Bipolar disorder: dominant or recessive on chromosome 5?

Rizatriptan (MK-462) is a potent 5HTID receptor agonist. This multicenter, double-blind, placebo-controlled, outpatient study investigated the clinical efficacy, safety, and tolerability of rizatriptan (2.5, 5, and 10 mg) as a function of dose for acute migraine. Patients with moderate or severe migraine (n = 417) were treated with placebo (n = 67), rizatriptan 2.5 mg (n = 75), 5 mg (n = 130), or rizatriptan 10 mg (n = 145). Headache severity, functional disability, and migraine symptoms were measured immediately before dosing (0) and at 0.5, 1, 1.5, 2, 3, and 4 h post-dose. Patients were permitted to take a second dose of test drug at 2 h if their headache pain was moderate or severe (i.e., placebo initially-->rizatriptan 10 mg as optional second dose; rizatriptan 2.5 mg, 5 mg, or 10 mg initially-->placebo as optional second dose). An upward dose-response relationship was observed among placebo, rizatriptan 2.5 mg, 5 mg, and 10 mg in the primary efficacy measure of proportion of patients reporting pain relief, i.e., a change in headache severity to "no pain or mild pain" at 2 h post-dose. The relationship was evident even at the first recorded timepoint, 30 min, and was statistically significant at 1.5 h and beyond. At the primary timepoint of 2 h after the initial dose, the proportion of patients reporting pain relief was 47.6% for rizatriptan 10 mg; 45.4% for rizatriptan 5 mg; 21.3% for rizatriptan 2.5 mg; and 17.9% for placebo. Seventy percent of patients on rizatriptan 10 mg reported pain relief at 4 h. Patients who took rizatriptan 5 mg and 10 mg were significantly less functionally disabled than those who took placebo at 1.5 and 2 h post-dose. Rizatriptan 10 mg was consistently more effective than 5 mg, although the differences were not statistically significant. The most frequent clinical adverse events were dizziness, somnolence, and asthenia/fatigue. No patients were discontinued for any adverse experiences and there were no serious adverse experiences.     

Loneliness: Paradox or artifact?

Comments on the article by R. Kraut et al (see record 1998-10886-001) regarding associations between Internet use and depression and social interaction. The author examines a methodological flaw in the data: the researchers inadvertently selected participants whose social contacts (high school students graduating, their parents, and people with very high levels of community involvement) were likely to decline during the course of the study, even without Internet access. Therefore, it is possible that the reported increases in loneliness and depression would have occurred even had no Internet access been provided. Furthermore, because those participants with the greatest loss of social contacts might fill their now empty hours with Internet usage, the observed negative correlation between social contact and Internet usage might indicate that isolation leads to Internet usage—a causal relationship opposite to that posited by the researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Questionnares: Use or Abuse?

The author opines that if the percentage of return on mail questionnaire studies using psychologists as subjects is declining, he should not be surprised. He states that although his position is not unique, he receives perhaps 10 requests per year. Out of wishes to advance science and help colleagues he usually complies with such requests for information, but finds that it has been rare, in his experience, to receive an acknowledgment for my efforts, and rarer still, to receive any feedback or report of findings of a study. He feels that such a practice on the part of researchers shows a decided lack of professional courtesy and will perhaps ultimately lead to scientific inquiries being ignored or dealt with perfunctorily and dismissed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arbiter: Psychologist or psychiatrist?

Presents the author's views on the tenor of the negotiations between the American Psychological Association's (APA's)Committee on Relations with Psychiatry and its opposite number from the American Psychiatric Association. His concern stems primarily from what is considered to be ambivalence on the part of the group as it is expressed in their negotiations with the psychiatrists, as well as the official position of the American Psychological Association. To be more specific: While we consider ourselves competent to handle our affairs as scientists and teachers, and would resent any intrusion in these areas, we appear to be less sure of ourselves in the area of practice, and much more explicitly, private practice. He points to the Ethical Standards of Psychologists (1953) that state, under Principle 2.51-4: The psychologist who engages in psychotherapy is obligated to assist his client, in obtaining professional help for all important aspects of his problem which fall outside the boundaries of the psychologist's competence. Most frequently this principle will require that adequate provision be made for the diagnosis and treatment of medical problems. As a commentary on this principle it is stated: To this end, psychologists doing psychotherapy may be expected to establish and maintain effective inter-communication with a psychologically-oriented physician. The usual and most desirable interpretation of this principle is that the clinical psychologist will establish an effective working relationship with a psychiatrist. He feels that while one can enthusiastically endorse the principle, it becomes changed in the commentary, so that the competence of the psychology practitioner is questioned. In effect the commentary acknowledges the psychiatrist's greater competence in the psychological, as well as the medical sphere. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning curves: Facts or artifacts?

"It is our purpose in this paper to show that the arbitrary choice of a cutoff point in the dichotomizing of continuous response distributions can impose significant constraints upon the shape of resulting learning curves, and that this can form the basis of misleading theoretical interpretations. We have chosen for illustration of this point the use of time-on-target scores as indicants of the level of skill attained in tracking tasks. However, we believe that the principles developed are quite general and apply to many learning situations." 18 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vascular dementia: dead or alive?

Allergic respiratory inflammation in target organs does not occur in any atopic (genetically susceptible) subject, since other not fully characterized factors can influence the subsequent development of overt clinical disease. Here are presented some recent developments in experimental animal and human research that can offer a new "non-classical" interpretation about the way by which allergens are recognized and allergic inflammation persists. These aspects of the immunopathogenesis of allergic diseases can now be viewed as organ-specific pathways, acting independently from other peripheral lymphoid organs. This is a consequence of new knowledge about the function of, and molecular interactions by, intraepithelial gammadelta T cells and CD1+ dendritic cells. The allergic subject, unlike the normal one, is equipped at the mucosal surface by particular T cell and antigen-presenting cell (APC) subsets that enable them to recognize undenatured proteic and non-proteic (glycolipidic) external structures of aerodispersed particles, presented in the context of CD1 molecules. Once initiated, the mucosal allergic reaction cannot be turned off in atopic individuals because CD4+ allergen-specific T cells lack surface Fas receptor. This defect, that impairs the so-called activation-induced programmed cell death (determined by Fas/FasL interaction), is caused by the local Th2-type cytokine milieu.     

Body image disturbance in body dysmorphic disorder and eating disorders. Obsessions or delusions?

At this time, the question posed by this article's title--body image disturbance in body dysmorphic disorder and eating disorders: obsessions or delusions?--is probably best answered "both." Both disorders appear to be characterized by obsessional and delusional thinking. In addition, it is likely that their nondelusional and delusional variants constitute a single disorder encompassing a spectrum of insight, with the entire spectrum characterized by obsessional thinking. This view represents a considerable departure from DSM-III-R, in which the psychotic disorders were encapsulated in a separate section of the manual and considered different disorders from their nonpsychotic variants. The one exception was the mood disorders, which were acknowledged to have psychotic variants that were classified in the manual's "nonpsychotic" section. In DSM-IV, on the basis of emerging empirical evidence about the dimensional nature of the psychotic/nonpsychotic boundary, the dichotomy between delusional and nondelusional disorders is less clear. The double coding allowed for BDD acknowledges that BDD and its delusional disorder variant may constitute a single disorder; that allowed for OCD acknowledges that OCD may be delusional. With regard to eating disorders, however, DSM-IV is surprisingly silent, perhaps because delusional preoccupations are less common than in BDD. These issues also may apply to other disorders. Like BDD, hypochondriasis is classified as a somatoform disorder, with its delusional variant a type of delusional disorder, somatic type. Do the delusional and nondelusional variants of hypochondriasis constitute the same disorder? Do other types of somatic delusional disorder, such as parasitosis and olfactory reference syndrome (the belief that one emits a foul body odor) have nondelusional variants? It is likely that a number of disorders span a spectrum from delusional to nondelusional thinking, with unlimited shades of gray in between. Future research may indicate that obsessional disorders such as BDD, anorexia, OCD, and hypochondriasis, as well as other disorders such as major depression, should have qualifiers or subtypes--for example, "with good insight," "with poor insight," and "with delusional (or psychotic) thinking"--with an implied continuum of insight embraced by a single disorder. Such an approach, which scatters psychosis throughout the nomenclature, ultimately may be shown to be a more valid and clinically useful classification approach. Answers to these questions will not only improve our classification system but also may have important treatment implications. For example, the preliminary finding that delusional BDD responds preferentially to SRIs but not to neuroleptic agents contradicts conventional wisdom about the treatment of psychosis.(ABSTRACT TRUNCATED AT 400 WORDS)     

Disorders of extreme stress following war-zone military trauma: Associated features of posttraumatic stress disorder or comorbid but distinct syndromes?

Disorders of extreme stress not otherwise specified (DESNOS) and posttraumatic stress disorder (PTSD) were found to be comorbid but distinct among military veterans seeking inpatient PTSD treatment: 31% qualified for both conditions, 29% were diagnosed PTSD only, 26% were classified DESNOS only, and 13% met criteria for neither. PTSD diagnosis was associated with elevated levels of war-zone trauma exposure and witnessing atrocities and with impairment on the Mississippi Scale for Combat-Related PTSD and the Penn Inventory. DESNOS classification (but not PTSD) was associated with (a) early childhood trauma and participation in war-zone atrocities, (b) extreme levels of intrusive trauma reexperiencing, (c) impaired characterological functioning (object relations), and (d) use of intensive psychiatric services. PTSD and DESNOS may be comorbid but distinct posttraumatic syndromes and, as such, warrant careful clinical and scientific investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models for psychiatry: icons or effigies?

Toulmin notes that a good model takes us beyond the phenomena from which we began [67]. It also tempts us. Models demand that we attempt to represent the dynamic relationships between variables. When we use them, we risk insulating our findings from empirical disproof [68]. Self-certifying myths, like articles of faith, need to yield to the demands of science. Psychiatric theory and practice need to yield to the demands of experience. We need to move away from ethereal assumptions to tangible mastery of the understanding of behavior. Freud, in The Interpretation of Dreams [69], writes, "Analogies of this kind are only intended to assist us in our attempt to make the complications of mental functioning intelligible. We are justified, in my view, in giving free rein to our speculations so long as we retain the coolness of our judgment and do not mistake the scaffolding for the building. We have been obliged to build. If we are not wholly in error, other lines of approach are bound to lead us into much the same region and the time may come when we shall find ourselves more at home in it!"     

Change on SVIB: Dice or men?

The profile report form for the strong Vocational Interest Blank has shaded areas, established by throwing dice, to indicate chance scores on the various scales. The SVIB manual suggests that this shaded area be used as a reference point to determine if a given score is significant. This article suggests that the shaded areas should be determined by scores of the Men-in-General group instead of throwing dice. The effect of this on the shaded area is shown on a sample profile report form. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Space phobia: syndrome or agoraphobic variant?

Four elderly women had intense fears of falling when there was no visible support at hand or on seeing space cues while driving. Two patients had cervical spondylosis. The mean age at onset of the fear was 54--thirty years later than that for agoraphobia. Fear of public places and of heights was not prominent, nor was depersonalisation or depression. These "space phobias" might be a hitherto unrecognised syndrome or an unusual variant of agoraphobia. The visuospatial reflexes involved might illuminate the pathogenesis of certain fears.     

Schizophrenic intellectual impairment: uniform or differential?

The SRA Tests of Primary Mental Abilities were selected as instruments to investigate the hypothesis that differential impairment of intellectual test performance is a concomitant of schizophrenia. A wide variety of hospitalized schizophrenic and normal subjects matched roughly as to age and education were used. The results of this investigation do not support the hypothesis of differential impairment of schizophrenic test performance; however, severe overall impairment of schizophrenic intellectual performance and differential impairment of performance on certain kinds of intellectual tasks as a result of aging in normals were clearly shown. 28 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are self-perceivable neuropsychological deficits in patients with neuroses or personality disorder diagnoses indicative of later schizophrenia?

We designed a spreadsheet package for the computation of plausibility of paternity, that can cope with highly polymorphic genetic markers and cases of deceased parties. The application program is Microsoft EXCEL, which is one of the best-selling spreadsheet software running on both Microsoft Windows and Macintosh OS. Komatsu's formula for paternity testing was mainly employed in the spreadsheet package. Probability of the mother-child-alleged father combination was calculated using "IF" function to compare the members' genotypes, whereas "VLOOKUP (or HLOOKUP)" function was employed to refer to a list of genes and their frequencies. In case of a phenotype consisting of several genotypes, the list of phenotypes versus genotypes was also given, to which the function referred. To extend these spreadsheets available for the test of deceased party, additional sheets were also created to estimate frequencies of alleged father's possible genotypes. These probabilities were calculated on the basis of types of his parents and siblings, those of his wife and their biological children, and those of both. This package would be cut out to compute the probability of paternity with extremely polymorphic loci with gentle user interface. Calculation time is satisfactorily short, although it requires considerably large disk space in some extremely complicated cases. Japanese version of this package is freely available at anonymous FTP site of the Department of Forensic Medicine, Tohoku University School of Medicine.     

The powerful placebo effect: fact or fiction?

In 1955, Henry K. Beecher published the classic work entitled "The Powerful Placebo." Since that time, 40 years ago, the placebo effect has been considered a scientific fact. Beecher was the first scientist to quantify the placebo effect. He claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone. This publication is still the most frequently cited placebo reference. Recently Beecher's article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever. False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. These factors are still prevalent in modern placebo literature. The placebo topic seems to invite sloppy methodological thinking. Therefore awareness of Beecher's mistakes and misinterpretations is essential for an appropriate interpretation of current placebo literature.     

Sexual behavior at work: Fun or folly?

Sexual behavior at work (e.g., sexual jokes and propositions) has been largely portrayed as offensive and harmful. The current research represents the first studies to test whether this is typically the case. Study 1 surveyed manufacturing and social service workers (N = 238) about their psychological well-being, work withdrawal, and exposure to sexual behavior at work. Respondents indicated how often they were exposed to different sexual behaviors and how much they enjoyed or were bothered by them. Study 2 surveyed university staff (N = 1,004) about their psychological well-being, drug use, feelings of being valued at work, and exposure to sexual behavior at work. Fifty-eight percent of employees in Study 1 were exposed to sexual behavior in the past 2 years; 40% of employees in Study 2 were exposed to sexual behavior in the past year. Some women and many men reported enjoying sexual behavior at work. Despite this, exposure to sexual behavior at work predicted negative employee work and psychological well-being, even for employees who said they enjoyed the experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bias in binge eating disorder: How representative are recruited clinic samples?

The aim of this study was to investigate sampling bias as it affects recruited clinic samples of binge eating disorder (BED). Demographic and clinical characteristics of a recruited clinic sample were compared with a community sample. The 2 groups met the same operational definition of BED and were assessed using the same primarily interview-based methods. Ethnicity, severity of binge eating, and social maladjustment were found to increase treatment seeking among participants with BED rather than levels of psychiatric distress or comorbidity. These findings suggest that previous studies using recruited clinic samples have not biased estimates of psychiatric comorbidity in BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Atherosclerotic renal artery stenosis: ostial or truncal?

PURPOSE: To evaluate a discrepancy between the location of renal artery stenoses on intraarterial digital subtraction angiographic (DSA) images and that on spiral computed tomographic (CT) angiograms. MATERIALS AND METHODS: The spiral CT angiograms and intraarterial DSA images of 40 consecutive patients with atherosclerotic renal artery stenoses were examined retrospectively. Stenoses were classified as truncal or ostial. The atherosclerotic changes in the abdominal aorta were graded. RESULTS: Fifty-eight stenoses were demonstrated. In 48 ostial stenoses, there was no discrepancy in the location of the stenoses on spiral CT angiograms and DSA images. In 10 patients, spiral CT angiography showed an ostial lesion, whereas DSA demonstrated an apparent truncal lesion. Most of these stenoses ("pseudotruncal" ostial stenoses) were in patients with severe aortic atherosclerotic disease. CONCLUSION: A renal artery stenosis at or within 10 mm of an atherosclerotic aorta at DSA may be diagnosed as an ostial stenosis.     

Emotional intelligence: New ability or eclectic traits?

Some individuals have a greater capacity than others to carry out sophisticated information processing about emotions and emotion-relevant stimuli and to use this information as a guide to thinking and behavior. The authors have termed this set of abilities emotional intelligence (EI). Since the introduction of the concept, however, a schism has developed in which some researchers focus on EI as a distinct group of mental abilities, and other researchers instead study an eclectic mix of positive traits such as happiness, self-esteem, and optimism. Clarifying what EI is and is not can help the field by better distinguishing research that is truly pertinent to EI from research that is not. EI--conceptualized as an ability--is an important variable both conceptually and empirically, and it shows incremental validity for predicting socially relevant outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revisiting the insanity defense: contested or consensus?

The author assesses the accuracy of both the public's opinion and researchers' conclusions regarding the method of adjudication of insanity cases and investigates the impact of the various types of reforms enacted in the 1980s on the degree to which insanity cases are contested. Data from seven states are analyzed. The public's view that insanity cases are typically resolved by a jury trial is inaccurate. Only 14.4 percent of the 7,299 insanity cases involved a jury trial. Likewise, scholars' views that most cases are resolved through plea-bargained insanity acquittals are inaccurate. Only 42.9 percent of all insanity cases are plea bargains, and 87.9 percent of all plea bargains are to a conviction. Jury trials are most likely to occur when the case involves a violent crime such as murder and the defendant has not been diagnosed with a major mental illness. Public fears that defendants easily "fool" juries into an inappropriate insanity acquittal are also unfounded. Only 16.1 percent of all jury trials result in an insanity acquittal. In three states, the figure is 10 percent or less. Contrary to the conclusions drawn by some scholars, this author finds that several types of reforms enacted in the 1980s affected the processing of insanity cases.