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The role of the TCI-R (Temperament Character Inventory) in individualized treatment plannning in a population of addicted professionals.

J Addict Dis. 2007;26 Suppl 1:51-64

Authors: Angres DH, Nielsen AK

This article discusses a multi-faceted treatment paradigm used to service professionals with addictive disorders. Individualized treatment plans are developed based on a multitude of factors including administration of the TCI-R (Temperament Character Inventory), MCMI-III (Millon Clinical Multiaxial Inventory) and the WASI (Wechsler Abbreviated Scale of Intelligence). Treatment goals include specific therapeutic interventions and patient and therapist-directed tasks related to enhanced development of the character dimensions of Self-Directedness, Cooperativeness and Self-Transcendence, as measured on Cloninger’s TCI-R inventory.

PMID: 19283974 [PubMed - indexed for MEDLINE]

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Underweight eating disorder without over-evaluation of shape and weight: Atypical anorexia nervosa?

Int J Eat Disord. 2008 Dec;41(8):705-12

Authors: Dalle Grave R, Calugi S, Marchesini G

OBJECTIVE: Underweight patients with eating disorder not otherwise specified without the over-evaluation of shape and weight (EDNOS-W) represent a diagnostic challenge. We aimed to evaluate their clinical characteristics and treatment outcome, compared with anorexia nervosa (AN) cases. METHOD: Eighty-eight consecutive patients (81 females; age range 13-50 years, 71 AN, and 17 EDNOS-W) were studied. The differential diagnosis of AN and EDNOS-W was based on the eating disorder examination. RESULTS: Compared with AN, EDNOS-W cases had a milder eating disorder psychopathology, but no differences in anthropometric and clinical data. The response to inpatient cognitive behavioral treatment was good and similar between groups, and no differences in the dropout rate or time-to-dropout were observed. The normalization of body weight in EDNOS-W cases was not associated with the appearance of the over-evaluation of shape and weight. CONCLUSION: The data gives preliminary support to the proposal to include EDNOS-W in the diagnosis of AN.

PMID: 18523958 [PubMed - indexed for MEDLINE]

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Examining the conceptual model of integrative cognitive-affective therapy for BN: Two assessment studies.

Int J Eat Disord. 2008 Dec;41(8):748-54

Authors: Wonderlich SA, Engel SG, Peterson CB, Robinson MD, Crosby RD, Mitchell JE, Smith TL, Klein MH, Lysne CM, Crow SJ, Strauman TJ, Simonich HK

OBJECTIVE: Two studies sought to examine predictions of the Integrative Cognitive-Affective Therapy (ICAT) model, which views bulimic symptoms in terms of inter-relations between self-concept discrepancies, negative affect, and self-directed coping styles. The present results examine assessment-related predictions of this model. METHOD: Individuals with bulimic symptoms were compared to noneating disorder control participants in two studies involving central constructs of the ICAT model. RESULTS: In both studies, bulimic individuals displayed higher levels of self-discrepancy and negative self-directed styles, supporting predictions of the model. Also predicted by the model, negative mood states mediated relations between bulimic status and negative self-directed coping styles in Study 2. CONCLUSION: Assessment-related predictions of the ICAT model of bulimic symptoms were supported in two studies. These initial results support further tests of the model in longitudinal designs, contrasts of different clinical populations, and treatment-evaluation studies.

PMID: 18528869 [PubMed - indexed for MEDLINE]

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Reducing overweight and obesity: closing the gap between primary care and public health.

Fam Pract. 2008 Dec;25 Suppl 1:i10-6

Authors: Anderson P

BACKGROUND: Although overweight and obesity are major risk factors for ill health and premature death, leading to significant increases in workload and prescribing costs, primary health care providers continue to find managing overweight and obesity a difficult business. OBJECTIVES: Six questions are addressed in an attempt to close the gap between primary care activities and public health goals to reduce overweight and obesity: what is overweight and obesity; what is the health impact of overweight and obesity; is individually directed advice effective in reducing overweight and obesity; can we increase the involvement of primary care in reducing overweight and obesity; how can public health actions complement the role of primary care; and how do we chose cost-effective interventions? METHOD: Systematic reviews and key texts were identified from literature searches to provide a narrative summary to answer the six questions. RESULTS: Overweight is defined as a body mass index (BMI) of > or = 25 and obesity as a BMI of > or = 30 where BMI = weight (kg)/height (m(2)). There is a positive relationship between the level of BMI and a wide range of conditions, including cancers and cardiovascular diseases. There is evidence that individually directed advice can reduce overweight and obesity or its risk. There is mixed evidence for the effectiveness of strategies in increasing the involvement of primary care in reducing overweight and obesity. There are many examples of public health actions that complement the role of primary care in reducing overweight and obesity. Overall cost-effective policy analyses have not been done per se for overweight and obesity but have shown that a combination of personal and non-personal interventions can be effective and cost-effective in reducing cardiovascular events. CONCLUSION: The gap between primary care and public health in reducing overweight and obesity can be closed, but it requires sustained political support and investment.

PMID: 18796703 [PubMed - indexed for MEDLINE]

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Lion - tiger - stripes: Neural correlates of indirect semantic priming across processing modalities.

Neuroimage. 2009 Mar 1;45(1):224-36

Authors: Sass K, Krach S, Sachs O, Kircher T

“Lions” do not have “stripes”. However, via the word “tiger” both words are closely connected within the semantic network. With the present study we pursued two goals: to detect neural correlates of (1) directly and indirectly related word pairs by means of priming, and (2) to assess the effect of presentation modality. Stimuli were presented with a short SOA of 350 ms as subjects performed a lexical decision task during fMRI measurement. Four experimental conditions were compared: directly related (picture-frame), indirectly related (anvil-nail), unrelated (steamboat-needle) and nonword trials (chalk-edan), presented in a uni- (word-word) and cross-modal (auditory-word) version. Behavioral data revealed a modality-independent priming effect only for direct semantic priming. On a neural level, directly linked words led to left-lateralized activations in fronto-temporo-parietal areas. Indirect priming led to right-hemispheric fronto-parietal signal changes. Common areas of activation for uni- and cross-modal priming were found within the left middle temporal gyrus and right precuneus for direct priming and within the right insula for indirect priming. The comparison of the semantic distances (direct>indirect) showed one region activated modality-independent: the precuneus. Direct priming is associated with activation clusters corresponding to a large left-lateralized network. Indirect priming recruits right-hemispheric regions, reflecting widespread semantic fields and attentional components. The modality-independent comparison of direct and indirect priming revealed common areas of activation supporting an amodal rather than multiple semantic systems. The activation related to semantic distances underpins the special role of the precuneus. This region is involved in semantic priming and association processing whereas episodic memory contents might be addressed.

PMID: 19026751 [PubMed - indexed for MEDLINE]

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Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain–a randomized controlled trial.

Pain. 2009 Feb;141(3):248-57

Authors: Wicksell RK, Melin L, Lekander M, Olsson GL

Although several studies have illustrated the effectiveness of cognitive behavior therapy (CBT) on adult pain patients, there are few randomized controlled trials on children and adolescents. There is particularly a need for studies on pediatric patients who are severely disabled by longstanding pain syndromes. Acceptance and Commitment Therapy, as an extension of traditional CBT, focuses on improving functioning and quality of life by increasing the patient’s ability to act effectively in concordance with personal values also in the presence of pain and distress. Following a pilot study, we sought to evaluate the effectiveness of an ACT-oriented intervention based on exposure and acceptance strategies and to compare this with a multidisciplinary treatment approach including amitriptyline (n=32). The ACT condition underwent a relatively brief treatment protocol of approximately 10 weekly sessions. Assessments were made before and immediately after treatment, as well as at 3.5 and 6.5 months follow-up. Prolonged treatment in the MDT group complicated comparisons between groups at follow-up assessments. Results showed substantial and sustained improvements for the ACT group. When follow-up assessments were included, ACT performed significantly better than MDT on perceived functional ability in relation to pain, pain intensity and to pain-related discomfort (intent-to-treat analyses). At post-treatment, significant differences in favor of the ACT condition were also seen in fear of re/injury or kinesiophobia, pain interference and in quality of life. Thus, results from the present study support previous findings and suggest the effectiveness of this ACT-oriented intervention for pediatric longstanding pain syndromes.

PMID: 19108951 [PubMed - indexed for MEDLINE]

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Enhancing daily functioning with exposure and acceptance strategies: an important stride in the development of psychological therapies for pediatric chronic pain.

Pain. 2009 Feb;141(3):189-90

Authors: Palermo TM

PMID: 19114294 [PubMed - indexed for MEDLINE]

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The development of a ‘best practice’ service for women in a medium-secure psychiatric setting: treatment components and evaluation.

Clin Psychol Psychother. 2008 Sep;15(5):304-19

Authors: Long CG, Fulton B, Hollin CR

The inadequacy of inpatient facilities for women with severe psychiatric and co-morbid difficulties has been repeatedly documented. The establishment of effective therapeutic programmes for women in medium psychiatric facilities is also in their infancy, and little research has been undertaken. This article describes the development of a ‘best practice’ psychological treatment programme for women with a dual diagnosis. Emphasis is placed on the need to develop further intensive gender-specific services using an established model for effective therapeutic service development. In addition to a detailed description of the group therapy programme, staff training initiatives, methods for ensuring treatment integrity and a methodology for service evaluation is given. Copyright (c) 2008 John Wiley & Sons, Ltd.

PMID: 19115450 [PubMed - indexed for MEDLINE]

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The hypothesis of an impact of ozone on the occurrence of completed and attempted suicides.

Med Hypotheses. 2009 Mar;72(3):338-41

Authors: Biermann T, Stilianakis N, Bleich S, Thürauf N, Kornhuber J, Reulbach U

Air pollution and its impact on human health are of growing concern throughout the world. Recent studies have mainly focussed on respiratory and vascular mortality. The existence of seasonality of ozone distribution and also of the occurrence of suicides as well as suicide attempts is generally accepted, though an interconnection of both phenomena has not yet been established. This hypothesis of an influence of ozone on the occurrence of suicidality was tested on preliminary data (1008 suicides and 917 suicide attempts from a larger epidemiological sample in Middle-Franconia from 2004 to 2007). A higher suicide rate than expected could be observed from July to September, whereas the rates of the suicide attempts did not show a seasonality in relation to ozone levels. To further strengthen the hypothesis, ozone levels differed significantly (T = -2.5; p = 0.014) between days where one or no suicide were observed (mean ozone: 79.8 microg/m(3); SD: 36.3) and days with two or more suicides (mean ozone: 86.4 microg/m(3); SD: 39.4). This phenomenon might be explained including sociological, biological as well as psychological effects. Sociologically, behaviour precipitating suicide might be influenced by climatic variables such as the weather or air pollution causing fatigue or cardio-respiratory symptoms influencing individual well-being in general thereby possibly leading to the decision to end one’s life. Biologically, ozone is able to influence the immune system, is a strong trigeminal irritant and might influence neurotransmitter systems such as serotonin, which are known to vary with season and play a major role in impulsivity, aggression, depression and thereby suicidality. Putative psychological explanations for the suicide peak in summer include the influence of a higher ambient temperature leading individuals to a more disinhibited, aggressive and violent behaviour possibly resulting in an increased proneness for suicidal acts that is influenced by ozone. This might lead one to speculate whether ozone is able to account - at least amongst others - for the seasonal distribution of suicides or might even be a causative agent in the multifactorial genesis of a suicide. If this hypothesis is found to be true, further research should focus on the underlying mechanisms. Furthermore, this might be a strong argument to further encourage environment protection.

PMID: 19027246 [PubMed - indexed for MEDLINE]

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Spacing extinction trials alleviates renewal and spontaneous recovery.

Learn Behav. 2009 Feb;37(1):60-73

Authors: Urcelay GP, Wheeler DS, Miller RR

Studies of extinction in classical conditioning situations can reveal techniques that maximize the effectiveness of exposure-based behavior therapies. In three experiments, we investigated the effect of varying the intertrial interval during an extinction treatment in a fear-conditioning preparation with rats as subjects. In Experiment 1, we found less fear at test (i.e., more effective extinction) when extinction trials were widely spaced, relative to intermediate or massed extinction trials. In Experiment 2, we used an ABA renewal procedure and observed that spaced trials attenuated renewal of conditioned fear relative to massed trials. In Experiment 3, we used a similar design, but instead of changing the physical context at the time of testing, we interposed a retention interval after the extinction treatment to produce a change in the temporal context. The results showed less spontaneous recovery of fear after spaced than after massed extinction trials. These results suggest that extinction is more enduring when the extinction trials are spaced rather than massed. Although the benefits of spacing trials are small when there is no contextual change from extinction to testing, a change in either physical or temporal context following massed extinction trials leads to a recovery from extinction, which is reduced when the trials are spaced.

PMID: 19122053 [PubMed - indexed for MEDLINE]

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