In a 9-year longitudinal investigation, 4 subjects learned and relearned 300 English-foreign language word pairs. Either 13 or 26 relearning sessions were administered at intervals of 14, 28, or 56 days. Retention was tested for 1.2.3. or 5 years after training terminated. The longer intersession intervals slowed down acquisition slightly, but this disadvantage during training was offset by substantially higher retention. Thirteen retraining sessions spaced at 56 days yielded retention comparable to 26 sessions spaced at 14 days. The retention benefit due to additional sessions was independent of the benefit due to spacing, and both variables facilitated retention of words regardless of difficulty level and of the consistency of retrieval during training. The benefits of spaced retrieval practice to long-term maintenance of access to academic knowledge areas are discussed.
Introduction Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are very common in patients taking selective serotonin reuptake inhibitors (SSRIs). It has been assumed that these side effects always resolve after discontinuing treatment, but recently, four cases were presented in which sexual function did not return to baseline. Here, we describe three more cases. Case #1: A 29-year-old with apparently permanent erectile dysfunction after taking fluoxetine 20 mg once daily for a 4-month period in 1996. Case #2: A 44-year-old male with persistent loss of libido, genital anesthesia, ejaculatory anhedonia, and erectile dysfunction after taking 20-mg once daily citalopram for 18 months. Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since taking several different SSRIs over a 2-year period from 2003–2005. Results No psychological issues related to sexuality were found in any of the three cases, and all common causes of sexual dysfunction such as decreased testosterone, increased prolactin or diabetes were ruled out. Erectile capacity is temporarily restored for Case #1 with injectable alprostadil, and for Case #2 with oral sildenafil, but their other symptoms remain. Case #3 has had some reversal of symptoms with extended-release methylphenidate, although it is not yet known if these prosexual effects will persist when the drug is discontinued. Conclusion SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations were briefly discussed.
The effects of a role‐induction procedure on beginning counselor‐trainees' perceptions of supervision were examined using a 10‐minute audiotaped summary of Bernard's (1979) model of supervision. Nineteen trainees were administered the role‐induction procedure at either the 2nd, 5th, or 9th week of the academic term. Two self‐report scales assessed trainees' conceptualization of supervision as well as expectations and attitudes toward the supervisory process. Results indicated that trainees evaluated supervision more negatively over the time period before the role induction. Following role induction, trainees reported a clearer conceptualization of supervision and a greater willingness to reveal concerns to their supervisors.
Post-market prevalence studies have found that Selective Serotonin Reuptake Inhibitor (SSRI) and SerotoninNorepinephrine Reuptake Inhibitor (SNRI) sexual side effects occur at dramatically higher rates than initially reported in pre-market trials. Prescribing and practice conventions rest on the untested assumption that individuals who develop sexual dysfunction secondary to SSRI and SNRI antidepressant medications return fully to their pre-medication sexual functioning baseline shortly after discontinuing treatment. Most individuals probably do return to their previous level of sexual functioning, however recent case reports, consumer-provided Internet-based information, incidental research findings, and empirical evidence of persistent post SSRI sexual benefits in the premature ejaculation literature suggest that for some individuals, SSRI and SNRI-emergent sexual side effects persist indefinitely after discontinuing the medications. The literature poorly captures the full spectrum of SSRI/SNRI sexual side effects, and a lack of systematic follow-up in the sexual side effects research precludes detection of post SSRI/SNRI sexual dysfunction, leaving the formal knowledge base inadequate and even inaccurate, raising informed consent issues, and leaving clinicians vulnerable to practicing in ways that may be hurtful to patients in spite of their best efforts to inform themselves.
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