P. Murphy

Does alexithymia differentiate between patients with nonepileptic seizures, patients with epilepsy, and nonpatient controls?

Considering the evidence of an association between alexithymia and somatization, this study aimed to discover whether alexithymia could distinguish patients with psychogenic nonepileptic seizures (NES) from those with epilepsy (ES) and nonpatient controls (C). Toronto Alexithymia Scale (TAS-20) scores were obtained from 21 matched participants from each of these groups, together with measures of anxiety and depression. Overall TAS-20 scores did not differentiate the three groups after controlling for anxiety and depression, but scores on certain subscales of the TAS-20 differed significantly between the patient groups and the controls. Although alexithymia could not discriminate individuals with NES from those with organic manifestations, whether the etiology of alexithymia may differ according to patient group was discussed. Given that 90.5% of NES patients were identified as alexithymic, treatment approaches used for individuals with alexithymia may be usefully applied to those with NES.

Executive Working Memory Deficits in Abstinent Ecstasy/MDMA Users: A Critical Review

Aims: This review examined studies of executive functioning in abstinent ecstasy (3,4-methylenedioxymethamphetamine, MDMA) users on tasks which had been empirically mapped onto updating, shifting, inhibition and accessing long-term memory executive processes. Studies of some aspects of visuospatial memory performance were also included because of the investment of executive resources in such tasks. Methods:Thirty-three studies were identified for the review following searches of the Psychinfo and Medline databases. Inclusion criteria were the reporting of new empirical findings from participants drug free at the time of testing, in peer-reviewed journals in the English language. Results:Evidence for ecstasy-related performance deficits was strongest for the updating of verbal material, and for visuospatial memory tasks requiring additional processing beyond storage and retrieval. Such processing suggested that the overall level of executive demand was an important consideration. Executive shifting showed little evidence of ecstasy-related impairment, whilst examination of inhibition and long-term memory access presented an unclear picture. Conclusions: All but one of the studies had a cross-sectional design. Although this is a potential weakness with regard to confounds, the necessity of such designs was acknowledged. Studies were generally aware of the need to control for potential confounds, especially the effects of other drugs, through a mixture of group designs and statistical techniques. It was recommended that future studies of executive functioning in ecstasy users should detail the relationship of the tasks and dependent variables reported to specific executive processes and consider the level of executive demand imposed by such tasks.

Evidence for executive deficits among users of MDMA (Ecstasy).

Random letter generation and computation span are tasks known to load on executive, prefrontal resources. Previous research suggests that Ecstasy users are impaired on random letter generation. The current study, employing a larger sample (44 current Ecstasy users, and 59 non-Ecstasy users), together with more effective statistical controls for other drug use, failed to replicate previous findings. Ecstasy users were unimpaired on all measures of random generation performance. A significant difference was obtained on the computation span measure, with Ecstasy users scoring significantly lower than non-Ecstasy users. This difference remained statistically significant following control for various indicators of the use of other drugs including cannabis. The results are discussed in terms of the potential effects that Ecstasy might have on different component executive processes.

The effects of heavy social drinking on executive function: a systematic review and meta-analytic study of existing literature and new empirical findings.

Previous investigations of executive function in alcohol dependent and in social drinkers have not always produced consistent results and have not utilised key indicators of recent theoretical models of Executive Function (EF). The present paper reports the results of two studies that seek to address these limitations.

Reasoning deficits in ecstasy (MDMA) polydrug users

Rationale/objectivesPrevious research has shown that ecstasy users are impaired in thinking and reasoning. The present study sought to explore the possibility that syllogistic reasoning errors in ecstasy users were due to an inability to construct a model of the premises due to working memory limitations.MethodsTwenty-nine ecstasy users and 25 nonecstasy user controls completed abstract syllogistic reasoning problems varying in difficulty. Pairs of premises were provided, and participants were required to generate conclusions that followed necessarily from them.ResultsOn the easier problems, both groups performed at well above chance although nonusers achieved significantly more correct responses. Consistent with existing research, on the more difficult problems, errors by nonusers were characterised by incorrect conclusions suggesting that while nonusers have the working memory capacity to construct a single model of the premises, this is not an exhaustive representation and usually results in an erroneous conclusion. On the other hand, for all problem types, ecstasy users, rather than produce incorrect responses, were more likely to fail to generate a conclusion.ConclusionsThe present results are consistent with the possibility that ecstasy users with their reduced working memory capacity may experience difficulty in constructing even a single model of the premises. While this might be attributable to the effects of 3,4-methlylenedioxymethamphetamine neurotoxicity, many of the ecstasy users in the present study were polydrug users. Thus, the possibility that other drugs including cannabis and cocaine might contribute to the present results cannot be excluded.

Users' perceptions of the risks and effects of taking ecstasy (MDMA): a questionnaire study

This self-report questionnaire study examined ecstasy usersí perceptions of the risks associated with their use of ecstasy, their precautions against such risks, and its perceived effects on their lives. Gender differences in these areas were also explored. The sample comprised 328 ecstasy users (139 female, 187 male, one transsexual) with a mean age of 22.5 years (SD = 4.9 years). Questionnaires were completed either in hard copy or through a website concerned with ecstasy use. The results showed that friends were the most common source of information about ecstasy for the sample overall, although females were more likely to utilize this source than males. None of the .ve categories of perceived risk (e.g. psychiatric, physical) showed a signi.cant gender difference. Males were more likely to take rest breaks whilst females were more likely to limit consumption as a precaution against harm. Three factors emerged from a principal components analysis concerning perceived personal change since initiation of ecstasy use. Factor 1 (23.8% of the variance) concerned negative experiences (e.g. depression). Factor 2 (22.0% of the variance) concerned positive personal qualities (e.g. caring). Factor 3 (10.5% of the variance) concerned selective aspects of functioning (e.g. alertness). The pattern of Factor 1 and Factor 2 scores over time suggested that 6 years since initiation of ecstasy use might be a time when some long-term users may be open to reassess their use of the drug. Broader implications of the .ndings for health education initiatives aimed at ecstasy users are discussed.

Social services homecare for people with motor neurone disease/amyotrophic lateral sclerosis: why are such services used or refused?

Many patients with the terminal condition motor neurone disease/amyotrophic lateral sclerosis (MND/ALS) do not access social service homecare, which may have implications for the location of end-of-life care. We aimed to identify factors related to uptake of such care in MND/ALS. A case note review of patients at a UK MND/ALS clinic (N = 97) provided data concerning disease onset and severity, demographic variables and care received. Narrative interviews with people with MND/ALS (N = 24) and family carers (N = 18) explored their perspectives on social services homecare. Quantitative analyses highlighted the role of increasing disease severity and age for social services homecare uptake. However, qualitative findings revealed a number of barriers delaying the uptake of such care. ‘Internal’ issues focused on retaining control and normality within the home. ‘External’ issues arose from limited understanding of the disease amongst service providers and lack of awareness of service entitlement amongst patients and carers. Multiple factors are implicated in the uptake of social services homecare. Uncertainties surrounding service entitlement must be addressed, including the simplification of bureaucratic procedures and clarification of the roles of health and social care professionals. Service providers need a greater awareness of the nature of the disease and their role in its management.

Cannabis-related deficits in real-world memory

Research shows that cannabis users exhibit deficits in prospective memory (PM) and executive function, which persist beyond acute intoxication. However, many studies rely on self‐reports of memory failures or use laboratory‐based measures that may not mimic functional deficits in the real world. The present study aimed to assess real‐world memory functioning.

Syllogistic reasoning performance in MDMA (ecstasy) users

Previous research has demonstrated working memory and executive deficits in recreational users of MDMA (3,4-methylenedioxymethamphetamine; Ecstasy). In turn, both of these constructs have been implicated in syllogistic reasoning performance. Twenty-two MDMA users (mean age = 21.36) and 26 MDMA nonuser controls (mean age = 21.31) were tested on syllogisms of varying difficulty and on measures of working memory and executive functioning. MDMA users were significantly impaired in aspects of syllogistic reasoning, and the effect remained significant after the authors controlled for the use of other drugs. However, the MDMA-related variance was reduced to below statistical significance following control for group differences in working memory span. The results are consistent with the possibility that MDMA-related deficits in aspects of executive functioning result in impaired reasoning performance among MDMA users.

Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study

INTRODUCTION Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection. METHODS 60 heels with intractable plantar fasciitis who had failed conservative treatment were randomised to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared. RESULTS Pre-injection, the two groups were well matched with no statistically significant difference. At 3 months, all three outcome scores had significantly improved from their pretreatment level in both groups. The scores in the Steroid arm were marginally better than in the PRP arm, but this difference was not statistically significant. At 6 months, there was no statistically significant difference between the two groups, though there was a trend for the PRP scores to become better than the Steroid scores. At 12 months, the RM, VAS and AOFAS scores in the PRP arm (1.9, 3.3 and 88.5) were significantly better than the Steroid arm (2.6, 5.3 and 75) with P values of .013, .028 and .033, respectively. CONCLUSIONS PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection.