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Interaction between gene variants of the serotonin transporter promoter region (5-HTTLPR) and catechol O-methyltransferase (COMT) in borderline personality disorder.

Am J Med Genet B Neuropsychiatr Genet. 2009 Jun 5;150B(4):487-95

Authors: Tadić A, Victor A, Başkaya O, von Cube R, Hoch J, Kouti I, Anicker NJ, Höppner W, Lieb K, Dahmen N

Borderline personality disorder (BPD) is characterized by a heterogeneous symptomatology with instability in impulse control, interpersonal relationships and self-image. BPD patients display repeated self-injury, chronic suicidal tendencies and emotional dysregulation, mainly dysregulation of negative affect. In its etiology, genetic and environmental factors have been suggested. Recently, an investigation in male healthy volunteers found gene-gene effects of the catechol-O-methyl-transferase (COMT) low-activity (Met(158)) and the low-expression allele of the deletion/insertion (short/long or S/L, respectively) polymorphism in the serotonin transporter-linked promoter region (5-HTTLPR) on the central processing of aversive stimuli. The purpose of the present study was to test for association between BPD and the COMT Val(158)Met single nucleotide polymorphism (SNP), the 5-HTTLPR S/L variant and the interaction of these two gene variants. One hundred sixty one well-defined Caucasian BPD patients and 156 healthy controls were recruited from central Germany. In BPD patients, the genotype COMT Met(158)Met was over-represented compared to healthy controls (P = 0.0085; adjusted P = 0.034). We observed no differences in 5-HTTLPR genotypes between BPD and controls (P = 0.286). Additionally, the COMT Met(158)Met genotype was significantly over-represented in BPD patients carrying at least one 5-HTTLPR S allele (P = 0.0007; adjusted P = 0.028). Logistic regression analysis confirmed an interaction of the COMT Met(158) and the 5-HTTLPR S allele (P = 0.001). These data suggest an involvement of altered dopaminergic and/or noradrenergic neurotransmission as well as an interactive effect of COMT and 5-HTTLPR gene variants in the etiology of BPD, and underline the usefulness of analyses of gene-gene effects in diseases of complex inheritance with multiple genes involved.

PMID: 18756498 [PubMed - indexed for MEDLINE]

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Analysis of enacted difficult conversations in neonatal intensive care.

J Perinatol. 2009 Apr;29(4):310-6

Authors: Lamiani G, Meyer EC, Browning DM, Brodsky D, Todres ID

OBJECTIVE: To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. STUDY DESIGN: Physicians, nurses, social workers, and chaplains (n=50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS). RESULT: Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD=P<0.005; RN=P<0.05), focused more on family’s opinion and understanding (MD=P<0.01; RN=P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. CONCLUSION: Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.

PMID: 19148109 [PubMed - indexed for MEDLINE]

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Generalized anxiety disorder in older medical patients: diagnostic recognition, mental health management and service utilization.

J Clin Psychol Med Settings. 2009 Jun;16(2):178-85

Authors: Calleo J, Stanley MA, Greisinger A, Wehmanen O, Johnson M, Novy D, Wilson N, Kunik M

BACKGROUND: Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. METHODS: Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. RESULTS: Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, chi(2) (2, N = 225) = 4.75, p < .05. CONCLUSIONS: Most patients with anxiety do not have anxiety or symptoms documented in their medical records.

PMID: 19152056 [PubMed - indexed for MEDLINE]

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CBT for anxiety and associated somatic complaints in pediatric medical settings: an open pilot study.

J Clin Psychol Med Settings. 2009 Jun;16(2):169-77

Authors: Masia Warner C, Reigada LC, Fisher PH, Saborsky AL, Benkov KJ

OBJECTIVE: To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. BACKGROUND: Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. METHOD: Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. RESULTS: All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children’s physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. CONCLUSIONS: Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care.

PMID: 19152057 [PubMed - indexed for MEDLINE]

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Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates.

J Clin Psychol Med Settings. 2009 Jun;16(2):200-7

Authors: Lush E, Salmon P, Floyd A, Studts JL, Weissbecker I, Sephton SE

OBJECTIVES: Fibromyalgia, a chronic pain syndrome, is often accompanied by psychological distress and increased basal sympathetic tone. In a previous report it was shown that mindfulness-based stress-reduction (MBSR) reduced depressive symptoms in patients with fibromyalgia with gains maintained at two months follow-up (Sephton et al., Arthr Rheum 57:77-85, 2007). This second study explores the effects of MBSR on basal sympathetic (SNS) activation among women with fibromyalgia. METHODS: Participants (n = 24) responded to a television news appearance, newspaper, and radio advertisements. Effects on anxiety, depressive symptoms, and SNS activation measures were tested before and after MBSR using a within-subjects design. RESULTS: The MBSR treatment significantly reduced basal electrodermal (skin conductance level; SCL) activity (t = 3.298, p = .005) and SCL activity during meditation (t = 4.389, p = .001), consistent with reduced SNS activation. CONCLUSIONS: In this small sample, basal SNS activity was reduced following MBSR treatment. Future studies should assess how MBSR may help reduce negative psychological symptoms and attenuate SNS activation in fibromyalgia. Further clarification of psychological and physiological responses associated with fibromyalgia may lead to more beneficial treatment.

PMID: 19277851 [PubMed - indexed for MEDLINE]

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Suggested visual hallucinations in and out of hypnosis.

Conscious Cogn. 2009 Jun;18(2):494-9

Authors: Mazzoni G, Rotriquenz E, Carvalho C, Vannucci M, Roberts K, Kirsch I

We administered suggestions to see a gray-scale pattern as colored and a colored pattern in shades of gray to 30 high suggestible and eight low suggestible students. The suggestions were administered twice, once following the induction of hypnosis and once without an induction. Besides rating the degree of color they saw in the stimuli differently, participants also rated their states of consciousness as normal, relaxed, hypnotized, or deeply hypnotized. Reports of being hypnotized were limited to highly suggestible participants and only after the hypnotic induction had been administered. Reports of altered color perception were also limited to high suggestibles, but were roughly comparable regardless of whether hypnosis had been induced. These data indicate that suggestible individuals do not slip into a hypnotic state when given imaginative suggestions without the induction of hypnosis, but nevertheless report experiencing difficult suggestions for profound perceptual alterations that are pheonomenologically similar to what they report in hypnosis.

PMID: 19289292 [PubMed - indexed for MEDLINE]

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When 9 is not on the right: implications from number-form synesthesia.

Conscious Cogn. 2009 Jun;18(2):366-74

Authors: Gertner L, Henik A, Kadosh RC

Number-form synesthetes consciously experience numbers in spatially-defined locations. For non-synesthete individuals, a similar association of numbers and space appears in the form of an implicit mental number line as signified by the distance effect-reaction time decreases as the numerical distance between compared numbers increases. In the current experiment, three number-form synesthetes and two different non-synesthete control groups (Hebrew speaking and English speaking) performed a number comparison task. Synesthete participants exhibited a sizeable distance effect only when presented numbers were congruent with their number-form. In contrast, the controls exhibited a distance effect regardless of congruency or presentation type. The findings suggest that: (a) number-form synesthesia impairs the ability to represent numbers in a flexible manner according to task demands; (b) number-form synesthesia is a genuine tangible experience, triggered involuntarily; and (c) the classic mental number line can be more pliable than previously thought and appears to be independent of cultural-lingo direction.

PMID: 19297197 [PubMed - indexed for MEDLINE]

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Integrating simulated teaching/learning strategies in undergraduate nursing education.

Int J Nurs Educ Scholarsh. 2009;6(1):Article7

Authors: Sinclair B, Ferguson K

In this article, the results of a mixed-methods study integrating the use of simulations in a nursing theory course in order to assess students’ perceptions of self-efficacy for nursing practice are presented. Nursing students in an intervention group were exposed to a combination of lecture and simulation, and then asked to rate their perceptions of self-efficacy, satisfaction and effectiveness of this combined teaching and learning strategy. Based on Bandura’s (1977, 1986) theory of self-efficacy, this study provides data to suggest that students’ self-confidence for nursing practice may be increased through the use of simulation as a method of teaching and learning. Students also reported higher levels of satisfaction, effectiveness and consistency with their learning style when exposed to the combination of lecture and simulation than the control group, who were exposed to lecture as the only method of teaching and learning.

PMID: 19341357 [PubMed - indexed for MEDLINE]

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The influence of instructions and terminology on the accuracy of remember-know judgments.

Conscious Cogn. 2009 Jun;18(2):401-13

Authors: McCabe DP, Geraci LD

The remember-know paradigm is one of the most widely used procedures to examine the subjective experience associated with memory retrieval. We examined how the terminology and instructions used to describe the experiences of remembering and knowing affected remember-know judgments. In Experiment 1 we found that using neutral terms, i.e., Type A memory and Type B memory, to describe the experiences of remembering and knowing reduced remember false alarms for younger and older adults as compared to using the terms Remember and Know, thereby increasing overall memory accuracy in the neutral terminology condition. In Experiment 2 we found that using what we call source-specific remember-know instructions, which were intended to constrain remember judgments to recollective experiences arising only from the study context, reduced remember hits and false alarms, and increased know hits and false alarms. Based on these data and other considerations, we conclude that researchers should use neutral terminology and source-specific instructions to collect the most accurate reports of the experiences of remembering and knowing arising from the study context.

PMID: 19344688 [PubMed - indexed for MEDLINE]

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Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder.

J Psychiatry Neurosci. 2009 May;34(3):175-80

Authors: Konarski JZ, Kennedy SH, Segal ZV, Lau MA, Bieling PJ, McIntyre RS, Mayberg HS

BACKGROUND: Longitudinal neuroimaging investigations of antidepressant treatment offer the opportunity to identify potential baseline biomarkers associated with poor outcome. METHODS: To explore the neural correlates of nonresponse to cognitive behavioural therapy (CBT) or venlafaxine (VEN), we compared pretreatment (18)F-fluoro-2-deoxy-d-glucose positron emission tomography scans of participants with major depressive disorder responding to either 16 weeks of CBT (n = 7) or VEN treatment (n = 9) with treatment nonresponders (n = 8). RESULTS: Nonresponders to CBT or VEN, in contrast to responders, exhibited pretreatment hypermetabolism at the interface of the pregenual and subgenual cingulate cortices. LIMITATIONS: Limitations of our study include the small sample sizes and the absence of both arterial sampling to determine absolute glucose metabolism and high-resolution structural magnetic resonance imaging coregistration for region-of-interest analyses. CONCLUSION: Our current findings are consistent with those reported in previous studies of relative hyperactivity in the ventral anterior cingulate cortex in treatment-resistant populations.

PMID: 19448846 [PubMed - indexed for MEDLINE]

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