MED: Psychiatry Papers

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    Global mental health: the role of collaboration during the COVID-19 pandemic
    (2021) Hook, Kimberly; Carroll, Haley A.; Louis, Elizabeth F.; Prom, Maria C.; Stanton, Amelia M.; Bogdanov, Sergiy; Chiliza, Bonginkosi; Freier, Luisa Feline; Rukundo, Godfrey Zari; Ghebrehiwet, Senait; Borba, Christina P.C.; Fricchione, Gregory L.; Henderson, David C.
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    Prevalence and Predictors of Health Service Use among Iraqi Asylum Seekers in the Netherlands
    (D. Steinkopff-Verlag, 2007-8-3) Laban, Cornelis J.; Gernaat, Hajo B. P. E.; Komproe, Ivan H.; de Jong, Joop T.V.M.
    BACKGROUND. A long asylum procedure is associated with higher prevalence rates of psychiatric disorders, lower quality of life, higher disability and more physical health problems. Additional knowledge about health seeking behavior is necessary to guide governments and health professionals in their policies. OBJECTIVE. To measure service use among one of the biggest asylum seekers population in the Netherlands and to assess its relationships with predisposing and need variables (including post-migration living problems). METHOD. Two groups were randomly selected: Group 1 (n = 143), less than 6 months and Group 2 (n = 151), more than 2 years in the Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires, which contained instruments to measure psychiatric disorders, quality of life, disability, physical health and post-migration living problems. Use of preventive and curative (physical and mental) health services was measured and the relationship with predisposing and need risk factors was estimated with univariate and multivariate logistic regression analyses. RESULTS. A long asylum procedure is not associated with higher service use, except for mental health service use and drug use. Use of mental health services is, however, low compared to the prevalence of psychiatric disorders. Low quality of perceived general health and functional disability are the most important predictors of services use. Psychopathology predicts use of a medical specialist (non-psychiatrist), but does not predict mental health service use. CONCLUSION. A high percentage of asylum seekers with a psychiatric disorder is not getting adequate treatment. There is a mismatch between the type of health problem and the type of health service use. The various health services should work together in education, detection, referral and care in order to provide help to this group of patients.
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    Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11
    (Public Library of Science, 2009-8-4) Prigerson, Holly G.; Horowitz, Mardi J.; Jacobs, Selby C.; Parkes, Colin M.; Aslan, Mihaela; Goodkin, Karl; Raphael, Beverley; Marwit, Samuel J.; Wortman, Camille; Neimeyer, Robert A.; Bonanno, George; Block, Susan D.; Kissane, David; Boelen, Paul; Maercker, Andreas; Litz, Brett T.; Johnson, Jeffrey G.; First, Michael B.; Maciejewski, Paul K.
    Holly Prigerson and colleagues tested the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and care of bereaved individuals at heightened risk of persistent distress and dysfunction. BACKGROUND. Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. METHODS AND FINDINGS. A total of 291 bereaved respondents were interviewed three times, grouped as 0–6, 6–12, and 12–24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. CONCLUSIONS. The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11.
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    The Physician Clinical Support System-Buprenorphine (PCSS-B): A Novel Project to Expand/Improve Buprenorphine Treatment
    (Springer-Verlag, 2010-5-11) Egan, James E.; Casadonte, Paul; Gartenmann, Tracy; Martin, Judith; McCance-Katz, Elinore F.; Netherland, Julie; Renner, John A.; Weiss, Linda; Saxon, Andrew J.; Fiellin, David A.
    Opioid dependence is largely an undertreated medical condition in the United States. The introduction of buprenorphine has created the potential to expand access to and use of opioid agonist treatment in generalist settings. Physicians, however, often have limited training and experience providing this type of care. Some physicians believe having a mentoring relationship with an experienced provider during their initial introduction to the use of buprenorphine would ease implementation. Our goal was to describe the development, implementation, resources, and evaluation of the Physician Clinical Support System-Buprenorphine (PCSS-B), a federally funded program to improve access to and quality of treatment with buprenorphine. We provide a description of the PCSS-B, a national network of 88 trained physician mentors with expertise in buprenorphine treatment and skills in clinical education. We provide information regarding the use the PCSS-B core services including telephone, email and in-person support, a website, clinical guidances, a warmline and outreach to primary care and specialty organizations. Between July 2005 and July 2009, 67 mentors and 4 clinical experts reported providing mentoring services to 632 participants in 48 states, Washington DC and Puerto Rico. A total of 1,455 contacts were provided through email (45%), telephone (34%) and in-person visits (20%). Seventy-six percent of contacts addressed a clinical issue. Eighteen percent of contacts addressed a logistical issue. The number of contacts per participant ranged from 1–125. Between August 2005 and April 2009 there were 72,822 visits to the PCSS-B website with 179,678 pages viewed. Seven guidances were downloaded more than 1000 times. The warmline averaged more than 100 calls per month. The PCSS-B model provides support for a mentorship program to assist non-specialty physicians in the provision of buprenorphine and may serve as a model for dissemination of other types of care.
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    Development of a multi-layered psychosocial care system for children in areas of political violence
    (BioMed Central, 2010-6-16) Jordans, Mark J.D.; Tol, Wietse A.; Komproe, Ivan H.; Susanty, Dessy; Vallipuram, Anavarathan; Ntamatumba, Prudence; Lasuba, Amin C.; de Jong, Joop T.V.M.
    Few psychosocial and mental health care systems have been reported for children affected by political violence in low- and middle income settings and there is a paucity of research-supported recommendations. This paper describes a field tested multi-layered psychosocial care system for children (focus age between 8-14 years), aiming to translate common principles and guidelines into a comprehensive support package. This community-based approach includes different overlapping levels of interventions to address varying needs for support. These levels provide assessment and management of problems that range from the social-pedagogic domain to the psychosocial, the psychological and the psychiatric domains. Specific intervention methodologies and their rationale are described within the context of a four-country program (Burundi, Sri Lanka, Indonesia and Sudan). The paper aims to contribute to bridge the divide in the literature between guidelines, consensus & research and clinical practice in the field of psychosocial and mental health care in low- and middle-income countries.
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    The Alzheimer's Disease-Associated Amyloid β-Protein Is an Antimicrobial Peptide
    (Public Library of Science, 2010-3-3) Soscia, Stephanie J.; Kirby, James E.; Washicosky, Kevin J.; Tucker, Stephanie M.; Ingelsson, Martin; Hyman, Bradley; Burton, Mark A.; Goldstein, Lee E.; Duong, Scott; Tanzi, Rudolph E.; Moir, Robert D.
    BACKGROUND. The amyloid β-protein (Aβ) is believed to be the key mediator of Alzheimer's disease (AD) pathology. Aβ is most often characterized as an incidental catabolic byproduct that lacks a normal physiological role. However, Aβ has been shown to be a specific ligand for a number of different receptors and other molecules, transported by complex trafficking pathways, modulated in response to a variety of environmental stressors, and able to induce pro-inflammatory activities. METHODOLOGY/PRINCIPAL FINDINGS. Here, we provide data supporting an in vivo function for Aβ as an antimicrobial peptide (AMP). Experiments used established in vitro assays to compare antimicrobial activities of Aβ and LL-37, an archetypical human AMP. Findings reveal that Aβ exerts antimicrobial activity against eight common and clinically relevant microorganisms with a potency equivalent to, and in some cases greater than, LL-37. Furthermore, we show that AD whole brain homogenates have significantly higher antimicrobial activity than aged matched non-AD samples and that AMP action correlates with tissue Aβ levels. Consistent with Aβ-mediated activity, the increased antimicrobial action was ablated by immunodepletion of AD brain homogenates with anti-Aβ antibodies. CONCLUSIONS/SIGNIFICANCE. Our findings suggest Aβ is a hitherto unrecognized AMP that may normally function in the innate immune system. This finding stands in stark contrast to current models of Aβ-mediated pathology and has important implications for ongoing and future AD treatment strategies.
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    Genetic Influences in Emotional Dysfunction and Alcoholism-Related Brain Damage
    (Dove Medical Press, 2005) Oscar-Berman, Marlene; Bowirrat, Abdalla
    Alcoholism is a complex, multifactorial disorder involving problematic ethanol ingestion; it results from the interplay between genetic and environmental factors. Personality, likewise, is formed from a combination of inherited and acquired influences. Because selected dimensions of emotional temperament are associated with distinct neurochemical substrates contributing to specific personality phenotypes, certain aspects of abnormal emotional traits in alcoholics may be inherited. Emotions involve complex subjective experiences engaging multiple brain regions, most notably the cortex, limbic system, and cerebellum. Results of in vivo magnetic resonance imaging and post-mortem neuropathological studies of alcoholics indicate that the greatest cortical loss occurs in the frontal lobes, with concurrent thinning of the corpus callosum. Additional damage has been documented for the amygdala and hippocampus, as well as in the white matter of the cerebellum. All of the critical areas of alcoholism-related brain damage are important for normal emotional functioning. When changes occur in these brain regions, either as a consequence of chronic ethanol abuse or from a genetic anomaly affecting temperament and/or a vulnerability to alcoholism, corresponding changes in emotional functions are to be expected. In alcoholics, such changes have been observed in their perception and evaluation of emotional facial expressions, interpretation of emotional intonations in vocal utterances, and appreciation of the meaning of emotional materials.
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    Measurement of treatment adherence with antipsychotic agents in patients with schizophrenia
    (Dove Medical Press, 2009-10-12) Ren, Xinhua S.; Herz, Lawrence; Qian, Shirley; Smith, Eric; Kazis, Lewis E.
    The importance of medication adherence in sustaining control of schizophrenic symptoms has generated a great deal of interest in comparing levels of treatment adherence with different antipsychotic agents. However, the bulk of the research has yielded results that are often inconsistent. In this prospective, observational study, we assessed the measurement properties of 3 commonly used, pharmacy-based measures of treatment adherence with antipsychotic agents in schizophrenia using data from the Veterans Health Administration during 2000 to 2005. Patients were selected if they were on antipsychotics and diagnosed with schizophrenia (N = 18,425). A gap of ≥30 days (with no filled index medication) was used to define discontinuation of treatment as well as medication "episodes," or the number of times a patient returned to the same index agent after discontinuation of treatment within a 1-year period. The study found that the 3 existing measures differed in their approaches in measuring treatment adherence, suggesting that studies using these different measures would generate different levels of treatment adherence across antipsychotic agents. Considering the measurement problems associated with each existing approach, we offered a new, medication episode-specific approach, which would provide a fairer comparison of the levels of treatment adherence across different antipsychotic agents.
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    Activation instead of Blocking Mesolimbic Dopaminergic Reward Circuitry Is a Preferred Modality in the Long Term Treatment of Reward Deficiency Syndrome (RDS): A Commentary
    (BioMed Central, 2008-11-12) Blum, Kenneth; Chen, Amanda Lih-Chuan; Chen, Thomas J.H.; Braverman, Eric R.; Reinking, Jeffrey; Blum, Seth H.; Cassel, Kimberly; Downs, Bernard W.; Waite, Roger L.; Williams, Lonna; Prihoda, Thomas J.; Kerner, Mallory M.; Palomo, Tomas; Comings, David E.; Tung, Howard; Rhoades, Patrick; Oscar-Berman, Marlene
    BACKGROUND AND HYPOTHESIS. Based on neurochemical and genetic evidence, we suggest that both prevention and treatment of multiple addictions, such as dependence to alcohol, nicotine and glucose, should involve a biphasic approach. Thus, acute treatment should consist of preferential blocking of postsynaptic Nucleus Accumbens (NAc) dopamine receptors (D1-D5), whereas long term activation of the mesolimbic dopaminergic system should involve activation and/or release of Dopamine (DA) at the NAc site. Failure to do so will result in abnormal mood, behavior and potential suicide ideation. Individuals possessing a paucity of serotonergic and/or dopaminergic receptors, and an increased rate of synaptic DA catabolism due to high catabolic genotype of the COMT gene, are predisposed to self-medicating any substance or behavior that will activate DA release, including alcohol, opiates, psychostimulants, nicotine, gambling, sex, and even excessive internet gaming. Acute utilization of these substances and/or stimulatory behaviors induces a feeling of well being. Unfortunately, sustained and prolonged abuse leads to a toxic" pseudo feeling" of well being resulting in tolerance and disease or discomfort. Thus, a reduced number of DA receptors, due to carrying the DRD2 A1 allelic genotype, results in excessive craving behavior; whereas a normal or sufficient amount of DA receptors results in low craving behavior. In terms of preventing substance abuse, one goal would be to induce a proliferation of DA D2 receptors in genetically prone individuals. While in vivo experiments using a typical D2 receptor agonist induce down regulation, experiments in vitro have shown that constant stimulation of the DA receptor system via a known D2 agonist results in significant proliferation of D2 receptors in spite of genetic antecedents. In essence, D2 receptor stimulation signals negative feedback mechanisms in the mesolimbic system to induce mRNA expression causing proliferation of D2 receptors. PROPOSAL AND CONCLUSION. The authors propose that D2 receptor stimulation can be accomplished via the use of Synapatmine™, a natural but therapeutic nutraceutical formulation that potentially induces DA release, causing the same induction of D2-directed mRNA and thus proliferation of D2 receptors in the human. This proliferation of D2 receptors in turn will induce the attenuation of craving behavior. In fact as mentioned earlier, this model has been proven in research showing DNA-directed compensatory overexpression (a form of gene therapy) of the DRD2 receptors, resulting in a significant reduction in alcohol craving behavior in alcohol preferring rodents. Utilizing natural dopaminergic repletion therapy to promote long term dopaminergic activation will ultimately lead to a common, safe and effective modality to treat Reward Deficiency Syndrome (RDS) behaviors including Substance Use Disorders (SUD), Attention Deficit Hyperactivity Disorder (ADHD), Obesity and other reward deficient aberrant behaviors. This concept is further supported by the more comprehensive understanding of the role of dopamine in the NAc as a "wanting" messenger in the meso-limbic DA system.
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    Frontal Brain Dysfunction in Alcoholism with and without Antisocial Personality Disorder
    (Dove Medical Press, 2009-06-10) Oscar-Berman, Marlene; Valmas, Mary M.; Sawyer, Kayle S.; Kirkley, Shalene M.; Gansler, David A.; Merritt, Diane; Couture, Ashley
    Alcoholism and antisocial personality disorder (ASPD) often are comorbid conditions. Alcoholics, as well as nonalcoholic individuals with ASPD, exhibit behaviors associated with prefrontal brain dysfunction such as increased impulsivity and emotional dysregulation. These behaviors can influence drinking motives and patterns of consumption. Because few studies have investigated the combined association between ASPD and alcoholism on neuropsychological functioning, this study examined the influence of ASPD symptoms and alcoholism on tests sensitive to frontal brain deficits. The participants were 345 men and women. Of them, 144 were abstinent alcoholics (66 with ASPD symptoms), and 201 were nonalcoholic control participants (24 with ASPD symptoms). Performances among the groups were examined with Trails A and B tests, the Wisconsin Card Sorting Test, the Controlled Oral Word Association Test, the Ruff Figural Fluency Test, and Performance subtests of the Wechsler Adult Intelligence Scale. Measures of affect also were obtained. Multiple regression analyses showed that alcoholism, specific drinking variables (amount and duration of heavy drinking), and ASPD were significant predictors of frontal system and affective abnormalities. These effects were different for men and women. The findings suggested that the combination of alcoholism and ASPD leads to greater deficits than the sum of each.
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    Attention-Deficit-Hyperactivity Disorder and Reward Deficiency Syndrome
    (Dove Medical Press, 2008) Blum, Kenneth; Chen, Amanda Lih-Chuan; Braverman, Eric R.; Comings, David E.; Chen, Thomas J.H.; Arcuri, Vanessa; Blum, Seth H.; Downs, Bernard W.; Waite, Roger L.; Notaro, Alison; Lubar, Joel; Williams, Lonna; Prihoda, Thomas J.; Palomo, Tomas; Oscar-Berman, Marlene
    Molecular genetic studies have identified several genes that may mediate susceptibility to attention deficit hyperactivity disorder (ADHD). A consensus of the literature suggests that when there is a dysfunction in the "brain reward cascade," especially in the dopamine system, causing a low or hypo-dopaminergic trait, the brain may require dopamine for individuals to avoid unpleasant feelings. This high-risk genetic trait leads to multiple drug-seeking behaviors, because the drugs activate release of dopamine, which can diminish abnormal cravings. Moreover, this genetic trait is due in part to a form of a gene (DRD2 A1 allele) that prevents the expression of the normal laying down of dopamine receptors in brain reward sites. This gene, and others involved in neurophysiological processing of specific neurotransmitters, have been associated with deficient functions and predispose individuals to have a high risk for addictive, impulsive, and compulsive behavioral propensities. It has been proposed that genetic variants of dopaminergic genes and other "reward genes" are important common determinants of reward deficiency syndrome (RDS), which we hypothesize includes ADHD as a behavioral subtype. We further hypothesize that early diagnosis through genetic polymorphic identification in combination with DNA-based customized nutraceutical administration to young children may attenuate behavioral symptoms associated with ADHD. Moreover, it is concluded that dopamine and serotonin releasers might be useful therapeutic adjuncts for the treatment of other RDS behavioral subtypes, including addictions.
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    Rule Knowledge Aids Performance on Spatial and Object Alternation Tasks by Alcoholic Patients with and Without Korsakoff's Amnesia
    (Dove Medical Press, 2007) Bardenhagen, Fiona J.; Oscar-Berman, Marlene; Bowden, Stephen C.
    Delayed alternation (DA) and object alternation (OA) tasks traditionally have been used to measure defective response inhibition associated with dysfunction of frontal brain systems. However, these tasks are also sensitive to nonfrontal lesions, and cognitive processes such as the induction of rule-learning strategies also are needed in order to perform well on these tasks. Performance on DA and OA tasks was explored in 10 patients with alcohol-induced persisting amnestic disorder (Korsakoff's syndrome), 11 abstinent long-term alcoholics, and 13 healthy non-alcoholic controls under each of two rule provision conditions: Alternation Rule and Correction Rule. Results confirmed that rule knowledge is a crucial cognitive component for solving problems such as DA and OA, and therefore, that errors on these tasks are not due to defective response inhibition alone. Further, rule-induction strategies were helpful to Korsakoff patients, despite their poorer performance on the tasks. These results stress the role of multiple cognitive abilities in successful performance on rule induction tasks. Evidence that these cognitive abilities are served by diffusely distributed neural networks should be considered when interpreting behavioral impairments on these tasks.
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    Test of Variables of Attention (TOVA) as a Predictor of Early Attention Complaints, an Antecedent to Dementia
    (Dove Medical Press, 2010-10-15) Braverman, Eric R.; Chen, Amanda Lih-Chuan; Chen, Thomas J.H.; Schoolfield, John D.; Notaro, Alison; Braverman, Dasha; Kerner, Mallory; Blum, Seth H.; Arcuri, Vanessa; Varshavskiy, Michael; Damle, Uma; Downs, B. William; Waite, Roger L.; Oscar-Berman, Marlene; Giordano, John; Blum, Kenneth
    The goal of this study was to determine if impairments detected by the test of variables of attention (TOVA) may be used to predict early attention complaints and memory impairments accurately in a clinical setting. We performed a statistical analysis of outcomes in a patient population screened for attention deficit hyperactivity disorder or attention complaints, processing errors as measured by TOVA and the Wechsler Memory Scale (WMS-III) results. Attention deficit disorder (ADD) checklists, constructed using the Diagnostic and Statistical Manual of Mental Disorders 4th Edition criteria, which were completed by patients at PATH Medical, revealed that 72.8% of the patients had more than one attention complaint out of a total of 16 complaints, and 41.5% had more than five complaints. For the 128 males with a significant number of ADD complaints, individuals whose scores were significantly deviant or borderline (SDB) on TOVA, had a significantly greater number of attention complaints compared with normals for omissions (P > 0.02), response time (P > 0.015), and variability (P > 0.005), but not commissions (P < 0.50). For males, the mean scores for auditory, visual, immediate, and working memory scores as measured by the WMS-III were significantly greater for normals versus SDBs on the TOVA subtest, ie, omission (P > 0.01) and response time (P > 0.05), but not variability or commissions. The means for auditory, visual, and immediate memory scores were significantly greater for normals versus SDBs for variability (P > 0.045) only. In females, the mean scores for visual and working memory scores were significantly greater for normals versus SDBs for omissions (P > 0.025). The number of SDB TOVA quarters was a significant predictor for "impaired" or "normal" group membership for visual memory (P > 0.015), but not for the other three WMS-III components. For males, the partial correlation between the number of attention complaints and the number of SDB TOVA quarters was also significant (r = 0.251, P > 0.005). For the 152 females with a significant number of attention complaints, no significant differences between SDBs and normals were observed (P < 0.15). This is the first report, to our knowledge, which provides evidence that TOVA is an accurate predictor of early attention complaints and memory impairments in a clinical setting. This finding is more robust for males than for females between the ages of 40 and 90 years.
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    MRI parameters of Alzheimer's disease in an Arab population of Wadi Ara, Israel
    (Dove Medical Press, 2005) Bowirrat, Abdalla; Reider-Groswasser, Irith I.; Oscar-Berman, Marlene; Aizenstein, Orna; Levy, Gad; Korczyn, Amos D.
    Magnetic resonance imaging (MRI) findings are reported from 15 individuals in an Arab–Israeli community who were diagnosed with Alzheimer's disease (AD). The quantitative parameters that were used for MRI analyses included gradings (0–3) and linear measurements of different brain structures. Generalized tissue loss was assessed by combined measurements of the ventricles (ventricular score, VS) and sulcal grading and width (SG, SW, respectively). Loss of brain tissue in specific regions of interest, eg, temporal lobes, basal ganglia, and midbrain, was evaluated by precise measurements. We observed abnormal tissue characteristics, expressed as high intensity foci in white matter on T2W sequences, as well as tissue loss, both generalized and focal. Most notable were changes involving the head of the caudate nuclei, the midbrain, and to a lesser degree, medial temporal structures.
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    Benefits of Stimulus Congruency for Multisensory Facilitation of Visual Learning
    (Public Library of Science, 2008-1-30) Kim, Robyn S.; Seitz, Aaron R.; Shams, Ladan
    BACKGROUND. Studies of perceptual learning have largely focused on unisensory stimuli. However, multisensory interactions are ubiquitous in perception, even at early processing stages, and thus can potentially play a role in learning. Here, we examine the effect of auditory-visual congruency on visual learning. METHODOLOGY/PRINCIPLE FINDINGS. Subjects were trained over five days on a visual motion coherence detection task with either congruent audiovisual, or incongruent audiovisual stimuli. Comparing performance on visual-only trials, we find that training with congruent audiovisual stimuli produces significantly better learning than training with incongruent audiovisual stimuli or with only visual stimuli. CONCLUSIONS/SIGNIFICANCE. This advantage from stimulus congruency during training suggests that the benefits of multisensory training may result from audiovisual interactions at a perceptual rather than cognitive level.
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    Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome
    (Springer US, 2009-7-24) Allen, Laura B.; White, Kamila S.; Barlow, David H.; Shear, M. Katherine; Gorman, Jack M.; Woods, Scott W.
    Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed.
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    Brief screening for co-occurring disorders among women entering substance abuse treatment
    (BioMed Central, 2006-9-7) Lincoln, Alisa K.; Liebschutz, Jane M.; Chernoff, Miriam; Nguyen, Dana; Amaro, Hortensia
    BACKGROUND. Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374). RESULTS. Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness. CONCLUSION. Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment
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    Lack of Association between Angiotensin-Converting Enzyme and Dementia of the Alzheimer's Type in an Elderly Arab Population in Wadi Ara, Israel
    (Dove Medical Press, 2005) Bowirrat, Abdalla; Cui, Jing; Waraska, Kristin; Friedland, Robert P.; Oscar-Berman, Marlene; Farrer, Lindsay A.; Korczyn, Amos; Baldwin, Clinton T.
    The angiotensin-converting enzyme (ACE), a protease involved in blood pressure regulation, has been implicated as an important candidate gene for Alzheimer's disease (AD). This study investigated whether the ACE gene insertion–deletion (ID) polymorphism is associated with risk of developing dementia of Alzheimer's type (DAT) in an Arab–Israeli community, a unique genetic isolate where there is a high prevalence of DAT. In contrast to several other studies, we found no evidence of an association between this polymorphism and either DAT or age-related cognitive decline (ARCD).
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    Staying Cool When Things Get Hot: Emotion Regulation Modulates Neural Mechanisms of Memory Encoding
    (Frontiers Research Foundation, 2010-12-22) Hayes, Jasmeet Pannu; Morey, Rajendra A.; Petty, Christopher M.; Seth, Srishti; Smoski, Moria J.; McCarthy, Gregory; LaBar, Kevin S.
    During times of emotional stress, individuals often engage in emotion regulation to reduce the experiential and physiological impact of negative emotions. Interestingly, emotion regulation strategies also influence memory encoding of the event. Cognitive reappraisal is associated with enhanced memory while expressive suppression is associated with impaired explicit memory of the emotional event. However, the mechanism by which these emotion regulation strategies affect memory is unclear. We used event-related fMRI to investigate the neural mechanisms that give rise to memory formation during emotion regulation. Twenty-five participants viewed negative pictures while alternately engaging in cognitive reappraisal, expressive suppression, or passive viewing. As part of the subsequent memory design, participants returned to the laboratory two weeks later for a surprise memory test. Behavioral results showed a reduction in negative affect and a retention advantage for reappraised stimuli relative to the other conditions. Imaging results showed that successful encoding during reappraisal was uniquely associated with greater co-activation of the left inferior frontal gyrus, amygdala, and hippocampus, suggesting a possible role for elaborative encoding of negative memories. This study provides neurobehavioral evidence that engaging in cognitive reappraisal is advantageous to both affective and mnemonic processes.
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    In Vivo Expression of Polyglutamine-Expanded Huntingtin by Mouse Striatal Astrocytes Impairs Glutamate Transport: A Correlation with Huntington's Disease Subjects
    (Oxford University Press, 2010-05-21) Faideau, Mathilde; Kim, Jinho; Cormier, Kerry; Gilmore, Richard; Welch, Mackenzie; Auregan, Gwennaelle; Dufour, Noelle; Guillermier, Martine; Brouillet, Emmanuel; Hantraye, Philippe; Déglon, Nicole; Ferrante, Robert J.; Bonvento, Gilles
    Huntington's disease (HD) is a neurodegenerative disorder previously thought to be of primary neuronal origin, despite ubiquitous expression of mutant huntingtin (mHtt). We tested the hypothesis that mHtt expressed in astrocytes may contribute to the pathogenesis of HD. To better understand the contribution of astrocytes in HD in vivo, we developed a novel mouse model using lentiviral vectors that results in selective expression of mHtt into striatal astrocytes. Astrocytes expressing mHtt developed a progressive phenotype of reactive astrocytes that was characterized by a marked decreased expression of both glutamate transporters, GLAST and GLT-1, and of glutamate uptake. These effects were associated with neuronal dysfunction, as observed by a reduction in DARPP-32 and NR2B expression. Parallel studies in brain samples from HD subjects revealed early glial fibrillary acidic protein expression in striatal astrocytes from Grade 0 HD cases. Astrogliosis was associated with morphological changes that increased with severity of disease, from Grades 0 through 4 and was more prominent in the putamen. Combined immunofluorescence showed co-localization of mHtt in astrocytes in all striatal HD specimens, inclusive of Grade 0 HD. Consistent with the findings from experimental mice, there was a significant grade-dependent decrease in striatal GLT-1 expression from HD subjects. These findings suggest that the presence of mHtt in astrocytes alters glial glutamate transport capacity early in the disease process and may contribute to HD pathogenesis.