Sequential analysis of the effects of naltrexone on the environmental meditation of self-injurious behavior.

Accumulated evidence shows that biology and the environment can mediate self-injurious behavior (SIB) in persons with mental retardation. Whether pharmacological treatment alters the environmental mediation of self-injury is unclear. Opioid antagonist effects on sequential dependencies for self-injury were studied in the context of experimental single-subject double-blind placebo-controlled designs. Direct observational data were collected for 4 adult subjects in real time on daily rate of SIB and staff interactions. Clinically significant reductions (i.e., ≥ 33%) in SIB rate were observed for 3 of the 4 subjects. For all subjects, the magnitude of the sequential dependency between staff behavior and self-injury was significantly greater during treatment with naltrexone than during treatment with a placebo. Results are discussed in relation to behavioral mechanisms of action regulating medication effects for self-injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case study: paradoxical response to naltrexone treatment of self-injurious behavior

Opioid receptor antagonists have been studied in the management of self-injurious behavior (SIB) in developmentally disabled individuals. The authors present a case of a severely retarded, autistic man whose SIB increased dramatically during a trial of naltrexone. A paradoxical increase in SIB, attributed to the extinction burst phenomenon during the initial period of nonreward, is known to occur during treatment with naloxone, a short-acting parenteral opioid antagonist. It has only once been reported during treatment with naltrexone, a long-acting orally administered agent. Opioid analgesic effects and learning theory can explain both increases and decreases in SIB after opioid blockade.     

Momentum versus extinction effects in the treatment of self-injurious escape behavior

S. Enteritidis HY-1 isolated during quarantine from chicks imported from England was used. Laying hens at the age of 34 weeks were inoculated orally with 10(10) organisms (10 birds), intramuscularly with 10(9) (5 birds), and intravenously with 10(9) (5 birds). Egg production did not change in hens infected orally, although it was reduced in hens infected intramuscularly for 2-3 weeks post inoculation. For one month, internally infected eggs of which the shells were not contaminated were found: one out of 65 eggs in hens infected orally and three out of 36 eggs in hens infected intramuscularly. This experiment demonstrated the ability of S. Enteritidis isolated from chicks imported from England to cause transovarian infection.     

Inhibitory effects of naltrexone on the induction of parental behavior in juvenile rats

Juvenile rats are rapidly responsive to pups soon after weaning, displaying maternal-like behaviors such as licking, retrieving, grouping, and crouching over pups. As juveniles reach 30 days of age, they become less responsive to pups and show increased latencies to display the same parental behaviors. In light of previous data implicating opiates in the display of ongoing maternal behavior, we administered naltrexone, a long-acting opiate antagonist, beginning 5 and 9 days prior to and continuing throughout the period of behavioral testing, which started at 26 or 30 days of age. Male and female juveniles treated with 10 mg/kg of naltrexone SC for 9 days (days 21 to 29 of age) prior to and during behavioral testing (days 30 to 37) showed longer latencies to retrieve, group, and crouch over pups than did the vehicle-injected controls. These results suggest that opioids may have a stimulatory role in parental behavior during this prepubertal period.     

Assessment of self-injurious behavior maintained by access to self-restraint materials

Metastatic tumor is one of several etiologies of space-occupying masses in the orbit that accounts for 1%-13% of all orbital masses (1). In the adult patient population, breast cancer is the most common tumor to metastasize to the orbit followed by metastases from the lung, prostate and gastrointestinal tract (2). It is rare for carcinoid tumors to metastasize to the eye or to the orbit. Carcinoid tumors arise from Kulchitsky cells that originate in the neural crest. Histologically, these tumors resemble, but are not as aggressive as, adenocarcinomas. Most carcinoids arise in the gastrointestinal tract or the lung. The most common site for carcinoid metastases is the liver. On anatomical imaging studies, such as CT and magnetic resonance imaging, metastatic orbital carcinoid tumors appear as nonspecific tumor masses. Carcinoid tumors have an affinity for uptake of the radiopharmaceutical 131I-metaiodobenzylguanidine (MIBG) (3). We report a case of a patient with a known carcinoid tumor who developed a left orbital mass that demonstrated abnormal uptake of 131I-MIBG indicative of metastatic carcinoid tumor to the orbit.     

Different types of self-injurious behavior in bulimia nervosa

This study introduces a new method of determining sex based on four morphological features of the posterior, distal humerus. The technique was developed on a 20th century anatomy series, the University of Toronto Grant Skeletal Collection, and was tested on 35 known individuals from the University of New Mexico Documented Collection and 93 individuals from the William M. Bass Donated Skeletal Collection. Four statistically significant characteristics relating to the carrying angle of the arm are identified (p < 0.05). Together, they are capable of determining sex with 92% accuracy.     

Using economics to assess the place of screening

To an economist the place of screening is, in principle, no different from that of any other medical intervention. Any screening activity should be evaluated in terms of the costs it incurs and the benefits it produces. The reasoning for this is based on one fundamental principle of economics: that of opportunity cost. Resources are scarce, requiring choices to be made about what health care to provide and what not to provide. Sacrifices will be made through not taking up some opportunities, and the benefits of these sacrifices are known as opportunity costs. The place of economics is to assist decision making to promote efficiency and equity in the health care sector. To do this it is necessary to relate the benefits of any screening activity to its costs. Of course, the practicalities of applying economics to assessment of screening activities may be different than for other areas of health care. For instance, screening has a broader range of outcomes than most types of health care, including investment in knowledge as well as health gain. This does have implications for the way in which these outcomes are valued in an economic analysis. This means that economics can be applied to a wide range of policy questions about screening. In this paper examples from applications of economics are used to consider the following issues: How should we set out and estimate costs and benefits (using the example of cholesterol screening)? What is benefit and how should it be measured (using an example from cystic fibrosis carrier screening)? How can economics be used to examine equity issues in screening (using an example from bone mineral density screening)? Together, these case studies highlight the range of screening issues to which economics can be usefully applied.     

Using cognitive science methods to assess the role of social information processing in sexually coercive behavior.

74 undergraduate men completed cognitive performance tasks assessing perceptual organization, classification, and category learning, as well as self-report measures relevant to sexual coercion. The stimuli were slides of Caucasian women who varied along affect and physical exposure (i.e., sensuality) dimensions. Data were analyzed using a weighted multidimensional scaling model, signal-detection theory analyses, and a connectionist learning model (RASHNL; J. K. Kruschke and M. K. Johansen, 1999). Individual differences in performance on the classification and category-learning tasks were congruent with individual differences in perceptual organization. Additionally, participants who showed relatively more attention to exposure than to affect were less sensitive to women's negative responses to unwanted sexual advances. Overall, the study demonstrates the feasibility and utility of cognitive science methods for studying information processing in psychopathology, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using ultrasound to assess the fetus at risk

In early pregnancy, ultrasonic scanning is valuable if the patient's menstrual history is unreliable or if uterine size is less than expected. The crown-rump length of the embryo can be measured from the sixth week of gestation, and pulsation of the heart detected from the seventh. The crown-rump length of the early embryo gives precise information about maturity. Somewhat later in pregnancy, fetal maturity and growth rate can be assessed accurately by measurement of the biparietal diameter. The head circumference and the fetal upper abdominal circumference together give the head-abdomen ratio, which can be helpful in assessing fetal nutrition. The abdominal circumference also may be used to predict fetal weight.     

On the use of aversive techniques in controlling self-injurious behavior.

Responds to G. P. Koocher's (1976) interpretation of B. G. Tate and A. S. Baroff's (1966) study on the use of shock in controlling self-injurious behavior and expresses appreciation for Koocher's concern about the use of aversive techniques in controlling difficult behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severe self-injurious behavior: The problem of clinical control.

Describes the long-term treatment program and follow-up of a case of chronic, severe, multiple self-injurious behavior. The intensity, frequency, and multiplicity of self-injurious behavior in a boy 1st seen at age 61/2 yrs is unparalleled in the literature. Treatment spanned 10 mo and more than 1,000 therapy hrs. Contingent electric shock and differential reinforcement of other behavior were the primary techniques utilized. The specifics of the punishment and reinforcement contingencies were modified throughout the program as a function of the behavior, thereby allowing for evaluation of the various components of the treatment procedures. Although initial results were only partially successful, total suppression was eventually achieved in the laboratory setting. The procedures described for extending this control to the natural environment proved only moderately successful. The technical, ethical, and theoretical issues concerning the treatment of severe self-injurious behavior are discussed. It is suggested that the extrapolation of laboratory evidence to the natural setting is premature in the case of severe self-injurious behavior. Suggested criteria for the assessment of successful clinical treatment of self-injurious behavior are offered. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective effects of naltrexone on food pleasantness and intake

The effects of 50 mg naltrexone on both pleasantness and intake of 10 common food items were investigated using a double-blind placebo-controlled study with 16 male volunteers. Rated food pleasantness was reduced significantly in the naltrexone condition compared with both controls (placebo and baseline). However, pleasantness ratings were not affected uniformly across foods, with sweetened, fatty, and high-protein foods being most affected. Changes in rated unpleasantness generally mirrored those for pleasantness, but evaluations of saltiness and sweetness were unaffected by naltrexone. Although total intake was reduced in the naltrexone condition, this was not significant compared with placebo. However, fat and protein intakes were significantly less following naltrexone. The effect of naltrexone on intake was also food dependent, but in this case intake of sweet foods was spared relative to other food categories. The apparent discrepancy between liking and intake data with sweet foods could be interpreted in terms of the likely influence of normal eating styles on food selection during a buffet-style meal, and may explain some contradictions in previous studies of this kind. The implications for understanding opioid involvement in food acceptability are discussed.     

Using the patient's plan to assess progress in psychotherapy.

Describes the application of a formulation of the patient's plan in psychotherapy research. Use of patient plan formulations to (1) study the effects of therapist intervention on patient progress (within-session change) and (2) develop individualized psychodynamic outcome measures (plan attainment) are discussed in studies by G. Silberschatz (1986) and Silberschatz et al (see record 1987-07982-001), respectively. If the therapist helps the patient disconfirm pathological beliefs (by passing tests or intervening in plan-compatible ways) the patient is likely to progress toward achieving therapy goals with a more favorable outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the incremental method to assess the economic effect of capital investments

Questions of applying the incremental method to calculate the economic effect of capital investments are considered. The author’s methodology for determining the economic effect with this method while allowing for the specific features of fiscal accounting in the Russian Federation is suggested, and an example of calculating the integrated economic effect and pay-back period with its use is presented.     

The motivation of self-injurious behavior: A review of some hypotheses.

The literature on self-injurious behavior suggests 5 major hypotheses concerning the motivation of such behavior: (a) Self-injurious behavior is a learned operant, maintained by positive social reinforcement (positive reinforcement hypothesis); (b) self-injurious behavior is a learned operant, maintained by the termination of an aversive stimulus (negative reinforcement hypothesis); (c) self-injurious behavior is a means of providing sensory stimulation (self-stimulation hypothesis); (d) self-injurious behavior is the product of aberrant physiological processes (organic hypothesis); and (e) self-injurious behavior is an attempt to establish ego boundaries or to reduce guilt (psychodynamic hypotheses). Data bearing on each hypothesis are reviewed and evaluated. It is suggested that effective treatment may depend on a recognition of the different motivational sources of self-injurious behavior and the developmental relationships existing among these sources. Animal analog experiments may provide clues to the motivation of self-injurious behavior in cases in which human experimentation is ethically indefensible. (88 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of shock intensity in the treatment of longstanding and severe self-injurious behavior

A comparison of shock intensity was conducted while treating a young woman with mental retardation and severe self-injurious behavior (SIB). Two levels of shock intensity were evaluated: 3.5 milliamps (mA) delivered via the Self-Injurious Behavior Inhibiting System (SIBIS) and 18.5 mA delivered via the Hot Shot Power Mite. A combined reversal and multiple baseline across behaviors design was used to evaluate treatment effects. SIBIS in conjunction with differential reinforcement and extinction of self-injurious escape behavior produced minimal reductions in SIB. The Hot Shot combined with extinction of self-injurious escape behavior and reinforcement for compliance resulted in immediate and large reductions in SIB. Residential staff were trained to implement contingencies by the fourth day of treatment with excellent generalization from 30-min sessions to the natural environment across all waking hours. Continuous protective restraints were eliminated within the first month of treatment. Progress occurred in personal care, vocational training, independence, and communication. Treatment effects were maintained for approximately 6 months until a relapse occurred after home visits.     

Short-term effects of naltrexone in 155 heroin ex-addicts

The narcotic antagonist naltrexone was administered for periods of up to 8 months to a total of 155 patients at a dose of 40-200 mg per day. The antagonistic effect of naltrexone was tested by injections of heroin. Eighty milligrams of natrexone was effective for 48hr. The antagonistic effect decreased at 72 hr after the administration of 120-200 mg of naltrexone. Laboratory tests indicated no signs of toxicity. Naltrexone may elicit an increase in blood pressure and opigastric pain. Neither of these side effects appear clinically important. No signs of dependence on naltrexone were detected. These results suggest that naltrexone may be useful for clinical treatment of opiate dependence.