Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.

An introductory course in philosophy of medicine.

Philosophy of medicine, narrowly defined as ontology and epistemology of medicine, is a well developed research field, yet education in this field is less well developed. The aim of this paper is to present an educational development in philosophy of medicine-an introductory course in philosophy of medicine. Central features of the course are described. Participants (medical undergraduate students) scored high on average. The conclusion is that further such educational ventures in philosophy of medicine should be developed and implemented.

Depression and competence to refuse psychiatric treatment.

Individuals with major depression may benefit from psychiatric treatment, yet they may refuse such treatment, sometimes because of their depression. Hence the question is raised whether such individuals are competent to refuse psychiatric treatment. The standard notion of competence to consent to treatment, which refers to expression of choice, understanding of medical information, appreciation of the personal relevance of this information, and logical reasoning, may be insufficient to address this question. This is so because major depression may not impair these four abilities while it may disrupt coherence of personal preferences by changing them. Such change may be evaluated by comparing the treatment preferences of the individual during the depression to his or her treatment preferences during normal periods. If these preferences are consistent, they should be respected. If they are not consistent, or past treatment preferences that were arrived at competently cannot be established, treatment refusal may have to be overridden or ignored so as to alleviate the depression and then determine the competent treatment decision of the individual. Further study of the relation between depression and competence to refuse or consent to psychiatric treatment is required.

A prospective study of posttraumatic stress symptoms and nonadherence in survivors of a myocardial infarction (MI).

We examined a novel hypothesis that links symptoms of MI-related posttraumatic stress disorder (PTSD) to nonadherence. According to this hypothesis, patients who are traumatized by their medical illness do not take their medications as prescribed. As a part of the avoidance dimension of PTSD, patients who are traumatized may avoid being reminded of the MI by not taking the medication. MI survivors were prospectively followed for 6 months to 1 year. Adherence was assessed by pill count of Captopril. Demographic variables, medical risk factors, PTSD, and other psychiatric symptom dimensions were evaluated during follow-up. One hundred two of 140 recruited patients completed follow-up. Nonadherence to Captopril was associated with poor medical outcome (r=.93, P=.006). Above-Threshold PTSD symptoms were associated with nonadherence to medications (P=.05). No other psychiatric symptom dimensions were independently associated with nonadherence. Nonadherence to medications predicts adverse outcome during the first year after an acute MI. Nonadherence is associated with PTSD symptoms, which may either be a marker for or a cause of nonadherence. Treatment of PTSD may prove to be a useful approach for improving adherence.

The relation of social support-seeking to quality of life in schizophrenia.

Social support-seeking has been shown to improve the outcome of schizophrenia. However, no study to date has documented the impact of social support seeking on self-perceived quality of life in schizophrenia, particularly not on the relation between symptoms and quality of life. The present study explored this issue with a sample of 58 outpatients diagnosed with schizophrenia without comorbidity. Social support seeking, symptoms (positive, negative, and extrapyramidal), and multidimensional self-reported quality of life were assessed cross-sectionally. Negative symptoms were inversely related to the quality of life domain of activities of daily living. Other symptoms and social support-seeking were not related to quality of life, and social support-seeking did not interact with symptoms in their relation to quality of life. Social support-seeking may thus not be beneficial (nor disruptive) as a way of coping with symptoms in schizophrenia. More studies are needed in order to investigate the relation of social support-seeking to symptoms and to quality of life in serious mental illnesses such as schizophrenia, so that interventions with persons suffering from these disorders may be better guided.

The impact of coping on the relation between symptoms and quality of life in schizophrenia.

The relation between severity of symptoms and level of quality of life in schizophrenia is not strong. This situation may be explained by the hypothesis that the relation is moderated by ways of coping which are known to overcome stress. The main objective of the study was to evaluate this hypothesis by assessing the relations between positive and negative symptoms, problem-focused and emotion-focused ways of coping, and various domains of quality of life in a group of psychiatric outpatients diagnosed with schizophrenia. Subjects were recruited from a community mental health center. Fifty-eight adult outpatients diagnosed with schizophrenia who gave informed consent were assessed cross-sectionally with the Positive and Negative Syndrome Scale (PANSS), the Ways of Coping Checklist, and the Wisconsin Quality of Life Index. Negative symptoms were inversely related to activities of daily living, and positive symptoms were directly related to distress. There were no other significant relations between symptoms and quality of life. Problem-focused and emotion-focused coping did not moderate the relation between symptoms and quality of life. Further study is required concerning coping in schizophrenia.

A meta-ethical critique of care ethics.

A meta-ethical analysis demonstrates that care ethics is a grounded in a distinct mode of moral reasoning. This is comprised primarily of the rejection of principles such as impartiality, and the endorsement of emotional or moral virtues such as compassion, as well as the notion that the preservation of relations may override the interests of the individuals involved in them. The main conclusion of such a meta-ethical analysis is that such meta-ethical foundations of care ethics are not sound. Reasonable alternatives for care ethics may be its formulation as an additional principle within an established principlist framework, or the move to a dialogical ethics, where the good to be acted upon is not decided in advance but rather critically discussed and established within the encounter of the parties involved.