Prognostic Value of Motor Timing in Treatment Outcome in Patients With Alcohol- and/or Cocaine Use Disorder in a Rehabilitation Program.

Introduction: Individuals with Substance Use Disorder (SUD) often have cognitive deficits in multiple domains, including motor timing deficits, with recovery times of up to 1 year. Cognitive deficits influence treatment outcomes and abstinence. To our knowledge, timing deficits have not been investigated with regard to treatment outcome and relapse. Methods: This prospective study tested the prognostic value of motor timing in SUD with regard to treatment outcome. The study sample consisted of 74 abstinent in-patients at a private treatment programme for drug/alcohol dependence at the Momentum Mental Healthcare clinic in Somerset West, South Africa, diagnosed with alcohol and/or cocaine dependence. Participants were tested at three points: (i) Within 72 hours of the start of the treatment programme (ii) after completion of the treatment programme at 8 weeks (measure of treatment response) through filling out self-report questionnaires and experimental motor task testing, and (iii) a third visit followed through a telephonic interview at 12-months (measure of relapse). Results: Motor timing alone predicted 27 percent of the variance in alcohol self-efficacy score change, and 25 percent variance in cocaine self-efficacy change scores at treatment completion. Specifically, spatial errors, synchronization errors and inter- response interval errors of a spatial tapping task at baseline predicted self-efficacy in alcohol self-efficacy. Cocaine self-efficacy was predicted by spatial errors and contact times of a spatial tapping task at very high tempi (300 ms) only. The high rate of dropout at 12 months post-treatment did not allow for further analysis of the prognostic value of motor timing on relapse. Conclusions: The results of this investigation show us that motor timing holds prognostic value with regard to treatment outcomes. Motor timing predictors for relapse require further investigation going forward.

Basal cortisol and DHEA levels in women with borderline personality disorder.

Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients' cortisol secretions decreased relatively less steep during the day than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.

Movement planning deficits in schizophrenia: failure to inhibit automatic response tendencies.

INTRODUCTION: Explicit planning deficits have been reported frequently in patients with schizophrenia. This study addressed the question whether these patients would already encounter difficulties in a more "implicit" process of planning an optimal sequence of movements in simple actions. METHODS: Twenty patients with schizophrenia and 20 controls participated in the study. The motor tasks consisted of copying simple line drawings in which the planning of a movement sequence was taxed along various dimensions. In the first task the number of line elements varied between one and two, and the two-line figures differed with respect to the ease with which the so-called graphic production rules could be applied. In the second task the spatial position of the drawing varied between an easy centre position and a somewhat more difficult corner location. In the third task, subjects were asked to start copying either at a preferred or at a less preferred starting point. RESULTS: The results showed that the patients did not encounter planning difficulties while copying the one- or two-segment patterns. However, the variations in the spatial conditions and starting point did affect the patients' performance more than that of the controls. Whereas the patients with higher negative symptom scores tended to be slower when they were forced to start drawing at a particular point, the patients predominantly exhibiting features of disorganisation proved to be faster in this condition. CONCLUSIONS: The findings suggest a fairly intact initiation of simple movement sequences in patients with schizophrenia, but difficulties in inhibiting automatic response tendencies. It is concluded that this inhibition failure may play an important role in the planning difficulties these patients experience.

Frequency and trends of interventions of prescriptions in Flemish community pharmacies.

OBJECTIVE: To study the role of the community pharmacist in medication management. METHOD: Participating Flemish pharmacists quantified their interventions during two weeks by use of validated diagrams. The clinical interventions were recorded in detail, while the technical interventions were only registered. RESULTS: 124 pharmacists participated. Intervention was needed in 4.1% of the total number of prescriptions (n = 87.647). On average, 20.2 technical and 8.4 clinical interventions over a period of 2 weeks per pharmacy were needed. The main problem was missing or incorrect data on administering the drug (23%). Missing or incorrect advice (37.8%), dose-related problems (26.1%) and interactions or contra-indications (20.2%) were mentioned as important clinical discrepancies. The pharmacists utilized the patient medication records to solve most of the problems. In one out of five cases, the physician was contacted. CONCLUSION: Interventions by community pharmacists in medication management have been recorded in this study. The results should be translated into a process of integrated pharmaceutical care.