bluuebunny/crossref_metadata_2025 huggingface dataset:
Review Article : Shoutd "Probation" be Involved in Marital Work?
Authors: Chapman Jack
Published: March 2007

(Until his retirement last year, Jack Chapman worked for several years in the Inner London divorce court welfare section. He is still acknowledged as one of NAPO's authorities on domestic work and contributed to NAPO's evidence to the working party, whose report he now reviews.)
Sharing Clinical Responsibility
Authors: Tonak Dorothy , Sher Mannie
Published: March 2007

This article describes the work of two professional people from different agencies providing help to a psychiatrically disturbed arsonist. It highlights the conflicts for the client and for the probation officer and social worker and focuses attention on the issue of collaborative work.
Our Way down South
Authors: Goslin John
Published: March 2007

A member of Bournemouth Branch writes about work and pleasure on the Dorset coast. Tips for pleasure-seekers during Conference.
Who makes Policy: Why and How?
Authors: Adam Sheena , Moss Les , Pleasance Geoff
Published: March 2007

At a time when issues about the management and purpose of the Probation and After-Care Service are being debated, members of the Greater Manchester branch of NAPO draw attention to local develop ments which they have found disturbing, and relate them to issues of importance to the Service and NAPO nationally.

In view of the article's critical stance towards the management of their area, the Editorial Advisory Board gave a limited right of reply to the CPO of Greater Manchester, for publication in this issue. That reply follows the main article.
A CSV Placement from Prison
Authors: Michael Peter
Published: March 2007

The author, now on parole, describes his short Community Service Volunteer placement, arranged after he had been given his parole date. He makes a number of comments on the effects of imprison ment, and how people may better be prepared for the world outside.
Information Training in Pakistan
Authors: Mohammedally Rafia
Published: March 2007

Facilities for para-professional training and professional education in library and informa. tion work in Pakistan are described. The Uni versity Grants Commission Curriculum for Lib rary and Information Science has been intro duced in all university library science depart ments. The lack of teaching staff and profes sional literature create serious problems. Post- experience courses are offered through an Anglo-Pakistani cooperation programme. Selected Unesco documents on education and training are listed.
IFLA and Regional Participation
Authors: Laverne Carroll Frances
Published: March 2007

Edited text of an interview with Joseph Soosai, former Chief Librarian, Rubber Research Institute of Malaysia, about his seventeen years' involvement with the regional activities programmes of the International Federation of Library Associations and Institutions (IFLA). Discusses the origins and organization of the programme, the establishment of the Regional Development Fund and IFLA's core programme for the Advancement of Librarianship in the Third World (ALP). Emphasizes the important contribution which regional and subregional library associations can make to library development in the Third World and proposes the establishment of a worldwide network of national, subregional and regional associations, with IFLA at the apex.
Word from an IFLA fox: an interview with Else Granheim
Authors: Laverne Carroll Frances
Published: March 2007

Edited text of an interview with Else Granheim, Director General, Statens Bibliotektilsyn (Norwegian Directorate for Public and School Libraries), Oslo, and former President of the International Federation of Library Associations and Institutions (IFLA). The role of president of IFLA is discussed from the point of view of a woman, the only one who has held the office. Also, the structure and problems of IFLA are discussed.
The information imperative in the development of the Commonwealth Caribbean
Authors: Henry Ralph M. , Henry Ralph M.
Published: March 2007

Analyzes the relationship between information and economic performance in Commonwealth Caribbean countries and concludes that these countries have to develop a high level of information sensitivity among their populations in order to survive.
Energy information services: experience of the Regional Energy Resources Information Centre (RERIC)
Authors: Suraniranat On-anong , Vespry H.A. , Paisarnat Somchart
Published: March 2007

Describes the activities and services of the Regional Energy Resources Information Centre (RERIC) at the Library and Regional Documentation Centre of the Asian Institute of Technology, Bangkok, Thailand.
An automated microfilm system in Hong Kong
Authors: Chow Wing S.
Published: March 2007

The use of microfilm as a means of governing huge volumes of documents in offices is familiar to many. However, the planning issue for designing and implementing a microfilm system has not been adequately addressed by practitioners. Presents a protocol for the planning of a computer-based microfilm system that has been designed and implemented in the library of a medium-sized manufacturing firm in Hong Kong. To facilitate the planning process, a number of decision support systems were developed.
Scientific and technical information in Ghana
Authors: Alemna A.A.
Published: March 2007

Describes the situation of scientific research and the provision of scientific and technical information in Ghana, with special reference to the role of the Ghana National Scientific and Technological Information Network (GHASTINET). Obstacles to the provision of adequate resources of scientific literature include: lack of finance; difficulty in identifying local publications; inappropriate gifts from donors; and lack of library staff with scientific backgrounds. Includes recommendations for improving the situation.
The international standard for the description of archives: a progress report
Authors: Cook Michael
Published: March 2007

Progress report on efforts to develop an international standard for the description of archives (ISDA(G)) under the auspices of the International Council on Archives (ICA).
The 5-HT1A agonists 8-OH-DPAT, buspirone and ipsapirone attenuate stress-induced anorexia in rats
Authors: Dourish C.T. , Kennett G.A. , Curzon G.
Published: March 2007

The effects of 5-HT agonists and antagonists, benzodiazepine anxiolytics and tricyclic antidepressants on restraint stress-induced anorexia in rats were examined. The selective 5-HT1A agonists 8-hydroxy-2-(di- n-propylamino)tetralin (8-OH-DPAT), buspirone and ipsapirone, when injected 2 h after the termination of stress, attenuated stress-induced anor exia and body weight loss. The effects of 8-OH-DPAT on stress-induced anorexia were blocked by the 5-HT1A antagonist spiperone but not by the 5-HT2 antagonist ketanserin. The preferential 5-HT1B agonists RU-24969 and quipazine induced anorexia in unstressed rats and tended to supplement the anorectic effects of stress. The benzodiazepines chlordiazepoxide and diazepam and the 5-HT antagonist cyproheptadine had no effect on stress-induced anorexia, when given (like the 5-HT1A agonists) 2 h after the stress. Similarly, daily injection for 2 weeks of the tricyclic antidepressants desipramine and sertraline had no beneficial effect. The data suggest that 8-OH-DPAT, buspirone and ipsapirone attenuate stress-induced anorexia in rodents by a hyperphagic action on 5-HT1A receptors.
Antidepressants: Their efficacy and place in therapy
Authors: Paykel E.S.
Published: March 2007

This paper reviews and relates to the wider published literature a series of studies directed to the broad question of which antidepressant treatment is required for which kind of depressed patient. Adequate methodology requires comparisons with placebo and other active drugs, rather than analysis of single treatment groups, so that the magnitude of therapeutic benefit due to specific drug effects can be measured. Reasonably firm conclusions are now possible. Electroconvulsive therapy (ECT) is most effective in severely depressed patients, particularly those with delusions or retardation, and is superior to antidepressant drugs in such patients. Monoamine oxidase (MAO) inhibitors show some selectivity towards patients with anxiety or reversed functional shift symptoms, but this selectivity appears quite limited, and tricyclic antidepressants also benefit such patients. The possibility of other factors, not well reflected in clinical features, which determine consistency of response requires further investigation. Recent evidence has led to re-evaluation of the earlier view that tricyclic antidepressants were specifically indicated in endogenous depressions. They appear to be broad-spectrum antidepressants, with efficacy extending more widely into neurotic disorders, mixed anxiety depressions, anxiety disorders, and into the relatively mild non-endogenous depressions of general practice.
Antidepressant treatments, including electroconvulsive shock and the putative antidepressant sibutramine hydrochloride, do not alter [3H]-prazosin binding to rat cortical membranes
Authors: Martin K.F. , Phillips I. , Heal D.J. , Buckett W.R.
Published: March 2007

Treatment for 1, 3 or 10 days with sibutramine hydrochloride (3 mg/kg), desi pramine (10 mg/kg), amitriptyline (10 mg/kg) or pargyline (10 mg/kg) did not effect the number or affinity of α1-adrenoceptors as determined by [3H]-prazosin binding to rat cerebral cortical membranes. Similarly, neither single, nor repeated (five times over 10 days) electroconvulsive shocks, given under halothane anaesthesia had any effect on the parameters of [3H]-prazosin binding. These data suggest that the clinical actions of these treatments are unlikely to involve changes in α1-adrenoceptor function.
A double-blind placebo-controlled study of rolipram in depressed in-patients
Authors: Rowlands M.W.D. , Silverstone T. , Cookson J.C.
Published: March 2007

In a double-blind study, rolipram, a new phosphodiesterase inhibitor, was com pared to placebo in 20 hospitalized depressed patients. There was a high rate of non- completion (11 out of 20) at 28 days. No difference was found in the clinical improvement between the two groups.
5-HT1A Receptors in major depression
Authors: Yates M. , Ferrier I.N.
Published: March 2007

The 5-HT1A receptor has been studied using quantitative tritium film auto radiography in post-mortem frontal cortex of 15 cases suffering from major depression and controls matched for age, sex, post-mortem delay and storage time. 5-HT1A receptor binding in the depressive cohort was not significantly different from control values. No consistent effects of antidepressant medication or mental state at death were seen on the results.
Critique
Authors: Salmon P. , Stanford S.C.
Published: March 2007

Because stress is implicated in serious psychiatric and physical illnesses, it is important to investigate the central neurochemical mechanisms which determine resistance to stress. Two features of much existing animal work limit its relevance to man. First, it has disregarded differences between individuals, focussing instead on group means. Secondly, it has concentrated on noxious forms of stress. Preliminary studies suggest that inferences from this work may not apply to individual differences, or to non-noxious stress. Therefore, a strategy is proposed for addressing the neurochemical basis of individual differences in resistance to non-noxious stress.
Invited commentary: complexities in evaluating neurobiological models for stress resistance
Authors: Krystal John H.
Published: March 2007

Professors Salmon and Stanford are to be commended for their efforts in drawing attention to noradrenergic contributions to stress resistance and the potential importance of within-subject patterns of stress response. In commenting on their paper, I would like to develop the following points: (1) self-control over stress exposure strongly influences the noradrenergic response to stress; (2) β-receptor regulation may reflect a lower sensitivity to stress under a carefully specified range of conditions; and (3) genetic and environmental factors may interact in a complex fashion that may not fit simple linear models based on β-receptor function.
The effect of the CS-UCS interval and extinction on place conditioning and analgesic tolerance with morphine
Authors: Hinson Riley E. , McKee Sherry A. , Lovenjak Tom , Wall Anne-Marie
Published: March 2007

In experiment 1, a CS-UCS interval study of place conditioning and analgesic tolerance with morphine was conducted. Morphine (10 mg/kg i.p.) was administered to separate groups of rats either 2 h prior to, 1 h prior to, immediately prior to, immediately after or 2 h after 30-min confinement in one end compartment of a place conditioning apparatus. A total of three choice tests was given, one after every six morphine injections. A preference for the end compartment contingent upon morphine injection was shown in groups that received morphine prior to end compartment placement. Groups that received morphine after end compartment placement were not different in their preference behavior from groups that received only saline during place conditioning training. A hot-plate test for tolerance to the analgesic effect of morphine was given at the end of all choice testing. All groups that had received morphine during place conditioning training were equally tolerant. These results indicate a dissociation between the analgesic effect of morphine and the effect that produces place preference, since the former was not affected by temporal parameters that did affect the latter. In the second experiment, the effect of extinction on a morphine-induced place preference was studied using extinction procedures that, in contrast to previous studies, equated exposure to both end compartments. Whereas the morphine-induced place preference was undiminished by a 10-day retention period in which animals received saline injections in the home cage, extinction trials during the same period eliminated the place preference. These results provide evidence that morphine-induced place preferences involve associative processes.
Comparative amnesic and sedative effects of lorazepam and oxazepam in healthy volunteers
Authors: Curran H.Valerie , Gorenstein Clarice , Lader Malcolm
Published: March 2007

Oxazepam and its chlorinated derivative, lorazepam, have similar half-lives but differing potencies. This study compared the effects of these two benzodiazepines with a placebo on memory, mood and psychomotor function. Thirty six volunteers took part in a double-blind, independent groups design. Subjects completed a battery of tests before and 2.5 h after drug administration. Lorazepam 2 mg produced more profound subjective and motor sedation than oxazepam 30 mg, and this in turn produced a similar, global pattern of impairments across a wide range of tasks. However, lorazepam produced greater decrements than oxazepam on a task involving episodic memory even when sedative effects were partialled out. We suggest that this finding may reflect either differential task sensitivities or a contribution of priming to performance on the explicit memory task.
Clomipramine and initial worsening in panic disorder: beyond the 'jitteriness syndrome'
Authors: Ramos Renato T. , Gentil Valentim , Gorenstein Clarice
Published: March 2007

The time course and the phenomenology of the initial response to clomipramine (10-20 mg/day) was investigated in 70 patients with panic disorder with or without agoraphobia. Nineteen (27.1%) patients reported worsening of their clinical state which, on average, began 28 h after the first dose and lasted for 5 days. Increase in the frequency and severity of panic attacks was the most frequent finding (14 patients), followed by psycho- stimulant (jitteriness; n=9), depressive (n=8) and tonic anxiety symptoms (n=7). This pattern of initial worsening is different from the 'jitteriness syndrome' described for other antidepressants. Its implications for the understanding of the pathophysiology of panic disorder are discussed.
5-HT 1A receptors and changes in extracellular 5-HT in the guinea-pig prefrontal cortex: involvement in aversive behaviour
Authors: Rex A. , Marsden C.A. , Fink H.
Published: March 2007

The study demonstrates that guinea-pigs handled daily from birth exhibit similar behaviour to rats on the elevated plus maze. Simultaneously performed intra-cortical microdialysis showed that placing guinea-pigs on the elevated plus maze results in an increase in extracellular 5-HT in the frontal cortex. 8-OH-DPAT (0.3 mg/kg s.c.) reduced significantly the increase in cortical extracellular 5-HT and resulted in an 'anxiolytic' profile of behaviour. Pre-treatment with the 5-HT1 antagonist methiothepin (10.0 mg/kg) antagonized the behavioural effects and prevented the increase in cortical extracellular 5-HT normally produced by exposure to the elevated plus maze. Methiothepin alone had no effect on behaviour in the elevated plus maze. 5-CT (0.1 mg/kg i.p.) abolished the rise in extracellular 5-HT, but did not produce an 'anxiolytic' profile of behaviour on the elevated plus maze. The results show that an increase in cortical extracellular 5-HT occurs in the saline- treated guinea-pig exposed to aversive conditions. It remains to be determined whether the 'anxiolytic' effect of 8-OH-DPAT in the guinea-pig is causally associated with decreased basal extracellular 5-HT. The results however indicate that there is no simple relationship between inhibition of 5-HT release and behaviour indicative of 'anxiolytic' drug actions.
The effects of CRF and α-helical CRF on anxiety in normal and hypophysectomized rats
Authors: Adamec Robert E. , McKay Don
Published: March 2007

The effect of corticotrophin-releasing factor (CRF) on anxiety in normal and hypophysectomized (HYPOX) rats was investigated. Intracerebroventricular injection (i.c.v.) of 2 μg of CRF increased anxiety in the elevated plus maze test in normal and HYPOX rats. Anxiety was measured as the ratio of time spent in the open arms of the maze to total time spent in all arms of the maze. CRF also reduced head dipping and rearing in the hole board, and the number of entries into the arms of the plus maze. These latter changes in behavior were independent of the changes in anxiety. All behavioral effects of CRF in HYPOX rats were blocked completely by the CRF receptor blocker, α-helical CRF (50 μg). Completeness of hypophysectomy was assessed by measuring plasma corticosterone (CORT) level changes 20 min after i.c.v. CRF (2 μg). CORT levels of all HYPOX rats given CRF were well below (< 1/10th) resting baseline levels of normal rats. Moreover, i.c.v. injection of saline vehicle nearly tripled CORT levels over resting baseline in normal rats, and CRF increased CORT levels 2-fold over vehicle. Taken together, these findings replicate the observation that CRF administered i.c.v. to rats is selectively anxiogenic in the elevated plus maze. They also indicate that the anxiety produced by CRF does not involve activation of the pituitary—adrenal axis. Rather, CRF-induced anxiety depends on the binding of CRF to central nervous system CRF receptors. Finally, the plasma CORT data indicate that i.c.v. injection of saline vehicle is stressful, as is injection of CRF.
The effect of Ro 15-4513, an inverse agonist at the benzodiazepine receptor, on the exploratory response to novelty in the playground maze
Authors: Nicholls Briony , Mellanby Jane , Smith Stephen
Published: March 2007

The effects of chlordiazepoxide and the inverse agonist, Ro 15-4513, were compared on the exploratory response of rats to a novel object introduced into a familiar environment containing seven familiar objects. While chlordiazepoxide (5 mg/kg) increased the novelty response, Ro 15-4513 reduced the response in a dose-dependent manner (0.5-5.0 mg/kg). This action was specific to novelty since the response to the familiar objects was unaffected. Both drugs produced some reduction in ambulation. The effects of both drugs were blocked by flumazenil (10 mg/kg), which at this dose did not itself have any intrinsic effect on the response. Muscimol (0.001 mg/kg) had a weak chlordiazepoxide-like effect and baclofen (3 mg/kg) had a weak effect in the opposite direction.
The efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants
Authors: Anderson I.M. , Tomenson B.M.
Published: March 2007

A meta-analysis of the efficacy of five selective serotonin re-uptake inhibitors (SSRIs) against non-selective and noradrenergic re-uptake inhibitors (mainly tricyclic antidepressants, TCAs) is presented. Fifty five double- blind studies were identified after excluding those multiply reported or with methodological problems likely to bias the outcome in favour of SSRIs. Standardised effect sizes and 95% confidence intervals were calculated based on the difference in the reduction in mean Hamilton depression rating scale (HDRS) scores for the two antidepressants. For studies not reporting standard deviations, the pooled variance from complete studies was used and a variance-weighted mean effect size calculated. There were no differences in efficacy between SSRIs and comparator antidepressants for SSRIs taken together or individually. If studies were classified into high and low depression scores based on a median split of initial HDRS scores, there was a slight advantage to TCAs in the high HDRS group. In addition, SSRIs were slightly less effective than TCAs in in-patients and against combined serotonin and noradrenaline re-uptake inhibitors (clomipramine and amitriptyline). These findings were accounted for by a clinically significant lower efficacy of paroxetine in these subgroups. In contrast, SSRIs as a group were marginally more effective than noradrenergic antidepressants, a finding accounted for by two studies with sertraline. Fluvoxamine was the only SSRI to have been tested adequately in in-patients, where it displayed equal efficacy to TCAs. This meta-analysis confirms that SSRIs and TCAs are in general equally effective, but suggests that paroxetine's efficacy in in-patients and against clomipramine and amitriptyline is not proven.
A cognitive dysfunction in anxiety and its amelioration by effective treatment with SSRIs
Authors: Weinstein Aviv M. , Nutt David J.
Published: March 2007

There is extensive research suggesting an abnormal selective attention to threat in anxiety disorders. We assessed the processing of emotional cognitions of physical anxiety, psycho-social fears, depression and positive affect in a cohort of 15 patients with active anxiety disorder (mostly panic) in comparison with a group of 15 depressed patients and 15 recovered panic patients after treatment with antidepressants (all selective serotonin re-uptake inhibitors) and an age- and sex-matched normal control group. Anxious patients showed delayed processing of emotional words (both negative and positive) compared with depressed patients. The successfully treated group showed no such interference and their responses were indistinguishable from controls. It would therefore appear that anxious patients (panic and generalized anxiety disorder) are affected primarily (but not exclusively) by themes of self-harm and psycho-social fears, and that this cognitive dysfunction in pathological anxiety is a state rather than trait feature of the condition, which is responsive to pharmacological intervention.
Menstrual cycle effects on the action of buspirone on food intake in healthy female volunteers
Authors: Goodall E.M. , Whittle M. , Cookson J. , Cowen P.J. , Silverstone T.
Published: March 2007

We studied the effect of single doses of the 5-HT1A agonist buspirone (10 mg and 20 mg) on food intake during the menstrual cycle of nine healthy women, none of whom were on a contraceptive pill. In a double-blind placebo-controlled trial, subjects were tested over three cycles, receiving one treatment per cycle. Within each cycle, they were tested at two time points; mid-follicular and late luteal. Food intake following 20 mg buspirone was significantly higher in the luteal phase, suggesting the possibility of pre-menstrually enhanced 5-HT receptor sensitivity.
Caffeine withdrawal symptoms and rate of metabolism
Authors: Lader Malcolm , Cardwell Claire , Shine Philip , Scott Nigel
Published: March 2007

Forty normal subjects (mean age 36) had their caffeine intake estimated by keeping a diary (n=40) and also by analysing provided samples of tea and coffee (n=28). A test dose of caffeine (500 mg) was given and a series of salivary samples analysed to estimate pharmacokinetic measures of the rate of caffeine metabolism. They then underwent 48 h of placebo substitution using double-blind procedures. A wide range of physiological, psychological and subjective measures were taken on successive days during withdrawal and resumption of caffeine. On withdrawal, 27 subjects reported tiredness and 18 developed headache. Electroencephalograph, skin conductance and blood pressure changes were apparent. Sleep improved on withdrawal but subjects reported feeling less alert and more tired. The higher the usual caffeine intake, the greater the unpleasant feelings on withdrawal and the more marked the reversal of feelings on resumption. The faster the metabolism of caffeine, the less the drop in anxiety during withdrawal and the less its return on resumption. These correlations were, however, rather weak and sporadic.
Some behavioural and neurochemical effects of ipsapirone in two rodent models of depression
Authors: McNamara Mairead G. , Kelly John P. , Leonard Brian E.
Published: March 2007

The effect of ipsapirone (3 and 10 mg/kg once daily, i.p. for 21 days), was assessed in two animal models of depression, namely the forced swim test and on the hyperactive response of the olfactory bulbectomized (OB) rat in the 'open field' test. The response to 8-hydroxy-2-(di- n-propylamino)tetralin (8-OH-DPAT; 0.15 mg/ kg, s.c.)-induced hypothermia in rats was examined on day 16 of ipsapirone treatment. In the forced swim test, subacute treatment with ipsapirone (3 and 10 mg/kg) significantly reduced the immobility time in both sham and OB groups. In the OB rat model, chronic treatment with 10 mg/kg ipsapirone antagonized the lesion- induced hyperactivity in the 'open field' apparatus. The hypothermic response to 8-OH-DPAT was attenuated after chronic treatment with 3 mg/kg ipsapirone in both sham and OB groups, while 10 mg/kg ipsapirone attenuated this temperature reduction only in the sham group ( p<0.05). Ipsapirone (10 mg/kg) significantly increased home cage locomotor activity counts on days 15 and 21 of drug treatment in the OB dose group, but only on day 21 in the sham dose group (p < 0.05). Ipsapirone (10 mg/kg) caused a significant reduction in rectal temperature 30 min following drug administration in the sham group on day 1 (p < 0.05) but in the OB group on days 1, 7, 15 and 22 ( p < 0.05) of drug treatment. No significant differences in basal serum corticosterone concentrations were found either associated with olfactory bulbectomy or drug treatment. Chronic ipsapirone treatment did not attenuate the reductions in noradrenaline and serotonin in the frontal cortex of OB animals. It can be concluded that ipsapirone shows antidepressant-like activity in the forced swim test and the OB rat model of depression.
The inhibition of the pupillary light reflex by the threat of an electric shock: a potential laboratory model of human anxiety
Authors: Bitsios P. , Szabadi E. , Bradshaw C.M.
Published: March 2007

It has been shown that the eye-blink response evoked by an abrupt loud white noise ('acoustic startle') is potentiated when the subjects anticipate an aversive stimulus, e.g. an electric shock ('fear-potentiated startle'). It has been proposed that this paradigm may be a useful laboratory model of human anxiety. We examined whether the threat of an electric shock, as used in the fear-potentiated startle paradigm, would affect the pupillary light reflex, in 12 healthy volunteers. Light stimuli (0.32 mW/cm2, 200 msec) were generated by a light-emitting diode, and pupil diameter was monitored by computerized binocular infrared television pupillometry in the dark. The light reflex was recorded during either the anticipation of a shock ('threat' blocks) or periods in which no shocks were anticipated ('safe' blocks). The shock consisted of a single square wave current pulse (1.5 mA, 50 msec) applied to the median nerve. At the end of each 'threat' or 'safe' block, subjects rated their anxiety using visual analogue scales. Two-factor analysis of variance (condition x block) showed that in the 'threat' condition there was a consistent increase in initial pupil diameter, a decrease in light reflex amplitude and an increase in alertness and anxiety ratings. These effects were observable before the subjects received any shock (a single stimulation of the median nerve). These results show that the anticipation of an electric shock can modify not only the startle reflex response but also the pupillary light reflex, suggesting that the inhibition of the light reflex by threat may be another suitable laboratory model of human anxiety.
Neuropsychological and neuroimaging evidence for the involvement of the frontal lobes in depression
Authors: Goodwin Guy M.
Published: March 2007

The onset and reversibility of major depression is likely to be explained by diffuse neuromodulatory mechanisms rather than permanent abnormalities of connectivity and neurotransmission. However, the expression of mood state appears to involve fronto-striatal mechanisms. Lesions of the ventral frontal cortex give rise to profound modification of affect and behaviour not explained by effects on current intellectual function. These may represent the most extreme possible disturbances of emotional experience. Neuropsychological testing in major depression shows evidence of slowing in motor and cognitive domains with additional prominent effects on mnemonic function most marked in the elderly. Structural imaging with X-ray computed tomography or magnetic resonance imaging in older patients with major depression shows evidence of structural abnormality compared with controls. These findings are not highly localizing but they tend to confirm the role of cognitive impairment as an important age-related risk factor for major depression. Perfusion or metabolic imaging reflects both reversible changes in function and permanent loss of active neurones. The usual finding has been reductions in anterior brain structures in major depression. Hypoperfusion tends to be greatest in frontal, temporal and parietal areas and most extensive in older (male) patients; high Hamilton scores tend to be associated with reduced uptake. There have also been correlations in the cingulate cortex between increased perfusion and other aspects of the mental state. In general, reductions in frontal areas may be more likely in patients with impoverished mental states. The more prominent impairments of memory are likely to be associated with the finding of impaired temporal function or with a more diffuse failure of neuromodulation.
Effects of ibotenic acid-induced loss of neurons in the medial prefrontal cortex of rats on behavioral vigilance: evidence for executive dysfunction
Authors: Miner Lee Ann H. , Ostrander Michelle , Sarter Martin
Published: March 2007

Rats were trained in a previously validated task for the assessment of sustained attention, or vigilance. This task required the animals to discriminate between signals of variable lengths and non-signal events by making an appropriate lever press. The performance of sham-lesioned animals in this task was characterized by a signal-length dependent number of hits. Also, approximately 70 percent of the non-signals were correctly rejected. Ibotenic acid-induced lesions of the medial prefrontal cortex decreased the relative number of hits and correct rejections and, in essence, resulted in random lever selection. The lesion did not affect the number of omissions or side bias. Furthermore, the performance of lesioned animals was insensitive to the detrimental effects of distractors. The effects of the lesions do not support an interpretation in terms of sustained attention. Rather, the pattern of the lesioned animals' performance is speculated to reveal a fundamental disruption of decisional processes, reminiscent of the executive dysfunctions observed in patients with damage to ventromedial prefrontal areas or with schizophrenia.
Effects of a specific CCK-A antagonist, Loxiglumide, on postprandial mood and sleepiness
Authors: Wells Anita S. , Read N.W. , Fried M. , Borovicka J. , D'Amato M.
Published: March 2007

Previous studies have demonstrated that feelings of sleepiness increase after ingestion of a fat-rich meal. The aim of the study was to test the hypothesis that postprandial sleepiness is mediated by cholecystokinin (CCK) acting on CCK-A receptors. A double-blind crossover study was conducted. Twelve male volunteers ate a high-fat morning meal [54% energy fat, 41% energy carbohydrate (CHO)]. On one day they received an i.v. infusion of Loxiglumide, a CCK-A receptor antagonist (30 mg/kg/h for 10 min then 10 mg/kg/h for 3 h 10 min). On another day the protocol was repeated except a saline placebo infusion was given at similar rates as the Loxiglumide, starting 20 min before the meal. Subjects' mood and sleepiness were monitored throughout using questionnaires and performance tasks. The results indicate that ratings of vigour were significantly lower during the Loxiglumide infusion than during the saline infusion, [ F(1,10)=6.65; p=0.027]. Subjects who were infused with Loxiglumide on their first test day felt significantly (p < 0.05) more fatigued, sleepy and tense and less vigorous, less efficient and had lower energetic arousal during the Loxiglumide infusion than during the saline infusion. In conclusion, the results suggest that the postprandial decline in feelings of alertness after a fat-rich meal is not mediated solely by CCK acting through CCK-A receptors.
Conditioning factors in drug abuse: can they explain compulsion?
Authors: O'Brien Charles P. , Childress Anna Rose , Ehrman Ronald , Robbins Steven J.
Published: March 2007

There is a good deal of clinical evidence suggesting that compulsion to resume drug taking is an important part of the addiction syndrome. The symptoms comprising motivation to resume drug use, namely craving and compulsion, have been studied experimentally in human subjects. While much work remains to be done, there is evidence showing that these symptoms are influenced by learning. The research has been guided by animal studies demonstrating that drug effects can be conditioned. Much attention has been directed toward demonstrating the existence of drug conditioning in human addicts and exploring the neurological structures that may underlie such learned responses. We do not yet know the relative importance of learning in the overall phenomenon of relapse, and treatments based on conditioning principles are still under investigation.
Evidence that NMDA-dependent limbic neural plasticity in the right hemisphere mediates pharmacological stressor (FG-7142)-induced lasting increases in anxiety-like behavior
Authors: Adamec Robert E.
Published: March 2007

The anxiogenic β-carboline, FG-7142, produces intense anxiety in humans and anxiety-like behavior in animals. FG-7142 also mimics the effects of exogenous stressors. In cats, FG-7142 lastingly changes defensive and aggressive behavior. Long-term potentiation (LTP) of neural transmission between limbic structures known to modulate feline defensive response to threat accompany behavioral changes. A series of three reports describes experiments designed to test the hypothesis that behavioral changes depend upon an N- methyl-D-aspartate (NMDA) receptor-based LTP of efferent transmission from the amygdala. This first study characterizes the dose and time effects of injection of the NMDA receptor blocker 7-amino-phosphono heptanoic acid (AP7) on efferent transmission from the cat amygdala to the ventromedial hypothalamus (VMH). Effects of doses of 0.5-10 mg/kg (i.v.) of AP7 on potentials evoked in the VMH by single pulse stimulation of the basal amygdala were examined. In order to localize the action of the drug, concurrent measurements were taken of potentials evoked in the VMH by stimulation of the efferent fibers from the amygdala to the VMH (ventral amygdalofugal pathway, VAF). There was a dose-dependent reduction in the amygdalo-VMH evoked potential. The greatest reduction occurred at 5 mg/kg. Effects peaked at 10 min, and persisted for at least 1 h after injection. In contrast, AP7 increased the VAF-VMH-evoked potential at 10 min after injection, with a maximal increase at 5 mg/kg. The data suggest that NMDA receptors intrinsic to the amygdala modulate excitatory efferent transmission from amygdala to VMH in the cat. It is speculated that a glutamatergic projection to γ-aminobutyric acid tonic inhibitory systems in theVMH accounts for theVAF-VMH results.
Selective serotonin reuptake inhibitors and hyponatraemia: review and proposed mechanisms in the elderly
Authors: Kirchner V. , Silver L.E. , Kelly C.A.
Published: March 2007

The association between selective serotonin reuptake inhibitors (SSRIs) and hyponatraemia has been well documented, the elderly appearing to be at greatest risk. An analysis of data of hyponatraemia in the elderly using SSRIs from all published cases and from the Committee on Safety of Medicines found that the mean time to detection was about 3 weeks after commencing SSRIs. A wide range of time to detection (1-253 days) and non-specific symptoms suggest hyponatraemia is detected by chance rather than being specifically looked for. In the elderly there are physiological changes, a high prevalence of medical illnesses and concomitant drug use, which may precipitate hyponatraemia. Together with a risk of altered water regulation in psychiatric illness this may account for the particular susceptibility of the elderly to hyponatraemia whilst using SSRIs.
Beer as an STS Issue: To Beer or Not To Beer - That Is the Question
Authors: Williams W.F.
Published: March 2007

In this module, which first appeared in Vol. 9, Nos. 2&3, pp. 168-170, 1989, an error in a formula appeared three times: CO2 and C2HSOH should read CO2. The entire article is reprinted here. The editors apoligize for this and regret any confusion this may have caused.
Inpatient Management Protocols to Reduce Health Care Costs
Authors: Wachtel Tom , Moulton Anne W. , Pezzullo John , Hamolsky Milton
Published: March 2007

A group of 12 internists, members of a university-affiliated hospital, designed and imple mented protocols for the general inpatient management of four medical problems (chest pain, stroke, pneumonia, and upper gastrointestinal hemorrhage). Hospital charges for the 63 cases were compared with charges generated by 64 controls who had been patients admitted to the same physicians with the same diagnoses during the same period of the preceding year, before the project was begun. A group of nonparticipating internists was similarly evaluated during the two time periods to control for changes in practice patterns extraneous to the intervention. Adjustment was made for inflation (6%) and differences in case mix. The program resulted in a 15% reduction in total average charge generated by the cases. Sizeable reductions were achieved in utilization of EKGs (34.8%), x-rays (15.4%), laboratory testing (20.4%), and drugs (11.4%). Given the prevailing attitude that health care costs are too high and that many services are unnecessary, the benefit of altering physician behavior by using standards established by them for themselves could be substantial, es pecially with the threat of more restrictive and less sympathetic modes of controlling costs. Key words: cost containment; inpatient management; protocols; standards of care. (Med Decis Making 6:101-109, 1986)
Increasing the Power of Clinical Trials Through Judgment Analysis
Authors: Stewart Thomas R. , Joyce C.R.B.
Published: March 2007

A method for increasing the statistical power of clinical trials to detect clinically important differences is described. Inconsistency in physicians' overall judgments of treatment effec tiveness adds "noise" to a trial that may mask either the superiority or the inferiority of particular treatments. The method described here uses "judgment analysis" to reduce errors in an individual's overall judgments of treatment effectiveness. The method can also be used to reduce error variance due to differences in judgment between physicians and may thus be particularly useful in multicenter trials. The method is illustrated with results from a recent trial. Key words: statistical power; experimental design; multi-investigator trials; judgment analysis; clinical judgment. (Med Decis Making 8:33-38, 1988)
Data Assessing the Usefulness of screening Obstetrical Ultrasonography for Detecting Fetal and Placental Abnormalities in Uncomplicated Pregnancy
Authors: Li Theodore C.M. , Greenes Robert A. , Weisberg Monica , Millan Doris , Flatley Margaret , Goldman Lee
Published: March 2007

To investigate the usefulness of screening in low-risk populations, the authors evaluated the yield of ultrasonography for detecting abnormalities in 678 clinically uncomplicated preg nancies. The yield of ultrasonography in high-risk women who were referred for amniocen tesis was remarkably similar to the yield in other women. All four diagnoses of twins were correct, but overall only six of 12 initial ultrasound diagnoses of fetal demise or fetal anomalies were confirmed at delivery. Of the eight major fetal anomalies present at delivery, including two cases of Down's syndrome, three had been detected by ultrasonography; none of the nine minor anomalies had been detected, usually because they were too small or might be detectable only at a later gestational age. Although ultrasonography may have a nearly perfect predictive value for certain anomalies, on average, in this study, positive ultrason ography increased the probability of an adverse outcome of pregnancy from 5.3% to 36%, while a normal ultrasound examination decreased the probability to 4.4%. These data, which emphasize the implications of screening a low-risk population, suggest that recommendations regarding routine screening obstetrical ultrasonography should await sufficiently large con trolled trials demonstrating consistent clinical benefit, in terms of reassurance or of providing a baseline for future comparison or in terms of improved outcome at a reasonable cost. Key words: ultrasonography; fetal anomaly; screening. (Med Decis Making 8:48-54, 1988)
Primacy Effects in Clinical Judgments of Contingency
Authors: Curley Shawn P. , Young Mark J. , Kingry Margaret J. , Yates J. Frank
Published: March 2007

In contingency judgment a primacy effect exists when a conclusion about the relationship between clinical variables is inordinately influenced by cases seen earlier rather than later in a presentation sequence. In this study, medical and nursing trainees evidenced this behavior in a hypothetical clinical judgment situation. The behavior was tied to an attention decrement explanation, by which inattention to the later-presented cases leads to inaccurate recall of the relative frequencies of observed cases, which in turn induces a misjudgment of a disease-finding contingency. An explicit intervention based on this hypothesis, forcing attention to later cases by warning that recall of the case frequencies would be required, was effective in reducing primacy effects among medical students. A related, but less explicit, intervention was also tried. This intervention did not significantly reduce primacy effects among nursing students, but was somewhat effective among general undergraduate students performing a non-clinical contingency judgment task. Key words: clinical judgment; diagnosis; decision making. (Med Decis Making 8:216-222, 1988)
Use of Linear Models to Analyze Physicians' Decisions
Authors: Wigton Robert S.
Published: March 2007

Linear models of judgment are powerful tools for studying medical decision making. The recent increase in applications of these models to medicine reflects more available computing resources and the parallel development of clinical prediction rules derived from multivariate analysis of patient data. Psychological research into expert and novice decision making shows that linear models derived from judges' decisions usually predict future decisions more accurately than either the judge or a mechanical application of the judge's stated policies. Studies of medical decision making have shown similar results, as well as marked variation among experts in how they appear to use clinical information. Cognitive feedback, which is feedback to the learner of the judgment model derived from previous decisions, is highly effective for teaching complex judgment tasks. Many technical problems remain to be mastered in constructing linear models of medical judgment. These include how to select the correct variables, how to provide a selection of variables broad enough to accommodate individual variations in strategy, how to model intercorrelated variables, and how to char acterize and aggregate individual strategies. Despite the methodologic challenges, linear models remain a powerful method for studying how physicians combine multiple items of imperfect information to make a judgment. These techniques may provide important insights into variation in physician judgments. In addition, they hold promise in teaching the appro priate integration of complex data in the day-to-day practice of medicine. Key words: linear models; medical judgment; diagnosis; prognosis. (Med Decis Making 8:241-252, 1988)
Immunization of Asymptomatic HIV-infected Children with Measles Vaccine: Assessment of Risks and Benefits
Authors: Onorato Ida M. , Orenstein Walter A. , Hinman Alan R. , Rogers Martha F. , Koplan Jeffrey P.
Published: March 2007

Because HIV infection is associated with immunologic abnormalities, concerns have been expressed about the safety and efficacy of vaccination of infected children with live virus vaccines. The authors used decision analysis to assess the likely impacts of four alternative policies for immunization of asymptomatic HIV-infected children with measles vaccine. Prob abilities for vaccine efficacy, vaccine-related adverse events, and measles complications in HIV-infected children and the prevalence of HIV infection in the birth cohort were obtained from a modified Delphi survey. Using median estimates from the Delphi survey, there were no major differences in outcomes under any proposed policy. Using the most extreme estimates, serologic testing and exclusion of seropositive children from vaccination or ex clusion of all high-risk children decreased vaccine-associated adverse events without greatly increasing measles complications, primarily because of the current low incidence of measles. Under conditions assumed to exist in the United States today, alternate immunization policies have only minor differences in societal impact although costs would certainly differ. Key words: decision analysis; measles vaccine; pediatric AIDS. (Med Decis Making 1989;9:76- 83)
How Physicians Use the Stress Test for the Management of Angina
Authors: Hartz Arthur , Houts Peter , Bartholomew Mary , Goldman Stuart , Kantner Theodore , Deber Raisa
Published: March 2007

The authors examined physicians' reasons for ordering an exercise tolerance test and the influence of the test results on management decisions. Subjects of this study included 265 family physicians in Pennsylvania who completed a questionnaire on the management of a patient with typical chronic stable angina. Eighty-one percent of the respondents reported they would order a noninvasive stress test as a first step in the management of the patient. Of these physicians, 40% would refer the patient to a cardiologist only if the exercise tolerance test were strongly positive, 8% would refer only if it were negative, and 53% would not change their referral decisions on the basis of test results. No more than 57% of the physicians rated as very important any given reason for ordering a noninvasive diagnostic test. The results suggest that a test may be ordered routinely but without a consensus as to why it is ordered and without an effect on clinical management decisions.