Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations

OBJECTIVES

Psychotic-like anomalous experiences are not inherently distressing, nor do they inevitably lead to clinical conditions. However, distress is an important predictor of onset and relapse in psychosis, and a primary indicator of problematic mental health. This study aimed to identify factors that predict distress across three groups with anomalous experiences.

DESIGN AND METHODS

This study used a cross-sectional design. Participants in 'Diagnosed' (n = 35), 'At Risk' (n = 20), and 'Undiagnosed' (n = 36) groups completed the Appraisals of Anomalous Experiences Interview (AANEX; Brett et al., 2007, Br. J. Psychiatry, 191, s23), which taps anomalies experienced, appraisals, and other psychological and contextual variables. A series of ordinal logistic regression analyses was conducted to investigate which variables predicted anomaly-related distress.

RESULTS

Predictors of higher distress were anomalous states characterized by changes in awareness and cognitive functioning (rather than more typical positive symptoms), appraisals of experiences as caused by 'other people', and greater attempted control over experiences. Predictors of lower distress were 'spiritual' appraisals, greater perceived social support/understanding, greater perceived controllability, and reacting with a 'neutral response'.

CONCLUSIONS

While psychotic-like experiences themselves are not necessarily distressing, appraisals and responses to anomalies do predict distress, as do factors relating to the social context. This adds support to the cognitive-behavioural models, and continuum models, of positive psychotic symptoms.

Alkaline phosphatase protects against renal inflammation through dephosphorylation of lipopolysaccharide and adenosine triphosphate

BACKGROUND AND PURPOSE

Recently, two phase-II trials demonstrated improved renal function in critically ill patients with sepsis-associated acute kidney injury treated with the enzyme alkaline phosphatase. Here, we elucidated the dual active effect on renal protection of alkaline phosphatase.

EXPERIMENTAL APPROACH

The effect of human recombinant alkaline phosphatase (recAP) on LPS-induced renal injury was studied in Sprague-Dawley rats. Renal function was assessed by transcutaneous measurement of FITC-sinistrin elimination in freely moving, awake rats. The mechanism of action of recAP was further investigated in vitro using conditionally immortalized human proximal tubular epithelial cells (ciPTEC).

KEY RESULTS

In vivo, LPS administration significantly prolonged FITC-sinistrin half-life and increased fractional urea excretion, which was prevented by recAP co-administration. Moreover, recAP prevented LPS-induced increase in proximal tubule injury marker, kidney injury molecule-1 expression and excretion. In vitro, LPS-induced production of TNF-α, IL-6 and IL-8 was significantly attenuated by recAP. This effect was linked to dephosphorylation, as enzymatically inactive recAP had no effect on LPS-induced cytokine production. RecAP-mediated protection resulted in increased adenosine levels through dephosphorylation of LPS-induced extracellular ADP and ATP. Also, recAP attenuated LPS-induced increased expression of adenosine A2A receptor. However, the A2A receptor antagonist ZM-241385 did not diminish the effects of recAP.

CONCLUSIONS AND IMPLICATIONS

These results indicate that the ability of recAP to reduce renal inflammation may account for the beneficial effect observed in septic acute kidney injury patients, and that dephosphorylation of ATP and LPS are responsible for this protective effect.

Misattribution bias of threat-related facial expressions is related to a longer duration of illness and poor executive function in schizophrenia and schizoaffective disorder

BACKGROUND

While it is known that patients with schizophrenia recognize facial emotions, specifically negative emotions, less accurately, little is known about how they misattribute these emotions to other emotions and whether such misattribution biases are associated with symptoms, course of the disorder, or certain cognitive functions.

METHOD

Outpatients with schizophrenia or schizoaffective disorder (n=73) and healthy controls (n=30) performed a computerised Facial Emotion Attribution Test and Wisconsin Card Sorting Test (WCST). Patients were also rated on the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Patients were poor at recognizing fearful and angry emotions and attributed fear to angry and angry to neutral expressions. Fear-as-anger misattributions were predicted independently by a longer duration of illness and WCST perseverative errors.

CONCLUSION

The findings show a bias towards misattributing fearful and angry facial emotions. The propensity for fear-as-anger misattribution biases increases as the length of time that the disorder is experienced increases and a more rigid style of information processing is used. This, at least in part, may be perpetuated by subtle fearfulness expressed by others while interacting with people with schizophrenia.

α7 nicotinic acetylcholine receptor agonist GTS-21 attenuates ventilator-induced tumour necrosis factor-α production and lung injury

BACKGROUND

Mechanical ventilation (MV) induces an inflammatory response that can lead to lung injury. The vagus nerve can limit the inflammatory response through the cholinergic anti-inflammatory pathway. We evaluated the effects of stimulation of the cholinergic anti-inflammatory pathway with the selective partial α7 nicotinic acetylcholine receptor (α7nAChR) agonist GTS-21 on inflammation and lung injury induced by MV using clinically relevant ventilator settings. Furthermore, we investigated whether altering endogenous cholinergic signalling, by administration of the non-specific nAChR antagonist mecamylamine and the peripherally acting acetylcholinesterase inhibitor neostigmine, modulates the MV-induced inflammatory response.

METHODS

C57BL6 mice were injected i.p. with either the selective α7nAChR agonist GTS-21 (8 mg kg(-1)), the acetylcholinesterase inhibitor neostigmine (80 μg kg(-1)), the nAChR antagonist mecamylamine (1 mg kg(-1)), or a placebo; followed by 4 h of MV (8 ml kg(-1), 1.5 cm H(2)O PEEP).

RESULTS

MV resulted in release of cytokines in plasma and lungs compared with unventilated mice. Lung and plasma levels of tumour necrosis factor (TNF)-α, but not of interleukin-10, were lower in GTS-21-treated animals compared with placebo (P<0.05). In addition, GTS-21 lowered the alveolar-arterial gradient, indicating improved lung function (P=0.04). Neither neostigmine nor mecamylamine had an effect on MV-induced inflammation or lung function.

CONCLUSIONS

MV with clinically relevant ventilator settings results in pulmonary and systemic inflammation. Stimulation of the cholinergic anti-inflammatory pathway with GTS-21 attenuates MV-induced release of TNF-α, which was associated with reduced lung injury. Modulation of endogenous cholinergic signalling did not affect the MV-induced inflammatory response. Selective stimulation of the cholinergic anti-inflammatory pathway may represent new treatment options for MV-induced lung injury.

A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations

Studies on cognitive behavioural therapy for psychosis (CBTp) have developed from evaluating generic approaches to focusing on specific symptoms. The evidence for targeted studies on delusions and hallucinations was reviewed. We included randomized controlled trials (RCTs) examining the effect of individualized CBT-based interventions focusing either on delusions or on hallucinations. Twelve suitable RCTs were identified. Four RCTs focused on delusions, of which three took a focused approach targeting mechanisms assumed causal to persecutory delusions. Eight RCTs focused on hallucinations, a common component of these studies being a focus on the perceived power imbalance between the voice(s) and the voice-hearer, to reduce distress and dysfunction. Only three RCTS were powered adequately; the remainder were pilot trials. All trials reported effect sizes against treatment-as-usual above d=0.4 on at least one primary outcome at post-therapy, with several effects in the large range. Effects on the primary outcome were maintained for five of the seven studies that had significant outcomes and reported a follow-up comparison, but most of the follow-up periods were brief. Although targeted studies are still in their infancy, the results are promising with a tendency towards higher effects compared to the small-to-moderate range found for generic CBTp. In clinical practice, CBTp will need to continue including a range of approaches that can be adapted to patients in a flexible manner according to the primary goals and prevalent combination of symptoms. However, symptom-focused and causal-interventionist approaches are informative research strategies to evaluate the efficacy of separate components or mechanisms of generic CBTp.

Opportunities and challenges in Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI): evaluating the first operational year of the South London and Maudsley (SLaM) demonstration site for psychosis

Despite its demonstrated clinical and economic effectiveness, access to Cognitive Behavioural Therapy for psychosis (CBTp) in routine practice remains low. The UK National Health Service (NHS England) Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aims to address this problem. We report 14-month outcomes for our psychosis demonstration site. Primary and secondary care and self-referrals were screened to check the suitability of the service for the person. Psychotic symptoms, distress, service use, functioning and satisfaction were measured before and after therapy, by trained assessors. User-defined wellbeing and goal-attainment were rated sessionally. Access to CBTp increased almost threefold (2011/12 accepted referrals/year n = 106; 2012/13, n = 300). The IAPT-SMI assessment protocol proved feasible and acceptable to service users, with paired primary outcomes for 97% of closed cases. Therapy completion (≥5 sessions) was high (83%) irrespective of ethnicity, age and gender. Preliminary pre-post outcomes showed clinical improvement and reduced service use, with medium/high effect sizes. User-rated satisfaction was high. We conclude that individual psychological interventions for people with psychosis can be successfully delivered in routine services using an IAPT approach. High completion rates for paired outcomes demonstrate good user experience, clinical improvement, and potential future cost savings.

Making health care quality reports easier to use

BACKGROUND

Although there is evidence that consumers want comparative quality information, most studies indicate that consumers make limited use of the data in decision making. The reasons for the limited use appear to be the complexity of the information and the difficulty of processing and using the amount of information in reports. The purpose of this investigation was to determine whether there are approaches to reporting comparative information that make it easier for consumers to comprehend the information. Further, the degree to which consumers who have a low level of skill can accurately use that information when it is presented in a format that is easier to use was examined.

METHODS

The study used an experimental design to examine how different presentation approaches affect the use of information. Participants were randomly assigned to different conditions and were asked to review information and complete a decision task related to using comparative information and making health plan selections. Two separate convenience samples were used in the study: an elderly Medicare sample (N = 253), and a nonelderly sample (N = 239).

RESULTS

The findings indicate that there are data presentation approaches that help consumers who have lower skills use information more accurately. Some of these presentation strategies (for example, relative stars) improve comprehension among the lower skilled, and other strategies (for example, evaluative labels) appear to aid those in the midrange of comprehension skill.

CONCLUSIONS

Using these approaches in reporting would likely increase the use of the comparative information and increase the efficacy of reporting efforts.

The challenges of involving traditional healers in HIV/AIDS care

In sub-Saharan Africa, traditional healers play a major role in providing for the needs of people, particularly in rural areas where western health care is unavailable. Despite a paucity of reliable figures to determine the prevalence of traditional medicine usage, it is estimated that some 70% of sub-Saharan Africans access traditional healers. There is now mounting evidence of the importance of involving traditional healers in the management of the HIV/AIDS epidemic--both for their potential benefits, although poorly researched and understood, and to reduce the impact that some traditional healing interventions may play on the spread of HIV/AIDS and unsafe treatment of infected patients. While there are few collaborative projects between traditional healers and biomedical health providers, there is an enthusiasm on the part of traditional healers to collaborate and learn from their western-trained counterparts. Collaboration is essential, given the changing epidemic of HIV and the dynamic relationship between the two health sectors.

Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries

Psychotic experiences (PEs) are common in the general population but do not necessarily reflect a risk status if they occur in relative isolation or are not distressing. Emerging evidence suggests that PEs might be experienced as more benign for individuals from collectivistic low- and middle-income countries (LAMIC) compared with individualistic high-income countries (HIC). The aim of this study was to determine whether: (1) self-reported PEs are less distressing in community samples from LAMIC than from HIC; (2) the network of PEs is significantly less connected in a sample from LAMIC than from HIC. Adults from 8 HIC (n = 4669) and 5 LAMIC (n = 2472) were compared. The lifetime frequency of PEs and related distress were assessed with the Community Assessment of Psychic Experiences. We analyzed the associations of PEs with distress and country type. The interconnection of PEs was visualized by a network analysis and tested for differences in global connection strengths. The average endorsement rates of PEs were significantly higher in LAMIC than in HIC (χ2 = 1772.87, P < .01, Φcramer = 0.50). There was a universal positive correlation between higher frequency of PEs and more distress, but the distress levels controlled for frequency were significantly higher in HIC (R2 = 0.11; b = 0.26; SE = 0.01; T = 17.68; P < .001). Moreover, the network of PEs was significantly less connected in LAMIC (S = 0.40, P < .05). The findings indicate that PEs are of less clinical relevance in LAMIC compared with HIC. The universal use of current high-risk criteria might thus not be adequate without consideration of associated distress and cultural values.

High incidence of HCV in HIV-negative men who have sex with men using pre-exposure prophylaxis

BACKGROUND & AIMS

HCV has emerged as a sexually transmitted infection (STI) among HIV-positive men who have sex with men (MSM). We evaluated HCV incidence and its risk factors among HIV-negative MSM using HIV pre-exposure prophylaxis (PrEP).

METHODS

Participants of the Amsterdam PrEP project were tested for HCV antibodies or HCV-RNA every 6 months. Participants used daily or event-driven PrEP and could switch regimens during follow-up. We calculated incidence rates (IRs) for overall HCV infection and separately for primary and re-infection. A univariable Bayesian exponential survival model was used to identify risk factors associated with incident HCV infection. The HCV NS5B gene fragment (709 bp) was sequenced and compared to HCV isolates from HIV-positive MSM and other risk groups (n = 419) using phylogenetic analysis.

RESULTS

Among 350 participants contributing 653.6 person-years (PYs), we detected 15 HCV infections in 14 participants (IR = 2.30/100PY). There were 8 primary infections (IR = 1.27/100PY) and 7 re-infections (IR = 27.8/100PY). IR was 2.71/100PY in daily and 1.15/100PY in event-driven PrEP users. Factors associated with incident HCV infection were higher number of receptive condomless anal sex acts with casual partners (posterior hazard ratio [HR] 1.57 per ln increase; 95% credibility interval [CrI] 1.09-2.20), anal STI (posterior HR 2.93; 95% CrI 1.24-7.13), injecting drug use (posterior HR 4.69; 95% CrI 1.61-12.09) and sharing straws when snorting drugs (posterior HR 2.62; 95% CrI 1.09-6.02). We identified robust MSM-specific HCV clusters of subtypes 1a, 4d, 2b and 3a, which included MSM with and without HIV.

CONCLUSIONS

HIV-negative MSM using PrEP are at risk of incident HCV infection, while identified risk factors are similar to those in HIV-positive MSM. Regular HCV testing is needed, especially for those with a previous HCV infection and those reporting risk factors.

LAY SUMMARY

We report that hepatitis C virus infections are frequently acquired among HIV-negative men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV infection. New infections occurred more frequently in those reporting receptive anal sex without using condoms, having an anal sexually transmitted infection, injecting drugs, and sharing straws when snorting drugs. The viruses found in HIV-negative men using pre-exposure prophylaxis are genetically similar to those in HIV-positive men, but not in other hepatitis C risk groups, suggesting that (sexual) transmission is occurring between HIV-positive MSM and HIV-negative MSM using pre-exposure prophylaxis.

CLINICAL TRIAL NUMBER

Dutch trial registration number NTR5411.

Salmonella enteritidis phage type 4 infection of broiler chickens: a hazard to public health

The pericardial fluids and contents of caeca and spleens from 81 broiler chickens that had been condemmed at processing factories because of macroscopic pericarditis were examined for Salmonella species. 47 (58%) of these chickens yielded S enteritidis phage type (PT) 4. Viable counts of the organism in fluids from 6 of the most severely affected hearts ranged from 10(4) to 10(7) colony-forming units/ml. S enteridis PT4 was also isolated from 8 of 20 fresh chilled chickens on retail sale. No other serotype of Salmonella or phage type of S enteritidis was cultured either from the chickens with pericarditis or from the fresh chilled chicken.

Influence of biofilms on microbial contamination in dental unit water

Water from dental units (DU), used for cooling and clearing the field of dental operations, is frequently contaminated by microorganisms. Retrograde spread of oral microbes into DU tubuing, contaminated plumbing systems and endogenous DU contamination have been implicated. This study investigated the contribution of DU tubing to this contamination in 11 randomly selected DU. The times required, under standardized conditions, for DU bacterial levels to decrease in response to the flushing caused by DU operation, or increase in response to stagnation caused by shutting down the DU, were measured. The DU tubing was then removed and similarly manipulated. The results showed similar bacterial levels and populations in the DU and their corresponding tubes. Sixteen control samples taken from the connecting plumbing system at distant locations, after periods of stagnation which result in DU bacterial contamination, were negative. This suggests the plumbing, in our system, is not an important factor. Thus, DU can endogenously contaminate the water passing through them; their tubes have the potential to generate similar magnitudes of bacterial contamination to that determined from intact DU. Scanning electron microscopy of the tube lumens showed a biofilm, characterized by microorganisms embedded in an amorphous matrix in all cases. This biofilm could act as a reservoir to facilitate rapid recontamination. Further analysis of the data indicates there could be other contributing factors.

Albumin dialysis: single pass vs. recirculation (MARS)

The single pass albumin dialysis (SPAD) was reported to be an alternative to the Molecular Adsorbent Recirculating System (MARS) for the effective removal of protein bound substances in liver failure. Three SPAD experiments using different albumin concentrations and dialysate flow rates were performed. In each experiment, 1000 ml human donor plasma, spiked with 250 mg unconjugated bilirubin, 200 mg sulfobromophthalein (BSP) and 115 mg glycocholic acid (N-[3alpha,7alpha,12alpha-trihydroxy-24-oxycholan-24-yl]glycine) - a conjugated bile acid (BA), circulated in a closed loop with 150 ml/min and was dialysed against albumin solution. These substances are bound to the different binding sites of albumin and have different association constants. For the comparison, the standard MARS experiment was performed using the same plasma flow rate of 150 ml/min. Moreover, the clearances of bilirubin for MARS and SPAD during clinical treatments were calculated using own data and those reported by Seige, Kreymann, Jeschke, et al. in Transplant Proc 1999; 31: 1371-5. The concentrations of bilirubin, BSP and BA were measured in plasma and dialysate and for these substances clearances (Cl) were calculated. It is known that the elimination rate of bilirubin is not very high during albumin dialysis in comparison to other substances, like bile acids, due to the high association constant. An increase of albumin concentration or the flow rate improved the efficacy but also raised the costs substantially. In this study, we have shown that MARS is the more effective kind of albumin dialysis for the important substances like bile acids. By SPAD an improvement of efficacy can be reached only by dramatic increase of the costs. Also, the earlier experiments showed that MARS is safer because of the removal of the stabilizers, which are normally included in the commercial albumin solutions.

Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck: long-term results

PURPOSE

A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA).

PATIENTS AND METHODS

One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed.

RESULTS

Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%.

CONCLUSION

PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.

Rhabdomyosarcoma of the oral and paraoral region

Oral rhabdomyosarcoma (RMS) was studied by analysis of eight such cases which presented over a 25-year period. Rhabdomyosarcoma was the fourth most common oral sarcoma (7.5%) from this period after osteosarcoma (32%), fibrosarcoma (19%), and chondrosarcoma (9%). In patients younger than 20 years, RMS was the second most common sarcoma (six cases) after osteosarcoma (ten cases). Combined analysis with 113 further cases documented in the literature showed the majority of cases (71.2%) were embryonal. The alveolar subtype was considered a distant second in frequency (12.3%) even though the pleomorphic subtype was apparently more common (16.4%). However, the pleomorphic cases were diagnosed before histologic criteria were established to discern this entity from other pleomorphic sarcomas and this data is probably unreliable. Site predilections were found for the soft palate, maxillary sinus and alveolus, posterior mandibular region, cheek and lip and possibly tongue. The gingiva and floor of mouth were uncommon sites. There was a predilection for occurrence in the first two decades with a decline in the third decade. Documentation of recent cases treated with a multidisciplinary approach indicated that lesions in the oral soft tissues have a good prognosis; 17 of 21 such cases showed no evidence of disease after a mean follow-up period of 7.2 years (SD = 4.4). In contrast, four of five cases in the posterior mandible resulted in death after a mean period of 1.1 years (SD = 0.3).

Involvement of VEGFR-2 (kdr/flk-1) but not VEGFR-1 (flt-1) in VEGF-A and VEGF-C-induced tube formation by human microvascular endothelial cells in fibrin matrices in vitro

Different forms of vascular endothelial growth factor (VEGF) and their cellular receptors (VEGFR) are associated with angiogenesis, as demonstrated by the lethality of VEGF-A, VEGFR-1 or VEGFR-2 knockout mice. Here we have used an in vitro angiogenesis model, consisting of human microvascular endothelial cells (hMVEC) cultured on three-dimensional (3D) fibrin matrices to investigate the roles of VEGFR-1 and VEGFR-2 in the process of VEGF-A and VEGF-C-induced tube formation. Soluble VEGFR-1 completely inhibited the tube formation induced by the combination of VEGF-A and TNF alpha (VEGF-A/TNF alpha). This inhibition was not observed when tube formation was induced by VEGF-C/TNF alpha or bFGF/TNF alpha. Blocking monoclonal antibodies specific for VEGFR-2, but not antibodies specifically blocking VEGFR-1, were able to inhibit the VEGF-A/TNF alpha-induced as well as the VEGF-C/TNF alpha-induced tube formation in vitro. P1GF-2, which interacts only with VEGFR-1, neither induced tube formation in combination with TNF alpha, nor inhibited or stimulated by itself the VEGF-A/TNF alpha-induced tube formation in vitro. These data indicate that VEGF-A or VEGF-C activation of the VEGFR-2, and not of VEGFR-1, is involved in the formation of capillary-like tubular structures of hMVEC in 3D fibrin matrices used as a model of repair-associated or pathological angiogenesis in vitro.

Neuroimaging correlates of negative priming

Many theoretical accounts of selective attention and memory retrieval include reference to active inhibitory processes, such as those argued to underlie the negative priming effect. fMRI was used in order to investigate the areas of cortical activation associated with Stroop interference, Stroop facilitation and Stroop negative priming tasks. The most significant activation within the negative priming task was within the inferior parietal lobule, left temporal lobe and frontal lobes. Areas of cortical activation are discussed with reference to theoretical accounts of the negative priming effect.

A qualitative comparison of psychotic-like phenomena in clinical and non-clinical populations

OBJECTIVES

To explore the nature and context of psychotic-like phenomena in clinical (C) and non-clinical (NC) participants, and to investigate whether the factors involved with triggering a psychotic-like 'out-of-the-ordinary' experience (OOE) can be distinguished from those determining its clinical consequences.

DESIGN AND METHODS

Qualitative data were collected by semi-structured interviews, and analysed using interpretative phenomenological analysis (IPA). Twelve participants, who reported OOEs starting in the last 5 years, were split into C and NC groups depending on whether they were involved with mental-health services as a result of their experiences. Inter-group comparisons of emergent themes were made.

RESULTS

Inter-group similarities were found in the triggers and subjective nature of experiences, with clearer group differences in the inter-personal and background personal contexts, and how the experiences were incorporated into their lives. In particular, the inter-personal theme of validation was identified as important in distinguishing the clinical consequences of OOEs.

CONCLUSIONS

It is not the OOE itself that determines the development of a clinical condition, but rather the wider personal and interpersonal contexts that influence how this experience is subsequently integrated. Theoretical implications for the refinement of psychosis models are outlined, and clinical implications for the validation and normalization of psychotic-like phenomena are proposed.

Self-discrepancies, attentional bias and persecutory delusions

BACKGROUND

Persecutory delusions appear to involve abnormal attentional biases to threat-related information, particularly information related to the self. The present study aimed to investigate attentional biases to different types of perceived threat and changes in self-perception in response to exposure to such threat-related material.

METHOD

Discrepancies between actual self, ideal self and perceived others' self-representations were assessed in three groups of participants; 13 people experiencing persecutory delusions, 11 people in a psychiatric comparison group, and 13 in a non-psychiatric comparison group. An adaptation of the emotional Stroop task was then used as an experimental manipulation of attentional bias to five different types of threat (sociotropic, autonomic, physical, ego threats from others, and self-directed ego threats). Self-discrepancies were then again assessed.

RESULTS

Before administration of the emotional Stroop task, there were no significant differences between the groups in terms of their self-actual:self-ideal and self-actual:other-actual discrepancies. However, after the administration of the Stroop task, significant differences between the clinical groups were observed, mirroring significant reductions in self-actual:self-ideal discrepancies and significant increases in self-actual:other-actual discrepancies in the paranoid participants.

CONCLUSIONS

This paper is novel in repeating the assessment of self-discrepancies after the processing of threat-related information. These findings are consistent with Bentall, Kinderman, and Kaney's (1994) model of paranoid ideation and findings reported by Kinderman and Bentall (2000).

Longitudinal radiographic assessment of dense bone islands of the jaws

OBJECTIVES

This study assessed dense bone island (DBI) inception and growth in jaws.

STUDY DESIGN

A population of 2991 patients (age range 5 to 35 years) was studied with at least two panoramic radiographs taken 1 to 10 years apart for each patient. Lesions were digitized and measured with computer measuring software. The size of the earliest DBI was compared with subsequent DBI measurements after the latter measurement was normalized with reference to the size of the nearest tooth.

RESULTS

Sixty-nine patients with DBIs were identified. A total of 3.1% of the patients with DBI were found in the 5- to 10-year age range, with the first patient in the DBI group found at 9.4 years. A significantly higher proportion (p = 0.002) of the unaffected patients (26%) was found in the same 5-to 10-year age range. The proportions of patients in the DBI and unaffected groups in older age ranges were similar. Assessment of DBI size changes showed that 43% of the 53 DBIs detected between 9.4 and 19 years enlarged (mean change, 212%), and 17% diminished (mean change, 49%). In comparison, 29.4% of 17 DBIs detected between 20 and 35 years enlarged (mean change, 153%), and 5.9% diminished (mean change, 60%).

CONCLUSION

Our results indicate that DBIs are labile lesions, develop during early adolescence, and retain a potential for enlargement, or to a lesser extent shrinkage, into adulthood.

Lingual mandibular sequestration and ulceration

This study analyzed 11 patients who had small sequestra associated with ulceration of the lingual mucosa in the posterior mandibular molar area at the level of the mylohyoid ridge. The patients were adults (mean age, 45.3 years) with complaints of sensitive, occasionally painful lesions that appeared for periods that ranged from 1 week to several months. No abnormalities were evident on periapical radiographs; however, in three cases in which occlusal radiographs were available, small irregular radiopacities contiguous with the cortex were noted. Spontaneous exfoliation or surgical removal of the sequestrum resulted in resolution of the lesion. The possible etiologic factors associated with this apparent clinical-pathologic entity are discussed.

Rough hypoplastic amelogenesis imperfecta with follicular hyperplasia

This report documents a unique case of rough hypoplastic amelogenesis imperfecta with apparent anterior oligodontia and multiple anomalies of the associated mesenchymally derived tissues. Multiple unerupted teeth showed hypercementosis, distorted roots with aberrant dentin formation, and marked follicular hyperplasia. The hyperplastic follicles had a complex histopathologic appearance that recapitulated some features of the WHO-type odontogenic fibroma. The features of these teeth, the nature of the associated follicular lesions, and their relationship to the unerupted teeth are discussed.