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Manifest psychosis in neurosyphilis.

Gen Hosp Psychiatry. 2009 Jul-Aug;31(4):379-81

Authors: Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M

INTRODUCTION: Recent surveys have assessed a remarkable increase in the prevalence of infectious syphilis. If left untreated, 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. CASE REPORT: The authors present a case of an acute psychosis during and after pregnancy in a 37-year-old woman, which was identified as a manifestation of neurosyphilis after admission to a psychiatric ward. The positive screening test for syphilis provided the first hint of syphilis and gave direction for further diagnosis and specific treatment. Subsequently, the patient was treated with psychotropic medication concurrent with an adequate antibiotic treatment for neurosyphilis and was simultaneously psychologically monitored. An improvement of psychotic symptoms during antibiotic therapy was observed. CONCLUSION: This case emphasises that neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases. Owing to current epidemiological data and difficulties in diagnosing syphilis, routine screening tests in the psychiatric field are necessary.

PMID: 19555800 [PubMed - indexed for MEDLINE]

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How to deal with cost differences at baseline.

Pharmacoeconomics. 2009;27(6):519-28

Authors: van Asselt AD, van Mastrigt GA, Dirksen CD, Arntz A, Severens JL, Kessels AG

To our knowledge, adjustment for baseline imbalances in costs has never been performed in trial-based cost-effectiveness analyses. We used data from a clinical trial performed in the Netherlands comparing two outpatient psychotherapies: schema-focused therapy (SFT) versus transference-focused psychotherapy (TFP). Costs were assessed with a cost interview. Outcome was the proportion of recovered patients measured with the Borderline Personality Disorder Severity Index (BPDSI-IV). We used three methods to adjust the costs for baseline differences: (i) mean difference adjustment, calculating total costs after baseline by adjusting the difference between groups with the difference of the mean baseline costs; (ii) delta adjustment, calculating the individual differences between patient baseline and the subsequent measurements (concerning incremental costs, this is the same as mean difference adjustment); and (iii) regression-based adjustment, adjusting total costs with a regression model, with total costs as the dependent variable and baseline costs as the independent variable. Mean baseline costs were euro3339 for SFT and euro4238 for TFP, a mean difference of euro899. Total unadjusted follow-up costs were euro30 822 for SFT and euro36 812 for TFP. The fraction of recovered patients was 45% for SFT and 24% for TFP. Cost-effectiveness acceptability curves show that mean difference and delta adjustments are different from the regression-based methods. Although the routine starting point of an analysis should always be an unadjusted analysis of the cost effectiveness, a baseline difference between treatment groups should be adjusted for. This should be done by reported patient characteristics or, when these are not sufficiently present, by baseline costs as a substitute. This adjustment should be carried out most preferably with a regression-based method.

PMID: 19640014 [PubMed - in process]

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When cancer is associated with illness but no longer with animal or zodiac sign: Investigation of biased semantic networks in obsessive-compulsive disorder (OCD).

J Anxiety Disord. 2009 Jul 8;

Authors: Jelinek L, Hottenrott B, Moritz S

Building upon semantic network models, it is proposed that individuals with obsessive-compulsive disorder (OCD) process ambiguous words (e.g., homographs such as cancer) preferably in the context of the OC meaning (i.e., illness) and connect them to a lesser degree to other (neutral) cognitions (e.g., animal). To investigate this assumption, a new task was designed requiring participants to generate up to five associations for different cue words. Cue words were either emotionally neutral, negative or OC-relevant. Two thirds of the items were homographs, while the rest was unambiguous. Twenty-five OCD and 21 healthy participants were recruited via internet. Analyses reveal that OCD participants produced significantly more negative and OC-relevant associations than controls, supporting the assumption of biased associative networks in OCD. The findings support the use of psychological interventions such as Association Splitting that aim at restructuring associative networks in OCD by broadening the semantic scope of OC cognitions.

PMID: 19640676 [PubMed - as supplied by publisher]

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From Prototype to Product: Development of a Primary Care/Internet Based Depression Prevention Intervention for Adolescents (CATCH-IT).

Community Ment Health J. 2009 Jul 30;

Authors: Landback J, Prochaska M, Ellis J, Dmochowska K, Kuwabara SA, Gladstone T, Larson J, Stuart S, Gollan J, Bell C, Bradford N, Reinecke M, Fogel J, Van Voorhees BW

We describe the prototype to product development process of a low cost, socio-culturally relevant, easily implemented Internet-based depression prevention intervention for adolescents in primary care. The intervention named “Project CATCH-IT” (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training) includes an initial motivational interview in primary care to engage the adolescent, fourteen Web-based modules based on behavioral activation, cognitive behavioral and interpersonal psychotherapy which target known risk factors, and a follow-up motivational interview in primary care. This was successfully fielded in a pilot study with 25 adolescents. We know of no other similar interventions developed for the prevention of depression in youth that is potentially universally available at low cost and that utilizes existing systems of healthcare providers.

PMID: 19641992 [PubMed - as supplied by publisher]

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[Telemedicine and psychotherapy–empathy through distant cyberspace?]

Psychother Psychosom Med Psychol. 2009 Aug;59(8):289-90

Authors: Teufel M, Giel KE, Zipfel S

PMID: 19642058 [PubMed - in process]

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Emotional learning during dissociative states in borderline personality disorder.

J Psychiatry Neurosci. 2009 May;34(3):214-22

Authors: Ebner-Priemer UW, Mauchnik J, Kleindienst N, Schmahl C, Peper M, Rosenthal MZ, Flor H, Bohus M

BACKGROUND: Neurobiological findings and clinical data suggest that dissociative experience inhibits conditioning processes, but experimental studies are lacking. The aim of our study was to determine whether high states of dissociative experience would specifically alter emotional learning, but not declarative knowledge. METHODS: We used an aversive differential delay conditioning procedure in 33 unmedicated patients with borderline personality disorder (BPD) and 35 healthy controls. RESULTS: Patients with BPD who had high state dissociative experiences (BPD D+) showed diminished acquisition of differential aversive delay conditioning with respect to emotional learning compared with those who did not experience dissociative symptoms (BPD D-) and healthy controls (skin conductance response; interaction dissociation x quadratic time x type, p = 0.009). Specifically, the control group and the BPD D- subgroup showed an increase in valence and arousal to the conditioned stimulus (CS+) during the conditioning procedure (all p < 0.012) and demonstrated differential skin conductance responses in the acquisition and extinction phases. In contrast, the BPD D+ subgroup showed no increase in valence and arousal to CS+ or differential response regarding skin conductance. We examined general psychopathology, trauma history, perceptual differences and posttraumatic stress disorder as confounding factors, but we found no evidence of bias. LIMITATIONS: Subdividing the BPD group reduced power. In addition, because our sample included only women, the generalizability of our results is constrained. Furthermore, we performed no separate analysis of the influence of different aspects of dissociation on the learning process. CONCLUSION: Emotional, amygdala-based learning processes seem to be inhibited during state dissociative experience. State dissociative experience may alter acquisition and extinction processes and should be closely monitored in exposure-based psychotherapy.

PMID: 19448852 [PubMed - indexed for MEDLINE]

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The U.S. Food and Drug Administration has published three draft guidances designed to help growers and others across the entire supply chain minimize or eliminate microbial contamination in tomatoes, leafy greens, and melons.

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This guidance is intended to assist domestic firms and foreign firms exporting leafy greens into the United States (U.S.) by recommending practices to minimize the microbial food safety hazards of the products throughout the entire leafy greens supply chain.

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[Role playing as an essential element of simulation procedures in medicine]

Z Evid Fortbild Qual Gesundhwes. 2008;102(10):642-7

Authors: Dieckmann P, Rall M, Eich C, Schnabel K, Jünger J, Nikendei C

Role playing is an important element of virtually all simulation-based procedures. An improved understanding for methodological aspects facilitates its goal-oriented use in education and training, research and examinations. In the present paper we describe how different forms of role play are used in different simulation-based procedures. We describe a plausibility study from skills labs demonstrating that the introduction of role-playing can increase perceived realism. Finally we derive practical suggestions for the conduction of role plays in medical simulation.

PMID: 19402351 [PubMed - indexed for MEDLINE]

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Dynamic pupillary exchange engages brain regions encoding social salience.

Soc Neurosci. 2009;4(3):233-43

Authors: Harrison NA, Gray MA, Critchley HD

Covert exchange of autonomic responses may shape social affective behavior, as observed in mirroring of pupillary responses during sadness processing. We examined how, independent of facial emotional expression, dynamic coherence between one’s own and another’s pupil size modulates regional brain activity. Fourteen subjects viewed pairs of eye stimuli while undergoing fMRI. Using continuous pupillometry biofeedback, the size of the observed pupils was varied, correlating positively or negatively with changes in participants’ own pupils. Viewing both static and dynamic stimuli activated right fusiform gyrus. Observing dynamically changing pupils activated STS and amygdala, regions engaged by non-static and salient facial features. Discordance between observed and observer’s pupillary changes enhanced activity within bilateral anterior insula, left amygdala and anterior cingulate. In contrast, processing positively correlated pupils enhanced activity within left frontal operculum. Our findings suggest pupillary signals are monitored continuously during social interactions and that incongruent changes activate brain regions involved in tracking motivational salience and attentionally meaningful information. Naturalistically, dynamic coherence in pupillary change follows fluctuations in ambient light. Correspondingly, in social contexts discordant pupil response is likely to reflect divergence of dispositional state. Our data provide empirical evidence for an autonomically mediated extension of forward models of motor control into social interaction.

PMID: 19048432 [PubMed - indexed for MEDLINE]

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