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Notes: In “The Misperception of Psychopathology: Problems with the Norms of the Comprehensive System for the Rorschach,” we reviewed results from 32 studies and concluded that the norms of the Comprehensive System (CS) are inaccurate and tend to make nonpatient Americans appear psychologically disordered. Hunsley and Di Giulio, Widiger, and Aronow all agree that our review uncovered serious problems with the CS norms. However, CS proponents Exner and Meyer disagree. In this reply we address criticisms and express the hope that CS proponents will eventually acknowledge the importance of the research findings and develop more accurate norms.

Notes: We share Meehl's view that taxometric procedures hold considerable promise for elucidating questions regarding psychiatric comorbidity. Drawing on examples from the domain of childhood disruptive disorders, we discuss why the issues raised by Meehl are scientifically and pragmatically important and outline several profitable applications of taxometric methods to questions of comorbidity (e.g., estimating the statistical relations between latent taxa). We explain why taxometric methods and other sophisticated latent variable methods are needed to answer such questions and provide examples of how certain statistical methods have been used to make erroneous inferences regarding taxonicity. Several important unresolved issues bearing on the use of taxometric procedures and their application to questions of comorbidity are delineated, including (a) the distributional assumptions of taxometric methods, (b) the construct validation of provisional taxa identified by taxometric analyses, (c) the relation of taxometric methods to other latent variable techniques (e.g., latent class analysis), (d) the potential existence of spurious taxa, (e) the question of “fuzzy taxonicity,” and (f) “configural taxa.” We conclude with a discussion of analytic methods for characterizing and understanding the covariation between latent dimensions as opposed to taxa.

Notes: The norms of the Comprehensive System (CS) for the Rorschach have been praised for their scientific and clinical value. However, recent findings by Shaffer, Erdberg, and Haroian suggest that the CS norms are inaccurate. We examined 14 CS variables in 32 studies of non-patient adults. The participants in these studies exhibited statistically and clinically significant differences from CS nonpatient norms for all 14 variables. Overall, nonpatient adults tended to appear pathological when compared with the CS norms. The implications of these findings for misdiagnosis and the misperception of psychopathology are discussed. Use of the CS norms in clinical or forensic settings is inadvisable. Commonly held beliefs about the validity of CS variables are likely to be false and in need of revision.

Notes: Galantamine hydrobromide is a tertiary alkaloid drug that has been developed and approved in a number of countries including the USA and several countries in Europe as a treatment for mild-to-moderate Alzheimer's disease (AD). Galantamine has a unique, dual mode of action. It is a reversible, competitive inhibitor of acetylcholinesterase (AChE), and is the only drug actively marketed for the treatment of AD with proven activity as an allosteric modulator of nicotinic acetylcholine receptors (nAChRs). This latter activity is thought to be particularly important since decreases in the expression and activity of nAChRs make a large contribution to the reduction in central cholinergic neurotransmission in patients with AD. Galantamine exhibits favorable pharmacokinetic characteristics including predictable linear elimination kinetics at the recommended maintenance doses (16 and 24 mg/day), a relatively short half-life (approximately 7 h) and high bioavailability. It is extensively metabolized in numerous pathways, mainly in the liver via cytochrome P450 enzymes CYP2D6 and CYP3A4, and has a low potential for clinically significant drug-drug interactions. During four large randomized, double-blind, placebo-controlled trials of up to 6 months duration, galantamine 16 and 24 mg/day significantly benefited cognitive and global function, ability to perform activities of daily living (ADL) and behavior, relative to placebo and baseline, for up to 6 months. Caregiver burden (time spent by caregivers supervising patients or assisting them with ADL), and caregiver distress (related to patients' behavioral symptoms) were also reduced. Cognitive and functional abilities were preserved at or near baseline for at least 12 months in patients who received galantamine 24 mg/day for 12 months in a long-term US study. These benefits were maximized by early and continued galantamine treatment and, again, were associated with significant reductions in caregiver burden. Trials of the efficacy of galantamine in dementia related to cerebrovascular disease have also yielded positive results. There are no safety concerns associated with the use of galantamine. The incidence of adverse events, particularly cholinergically mediated events affecting the gastrointestinal system, is generally low and can be minimized using the recommended slow dose-escalation scheme. Galantamine may, therefore, help to reduce the overall burden and cost involved in caring for dementia patients. Taking all evidence into account, galantamine has the potential to become a first-line therapy for dementia.