Interactive effects of behavior and reproductive hormones on sex differences in risk for coronary heart disease

It is well known that women in the United States, as in most industrialized countries in the world, are protected from coronary heart disease (CHD), relative to men. It is thought that this protection is by and large due to the effects of female reproductive hormones (i.e., estrogens) on lipid and lipoprotein metabolism and blood pressure, although women's relatively low rates of cigarette smoking are also thought to play a role. However, epidemiological studies that statistically adjust for sex differences in lipids, blood pressure, and smoking status cannot explain sex differences in CHD morbidity and mortality. Also, inconsistent with a simple main-effect model of reproductive hormones are data showing elevated risk of myocardial infarction and stroke among women who use oral contraceptives. Men who are prescribed estrogens have elevated risk of CHD, and case-control studies show that male CHD patients have elevated estradiol, compared to controls. This article suggests that simple main-effect models of female protection from CHD are inadequate. It argues that reproductive hormones are important determinants of protection from CHD, in interaction with behavioral characteristics. It also demonstrates that reproductive hormones can influence behavioral characteristics and that behavioral characteristics can influence the effects of reproductive hormones on CHD risk factors.     

Cognitive estimations as a measure of executive dysfunction in childhood epilepsy

Children and adolescents with epilepsy are known to demonstrate executive function deficits. Despite prior work that has shown that cognitive estimation tasks are sensitive to executive dysfunction in children, such tasks have not been studied in children with epilepsy. This is particularly important given the fact that executive tasks have heretofore shown poor ecological validity, and it has been speculated that estimation tasks may show stronger ecological validity than other executive tests. One hundred and thirteen clinically referred children and adolescents with epilepsy were included. The Biber Cognitive Estimations Test was sensitive to cognitive dysfunction, with about half showing impairments on this task in comparison to age-matched normative data; the most frequently impaired subscales were quantity estimation and time estimation. Moreover, the Biber Cognitive Estimation Test showed moderate correlations with not only overall intellectual functions and academic achievement but also other commonly administered tests of executive functions, including digit span, Trailmaking, and the Tower of London but not with the contingency naming test. Cognitive estimations were also modestly correlated with age of epilepsy onset but not other epilepsy-severity variables such as number of antiepilepsy drugs (AEDs) or seizure frequency. Unfortunately, the hypothesis that the Biber Cognitive Estimation Test would show strong ecological validity was not supported, as it showed weak relations with parent-reported executive function deficits. The significance and limitations of this investigation are discussed.     

AEDs and psychotropic drugs in children with autism and epilepsy

The efficacy of antiepileptic drugs (AEDs) and psychotropic medications in children with autism is limited to the treatment of seizures or to specific behaviors such as irritability, impulsivity, hyperactivity, repetitive behaviors, or aggression. The reliability and value of the available data--to determine the efficacy of these medications in autism--are limited by lack of controlled clinical trials, the small number of subjects, the heterogeneity of the population studied, and the brief duration of most drug trials. Indeed, few controlled clinical trials using AEDs in autism, with or without seizures, have been conducted. Because some AEDs also have a positive effect on mood, the benefits that children with autism sometimes obtain from these medications may not be due to the treatment of the abnormal electrical activity or the seizures per se but to an effect on common neuronal systems responsible for both behavior and epilepsy. The relationship between epilepsy and autism, and specifically the effects that abnormal electrical activity may have on the developing brain, may provide some valuable insights into the type of studies that are needed to help us understand the pathophysiology of autism.     

The Portland Neurotoxicity Scale: validation of a brief self-report measure of antiepileptic-drug-related neurotoxicity

The Portland Neurotoxicity Scale (PNS) is a brief patient-based survey of neurotoxicity complaints commonly encountered with the use of antiepileptic drugs (AEDs). The authors present data on the validity of this scale, particularly when used in longitudinal studies. Participants included 55 healthy controls, 23 epilepsy patient controls, and 86 healthy volunteers who took various AEDs or placebos for 12 weeks as part of randomized, double-blind studies of AED effects on cognitive abilities. Test-retest reliability in the control groups averaged .80 (total score). Test-retest changes in the PNS were sensitive to AED usage in general (p < .001) and to each of the five AEDs tested but not to placebo. Test-retest changes in the PNS were strongly correlated with several scales of the Profile of Mood States but only weakly correlated with objective cognitive test measures. The PNS has satisfactory psychometric properties and is sensitive to AED usage in test-retest studies.     

The effect of alterations in consciousness on quality of life (QoL) in epilepsy: searching for evidence

The impact of epilepsy on quality of life (QoL) is well-documented. The ability of epileptic seizures to alter the conscious states of patients is also well established. Although there is much research on the QoL of people with epilepsy, few researchers have looked specifically at the effect of sudden, unanticipated alterations of consciousness on QoL. This lack of systematic studies of consciousness alterations and QoL in epilepsy limits our ability to shed light on this interrelation. In this article, with these limitations in mind, we focus on studies of newer AEDs. We review the evidence as to whether a significant reduction (typically more than 50%) in seizures that induce alterations of consciousness, as a result of switching to one of the newer AEDs, leads to improvements in QoL. We draw on this literature to speculate on the relationship between ictal consciousness alterations and poor QoL in epilepsy, to identify contributory and confounding factors and to highlight implications for future research. We suggest that an understanding of how factors associated with consciousness impairment affect QoL could help the treatment and management of these patients.     

Effects of alcohol on variability-contingent reinforcement in human subjects

Subjects responded under LAG-5 reinforcement conditions after consuming alcohol in table wine (0.4 g/kg ethanol). For reinforcement (points), a four-response sequence from two buttons was required which differed from the previous five sequences of four responses. In addition, some subjects responded under restricted conditions in which sequences were limited to those of moving a cursor within a 3 x 3 matrix, while other subjects had no such restrictions. Also some subjects worked alone while others were accompanied by an experimenter. Analysis showed that compared to controls, men in the unrestricted condition who received alcohol showed increased uncertainty in responding while comparable women receiving alcohol showed a decrease in uncertainty of responding. The results are discussed in terms of previous work on alcohol and behavioral variability.     

The enhancing effects of anxiety on arousal in sexually dysfunctional and functional women

Effects of anxiety on sexual arousal were examined to determine if sexually dysfunctional and functional women exhibit different patterns of physiological and subjective response. Subjects viewed 2 videotape conditions: an anxiety-evoking and neutral-control preexposure stimulus, each paired with a sexual arousal-evoking stimulus. Anxiety preexposure enhanced the rate and magnitude of genital arousal for both dysfunctional and functional subjects in relation to the neutral condition. Despite increased genital responses, both groups reported less subjective sexual arousal after anxiety preexposure. Functional subjects exhibited greater physiological but not subjective arousal than dysfunctional subjects in both conditions. Results are discussed in terms of desynchronous patterns of sexual response, mechanisms by which sympathetic activation enhances sexual arousal, and implications for treatment of sexual dysfunction in women.     

The effects of visual similarity on proofreading for misspellings

In three experiments, subjects read prose passages and circled misspellings in them. The misspelled words were created by replacing a single letter with another one. The visual similarity between the correct letter and the one that was substituted for it increased the percentage of proofreading errors. The results suggest that proofreaders search through a visual representation of the text and that a hierarchical feature test is applied to this representation, according to which subjects give first priority to resolving letter envelope and second priority to discriminating additional visual features. A sophisticated-guessing decision rule is also implicated for the misspellings that do not alter letter envelope: Subjects are tolerant of missing letter features but are intolerant of additional features.     

Treatment of epilepsy in the multiply handicapped

The medical management of epilepsy in the multi-handicapped patient requires careful evaluation, classification, and pharmacologic treatment. It is estimated that 20-40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal experience related to the use of newer AEDs in the chronic management of epilepsy syndromes in children and adults, as well as information available on the treatment of seizures in individuals with mental retardation and associated handicaps. Furthermore, clusters of seizures, prolonged seizures and status epilepticus are more commonly seen in the multiply handicapped and mentally retarded population and require special attention. The new antiepileptic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage in some multiply handicapped patients, be it for seizure control or medication tolerance. Furthermore, new modalities of treatment for prolonged seizures allow better efficacy both outside of hospital and within hospital facilities. The treatment of epilepsy in multi-handicapped and retarded adults and children has significantly advanced in the past few years, and much of this improvement can be attributed to improved knowledge and monitoring of new antiepileptic drugs. Conventional anticonvulsants remain first line therapy for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients.     

The Effect on Behavior of Being in a Control Group

This study examined how individuals react when they know they are missing an experimental treatment as a function of having been assigned to a control group. Subjects in one condition were informed that they were a control group and would miss receiving extra money for doing well on experimental tasks. Subjects in a second condition were informed that they would miss receiving electric shocks for doing poorly on the same tasks. In the third condition subjects were given no information about missed conditions. Subjects who believed they were missing the chance to receive extra money tended to do worse, while those who believed they were missing the shocks did better on the experimental tasks than did subjects unaware of any other condition. In addition, missing-reward subjects made more errors and did less work than did missing-punishment subjects. There were no differences in attitude towards the experiment as a function of experimental condition. Differences in task performance were discussed in terms of inequity theory (Adams, 1963), the evaluation of social programs, and Campbell's (Note 1) suggestion of "informed randomization.     

Chronic Pain Syndromes and Violence Against Women

Abstract

Chronic pain is a common form of disability, and is often reported among women with a history of victimization. In the present study, we combine six pain symptoms into a measure of self-reported pain, and compare women who have experienced child or domestic abuse with those who do not report such a history. A sample of 110 female patients (57 abused, 53 non-abused controls) was drawn from an adult primary-care practice of 905 patients in a small, affluent, predominantly Caucasian community in northern New England. The subjects ranged in age from 18 to 88 (M = 47). Subjects completed a self-administered questionnaire that was used clinically as part of the new-patient work-up. Women who reported either child or domestic abuse were significantly more likely to report pain symptoms than women in the control group. There was no significant difference between women who had experienced domestic abuse vs. child abuse alone. These findings held true even after controlling for depression.     

Reproductive‐age women are overrepresented among perpetrators of husband killing

When a woman kills her husband, it is almost always an unplanned action of self‐defense against a battering husband or a last‐ditch attempt to survive a batterer's tyranny. Younger, reproductive‐age women are battered and killed by husbands at higher rates than are older, postreproductive‐age women. Because husband killing occurs in the context of self‐defense or as a last‐ditch effort to survive, reproductive‐age women should kill their husbands at higher rates than do postreproductive‐age women. I used a sample of 8,077 husband killings to test this hypothesis. Results support the hypothesis and document that (1) the highest rates of husband killing are for the youngest women, (2) the youngest husbands are at greatest risk of being killed by their wives, (3) women married to older men kill their husbands at higher rates than do women married to same‐age men and women married to younger men, and (4) reproductive‐age women kill their husbands at higher rates than do postreproductive‐age women across two groups: women married to younger men and women married to older men. Discussion suggests directions for future work that can improve the identification of women at greatest risk for husband killing. Aggr. Behav. 26:309–317, 2000. © 2000 Wiley‐Liss, Inc.     

A poor metabolizer for cytochromes P450 2D6 and 2C19: a case report on antidepressant treatment

Scientific literature has never described a poor metabolizer for both the cytochrome P450 (CYP) 2D6 and the CYP 2C19. They are expected to be rare (<1% in different ethnic groups) and prone to adverse drug reactions with many antidepressants. In an ongoing pharmacogenetic study, after genotyping 1,576 subjects in three Kentucky state hospitals we have found one poor metabolizer for both CYP 2D6 and CYP 2C19, which corresponds to a prevalence of 0.06% (95% CI 0.01 to 0.36). The naturalistic antidepressant treatment of this poor metabolizer for both enzymes is described in this article. As genotyping reaches clinical practice, it will be interesting to prospectively establish whether mirtazapine is a reasonable choice as an antidepressant for these patients, as the data and this case suggest.     

Barriers to the management of patients with surgically remediable intractable epilepsy

It is estimated that only a small proportion of patients with surgically remediable intractable epilepsy receive surgical treatment. There are multiple reasons why this is the case. Patients with intractable epilepsy are sometimes severely disabled and disability can create barriers to getting recommended care. Patients with epilepsy are not well informed about their condition and the available treatments. The incidence of epilepsy is similar in minority populations, and surgically remediable epilepsy frequently presents in adolescence. Nevertheless, these vulnerable populations have specific barriers to receiving epilepsy care, which are often not addressed. In addition, despite scientific evidence for the benefits of the surgical treatment of epilepsy, many healthcare providers do not recommend or adequately discuss surgery with patients. Solutions to these barriers will require interventions that result in informed and capable patients who actively participate in their care and healthcare providers who practice culturally sensitive, recommended care.     

Receipt of a False Positive Test Result During Routine Screening for Ovarian Cancer: A Teachable Moment?

The term "teachable moment" (TM) has been used to describe a life transition or event which motivates an individual to change a behavior or presents an opportunity to intervene to prompt behavior change. We examined whether receipt of a false positive ovarian cancer (OC) screening result may represent a TM. 403 women participating in an OC screening program completed questionnaires assessing demographic, clinical, behavioral, and psychosocial information. The TM was operationalized as expressed interest in receiving health-related information. We hypothesized that among women receiving a false positive screening test result, those women who had experienced greater personal perceived risk for OC as well as distress would be more interested in receiving health-related information than women receiving a normal result. Analyses revealed that women receiving a false positive screening result were less interested in receiving health-related information than women receiving a normal screening result. For women receiving a false positive result, expressed interest in receipt of health-related information was only modestly related to distress and related even less to perceptions of OC risk. Our data do not support viewing a false positive OC screening result as a TM. Potential explanations for the current findings as well as recommendations for future research investigating the TM are discussed.     

Effects of Contrived information of Female and Male Performance on the Achievement Behavior of Preschool Girls and Boys1

Twenty-four girls and 24 boys enrolled in a university preschool were given two trials each to perform a marble-dropping task. After the first trial, subjects in the sex-appropriate condition were told that children of their sex perform the task better than children of the opposite sex. Subjects in the sex-inappropriate condition were told that children of their sex perform the task less well than children of the opposite sex. It was hypothesized that sex-appropriate subjects would set higher goals for Trial 2 than control subjects receiving no information and that sex-inappropriate subjects would set lower goals than control subjects. The hypotheses were not supported. Instead, children of both sexes set significantly higher goals when told that boys do better at the task. Interpretations of the results are offered.     

The effects of episodic and semantic memory on the identification of sentences masked by white noise

Two studies examine how episodic and semantic memory affect subjects’ abilities to repeat sentences masked by white noise. Subjects first hear a list of 70 sentences that are not masked. Subjects in the framework conditions are told prior to hearing the list that all sentences refer to a contextual framework concerning a deserted island. Subjects in the no-framework groups are not given this information. Subjects in the framework-after condition are given this information only after hearing the list of sentences. Subjects then perform a white-noise identification task. The results indicate that framework subjects are able to identify both old and new framework-related information better than other subjects. Subjects in the no-framework and framework-after conditions identify old information better than control subjects who do not participate in an acquisition phase. Emphasis is placed on the interdependence of episodic and semantic memory, including conditions leading to such interdependence.     

Reproductive life events and sexual functioning in women: case reports

Are reproductive life events in women associated with an increased risk of sexual dysfunction? Female sexual dysfunction effects up to 40% of women in the United States between 18 and 59 years of age. Sexual dysfunction may be accompanied by fluctuations in gonadal hormone secretion, making women more vulnerable to sexual symptoms, especially during times of reproductive life events. Reproductive life events, such as the use of birth control pills, various phases of the menstrual cycles, postpartum and lactation states, and perimenopause, are highly correlated with changes in sex steroids. As an understanding of the role of sex steroids on sexual functioning is elucidated, clinicians will be able to offer more specific and effective treatment options for women during various phases of reproductive life. Several case studies are presented to illustrate the unique clinical considerations that a clinician must consider when treating the biologic component of female sexual dysfunction.     

Tailoring treatment of depression for women across the reproductive lifecycle: the importance of pregnancy, vasomotor symptoms, and other estrogen-related events in psychopharmacology

Compared with men, women are at increased risk of depression, especially at several reproductive-related lifecycle points. This may be partially due to changing levels of estrogen, a hormone that can affect levels of neurotransmitters and neural proteins. As estrogen levels vary throughout the lifespan, risk of depression in women also varies, and not all treatments are appropriate or effective at all times. In adolescence, onset of depression may be associated with onset of puberty, but treating underage girls with antidepressants can risk suicidality. In females of childbearing age, mood disturbances associated with menstrual cycles signal a risk for later full-blown major depressive disorder. In depressed pregnant and postpartum women, risks of treatment versus risks of nontreatment are intricate and require case-by-case evaluation. In perimenopause, vasomotor symptoms may be harbingers of oncoming depression and also may signal the presence of dysregulated hormones and neurotransmitters. Relieving vasomotor symptoms may be a necessary dimension of treating depression. In postmenopause, response to selected antidepressants may depend on whether the patient is also taking hormone-replacement therapy. To attain optimal outcomes, modern psychopharmacologists must tailor treatment of depression to a woman's reproductive stage of life.     

The role of performance-related similarity in social comparison of abilities: A test of the related attributes hypothesis

The hypothesis that individuals evaluate their abilities by comparison with others who are similar on nonability attributes that are related to performance has been supported in recent experiments. However, since these experiments did not include conditions in which attributes were unrelated to performance, they provide no evidence that it was the relationship of attributes to performance that explains why subjects compared with similar others. In the present experiment, 66 female undergraduates could choose to compare their test performance to the performance of women who were similar or dissimilar to themselves in physical attractiveness and the college they attended. In a 2 × 2 design these attributes were either related or unrelated to test performance. Results showed that only the performance relevance of college attended influenced comparison choices. Subjects compared with similarly attractive women even when attractiveness was unrelated to performance. These results indicate that identification of the conditions in which people do and do not consider the relevance of attributes to performance in selecting comparison others warrants attention.