Anatomy of schizophrenia revisited

BACKGROUND: The purpose of this study was to investigate whether obliterative bronchiolitis might occur after xenogenic pulmonary transplantation. A model for obliterative airway disease (OAD) after tracheal allograft transplantation in the rat undergoes tracheal obliteration with histologic features characteristic of obliterative bronchiolitis in human lung transplant recipients. Using this model, the pathogenesis of OAD and its prevention with immunosuppressive drugs was studied in rat recipients of hamster tracheal grafts. METHODS: Tracheae from 30 hamsters (xenografts) or 23 Brown-Norway rats (allografts) were implanted and wrapped in the greater omentum of untreated Lewis rats. The grafts were removed on day 1, 3, 7, 14, 21, or 28 after transplantation and stained with hematoxylin and eosin and Masson's trichrome and by immunohistochemistry and immunofluorescence (IFL) techniques. In addition, 25 recipients were treated with cyclosporine (CsA, 10 mg/kg p.o.), leflunomide (LFM, 20 mg/kg p.o.), or rapamycin (RPM, 6 mg/kg i.p.) for 14 or 21 days (5 animals per treatment group). Visual and morphometric analyses were used to evaluate the extent of airway obliteration, luminal coverage by respiratory or flattened cuboidal epithelium, and extent and density of peritracheal cellular inflammation. RESULTS: In all xenografts, a neutrophilic infiltration of the mucosa and submucosa was observed from day 1 until day 14 and was associated with complete loss of tracheal epithelium by day 14. A marked peritracheal mononuclear cellular infiltrate mixed with plasma cells and eosinophils was seen on days 7 and 14. Both the extent of peritracheal inflammation and the density of the mononuclear cell infiltrate were significantly increased in xenograft tracheae when compared with the allografts. Tracheal obliteration began on day 14 and reached a maximum of 43% on day 21 with evidence of intraluminal fibrosis. In contrast to IFL of allografts, IFL of xenografts demonstrated marked deposition of rat immunoglobulin in the peritracheal tissue on days 7 and 14. The effects of treatment with immunosuppressive drugs on tracheal graft narrowing and protection of respiratory epithelium were as follows: After 14 days of treatment, the percentage of tracheal graft narrowing was 12%, 23%, and 19% in the no treatment, CsA, and LFM groups, respectively; the percentage of respiratory epithelium at 14 days was 0%, 21%, and 95%. After 21 days of treatment, the percentage of tracheal graft narrowing was 43%, 49%, 12%, and 5% for the no treatment, CsA, LFM, and RPM groups, respectively; the percentage of respiratory epithelium at 21 days was 0%, 39%, 86%, and 0%. Using computerized morphometry, the extent and densities of the peritracheal cellular infiltrates were significantly reduced in LFM- and CsA-treated groups when compared with untreated xenograft controls. LFM and RPM, but not CsA, significantly reduced the degree of luminal obliteration compared with no treatment (P<0.05). LFM and, to a lesser extent, CsA were able to prevent the loss of normal respiratory epithelium. Analysis by IFL revealed a marked decrease in rat immunoglobulin deposition in xenografts from LFM- and RPM-treated groups compared with xenografts from CsA-treated or untreated rats. CONCLUSIONS: (1) OAD occurs not only after tracheal allotransplantation but also after xenotransplantation. (2) Subepithelial infiltration of neutrophils and the appearance of plasma cells and eosinophils in the peritracheal infiltrates distinguished the histology of rejected xenografts from allografts. (3) Antibody deposition was detected by IFL only in xenografts. (4) Treatment with LFM or RPM significantly decreased the severity of luminal obliteration. Importantly, LFM also prevented the loss of respiratory epithelium.     

Comorbidity of schizophrenia and substance abuse: Implications for treatment.

The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Betrayed as boys: Psychodynamic treatment of sexually abused men.

Reviews the book, Betrayed as boys: Psychodynamic treatment of sexually abused men by Richard B. Gartner (see record 1999-02461-000). Dr. Gartner effectively helps the reader understand the impact of sexual activity with trusted adults (usually male, but sometimes female) upon the course of life development for some boys. He does not deal with perpetrators. He has judiciously thought through the difficult issues and presented his knowledge and clinical experience as a psychotherapist clearly. Even though I do not share his interpersonal psychoanalytic approach to treatment, I could easily recognize my patients in his cases, and I could learn much from seeing the way he handled their situations. For someone less knowledgeable in this area, the book provides a wonderful and accessible opportunity to learn about sexual abuse and betrayal of males. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic enhancement of cognitive-behavioral interventions for pain: An analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n=135) and low (n=150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative versus directive interventions in the treatment of eating disorders: Implications for care providers.

Given that individuals with eating disorders, are typically ambivalent about changing their eating patterns, what approach is most helpful in working with this challenging group? This research compared the responses of clients with eating disorders and those of care providers to written clinical vignettes. All participants rated collaborative interventions as more acceptable and more likely to produce positive clinical outcomes than directive interventions. In addition, clients who were least ready for change rated directive interventions as less acceptable and less likely to produce adherence than did clients who were more ready. Despite participants' clear preference for collaborative interventions, directive interventions were rated as equally likely to occur. The implications of participant preferences and reasons that these preferences may not be reflected in actual clinical practice are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonpharmacological interventions for insomnia in older adults: A meta-analysis of treatment efficacy.

The benefit of nonpharmacological interventions for insomnia in old age was investigated. A total of 13 single-outcome studies from 1966–1998 involving 388 patients (mean age exceeding 60 years, minimum age in sample, 50 years) were included in a meta-analysis of treatment efficacy. This analysis demonstrated that behavioral interventions produce improvements in sleep parameters of older insomniacs, measured in terms of sleep-onset latency, number of nocturnal awakenings, time awake after sleep onset, and total sleep time. Clinical improvements seen at posttreatment were maintained at followups (averaging 6 months). It is concluded that behavioral treatments produce significant and long-lasting improvements in the sleep pattern of older insomniacs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quetiapine: a new atypical antipsychotic for the treatment of schizophrenia

In the first of a new series of updates on recent advances in medication, RICHARD GRAY outlines the dibenzothiazepine quetiapine, which offers an alternative to conventional antipsychotics for the treatment of schizophrenia, with fewer side effects.     

Options in the treatment of chemotherapy-induced emesis

PURPOSE: The incidence and duration of chemotherapy-induced emesis, pathophysiology of the emetic response, and antiemetic treatment of options are reviewed. OVERVIEW: Nausea and vomiting are among the most common and debilitating side effects of cancer chemotherapy. If not controlled, these side effects may interfere with the delivery of potentially life-saving treatment. Acute, delayed, and anticipatory nausea and vomiting may be prevented by appropriate antiemetic therapy. Drug selection is based on the emetogenicity of the patient's cancer treatment and potency of the antiemetic agent. Efficacy and safety of the antiemetic regimen are often improved by combining agents with different mechanisms of action. CLINICAL IMPLICATIONS: By preventing and controlling chemotherapy-induced emesis, clinicians may improve cancer patients' functional status and quality of life significantly. Improved tolerability may lead to greater patient acceptance of chemotherapy and prevent premature withdrawal from or cessation of treatment. Controlling chemotherapy-induced emesis also helps to decrease the direct and indirect costs of managing cancer.     

Psychological interventions for terroristic trauma: Symptoms, syndromes, and treatment strategies.

Terrorist attacks combine features of criminal assaults, disasters, and acts of war. Accordingly, much of the clinical knowledge in treating this relatively new kind of traumatic event is adapted from experiences in treating victims of criminal assault, homicidal bereavement, natural and manmade disasters, war and political violence, workplace homicide, and school shootings. This article reviews the pertinent literature on these types of trauma and combines this information with the author's own experience in treating direct and indirect victims and survivors of recent terrorist attacks. The article describes the psychological syndromes resulting from terrorism and discusses crisis intervention, individual therapy, and family therapy modalities for treating victims of terror. Last, the role of mental health clinicians in the larger national and international response to terroristic trauma is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the quality of outpatient treatment for schizophrenia

OBJECTIVE: Usually it is not possible to study the initial systemic response in patients with acute pancreatitis in the first hours after onset of the disease. We used postendoscopic retrograde pancreatography (ERP) pancreatitis as a model to study cytokine and anticytokine release in the early phase of human acute pancreatitis. METHODS: Post-ERP pancreatitis was defined as a threefold increase in serum amylase and at least two of the following clinical symptoms: abdominal pain, nausea, vomiting or peritonism 24 h after ERP. Serum levels of pro-inflammatory cytokines interleukin-1beta (IL-1beta), interleukin-6 (IL-6), interleukin-8 (IL-8), tumour necrosis factor alpha (TNF), as well as endogenous antagonistic mediators of the systemic inflammatory response such as soluble tumour necrosis factor alpha receptors p55 (TNFR p55) and p75 (TNFR p75), and IL-1-receptor antagonist (IL-1-RA) and interleukin-2-receptor (IL-2R) as indicators of lymphocyte activation were measured before and 0, 1, 4, 12, 24 and 48 h after ERP. In nine patients with acute post-ERP pancreatitis, these parameters were monitored daily until C-reactive protein (CRP) was within normal ranges and were compared to patients without pancreatitis after ERP. RESULTS: IL-1beta was not detectable in five patients with and four patients without post-ERP pancreatitis. The values of the remaining patients in both groups were lower than 3.9 pg/ml. IL-8 and IL-1-RA serum concentrations peaked 12 h after ERP (132.9 and 3245.0 pg/ml respectively) compared to patients without post-ERP pancreatitis (25.8 and 389.9 pg/ml respectively). The IL-6 concentration increased to 81.6 pg/ml (8.0 pg/ml in control patients) 24 h after ERP, while the peak values for CRP were measured 72 h after ERP (164.0 versus 7.7 mg/l). IL-2R content was maximally elevated 144 h after ERP (688.8 versus 255.9 U/ml), while concentrations of TNF and its receptors showed no significant change over time. CONCLUSION: The initial response of the cytokine network to damage of the human pancreas leading to acute pancreatitis includes the release of IL-8 and the IL-1 antagonist IL-1-RA, while IL-1beta is not found in the systemic circulation. The TNF system does not seem to be involved as indicated by the lack of detectable changes in TNF and the soluble TNFR p55 and p75 serum concentrations. Lymphocyte activation as indicated by elevated IL-2R levels occurred days after the initial trauma. Even mild post-ERP pancreatitis leads to significant systemic release of cytokines and their biological counterparts.     

The shared image guiding the treatment process. A precondition for integration of the treatment of schizophrenia

The aim of the study reported here was to develop psychotherapeutic in-patient treatment for acute schizophrenia, following the principles of a need-adapted approach. To improve the integration of experiences which hospital staff have with acutely psychotic patients and their families, systematic supervision sessions were organised. In these sessions, it was possible to achieve shared psychological images through while the whole staff could integrate patients' behaviour and symptoms, both symbolic and non-symbolic. Such an image was called 'the shared image guiding the treatment process' (SIGTP). The process of achieving the SIGTP was interpreted through Peircean semiotics, especially the concepts of indexical, iconic, and symbolical signs. An SIGTP was considered to have been achieved in the early phase of the supervision process in 32 of the 54 cases. For the patients, SIGTP and the need-adaptation connected with it meant achieving a more realistic and more functional ordering of their experiences.     

Sexual offender recidivism revisited: A meta-analysis of recent treatment studies.

Meta-analyses were performed on 12 studies of treatment with sexual offenders (N?=?1,313). A small, but robust, overall effect size was found for treatment versus comparison conditions (r?=?.12). The overall recidivism rate for treated sexual offenders was .19 versus .27 for untreated sexual offenders. Treatment effect sizes across studies, however, were heterogeneous. Effect sizes were larger in studies that had higher base rates of recidivism, had follow-up periods longer than 5 years, included outpatients, and involved cognitive-behavioral or hormonal treatments. Cognitive-behavioral (p?p?     

Psychological interventions with AIDS and HIV: Prevention and treatment.

In the decade since AIDS was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with HIV conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and iv drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "2nd wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Conceptualization and treatment of paranoid schizophrenia: A deficit-discontinuity view.

Discusses the problems of obtaining trust and treating delusions in paranoid schizophrenia in the context of the conflict-continuity vs deficit-discontinuity debate regarding the development of the disorder. Therapeutic principles derived from a deficit-discontinuity model aimed at developing trust and attacking delusions are outlined. These principles include (1) always challenge a delusion; (2) provide simple explanations for faulty inferences, avoiding psychodynamic (genetic) interpretations; (3) teach generalization; (4) identify and encourage the avoidance of pathogenic environmental situations; (5) identify and utilize internal cues to prevent the emergence of delusional ideas; and (6) use medication when necessary. The model seeks to help patients control delusional ideas and unrealistic thoughts and to avoid situations that stimulate such thoughts. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Resistance: Psychodynamic and Behavioral Approaches.

[Correction Notice: An erratum for this article was reported in Vol 7(1) of Psychoanalytic Psychology (see record 2007-10573-001). In this review, the phrase "in his inimical style" (p.238) should read "in his inimitable style.] This three-part edited collection of chapters considers the problem of resistance in psychotherapy. The term is defined and considered from several radically difference psychological perspectives. The psychoanalytic approach in Part I consists of four chapters written by authorities in the field. The four chapters of Part II concern both cognitive and pure behavioral approaches. Part III contains eight brief chapters in which the authors were invited to comment on one author's contributions. In the main the authors remain focused and concise, but it is very obvious that resistance has a remarkably broad variety of definitions, and that some of these definitions are so different that the authors do not appear to be speaking of similar phenomena. What is also clear from this complicated edited collection is that the clinician needs to be much more flexible in his theoretical positions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychodynamic research perspectices on development, psychopathology, and treatment in later life.

Reports on a meeting held at the National Institute of Mental Health (NIMH). At this meeting, over 700 psychoanalysts and other mental health professionals and investigators gathered to consider research on the interplay of personality, biology, and society in shaping adaptation to aging. The convening of this meeting, co-sponsored by the Center for Studies of the Mental Health of the Aging and the Psychosocial Treatments Research Branch, marked the first time that NIMH had sponsored a conference in which the clinical and theoretical contributions of psychoanalysis to the study of normal and pathological development had been so explicitly recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the social validity of behavioral interventions: A review of treatment acceptability measures.

Increased attention to the construct of social validity in school psychology research and practice has resulted in a focus on treatment acceptability, the extent to which interventions are considered appropriate, effective, and fair. Questionnaires represent the typical measurement approach to treatment acceptability. This article reviews treatment acceptability measures and practices that have been developed and used to assess the social validity of behavioral interventions. A comparative framework was developed and applied to provide a systematic critique of 9 treatment acceptability measures along such dimensions as content and purpose of the instrument, psychometric properties, scoring procedures and interpretation, and use of the measure in research in practice. No one instrument was selected to be the most comprehensive and it is argued that treatment acceptability assessment practices need to move beyond the traditional questionnaire format. Alternatives to rating scales are presented and directions for future research regarding the measurement of treatment acceptability are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Behavioral rehabilitation of the "treatment-refractory" schizophrenia patient: Conceptual foundations, interventions, and outcome data.

This article describes an intensive, inpatient behavioral rehabilitation program for patients with schizophrenia who have been considered "treatment-refractory" at state hospitals. The program is a public-private partnership involving state and private hospitals and community residence providers. The essential elements of this program are described, along with the conceptual and philosophical bases of its treatment and examples of staff behaviors critical to treatment success. Outcome data are then discussed to emphasize the point that when evidence-based psychological treatment is implemented with this population, outcomes can be positive in most cases, and therefore, the number of treatment-refractory patients is actually far less than is estimated on the basis of response to medication alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)