Leisure-time physical activity and psychosocial well-being in adolescents after cancer diagnosis.

This preliminary study examined the relationship between leisure time physical activity (LTPA) and psychosocial well-being in 53 adolescents who were previously diagnosed with cancer. Participants completed a mailed, self-administered questionnaire in which they recalled their LTPA (including leisure time exercise and organized sport) at three time points (prediagnosis, treatment, and posttreatment). They also reported their current psychosocial well-being by using measures of depression and self-concept. Examination of the LTPA data revealed four main patterns across the cancer experience that were labeled maintainers (active at all three time points), temporary relapsers (active prediagnosis, inactive during treatment, active posttreatment), permanent relapsers (active prediagnosis, inactive during treatment, inactive posttreatment), and nonparticipants (inactive at all three time points). Multivariate analyses of variance indicated that self-concept differed significantly across the four organized sport patterns. Follow-up univariate analyses revealed significant differences for general self-concept, physical abilities, parental relations, same sex relations, and opposite sex relations with effect sizes ranging from medium-large to large. Post hoc tests generally showed that the maintainers exhibited superior scores on psychosocial well-being compared with the other three patterns. It was concluded that LTPA patterns across the cancer experience may be related to psychosocial well-being in adolescents after cancer diagnosis but that further research is warranted.

Neuropsychologic deficits in children with Langerhans cell histiocytosis.

BACKGROUND: Manifestations of Langerhans cell histiocytosis (LCH) in children range from only a rash, to bony lesions accompanied by pain, to major organ disease. When the central nervous system (CNS) is affected, the LCH patient may exhibit signs and symptoms of hypothalamic and pituitary dysfunction (most often resulting in diabetes insipidus or other endocrinopathies) or more global neurologic and neuropsychologic sequelae. Surprisingly, researchers have only recently begun to examine the neuropsychologic manifestations of the disease, but early findings suggest that they may, in fact, be significant in a small percentage of children with LCH. PROCEDURE: We evaluated two CNS-positive patients with LCH and long-term intermittent treatments, using extensive neuropsychologic assessments, including intellectual functioning, memory, visual-motor functioning, attention and concentration, sensory and motor performance, and gross academic achievement. Objective measures of behavior were obtained through parental report. Neuroradiologic imaging was obtained concurrently with the neuropsychologic evaluations. RESULTS: The neuropsychologic assessments indicated significant deficits in a number of the measured areas of functioning. Global cognitive deficiencies in full-scale IQ were identified, as were deficits in memory, attention/concentration, and perceptual-organizational capabilities. Similarities were noted in the patterns of deficits obtained with both patients, despite differences in the pathophysiology of their disease. Behavioral functioning in both children had suffered, presumably in relation to the neuropsychologic deficits. There were radiologic findings of gross cerebellar white matter damage in one patient, in addition to focal (e.g., hypothalamic) lesions in the other. CONCLUSIONS: LCH has an adverse impact on cognitive functions in some children with evidence of CNS involvement, and further study into the etiology, incidence, and means of remedial intervention is needed.

Clomipramine treatment and behaviour therapy with agoraphobic women.

The separate and combined effects of clomipramine hydrochlorzide and behaviour therapy on agoraphobic symptoms were investigated in a 28-week placebo-controlled double-blind clinical trial. One hundred and eight women diagnosed as agoraphobic were randomly assigned to one of four treatment conditions: clomipramine alone, behaviour therapy alone, clomipramine and behaviour therapy or placebo. Sixty women completed the assigned treatment. Clomipramine was prescribed in weekly increments to a maximum of 300 mg per day, with a mean dosage at week 8 of 94.6 mg per day. Behaviour therapy focused on graded in vivo exposure therapy. Assessments of patients were performed at six points prior to and during the trial and included standardized questionnaires, daily diaries and a Behavioral Approach Test. Significant main effects for both clomipramine and behaviour therapy on 15 and 12 of the dependent measures respectively were found but no interaction of treatments emerged.

Menstrual cycle phase is a potential confound in psychophysiology research.

Effects of menstrual cycle phase on physiological levels and reactivity were studied in a within-subject design with 20 women aged 18-30 years. Basal body temperature was monitored daily; follicular and luteal recording sessions occurred before and after the ovulatory temperature rise, respectively. The design consisted of task and rest periods, presented in counterbalanced order across phases. Half the subjects began during their follicular phase and half began during their luteal phase. Follicular and luteal phases were compared for differences between baseline resting levels, as well as for reactivity. The results showed menstrual phase differences in heart rate, pulse transit time, and EEG alpha, particularly during tasks, but no difference in reactivity. Habituation effects in the group that began during the follicular phase often masked luteal activation. In spite of the fact that not all statistical results achieved significance, the consistency of most trends supports the conclusion that physiological recording sessions with women might best be restricted to the follicular phase.

Clomipramine treatment of agoraphobic women. An eight-week controlled trial.

The efficacy of clomipramine hydrochloride in the treatment of agoraphobia was investigated in an eight-week placebo-controlled double-blind study. One hundred eight women diagnosed as agoraphobic by DSM-III guidelines were randomly assigned to the clomipramine or placebo group; 70 women (mean age, 36.6 years) completed the eight-week trial. The study medication was prescribed on the basis of weekly increments to a maximum of 300 mg/d, with a mean dosage at week 8 in the clomipramine hydrochloride group of 82.8 mg/d. Assessments performed prior to the trial and at the four- and eight-week points included the completion of standardized questionnaires and daily diaries, as well as the administration of a Behavioral Approach Test. Clomipramine was significantly superior to the placebo on several indexes of phobic symptoms and on measures of depression and dysphoria. Results are discussed in terms of the hypothesized action of clomipramine and the pattern of significant findings.

A comparison of three approaches for the determination of baseline levels of physiological activity.

The traditional means of determining baseline levels of physiological activity in research evaluating responses to stressful stimuli has been to record activity during rest periods either before or interspersed with periods of stimulation. Subjects may, however, anticipate the impending stimulation, thus elevating their levels of physiological activity even during periods of presumed rest. Eight physiological responses--forehead muscle tension, heart rate, heart rate variability, skin resistance level and non-specific responses, systolic and diastolic blood pressure, and pulse transit time--were recorded from 39 subjects during sessions which included both task and rest periods, and during sessions with only rest periods and periods of viewing slides of restful scenery. The results indicate a significant decrease in levels of physiological activity in most of the 8 physiological measures when activity was recorded during sessions in which no tasks were presented. The lowest levels of physiological activity were recorded while subjects viewed slides. These results suggest that the traditional approach to the determination of baseline may yield levels of physiological activity contaminated by anticipation of upcoming stimuli.

The stability of physiological reactivity over multiple sessions.

Although individual response stereotypy (IRS) has been a subject of research for many years, the stability of the phenomenon, though often assumed, has not been adequately proven. The present study evaluated stability of reactivity profiles of eight variables (heart rate, heart rate variability, integrated muscle tension, skin resistance level, skin resistance response, systolic blood pressure, diastolic blood pressure, and pulse transit time) over four sessions of laboratory tasks in comparison to two subsequent sessions of rest periods. The two major characteristics of IRS--stability and uniqueness--were fulfilled. On the other hand, the first session was found to be an inadequate predictor of the stable composite profiles. Thus the IRS profiles which are determined from multiple observations over time are different from those which are calculated in the traditional manner with a single recording session.

A double-blind investigation of the relationship between seizure activity and the sleep EEG following EEG biofeedback training.

The sleep EEGs of eight medically refractory epileptic patients were examined as part of a double-blind, ABA crossover study designed to determine the effectiveness of EEG biofeedback for the control of seizures. The patients were initially reinforced for one of three EEG criteria recorded from electrodes placed over sensorimotor cortex: (a) suppression of 3- to 7-Hz activity, (b) enhancement of 12- to 15-Hz activity, or (c) simultaneous suppression of 3- to 7-Hz and enhancement of 11- to 19-Hz activity. Reinforcement contingencies were reversed during the second or B phase, and then reinstated in their original form during the final A' phase. All-night polysomnographic recordings were obtained at the end of each conditioning phase and were subjected to both visual and computer-based power spectral analyses. Four of the patients showed changes in their nocturnal paroxysmal activity that were either partially or totally consistent with the ABA' contingencies of the study. The spectral data proved difficult to interpret, though two trends emerged from the analyses. Decreases in nocturnal 4- to 7-Hz activity were correlated with decreases in seizure activity, and increases in 8- to 11-Hz activity were correlated with decreases in seizure activity. These findings were shown to strengthen the hypothesis that EEG biofeedback may produce changes in the sleep EEG that are related to seizure incidence.

EEG operant conditioning in intractable epileptics.

Eight epileptic patients with mixed seizures refractory to medical control participated in a double-blind crossover study to determine the effectiveness of operant conditioning of the EEG as an anticonvulsant procedure. Baseline levels of seizures were recorded for four months prior to the beginning of treatment. Participants then received false (noncontingent) feedback for two months followed by an ABA-patterned training program lasting a total of ten months. Subjects were assigned to three treatment groups based on different schedules of EEG feedback. They were first trained (A1 phase) either to suppress slow activity (3 to 8 Hz), to enhance 12- to 15-Hz activity, or to simultaneously suppress 3- to 8-Hz and enhance 11- to 19-Hz activity. This was followed by a B phase, in which patients were trained to enhance slow activity (3 to 8 Hz). In the final phase (A2), the initial training contingencies were reinstated. Neuropsychological tests were performed before and after training, and changes in EEG activity as determined by Fast Fourier spectral analyses were analyzed. Five of eight patients experienced a decrease in their mean monthly seizure rate at the completion of feedback training as compared with their initial baseline level.