Late-life depressed mood and weight change contribute to the risk of each other

OBJECTIVE

Weight change may be considered an effect of depression. In turn, depression may follow weight change. Deteriorations in health may mediate these associations. The objective was to examine reciprocal associations between depressed mood and weight change, and the potentially mediating role of deteriorations in health (interim hospitalizations and incident mobility imitation) in these associations.

METHODS

Data were from 2406 black and white men and women, aged 70-79 from Pittsburgh, Pennsylvania and Memphis, Tennessee participating in the Health, Aging and Body composition (Health ABC) study. Depressed mood at baseline (T1) and 3-year follow-up (T4) was measured with the CES-D scale. Three weight change groups (T1-T4) were created: loss (>or=5% loss), stable (within +/-5% loss or gain), and weight gain (>or=5% gain).

RESULTS

At T1 and T4, respectively 4.4% and 9.5% of the analysis sample had depressed mood. T1 depressed mood was associated with weight gain over the 3-year period (OR:1.91; 95%CI:1.13-3.22). Weight loss over the 3-year period was associated with T4 depressed mood (OR:1.51; 95%CI:1.05-2.16). Accounting for deteriorations in health in the reciprocal associations between weight change and depressed mood reduced effect sizes between 16-27%.

CONCLUSIONS

In this study, depressed mood predicted weight gain over three years, while weight loss over three years predicted depressed mood. These associations were partly mediated through deteriorations in health. Implications for clinical practice and prevention include increased awareness that depressed mood can cause weight change, but can also be preceded by deteriorations in health and weight change.

Through the lens of therapeutic jurisprudence: the relationship between empowerment in the court system and well-being for intimate partner violence victims

Research has established the connection between intimate partner violence victims' empowering experiences in the court system and their satisfaction with the process, but not between these experiences and victims' broader wellbeing, a link suggested by the framework of therapeutic jurisprudence. This study investigated the relationship between empowerment and victim depression, quality of life, fear, and intention to use the system in the future among 142 court-involved women. At 3 and 6 months after recruitment, over and above repeat abuse, the outcome of the criminal case, and expectations about the court system, more empowering experiences in the court predicted improvement in depression and quality of life, in addition to stronger intention to use the system in the future if needed. Implications include the need for research on what aspects of victim experience in the court are empowering and evaluations of innovations that can increase the likelihood they will occur.

Corporate psychopathy: Talking the walk

There is a very large literature on the important role of psychopathy in the criminal justice system. We know much less about corporate psychopathy and its implications, in large part because of the difficulty in obtaining the active cooperation of business organizations. This has left us with only a few small-sample studies, anecdotes, and speculation. In this study, we had a unique opportunity to examine psychopathy and its correlates in a sample of 203 corporate professionals selected by their companies to participate in management development programs. The correlates included demographic and status variables, as well as in-house 360 degrees assessments and performance ratings. The prevalence of psychopathic traits-as measured by the Psychopathy Checklist-Revised (PCL-R) and a Psychopathy Checklist: Screening Version (PCL: SV) "equivalent"-was higher than that found in community samples. The results of confirmatory factor analysis (CFA) and structural equation modeling (SEM) indicated that the underlying latent structure of psychopathy in our corporate sample was consistent with that model found in community and offender studies. Psychopathy was positively associated with in-house ratings of charisma/presentation style (creativity, good strategic thinking and communication skills) but negatively associated with ratings of responsibility/performance (being a team player, management skills, and overall accomplishments).

Is impulsivity a link between childhood abuse and suicide?

Childhood abuse and neglect are known to affect psychological states through behavioral, emotional, and cognitive pathways. They increase the risk of having psychiatric diseases in adulthood and have been considered risk factors for suicidal behavior in all diagnostic categories. Early, prolonged, and severe trauma is also known to increase impulsivity, diminishing the capacity of the brain to inhibit negative actions and to control and modulate emotions. Many neurobiological studies hold that childhood maltreatment may lead to a persistent failure of the inhibitory processes ruled mainly by the frontal cortex over a fear-motivated hyperresponsive limbic system. Multiple neurotransmitters and hormones are involved in the stress response, but, to our knowledge, the two major biological consequences of the chronic exposure to trauma are the hypofunction of the serotonergic system and changes in the hypothalamic-pituitary-adrenal axis function. Some of these findings overlap with the neurobiological features of impulsivity and of suicidal behavior. Impulsivity has also been said to be both a consequence of trauma and a risk factor for the development of a pathological response to trauma. Thus, we suggest that impulsivity could be one of the links between childhood trauma and suicidal behavior. Prevention of childhood abuse could significantly reduce suicidal behavior in adolescents and adults, in part, through a decrease in the frequency of impulsive behaviors in the future.

Current developments in behavioral interventions for tobacco cessation

PURPOSE OF REVIEW

Tobacco use causes a significant amount of mortality and morbidity globally. The search for optimal cost-effective treatment interventions continues as current treatment modalities at best offer modest success in treatment outcome. This review evaluates current developments in behavioral interventions for tobacco cessation and their effectiveness.

RECENT FINDINGS

Most studies of behavioral interventions reported moderate success in quitting tobacco at 6 months. This finding is seen across different professionals providing interventions in diverse settings using various modalities. Behavioral interventions in adolescents and pregnancy seem presently more effective than pharmacotherapy. Technology-driven interventions have gained recent popularity. Combining interventions shows promising results compared with a single intervention.

SUMMARY

Most tobacco cessation intervention studies are from developed countries and for cigarette smoking. Long-term cessation still poses a challenge. Given the high global morbidity and mortality, there is a need to develop evidence-based, cost-effective intervention in developing countries for both smoking and smokeless tobacco use. Tobacco addiction produces neurobiological and behavioral change and optimal approaches involving behavioral methods and pharmacotherapy need to be developed.

Sex differences in Wisconsin Schizotypy Scales--a meta-analysis

Previous single studies have found inconsistent results on sex differences in positive schizotypy, women scoring mainly higher than men, whereas in negative schizotypy studies have often found that men score higher than women. However, information on the overall effect is unknown. In this study, meta-analytic methods were used to estimate sex differences in Wisconsin Schizotypy Scales developed to measure schizotypal traits and psychosis proneness. We also studied the effect of the sample characteristics on possible differences. Studies on healthy populations were extensively collected; the required minimum sample size was 50. According to the results, men scored higher on the scales of negative schizotypy, ie, in the Physical Anhedonia Scale (n = 23 studies, effect size, Cohen d = 0.59, z test P < .001) and Social Anhedonia Scale (n = 14, d = 0.44, P < .001). Differences were virtually nonexistent in the measurements of the positive schizotypy, ie, the Magical Ideation Scale (n = 29, d = -0.01, P = .74) and Perceptual Aberration Scale (n = 22, d = -0.08, P = .05). The sex difference was larger in studies with nonstudent and older samples on the Perceptual Aberration Scale (d = -0.19 vs d = -0.03, P < .05). This study was the first one to pool studies on sex differences in these scales. The gender differences in social anhedonia both in nonclinical samples and in schizophrenia may relate to a broader aspect of social and interpersonal deficits. The results should be taken into account in studies using these instruments.

Mediating effect of mental disorders in the pathway between life events and mental health services use: results from the Baltimore Epidemiologic Catchment Area study

This study assessed the role of some common mental health conditions as mediators in the pathway between suffering life events and using mental health services. The participants were from the Baltimore Epidemiologic Catchment Area cohort, interviewed in 1993 to 1996 and 2004 to 2005. Longitudinal data analysis was used to identify models with significant mediation. Only alcohol abuse/dependence disorder was a significant mediator in the pathway between suffering a life-threatening illness and using mental health services in a general medical setup. Female gender, being more than 65 years old, prior use of services and availability of health insurance were some of the factors that significantly predicted service use in that model. Some of other factors like social networks and social support, attitudes towards services, and stigma, may play a role in determining service use. Future research should investigate the role of such factors as mediators for mental health service use.

Anticonvulsant use, bipolar disorder, and risk of fracture among older adults in the Veterans Health Administration

OBJECTIVES

To investigate the association between anticonvulsant use and fracture risk among older patients, including those with bipolar disorder (BD), an indicated condition for treatment with this class of medications.

DESIGN

A prospective cohort study with 4.5 years of follow-up analyzed using both Cox proportional hazards modeling and propensity score techniques.

SETTING

National sample selected from Veterans Health Administration records.

PARTICIPANTS

A representative sample of 67,387 Veterans Administration patients aged 50 years and older selected in fiscal year 2002 and followed until 2006, including 29,029 with a diagnosis of BD identified from the Veterans Administration National Psychosis Registry. Pharmacy records identified 19,635 patients who had ever used anticonvulsant medications.

MEASUREMENTS

Incident fracture at any site and incident hip fracture indicated by administrative data.

RESULTS

There were 4,367 fractures over the 4.5-year study period. Approximately two-thirds of patients with BD were prescribed anticonvulsants, and diagnosis of BD was associated with 20% increased risk of fracture independent of anticonvulsant use. Cumulative incidence of fracture was higher among anticonvulsant users relative to never users (35.7 per 1,000 versus 14.2 per 1,000 person-years). In fully adjusted models, anticonvulsant use was associated with over twofold greater risk of fracture (hazard ratio: 2.42, 95% confidence interval: 2.23-2.633). Current use was associated with the greater risk of fracture relative to former use. Duration of anticonvulsant use was significantly associated with increased fracture risk in a graded, nonlinear manner.

CONCLUSIONS

Use of anticonvulsants is associated with increased risk of fracture among older patients with BD and among those without serious mental illness.

Somatosensory system deficits in schizophrenia revealed by MEG during a median-nerve oddball task

Although impairments related to somatosensory perception are common in schizophrenia, they have rarely been examined in functional imaging studies. In the present study, magnetoencephalography (MEG) was used to identify neural networks that support attention to somatosensory stimuli in healthy adults and abnormalities in these networks in patient with schizophrenia. A median-nerve oddball task was used to probe attention to somatosensory stimuli, and an advanced, high-resolution MEG source-imaging method was applied to assess activity throughout the brain. In nineteen healthy subjects, attention-related activation was seen in a sensorimotor network involving primary somatosensory (S1), secondary somatosensory (S2), primary motor (M1), pre-motor (PMA), and paracentral lobule (PCL) areas. A frontal-parietal-temporal "attention network", containing dorsal- and ventral-lateral prefrontal cortex (DLPFC and VLPFC), orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), superior parietal lobule (SPL), inferior parietal lobule (IPL)/supramarginal gyrus (SMG), and temporal lobe areas, was also activated. Seventeen individuals with schizophrenia showed early attention-related hyperactivations in S1 and M1 but hypo-activation in S1, S2, M1, and PMA at later latency in the sensorimotor network. Within this attention network, hypoactivation was found in SPL, DLPFC, orbitofrontal cortex, and the dorsal aspect of ACC. Hyperactivation was seen in SMG/IPL, frontal pole, and the ventral aspect of ACC in patients. These findings link attention-related somatosensory deficits to dysfunction in both sensorimotor and frontal-parietal-temporal networks in schizophrenia.

Executive function in pediatric bipolar disorder and attention-deficit hyperactivity disorder: in search of distinct phenotypic profiles

Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods.

Cranial Nerve VIII: Hearing and Vestibular Functions

Cranial nerve VIII brings sound and information about one's position and movement in space into the brain. The auditory and vestibular systems subserve several functions basic to clinical medicine and to psychiatry. This article covers the basics of cranial nerve VIII, hearing and vestibular systems, including common problems with hearing and balance, problems with hearing and balance that tend to be found in psychiatric patients, and some simple assessments of value in clinical practice.

A prospective study of predictors of depression symptoms in police

Police work is one of the most stressful occupations. Previous research has indicated that work stress and trauma exposure may place individuals at heightened risk for the development of depression symptomatology. This prospective longitudinal study was designed to examine predictors of depression symptoms in police service. Participants comprised 119 healthy police recruits from an ongoing prospective study. They completed baseline measures of depression symptoms, childhood trauma exposure, neuroticism, and self-worth during academy training. Follow-up measures of depression symptoms, PTSD symptoms, critical incident exposure, negative life events, and routine work environment stress were assessed after 12 months of police service. Hierarchical linear regression analysis was conducted to examine predictors of current levels of depression symptoms, controlling for baseline depression symptoms and current PTSD symptoms. Greater childhood trauma exposure, lower self-worth during training, and greater perceived work stress in the first year of police service predicted greater depression symptoms at 12 months. Depression symptoms at 1 year of police service were partly independent from PTSD symptoms at 12 months. Greater childhood trauma exposure and lower self-worth during training may be important variables to screen as risk factors for duty-related depression. Strategies to reduce routine work environment stress have the potential to decrease duty-related depression in law enforcement.

Socioemotional deficits associated with obsessive-compulsive symptomatology

Increasing emphasis has been placed on the role of socioemotional functioning in models of obsessive-compulsive disorder (OCD). The present study investigated whether OCD symptoms were associated with capacity for theory of mind (ToM) and basic affect recognition. Non-clinical volunteers (N=204) completed self report measures of OCD and general psychopathology, in addition to behavioral measures of ToM and affect recognition. The results indicated that higher OCD symptoms were associated with reduced ToM, as well as reduced accuracy decoding the specific emotion of disgust. Importantly, these relationships could not be attributed to other, more general features of psychopathology. The findings of the current study therefore further our understanding of how the processing and interpretation of social and emotional information is affected in the context of OCD symptomatology, and are discussed in relation to neuropsychological models of OCD.

A measure of smoking abstinence-related motivational engagement: development and initial validation

INTRODUCTION

Although a great deal of research has focused on measuring motivation and readiness to quit smoking, little research has assessed gross motivational changes after a smoker has made an attempt to quit smoking. Unlike previous single-item global measures of motivation to remain abstinent, we developed the abstinence-related motivational engagement (ARME) scale to evaluate the degree to which abstinence motivation is reflected by an ex-smoker's daily experience in areas that include cognitive effort, priority, vigilance, and excitement. The aim of this study was to collect reliability and initial construct validity data on this new measure.

METHODS

Participants were 199 ex-smokers recruited from the community and smoking cessation Web sites. Participants completed online measures including a global motivation measure, the ARME scale, demographic questionnaire, and a measure of cessation self-efficacy.

RESULTS

The 16-item ARME questionnaire demonstrated high internal consistency reliability (alpha = .89). Analyses provided support for convergent, discriminant, and construct validity of the scale. ARME demonstrated the predicted correlation with a traditional measure of global cessation motivation, yet, also as predicted, only the ARME was negatively associated with length of abstinence. Moreover, as hypothesized, ex-smokers engaged in the quitting process via ongoing smoking Web site participation showed higher ARME scores than a comparison community sample. A five-item short form demonstrated similar psychometric properties.

DISCUSSION

This study provided initial support for the ARME construct and offers two versions of a reliable instrument for assessing this construct. Future research will examine the ARME as a predictor of cessation outcome and a potential target for relapse prevention.

Desvenlafaxine succinate: a newer antidepressant for the treatment of depression and somatic symptoms

Desvenlafaxine succinate (DVS) is one of several serotonin-norepinephrine reuptake inhibitors (SNRIs). Others are venlafaxine hydrochloride, milnacipran, and duloxetine. Desvenlafaxine has been approved by the US Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD) based on a number of randomized, placebo-controlled clinical trials. Clinical studies have investigated the efficacy of DVS in doses ranging from 50 to 400 mg/day for the treatment of MDD in adult outpatients. The effects of DVS 50 mg/day have been clearly distinguished from placebo in the reduction of MDD symptoms in such clinical trials. No additional therapeutic benefits were found at doses > 50 mg/day. The recommended dose of DVS ranges from 50 to 100 mg. Desvenlafaxine is currently the third SNRI approved by the FDA for this indication. Preliminary evidence also suggests the clinical usefulness of DVS in the treatment of vasomotor symptoms of menopause, anxiety symptoms, and painful physical symptoms. The modified pharmacokinetic and pharmacodynamic profiles of DVS differentiate this drug from the original product, venlafaxine. Significant points of difference, compared with venlafaxine, are once-daily dosing and the achievement of steady-state plasma concentrations within 4 to 5 days. To summarize, current evidence indicates that DVS has proven efficacy, acceptable safety and tolerability profiles, convenient dosing, and minimal impact on the cytochrome P450 enzyme system. A reduced risk for pharmacokinetic drug interactions is a potential advantage over other selective serotonin noradrenaline reuptake inhibitors. Desvenlafaxine succinate has demonstrated its efficacy for treating MDD but its variable efficacy, as shown in individual studies, limited long-term data, and its different risk-to-benefit ratio compared with earlier antidepressants, means that further investigation of this drug is necessary.

Dialectic behavioural therapy has an impact on self-concept clarity and facets of self-esteem in women with borderline personality disorder

Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self-esteem and low self-concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self-esteem and self-concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self-esteem, self-concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self-concept clarity compared with those on the waiting list. Further, the scales of global self-esteem and, more specifically, the facets of self-esteem self-regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self-esteem in this group. On the other hand, the scale of earning self-esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self-esteem and self-concept clarity, and thus on identity disturbance, in women with BPD.

Consequences of an adolescent onset and persistent course of alcohol dependence in men: adolescent risk factors and adult outcomes

BACKGROUND

While there is an extensive literature on the correlates of alcohol use disorders (AUD; alcohol abuse and dependence), there are relatively few prospective studies of representative birth cohorts that have examined the unique effects of an adolescent onset and persistent course of AUD on a wide range of psychosocial variables.

METHODS

A longitudinal, community-based sample of 530 men was used to examine the impact of an adolescent onset (AUD+ at age 17) and persistent course (AUD+ at age 29) of AUD on adolescent and adult functioning including substance use, antisocial behavior, mental health problems, overall psychosocial functioning, environmental risk and protective factors, and social outcomes such as peer and romantic relationships, marriage, educational and occupational attainment, and parenthood.

RESULTS

An adolescent onset of AUD (n = 57) was associated with severe deficits across multiple domains of psychosocial functioning in adolescence. Measures of behavioral disinhibition in adolescence were strong predictors of a persistent course of AUD (n = 93). Nearly 40% of men with an adolescent onset were able to desist by age 29, and were similar, but not identical to men who never experienced an AUD in terms of adult functioning. Men with an adolescent onset and persistent course of AUD exhibited the most severe deficits in functioning.

CONCLUSION

Results emphasize the importance of examining developmental course to understand the etiology of AUD. Our findings are optimistic in that individuals who desist from AUD are able to achieve high levels of psychosocial functioning. Our findings suggest that future research on the persistence of AUD into adulthood should focus on the contributions of behavioral disinhibition and social environment variables including peer and romantic relationships.

Favorite green, waterside and urban environments, restorative experiences and perceived health in Finland

The study investigated restorative experiences in relation to respondents' everyday favorite places and analysed the associations between the use of favorite places, restorative experiences, their determinants and aspects of self-rated health. A simple random sample of 1273 inhabitants, aged between 15 and 75 years, of two major cities in Finland (Helsinki and Tampere) completed a postal questionnaire. A subsample of the answers from inhabitants with a self-reported distance from home to a favorite place of 15 km or less (n = 1089) was analysed. Restorative experiences in favorite exercise and activity outdoor areas, waterside environments and extensively managed natural settings (mainly urban woodlands) were stronger than in favorite places in built urban settings or green spaces in urban settings (mostly parks). The results revealed a link between the need for restoration (worries and stress), the use of environmental self-regulation strategies (favorite places) and restorative outcomes. The more worries about money and work (during the last month) a person had, the more stressed a person had felt during the last year, the less energetic s/he had felt, the lower was the number of visits to the favorite place (during the last 6 months) and the lower the typical level of restorative experiences. Inconsistently, the direct path suggested that the more worries about money and work, the higher the typical level of restorative experiences. The findings increase knowledge of health-enhancing environments and have implications for stress and work recovery research.

Child maltreatment and memory

Exposure to childhood trauma, especially child maltreatment, has important implications for memory of emotionally distressing experiences. These implications stem from cognitive, socio-emotional, mental health, and neurobiological consequences of maltreatment and can be at least partially explained by current theories concerning the effects of childhood trauma. In this review, two main hypotheses are advanced: (a) Maltreatment in childhood is associated with especially robust memory for emotionally distressing material in many individuals, but (b) maltreatment can impair memory for such material in individuals who defensively avoid it. Support for these hypotheses comes from research on child abuse victims' memory and suggestibility regarding distressing but nonabusive events, memory for child abuse itself, and autobiographical memory. However, more direct investigations are needed to test precisely when and how childhood trauma affects memory for emotionally significant, distressing experiences. Legal implications and future directions are discussed.

Longitudinal modelling of academic buoyancy and motivation: do the '5Cs' hold up over time?

BACKGROUND

Academic buoyancy is students' ability to successfully deal with setbacks and challenges that are typical of academic life. The present study extends previous preliminary cross-sectional work that tentatively identified five motivational predictors of academic buoyancy - referred to as the '5Cs' of academic buoyancy: confidence (self-efficacy), coordination (planning), commitment (persistence), composure (low anxiety), and control (low uncertain control).

AIMS

The study seeks to more clearly ascertain the effects of motivation (and its mediating role) on academic buoyancy over and above prior academic buoyancy.

SAMPLE

The study comprised N=1,866 high school students from six schools.

METHOD

Longitudinal data were collected (1 year apart) and the hypothesized model exploring longitudinal effects was tested using structural equation modelling.

RESULTS

After controlling for prior variance in academic buoyancy, the 5Cs were significant predictors of subsequent academic buoyancy. Furthermore, over and above the direct effects of prior academic buoyancy on subsequent academic buoyancy, the 5Cs significantly mediated this relationship.

CONCLUSIONS

The study concludes with a discussion of the substantive, applied, and methodological implications for researchers and practitioners seeking to investigate and address the academic buoyancy of students who require the capacity to effectively function in an ever-challenging school environment.

Ecological momentary assessment (EMA) in studies of substance use

Ecological momentary assessment (EMA) is particularly suitable for studying substance use, because use is episodic and thought to be related to mood and context. This article reviews EMA methods in substance use research, focusing on tobacco and alcohol use and relapse, where EMA has been most applied. Common EMA designs combine event-based reports of substance use with time-based assessments. Approaches to data organization and analysis have been very diverse, particularly regarding their treatment of time. Compliance with signaled assessments is often high. Compliance with recording of substance use appears good but is harder to validate. Treatment applications of EMA are emerging. EMA captures substance use patterns not measured by questionnaires or retrospective data and holds promise for substance use research.

Ethnomedicine and ethnobotany of fright, a Caribbean culture-bound psychiatric syndrome

BACKGROUND

"Fright" is an English-speaking Caribbean idiom for an illness, or ethnomedical syndrome, of persistent distress. A parallel ethnopsychiatric idiom exists in the French Antilles as sésisma. Fright is distinct from susto among Hispanics, though both develop in the wake of traumatic events. West Indian ethnophysiology (ethnoanatomy) theorizes that an overload of stressful emotions (fear, panic, anguish or worry) causes a cold humoral state in which blood coagulates causing prolonged distress and increased risks of other humorally cold illnesses.

METHODS

Qualitative data on local explanatory models and treatment of fright were collected using participant-observation, informal key informant interviews and a village health survey. Ethnobotanical and epidemiological data come from freelist (or "free-list") tasks, analyzed for salience, with nearly all adults (N = 112) of an eastern village in Dominica, and a village survey on medicinal plant recognition and use (N = 106).

RESULTS

Along with prayer and exercise, three herbs are salient fright treatments: Gossypium barbadense L., Lippia micromera Schauer, and, Plectranthus [Coleus] amboinicus [Loureiro] Sprengel. The survey indicated that 27% of village adults had medicated themselves for fright. Logistic regression of fright suffering onto demographic variables of age, education, gender, parental status and wealth measured in consumer goods found age to be the only significant predictor of having had fright. The probability of having (and medicating for) fright thus increases with every year.

CONCLUSIONS

While sufferers are often uncomfortable recalling personal fright experiences, reporting use of medicinal plants is less problematic. Inquiry on fright medical ethnobotany (or phytotherapies) serves as a proxy measurement for fright occurrence. Cross-cultural and ethnopharmacology literature on the medicinal plants suggests probable efficacy in accord with Dominican ethnomedical notions of fright. Further, the cultural salience and beliefs about these medicines may give these medications extra psychoneuroimmune (i.e. mind-body) benefits, or placebo-like effects, for this stress-related folk illness.

Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: a randomized clinical trial

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical model's stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior.

Using experience sampling methods/ecological momentary assessment (ESM/EMA) in clinical assessment and clinical research: introduction to the special section

This article introduces the special section on experience sampling methods and ecological momentary assessment in clinical assessment. We review the conceptual basis for experience sampling methods (ESM; Csikszentmihalyi & Larson, 1987) and ecological momentary assessment (EMA; Stone & Shiffman, 1994). Next, we highlight several advantageous features of ESM/EMA as applied to psychological assessment and clinical research. We provide a brief overview of the articles in this special section, each of which focuses on 1 of the following major classes of psychological disorders: mood disorders and mood dysregulation (Ebner-Priemer & Trull, 2009), anxiety disorders (Alpers, 2009), substance use disorders (Shiffman, 2009), and psychosis (Oorschot, Kwapil, Delespaul, & Myin-Germeys, 2009). Finally, we discuss prospects, future challenges, and limitations of ESM/EMA.

Randomized trial to reduce club drug use and HIV risk behaviors among men who have sex with men

The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for 1 year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p < .02; small to medium effect size). MI did not result in a significant reduction in risky sex relative to education. The results support the use of MI targeting club drug use in at-risk or mildly dependent users not seeking treatment but not in more severely dependent users. MI does not appear effective in reducing risky sexual behavior in this population.

Are We Medicalizing Women’s Misery? A Critical Review of Women’s Higher Rates of Reported Depression

Epidemiological research consistently reports that women experience higher rates of depression than men. Competing biomedical, psychological and sociocultural models adopt a realist epistemology and a discourse of medical naturalism to position depression as a naturally occurring pathology within the woman, caused by biology, cognitions or life stress. Feminist critics argue that this medicalizes women’s misery, legitimizes expert intervention, and negates the political, economic and discursive aspects of experience. However, the alternative model of social constructionism may appear to dismiss the ‘real’ of women’s distress, and deny its material and intrapsychic concomitants, as well as negate relevant research findings. A critical review of sociocultural and psychological research on women’s depression is conducted. It is argued that a critical-realist epistemology allows us to acknowledge the material-discursive-intrapsychic concomitants of experiences constructed as depression, without privileging one level of analysis above the other, in order to understand women’s higher rates of reported depression.

Preconscious processing biases predict emotional reactivity to stress

BACKGROUND

Anxiety vulnerability is associated with biases in attention: a tendency to selectively process negative relative to neutral or positive information. It is not clear whether this bias is: 1) related to the physiological response to stressful events, and 2) causally related to the development of anxiety disorders.

METHODS

We tested the predictive value of both preconscious and conscious attention biases in a prospective study of stress reactivity in a nonclinical sample. One hundred four male participants were assessed at baseline and then again 4 months (n = 82) and 8 months later (n = 70). Salivary cortisol and self-report measures were obtained at the baseline testing session in addition to measures of biased attention. Subsequent emotional reactivity was assessed by means of salivary cortisol and self-reported state-anxiety responses during a laboratory-based stressor (4 months later) as well as during a real-life stressor 8 months later (i.e., examination period).

RESULTS

Regression analyses indicated that a preconscious negative processing bias was the best predictor of the cortisol response to stressful events. Importantly, a measure of selective processing provided a better indicator of subsequent emotional reactivity than self-report measures of neuroticism, trait-anxiety, and extraversion.

CONCLUSIONS

These results suggest that preconscious biases toward negative material play a causal role in heightened anxiety vulnerability. Our results illustrate the potential utility of preconscious biases in attention in providing an early marker of anxiety vulnerability and a potential target for treatment intervention.

5-hydroxytryptamine 2C receptors in the basolateral amygdala are involved in the expression of anxiety after uncontrollable traumatic stress

BACKGROUND

Exposure to uncontrollable stressors often increases anxiety-like behavior in both humans and rodents. In rat, this effect depends on stress-induced activity within the dorsal raphe nucleus (DRN). However, the role of serotonin in DRN projection regions is largely unknown. The goals of this study were to 1) assess the effect of uncontrollable stress on extracellular serotonin in the basolateral amygdala during the anxiety test, 2) determine whether DRN activity during a poststress anxiety test is involved in anxiety-like behavior, and 3) determine the role of the serotonin 2C receptor (5-HT(2C)) in uncontrollable stress-induced anxiety.

METHOD

Rats were exposed to tail shocks that were either controllable or uncontrollable. On the following day, anxiety-like behavior was assessed in a Juvenile Social Exploration (JSE) test. Basolateral amygdala (BLA) extracellular serotonin concentrations were assessed during JSE by in vivo microdialysis 24 hours after uncontrollable stress, controllable stress, or no stress. In separate experiments, drugs were administered before the JSE test to inhibit the DRN or to block 5-HT(2C) receptors.

RESULTS

Exposure to uncontrollable shock reduced later social exploration. Prior uncontrollable stress potentiated serotonin efflux in the BLA during social exploration, but controllable stress did not. Intra-DRN 8-OH-DPAT and systemic and intra-BLA 5-HT(2C) receptor antagonist SB 242,084 prevented the expression of potentiated anxiety in uncontrollably stressed rats. Intra-BLA injection of the 5-HT(2C) agonist CP 809,101 mimicked the effect of stress.

CONCLUSIONS

These results suggest that the anxiety-like behavior observed after uncontrollable stress is mediated by exaggerated 5-HT acting at BLA 5-HT(2C) receptors.

An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): causal pathways and treatment implications

Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPT's efficacy as an intervention for individuals with an eating disorder.

Multilevel analysis of covariation in socioeconomic predictors of physical functioning and psychological well-being among older people in rural Vietnam

Background

There remains a lack of research on co-variation of multiple health outcomes and their socio-economic co-patterning, especially among the elderly. This papers aims to 1) examine the effects of different socio-economic factors on physical functioning and psychological well-being among older adults in a rural community in northern Vietnam; and 2) investigate the extent to which the two outcomes variables co-vary within individuals.

Methods

We analyzed the data from the WHO/INDEPTH study on global ageing and adult health conducted on 8535 people aged 50 years old and over in Bavi district of Vietnam in 2006. A multivariate response model was constructed to answer our research questions. The model treats the individual as a level two unit and the multiple measurements observed within an individual as a level one unit.

Results

Lower physical functioning and psychological well-being were found in 1) women; 2) older people; 3) people with lower education level; 4) people who were currently single; 5) respondents from poorer household; and 6) mountainous dwellers compared to that in those of other category(ies) of the same variable. Socioeconomic factors accounted for about 24% and 7% of variation in physical functioning and psychological well-being scores, respectively. The adjusted correlation coefficient (0.35) indicates that physical functioning and psychological well-being did not strongly co-vary.

Conclusions

The present study shows that there exist problems of inequality in health among older adults in the study setting. This finding highlights the importance of analyzing multiple dimensions of health status simultaneously in inequality investigations.

Amygdala volume correlates positively with fearfulness in normal healthy girls

Research into the neural underpinnings of fear and fear-related pathology has highlighted the role of the amygdala. For instance, bilateral damage to the amygdaloid complex is associated with decreased appreciation of danger and recognition of fear in humans, whereas enlarged amygdala volume is associated with internalizing syndromes. It is unknown whether amygdala volume and fearfulness are related in the absence of pathology. We examined the correlation between normal fearfulness and amygdala morphology in 116 healthy children and adolescents (60 boys, 56 girls, age 7-17 years). Fearfulness was measured using the parent ratings on the Pediatric Behavior Scale and amygdala volumes were determined by manual tracing. We found a positive correlation between right amygdala volume in girls (r = 0.29). This relationship was more robust and present bilaterally when analyses were limited to girls with a positive nuclear family history of depression (for left r = 0.63; for right r = 0.58). In boys there was no significant relationship which may suggest that biological mechanisms differ between sexes. Given the role of enlarged amygdala volume in pathology, these findings may indicate that variation in amygdala morphology marks susceptibility to internalizing disorders.

Management of Psychosexual Problems in Primary Care

Sexual health can be described as enjoying and fulfilling sexual desires without causing harm, physical or psychological, to oneself or others. Psychosexual problems affect about 40% of the population and sexual functioning is an important part of a patient's health and well-being. Patients often present late due to embarrassment and commonly with an alternative problem. Learning to recognize and act upon both verbal and non-verbal clues, with empathy, is essential in their management. This article aims to give an overview of common psychosexual problems, specific circumstances where they present more frequently and management options.

Motivation and Autonomy in Counseling, Psychotherapy, and Behavior Change: A Look at Theory and Practice 1ψ7

Motivation has received increasing attention across counseling approaches, presumably because clients’ motivation is key for treatment effectiveness. The authors define motivation using a self-determination theory taxonomy that conceptualizes motivation along a relative-autonomy continuum. The authors apply the taxonomy in discussing how various counseling approaches address client motivation and autonomy, both in theory and in practice. The authors also consider the motivational implications of nonspecific factors such as therapeutic alliance. Across approaches, the authors find convergence around the idea that clients’ autonomy should be respected and collaborative engagement fostered. The authors also address ethical considerations regarding respect for autonomy and relations of autonomy to multicultural counseling. The authors conclude that supporting autonomy is differentially grounded in theories and differentially implemented in approaches. Specifically, outcome-oriented treatments tend to consider motivation a prerequisite for treatment and emphasize transparency and up-front consent; process-oriented treatments tend to consider motivation a treatment aspect and give less emphasis to transparency and consent.

Trait anxiety affects decision-making differently in healthy men and women: towards gender-specific endophenotypes of anxiety

Excessive levels of trait anxiety are a risk factor for psychiatric conditions, including anxiety disorders and substance abuse. High trait anxiety has been associated with altered cognitive functioning, in particular with an attentional bias towards aversive stimuli. Decision-making is a crucial aspect of cognitive functioning that relies on the correct processing and control of emotional stimuli. Interestingly, anxiety and decision-making share underlying neural substrates, involving cortico-limbic pathways, including the amygdala, striatum and medial and dorsolateral prefrontal cortices. In the present study, we investigated the relationship between trait anxiety, measured by the State-Trait Anxiety Inventory, and complex decision-making, measured by the Iowa Gambling Task, in healthy male and female volunteers. The main focus of this study was the inclusion of gender as a discriminative factor. Indeed, we found distinct gender-specific effects of trait anxiety: in men, both low and high anxiety groups showed impaired decision-making compared to medium anxiety individuals, whereas in women only high anxiety individuals performed poorly. Furthermore, anxiety affected decision-making in men early in the task, i.e. the exploration phase, as opposed to an effect on performance in women during the second part of the test, i.e. the exploitation phase. These findings were related to different profiles of trait anxiety in men and women, and were independent of performance in the Wisconsin Card Sorting Test and cortisol levels. Our data show gender-specific effects of trait anxiety on emotional decision-making. We suggest gender-specific endophenotypes of anxiety to exist, that differentially affect cognitive functioning.

Effects of socioeconomic status on brain development, and how cognitive neuroscience may contribute to levelling the playing field

The study of socioeconomic status (SES) and the brain finds itself in a circumstance unusual for Cognitive Neuroscience: large numbers of questions with both practical and scientific importance exist, but they are currently under-researched and ripe for investigation. This review aims to highlight these questions, to outline their potential significance, and to suggest routes by which they might be approached. Although remarkably few neural studies have been carried out so far, there exists a large literature of previous behavioural work. This behavioural research provides an invaluable guide for future neuroimaging work, but also poses an important challenge for it: how can we ensure that the neural data contributes predictive or diagnostic power over and above what can be derived from behaviour alone? We discuss some of the open mechanistic questions which Cognitive Neuroscience may have the power to illuminate, spanning areas including language, numerical cognition, stress, memory, and social influences on learning. These questions have obvious practical and societal significance, but they also bear directly on a set of longstanding questions in basic science: what are the environmental and neural factors which affect the acquisition and retention of declarative and nondeclarative skills? Perhaps the best opportunity for practical and theoretical interests to converge is in the study of interventions. Many interventions aimed at improving the cognitive development of low SES children are currently underway, but almost all are operating without either input from, or study by, the Cognitive Neuroscience community. Given that longitudinal intervention studies are very hard to set up, but can, with proper designs, be ideal tests of causal mechanisms, this area promises exciting opportunities for future research.

Cerebellar telomere length and psychiatric disorders

We tested whether telomere length is altered in the brains of patients diagnosed with major depression (MD), bipolar disorder (BD) and schizophrenia (SZ) by measuring mean telomere length (mTL) with real-time PCR. The samples are cerebellar gray matter from 46 SZ, 46 BP, and 15 MD patients, and 48 healthy controls. We found no difference in mTL between SZ and controls, BD and controls, MD and controls, or all cases and controls; no correlation between mTL and age was observed, either. This suggests that brain gray matter is unlikely to be related to the telomere length shortening reported in blood of psychiatric patients. White matter deserves further investigation as it has been reported to have a different mTL dynamic from gray matter. Since mTL has been reported to be a heritable quantitative trait, we also carried out genome-wide mapping of genetic factors for mTL, treating mTL as a quantitative trait. No association survived correction of multiple testing for the number of SNPs studied. The previously reported rs2630578 (BICD1) association was not replicated. This suggests that telomere length of cerebellar gray matter is determined by multiple loci with "weak effects."

The time line of threat processing and vagal withdrawal in response to a self-threatening stressor in cognitive avoidant copers: evidence for vigilance-avoidance theory

Using a spatial cueing paradigm with emotional and neutral facial expressions as cues, we examined early and late patterns of information processing in cognitive avoidant coping (CAV). Participants were required to detect a target that appeared either in the same location as the cue (valid) or in a different location (invalid). Cue-target onset asynchrony (CTOA) was manipulated to be short (250 ms) or long (750 ms). CAV was associated with early facilitation and faster disengagement from angry faces. No effects were found for happy or neutral faces. After completing the spatial cueing task, participants prepared and delivered a public speech and heart rate variability (HRV) was recorded. Disengagement from angry faces was related to a decrease in HRV in response to this task. Together, these data suggest that CAV is related to early engagement followed by disengagement from threat-related cues that might impact physiological stress responses.

The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors

BACKGROUND

Neuroticism is a personality trait expressing nervousness and insecurity. Associations between neuroticism and morbidity in long-term cancer survivors have hardly been explored. The aim of this study was to explore associations between neuroticism and somatic and mental morbidity and lifestyle issues in long-term survivors of testicular cancer (TCSs).

MATERIAL AND METHODS

All Norwegian TCSs treated between 1980 and 1994 (n = 1 814) were invited to this cross-sectional study. Among them 1 428 (79% response rate) delivered valid data. Neuroticism was self-rated on an abridged version of the Eysenck Personality Inventory. Information was collected by mailed questionnaires. The associations of neuroticism and self-reported variables were tested with multivariate logistic regression analyses.

RESULTS

Neuroticism was significantly associated with presence of somatic complaints, reduced physical function, neurotoxic side-effects (tinnitus, hearing impairment, peripheral neuropathy, and Raynaud's Phenomenon), self-esteem, concerns about not being able to father children, sexual problems, hazardous alcohol use, daily use of medication, use of sedatives and hypnotics, recent visits to a general practitioner, and seeing a psychologist/ psychiatrist after ended cancer treatment. Poor self-rated health, higher number of negative life events, economical problems and problems getting loans granted showed significant associations with neuroticism.

DISCUSSION

Neuroticism in TCSs at long-term follow-up is significantly associated with somatic and mental morbidities, and several aspects of unhealthy lifestyle. High levels of neuroticism should be considered in TCSs expressing multiple complaints and concerns at follow-up consultations. Assessment of neuroticism may be clinically important in order to offer appropriate interventions to prevent and manage morbidity in TCSs.

Depression and language acculturation correlate with smoking among older Asian American adolescents in New York City

OBJECTIVE

To explore the correlates of smoking status among a sample of Asian American adolescents in New York City (NYC).

DESIGN AND SAMPLE

This descriptive, correlational study compared current smokers and current nonsmokers in terms of age, gender, ethnicity, academic performance, acculturation, depressive symptoms, smoking history, and parental, sibling, and peer smoking. The convenience sample included 328 Asian American adolescents, ages 16-19, who lived in NYC, and were recruited from members, friends, and affiliates of 6 organizational sources.

MEASURES

The study used demographic, depression (Center for Epidemiological Studies Depression scale), English language acculturation, and smoking opportunity survey questionnaires.

RESULTS

Statistical analyses revealed that being older, being more English-language acculturated, having poor academic performance, increased depressive symptoms, and having siblings and peers who smoked were significantly associated with current smoking.

CONCLUSIONS

Asian American adolescents initiate smoking later than other groups. Depressive symptoms were at high levels in the sample and were correlated with smoking. Thus, for Asian American adolescents, smoking prevention programs should be extended to later grades, with particular attention to low-performing students and those who are more acculturated. Likewise, programs that identify and assist adolescents with depressive symptoms may be useful in smoking prevention.

Emotions beyond the laboratory: theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment

Questionnaire and interview assessment can provide reliable data on attitudes and self-perceptions on emotion, and experimental laboratory assessment can examine functional relations between stimuli and reactions under controlled conditions. On the other hand, ambulatory assessment is less constrained and provides naturalistic data on emotion in daily life, with the potential to (1) assure external validity of laboratory findings, (2) provide normative data on prevalence, quality and intensity of real-life emotion and associated processes, (3) characterize previously unidentified emotional phenomena, and (4) model real-life stimuli for representative laboratory research design. Technological innovations now allow for detailed ambulatory study of emotion across domains of subjective experience, overt behavior and physiology. However, methodological challenges abound that may compromise attempts to characterize biobehavioral aspects of emotion in the real world. For example, emotional effects can be masked by social engagement, mental and physical workloads, as well as by food intake and circadian and quasi-random variation in metabolic activity. The complexity of data streams and multitude of factors that influence them require a high degree of context specification for meaningful data interpretation. We consider possible solutions to typical and often overlooked issues related to ambulatory emotion research, including aspects of study design decisions, recording devices and channels, electronic diary implementation, and data analysis.

Polymorphisms of the mu-opioid receptor and dopamine D4 receptor genes and subjective responses to alcohol in the natural environment

Polymorphisms of the mu-opioid receptor (OPRM1) and dopamine D4 receptor (DRD4) genes are associated with subjective responses to alcohol and urge to drink under laboratory conditions. This study examined these associations in the natural environment using ecological momentary assessment. Participants were non-treatment-seeking heavy drinkers (n = 112, 52% female, 61% alcohol dependent) who enrolled in a study of naltrexone effects on craving and drinking in the natural environment. Data were culled from 5 consecutive days of drinking reports prior to medication randomization. Analyses revealed that, after drinking, carriers of the Asp40 allele of the OPRM1 gene reported higher overall levels of vigor and lower levels negative mood, as compared to homozygotes for the Asn40 variant. Carriers of the long allele (i.e., >or=7 tandem repeats) of the DRD4 endorsed greater urge to drink than homozygotes for the short allele. Effects of OPRM1 and DRD4 variable-number-of-tandem-repeats genotypes appear to be alcohol dose-dependent. Specifically, carriers of the DRD4-L allele reported slight decreases in urge to drink at higher levels of estimated blood alcohol concentration (eBAC), and Asp40 carriers reported decreases in vigor and increases in negative mood as eBAC rose, as compared to carriers of the major allele for each gene. Self-reported vigor and urge to drink were positively associated with alcohol consumption within the same drinking episode. This study extends findings on subjective intoxication, urge to drink, and their genetic bases from controlled laboratory to naturalistic settings.

Personality disorder: a new global perspective

Personality disorder is now being accepted as an important condition in mainstream psychiatry across the world. Although it often remains unrecognized in ordinary practice, research studies have shown it is common, creates considerable morbidity, is associated with high costs to services and to society, and interferes, usually negatively, with progress in the treatment of other mental disorders. We now have evidence that personality disorder, as currently classified, affects around 6% of the world population, and the differences between countries show no consistent variation. We are also getting increasing evidence that some treatments, mainly psychological, are of value in this group of disorders. What is now needed is a new classification that is of greater value to clinicians, and the WPA Section on Personality Disorders is currently undertaking this task.