Neuropsychological effects and attitudes in patients following electroconvulsive therapy Miriam Feliu1,2, Christopher L Edwards1,2,3, Shiv Sudhakar4, Camela McDougald1, Renee Raynor5, Stephanie Johnson6, Goldie Byrd7, Keith Whitfield8, Charles Jonassaint8, Heather Romero1, Lekisha Edwards1, Chante’ Wellington1, LaBarron K Hill9, James Sollers, III9, Patrick E Logue11Department of Psychiatry and Behavioral Sciences; 2Duke Pain and Palliative Care Center; 3Department of Medicine, Division of Hematology; 4Drexel University Medical School; 5Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; 6Science Directorate, American Psychological Association; 7Department of Biology, North Carolina A&T State University; 8Department of Psychology, Duke University; 9Department of Psychology, The Ohio State University The current study examined the effects of electroconvulsive therapy (ECT) on neuropsychological test performance. Forty-six patients completed brief neuropsychological and psychological testing before and after receiving ECT for the treatment of recalcitrant and severe depression. Neuropsychological testing consisted of the Levin Selective Reminding Test (Levin) and Wechsler Memory Scale-Revised Edition (WMS-R). Self-report measures included the Beck Depression Inventory (BDI), the Short-Term Memory Questionnaire (STMQ), and several other measures of emotional functioning and patient attitudes toward ECT. The mean number of days between pre-ECT and post-ECT testing was 24. T-test revealed a significant decrease in subjective ratings of depression as rated by the BDI, t(45) = 9.82, P < 0.0001 (Pre-BDI = 27.9 ± 20.2; post-BDI = 13.5 ± 9.7). Objective ratings of memory appeared impaired following treatment, and patients’ self-report measures of memory confirmed this decline. More specifically, repeated measures MANOVA [Wilks Lambda F(11,30) = 4.3, p < 0.001] indicated significant decreases for measures of immediate recognition memory (p < 0.005), long-term storage (p < 0.05), delayed prose passage recall (p < 0.0001), percent retained of prose passages (p < 0.0001), and percent retained of visual designs (p < 0.0001). In addition, the number of double mentions on the Levin increased (p < 0.02). This study suggests that there may be a greater need to discuss the intermittent cognitive risks associated with ECT when obtaining informed consent prior to treatment. Further that self-reports of cognitive difficulties may persist even when depression has remitted. However, patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable.Keywords: electroconvulsive therapy, neuropsychology, attitudes, memory

Healthcare disparities in pain management represent one of the most persistent and pernicious manifestations of systemic bias within medicine. This comprehensive review examines the complex intersection of implicit bias, racial stigmatization, and clinical decision-making in the context of sickle cell disease, a predominantly African descent genetic disorder characterized by severe recurrent acute pain episodes and chronic pain that worsens with age. Through analysis of empirical research spanning psychosocial functioning, pain perception, healthcare utilization patterns, and provider attitudes, we demonstrate how societal-level prejudices become institutionalized within medical practice, resulting in systematic undertreatment of legitimate pain and inappropriate labeling of patients as drug-seeking. The current opioid crisis has paradoxically exacerbated these disparities, as heightened scrutiny of narcotic prescribing disproportionately affects minority patients who already face substantial barriers to adequate pain management. We argue that understanding the biopsychosocial complexity of sickle cell disease within its historical and social context is essential for dismantling discriminatory practices and achieving equitable healthcare delivery. This paper presents a framework for recognizing and addressing implicit bias in clinical settings while maintaining appropriate safeguards against prescription drug diversion. The implications extend beyond sickle cell disease to encompass broader questions about how societal inequities become embedded in medical practice and perpetuated through ostensibly objective clinical assessments.

Objective: To delineate the etiology, symptomatology, and treatment of Polycythemia Vera in adults with Sickle Cell Disease. The current review contains a review of the 4 case reports that we found on the topic. To our knowledge, no other case reports exist. Methods: We reviewed the scientific literature to discover case reports that included the topic of PV. We noted consistencies in presentation, evaluation, treatment, and clinical outcomes. Results: We reviewed 4 case reports and a limited number of clinical papers on PV in SCD. We found and reported on consistencies in clinical presentation and the diversity of treatments. We reported hematological, bone marrow, and radiographic findings. Conclusions: There is great variability in the evaluation and treatment of cases of PV in SCD. We advocate for more research and deconstructing the complicated relationship between these two comorbid disorders.

Objective: To delineate the explore potential etiological contributions to subcutaneous panniculitis-like T-cell lymphoma (SPTCL) in adults with sickle cell disease. Sickle cell disease (SCD) is an inherited hematologic disorder where standard treatment may enhance risk of the development of rare comorbidities like SPTCL. Methods: We reviewed the scientific literature and only found one case report detailing the development of SPTCL in an adult with SCD. Results: We reviewed 1 case reports and the general literature on hematolymphoid disorders. We discovered that there are several potential mechanisms to explain SPTCL in SCD but no conclusive evidence to support either. We reported radiographic, serological, immune, and hematological finding from the previous case. Conclusions: SPTCL is a complex disorder with a likely multifactoral etiology. The development of the disease in adults with SCD is rare but possible as evidenced by a published case report. We advocate for additional attention to the intersection of these two diseases for the purpose of better understanding their etiology and epidemiology. More research is needed.

The Voting Rights Act of 1965 was established to enforce voting rights guaranteed by the Fourteenth and Fifteenth amendments. Unfortunately, Blacks faced additional barriers when attempting to exercise their right to vote. Moreover, focusing on voting specifically among adults living with Sickle Cell Disease (SCD), we assessed voter participation as a form of advocacy to evaluate if political involvement was related to psychological status. We found that 72% of adults with SCD in our sample routinely voted in government elections. We examined psychological symptoms using the Symptom Checklist -90 (SCL-90-R). Voters consistently presented with better psychological status than nonvoters. Voters reported significantly lower levels of interpersonal sensitivity, anxiety, specific phobia, and psychosis than nonvoters (p<.05). We interpret our findings as a non-characterological and non-volitional explanation for political participation among adults with SCD.