Deficits in striatal dopamine release in cannabis dependence.

Most drugs of abuse lead to a general blunting of dopamine release in the chronic phase of dependence, which contributes to poor outcome. To test whether cannabis dependence is associated with a similar dopaminergic deficit, we examined striatal and extrastriatal dopamine release in severely cannabis-dependent participants (CD), free of any comorbid conditions, including nicotine use. Eleven CD and 12 healthy controls (HC) completed two positron emission tomography scans with [11C]-(+)-PHNO, before and after oral administration of d-amphetamine. CD stayed inpatient for 5-7 days prior to the scans to standardize abstinence. Magnetic resonance spectroscopy (MRS) measures of glutamate in the striatum and hippocampus were obtained in the same subjects. Percent change in [11C]-(+)-PHNO-binding potential (ΔBPND) was compared between groups and correlations with MRS glutamate, subclinical psychopathological and neurocognitive parameters were examined. CD had significantly lower ΔBPND in the striatum (P=0.002, effect size (ES)=1.48), including the associative striatum (P=0.003, ES=1.39), sensorimotor striatum (P=0.003, ES=1.41) and the pallidus (P=0.012, ES=1.16). Lower dopamine release in the associative striatum correlated with inattention and negative symptoms in CD, and with poorer working memory and probabilistic category learning performance in both CD and HC. No relationships to MRS glutamate and amphetamine-induced subclinical positive symptoms were detected. In conclusion, this study provides evidence that severe cannabis dependence-without the confounds of any comorbidity-is associated with a deficit in striatal dopamine release. This deficit extends to other extrastriatal areas and predicts subclinical psychopathology.

Long-term effects of a community intervention for early identification of first-episode psychosis.

OBJECTIVE: To assess whether an Early Case Identification Program (ECIP) for first-episode psychosis (FEP), which showed no significant short-term effects, has a delayed impact on duration of untreated psychosis (DUP). METHOD: Using a historical control design, FEP patients were assessed on clinical variables over three consecutive phases, 2 years prior, 2 years during and 3 years after implementation of the ECIP. Additional analyses were conducted on non-affective and schizophrenia spectrum psychoses cases only. RESULTS: There was no overall significant difference in DUP across the three phases. For cases treated within the first year of illness a nonsignificant reduction in DUP to less than 2 months observed during the active phase was sustained post-ECIP. CONCLUSION: In some jurisdictions community-wide early case detection may fail to have an immediate or delayed effect on DUP, especially for cases who normally present for treatment with DUP >1 year.

Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories.

BACKGROUND: Few studies have examined the underlying factor structure of signs and symptoms occurring before the first psychotic episode. Our objective was to determine whether factors derived from early signs and symptoms are differentially associated with non-affective versus affective psychosis. METHOD: A principal components factor analysis was performed on early signs and symptoms reported by 128 individuals with first-episode psychosis. Factor scores were examined for their associations with duration of untreated illness, drug abuse prior to onset of psychosis, and diagnosis (schizophrenia versus affective psychosis). RESULTS: Of the 27 early signs and symptoms reported by patients, depression and anxiety were the most frequent. Five factors were identified based on these early signs and symptoms: depression, disorganization/mania, positive symptoms, negative symptoms and social withdrawal. Longer duration of untreated illness was associated with higher levels of depression and social withdrawal. Individuals with a history of drug abuse prior to the onset of psychosis scored higher on pre-psychotic depression and negative symptoms. The two mood-related factors, depression and disorganization/mania, distinguished the eventual first-episode diagnosis of affective psychosis from schizophrenia. Individuals with affective psychosis were also more likely to have a 'mood-related' sign and symptom as their first psychiatric change than individuals later diagnosed with schizophrenia. CONCLUSIONS: Factors derived from early signs and symptoms reported by a full diagnostic spectrum sample of psychosis can have implications for future diagnostic trajectories. The findings are a step forward in the process of understanding and characterizing clinically important phenomena to be observed prior to the onset of psychosis.

Chinese medicine users in the United States. Part II: Preferred aspects of care.

OBJECTIVES: While a limited amount of data describe who seeks Chinese medicine care and for what conditions, there have been few attempts to explain what users think the care does for them, or why they value and "like" the care. This article presents such data via an analysis of a sample of 460 handwritten stories collected as part of a mixed quantitative qualitative survey of 6 acupuncture clinics in 5 states. RESULTS: Quantitative data collected in this survey (Part I) showed that respondents were highly satisfied with their Chinese medicine care. The qualitative analysis found that respondents valued relief of presenting complaints as well as expanded effects of care including improvements in physiological and psychosocial adaptivity. In addition, respondents reported enjoying a close relationship with their Chinese medicine practitioner, learning new things, and feeling more able to guide their own lives and care for themselves. While these factors mesh well with Chinese medicine theory, respondents did not reveal familiarity with that theory. Instead, their language and experiences indicate familiarity with an holistic model of healthcare--and they seem to have experienced Chinese medicine care as holistic care. CONCLUSIONS: This finding matters because it shows that respondents are not seeking an 'exotic' kind of healthcare, but are utilizing a homegrown, if nonmainstream, model of healthcare. The finding also matters because it shows that an holistic health delivery model is not only feasible, but currently exists in the United States: how Chinese medicine practitioners are trained, and how they subsequently deliver their care, could serve as a model for American healthcare reform.

Chinese medicine users in the United States. Part I: Utilization, satisfaction, medical plurality.

OBJECTIVES: Chinese medicine is growing in popularity and offers an important alternative or complement to biomedical care, but little is known of who uses it or why they purchase it. This article reports the first in-depth, large-scale (n = 575) survey of United States acupuncture users. DESIGN: An anonymous mixed quantitative-qualitative survey questionnaire assessed user demographics, Chinese medicine modalities used, complaints, response to care, other health-care used, and satisfaction with care in six general-service clinics in five states. RESULTS AND CONCLUSIONS: The user demographic picture was of mid-age, well-educated, employed, mid-income patients. They sought care for a wide variety of conditions; top uses were for relief of musculoskeletal dysfunction, mood care, and wellness care. A large majority reported "disappearance" or "improvement" of symptoms, improved quality of life, and reduced use of selected measures including prescription drugs and surgery. Respondents reported utilizing a wide array of practices in addition to Chinese medicine, while also expressing extremely high satisfaction with Chinese medicine care. The evidence indicates that these respondents behave as astute consumers within a plural health care system. Part II (in press) details reasons given for satisfaction and situates respondent attitudes within a larger sociocultural framework.

Social science theory and methods in the study of alternative and complementary medicine.

Anthropology is a holistic science with theory, data, and methods that can be of great service to researchers on alternative medicine. In this paper useful models and methodologic stances were identified that can help researchers to deal creatively with the stresses imposed on science by worldview preferences that differ among both scientists and healthcare systems. I have argued that rather than prefer one paradigm over another, researchers should select techniques based on a rationale featuring deep knowledge of the context of the healthcare issue they want to study. This will not only produce the most accurate and useful data, but should also help free science of its current strictures and allow expansion into a wider conversation about human and medical realities.

Central nervous system toxoplasmosis in the AIDS patient.

Toxoplasmosis is a central nervous system infection commonly occurring in persons with HIV disease. The disease can manifest as encephalitis and cause neurological damage. The author presents an overview of the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of toxoplasmosis. The nurse's role in the management of patients diagnosed with the disease is discussed, including doing comprehensive, on-going assessments, providing education, and addressing quality-of-life issues.

Walk a mile in my shoes: culturally sensitive food-habit research.

Issues of cultural meaning loom large in efforts to gather dietary data accurate enough to support nutritional analyses, identify marginal diets, or relate risk to dietary pattern. When scientifically trained researchers work in nonscientific settings--which are common in both the Western and non-Western worlds--many important problems of design, collection, and interpretation arise. Assumptions about the appropriateness of dietary patterns vary markedly from setting to setting, including assumptions about who makes dietary decisions. The definition of risk that is meaningful to food specialists may not be so to target populations. Even attitudes toward asking questions vary from society to society. Researchers can resolve many cultural communication issues by awareness, attention, and judicious combination of culturally sensitive qualitative and quantitative research techniques.

Public beliefs about the amount of fiber in foods.

Despite the current interest in fiber in foods and dietary recommendations to increase fiber consumption, relatively little attention has been paid to public beliefs about fiber in foods. We used a mail questionnaire in a sample of 478 adults to assess public beliefs about the amount of fiber in 40 different foods and compared these beliefs with laboratory data about fiber content. Almost all respondents had heard of both fiber and roughage, and many (40%) believed that fiber and roughage were different concepts. Most respondents rated the amount of fiber in the 40 foods similarly to actual fiber content. Few differences in beliefs about fiber in foods existed among demographic groups. Factor analysis of the ratings of the 40 foods revealed three underlying dimensions: 1) fruits and vegetables, 2) animal products, including meat and dairy foods, and 3) grains, including breads and cereals. These findings reveal that some people believe that fiber differs from roughage, but their beliefs about the amount of fiber in foods matches fairly well with scientific data about fiber content. Nutritionists may benefit from assessing beliefs about concepts such as fiber and roughage before attempting to change food consumption behaviors.

The good body: when big is better.

An important cultural question is, "What is a 'good'--desirable, beautiful, impressive--body?" The answers are legion; here I examine why bigger bodies represent survival skill, and how this power symbolism is embodied by behaviors that guide larger persons toward the top of the social hierarchy. bigness is a complex concept comprising tallness, boniness, muscularity and fattiness. Data show that most people worldwide want to be big--both tall and fat. Those who achieve the ideal are disproportionately among the society's most socially powerful. In the food-secure West, fascination with power and the body has not waned, but has been redefined such that thinness is desired. This apparent anomaly is resolved by realizing that thinness in the midst of abundance--as long as one is also tall and muscular--still projects the traditional message of power, and brings such social boons as upward mobility.

Protein-energy malnutrition as a culture-bound syndrome.

A new definition of the concept of culture-bound syndrome demonstrates that culture-boundedness is common and applies as well to Western biomedical disease categories as to nonWestern categories. Culture-boundedness is important when a common disorder with a large sociopsychological component is frequently treated, but unsuccessfully. To improve intervention success, therapists must recognize and accept that clients and interventionists may employ widely dissimilar culture-bound explanatory models. Therapists must learn to synthesize among models, neither rejecting nor discounting those of clients. The fact that Western notions of cause are culture-bound has gone largely unrecognized because of the tendency among biomedical scientists to treat science as if it were culture-free and universally comprehensible. This is of course a naive and invalid understanding. These points are illustrated for the case of protein-energy malnutrition. If those who design and facilitate intervention to alleviate hunger can come to understand that the scientific explanatory model of protein-energy malnutrition is only one among several cogent models, they will be in a strong position to understand intervention failure and possibly to overcome it.

Probable malignancy in a Sadlermiut Eskimo mandible.

The mandible of a Sadlermiut Eskimo woman, age at death 28 to 30 years, displays numerous well-formed formamina concentrated bilaterally around the mental foramina. Differential diagnosis identifies this lesion with highest probability as a metastatic cancerous lesion: of less likelihood are sarcoma, hyperparathyroidism, hemangioma, and osteomyelitis. The specimen deserves attention because identification of malignancy in paleopathological material is uncommon and difficult, and because malignancies in aboriginal Eskimo populations are reputed to have been rare or absent.