Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.

An introductory course in philosophy of medicine.

Philosophy of medicine, narrowly defined as ontology and epistemology of medicine, is a well developed research field, yet education in this field is less well developed. The aim of this paper is to present an educational development in philosophy of medicine-an introductory course in philosophy of medicine. Central features of the course are described. Participants (medical undergraduate students) scored high on average. The conclusion is that further such educational ventures in philosophy of medicine should be developed and implemented.

Depression and competence to refuse psychiatric treatment.

Individuals with major depression may benefit from psychiatric treatment, yet they may refuse such treatment, sometimes because of their depression. Hence the question is raised whether such individuals are competent to refuse psychiatric treatment. The standard notion of competence to consent to treatment, which refers to expression of choice, understanding of medical information, appreciation of the personal relevance of this information, and logical reasoning, may be insufficient to address this question. This is so because major depression may not impair these four abilities while it may disrupt coherence of personal preferences by changing them. Such change may be evaluated by comparing the treatment preferences of the individual during the depression to his or her treatment preferences during normal periods. If these preferences are consistent, they should be respected. If they are not consistent, or past treatment preferences that were arrived at competently cannot be established, treatment refusal may have to be overridden or ignored so as to alleviate the depression and then determine the competent treatment decision of the individual. Further study of the relation between depression and competence to refuse or consent to psychiatric treatment is required.

A prospective study of posttraumatic stress symptoms and nonadherence in survivors of a myocardial infarction (MI).

We examined a novel hypothesis that links symptoms of MI-related posttraumatic stress disorder (PTSD) to nonadherence. According to this hypothesis, patients who are traumatized by their medical illness do not take their medications as prescribed. As a part of the avoidance dimension of PTSD, patients who are traumatized may avoid being reminded of the MI by not taking the medication. MI survivors were prospectively followed for 6 months to 1 year. Adherence was assessed by pill count of Captopril. Demographic variables, medical risk factors, PTSD, and other psychiatric symptom dimensions were evaluated during follow-up. One hundred two of 140 recruited patients completed follow-up. Nonadherence to Captopril was associated with poor medical outcome (r=.93, P=.006). Above-Threshold PTSD symptoms were associated with nonadherence to medications (P=.05). No other psychiatric symptom dimensions were independently associated with nonadherence. Nonadherence to medications predicts adverse outcome during the first year after an acute MI. Nonadherence is associated with PTSD symptoms, which may either be a marker for or a cause of nonadherence. Treatment of PTSD may prove to be a useful approach for improving adherence.

The relation of social support-seeking to quality of life in schizophrenia.

Social support-seeking has been shown to improve the outcome of schizophrenia. However, no study to date has documented the impact of social support seeking on self-perceived quality of life in schizophrenia, particularly not on the relation between symptoms and quality of life. The present study explored this issue with a sample of 58 outpatients diagnosed with schizophrenia without comorbidity. Social support seeking, symptoms (positive, negative, and extrapyramidal), and multidimensional self-reported quality of life were assessed cross-sectionally. Negative symptoms were inversely related to the quality of life domain of activities of daily living. Other symptoms and social support-seeking were not related to quality of life, and social support-seeking did not interact with symptoms in their relation to quality of life. Social support-seeking may thus not be beneficial (nor disruptive) as a way of coping with symptoms in schizophrenia. More studies are needed in order to investigate the relation of social support-seeking to symptoms and to quality of life in serious mental illnesses such as schizophrenia, so that interventions with persons suffering from these disorders may be better guided.

A meta-ethical critique of care ethics.

A meta-ethical analysis demonstrates that care ethics is a grounded in a distinct mode of moral reasoning. This is comprised primarily of the rejection of principles such as impartiality, and the endorsement of emotional or moral virtues such as compassion, as well as the notion that the preservation of relations may override the interests of the individuals involved in them. The main conclusion of such a meta-ethical analysis is that such meta-ethical foundations of care ethics are not sound. Reasonable alternatives for care ethics may be its formulation as an additional principle within an established principlist framework, or the move to a dialogical ethics, where the good to be acted upon is not decided in advance but rather critically discussed and established within the encounter of the parties involved.

The impact of coping on the relation between symptoms and quality of life in schizophrenia.

The relation between severity of symptoms and level of quality of life in schizophrenia is not strong. This situation may be explained by the hypothesis that the relation is moderated by ways of coping which are known to overcome stress. The main objective of the study was to evaluate this hypothesis by assessing the relations between positive and negative symptoms, problem-focused and emotion-focused ways of coping, and various domains of quality of life in a group of psychiatric outpatients diagnosed with schizophrenia. Subjects were recruited from a community mental health center. Fifty-eight adult outpatients diagnosed with schizophrenia who gave informed consent were assessed cross-sectionally with the Positive and Negative Syndrome Scale (PANSS), the Ways of Coping Checklist, and the Wisconsin Quality of Life Index. Negative symptoms were inversely related to activities of daily living, and positive symptoms were directly related to distress. There were no other significant relations between symptoms and quality of life. Problem-focused and emotion-focused coping did not moderate the relation between symptoms and quality of life. Further study is required concerning coping in schizophrenia.

The ends of medical intervention and the demarcation of the normal from the pathological.

This study examines the ends of medical intervention and argues that mainstream contemporary medicine assumes that appropriate ends may be discovered (i.e., naturalism), rather than created or decided upon (i.e., conventionalism). The essay then applies these considerations to the problem of the demarcation of the normal from the pathological. I argue that the common formulations of this dispute commit a fallacy, as they characterize the "normal" as a state of the organism and not as an ongoing process within it. Such a process may be characterized as self-creation and self-repair. Such considerations support the conclusion that normality may be regarded as a regulative idea, rather than as an end-state, and as part of the ends of medical intervention, depending upon choice and context.

Visual search in schizophrenia: latent inhibition and novel pop-out effects.

A visual search task was used to assess attentional function in a mixed group of schizophrenic patients and in normal controls. Subjects identified presence or absence of a unique shape presented with homogeneous distractors. Response time (RT) was examined as a function of prior experience with target, distractor, or both. On each trial, targets and/or distractors were either novel or familiar. Schizophrenic patients were slower than controls in all conditions. In the test phase, three target/distractor conditions were examined (PE - target and distractors pre-exposed but reversed; NPE - target novel and distractors pre-exposed; NOV - novel target and distractors). As predicted, normal controls, but not schizophrenics, showed latent inhibition (LI: PE minus NPE). The latter finding was due to the absence of normal LI in female patients. A novel pop-out effect (NOV minus NPE) was obtained which did not interact with any of the other variables. The results suggest that the LI effect is indeed related to the processing of irrelevant stimuli, and that, at least female schizophrenic patients process such stimuli differently from controls. Past inconsistencies in the LI-schizophrenia literature may be the result of disproportionate gender compositions in patient and control groups.

The biopsychosocial model of medicine revisited: a meta-theoretical excursion.

Engel's biopsychosocial model of medicine has been widely endorsed by contemporary medicine, at least in theory. Yet, whereas Engel's notion refers mainly to physician-patient communication, the prevalent interpretation of this model is mainly etiological. The present meta-theoretical study examines the relation between the different notions of the model. Using logical analysis and the theory of (critical) rationality, in particular Wettersten's theory of (complementary) styles of rationality, it is argued that the different notions of the model may be complementary, rather than contradictory or incommensurable as usually implied by those holding them.

Breaking bad news and personality assessment.

Breaking bad news to seriously ill patients is an especially difficult and important part of patient education and counseling. Guidelines for breaking bad news have been previously presented, but this is the first report to address the personality of the patient in deciding how to break had news. A case study of a patient diagnosed with amyotrophic lateral sclerosis is presented. A psychiatric consultation assisted in assessing the patient's personality and thus preparing the medical staff for breaking the bad news to him. The patient was assessed as having an obsessive-compulsive personality, and consequently the staff was instructed to concentrate on facts and not on feelings when breaking the bad news to him. The patient coped adaptively with this procedure, as did the staff. This case report illustrates that personality assessment may be of benefit in breaking bad news to seriously ill patients. It remains to be seen whether this procedure can be successfully generalized to other patients and settings as well as to other domains of patient education and counseling, and if so--whether this will also prove to be cost-effective.

The greater Manila dengue hemorrhagic fever epidemic of 1966

In a study of 408 clinically-diagnosed cases of hemorrhagic fever, from the 1966 Greater Manila epidemic, the largest on record in the Philippines, 217 were confirmed as dengue infections, and 54 strains of dengue virus of three types were recovered. The disease afffected mostly children aged 5 to 14 years, but adults were also significantly involved. Distribution was largely central-urban and outer-urban, with fewer cases in rural areas. Correlation of data for incidence and distribution of positive cases and strains of dengue virus isolated indicated that the epidemic extended from May to October, peaked in July and August, and was caused by dengue type 3. Dengue types 2 and 4 appeared to maintain a low endemic level throughout the period of study. There was no evidence that dengue type 1 or other arboviruses were involved. All cases of hemorrhagic fever with shock, except possibly two, had secondary antibody responses, but no other correlation of antibody response to severity of disease could be made.(Summary)

Relation between command hallucinations and dangerous behavior.

This article presents an updated review of studies on the relation between command hallucinations and dangerous behavior. The author reviewed all studies published between 1966 and 1997 according to MEDLINE and between 1974 and 1997 according to PSYCLIT. Forty-one studies were found, of which 82.9 percent dealt with the relation between command hallucinations and dangerous behavior. Of these studies, 32.3 percent were controlled, and they were grouped into three partially overlapping classes: those concerned with violent behavior, those concerned with suicidal behavior, and those concerned with mediating variables. Most of these studies agreed on the non-existence of an immediate relation between command hallucinations and dangerous (violent or suicidal) behavior. Even though the studies were divided about the existence of a relation between severity/dangerousness of command content and compliance with the commands, there was agreement about the existence of a direct relation between compliance with commands and both benevolence and familiarity of commanding voice. It seems that the research and knowledge available to date on this subject is both scant and methodologically weak. Future study should probably concentrate on mediating factors, such as appraisal and coping attitudes and behaviors.

Modified crisis intervention for personality disorder.

This study proposes that the goal of crisis intervention for persons with personality disorders should be to return them to their pre-crisis level of functioning, even though this is maladaptive. This is contrasted with standard crisis intervention, which aims to return normal or neurotic persons to their pre-crisis normal or neurotic functioning, usually by means of few and short-term therapeutic encounters. The modification proposed costs more time and resources in persons with personality disorders in crisis and fits the intervention to the personality type. This is illustrated by the case of Eve, a patient in crisis, whose pre-crisis functioning was maladaptive because of a dependent personality disorder. The goal of (modified) crisis intervention in this case was to return the patient to her dependent lifestyle, by means of pharmacotherapy combined with intensive supportive psychotherapy during 3-4 months of partial (day) hospitalization. The special nature of crisis in personality disorders is discussed.