Treatment with medications affecting dopaminergic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter

Medications with dopamine antagonist properties, such as haloperidol, and those with serotonin reuptake inhibitor properties, such as clomipramine, have been shown to improve fluency. To examine the degree to which each of these two pharmacological mechanisms might independently affect fluency, a selective serotonin reuptake inhibitor, paroxetine, and a selective dopamine (D-2) antagonist, pimozide, were evaluated. Both types of medications also affect mood and anxiety, factors that could influence fluency levels. Therefore, we also evaluated the medications’ effects on generalized and speech-related anxiety and the relationships between changes in anxiety and changes in fluency in 11 subjects with a history of developmental stuttering. The randomized, double blind, placebo-controlled crossover study that was designed had to be terminated prior to completion due to severe side effects following withdrawal from paroxetine. Even with a reduced sample size (n = 6), significant improvement in percent fluent speaking time (p = 0.02) was found using a telephone task between baseline and pimozide (n = 6), with average duration of dysfluencies significantly shorter (p = 0.04) but no significant difference in the estimated number of dysfluencies per minute. This significant improvement was associated with non-significant increases in generalized anxiety, but non-significant decreases in speech-related anxiety. No significant differences were found in fluency between baseline and paroxetine (n = 5). These preliminary results suggest that fluency improvement is more likely to be mediated by dopaminergic rather than serotonergic mechanisms. Due to its side effects, however, pimozide may be considered a risk for treatment of stuttering.

Educational objectives: As a result of reading this paper the reader will describe and explain: (1) how medications may affect fluency and the rationale for selecting medications for treatment trials; (2) the interrelationship between fluency and anxiety; and (3) factors important in developing clinical trials using medications.     

Reliability and validity of the Yale Global Tic Severity Scale

To investigate the reliability and validity of the Yale Global Tic Severity Scale (YGTSS), 28 youth aged 6 to 17 years with Tourette's syndrome (TS) participated in the study. Data included clinician reports of tics and obsessive-compulsive disorder (OCD) severity, parent reports of tics, internalizing and externalizing problems, and child reports of depression and anxiety. All children participated in a 2nd YGTSS administration by the same rater 48 days later. Good internal consistency and stability were found for the YGTSS scores. YGTSS scores demonstrated strong correlations with parent-rated tic severity (r = .58-.68). YGTSS scores were not significantly related to measures of clinician ratings of OCD severity (r = .01-.15), parent ratings of externalizing and internalizing behavior (r = -.07-.20), and child ratings of depression (r = .02-.26) and anxiety (r = -.06 -.28). Findings suggest that the YGTSS is a reliable and valid instrument for the assessment of pediatric TS.     

Brain stimulation techniques in the treatment of obsessive-compulsive disorder: current and future directions

Recent studies on the epidemiology of obsessive-compulsive disorder (OCD) estimate 50 million patients suffer from OCD worldwide, thus making it a global problem. The treatment of OCD has changed substantially over the last 2 decades following the introduction of selective serotonin reuptake inhibitors, which provide symptom improvement in approximately 60% of patients. However, some patients remain resistant to the standard pharmacologic and behavioral treatments. Although some treatment-resistant patients respond to pharmacologic augmentations, others do not, and there is evidence that some of the most severe cases benefit from treatment with neurosurgical interventions. Besides pharmacologic, behavioral, and neurosurgical approaches, different brain stimulation methods-transcranial magnetic stimulation, deep brain stimulation, and electroconvulsive therapy-have been investigated in treatment-resistant patients with OCD. However, available data about the use of these techniques in OCD treatment are quite limited in terms of sample size and study design, given the difficulty in conducting standard blinded trials for these procedures. In addition, none of the mentioned treatments have received Food and Drug Administration approval for the treatment of OCD. Nevertheless, promising findings regarding efficacy, tolerability, and non-invasiveness and/or reversibility of these techniques have increased interest in investigating their use in treatment-resistant OCD.     

Unheard Alaska: Culturally Anchored Participatory Action Research on Sobriety with Alaska Natives

Alcohol research in Alaska Native communities has a contentious history. This project has attempted to address a critical need for research to guide alcohol abuse prevention and treatment with Alaska Natives using culturally anchored participatory action research. The process of grounding the research methodology in the culture and community is described, along with its contribution to community psychology's understanding of the importance of cultural factors. Tensions between indigenous values and ways of knowing, and Western research methodologies are delineated, along with how these tensions were resolved. Important issues that arose in doing culturally anchored participatory action research are described. These included the development of a community of inquiry, key methodological decisions, the empowerment of participants as coresearchers, and flexibility in research implementation.     

Implicit and explicit measures of sexual orientation attitudes: in group preferences and related behaviors and beliefs among gay and straight men

The relations among implicit and explicit measures of sexual orientation attitudes and sexual-orientation-related behavior and beliefs among gay men (Study 1) and straight men (Studies 1 and 2) were explored. Study 1 found relations between implicit and explicit measures of sexual orientation attitudes, large differences between gay and straight men on both implicit and explicit measures, and that these measures predicted sexual-orientation-related behaviors among gay men. Also, only straight men exhibited a negative relation between their attitudes toward homosexuality and heterosexuality. Study 2 found that as straight men held more negative attitudes toward homosexuality, they more strongly endorsed the importance of heterosexual identity and of traditional masculine gender roles. These endorsements mediated the negative relation between their attitudes toward heterosexuality and homosexuality. Implications for assessing attitudes toward sexual orientation and their relations for sexual orientation identity are discussed.     

Inventory of college challenges for ethnic minority students: psychometric properties of a new instrument in Chinese Americans

The Inventory of College Challenges for Ethnic Minority Students (ICCEMS) is a newly developed instrument that assesses challenges faced by ethnic minority college students across a range of cultural, academic, social, and practical domains. The present study tested the ICCEMS among Chinese American students in an attempt to identify its factor structure and assess its psychometric properties. A total of 13 factor domains emerged. The Cronbach's alpha and 1-month test-retest reliability of the subscales and the overall scale supported their reliability. Both criterion and construct validities were also demonstrated. Chinese American college students faced the greatest challenges in terms of unclear career direction and academic demands.     

Group interventions for patients with cancer and HIV disease: part IV. Clinical and policy recommendations

Group interventions have assumed a growing role in primary prevention and supportive care for cancer and HIV disease. Earlier sections of this Special Report examined empirical findings for these interventions and provided recommendations for future research. The current section offers brief recommendations for service providers, policymakers, and stakeholders. Group services now occupy an increasingly prominent place in primary prevention programs and medical settings. In previous sections of this Special Report (Sherman, Leszcz et al., 2004; Sherman, Mosier et al., 2004a, 2004b) we examined the efficacy of different group interventions at different phases of cancer or HIV disease, considered characteristics of the intervention and the participants that might influence outcomes, and discussed mechanisms of action. Methodological challenges and priorities for future research were highlighted. In this, the final section, we offer brief recommendations for service providers, policymakers, and other stakeholders. We consider some of the barriers that constrain use of empirically-based group interventions and note how these programs might be implemented more widely and effectively.     

Methodological issues in cross-cultural and multicultural rorschach research

Hermann Rorschach researched the utility of his inkblot experiment to understand psychopathology and cultural differences. Contemporary research with the Rorschach has evaluated its utility as a test, although it may more properly represent a clinical method with somewhat different evaluation criteria. Recent controversy regarding the adequacy of the Rorschach as a test and the adequacy of its normative data has at times distorted and oversimplified important methodological issues inherent in the study of cultural difference. Cultural processes remain a central and inadequately examined variable in Rorschach research; an important emergent area of inquiry is the Rorschach's clinical utility as a cross-cultural assessment instrument. We review multicultural and cross-cultural methodological issues intrinsic to contemporary Rorschach research here. Consideration of cultural issues enlarges and enriches the Rorschach clinical utility debate and suggests underexplored research strategies that can contribute to its resolution.     

The beat goes on: rhythmic modulation of cortical potentials by imagined tapping

A frequency analysis was used to tag cortical activity from imagined rhythmic movements. Participants synchronized overt and imagined taps with brief visual stimuli presented at a constant rate, alternating between left and right index fingers. Brain potentials were recorded from across the scalp and topographic maps made of their power at the alternation frequency between left and right taps. Two prominent power foci occurred in each hemisphere for both overt and imagined taps, one over sensorimotor cortex and the other over posterior parietal cortex, with homologous foci in opposite hemispheres arising from oscillations 180 degrees out of phase. These findings demonstrate temporal isomorphism at a neural level between overt and imagined movements and illustrate a new approach to studying covert actions.