Worth the Risk? Relationship of Incentives to Risk and Benefit Perceptions and Willingness to Participate in Schizophrenia Research

Objective: Providing incentives for research participation is widely practiced but minimally studied. In schizophrenia research, questions about capacity to consent and potential vulnerability may raise concerns when offering incentives for participation. Despite empirical attention focused on consent and decision-making capacity in schizophrenia, the issue of incentives has been essentially ignored. We examined willingness to participate in research, in relation to perceived risks and benefits, among people with schizophrenia and schizoaffective disorder. Method: Forty-six people with schizophrenia or schizoaffective disorder rated perceived risks and benefits of 5 hypothetical research vignettes. They also indicated whether they would be willing to participate at each of 5 incentive levels (including no compensation). Cognition was assessed with Mattis Dementia Rating Scale. Results: Ratings of risk and potential personal benefit were inversely correlated. For all scenarios, significant correlations were found between perceived risk and willingness to participate for greater compensation. Conversely, lower perceived likelihood of benefit was associated with a higher compensation threshold for participation in each scenario. Even at the highest proffered payment level for each scenario, however, a substantial proportion of respondents were not willing to participate. Risk assessment and willingness to participate (at all levels of compensation) were not associated with demographic variables or cognitive status. Conclusions: Determining whether incentives impede voluntarism remains an important task for empirical ethics research. Assessing potential research participants’ understanding and perceptions of risks, benefits, and alternatives to participation will help ensure that informed consent fulfills its mission—embodying the ethical principle of respect for persons.     

Antibodies to GD1alpha and to GQ1beta in Guillain-Barré syndrome and the related disorders.

Certain species of anti-ganglioside antibodies are associated with specific clinical features in various neurologic diseases. Serum autoantibodies to these minor gangliosides were investigated in a number of neurological diseases in order to examine the biological functions of GD1alpha and GQ1beta. Eleven patients with Guillain-Barré syndrome had remarkably high IgG anti-GD1alpha antibody titers, but no GD1alpha was detected in human peripheral nerve. An absorption study showed that IgG anti-GD1alpha antibodies from eight of the 11 patients were significantly absorbed by GD1a and GM1b, indicative that the IgG anti-GD1alpha antibodies cross-react with GD1a and GM1b. Both GD1a and GM1b have been reported to be target molecules for serum antibodies in certain patients with Guillain-Barré syndrome. GD1alpha may induce the production of IgG anti-GD1alpha antibody which cross-reacts with GD1a or GM1b, and subsequently functions in the development of Guillain-Barré syndrome. The IgGs from six patients with Fisher's syndrome who had the anti-GQ1beta antibody had anti-GQ1b activity as well. All the patients had external ophthalmoplegia, but no GQ1beta was detected in the human oculomotor nerve, further evidence that GQ1b, not GQ1beta, is the molecule targeted by the autoantibody in Fisher's syndrome.     

How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate?

We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.     

Is amount of food intake in overweight and obese children related to their psychopathology and to maternal eating behavior?

Objective

To explore the relationship among the amount of food intake of 8- to 12-years old overweight children, their psychopathology (internalizing, externalizing and attention problems) and the mothers' amount of food intake.

Methods

In a previous trial designed to test the influence of a preload on food intake, overweight to obese children and their mothers participated in a taste test thereby consuming a preweighed amount of a mousse-like dessert, which was reweighed again at the end. In the current study, we reanalyzed these data by assessing the relationship between children's amount of food intake and their psychopathology, as measured with the Child Behavior Checklist.

Results

We found that children with high scores for attention problems consumed larger amounts of food. No such relationship could be observed for children's externalizing problems. Additionally, a positive and direct effect of mother's amount of food intake on children's energy food intake was present even when accounting for children's psychopathology.

Conclusion

Results suggest that besides mothers' influence on children's food intake, children's problems to self-regulate impulses may be related to uncontrolled eating behavior and weight gain.     

Oropharyngeal freezing and its relation to dysphagia – An analogy to freezing of gait

IntroductionThe pathophysiology of dysphagia in Parkinson's disease (PD) is heterogeneous and poorly understood at present. This study investigated the phenotypes, prevalence and pathophysiology of oropharyngeal freezing (OPF) in PD and its relation to dysphagia.MethodsIn a prospective study, 50 PD patients were systematically screened for OPF using flexible endoscopic evaluation of swallowing (FEES). In addition, FEES-videos of 50 patients with post-stroke dysphagia and 50 healthy subjects were retrospectively evaluated as control groups. In PD patients freezing was assessed with the “freezing of gait (FoG) questionnaire” and the relationship between OPF and FoG was analyzed.ResultsIn analogy to FoG, signs for OPF presented as either temporarily missing or delayed swallowing reflex in combination with freezing associated movement abnormalities e.g. festination, trembling, or akinesia. Seventeen PD patients (34%) showed considerable signs for OPF (15 cases of festination, 3 cases of trembling, 3 cases of akinesia). In the patients with post-stroke dysphagia, OPF was detected in 2 patients (4%). The healthy subjects showed no signs for OPF. The distribution of OPF differed significantly between the investigated groups (p < 0.01). PD patients with signs for OPF scored significantly higher in the FoG-questionnaire (12.69 ± 6.37) compared to patients without OPF (7.29 ± 5.17; p < 0.01).ConclusionSwallowing in PD patients can be impaired by OPF. We suggest that OPF and FoG share common pathophysiologic mechanisms based on their association and similar semiologies.     

Medical therapy of epilepsy: When to initiate treatment and when to combine?

Abstract Most patients reporting more than one well-documented or witnessed seizure require prophylactic antiepileptic (AED) therapy. Those with an underlying brain disorder and/or an abnormal electroencephalogram should probably be treated after their first event. The goal should be maintenance of a normal lifestyle by complete seizure control with no or minimal side-effects. Failure of the first AED due to lack of efficacy implies refractoriness. A policy of consecutive substitutions is unlikely to be an effective strategy. Thus, if the first or second monotherapy improves control but does not produce seizure freedom, an AED with different and perhaps multiple mechanisms of action should be added. Strategies for combining drugs should involve individual assessment of patient-related factors, including seizure type and epilepsy syndrome classifications coupled with an understanding of the pharmacology, side-effects and interaction profile of the AEDs. Reducing the dose of one or more AEDs may help accommodate the introduction of a second or third drug. An orderly approach to the pharmacological management and, when appropriate, surgical investigations for each epilepsy syndrome will optimise the chance of perfect seizure control and help more people achieve safer and more fulfilled lives.     

“I Have Been Trying to Get Them to Respond to Me”: Sexuality and Agency in Psychoanalysis

Psychoanalytic theory has seen many changes in the past 100 years. But in the process, sexuality, as the centerpiece of our understanding of human motivation and conflict, seems to have gotten lost. As they did a century ago, clinicians today deal with sexual transferences and countertransferences. And issues of gender and sexual orientation are widely discussed. Yet, across most current theoretical perspectives, nothing compels us to focus on sexuality, as such, in the way that was once absolutely essential.

During the same period, psychoanalytic approaches have consistently been concerned with questions of personal agency, i.e., its disruption in development and restoration in treatment. Indeed, the aim of treatment was traditionally understood as enabling patients to repossess their experience of themselves as “agents” in relation to their own disowned motives, affects, and drives (“where id was, there shall ego be”). In contemporary interpersonal, intersubjective, and relational perspectives, the issue of agency takes on even more central significance.

This article explores how these two seemingly different conceptual and developmental frameworks—sexuality as a function of mind, and agency as a derivative of relational experience—may be compatible. Here, I examine the relationship of sexuality and the experience of agency in parent–child and analyst–patient relationships, and suggest that sexuality as such may yet have a central role in contemporary psychoanalytic thinking and in our understanding of the basic nature of psychic functioning.     

Children’s reactions to parental and sibling death

A signi.cant population of children will experience bereavement because of the death of a parent or a sibling. This grief is different from the bereavement seen in adults and needs to be understood in a developmental context. Cognitive and emotional understanding of death and dying in children gradually evolves with age. This report provides clinicians with information regarding the unique developmental elements in children that relate to the process of bereavement secondary to parental and sibling loss, risk factors for complicated grief, the warning signs of depression and anxiety beyond normal grief reaction, and the guidelines for intervention in children.     

Which depressed patients respond to nefazodone and when?

BACKGROUND: Retrospective data analyses were conducted of a single-blind trial of 993 outpatients with nonpsychotic major depression (DSM-III-R) treated for 12 weeks with nefazodone to provide a more specific picture of the nature and timing of response or remission to acute-phase treatment. METHOD: All patients participated in a single-blind, 16-week lead-in to obtain responders eligible for a subsequent double-blind, randomized continuation phase trial. Outcomes were defined by the 17-item Hamilton Rating Scale for Depression (HAM-D). A > or = 50% reduction from baseline defined response, and a total HAM-D exit score of < or =8 defined remission. RESULTS: Of all patients who entered the trial, 41.8% (last observation carried forward) responded at or before week 4 (early responders), and an additional 25.2% responded thereafter; 18.3% achieved remission at or before week 4; 33.6% achieved remission after week 4. Thus, 77.3% of those responding ultimately remitted. On average, remission followed response by 2 weeks. The average end-of-treatment dose was 376 mg/day at exit (last observation carried forward). Responders or remitters (as opposed to nonresponders or nonremitters) had lower baseline depressive symptomatology and were more likely to be married or cohabiting. CONCLUSION: The full symptomatic benefit of antidepressant medication may not be apparent until completion of an 8- to 10-week trial. A high number of responders ultimately attained remission. Baseline demographic and clinical features were not highly predictive of who would or would not benefit from nefazodone. For routine care, a minimal acute-phase trial, using a 50% reduction in baseline symptom severity to define response, should be 8 weeks. Whether ultimate nonresponders can be identified earlier than 8 weeks deserves further study.     

Infants’ neural responses to helping and hindering scenarios

A growing literature suggests infants prefer prosocial others over antisocial others. Although recent studies have begun to explore the neural mechanisms underlying these responses (Cowell and Decety, 2015; Gredebäck et al., 2015), these studies were based on relatively small samples and focused on distinct aspects of sociomoral responding. The current preregistered study systematically examined infants’ neural responses both to prosocial/antisocial interactions and to prosocial/antisocial characters, using larger samples and two distinct age groups. We found that 6- (but not 12-) month-olds showed higher relative right frontal alpha power (indexing approach motivation) when viewing helping versus hindering scenarios. Consistent with past EEG work, infants showed no group-level manual preferences for the helper. However, analyses of infants’ neural responses toward images of the helper versus hinderer revealed that both 6- and 12-month-olds showed differential event-related potential (ERP) responses in the P400 and N290 components (indexing social perception) but not in the Nc component (indexing attentional allocation), suggestive that infants’ neural responses to prosocial versus antisocial characters reflect social processing. Together, these findings provide a more comprehensive account of infants’ responses to prosocial/antisocial interactions and characters, and support the hypothesis that both motivational and socially relevant processes are implicated in infants’ sociomoral responding.     

Is it time to replace the Wada test and put awake craniotomy to sleep?

The question we address here is whether the invasive presurgical brain mapping approaches of direct cortical stimulation and of the Wada procedure can be replaced by noninvasive functional neuroimaging methods (functional magnetic resonance imaging [fMRI], magnetoencephalography [MEG], transcranial magnetic stimulation and [TMS]). First, we outline the reasons for contemplating such a replacement. Second, we present evidence to the effect that the efficacy of the invasive and noninvasive methods, while suboptimal, is comparable. Third, we discuss additional advantages of noninvasive presurgical brain mapping and conclude that there are no longer compelling reasons for opting for invasive mapping in many if not most cases provided that the non‐invasive methods are available. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .     

Response to letter to the editor “Calcitonin gene-related peptide and traumatic brain injury”

<正>Dear Sir,Since the present study is mainly an observational study,though prospective,we did not use any particular treatment methods for all traumatic brain injury(TBI)patients.The main purpose of the research is to investigate the relationship between calcitonin