On the importance of being first: serial order effects in the interaction between action plans and ongoing actions.

When we plan sequences of actions, we must hold some elements of the sequence in working memory (WM) while we execute others. Research shows that execution of an action can be delayed if it partly overlaps (vs. does not overlap) with another action plan maintained in WM (partial repetition cost). However, it is not known whether all features of the action maintained in WM interfere equally with current actions. Most serial models of memory and action assume that interference will be equal, because all action features in the sequence should be activated to an equal degree in parallel; others assume that action features earlier in the sequence will interfere more than those later in the sequence, because earlier features will be more active. Using a partial repetition paradigm, this study examined whether serial position of action features in action sequences maintained in WM have an influence on current actions. Two stimulus events occurred in a sequence, and participants planned and maintained an action sequence to the first event (action A) in WM while executing a speeded response to the second event (action B). Results showed delayed execution of action B when it matched the first feature in the action A sequence (partial repetition cost), but not when it matched the last feature. These findings suggest that serial order is represented in the action plan prior to response execution, consistent with models that assume that serial order is represented by a primacy gradient of parallel feature activation prior to action execution.

A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan.

OBJECTIVE: The authors conducted a 15-week randomized controlled trial of the alpha-1 adrenoreceptor antagonist prazosin for combat trauma nightmares, sleep quality, global function, and overall symptoms in active-duty soldiers with posttraumatic stress disorder (PTSD) returned from combat deployments to Iraq and Afghanistan. METHOD: Sixty-seven soldiers were randomly assigned to treatment with prazosin or placebo for 15 weeks. Drug was titrated based on nightmare response over 6 weeks to a possible maximum dose of 5 mg midmorning and 20 mg at bedtime for men and 2 mg midmorning and 10 mg at bedtime for women. Mean achieved bedtime doses were 15.6 mg of prazosin (SD=6.0) and 18.8 mg of placebo (SD=3.3) for men and 7.0 mg of prazosin (SD=3.5) and 10.0 mg of placebo (SD=0.0) for women. Mean achieved midmorning doses were 4.0 mg of prazosin (SD=1.4) and 4.8 mg of placebo (SD=0.8) for men and 1.7 mg of prazosin (SD=0.5) and 2.0 mg of placebo (SD=0.0) mg for women. Primary outcome measures were the nightmare item of the Clinician-Administered PTSD Scale (CAPS), the Pittsburgh Sleep Quality Index, and the change item of the Clinical Global Impressions Scale anchored to functioning. Secondary outcome measures were the 17-item CAPS, the Hamilton Depression Rating Scale, the Patient Health Questionnaire-9, and the Quality of Life Index. Maintenance psychotropic medications and supportive psychotherapy were held constant. RESULTS: Prazosin was effective for trauma nightmares, sleep quality, global function, CAPS score, and the CAPS hyperarousal symptom cluster. Prazosin was well tolerated, and blood pressure changes did not differ between groups. CONCLUSIONS: Prazosin is effective for combat-related PTSD with trauma nightmares in active-duty soldiers, and benefits are clinically meaningful. Substantial residual symptoms suggest that studies combining prazosin with effective psychotherapies might demonstrate further benefit.