, followed of a cubic kernel function Support Vector Machine in order to validate the speech corpus. As a result, human-specific acoustic properties (...) of emotional voice signals will be identified. Secondly, those identified acoustic properties will be modified to synthesize the recorded human emotional voices. Thirdly, both human and synthesized utterances will be used to study the electroencephalographic correlate of affective prosody processing in typically developed and autistic children. Finally, and on the basis of the outcomes, synthesized voice-enhanced environments will be created to develop an intervention based on social-robot and Social StoryTM for autistic children to improve affective prosodies discrimination. This protocol has been registered at BioMed Central under the following number: ISRCTN18117434. (shrink)

Speech is a primary means of human communication and one of the most basic features of human conduct. Voice is an important part of its subsystems. A speech disorder is a condition that affects the ability of a person to speak normally, which occasionally results in voice impairment with psychological and emotional consequences. Early detection of voice problems is a crucial factor. Computer-based procedures are less costly and easier to administer for such purposes than traditional (...) methods. This study highlights the following issues: recent studies, methods of voice pathology detection, machine learning and deep learning (DL) methods used in data classification, main datasets utilized, and the role of Internet of things (IoT) systems employed in voice pathology diagnosis. Moreover, this study presents different applications, open challenges, and recommendations for future directions of IoT systems and artificial intelligence (AI) approaches in the voice pathology diagnosis. Finally, this study highlights some limitations of voice pathology datasets in comparison with the role of IoT in the healthcare sector, which shows the urgent need to provide efficient approaches and easy and ideal medical diagnostic procedures and treatments of disease identification for doctors and patients. This review covered voice pathology taxonomy, detection techniques, open challenges, limitations, and recommendations for future directions to provide a clear background for doctors and patients. Standard databases, including the Massachusetts Eye and Ear Infirmary, Saarbruecken Voice Database, and the Arabic Voice Pathology Database, were used in most articles reviewed in this article. The classes, features, and main purpose for voice pathology identification are also highlighted. This study focuses on the extraction of voice pathology features, especially speech analysis, extends feature vectors comprising static and dynamic features, and converts these extended feature vectors into solid vectors before passing them to the recognizer. (shrink)

As development of the speech recognition system entirely depends upon the spoken language used for its development, and the very fact that speech technology is highly language dependent and reverse engineering is not possible, there is an utmost need to develop such systems for Indian languages. In this paper we present the implementation of a time delay neural network system (TDNN) in a modular fashion by exploiting the hidden structure of previously phonetic subcategory network for recognition of Hindi (...) consonants. For the present study we have selected all the Hindi phonemes for srecognition. A vocabulary of 207 Hindi words was designed for the task-specific environment and used as a database. For the recognition of phoneme, a three-layered network was constructed and the network was trained using the back propagation learning algorithm. Experiments were conducted to categorize the Hindi voiced, unvoiced stops, semi vowels, vowels, nasals and fricatives. A close observation of confusion matrix of Hindi stops revealed maximum confusion of retroflex stops with their non-retroflex counterparts. (shrink)

In this paper, we study the performance of baseline hidden Markov model (HMM) for segmentation of speech signals. It is applied on single-speaker segmentation task, using Hindi speech database. The automatic phoneme segmentation framework evolved imitates the human phoneme segmentation process. A set of 44 Hindi phonemes were chosen for the segmentation experiment, wherein we used continuous density hidden Markov model (CDHMM) with a mixture of Gaussian distribution. The left-to-right topology with no skip states has been selected as (...) it is effective in speech recognition due to its consistency with the natural way of articulating the spoken words. This system accepts speech utterances along with their orthographic “transcriptions” and generates segmentation information of the speech. This corpus was used to develop context-independent hidden Markov models (HMMs) for each of the Hindi phonemes. The system was trained using numerous sentences that are relevant to provide information to the passengers of the Metro Rail. The system was validated against a few manually segmented speech utterances. The evaluation of the experiments shows that the best performance is obtained by using a combination of two Gaussians mixtures and five HMM states. A category-wise phoneme error analysis has been performed, and the performance of the phonetic segmentation has been reported. The modeling of HMMs has been implemented using Microsoft Visual Studio 2005 (C++), and the system is designed to work on Windows operating system. The goal of this study is automatic segmentation of speech at phonetic level. (shrink)

This study investigated how coda voicing contrast in English would be phonetically encoded in the temporal vs. spectral dimension of the preceding vowel (in vowel duration vs. F1/F2) by Korean L2 speakers of English, and how their L2 phonetic encoding pattern would be compared to that of native English speakers. Crucially, these questions were explored by taking into account the phonetics-prosody interface, testing effects of prominence by comparing target segments in three focus conditions (phonological focus, lexical focus, and no focus). (...) Results showed that Korean speakers utilized the temporal dimension (vowel duration) to encode coda voicing contrast, but failed to use the spectral dimension (F1/F2), reflecting their native language experience—i.e., with a more sparsely populated vowel space in Korean, they are less sensitive to small changes in the spectral dimension, and hence fine-grained spectral cues in English are not readily accessible. Results also showed that along the temporal dimension, both the L1 and L2 speakers hyperarticulated coda voicing contrast under prominence (when phonologically or lexically focused), but hypoarticulated it in the non-prominent condition. This indicates that low-level phonetic realization and high-order information structure interact in a communicatively efficient way, regardless of the speakers’ native language background. The Korean speakers, however, used the temporal phonetic space differently from the way the native speakers did, especially showing less reduction in the no focus condition. This was also attributable to their native language experience—i.e., the Korean speakers’ use of temporal dimension is constrained in a way that is not detrimental to the preservation of coda voicing contrast, given that they failed to add additional cues along the spectral dimension. The results imply that the L2 phonetic system can be more fully illuminated through an investigation of the phonetics-prosody interface in connection with the L2 speakers’ native language experience. (shrink)

Theorists have found it difficult to reconcile the unity of inner speech as a mental state kind with the diversity of its manifestations. I argue that existing views concerning the content of inner speech fail to accommodate both of these features because they mistakenly assume that its content is to be found in the ‘speech processing hierarchy’, which includes semantic, syntactic, phonemic, phonetic, and articulatory levels. Upon rejecting this assumption, I offer a position on which the content (...) of inner speech is determined by voice processing, of which speech processing is but one component. The resulting view does justice to the idea that inner speech is a motley assortment of episodes that nevertheless form a kind. (shrink)

Many philosophers and psychologists have sought to explain experiences of auditory verbal hallucinations and “inserted thoughts” in schizophrenia in terms of a failure on the part of patients to appropriately monitor their own inner speech. These self-monitoring accounts have recently been challenged by some who argue that AVHs are better explained in terms of the spontaneous activation of auditory-verbal representations. This paper defends two kinds of self-monitoring approach against the spontaneous activation account. The defense requires first making some important (...) clarifications concerning what is at issue in the dispute between the two forms of theory. A popular but problematic self-monitoring theory is then contrasted with two more plausible conceptions of what the relevant self-monitoring deficits involve. The first appeals to deficits in the neural mechanisms that normally filter or attenuate sensory signals that are the result of one’s own actions. The second, less familiar, form of self-monitoring approach draws an important analogy between Wernicke’s aphasia and AVHs in schizophrenia. This style of self-monitoring theory pursues possible connections among AVHs, inserted thoughts, and the disorganized speech characteristic formal thought disorder. (shrink)

Inner speech is commonly understood as the conscious experience of a voice within the mind. One recurrent theme in the scientific literature is that the phenomenon involves a representation of overt speech, for example, a representation of phonetic properties that result from a copy of speech instructions that were ultimately suppressed. I propose a larger picture that involves some embodied objects and their misperception. I call it “the Body Error Theory,” or BET for short. BET is (...) a form of illusionism, but the particular version I favor is a cross-modal illusion. Newly described here, my hypothesis is that the experience of inner speech arises from a mix of interoception and audition. Specifically, there is the detection of slight but well-confirmed activities in the speech musculature that occur during inner speech, which helps to transform representations of normal but quiet nonverbal sounds that inevitably occur during inner speech, from breathing to background noise, into a mistaken perception of inner speech. Simply put, activities in the speech musculature mix with sounds to create the appearance of speech sounds, which thus explains the “voice within the mind.” I also show how BET’s cross-modal system fits with standard information processing accounts for speech monitoring and how it accommodates the central insights of leading theories of inner speech. In addition, I show how BET is supported by data from experience-sampling surveys and how it can be empirically tested against its rivals. (shrink)

. Epochs present in the voiced speech are defined as time instants of significant excitation of the vocal tract system during the production of speech. Nonstationary nature of excitation source and vocal tract system makes accurate identification of epochs a difficult task. Most of the existing methods for epoch detection require prior knowledge of voiced regions and a rough estimation of pitch frequency. In this paper, we propose a novel method that relies on time-order representation based on short-time (...) Fourier–Bessel series expansion which can be employed on entire speech signal to detect epochs without any prior information. The proposed method automatically detects voiced regions in the speech signal by computing the marginal energy density with respect to time in the low frequency range from the energy distribution in the time-frequency plane. An estimate of pitch frequency for each detected voiced region is then obtained by computing the marginal energy density with respect to frequency in the LFR from the energy distribution in the time-frequency plane. Epochs are located for each detected voiced region as peaks in the derivative of the low pass filtered signal corresponding to falling edges of peak negative cycles in the LPF signal synthesized from TOR coefficients corresponding to LFR. Experimental results obtained by the proposed method on speech signals taken from the CMU-Arctic database are found to be promising. The proposed method detects epochs with high accuracy and reliability. (shrink)

Background: The field of voice and speech analysis has become increasingly popular over the last 10 years, and articles on its use in detecting neurodegenerative diseases have proliferated. Many studies have identified characteristic speech features that can be used to draw an accurate distinction between healthy aging among older people and those with mild cognitive impairment and Alzheimer's disease. Speech analysis has been singled out as a cost-effective and reliable method for detecting the presence of both (...) conditions. In this research, a systematic review was conducted to determine these features and their diagnostic accuracy.Methods: Peer-reviewed literature was located across multiple databases, involving studies that apply new procedures of automatic speech analysis to collect behavioral evidence of linguistic impairments along with their diagnostic accuracy on Alzheimer's disease and mild cognitive impairment. The risk of bias was assessed by using JBI and QUADAS-2 checklists.Results: Thirty-five papers met the inclusion criteria; of these, 11 were descriptive studies that either identified voice features or explored their cognitive correlates, and the rest were diagnostic studies. Overall, the studies were of good quality and presented solid evidence of the usefulness of this technique. The distinctive acoustic and rhythmic features found are gathered. Most studies record a diagnostic accuracy over 88% for Alzheimer's and 80% for mild cognitive impairment.Conclusion: Automatic speech analysis is a promising tool for diagnosing mild cognitive impairment and Alzheimer's disease. The reported features seem to be indicators of the cognitive changes in older people. The specific features and the cognitive changes involved could be the subject of further research. (shrink)

ABSTRACT Discourse Diversity Database (3D) is a corpus designed for clinical linguistics research. It consists of oral speech samples of three different genres: picture-elicited narratives, personal stories, and picture-based instructions. The sub-sections of 3D include recordings by Russian speakers from three independent groups: people with brain tumors before and after tumor removal, people with schizophrenia, and neurologically healthy individuals. This article is devoted to the description of the data collection, the annotation scheme, and the specific characteristics of each (...) sub-section of the corpus. (shrink)

Pragmatic disorders in children and adults have been the focus of clinical investigations for approximately 40 years. In that time, clinicians and researchers have established a diverse range of pragmatic phenomena that are disrupted in these disorders. Pragmatic deficits include problems with the use and understanding of speech acts, the processing of non-literal language, failure to adhere to Gricean maxims in conversation and discourse deficits. These deficits are found in several clinical populations including individuals with (...) autistic spectrum disorders, schizophrenia, traumatic brain injury and right-hemisphere damage. However, what is less often investigated is the social impact of pragmatic disorders on the children and adults who are affected by them. In this paper, I examine what is known about pragmatic disorders in these clinical groups. I then consider the wider social consequences of these disorders, where consequences are broadly construed to include factors that act as indicators of social adjustment. (shrink)

The study of pragmatic disorders is of interest to speech-language pathologists who have a professional responsibility to assess and treat communication impairments. However, these disorders, it will be argued in this paper, have a significance beyond the clinical management of clients with communication impairments. Specifically, pragmatic disorders can now make a contribution to the diagnosis of a range of clinical conditions in which communication is adversely affected. These conditions include attention deficit hyperactivity disorder, the (...) autistic spectrum disorders, schizophrenia and the dementias. Pragmatic disorders are already among the criteria used to diagnose some of these conditions, although they are not described in these terms. In other conditions, pragmatic disorders have potential diagnostic value in the absence of reliable biomarkers of these conditions and similar initial presenting symptoms. Using clinical data, and the findings of empirical studies, the case is made for the inclusion and/or greater integration of pragmatic disorders in the formal classificatory systems that are used to diagnose a range of disorders. A previously unrecognised role for pragmatic impairments in the nosology and diagnosis of clinical disorders is thereby established. (shrink)

Clinical neuropsychologists have been working in Germany since the 1980s, and specific training in the discipline has been available since 1993. The qualification currently requires 3 years of practical training, 400 h of theoretical learning, 100 h of supervision, five reports on patients and an oral examination. After its completion, neuropsychologists can work as employees in clinical settings. For a substantial period of time, neuropsychologists working in their own practices faced complex challenges in working with outpatients, whose health (...) insurers did not cover the cost of this treatment. State approval of neuropsychological diagnostic procedures and therapy was achieved in 2011, on the basis of evidence showing the method’s high effectiveness; statutory health insurers therefore now pay out for delivery of these services on an outpatient basis, too. In Germany, neuropsychologists work in all areas of the diagnosis of functional disorders, with children, adolescents, adults and older adults, and carry out treatment. Clinical neuropsychologists provide patients with individualized tools for managing their brain damage, supply exercises and tasks for them to undertake at home, and give input on administrative matters, such as determining the degree of a patient’s disability. Treatment takes place in close collaboration with members of related professions, such as physiotherapists, occupational therapists and speech therapists. Neuropsychologists also work as assessors, investigating, for example, the extent of a patient’s ability to work after sustaining CNS damage or the need for medical retirement. The earnings of clinical neuropsychologists vary widely, currently averaging between €3,000 and €4,000 gross per month for employed neuropsychologists; self-employed neuropsychologists in their own practices can currently bill statutory health insurers for around €100.00 per hour. Despite the generally good working conditions in this discipline, Germany is suffering from a shortage of clinical neuropsychologists. An approximate total of 800 psychologists have completed training in this field, while around 50,000 patients could benefit from neuropsychological treatment every year. (shrink)

Patients with psychotic disorders experience a range of reality distortions. These often include auditory-verbal hallucinations, and thought insertion to a lesser degree; however, their mechanisms and relationships between each other remain largely elusive. Here we attempt to establish a integrative model drawing from the phenomenology of both AVHs and TI and argue that they in fact can be seen as ‘spectra’ of experiences with varying degrees of agency and ownership, with ‘silent and internal own thoughts’ on one extreme and (...) ‘fully external and clearly audible voices’ in the absence of a speaker on the other. We believe a spectral model will add emphasis to the continuity of experience and help to better understand how one type of psychotic symptom may interact with another, and put forward the argument that the experience of TI itself is not sufficient to classify as a delusion. In addition we aim to discuss some of the conceptual issues surrounding AVHs and TI with first-person accounts and current philosophical and neuropsychological theories in mind. We propose that the mechanisms behind AVHs and TI are more complex than source-monitoring deficits; indeed, to understand such phenomena one must appreciate that their very ‘existence’ and ‘reality’ as experienced by the individual have much deeper implications and meaning, both philosophically and clinically. (shrink)

Background Analysis of aphasic narratives can be a challenge for clinicians. Previous studies have mainly employed measures that categorized speech samples at the word level. They included quantification of the use and misuse of different word classes, presence and absence of narrative contents and errors, paraphasias, and perseverations, as well as morphological structures and errors within a narrative. In other words, a great amount of research has been conducted in the aphasiology literature focusing on micro-linguistic structures of oral narratives. (...) Aspects of macro- linguistic structures, such as the analysis of content information by a speaker, consistency of using cohesive devices to present information within a narrative, and order of presenting information necessary to form a coherent discourse, have not been extensively investigated. The current investigation proposes a clinical analytic system to target three aspects of macro-linguistic structures in narratives among speakers with aphasia. Specifically, (1) the presence of search events (i.e., the mentioning of key events that allow the listener to understand; Capilouto, Wright, &Wagovich, 2006) within a narrative, (2) the sequence of the mentioned events, and (3) the informativeness (i.e., the fulfillment of lexical items that allow the user to understand what the event is detailing) of the event contents, were focused in the proposed framework. Method Ten controls transcripts from were selected from the AphasiaBank (MacWhinney, Fromm, Forbes, & Holland, 2011). Three narrative tasks, including sequential picture description of ‘Refused Umbrella’, procedural narrative of making a ‘Peanut Butter and Jelly Sandwich’, and telling of ‘Cinderella’ story, were used to establish normative data for the basis of analysis. Specifically, the Search Events (e) and Informative Words (i) used by at least 70% of the speakers were listed for each genre. The sequential order of mentioning the Search Events, i.e., common order of events in 90% of the speakers, (s.total) was determined. Twelve speakers with aphasia (nine fluent and three non-fluent) were recruited and administered the Western Aphasia Battery and Object and Action Naming Battery. Their performance in the above three discourse tasks were orthographically transcribed and analyzed using the following measures: e.total, e.matched with norm, e.missed, e.irrlevant, e.extra, s.total, i.pb&j, i.umbr, i.cind, and i.total. Three samples were randomly chosen to be re-analyzed for inter- and intra-rater reliability. Results Results of an independent t-test suggested significant differences between the fluent and non-fluent subjects in sequential order of Search Events for all genres (s.total) and i.total, suggesting sensitivity of this framework to differentiate between the two fluency groups. Results of Pearson product-moment correlations revealed significant relation between Informative Words and WAB spontaneous speech scores, AQ, as well as OAB scores, for both aphasic groups. The mean value of coefficients for intra-rater reliability (0.992), with significant correlations on e.match, e.miss, and e.extra, was higher than that of inter-rater reliability (0.897). Discussion Based on our preliminary results, this objective framework allowed clinical evaluation of impairment in macro-linguistic structures present in aphasic discourse. Further extension should involve more subjects encompassing a wider range of severity with different types of aphasia. (shrink)

This article concerns sound aesthetic preferences for European foreign languages. We investigated the phonetic-acoustic dimension of the linguistic aesthetic pleasure to describe the “music” found in European languages. The Romance languages, French, Italian, and Spanish, take a lead when people talk about melodious language – the music-like effects in the language (a.k.a., phonetic chill). On the other end of the melodiousness spectrum are German and Arabic that are often considered sounding harsh and un-attractive. Despite the public interest, limited research has (...) been conducted on the topic of phonaesthetics, i.e., the subfield of phonetics that is concerned with the aesthetic properties of speech sounds (Crystal, 2008). Our goal is to fill the existing research gap by identifying the acoustic features that drive the auditory perception of language sound beauty. What is so music-like in the language that makes people say “it is music in my ears”? We had 45 central European participants listening to 16 auditorily presented European languages and rating each language in terms of 22 binary characteristics (e.g., beautiful – ugly and funny – boring) plus indicating their language familiarities, L2 backgrounds, speaker voice liking, demographics, and musicality levels. Findings revealed that all factors in complex interplay explain a certain percentage of variance: familiarity and expertise in foreign languages, speaker voice characteristics, phonetic complexity, musical acoustic properties, and finally musical expertise of the listener. The most important discovery was the trade-off between speech tempo and so-called linguistic melody (pitch variance): the faster the language, the flatter/more atonal it is in terms of the pitch (speech melody), making it highly appealing acoustically (sounding beautiful and sexy), but not so melodious in a “musical” sense. (shrink)

Voices are a complex and rich acoustic signal processed in an extensive cortical brain network. Specialized regions within this network support voice perception and production and may be differentially affected in pathological voice processing. For example, the experience of hallucinating voices has been linked to hyperactivity in temporal and extra-temporal voice areas, possibly extending into regions associated with vocalization. Predominant self-monitoring hypotheses ascribe a primary role of voice production regions to auditory verbal hallucinations. Alternative postulations view (...) a generalized perceptual salience bias as causal to AVH. These theories are not mutually exclusive as both ascribe the emergence and phenomenology of AVH to unbalanced top-down and bottom-up signal processing. The focus of the current study was to investigate the neurocognitive mechanisms underlying predisposition brain states for emergent hallucinations, detached from the effects of inner speech. Using the temporal voice area localizer task, we explored putative hypersalient responses to passively presented sounds in relation to hallucination proneness. Furthermore, to avoid confounds commonly found in in clinical samples, we employed the Launay-Slade Hallucination Scale for the quantification of HP levels in healthy people across an experiential continuum spanning the general population. We report increased activation in the right posterior superior temporal gyrus during the perception of voice features that positively correlates with increased HP scores. In line with prior results, we propose that this right-lateralized pSTG activation might indicate early hypersensitivity to acoustic features coding speaker identity that extends beyond own voice production to perception in healthy participants prone to experience AVH. (shrink)

Formal thought disorder (FTD) is a clinical mental condition that is typically diagnosable by the speech productions of patients. However, this has been a vexing condition for the clinical community, as it is not at all easy to determine what “formal” means in the plethora of symptoms exhibited. We present a logic-based model for the syntax–semantics interface in semantic networking that can not only explain, but also diagnose, FTD. Our model is based on description logic (DL), which (...) is well known for its adequacy to model terminological knowledge. More specifically, we show how faulty logical form as defined in DL-based Conception Language (CL) impacts the semantic content of linguistic productions that are characteristic of FTD. We accordingly call this the dyssyntax model. (shrink)

Borderline personality disorder (BPD) is characterized by severe disturbances in a subject’s sense of identity. Persons with BPD suffer from recurrent feelings of emptiness, a lack of self-feeling, and painful incoherence, especially regarding their own desires, how they see and feel about others, their life goals, or the roles to which they commit themselves. Over the past decade or so, clinical psychologists, psychotherapists, and psychiatrists have turned to philosophical conceptions of selfhood to better understand the borderline-specific ruptures in the (...) sense of identity, which are frequently associated with severe affective instability and turbulence in interpersonal relationships. Fuchs (2007) has suggested that these disturbances in self-experience can best be described and explained by using notions—widely discussed in philosophy and psychology—ofnarrativityandnarrative identity. On such a narrative view, key features of BPD present significant modifications of proto-narrative structures and inhibit the development of a narrative identity, resulting in a disturbed sense of identity. Although the role of narrativity in BPD has been acknowledged by many researchers, some have voiced dissatisfaction with what they take to be limitations of a narrativistic understanding of the disorders of identity characterizing BPD, and have proposed alternative, allegedly non-narrativistic, accounts. In this paper, we critically examine an example of the latter, viz. Gold and Kyratsous’ (2017) account ofthe person as an intrapersonal team reasoner. We defend a narrativistic understanding of BPD identity disorder against their objections. To this end, we propose a broader, and more finely-differentiated, concept of narrativity. On this account, four aspects of narrativity are distinguished, the disordering of which can affect those with BPD. As it turns out, our account implies that even Gold and Kyratsous—in order to ground their approach—must either make use of these aspects or propose an as-yet unarticulated alternative. This casts doubt upon whether their approach is non-narrativistic after all. (shrink)

Uttered language does not necessarily reflect the planned communications of schizophrenia patients, nor do their delusions necessarily reflect basic failures of inferential reasoning. The role of inhibitory failure in the production of speech and the role of primary experiences of discrepancy between intention and action, and between experience–based expectations and perceived realities account for many of the clinical phenomena that have led to the conclusion that these patients have a ‘thought’ disorder, or a ‘disturbed’ mind. The alternatives and (...) the evidence are summarized in this paper. (shrink)

Resumen: En este trabajo, se observa la variación fonética del fonema oclusivo bilabial sonoro en el español no estándar en una muestra de hablantes chilenos de ocho ciudades, cuyas ubicaciones geográficas permiten cubrir los principales sectores urbanos del país. En los resultados se evidencia un marcado uso del alófono aproximante labiodental sonoro en este tipo de habla y un comportamiento relativamente homogéneo en todo el país respecto de las principales variantes del fonema oclusivo bilabial sonoro. La comparación del fonema oclusivo (...) bilabial sonoro entre el español no estándar y el estándar muestra marcadas diferencias, datos que sugieren un cambio lingüístico en proceso desde el alófono aproximante bilabial sonoro al alófono aproximante labiodental sonoro.: In this study, we observed the phonetic variation of voiced bilabial occlusive phoneme in non-standard Spanish in a sample of Chilean speakers from cities whose geographical locations allow to cover the main urban sectors of the country. The results that show a marked use of voiced labiodental approximant allophone in this type of speech an a relatively homogenous behaviour in the whole country of the main variants of the voiced bilabial occlusive phoneme are presented. The comparison of voiced bilabial occlusive phoneme between non-standard and standard Spanish shows clear differences, data that suggest a linguistic change in process from voiced bilabial approximant allophone to voiced labiodental approximant allophone. (shrink)

Youth is a critical period in the development of maladaptive eating behaviors. Previous systematic reviews suggest the etiological significance of parent-child relationships for the onset of disordered eating in youth, but less is known about the role of parenting styles. This rapid scoping review aimed to identify whether research supports the role of parenting styles in the development of disordered eating symptoms among youths. Sixteen studies, retrieved from three databases, met the inclusion criteria: original studies, published in English, examined the (...) effect of parenting styles on cognitive and behavioral disordered eating outcomes, among young people up to 18 years of age. Studies supported an association between various youth disordered eating symptoms such as unhealthy weight control behaviors, and experiences of adverse parenting styles characterized by high levels of control and low levels of responsiveness. Associations between adverse parenting styles and youth disordered eating were frequently indirect and differed depending on the sex of the parent and offspring. Synthesis of findings was limited due to variation in the operationalization and measurement of parenting styles, family context and disordered eating across studies. Longitudinal and standardized research is required to better understand the dynamic associations between parenting styles and youth disordered eating. Implications for family-based care in clinical practice are discussed. (shrink)

The reporting of clinical trial data is necessary not only for doctors to determine treatment efficacy, but also to explore new questions without unnecessarily repeating trials, and to protect patients and the public from dangers when data are withheld. This issue is particularly salient in those trials involving invasive neurosurgical interventions, such as deep brain stimulation (DBS), for ‘treatment refractory’ psychiatric disorders. Using the federal database ClinicalTrials.gov, it was discovered that out of the completed or unknown‐status trials related (...) to psychiatric DBS up to November 2018, only two had submitted results to ClinicalTrials.gov. These results suggest that, despite federal requirements to report clinical trial data, reporting on psychiatric DBS trials is problematically minimal. It is argued that a human rights approach to this problem establishes a legal and ethical foundation for the need to report clinical trial results in this area. (shrink)

The voices and visions experienced by Emanuel Swedenborg remain a topic of much debate. The present article offers a reconsideration of these experiences in relation to changes in psychiatric practice. First, the phenomenology of Swedenborg's experiences is reviewed through an examination of his writings. The varying conceptualizations of these experiences by Swedenborg and his contemporaries, and by psychiatrists of later generations, are examined. We show how attempts by 19th- and 20th-century psychiatrists to explain Swedenborg's condition as the result of either (...) schizophrenia or epilepsy are unable to account for his experiences. We then demonstrate that the re-emergence of the 19th-century concept of `hallucinations in the sane' offers an alternative way to understand Swedenborg's experiences outside typical discourses of mental illness. Finally we argue that Swedenborg's experiences should be understood as exemplifying phenomena which we term `hallucinations without mental disorder', and investigate how conceiving of Swedenborg in this way can inform future research into the experience and clinical significance of hallucinations. (shrink)

Speech categories are defined by multiple acoustic dimensions and their boundaries are generally fuzzy and ambiguous in part because listeners often give differential weighting to these cue dimensions during phonetic categorization. This study explored how a listener's perception of a speaker's socio-indexical and personality characteristics influences the listener's perceptual cue weighting. In a matched-guise study, three groups of listeners classified a series of gender-neutral /b/-/p/ continua that vary in VOT and F0 at the onset of the following vowel. Listeners (...) were assigned to one of three prompt conditions and rated the talker in terms of vocal gender prototypicality, attractiveness, friendliness, confidence, trustworthiness, and gayness. Male listeners and listeners who saw a male face showed less reliance on VOT compared to listeners in the other conditions. Listeners' visual evaluation of the talker also affected their weighting of VOT and onset F0 cues, although the effects of facial impressions differ depending on the gender of the listener. The results demonstrate that individual differences in perceptual cue weighting are modulated by the listener's gender and his/her subjective evaluation of the talker. These findings lend support for exemplar-based models of speech perception and production where socio-indexical features are encoded as a part of the episodic traces in the listeners' mental lexicon. This study also shed light on the relationship between individual variation in cue weighting and community-level sound change by demonstrating that VOT and onset F0 co-variation in North American English has acquired a certain degree of socio-indexical significance. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Talking Cures, the Clinic, and the Value of the IneffableDaniel Berthold (bio)KeywordsMadness, disease, the normal, the abnormal, the ineffable, Hegel, Kierkegaard, LacanI am most grateful to my readers, James Phillips and Louis Sass, who have led me to several new insights by suggesting ways of complicating my reading of a Lacanian approach to Hegel's and Kierkegaard's conceptions of madness. I am a Kierkegaard and Hegel scholar, with very little (...) pretense to expertise about Lacan and regrettably even less about the theory and practice of psychiatry. In submitting my essay to Philosophy, Psychiatry, & Philosophy, I was hoping to entice a community of practitioners and theoreticians I have great respect for to consider the musings of a philosopher on topics which engage them as thinkers and actors in their professions. I could not possibly have hoped for more intelligent and provocative replies than I have been given by my two respondents.Phillips' framing of his response in terms of the distinction between the "madness of the philosophers" and the "madness of the clinic" is very helpful. It is a distinction that is indeed central to the question of the possibility of dialogue between philosophers and clinicians—so central, in fact, that it is generous of Phillips not to reproach me for failing to mention it. On the one hand, the challenge for philosophers is to show that their descriptions are not merely metaphoric and that their preoccupation with the dark side of human experience connects in some way with the reality of disease, so that there is some way for clinicians to translate their language into the language of psychiatry. Otherwise, philosophers will have only poetic or literary interest for the psychiatrist or psychologist.On the other hand, the challenge for clinicians is the extent to which they are open to moving beyond a reduction of "mental illness" to a purely biological conception of disease. One needn't go so far—nor should we—as Thomas Szasz or Michel Foucault in seeing "mental disease" as itself merely a metaphor. But granting the evidence of underlying organic disorder, symptoms nevertheless display themselves as mental and behavioral states (what Hegel calls "shapes of consciousness") that, as Hegel argued, are paralleled in "normal" experience, so that the distinction between disease and normality (and hence illness and metaphor) is often elusive. Madness "has the healthy consciousness for its presupposition," Hegel writes, because the healthy mind is still grappling with the same sorts of contradictions and feelings of alienation, the same "infinite pain" which characterizes insanity. Madness is not the absolute "other" of rationality, but an echo of it (1978, 3:382, 408).Hegel himself accepted the medicalization of madness that began to occur in the late eighteenth [End Page 325] century, and rejected the metaphysical and theological categories of what was called "romantic medicine." But he also cautioned against the narrowness of the "somatic" school which he felt lacked sufficient explanatory value if not connected to a "speculative" (i.e., philosophic) framework (see Berthold-Bond 1995, ch. 2).It might even be argued that every person seeking therapy is first of all suffering from "philosophic" madness, at least in the sense that initially she does not understand her own suffering as "disease," but experiences her torment in the vocabulary of the philosopher. Thus the philosopher's descriptions are the closest to the subject's own self-understanding, and while the therapist must seek to rephrase these descriptions into the vocabulary of the clinic (just as Hegel, for example, translated his own philosophic description of the madness of his friend Hölderlin in the Phenomenology as the "lost soul" whose "light dies away within it" into the medical category of Wahnsinn—mania or frenzy, which today we would call schizophrenia—in the classificatory scheme of mental disorder he gives in the Encyclopaedia; 1977, 400; 1978, 408)—there is a real question about which vocabulary is a metaphor for the other.The second main point Phillips addresses, which is taken up in different ways by Sass as well, has to do with the relation between speech and silence in madness. Phillips finds that Kierkegaard offers a more complex and subtle view than... (shrink)

This mini-review provides a detailed outline of studies that have used multimodal approaches in non-invasive brain stimulation to investigate the pathophysiology of the three common movement disorders, namely, essential tremor, Parkinson’s disease, and dystonia. Using specific search terms and filters in the PubMed®database, we finally shortlisted 27 studies in total that were relevant to this review. While two-thirds (Brittain et al., 2013) of these studies were performed on Parkinson’s disease patients, we could find only three studies that were conducted (...) in patients with essential tremor. We clearly show that although multimodal non-invasive brain stimulation holds immense potential in unraveling the physiological mechanisms that are disrupted in movement disorders, the technical challenges and pitfalls of combining these methods may hinder their widespread application by movement disorder specialists. A multidisciplinary team with clinical and technical expertise may be crucial in reaping the fullest benefits from such novel multimodal approaches. (shrink)

A number of studies have shown that phonetic peculiarities, especially at the coarticulation level, exist in the disfluent as well as in the perceptively fluent speech of people who stutter (PWS). However, results from fluent speech are disparate and not easily interpretable. Are the coarticulatory features a manifestation of the disorder, or rather a compensation for the disorder itself? Our purpose is to investigate the coarticulatory behavior in the fluent speech of PWS in the attempt to answer (...) the question on its symptomatic or adaptive nature. In order to achieve this, we have studied the speech of 21 adult PWS (10 French and 11 Italian) compared to that of 20 fluent adults (10 French and 10 Italian). The participants had to repeat simple CV syllables in short carrier sentences, where C = /b, d, g/ and V = /a, i, u/. Crucially, this repetition task was performed under a condition with normal auditory feedback (NAF) for both the groups, and under a fluency-enhancing condition (only for PWS) due to an altered auditory feedback (AAF). The degree of coarticulation was measured by means of the Locus Equations (LE). Under NAF conditions, the coarticulation degree observed in fluent PWS speech is lower than that of the PWNS, and, more importantly, in AAF condition, PWS coarticulation appears even weaker than in the NAF condition. The latter result allows to interpret the low degree of coarticulation found in fluent speech of PWS under NAF condition as a compensation for the disorder, based on the fact that coarticulation is weaker in fluency-enhancing conditions. Since a lower degree of coarticulation is associated to a greater separation between the places of articulation of the consonant and the vowel, these results are compatible with the hypothesis that larger articulatory movements could be responsible for the stabilization of the PWS speech motor system, increasing the kinesthetic feedback from the effector system. This interpretation shares with a number of relatively recent proposal the idea that stuttering derives from an impaired feedforward (open-loop) control system, which makes PWS rely more heavily on a feedback-based (closed loop) motor control strategy. (shrink)

BackgroundAlthough a large number of clinical trials on interventions demonstrating efficacy (or lack thereof) are conducted annually, much of this evidence is not accessible to scientists and clinicians.ObjectivesWe aimed to determine the publication rate of posttraumatic stress disorder (PTSD) trials that have been registered in clinical trial registries, and the factors associated with publication.MethodsTrials, completed on January 15, 2015, were identified via the US National Institutes of Health clinical trials registry, the European Union Clinical Trials Register (...) and the WHO International Clinical Trials Registry Platform. A systematic search for publications (published by the end of March 2018) related to each of the registered trials were then performed.ResultsFour hundred and thirty-eight of 1982 potentially eligible trials were included. Only 34% of interventional trials were registered prior to initiation, 9% were registered within 2 months of starting and 20% after trial completion. Of the 438 included trials, 72% had generated peer-reviewed publications, while an additional 7% had disseminated results in some other form (such as on the trial database), 26 months after trial completion. Randomisation of a trial was the only factor individually associated with publication, in logistic regression analysis (p < 0.001). Intervention type, university as sponsor and study registration prior to completion were factors that influenced the time to publication, using Cox regression (p < 0.001).ConclusionsThis study underscores the importance of timely and accurate publication and dissemination of trial results, in order to avoid the potential waste of resources and to ensure research integrity and patient safety. We suggest that authors and journal editors adhere to conditions set out by the International Committee of Medical Journal Editors and that more diligent data sharing is encouraged through prospective trial registration and trial reporting websites. (shrink)

Background: People with a personality disorder suffer from enduring inflexible patterns in cognitions and emotions, leading to significant subjective distress, affecting both self and interpersonal functioning. In clinical practice, Dance Movement Therapy is provided to clients with a PD, and although research continuously confirms the value of DMT for many populations, to date, there is very limited information available on DMT and PD. For this study, a systematic literature review on DMT and PD was conducted to identify the content (...) of the described DMT interventions and the main treatment themes to focus upon in DMT for PD.Methods: A systematic search was conducted across the following databases: EMBASE, MEDLINE, PubMed, WEB OF SCIENCE, PsycINFO/OVID, and SCOPUS following the PRISMA guidelines. The Critical Appraisal Skills Programme for qualitative studies was used to rank the quality of the articles. The Oxford Center for Evidence-based Medicine standards were applied to determine the hierarchical level of best evidence. Quantitative content analysis was used to identify the intervention components: intended therapeutic goals, therapeutic activities leading to these goals, and suggested therapeutic effects following from these activities. A thematic synthesis approach was applied to analyze and formulate overarching themes.Results: Among 421 extracted articles, four expert opinions met the inclusion criteria. Six overarching themes were found for DMT interventions for PD: self-regulation, interpersonal relationships, integration of self, processing experiences, cognition, and expression and symbolization in movement/dance. No systematic descriptions of DMT interventions for PD were identified. A full series of intervention components could be synthesized for the themes of self-regulation, interpersonal relationships, and cognition. The use of body-oriented approaches and cognitive strategies was in favor of dance-informed approaches.Conclusions: Dance movement therapists working with PD clients focus in their interventions on body-related experiences, non-verbal interpersonal relationships, and to a lesser extent, cognitive functioning. A methodological line for all intervention components was synthesized for the themes of self-regulation, interpersonal relationships, and cognition, of importance for developing systematic intervention descriptions. Future research could focus on practitioners' expertise in applying DMT interventions for PD to develop systematic intervention descriptions and explore the suitability of the identified themes for clinical application. Clients' experiences could offer essential insights on how DMT interventions could address PD pathology and specific PD categories. (shrink)

Night eating syndrome is currently classified as an Other Specified Feeding or Eating Disorder under the Diagnostic Statistical Manual−5. This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders, obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. Lastly, we aimed to (...) appraise the quality of the studies being included in the review. We conducted a systematic search on three databases which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome. (shrink)

BackgroundDespite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to “share” meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM. This study explored physicians’ experiences of SDM in the management of paediatric patients (...) with prolonged disorders of consciousness (PDOC). Specifically, we focused on physicians’ SDM approaches, representations, and ethical justifications for engaging in SDM.MethodsWe used a qualitative approach to explore the SDM experiences of 13 ICU physicians, paediatricians, and neurologists based in Switzerland who have been or were involved in the care of paediatric patients living with PDOC. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data were analysed through thematic analysis.ResultsWe found that participants followed three main decision-making approaches: the “brakes” approach, characterized by maximized family’s decisional freedom, though conditional to physician’s judgment regarding the medical appropriateness of a treatment; the “orchestra director” approach, characterized by a multi-step decision-making process led by the main physician aimed at eliciting the voices of the care team members and of the family; and the “sunbeams” approach, characterized by a process oriented to reach consensus with family members through dialogue, where the virtues of the physician are key to guide the process. We also found that participants differed in the moral justifications sustaining each approach, citing the duty to respect parental autonomy, to invest in an ethics of care, and to employ physicians’ virtues to guide the decision-making process.ConclusionOur results show that physicians come to perform SDM in different ways, with several representations, and distinct ethical justifications. SDM training among health care providers should clarify the ductility of SDM and the several ethical motivations underpinning it, rather than insisting on the principle of respect for patient’s autonomy as its only moral foundation. (shrink)

The performance of most of the state-of-the-art speaker recognition systems deteriorates under degraded conditions, owing to mismatch between the training and testing sessions. This study focuses on the front end of the speaker verification system to reduce the mismatch between training and testing. An adaptive voice activity detection algorithm using zero-frequency filter assisted peaking resonator was integrated into the front end of the SV system. The performance of this proposed SV system was studied under degraded conditions with 50 selected (...) speakers from the NIST 2003 database. The degraded condition was simulated by adding different types of noises to the original speech utterances. The different types of noises were chosen from the NOISEX-92 database to simulate degraded conditions at signal-to-noise ratio levels from 0 to 20 dB. In this study, widely used 39-dimension Mel frequency cepstral coefficient features were used, and Gaussian mixture model–universal background model was used for speaker modeling. The proposed system’s performance was studied against the energy-based VAD used as the front end of the SV system. The proposed SV system showed some encouraging results when EMD-based VAD was used at its front end. (shrink)

ObjectivesTo identify and analyse ethical considerations raised when individuals with body dysmorphic disorder consult for non-surgical cosmetic procedures.MethodsEthical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals.FindingsNon-surgical cosmetic interventions were viewed not to be in the best interests of individuals with BDD, as they fail to address core psychological issues, result in (...) dissatisfaction post-procedure, and risk harm. Referral to mental health services was advocated, however numerous obstacles to this were perceived. The issue of capacity to consent to non-surgical cosmetic procedures raised questions regarding whether standard capacity assessment is sensitive to the manner in which BDD may influence decision-making processes. In addition, concerns were voiced that decisions made by individuals with BDD in this context may be judged foolish, and thus wrongly equated with lack of capacity.Discussion/conclusionsEthical analysis, informed by the available evidence base, suggests that it is generally not in the best interests of individuals with BDD to undergo non-surgical cosmetic intervention, and referral to mental health services is indicated. Analysis of capacity draws parallels between BDD and anorexia nervosa, as decision-making capacity in both conditions can be impaired by pathological values derived from the disorder. Means of differentiating clinical assessment of pathological values from inappropriate value judgements are advocated, in order to safeguard against the latter encroaching into capacity assessment. (shrink)

BackgroundThe diagnosis of Attention deficit hyperactivity disorder is primarily dependent on parents’ and teachers’ reports, while children’s own perspectives on their difficulties and strengths are often overlooked.GoalTo further increase our insight into children’s ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children’s self-reports, parents’ and teachers’ reports, and standardized continuous performance test data. We also examined whether the addition of children’s perceptions of ADHD-symptoms to parents’ and teachers’ reports would be reflected by objective (...) and standardized data.MethodsThe study included 190 children with ADHD, aged 7–10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children’s self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist, Teacher’s Report Form, and CPT scores.ResultsChildren’s self-evaluations of their functioning were globally associated with their teachers’ and parents’ evaluations, but not uniquely. Children’s self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not.ConclusionPrimary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children’s perspectives into account during ADHD diagnosis and treatment is highlighted. (shrink)

In the last few years, avatars have been increasingly used in treating persistent persecutory auditory verbal hallucinations. The digital representation (an avatar) of persecutory hallucinations is voiced by the therapist and engages the patient in a dialogue, progressively conceding its power and, hence, reducing the stress experienced by the patient. Such attempts at integrating digital representations and cognitive behavior therapy raise a range of philosophical questions, which this chapter tackles along two trajectories. From an epistemological standpoint, we inquire what notion (...) of mental disorder can underlie the use of avatar therapy, and how our understanding of psychiatric diseases can be affected by the implementation of such a therapy. Relatedly, from an ethical standpoint, we reflect on some of the controversial issues posed by such therapeutic strategies. Discussing selected epistemological and ethical aspects stemming from the latest relevant literature both in philosophy and in psychiatry, the chapter aims to provide a tentative evaluation of trade-offs between the promises of and the limits to this therapeutic option. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:It Is Going to Be a Long Clinic DaySalvador Cruz-FloresIt was a routine neurology clinic day. I entered the room where one of the residents was seeing a patient that we will call Patty, a 32-year-old long-standing epilepsy patient. Patty was sitting in the chair with her husband by her side. She started screaming at me, complaining that she was tired of feeling sick and unable to do anything. (...) She had been in and out of emergency rooms with a variety of complaints, from passing out to dizziness with nausea and vomiting. She was visibly angry and started cursing me with direct expletives and blaming me for all her ailments.Her husband was quiet and, at times, would cover his face as if he was embarrassed. I felt an initial burst of anger. I felt my face getting red. I made a great effort to stay quiet, leaned on the exam table facing them, lowered my voice, and braced to take the barrage of insults that were coming my way. I had to make a strong conscious effort to control my emotions and let her vent. I felt that if I responded in kind, I would inflame the situation. Moreover, a resident and a student working with me that day were also present in the room, and I felt it was my duty to behave professionally, so I sat and tried to do active listening with the idea of offering solutions to her complaints. I am not sure how long the event lasted, but it seemed like an eternity. As she slowed down, I apologized for making her feel not cared for, repeated some of her complaints, and tried to offer solutions to them, but she would not have it and did not accept anything I said. She wanted to get her prescriptions and leave the clinic. I offered to have one of my colleagues do the follow-up as she really did not want to see me anymore.Patty is one of those patients that when you see the name in the schedule, you cringe and tell yourself, it is going to be a long clinic day. She could be in the group of patients who are considered very difficult. Before me, she had been seen by several other neurologists. They likely also preferred not to see her on the schedule because she is one of the 20–30% of patients that have a type of functional psychogenic disorder that becomes more complicated because of the coexistence of epileptic seizures along with non-epileptic psychogenic events. The latter is a more problematic event because it does not respond to pharmacological treatment and causes a lot of disability. The best way to establish whether an event is a true epileptic event or a non-epileptic psychogenic event is to do continuous electroencephalographic monitoring to capture as many events as possible on video. I tried different combinations of medications to no avail and with significant side effects. I tried to set her up for electroencephalogram home monitoring to tease the epileptic and psychogenic events apart. In truth, her social circumstances, insurance coverage, and economic situation made it impossible to do so. Every time she came to the clinic, she had a multitude of complaints, and she would ask for a medication to treat the problem. Any mention of the potential psychogenic nature of her problems would result in a defensive attitude "so you are saying I am crazy." We discussed multiple times the need to be careful with the medications and the potential bad side effects. I wanted to help her, but with every visit, there seemed to be a barrier, and the visit would end on bad terms. At least, that is how I felt. I was left every time, with a feeling of frustration. I believe that she left the clinic feeling the same. That day, I left the clinic upset and depressed. I tried to convince myself I had done all I could to help her. I just could not understand why this was the result.Several years have passed since I have seen Patty in the clinic. She certainly has not... (shrink)

Background Transcranial direct current stimulation (tDCS) is a brain stimulation technique currently being researched as an alternative or complimentary treatment for various neurological disorders. There is little knowledge about experiences of the participants of tDCS clinical research, especially from pediatric studies. Methods An interview study with typically developing minors (n = 19, mean age 13,66 years) participating in a tDCS study, and their parents (n = 18) was conducted to explore their views and experiences and inform the ethical (...) analysis. Results Children (10–13 years old) and adolescents (14–18 years old) reported good experiences with the stimulation. Next to financial incentives, main motives to participate in the study were curiosity and the possibility to help develop treatments for children affected by neurological disorders. They could also see a potential of using tDCS in a non-medical setting, especially regarding the provision of equal opportunity, e.g. in education. Parents also presented a positive attitude towards tDCS and their children participation in the basic research study. Nevertheless, their understanding of tDCS was rather poor. Even though many of them understood the techniques, they often did not see the link between the (current) lack of side effects and an absence of longitudinal studies. Parents were also cautious about using tDCS for non-medical/enhancement purposes. Conclusions The study findings show a need for more transparent information about the state of the art of tDCS, its function and what it might be able to offer, especially considering the good acceptability of tDCS. (shrink)

This article is situated within the framework of schema therapy and offers a comprehensive and clinically useful list of schema modes that have been identified as being relevant to conceptualizing complex psychological problems, such as those posed by personality disorders, and, in particular, the way that those problems are perpetuated. Drawing on the schema therapy literature, as well as other literature including that of cognitive behavior therapy and metacognitive therapy, over eighty modes are identified altogether, categorized under the widely (...) accepted broad headings of Healthy Adult, Child modes, Parent modes and coping modes which are, in turn, divided into Surrender, Detached/Avoidant, and Overcompensator. An additional category is included: Repetitive Unproductive Thinking. This draws attention to the recognition by metacognitive therapists that such covert behaviors play a significant role in amplifying distress and perpetuating a range of psychological problems and symptoms. In addition to the modes themselves, several concepts are defined that are directly relevant to working with modes in practice. These include: default modes, blended modes, mode suites and mode sequences. Attention is also drawn to the way in which Child modes may be hidden “backstage” behind coping modes, and to the dyadic relationship between Child modes and Parent modes. Also relevant to practice are: the recognition that Critic voices may have different sources and this has implications for treatment, the concept of complex modes in which several submodes work together, and the fact that in imagery work and image of a child may not represent a Vulnerable Child, but a Coping Child. The modes and mode processes described are directly relevant to clinical practice and, in addition to being grounded in the literature, have grown out of and proved to be of practical use in conceptualizing my own cases, and in supervising the cases of other clinicians working within the schema therapy framework. (shrink)

Auditory verbal hallucinations form an essential criterial feature in the schizophrenia definition in the Diagnostic and Statistical Manual of Mental Disorders -IV and International Classification of Diseases -10. In both classificatory systems, the presence of a hallucinatory voice that continuously comments the patient’s behavior or thoughts, or the presence of several voices that discuss the patient with each other, is a sufficient criterion to diagnose schizophrenia. The DSM-IV defines a hallucination as “a sensory perception that has the..

Stuttering is a neurodevelopmental speech disorder characterized by the symptoms of speech repetition, prolongation, and blocking. Stuttering-related dysfluency can be transiently alleviated by providing an external timing signal such as a metronome or the voice of another person. Therefore, the existence of a core motor timing deficit in stuttering has been speculated. If this is the case, then motoric behaviors other than speech should be disrupted in stuttering. This study examined motoric performance on four complex bimanual (...) tasks in 37 adults who stutter and 31 fluent controls. Two tasks utilized bimanual rotation to examine motor dexterity, and two tasks used the bimanual mirror and parallel tapping movements to examine timing control ability. Video-based analyses were conducted to determine performance accuracy and speed. The results showed that individuals who stutter performed worse than fluent speakers on tapping tasks but not on bimanual rotation tasks. These results suggest stuttering is associated with timing control for general motor behavior. (shrink)

This review article summarizes various functions of the dorsolateral prefrontal cortex that are related to language processing. To this end, its connectivity with the left-dominant perisylvian language network was considered, as well as its interaction with other functional networks that, directly or indirectly, contribute to language processing. Language-related functions of the DLPFC comprise various aspects of pragmatic processing such as discourse management, integration of prosody, interpretation of nonliteral meanings, inference making, ambiguity resolution, and error repair. Neurophysiologically, the DLPFC seems to (...) be a key region for implementing functional connectivity between the language network and other functional networks, including cortico-cortical as well as subcortical circuits. Considering clinical aspects, damage to the DLPFC causes psychiatric communication deficits rather than typical aphasic language syndromes. Although the number of well-controlled studies on DLPFC language functions is still limited, the DLPFC might be an important target region for the treatment of pragmatic language disorders. (shrink)

In this article, epoch-based dynamic features such as sequence of epoch interval values and epoch strength values are explored to classify infant cries. Epoch is the instant of significant excitation of the vocal tract system during the production of speech. For voiced speech, the most significant excitation takes place around the instant of glottal closure. The different types of infant cries considered in this work are hunger, pain, and wet diaper. In this work, epoch strength and epoch interval (...) features are used to represent infant cry-specific information from the acoustic signal. In this study, the proposed features such as epoch interval and epoch strength values are determined using zero-frequency filter-based method. Gaussian mixture models are used to classify the above-mentioned cries from the features proposed in this work. GMMs are developed separately for each of the cries using the proposed features. The infant cry database collected under a telemedicine project at the Indian Institute of Technology Kharagpur has been used for this study. In the first step, infant cry recognition accuracy is investigated separately using epoch interval and epoch strength features. To enhance recognition performance, GMMs developed using various features are combined through score level fusion techniques. The recognition performance using a combination of evidence is found to be superior over individual systems. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.