Biomedical subjects

P Willner

Publications and source records attributed to P Willner.

At least 19 recordsLinked to original sources

PubMed2005

The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical overview.

Historically, people with learning disabilities have had little or no access to psychotherapeutic interventions, although there are signs that, over the past decade, this situation has seen some gradual improvement. This paper provides an overview of the evidence for the effectiveness of psychodynamic, cognitive-behavioural and cognitive therapies in this client group. The available data support the position that all three approaches can be effective in people with mild learning disabilities and in a proportion of people with more severe conditions. However, the literature reporting outcomes of psychotherapeutic interventions in people with learning disabilities is extremely limited, and there is a conspicuous and unjustified poverty of randomized controlled trials. There is also very little evidence regarding either the importance of specific components of therapeutic packages, or the optimal manner of delivering these interventions to people with learning disabilities.

Cognitive Behavioral Therapy↗

PubMed2005

Assessment of anger coping skills in individuals with intellectual disabilities.

Recent controlled studies have supported the effectiveness of anger management training for people with intellectual disabilities (IDs). This report describes an evaluation instrument designed to assess their usage of specific anger coping skills. The Profile of Anger Coping Skills (PACS) is designed for completion by a staff member or carer. Three situations are first elicited in which a client frequently displays anger. The respondent then rates each situation for the extent to which the client deploys each of eight behavioural and cognitive coping skills. In a preliminary reliability study, 20 users of a day service for people with IDs were rated independently by two staff members, with one of them completing the assessment on two separate occasions: the PACS showed good test-retest reliability and lower, but still acceptable, interrater reliability. The PACS was subsequently used, in a different day service, as part of the assessment pack administered before and after a 12-week anger management group, with a parallel assessment of an untreated control group. The treated group showed substantial decreases in measures of anger, which were maintained at 6-month follow-up. Increases in PACS-rated anger coping skills were also seen in all participants in the anger management group, but not in the control group. There were differences in the extent to which different coping skills were acquired by the treated group, and there were also individual differences in the profile of specific skills acquired. It is concluded that the PACS is a reliable instrument for assessing anger coping skills, particularly when used repeatedly with the same informant. It provides information that is useful for both individual care planning and the design of future anger management programmes.

Adaptation, Psychological↗

PubMed2004

Influence of nicotine gum on acute cravings for cigarettes.

Reviews of nicotine gum trials generally confirm the efficacy of this substitute in smoking cessation. However, little research has considered the efficacy of nicotine gum as a method for alleviating acute cravings in situations where smokers are not permitted to smoke. The aim of the present study was to evaluate the efficacy of nicotine gum in alleviating acute cravings for cigarettes using the subjective multi-dimensional Questionnaire of Smoking Urges (QSU) and the objective progressive ratio (PR) measures of craving. Forty-five regular smokers participated in a double-blind placebo-controlled trial. All participants were required to abstain from cigarettes for a period of 4 h. Fifteen of the participants were required to chew nicotine gum, 15 were required to chew placebo gum and 15 received no intervention during this abstinence period. All participants then completed the QSU, PR and mood and anxiety questionnaires. The results revealed that participants who had been in either of the gum conditions reported significantly lower QSU factor 1 and factor 2 craving scores after 4 h abstinence than those who had received no intervention. Although a significant partial correlation between QSU factor 1 and 2 scores and the number of reinforcers earned under the PR procedure was observed, the results revealed no significant difference between groups on measures of PR performance or mood and anxiety. Both nicotine and placebo gum are equally effective at reducing acute cravings for cigarettes.

Affect↗

PubMed2004

Cavernous transformation of the portal vein causing jaundice, presenting in the form of Wilson's disease.

The following is a case review of portal vein cavernous malformation presenting with intermittent cholestasis and jaundice in a 4 year old child. Correct assessment was supported by radiology, later laparoscopy, yet hindered by histopathology representative Wilson's disease and elevated urinary copper excretion. During surgical procedure the stenosis of the common bile duct secondary to extremely dilated portal vein reticulation was solved by Roux-en-Y choledochojejunostomy. After a one-year follow up the child remains asymptomatic.

Anastomosis, Roux-en-Y↗

PubMed2002

The validity of animal models of predisposition to depression.

Some animal models of depression, including the majority of the more recently introduced models, are better characterized as models of predisposition to depression. In the first part of this paper, we show that the basis for such a model could be either a procedure that increases the ease with which an analogue of major depression may be evoked, or a presentation analogous to dysthymia (chronic mild depression). We then consider how the concepts of predictive, face, and construct validity apply to such models. Next, we review the validity of the available models of predisposition to depression, which derive from genetics, genomics, developmental manipulations, and brain lesioning. Finally, we compare the performance of the different models, using a novel scoring system that formalizes the evaluation of animal models against each of the three sets of validation criteria.

Animals↗

PubMed2001

A view through the gateway: expectancies as a possible pathway from alcohol to cannabis.

AIM: The aim of this study was to test the hypothesis that cannabis outcome expectancies would be more positive in adolescents who drink alcohol than in non-drinkers. PARTICIPANTS AND SETTING: The participants in the study were 4544 11-16-year-olds attending eight secondary schools located in the north-west midlands of England. PROCEDURE: Participants completed an anonymous self-report questionnaire that incorporated sections designed to tap adolescents' expectancies of positive and negative outcomes of alcohol and cannabis use, together with other questions relating to substance use and associated issues. RESULTS: Four reliable six-item scales were derived, and used to measure positive and negative alcohol and cannabis outcome expectancies. Negative expectancies were relatively stable across age and frequency of substance use, particularly for alcohol. However, positive expectancies for both substances increased markedly with age and, independently, with frequency of use. Positive alcohol and cannabis outcome expectancies were meaningfully related to expectancies of future substance use, and to measures of problem drug use and resistance to peer influence, supporting the validity of these expectancy measures, and their possible value as diagnostic screening instruments. The main hypothesis of the study was supported: among respondents who reported never using cannabis, positive cannabis outcome expectancies increased and negative cannabis outcome expectancies decreased with increasing frequency of alcohol use. CONCLUSIONS: The results are consistent with a version of the 'gateway hypothesis' for the relationship between alcohol and cannabis use (alcohol use leads to changes in cannabis expectancies and thereby to cannabis use), but a proper test of the hypothesis requires a longitudinal study.

Adolescent↗

PubMed2001

Motivation for alcohol assessed by multiple variable interval schedule behaviour: effects of reward size and alcohol cues.

Altered motivation for drugs of abuse is a central feature of most definitions of drug dependence and the impact of drug-related cues on motivation is of current interest. However, since most studies of cue-reactivity have not used behavioural measures of motivation, their results are often difficult to interpret in motivational terms. In the current paper we describe two experiments in which a behavioural technique, based on multiple variable interval (VI) schedules of reinforcement, was used to study motivation for alcohol in human subjects. In both experiments, subjects attended for several sessions and, during each session, were exposed to a 6-ply VI schedule (values ranged from 1 to 720 s), during which they earned points that were later exchanged for a preferred beer or lager. In Experiment 1 the procedure was validated by showing that changes in the magnitude of reinforcement altered behaviour appropriately. In Experiment 2 we found evidence that the presence of an alcohol-related cue increased the value of alcohol rewards. The results are discussed with reference to a model for the behavioural effects of drug-related cues in triggering relapse and a number of problems we found in using the multiple variable interval schedule procedure.

Adult↗

PubMed2001

Mediation of depression by perceptions of defeat and entrapment in high-stress mothers.

Previous studies have demonstrated a causal role of stress in depression, and an association between depression and perceptions of defeat and entrapment. The present study was conducted to determine whether perceptions of defeat/entrapment mediate the relationship between stress and depression. Seventy-six mothers of children attending specialist educational provision for a range of special needs completed the Parenting Stress Index-Short Form (PSI-SF), Defeat and Entrapment Scales, the Beck Depression Inventory (BDI), and the Fawcett-Clark Pleasure Capacity Scale (FCPCS). Relative to population norms, respondents reported very high levels of stress, moderately high levels of defeat/entrapment, mild depression, and very low hedonic capacities. Most of these measures were more extreme in younger mothers and those with a prior history of depression. FCPCS scores were correlated negatively with stress, after controlling for levels of defeat/entrapment, but were not correlated with BDI scores, suggesting that the FCPCS may be an unsuitable instrument for use in the present participant population. Significant positive correlations were found between all measures of stress, defeat/entrapment and depression. After controlling for PSI-SF scores, correlations between BDI and defeat/entrapment scores remained highly significant. However, after controlling for defeat/entrapment, correlations between BDI and PSI-SF scores were non-significant. Hence, perceptions of defeat/entrapment mediate the relationship between stress and depression. This relationship was confirmed formally using regression analysis. Because respondents reported high levels of stress in contrast to mild levels of depression, a causal link can be inferred, running from stress via defeat/entrapment to depression.

Adult↗

PubMed2000

Smoking-related cues elicit craving in tobacco "chippers": a replication and validation of the two-factor structure of the Questionnaire of Smoking Urges.

RATIONALE: The reliability and validity of the Questionnaire of Smoking Urges (QSU), a multi-factorial measure of cravings to smoke cigarettes has recently been called into question. OBJECTIVE: In the first phase of the present study, the reliability of the two-factor structure of QSU was examined. The new and original factor structures were then used to investigate the effects of 2 h of abstinence from smoking, and exposure to smoking-related cues, in a subset of the same sample of regular smokers. The present study also investigated the effects of smoking-related cues on QSU measures in tobacco "chippers" (occasional non-dependent smokers). METHODS: The factor structure of the QSU was investigated with a factor analysis of responses to the 32 QSU items produced by a sample of 271 regular smokers. A subset of these data was used to assess the influence of abstinence and cues on QSU factor scores. The final study used a sample of 32 tobacco chippers to assess the effect of smoking-related cues on their QSU factor scores. RESULTS: The results revealed a two-factor structure almost identical to that published by Tiffany and Drobes. In the second experiment, a brief period of abstinence significantly elevated factor 1 scores, but not factor 2 scores, compared to the non-abstinent condition. Exposure to smoking-related cues significantly elevated factor 2 scores and also tended to elevate factor 1 scores. In experiment 3, exposure to smoking-related cues significantly elevated factor 1 scores, but not factor 2 scores, in tobacco chippers. CONCLUSION: The QSU is a psychometrically sound instrument for the assessment of urges to smoke, which shows good construct validity. The two factors of the QSU show differential discriminative properties.

Adolescent↗

PubMed2000

Further validation and development of a screening instrument for the assessment of substance misuse in adolescents.

AIM: The aim of this study was to investigate the validity of the Substance Misuse in Adolescence Questionnaire, which has been proposed as a screening instrument for problem drug use in adolescents. PARTICIPANTS AND SETTING: The participants in the study were 4544 11-16-year-olds attending eight secondary schools located in the north-west midlands of England. PROCEDURE: Participants completed an anonymous self-report questionnaire that incorporated a modified version of the SMAQ (the Assessment of Substance Misuse in Adolescence: ASMA), together with other questions relating to substance use and associated issues. RESULTS: The ASMA showed good reliability, both within the overall sample of respondents, and in a drug-using subsample. Principal-components analysis returned a single factor when applied either to the whole sample or to the drug-using subsample; 1.4% of respondents met a criterion equivalent to that proposed by Swadi (1997) for 'problem drug use' (ASMA > 12). A further 6.4% reached a threshold for potentially problematic drug use (ASMA > 8) and could be considered 'at risk'. In regression analyses, ASMA scores were predicted by drug-related variables, and by low resistance to peer influence (RPI), but not by alcohol-related variables. The highest ASMA scores and lowest levels of RPI were found in heroin users. Respondents' perceptions of their future risk of drug or alcohol problems were predicted by RPI and by frequency of drug use and drunkenness. CONCLUSIONS: The ASMA may be a useful screening instrument for identifying problem drug use in adolescents unknown to treatment services.

Adolescent↗

PubMed2000

Alcohol sales to underage adolescents: an unobtrusive observational field study and evaluation of a police intervention.

AIMS: The aims of this study were to assess the ease with which adolescents in the United Kingdom are able to buy alcohol, to obtain information concerning vendors' perceptions of alcohol sales to adolescents, and to evaluate a police intervention intended to reduce underage alcohol sales. DESIGN, SETTING, SUBJECTS: An unobtrusive naturalistic field study was conducted in two urban locations. Pairs of 13- and 16-year-old boys and girls were trained to attempt the purchase of different types of alcohol (alcopops, beer, cider, wine, spirits) from four different types of retail outlets (corner shops, off-licence, public houses and supermarkets), under the supervision of a researcher and typically a parent. The assessment was repeated, with the omission of the 13-year-old boys, following a police intervention in one of the performance sites, consisting of warning letters and visits to vendors, and the issue of a small number of police cautions. A total of 62 underage confederates in all attempted 470 test purchases in phase 1 and 348 in phase 2. Between the two waves of test purchases a sample (n = 95) of the same vendors was surveyed by telephone. FINDINGS: In phase 1, sales resulted from 88.1% of purchase attempts by 16-year-old girls, 77% of attempts by 16-year-old boys, 41.6% of 13-year-old girls and 4.1% of 13-year-old boys. These figures were generally comparable across locations, alcohol types and outlet types. Refusals were more likely when another vendor was present. Eighty per cent of sales to 16-year-olds and 65% of sales to 13-year-old girls were made without challenge. "Prove-It" ID cards were requested in fewer than 12% of purchase attempts in both age groups. Overall, there was no evidence that the police intervention reduced sales of alcohol to 16-year-olds. There was a hint that the intervention may have caused a very short-lasting decrease in sales to 13-year-old girls, but this was contained within an overall increase in sales to this group. Alcohol vendors reported that they rarely encountered underage customers or refused sale though 90% of vendors said that if they became suspicious, they would request ID. Only two vendors believed that they were likely to suffer adverse consequences if they sold alcohol to minors. CONCLUSIONS: These data suggest that 16-year-olds, and girls as young as 13, have little difficulty in purchasing alcohol, and that there is little difference between different types of outlets in their willingness to sell alcohol to minors. Vendors perceive little risk in selling alcohol to adolescents. The fact that the police intervention failed to decrease sales suggests that vendors do not change their behaviour in response to the threat of legal action.

Adolescent↗

PubMed1999

The Questionnaire of Smoking Urges is sensitive to abstinence and exposure to smoking-related cues.

The Questionnaire of Smoking Urges (QSU) was designed to measure cravings elicited by abstinence from cigarette smoking. In the present study, the sensitivity of the QSU both to brief periods of abstinence and to exposure to smoking-related cues was investigated. A progressive ratio (PR) operant procedure was also employed, in which behaviour was maintained either by primary reinforcement (puffs on a cigarette) or by secondary reinforcement (tokens exchanged later for puffs on a cigarette) in separate experiments. Dependent smokers, who were not abstinent or who were abstinent for either 2 or 4 h, were tested in both a cue-rich and a no-cue environment. The results indicated that the QSU was sensitive both to brief periods of abstinence and to exposure to smoking-related cues, but the effect of smoking-related cues on QSU scores was maximal in non-abstinent smokers. In contrast, neither abstinence nor exposure to smoking-related cues significantly influenced the number of reinforcers earned, or the number of responses made, in either PR task. However, there was a significant interaction between gender and degree of abstinence on PR performance under primary reinforcement, and correlations between PR and QSU measures that were dependent on a complex interaction between the presence/absence of smoking-related cues and the type of reinforcer used. These results suggest that the QSU is sensitive to subtle influences on subjective urges to smoke in dependent smokers and, although PR measures are relatively insensitive to these influences, there is some evidence that PR performance is related to subjective measures of the urge to smoke.

Carbon Monoxide↗

PubMed1999

The relevance of problems and models to treatment outcome: a comparative study of two agencies.

The aim of this study was to compare the progress of clients attending two substance misuse treatment agencies. A wide range of problems were recorded at 1, 3-6, and 12 month intervals; these included measures of substance misuse and dependence together with social problems and physical and mental health problems. Differences in outcome between the two agencies were entirely attributable to the number and severity of a range of problems rather than simply to severity of dependence or differences between the agencies themselves. This raised questions of how treatment outcomes are understood and explained, and the usefulness of therapeutic models per se.

Adaptation, Psychological↗

PubMed1998

Real time measurement of stimulated dopamine release in the conscious rat using fast cyclic voltammetry: dopamine release is not observed during intracranial self stimulation.

Fast cyclic voltammetry (FCV) was used to measure real time release of electrically stimulated endogenous dopamine in the nucleus accumbens (NAc) of conscious freely moving rats for up to 17 days. The method of electrode construction, implantation, electrical stimulation and recording of changes of extracellular dopamine concentration in the conscious rat are described. Rats trained on a continuous reinforcement schedule to perform intracranial self stimulation (ICSS) were implanted with electrodes for FCV. During ICSS, no faradaic signal was observed at an electrode implanted in the NAc. Decreasing the intensity of the stimulating current abolished ICSS, increasing the stimulating current disrupted ICSS. Operator delivered electrical stimulations using currents greater than those needed for ICSS yielded dopamine signals. It is concluded that during ICSS, sufficient dopamine does not reach the extracellular fluid space to yield a faradaic signal detectable by FCV.

Animals↗

PubMed1998

"Depression" increases "craving" for sweet rewards in animal and human models of depression and craving.

This study consisted of two experiments, one in rats and one in human volunteers, that used the identical progressive ratio (PR) operant procedure. In both experiments, responding was reinforced under a progressively increasing work requirement, and different groups of subjects received reinforcers that varied in sweetness. In experiment 1, rats were subjected to chronic mild stress, a well-validated animal model of depression. Performance under the PR schedule increased in subjects reinforced with conventional precision pellets (which contain 10% sucrose) or very sweet pellets, but not in subjects reinforced with sugar-free pellets. In experiment 2, volunteers were subjected to a depressive musical mood induction. Performance under the PR schedule increased in subjects reinforced with chocolate buttons, but not in subjects reinforced with with buttons made from the relatively unpalatable chocolate substitute carob. In experiment 2, depressive mood induction also increased chocolate craving, as measured by a novel questionnaire, and there were significant correlations between chocolate craving and chocolate-reinforced PR performance. These results suggest that performance under the PR schedule provides a measure of craving rather than reward, and that craving for sweet rewards is increased by depressive mood induction in both animal and human models. Implications for the interpretation of pharmacological studies using the PR procedure are also discussed.

Adult↗

PubMed1998

Deprivation state but not nicotine content of the cigarette affects responding by smokers on a progressive ratio task.

In two experiments, we used a progressive ratio schedule to explore factors associated with smoking motivation. In study 1, smokers who had abstained for more than 8 h bar-pressed for longer to obtain puffs on a cigarette than did non-deprived smokers. Neither group, however, showed nicotine-induced improvements in performance on an attention-demanding task. In the second study, two groups of minimally deprived smokers worked on the progressive ratio task for puffs of either a standard or an ultralow nicotine cigarette. The amount of work expended for puffs was the same for both cigarettes. The groups were also indistinguishable in terms of their subjective experience of the impact of smoking. These results suggest that the addition of nicotine to the cigarette may not have an immediate impact on the effort expended for a puff on that cigarette, and that short term changes in craving may be observed independent of satiety effects associated with nicotine ingestion. We conclude that the progressive ratio task is a useful and sensitive measure of desire to smoke, although the two experiments highlight the complexity of the relationship between subjective, objective and behavioural measures of smoking and nicotine ingestion in humans.

Adolescent↗

PubMed1998

A comparison of two alcohol craving questionnaires.

AIM: To compare two multi-dimensional questionnaires to measure cravings and urges for alcohol: the Alcohol Craving Questionnaire (ACQ: Singleton, Henningfield and Tiffany, 1994a) and the Desires for Alcohol Questionnaire (DAQ: Clark et al., 1996). DESIGN, SETTING, AND PARTICIPANTS: Both questionnaires were administered, in a counterbalanced order, to a total of 380 recreational drinkers. In a further study, a shortened version of the DAQ was administered to a sample of 131 drinkers attending AA or a treatment centre. Exploratory factor analyses were carried out on the data and relationships between questionnaire score and other variables were assessed. FINDINGS: In recreational drinkers both instruments appeared to have a three-factor structure. The DAQ appeared superior to the ACQ in a number of respects: it produced more reliable factors; its structure accounted for a higher proportion of the variance; the factor inter-correlations were somewhat lower; in a combined analysis of both instruments most of the factors retained came from the DAQ; and the DAQ discriminated better between bing and non-binge drinkers and excessive and moderate drinkers. A similar factor structure was found for the DAQ in the alcoholic subjects with addition of a factor of "controllability". CONCLUSIONS: The results support a multifactorial account of alcohol craving, and indicate that the DAQ has some advantages over the ACQ as a research tool.

Adolescent↗

PubMed1998

Patterns of alcohol, cigarette and illicit drug use in English adolescents.

AIMS: The aim of this study was to describe associations between alcohol, tobacco and illicit drug use in adolescents and demographic factors associated with substance use. DESIGN, SETTING, SUBJECTS: The study was a classroom survey of the total population of pupils (n = 5383, ages 11-16) in six schools selected from different locations around England. MEASURES: Respondents were asked confidentially about their use and extent of use of alcohol, cigarettes and illegal drugs. FINDINGS: The prevalence of regular substance use within the sample rose from 30.4% at age 11 to 83.9% at age 16. The prevalence of alcohol use did not differ between girls and boys, but smoking was more prevalent in girls and illegal drug use was more prevalent in boys. Alcohol was used more frequently than any other substance, or combination of substances, and alcohol use almost invariably accompanied the use of other substances: exclusive use of cigarettes or illegal drugs was negligible. In addition, high levels of alcohol intoxication were associated with increased use of both illegal drugs and cigarettes. Overall, around half the drinkers (46.8%) preferred alcopops to other types of alcoholic drink; this figure was greater in girls (56.4%) than in boys (37.1%), but fell sharply with age (62.9% at age 11; 37.7% at age 16), particularly in boys. Preference for spirits increased with age, and was particularly marked in girls (28.4% in girls vs. 18.5% in boys at age 16). Spirits drinkers were more likely to use cigarettes and drugs, and had been more frequently drunk, than either beer/wine or alcopops drinkers; these measures also tended to be higher in alcopop drinkers than in beer/wine drinkers, particularly among 11-13-year-old girls. CONCLUSION: The use of both tobacco and illicit drugs appears to be strongly associated with alcohol use, which is more prevalent, and the risk of smoking and illicit drug use is particularly high in adolescents who report high levels of drunkenness. Our results are consistent with a simple threshold model of substance abuse in which alcohol occupies a low threshold position relative to the higher threshold of cigarettes and illegal drugs. Smoking, drug use and drunkenness were lowest in beer/wine drinkers, intermediate in alcopop drinkers, and highest in spirits drinkers.

Adolescent↗