What is ‘Substance Misuse’?
13 Jan 2011-pp 9-28
TL;DR: The need to improve recognition of substance misuse in patients receiving palliative care, and to meet the challenges palliatives care teams face when caring for patients who have current or past opiate, benzodiazepine or alcohol addictions, emerged.
Abstract: This literature review concerned the end of life care needs of patients with drug and alcohol addiction, particularly in the UK, and to identify existing good practice guidance. Three themes emerged: » The need to improve recognition of substance misuse in patients receiving palliative care, and to meet the challenges palliative care teams face when caring for patients who have current or past opiate, benzodiazepine or alcohol addictions. » A lack of UK literature addressing the end of life care needs of patients with drug and alcohol addiction. There are articles in the US literature concerning a family-systems approach to the care of dying patients who have misused substances, and the role of social workers and counsellors in the care of dying patients receiving opiate-substitution treatment. » Inequitable access to end of life and palliative care services for homeless people, many of whom are addicted to substances or alcohol.
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TL;DR: The results of these studies point to the importance of the hippocampal complex for normal memory function in patients who had undergone similar, but less radical, bilateral medial temporallobe resections, and as a warning to others of the risk to memory involved in bilateral surgical lesions of the hippocampusal region.
Abstract: In 1954 Scoville described a grave loss of recent memory which he had observed as a sequel to bilateral medial temporal-lobe resection in one psychotic patient and one patient with intractable seizures. In both cases the operations had been radical ones, undertaken only when more conservative forms of treatment had failed. The removals extended posteriorly along the mesial surface of the temporal lobes for a distance of approximately 8 cm. from the temporal tips and probably destroyed the anterior two-thirds of the hippocampus and hippocampal gyrus bilaterally, as well as the uncus and amygdala. The unexpected and persistent memory deficit which resulted seemed to us to merit further investigation. We have therefore carried out formal memory and intelligence testing of these two patients and also of eight other patients who had undergone similar, but less radical, bilateral medial temporallobe resections.* The present paper gives the results of these studies which point to the importance of the hippocampal complex for normal memory function. Whenever the hippocampus and hippocampal gyrus were damaged bilaterally in these operations some memory deficit was found, but not otherwise. We have chosen to report these findings in full, partly for their theoretical significance, and partly as a warning to others of the risk to memory involved in bilateral surgical lesions of the hippocampal region.
7,041 citations
TL;DR: By better understanding AD inflammatory and immunoregulatory processes, it should be possible to develop anti-inflammatory approaches that may not cure AD but will likely help slow the progression or delay the onset of this devastating disorder.
4,319 citations
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TL;DR: A review of the existing evidence for the mediating role of pain‐related fear, and its immediate and long‐term consequences in the initiation and maintenance of chronic pain disability, and the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain.
Abstract: &NA; In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al.(Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear‐avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401‐408).ntroduced a so‐called ‘fear‐avoidance’ model. The central concept of their model is fear of pain. ‘Confrontation’ and ‘avoidance’ are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear‐avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain‐related fear, and its immediate and long‐term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain‐related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear‐related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain‐related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain‐related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.
3,661 citations
TL;DR: Event-related functional magnetic resonance imaging and a task-switching version of the Stroop task were used to examine whether these components of cognitive control have distinct neural bases in the human brain and a double dissociation was found.
Abstract: Theories of the regulation of cognition suggest a system with two necessary components: one to implement control and another to monitor performance and signal when adjustments in control are needed. Event-related functional magnetic resonance imaging and a task-switching version of the Stroop task were used to examine whether these components of cognitive control have distinct neural bases in the human brain. A double dissociation was found. During task preparation, the left dorsolateral prefrontal cortex (Brodmann's area 9) was more active for color naming than for word reading, consistent with a role in the implementation of control. In contrast, the anterior cingulate cortex (Brodmann's areas 24 and 32) was more active when responding to incongruent stimuli, consistent with a role in performance monitoring.
3,545 citations
01 Apr 2009
TL;DR: This work has pinpointed the amygdala as an important component of the system involved in the acquisition, storage, and expression of fear memory and has elucidated in detail how stimuli enter, travel through, and exit the amygdala.
Abstract: The field of neuroscience has, after a long period of looking the other way, again embraced emotion as an important research area. Much of the progress has come from studies of fear, and especially...
2,614 citations