The place of additional individual psychotherapy in the treatment of alcoholism: a randomized controlled study in nonresponders to anticraving medication-results of the PREDICT study.

BACKGROUND: Goal of the presented study is to evaluate whether alcohol-dependent patients given additional individual psychotherapy after a heavy relapse during pharmacotherapy remain abstinent for longer than those who continue with pharmacotherapy alone. METHODS: In a randomized, multicenter study, 109 alcohol-dependent patients who had suffered a heavy relapse either while receiving anticraving medication or placebo were randomized into 2 groups. One group received medication, medical management, and additional individual, disorder-specific, cognitive-behavioral psychotherapy, while the control group received medication and medical management only. Main outcome was defined as days until first heavy relapse. RESULTS: Fifty-four patients were randomized to the psychotherapy group, 55 to the control group. Intention-to-treat and completer analyses found no differences between groups, whereas as-treated analyses (patients who actually received psychotherapy compared with those who did not) found a significant effect of psychotherapy. CONCLUSIONS: Our data indicate that patients that are willing to attend psychotherapy benefit from receiving psychotherapy in addition to pharmacotherapy. We suggest that it may be beneficial to consider patients' preferences concerning psychotherapy at an earlier stage during treatment.

Functional organization of primary somatosensory cortex depends on the focus of attention.

We used magnetic source imaging in human subjects to reveal within-subject variations of the homuncular hand representation within the primary somatosensory cortex modulated by attention. In one condition subjects were trained to detect sequential leftward or rightward stimulus motion across the fingers of the left hand ("hand" condition) and in a different condition to detect stimulus motion at a specific finger on this hand ("finger" condition). Afferent input was controlled by applying exactly the same stimulus pattern to the digits in the two tasks. Segregation of the somatotopic hand representation (an increase in the distance between the representations of digits 2 and 5) was observed, commencing with the onset of practice, in the finger relative to the hand condition. Subsequent training in the hand and finger conditions with feedback for correctness did not modify segregation, indicating that segregation was a task effect and not a training effect. These findings indicate that the hand representation within the primary somatosensory cortex is not statically fixed but is dynamically modulated by top-down mechanisms to support task requirements. A greater capacity for modulation of the functional cortical organization was positively correlated with superior learning and task performance.