Psychosocial Functioning in Children and Adolescents with Extreme Obesity

The aim of this study was to investigate the psychosocial differences among obese pediatric patients, particularly those who are "extremely obese" as compared to "obese." Information was collected for 249 subjects at a multidisciplinary treatment clinic for obese youth. A battery of measures was administered and demographic data and height/weight was obtained. The results showed positive correlations between degree of obesity, psychosocial functioning, and quality of life. Specifically, the "extremely obese" were significantly more depressed, more socially anxious, and had poorer quality of life than the "obese" group. Girls and Caucasians were more socially anxious than boys and African Americans, respectively. There is mounting evidence that children and adolescents who are extremely obese are most at risk for psychiatric and medical disorders. Thus, targeting this group for assessment and/or designing treatment options specific for "extremely obese" youth is critical for the successful management of this population.     

Mesothalamic discharge in a chronic pain,allergy and fluid retention syndrome (case report)

A 32-year-old woman was bedridden for a year because of chronic pain and headaches. She had insomnia, depression, suicidal thoughts and a severe chemical allergy. She had been on steroid therapy for two years and became Cushingoid with striae in the arm pits, groins and abdomen. However, she had no hypertension, nor the buffalo fat and hirsutism. She was very edematous, with a weight gain from 112 to 180 lbs. The fluid retention did not conform to the syndrome of inappropriate antidiuretic hormone. Studies revealed abnormal scalp EEG discharges and high-voltage seizure discharges in the posterior thalamus. Electrothalamic stimulation suppressed the thalamic discharges and relieved the patient’s pelvic pain and headaches. After one month of several thalamic stimulations per day, she was able to get out of bed and ambulate. In addition, the patient no longer was edematous and was tolerating perfumes and floor detergents. Steroids were progressively reduced without complications of withdrawal. She went from a completely steroid dependent state to independent during the first 1-1/2 yrs of thalamic stimulation. With continued thalamic stimulation she has done well for 8-1/2 yrs, weighs 112 lbs, keeps house and drives a car. It’s speculated the illness is a chronic pain multiple system syndrome predominantly due to mesothalamic discharges and body infirmities. The mesothalamic discharge implicated neural networks, which represent biologic systems, i.e. pain, sleep, fluid retention, etc. Therapeutic stimulation attenuates the discharges and the neural networks return to their normal set points of homeostasis.     

Unitization,similarity, and overt attention in categorization and exposure

Unitization, the creation of new stimulus features by the fusion of preexisting features, is one of the hypothesized processes of perceptual learning (Goldstone Annual Review of Psychology, 49:585–612, 1998). Some argue that unitization occurs to the extent that it is required for successful task performance (e.g., Shiffrin & Lightfoot, 1997), while others argue that unitization is largely independent of functionality (e.g., McLaren & Mackintosh Animal Learning & Behavior, 30:177–200, 2000). Across three experiments, employing supervised category learning and unsupervised exposure, we investigated three predictions of the McLaren and Mackintosh (Animal Learning & Behavior, 30:177–200, 2000) model: (1) Unitization is accompanied by an initial increase in the subjective similarity of stimuli sharing a unitized component; (2) unitization of a configuration occurs through exposure to its components, even when the task does not require it; (3) as unitization approaches completion, salience of the unitized component may be reduced. Our data supported these predictions. We also found that unitization is associated with increases in overt attention to the unitized component, as measured through eye tracking.     

Termination in family therapy—developing a structural approach

Termination is a neglected topic within the major schools of family therapy that draw upon systemic frameworks. This paper attempts to develop a conceptual framework for understanding termination as a process which, if handled correctly, may have a surprising degree of therapeutic potential. Termination is therefore seen not just as a passive process of ending therapy, but as a potentially empowering process which can help clients from slipping back into old ways of functioning. Follow-up sessions can therefore be reconceptualized as integral steps in an active termination process which can be extended over a number of months. The precipitate ending of sessions may be justifiable from a theoretical point.of view within certain models, but within a structural framework (which places such a strong emphasis on joining) the effects of rapid termination may not only be counter-productive but may reflect underlying problems that reflect the needs of the therapist rather than the needs of the family that is in therapy.     

Limbic stimulation-induced hypersexuality

Postictal sexual drive levels induced by limbic discharges were studied in eight adult male cats. Although sexual drive was exclusively dependent upon the presence or absence of testosterone, the level or degree of drive was dependent on the relative amounts of circulating testosterone and catecholamines in addition to the bioelectric state of the testosterone-binding cells. The limbic discharge was thought to induce postictal hypersexuality by its propagated discharge, suppressing the association neocortex and simultaneously activating the sexual hormone-binding cells of the diencephalon. The dissociation of the neocortex from the diencephalon was considered as a functional postictal diaschisis. These postictal physiologic changes were thought to account for the irrational automatic behavior and memory loss characteristic of patients with psychomotor seizures.     

Dextrorphan effects on cocaine and brainstem perturbation

Dextrorphan is a noncompetitive blocker of N-methyl-D-aspartate (NMDA) receptors. Since NMDA blockers are known to reduce the locomotor stimulatory and toxic effects of cocaine, it was speculated that dextrorphan would attenuate cocaine-induced behavioral excitatory motor activity associated with and without mechanical perturbation of the brainstem. Technique: Motor activity was recorded following dextrorphan and/or cocaine challenge in 25 SHR rats. Ten were naive subjects. Mini-osmotic pumps delivering cocaine (2.5 mg/0.49 ul/hr) were placed in 15 subjects, and infusion was halted after the third infusion day. On the fifth day either a dextrorphan (25 mg/kg, subcutaneous) or a dextrorphan and cocaine (40 mg/kg, intraperitoneal) challenge was done. Ten rats had bipolar electrode implants in the bilateral brainstem. Five were treated with DC current lesions in each of 12 days over a 3-week period. The effects of brainstem lesions on escape behavior were also evaluated in those five subjects. Results: In the naive subjects, dextrorphan reduced motor activity (P=.0001), whereas combined cocaine and dextrorphan increased motor activity (P=0.04). In lesioned subjects, dextrorphan decreased motor activity (P=0.0001). In electrode implant subjects, combined dextrorphan and cocaine challenge decreased the motor activity (P=0.04). Hyperactivity in the electrode implant group was greater than in the lesioned subjects. Midbrain electrolytic lesions attenuated escape behavior. A variety of behaviors were produced by brainstem lesions. Conclusions: Dextrorphan and brainstem lesions reduced motor hyperactivity and escape behavior. In electrode implant subjects dextrorphan counteracted the expected cocaine excitatory motor effects. Dextrorphan did not activate nor facilitate seizures.