Adolescents with Anti-Social Personality

Adolescents with antisocial personality disorder seem to have difficulties in taking into account all the relevant information in social interactions, such as other people’s intentions. The researchers hypothesize that this in turn leads to more antisocial behavior.

Adolescents with antisocial personality disorder inflict serious physical and psychological harm on both themselves and others. However, little is yet known about the underlying neural processes. Researchers at the University of Leiden and the Max Planck Institute for Human Development have pinpointed a possible explanation: Their brain regions responsible for social information processing and impulse control are less developed.

The study focused on incarcerated delinquent adolescents from the Netherlands aged between 15 and 21 years who had been diagnosed with an antisocial personality disorder. The researchers had the adolescents play the mini-ultimatum game. In this cooperative game, which simulates fairness considerations, the player is offered a sum of money by another player. The player is also told whether the opponent could have made a fairer offer or had no alternative.

Brain activity during the game was measured using functional magnetic resonance imaging (fMRI). By comparing the findings with those of a control group of nondelinquent adolescents, the researchers were able to determine what was going on in participants’ brains in the context of fairness considerations.

“No” to unfair offers

The delinquent adolescents showed less activation than the control group in the temporoparietal junction and in the inferior frontal gyrus. These areas of the brain are responsible for functions including the ability to put oneself in another person’s position and impulse control. In both groups, the researchers observed similar levels of activation in the dorsal anterior cingulate cortex and in the anterior insula – areas of the brain associated with affective processes.

The findings indicate that although both groups showed the same levels of emotional reactivity to unfair offers, the delinquent adolescents rejected these offers more often. In contrast to the control group, they did not take account of their opponent’s intention – or of whether their opponent had no alternative.

Marsh, A. A., Finger, E. C., Fowler, K. A., Adalio, C. J., Jurkowitz, I. N., Schechter, J. C., & … Blair, R. R. (2013). Empathic responsiveness in amygdala and anterior cingulate cortex in youths with psychopathic traits. Journal Of Child Psychology & Psychiatry, 54(8), 900-910. doi:10.1111/jcpp.12063

 

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Why is Nursing Going into Advanced Practice?

By 1980, the American Nurses Association has (ANA) has declared that “specialization in nursing is now clearly established and that specialization is a mark of the advancement of the nursing profession”. Advanced nursing practice has reached increasing levels of acceptance and demand, interprofessional conflicts increased, with medicine perceiving Clinical Nurse Managers (CNMs) as a competitive threat. According to Hamric (1989), the role of the Clinical Nurse Specialists (CNS) “originated for the purpose of improving the quality of nursing care provided to patients” the historical development of psychiatric CNSs is the oldest and one of the most highly developed CNS specialties. This growth in the psychiatric nursing body of knowledge provided the support for psychiatric nurses to begin exploring new leadership roles in the care of mental health clients in both inpatient and outpatient settings. The impressive development of the psychiatric CNS role helped initiate the growth of other CNS specialty areas.

As the number of Nurse Practitioners (NPs) is increasing in response to the increasing demand, and the NP role has attracted considerable attention from professional groups and policy makers. The Obama Administration’s records on supporting the nursing workforce has stated the following  “…With implementation of the law, we have new opportunities to move to a health care system that focuses on increased access to primary care, improved care coordination and an emphasis on prevention and wellness—efforts nurses have focused on from the beginning. This is what the future of health care looks like, and it makes the work and expertise of America’s nurses more important than ever.”

Advanced nursing practice includes specialization but goes beyond it. The skills we learn in a Masters Program function synergistically to produce a whole that is greater than the sum of its parts. For the many reasons I chose to enroll in the Masters, is because I want to possess advanced health assessment, diagnostic, and clinical management skills that include pharmacological management. I want to feel more autonomous in my direct clinical practice. I have always been dedicated to coaching of patients, families and other health care providers, so, a masters in nursing will legitimize my professional attitude and practice. Another reason that is crucial for me is research, evidenced based practice is the golden frame for us; nurses, so research skills including, utilization, evaluation, and conduct are well taught and developed in the Masters program.

The common rule is that a Masters degree is inevitable for advanced practices nurses (APNs). The role of an APN, whether in primary care or acute care, makes a bigger difference because it challenges the status quo. The role is so expanded that includes, and is not limited to collaboration, leadership, management, and ethical decision-making.