Trait sexual motivation questionnaire: concept and validation.

INTRODUCTION: Trait sexual motivation defines a psychological construct that reflects the long-lasting degree of motivation for sexual activities, which is assumed to be the result of biological and sociocultural influences. With this definition, it shares commonalities with other sexuality-related constructs like sexual desire, sexual drive, sexual needs, and sexual compulsivity. AIM: The Trait Sexual Motivation Questionnaire (TSMQ) was developed in order to measure trait sexual motivation with its different facets. METHODS: Several steps were conducted: First, items were composed assessing sexual desire, the effort made to gain sex, as well as specific sexual behaviors. Factor analysis of the data of a first sample (n = 256) was conducted. Second, the factor solution was verified by a confirmatory factor analysis in a second sample (n = 498) and construct validity was demonstrated. Third, the temporal stability of the TSMQ was tested in a third study (n = 59). MAIN OUTCOME MEASURE: Questionnaire data. RESULTS: The exploratory and confirmatory factor analyses revealed that trait sexual motivation is best characterized by four subscales: Solitary Sexuality, Importance of Sex, Seeking Sexual Encounters, and Comparison with Others. It could be shown that the test quality of the questionnaire is high. Most importantly for the trait concept, the retest reliability after 1 year was r = 0.87. CONCLUSION: Our results indicate that the TSMQ is indeed a suitable tool for measuring long-lasting sexual motivation with high test quality and high construct validity. A future differentiation between trait and state sexual motivation might be helpful for clinical as well as forensic research.

At the second glance: stability of neural responses toward visual sexual stimuli.

INTRODUCTION: Studies investigating the neural responses toward sexual stimuli can provide an important basis for further understanding disorders of sexual functioning. Although our knowledge of the neural correlates of sexual stimulus processing has increased considerably in the last decade, the stability of the observed effects in studies on neural sexual responses has been rather neglected. AIMS: The current study aimed to test the stability of behavioral and neural responses to visual sexual stimuli in men and women over a time span of 1 to 1.5 years. To disentangle valence and arousal-related aspects of sexual stimulus processing, we employed not only sexual and neutral, but also positive and negative emotional stimuli. METHODS: A sample of 56 subjects (24 women) was assessed twice, with an interval of 1 to 1.5 years between assessments. During a functional magnetic resonance imaging (fMRI) session, participants passively viewed sexual, neutral, positive, and negative emotional pictures. Pictures were presented in 24 blocks of five pictures each. Every block was rated immediately after its presentation with respect to valence, arousal, and sexual arousal. MAIN OUTCOME MEASURES: Blood oxygen level dependent (BOLD) responses measured by fMRI and stimulus ratings. RESULTS: fMRI analyses revealed a distributed network involved in the processing of sexual stimuli, with large parts of this network being consistently activated at both assessment points. Nucleus accumbens, anterior cingulate, occipital and parietal cortex showed the most robust results with respect to group stability. Responses of anterior cingulate, orbitofrontal, parietal and occipital cortex showed interindividual stability. Gender differences were restricted to a few regions of interest. CONCLUSIONS: Our data indicate stability of neural responses toward sexual stimuli not only on the group but also on the individual level. Activation of parietal and occipital cortex might reflect a trait like character of attention related responses toward sexual stimuli.

Gender commonalities and differences in the neural processing of visual sexual stimuli.

INTRODUCTION: Few studies so far have directly compared the neural processing of visual sexual stimuli in men and women. Also, most of these studies only compared sexual with neutral stimuli, making it difficult to disentangle sexual stimulus processing from general emotional processing. AIM: The current study aimed to explore gender commonalities and differences in neural activity associated with the processing of visual sexual stimuli in a large sample of 50 men and 50 women. In order to disentangle effects of sexual processing from those of general emotional processing, we employed sexual, neutral, positive, and negative emotional pictures. METHODS: Subjects passively viewed sexual, neutral, positive, and negative emotional pictures during a functional magnetic resonance imaging (fMRI) session. Pictures were presented in 24 blocks of five pictures each. Every block was rated immediately after its presentation with respect to valence, arousal, and sexual arousal. MAIN OUTCOME MEASURES: Blood oxygen level dependent responses measured by fMRI and subjective ratings. RESULTS: fMRI analysis revealed a distributed network for the neural processing of sexual stimuli comprising the hypothalamus, the nucleus accumbens, as well as orbitofrontal, occipital, and parietal areas. This network could be identified (i) for both men and women, with men showing overall stronger activations than women and (ii) independent of general emotional arousal or valence effects. CONCLUSION: Our data speak in favor of a common neural network associated with the processing of visual sexual stimuli in men and women. Apart from the observed gender commonalities, overall stronger responses in men were observed that might indicate stronger sexual responsivity in men.

Neural activation toward erotic stimuli in homosexual and heterosexual males.

INTRODUCTION: Studies investigating sexual arousal exist, yet there are diverging findings on the underlying neural mechanisms with regard to sexual orientation. Moreover, sexual arousal effects have often been confounded with general arousal effects. Hence, it is still unclear which structures underlie the sexual arousal response in homosexual and heterosexual men. AIM: Neural activity and subjective responses were investigated in order to disentangle sexual from general arousal. Considering sexual orientation, differential and conjoint neural activations were of interest. METHODS: The functional magnetic resonance imaging (fMRI) study focused on the neural networks involved in the processing of sexual stimuli in 21 male participants (11 homosexual, 10 heterosexual). Both groups viewed pictures with erotic content as well as aversive and neutral stimuli. The erotic pictures were subdivided into three categories (most sexually arousing, least sexually arousing, and rest) based on the individual subjective ratings of each participant. MAIN OUTCOME MEASURES: Blood oxygen level-dependent responses measured by fMRI and subjective ratings. RESULTS: A conjunction analysis revealed conjoint neural activation related to sexual arousal in thalamus, hypothalamus, occipital cortex, and nucleus accumbens. Increased insula, amygdala, and anterior cingulate gyrus activation could be linked to general arousal. Group differences emerged neither when viewing the most sexually arousing pictures compared with highly arousing aversive pictures nor compared with neutral pictures. CONCLUSION: Results suggest that a widespread neural network is activated by highly sexually arousing visual stimuli. A partly distinct network of structures underlies sexual and general arousal effects. The processing of preferred, highly sexually arousing stimuli recruited similar structures in homosexual and heterosexual males.

Contingency learning in human fear conditioning involves the ventral striatum.

The ability to detect and learn contingencies between fearful stimuli and their predictive cues is an important capacity to cope with the environment. Contingency awareness refers to the ability to verbalize the relationships between conditioned and unconditioned stimuli. Although there is a heated debate about the influence of contingency awareness on conditioned fear responses, neural correlates behind the formation process of contingency awareness have gained only little attention in human fear conditioning. Recent animal studies indicate that the ventral striatum (VS) could be involved in this process, but in human studies the VS is mostly associated with positive emotions. To examine this question, we reanalyzed four recently published classical fear conditioning studies (n = 117) with respect to the VS at three distinct levels of contingency awareness: subjects, who did not learn the contingencies (unaware), subjects, who learned the contingencies during the experiment (learned aware) and subjects, who were informed about the contingencies in advance (instructed aware). The results showed significantly increased activations in the left and right VS in learned aware compared to unaware subjects. Interestingly, this activation pattern was only found in learned but not in instructed aware subjects. We assume that the VS is not involved when contingency awareness does not develop during conditioning or when contingency awareness is unambiguously induced already prior to conditioning. VS involvement seems to be important for the transition from a contingency unaware to a contingency aware state. Implications for fear conditioning models as well as for the contingency awareness debate are discussed.

Neural activations of the acquisition of conditioned sexual arousal: effects of contingency awareness and sex.

INTRODUCTION: Learning processes like classical conditioning are involved in mediating sexual behavior. Yet, the neural bases underlying these processes have not been investigated so far. AIM: The aim of this study was to explore neural activations of classical conditioning of sexual arousal with respect to sex differences and contingency awareness. METHODS: In the acquisition phase, a geometric figure (CS+) was presented for 8 seconds and was followed by highly sexual arousing pictures (UCS), whereas another figure (CS-) predicted neutral pictures. Ratings and contingency awareness were assessed after the entire conditioning procedure. Forty subjects (20 females) were classified into one of four groups according to their sex and the development of contingency awareness (aware females, aware males, unaware females, and unaware males). MAIN OUTCOME MEASURES: Blood oxygen level dependent (BOLD) responses measured by functional magnetic resonance imaging (fMRI), skin conductance responses (SCRs), and subjective ratings. RESULTS: fMRI analysis showed two effects (awareness and sex) when comparing CS+ with CS-: (i) aware compared to unaware subjects showed enhanced differentiation (e.g., ventral striatum, orbitofrontal cortex, occipital cortex); and (ii) men showed increased activity compared to women in the amygdala, thalamus, and brainstem. CS+ and CS- ratings differed in aware subjects only. However, no conditioned SCRs occurred in any group. CONCLUSION: The increased activity in men is in line with theories postulating that men are generally more prone to conditioning of sexual arousal. Further, contingency awareness seems to be an important factor in appetitive learning processes, which facilitates conditioning processes.

Cognitive functioning during methadone and buprenorphine treatment: results of a randomized clinical trial.

Cognitive impairment in drug-dependent patients receiving methadone (MMP) maintenance treatment has been reported previously. We assessed cognitive functioning after at least 14 days of stable substitution treatment with buprenorphine (BUP) or MMP and after 8 to 10 weeks. We performed a randomized, nonblinded clinical trial in 59 drug-dependent patients receiving either BUP or MMP maintenance treatment and healthy normal controls (n = 24) matched for sex, age, and educational level. Thirteen patients dropped out of the study before the second testing was performed (BUP, n = 22; MMP, n = 24). A neuropsychological test battery was used to measure selective attention, verbal memory, motor/cognitive speed, and cognitive flexibility. In addition, subjective perceived stress was assessed with a questionnaire. Patients in both treatment groups performed equally well in all of the cognitive domains tested. Both BUP and MMP patients showed significantly improved concentration and executive functions after 8 to 10 weeks of stable substitution treatment. The control group achieved better results than the BUP and MMP groups in most cognitive domains, indicating cognitive impairment in the patients. Perceived stress did not show any significant change after 8 to 10 weeks of treatment, and no major differences were detected between the 3 groups. No effects of perceived stress on cognitive function were found. Our results indicate a cognitive impairment in patients receiving maintenance treatment with BUP or MMP compared with healthy controls. Selective attention improved in both patient groups during treatment. We propose that the improvement of attention may facilitate rehabilitation of drug-dependent patients.

Effects of inpatient psychotherapy on the stability of alexithymia characteristics.

BACKGROUND: Although alexithymia is associated with several psychiatric disorders, there has been little research into the effects of psychodynamic psychotherapies on this condition. Here, the influence of inpatient multimodal psychodynamic psychotherapy on alexithymia and symptom load was evaluated in a large sample of patients. METHODS: Alexithymia [measured with the Toronto Alexithymia Scale (TAS)-26] and psychological stress and depression [measured with the Symptom Checklist 90 Revised (SCL-90-R)] were evaluated at admission and after inpatient multimodal psychotherapy in patients with various psychosomatic and psychiatric disorders admitted to this unit between 2002 and 2005. Patients undergoing both short-term (up to 4 weeks) and long-term treatment (8-12 weeks) were studied. Analyses of covariance were used to analyse the data on depression (SCL-90-R) and psychological stress (SCL-90-R), and correlations between admission and discharge scores for the TAS-26 were computed to evaluate mean and relative stability of alexithymia. RESULTS: Data on 397 of the 568 patients admitted were analysed. Psychological stress and depression (SCL-90-R) decreased significantly during the study across all diagnostic groups. The TAS-26 total score also decreased significantly, showing that there was no mean stability of alexithymic characteristics. However, the significance of decrease was lost when psychological stress and depression were controlled for. Highly significant correlations between TAS-26 sores before and after treatment reflected high relative stability of alexithymia. CONCLUSIONS: During inpatient multimodal psychodynamic treatment, the symptom load and alexithymia in our patients decreased. The high relative stability of alexithymia shown supports the view that alexithymia is a relative stable personality trait.

Effects of haloperidol and risperidone on psychomotor performance relevant to driving ability in schizophrenic patients compared to healthy controls.

The effects of antipsychotic treatment on the psychomotor performance and driving ability of schizophrenic patients is subject of investigation. The present study was designed to evaluate the effects of an atypical neuroleptic (risperidone) in comparison to a conventional dopamine antagonist neuroleptic (haloperidol) on several dimensions of psychomotor performance (visual perception, attention, reaction time, and sensorimotor performance) considered to be of relevance in evaluating driving fitness. Psychomotor performance was assessed by means of the ART 90 (act-and-react test), a computerized test battery which is frequently used in diagnosis of psychomotor performance. The 40 participating patients were examined at discharge following psychopathological stabilisation; 20 received haloperidol medication, 20 received the atypical neuroleptic risperidone. Nineteen healthy individuals were studied as a control group. Our findings indicate a remarkably reduced psychomotor performance in both groups of schizophrenic patients compared to healthy controls. We did find a significant but low correlation between age and some items of the RST3 and between age and the tracking performance on the PVT. The younger patients showed a better test performance than older patients. The BPRS-score was significantly correlated with only two items of the RST3. However, patients under treatment with risperidone showed significantly better results compared to patients treated with haloperidol. Only one (5%) subject passed all subtests without major failures and could be regarded as competent to drive. Among patients with risperidone, seven patients (35%) passed all test parameters without major failures. Clinical implications of these findings are discussed.

Sex attracts: investigating individual differences in attentional bias to sexual stimuli.

We investigated the impact of sexual stimuli and the influence of sexual motivation on the performance in a dot-probe task and a line-orientation task in a large sample of males and females. All pictures (neutral, erotic) were rated on the dimensions of valence, arousal, disgust, and sexual arousal. Additionally, questionnaires measuring sexual interest/desire/motivation were employed. The ratings of the sexual stimuli point to a successful picture selection because sexual arousal did not differ between the sexes. The stimuli were equally arousing for men and women. Higher scores in the employed questionnaires measuring sexual interest/desire/motivation led to higher sexual arousal ratings of the sex pictures. Attentional bias towards sex pictures was observed in both experimental tasks. The attentional biases measured by the dot-probe and the line-orientation task were moderately intercorrelated suggesting attentional bias as a possible marker for a sex-attention trait. Finally, only the sexual sensation seeking score correlated with the attentional biases of the two tasks. Future research is needed to increase the predictive power of these indirect measures of sexual interest.

Learning to like disgust: neuronal correlates of counterconditioning.

Converging lines of research suggest that exaggerated disgust responses play a crucial role in the development and maintenance of certain anxiety disorders. One strategy that might effectively alter disgust responses is counterconditioning. In this study, we used functional magnetic resonance imaging (fMRI) to examine if the neuronal bases of disgust responses are altered through a counterconditioning procedure. One disgust picture (conditioned stimulus: CS+disg) announced a monetary reward, while a second disgust picture (CS-disg) was never paired with the reward. Two neutral control pictures (CS+con/CS-con) were conditioned in the same manner. Analyses of evaluative conditioning showed that both CS+ were rated significantly more positive after conditioning as compared to the corresponding CS-. Thereby, the CS+disg and the CS+con received an equal increase in valence ratings. Regarding the fMRI data, ANOVA results showed main effects of the conditioning procedure (i.e., CS+ vs. CS-) in the dorsal anterior cingulate cortex. Further, main effects of the picture category (disgust vs. control) were found in the bilateral insula and the orbitofrontal cortex. No interaction effects were detected. In conclusion, the results imply that learning and anticipation of reward was not significantly influenced by the disgust content of the CS pictures. This suggests that the affect induced by the disgust pictures and the affect created by the anticipation of reward may not influence the processing of each other.

Individual differences in neural correlates of fear conditioning as a function of 5-HTTLPR and stressful life events.

Fear learning is a crucial process in the pathogeneses of psychiatric disorders, which highlights the need to identify specific factors contributing to interindividual variation. We hypothesized variation in the serotonin transporter gene (5-HTTLPR) and stressful life events (SLEs) to be associated with neural correlates of fear conditioning in a sample of healthy male adults (n = 47). Subjects were exposed to a differential fear conditioning paradigm after being preselected regarding 5-HTTLPR genotype and SLEs. Individual differences in brain activity as measured by functional magnetic resonance imaging (fMRI), skin conductance responses and preference ratings were assessed. We report significant variation in neural correlates of fear conditioning as a function of 5-HTTLPR genotype. Specifically, the conditioned stimulus (CS(+)) elicited elevated activity within the fear-network (amygdala, insula, thalamus, occipital cortex) in subjects carrying two copies of the 5-HTTLPR S' allele. Moreover, our results revealed preliminary evidence for a significant gene-by-environment interaction, such as homozygous carriers of the 5-HTTLPR S' allele with a history of SLEs demonstrated elevated reactivity to the CS(+) in the occipital cortex and the insula. Our findings contribute to the current debate on 5-HTTLPR x SLEs interaction by investigating crucial alterations on an intermediate phenotype level which may convey an elevated vulnerability for the development of psychopathology.

Neural responses to smoking stimuli are influenced by smokers' attitudes towards their own smoking behaviour.

An important feature of addiction is the high drug craving that may promote the continuation of consumption. Environmental stimuli classically conditioned to drug-intake have a strong motivational power for addicts and can elicit craving. However, addicts differ in the attitudes towards their own consumption behavior: some are content with drug taking (consonant users) whereas others are discontent (dissonant users). Such differences may be important for clinical practice because the experience of dissonance might enhance the likelihood to consider treatment. This fMRI study investigated in smokers whether these different attitudes influence subjective and neural responses to smoking stimuli. Based on self-characterization, smokers were divided into consonant and dissonant smokers. These two groups were presented smoking stimuli and neutral stimuli. Former studies have suggested differences in the impact of smoking stimuli depending on the temporal stage of the smoking ritual they are associated with. Therefore, we used stimuli associated with the beginning (BEGIN-smoking-stimuli) and stimuli associated with the terminal stage (END-smoking-stimuli) of the smoking ritual as distinct stimulus categories. Stimulus ratings did not differ between both groups. Brain data showed that BEGIN-smoking-stimuli led to enhanced mesolimbic responses (amygdala, hippocampus, insula) in dissonant compared to consonant smokers. In response to END-smoking-stimuli, dissonant smokers showed reduced mesocortical responses (orbitofrontal cortex, subcallosal cortex) compared to consonant smokers. These results suggest that smoking stimuli with a high incentive value (BEGIN-smoking-stimuli) are more appetitive for dissonant than consonant smokers at least on the neural level. To the contrary, smoking stimuli with low incentive value (END-smoking-stimuli) seem to be less appetitive for dissonant smokers than consonant smokers. These differences might be one reason why dissonant smokers experience difficulties in translating their attitudes into an actual behavior change.

Can you hear a difference? Neuronal correlates of melodic deviance processing in children.

Many studies investigating music processing in adult musicians and nonmusicians point towards pronounced behavioral and neurophysiological differences between the two groups. Recent studies indicate that these differences can already be found in early childhood. Further, electro-encephalography studies using musical discrimination tasks have demonstrated that differences in music processing become more pronounced when explicitly rather than implicitly trained musical abilities are required. Exploring the functional neuroanatomy underlying the processing of different expectation violations in children and its association with musical training, we investigated neural responses to different melodic deviances in musically trained and untrained children. Using functional magnetic resonance imaging, children (aged 11-14 years) were examined while comparing pairs of short melodies that were either identical or differed with respect to four notes. The implemented deviances were either subtle (by inserting plausible in-key notes) or obvious (by inserting implausible out-of-key notes). Our results indicate a strong association between musical training and functional neuroanatomy of the brain. Similar to research on music processing in adults, the processing of obvious melodic deviances activated a network involving inferior frontal, premotor and anterior insula regions in musically trained and untrained children. By contrast, subtle deviances led to activation in the inferior frontal and premotor cortex, the anterior insula, the superior temporal gyrus, and the supramarginal gyrus in musically trained children only. Our work provides further insights into the functional neuroanatomy of melody processing and its association with musical training in children, providing the basis for further studies specifying distinct musical processes (e.g. contour and interval processing).

The impact of coping style on gaze duration.

The understanding of individual differences in response to threat (e.g., attentional bias) is important to better understand the development of anxiety disorders. Previous studies revealed only a small attentional bias in high-anxious (HA) subjects. One explanation for this finding may be the assumption that all HA-subjects show a constant attentional bias. Current models distinguish HA-subjects depending on their level of tolerance for uncertainty and for arousal. These models assume that only HA-subjects with intolerance for uncertainty but tolerance for arousal ("sensitizers") show an attentional bias, compared to HA-subjects with intolerance for uncertainty and intolerance for arousal ("fluctuating subjects"). Further, it is assumed that repressors (defined as intolerance for arousal but tolerance for uncertainty) would react with avoidance behavior when confronted with threatening stimuli. The present study investigated the influence of coping styles on attentional bias. After an extensive recruiting phase, 36 subjects were classified into three groups (sensitizers, fluctuating, and repressors). All subjects were exposed to presentations of happy and threatening faces, while recording gaze durations with an eye-tracker. The results showed that only sensitizer showed an attentional bias: they gazed longer at the threatening face rather than at the happy face during the first 500 ms. The results support the findings of the relationship between anxiety and attention and extend these by showing variations according to coping styles. The differentiation of subjects according to a multifaceted coping style allows a better prediction of the attentional bias and contributes to an insight into the complex interplay of personality, coping, and behavior.

Hemodynamic brain correlates of disgust and fear ratings.

Inconsistent findings from several functional magnetic resonance imaging (fMRI) studies on fear and disgust raise the question which brain regions are relatively specialized and which are general in the processing of these basic emotions. Some of these inconsistencies could partially be due to inter-individual differences in the experience of the applied emotional stimuli. In the present study, we therefore correlated the participants' individual online reports of fear and disgust with their hemodynamic responses towards each of the fear- and disgust-inducing scenes. Sixty six participants (32 females) took part in the fMRI study. In an event-related design, they saw 50 pictures with different emotional impact (10 neutral, 20 disgust-inducing, 20 fear-inducing). Pictures were presented for 4 s and participants rated each picture online - just after the presentation - on the dimensions disgust and fear among others. The results indicate that the processing of disgust- and fear-inducing pictures involves similar as well as distinct brain regions. Both emotional stimulus categories resulted in activations in the extended occipital cortex, in the prefrontal cortex, and in the amygdala. However, insula activations were only significantly correlated with subjective ratings of disgust, pointing to a specific role of this brain structure in the processing of disgust.

Influence of the stress hormone cortisol on fear conditioning in humans: evidence for sex differences in the response of the prefrontal cortex.

The stress hormone cortisol is known to influence declarative memory and associative learning. In animals, stress has often been reported to have opposing effects on memory and learning in males and females. In humans, the effects of cortisol have mainly been studied at the behavioral level. The aim of the present experiment was to characterize the effects of a single cortisol dose (30 mg) on the hemodynamic correlates of fear conditioning. In a double-blind group comparison study subjects (17 females and 17 males) received 30 mg cortisol or placebo orally before participating in a discriminative fear conditioning paradigm. Results revealed that cortisol impaired electrodermal signs of learning (the first interval response) in males, while no conditioned SCRs emerged for the females independent of treatment. fMRI results showed that cortisol reduced activity for the CS+ > CS- comparison in the anterior cingulate, the lateral orbitofrontal cortex and the medial prefrontal cortex in males. Opposite findings (increase in these regions under cortisol) were detected in females. In addition, cortisol reduced the habituation in the CS+ > CS- contrast in the dorsolateral prefrontal cortex independent of sex. Finally, cortisol also modified the response to the electric shock (the UCS) by enhancing the activity of the anterior as well as the posterior cingulate. In sum, these findings demonstrate that in humans cortisol mostly influences prefrontal brain activation during fear conditioning and that these effects appear to be modulated by sex.

Driving ability in schizophrenic patients: effects of neuroleptics.

Recent studies indicate that individuals with schizophrenia have a two-fold incidence of traffic accidents. Cognitive and psychomotor impairment as a core feature of schizophrenia and the effects of neuroleptic treatment play an essential role in this respect. Few experimental studies have been conducted so far looking at the effects of neuroleptics on driving ability in schizophrenia. Controlled, randomised trials are totally missing. The limited database indicates that most schizophrenic patients show significant impairment in cognitive functions relevant for driving ability compared to healthy controls. There is some but limited evidence that patients under novel atypical neuroleptics show less impairment compared to conventional neuroleptics. More clinical and experimental studies are warranted.

Less impairment on one portion of a driving-relevant psychomotor battery in buprenorphine-maintained than in methadone-maintained patients: results of a randomized clinical trial.

BACKGROUND: Cognitive impairment in drug-dependent patients under methadone maintenance treatment has been reported before. We assessed whether patients under buprenorphine, a partial mu-opioid agonist, perform better in cognitive tests measuring psychomotor performance as described in previous nonrandomized studies. METHODS: We performed a randomized clinical trial in 62 drug-dependent patients under either buprenorphine or methadone treatment. Sixteen patients dropped out of maintenance therapy, before the testing was performed, after 8 to 10 weeks of treatment. Several subtests of the Act & React Test System test battery were used measuring visual perception, selective attention, vigilance, reactivity, and stress tolerance. FINDINGS: Although there were no differences in cognitive function at baseline, patients under buprenorphine treatment showed partially better results in some of the domains tested. The used tests are relevant when assessing driving ability. There was a significant correlation between dose of buprenorphine and some test results. We also found a correlation between age and reaction time and between duration of opioid dependence and results in some subtests. INTERPRETATIONS (CONCLUSIONS): When comparing both treatments in drug dependent patients, buprenorphine produces partially less impairment on cognitive functions in some of the subtests of the psychomotor battery than methadone. This difference is specially relevant when it comes to driving ability and social functioning.

Effects of haloperidol and atypical neuroleptics on psychomotor performance and driving ability in schizophrenic patients. Results from an experimental study.

The influence of antipsychotic treatment on the neuropsychological and psychomotor performance of schizophrenic patients is still a subject of investigation. The present study was designed to evaluate the effects of atypical neuroleptics in comparison with a conventional dopamine antagonist neuroleptic (haloperidol) on several dimensions of psychomotor performance (visual perception, attention, reaction time, and sensorimotor performance) considered to be of relevance in evaluating driving fitness. Psychomotor performance was assessed by means of the ART 90, a computerized Act and React Test which is generally used in diagnosis of psychomotor performance. The 49 participating patients were examined at discharge following psychopathological stabilisation; 20 received haloperidol, 29 received an atypical neuroleptic. Our findings demonstrate a remarkably reduced psychomotor performance in the haloperidol-treated group of schizophrenic patients compared with patients treated with atypical neuroleptics. Only 1 (5%) subject passed all subtests without major failures and could be regarded as competent to drive. Among patients with atypical neuroleptics, 7 patients (24%) passed all test parameters without major failures.