Defining Dry Eye from a Clinical Perspective

Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.     

A General Role for Early Onset Cues and Intra-Event Learning; Comment on McDonald and Siegel (2004).

Research on classical conditioning with drug unconditional stimuli has had a profound effect on the understanding of general conditioning processes. The experiment reported by R. V. McDonald and S. Siegel (see record 2004-10475-001) demonstrates that cues coincident with the onset of an event can become associated with the rest of the event. This sort of learning is probably ubiquitous and has been proposed as a mechanism behind the development of panic disorder, in which interoceptive cues coincident with the start of a panic attack can be associated with the rest of the attack and can eventually come to elicit full-blown panic on their own. Evidence that extinction exposure to early onset cues can reduce their power is especially important. Drug conditioning research continues to provide a powerful testing ground for important general principles of learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroticism and depressive symptoms among spouse caregivers: Do health behaviors mediate this relationship?

This study examined the mediating role of health behaviors in the relationship between neuroticism and depressive symptoms among spouse caregivers. Path analysis was used to test a model of the caregiver stress process among 233 caregivers of people with dementia. Results indicate that neuroticism has a significant direct effect on depressive symptoms and also indirectly influences depressive symptoms through health behaviors and perceived stress. When individual health behaviors were examined in the path model, only physical activity served a significant mediating role. These findings suggest that neuroticism may lead to depressive symptoms among caregivers partly through declines in physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of depressive symptoms during short-term rehabilitation: An attempted replication of the DOUR project.

Objective: To replicate and extend P. A. Lichtenberg and colleagues' (1996) cross-disciplinary intervention to improve physical and mental health among older adults. Participants: 14 depressed older adults (6 treatment, 8 control). Setting: The short-term rehabilitation unit of an urban nursing home. Intervention: Occupational therapists were trained to treat depression using pleasant events and cognitive-behavioral therapies. Outcome Measures: Geriatric Depression Scale, the Short Form-12, and the Multi-Level Assessment Instrument: Activities of Daily Living. Results: No significant group differences were found in physical or mental health. However, more control group members (75%) than treatment group members (33%) were depressed at study completion. Conclusions: The treatment of depressive symptoms can be integrated with a nonmental health treatment modality. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Drug Onset Cues, Conditioned Withdrawal, and Drug Relapse: Comment on McDonald and Siegel (2004).

Previous research has shown that under certain conditions environmental cues associated with morphine administration induce drug-opposite conditioned effects that mimic symptoms of opiate withdrawal. R. V. McDonald and S. Siegel (see record 2004-10475-001) extend these observations by demonstrating that acute exposure to a low dose of morphine induces symptoms of opiate withdrawal in rats previously exposed to a high dose of morphine. They hypothesized that early drug onset cues, repeatedly paired with later, larger drug effects, mediate the paradoxical effect of the low drug dose on behavior. They also hypothesized that conditioned withdrawal symptoms induced by the early drug onset cues may mediate the "priming" effect of drugs on relapse and craving. The authors of this comment discuss the degree to which the literature supports this hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of formal thought disorder and referential communication disturbances in schizophrenia.

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients, whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories leading to school-age conduct problems.

The present study applied a semiparametric mixture model to a sample of 284 low-income boys to model developmental trajectories of overt conduct problems from ages 2 to 8. As in research on older children, 4 developmental trajectories were identified: a persistent problem trajectory, a high-level desister trajectory, a moderate-level desister trajectory, and a persistent low trajectory. Follow-up analyses indicated that initially high and low groups were differentiated in early childhood by high child fearlessness and elevated maternal depressive symptomatology. Persistent problem and high desister trajectories were differentiated by high child fearlessness and maternal rejecting parenting. The implications of the results for early intervention research are discussed, with an emphasis on the identification of at-risk parent-child dyads. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disentangling the Sources of Opioid Withdrawal Responses: Comment on McDonald and Siegel (2004).

R. V. McDonald and S. Siegel (see record 2004-10475-001) present new evidence for the idea that opioid drug-opposite responses can become conditioned to cues of initial drug onset and that they could, therefore, play a role in the development of tolerance of some drug effects and a role in the elicitation of withdrawal-like symptoms in cases in which addicted individuals are exposed to small doses of the drug they normally consume. In this comment, some puzzling features of the data are discussed, and alternative explanations are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms erode self-esteem in severe mental illness: A three-wave, cross-lagged study.

Vulnerability, scar, and reciprocal-relations models of depressive symptoms and self-esteem were compared among people with severe mental illness (SMI; N=260) participating in a partnership-based intervention study. Assessments were conducted at baseline, midway through the intervention (after 4 months), and at termination (after 9 months). Cross-lagged, structural equation modeling analyses revealed that participants' baseline depressive symptoms predicted a decrease in self-esteem in the first 4 months but not in the subsequent 5 months of participation. Exploratory regression analyses indicated that improved social functioning buffered this deleterious effect of depressive symptoms. These findings, which are consistent with the scar model, highlight the fragile nature of the self and the importance of social functioning in recovery from SMI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of perfectionism and personality disorder features in response to brief treatment for depression.

Using data from the Treatment of Depression Collaborative Research Program (TDCRP), the authors compared the role of patients' perfectionism and features of personality disorder (PD) in the outcome of brief treatment for depression. Data were extracted as to patients' intake levels of symptoms; perfectionism; and PD features, measured as continuous variables, as well as their symptoms at termination; their contribution to the therapeutic alliance; and their satisfaction with social relations. Poorer therapeutic outcome was demonstrated for patients with elevated levels of perfectionism and odd-eccentric and depressive PD features. Patients' contribution to therapeutic alliance and satisfaction with social relations were predicted by perfectionism but not by PD features. Results highlight the central role played by patients' personality in the course of brief treatment for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)