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Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
Research indicates that people suffering from obsessive compulsive disorder (OCD) possess several cognitive biases, including a tendency to over-estimate threat and avoid risk. Studies have suggested that people with OCD not only over-estimate the severity of negative events, but also under-estimate their ability to cope with such occurrences. What is less clear is if they also miscalculate the extent to which they will be emotionally impacted by a given experience.
The aim of the current study was twofold. First, we examined if people with OCD are especially poor at predicting their emotional responses to future events (i.e. affective forecasting). Second, we analysed the relationship between affective forecasting accuracy and risk assessment across a broad domain of behaviours.
Forty-one OCD, 42 non-anxious, and 40 socially anxious subjects completed an affective forecasting task and a self-report measure of risk-taking.
Findings revealed that affective forecasting accuracy did not differ among the groups. In addition, there was little evidence that affective forecasting errors are related to how people assess risk in a variety of situations.
The results of our study suggest that affective forecasting is unlikely to contribute to the phenomenology of OCD or social anxiety disorder. However, that people over-estimate the hedonic impact of negative events might have interesting implications for the treatment of OCD and other disorders treated with exposure therapy.
Borsboom et al. have written a trenchant critique of biological reductionism in psychopathology. After commenting on recent controversies concerning the network perspective, I discuss ways of integrating biology into the network enterprise.
The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.
(Disaster Med Public Health Preparedness. 2011;5:S20-S31)
The purpose of this study was to test whether children and adolescents with anxiety disorders exhibit selective processing of threatening facial expressions in a pictorial version of the emotional Stroop paradigm. Participants named the colours of filters covering images of adults and children displaying either a neutral facial expression or one displaying the emotions of anger, disgust, or happiness. A delay in naming the colour of a filter implies attentional capture by the facial expression. Anxious participants, relative to control participants, exhibited slower colour naming overall, implying greater proneness to distraction by social cues. Children exhibited longer colour-naming latencies as compared to adolescents, perhaps because young children have a limited ability to inhibit attention to distracting stimuli. Adult faces were associated with slower colour naming than were child faces, irrespective of facial expressions in both groups, possibly because adults provide especially salient cues for children and adolescents. Inconsistent with prediction, participants with anxiety disorders were not slower than healthy controls at naming the colours of filters covering threatening expressions (i.e., anger and disgust) relative to filters covering faces depicting happy or neutral expressions.
Some questionnaire studies have shown increased mental health problems, including probable posttraumatic stress disorder (PTSD), in soldiers deployed to Iraq.
To test prospectively whether such problems change over time and whether questionnaires provide accurate estimates of deployment-related PTSD compared with a clinical interview.
Dutch infantry troops from three cohorts completed questionnaires before deployment to Iraq (n=479), and about 5 months (n=382, 80%) and 15 months (n=331, 69%) thereafter. Post-traumatic stress disorder was evaluated by questionnaire and clinical interview.
There were no group changes for general distress symptoms. The rates of PTSD for each cohort were 21, 4 and 6% based on questionnaires at 5 months. The deployment-related rates of PTSD based on the clinical interview were 4, 3 and 3%.
There was a specific effect of deployment on mental health for a small minority. Questionnaires eliciting stress symptoms gave substantial overestimations of the rate of PTSD.
Erdelyi's version of repression – trying successfully not to think about something – is no longer recognizably Freudian. Erdelyi fails to cite directed forgetting experiments involving psychiatric patients that indicate that the motivation to forget threatening material seldom translates into an ability to do so. The early Freud of the seduction theory of hysteria did inspire the recovered memory fiasco.
The terrorist attacks of September 11, 2001 prompted a wave of epidemiologic research, as the chapters in this edited volume illustrate. The three investigators, who have summarized their field work and selected findings in the first section of this volume, deserve much praise for their initiative in launching and completing their studies in the midst of local and national upheaval (Galea et al., this volume; Hoven et al., this volume; Silver et al., this volume). The three epidemiologic studies implemented field procedures, designed to produce data on the psychological responses to the 9/11 attacks that are representative of the targeted populations. These include New York City (NYC) public schoolchildren, adult residents of the NYC metropolitan area and all American adults. These investigators applied welltested state-of-the-art survey technologies to assure timeliness and efficiency. Data produced in these studies have been presented in multiple publications in leading medical journals and more publications are sure to follow. The chapters included herein focus primarily on the conduct of the research, organizational support, design options that were considered and the rationale for the choices that were made. In giving these accounts, the chapters contribute an interesting and instructive perspective that is often hidden from view. The more difficult goal of outlining lessons that could influence policy remains elusive. Recommendations for prevention programs that are not based on rigorous evaluation would be unwarranted.
Perhaps because of the enormity of the terrorist attacks or because of the upsurge in patriotic sentiment occurring in their wake, critical discussion of the conceptual underpinnings and implications, or even the methodological aspects of this work, has been largely absent.
Acute tryptophan depletion transiently induces symptoms in those with remitted depression. The behavioural specificity is uncertain, however. Recently, symptom provocation studies have become controversial, particularly in the USA.
To assess the specificity of acute tryptophan depletion. To investigate systematically the subjective experiences of those taking part in a symptom provocation study.
Twenty individuals with remitted depression underwent acute tryptophan depletion in a double-blind, crossover trial. Psychiatric symptoms and self-schemata relevant to depression were assessed. The quality of the informed consent procedure and subjective experiences were also evaluated.
Acute tryptophan depletion induced a specific depressive response. The effects were more pronounced in females than in males. Participants were quite satisfied with the informed consent procedure. They had understood that this was a fundamental research project and personal benefits were not expected. However, some participants still found it a positive experience.
Acute tryptophan depletion is a suitable model of vulnerability to depression, from both a scientific and an ethical perspective.
Individuals with body dysmorphic disorder (BDD) suffer from unpleasant, repetitive thoughts about imagined defects in appearance which are difficult to control.
The purpose of this study was to test for deficits in cognitive inhibition in BDD.
To test for deficits in cognitive inhibition in BDD, we applied a negative priming paradigm. Specifically, we explored whether BDD patients exhibit greater deficits in cognitive inhibition when lexical targets are threatening than when they are non-threatening.
Surprisingly, BDD patients exhibited deficits in cognitive inhibition only for non-threatening but not for threatening information.
Although BDD patients often describe their negative thoughts about their appearance as distressing, they may experience them as valid and thus may not try to control them.
Anxiety-disordered patients and individuals with high trait anxiety tend to interpret ambiguous information as threatening. The purpose of this study was to investigate whether interpretive biases would also occur in body dysmorphic disorder (BDD), which is characterized by a preoccupation with imagined defects in one's appearance. We tested whether BDD participants, compared with obsessive-compulsive disorder participants and healthy controls, would choose threatening interpretations for ambiguous body-related, ambiguous social, and general scenarios. As we hypothesized, BDD participants exhibited a negative interpretive bias for body-related scenarios and for social scenarios, whereas the other groups did not. Moreover, both clinical groups exhibited a negative interpretive bias for general scenarios.
We used a negative priming paradigm to test for deficits in cognitive inhibition in patients with obsessive-compulsive disorder (OCD), and to examine whether they exhibit greater inhibitory deficits when lexical targets are
threat-related than when they are neutral. The results indicated that OCD patients, relative to healthy control participants,
exhibited only marginally significant (p < .10) deficits in negative priming at short (100 ms), but not long (500 ms),
stimulus onset asynchronies. There was no evidence that OCD patients exhibited disproportionate difficulty
inhibiting negative words, nor was there any evidence that negative priming deficits differed between OCD checkers
and OCD noncheckers.
Poole, de Jongh and Spector ask for empirical research rather than emotive
arguments when evaluating EMDR. When one applies this standard, Poole
et al.’s remaining points are devoid of substance. EMDR, like other Power
Therapies, is a “miracle” cure that has failed.
Recent “Power Therapies” claim near miraculous
cures but fare less well under controlled testing. These developments recall
for cognitive behavior therapists the history of past “cures” that
temporarily induced high levels of expectancies, but failed the test of time.
Testing a variant of Wegner's (1989) “thought suppression” paradigm, we had subjects identify a personally-relevant negative thought that had been troubling them recently. Subjects were then randomly assigned either to a negative target thought group or to a neutral target thought (“white bear”) group, and randomly assigned either to an initial suppression condition (followed by a free expression period) or an initial free expression condition (followed by a suppression period). The results revealed that subjects in the neutral thought group experienced a decline in thoughts about white bears throughout the course of the experiment, whereas subjects asked first to suppress a personally relevant negative thought experienced nearly a three-fold increase in its frequency of occurrence when later given permission to express it. These findings suggest that negatively valent thoughts may respond differently than neutral thoughts following attempts to suppress them.
Analysing data from the Epidemiologic Catchment Area (ECA) study, Weissman and colleagues reported that panic disorder was strongly associated with suicide attempt. However, they did not control optimally for comorbid disorders known to increase suicide risk.
Reanalysing the ECA data, we controlled for comorbid disorders in the aggregate rather than one at a time when we estimated the association between panic disorder and suicide attempt.
Panic disorder was not associated with an increased risk of suicide attempt.
Comorbid conditions strongly influence whether people with panic disorder are at especial risk of suicide attempt.