Information constraints in medical encounters

This article describes three kinds of information constraints in medical encounters that have not been discussed at length in the medical ethics literature: constraints from the concept of a disease, from the diffusion of medical innovation, and from withholding information. It describes how these limit the reliance rational people can justifiably put in their doctors, and even the reliance doctors can have on their own advice. It notes the implications of these constraints for the value of informed consent, identifies several procedural steps that could increase the value of the latter and improve diffusion of innovation, and argues that recognition of these constraints should lead us to devise protections which intrude on but can improve these encounters.     

The obsessive compulsive spectrum: a survey of 800 practitioners

The obsessive-compulsive (OC) spectrum is a group of related disorders that appear to share symptomatology, neurobiology, and treatment response with obsessive-compulsive disorder. To collect data on the appreciation of the OC spectrum concept among clinicians, 800 participants completed a questionnaire to help determine their understanding and appreciation of this concept, at a workshop on the OC spectrum.     

A nonparametric test for the two-sample problem

Moses [3] has proposed a nonparametric test of the null hypothesis that two samples, say a treatment and a control group, have been drawn from the same population; his test is designed to be sensitive to the alternative hypothesis that the treatment group is extreme in either or both directions as compared with the controls. This paper presents a test of similar character, except that rather than being based on a range of the control group ranks, it depends upon the variance of those ranks. This has the advantage of making ties less troublesome. Tables of significance values are presented for some small sample sizes. A normal approximation is developed and seen to be useful.This research was partially sponsored by a Public Health Biostatistics Training Grant at Stanford University.I wish to thank Professor Lincoln E. Moses of Stanford University for suggesting the problem, and for his invaluable assistance in the preparation of this paper.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

Impact of recent findings on study design of future autism clinical trials

There are specific challenges to studying the design of pharmacologic trials in child/adolescent and adult autism, such as subject stratification and parallel versus crossover designs. This article describes how optimal study design is influenced by subject selection and outcome measures chosen. Lessons learned in study design from the Research Units on Pediatric Psychopharmacology Autism Network trial with risperidone, Seaver Center trials with fluoxetine and valproate, Dartmouth trials with amantadine, and National Institutes of Health secretin trials are highlighted. The Internet System for Assessing Autistic Children system for managing multicenter clinical trials in autism and statistical issues in autism research are also described.     

CYBER COMMUNITY IN THE VALLEY OF THE SHADOW OF DEATH

This article provides an examination of the communicative needs and practices of those who have survived the loss of a loved one to suicide. Based on a study of a face-to-face support group for parents of children lost to suicide, and over 10,000 e-mails from a number of online support groups for survivors of the loss of a loved one to suicide, this article discusses intense communicative relations, exclusion from the general society, self-accrediting of experts in grief, reconstruction of identity to include the loss, ownership of the suicide, and rebuilding community.