Does stimulant medication decrease the lower extremity response times of children with and without attention-deficit/hyperactivity disorder?

In 2005 Pedersen and Surburg reported that stimulant medications reduced the lower extremity response times of 16 boys with Attention-Deficit/Hyperactivity Disorder. However, as boys without ADHD and girls with and without ADHD were not studied, one cannot conclude that reported effects represent a medication effect unique to children with ADHD. An alternative hypothesis is presented: that stimulant medications produce an excitatory effect in the central nervous system by increased occupancy of postsynaptic dopamine receptors to reduce the lower extremity response times of children in general. Well-designed controlled clinical trials are needed to evaluate this hypothesis.     

‘The lesser of two evils…’ – views of persons with rheumatoid arthritis on medication adherence: a qualitative study

Objective: This study aimed to explore medication adherence among adherent and non-adherent persons suffering from rheumatoid arthritis (RA). A special focus was put on the reasons accounting for successful medication adherence and on potential barriers or facilitating factors.

Design: A qualitative study with semi-structured interviews was conducted. Eighteen participants were recruited through stratified purposive sampling according to their medication adherence level. Interviews were analysed by interpretative phenomenological analysis.

Results: Medication adherence behaviour was described on a continuum ranging from non-adherent to adherent. Participants’ current adherence level was represented as a result of inner negotiations between a variety of influential factors and the successful application of a range of strategies. The influential factors were: experiences with medication, outcome expectations, knowledge of therapeutic options, the traits ‘openness’ and ‘conscientiousness’, belief in medical progress, characteristics of the medication, level of trust in one’s physician, and perceived autonomy. Facilitating strategies were: establishing routines, using social support and the deliberate suppression of information about potential adverse events.

Conclusion: The experience of and the reasons for medication (non-)adherence from the perspective of people with RA were explored comprehensively. Participants’ ongoing negotiations between adherence and non-adherence emerged as a key finding with implications for health service providers.     

Effects of disease severity and medication state on postural control asymmetry during challenging postural tasks in individuals with Parkinson’s disease

The aim of this study was to investigate the effects of disease severity and medication state on postural control asymmetry during challenging tasks in individuals with Parkinson’s disease (PD). Nineteen people with PD and 11 neurologically healthy individuals performed three standing task conditions: bipedal standing, tandem and unipedal adapted standing; the individuals with PD performed the tasks in ON and OFF medication state. The participants with PD were distributed into 2 groups according to disease severity: unilateral group (n = 8) and bilateral group (n = 11). The two PD groups performed the evaluations both under and without the medication. Two force plates were used to analyze the posture. The symmetric index was calculated for various of center of pressure. ANOVA one-way (groups) and two-way (PD groups × medication), with repeated measures for medication, were calculated. For main effects of group, the bilateral group was more asymmetric than CG. For main effects of medication, only unipedal adapted standing presented effects of PD medication. There was PD groups × medication interaction. Under the effects of medication, the unilateral group presented lower asymmetry of RMS in anterior–posterior direction and area than the bilateral group in unipedal adapted standing. In addition, the unilateral group presented lower asymmetry of mean velocity, RMS in anterior–posterior direction and area in unipedal standing and area in tandem adapted standing after a medication dose. Postural control asymmetry during challenging postural tasks was dependent on disease severity and medication state in people with PD. The bilateral group presented higher postural control asymmetry than the control and unilateral groups in challenging postural tasks. Finally, the medication dose was able to reduce postural control asymmetry in the unilateral group during challenging postural tasks.     

Younger and older adults’ associative memory for medication interactions of varying severity

While older adults face various deficits in binding items in memory, they are often able to remember information that is deemed important. In Experiment 1, we examined how younger and older adults remember medication interactions of varying severity. There were no age differences in overall memory accuracy, but older adults’ performance depended on the severity of the interactions (such that the interactions associated with the most severe health outcomes were remembered most accurately) while younger adults’ did not. In Experiment 2, a similar task was designed to create interference in memory. Even with this more difficult task there were no age differences in recall accuracy, and both age groups remembered the interactions with the severe outcomes most accurately. These findings suggest that, under certain circumstances, older adults do not face deficits in associative recognition accuracy of information that varies in importance.     

Welcome to the ‘Paradigm War’: the case of antidepressant medication

Mindfulness-based therapies are a recent development within the cognitive-behavioural tradition and an important element of the third wave cognitive behavioural therapy models. A number of these therapies could be considered to have mindfulness as a major component of the therapy. There has been a considerable growth of interest in these therapies with an accompanying increase in their evidence base. While a number of reviews have been conducted, these therapies were not comprehensively appraised. The most prominent of these therapies, mindfulness-based cognitive therapy, was developed to reduce relapse in recurrent depression. We conducted a meta-analysis which looked at therapies considered to have mindfulness as a major component. We investigated whether this group of therapies was effective in reducing current depressive symptomatology as measured by the Beck depression inventory (BDI). A total of 11 studies were included in the analysis. We found a significant mean reduction score in current depressive symptomatology, as measured by the BDI, of 8.73 points (95% confidence interval?=?6.61, 10.86). We found evidence for the effectiveness of these major-component therapies in reducing levels of active depression. The robustness of these findings is discussed alongside the implications for research and practice within the context of the current literature.     

What role do lay beliefs about hypertension etiology play in perceptions of medication effectiveness?

BACKGROUND: Some people take the disease label "hypertension" literally; leading to the belief that increasing relaxation instead of medication is the best treatment for this condition. We experimentally tested the effect of such underlying beliefs on ratings of interventions for hypertension and compared alternative communication strategies to increase medication effectiveness ratings. METHODS: Outpatients (N = 152) with a known diagnosis of hypertension read a vignette describing an asymptomatic condition and recommended treatment. Experimental factors were the disease label (Hypertension vs. Korotkoff's Syndrome) and type of argument designed to persuade the reader that medication is most effective (Causal vs. Correlational). MEASURES: Background measures included demographics, beliefs that stress causes health problems and trust in physicians. Outcomes were effectiveness ratings for interventions to treat the condition. RESULTS: Participants who read a vignette describing "Hypertension" rated "relaxing more" as significantly more effective than participants exposed to the same condition but with the unfamiliar "Korotkoff's Syndrome" label, [F(1, 141) = 5.22, p = .024]. However, medication, reducing salty foods and losing weight were rated as more effective than relaxing more. Intervention ratings did not differ by type of argument presented. There was a significant interaction of disease label and trust in physicians [F(1, 125) = 7.01, p = .009]. Individuals with low trust rated medication as significantly less effective when exposed to an unfamiliar disease label. CONCLUSIONS: This study confirms the effect of the hypertension disease label on ratings of different interventions for the condition. However, participants rated biomedically recommended interventions as more effective than those not endorsed.     

Impact of Parkinson’s disease and dopaminergic medication on adaptation to explicit and implicit visuomotor perturbations

The capacity to learn new visuomotor associations is fundamental to adaptive motor behavior. Evidence suggests visuomotor learning deficits in Parkinson’s disease (PD). However, the exact nature of these deficits and the ability of dopamine medication to improve them are under-explored. Previous studies suggested that learning driven by large and small movement errors engaged distinct neural mechanisms. Here, we investigated whether PD patients have a generalized impairment in visuomotor learning or selective deficits in learning from large explicit errors which engages cognitive strategies or small imperceptible movement errors involving primarily implicit learning processes. Visuomotor learning skills of non-medicated and medicated patients were assessed in two reaching tasks in which the size of visuospatial errors experienced during learning was manipulated using a novel three-dimensional virtual reality environment. In the explicit perturbation task, the visuomotor perturbation was applied suddenly resulting in large consciously detected initial spatial errors, whereas in the implicit perturbation task, the perturbation was gradually introduced in small undetectable steps such that subjects never experienced large movement errors. A major finding of this study was that PD patients in non-medicated and medicated conditions displayed slower learning rates and smaller adaptation magnitudes than healthy subjects in the explicit perturbation task, but performance similar to healthy controls in the implicit perturbation task. Also, non-medicated patients showed an average reduced deadaptation relative to healthy controls when exposed to the large errors produced by the sudden removal of the perturbation in both the explicit and implicit perturbation tasks. Although dopaminergic medication consistently improved motor signs, it produced a variable impact on learning the explicit perturbation and deadaptation and unexpectedly worsened performance in some patients. Considered together, these results indicate that PD selectively impairs the ability to learn from large consciously detected visuospatial errors. This finding suggests that basal ganglia-related circuits are important neural structures for adaptation to sudden perturbations requiring awareness and high-cost action selection. Dopaminergic treatment may selectively compromise the ability to learn from large explicit movement errors for reasons that remain to be elucidated.     

Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs,experiential feedback and habit development

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients’ illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theorised to contribute to prediction of long-term medication adherence: ‘coherence’ of patients’ beliefs from experiences with treatment and habit development. Seventy-one hypertensive patients reported their treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength in a baseline interview. Patients then used an electronic monitoring pill bottle for approximately one month. Patients’ medication habit-strength was the strongest predictor of all adherence measures, explaining 6–27% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with ‘weaker’ habits. However, patients’ experiences were found to predict intentional non-adherence and habit strength was found to predict unintentional adherence. Practitioners may assess patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. Future research should assess the current theoretical predictions in a hypertension inception sample and in populations with symptomatic conditions.     

Equality Endows Men with Prosperity—A Discussion with Michael Sanders

<正>Wang:Thank you for accepting our interview.I heard that you had a great time during the tour around Nanjing.What are your impressions of Nanjing? Mike:Well,first of all,I'd like to thank you for the invitation and the hospitality that has been shown me.I very much enjoyed my two trips on Sunday and Monday.I thought the Purple Mountain was very beautiful,and I was very impressed by the Dr Sun Yat Sen Mausoleum and the Linggu Temple, and the Ming Xiaoling Mausoleum was wonderful,particularly the ceremonial avenue with its animal statues.There is nothing comparable to that in England, so it was a real pleasure to see it.So I am very much enjoying my stay in China. Wang:Professor Xu Fangfu from the University of Petroleum asked me to pass on his greetings.I invited him,but he is very busy with his courses and cannot make it this time. Mike:I'm sorry not to have the chance to meet Professor Robin as I knew him in Manchester.It would be very nice if you could pass on my greetings to him.     

Family Therapy with Couples and Individuals with Parkinson’s Disease

Family therapists are increasingly called upon to work with individuals and families with medical issues, but often do not have sufficient background on the issue to be most helpful. The purpose of this paper is to help family therapists understand Parkinson’s Disease (PD) and its impact on the individual and his or her family. PD is the second most prevalent neurodegenerative disorder in the United States, following Alzheimer’s disease (Hirtz et al., Neurology 68:326–337, 2007). According to the Parkinson’s Disease Foundation, approximately 60,000 individuals are diagnosed with PD every year, and approximately one million Americans are currently living with PD. In this paper, we provide an overview of PD based on research and the second author’s many years of providing services for individuals with PD, as well as offer specific recommendations for providing family therapy using narrative, solution-focused and emotionally focused therapy based on the first author’s work as a family therapist with individuals, groups, and couples dealing with PD.     

D. Z. Phillips’ problems with evil and with God

It is widely held that the logical problem of evil, which alleges an inconsistency between the existence of evil and that of an omnipotent and morally perfect God, has been solved. D. Z. Phillips thinks this is a mistake. In The Problem of Evil and the Problem of God, he argues that, within the generally assumed framework, “neither the proposition ’God is omnipotent’ nor the proposition ‘God is perfectly good’ can get off the ground.” Thus, the problem of evil leads to the problem of God. Phillips goes on to provide an alternative response to the problem of evil, expounded by means of his Wittgensteinian analyses of various concepts drawn from the Christian tradition. I argue that his criticisms of the traditional conception of God either fail outright or are at best inconclusive. I also point out that the religious concepts analyzed by Phillips are not and cannot be the same concepts as those employed in the Christian tradition from which they are supposedly drawn. For the concepts as traditionally employed presuppose the actual existence and activity of precisely the sort of being that, according to Phillips, “God cannot be.”     

What is Wrong with “What is Wrong with Rational Suicide”

In “What is Wrong with Rational Suicide,” Pilpel and Amsel develop a counterexample that allegedly confounds attempts to condition the moral permissibility of suicide on its rationality. In this counterexample, a healthy middle aged woman with significant life accomplishments, but no dependents, disease, or mental disorder opts to end her life painlessly after reading philosophical texts that persuade her that life is meaningless and bereft of intrinsic value. Many people would judge her suicide “a bad mistake” despite its meeting “robust” conditions for rationality. Hence, Pilpel and Amsel conclude, even robust conditions for the rationality of suicide “fail to do their job: to exclude intuitively unacceptable suicides from being permissible.” I argue here that this counterexample fails to cast doubt on philosophical attempts to account for the moral permissibility of suicide in terms of its rationality.     

Working with psychosis: Part 2 – encounters with an omnipotent super-ego

This is the second in a series of four papers presenting work with a man suffering from a bipolar disorder. The present paper describes the second year of the work and my encounters with an omnipotent super-ego which made ferocious attacks on the work, especially when there were any developments. The attacks were particularly disabling because my own implacable super-ego was mobilized in the counter-transference. Consequently developments seemed to melt away as my patient and I were often reduced to mindless states. I came to understand that these omnipotent attacks were stirred by feelings of infantile helplessness and dependency, and were a means of trying to manage a dread of falling to pieces and unintegration.     

Coping with Negative Emotions: Connections with Adolescents’ Academic Performance and Stress

The authors assessed connections among adolescents’ emotional dispositions, negative academic affect, coping strategies, academic stress, and overall grade point average (GPA). A total of 119 ninth through 12th-grade students completed assessments for (a) overall positive and negative moods, (b) GPA, and (c) academically related variables involving stress, negative emotions, and engaged and disengaged coping strategies. Greater negative academic affect and disengaged coping were related to lower GPAs, and disengaged coping mediated the connection between negative academic affect and GPA. By contrast, higher academic stress was related to students’ overall moods, negative academic affect, and disengaged coping; disengaged coping mediated the connection between academic stress and negative overall moods. Discussion focused on the especially problematic nature of disengaged academic coping.