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PubMed2003

Effect of the postictal state on visual-spatial memory in immature rats.

Postictal cognitive impairment following seizures can last from minutes to days and be disabling to the patient. The purpose of this study was to compare the behavioral features of seizures with postictal memory impairment in young seizure-naive rats and rats with a prior history of status epilepticus (SE) and examine the relationship between postictal EEG changes and cognitive recovery. Following training in the water maze to asymptote levels of learning, rats with a prior history of SE and seizure-naive rats had flurothyl-induced generalized seizures and time to recovery to baseline was then measured. Following generalized seizures rats had impaired performance in the water maze with the duration of the cognitive deficits exceeding the length of the seizure. There was not a close relationship between duration of cognitive impairment and either latency to onset of seizure or duration. The animal's neurological status was a factor in the duration of cognitive impairment following seizures; while there were no differences between SE and seizure-naive rats in latency to seizure onset or duration of the seizures, animals with a prior history of SE had a longer period of impairment following a seizure than animals without such a history. Postictal cognitive impairment was associated with changes in theta activity in animals with a prior history of SEs but not in seizure-naive animals. Caffeine, when administered following the seizure, reduced postictal cognitive impairment in a dose-dependent manner. This study demonstrates that duration of postictal cognitive impairment is not directly related to duration of the seizure. The neurological status of the animal is a determining factor in duration of postictal impairment.

Animals↗
PubMed1996

Aspirin use and cognitive function in the elderly.

Decline in cognitive function in the elderly is common and represents a major clinical and public health concern. Aspirin may reduce the decline in cognitive function by influencing multi-infarct dementia, but data are sparse. The East Boston Senior Health Project is a population-based cohort study that enrolled 3,809 community-dwelling residents aged 65 years and older in 1982-1983 and followed them with home visits every 3 years until 1988-1989. Trained interviewers assessed cognitive function by using the Short Portable Mental Status Questionnaire and assessed medication use, including over-the-counter drugs. Response to the Short Portable Mental Status Questionnaire was scored as high, medium, or low, and decline was defined as transition to a lower category. Participants who used drugs containing aspirin in the 2 weeks prior to the interview were classified as aspirin users. Multiple logistic regression was used to obtain adjusted odds ratios and their 95% confidence intervals for decline of cognitive function. The estimating equation approach was used to adjust the standard errors for repeated measurements. Aspirin users had an odds ratio for cognitive decline of 0.97 (95% confidence interval 0.82-1.15). Low frequency of aspirin use (less than daily) was associated with an odds ratio of 0.87 (95% confidence interval 0.69-1.09). Although no substantial effect was observed, the data are also compatible with a modest benefit of aspirin, especially with intermittent use, on decline of cognitive function. Concern about small residual biases from self-selection or confounding suggests that randomized trials will be necessary to provide definitive data on this question.

Aged↗
PubMed2005

Persistent effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects--a randomized controlled trial.

Psychosocial stress leads to a release of cortisol. While this psychoneuroendocrine response helps to maintain physiological as well as psychological equilibrium under stress, exaggerated secretion of cortisol has been shown to have negative effects on somatic health and cognitive functioning. The study set out to examine the long-term effects of cognitive-behavioral stress management training on cortisol stress responses in healthy men and women. Eighty-three healthy subjects were randomly assigned to cognitive-behavioral stress management (CBSM) training or a control condition. Four months after the CBSM, 76 subjects underwent a standardized psychosocial stress test. Salivary cortisol responses were assessed repeatedly before and after the stress test. Subjects in the CBSM group showed significantly reduced cortisol stress responses. With regard to gender, this effect was observed in both men and women. However, the magnitude of the CBSM effect on cortisol responses was smaller in women than in men. Use of oral contraceptives in women influenced the cortisol response, but did not have an impact on the CBSM effect on cortisol. The results show that the previously reported attenuation of cortisol stress responses through CBSM persists and are observable in both men and women. Since stress-induced alterations of hypothalamus pituitary adrenal axis functioning are discussed to be involved in the onset and maintenance of both somatic and psychiatric conditions, similar interventions could be used for prevention and therapy of these detrimental stress effects.

Acute Disease↗
PubMed2003

Chronic intermittent nicotine administration attenuates traumatic brain injury-induced cognitive dysfunction.

Traumatic brain injury (TBI) initiates immediate and secondary neuropathological cascades that can result in persistent neurological dysfunction. Previous studies from our laboratory have shown that experimental rat brain injury causes a rapid and persistent decrease in CNS alpha7* nicotinic cholinergic receptor (nAChr) expression. The purpose of this study was to investigate whether intermittent nicotine injections could improve cognitive performance in the Morris water maze (MWM) following experimental brain injury. Adult male rats were anesthetized and subjected to a 1.5 mm controlled cortical impact (CCI) injury of the somatosensory cortex. Animals received twice daily i.p. nicotine injections for 11 days prior to CCI, 11 days following CCI or during both pre- and post-surgical intervals. MWM training was initiated 12 days post-injury. In the training phase of cognitive testing, twice-daily nicotine treatment following injury attenuated trauma-induced deficits in the distance traveled to reach the escape platform. This group of animals also had improvements in several measures of the probe test, including time spent, distance traveled and total entries into the target quadrant. TBI caused significant deficits in alpha7* nAChr expression in several regions of the hippocampus and cerebral cortex, which were largely unaffected by intermittent nicotine treatment. However, nicotine treatment up-regulated [(3)H]-epibatidine binding to non-alpha7* nAChrs, attenuating TBI-induced deficits in receptor expression in several brain regions evaluated. These results suggest that nicotine is efficacious at attenuating CCI-induced cognitive deficits in a manner independent of changes in alpha7* nAChr expression, perhaps via up-regulation of non-alpha7* nAChrs.

Animals↗
PubMed1996

Psychological factors in intensive management of insulin-dependent diabetes mellitus.

With the publication of the DCCT results in 1993, hope has been given to patients with type I diabetes that blindness, kidney failure, and neuropathies are not necessarily what awaits them. However, to assume that diabetes is simply a disease that can be controlled "if only the patient would be compliant" is an incredibly naive way to approach treatment. Practitioners need to be keenly aware of not only the complexities of intensive management of type I diabetes but perhaps more importantly the numerous psychological factors that determine whether treatment adherence will occur. Psychological issues such as patient perceptions of symptoms, fear, unawareness of symptoms because of autonomic dysregulation or cognitive decline, attitudes, and control issues need to be assessed. These issues can be assessed quite easily with questionnaires, scales, and interview schedules readily available to practitioners. Additionally, for those patients who may not be attuned to monitoring physiologic or cognitive cues, awareness training and other coping skills interventions are available that can be incorporated into existing diabetes education programs. A mutual effort by the patient and health-care provider team can lead to success in intensive management of IDDM.

Attitude↗
PubMed1992

Exercise for older women: a training method and its influences on physical and cognitive performance.

The decline in physical and mental ability often associated with increasing age in adults has both social and economic implications that affect most nations. Hence, the maintenance of functional capacity and independence of the older person are beneficial both for the individual and society alike. One way to enhance functioning in old age is physical exercise. However, few methods exist that enable older people to monitor and regulate exercise intensity without using expensive apparatus. Utilizing the individual's subjective feeling of perceived exertion through the use of a simple rating scale is an approach that differs markedly from those previously employed. The present study used the ratings of perceived exertion (RPE) scale to induce different exercise intensities in groups of older women. Walking was chosen as the type of exercise since most older women are unfamiliar with, or afraid to engage in, other types of physical exercise such as bicycling or running. Results indicated that physical exercise capacity increased after 3 months of regular low-intensity walking in the exercise groups but not in nonexercising controls. Furthermore, these changes were accompanied by improved digit span performance. In conclusion, this study has shown that the RPE scale may be used for exercise regulation and that older women would seem to be able to use the scale to monitor and regulate their exercise intensity in an outdoor environment in much the same way as younger individuals.

Aged↗
PubMed2004

Swim posture of mice does not affect performance in the water maze.

We quantified swim postures of mice in relation to their cognitive performance. After training in a water maze, young (5-6 months) and aged (14-16 months) female apolipoprotein E-knockout (apoE0/0) mice and wild type controls were video taped while swimming. Subsequently, angles of body points with the water surface were calculated. Mice with a more horizontal swim posture (young and aged apoE0/0, aged wild type mice) also showed an increased body weight. However, swim posture was not related to cognitive performance.

Aging↗
PubMed2006

Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability.

Fear of arousal symptoms, often referred to as anxiety sensitivity (AS) appears to be associated with risk for anxiety pathology and other Axis I conditions. Findings from a longitudinal prevention program targeting AS are reported. Participants (n=404) scoring high on the Anxiety Sensitivity Index (ASI) were randomly assigned to receive a brief intervention designed to reduce AS (Anxiety Sensitivity Amelioration Training (ASAT)) or a control condition. Participants were followed for up to 24 months. Findings indicate that ASAT produced greater reductions in ASI levels compared with the control condition. Moreover, reductions were specific to anxiety sensitivity relative to related cognitive risk factors for anxiety. ASAT also produced decreased subjective fear responding to a 20% CO(2) challenge delivered postintervention. Data from the follow-up period show a lower incidence of Axis I diagnoses in the treated condition though the overall group difference was not statistically different at all follow-up intervals. Overall, findings are promising for the preventative efficacy of a brief, computer-based intervention designed to decrease anxiety sensitivity.

Adolescent↗
PubMed1996

The Psychological Management of Tinnitus: Comparison of a Combined Cognitive Educational Program, Education Alone and a Waiting-List Control.

Sixty subjects with chronic tinnitus were randomly allocated to one of three experimental conditions: (1) cognitive coping skills training (attention diversion, imagery training and thought management skills) combined with education. (2) education-only, or (3) waiting-list control. The two treatment groups improved significantly more than the waiting-list control on measures of frequency of use of coping strategies, benefits derived from the use of coping strategies, irrational beliefs and knowledge about tinnitus. Subjects who received the combined cognitive/education intervention demonstrated significantly greater reductions in distress and handicaps associated with tinnitus, and engagement in dysfunctional cognitions, than the subjects who received education alone. No significant effects were obtained on measures of depression, locus of control, or on daily ratings of subjective loudness, noticeability or bothersomeness of the tinnitus. At the 12-month follow-up, the differential treatment effects had dissipated. Although the treatment resulted in statistically significant effects, the size of the clinical effects is rather modest. Implications for the further development of treatment techniques are discussed.

Journal Article↗
PubMed2004

Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial.

BACKGROUND: Little is known about the efficacy of educational interventions for reducing the stigma associated with depression. AIMS: To investigate the effects on stigma of two internet depression sites. METHOD: A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive-behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention. RESULTS: Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive-behavioural therapy literacy. CONCLUSIONS: The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.

Adult↗
PubMed1996

The disruption of spatial cognition and changes in brain amino acid, monoamine and acetylcholine in rats with transient cerebral ischemia.

We investigated the disruption of spatial cognition due to transient forebrain ischemia using an 8-arm radial arm maze task in rats. Five or 10 min of ischemia did not affect the task acquisition. When rats established spatial cognition by daily training of the task, 10 min of ischemia significantly decreased the number of correct choices and increased the errors in the task when performed 24 h after reperfusion. These changes, however, returned to the normal level after about 4 days of daily training. Glutamic acid (Glu) and acetylcholine (ACh) release from the dorsal hippocampus (DH) was observed to transiently increase during ischemia. However, neither the content of noradrenaline (NA) nor the release of NA in the DH changed during ischemia. The NA and ACh release from the DH, however, gradually decreased during reperfusion, and the decrease became significant at 24 h after reperfusion. The NA content of the frontal cortex (FC) and the DH increased 7 days after reperfusion. These results suggest that the disruption of spatial cognition induced by 10 min of ischemia may be attributed to a greater degree to the dysfunction of the hippocampal ACh and NA, and cortical NA systems, rather than to the development of neuronal cell death in these areas.

Acetylcholine↗
PubMed2000

Can the criminal law ever be therapeutic?

This paper addresses the question of whether criminal law, especially in its sentencing and penological aspects, can be adjusted in its workings to incorporate the perspective of therapeutic jurisprudence. A conceptual framework developed by Wexler, Winick, and their colleagues is employed to provide a basis for reflection on the operation and impact of sentencing processes. Of considerable importance in this exercise is a mounting volume of evidence concerning the outcomes of work with adjudicated offenders, which illustrates the potential of psycho-educational, behavioral-cognitive skills-training, and therapeutic programs for reduction of recidivism. Such intervention programs are currently offered within the limits set by, but are not intrinsic components of, judicial decisions. The psycho-legal implications of these findings are discussed and some possibilities surveyed for tentative exploration of actively therapeutic departures within crimino-legal decision-making.

Cognitive Behavioral Therapy↗
PubMed2004

Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.

The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12-month follow-up. Treatment also resulted in a short- and long-term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.

Adaptation, Psychological↗
PubMed2006

Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda.

Fear of vomiting (emetophobia) is a poorly understood anxiety disorder, with little research published into its conceptualization or treatment. The current article uses established cognitive and behavioral models of other anxiety disorders as a basis from which to propose a detailed model of emetophobia. The model proposes that emetophobia results from a constellation of factors including a general anxiety-vulnerability factor, a tendency to somatize anxiety as gastrointestinal distress, a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms, hypervigilance to gastrointestinal cues, beliefs about the unacceptability of vomiting, negatively reinforced avoidance behavior, and selective confirmation biases. A formulation-based treatment package for emetophobia is outlined, including arousal management skills, distraction/attention training, exposure and cognitive restructuring.

Attitude↗
PubMed1994

A cognitive-behavioral approach to temporomandibular dysfunction treatment failures: a controlled comparison.

The effects of cognitive-behavioral treatment for patients with temporomandibular disorders were studied by comparing active treatment to a wait-list control condition. Patients were predominantly women and had been referred to the study after having poor response to dental/physical medicine care. Patients' conditions were evaluated pretreatment and posttreatment based on self-report measures of pain, distress, and jaw function problems. They were examined by a dentist who assessed pain-free opening, muscle palpation pain, and tenderness of the temporomandibular joints. The 5-week cognitive-behavioral treatment included relaxation training, self-monitoring of stressors, and cognitive coping strategies. Treatment had its greatest impact on improving mood, especially anxiety; however, there were some effects on the patients' experiences of pain.

Adult↗
PubMed1993

Group cognitive-behavioral treatment of panic disorder.

The present study examined the efficacy of an 8-wk, cognitive-behavioral group treatment for panic disorder. Patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia were randomly assigned to treatment (N = 34) or delayed treatment control (N = 33). The treatment consisted of: (a) education and corrective information; (b) cognitive therapy; (c) training in diaphragmatic breathing; and (d) interoceptive exposure. At posttreatment, 85% of treated Ss were panic free, compared to 30% of controls. Treated Ss also showed clinically significant improvement on indices of anxiety, agoraphobia, depression and fear of fear. Recovery, as estimated conservatively by the attainment of normal levels of functioning on each of the major clinical dimensions of the disorder (i.e. panic, anxiety and avoidance), was achieved in 64% of the treated Ss and 9% of the controls. At the 6 month follow-up, 63% of the treated patients met criteria for recovery. These findings mirror those from recently-completed trials of individually-administered cognitive-behavioral treatment, and suggest that CBT is a viable alternative to pharmacotherapy in the treatment of panic disorder.

Adult↗
PubMed1995

Development and evaluation of an HIV-risk reduction program for female college students.

College students are engaging in high rates of behavior related to risk of infection from Human Immunodeficiency Virus (HIV) and other sexually transmitted diseases (STDs). A cognitive-behavioral skills training program for heterosexual college females focused on sexual assertiveness skills and the reduction of risk-related behaviors was designed and evaluated compared with an education-only program. Participants completed pre-intervention, post-intervention, and one-month follow-up assessments of: (a) HIV/STD-related knowledge and beliefs; (b) sexual, alcohol, and drug-related behaviors; and (c) sexual assertiveness role-plays. Skills training participants compared to education-only participants scored higher on sexual assertiveness skills, specific knowledge of HIV infection, and self-efficacy to perform lower risk sexual behaviors and reported a reduction in risk-related behaviors at post-intervention and follow-up assessments. The effectiveness of behavioral skills in HIV risk-reduction programs for college students is discussed.

Adolescent↗