As we have seen, modern nonstate approaches to hypnotherapy have been widely described as since the early 1970s. They do, as Dobson requires, place central emphasis upon the mediating role of cognitive factors in determining behavioural (and affective and physiological) responses to stimuli. These cognitive factors include role-perception (Sarbin Coe), attitudes and beliefs regarding hypnosis (Barber), specific cognitive and mental imagery strategies (Chaves, Spanos, Wagstaff), and expectations about their response to suggestion (Kirsch Lynn). However, arguably, hypnotherapy has always adopted a cognitive mediation model insofar as its founder, James Braid, specifically attributed the effect of physical interventionsto the dominant, expectant ideas which the subject adopted towards them, either spontaneously or in response to social influences such as imitation or hetero-suggestion. Many hypnotists have made their slogan: All hypnosis is self-hypnosis following Coue who said All suggestion is autosuggestion. Self-hypnosis and autosuggestion typically take the form of expectation, imagery, and self-talk. These cognitive constructs are among the primary mediating factors in cognitive-behavioural hypnotherapy. They are, and have always been, employed primarily in the service of observable behaviour change.
It is true that hypnotherapists originally made minimal use of formal outcome assessment. This is, I think, true of most psychotherapy conducted prior to the Second World War. However, since the 1950s they have tended to imitate assessment methods employed in other forms of psychotherapy, including CBT. In addition, hypnotherapists have traditionally drawn upon a number of tests and scales, derived from empirical research, which are designed to assess hypnotic responsiveness, most notably the Stanford Scale of Hypnotic Susceptibility and similar assessment tools which divide hypnotic responses into cognitive (e.g., hallucination, time distortion) and behavioural (e.g., arm heaviness, eye-closure) categories. Hypnotherapy is normally expected to commence with a full initial consultation and assessment of the clients presenting problem and their suitability for treatment, which typically encompasses affective, behavioural and cognitive factors. Assessment of outcomes in hypnotherapy most typically mirrors traditional behaviour therapy in that it has long (perhaps since before behaviour therapy) employed SUD (subjective units of disturbance) scales to monitor responses to imaginal (in vitro) or situational (in vivo) exposure, etc.
It therefore seems that much of modern hypnotherapy would meet the definitional critieria set forward by Prof. Dobson for classification as a form of cognitive-behavioural therapy (CBT) and that this is, of course, especially true of those approaches to hypnotherapy which deliberately adopt cognitive-behavioural theories of hypnosis. Moreover, in the case of clinicians and researchers who are influenced by Sarbin, Barber, and other major figures in the study of hypnosis, the terminology and concepts they employ will naturally tend to overlap with those used in CBT. Similar theories and terminology tend to encourage similar practices to some extent or at least to highlight the existing overlap between techniques which were previously described using different terminology. For example, hypnotic regression therapy was used extensively in the first and second world wars to treat PTSD. Modern CBT techniques used in PTSD beara striking practical resemblance to certain forms of hypnotic regression to traumatic events except that they use the term imaginal exposure to traumatic events instead. It is natural therefore, that modern hypnotherapists influenced by empiricalresearchand best practice would adopt a similar terminology and modify their existing techniques accordingly. These practical modifications are often relatively minor, and may largely entail a shift of emphasis between existing hypnotherapy techniques, e.g., moving away from older theories of emotional catharsis and placing greater emphasis upon cognitive restructuring, formerly referred to by hypnotherapists as rational , etc. There are, of course, specific concepts and interventions found in modern CBT which do not have any parallels in hypnotherapy. However, these can easily be imported into hypnotherapy just as hypnotherapy techniques (such as relaxation training, aversion therapy, and desensitisation methods) have previously been assimilated into behaviour therapy and CBT.
Indeed, as Weitzenhoffer and others have argued, many of the techniques employed in the field of CBT are predated by similar methods used in hypnotherapy. In some cases CBT techniques seem to have been directly derived from earlier hypnotherapy methods. It is not surprising, therefore, that a reciprocal inter-action, a mutual borrowing of techniques, has developed whereby the practice of hypnotic desensitisation, for example, which originally inspired behaviour therapy, has assimilated certain influences from subsequent use of related exposure methods in CBT. For example, in his recent book Cognitive Hypnotherapy (2009), Assen Alladin, one of the leading researchers in the field of clinical hypnosis, provides detailed treatment protocols for a range of common presenting problems which assimilate best practice from CBT with established theories and techniques from within the field of clinical hypnosis.
Hypnotherapy in the UK is considered a different modality from CBT and each tradition has its own regulations, training standards, and professional associations, etc. It therefore remains somewhat ambiguous whether the use of cognitive-behavioural hypnotherapy should be classified primarily as a form of CBT or hypnotherapy for accreditation purposes. There is some disagreement on this matter as both the theory and practice of cognitive-behavioural hypnotherapy appear to overlap both professions. However, the existence of cognitive and behavioural techniques in hypnotherapy, and cognitive-behavioural theories of hypnosis, largely predates the development of CBT as a profession and was historically considered to be part of the study of clinical hypnosis. My own conclusion, therefore, is that cognitive-behavioural hypnosis is very much an integralpart of the history hypnotherapy and a central sub-modality of modern hypnotherapy, albeit one very closely-related to modern CBT and drawing upon certain elements of its theory, practice, and research. However, it clearly draws to a far greater extent upon a much longer tradition of theory, practice, and research native to the field of hypnosis. In focusing upon the historical context, I have not had space to discuss in any detail the various modern variations of cognitive-behavioural theory in hypnosis but these continue to develop, and influence clinical applications independently, to some extent, of the parallel developments in CBT.
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Social-cognitive theory is based on the assumption that psychopathology results from unrealistic, maladaptive cognitions. One social-cognitive approach, Rational Emotive Therapy supposes that psychological difficulties such as low self-esteem are caused by irrational beliefs or irrational statements that people make to themselves. Therapy then involves identifying and disputing these irrational beliefs.
Social cognitive theory holds that maladaptive responses are learned as a result of exposure to inadequate and “sick” models of behavior. The idea of perceived self-efficacy also plays a central role in social cognitive theory. Perceived inefficacy in relation to rewarding outcomes leads to depression, low self-esteem and other dysfunctional cognitions. Dysfunctional expectancies and self-conceptions are at the core of perceived inefficacy.
Therapeutic change in social-cognitive theory involves the acquisition and maintenance of new patterns of thought and behavior through modeling and guided mastery. The main goal is to acquire change in the sense of efficacy. Desired activities are demonstrated by various models who experience positive consequences or at least no adverse consequences. The client views a model performing beneficial behaviors and also assists in performing the behaviors. In contrast with therapeutic approaches that emphasize verbal communication, social-cognitive theory concentrates on mastery experiences as vehicles of change.
In summary, there is no one theory or technique of social-cognitive therapy. Clinical applications of social-cognitive theory have had a tremendous impact on the field of therapy. Psychopathology is viewed as arising from distorted, incorrect, maladaptive cognitions concerning the self, others, and events in the world. Therapeutic change involves the process of replacing these maladaptive cognitions with ones that are more realistic and adaptive.
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Authors: Minozzi Silvia,Amato Laura,Davoli Marina
Click on the title above to gain access to the full-text
Abstract:
The scientific literature examining effective treatments for opioid dependent adults clearly indicates that pharmacotherapy is a necessary and acceptable component of effective treatments for opioid dependence. Nevertheless no studies have been published which systematically assess the effectiveness of the pharmacological maintenance treatment among adolescent.
Objectives
To assess the effectiveness of any maintenance treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions on retaining adolescents in treatment, reducing the use of substances and reducing health and social status
Search strategy
We searched the Cochrane Drugs and Alcohol Groups trials register (august 2008), MEDLINE (January 1966 to august 2008), EMBASE (January 1980 to august 2008), CINHAL (January 1982 to august 2008) and reference lists of articles
Selection criteria
Randomised and controlled clinical trials comparing any maintenance pharmacological interventions alone or associated with psychosocial intervention with no intervention, placebo, other pharmacological intervention included pharmacological detoxification or psychosocial intervention in adolescent (13-18 years)
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data
Main results
Two trials involving 187participants were included. One study compared methadone with LAAM for maintenance treatment lasting16 weeks after which patients were detoxified, the other compared maintenance treatment with buprenorphine naloxone with detoxification with buprenorphine. No meta-analysis has been performed because the two studies assessed different comparisons. Maintenance treatment seems more efficacious in retaining patients in treatment but not in reducing patients with positive urine at the end of the study. Self reported opioid use at 1 year follow up was significantly lower in the maintenance group even if both group reported high level of opioid use and more patients in the maintenance group were enrolled in other addiction treatment at 12 month follow up.
Authors conclusions
It is difficult to draft conclusions on the basis of only two trials. One of the possible reason for the lack of evidence could be the difficulty to conduct trial with young people due to practical and ethic reasons.
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ORLANDO, Florida / Orlando Sentinel / May 31, 2009
By Bard Lindeman | Special to the Sentinel
Question: My two older sisters are leaving all our aged mother's caregiving to me. Is there any way, legally, I can force them to participate?
Ms. Dutiful Daughter
Answer: In a word, "No."
Sorry, this is less a legal matter than it is a moral and cultural issue. Moreover, the question at the core of your hardship frames a national issue: "Who will care for Mom now?"
And at what cost in dollars and in other sacrifices?
Meantime, here are two possible ways to deal with your sisters' inattention to Mom. First, write a letter to the sisters, carefully explaining what your mother's care entails, and how you have contributed in both time and money.
Please, just the facts. Write it as an accountant would, without tears or hand-wringing, and do not assign either blame or guilt. Show this carefully crafted and sisterly letter to mother, before sending it.
Strategy No. 2: Take Mom out for ice cream (or Chardonnay) and give her your best argument for full caregiving participation, again tamping down anger, resentment and disappointment. Remember, you are working to win a critical ally, seeking to gain Dear Old Mom's support.
(Aside: You say that, to this time, mother does not accept that your sisters are abdicating, indeed "sitting this one out.")
The point being that your mother perhaps has a greater chance of persuading your sisters that caregiving responsibilities become simpler when they are shared, shared equally and continuously.
Years back, I read and celebrated Children of a Certain Age by Vivian E. Greenberg, social worker and author. Two splendid quotations from this 1994 guide for adults and their aging parents remain relevant: "You put such a stress on passion when you're young. You learn about the value of tenderness when you grow old." (Source: Joan Erikson, co-author with husband Erik of Vital Involvement in Old Age.)
Further, on the point: Ms. Greenberg belabors the obvious, commenting that parents and children need one another and how both must continue to grow and to learn: "to always be open to life's lessons."
Finally, she writes, "In whatever time is left to us, and no matter how old we are, it is never too late to do the work of becoming wise."
Your challenge, Ms. Dutiful Daughter, is to face your issue, admittedly thorny, and with uncommon patience and wisdom work through it all the while holding your family together.
If you accept that prayer could possibly help, I suggest that you begin now with a favorite entreaty.
GRAY NOTES: Quote of the week: "Caregiving is a complex process [and] worth every bit of the scholarly research and popular attention it now receives. Because of the toll it takes on people's lives, it has become a focal point in social work, nursing, and psychology. In gerontology, it is bound to the quality of life for elderly women and men." (Source: Vivian E. Greenberg, Children of a Certain Age.) ... Melancholy fact: By 2019, Medicare and Social Security will represent (eat up) 40 percent of the annual federal budget. That figure, plainly, is not sustainable. (Source: Newsweek) ... Headlines of note: "The Forgotten Market Online: Older Women." (The Wall Street Journal) ... Fact: more than one-fourth of all Medicare dollars are spent in the last year of life ... and 80 percent of those deaths take place in hospitals. (columnist Ellen Goodman) ... Odd fact: For cruise fans there is the blog: "ShipCritic." Editor Anne Campbell writes of the popular focus on culinary themes. It figures, she says, because after all "you eat all day long." Ugh! ... Lastly, there is golfing expert Jackie Burke's advice on putting. The 86-year-old says, simply: "If you can roll the ball across the green with your hand, you can roll it with a putter. It's the same deal." Burke adds, "Nothing's a sure shot. So you've got to play with a certain recklessness."
Bard Lindeman
E-mail: bardlindeman@bellsouth.
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Some anticancer drugs and prolonged or difficult cancer treatments also increase a patients risk of depression. In addition, certain types of cancerincluding head and neck, lung, and pancreatic cancershave been associated with an increased risk of depression. Therapists who are able to focus on patients death anxiety can help patients to focus on and reduce that anxiety, which can result in their awakening into a richer, more compassionate, less fearful state of being. Though there has been substantial prior research with LSD in cancer patients that demonstrated safety and some degree of efficacy, that research was conducted over 35 years ago. In order to generate data that will be accepted by todays regulatory agencies, new protocols must meet modern drug development standards.
Depending on length of stay, psychotherapists are challenged to set group goals and modify techniques for the broad range of patients in each group. Therapists will choose methods such as focused goals, closed memberships, and homogenous groups of patients based on symptoms or levels of psychological functioning . When cognitive behavioral therapy is used to treat tinnitus, it is intended to improve the patients attitude towards tinnitus, rather than to decrease the actual effects of tinnitus. The studys authors found that cognitive behavioral therapy led to a significant improvement in the study-participants quality of life. Two common forms of psychotherapy utilized for treatment of anxiety disorders are behavioral and cognitive therapy: in cognitive therapy, the therapist helps the patient to adapt his or her problematic thought patterns into those which are healthier. For example, the therapist might help someone with panic disorder to prevent panic attacks?and make those that do occur less intense?by teaching him or her how to mentally re-approach anxiety-inducing situations.
Two months after the treatment, 92 percent of MDMA patients had clinically significant improvement in their conditions: They were more open to therapy and were able to process the trauma. They managed to escape from their shells and shame, and to see lifelong patterns of behaviour. As it turns out, I have no conditions or labels. I feel sorry for young people who will have to go through the long and painful process of drug withdrawals before being able to find themselves again. This condition is characterized by excessive anxiety and worry, occurring more days than not for a period of at least 6 months, about a number of events or activities. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work.
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Lately, I have been searching holistic treatment for allergies and asthma. It was only in the recent years that I found out that they are related to each other.
After speaking to several Chinese doctors and naturopaths, I understand that a weak immune system may be the underlying cause of allergies and asthma. Medical experts agree that a lowered or improperly functioning immune system can and does result in several diseases such as asthma, allergies, arthritis, psoriasis, lupus, chronic fatigue syndrome and cancer to name just a few.
Antigens are large protein molecules of bacteria, viruses, chemicals and other substances that appear harmful from entering your body and our bodys immune systems form a barrier and work as the first line of defense against these diseases. The barriers include your skin, mucus, cough reflex, stomach acid and even enzymes in your tears, which destroy toxins. If the antigen or toxin manages to get past these barriers, then the immune system launches a second line of defense, found in your blood. They are white blood cells, which perform a protective function by seeking out and destroying foreign protein antigens.
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We are creating WisdomCards in priority order based on the most popular terms and phrases searched in health but want to hear from you.
You can search for this page title in other WisdomCards or if you would like us to create a WisdomCard for your search, send an email to requests@organizedwisdom.com and we'll be sure to add it to our list!
Have a great day.
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Abstract:
To compare the most severe lifetime (current or past) mood symptoms, duration of illness, and rates of lifetime comorbid disorders among youth with bipolar spectrum disorders [BP (bipolar-I, bipolar-II and bipolar–not otherwise specified)].
Methods: A total of 173 children (12 years) with BP, 101 adolescents with childhood-onset BP, and 90 adolescents with adolescent-onset BP were evaluated with standardized instruments.
Results: Depression was the most common initial and frequent episode for both adolescent groups, followed by mania/hypomania. Adolescents with childhood-onset BP had the longest illness, followed by children and then adolescents with adolescent-onset BP. Adjusting for sex, socioeconomic status, and duration of illness, while manic, both adolescent groups showed more and severe manic symptoms. Mood lability was more frequent in childhood-onset and adolescents with early-onset BP. While depressed, both adolescent groups showed more severe depressive symptoms, higher rates of melancholic and atypical symptoms, and suicide attempts than children. Depressed children had more severe irritability than depressed adolescents. Early BP onset was associated with attention-deficit hyperactivity disorder, whereas later BP onset was associated with panic, conduct, and substance use disorders. Above-noted results were similar when each BP subtype was analyzed separately.
Conclusions: Older age was associated with more severe and typical mood symptomatology. However, there were differences and similarities in type, intensity, and frequency of BP symptoms and comorbid disorders related to age of onset and duration of BP and level of psychosocial development. These factors and the normal difficulties youth have expressing and modulating their emotions may explain existing complexities in diagnosing and treating BP in youth, particular in young children, and suggest the need for developmentally sensitive treatments.
Lancashire Care staff can request the full-text of this article, email: susan.jennings@lancashirecare.nhs.
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Courtesy of Fibromyalgia Network - February 2009
While patients are rightfully concerned about not receiving adequate pain relief, physicians harbor fears about drug abuse, safety issues, and government oversight. New clinical guidelines for the use of chronic opioid therapy in chronic non-cancer pain patients, developed by consensus of the American Pain Society and the American Academy of Pain Medicine, may ease both patient and physician concerns.
The guidelines, published in the February issue of the Journal of Pain, offer a roadmap for physicians on how to safely prescribe opioids to patients with moderate to severe pain.* The authors specifically state that their report applies to patients with chronic non-cancer pain conditions, including common conditions such as back pain, osteoarthritis, fibromyalgia, and headache.
Throughout the guidelines, physicians are urged to evaluate their patients pain and function on a regular basis. And, if doctors are worried that a patient is abusing or misusing the prescribed opioid, they may need to reduce the time between scheduled office visits. In addition, physicians are encouraged to look at all of the available options for treating patients chronic pain, including the use of opioids, and it is emphasized that this class of medications will seldom provide sufficient pain control. This means that patients placed on opioids will likely need to be prescribed medications from other drug classes as well as non-drug therapies. And, physicians who do not have the skill-set to prescribe opioids need to coordinate their patients care with another doctor who is experienced in providing this therapy.
The American Pain Society emphasized the following three points to all its members this month:
The guidelines are comprehensive and evidenced-based to assist physicians in managing chronic opioid therapy, according to the American Pain Society President Charles Inturrisi, Ph.D
Regular monitoring of chronic opioid therapy patients is warranted because the therapeutic benefits of these medications are not static and can be affected by changes in the underlying pain condition, coexisting disease, or in psychological or social circumstances, said Gilbert J. Fanciullo, M.D., director of the division of pain and palliative care at Dartmouth Hitchcock Medical Center.
Cochair Perry Fine, M.D., professor of anesthesiology at the University of Utah Medical Center, added that doctors do not have to solely rely upon patient self reports. Pill counts, urine drug screening, family member or caregiver interviews, and prescription monitoring data may all be used to check for possible abuse or other opioid-related problems.
The message is clear that under most circumstances, there are reasonable ways for physicians to prescribe chronic opioid therapy for their patients in pain while emphasizing safety issues and minimizing side effects or the potential for drug misuse. The guidelines offer physicians 25 recommendations with detailed explanations on how to follow them—all to help doctors prescribe opioids to their chronic pain patients in a responsible fashion. In addition to the key points already made, here are other highlights from the published guidelines:
Clinicians may consider a trial of chronic opioid therapy (COT) for moderate to severe pain that is having an adverse impact on a patient’s function or quality of life as long as the therapeutic benefits outweigh the risks (abuse, misuse and addiction). Three different patient screening tools (questionnaires that are easy to administer) are included with the guidelines to help doctors assess potential risks associated with COT for a given patient (the SOAPP, the ORT, and the DIRE).
Before initiating a trial of COT, physicians should provide their patients with informed consent, which alerts patients to all of the potential risks associated with taking opioids. After informed consent, doctors should discuss with their patients a COT management plan that outlines the goals of therapy, expectations, monitoring requirements, etc. A sample consent form and management plan are included in the guideline.
Initial treatment with an opioid should be regarded as a therapeutic trial to determine if COT is effective. If the first opioid does not work or produces adverse side effects, other types of opioids may be tried, but patients need to keep in mind that opioids are prescribed on a trial basis.
Physicians should anticipate, identify, and track common opioid-associated side effects. Constipation is the most frequent problem, and unfortunately it does not go away or get better with continued use of the medication. With this in mind, doctors should recommend stool softeners or increased fiber intake when issuing patients an opioid prescription. Nausea or vomiting may occur but tends to diminish over a few days. If it lasts longer, doctors can prescribe a medication to treat this side effect. Sedation and clouded thinking usually goes away with continued opioid use, while reduction in sex hormones may appear down the road with COT. If a patient begins to experience a decrease in libido, sex hormones can be checked and supplemented if necessary. Other side effects may also occur, so patients and physicians need to be on the lookout for them.
Chronic pain is often a complex condition and physicians who prescribe COT should routinely promote other therapies, such as psychotherapy (pain can be awful to cope with), physical and occupational therapies for restoring function, and other non-drug approaches in addition to prescribing other non-opioid medications. The purpose of this recommendation is to treat the whole person and improve the odds that a patient with chronic pain will achieve a more fulfilling life.
Doctors need to counsel patients prior to starting COT and continue until a stable dose is reached or if the dose is later increased as the patients cognitive skills may be impaired for a short period of time. If clouded thought processes do occur, driving should temporarily be avoided so patients might want to start an opioid on a weekend when they do not have to drive. After a stable dose is reached, there is no evidence to suggest that patients on COT should be restricted from driving or engaging in most work activities.
The opioid guidelines give your doctor the how to advice for prescribing opioids, including sample copies of patient screening questionnaires, a consent form, management plan, and full details on how to responsibly prescribe opioids. However, they also assume that the prescribing physician is already knowledgeable about issues concerning this class of medications (i.e., the guidelines cannot possibly convert a novice into an expert on COT). Neither the patient nor physician should feel awkward about the consent and management forms, or random urine tests. Doctors who follow these guidelines should be better equipped to implement opioid therapies for their chronic pain patients (such as fibromyalgia) in a safe manner.
* Chou R, Fanciullo GJ, Fine PG, et al. J Pain 10(2):113-130, 2009.
Calling the Kettle Black
editorial comment
By Kristin Thorson, Editor, Fibromyalgia Network
Posted: February 27, 2009
If your newspaper ran the February 8th Associated Press article push boosts ailment, implying that the drug industry has fabricated fibromyalgia in an effort to churn a profit, you have every right to be furious!1 Controversy sells, and that was what the reporter, Matthew Perrone banked on. Perrone sought out Fred Wolfe, M.D., of Wichita, KS, because he knew from the January 14, 2008 front-page article in the New York Times that Wolfe had a track record for trashing patients with fibromyalgia and big, bad pharma as well. It is ironic, however, that Wolfe would make derogatory statements about the drug industry when he is heavily funded by six drug companies himself.
Wolfe is the director (and paid employee) of the National Data Bank for Rheumatic Diseases, a nonprofit registered as The Arthritis Research Center Foundation, Inc. Its mission is conducting ongoing research to improve conditions for people with arthritis, fibromyalgia, lupus and other conditions. He openly declares in his research papers, in which he is testing the effectiveness and safety of drugs for rheumatoid arthritis, that he is funded by Centocor, Aventis, Pfizer, Bristol-Myers Squibb, Amgen, and Abbott. So perhaps Wolfe’s dislike is not so much for the drug industry as it seems for fibromyalgia.
Prompted by mixed reports on increased cancer rates in people with rheumatoid arthritis (RA), Wolfe conducted an observational study on the incidence of cancer in RA patients who took the tumor necrosis factor (TNF) blocking agents Enbrel (etanercept) or Remicade (infliximab).2 His findings were derived from information in the National Data Bank (NDB) and per the NDBs agreement with Centocor, the maker of Remicade, the drug company was allowed to review Wolfes manuscript prior to publication. But Wolfe does not just cater to Centocor. His NDB organization has similar contractual agreements with Bristol-Myers Squibb and Sanofi-Aventis.
Wolfes study contradicted earlier reports of increased cancer risks for RA patients taking Enbrel or Remicade. It also confirmed that TNF blocking drugs are linked to skin cancers, including potentially deadly melanomas. Instead of using his findings to alert the medical community that these drugs may pose a health hazard, Wolfe went on record with WebMD as stating: The drugs, at this moment, do not seem to add any risk except for skin cancer and melanoma. This is a small overall risk and I do not think people should be concerned. He also added that the risks did not outweigh the benefit for patients who truly need the new drugs.3
While there is no argument that people with RA deserve effective therapies, do you not think it is odd that Wolfe is the one pushing drugs on RA patients while in the recent AP article he bashes the drug industry for fabricating fibromyalgia to boost their sales? Yet he is quoted in the AP article as saying, I think the purpose of most pharmaceutical company efforts is to do a little disease-mongering and to have people use their drugs. Further in the article he says, The underlying purpose here is really marketing, and they do that by sponsoring symposia and hiring physicians to give lectures and prepare materials. Wolfes negative sentiments about fibromyalgia appear clear in a February 2009 report in which he writes, Recently, regulatory authorities have approved treatments for fibromyalgia, offering some de facto support, although no proof, for fibromyalgia as a distinct disorder.4 However, there was a time when RA had no but that does not mean that the patients who suffered with it years ago did not have a real disease.
It is true that Wolfe was the lead author for the 1990 American College of Rheumatology criteria for fibromyalgia, but that was 18 years ago and much has changed.5 In 1990, the number of rheumatologists who were skeptical about the realness of fibromyalgia far outnumbered the believers. I should know, because I hosted an information booth on fibromyalgia at the annual rheumatology meetings throughout the 1990s, and in the early years I can attest to the ugly controversies surrounding this disease.
In 1994, Wolfe orchestrated a consensus conference (paid by the insurance industry) whose primary goal was to trivialize fibromyalgia and restrict patient care.6 Why he wanted to turn his back on fibromyalgia is still unknown, but his efforts failed. During the past eight years, the rheumatologists have rallied to increase the legitimacy of fibromyalgia by developing guidelines for improving the quality of research and for testing therapies to treat this patient population. Today, Wolfe and many of his colleagues do not see eye to eye when it comes to issues concerning fibromyalgia. At age 74, he appears to get his jollies by trash-talking fibromyalgia to headline-mongering reporters.
For all of you who were subjected to the AP story, I hope my comments help you understand the nonsensical nature of the article and that you can ignore any future reports that happen to quote Wolfe. I also want to make three additional points about the AP article:
Although Wolfes own nonprofit takes money from the drug companies, this does not mean that all nonprofits and organizations that help patients must do the same to stay afloat. Fibromyalgia Network and its sister organization, the American Fibromyalgia Syndrome Association (AFSA), have never received money from the pharmaceutical industry or other companies that could bias the way these two organizations operate.
Daniel Clauw, M.D., of the University of Michigan, did receive a small grant award from the National Fibromyalgia Research Association (NFRA) in Salem, OR, but the NFRA should not be confused with the National Fibromyalgia Association (NFA). NFRA does not receive money from the drugmakers.
The article implies that Clauws brain imaging research, which has documented many brain processing abnormalities over the past ten years, was tainted by drug money. That simply is not true because the funding for these studies came from government grants based on the merits of his proposals. Most of us conducting research in the field of fibromyalgia were here ten years before the drug industry even took notice of this disease, Clauw points out.
Perrone M. Associated Press © hosted by Google, Feb 8, 2009; (AP article).
Wolfe F, Michaud K. Arthritis Rheum 56(9):2886-2895, 2007.
DeNoon DJ. WebMD Health News Aug. 29, 2007; (WebMD article).
Wolfe F, Michaud K. J Rheumatol First Release Feb. 15, 2009; doi:10.3899/jrheum.080897.
Wolfe F, et al. Arthritis Rheum 33(2):160-72, 1990.
Wolfe F. J Rheumatol 23(3):534-9, 1996.
Kaufmann I, et al. Rheumatol Int [epub ahead of print] December 4, 2008.
Kaufmann I, et al. Clin Immunol 125:103-111, 2007.
(http://www.fmnetnews.com/basics-news.ph
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This site is provided for informational purposes only. To remain unbiased, we do not accept endorsements, advertisements, or pharmaceutical industry grants. Patients should always consult their physician for medical advice and treatment.
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The study, by Drs. Jutta Stoffer and Klaus Lieb, analyzed data from 27 randomized controlled trials of medications for BPD, and found that no single medication was effective in reducing overall BPD symptom severity. However, some mood stabilizing drugs and second-generation antipsychotic medications did have have a significant impact on some of the core symptoms of BPD.
The authors of the study concluded that medication therapy for BPD should be targeted at specific BPD symptoms, rather than the overall disorder. They also noted that while it is very common to prescribe antidepressant medications for BPD (such as selective serotonin reuptake inhibitors, or SSRIs), there is no evidence that these medications have any impact on BPD symptoms (although they do impact related disorders, e.g., depression).
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Written with Philip Hanno, MD, MPH, as slice of Beyond the Abstract on www.oldpharm.com UroToday - the only urology website with rich contented documentary by worldwide urology switch assessment leaders actively affianced in clinical go for a run through.
Natural peptides Anti-microbial peptides be evolutionarily ancient contamination fighters found in orgqnisms from grass to amphibians to human. the human thing, thd peptides reveal wide awake in the maw, lungs and insides, and in body fluid dear to sweat and tears. Anti-microboal peptides targe a range of pathobens and collectively bump sour next to gang fractture in the invaders vell membranes.
Further grades from the survey will be announced in 2005.
Because of this, bacterial hostility to the peptides be once in a while observed.
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EAN : 9780817315436
ISBN : 0817315438
Author : Mark A. Rees, Patrick C. Livingood
Publisher : University Alabama Press
Pub Date : 2006-12-31
Pages : 280
Language : English
Description : Plaquemine, Louisiana, about 10 miles south of Baton Rouge on the banks of the Mississippi River, seems an unassuming southern community for which to designate an entire culture. Archaeological research conducted in the region between 1938 and 1941, however, revealed distinctive cultural materials that provided the basis for distinguishing a unique cultural manifestation in the Lower Mississippi Valley. Plaquemine was first cited in the archaeological literature by James Ford and Gordon Willey in their 1941 synthesis of eastern U.S. prehistory. Lower Valley researchers have subsequently grappled with where to place this culture in the local chronology based on its ceramics, earthen mounds, and habitations. Plaquemine cultural materials share some characteristics with other local cultures but differ significantly from Coles Creek and Mississippian cultures of the Southeast. Plaquemine has consequently received the dubious distinction of being defined by the characteristics it lacks, rather than by those it possesses. The current volume brings together 11 leading scholars devoted to shedding new light on Plaquemine and providing a clearer understanding of its relationship to other Native American cultures. It is the first major book to specifically address the archaeology of Plaquemine societies. The authors provide a thorough yet focused review of previous research, recent revelations, and directions for future research. They present pertinent new data on cultural variability and connections in the Lower Mississippi Valley and interpret the implications for similar cultures and cultural relationships. This volume finally places Plaquemine on the map, incontrovertibly demonstrating the accomplishments and importance of Plaquemine peoples in the long history of native North America.
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Eco family spa allows you to swim as well as to relax at the spa end. It has the same layout as our Luxury swim spa but is more economical and affordable. A swim spa give you somewhere to swim and spa.
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Rejuvenate - 1. to make young or youthful again, give new vigor to
2. to restore to an original or new state.
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2. Physical or intellectual vigor; energy.
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Thank you for visiting and good health to all.
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The program, called "Project CATCH-IT," uses proven methods, such as cognitive-behavioral therapy, behavioral activation and interpersonal therapy, to teach the teens to change their behavior and to learn better coping skills. It includes a series of 14 modules that the teens can work through online through a secure website.
The researchers tested the program in 83 teens and young adults who were considered to be at risk for depression. The patients were randomly assigned to undergo either a brief discussion about depression with a doctor or a longer "motivational interview." Both groups were then given the Internet address for Project CATCH-IT.
Most of the teens in the study opted to visit the website, which was found to be effective in preventing future episodes of the depression. Based on a standard score, the percentage of patients with "clinically significant" depression decreased from 50% at the start of the study to no more than 15% at the three months follow-up.
The researchers hypothesized that the teens who had received the motivational interview might do better than those who had only talked briefly with a doctor, but overall depression scores were similar for both groups. Those who had received the motivational interview did do better in certain areas, however, such as having fewer thoughts of self-harm and hopelessness. Patients who received the motivational interview also spent more time using the website, which may have contributed to their additional improvements.
Study author Dr. Benjamin W. Van Voorhees of the University of Chicago suggests that Internet-based programs like Project CATCH-IT "may offer a low-cost way to implement depression prevention in community settings."
A version of Project CATCH-IT is available to the general public at http://catchit-public.bsd.uchicago.edu/.
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[Trauma and rehabilitation]
Laureys, Stevena; Giacino, Joseph Tb; Schiff, Nicholas Dc; Schabus, Manuela,d; Owen, Adrian Me
aCyclotron Research Center and Neurology Department, University of Liège, Liège, Belgium
bJFK Medical Center, Edison, New Jersey, USA
cLaboratory of Cognitive Neuromodulation, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, USA
dPhysiological Psychology, University of Salzburg, Salzburg, Austria
eMRC Cognition and Brain Sciences Unit, Cambridge, UK
Correspondence to Dr Steven Laureys, Cyclotron Research Center and Neurology Department, University of Liège, Sart Tilman B30, 4000 Liège, Belgium Tel: +32 4 366 23 16; fax: +32 4 366 29 46; e-mail: steven.laureys@ulg.ac.be
Sponsorship: S.L. is Research Fellow at the Belgian Fonds National de la Recherche Scientifique (FNRS) and is supported by grants from FNRS, the University of Liège and the Mind Science Foundation, Texas. J.T.G.'s contribution was supported in part by the National Institute on Disability and Rehabilitation Research (award H133A020518). N.D.S. is supported by NS02172, NS43451 and the Charles A. Dana Foundation. M.S. is supported by an Erwin Schrödinger fellowship of the Austrian Science Fund (FWF; J2470-B02).
Abstract
Purpose of review: We discuss the problems of evidence-based neurorehabilitation in disorders of consciousness, and recent functional neuroimaging data obtained in the vegetative state and minimally conscious state.
Recent findings: Published data are insufficient to make recommendations for or against any of the neurorehabilitative treatments in vegetative state and minimally conscious state patients. Electrophysiological and functional imaging studies have been shown to be useful in measuring residual brain function in noncommunicative brain-damaged patients. Despite the fact that such studies could in principle allow an objective quantification of the putative cerebral effect of rehabilitative treatment in the vegetative state and minimally conscious state, they have so far not been used in this context.
Summary: Without controlled studies and careful patient selection criteria it will not be possible to evaluate the potential of therapeutic interventions in disorders of consciousness. There also is a need to elucidate the neurophysiological effects of such treatments. Integration of multimodal neuroimaging techniques should eventually improve our ability to disentangle differences in outcome on the basis of underlying mechanisms and better guide our therapeutic options in the challenging patient populations encountered following severe acute brain damage.
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