Systematic Review and Meta-Analysis on Neuropsychological Effects of Long-Term Use of Opioids in Patients With Chronic Noncancer Pain.

BACKGROUND AND OBJECTIVE: Opioid treatments are often prolonged because of the pathology causing pain. We focused on the cognitive functions in patients with chronic pain treated with opioids. This topic is currently controversial, but in practice, the consequences are important in patients' daily lives, social interactions, working ability, and driving. DATABASE AND DATA TREATMENT: Medline and Embase databases were searched for eligible articles. We included studies that enrolled patients with chronic noncancer pain, studies with patients receiving opioid treatment, studies with a control group not using opioids, and studies in which cognitive functions were evaluated with specific tests. The cognitive areas examined were as follows: attention, reaction time, executive functions, psychomotor speed, memory, and working memory. From 356 abstracts screened, 9 articles satisfied eligibility criteria and were included in our review: 7 observational and 7 experimental studies. We classified the pain treatments as follows: opioids, other drugs active on the central nervous system (CNS) (antidepressants/anticonvulsants), and treatments not specifically targeted to the CNS. RESULTS: Statistically significant differences were seen only with regard to attention between opioids alone and no centrally acting treatment (standardized mean difference [SMD]: -0.53, 95% confidence interval [CI] : -0.91, -0.15; P = 0.007; I2 = 23%) and between opioids combined with antidepressants and/or anticonvulsants and no centrally acting treatment (SMD: -0.62, 95% CI: -1.04, -0.20; P = 0.004; I2 = 0%). No other significant differences were observed. CONCLUSIONS: Opioids reduce attention when compared with treatments not targeted on the CNS. If opioids are used together with antidepressants and/or anticonvulsants, this effect increases. SIGNIFICANCE: These findings on the neuropsychological effects of opioids could be used to generate strategies to refine pain treatments.

Temporally extended self-awareness and affective engagement in three-year-olds.

The aim of the current study was to analyze the role of affective engagement during social interaction on the emergence of a temporally extended self (TES). A Delayed Self Recognition task was administered in two different social contexts: in presence of the mother ("Mother condition") or in presence of an unfamiliar person ("Experimenter condition"). The same sample of 71 tree-year-olds was tested twice in these two treatment conditions. Results showed higher self-recognition scores in the "Mother condition". These findings are consistent with developing-self theories that emphasize the impact of reciprocal social interaction on the emergence of self-awareness, and support a conception of the Self as a dialogic entity. We interpreted this link as a evidence that, when completing the procedure with their mother, children are aware of her attention, which corresponds to a familiar mode of self-perception, as well as to a peculiar affective consciousness of Self.

Drug prescription appropriateness in the elderly: an Italian study.

PURPOSE: Correct drug prescription in the elderly is a difficult task that requires careful survey of the current pharmacological therapies. In this article, we reviewed the drug prescriptions provided to 860 persons aged 65 years or over, residing in a small city of Lombardy, Italy. METHODS: Subjects were recruited from a local nursing home, the Pavia and Vigevano Neuropsychological Center for Alzheimer's Disease, general practitioners' offices, and the local University of the Third Age. For each patient, the amount of potentially inappropriate prescriptions (PIPs), sedative and anticholinergic load (SL and AL, respectively), and drug-drug interactions were evaluated. RESULTS: Widespread polypharmacy, giving rise to 10.06% of PIPs in the whole collection of prescriptions, was observed. In particular, PIPs mainly concern drugs acting at the central nervous system level, mostly benzodiazepines and antipsychotics. Moreover, approximately one-fourth of the subjects had an elevated SL and approximately one-tenth a high AL. Drug-drug interactions were frequent (266 requiring medical attention), up to five for each single patient. Of concern was the underuse of antidementia drugs: only 20 patients received a cholinesterase inhibitor or memantine, although 183 patients were potentially suitable for this treatment. CONCLUSION: These results demonstrate the need to develop novel strategies aimed at improving the quality of drug prescription.

Familiarity is not notoriety: phenomenological accounts of face recognition.

From a phenomenological perspective, faces are perceived differently from objects as their perception always involves the possibility of a relational engagement (Bredlau, 2011). This is especially true for familiar faces, i.e., faces of people with a history of real relational engagements. Similarly, valence of emotional expressions assumes a key role, as they define the sense and direction of this engagement. Following these premises, the aim of the present study is to demonstrate that face recognition is facilitated by at least two variables, familiarity and emotional expression, and that perception of familiar faces is not influenced by orientation. In order to verify this hypothesis, we implemented a 3 × 3 × 2 factorial design, showing 17 healthy subjects three type of faces (unfamiliar, personally familiar, famous) characterized by three different emotional expressions (happy, hungry/sad, neutral) and in two different orientation (upright vs. inverted). We showed every subject a total of 180 faces with the instructions to give a familiarity judgment. Reaction times (RTs) were recorded and we found that the recognition of a face is facilitated by personal familiarity and emotional expression, and that this process is otherwise independent from a cognitive elaboration of stimuli and remains stable despite orientation. These results highlight the need to make a distinction between famous and personally familiar faces when studying face perception and to consider its historical aspects from a phenomenological point of view.

Experience with V-STORE: considerations on presence in virtual environments for effective neuropsychological rehabilitation of executive functions.

The paper discusses the use of immersive virtual reality systems for the cognitive rehabilitation of dysexecutive syndrome, usually caused by prefrontal brain injuries. With respect to classical P&P and flat-screen computer rehabilitative tools, IVR systems might prove capable of evoking a more intense and compelling sense of presence, thanks to the highly naturalistic subject-environment interaction allowed. Within a constructivist framework applied to holistic rehabilitation, we suggest that this difference might enhance the ecological validity of cognitive training, partly overcoming the implicit limits of a lab setting, which seem to affect non-immersive procedures especially when applied to dysexecutive symptoms. We tested presence in a pilot study applied to a new VR-based rehabilitation tool for executive functions, V-Store; it allows patients to explore a virtual environment where they solve six series of tasks, ordered for complexity and designed to stimulate executive functions, programming, categorical abstraction, short-term memory and attention. We compared sense of presence experienced by unskilled normal subjects, randomly assigned to immersive or non-immersive (flat screen) sessions of V-Store, through four different indexes: self-report questionnaire, psychophysiological (GSR, skin conductance), neuropsychological (incidental recall memory test related to auditory information coming from the "real" environment) and count of breaks in presence (BIPs). Preliminary results show in the immersive group a significantly higher GSR response during tasks; neuropsychological data (fewer recalled elements from "reality") and less BIPs only show a congruent but yet non-significant advantage for the immersive condition; no differences were evident from the self-report questionnaire. A larger experimental group is currently under examination to evaluate significance of these data, which also might prove interesting with respect to the question of objective-subjective measures of presence.