Cessation of long-term naltrexone administration: longitudinal follow-ups.

Longitudinal follow-ups of the cessation of long-term Naltrexone administration (1 year of drug therapy) were conducted with a young woman (in her early 30s) with profound mental retardation who had previously displayed dramatic decreases in her self-injurious behaviors (SIB) both during, and for a period of at least 6 months following termination of drug treatment. After 2 and 4 years, post-Naltrexone therapy, the subject continued to exhibit near-zero rates of SIB episodes despite significant turnovers in her direct care staff by the 2-year follow-up, and changes in her physical/living environment and fellow residents by 4-year follow-up. These findings provide further support to the idea that long-term Naltrexone administration may result in highly durable reductions in SIB long after treatment ends and argue against certain aspects of the subject's environment affecting her rates of SIB significantly. These results are discussed in light of the endogenous opiate system theories of SIB. A functional analysis and discussion of the effectiveness of behavioral treatments for her few remaining SIB episodes are also provided.

Spinal cord injury and anxiety: a comprehensive review.

Although there have been past literature reviews which have addressed the psychological adjustment, consequences, and impact/reaction to spinal cord injury, as well as reviews of depression after spinal cord injury, there appears to be an absence of reviews which have focused primarily on the relationship between spinal cord injury and anxiety. The purpose of this paper is to present a comprehensive review of the relatively recent (the past 23-31 years depending on the database utilized) scientific literature as it pertains to anxiety reactions in spinal cord injured individuals. Specifically, this paper provides reviews of the prevalence/presence of anxiety reactions, as well as the correlates of anxiety, in the spinal cord injured population. Furthermore, this paper reviews the relatively few articles which have addressed the treatment of such symptomatology in spinal cord injured individuals. Methodological concerns and limitations of the existing literature and directions for future research are also provided.

Utilization of a comprehensive sensory stimulation program with a comatose tetraplegic patient.

To date, there has been a relative absence of studies which have examined the utility and effectiveness of sensory stimulation procedures in comatose, spinal-cord-injured patients. This report describes the interdisciplinary utilization (within an acute care setting) of a comprehensive sensory stimulation programme with a 21-year-old, comatose, tetraplegic male patient. To promote behavioural arousal, multiple sensory stimulation sessions were conducted with the patient daily. Within each session (and across sensory modalities), the effectiveness of sensory stimulation procedures was evaluated via use of A-B-A within-subject designs. Results indicated that the patient exhibited significantly greater behavioural arousal during sensory stimulation (B1), as compared to pre-(A1) and post-(A2) treatment baselines. There was also a non-significant trend of increased behavioural arousal during the post- as compared to the pre-treatment baselines (i.e. carry-over effect). By termination of this programme, the patient exhibited an overall increased level of arousal/behavioural responsiveness (i.e. decreased coma) as compared to his level at the initiation of this programme. These findings are discussed in light of factors that may affect the effectiveness and implementation of such sensory stimulation programmes with comatose, tetraplegic patients in acute care settings.