The Efficacy of Lidocaine in Disrupting Cocaine Cue-Induced Memory Reconsolidation.

RATIONAL: Cue-induced craving memories, linked to drug-seeking behaviors, require key molecular processes for memory reconsolidation. Lidocaine, a sodium channel blocker, inhibits NMDA receptor activation and suppresses nitric oxide and ERK production. These processes are required for memory re-consolidation; inhibiting them may reduce cue-related craving memories in cocaine dependent subjects. OBJECTIVES: To assess the efficacy of lidocaine in decreasing cue-induced cocaine craving and cocaine use. METHODS: Treatment-seeking cocaine-dependent participants (n = 33, 25 men) were recruited. Personalized craving and relaxation scripts were developed. Participants were then randomly assigned in a double-blind design to either receive intravenous lidocaine immediately following a cocaine craving script (lidocaine/craving), saline following a craving script (saline/craving), or lidocaine following a relaxation script (lidocaine/relax). One week following the infusion, cue-induced craving was assessed in the same paradigm without an infusion. Cocaine use and craving were assessed for 4 weeks following infusion. RESULTS: The administration of lidocaine during craving induction (lidocaine/craving) did not decrease cue-induced craving during craving reactivation one week later or craving and cocaine use over the 4-week follow-up period compared to the saline/craving group. There were no significant differences in craving and cocaine use between the lidocaine/relax and saline/craving groups. CONCLUSION: Lidocaine administered following craving induction did not decrease subsequent cue-induced craving or cocaine use. Blocking the reconsolidation of craving-related memories with pharmacological agents remains an important area of investigation.

Prevalence and cervical organism burden among Louisiana women with Trichomonas vaginalis infections.

Trichomonas vaginalis is the most common curable sexually transmitted infection (STI) worldwide. Although predominately asymptomatic, the disease spectrum of trichomoniasis in women is characterized primarily by signs and symptoms of vaginitis, including purulent discharge and localized vulvar pruritus and erythema. Several FDA-cleared nucleic acid amplification tests (NAATs) are available for the diagnosis of T. vaginalis infections, but laboratory developed tests (LDTs) are widely utilized and cost-effective solutions in both the research and clinical diagnostic settings. LDT diagnosis of T. vaginalis is particularly appealing since it can be performed using remnant specimens collected for other STI testing. Using a LDT implemented as part of this study, T. vaginalis was detected in 7% of participating Louisiana women (14/199). The mean T. vaginalis organism burden was 1.0x106 ± 4.5x105 organisms per mL of ThinPrep PreservCyt. Using DNA eluates obtained after HPV testing on the cobas 4800 system, the T. vaginalis LDT was characterized by excellent intra- and interassay reproducibility (coefficient of variation values all <3.5%). Compared with two commercially available NAATs from TIB MOLBIOL, the sensitivity and specificity of the LDT was 92.9 and 99.5%, respectively. Collectively, this study details the diagnostic and quantitative utility of a LDT for T. vaginalis. When applied in the clinical research setting, we confirmed the high prevalence of T. vaginalis, but also observed extraordinarily high organism burdens in the cervix. These findings highlight the unique host-pathogen relationship of T. vaginalis with lower reproductive tract tissues, and substantiate the need for continued investigation of this highly prevalent STI.

Anxiety and anhedonia in depression: Associations with neuroticism and cognitive control.

BACKGROUND: Despite the fact that higher levels of anxiety and anhedonia in Major Depressive Disorder (MDD) are linked to poorer treatment outcomes, mechanisms contributing to these clinical presentations remain unclear. Neuroticism, impaired cognitive control, and blunted reward learning may be critical processes involved in MDD and may help to explain symptoms of anxiety and anhedonia. METHODS: Using baseline data from patients with early-onset MDD (N = 296) in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) trial, we conducted a path analysis to model relationships between neuroticism, cognitive control, and reward learning to levels of anxiety and anhedonia. RESULTS: Neuroticism was positively associated with both anhedonia (standardized coefficient = 0.26, p < .001) and anxiety (standardized coefficient = 0.40, p < .001). Cognitive control was negatively associated with anxiety (standardized coefficient = -0.18, p < .05). Reward learning was not significantly associated with either anxiety or anhedonia. LIMITATIONS: Extraneous variables not included in the model may have even more influence in explaining symptoms of anxiety and anhedonia. Restricted range in these variables may have attenuated some of the hypothesized relationships. Most important, because this was a cross-sectional analysis in a currently depressed sample, we cannot draw any causal conclusions without experimental and longitudinal data. CONCLUSIONS: These cross-sectional findings suggest that neuroticism may contribute to anxiety and anhedonia in patients with early onset and either chronic or recurrent MDD, while enhanced cognitive control may protect against anxiety.

Temptation Minus Self-Efficacy in Alcohol Relapse: A Project MATCH Follow-Up.

OBJECTIVE: Relapse is a crucial event that occurs for many individuals during recovery from alcohol use disorder. This article examines the impact of temptation to drink and self-efficacy to abstain on two distinct aspects of relapse. Causal chain analyses from Project MATCH, a multisite alcoholism treatment trial, provided initial support for the difference between temptation and self-efficacy as a predictor of alcohol use outcomes. In the current study, the Temptation minus Self-Efficacy (T-S) score from the Alcohol Abstinence Self-Efficacy Scale (AASE) is investigated as a predictor of two alcohol use outcomes that were not analyzed in previous Project MATCH reports. METHOD: This study evaluated the ability of end-of-treatment T-S (calculated as Temptation minus Self-Efficacy scores on AASE) to predict time to first drink and number of drinks on first drinking day. Data were analyzed on 627 participants from Project MATCH who relapsed after completing treatment and achieving a period of abstinence. RESULTS: T-S at end of treatment was a significant predictor of two alcohol use outcomes during the 1-year follow-up period. In addition, situation-specific subscale scores of T-S predicted alcohol use outcomes. T-S in social/positive situations predicted time to first drink. T-S in negative affect situations predicted number of drinks on first drinking day. CONCLUSIONS: Results support end-of-treatment measurement discrepancy between AASE scales of Temptation and Abstinence Self-Efficacy as a predictor of time to first drink and number of drinks on first drinking day among individuals who relapse after treatment.

Trends in systemic psoriasis treatment therapies from 1993 through 2010.

BACKGROUND: Moderate-to-severe psoriasis generally requires systemic therapy, and is often undertreated. OBJECTIVE: To determine and analyze what courses of treatment and in what frequency are being utilized to combat psoriasis in the United States. METHODS: Analysis of data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) of the National Center for Health Statistics. Data were analyzed to examine the prevalence of different therapy techniques to combat psoriasis from 1993 through 2010. The trends for phototherapy, methotrexate (MTX), retinoids, cyclosporine A (CSA), systemic steroids, and biologics were all analyzed over the entire 18-year period and independently before and after the introduction of biologics in 2002. RESULTS: From 1993 to 2010, the trend for total systemic treatments has not significantly increased (P=0.5). Frequency of phototherapy treatments significantly decreased from 1993 to 2010 (P<0.001). Since the introduction of biologics in 2002, their frequency has significantly increased, becoming the most frequently used treatment from 2008-2010 (P<0.0001). LIMITATIONS: Severity of psoriasis was not recorded in the NAMCS and NHAMCS. CONCLUSIONS: The frequency of systemic treatments to treat psoriasis has not significantly increased from 1993 to 2010. Despite the introduction of biologics, it appears that little progress has been made in reducing under-treatment of moderate-to-severe psoriasis.

Decreasing frequency of office visits on fridays.

OBJECTIVES: To determine if the frequency of physician visits on Fridays varied over the course of 1997 to 2010, and if it varied by geographical region. METHODS: Data from the National Ambulatory Medical Care Survey (NAMCS) of the National Center for Health Statistics were analyzed to examine the frequency of office visits with physicians on Friday from 1997 to 2010, and the same data were also stratified by geographical location. RESULTS: Fewer office visits occurred on Fridays compared to other weekdays, and the percentage of total visits that occurred on Fridays decreased over time (p = 0.04). Comparing between the different geographical regions, the South had the lowest rate of Friday visits and the West had the highest rate. The Northeast (p = 0.003) and South (p < 0.0001) had significantly lower rates than the West. CONCLUSION: Although patients and physicians alike are disappointed in the amount of time physicians and patients spend face to face, physicians are currently not utilizing every day of the common workweek to see patients.