Creation of a Psychotic Disorders Research Advisory Board as a Shared Resource

Community engagement is important for research, yet many researchers do not routinely seek feedback from people with lived experience. A key barrier to this engagement is that the resources required to create an advisory board may be unavailable to individual investigators, and creating an advisory board for a single study may often be impractical. In this column, the authors describe how to create a standing research advisory board that can serve as a shared resource for researchers and community members and provide a psychosis research advisory board example to aid discussion.

Readiness for treatment predicts depression outcomes in a partial hospital program

Evidence-based interventions vary in effectiveness for individuals with depression, which has a large public health burden. Readiness for change or treatment can be an important individual difference predictor of depression outcomes. To inform public service initiatives targeting readiness for treatment, characterizing readiness across settings and levels of care is key. However, limited data exist on the role of readiness for treatment in acute psychiatric settings and in particular, partial hospital programs which are key points in the continuity of inpatient and outpatient care. The present study assessed readiness for treatment in terms of importance, confidence, and motivation to engage in a partial hospital program and tested whether higher levels of readiness were associated with better treatment outcomes among clients with depression. Participants (N = 192) with major depressive disorder rated their readiness for treatment (Readiness Rulers), depression (Patient Health Questionnaire-9), and global improvement (Clinical Global Impression Scale-Improvement Self-Report) while enrolled in a partial hospital program. Generalized linear regression models assessed the effect of baseline readiness on outcomes at discharge, adjusted for baseline level of the outcome, age, sex, race, and ethnicity. Greater baseline readiness predicted reduced depression and better global improvement at discharge. Higher confidence and motivation to engage in treatment, but not importance, were associated with better depression outcomes. Identifying and addressing readiness for treatment by leveraging public health systems and services (e.g., help lines, family interventions) prior to or upon starting a partial hospital program may be useful to maximize gains in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pilot development and feasibility of telehealth Community Reinforcement and Family Training (CRAFT) for early psychosis and substance use

Substance use is associated with poor outcomes for individuals with early psychosis. Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that helps families to reduce substance use, engage in treatment, and improve family wellbeing, but it has not yet been studied for psychosis and substance use. The present study aimed to develop and evaluate a telehealth intervention utilizing CRAFT for families experiencing early psychosis and substance use. Twenty family members completed six to eight telehealth sessions of CRAFT adapted for early psychosis (CRAFT-EP). Participants completed an assessment battery at baseline, mid- and post-intervention, a three-month follow-up, surveys after each session, and a focus group to measure mean percentage of sessions completed, mean program satisfaction ratings, telehealth preference, and qualitative feedback. Participants had 100% session completion, and program satisfaction was at or near excellent for 99% of sessions. Half of participants preferred a primarily virtual hybrid program, whereas 45% preferred exclusively virtual visits. Communication was the most helpful topic, and participants requested additional written examples and resources. CRAFT-EP is feasible and acceptable to serve as the active intervention in a pilot randomized controlled trial comparing treatment as usual plus CRAFT-EP to treatment as usual.

Distressed and distracted by COVID-19 during high-stakes virtual interviews: The role of job interview anxiety on performance and reactions

Employers have increasingly turned to virtual interviews to facilitate online, socially distanced selection processes in the face of the COVID-19 pandemic. However, there is little understanding about the experience of job candidates in these virtual interview contexts. We draw from Event System Theory (Morgeson et al., 2015) to advance and test a conceptual model that focuses on a high-stress, high-stakes setting and integrates literatures on workplace stress with literatures on applicant reactions. We predict that when applicants ruminate about COVID-19 during an interview and have higher levels of COVID-19 exhaustion, they will have higher levels of anxiety during virtual interviews, which in turn relates to reduced interview performance, lower perceptions of fairness, and reduced intentions to recommend the organization. Further, we predict that three factors capturing COVID-19 as an enduring and impactful event (COVID-19 duration, COVID-19 cases, COVID-19 deaths) will be positively related to COVID-19 exhaustion. We tested our propositions with 8,343 job applicants across 373 companies and 93 countries/regions. Consistent with predictions, we found a positive relationship between COVID-19 rumination and interview anxiety, and this relationship was stronger for applicants who experienced higher (vs. lower) levels of COVID-19 exhaustion. In turn, interview anxiety was negatively related to interview performance, fairness perceptions, and recommendation intentions. Moreover, using a relevant subset of the data (n = 6,136), we found that COVID-19 duration and deaths were positively related to COVID-19 exhaustion. This research offers several insights for understanding the virtual interview experience embedded in the pandemic and advances the literature on applicant reactions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Working through an "infodemic": The impact of COVID-19 news consumption on employee uncertainty and work behaviors

Uncertainty is a defining feature of the COVID-19 pandemic. However, because uncertainty is an aversive state, uncertainty reduction theory (URT) holds that employees try to manage it by obtaining information. To date, most evidence for the effectiveness of obtaining information to reduce uncertainty stems from research conducted in relatively stable contexts wherein employees can acquire consistent information. Yet, research on crises and news consumption provides reasons to believe that the potential for information to mitigate uncertainty as specified by URT may break down during crises such as the COVID-19 pandemic. Integrating URT with research on crises and news consumption, we predict that consuming news information during crises-which tends to be distressing, constantly evolving, and inconsistent-will be positively related to uncertainty. This in turn may have negative implications for employee goal progress and creativity; two work outcomes that take on substantial significance in times of uncertainty and the pandemic. We further predict that death anxiety will moderate this relationship, such that the link between employees' news consumption and uncertainty is stronger for those with lower levels of death anxiety, compared to those with higher levels. We test our theorizing via an experience-sampling study with 180 full-time employees, with results providing support for our conceptual model. Our study reveals important theoretical and practical implications regarding information consumption during crises such as the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A work-family enrichment intervention: Transferring resources across life domains

This study expands the work-family enrichment literature by integrating enrichment theory (Greenhaus & Powell, 2006), social-cognitive theory (Bandura, 2001), capitalization theory (e.g., Gable, Reis, Impett, & Asher, 2004), and creative cognition theory (e.g., Smith, Ward, & Finke, 1995), in order to advance a novel conceptual model of the effects of resource transfer training on enrichment and job satisfaction. The model was tested by developing and evaluating a work-to-family enrichment training program, the Resource Transfer Training, which was based on Greenhaus and Powell's (2006) enrichment theory and interpersonal capitalization theory (Ilies, Keeney, & Scott, 2011). The training was administered to 163 administrative employees using a longitudinal prepost experimental design. Consistent with hypotheses, findings indicated that, compared to a control training condition, the Resource Transfer Training increased development-based enrichment from work to family (the transfer of skills, knowledge and values). Furthermore, the effect of the training on both development-based and affect-based enrichment (the transfer of positive affect) was mediated by enrichment self-efficacy, and the indirect effects of the training on enrichment were moderated by initial social-emotional work resources. Finally, as hypothesized, enrichment self-efficacy and enrichment experiences sequentially mediated the effect of the training on job satisfaction. This work advances theory by demonstrating that human agency can facilitate enrichment experiences across roles, and by exploring new antecedents of enrichment through theoretically driven training components. It advances practice by devising and testing a work-to-family enrichment intervention that can serve as a tool for organizations to increase positive synergy between work and nonwork roles. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Working in a pandemic: Exploring the impact of COVID-19 health anxiety on work, family, and health outcomes

The COVID-19 pandemic has unhinged the lives of employees across the globe, yet there is little understanding of how COVID-19 health anxiety (CovH anxiety)-that is, feelings of fear and apprehension about having or contracting COVID-19-impacts critical work, home, and health outcomes. In the current study, we integrate transactional stress theory (Lazarus & Folkman, 1984) with self-determination theory (Deci & Ryan, 2000) to advance and test a model predicting that CovH anxiety prompts individuals to suppress emotions, which has detrimental implications for their psychological need fulfillment. In turn, lack of psychological need fulfillment hinders employees' abilities to work effectively, engage with their family, and experience heightened well-being. Our model further predicts that handwashing frequency-a form of problem-focused coping-will mitigate the effects of CovH anxiety. We test our propositions using a longitudinal design that followed 503 employees across the first four weeks that stay-at-home and social distancing orders were enacted. Consistent with predictions, CovH anxiety was found to impair critical work (goal progress), home (family engagement) and health (somatic complaints) outcomes due to increased emotion suppression and lack of psychological need fulfillment. Further, individuals who frequently engage in handwashing behavior were buffered from the negative impact of CovH anxiety. Combined, our work integrates and extends existing theory and has a number of important practical implications. Our research represents a first step to understanding the work-, home-, and health-related implications of this unprecedented situation, highlighting the detrimental impact of the anxiety stemming from the COVID-19 pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Functional connectivity in distinct cognitive subtypes in psychosis

BACKGROUND

Cognitive dysfunction is common in psychotic disorders, and may reflect underlying pathophysiology. However, substantial cognitive heterogeneity exists both within and between diagnostic categories, creating challenges for studying the neurobiology of cognitive dysfunction in patients. The aim of this study was to identify patients with psychosis with intact versus impaired cognitive profiles, and to examine resting state functional connectivity between patient groups and compared to healthy controls to determine the extent to which patterns of connectivity are overlapping or distinct.

METHODS

Participants with affective or non-affective psychosis (n=120) and healthy controls (n=31) were administered the MATRICS Consensus Cognitive Battery, clinical and community functioning assessments, and an fMRI scan to measure resting state functional connectivity (RSFC). Cognitive composite scores were used to identify groups of patients with and without cognitive dysfunction. RSFC was compared between groups of patients and healthy controls, controlling for demographic and clinical variables.

RESULTS

Both cognitively intact and cognitively impaired patients showed decreased intrinsic connectivity compared to controls in frontoparietal control (FPN) and motor networks. Patients with cognitive impairment showed additional reductions in FPN connectivity compared to patients with intact cognition, particularly in subnetwork A.

CONCLUSIONS

We leveraged the heterogeneity in cognitive ability among patients with psychosis to disentangle the relative contributions of cognitive dysfunction and presence of an underlying psychotic illness using resting state functional connectivity. These findings suggest at least partially separable effects of presence of a psychotic disorder and neurocognitive impairment contributing to network dysconnectivity in psychosis.

Sex differences in tobacco smokers: Executive control network and frontostriatal connectivity

BACKGROUND

Women experience greater difficulty quitting smoking than men, which may be explained by sex differences in brain circuitry underlying cognitive control. Prior work has linked reduced interhemispheric executive control network (ECN) coupling with poor executive function, shorter time to relapse, and greater substance use. Lower structural connectivity between a key ECN hub, the dorsolateral prefrontal cortex (DLPFC), and the dorsal striatum (DS) also contributes to less efficient cognitive control recruitment, and reduced intrahemispheric connectivity between these regions has been associated with smoking relapse. Therefore, sex differences were probed by evaluating interhemispheric ECN and intrahemispheric DLPFC-DS connectivity. To assess the potential sex by nicotine interaction, a pilot sample of non-smokers was evaluated following acute nicotine and placebo administration.

METHODS

Thirty-five smokers (19 women) completed one resting state functional magnetic resonance imaging scan. Seventeen non-smokers (8 women) were scanned twice using a repeated measures design where they received 2 and 0 mg nicotine.

RESULTS

In smokers, women had less interhemispheric ECN and DLPFC-DS coupling than men. In non-smokers, there was a drug x sex interaction where women, relative to men, had weaker ECN coupling following nicotine but not placebo administration.

CONCLUSIONS

The current work indicates that nicotine-dependent women, versus men, have weaker connectivity in brain networks critically implicated in cognitive control. How these connectivity differences contribute to the behavioral aspects of smoking requires more testing. However, building on the literature, it is likely these deficits in functional connectivity contribute to the lower abstinence rates noted in women relative to men.

Negative symptoms and the formation of social affiliative bonds in schizophrenia

Negative symptoms in schizophrenia are characterized by deficits in normative experiences and expression of emotion, and they are associated with poor social functioning. Negative symptoms relating to deficits in motivation and pleasure may hinder the development of affiliative bonds. The current study used a novel procedure to examine the relation between negative symptoms and the development of social affiliation within a laboratory setting. Fifty-five men (35 controls; 20 with a schizophrenia spectrum disorder) completed three Social Affiliation Enhancement Tasks with an experimenter partner. Self-reported affiliation and affect ratings were assessed before and after the affiliative interaction. Across groups, social affiliation and positive affect increased following the interactive tasks. However, the schizophrenia group reported less positive and more negative affect than controls. Within individuals with schizophrenia, negative symptoms reflecting motivation and pleasure deficits and self-reported social anhedonia were associated with less affiliative feelings of interpersonal closeness and less willingness to interact. Additionally, these self-reported reactions to the interaction partner were significantly related to social functioning in the community. These findings indicate that though individuals with schizophrenia can form affiliative bonds, the extent to which this is possible may be limited by negative symptoms relating to motivation and pleasure. Additional research will be necessary to examine just how these negative symptoms interfere with social affiliation.

Understanding the dark and bright sides of anxiety: A theory of workplace anxiety

Researchers have uncovered inconsistent relations between anxiety and performance. Although the prominent view is a "dark side," where anxiety has a negative relation with performance, a "bright side" of anxiety has also been suggested. We reconcile past findings by presenting a comprehensive multilevel, multiprocess model of workplace anxiety called the theory of workplace anxiety (TWA). This model highlights the processes and conditions through which workplace anxiety may lead to debilitative and facilitative job performance and includes 19 theoretical propositions. Drawing on past theories of anxiety, resource depletion, cognitive-motivational processing, and performance, we uncover the debilitative and facilitative nature of dispositional and situational workplace anxiety by positioning emotional exhaustion, self-regulatory processing, and cognitive interference as distinct contrasting processes underlying the relationship between workplace anxiety and job performance. Extending our theoretical model, we pinpoint motivation, ability, and emotional intelligence as critical conditions that shape when workplace anxiety will debilitate and facilitate job performance. We also identify the unique employee, job, and situational characteristics that serve as antecedents of dispositional and situational workplace anxiety. The TWA offers a nuanced perspective on workplace anxiety and serves as a foundation for future work. (PsycINFO Database Record

Reduced interhemispheric executive control network coupling in men during early cocaine abstinence: A pilot study

BACKGROUND

Individuals who use cocaine have fewer cognitive resources needed to maintain abstinence. This is evidenced by blunted brain function during cognitive control tasks and reduced communication between brain regions associated with cognitive function. For instance, relapse vulnerability is heightened in individuals with less communication between the right and left frontoparietal executive control network (ECN). Given that recent cocaine use enhances such communication, it is plausible that recency of cocaine use influences interhemispheric ECN communication. However, it is unclear whether ECN communication weakens over the course of early cocaine abstinence, which may then enhance relapse risk.

METHODS

In ten men with cocaine use disorder, we conducted a preliminary assessment of the relationship between the number of days since last cocaine use (1-3days) and interhemispheric ECN coupling using resting state functional magnetic resonance imaging (fMRI).

RESULTS

Reduced interhemispheric ECN coupling was associated with increasing days since last cocaine use; weaker coupling was also associated with lower urine cocaine metabolite concentrations. This association was more prominent in prefrontal than parietal ECN-subregions.

CONCLUSIONS

Preliminary results indicate that resting state interhemispheric ECN coupling weakens within the first few days following last cocaine use. Because of the known link between reduced ECN interhemispheric coupling and relapse vulnerability, these results suggest that relapse risk may increase the longer an individual abstains during an early quit attempt. Treatments focused on reversing this coupling deficit may facilitate abstinence.

Inefficient effort allocation and negative symptoms in individuals with schizophrenia

Negative symptoms like avolition and anhedonia are thought to involve difficulties with reward processing and motivation. The current study aimed to replicate and extend prior findings that individuals with schizophrenia display reduced willingness to expend effort for rewards and that such reduced effort is associated with negative symptoms, poor functioning, and cognitive impairment. The present study compared the effortful decision making of individuals with schizophrenia (n=48) and healthy controls (n=27) on the Effort Expenditure for Rewards Task (EEfRT). Individuals with schizophrenia chose a smaller proportion of hard tasks than healthy controls across all probability and reward levels with the exception of trials with a 12% probability and low or medium reward magnitude wherein both groups chose similarly few hard tasks. Contrary to expectations, in individuals with schizophrenia, greater negative symptoms were associated with making more effortful choices. Effortful decision making was unrelated to positive symptoms, depression, cognition, and functioning in individuals with schizophrenia. Our results are consistent with prior findings that revealed a pattern of inefficient decision making in individuals with schizophrenia relative to healthy controls. However the results did not support the hypothesized association of negative symptoms and reduced effort in schizophrenia and highlight prior inconsistencies in this literature. Future research is needed to understand what factors may be related to diminished effortful decision making in schizophrenia and the clinical significance of such performance deficits.

Motivation and effort in individuals with social anhedonia

It has been proposed that anhedonia may, in part, reflect difficulties in reward processing and effortful decision making. The current study aimed to replicate previous findings of effortful decision making deficits associated with elevated anhedonia and expand upon these findings by investigating whether these decision making deficits are specific to elevated social anhedonia or are also associated with elevated positive schizotypy characteristics. The current study compared controls (n=40) to individuals elevated on social anhedonia (n=30), and individuals elevated on perceptual aberration/magical ideation (n=30) on the Effort Expenditure for Rewards Task (EEfRT). Across groups, participants chose a higher proportion of hard tasks with increasing probability of reward and reward magnitude, demonstrating sensitivity to probability and reward values. Contrary to our expectations, when the probability of reward was most uncertain (50% probability), at low and medium reward values, the social anhedonia group demonstrated more effortful decision making than either individuals high in positive schizotypy or controls. The positive schizotypy group only differed from controls (making less effortful choices than controls) when reward probability was lowest (12%) and the magnitude of reward was the smallest. Our results suggest that social anhedonia is related to intact motivation and effort for monetary rewards, but that individuals with this characteristic display a unique and perhaps inefficient pattern of effort allocation when the probability of reward is most uncertain. Future research is needed to better understand effortful decision making and the processing of reward across a range of individual difference characteristics.

Do candidate reactions relate to job performance or affect criterion-related validity? A multistudy investigation of relations among reactions, selection test scores, and job performance

Considerable evidence suggests that how candidates react to selection procedures can affect their test performance and their attitudes toward the hiring organization (e.g., recommending the firm to others). However, very few studies of candidate reactions have examined one of the outcomes organizations care most about: job performance. We attempt to address this gap by developing and testing a conceptual framework that delineates whether and how candidate reactions might influence job performance. We accomplish this objective using data from 4 studies (total N = 6,480), 6 selection procedures (personality tests, job knowledge tests, cognitive ability tests, work samples, situational judgment tests, and a selection inventory), 5 key candidate reactions (anxiety, motivation, belief in tests, self-efficacy, and procedural justice), 2 contexts (industry and education), 3 continents (North America, South America, and Europe), 2 study designs (predictive and concurrent), and 4 occupational areas (medical, sales, customer service, and technological). Consistent with previous research, candidate reactions were related to test scores, and test scores were related to job performance. Further, there was some evidence that reactions affected performance indirectly through their influence on test scores. Finally, in no cases did candidate reactions affect the prediction of job performance by increasing or decreasing the criterion-related validity of test scores. Implications of these findings and avenues for future research are discussed.

Brain gamma-aminobutyric acid (GABA) abnormalities in bipolar disorder

OBJECTIVES

Gamma-aminobutyric acid (GABA) abnormalities have been implicated in bipolar disorder. However, due to discrepant studies measuring postmortem, cerebrospinal fluid, plasma, and in vivo brain levels of GABA, the nature of these abnormalities is unclear. Using proton magnetic resonance spectroscopy, we investigated tissue levels of GABA in the anterior cingulate cortex and parieto-occipital cortex of participants with bipolar disorder and healthy controls.

METHODS

Fourteen stably medicated euthymic outpatients with bipolar disorder type I (mean age 32.6 years, eight male) and 14 healthy control participants (mean age 36.9 years, 10 male) completed a proton magnetic resonance spectroscopy scan at 4-Tesla after providing informed consent. We collected data from two 16.7-mL voxels using MEGAPRESS, and they were analyzed using LCModel.

RESULTS

GABA/creatine ratios were elevated in bipolar disorder participants compared to healthy controls [F(1,21) = 4.4, p = 0.048] in the anterior cingulate cortex (25.1% elevation) and the parieto-occipital cortex (14.6% elevation). Bipolar disorder participants not taking GABA-modulating medications demonstrated greater GABA/creatine elevations than patients taking GABA-modulating medications.

CONCLUSIONS

We found higher GABA/creatine levels in euthymic bipolar disorder outpatients compared to healthy controls, and the extent of this elevation may be affected by the use of GABA-modulating medications. Our findings suggest that elevated brain GABA levels in bipolar disorder may be associated with GABAergic dysfunction and that GABA-modulating medications reduce GABA levels in this condition.

Screening for negative symptoms: preliminary results from the self-report version of the Clinical Assessment Interview for Negative Symptoms

Though negative symptoms in schizophrenia are associated with a host of deleterious outcomes (e.g., White et al., 2009), not all individuals with schizophrenia suffer from negative symptoms (e.g., Blanchard et al., 2005). Thus, methods to quickly screen and identify patients for more intensive clinical interview assessments may have significant clinical and research utility. The present study is a preliminary examination of the reliability and validity of a self-report version of the newly developed Clinical Assessment Interview for Negative Symptoms (CAINS; Blanchard et al., 2011; Forbes et al., 2010; Horan et al., 2011). The CAINS-SR is a 30-item self-report measure that assesses Experiential (avolition, anhedonia, asociality) and Expressive (blunted affect, alogia) domains of negative symptoms. Participants (N = 69) completed the CAINS-SR questionnaire and were evaluated with symptom interviews using the CAINS and other non-negative symptom interviews that assessed psychotic, affective, and other symptoms. The Experience subscale of the CAINS-SR demonstrated good internal consistency, convergent validity, and discriminant validity, while the poorer psychometric properties of the Expression subscale suggest that self-report of negative symptoms should focus on the experiential domain. Overall, preliminary findings indicate that the CAINS-SR (addressing experiential deficits) may be a useful complement to the clinician-rated interview measure. Future research on the sensitivity and specificity of the CAINS-SR will determine its suitability as a screening measure.

Individual differences in multiple dimensions of aggression: a univariate and multivariate genetic analysis

Previous behaviour genetic studies of aggression have yielded inconsistent results: reported heritabilities for different types of aggressive behaviour ranging from 0 to 0.98. In the present study, 247 adult twin pairs (183 MZ pairs; 64 same-sex DZ pairs) were administered seven self-report questionnaires which yielded 18 measures of aggression. Univariate genetic analyses showed moderate to high heritabilities for 14 of these 18 measures and for a general aggression factor and three correlated aggression factors extracted from the measures. Multivariate genetic analyses showed sizeable genetic correlations between the different dimensions of aggression. Thus, individual differences in many types of aggressive behaviour are attributable to some extent to genetic factors and there is considerable overlap between the genes that operate on different types of aggressive behaviour.

Nature vs nurture: Are leaders born or made? A behavior genetic investigation of leadership style

With the recent resurgence in popularity of trait theories of leadership, it is timely to consider the genetic determination of the multiple factors comprising the leadership construct. Individual differences in personality traits have been found to be moderately to highly heritable, and so it follows that if there are reliable personality trait differences between leaders and non-leaders, then there may be a heritable component to these individual differences. Despite this connection between leadership and personality traits, however, there are no studies of the genetic basis of leadership using modern behavior genetic methodology. The present study proposes to address the lack of research in this area by examining the heritability of leadership style, as measured by self-report psychometric inventories. The Multifactor Leadership Questionnaire (MLQ), the Leadership Ability Evaluation, and the Adjective Checklist were completed by 247 adult twin pairs (183 monozygotic and 64 same-sex dizygotic). Results indicated that most of the leadership dimensions examined in this study are heritable, as are two higher level factors (resembling transactional and transformational leadership)derived from anobliquely rotated principal components factors analysis of the MLQ. Univariate analyses suggested that 48% of the variance in transactional leadership may be explained by additive heritability, and 59% of the variance in transformational leadership may be explained by non-additive (dominance) heritability. Multi-variate analyses indicatedthat most ofthe variables studiedshared substantial genetic covariance, suggesting a large overlap in the underlying genes responsible for the leadership dimensions.

Abnormal medial prefrontal cortex resting-state connectivity in bipolar disorder and schizophrenia

Bipolar disorder and schizophrenia overlap in symptoms and may share some underlying neural substrates. The medial prefrontal cortex (MPFC) may have a crucial role in the psychophysiology of both these disorders. In this study, we examined the functional connectivity between MPFC and other brain regions in bipolar disorder and schizophrenia using resting-state functional magnetic resonance imaging (fMRI). Resting-state fMRI data were collected from 14 patients with bipolar disorder, 16 patients with schizophrenia, and 15 healthy control subjects. Functional connectivity maps from the MPFC were computed for each subject and compared across the three groups. The three groups showed distinctive patterns of functional connectivity between MPFC and anterior insula, and between MPFC and ventral lateral prefrontal cortex (VLPFC). The bipolar disorder group exhibited positive correlations between MPFC and insula, and between MPFC and VLPFC, whereas the control group exhibited anticorrelations between these regions. The schizophrenia group did not exhibit any resting-state correlation or anticorrelation between the MPFC and the VLPFC or insula. In contrast, neither patient group exhibited the significant anticorrelation between dorsal lateral prefrontal cortex (DLPFC) and MPFC that was exhibited by the control group. The decoupling of DLPFC with MPFC in bipolar disorder and schizophrenia is consistent with the impaired executive functioning seen in these disorders. Functional connectivity between MPFC and insula/VLPFC distinguished bipolar disorder from schizophrenia, and may reflect differences in the affective disturbances typical of each illness.

The Jekyll and Hyde of Emotional Intelligence

Does emotional intelligence promote behavior that strictly benefits the greater good, or can it also advance interpersonal deviance? In the investigation reported here, we tested the possibility that a core facet of emotional intelligence—emotion-regulation knowledge—can promote both prosocial and interpersonally deviant behavior. Drawing from research on how the effective regulation of emotion promotes goal achievement, we predicted that emotion-regulation knowledge would strengthen the effects of other-oriented and self-oriented personality traits on prosocial behavior and interpersonal deviance, respectively. Two studies supported our predictions. Among individuals with higher emotion-regulation knowledge, moral identity exhibited a stronger positive association with prosocial behavior in a social dilemma (Study 1), and Machiavellianism exhibited a stronger positive association with interpersonal deviance in the workplace (Study 2). Thus, emotion-regulation knowledge has a positive side and a dark side.

Umbilical cord nucleated red blood cell counts: normal values and the effect of labor

OBJECTIVE

To determine the umbilical cord blood nucleated red blood cell (UC-nRBC) count in uncomplicated pregnancies delivered by elective cesarean section or delivered vaginally.

METHODS

A total of 57-term singleton pregnancies were studied: 33 with elective cesarean sections and 24 with vaginal deliveries. UC-nRBC was analyzed for its nucleated red blood cell counts. A logarithmic transformation of the data was used for statistical analysis.

RESULTS

The mean+/-standard deviation (s.d.) for nucleated red blood cell per 100 white blood cells (nRBC/100WBC) from the elective cesarean section group was 7.8+/-7.4. The vaginal delivery group had a mean value of 9.3+/-10.5, which was not significantly different. A value of 22 nRBC/100WBC defined the upper 95% confidence limit. The correlation between absolute nRBC and nRBC/100 WBC was 0.97.

CONCLUSION

Although chronic hypoxia is associated with elevated nRBC, the stress of uncomplicated labor does not change the level. This adds credence to its use as a marker for hypoxia preceding labor and delivery.

A statistical method for the determination of absorption rate constant estimated using the rat single pass intestinal perfusion model and multiple linear regression

The guide "Waiver of In Vivo Bioavailability and Bioequivalence Studies for Immediate Release Solid Dosage Forms Containing Certain Active Moieties/Active Ingredients Based on a Biopharmaceutical Classification System" (Rockville, MD: CDER, 2000) outlined non-in vivo tests of permeability that may satisfy the classification of a compound in the biopharmaceutical classification system. However, absent from that document were specific statistical methods to legitimatize the non-in vivo tests. This report describes the appropriate statistical treatment of absorption data, and recommends its adoption in the estimation of absorption and/or permeability measurements. The calculation of the absorption rate constants (k(a)) of ten compounds by a new multiple linear regression (MLR) method was completed after the separate perfusion of each compound through the rat single pass intestinal perfusion model (n = 3 rats per compound). Studentized residuals were evaluated to determine whether any statistically significant outliers were present in the data. The standard error of k(a) was estimated using variance components from the random effects model. The results were compared with the "traditional method" for k(a) calculations. Although both methods produced similar values of k(a), the MLR method's error estimate included multiple components of variability, which was largely ignored by the traditional method. The MLR method provided objective tests for outliers and achievement of steady-state. A preferred method for the statistical analysis of absorption data was demonstrated. These methods should be applied to all forms of permeability measurements, especially the non-in vivo measurements that classify a compound in the biopharmaceutical classification system.

Effects of storage conditions and hemolysis on vitamin E concentrations in porcine serum and liver

Vitamin E (alpha-tocopherol) is an antioxidant vitamin important in protecting unsaturated fatty acids in lipid membranes from peroxidation. Variation in collection, storage, and shipping conditions of samples can potentially lead to breakdown of vitamin E prior to analysis. Therefore, the purposes of this project were 1) to determine the stability of vitamin E in refrigerated and frozen porcine liver and serum and 2) to evaluate the effects of red blood cell (RBC) hemolysis on porcine serum vitamin E concentrations. Porcine liver and nonhemolyzed serum were collected and stored refrigerated or frozen. Samples were analyzed for vitamin E immediately or on days 2, 3, 7, or 14. In addition, porcine RBCs were added to normal serum at concentrations from 1 x 10(6) to 1 X 10(9) RBC/ml and hemolyzed by freeze-thaw prior to analysis for vitamin E or products of lipid peroxidation.

Individual differences in multiple dimensions of aggression: a univariate and multivariate genetic analysis

Previous behaviour genetic studies of aggression have yielded inconsistent results: reported heritabilities for different types of aggressive behaviour ranging from 0 to 0.98. In the present study, 247 adult twin pairs (183 MZ pairs; 64 same-sex DZ pairs) were administered seven self-report questionnaires which yielded 18 measures of aggression. Univariate genetic analyses showed moderate to high heritabilities for 14 of these 18 measures and for a general aggression factor and three correlated aggression factors extracted from the measures. Multivariate genetic analyses showed sizeable genetic correlations between the different dimensions of aggression. Thus, individual differences in many types of aggressive behaviour are attributable to some extent to genetic factors and there is considerable overlap between the genes that operate on different types of aggressive behaviour.

Nature vs nurture: are leaders born or made? A behavior genetic investigation of leadership style

With the recent resurgence in popularity of trait theories of leadership, it is timely to consider the genetic determination of the multiple factors comprising the leadership construct. Individual differences in personality traits have been found to be moderately to highly heritable, and so it follows that if there are reliable personality trait differences between leaders and non-leaders, then there may be a heritable component to these individual differences. Despite this connection between leadership and personality traits, however, there are no studies of the genetic basis of leadership using modern behavior genetic methodology. The present study proposes to address the lack of research in this area by examining the heritability of leadership style, as measured by self-report psychometric inventories. The Multifactor Leadership Questionnaire (MLQ), the Leadership Ability Evaluation, and the Adjective Checklist were completed by 247 adult twin pairs (183 monozygotic and 64 same-sex dizygotic). Results indicated that most of the leadership dimensions examined in this study are heritable, as are two higher level factors (resembling transactional and transformational leadership) derived from an obliquely rotated principal components factors analysis of the MLQ. Univariate analyses suggested that 48% of the variance in transactional leadership may be explained by additive heritability, and 59% of the variance in transformational leadership may be explained by non-additive (dominance) heritability. Multivariate analyses indicated that most of the variables studied shared substantial genetic covariance, suggesting a large overlap in the underlying genes responsible for the leadership dimensions.

An epidemiologic investigation of unexpected refractive errors following cataract surgery

OBJECTIVE

To determine the extent and magnitude of unexpected refractive errors following cataract surgery with intraocular lens (IOL) implantation and to determine what characteristics were associated with the errors.

DESIGN

In this nonconcurrent prospective study, preoperative, intraoperative and postoperative information was collected from the charts of the 523 consecutive patients who underwent cataract extraction and polymethylmethacrylate IOL implantation performed by one of nine participating surgeons between Jan. 1 and Apr. 30, 1995, or the same dates in 1996.

SETTING

University-affiliated eye care centre in Vancouver.

OUTCOME MEASURE

Postoperative excess correction, calculated for each patient by subtracting the actual postoperative spherical equivalent from the expected spherical equivalent. Eyes with an excess correction of more than 1.00 dioptre were considered "overcorrected."

RESULTS

Univariate analysis showed that the formula used to calculate the lens power, axial length, year of surgery, A-constant/surgeon factor used and lens manufacturer were associated with overcorrection. In a logistic regression model, lens manufacturer was the only variable independently associated with overcorrection.

CONCLUSIONS

Routine reporting and follow-up is necessary to identify this kind of "outbreak" and the associated factors. The current guidelines of the Health Protection Branch, Health Canada, for evaluation of IOLs that have changed manufacturers are not adequate to identify the kind of error that we detected.

Gene knockout of the intracellular amylase gene by homologous recombination in Streptococcus bovis

Streptococcus bovis expresses two different amylases, one intracellular and the other secreted. A suicide vector containing part of the intracellular alpha-amylase gene from Streptococcus bovis WI-1 was recombined into the S. bovis WI-1 chromosome to disrupt the endogenous gene. Recombination was demonstrated by Southern blot, and zymogram analysis confirmed the loss of the intracellular amylase. Amylase activity in cell-free extracts of the recombinant grown in the presence of 1% starch was only 7% of wild type. The rate of logarithmic growth of the recombinant was 15-20% of the wild type in medium containing either 1% glucose, starch, or cellobiose. Revertants and non-amylase control recombinants had logarithmic growth rates that were the same as wild type. Plasmid transformants containing multiple copies of the cloned gene expressed up to threefold higher levels of intracellular amylase activity than wild type but did not demonstrate elevated growth rates. These results suggest that a critical level of expression of the intracellular amylase gene may be important for rapid growth of the bacterium.

Paediatrics at the cutting edge: do we need clinical ethics committees?

OBJECTIVES

To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics.

DESIGN

Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals.

SETTING

Two major London children's hospitals.

RESULTS

Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and treatment; lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting.

CONCLUSION

Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees.

Environmental predictors of personality differences: a twin and sibling study

Nonshared environmental influences have consistently been shown to account for at least as much of the variance in personality as genetic factors, but the nature of these nonshared influences has largely remained unidentified. To identify environmental predictors of differential personality development, the Personality Research Form and 4 measures of people's perceptions of their background environments were administered to 143 adult twin pairs (93 monozygotic [MZ] and 50 dizygotic [DZ] and 66 pairs of same-sex nontwin (NT) siblings. Differences between MZ twins, DZ twins, and NT siblings in a number of dimensions of personality were significantly related to differences on the environmental measures, and phenotypic correlations between the personality and environment measures were themselves entirely attributable to correlated nonshared environmental effects.

Environmental predictors of personality differences: a twin and sibling study

Nonshared environmental influences have consistently been shown to account for at least as much of the variance in personality as genetic factors, but the nature of these nonshared influences has largely remained unidentified. To identify environmental predictors of differential personality development, the Personality Research Form and 4 measures of people's perceptions of their background environments were administered to 143 adult twin pairs (93 monozygotic [MZ] and 50 dizygotic [DZ] and 66 pairs of same-sex nontwin (NT) siblings. Differences between MZ twins, DZ twins, and NT siblings in a number of dimensions of personality were significantly related to differences on the environmental measures, and phenotypic correlations between the personality and environment measures were themselves entirely attributable to correlated nonshared environmental effects.

The elderly with a learning disability (mental retardation): an overview

This article is a review of the literature on the elderly with a learning disability, focusing on demographic data, functional abilities, mental health, physical health, and service use. This particular population is increasing and will have high health and social care needs. They share with their non-learning-disabled peers the problems of aging, namely the age-related infirmities of dementia, sensory impairment, urinary incontinence, and poor mobility. They develop psychiatric disorders that remain unrecognized and untreated. Some are cared for by aging parents who also may be frail with serious health problems. Further research is required on the quality of life, successful indicators of aging, and guidance on the type of service that will meet the needs of this group.

A 5-year survival study of general surgical patients aged 65 years and over

A prospective 5-year survival study of 900 patients, aged 65 years and over, undergoing a general surgical procedure, demonstrated that following an initial high mortality rate the survival of the group as a whole approached that of an age-matched population. Non-elective admissions, age 75 years and over, ASA grade 4-5 and major surgery were associated with a high early mortality. Mortality associated with malignancy extended over 1 year. The study reinforces the conclusion that age alone should be no bar to surgery and anaesthesia, endorses the findings of the National Confidential Enquiry into Peri-operative deaths and emphasises the need to re-examine the provision of anaesthetic and surgical services in District General Hospitals. The benefits of elective admission in the very old are highlighted, along with the potential for extension of day case surgery.

Evaluation of multiple frequency bio-electrical impedance analysis in paediatric subjects

The efficacy of multiple frequency bio-electrical impedance analysis (MFBIA) at discrete frequencies in predicting body cell mass, total body water, and fat-free mass compartments was investigated in healthy (n=30) and diseased (n=40) paediatric populations. Correlation coefficients achieved by comparing MFBIA with reference techniques using Deming's regression analysis were in excess of 0.9, but were not superior to those achieved comparing reference techniques with the traditional BIA application at 50 kHz. Applying the 95% limits of agreement procedure to the results showed that the agreement between the techniques was not sufficient for the technique to be of value in individual body composition assessments. The use of MFBIA at discrete frequencies does not improve the accuracy of estimations of body compartment sizes in paediatric subjects compared with those obtained with BIA at 50 kHz.

Activity of antiphospholipid antibody ELISA cofactor in different animal sera

A plasma protein cofactor, beta 2-glycoprotein I (beta 2GPI), also known as apolipoprotein H, is necessary to detect certain antiphospholipid antibodies (aPA) to negatively charged phospholipids (PL) in the ELISA. Inasmuch as sera are diluted 1:100 before testing, the concentration of native beta 2GPI may be insufficient to provide an optimal aPA ELISA signal. Therefore, many laboratories add adult bovine serum (ABS) to the diluent buffer to provide a consistent level of cofactor for optimal aPA binding. To determine if other animal sera can provide the cofactor, cat, chicken, dog, horse, goat, guinea pig, mouse, pig, rat, and sheep were tested as diluent supplements in the aPA ELISA. To measure cofactor activity in these animal sera, ELISA for aPA to anionic phospholipids were performed. Two aPA positive patient plasmas were selected for study; one with cofactor-dependent and one with cofactor-independent aPA. Only four of the animal sera tested (bovine, pig, sheep, and cat) supported the cofactor-dependent aPA in ELISA. The cofactor-independent aPA was positive in the presence of each animal serum except bovine and rat. In order to determine whether these animal sera contain a beta 2GPI-like molecule, Western blot analyses were performed. By using a polyclonal antiserum produced to human beta 2GPI, specific beta 2GPI-like cross-reactivity was observed with all animal sera except the chicken. In summary, cofactor activity in animal sera varied significantly; however, bovine and pig sera appear to allow optimal binding of cofactor dependent aPA.

Idiopathic sclerosing inflammation of the orbit: immunohistologic analysis and comparison with retroperitoneal fibrosis

Idiopathic sclerosing inflammation of the orbit is clinically characterized by an insidious, chronic and progressive fibrosing process damaging orbital structures through entrapment and mass effect. Histologically, desmoplasia and a sparse infiltrate of lymphocytes, histiocytes, plasma cells, and occasional neutrophils and eosinophils are seen. An immune pathogenesis is suspected but presently poorly understood. To characterize the inflammatory infiltrate and to compare orbital and other inflammatory fibrosing lesions, immunoperoxidase studies using the streptavidin method were performed on 16 formalin or Bouins' fixed, paraffin-embedded orbital biopsy specimens and six specimens of retroperitoneal fibrosis. Positive staining of orbital tissue occurred as follows: T-cells (UCHL-1) 94% of cases, B-cells (L26) 40%, tissue macrophages (KP-1) 56%, HLA Dr positive antigen presenting cells and activated T-cells (LN3) 44%, and immunoglobulins (kappa, 80%; lambda, 63%, IgG, 73%, IgA, 44% and IgM, 31%). Results were strikingly similar for retroperitoneal fibrosis. These findings imply a cell mediated pathogenesis in idiopathic sclerosing inflammation of the orbit that is similar to retroperitoneal fibrosis and suggest therapeutic potential for agents modifying this facet of the immune system.

The cost impact of cytomegalovirus disease in renal transplant recipients

A retrospective case controlled study was performed to determine the cost impact of cytomegalovirus disease in the first year following renal transplantation as a basis for the analysis of cost effectiveness of prophylactic and therapeutic regimens directed at CMV infection. Eleven sequential cases of organ-specific CMV disease were matched with 22 controls for age, diabetic status, and donor/recipient CMV serologic status from 119 consecutive first cadaveric renal transplant recipients performed at a single university-affiliated, solid organ transplant unit between January 1, 1988 and March 31, 1990. The groups were comparable for sex, HLA match and mismatch, incidence of initial graft dysfunction, and immunosuppression. Hospitalization data, resource utilization, and costs for all 33 subjects were obtained for a one-year period after transplantation. The mean initial hospitalization time was comparable for both CMV cases and controls (14.5 vs. 15.0 days, P = NS), but patients developing CMV disease averaged 59 hospital days during the first year posttransplant versus 22 days in the control group (P = 0.001). A mean of 31 days hospitalization was directly related to CMV disease. Mean total institutional costs, calculated in 1988 Canadian dollars, were 2.5 times higher for patients with CMV disease than for controls ($42,611 vs. $17,309, P = 0.001), reflecting predominantly a difference in general ward ($19,988 vs. $7484, P = 0.001), hotel ($2508 vs. $927, P = 0.001), clinical laboratory ($5420 vs. $2558, P = 0.0001), radiology ($1581 vs. $640, P = 0.05), and pharmacy ($4916 vs. $1782, P = 0.01) costs and utilization. Operating room, special ward, ancillary, and mean per diem costs ($719 vs. $790, P = NS) were not significantly different between the two groups. Functional graft survival at 1 year was 72% in patients with CMV disease compared with 86% in controls, reducing the mean calculated cost-effectiveness of transplantation by 2.9-fold. These data show that CMV disease has significant economic impact on renal transplantation as a result of extended hospitalization. In order to develop a cost effective management approach to CMV infection, this impact must be considered when assessing therapeutic and prophylactic regimens and protocols of organ allocation.

Conjunctival and uveal melanoma in the dysplastic nevus syndrome

The dysplastic nevus syndrome was conceptualized in the late 1970s, and the subsequent proposal of a genetic relationship with ocular melanoma has stimulated debate in the literature which remains unresolved. We present the case of a 60-year-old man with histologically proven sporadic dysplasic nevus syndrome and a prior history of nine cutaneous melanomas, who developed a large, exophytic melanoma of the cornea and limbal conjunctiva. Cytogenetic analysis of this melanoma revealed a clonal 1;14 translocation. We believe this is the first reported case to use cytogenetic techniques in the analysis of conjunctival melanoma, either associated with dysplastic nevus syndrome or in isolation. We review the clinical literature as well as the cytogenetic and molecular genetic data related to the possible association of cutaneous melanoma, conjunctival and uveal melanoma and the dysplastic nevus syndrome.

Cyclosporine A for the treatment of necrotizing scleritis and corneal melting in patients with rheumatoid arthritis

Two of the ocular complications of rheumatoid arthritis (RA), necrotizing scleritis and keratolysis, have been associated with poor response to standard ocular therapy, and thus poor ocular outcome. We describe 6 patients with active ocular disease and active RA who failed to respond to disease modifying agents or immunosuppressive therapy and whose ocular and arthritic disease subsequently responded to cyclosporine A. Drug related complications were consistent with those reported for patients receiving similar doses for RA.