Patterns of benzodiazepine prescribing by neuropsychiatrists and general practitioners for elderly patients in Germany in 2014
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BACKGROUND: The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). METHODS: This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. RESULTS: The share of people taking benzodiazepines prescribed by GP increased from 3.2% in patients aged between 65 and 69 years to 8.6% in patients aged between 90 and 100 years, whereas this share increased from 5.4% to 7.1% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9%; NP: 5.5%), depression (GP: 17.9%; NP: 29.8%), and anxiety disorders (GP: 14.5%; NP: 22.8%). Lorazepam (30.3%), oxazepam (24.7%), and bromazepam (24.3%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4%), diazepam (14.8%), and oxazepam (11.2%) were those more frequently prescribed to NP patients. CONCLUSION: Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP.
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Interactions between task difficulty and hemispheric distribution of attended locations: implications for the splitting attention debate.

Whether attention can be split between multiple regions in space simultaneously is an ongoing controversy in attention research. We argue that the debate could be resolved if the distribution of target locations over hemifields and task difficulty are both considered. This premise was tested in five experiments in which 48 subjects compared the identity of two out of four stimuli. In an easy task, within each hemifield, performance (reaction times and error rates) was better for adjacent targets than for separated ones, but across hemifields, performance for separated and adjacent stimuli was similar. In difficult tasks, performance was always better when the stimuli were presented across the hemifields indicating a bilateral field advantage. Moreover, the difference between adjacent and separate conditions within one hemifield diminished with increasing task difficulty. We propose a modified model of visuo-spatial attention, which permits the hemispheres to maintain and control simultaneous attentional foci.

Differential effects of target probability on saccade latencies in gap and warning tasks.

Saccade latencies are significantly reduced by extinguishing a foveal fixation stimulus before the appearance of a saccade target. It has been shown recently that this "fixation offset effect" (FOE) can be modulated by varying target probability. Cortico-collicular top-down effects have been assumed to mediate this strategic FOE modulation. Here, we have investigated strategic FOE modulation in 14 healthy human subjects performing gap and warning tasks. In the former task, the central fixation point was extinguished 200 ms before target onset. In the latter task, the central fixation point changed its colour 200 ms before target onset, but remained illuminated until the target appeared. Target probability was varied block-wise between 25 and 75%. In both tasks, mean latencies decreased with increasing target probability. However, in contrast with what can be expected from preceding studies, we found no differential modulation of mean latencies by target probability between tasks. Instead, we observed differential probability-dependent changes in latency distributions. In the gap task, discrete changes of saccade latencies were found, with a probability-dependent change in frequency of express and regular latencies. By contrast, in the warning task a shift of the entire latency distribution towards longer latencies with low target probability was found. We conclude that strategic modulation of saccade latencies by target probability may be mediated by two distinct neural mechanisms. Selection of either mechanism seems to depend critically on activation of the fixation system.

Saccades to spatially extended targets: the role of eccentricity.

Size and eccentricity of visual targets are known to modulate saccade parameters. Here we asked for a possible interaction between these target properties. We investigated latency and amplitude of saccades to targets of varying diameter presented at various eccentricities in the visual field. Effects of target size on saccadic eye movements highly depended on eccentricity of saccade targets. For large saccade targets, latencies increased and mean amplitudes decreased mainly at parafoveal eccentricities. By contrast, scatter of saccade amplitudes increased nearly linearly with target size and eccentricity. These effects are consistent with the known functional anatomy of the superior colliculus. Size- and eccentricity-related changes in saccade parameters may depend on distinct subpopulations of collicular neurons.

Target size modulates saccadic eye movements in humans.

The authors investigated mechanisms involved in transformation of spatially extended targets into saccadic eye-movement vectors. Human subjects performed horizontal saccades to targets of varying diameter, which contained no conspicuous elements within the target shape. With increasing target size, express saccades and saccades with fast regular latencies decreased in frequency, whereas frequency of saccades with slow regular latencies increased. For all targets, saccade amplitude distributions showed a peak close to the geometric center of the targets. However, with large targets, increased scatter of saccade amplitudes and increased undershoot of the target center was observed. These effects may reflect distinct subprocesses involved in sensorimotor transformation to spatially extended targets, and may result from modulation of neuronal activity in the superior colliculus.

Oculomotor effects of delta-9-tetrahydrocannabinol in humans: implications for the functional neuroanatomy of the brain cannabinoid system.

The significance of cannabinoid signaling for human cognition and motor control is still poorly understood. Here, we have investigated acute behavioral effects of oral delta-9-tetrahydrocannabinol (THC) with oculomotor paradigms in 12 healthy human subjects. Compared to baseline testing: (i) THC increased latencies of reflexive visually guided saccades, while their accuracy was not affected; (ii) latencies of memory-guided saccades were unaffected, but THC modulated accuracy of these eye movements by increasing average gain and gain variability; (iii) frequency of anticipated memory-guided saccades and antisaccade errors was increased; (iv) the saccade amplitude/peak velocity relationships were not affected. These results show that THC acts on selected aspects of saccade control, namely spatial attention shifts, fine tuning of volitional saccades, spatial working memory and inhibition of inappropriate saccades. The pattern of effects suggests modulation of neuronal activity in substantia nigra pars reticulata and/or dorsolateral prefrontal cortex and sparing of the eye fields and the final motor pathway for saccades. Behaviorally, our findings reflect the distribution of CB-1 cannabinoid receptors in the human neocortex, basal ganglia and brainstem and provide evidence for participation of the cannabinoidergic system in high level control of saccades and associated cognitive functions. Saccadic eye movements may provide an objective measure of motor and cognitive effects of cannabinoids.