Loss Of Volition Research Articles

Phenomenology of addictive craving: recognition and clinical utility

Addiction with its “craving” is a major health problem, world wide. It is useful toknow features of addictive “craving” to distinguish it from desire. These include its instrumentalfocus, its intensity, its imperative nature, its urgency, its salience, and its sense of necessity. Associated emotions include anticipated joy; anger, dysphoria, and fear, in deprivation; and desperation. Associated executive dysfunctions include distortions, rationalizations, preoccupations, ego syntonicity, poor judgment, loss of volition, and lack insight. Differences from other desires for drugs include those desired for pleasure, for social function, and for medical or psychiatric need. Addiction “craving” needs to be distinguished from medical need, psychological dependence, and physical dependence. The biology of addictive “craving” drives itas a motivational force unto itself. The risks of developing addiction include past addiction, developmental factors, social factors, psychological factors, impulsivity, constitutional factors. But addiction requires that the patient reach a threshold of quantity and frequency in use. Someclinical considerations include a patient’s reluctance to disclose “craving,” the resort to illegitimate sources, the need for sound monitoring when medically prescribed

An Epidemic of Apathy: Abulia and the Language of Pathology in Baroja’s Early Fiction

ABSTRACT: The literary exposition of abulia in Pío Baroja’s early novels, especially La lucha por la vida trilogy, illuminates the ways in which diagnostic language from psychopathology was adapted, assimilated, and disseminated through the trajectories of fictional characters who suffer from a loss of volition. This article analyzes cultural narratives about abulia in Baroja’s early fiction, demonstrating that they constitute a resonant pathological metaphor during a period in Spain’s history defined by national introspection and regenerationist debates. By tracing metaphorical explanations for social, political, and economic circumstances conveyed through the literary appropriation of medical terminology, this study explores comparisons between abulia and the gendered and class-based associations of neurasthenia at the turn of the twentieth century. Although the assumed causes of each condition are different, this process of transposition between medicine and metaphor anticipates the contemporary social, cultural, and ideological shaping of concepts such as stress and burnout.

Factors Associated With Dementia Knowledge and Dementia Worry in the South Korean Elderly Population.

ObjectiveSouth Korea is one of the countries with a very fast aging rate, and the prevalence of dementia is rapidly increasing. However, there are relatively few studies pertaining to sociodemographic and physical health-related factors associated with dementia knowledge and dementia worry. MethodsThis was a cross-sectional survey of a community in Seocho-gu, Seoul, Republic of Korea. Overall, 1,869 adults aged 60 years participated. Participants completed an online interview or face-to-face interview. Survey data comprised self-report questions including dementia knowledge, dementia worry, demographic, psychological, exercise, and cognitive activities. We conducted logistic regression analysis. ResultsThere was a significant positive association between dementia worry and knowledge. Family history of dementia, education, income, sleep problems, depressed mood and loss of volition, chronic diseases, and presence of a past job were associated with dementia knowledge or worry. Reading, art, or social cognitive activities had a significant positive association with dementia knowledge, and writing or musical cognitive activities had a negative association with dementia worry. ConclusionWe found that people with more dementia knowledge and less dementia worry engaged more in cognitive activities that could prevent dementia. Public education should be planned to improve dementia knowledge and reduce dementia worry.

Epidemiologic studies on depression and suicide

Major depressive disorder (MDD) is defined as a state of depressed mood, loss of volition and interest, feelings of guilt and worthlessness, sleep problems, poor appetite, loss of energy, and poor concentration, which causes disability in personal and social activities. Lifetime prevalence of MDD is...

Development and Validation of a Screening Scale for Depression in Korea: The Lee and Rhee Depression Scale

ObjectiveThe aim of this study was to develop a culturally sensitive instrument that addressed how individuals express and experience depression to detect this disorder in Koreans. We also assessed the validity, reliability, and diagnostic utility of this scale (Lee and Rhee Depression Scale; LRDS).MethodsThe sample consisted of 3,697 normal adults selected from 12 administrative districts (Do) and 448 Korean patients diagnosed with depression using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Reliability was calculated using Cronbach's α. Construct validity, discriminant validity, and concurrent validity were also measured. Receiver-operator-characteristic (ROC) analysis was employed to evaluate diagnostic efficiency.ResultsThe LRDS was found to be a reliable instrument (Cronbach's α=0.95) consisting of six factors: negative thinking about the future, negative thinking about the self, worry and agitation, depressed mood, somatization, and loss of volition. Comparison of LRDS scores discriminated the group of patients with depression from the normal individuals in the control group. The measure showed good concurrent validity in that scores were significantly and strongly correlated with scores on established scales such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), and the D scale of the Minnesota Multiphasic Personality Inventory-second edition (MMPI-2). Diagnostic efficiency was 77.7%, and the cut-off scores were 65 for males and 70 for females.ConclusionTo our knowledge, this is the first study to develop a depression-screening scale on the basis of Korean patients' complaints about the disorder. As a culturally sensitive tool, the LRDS will be useful in clinical and research settings in Korea.

Skeletal muscle contractile properties and proinflammatory cytokine gene expression in human endotoxaemia

Muscle dysfunction associated with sepsis contributes to morbidity and mortality but the underlying mechanisms are unclear. This study examined whether muscle weakness relates to an intrinsic defect in contraction, or to central mechanisms associated with acute illness, and whether systemic endotoxaemia induces changes in gene expression for proinflammatory cytokines within human muscle in vivo. In this experimental study, 12 healthy men received intravenous Escherichia coli lipopolysaccharide (LPS, 4 ng/kg) or saline (control). Voluntary and electrically stimulated quadriceps contraction, and tumour necrosis factor (TNF) alpha mRNA expression in quadriceps muscle biopsies were studied before and after the infusion. Endotoxaemia induced transient weakness of voluntary quadriceps contraction, equivalent to a 7.8 (95 per cent confidence interval 2.1 to 13.5) per cent reduction in contractile force at 180 min (P = 0.027) and a 9.0 (5.2 to 12.8) per cent reduction at 300 min (P = 0.008). Electrically stimulated contraction was unaffected. LPS administration resulted in an apparent fibre-specific induction of TNF-alpha mRNA. Endotoxaemia results in a reduction in voluntary muscle contractile force without an apparent defect in stimulated muscle contraction. Loss of volition may be a more important factor than intrinsic dysfunction in acute sepsis-associated human muscle weakness.

Re‐administration of mirtazapine could overcome previous mirtazapine‐ associated restless legs syndrome?

Mirtazapine (MIR) has been proved to be effective and tolerable in the treatment of depression with its unique pharmacological profiles, by blockades of the postsynaptic 5-HT2 and 5-HT3 receptors and presynaptic α2-autoreceptor, and by stimulating postsynaptic 5-HT1 receptor.1 Recently, several reports,2, 3 including our group,4 have presented MIR-associated restless legs syndrome (RLS) characterized by unpleasant aching sensation of both legs with creeping and crawling feelings, of which the pathophysiology is unclear but mainly supposed to be related to dysfunction of the dopamine pathway and presented mostly by serotonergic-stimulating agents.5 Interestingly, we experienced two cases that did not show MIR-associated RLS after re-administration of MIR, though they suffered RLS at the first administration of the drug. As reported previously,4 a 56-year-old Korean female patient with a diagnosis of major depressive disorder, according to the 4th edition of the Diagnostic and Statistical Manual (DSM-IV), showed RLS after MIR treatment on the 5th day of MIR administration and recovered 4 days after stopping MIR. She was not found to have any laboratory abnormalities and underlying medical causes might be predisposed to RLS, thus, MIR was switched to paroxetine of 20 mg/day. She had not visited the outpatient clinic after discharge for 7 months. She revisited the outpatient clinic for depressed mood, loss of energy, and suicide ideation and so was given paroxetine of 20 mg/day in the first place, showing no response in depressive symptoms, especially insomnia. MIR was reapplied and effectively worked, improving her depressive symptoms including insomnia without RLS. A 58-year-old female with a DSM-IV diagnosis of major depressive disorder, visited the outpatient clinic of Kangnam St. Mary's Hospital. She complained of severe insomnia, anxiety, agitation and loss of volition. All laboratory screenings for her medical condition showed no definite abnormality and she was given MIR of 15 mg/day and it was increased to 30 mg/day on day five. She reported RLS symptoms such as deep creeping sensation in both legs upon falling asleep, which was aggravated at night. Further evaluation for RLS showed no evidence of any medical illness. MIR was switch to tianeptine of 50 mg/day as clonazepam of 1 mg/day for 5 days was not effective. She was maintained with the same dose of tianeptine for about 2 months, showing moderate improvement of depressive symptoms. However, there was no follow-up visit since then. At 4 months later, she revisited the outpatient clinic due to recurred depression related to familial conflict, and insomnia was her main complaint. MIR of 15 mg/day was re-administered to her and increased to 30 mg/day on day eight, MIR successfully treated her depressive symptoms without RLS. This report led us to speculate on how these two patients could escape from MIR-associated RLS that they had previously experienced, with using the same dosing schedule. As is well known, the complicated role of noradrenergic and serotonergic transmission would be contributed to the pathogenesis of the RLS, although the equivocally suggested pathophysiology of RLS is a dysfunction of the subcortical central nervous system, mainly via the dopamine pathway.5 This unclear pathophysiology makes us not preclude the exact mechanism of the findings of this report. We might suppose: previous MIR administration would alter the suggested 5-HT and noradrenergic neurotransmission system including receptor sensitivity, past experience may affect the individual sensitivity to RLS, and finally, although it is very coincidental, spontaneous resolution of an undetected causative factor at a past medical examination. In conclusion, this report may suggest that MIR would be an exploratory model of RLS as a pharmacological approach in the etiopathogenesis of RLS3 and further studies on the role of MIR in the development of RLS could be launched.

Arguments against the cognitive dysmetria hypothesis of schizophrenia.

Recently, the 'cognitive dysmetria' theory for schizophrenia has been formulated. According to this theory, a primary neurocognitive dysfunction is the core of schizophrenia and underlies symptom formation. The suggested perceptual fragmentation of external stimuli and inability to connect such perceptions with internal schemata is suggested to lead to positive symptoms, while defensive self-restriction and the exhaustion of the mental apparatus lead to negative symptomatology. Objections to this theory include observations (i) that patients with dominant positive symptoms, e.g., delusions, hallucinations, manifest better neurocognitive function and (ii) that typically antipsychotics significantly reduce positive symptoms and thus improve both the clinical picture and the functioning (to the extent it is reduced with positive symptoms) of the patients, yet have little or no effect on negative, e.g., loss of volition, emotional blunting, and neurocognitive symptomatology, e.g., attentional and memory deficit. The literature suggests that neurocognitive symptoms group independently of other symptomatology. It is suggested that there is currently more evidence against than in favor of the 'cognitive dysmetria' theory.

Hypofrontality in schizophrenia: distributed dysfunctional circuits in neuroleptic-naïve patients

There have been reports that patients with schizophrenia have decreased metabolic activity in prefrontal cortex. However, findings have been confounded by medication effects, chronic illness, and difficulties of measurement. We aimed to address these problems by examination of cerebral blood flow with positron emission tomography (PET). We studied 17 neuroleptic-naïve patients at the early stages of illness by means of image analysis and statistical methods that can detect abnormalities at the gyral level. An initial omnibus test with a randomisation analysis indicated that patients differed from normal controls at the 0.06 level. In the follow-up analysis, three separate prefrontal regions had decreased perfusion (lateral, orbital, medial), as well as regions in inferior temporal and parietal cortex that are known to be anatomically connected. Regions with increased perfusion were also identified (eg, thalamus, cerebellum, retrosplenial cingulate), which suggests an imbalance in distributed cortical and subcortical circuits. These distributed dysfunctional circuits may form the neural basis of schizophrenia through cognitive impairment of the brain, which prevents it from processing input efficiently and producing output effectively, thereby leading to symptoms such as hallucinations, delusions, and loss of volition.

Alternative approaches to the discovery of novel antipsychotic agents.

Currently used drugs that are effective treatments for schizophrenia have one single factor in common — their ability to antagonise the actions of dopamine at post-synaptic dopamine D2 receptors [1–4]. This action is at the cornerstone of the dopamine hypothesis of schizophrenia and has served as the basis of the primary screen for the discovery of structurally diverse antipsychotic compounds for almost twenty years. However, general blockade of D2 receptors in the CNS is associated with two major side effects: (i) the induction of abnormal movement syndromes [5] and (ii) the stimulation of prolactin secretion [6, 7]. Furthermore, most antipsychotic drugs are effective treatments for the positive symptoms of schizophrenia (delusions, hallucinations, thought disorders), but their efficacy against the negative symptoms associated with the disease (flattening of affect, poverty of speech, loss of volition) is less easy to demonstrate [8]. Many compounds also have autonomic and cardiovascular effects that can limit their usefulness [9]. Thus, much effort has been, and is currently being, expended in the search for ways of attenuating dopaminergic function without inducing motor, hormonal or other potentially harmful side-effects, yet retaining or improving clinical efficacy.

Influence of Cerebellar Hemorrhage on the Higher Cerebral Functions

It has been observed since long that the cases of cerebellar hemorrhage often had the difficulty of rehabilitation not only by a truncal ataxia but also by a retarded intelligence, a loss of volition and a decreased attention span. The authors investigated 7 cases of operated cerebellar hemorrhage of moderate size on how they were disturbed on the higher cerebral functions by applying them WAIS and other several neuropsychological test batteries. The frontal lobe functions were examined by the original test batteries of our design. As the results, there was the moderate or severe decrease of WAIS on all 7 cases and also marked disturbance of the frontal lobe functions on 4 cases excluding 3 unapplicable cases. The above results will suggest anyhow that the cerebellar damage around the dentate nucleus would give rise the disturbance of generalized higher cerebral functions, though its mechanism has not not been elucidated. It would be very important for us now on to examine extensive higher cerebral function on those cases of cerebellar hemorrhage.