Co-morbid obsessive-compulsive disorder and depression: a Bayesian network approach

BACKGROUND

Obsessive-compulsive disorder (OCD) is often co-morbid with depression. Using the methods of network analysis, we computed two networks that disclose the potentially causal relationships among symptoms of these two disorders in 408 adult patients with primary OCD and co-morbid depression symptoms.

METHOD

We examined the relationship between the symptoms constituting these syndromes by computing a (regularized) partial correlation network via the graphical LASSO procedure, and a directed acyclic graph (DAG) via a Bayesian hill-climbing algorithm.

RESULTS

The results suggest that the degree of interference and distress associated with obsessions, and the degree of interference associated with compulsions, are the chief drivers of co-morbidity. Moreover, activation of the depression cluster appears to occur solely through distress associated with obsessions activating sadness - a key symptom that 'bridges' the two syndromic clusters in the DAG.

CONCLUSIONS

Bayesian analysis can expand the repertoire of network analytic approaches to psychopathology. We discuss clinical implications and limitations of our findings.

Dysphoria is a risk factor for depression in medically ill older people

OBJECTIVES

Depression in older people is commonly under diagnosed and is associated with increased morbidity and mortality. Because older people currently occupy 65% of acute hospital beds, it is crucial for them to be properly assessed for depression to optimise their medical care. The aim of this study was to identify potential risk factors for depression in the medically ill in order to improve their inpatient care.

METHODS

This was a 2-year observational study of consequent referrals to the Newcastle Liaison Team for Older Adults. Out of a total number of 1586 referred patients, 1197 were included in the final analysis of data. Information about their age, main medical history, cognitive impairment and use of antidepressants was collected. All subjects were screened for dementia, depression and delirium. Proportions were compared using the chi-squared test. Clinical depression as a binary variable was modelled using logistic regression.

RESULTS

Higher risk for depression was associated with pain (odds ratio (OR) = 1.76; p = 0.033) and a previous history of depression (OR = 2.22; p < 0.001). Cognitive impairment (OR = 0.44, p < 0.001) and delirium (OR = 0.49; p < 0.001) decreased the likelihood for having depression. Subjective feelings of emptiness, being unhappy and depressed alone (R²  = 37.4%) and cognitive impairment (R²  = 39.5%) were the best multivariable model to explain depression in medically ill people.

CONCLUSION

Dysphoric mood results in depression in older people with medical health problems. Copyright © 2016 John Wiley & Sons, Ltd.

The voice of emotional memory: content-filtered speech in panic disorder, social phobia, and major depressive disorder

We asked patients with either panic disorder, social phobia, or major depressive disorder and healthy control participants to describe their most frightening experience and to describe an emotionally neutral experience. Both fear and neutral autobiographical memories were audiotaped and processed through a low-pass filter that eliminated frequencies above 400 Hz, thereby abolishing semantic content but leaving paralinguistic aspects like rate, pitch, and loudness intact, and these convey emotional cues. Raters blind to content and diagnosis rated the content-filtered speech clips on emotional dimensions. The results revealed that content-filtered fear memories received significantly higher ratings on anxious, aroused, and dominant (but not sad or negative) scales than did content-filtered neutral memories, irrespective of the diagnostic status of the speaker. Content-filtered speech appears promising as an on-line probe of emotional processing during accessing of autobiographical memories.

Emotion- and intrusion-based reasoning in Vietnam veterans with and without chronic posttraumatic stress disorder

Patients suffering from anxiety disorders other than posttraumatic stress disorder (PTSD) interpret anxiety responses themselves as evidence that threat is impending: "if anxiety, then threat" (Arntz, Rauner, & van den Hout, 1995, Behaviour Research and Therapy, 33, 917-925). This "emotion-based reasoning" (ER) may render a disorder self-perpetuating. Analogous to ER, danger might also be inferred from the presence of intrusions: "intrusion-based reasoning" (IR). The aims of this study were to test whether ER and IR are involved in chronic PTSD. Vietnam combat veterans with or without PTSD or other anxiety disorders rated perceived danger of brief scenarios in which information about objective danger (danger vs safety) and response (anxiety/intrusions vs non-distressing emotion) was systematically varied. Two series were administered: ER-scenarios were non-specific for PTSD and IR-scenarios were specific for PTSD. Relative to control participants, PTSD patients engaged in both ER and IR: whereas veterans without PTSD inferred the danger of scenarios from objective stimulus information, veterans with PTSD also inferred danger from the presence of anxiety or intrusions. Further analyses showed that these effects were largely mediated by perceived uncontrollability.

Examination of temporal trends in the incidence of childhood leukaemias and lymphomas provides aetiological clues

The age-sex distributions and temporal trends in incidence of leukaemia and lymphoma from the Manchester Children's Tumour Registry (MCTR), 1954-1998, are reported. This 45-year study includes 1795 children, all of whom had a histologically and/or cytologically verified leukaemia or lymphoma. At the time of their diagnoses all the children were under 15 years of age and were resident in a geographically defined area of northwest England covered by the MCTR. Log-linear modelling identified significant linear increases in acute lymphoblastic leukaemia (ALL) (average annual increase 0.7%; P= 0.005) and in Hodgkin's disease (HD) (1.2%, P=0.04), but not in acute myeloid leukaemia (AML), nor in non-Hodgkin's lymphoma (NHL). The increase in ALL was most pronounced amongst males, aged 1-4 years, and is likely to be due to precursor B-cell leukaemias. The increases in ALL and HD are discussed in relation to current hypotheses suggesting a role for infection. Additionally, a non-linear cohort effect was identified for NHL (P= 0.008), which may indicate the involvement of environmental factors other than infection.

The anxiety sensitivity index: item analysis and suggestions for refinement

Anxiety sensitivity is the fear of anxiety-related sensations, and is measured by the 16-item Anxiety Sensitivity Index (ASI). Despite the popularity and utility of the ASI in research, a number of studies have provided evidence for the inadequacy of several items, and item-to-scale correlations for the ASI have not been published. In this study, a converging set of analyses to evaluate the item adequacy and factor structure of the ASI was used. The results of these multiple analyses converged nicely suggesting that Items 1, 5, 7, 8, and 13 should be considered for removal from the instrument. The impact of removing these problematic items from the scale was explored through the reanalysis of data from 3 previously published studies that compared the original ASI with the new 11-item version (the ASI minus the 5 problematic items). The results of these analyses suggest that the 2 scales function comparably in many respects but that the new version may be a more precise measure of anxiety sensitivity. The 11-item ASI appears to tap 2 primary aspects of anxiety sensitivity: fears of somatic sensations of anxiety and fears of loss of mental control. Suggestions for further development of the ASI are offered.

Temporal increases in the incidence of childhood solid tumors seen in Northwest England (1954-1998) are likely to be real

BACKGROUND

There has been speculation that increasing trends in incidence of childhood central nervous system tumors and infant neuroblastoma in the United States have been due to diagnostic improvements or reporting changes. To investigate whether or not such trends could be explained in this way in the U.K., the authors used population-based data from Northwest England to analyze incidence trends in childhood solid tumors.

METHODS

Cases were diagnosed during 1954-1998 and were grouped according to a morphology-based classification scheme. More than 95% of diagnoses were based on special histopathologic review. Tissue sections were retained, and diagnoses were rereviewed to ensure consistency in classification throughout the time period. Age-, gender- and period-specific incidence rates were calculated. Analyses were performed with chi-square tests and Poisson regression.

RESULTS

There was an overall increase in the incidence of all childhood solid tumors of 0.9% each year. A temporal increase was found in childhood brain tumors characterized by, in particular, annual increases of 1% in pilocytic astrocytoma, 1% in primitive neuroectodermal tumors, and 2.3% in miscellaneous gliomas. The incidence of germ cell tumors increased at a rate of 2.6% each year.

CONCLUSIONS

These increases could not be attributed to changes in diagnostic practice, and it is unlikely that the increases were due to changes in reporting practice. Further, the restriction of the increases to certain groups, with stable rates in others, argued against the changes being artifactual. The authors concluded that the increases in incidence were likely to be real.

Tertullian's motto and Callahan's method

The purposes of this commentary are to provide a critique of Callahan's (this issue) article on Thought Field Therapy (TFT) and to discuss when our commitment to intellectual open-mindedness requires that we attend to nontraditional treatment interventions in clinical psychology.

Relative frequency and morphology of cancers in carriers of germline TP53 mutations

The spectrum and frequency of cancers associated with germline TP53 mutations are uncertain. To address this issue a cohort of individuals from 28 families with Li-Fraumeni syndrome, segregating germline TP53 mutations was established. Predicted cancers were estimated by applying age, morphology, site and sex-specific UK cancer statistics to person-years at risk. Observed and predicted cancers were compared and two-sided P-values calculated. Cancer types occurring to excess and showing P-values <0.02, were designated strongly associated with germline TP53 mutations. These were removed from the data and a second round of analyses performed. Cancer types with P-values <0.02 and 0.02-0.05 in the second round analyses were considered moderately and weakly associated respectively. Strongly associated cancers were: breast carcinoma, soft tissue sarcomas, osteosarcoma, brain tumours, adrenocortical carcinoma, Wilms' tumour and phyllodes tumour. Carcinoma of pancreas was moderately associated. Leukaemia and neuroblastoma were weakly associated. Other common carcinomas including lung, colon, bladder, prostate, cervix and ovary did not occur to excess. Although breast carcinoma and sarcomas were numerically most frequent, the greatest increases relative to general population rates were in adrenocortical carcinoma and phyllodes tumour. We conclude that germline TP53 mutations do not simply increase general cancer risk. There are tissue-specific effects.

Missing the forest for the trees? Deficient memory for linguistic gist in obsessive-compulsive disorder

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) exhibit recall deficits on word learning tasks, mediated by their failure to detect semantic connections among the words.

METHODS

In the present experiment, using methods devised by Bransford & Franks (1971), we tested whether this encoding problem impairs their extraction of gist from complex linguistic material.

RESULTS

Consistent with our hypothesis, OCD patients extracted less gist from related sentences than did healthy participants. The groups did not differ in recognition memory for individual sentences or in criterion for affirming previously encountered sentences as 'old', as evinced by signal detection indices of memory sensitivity (d') and response bias (beta), or in recognition memory confidence.

CONCLUSIONS

These data provide further evidence that OCD patients exhibit less reliance on organizational strategies than do healthy control participants. These data are consistent with neuropsychological research suggestive of prefrontal executive problems in OCD.

On the scientific status of cognitive appraisal models of anxiety disorder

The cognitive paradigm for understanding and treating anxiety disorders comprises two distinct and potentially incompatible approaches: appraisal and information-processing. Advocates of the latter approach have sharply criticized the scientific adequacy of the appraisal models popularized by cognitive therapists. The purpose of this essay is to provide a reappraisal of these critiques of appraisal, and to defend an argument for methodological pluralism.

Directed forgetting of trauma cues in adults reporting repressed or recovered memories of childhood sexual abuse

An item-cuing directed forgetting task was used to investigate whether women reporting repressed (n = 13) or recovered (n = 13) memories of childhood sexual abuse (CSA) exhibit an avoidant encoding style (and resultant impaired memory) for trauma cues relative to women reporting no CSA experience (n = 15). All participants viewed intermixed trauma (e.g., molested), positive (e.g., confident), and categorized neutral (e.g., mailbox) words on a computer screen and were instructed either to remember or to forget each word. The results provided no support for the hypothesis that people reporting either repressed or recovered memories of CSA are especially adept at forgetting words related to trauma. These groups recalled words they were instructed to remember more often than words they were instructed to forget regardless of whether they were trauma related.

On Wakefield's harmful dysfunction analysis of mental disorder

Wakefield's harmful dysfunction analysis of mental disorder is among the most rigorous and thoughtful attempts to address serious conceptual problems that beset the foundations of abnormal psychology. According to Wakefield, disorder is a hybrid concept comprising a factual component specifying derangement in a naturally-selected function, and a value component specifying the resultant harm. It is unclear, however, whether an evolutionary interpretation of dysfunction is either feasible or necessary; a nonhistorical causal role analysis of psychological function may enable ascription of disorder (assuming resultant harm). Moreover, the dysfunction component itself appears hybrid, comprising both a factual assertion about the state of a mechanism and a normative assertion implying that the mechanism is not functioning as it ought be.

Personality profiles, dissociation, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse

Women reporting either repressed, recovered, or continuous memories of childhood sexual abuse or no abuse history completed questionnaires tapping personality traits, absorption (fantasy proneness), dissociation, depression, and posttraumatic stress. Planned contrasts indicated that recovered memory participants scored higher on absorption and dissociation than did those reporting either continuous memories or no abuse history; repressed memory participants scored nonsignificantly higher than did recovered memory participants. On measures of distress, continuous memory participants were indistinguishable from nonabused participants, repressed memory participants scored highest, and recovered memory participants scored midway between continuous and repressed memory participants.

Anxiety sensitivity index: normative data and its differentiation from trait anxiety

In the present study we report: (1) normative data on the Spanish version of the Anxiety Sensitivity Index (ASI); and (2) empirical evidence related to differentiation between the constructs of anxiety sensitivity and trait anxiety. A sample of 390 university students (ranging in age from 18 to 34 years) completed the ASI and Spielberger's Trait Anxiety Scale (STAI-T). The means and standard deviations for the Spanish version of the ASI are similar to the ones reported by Peterson and Reiss (Anxiety Sensitivity Index Manual, 2nd edition. Worthington, OH: International Diagnostic Systems, 1992) for the English version. Factor analysis of the joint ASI and STAI-T items yielded two different factors; the STAI-T items load onto one factor (i.e., the trait anxiety factor) and the ASI items load onto the other factor (i.e., the anxiety sensitivity factor). Findings provide empirical support for validation of the Spanish ASI and are consistent with a construct distinction between anxiety sensitivity and trait anxiety.

Directed forgetting of trauma cues in adults reporting repressed or recovered memories of childhood sexual abuse

An item-cuing directed forgetting task was used to investigate whether women reporting repressed (n = 13) or recovered (n = 13) memories of childhood sexual abuse (CSA) exhibit an avoidant encoding style (and resultant impaired memory) for trauma cues relative to women reporting no CSA experience (n = 15). All participants viewed intermixed trauma (e.g., molested), positive (e.g., confident), and categorized neutral (e.g., mailbox) words on a computer screen and were instructed either to remember or to forget each word. The results provided no support for the hypothesis that people reporting either repressed or recovered memories of CSA are especially adept at forgetting words related to trauma. These groups recalled words they were instructed to remember more often than words they were instructed to forget regardless of whether they were trauma related.

Personality profiles, dissociation, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse

Women reporting either repressed, recovered, or continuous memories of childhood sexual abuse or no abuse history completed questionnaires tapping personality traits, absorption (fantasy proneness), dissociation, depression, and posttraumatic stress. Planned contrasts indicated that recovered memory participants scored higher on absorption and dissociation than did those reporting either continuous memories or no abuse history; repressed memory participants scored nonsignificantly higher than did recovered memory participants. On measures of distress, continuous memory participants were indistinguishable from nonabused participants, repressed memory participants scored highest, and recovered memory participants scored midway between continuous and repressed memory participants.

Film-induced sadness as a trigger for disinhibited eating

OBJECTIVE

We tested whether film-induced sadness enhances food intake in restrained eaters.

METHOD

Female participants scoring either high or low on a measure of dietary restraint viewed two film segments in counterbalanced order on successive days: an emotionally neutral travelogue and a sad film depicting the death of the young female protagonist.

RESULTS

Contrast analyses revealed that film-induced sadness significantly reduced food intake in low-restraint individuals, but only nonsignificantly increased it in high-restraint individuals.

DISCUSSION

When sadness is induced without an apparent ego threat, high-restraint participants may not exhibit as much disinhibited eating as when they are exposed to mood inductions that threaten their self-esteem.

Incidence of childhood precursor B-cell acute lymphoblastic leukaemia in north-west England

A temporal increase in the incidence of childhood acute lymphoblastic leukaemia (ALL) in the UK has been noted. We present data from the Manchester Children's Tumour Registry which provide strong evidence that the increase is a result of an increase in the precursor B-cell subtype. In the childhood peak (age 1-4 years), the annual increase in precursor B-cell ALL between 1980 and 1998 was 3.0% (p=0.024). Recent findings are consistent with the causal involvement of infections in precursor B-cell ALL.

Cognitive processing of trauma cues in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

Psychologically traumatized people exhibit delayed color naming of trauma words in the emotional Stroop task. Four groups of participants were asked to color name positive words, neutral words, and trauma words; these groups included 15 women who believed that they harbored repressed memories of childhood sexual abuse (CSA), 13 women who reported recovered memories of CSA, 15 women who had never forgotten their CSA, and 12 women who had never been abused. Repressed-memory participants exhibited patterns of interference indistinguishable from those of the nonabused control group participants. Irrespective of group membership, the severity of self-reported posttraumatic stress disorder symptoms was the only significant predictor of trauma-related interference, r(48) = .30, p < .05.

Space-time clustering patterns in childhood leukaemia support a role for infection

Previous studies of space-time clustering in childhood leukaemia have produced equivocal and inconsistent results. To address this issue we have used Manchester Children's Tumour Registry leukaemia data in space-time clustering analyses. Knox tests for space-time interactions between cases were applied with fixed thresholds of close in space, <5 km and close in time <1 year apart. Addresses at birth as well as diagnosis were utilized. Tests were repeated replacing geographical distance with distance to the Nth nearest neighbour. N was chosen such that the mean distance was 5 km. Data were also examined by a second order procedure based on K-functions. All methods showed highly significant evidence of space-time clustering based on place of birth and time of diagnosis, particularly for all leukaemias aged 0-14 and 0-4 years, and acute lymphoblastic leukaemia (ALL) 0-4 years. Some results based on location at diagnosis were significant but mainly gave larger P-values. The results are consistent with an infectious hypothesis. Furthermore, we found an excess of male cases over females involved in space-time pairs. We suggest this may be related to genetic differences in susceptibility to infection between males and females. These findings provide the basis for future studies to identify possible infectious agents.

False recognition in women reporting recovered memories of sexual abuse

False recognition--the mistaken belief that one has previously encountered a novel item--was examined in four groups of subjects: women reporting recovered memories of childhood sexual abuse, women who believe that they were sexually abused as children but who cannot recall this abuse (the "repressed" group), women who were sexually abused as children and always remembered the abuse, and women with no history of childhood sexual abuse. Subjects were administered a Deese/Roediger-McDermott paradigm. The results suggest that the recovered-memory group was more prone to false recognition than the other groups. In addition, women reporting recovered and repressed memories showed greater reduction in false recognition across study trials than did other subjects, perhaps reflecting strategic changes in performance.

Space-time clustering of Hodgkin's Disease in parts of the UK, 1984-1993

The object of this study was to examine cases of Hodgkin's Disease (HD) for evidence of space-time clustering of onsets by age group, sex and disease subtype. Data comprised 2024 cases of HD aged 0-79 years arising throughout the period 1984 to 1993 in the areas covered by a specialist population based register of leukaemias and lymphomas. Knox space-time analysis was used separately for 3 different age groups: childhood (0-14 years), young adult (15-34 years) and older adults (35-79 years); for adult cases separate analysis was carried out by sex and for the nodular and non-nodular sclerosing subtypes. Results showed that space-time clustering of onsets was limited to the nodular sclerosing cases. It was more prominent in young adult nodular sclerosing cases aged 15-34 years (particularly females) diagnosed in the period 1984-88, than in those diagnosed in 1989-93. We conclude that clustering may provide further evidence that an infectious process is involved in the aetiology of young adult nodular sclerosing cases of HD.

Future directions in the treatment of anxiety disorders: an examination of theory, basic science, public policy, psychotherapy research, clinical training, and practice

This article represents a transcribed roundtable discussion on anxiety disorders that took place at the 1998 Society for Psychotherapy Research in Snowbird, Utah. Eminent experts in the field of anxiety disorders took part in a discussion that focused on issues related to theory, basic science, public policy, therapy research, clinical training, and practice. Important topics addressed by the panel included the role of theory in research and clinical practice, the importance of psychopharmacological interventions, efficacy versus effectiveness research, the impact of public policy on research advancement, and the interface between basic science, research, and clinical practice.

Effects of guided imagery on memory distortion in women reporting recovered memories of childhood sexual abuse

We tested whether having participants imagine unusual childhood events inflates their confidence that these events happened to them, and tested whether this effect is greater in women who report recovered memories of childhood sexual abuse than in women who do not. Participants were pretested on how confident they were that certain childhood events had happened to them before being asked to imagine some of these events in the laboratory. New confidence measures were readministered. Although guided imagery did not significantly inflate confidence that early childhood events had occurred in either group, the effect size of inflated confidence was more than twice as large in the control group as in the group with recovered memory. These data suggest that individuals can counteract memory distortions potentially associated with guided imagery, at least under some conditions.

Is panic disorder linked to cognitive avoidance of threatening information?

We used a directed-forgetting paradigm to investigate whether panic disorder patients cognitively avoid threatening information. To determine if hemispheric laterality predicts processing biases in this paradigm, we used dichotic listening methods to ascertain participants' auditory perceptual asymmetry (PA). Panic disorder patients and healthy control participants viewed a series of intermixed threat, positive, and neutral words, each followed by an instruction to either remember the word or forget it. They then performed free recall and recognition tests for all words, irrespective of initial instructions. Directed-forgetting effects occurred equally for all word types: both groups recalled remember-words better than forget-words. Because this task is strongly affected by encoding style, panic patients as a group do not seem to avoid encoding threat cues. However, PA analyses revealed that cognitive avoidance of threat forget-words was significantly associated with greater left hemisphere bias in the control group and nonsignificantly associated with lesser left hemisphere bias in the panic disorder group.

Regional cerebral blood flow during script-driven imagery in childhood sexual abuse-related PTSD: A PET investigation

OBJECTIVE

The purpose of this study was to determine whether anterior limbic and paralimbic regions of the brain are differentially activated during the recollection and imagery of traumatic events in trauma-exposed individuals with and without posttraumatic stress disorder (PTSD).

METHOD

Positron emission tomography (PET) was used to measure normalized regional cerebral blood flow (CBF) in 16 women with histories of childhood sexual abuse: eight with current PTSD and eight without current PTSD. In separate script-driven imagery conditions, participants recalled and imagined traumatic and neutral autobiographical events. Psychophysiologic responses and subjective ratings of emotional state were measured for each condition.

RESULTS

In the traumatic condition versus the neutral control conditions, both groups exhibited regional CBF increases in orbitofrontal cortex and anterior temporal poles; however, these increases were greater in the PTSD group than in the comparison group. The comparison group exhibited regional CBF increases in insular cortex and anterior cingulate gyrus; increases in anterior cingulate gyrus were greater in the comparison group than in the PTSD group. Regional CBF decreases in bilateral anterior frontal regions were greater in the PTSD group than in the comparison group, and only the PTSD group exhibited regional CBF decreases in left inferior frontal gyrus.

CONCLUSIONS

The recollection and imagery of traumatic events versus neutral events was accompanied by regional CBF increases in anterior paralimbic regions of the brain in trauma-exposed individuals with and without PTSD. However, the PTSD group had greater increases in orbitofrontal cortex and anterior temporal pole, whereas the comparison group had greater increases in anterior cingulate gyrus.

Leukemias and lymphomas: time trends in the UK, 1984-93

OBJECTIVE

To investigate recent time trends of some selected and common neoplasms of the blood and lymphatic tissues.

METHODS

A specialist population-based register of hematological and related neoplasms was set up in parts of the UK in 1984. Secular changes over the first 10 years were investigated using log-linear Poisson modeling. The results are presented in tabular and graphical form.

RESULTS

The analyses of 26,899 cases revealed a decline in incidence of acute myeloid leukaemia (AML), the myeloproliferative disorders (MPD) including chronic myeloid leukaemia (CML) and, in males only, Hodgkin's disease (HD). No secular trends for acute lymphoblastic leukaemia (ALL) were observed at any age. A marked increase in incidence in non-Hodgkin's disease (NHL) and the pre-leukemia group of myeloid dysplasias (MDS) was found.

CONCLUSIONS

The rise in MDS and decline in AML and related conditions are most likely to reflect diagnostic changes. Changes in NHL may reflect, in part, a similar phenomena, but an underlying upward trend cannot be excluded. The decline in HD is in one gender only and the significance of this remains to be investigated.

Space-time clustering of acute lymphoblastic leukaemia in parts of the U.K. (1984-1993)

Age-related differences in the incidence and immunological subtypes of acute lymphoblastic leukaemia (ALL) suggest that it may be composed of more than one disease entity, each with different aetiologies. Childhood leukaemia (of which the majority of cases are ALL) has been suspected of having an infectious aetiology, but few studies have systematically examined ALL for clustering by age group. The aim of this study was to examine ALL for evidence of space-time clustering of date and place of diagnosis by age group. Knox space-time analysis was carried out separately for three different age groups: childhood (0-14 years), young adult (15-34 years) and older adults (35-79 years). Data on 968 cases of ALL aged 0-79 years, arising during 1984-1993 in the areas covered by a specialist population based register of leukaemias and lymphomas in parts of the U.K., were used in the analysis. Space-time clustering of diagnoses was limited to children aged 0-14 years. It was more prominent in those diagnosed in the period 1984-1988, than in those diagnosed in 1989-1993. The clustering may indicate an infectious aetiology for childhood ALL, or could be the result of episodic exposures to some environmental hazard.

EMDR and Mesmerism: a comparative historical analysis

Eye movement desensitization and reprocessing (EMDR) is among the fastest growing interventions in the annals of psychotherapy. Although many psychologists have commented on its presumably unusual origins and dissemination, history reveals its many parallels with Mesmerism, a previous therapy that spread rapidly throughout 18th century Europe and America. The purpose of this article is to document the many striking similarities between the history of Mesmerism and the history of EMDR.

Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information.

The emotional counting Stroop paradigm: a functional magnetic resonance imaging probe of the anterior cingulate affective division

BACKGROUND

The emotional counting Stroop (ecStroop) functional magnetic resonance imaging (fMRI) activation paradigm was designed to recruit the anterior cingulate affective division (ACad).

METHODS

Nine normal, healthy male and female subjects (mean age 24.2 years) reported via button press the number of neutral and negative words that appeared on a screen while reaction time and fMRI data were acquired.

RESULTS

We observed a) greater ACad activation for negative versus neutral words during initial presentation blocks; b) lower overall ACad signal intensity during task performance (i.e., both negative and neutral words) compared to the baseline fixation condition; and c) no reaction time increase to negative versus neutral words.

CONCLUSIONS

In a companion study of a cognitive version of the counting Stroop (Bush et al 1998), these same 9 subjects a) activated the more dorsal anterior cingulate cognitive division; b) also showed the overall decrease in ACad signal intensity; and c) demonstrated a reliable reaction time effect. Taken together, these data offer a within-group spatial dissociation of AC function based upon information content (i.e., cognitive vs. emotional) and/or presence of behavioral interference. We propose that the ecStroop will be a useful fMRI probe of ACad function in anxiety disorders.

Experimental approaches to cognitive abnormality in posttraumatic stress disorder

During the past decade, experimental psychopathologists have increasingly applied the concepts and methods of cognitive psychology to elucidate information-processing abnormalities in people with posttraumatic stress disorder (PTSD). These studies have shown that individuals with PTSD: (a) selectively process trauma-relevant material in the emotional Stroop paradigm; (b) exhibit enhanced memory for material related to trauma in explicit and perhaps implicit tests; (c) exhibit difficulty forgetting trauma words during directed forgetting; and (d) exhibit problems retrieving specific autobiographical memories in response to cue words, instead recalling "overgeneral" memories. These studies suggest that experimental methods can complement traditional, self-report methods for studying cognitive disturbances in PTSD.

Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information.

Mortality and cancer incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group

Patients with acromegaly have a reduced life expectancy, with the accepted causes for premature death being vascular and respiratory disease. Increased mortality from malignant disease has also been reported. We, therefore, performed a multicenter retrospective cohort study of 1362 patients with acromegaly and investigated the relationships of mortality and cancer incidence with GH levels, duration of disease, and age at diagnosis. The overall cancer incidence rate [standardized incidence ratio, 0.76; 95% confidence interval (CI), 0.60-0.95] was lower than that in the general population of the United Kingdom, and there was no significant increase in site-specific cancer incidence rates. The overall cancer mortality rate was not increased, but the colon cancer mortality rate (standardized mortality ratio, 2.47; 95% CI, 1.31-4.22) was higher than expected. Mortality rates due to colon cancer, all malignant disease, cardiovascular disease and overall mortality were increased with higher posttreatment GH levels (P for trends, <0.02, <0.05, <0.02, and <0.0001). The overall mortality rate in patients with acromegaly with posttreatment GH levels less than 2.5 ng/mL (5 mU/L) was comparable to that in the general population of the United Kingdom (standardized mortality ratio, 1.10; 95% CI, 0.89-1.35). We conclude that high posttreatment GH levels are associated with an increased overall mortality rate and increased mortality rates due to colon cancer, cardiovascular disease, and all malignant disease. Posttreatment GH levels less than 2.5 ng/mL (5 mU/L) result in an overall mortality rate similar to that in the general population.

Lower precombat intelligence is a risk factor for posttraumatic stress disorder

The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests.

Lower precombat intelligence is a risk factor for posttraumatic stress disorder

The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests.

The assessment of platelet derived growth factor concentration in post myocardial infarction and stable angina patients

Platelet derived growth factor (PDGF) has been implicated in the pathogenesis of atherosclerosis. PDGF is released by aggregating platelets and monocytes which gather around sites of arterial injury. In the study reported here the concentration of plasma PDGF was measured in post myocardial infarction (MI) patients (n = 28), angina patients (n = 25), and control subjects (n = 27). Venous blood samples were taken and the concentration of PDGF determined by an enzyme linked immunosorbent assay (ELISA). Plasma PDGF concentrations were significantly higher in the post MI group compared to both the control and angina groups (P < or = 0.05). The increase in PDGF concentration may be due to increased activation of platelets or monocytes since these two cells are major sources of plasma PDGF. High concentrations of PDGF in the circulation could further accelerate the progression of the disease.

The trauma response of children and adolescents. Future directions in research

Although trauma research in children lags behind that of adults and is often preliminary or unreplicated, current work promises rich understanding of the neurobiologic and psychologic mechanisms underlying the trauma response of the young. Epidemiologic and longitudinal, prospective, controlled studies sensitive to cultural and developmental differences are needed to illuminate the natural history of posttraumatic stress disorder and to show how trauma and its response interact with family, school, and community factors. Promising profound implications for society, such data would enable mental health professionals, educators, and policy makers to develop standards for prevention, detection, and intervention to optimize children's developmental trajectory.

Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density

BACKGROUND

The incidence of insulin-dependent diabetes mellitus (IDDM) incidence varies between and within countries. The origins of this variation are disputed, but they involve both genetic and non-genetic influences. To explore the role of environmental factors in the aetiology of IDDM we have examined the incidence in small geographical areas and related it to variables derived from national censuses.

METHODS

This is an ecological analysis of incidence data from a register of children with IDDM covering the counties of West Yorkshire, North Yorkshire and Humberside in the north of England. All children aged < or = 16, diagnosed with IDDM between 1978 and 1990 were eligible for inclusion. Spatial variation in incidence between electoral wards was investigated using Poisson regression, in relation to socioeconomic status, population density, urban-rural status and measures of geographical isolation. Ward child populations varied in size from 84 to 7197 (mean = 1545).

RESULTS

Rates were significantly lower in wards of high population density and with many overcrowded houses. The rate ratio for areas in the upper half of the childhood density distribution was 0.88 (95% confidence interval (CI): 0.78-0.99) and for the two upper tertiles of household overcrowding the rate ratios were 0.84 (95% CI: 0.74-0.95) and 0.68 (95% CI: 0.58-0.79) respectively.

CONCLUSIONS

The incidence of childhood IDDM was associated with environmental factors including population density and overcrowded homes. A possible inference from these data is that patterns of infection are involved in the occurrence of IDDM. Analytical epidemiological studies will be needed to investigate these ideas further.

Effects of suppressing thoughts about body weight: a comparison of dieters and nondieters

OBJECTIVE

Experimental suppression of a neutral target thought often results in a subsequent "rebound" in the frequency of the thought. In this study, we tested the hypothesis that suppression of weight-related thoughts contributes to body weight preoccupations characteristic of dieters.

METHOD

Subjects included 19 female dieters and 21 female nondieters. Following a randomized design, subjects were asked either to suppress (experimental condition) or express (control condition) the thought of weighing themselves.

RESULTS

Nondieters demonstrated a significant rebound in frequency of the target thought following suppression (p < .05). Dieters expressed weight-related thoughts more frequently than nondieters, but did not show a rebound following target thought suppression.

DISCUSSION

Thought suppression may foster development of weight-related preoccupations whereas the role suppression plays in the maintenance of dieters' weight-related preoccupations remains unclear.

Age and sex distributions of hematological malignancies in the U.K

This paper reports on an analysis of nearly 27,000 hematological malignancies diagnosed in the U.K. in the 10-year period 1984 to 1993. The unique observations provided in this analysis are the similarity of the sex-specific curves by age for acute myeloid leukemia, myelodysplasia types, polycythemia rubra vera, and myelofibrosis (or myelosclerosis). The unusual age-sex-specific distribution of essential thrombocythemia, suggesting a unique epidemiology, has never been reported before. The unusual female excess of the nodular sclerosing adolescent peak in Hodgkin's disease and its rapid fall with time is potentially of great importance. An even younger childhood peak of acute lymphoblastic leukemia is presented. Overall these data represent the most reliable available in the U.K., being population based, specially collected and will form the basis of considerable further investigations.

Implicit and explicit memory for trauma-related information in PTSD

Experiments on content-dependent memory abnormalities in PTSD suggest several conclusions. First, PTSD patients exhibit enhanced recall of words related to trauma relative to trauma-exposed persons with the disorder. Recognition tests, however, appear insensitive to these effects. Second, PTSD patients do not exhibit implicit memory biases for trauma cues on implicit memory tasks that are strongly influenced by perceptual (e.g., orthographic) aspects of input. They may, however, exhibit enhanced implicit memory for trauma-related material on conceptually more complex tasks. Third, directed forgetting research suggests that adult survivors of childhood sexual abuse who have PTSD exhibit memory deficits only for neutral and positive material, not for material related to their abuse. Psychiatrically healthy survivors exhibit normal memory performance in this paradigm. Fourth, autobiographical memory research indicates that trauma survivors, especially those with PTSD, are characterized by difficulties retrieving specific memories from their past in response to cue words. These findings are especially dramatic in Vietnam combat veterans whose self-presentational style suggests a fixation to the war and a failure of their autobiography to unfold.

Selective encoding of threat in panic disorder: application of a dual priming paradigm

Patients with panic disorder and psychiatrically healthy control subjects performed a dual priming task whereby they viewed either lexical or non-lexical prime pairs before naming a target that had either threatening (e.g. collapse) or positive (e.g. cheerful) meaning. Lexical prime pairs comprised a threat word and a positive word, and non-lexical prime pairs comprised two rows of asterisks. Suggestive of a bias for encoding threat cues, panic disorder patients (under some conditions) were faster to name lexically primed threat targets than lexically primed positive targets. These data are consistent with the hypothesis that panic disorder is linked to an encoding bias for threatening relative positive information. A cognitive bias for selectively encoding threat cues may figure in the maintenance of anxiety states, such as panic disorder.

Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation

BACKGROUND

Relative regional cerebral blood flow (rCBF) changes were measured in Vietnam combat veterans with and without posttraumatic stress disorder (PTSD) during exposure to combat-related stimuli.

METHODS

Positron emission tomography was used to measure rCBF in 7 combat veterans with PTSD (PTSD group) and 7 healthy combat veterans (control group) who viewed and generated visual mental images of neutral, negative, and combat-related pictures.

RESULTS

Unlike control subjects, subjects with PTSD had increased rCBF in ventral anterior cingulate gyrus and right amygdala when generating mental images of combat-related pictures; when viewing combat pictures, subjects with PTSD showed decreased rCBF in Broca's area.

CONCLUSIONS

Results suggest that ventral anterior cingulate gyrus and right amygdala play a role in the response of combat veterans with PTSD to mental images of combat-related scenes. Reexperiencing phenomena of PTSD, which often involve emotional visual mental imagery, may be likewise associated with increased rCBF in these regions.

A comparison of three methods of analysis for age-period-cohort models with application to incidence data on non-Hodgkin's lymphoma

BACKGROUND

Various methods of analysis have been used to study age-period-cohort models. The main aim of this paper is to illustrate and compare three such methods. Those of Clayton and Schifflers, Robertson and Boyle, and De Carli and La Vecchia. The main differences between these methods lie in their approach to distinguish between linear-period and linear-cohort effects. Clayton and Schifflers do not attempt to solve this identification problem, whereas Robertson and Boyle, and De Carli and La Vecchia attempt to tackle this question.

METHODS

In order to study the assumptions and problems of these methods, we analysed data from 2678 subjects aged 30-84 in Yorkshire, UK, who were diagnosed with non-Hodgkin's lymphoma (NHL) during the period 1978-1991. Loglinear Poisson models were used to examine the effects of age, period and cohort.

RESULTS

All three methods of analysis agree that, after stratification for sex and county, the age-standardized rate has been increasing at about 5% per year. The Robertson-Boyle method differed from the Clayton-Schifflers method in showing a significant non-linear cohort effect, and a significant county-cohort interaction. The method of De Carli-La Vecchia agreed more closely with Clayton-Schifflers than with Robertson-Boyle.

CONCLUSIONS

The linear increase in incidence would lead to a doubling of the number of cases within 15 years. There is controversy over whether the identification problem can be solved and should be solved. Many authors would not rely on the results of the methods of Robertson and Boyle, or De Carli and La Vacchia.

Autobiographical memory in obsessive-compulsive disorder

Patients with obsessive-compulsive disorder (OCD) (N = 36) and healthy controls (N = 24) participated in an autobiographical memory experiment in which they were asked to retrieve specific personal memories in response to cue words having either positive (e.g. happy) or negative (e.g. anxiety) valence. Compared to control participants, OCD patients had difficulty retrieving specific memories and showed longer retrieval latencies. However, these overgenerality effects were not a function of OCD per se, but were related to a co-morbid diagnosis of major depression. The difficulty in retrieving specific autobiographical memories exhibited by OCD patients might reflect excessive cognitive capacity consumption due to pre-occupation with intrusive thoughts typical of major depression.