Mark T. Wagner

The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study

Case reports indicate that psychiatrists administered ±3,4-methylenedioxymethamphetamine (MDMA) as a catalyst to psychotherapy before recreational use of MDMA as ‘Ecstasy’ resulted in its criminalization in 1985. Over two decades later, this study is the first completed clinical trial evaluating MDMA as a therapeutic adjunct. Twenty patients with chronic posttraumatic stress disorder, refractory to both psychotherapy and psychopharmacology, were randomly assigned to psychotherapy with concomitant active drug (n = 12) or inactive placebo (n = 8) administered during two 8-h experimental psychotherapy sessions. Both groups received preparatory and follow-up non-drug psychotherapy. The primary outcome measure was the Clinician-Administered PTSD Scale, administered at baseline, 4 days after each experimental session, and 2 months after the second session. Neurocognitive testing, blood pressure, and temperature monitoring were performed. After 2-month follow-up, placebo subjects were offered the option to re-enroll in the experimental procedure with open-label MDMA. Decrease in Clinician-Administered PTSD Scale scores from baseline was significantly greater for the group that received MDMA than for the placebo group at all three time points after baseline. The rate of clinical response was 10/12 (83%) in the active treatment group versus 2/8 (25%) in the placebo group. There were no drug-related serious adverse events, adverse neurocognitive effects or clinically significant blood pressure increases. MDMA-assisted psychotherapy can be administered to posttraumatic stress disorder patients without evidence of harm, and it may be useful in patients refractory to other treatments.

Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study:

We report follow-up data evaluating the long-term outcomes for the first completed trial of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for chronic, treatment-resistant post-traumatic stress disorder (PTSD) (Mithoefer et al., 2011). All of the 19 subjects who received MDMA-assisted treatment in the original trial participated in the long-term follow-up (LTFU), with 16 out of 19 completing all of the long-term outcome measures, which were administered from 17 to 74 months after the original study’s final MDMA session (mean = 45.4; SD = 17.3). Our primary outcome measure used was the Clinician-Administered PTSD Scale (CAPS). Secondary outcome measures were the Impact of Events Scale-Revised (IES-R) and the Neuroticism Extroversion Oppenness Personality Inventory-Revised (NEO PI-R) Personality Inventory. We also collected a long-term follow-up questionnaire. Results for the 16 CAPS completers showed there were no statistical differences between mean CAPS score at LTFU (mean = 23.7; SD = 22.8) (t matched = 0.1; df = 15, p = 0.91) and the mean CAPS score previously obtained at Study Exit (mean = 24.6, SD = 18.6). On average, subjects maintained statistically and clinically-significant gains in symptom relief, although two of these subjects did relapse. It was promising that we found the majority of these subjects with previously severe PTSD who were unresponsive to existing treatments had symptomatic relief provided by MDMA-assisted psychotherapy that persisted over time, with no subjects reporting harm from participation in the study.

The Test of Memory Malingering (TOMM): normative data from cognitively intact, cognitively impaired, and elderly patients with dementia

This research adds to the psychometric validation of the Test of Memory Malingering (TOMM) by providing data for samples of elderly patients who are cognitively intact, cognitively impaired (non-dementia), and with dementia. Subjects were 78 individuals referred for evaluation of memory complaints. Significant group differences emerged between the dementia group and the two other groups (normals and cognitively impaired), although the latter two did not differ from each other. One hundred percent of normals and 92.7% of the cognitively impaired group made fewer than five errors (the suggested cut-off) on Trial 2 or the Retention trial of the TOMM, yielding an overall correct classification rate of 94.7%. However, the rate of misclassification for persons with dementia was high whether using a cut-point score of five, eight, or ten errors. This investigation extends the validity and clinical utility of this instrument. Results suggest that the TOMM is an useful index for detecting the malingering of memory deficits, even in patients with cognitive impairment, but only when dementia can be ruled out.

The Role of Personality and Other Factors in a Mother’s Decision to Initiate Breastfeeding:

The objective of the study was to measure the impact of personality and other factors on the decision to initiate breastfeeding. Mothers were enrolled (24-96 hours postpartum) and were classified as fully breastfeeding, formula-feeding, or combination-feeding. A semi-structured interview about maternal sociodemographics and attitudes and a standardized personality inventory (NEO-PI-R) were conducted. Eighty-seven mothers completed the study: 50 breastfeeders, 6 combination feeders, and 31 formula feeders. Because of small numbers, combination-feeder mothers (n = 6) were excluded from analyses. Maternal age, marriage, ethnicity, and socioeconomic status were significantly associated with breastfeeding. Breastfeeding and formula-feeding groups differed on 3 personality domains: extraversion (53.3 breastfeeding vs 46.9 formula-feeding, P = .002), openness (51.6 vs 46.2, P = .008), and agreeableness (48.5 vs 41.5, P = .01). In a multiple variable logistic regression model, extraversion (P = .03) and openness (P = .003) remained significant. Sociodemographics, experiential factors, and specific personality characteristics of mother were independently associated with maternal feeding decision.

Firearm presence in households of patients with Alzheimer's disease and related dementias.

OBJECTIVE: Attention has recently been drawn to the potential dangers of firearm use among patients with dementia. However, little is known about the actual prevalence of firearms in households with demented family members. This study seeks to determine the prevalence and loaded status of firearms in households with a demented family member in a sample of outpatients at a University memory disorders clinic.

The breast or the bottle? Determinants of infant feeding behaviors

Although various trends have placed breastfeeding in and out of vogue, in the twentieth century the greater availability of human milk substitutes mandates that a woman choose her infants feeding method. It appears that intrapsychic factors or life experiences, as well as certain social conditions, influence that choice. For example, the economic state of society historically has had significant impact on the role of women and the value placed on womans unique biologic contributions. Likewise, personality and attitudinal factors also may act as potential mediators of observed differences between lactating and nonlactating mothers in their mother-infant interactions. Finally, once the decision to breastfeed or bottle-feed has been made and carried through, additional physiologic mechanisms may mediate conscious behavioral intentions. The phenomenon of human lactation, then, is sensitive to a variety of interrelated factors that can be grouped as follows: (1) individual personality, (2) social forces, and (3) psychophysiologic mechanisms. An in-depth understanding of the specific factors that affect a womans decision to breastfeed will have far-reaching implications for future educational and interventional programs.

Transient Kluver–Bucy syndrome following complex partial status epilepticus

The characteristic features of Kluver-Bucy syndrome include hypersexuality, hyperorality, placidity, hypermetamorphosis, visual agnosia, changes in dietary habits, and memory impairment. Human cases have been reported with herpes simplex encephalitis, head injury, Picks disease, transtentorial herniation, adrenoleukodystrophy, and Reyes syndrome, all involving bilateral temporal lobe pathology. We present the case of a patient with no evidence of a structural lesion in the temporal lobes and behavioral changes consistent with Kluver-Bucy syndrome following complex partial status epilepticus.

The Effect of Recombinant TGFα, Human Milk, and Human Milk Macrophage Media on Gut Epithelial Proliferation Is Decreased in the Presence of a Neutralizing TGFα Antibody

Objective: An in vitro model was devised to compare the relative effects of recombinant transforming growth factor-alpha (TGFα), aqueous human milk, and human milk macrophage (HMM) medium on human fetal small intestinal cell (FHs-74) proliferation. Methods: Recombinant TGFα at increasing concentrations (range 0.01–1,000 ng/ml media), the aqueous fraction of human milk (AHM), or HMM medium was added to FHs-74 cells in the presence or absence of a neutralizing TGFα antibody (1 µg/ml medium). At 24 h, cell proliferation was measured and expressed as percent control. The experimental variables were (1) activators of cell growth (TGFα, AHM, and HMM medium); (2) increasing concentrations of TGFα, and (3) neutralizing antibody to TGFα. The dependent variable for all experiments was cell proliferation. Results: Significant effects for growth stimulators and TGFα concentration as measured by cell proliferation were found. Specifically, there was a dose-dependent effect of TGFα on cell proliferation to the 5-ng/ml concentration, with a plateau reached in cell proliferation at higher concentrations. The stimulatory effect of TGFα was decreased in the presence of TGFα antibody (mean ± SD 22 ± 7.1% decline, p < 0.001). In the presence of TGFα antibody, there was a 25 ± 3.1% decline in HM-stimulated growth (p < 0.004), and a 27.6 ± 3.2% decline in HMM medium-stimulated growth (p < 0.001). Conclusions: Neutralization of recombinant TGFα and that present in human milk and HMM medium by TGFα antibody led to a consistent decrease in in vitro human fetal small intestine epithelial proliferation without affecting cell viability. These results support the hypothesis that TGFα, whether derived from human recombinant sources, human milk or HMM medium has a measurable, trophic effect on in vitro human gut epithelial cells.

The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina

Inconsistencies in reports on methamphetamine (METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions.

A Validated Seven-Subtest Short Form for the WAIS-IV

This study presents a short form of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV; Wechsler, 2008) using the subtests (Block Design, Similarities, Digit Span, Arithmetic, Information, Coding, and Picture Completion) suggested by Ward (1990). These seven subtests were used to predict the full WAIS-IV Full-Scale IQ, as well as the Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed Index scores. Two different data sets were used: the first consisted of 70 subjects and the second consisted of 32 subjects. The first data set was used to create a linear regression and the second data set was used to validate the results and compare to the prorated score method from the WAIS-IV manual. The prorated estimated scores correlated significantly with their counterparts and proved to be a better method of estimating the Full-Scale IQ and most of the index scores, but the regression equation was better at predicting the Processing Speed Index. The current study is consistent with the Ward (1990) and Pilgrim, Meyers, Bayless, & Whetstone (1999) studies and represents a reliable and valid way of assessing intellectual functioning in an abbreviated format.