Neurobiology of Cocaine-Induced Organic Brain Impairment: Contributions from Functional Neuroimaging

The present review is directed at imparting the current knowledge regarding functional neuroimaging as a tool for enhancing the understanding of cerebrophysiologic and neurobehavioral consequences of stimulant abuse. Stimulants like cocaine are capable of inducing clinically significant neurocognitive impairment through direct action on the brain, and indirectly through other organs that influence cerebral physiology. Neurochemical dysregulation including profound effects on the serotonergic and dopaminergic systems have substantial physiological and neurobehavioral consequences. Brain hemorrhages, transient ischemic attacks, strokes, and seizures frequently follow cocaine use. The residual cerebropathologic consequences of cocaine are seen only in significant or pronounced brain events when structural neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are employed. However, recent research with newer functional neuroimaging techniques such as single photon emission, positron emission tomography, and quantitative electroencephalography have revealed high rates of significant alteration in brain function among cocaine users, with negative structural imaging studies. These findings are often associated with impairment on neuropsychological evaluation, also in the absence of positive findings on CT and MRI. Both cerebral metabolic and hypoperfusion anomalies are seen, especially in anterior and temporal brain regions. Observed changes can persist for months, and for some patients, may represent a permanent change in brain functioning.     

Do the magnocellular and parvocellular visual pathways contribute differentially to subitizing and counting?

We investigated the neurobiologies! basis of visual processes involved in object enumeration. Subitizing, the ability to rapidly and accurately enumerate four or fewer objects, is thought to depend on preattentive processing of visual stimuli, whereas counting of more numerous objects is thought to require serial shifts of attention. We attempted to distinguish between the hypothesis that the magnocellular (M) visual pathway is the preferential route for subitizing, and the alternative hypothesis that there is no selectivity for the M pathway or its counterpart, the parvocellular (P) visual pathway, in visual object enumeration. Green rectangles were presented on an equiluminant red background to impair M pathway processing. This slowed enumeration performance relative to a control condition in which object/background luminance differed, especially when the rectangles were relatively large and widely spaced and had constant retinal eccentricity. When low luminance contrast was used to impair processing along the P pathway, enumeration performance was slowed relative to a high-contrast control condition, especially when the rectangles were small and closely spaced. Overall, our manipulations affected enumeration performance without selectivity for subitizing or counting ranges and without altering the slope of the functions relating reaction time to numerosity. Thus, our results favor the hypothesis that visual enumeration does not depend preferentially on either the M or the P pathway.     

All work and no play: A focus on leisure time as a means for promoting health

In a study of 294 participants the relationship between attitude to leisure time and engagement in leisure activities and psychological and physical health was investigated Using questionnaire methods a consistent and significant relationship was found in that individuals with more positive attitudes towards and engagement in leisure activities experienced less general psychological distress, anxiety, depression, and hostility. They also experienced higher levels of positive affect and reported feeling physically healthier. Leisure measures were also related to levels of achievement motivation. The data points to leisure time behaviour as a rich source of information about coping styles and the positive use of leisure counselling as a therapeutic intervention.     

Cognitive appraisal,vulnerability and coping: An integrative analysis of appraisal and coping mechanisms

Research on stress has generally concluded that stress occurs within the person as a result of their cognitive appraisal of experience. However although a number of cognitive theories of emotion exist, an integrative analysis of cognitive appraisal and vulnerability to stress has not been produced. This report contains two studies. Study 1 draws together the major variables identified in the literature in an analysis of their power to differentiate between a clinical sample (n = 48), a self-help group (n = 54), and a control sample (n = 509). The analysis shows that achievement motivation, attributional style, problem-solving style, emotional reactivity; hopelessness, perceived control and perceived social support are significant discriminators. In a second study the relationship between these variables and aspects of life stress, work stress, life satisfaction, depression, anxiety, and positive affect were investigated. Again the data support an explanatory role for these variables. The suggestion is that these variables can be utilized in an integrative model of cognitive appraisal in the stress process to guide intervention.     

Case vignette: child abuse or acceptable cultural norms -- child psychiatrist's response; ethical issues in culturally relevant interventions; cultural contexts

Three families from the nation of the Gambia have become socially acquainted in the greater Metropolis area where they have relocated from their native country. All three families have preadolescent daughters. None of the girls has as yet undergone the ritual "female circumcision" commonly practiced in their native country. Five of the six parents think it would be a good idea to hold such a ritual ceremony in Metropolis next month. The sixth parent is uneasy about the procedure and wonders if it is appropriate anyway. The parent comes to talk with you, a physician or mental health professional, about this. The parent describes concerns about the procedure and the practice in general, but notes that some groups in the United States do "similar things," referring to the ritual circumcision of Jewish boys at 8 days of age. The parent adds that if the procedure is not possible in the United States, it could be done in the Gambia when the family returns there on holiday. Discussants were asked for their opinions regarding advice to the parent's ethical obligations (especially in the case of mandated reporting of suspected child abuse).     

SYMLOG: Clinical technology for therapist family of origin and family system appraisal

SYMLOG, an acronym for Systematic Multiple Level Observation of Groups, reflects a technology for the quantification and graphic organization of subjective observational data. The SYMLOG field diagram-a graphic diagram which reflects relational interactions on three dimensions-provides the opportunity to analyze the admixture of therapist family of origin dynamics in conjunction with family relational behaviors. This article presents a sample SYMLOG clinician family of origin evaluation with accompanying elaboration surrounding SYMLOG field theory.     

WHIMSICAL DESIRES

To desire is to want, but not necessarily to be disposed to do anything. That is to say, desiring does not necessarily involve having any disposition to act. To lend plausibility to this view I appeal to the example of whimsical desires that no action could help us to realise. What may lead us to view certain desires as whimsical is precisely the absence of any possibility of realizing them. While such desires might seem less than full‐blooded, I argue that we can have full‐blooded desires concerning such matters because of our (non‐whimsical) concern for others. That is to say, whimsical desires can have a borrowed seriousness. The article goes on to strengthen the separability of dispositions and desires by narrowing down the concept of triggering conditions for a disposition. If we allow the triggering conditions to be too broad then it will always make sense to say that someone with a desire simply must have a disposition because, all other things being equal, they would bring about what they desire if they were able to do so.     

An integrative theory of desistance from sex offending

Despite the fact that most offenders eventually desist from committing further crimes, there is an absence of comprehensive psychological and social accounts of the desistance process, beginning at the point when an individual decides to stop further offending, and finishing at the point of successful reentry and social reintegration. Building on previous work, the Integrated Theory of Desistance from Sex Offending represents an attempt to advance our understanding of desistance. The theory describes the desistance process in four phases: (1) decisive momentum (initial desistance), (2) rehabilitation (promoting desistance), (3) re-entry (maintaining desistance), and (4) normalcy (successful maintenance of desistance over a long period of time). The theory has significant implications for further theorizing, empirical research, clinical practice, and policy making.