Metacognition strengthens the association between neurocognition and attenuated psychosis syndrome: Preliminary evidence from a pilot study among treatment-seeking versus healthy adolescents.

Background: In a pilot study, we assessed the potential value of deficits at the metacognitive versus the neurocognitive level of functioning for identifying adolescents with attenuated psychotic syndrome (APS).

Method: Twenty-two treatment-seeking adolescents with APS, 42 treatment-seeking comparisons, and 34 age-matched healthy comparisons were evaluated using the Prodromal Questionnaire, the Structured Interview for Prodromal Syndromes, and the Mood and Anxiety Symptom Questionnaire. Neurocognitive and metacognitive functioning were assessed in two non-social (verbal memory and executive functioning) and two social (facial emotion perception and theory of mind) cognitive domains.

Basic self-disturbance, neurocognition and metacognition: A pilot study among help-seeking adolescents with and without attenuated psychosis syndrome.

Aim: The goal of this pilot study was to assess the association between basic self-disturbance (SD) and deficits in neurocognitive and metacognitive functioning among help-seeking adolescents with and without attenuated psychosis syndrome (APS).

Methods: Sixty-one non-psychotic, help-seeking adolescents (age 13-18) were assessed with the examination of anomalous self-experience, the structured interview for prodromal syndromes and a new metacognitive approach to neurocognitive assessment applied to two non-social (executive functions and verbal memory) and two social (theory of mind and emotion recognition) domains. After each answer, subjects were also requested to indicate their level of confidence in the answer and to decide whether they desired it to be "counted" toward their total score on the task.

Metacognition in non-psychotic help-seeking adolescents: associations with prodromal symptoms, distress and psychosocial deterioration.

Objective: To explore the notion that difficulties in metacognitive functioning are a core pre-psychotic feature of emerging schizophrenia and its spectrum.

Method: Seventy-eight help-seeking, non-psychotic adolescents (age 13-18) were assessed with the Prodromal Questionnaire (PQ), the Structured Interview for Prodromal Syndromes (SIPS), two scales of social and role functioning, and a metacognitive version of two non-social (verbal memory and executive functioning) and two social (facial emotion perception and Theory of Mind) cognition tasks. In addition to the standard administration of the tasks, subjects were also asked to rate their level of confidence in the correctness of each answer, and to choose whether they wanted it to be "counted" toward their overall performance score on the task.

Disturbances of basic self and prodromal symptoms among non-psychotic help-seeking adolescents.

Background: The goal of this study was to explore the notion that anomalies of self-experience (ASE) are a core, 'not-yet-psychotic' clinical phenotype of emerging schizophrenia and its spectrum. Method To accomplish this goal, we examined the relationship between ASE and commonly accepted risk markers in a sample of 87 help-seeking, non-psychotic adolescents (aged 14-18 years). ASE were assessed with the Examination of Anomalous Self-Experience (EASE), subclinical psychotic symptoms were assessed with the Prodromal Questionnaire and the Structured Interview for Prodromal Syndromes, deterioration in psychosocial functioning was assessed with the Social and Role Functioning Scales, and level of distress with the Mood and Anxiety Symptoms Questionnaire.

When customers exhibit verbal aggression, employees pay cognitive costs.

In 4 experimental studies, we show that customer verbal aggression impaired the cognitive performance of the targets of this aggression. In Study 1, customers' verbal aggression reduced recall of customers' requests. Study 2 extended these findings by showing that customer verbal aggression impaired recognition memory and working memory among employees of a cellular communication provider.

Medical clowning: even adults deserve a dream.

The article examines the significance of the integration of medical clowns as an intervention strategy with adult outpatients suffering from chronic illnesses. The study is based on content analysis of the documentation of the work of two medical clowns over two years. The dominant theme involves the definition of the clown's role and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families.

[The definition of the medical clown's role with adult patients].

In recent years, the healthcare system has grown increasingly aware of the need to develop and adopt new models and intervention methods aimed at improving patients' quality of life. As part of this perception, medical clowns have been integrated into hospitals, primarily in work with children. Recently, there have been attempts to integrate clowns into work with adult patients in emergency rooms, but this intervention method has not yet been systematically implemented and studied.

A Phase II study of the safety and efficacy of teriflunomide in multiple sclerosis with relapses.

Background: Teriflunomide, a dihydro-orotate dehydrogenase inhibitor, has immunomodulatory effects, including the ability to suppress experimental allergic encephalomyelitis. In this randomized, double-blind, placebo-controlled Phase II study, the authors examined the safety and efficacy of oral teriflunomide in multiple sclerosis (MS) with relapses.

Methods: Patients (n = 179) with relapsing-remitting MS (n = 157) or secondary progressive MS with relapses (n = 22) were randomized to receive placebo, teriflunomide 7 mg/day, or teriflunomide 14 mg/day for 36 weeks.

Novel methods for studying new antiepileptic drug pharmacology.

A number of new antiepileptic drugs act by indirect mechanisms and thus produce effects that may not best be measured by traditional blood studies of the drugs and their metabolites. Study of the indirect action of these drugs on GABA-mediated inhibition by microdialysis and nuclear MR spectroscopy has proved more relevant. These new investigative techniques may also prove valuable as compounds affecting glutamate or other excitatory neurotransmitters are developed.

Near-patient rapid assay of phenytoin concentration.

The Biotrack 516 is a simple, automated whole blood phenytoin (PHT) assay that reports corresponding total serum concentrations in 3 min. We compared Biotrack results in 58 patients with the total and unbound serum PHT concentrations measured by the standard TDx fluorescence polarization immunoassay. Correlation with total TDx concentration was high (r = 0.

Measurement of carbamazepine and carbamazepine epoxide in the human brain using in vivo microdialysis.

We report the first study of carbamazepine and carbamazepine-10,11-epoxide concentrations determined by using intracerebral microdialysis in three patients undergoing depth electrode studies for the evaluation of medically intractable epilepsy. Very small microdialysis catheters, affixed to and inserted with the depth electrodes, sampled drug concentration in the extracellular environment. We perfused artificial extracellular fluid continuously, and varied the perfusion rate to permit estimation of the absolute drug concentration in the extracellular space.

Differentiation of temporal lobe ictal behavior associated with hippocampal sclerosis and tumors of temporal lobe.

Ictal behavioral characteristics may reflect seizure spread patterns and provide a clue to seizure onset location, between or within specific cerebral lobes. Sequential symptomatology might therefore distinguish patients with hippocampal sclerosis from patients with temporal lobe tumors. To determine ictal behavioral differences in patients of these groups, we analyzed 145 seizures of 33 patients with hippocampal sclerosis (group I) and 79 seizures of 22 patients with temporal lobe tumors (group II).

Phenytoin concentrations in the human brain: an in vivo microdialysis study.

We report the first human study of phenytoin concentration using in vivo microdialysis, which permits sampling the extracellular environment of the brain. This technique has been applied to patients undergoing intracranial electrode investigation for intractable epilepsy. By varying the rate of perfusion (from 2.

A pharmacodynamic approach to the estimate of carbamazepine autoinduction.

Population-based pharmacokinetic prediction algorithms have been developed for several medications. A fundamental assumption has been that the kinetics remain constant over time. Carbamazepine (CBZ), however, induces its own metabolism in a concentration- and time-dependent manner.

A method for prediction of phenytoin levels in the acute clinical setting.

Phenytoin (PHT) administration is complicated by saturation kinetics within the therapeutic range, causing marked changes in drug concentration with small changes in dose. The "half-life" increases with concentration, varying from 8-24 hr up to weeks, making it difficult to obtain the steady state levels needed by most prediction algorithms and nomograms. A Bayesian prediction program (Epidose) is presented which explicitly models PHT absorption and elimination kinetics in the non-steady state.

Clinical and electrographic effects of acute anticonvulsant withdrawal in epileptic patients.

We retrospectively investigated the effects of acute antiepileptic drug (AED) withdrawal on seizure symptomatology--including frequency, clinical features, and electrical onset--by studying 35 patients during evaluation for epilepsy surgery. The highest risk for both partial and secondary generalized seizures occurred during absent or subtherapeutic, and not during rapidly falling, AED levels. AED withdrawal had minimal effect on clinical symptomatology or electrographic onset.

Compliance declines between clinic visits.

Adherence to prescribed drug dosing regimens declined substantially during the interval between clinic visits and drug level tests. Using microelectronic monitors to observe pill-taking habits, 20 patients averaged 88% compliance before and 86% compliance after the visit, but this dropped to 67% compliance a month later. These data indicate that spot drug levels do not represent long-term "steady-state" drug serum concentrations.

In vivo determination of valproate binding constants during sole and multi-drug therapy.

Valproate (VPA) is present in humans and is largely bound to protein. Only free drug is metabolized, and antiepileptic and toxic effects are probably related to free concentrations. By measuring serial free and total serum VPA levels after routine oral doses, we have determined individual in vivo protein binding parameters for 37 patients after a total of 49 separate drug administrations.

How often is medication taken as prescribed? A novel assessment technique.

The evaluation of the efficacy of medication is confounded when patients do not adhere to prescribed regimens. Overdosing, underdosing, and erratic dosing intervals can diminish drug action or cause adverse effects. Using a new method with epilepsy as a model, we assessed compliance with long-term medications among newly treated and long-term patients.