Difficulty Thinking Research Articles

A Qualitative Analysis of Experiential Challenges Associated with Meditation Practice

Although empirical interest in meditation has flourished in recent years, few studies have addressed possible downsides of meditation practice, particularly in community populations. In-depth interviews were conducted with 30 male meditators in London, UK, recruited using principles of maximum variation sampling, and analysed using a modified constant comparison approach. Having originally set out simply to inquire about the impact of various meditation practices (including but not limited to mindfulness) on men’s wellbeing, we uncovered psychological challenges associated with its practice. While meditation was generally reported to be conducive to wellbeing, substantial difficulties accounted for approximately one quarter of the interview data. Our paper focuses specifically on these issues in order to alert health professionals to potential challenges associated with meditation. Four main problems of increasing severity were uncovered: Meditation was a difficult skill to learn and practise; participants encountered troubling thoughts and feelings which were hard to manage; meditation reportedly exacerbated mental health issues, such as depression and anxiety; and in a few cases, meditation was associated with psychotic episodes. Our paper raises important issues around safeguarding those who practise meditation, both within therapeutic settings and in the community.

Symptoms, coping, and quality of life in pediatric brain tumor survivors: a qualitative study.

To explore the symptom experience, coping strategies, and children's descriptions of their quality of life (QOL) after treatment for a brain tumor. An interpretive descriptive qualitative study. A pediatric hospital setting in Ontario, Canada. 12 children aged 9-18 years. Content analysis of semistructured interviews was guided by interpretive description methodology. Children described symptoms including feeling tired, pain, headaches, emotional problems, difficulty thinking and remembering, problems with sleep, physical problems, and weight changes. Symptoms interfered with physical activity, keeping up with school, maintaining appearances, and communication. Coping strategies included reconditioning, taking breaks, taking medication, challenging themselves, volunteering, maintaining friendships, laughing, and using aids. Survivors experienced multiple symptoms that had an effect on their life, but overall, they described good QOL. Caregivers need to understand the complexity of their patient's symptom experience and its impact on his or her daily life. Coping strategies can be identified to help mitigate potentially negative QOL outcomes.

Ecological momentary assessment of sleep, symptoms, and mood during chemotherapy for breast cancer

This study examined the association of sleep before and during a chemotherapy (CT) cycle for breast cancer with symptoms and mood during a CT cycle. Twenty women undergoing CT for breast cancer completed the Pittsburgh Sleep Quality Index (PSQI) 1 h prior to a CT infusion. For 3 weeks following infusion, participants estimated sleep efficiency, minutes to sleep (sleep latency), number of nocturnal awakenings (sleep fragmentation (SF)), and sleep quality (SQ) each morning and rated symptoms (nausea, fatigue, numbness, and difficulty thinking) and mood three times daily (morning, afternoon, and evening) via ecological momentary assessments using automated handheld computers. The results showed that disturbed sleep (PSQI score > 5) prior to CT infusion was associated with greater fatigue, and more negative and anxious mood throughout the 3-week CT cycle, and good pre-CT infusion sleep (PSQI score < 5) buffered anxious mood in the first days following infusion. Time-lagged analyses controlling for mood/symptom ratings reported the previous evening revealed that longer sleep latency and greater SF were associated with greater daytime fatigue; poorer SQ and greater SF were antecedents of worse morning negative mood, and greater SF was associated with feeling more passive and drowsy. No evening symptom or mood ratings were related to subsequent SQ. These findings suggest that disturbed sleep before and after a CT infusion exacerbates fatigue, and negative, anxious, and drowsy mood during a CT cycle. Reducing sleep disturbance may be an important way to improve quality of life during CT.

A Survey of Synthetic Cannabinoid Consumption by Current Cannabis Users

ABSTRACT. Background: Despite growing concern about the increased rates of synthetic cannabinoid (SC) use and their effects, only limited data are available that addresses these issues. This study assessed the extent of SC product use and reported effects among a cohort of adult marijuana and tobacco users. Methods: A brief telephone interview was conducted with individuals who had given permission to be contacted for future research while screening for a cannabis/nicotine dependence medication development study (NCT01204723). Results: Respondents (N = 42; 88% participation rate) were primarily young adults, male, racially diverse, and high school graduates. Nearly all currently smoked tobacco and cannabis, with 86% smoking cannabis on 5 or more days per week. Nearly all (91%) were familiar with SC products, half (50%) reported smoking SC products previously, and a substantial minority (24%) reported current use (i.e., past month). Despite a federal ban on 5 common SCs, which went into effect on March 1, 2011, a number of respondents reported continued SC product use. Common reasons reported for use included, but were not limited to, seeking a new “high” similar to that produced by marijuana and avoiding drug use detection via a positive urine screen. The primary side effects were trouble thinking clearly, headache, dry mouth, and anxiety. No significant differences were found between synthetic cannabinoid product users (ever or current) and nonusers by demographics or other characteristics. Conclusions: Among current marijuana and tobacco users, SC product consumption was common and persisted despite a federal ban. The primary reasons for the use of SC-containing products seem to be to evade drug detection and to experience a marijuana-like high.

Acquiring Tastes through Online Activity: Neuroplasticity and the Flow Experiences of Web Users

Acquiring Tastes through Online Activity: Neuroplasticity and the Flow Experiences of Web Users

Fear of Hypoglycemia in Women and Men With Type 1 Diabetes

Severe hypoglycemia is a serious complication of type1 diabetes feared by many who have the disease. The aim of this study was to investigate specific fears related to hypoglycemia in adults with type 1 diabetes and to investigate how aspects of fear of hypoglycemia may differ between genders. A cross-sectional study with questionnaires sent to 636 patients with type 1 diabetes, aged 18-75 years, who attended the outpatient clinic at St. Olavs Hospital, Trondheim, Norway. Fears related to hypoglycemia were assessed using the Hypoglycemia Fear Survey II Worry subscale (HFS-II-Worry). The response rate was 70% (N = 445, 216 women and 229 men). The mean HFS-II-Worry score was higher in women than in men (2.46 [SD = 0.80] vs. 2.22 [SD = 0.74], respectively; p < .001). Women scored higher than men in all items in the HFS-II-Worry, and women's average scores were statistically significantly higher in 5 of the 18 items after correction for multiple comparisons. The largest gender differences in mean scores occurred in the items "low blood glucose interfering with important things," "becoming upset and difficult," "difficulty thinking clearly," and "feeling lightheaded or dizzy." In both women and men, the highest mean scores appeared in the worry items "become hypoglycemic while sleeping" and "not having food available." In this sample of Norwegian adults with type 1 diabetes, women expressed more concerns about hypoglycemia than men. The highest HFS-II-Worry scores occurred in the same items in women and men, but the largest gender differences in mean scores appeared across a variety of other items, some of which were related to social esteem.

Introduction: Life and Debt

Give back life I gaveyou pay me my money downso there's no questionI did it for love for anythingbut desireput tarnished nickel in my dishso guard will knowwhen he comeswith bleeding chickentied to his wristwith bitter promisethat we are not kinuncomm i tied for ever.-Audre Lorde, Generation IIIWhat, precisely, does it mean to say that our sense of morality and justice is reduced to language of business deal? What does it mean when we reduce moral obligations to debts? What changes when one turns into other? And how do we speak about them when our language has been so shaped by market? -A debt is obligation to pay certain sum of money. As result, debt, unlike any other form of obligation, can be precisely quantifiedOne does not need to calculate human effects; one need only calculate principal, balances, penalties, and rates of interest....-Graeber, Debt: The First 5,000 YearsAs editors, we share personal debt-and professional lifetime of giving and receiving-to City University of New York, Hunter College, and PhD programs in Political Science (Ros) and English (Meena) at CUNY Graduate Center. These have been academic homes whose students and colleagues have nurtured our thinking for so many years but also incubator of some troubling thoughts about meaning, in everyday life terms, of debt. The question of whole generation of young people bound by student debt is something that we see close at hand. It forms part of whole chain of injustices that affect them not only as students but also as recent immigrants (or children of immigrants), working-class people, and victims of racism and gender inequality-imminent castaways in precarious job market, in addition perhaps to their being foot soldiers in armies of medically uninsured and credit-deficient.So our decision to devote an issue of WSQto theme of was initially driven by outrage we shared with Occupy Movement, Occupy Student Debt Campaign, and their many allies across globe at ways in which higher education-our work world-has become a profit engine for financiers, asset speculators, and real estate developers (Occupy Student Debt Campaign 2013). As our CUNY colleague, sociologist Jack Hammond, has written concerning the student debt bubble, 'At more than one trillion dollars, student loans have grown to exceed total credit card debt. Debt has become standard part of college experience. Students take it on because they expect it to pay off in better jobs and higher salaries. But many will be disappointed (Hammond 2012). Monica Johnsons marvelous graphic novel, The Adventures of Dorrit Little, one chapter of which is printed in this issue, illustrates dire experience and limited choices of typical student slaving away at low-paying, food service job while contemplating lifetime of debt that grad school is likely to entail. Moreover, as Dorrit s wan expressions only hint at, new findings by medical researchers at Northwestern University show that stresses of having to pay off massive loans are hitting young people with health as well as financial costs-in form of higher blood pressure, hypertension, and depression (Von Hoffman 2013). Is student debt becoming an apparatus for training and disciplining bodies, an apprenticeship in debt enfranchisement? Has debt become newly normal way of performing citizenship?Debt is thus not only bleak reality that corrodes our institutions, families, and communities; it also raises larger political, philosophical, and historical questions that resonate globally. In contemplating an issue of WSQ. that would capture this landscape, we asked, what does it mean to live in world of debt-whether you are college student in United States, struggling farmer in India, homeowner, or country? …

SAT0560 Association between Individual Psychosocial Context and Early Chronic Musculoskeletal Pain in Young Adults

BackgroundResearch suggests that the onset of musculoskeletal pain and its evolution into a chronic condition is related to adverse psychosocial contexts throughout the life course. However, the specific individual socioeconomic...

Symptoms Associated With Mild Traumatic Brain Injury/Concussion

Traumatic brain injury (TBI) affects 1.4 million Americans annually, and mild TBI (MTBI) accounts for approximately 75% of those injured. For those with mild injury who seek treatment in an emergency department, there is inconsistency in the management and follow-up recommendations. Approximately, 38% of patients treated in the emergency department for MTBI are discharged with no recommendations for follow-up. In addition, there are an unknown number of persons with MTBI who do not seek healthcare after their injury. Persons with MTBI are, for the most part, managing their concussion symptoms on their own. The purpose of this study was to describe the symptom experience for persons with mild TBI and identify whether there was an association between being bothered by symptoms and self-management of symptoms. The sample for this study included 30 persons with MTBI and a 30-person comparison group. Results indicate that persons within 3 months of their MTBI report an average of 19 symptoms, whereas the comparison group reported six symptoms, and that the most frequently reported symptoms are not always the symptoms rated as most severe or most bothersome. Persons with MTBI reported their most common symptoms to be headache (n = 25, 83%), feeling tired (n = 24, 80%), difficulty thinking and being irritable (each n = 22, 73%), dizziness, trouble remembering, and being forgetful (each n = 21, 70%). There is a significant relationship between overall reports of being bothered by symptoms and the use of symptom management strategies (F = 8.322, p = .008). Persons are more likely to use symptom management strategies when they are bothered by the symptoms. Nurses can assist with symptom self-management by providing simple symptom management strategies to assist with the symptom management process. Early symptom management for the MTBI population may improve the outcomes such as return to work and role functions, for this population.

Differences in pain, symptom burden, and opioid use among cancer pain patients with active versus non-active disease.

e20568 Background: Many cancer survivors with non-active disease suffer with pain and other symptoms. This study investigated differences in symptoms and opioid use among cancer pain patients with active versus non-active disease. Methods: Data were obtained from 518 consecutive new patients seen at the Pain Management Center of MD Anderson Cancer Center from 01/01/09 to 06/30/09. Measures: Usual pain was rated on the Brief Pain Inventory. The Edmonton Symptom Assessment Scale (ESAS) was used for ratings of fatigue, shortness of breath, poor appetite, depression, anxiety, drowsiness, difficulty thinking clearly and insomnia. Opioid use was calculated in morphine equivalency daily dose (MEDD) milligrams based on the sum of long- and short-acting opioids used per day. Analyses of Data: Independent samples t-tests were used to make comparisons between patients with active versus non-active disease on continuous variables. Chi-square tests were used to make comparisons across disease status on categorical variables. Results: 349 patients had active disease; 169 patients had non-active disease. Patients with active disease received significantly higher MEDD (125.6 ± 158.8 mg) versus patients with non-active disease (74.4 ± 87.0 mg). Patients with active disease reported significantly higher mean scores on fatigue, poor appetite, and drowsiness. Average weekly pain scores were comparable and moderately high for both groups of patients. Other symptoms and clinical characteristics were not significantly different across disease status. Conclusions: Plausible explanations for the higher opioid use and symptom burden among patients with active disease are cancer treatments and disease progression. A higher level of pain medication is often needed to achieve pain management during active treatment or following recent surgery. The finding of higher fatigue, poor appetite, and drowsiness among those with active disease is also consistent with the symptom burden expected from treatment. Although patients with active disease have a greater symptom burden and need for pain medication, there is a need for pain and symptom management among patients in the non-active disease phase of survivorship.

Immediate Intervention: Life-Long Success

Immediate Intervention: Life-Long Success

Outpatient chemotherapy supportive care: Trial of an IT-integrated, NP-delivered system for unrelieved symptoms.

9137 Background: We tested an automated computer based remote monitoring system paired with nurse practitioner (NP) follow up using a case management system to address unrelieved symptoms. Methods: Prospectively 336 patients beginning a course of chemotherapy were randomized to the Telephone Care NP (TC) intervention (n 174) or usual care (UC) (n 162). All called daily reporting presence, severity, and distress (0-10 scale) for 11 common symptoms. Those in the TC intervention also received automated tailored symptom self-care messages and, based on automated alerts for unrelieved symptoms at moderate or higher levels, NP calls to further treat symptoms utilizing national guidelines. Results: There were no differences between groups on any demographics: 84% White, 56 years old, female (77%), breast (45%) or lung (17%) cancer. Average study days were 73 with 87% call completion. Prevalence of participants reporting moderate to severe symptoms were fatigue (86%), pain (80%), sleep (78%), nausea (60%), depressed mood (52%), anxious (49%), trouble thinking (48%), numbness (43%), sore mouth (38%), diarrhea (38%), and appearance concerns (35%). Mixed modeling with intention to treat was used to compare overall symptom scores by treatment condition (TC/UC) while accounting for individuals. Results indicate the TC group mean symptom score was significantly lower than UC (mean difference = .30, p &lt; .001). Also, each symptom was significantly lower for the TC group except for diarrhea. Poisson regression showed TC had lower Severe days than UC (est. means and SE) 3.16 (0.44) vs 10.24 (1.84), p &lt; .001; and lower Moderate days 8.91 (1.04) vs 19.06 (2.22), p &lt; .001. TC had somewhat higher Mild days than UC 19.85 (2.81) vs 13.75 (1.85), p = .06; and more No symptom days 66.06 (3.82) vs 52.02 (4.15), p = .01. Mixed modeling was used to explore TC intervention impact following NP calls for alerts. TC reduced symptom scores compared to UC over a 4 day period (mean difference = 1.28, p&lt; .001). Conclusions: Remote telephone monitoring of symptoms after chemotherapy with nurse practitioner follow up on moderate and severe symptoms results in decreased symptom severity, distress, fewer severe and moderate days and more no symptom days.

Changes in Pain and Other Symptoms in Patients With Painful Multiple Myeloma-Related Vertebral Fracture Treated With Kyphoplasty or Vertebroplasty

Patients with painful vertebral compression fractures produced by multiple myeloma (MM) often experience reduction in pain after spinal augmentation with kyphoplasty or vertebroplasty. Previous studies have shown pain reduction and improvement in functional status after augmentation, but no studies have examined the effect of augmentation on other cancer-related symptoms. We hypothesized that reduction in pain severity would be significantly associated with improvement in other reported symptoms. We retrospectively studied 79 patients who rated pain and symptom severity both before and after kyphoplasty or vertebroplasty. Pain was significantly reduced after spinal augmentation (1.3 on a 0 to 10 scale; effect size [ES] = .59; P < .001), as were anxiety (1.3; ES = .47), drowsiness (1.3; ES = .39), fatigue (1.1; ES = .32), depression (.7; ES = .28), and difficulty thinking clearly (.7; ES = .26) (all P < .05). Greater reduction in pain was associated with a greater number of symptoms being reduced. Interestingly, insomnia worsened regardless of any amount of improvement in pain. Because appropriate symptom control contributes to the overall well-being of cancer patients, future studies of pain reduction procedures should include measures of other symptoms to fully characterize the potential benefit of treating pain. PerspectiveAppropriate symptom control contributes to overall well-being for cancer patients. This study demonstrated that pain reduction after spinal augmentation with vertebroplasty or kyphoplasty was positively associated with reduction in other patient-reported cancer-related symptoms. Future studies of these augmentation procedures should measure multiple symptoms, in addition to pain and functional status.

Archiving Father and Son

Haunted by the estranged relationship with his son and the loss of his father three years ago, the author writes in the attempt to gather, to archive what needs to be preserved. The author proceeds by recollecting the positive memories he carries of his father and the troubling thoughts he holds about his son. Structured through fragments, the author accumulates an archival history, one that tells the story of the father his dad was and of the father that the author is to his own son.

Indigenous perspectives on depression in rural regions of India and the United States

Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.

Knowledge Grows About Puzzling Disorder

Although a handful of medications and some nondrug regimens are used to treat fibromyalgia, even more effective treatments may be on the horizon.

Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees

Although genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups. To compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of 'genetic' and 'sporadic' subgroups. Patients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample. Bipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible 'genetic' subgroup. A number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in identifying patients who may warrant further assessment for bipolarity. The major depressive disorder clusters potentially reflect genetic and sporadic subgroups which, if replicated independently, might enable an improved phenotypic definition of underlying bipolarity in genetic analyses.

Mr Houghton and Dr Führer: A Scholarly Vendetta and its Consequences

Between 1895 and 1921, the early history of Burma rested on a false premise: that the three oldest inscriptions found in Burma were genuine. Who forged these inscriptions? Why did they do so? By whom were the forgeries exposed? The answers to these questions prompt troubling thoughts about how state power impinged on the autonomous pursuit of knowledge during the high noon of the British Empire.

P01-167 - Refractory compulsive disorders and multi target areas treated with deep brain stimulation

BackgroundObsessive compulsive -disorder (OCD) is a group of highly debilitating condition characterized by intrusive troubling thoughts, repetitive, compulsive behaviours or mental rituals. According to the OMS, this is the tenth disease which produces a social incapacity. This behavior is associated with other diseases of the motor pathway as Parkinson, Tourrete, Lesh-Nyhan, PKAN, Huntington disease. A notable percentage of patients are refractory to pharmacological treatment and cognitive behaviour therapy. Increasing attention has been paid to the efficacy of DBS therapies in alleviating pharmacoresistant psychiatric disorders including OCD.PurposeThis prospective study was to determine the efficacy of DBS using multiple targets in a pharmacoresistant compulsion behavior population with heterogeneous symptoms in a multidisciplinary team.Population and methodsFive patients. Patients were classified according to their prominent features as follows: contamination/cleaning, symmetry/checking, exactness/counting and forbidden thoughts. The entire surgical procedure was performed under general anesthesia. Direct targeting based on sterotactic MRI without microelectrode recordings was done. A combination of two of the following targets was simultaneously implanted for all 5 patients: subthalamic nucleus, accumbens nucleus and bed nucleus of stria terminalis, limbic globus pallidus internus.All the patients have been assessed pre-and postoperatively using the Yale-Brown Obsessive Compulsive Scale.ResultsMean age at surgery was of 42.6 ± 12.68 years. Mean follow-up with DBS was of 21 ± 14.88 months.Mean preoperative Y-BOCS scores was 31.6 ± 2.70 and of 11 ± 7.97 postoperative (p = 0,057, Wilcoxon signed Rank test). Conclusion: Subthalamic nucleus and accumbens nucleus targets seem to be comparable in alleviating several subtypes of compulsions (checking, cleaning, counting) as well as obsessions.

The impact of pain reduction on other symptoms in patients with multiple myeloma-related painful vertebral fracture treated with kyphoplasty or vertebroplasty.

e19536 Background: Patients with cancer pain usually have associated symptoms. Generally, it is felt that a reduction in severity of pain will be associated with significant improvement in other symptoms as well. Patients with multiple myeloma (MM)-related painful vertebral compression fracture often show substantial reduction in pain after kyphoplasty (KP) or vertebroplasty (VP). We evaluated the association of changes in pain ratings with ratings of other cancer symptoms in this patient group. Methods: We retrospectively studied 79 patients with MM-related painful vertebral compression fracture who underwent KP or VP. The patients' ratings of pain and symptom severity using the Brief Pain Inventory (BPI) and the Edmonton Symptom Assessment Scale (ESAS), assessed both before and after undergoing KP or VP, were noted. Change scores and change score effect sizes were computed, and correlations were evaluated before and after treatment. Results: There were significant reductions in mean pain severity after treatment (1.8 on a 0-10 scale, p<.001). Effect-size reductions for the pain items ranged from 0.53 to 0.70. Also, significant reductions were noted (decreasing order) in anxiety (1.3, p<.001), drowsiness (1.3, p<.001), depression (0.80, p<.012), difficulty thinking clearly (0.79, p<.012), and fatigue (0.90, p<.028). Pain change scores were associated only with changes in anxiety. In contrast, depression change scores were related with all symptom change scores. Fatigue change scores were related to change scores in depression, anxiety, drowsiness, poor appetite, and insomnia. There were no significant differences between KP and VP in reducing pain. Conclusions: Most patients experienced pain reduction after KP or VP. Interestingly, while other symptoms were lower at follow up, pain reduction was significantly associated only with anxiety. The lack of a significant association between a reduction in pain with other symptoms suggests that simplistic views of symptom clusters need further evaluation and requires longitudinal examination. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Celgene, Millennium Celgene, Millennium Celgene, Medtronic, Inc., Millennium, Novartis