In order to evaluate the potential of intrathecal baclofen (IB) for treatment of severe spasticity, we meta-analyzed English-language literature and found that IB significantly reduces spasticity in most cases, reducing the mean Ashworth score from 3.9 to 1.6 (t-test: p ≤ .001) and the mean Penn spasm score from 3.2 to 0.6 (p < .001). No effectiveness differences by age or time since onset were evident; however, persons with cerebral palsy appear to experience less relief than do other diagnostic categories. Although 92% of all cases have a significant reduction in spasticity, a minority (8%) decide against implantation of a pump, and of those implanted, 8% discontinue treatment by one year, resulting in an overall 78% success rate. Dosage creep is about 15% per month, on average. Our conclusion is that IB is effective for treating spasticity but less so than previously claimed. Quantitative data to evaluate its effect on pain, comfort, and function are largely lacking. Further research on longer term effects, and complications, is necessary.

In prophylactic treatment of patients having bipolar disorders (BD), lithium, no doubt, plays an important role. The hypothesis of this register study was that said patients, thanks to lithium therapy, would spend fewer and shorter stays in the hospital. We used ipsative control techniques in a study of 60 patients during two periods of 20 months each, one before and the other after the lithium therapy began. We found significant statistical differences regarding the average number (p<.004) and length (p<.001) of stays in hospital comparing pre-lithium treatment to post-lithium treatment. These averages also revealed statistical differences with regard to age (number of stays,p<.002; length of stays,p<.047), with older patients obtaining greater benefit from treatment than younger patients. There were no such differences with regard to gender (number of stays,p<.602; length of stays,p<.584). That BD patients respond favorably to lithium treatment is a well-known finding. On the other hand, we know of no previous study indicating that older patients obtain better results with lithium therapy than do younger patients. Yet because this study occurred over a 20-year period, there are some grounds that probably would substantiate this comparative statement; namely, that one does comply more easily as one gets older, that diagnoses are currently more accurate than they were before, and that care routines have improved.

Children continually exposed to violence develop anxiety and depression and display aggressive behavior; however, little information is available about how repeated exposure to violence affects blood pressure (BP) and development of hypertension. This study examines the association between violence exposure and ambulatory BP in 40 healthy African-American adolescents. Participants wore a 24-hr ambulatory BP monitor and completed a survey on exposure to community violence. We computed average daytime and nighttime BP values based on subjects' self-reports of awake and asleep times. There were significant correlations between nighttime BP and reports of violence victimization and witnessing of violent events. In contrast, daytime BP significantly correlated with victimization but not with witnessing violence. Children classified as nondippers (show <10% decrease in BP from awake to asleep) reported witnessing a significantly greater number of violent events than did dippers (show ≥10% decrease in BP from awake to asleep). This study is the first to demonstrate that violence exposure in African-American adolescents relates to elevated BP responses, which may increase the risk for African-American adolescents for developing hypertension and related cardiovascular complications in early adulthood.

The purpose of this article is to address cross-cultural provider–patient communication difficulties and their subsequent interference with the quality of treatment. The work currently under way between the Western-trained medical profession and three underserved communities of Black South Africans accustomed to traditional medicine systems serves as the illustrative case. Specifically, in this international project, American psychologists are assisting highly educated, urban Afrikaner medical and health care professionals enhance the cancer treatment provided to rural, low-income Zulu, Tswana, and Pedi patients. This paper consists of several sections. The first section discusses the two cultures involved in the project, with an emphasis on facts about the underserved populations. The second section summarizes findings from the administration of translations of a quality of life instrument (FACT-G). The following section outlines key findings in the area of doctor–patient communication in the Western medical context and specific provider–patient research in South Africa. Communication patterns in medical contexts as influenced by culture as well as doctor–patient relationship expectations are the focus of discussion in the fourth section, and the next section presents related general cross-cultural factors as developed by Geert Hofstede and various multicultural psychology authors. The subsequent section provides additional information from Witte and Morrison on culturally influenced perspectives of health. The final section presents several overall conclusions and recommendations to further improve quality of treatment in cross-cultural contexts.

The relative contribution of posttraumatic stress symptoms and general activity level to the prediction of neurocognitive performance among individuals with chronic pain was investigated. Posttraumatic stress symptoms accounted for significant proportions of the variance in attention and concentration and memory after controlling for years of education and pain severity. Level of engagement in common daily activities was also a significant predictor of attention and concentration. Level of general activity moderated the relation between posttraumatic stress symptoms and reasoning ability, the expected negative relation between posttraumatic stress symptoms and reasoning ability was significant only among those chronic pain patients who reported low levels of engagement in tasks of daily living. Discussion focuses on the findings in terms of their many implications for assessment and treatment of emotional and neurocognitive difficulties experienced by persons with chronic pain.

The present study measured factual knowledge about electroconvulsive therapy (ECT) in a demographically stratified sample of the general public. Participants (n = 200) completed a 31-item true–false test regarding indications, procedures, and effects of ECT, rating their confidence in each answer on a 5-point Likert scale. The correlation between years of education and proportion of correct answers was significant. Proportion of correct answers and mean confidence did not differ by age or gender, but data suggest that misconceptions about ECT may be more prevalent among African-Americans than among Caucasian participants. Common misconceptions in the entire sample included that ECT is curative, ECT is painful, nausea and vomiting are problems commonly associated with ECT, and seizure induction is not an expected effect. Overall, participants indicated a low degree of confidence in their responses. Although participants answered dichotomous choice questions with a fair degree of accuracy, participants' low confidence in their answers suggests that ECT remains poorly understood. The paper concludes with general and specific suggestions made to improve public understanding of ECT.

In this study, we evaluated the impact of language variations on listeners with and without head injuries. Participants with and without previous head injuries rated speakers using either normal or motherese speech register. ANOVA results revealed that participants in both groups rated speakers using normal prosody and normal content more favorably than speakers who spoke in motherese content and prosody. When speakers used only one of these motherese components in their speech, listeners still found disfavor with it, though less so than when speakers incorporated both components. Although both components related to ratings of the speakers, content variations exerted a larger influence. This supports implications of previous studies and offers the caveat that not only is “what” you say important, but also “how” you say it.

Recent research has found that warning analogue malingerers about the ability to detect simulated symptoms of mild brain injury significantly reduced malingering behavior, but they still exhibited mildly impaired performance compared to controls. The present study re-examined the impact of warning about the ability to detect malingering on college students' simulation of mild brain injury sequelae and their ability to elude detection by a short form of the MMPI-2. Unwarned Simulators (n = 25), Warned Simulators (n = 26), and Controls (n = 28) did not differ significantly on finger and hand dexterity. Both groups of simulators exhibited more deficits in attention-concentration, memory, and some executive functions than the control group, but the MMPI-2 F scale invalidated the results of most simulators. Warning about detection of malingering did not significantly reduce simulation on any measure. These data and qualitative analysis of the comments offered by participants about their simulation efforts suggest that it may be difficult for naive individuals to simulate brain injury sequelae successfully across a variety of measures.

We used ratios of EMG amplitudes to characterize neural strategies of motoneuron recruitment for seven bilateral muscle groups of the back and neck during nine motor tasks to discriminate patients who sustained sprain/strain injuries (n=61) from a control population (n=400). Compensatory relationships between muscle pairs improved the predictability of hypoactivity or hyperactivity based on the probability distribution of muscle ratios obtained from uninjured subjects. We defined severity of hypoactive or hyperactive EMG activity by (a) the number of ratios that exceeded the normal range (95% confidence interval), (b) the compensatory relationship between these muscle pairs during each motor task, and (c) the consistency and frequency of hypoactivity or hyperactivity across nine motor tasks. Accuracy of the classification system was 88% with a specificity of 90% and a sensitivity of 70%. Between-session reliability for the overall classification of 40 controls and 44 patients was 93%. These results indicate that muscle ratios can objectively quantify altered strategies of motoneuron recruitment attributed to muscle trauma and pain common to spain/strain injuries.

Memory deficits are the most common neuropsychological sequelae after brain affections. We report the case of a 54-year-old, male patient who, after a diffuse hypoxic brain damage due to cardiac decompensation, received various forms of supportive treatment. The primary aim of the treatment process, namely, to allow him to live on his own and be able to remember, to plan, and to execute his ideas came to fruition during a process of altogether 1.5 years.