Cognitive aspects of chronic depression

Previous research on chronic depression has focused on its link with other mood disorders and Axis II personality disorders. However, there are few data examining whether the cognitive perspective applies to this condition. In this cross-sectional study, 42 outpatients with chronic depression were compared with 27 outpatients with nonchronic major depressive disorder and 24 never psychiatrically ill controls on cognitive variables thought to be related to vulnerability to depression (e.g., dysfunctional attitudes, attributional style, a ruminative response style, and maladaptive core beliefs). Both depressed groups were more elevated than a never-ill comparison group. However, chronically depressed individuals were generally more elevated on measures of cognitive variables than those with major depressive disorders even after controlling for mood state and personality disorder symptoms.     

Family etiology of chronic pain

The existence of family etiology of chronic pain is at present generally accepted as valid. Some family-related features are commonly witnessed in these patients. Pain patients are often raised by indifferent or abusing parents, submitted to parental pain models and taught a somatic vocabulary to label their emotions.They are rewarded for pain-behaviors. They communicate principally through illness, pain and complaints. Their familial status rests on the maintenance of the sick role.     

Factor-derived categories of chronic aphasia

A large sample of patients with aphasia (N = 118), unselected for etiology, were administered the Porch Index of Communicative Ability more than 6 months after the onset of aphasia. Factor analysis of PICA subtest scores identified five factors which accounted for 83.9% of the total variance. The factors were labeled speaking, writing, comprehension, gesturing, and copying. Cluster analyses of the factor scores yielded five patient categories which differed in the pattern of impairment on the language factors as well as in overall severity of aphasia. A subgroup of the parent sample consisting of 52 patients with localized left-hemisphere CVA had cluster analyses repeated after having first been studied as part of the larger sample. The factor-derived categories for the subgroup were similar to those of the entire group. Discriminant functions of the PICA raw scores of the 52-patient subsample correctly classified all of the patients. When discriminant functions were based upon the factor scores of the 118-patient parent sample, 80.7% of the 52 patients were correctly classified into the five categories.     

Effective psychotherapy of chronic schizophrenia

A method has been described to modify psychotherapy attitudinally and technically so that it is helpful with chronic psychotics--patients in a state hospital aftercare clinic. The method usually enables medications to be reduced and sometimes to be discontinued altogether. Two cases have been presented to demonstrate how the various new elements of the treatment method relate to each other, and to the rehabilitative services most chronic psychotics need.     

Electro-aversion therapy of chronic alcoholism

Twenty-six male patients with severe chronic alcoholism were treated with electro-aversion therapy according to two different designs. At follow-up after 12 months, 24 per cent had not had any relapse requiring admissions to hospital, 12 per cent were lost during the follow-up period, and 64 per cent had relapses. Before treatment all the patients had been admitted to hospital several times a year.

Aversion therapy without supplementary treatment is indicated mainly for patients who have intact social relationships and regular work. Treatment of advanced states of alcoholism requires supplementary treatment in the form of anxiety-relieving methods, psychosocial support and teaching the patient new and alternative habits.     

Developmental effects of acute, chronic, and withdrawal from chronic nicotine on fear conditioning

Pre-adolescence and adolescence are developmental periods associated with increased vulnerability for tobacco addiction, and exposure to tobacco during these periods may lead to long-lasting changes in behavioral and neuronal plasticity. The present study examined the short- and long-term effects of nicotine and nicotine withdrawal on fear conditioning in pre-adolescent, adolescent, and adult mice, and potential underlying substrates that may mediate the developmental effects of nicotine, such as changes in nicotinic acetylcholine receptor (nAChR) binding, CREB expression, and nicotine metabolism. Age-related differences existed in sensitivity to the effects of acute nicotine, chronic nicotine and nicotine withdrawal on contextual fear conditioning (no changes in cued fear conditioning were seen); younger mice were more sensitive to the acute effects and less sensitive to the effects of nicotine withdrawal 24 h post treatment cessation. Developmental differences in nAChR binding were associated with the effects of nicotine withdrawal on contextual learning. Developmental differences in nicotine metabolism and CREB expression were also observed, but were not related to the effects of nicotine withdrawal on contextual learning 24 h post treatment. Chronic nicotine exposure during pre-adolescence or adolescence, however, produced long-lasting impairments in contextual learning that were observed during adulthood, whereas adult chronic nicotine exposure did not. These developmental effects could be related to changes in CREB. Overall, there is a developmental shift in the effects of nicotine on hippocampus-dependent learning and developmental exposure to nicotine results in adult cognitive deficits; these changes in cognition may play an important role in the development and maintenance of nicotine addiction.     

Empowering chronic headache sufferers

Chronic headache pain affects sufferers and their families. Many headache sufferers lack self-discipline in controlling their headache pains. Although preventive medication is a must, medical treatment which excludes psychotherapeutic intervention reduces its effectiveness. Sufferers report increased tensions and stress with members of their families. This article reports on a program which includes headache sufferers' involvement in both family and individual therapy activities in a clinical setting. The role of the family therapist is primarily to encourage and empower sufferers to become involved in activities which can promote and increase communication, trust and self-confidence, leading toward a development of skills which can enable sufferers to utilize positive coping strategies in their effort to control headaches.     

Spousal perpetuation of chronic pain behavior

The literature reviewed here demonstrates that spousal response to pain display can reinforce and thereby perpetuate the patient's pain behavior. Relationships characterized as sick-role homeostatis reflect a nexus of behavioral contingencies which are highly resistant to treatment. Though such relationships could developde novo subsequent to accident or injury, modeling and familial effects in chronic pain suggest a rich personal and family history of chronic pain learning experiences. Spousal reinforcement of pain behavior is greater in satisfied relationships and tends to involve contingent attention and caring rather than assistance or taking over tasks and chores. As the vast majority of pain patients and spouses report being satisfied with their marriages, spousal involvement in chronic pain treatment is critical.     

Arousal-reducing effects of chronic stimulant use

A variety of studies withhabitual users of nicotine, caffeine, cocaine, and amphetamines have shown that administration of these stimulants has the paradoxical effect of lowering arousal states. Research on transmarginal inhibition shows that when subjects are presented with a succession of stimuli monotonically increasing in intensity, GSR and related arousal responses increase first and then begin to decline beyond a certain point of stimulus intensity. That is, following repeated exposure to intense stimuli, continued more intense stimulation has the effect of lowering arousal. Since stimulants subjectively heighten stimulus intensity, the transmarginal inhibition data provide a basis for explaining opposing effects of stimulants on arousal, depending on dose and frequency of use. It was hypothesized that when dose levels are low and usage is infrequent, arousal increases with stimulant intake. In contrast, when dose levels are high and frequent, arousal shows decrements with new intakes of stimulant. A new questionnaire measure of characteristic arousal was developed and correlated with subjects' reports of habitual levels of stimulant and sedative intake. Weekly total stimulant use correlated significantly and negatively with characteristic arousal level, providing support for the hypothesis. This lowered arousal of frequent stimulant users was not a confound of, or due to, concomitant frequent sedative use, since total stimulant and sedative use levels were uncorrelated.The author would like to thank Janice Schafrik for running the subjects in this study.     

Cognitive rehabilitation of chronic alcohol abusers

The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals’ abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.     

Contingency management of exercise by chronic schizophrenics

Research on the control and maintenance of exercise by chronic schizophrenics has been relatively neglected, despite widespread knowledge of the adverse consequences of sedentary living. The present study evaluated the effects of simple contingency-management procedures designed to encourage exercising by two psychotic residents living in a sheltered group home. For both subjects, the ABAB experimental analysis demonstrated the effectiveness of the intervention. Improved levels of exercise were maintained at follow-up and the contingency-management system was implemented as a regular part of the group home's rehabilitation program for all residents.