Psychopharmacology and conditional reflexes

Drugs may be used in several ways to investigate their role in behavior. (1) The placebo effect is usually connected with the relation of the person to the drug. (2) Using the drug as an unconditional stimulus, its action may help to analyze the role of peripheral vs. central stimuli in the formation of conditional reflexes; our work has shown that the effect of drugs which act solely at the peripheral nerve endings without the involvement of the central nervous system cannot become conditioned. (3) The action of drugs on the conditional reflex (CR) compared with their action on the unconditional reflex (UR) explains some of their behavioral effects. (4) Schizokinesis is often prominent in the action of drugs. Although a drug may increase the level of the heart rate, for example, it can, on the other hand, diminish the reactivity shown in the CR. Meprobamate and mescaline affect differently the cardiac and the motor components of the CR, illustrating a schizokinesis. (5) The type of individual is an important factor in the action of drugs; the same drug may have opposite effects on different individuals. This leads to the conclusion that a drug should fit the individual as well as the disease. (6) Autokinesis is often seen in drug action. Therefore a single dose of some drugs, such as acetylcholine, epinephrine or LSD, may permanently change the relationships between excitation and inhibition, in the direction of improvement or deterioration (positive or negative autokinesis).     

Internalized homophobia in men: wanting in the first person singular, hating in the first person plural

This paper focuses on the expression of internalized homophobia in men, arguing that the most powerful clinical use of this term depends upon its applicability to any man, without limitation to those whose primary object choice is homosexual. A number of dynamic situations are described to which the term might apply, elaborated by examples from contemporary culture and clinical practice. A central dynamic elucidated here is the move from an anxiety-ridden, first person singular voice to the promised safety of a first person plural voice--that is, from the dangerous position of "I want" to the more protected "we hate."     

A follow-up program for suicide attempters: evaluation of effectiveness.

Suicide attempters are a high-risk group in relation to ultimately completing suicide and are usually "treated and released" with little or no follow-up care. A 4-month follow-up outreach program for suicide attempters seen in the emergency room was developed with an emphasis on continuity and quantity of "treatment" received. Suicide attempters were randomly assigned to the "follow-up outreach" or "normal" treatment programs. Measures for the evaluation of effectiveness were (a) incidence of suicide reattempts and purposive accidents and (b) prevalence of drug misuse and excessive use of alcohol. The experimental group showed a statistically significant reduction in suicide reattempts and excessive use of alcohol, while the reduction of drug abuse, although not statistically significant, did conform to a trend indicating improvement. Purposive accidents occured at a relatively equal rate among both groups.     

Observational couple assessment: a cross-model comparison

This study compared the clinical rating scales from the Circumplex Model (CCRS), the McMaster Model of Family Functioning (MCRS) and the Family Health Scales (FHS). A central purpose was to investigate whether observational rating scales designed to measure family functioning can also be used to assess couple functioning. One hundred and sixty-six drug abusing women, receiving primary drug treatment in two metropolitan drug agencies in the southwest of the US, and their partners were videotaped while engaged in three couple tasks prior to receiving any treatment. The main findings indicated that all three rating scales have: (1) sufficient interrater reliability; (2) good construct validity, as reflected in factor analyses; and (3) very good convergent validity. However, there was some concern about whether these scales are as discriminating when measuring couples as they are when assessing families.     

Psychological factors and use of antiepileptic drugs: pilot work using an objective measure of adherence

Given the current emphasis on the "concordance" prescribing model, a study was designed to determine the influence of patients' beliefs about epilepsy, beliefs about medication and a range of neuroepilepsy variables on drug adherence among a sample of epilepsy patients. A special feature of the study was the use of a credible objective measure of drug adherence. Psychological health was also assessed. Thirty-seven patients were recruited from a local epilepsy clinic. Beliefs about epilepsy (illness representations), beliefs about epilepsy medication, anxiety, depression, neuroepilepsy status and adherence were all measured. Data were collected via clinical interview and questionnaire methods. Adherence with drug treatment was determined by an objective measure using low-dose phenobarbital as an indicator of adherence and, or, measurement of antiepileptic drug levels. Neither illness representations nor beliefs about epilepsy drugs were related to adherence. With the exception of time since last seizure, which was positively related to adherence, neuroepilepsy variables were unrelated to adherence. A number of significant associations between cognitive representations of epilepsy and mood were found.     

Forming a Consortium: A Design for Interagency Collaboration in the Delivery of Service Following the Disclosure of Incest

A central issue in the treatment of intrafamilial sexual abuse is the "secondary trauma" experienced by both the victimized child and her family when the wider system of regulatory and treatment agencies present redundant, incongruent, or conflicting perspectives and demands. This article describes an attempt to effect second-order change through formation of a consortium of regulatory and treatment agencies to develop a consistent and coordinated response to the disclosure of sexual abuse. Feminist, social constructionist, and organizational development ideas are used to develop principles of intersubjectivity, collaboration and a "both-and" stance, which have guided both the clinical and wider systems work.     

A contribution to "stiff man" syndrome

A patient with the clinical symptoms of the "Stiff-man"-syndrome, but an atypical course was introduced. Symptoms and course were compared with similar cases mentioned in literature. The "Stiff-man"-syndrome is probably a disease of central origin affecting the relationship between inhibitory and excitatory regulation of the muscle tonus, especially the exteroceptive reflex mechanisms. Several pathological processes of the CNS can be held responsible for the disturbance of the balance in this regulatory system.     

Citation Analysis Mapping of Journals in Applied and Clinical Psychology

This paper uses a method of citation analysis to establish the importance ranking and relative location of 23 major journals in the field of applied and clinical psychology and related disciplines. The asymmetric citations are modelled as being the product of the cited journals "importance," the citing journal's "receptivity,"and the "similarity" between the two journals. A maximum likelihood loglinear fit to this model is obtained. Multidimensional scaling of the derived similarities matrix provides an interpretable map of the journals' relative configuration. The changes in relative importance of the journals are reported for the years 1981 to 1988, together with maps of the journals for the periods 1981 to 1984 and 1985 to 1988. The results show a central core of general psychology journals, surrounded by three major groupings of applied psychology journals.     

Psychosocial Genetic Counseling in the Post-Nondirective Era: A Point of View

For three decades nondirectiveness has served as the central ethos for genetic counseling. It has evolved from narrow definitions defining what should not be done to broad definitions that promote active counseling skills in support of client autonomy and informed decision making. As broad definitions have been formulated, the term nondirective has become largely irrelevant to their content; it persists primarily as a historic relic. It has thus become an impediment to creative theory and clinical practice. I propose that nondirectiveness be replaced as the central ethos, while relevant components (providing balanced information, not imposing the counselor's values) are retained as elements of practice and ethics. This raises the question of what principle(s) should be adopted as a new guiding ethos. To promote a discussion of that issue I propose that the central ethos of genetic counseling should be to bring the psychosocial component into every aspect of the work.     

Discriminative stimulus properties of drugs: a brief history and a selective review

A brief history of the background of drug discrimination research is given, focusing on the concepts of "drug dissociation" or state-dependent learning; an alternative explanation to the state dependency concept is to view the drug as a discriminative stimulus. In drug discrimination learning both a qualitative and a quantitative dimension is identified as governing the discrimination, examples of which are provided in the text. Examples of how drug discrimination techniques may assist in future research are outlined.     

Understanding the relations between different forms of racial prejudice: a cognitive consistency perspective

Research on racial prejudice is currently characterized by the existence of diverse concepts (e.g., implicit prejudice, old-fashioned racism, modern racism, aversive racism) that are not well integrated from a general perspective. The present article proposes an integrative framework for these concepts employing a cognitive consistency perspective. Specifically, it is argued that the reliance on immediate affective reactions toward racial minority groups in evaluative judgments about these groups depends on the consistency of this evaluation with other relevant beliefs pertaining to central components of old-fashioned, modern, and aversive forms of prejudice. A central prediction of the proposed framework is that the relation between "implicit" and "explicit" prejudice should be moderated by the interaction of egalitarianism-related, nonprejudicial goals and perceptions of discrimination. This prediction was confirmed in a series of three studies. Implications for research on prejudice are discussed.     

Juvenile drug addiction: a typology of heroin addicts and their families

In this article the authors propose: 1) a typology of drug addiction cases consisting of four main classes: A. traumatic drug addiction, B. drug addiction from actual neuroses, C. transitional drug addiction, and D. sociopathic drug addiction; 2) a clinical study (with 18 months of follow-up data) involving 131 heroin addicts mostly treated with structural or counterparadoxical family therapy in the same psychotherapy center and in the same year; and 3) some preliminary conclusions emerging from an examination of the four-class typology with respect to the effectiveness of family therapy interventions. If, for example, structural family therapy techniques seem more suitable in type-B cases (similar to cases described by Haley in his Leaving Home), the counterparadoxical techniques are likely to be more effective in type-C cases (similar to the anorectics described by Selvini-Palazzoli).     

Measuring the core features of personality disorders in substance abusers using the Temperament and Character Inventory (TCI)

Personality disorders (PDs) are still classified through categorical taxonomies that are at odds with current research findings. Dimensional models provide a suitable alternative for measuring individual differences. However, as they have traditionally lacked a clear definition of the "disorder" construct, the clinical utility of these models has been limited. This study tests whether Cloninger's dimensional model is able to capture two domains: the features that differentiate PD subtypes from each other and the common core features underlying all PDs. Seventy-four drug dependent patients were independently assessed using the SCID-II and Cloninger's TCI. There was a slight relationship between TCI temperament dimensions and the DSM personality disorder subtypes, but the association was not specific enough to allow differential diagnosis. The character dimension Self-Directedness was strongly associated with the presence and severity of all PDs, irrespective of subtype, correctly classifying 77% of subjects. Character dimensions are a reliable, valid and low-cost tool for detecting PDs in drug abusers and may help to provide an operational definition of the common core features underlying all PDs.     

Conditioning of a discriminative drug stimulus: Overshadowing and blocking like procedures

Interactions between a drug discriminative stimulus ( D , 17.5 mg/kg of pentobarbital vs. N , saline) and exteroceptive stimulus conditions (light vs. dark) were examined in a T-maze, shock-escape task using conditioning procedures pertaining to the phenomena of "overshadowing" and "blocking". From an operational point of view, in the "overshadowing" procedure the stimulus compound is introduced from the outset of the training, whereas in the "blocking" procedure the stimuli components are introduced sequentially. When the compound discriminations were established, dose-generalization tests with various doses of pentobarbital (range 5.6–17.5 mg/kg) as well as saline (1 ml/kg) were carried out under both elements (light and dark) of the exteroceptive stimulus dimension. Prior training with drug ( D vs. N ) neutralized the potential influence of the exteroceptive dimension (light vs. dark); conversely training with the exteroceptive stimuli prior to the drug training accentuated the control over behavior by the visual stimuli. Dose-generalization results intermediate to those described above were observed in the group trained to discriminate the stimulus compound ( D plus light vs. N plus dark) from the outset of training. It may therefore be concluded that exteroceptive stimuli can compete with interoceptive drug stimuli for associative strength in the procedure used. Thus, the formal similarities between drug discriminative stimuli and more conventionally studied exteroceptive, sensory signals are furthered by the data.     

Reading Freud's "the Dynamics of Transference" one hundred years later

Freud's technical papers, "The Dynamics of Transference" in particular, established most of the basis for a century of clinical psychoanalytic work. A contemporary reading of that paper illustrates both the power of the original presentation and how far we have come. Close readings are given of crucial passages, including retranslations where Strachey's English arguably distorts Freud's language or intent. More broadly, Freud's conclusions are examined to reveal correspondences with current thinking or its foreshadowing. Although Freud drove toward unifying conclusions, he at the same time described a disparate array of clinical phenomena. The paper's central points are situated historically, both in Freud's evolution and in the subsequent evolution toward the pluralistic clinical theory of today. Freud encountered many of the challenges we face, noting them in ways both clinically useful and fruitful for other theorists. The use of the paper's central tenets is traced historically, showing how ideas that provide a radical, liberating, and facilitating guide for analysts can over time devolve into hackneyed rules. Finally, it is noted how transference phenomena are increasingly being discussed as a specific type of dyadic human experience. The task in the coming century is to develop theory and vocabulary for comprehending these phenomena and integrating them with Freud's intrapsychic concepts.     

Cognitive Models of Depression: The State of the Notion

This article describes a program of research on excessive reassurance-seeking and its relation to depression. Relevant theory, central predictions, and empirical work are summarized, and the research program's implications for depression science and clinical work are noted. We argue that excessive reassurance-seeking (a) is implicated as a potential contributory cause of depressive symptoms; (b) is involved in generating negative interpersonal outcomes, such as interpersonal disruptions and "contagious" depression; (c) relates to other theoretically important depression-related constructs in ways that may broaden and enhance depression theory and science; and (d) has potential import for the treatment and prevention of depression. The article may be of interest to those studying the social and clinical psychology of depression, as well as those engaged in the psychotherapy of depressed people, and may inspire future theoretical, empirical, and clinical work, with the ultimate aim of increasing understanding of and decreasing suffering from depression, a vexing (and increasing) human problem.     

Conditioning of successive adaptive responses to the initial effects of drugs

Data in the literature indicate that conditioned responses (CRs) generated by repeated pairing of conditional stimulus (CS) with administration of a neurotropic drug may resemble its unconditional effects or they may be opposite in direction; furthermore, the CRs may change as such pairings are continued. In explanation, it is hypothesized that as in conditioning of physiological reflexes, a CS repeatedly paired with administration of a neurotropic drug eventually comes to activate central“processing” events that are evoked by the“stimulus” properties of the drug,i.e., the effects of the drug at receptor sites inside or outside the pia mater which lie in the afferent arms of“reflex” neural circuits; or, the CS comes to activate central processing events that are evoked by centripetal feedback responses to the effects of the drug at receptor sites in the processing or efferent arms of reflex neural circuits. Depending on the receptor site action of the drug, the conditioned autonomic and/or neuromuscular responses that are observed may be in the same direction as, or opposite in direction to the unconditioned effects of the drug. With continued pairings of CS and drug, the unconditioned processing events evoked by the stimulus properties of the drug, and hence the CRs also, change in consequence of compensatory (sometimes“overshooting”) biochemical alterations proximal to the receptor site of action of the drug, induced by negative or positive neuronal feedback mechanisms. These concepts are utilized in a theory of opiate addiction and relapse.     

Metabolic syndrome and Alzheimer's disease: a link to a vascular hypothesis?

Current evidence from epidemiological, neuroimaging, pathological, pharmacotherapeutic, and clinical studies indicate an association of Alzheimer's disease with risk factors of vascular atherosclerotic disease either in isolation or in aggregate. "Metabolic syndrome" (MetS) is the name for a clustering of risk factors for cardiovascular disease and type 2 diabetes that are of metabolic origin. These include central obesity, elevated plasma glucose, high blood pressure, atherogenic dyslipidemia, a prothrombotic state, and a proinflammatory state. In this article, we provide an overview of the relevant literature with regard to the relationship of Alzheimer's disease with MetS. Accumulating evidence suggests a "vascular hypothesis" to be related to the pathology of Alzheimer's disease. In the light of this evidence, clinician may consider lifestyle interventions toward an early and effective cardiovascular risk-factor management to reduce the cardiometabolic and the cognitive decline risk, while further research of other preventive strategies may be warranted.     

Transdermal selegiline: the new generation of monoamine oxidase inhibitors

The clinical use of monoamine oxidase inhibitors (MAOIs) has declined due to concerns about food and drug interactions and waning physician experience. Evidence indicates that MAOIs are effective in depressive disorders, in particular depression with atypical features. Efforts to address safety issues have led to the development of more selective and reversible MAOIs, such as moclobemide. Selegiline, a selective monoamine oxidase B inhibitor, has been approved for the adjunctive treatment of Parkinson's disease at low doses. At higher doses, oral selegiline is also effective in major depressive disorder (MDD) but loses its selectivity and has the potential for tyramine interactions. To overcome these problems, a transdermal formulation of selegiline, the selegiline transdermal system (STS), was developed with novel pharmacokinetic and pharmacodynamic properties. Compared with oral administration, transdermal selegiline leads to sustained plasma concentrations of the parent compound, increasing the amount of drug delivered to the brain and decreasing metabolite production. In addition, STS allows targeted inhibition of central nervous system monoamine A (MAO-A) and monoamine B isoenzymes with minimal effects on MAO-A in the gastrointestinal and hepatic systems, thereby reducing the risk of interactions with tyramine-rich foods (the "cheese-reaction"). Clinical trials have found 6 mg/24 hours of STS to be effective in MDD without the need for dietary restrictions. The efficacy and safety profile of STS supports its use in MDD. It is possible that STS may demonstrate benefit in MDD with atypical features or MDD resistant to other antidepressants. However, more research is needed. Clinicians should familiarize themselves with the properties and indications for the new generation of MAOIs.     

Deterrence of drug driving: The impact of the ACT drug driving legislation and detection techniques

Drug driving is a significant road safety concern rendering the implementation of roadside drug testing in all Australian jurisdictions. The current research sought to examine the impact of recently introduced roadside oral fluid screening in the Australian Capital Territory (ACT). Specifically, the study sought to examine drivers’ awareness, perceptions and perceived deterrent impact of these operations and the degree to which they influence likelihood of future drug driving. A total of 801 male and female motorists aged 17–88 years of age completed a phone interview assessing demographics (e.g., driving and drug taking history), awareness and perceived effectiveness of roadside drug testing, and constructs central to both Classical Deterrence Theory (i.e., certainty, severity, swiftness) and reconceptualised deterrence theory (direct and vicarious experiences of both punishment and punishment avoidance) frameworks. Overall, despite an apparent decline in drug driving behaviour since the introduction of roadside testing, a large proportion of driver’s possessed a poor awareness of these operations and did not perceive a high certainty of apprehension. Age, punishment avoidance and vicarious punishment avoidance were found to predict future likelihood of drug driving, whilst Classical Deterrence Theory variables did not. Contrary to expectations and previous studies, few significant differences were found with regards to gender. Findings are interpreted in light of the recency of roadside drug testing in the ACT and the need for future studies to examine the impact of such operations. Further recommendations for augmenting the deterrence of drug driving are discussed.