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by Harlow s famous case, published in 1868; it has been the subject of numerous monographs ever since His patient, Phineas Gage, was a capable, God-fearing foreman of a railroad gang who became irreverent, dissipated, irresponsible, and vacillating (he also confabulated freely) following an injury in which an explosion drove a large iron tamping bar into his frontal lobes In Harlow s words, he was no longer Gage Another similarly dramatic example was Dandy s patient (the subject of a monograph by Brickner), who underwent a bilateral frontal lobotomy during the removal of a meningioma Feuchtwanger, in a clinical study of 200 cases of frontal lobe injury, was impressed with the lack of initiative, changes in mood (euphoria), and inattentiveness, without intellectual and memory de cits; Rylander, in a classic monograph, described similar changes in patients with unilateral and bilateral frontal lobectomies (see below) Kleist, under the heading of alogia, stressed the importance of loss of capacity for abstract thought, as shown in tests of analogies, proverbs, de nitions, etc In chimpanzees, Jacobsen observed that the removal of the premotor parts of the frontal lobes led to social indifference, tameness, placidity, forgetfulness, and dif culty in problem solving ndings that led Egas Moniz, in 1936, to perform prefrontal lobotomies on psychotic patients (see Damasio) This operation and its successor, prefrontal leukotomy (undercutting of the prefrontal white matter), reached their height of popularity in the 1940s and (tragically) provided the opportunity to study the effects of a wide range of frontal lobe lesions in a large number of patients The ndings in patients who underwent frontal leukotomy have been the subject of endless controversy Some workers claimed that there were few or no discernible effects of the operation, even with bilateral lesions Others insisted that if the proper tests were used, a series of predictable and diagnostic changes in cognition and behavior could be demonstrated The arguments pro and con and the inadequacies of many of the studies, both in methods of testing and in anatomic veri cation of the lesions (the extent and location of the lesions varied considerably, and this in uenced the clinical effects), have been well summarized by Walsh Admittedly, in patients who underwent bilateral frontal lobotomy, there was little if any impairment of memory function or of cognitive function as measured by intelligence tests and certainly no loss of alertness and orientation And some patients who had been disabled by schizophrenia, anxious depression, obsessive-compulsive neurosis, or a chronic pain syndrome did improve with respect to their psychiatric and pain symptoms However, many patients were left with changes in personality, much to the distress of their families They were indifferent to the feelings of others; gave no thought to the effects of their conduct; were tactless, distractible, and socially inept; and were given to euphoria and emotional outbursts Luria had an interesting conception of the role of the frontal lobes in intellectual activity He postulated that problem solving of whatever type (perceptual, constructive, arithmetical, psycholinguistic, or logical de nable also as goal-related behavior) proceeds in four steps: (1) the speci cation of a problem (in other words, a goal is perceived and the conditions associated with it are set); (2) formulation of a plan of action or strategy, requiring that certain linguistic activities be initiated in orderly sequence; (3) execution, including implementation and control of the plan; and (4) checking or comparing the results against the original plan to see if it was adequate Obviously such complex psychologic activity must implicate many parts of the cerebrum and will suffer to some extent from a lesion in any of the parts that contribute to the func-.

TABLE 1-5

Extrinsic value can be described as the risk value of the option The risk value is made up of several components One of these is time value, which is the length of time that the option writer or seller will assume risk for the sale A 5-year life insurance policy premium is much cheaper than a 15-year policy premium because the insurance company is exposed to risk for an additional 10 years on the 15-year policy Options are no different; time has risk, and therefore time has a premium cost to the buyer Time value can be present in options that are in the money, at the money, or out of the money Time value is the portion of premium in the options price that is above and beyond the intrinsic value If an option is at the money or out of the money, then the option would have no intrinsic value and would have time value only Time value can also be considered the risk value of an option When you purchase an option, you are compensating the writer for the risk and time of selling the option Included in the time value of the option is the risk assumed from the volatility of the market If the market price uctuates wildly, the writer naturally assumes that there is more risk than if a price is very stable, so the time value of the option

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tional system Luria found that when the frontal lobes are injured by disease, there was not only a general psychomotor slowing and easy distractibility but also an erroneous analysis of the abovelisted conditions of the problem The plan of action that is selected quickly loses its regulating in uence on behavior as a whole and is replaced by a perseveration of one particular link of the motor act or by the in uence of some connection established during the patient s past experience Furthermore, there was a failure to distinguish the essential sequences in the analysis and to compare the nal solution with the original conception of the problem Plausible as this scheme appears, like Goldstein s loss of the abstract attitude (the patient thinks concretely, ie, he reacts directly to the stimulus situation), such psychophysiologic analyses of the mental processes are highly theoretical, and the factors to which they refer are not easily measured In modern parlance, the frontal lobe, and particularly its prefrontal components, is said to exert an executive function, referring here to the overall control of other cognitive functions This allows for a type of self-monitoring that guides the selection of strategies to solve problems, the inhibition of incorrect responses, the ability to deal with change in focus and novelty in tasks, and probably to be able to generalize from experience Indeed, all ability to adapt to changes in circumstance requires this executive function Unlike some of the psychic properties mentioned above, these are subject to measurement by testing, but they are observable during the clinical examination as a deterioration in problem solving, by repetitiousness and stereotypies, and by ineptitude in managing simple social situations Probably the trouble all individuals experience in maintaining a stream of thought when interrupted tests this function Other Alterations of Behavior and Personality A lack of initiative and spontaneity is the most common effect of frontal lobe disease, and it is much easier to observe than to quantitate With relatively mild forms of this disorder, patients exhibit an idleness of thought, speech, and action, and they lapse into this state without complaint They are tolerant of most conditions in which they are placed, though they may act unreasonably for brief periods if irritated, seemingly unable to think through the consequences of their remonstrances They let members of the family answer questions and do the talking, interjecting a remark only rarely and unpredictably Questions directed to such patients may evoke only brief, unquali ed answers Once started on a task, they may persist in it ( stimulus bound ); ie, they tend to perseverate Fuster, in his studies of the prefrontal cortex, emphasizes the failure over time to maintain events in serial order (impairment of temporal grading) and to integrate new events and information with previously learned data Placidity is a notable feature of the behavior Worry, anxiety, self-concern, hypochondriasis, complaints of chronic pain, and depression are all reduced by frontal lobe disease, as they are by frontal lobotomy Extensive and bilateral frontal lobe disease is accompanied by a quantitative reduction in all psychomotor activity The number of movements, spoken words, and thoughts per unit of time diminish Milder degrees of this state, associated with only a delay in responses, are called abulia (page 359); the most severe degrees take the form of akinetic mutism (page 305) wherein a nonparalyzed patient, alert and capable of movement and speech, lies or sits motionless and silent for days or weeks on end The localization of this condition is quite imprecise It has been attributed to bilateral lesions in the ventromedial frontal regions or frontal-.

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