The clinical efficacy and safety of galantamine in the treatment of Alzheimer's disease

Alzheimer's disease is a progressive, neurodegenerative condition characterized by deficits in cognition, inability to perform activities of daily living, and alterations in behavior. Galantamine hydrobromide is the newest acetylcholinesterase inhibitor (AChEI) approved in the United States for the treatment of mild-to-moderate AD. The safety and efficacy of galantamine has been demonstrated in multiple randomized, Phase III trials of >2,600 patients with mild-to-moderate AD. Studies have found that galantamine improved or maintained performance in all domains of AD (cognition, function, behavior, and caregiver burden) in the short term and slowed the decline in performance or maintained baseline performance through 12 months. The dual mechanism of action may make galantamine a reasonable treatment option for both newly diagnosed patients and patients who have not benefitted from or have poorly tolerated current therapy.     

Mild hypoxia disrupts recollection,not familiarity

Yonelinas et al. (2002) found that hypoxic patients exhibited deficits in recollection that left familiarity relatively unaffected. In contrast, Manns, Hopkins, Reed, Kitchener, and Squire (2003) studied a group of hypoxic patients who suffered severe and equivalent deficits in recollection and familiarity. We reexamine those studies and argue that the discrepancy in results is likely due to differences in the hypoxic groups that were tested (i.e., differences in amnestic severity, subject sampling methods, and patient etiology). Yonelinas et al. examined memory in 56 cardiac arrest patients who suffered a brief hypoxic event, whereas Manns et al. examined a group of severely amnesic patients that consisted of 2 cardiac arrest patients, 2 heroin overdose patients, 1 carbon monoxide poisoning patient, and 2 patients with unknown etiologies. We also consider an alternative explanation proposed by Wixted and Squire (2004), who argued that the two patient groups suffered similar deficits, but that statistical or methodological artifacts distorted the results of each of Yonelinas et al.'s experiments. A consideration of those results, however, indicates that such an explanation does not account for the existing data. All of the existing evidence indicates that recollection, but not familiarity, is disrupted in mild hypoxic patients. In more severe cases of hypoxia, or those with more complex etiologies such as heroin overdose, more profound deficits may be observed.     

A review of research on chaplains and community-based clergy in the Journal of the American Medical Association, Lancet, and the New England Journal of Medicine: 1998-2000

Based on the content analysis of quantitative research appearing in three medical journals, the authors conclude that, despite the shared ideal of providing spiritual care to patients on the part of physicians and chaplains, there is little attention given in these journals demonstrating and promoting this shared perspective. Suggestions for future research that would focus on this common medicine/religion interface and concern are noted.     

Predicting who benefits from psychoeducation and self help for panic attacks

Self-help and psychoeducation have been identified as effective methods for delivering treatment, yet not everyone benefits from these brief interventions. Therefore it is clinically and economically useful to identify who is likely to require more intensive assistance. This paper develops a prognostic scale which predicts who will recover from panic attacks and who will require more assistance. Method: Random regression models were used to evaluate the relationship between predictive variables, baseline severity, and the rate of improvement in 117 people with DSMIV panic attacks who participated in a trial of a psycho-educational booklet, a self-help workbook, and brief group CBT over a 9-month period. ROC analysis was used to choose cut-off points on a scale made up of significant predictors. Results: Panic disorder and agoraphobia symptom measures were predicted by baseline social anxiety, and general mental health. There was no significant effect on the outcome for baseline depression or anxiety sensitivity. While general mental health (SF12 Mental Component scores) was predicted by the age at first panic attack, neuroticism, panic disorder and/or agoraphobia symptoms and a positive screen for alcohol use disorders. A prognostic scale based on simple additive scoring was equivalent to standard scores and significantly better than chance at predicting who would recover and who required face-to-face therapy. Conclusions: The prognostic scale may be used to guide the choice of psychoeducation, self-help or face-to-face therapy as the first step in stepped care.     

A multilevel analysis of effort, practice, and performance: effects; of ability, conscientiousness, and goal orientation

This article examines the relationship between motivation and performance during skill acquisition. The authors used multilevel analysis to investigate relationships at within- and between-person levels of analysis. Participants were given multiple trials of practice on an air traffic control task. Measures of effort intensity and performance were taken at repeated intervals. As expected, the relationship between effort and performance increased with practice. Furthermore, the rate at which this effect strengthened was faster for individuals with high-ability or low-performance orientation. There was also an interaction between learning and performance orientations that only emerged after practice. By the end of practice, the negative effects of performance orientation were stronger for individuals with high learning orientation. Results highlight the importance of adopting a multilevel framework to enhance understanding of the link between motivation and performance.     

Raters who pursue different goals give different ratings

J. N. Cleveland and K. R. Murphy (1992) suggested that phenomena such as rater errors and interrater disagreements could be understood in terms of differences in the goals pursued by various raters. We measured 19 rating goals of students at the beginning of a semester, grouped them into scales, and correlated these with teacher evaluations collected at the end of the semester. We found significant multiple correlations, both within classes and in an analysis of the pooled sample (adjusting for instructor mean differences, incremental R2 =.08). Measures of rating goals obtained after raters had observed a significant proportion of ratee performance accounted for variance (incremental R2 =.07) not accounted for by measures of goals obtained at the beginning of the semester.     

A model of childhood perceived peer harassment: analyses of the Canadian National Longitudinal Survey of Children and Youth Data

The authors developed a model of childhood perceived peer harassment, using several personality, peer, and familial characteristics of victims, and tested it with children 10 to 11 years old (N = 3,434) drawn from the Canadian National Survey of Children and Youth, which is a stratified random sample of 22,831 households in Canada. A 3-step analytic procedure with 3 separate subsamples of the children was used to explore psychosocial correlates of peer harassment. Results from the latent variable path analysis (comparative fit index = .90) showed that victims are likely to feel anxious and disliked by their peers. Their parents reported using high levels of control and low levels of warmth with their children and reported high levels of depression and marital conflict themselves. These results are discussed from a social-cognitive perspective.