Epilepsy treatment and creativity.

Creativity can be defined as the ability to understand, develop, and express, in a systematic fashion, novel orderly relationships. It is sometimes difficult to separate cognitive skills requisite for the creative process from the drive that generates unique new ideas and associations. Epilepsy itself may affect the creative process. The treatment of epilepsy and its comorbidities, by altering or disrupting the same neural networks through antiseizure drugs (ASDs), treatment of epilepsy comorbidities, ablative surgery, or neurostimulation may also affect creativity. In this review, we discuss the potential mechanisms by which treatment can influence the creative process and review the literature on the consequences of therapy on different aspects of creativity in people with epilepsy. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

Impact of long-term benzodiazepine use on cognitive functioning in young adults: the VISAT cohort.

PURPOSE: Results from a number of studies have suggested a relationship between cognitive alteration and benzodiazepine use in the elderly. The aim of this study was to determine the impact of benzodiazepine use on cognitive functions in a young adult population. METHODS: This study included 1,019 French salaried workers from the VISAT (Aging, Health and Work) cohort whose objective was to determine the long-term impact of working conditions on health and aging. Data were collected during interviews by occupational physicians in 1996, 2001 and 2006. Cognitive function was assessed using five cognitive tests (immediate free recall test, delayed free recall test, recognition test, Digit Symbol Substitution Subtest and visual search speed test). Cognitive scores obtained after a 10-year follow-up were investigated among three categories of benzodiazepine users, namely, non-users, occasional users and long-term users, using analysis of covariance models adjusted for several potential confounders in men and women separately. RESULTS: In the course of the 10 year-follow-up, 3.9% of subjects were defined as occasional users of benzodiazepine and 7.5% as long-term users. The analysis revealed a significant alteration of long-term memory in women whereas there was no significant association in men. CONCLUSIONS: Long-term use of benzodiazepine leads to specific impairment in long-term memory only in women.

Brain illness and creativity: mechanisms and treatment risks.

Brain diseases and their treatment may help or hurt creativity in ways that shape quality of life. Increased creative drive is associated with bipolar disorder, depression, psychosis, temporal lobe epilepsy, frontotemporal dementia, Parkinson disease treatments, and autism. Creativity depends on goal-driven approach motivation from midbrain dopaminergic systems. Fear-driven avoidance motivation is of less aid to creativity. When serotonin and norepinephrine lower motivation and flexible behaviour, they can inhibit creativity. Hemispheric lateralization and frontotemporal connections must interact to create new ideas and conceptual schemes. The right brain and temporal lobe contribute skill in novelty detection, while the left brain and frontal lobe foster approach motivation and more easily generate new patterns of action from the novel perceptions. Genes and phenotypes that increase plasticity and creativity in tolerant environments with relaxed selection pressure may confer risk in rigorous environments. Few papers substantively address this important but fraught topic. Antidepressants (ADs) that inhibit fear-driven motivation, such as selective serotonin reuptake inhibitors, sometimes inhibit goal-oriented motivation as well. ADs that boost goal-directed motivation, such as bupropion, may remediate this effect. Benzodiazepines and alcohol may be counterproductive. Although dopaminergic agonists sometimes stimulate creativity, their doing so may inappropriately disinhibit behaviour. Dopamine antagonists may suppress creative motivation; lithium and anticonvulsant mood stabilizers may do so less. Physical exercise and REM sleep may help creativity. Art therapy and psychotherapy are not well studied. Preserving creative motivation can help creativity and other aspects of well-being in all patients, not just artists or researchers.

Baseline odor identification ability predicts degradation of psychomotor vigilance during 77 hours of sleep deprivation.

Scores on the University of Pennsylvania Smell Identification Test, a measure of the functional integrity of the orbitofrontal cortex, were used to predict the vulnerability to cognitive declines during 77 hr of sleep deprivation. Twenty-one healthy volunteers completed the Smell Identification Test at rested baseline followed by repeated psychomotor vigilance testing throughout each night. Participants with better smell identification abilities sustained faster speeds and fewer lapses on the second and third nights of sleep deprivation than participants with lower scores. Individual differences in trait-like functioning of the orbitofrontal cortex are predictive of the ability to sustain alertness and vigilance during continuous wakefulness.

Psychotropic placebos create resistance to the misinformation effect.

Can a placebo for a psychotropic drug help participants resist the misinformation effect? To answer this question, we gave participants a mixture of baking soda and water and told half of them that the mixture was a cognition-enhancing drug called R273 and told the other half that it was an inactive version of the drug. Shortly thereafter, all participants took part in a three-stage misinformation experiment. Compared with participants who were told that they had taken the placebo, the participants who were told that they had taken the drug reported improved cognitive abilities and were less susceptible to the misinformation effect. We provide source-monitoring and mindfulness accounts of our findings.

The association of oral hydroxyurea therapy with improved cognitive functioning in sickle cell disease.

This study examined potential cognitive benefits of oral hydroxyurea therapy for children with sickle cell disease (SCD). Cognitive abilities of 15 children with SCD on hydroxyurea were compared to 50 other children with SCD, controlling for demographics and hematocrit. Children on hydroxyurea scored significantly higher on tests of verbal comprehension, fluid reasoning, and general cognitive ability than children not on the drug. The data therefore provide preliminary evidence of cognitive benefits of hydroxyurea. Mechanisms for this effect may be improved blood/oxygen supply to the brain or reduced fatigue and illness.

Problem-solving ability and comorbid personality disorders in depressed outpatients.

Major depressive disorder (MDD) is associated with poor problem-solving abilities. In addition, certain personality disorders (PDs) that are common among patients with MDD are also associated with limited problem-solving skills. Attempts to understand the relationship between PDs and problem solving can be complicated by the presence of acute MDD. Our objective in this study was to investigate the relationships between PDs, problem-solving skills, and response to treatment among outpatients with MDD. We enrolled 312 outpatients with MDD in an open, fixed-dose, 8-week fluoxetine trial. PD diagnoses were ascertained via structured clinical interview before and after fluoxetine treatment. Subjects completed the Problem-Solving Inventory (PSI) at both time points. We used analyses of covariance (ANCOVAs) to assess relationships between PD diagnoses and PSI scores prior to treatment. Subjects were divided into three groups: those with PD diagnoses that remained stable after fluoxetine treatment (N=91), those who no longer met PD criteria after fluoxetine treatment (N=119), and those who did not meet criteria for a PD at any time point in the study (N=95). We used multiple chi(2) analyses to compare rates of MDD response and remission between the three PD groups. ANCOVA was also used to compare posttreatment PSI scores between PD groups. Prior to fluoxetine treatment, patients with avoidant, dependent, narcissistic, and borderline PDs reported significantly worse problem-solving ability than did patients without any PDs. Only subjects with dependent PD remained associated with poorer baseline problem-solving reports after the effects of baseline depression severity were controlled. Patients with stable PD diagnoses had significantly lower rates of MDD remission. Across PD groups, problem solving improved as MDD improved. No significant differences in posttreatment problem-solving were found between PD groups after controlling for baseline depression severity, baseline PSI score, and response to treatment. Treatment with fluoxetine is less likely to lead to remission of MDD in patients with stable PDs. More study is needed to investigate causal links between PDs, problem solving, and MDD treatment response.

Maintenance therapy with synthetic opioids and driving aptitude.

AIMS: To assess the influence of methadone and buprenorphine maintenance treatment on the driving aptitude of opioid-dependent patients. DESIGN: Prospective, open label, outpatient maintenance, single-blind (investigator) study. PARTICIPANTS AND SETTING: Thirty opioid-dependent patients maintained on either methadone or buprenorphine were recruited from the drug-addiction outpatient clinic in Vienna. MEASUREMENTS: The traffic-relevant performance dimensions of the participants were assessed 22 h after receiving synthetic opioid maintenance therapy, by a series of seven tests constituting the Act & React Test System (ART) 2020 Standard test battery, developed by the Austrian Road Safety Board (ARSB). To test for additional consumption of illicit substances, blood and urine samples were taken at the beginning of the tests. FINDINGS: The patient group only differed from control subjects in two of the ART 2020 Standard tests. During a task to test the subject's attention under monotonous circumstances (Q1 test), patients had a significantly greater number of reactions (p = 0.027) and a significantly higher percentage of incorrect reactions than control subjects. When driving in a dynamic environment (DR2 test) patients had a significantly longer mean decision time (p = 0.029) and mean reaction time (p = 0.009) compared with control subjects. Interestingly, when separated into treatment groups, the mean decision and reaction times of buprenorphine-maintained patients in the DR2 test did not differ from controls, whereas patients maintained on methadone showed significantly prolonged mean decision (p = 0.009) and reaction times (p = 0.004). In this same test, patients who had consumed additional illicit drugs had a longer mean reaction time compared with control subjects (p = 0.036). CONCLUSION: The synthetic opioid-maintained subjects investigated in the current study did not differ significantly in comparison to healthy controls in the majority of the ART 2020 Standard tests.

The effects of anxious responding on mental arithmetic and lexical decision task performance.

Anxiety-related responding and skill deficits historically are associated with performance-based problems such as mathematics anxiety, yet the relative contribution of these variables to substandard performance remains poorly understood. Utilizing a 7% carbon dioxide (CO2) gas to induce anxiety, the present study examined the impact of anxious responding on two performance tasks, mental arithmetic and lexical decision. Independent variables included math anxiety group, gender, and gas condition. Dependent variables included task performance and physiological and self-report indices of anxiety. A total of 64 university undergraduate students participated. Physiological and verbal-report measures of anxiety supported the utility of 7% carbon dioxide-enriched air as an anxiety-inducing stimulus. Behavioral disruption on performance tasks, however, did not differ as a function of carbon dioxide inhalation. Performance did differ as a function of math anxiety. High math anxious individuals generally exhibited higher error rates on mathematical tasks, particularly on tasks designed to measure advanced math skill and those requiring working memory resources. These findings are discussed with reference to processing efficiency theory, discordance among anxiety response systems, and the intricacies associated with skill measurement.

Medication and fitness to drive.

PURPOSE: The aim of this study is to analyze the consumption patterns of medicaments among motor vehicle drivers who attend 'Medical Driving Test Centres' and the relation between habitual consumption of medicaments and fitness to drive. METHODS: The study was carried out on 8043 drivers who attended 25 Medical Driving Test Centres. RESULTS: 24.7% of drivers chronically consume medicaments while 6.8% consume medicaments along with alcohol every day. Of those who chronically consume medicaments with a warning about the medications on driving, 65.8% were considered 'fit' to drive, 27.3% 'fit with restrictions', 5.1% 'suspended' and 0.4% 'unfit'. CONCLUSIONS: The results show how frequent the consumption of medicaments along with alcohol is and that the great majority of drivers who take medicaments are considered fit to drive.

Alcohol as muse.

It has been argued that American writers do not drink any more than American plumbers. If so, as one commentator said, American plumbing would be a mess. No one can question the fact that American writers in this century have been excessive drinkers. Explanations why this might occur are presented in this paper. Walker Percy locates the problem in the dualing hemispheres of the brain. Others think alcohol is (as Hemingway said) a good way to end the day and shut off the creative process. An historian has proposed that alcoholics are loners, that writers also are loners, and this is why so many writers are alcoholic. Although the argument for this view is persuasive, it does not explain why the United States has so many more alcoholic writers than other countries, or, why the "epidemic" occurred in the twentieth century. Alcohol was largely not a problem for Americans in earlier centuries and, although there have been alcoholic writers in European countries, their numbers never approached a majority. Drinking is the "joy of Russia," but there have been very few alcoholic Russian writers. Dylan Thomas, Brendan Behan, and Evelyn Waugh notwithstanding, alcoholic writers have not been common in the United Kingdom or Ireland. It is easy to think of reasons why writers drink. It is more difficult to explain why so many drank in this country during this century.

Effects of prenatal exposure to diethylstilbestrol (DES) on hemispheric laterality and spatial ability in human males.

Ten males exposed to diethylstilbestrol (DES), a nonsteroidal synthetic estrogen, during gestation were compared to their matched, unexposed brothers on measures of brain hemispheric specialization for processing nonlinguistic spatial information and cognitive abilities. DES exposure was associated with reduced hemispheric laterality and lowered spatial ability. These data provide direct evidence of a relationship between brain laterality, spatial cognitive ability, and prenatal exposure to hormones in human males. Further, the implications of these findings for understanding sexual differentiation of the human brain are discussed.

Comparing the effects of alcohol and intelligence on text recall and recognition.

Forty male subjects were divided into two groups on the basis of their scores on a computerized intelligence test administered in a preliminary session. They then participated in a text recall and recognition experiment in which they received alcohol (1.0 ml/kg body weight) in one session and no alcohol in another session (the order being counterbalanced). Subjects were required to read a short passage, immediately recall as much of it as possible and then select from sets of four sentences the ones that appeared in the original passage (recognition). Although two different passages were used, and subjects knew about the memory tasks in advance, there was nevertheless a significant practice effect: subjects recalled 10.6 per cent more propositions on the second occasion than on the first, but this could be at least partly explained by the fact that they spent 10.0 per cent longer reading the second passage. There was also a significant 7.8 per cent slowing of reading time due to alcohol. Practice did not interact with either intelligence or alcohol on any measure of performance. Alcohol impaired the performance of high intelligence test scorers more than low scorers. The effects of intelligence and alcohol on free recall were quantitatively similar: high intelligence test scorers recalled 8.7 more propositions than low scorers; with alcohol, subjects recalled 8.3 fewer propositions than without alcohol. However, the effects were qualitatively different. The effect of intelligence was primarily on the recall of lower level propositions, whereas alcohol impaired the recall of both higher and lower level propositions. Furthermore, while there was no effect of intelligence on recognition, alcohol impaired performance such that more incorrect sentences were erroneously recognized, particularly those which altered the meaning of the original sentence, rather than merely its surface structure. In terms of Kintsch & van Dijk's (1978) model of text processing, the results are interpreted as suggesting that, while both intelligence and alcohol affect the capacity of the short-term memory buffer, there is an additional impairment with alcohol in the ability to select between higher and lower level propositions prior to filling the buffer.

Influence of blood lead on the ability and attainment of children in Edinburgh.

The effect of blood-lead on children's ability and attainment was investigated in a sample of 855 boys and girls aged 6-9 years from eighteen primary schools within a defined area of central Edinburgh. The geometric mean blood-lead value was 10.4 micrograms/dl. In a stratified subsample, 501 children completed individual tests of cognitive ability and educational attainment from the British Ability Scales (BAS). An extensive home interview with a parent was also done. Multiple regression analyses showed a significant negative relation between log blood-lead and BAS combined score, number skills, and word reading when thirty-three possible confounding variables were taken into account. There was a dose-response relation between blood-lead and test scores, with no evidence of a threshold. The size of the effect was small compared with that of other factors. Lead at low levels of exposure probably has a small harmful effect on the performance of children in ability and attainment tests.

Comparisons of pilot performance in simulated and actual flight.

Five highly experienced professional pilots performed instrument landing system approaches under simulated instrument flight conditions in a Cessna 172 airplane and in a Link-Singer GAT-1 simulator while under the influence of orally administered secobarbital (0, 100, and 200 mg). Tracking performance in two axes and airspeed control were evaluated continuously during each approach. The data from the airplane and simulator were compared. Error and RMS variability were about half as large in the simulator as in the airplane. The observed data were more strongly associated with the drug level in the simulator than in the airplane. Further, the drug-related effects were more consistent in the simulator. Improvement in performance suggestive of learning effects were seen in the simulator, but not in actual flight. It is concluded that the GAT-1 simulator is a useful and sensitive device for studies of the effects of mild stress on pilot performance, but extrapolation of simulator data to the flight environment must be approached with considerable caution.