Combination pharmacotherapy in alcoholism: a novel treatment approach

Combination pharmacotherapy has proven effective in a number of psychiatric disorders, including depression and schizophrenia. However, compared with other affective disorders, few studies have explored the use of combination therapy in alcoholism, and the majority have been limited to animal models. There is evidence to support a role for combination therapy in alcoholism. For example, several neurochemical systems, including the dopaminergic, serotonergic, and opioidergic, appear to affect alcohol intake. Studies in several different types of alcohol-preferring rats have suggested that coadministration of agents to target more than one of these systems simultaneously may produce beneficial effects on alcohol intake, while avoiding problematic effects, such as alterations in food or water intake. Data from preliminary clinical studies have shown trends toward combination therapy reducing alcohol intake in humans. While such findings are encouraging, they must be explored further in larger, randomized, double-blind trials.     

Dyskinesias differentiate autistic disorder from catatonia

Autistic disorder and catatonia are neuropsychiatric syndromes defined by impairments in social interaction, communication, and restricted, stereotypical motor routines. Assessments of children with these disorders are typically restricted in scope by the patients' limited ability to comprehend directions. The authors performed systematic assessments of dyskinesias on six prepubertal boys with autistic disorder and mental retardation and on one adolescent male with catatonia to determine if this type of information could be routinely obtained. The boys with autistic disorder had more stereotypies and tics, a greater degree of akathisia and hyperactivity, and more compulsions than the adolescent with catatonia. Catatonia was associated with catalepsy and dystonic postures. The authors conclude that the diagnostic accuracy and specificity of neuropsychiatric syndromes may be enhanced by the systematic assessment of the dyskinesias associated with each condition.     

From case management to prevention of scientific dishonesty in Denmark

In 1992, The Danish Medical Research Council established a national committee on scientific dishonesty with the twofold task of handling cases of scientific misconduct and taking preventive initiatives. Scientific dishonesty was proven in only five cases, but in another nine cases lesser degrees of deviations from good scientific practice were found. The experiences from a total of 24 treated cases indicated that three key areas were at the basis of most of the accusations and the deviations from good practice: uncertainty about 1) authorship, about 2) rights and duties to use scientific data and about 3) agreements at the initiation of joint studies. As a consequence guidelines on good practice have been issued on these key subjects. An earlier version of this paper was presented at a symposium, Scientific Misconduct. An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

Managing one's body using self-management techniques: practicing autonomy

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy.     

The facilitative effects of heart-rate feedback in the emotional processing of claustrophobic fear

This study examines predictions derived from Foa and Kozak's theory of emotional processing. We hypothesized that the provision of heart-rate feedback would facilitate emotional processing through a fuller activation of the participant's fear structure, and by focusing participants' attention on information that is incompatible with the fear structure, i.e., the interoceptive pattern of habituation. Nonclinical students (N = 54) showing marked claustrophobic fear received 30 min of self-directed exposure to a claustrophobic chamber. Three exposure conditions (heart-rate feedback, paced-tone control, and exposure only control) were examined across six 5-min exposure trials. Participants receiving heart-rate feedback displayed greater between-trial habituation across treatment trials and lower levels of fear at post-treatment. Treatment process findings failed to support the fear activation hypothesis. Implications of the findings for theories of fear reduction are discussed.     

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships.     

Demographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness

Although cognitive deficits often accompany severe mental illness, their implications for everyday functioning remain poorly understood. In this study, an occupational therapist (OT) rated the everyday functioning of 105 adult psychiatric patients. Using demographic, clinical, and cognitive variables, the authors tested alternative models to account for the observed variability in OT ratings. Although age, education, and the presence of schizophrenia each contributed to a model that accounted for 27% of the variation in functional independence, adding terms for auditory divided attention and verbal learning increased the proportion of explained variance to 45% and decreased the beta weights for age and education--but not schizophrenia--to nonsignificant levels. These findings demonstrate the relevance of cognitive performance to everyday functioning in severe mental illness. They are discussed with respect to hypothesized determinants of psychiatric disability.     

Distortions in definite distance and shape perception as measured by reaching without and with haptic feedback

Psychophysical studies reveal distortions in perception of distance and shape. Are reaches calibrated to eliminate distortions? Participants reached to the front, side, or back of a target sphere. In Experiment 1, feedforward reaches yielded distortion and outward drift. In Experiment 2, haptic feedback corrected distortions and instability. In Experiment 3, feedforward reaches with only haptic experience of targets replicated the shape distortions but drifted inward. This showed that outward drift in Experiment 1 was visually driven. In Experiment 4, visually guided reaches were accurate when participants used binocular vision but when they used monocular vision, reaches were distorted. Haptic feedback corrected inaccuracy and instability of distance but did not correct monocular shape distortions. Dynamic binocular vision is representative and accurate and merits further study.     

Risky driving behavior: a consequence of motion adaptation for visually guided motor action

The authors examined the effect of adaptation to expansion on overtaking maneuvers in a driving simulator. Following driving on a straight empty road for 5 min, drivers initiated overtaking substantially later (220-510 ms) than comparable maneuvers made following viewing a static scene or following 5 min of curve driving. Following adaptation to contraction (produced by driving backward), observers initiated overtaking significantly sooner. The removal of the road texture significantly reduced the size of the adaptation effect. The authors propose that these changes in overtaking behavior are due to misestimation of the time headway produced by local adaptation of looming detectors that signal motion-in-depth for objects near the focus of expansion. This adaptation effect may increase the risk of rear-end collisions during highway driving.