Topiramate in the preventive treatment of episodic migraine: a combined analysis from pilot,double-blind,placebo-controlled trials

The safety and efficacy of medications for preventive treatment of migraine is the subject of current concern and investigation in health care. Two single-center, double-blind, placebo-controlled studies were conducted to evaluate the efficacy and safety of topiramate for migraine prophylaxis. Seventy patients with a diagnosis of migraine were randomly assigned to topiramate-treated and placebo groups. The studies consisted of a 4-week baseline phase, a 6-8 week titration, and 8-12 weeks of maintenance. Topiramate was titrated from an initial dose of 25 mg/day to a target dose of 100 mg BID. The primary efficacy measure, the mean 28-day migraine frequency, was lower in topiramate-treated patients than in the placebo group (3.2 versus 3.8, P=.001). Similarly, topiramate treatment resulted in a significantly greater mean reduction in migraine frequency than did placebo (1.55 versus 0.47, P=.001) and a significantly higher responder rate (35.3% versus 8.3%, P=.008). Paresthesia was the most common side effect reported with topiramate treatment. Other topiramate-associated adverse events included altered taste, memory impairment, diarrhea, and appetite suppression/weight loss. The rates of discontinuation were similar for the topiramate group (n=10) and the placebo group (n=8). These results suggest that topiramate is effective and well tolerated in the preventive treatment of migraine headaches.     

Clauses and the semantic representation of words

When a sentence with more than one clause is processed, words of the first clause become less available for recall or recognition once the clause boundary has been passed. One common interpretation of this observation is that the representation of a given word shifts from a predominantly surface form (e.g., phonological or lexical) to a semantic form, after the clause boundary. Two experiments that test that interpretation are reported. In the first experiment, two-clause spoken sentences were followed by spoken word or picture probes. Pictures were intended to provide a fast semantic match to probed words, but a slow surface match. Although response times exhibited a robust main effect of the clause position of the probe, no interaction with probe type was found. Similar results were obtained in a second experiment that compared pictures with written word probes. The faster response to picture than to word probes in the second experiment indicates that subjects did not covertly name the picture, but made a semantic match (as intended). These observations suggest the following reinterpretation of earlier sentence memory experiments: Words in the most recent clause of a sentence are more available than words in an earlier clause because their semantic representations are more active, not because their surface representations are more active.     

Perceived stress and everyday memory complaints among older adult women

Abstract

Memory complaints among older adults are often influenced by depression and anxiety, but the association of stress to memory complaints has received little attention. We examined the associations of perceived stress, life events, and activity level to everyday memory complaints among healthy older women, while controlling for the influence of depression and anxiety. Participants (N=54) completed self-report questionnaires on memory complaints, perceived stress, recent life events, activity level, depression, and anxiety. Partial correlation analyses indicated that higher levels of perceived stress were associated with higher levels of memory complaints when controlling for the influence of depression and anxiety, but that life events and activity level were not related to memory complaints. This study highlights that perceived stress, like depression and anxiety, is a psychological factor that influences the appraisal of cognitive ability; however, larger and more heterogeneous samples will be needed to better understand the multifactorial nature of memory complaints in older adulthood.     

Development and Validation of a Dutch Translation of the Big Five Inventory (BFI)

The MMPI profiles of 74 low back pain patients who had previously been classified as "functional," "organic," or "mixed" were sorted into six profile groups. The six profile groups were those used by Pichot, Perse, Lekeous, Dureau, Perez, and Rychewaert (1972); denial, "conversion V" without defensiveness, "conversion V" with defensiveness, depressed/anxious, psychotic and normal. Results indicate that all six profile types are welt represented in the low back pain group. Evidence is also presented which shows that each of the pathological MMPI profile types examined across "functional," "organic," and "mixed" classification is significantly more elevated than a normal profile group on two scales (Lb, DOR) designed to measure functional aspects of pain. Pathological MMPI profile groups did not differ significantly from each other on the "functional," pain scales. The data presented in this study point to the relationship of various forms of psychopathology with "functional pain." The findings of this stud v would not support a homogeneous "pain personality" for low back pain patients. However, combined "conversion V" profiles accounted for 58% of the "functional" group, 45% of the "mixed" group and 35% of the "organic" group.     

The locus of semantic priming in RSVP target search

At what stage does semantic priming affect accuracy in target search? In two experiments, participants viewed two streams of stimuli, each including a target word among distractors. Stimulus onset asynchronies (SOAs) between the targets (T1 and T2) ranged from 53 to 213 msec. A word semantically related to one or neither of the targets preceded each trial. In Experiment 1, participants were instructed to report both targets. Although more primed than unprimed targets were reported, there was no cost for unprimed words. A strong interaction between SOA and T1 versus T2 was found, but priming did not interact with either variable. In Experiment 2, only related targets were reported. Performance was similar to that for primed targets in Experiment 1. Semantic priming does not seem to modulate how attentional resources are initially allocated between targets, but instead affects a later stage of processing, the point at which a target word reaches lexical identification.     

The Use of a Family History Risk Assessment Tool within a Community Health Care System: Views of Primary Care Providers

Primary care providers (PCPs) offered input regarding the incorporation of a family health history (FHH) risk assessment tool into a community health care system (CHCS). Sixteen PCPs participated in one of three focus groups. Perceived impediments included the lack of standard screening guidelines, effective screening tests, genetic counseling resources, and services for high-risk patients. The PCPs were concerned about their level of expertise, the cost of preventive health care, and genetic discrimination. They also were concerned about the use of a FHH tool by oncologists within the CHCS because of communication gaps between oncologists and PCPs, lack of clarity regarding follow-up and legal liability, and reimbursement issues. To integrate a FHH tool into a CHCS, PCPs will need consultation and referral services, evidence-based recommendations, and "just-in-time" educational resources. Oncologists who use the tool will need to develop a streamlined communication system with PCPs, establish clearly defined roles, and ensure patient follow-up.